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Gastric endoscopic mucosal resection is challenging due to the slippery mucosa, abundant blood vessels, and the presence of mucus. We developed gel immersion endoscopy to secure the visual field, even in a blood-filled gastrointestinal lumen in 2016. Clear gel with appropriate viscosity, instead of water, can prevent rapid mixture with blood and facilitate identification of the culprit vessel. We further optimized the gel for endoscopic treatment, and the resultant product, Viscoclear (Otsuka Pharmaceutical Factory) was first released in Japan in 2020. The viscosity of this gel has been optimized to maximize endoscopic visibility without compromising the ease of its irrigation. The aim of this study is to clarify the effectiveness of gel immersion endoscopic mucosal resection for small-sized early gastric neoplasms. Seven lesions in seven patients were treated by gel immersion endoscopic mucosal resection. The size of all lesions was under 10 mm. The median procedure time was 4.5 min. Intraoperative bleeding occurred in four of seven lesions immediately after snare resection and was easily controlled by endoscopic hemostatic forceps during the gel immersion endoscopy. The R0 resection rate was 100%. In conclusion, gel immersion endoscopic mucosal resection may be a straightforward, rapid, and safe technique for resecting superficial gastric neoplasms <10 mm in diameter.

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BACKGROUND AND AIMS: Colorectal serrated lesions (SLs) are precursors of colorectal carcinoma via the serrated neoplasia pathway. However, the success rate of endoscopic resection of large SLs is low. Therefore, this study aimed to determine the safety and efficacy of underwater endoscopic mucosal resection (UEMR) for SLs sized 10-20 mm. METHODS: This two-center prospective observational study included patients with at least one SL sized 10-20 mm. We resected the SLs by UEMR and performed tattooing at the resection site. Surveillance colonoscopy was performed 12 months postoperatively to evaluate local recurrence. The primary outcome was the complete resection rate of UEMR, which was defined as en bloc resection with no serrated tissue in the four marginal biopsies and histologically negative margins. RESULTS: UEMR was performed for 65 SLs in 58 patients, with a median lesion size of 14 mm. The en bloc, R0 resection, and complete resection rates were 87.7% (57/65), 61.5% (40/65), and 60.0% (39/65), respectively. Adverse events included 1 (1.5%) immediate bleeding and 1 (1.5%) delayed perforation. Surveillance colonoscopy was performed in 50 patients with 57 scars, and the rates of identification for tattoos and scars were 94.7% (54/57) and 100% (57/57), respectively. The recurrence rate was 5.3% (3/57), and all three recurrent lesions were completely resected endoscopically. CONCLUSIONS: This two-center prospective study demonstrated that UEMR for SLs sized 10-20 mm was comparable to previous conventional endoscopic mucosal resection outcomes.

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INTRODUCTION: Underwater endoscopic mucosal resection (uEMR) represents an alternative to conventional EMR for resection of sessile colorectal polyps. We aimed at assessing the efficacy and safety of uEMR for sessile colorectal polyps. METHODS: A retrospective analysis of endoscopy database was done for patients who underwent uEMR for sessile colorectal polyps more than 10 mm in size without any features of sub-mucosal invasion from two tertiary care centres in western India between January 2021 and June 2023. Exclusion criteria were other modes of endoscopic resection. Primary outcome was rate of en bloc resection. Secondary outcomes were complete resection rate, adverse events and recurrence rate. RESULTS: During the study period, 159 patients with 261 lesions met the study inclusion. Mean lesion size was 1.935 ± 0.71 cm with most lesion located in the rectum (75, 28.73%) followed by sigmoid colon (69, 26.43%). Most lesions had a Paris 0-Is morphology (192, 73.56%). Japan NBI Expert Team (JNET) IIa pattern was seen on narrow band imaging (NBI) in 221 (84.67%) lesions. Complete resection was achieved in 98.46% lesions (257/261). En bloc resection was achieved in 91.82% (236/257) lesions. Complications were seen in 6.8%, all of which were managed endoscopically. Recurrence was seen in 3.1% of polyps on follow-up. CONCLUSION: uEMR is a safe and efficacious technique for endoscopic resection for sessile colorectal polyps with high rates of en bloc resection for polyps more than 10 mm size.

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This paper introduces a new variable structure controller designed for depth control of an autonomous underwater sensor platform equipped with a variable buoyancy module. To that end, the prototype linear model is presented, and a finite element-based method is used to estimate one of its parameters, the hull deformation due to pressure. To manage potential internal disturbances like hull deformation or external disturbances like weight changes, a disturbance observer is developed. An analysis of the observer steady-state estimation error in relation to input disturbances and system parameter uncertainties is developed. The locations of the observer poles according to its parameters are also identified. The variable structure controller is developed, keeping energy savings in mind. The proposed controller engages when system dynamics are unfavorable, causing the vehicle to deviate from the desired reference, and disengages when dynamics are favorable, guiding the vehicle toward the target reference. A detailed analysis determines the necessary switching control actions to ensure the system reaches the desired reference. Finally, simulations are run to compare the proposed controller's performance with that of PID-based controllers recently developed in the literature, assessing dynamic response and energy consumption under various operating conditions. Both the VBM- and propeller-actuated vehicles were evaluated. The results demonstrate that the proposed controller achieves an average energy consumption reduction of 22% compared to the next most efficient PID-based controller for the VBM-actuated vehicle, though with some impact on control performance.

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Underwater image enhancement technology is crucial for the human exploration and exploitation of marine resources. The visibility of underwater images is affected by visible light attenuation. This paper proposes an image reconstruction method based on the decomposition-fusion of multi-channel luminance data to enhance the visibility of underwater images. The proposed method is a single-image approach to cope with the condition that underwater paired images are difficult to obtain. The original image is first divided into its three RGB channels. To reduce artifacts and inconsistencies in the fused images, a multi-resolution fusion process based on the Laplace-Gaussian pyramid guided by a weight map is employed. Image saliency analysis and mask sharpening methods are also introduced to color-correct the fused images. The results indicate that the method presented in this paper effectively enhances the visibility of dark regions in the original image and globally improves its color, contrast, and sharpness compared to current state-of-the-art methods. Our method can enhance underwater images in engineering practice, laying the foundation for in-depth research on underwater images.

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Artificial Intelligence (AI) and Machine Learning (ML) can assist producers to better manage recirculating aquaculture systems (RASs). ML is a data-intensive process, and model performance primarily depends on the quality of training data. Relatively higher fish density and water turbidity in intensive RAS culture produce major challenges in acquiring high-quality underwater image data. Additionally, the manual image annotation involved in model training can be subjective, time-consuming, and labor-intensive. Therefore, the presented study aimed to simulate fish schooling behavior for RAS conditions and investigate the feasibility of using computer-simulated virtual images to train a robust fish detection model. Additionally, to expedite the model training and automate the virtual image annotation, a process flow was developed. The 'virtual model' performances were compared with models trained on real-world images and combinations of real and virtual images. The results of the study indicate that the virtual model trained solely with computer-simulated images could not perform satisfactorily (mAP = 62.8%, F1 score = 0.61) to detect fish in a real RAS environment; however, replacing a small number of the virtual images with real images in the training dataset significantly improved the model's performance. The M6 mixed model trained with 630 virtual and 70 real images (virtual-to-real image ratio: 90:10) achieved mAP and F1 scores of 91.8% and 0.87, respectively. Furthermore, the training time cost for the M6 model was seven times shorter than that for the 'real model'. Overall, the virtual simulation approach exhibited great promise in rapidly training a reliable fish detection model for RAS operations.

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In recent years, the rapid accumulation of marine waste not only endangers the ecological environment but also causes seawater pollution. Traditional manual salvage methods often have low efficiency and pose safety risks to human operators, making automatic underwater waste recycling a mainstream approach. In this paper, we propose a lightweight multi-scale cross-level network for underwater waste segmentation based on sonar images that provides pixel-level location information and waste categories for autonomous underwater robots. In particular, we introduce hybrid perception and multi-scale attention modules to capture multi-scale contextual features and enhance high-level critical information, respectively. At the same time, we use sampling attention modules and cross-level interaction modules to achieve feature down-sampling and fuse detailed features and semantic features, respectively. Relevant experimental results indicate that our method outperforms other semantic segmentation models and achieves 74.66 % mIoU with only 0.68 M parameters. In particular, compared with the representative PIDNet Small model based on the convolutional neural network architecture, our method can improve the mIoU metric by 1.15 percentage points and can reduce model parameters by approximately 91 %. Compared with the representative SeaFormer T model based on the transformer architecture, our approach can improve the mIoU metric by 2.07 percentage points and can reduce model parameters by approximately 59 %. Our approach maintains a satisfactory balance between model parameters and segmentation performance. Our solution provides new insights into intelligent underwater waste recycling, which helps in promoting sustainable marine development.

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Conductive hydrogels as ideal candidate materials for flexible sensors have exhibited many promising applications. However, complex application environments, such as low temperatures or underwater conditions, have introduced new requirements for hydrogel sensors. Herein, a high-performance conductive hydrogel based on carboxymethyl cellulose-polyaniline (CMC-PANI) submicron spheres, poly (vinyl alcohol) (PVA) and phytic acid (PA) was designed and fabricated via a dual design strategy. CMC-PANI particles were introduced to not only empower the good electromechanical performance to the hydrogels, but also enhance the mechanical properties. The obtained hydrogel exhibited good mechanical property, anti-freezing, anti-swellable behavior and recyclable performance. Resistive-type strain sensors assembled by the prepared hydrogels exhibited high pressure sensitivity (34.17×10-2 kPa-1) and fast response time (100 ms), which can clearly detect the pulse beats. Moreover, the hydrogel sensors can achieve long-term stability, high sensitivity and fatigue resistance as an underwater sensor. Based on these favorable performances, the conductive polymer hydrogels may open up an enticing avenue for functional soft materials in health diagnostic and electronic components.

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This review examines the relationship between the physiological demands of diving and premature ventricular complexes (PVCs) in divers. In the general population, some individuals have a greater tendency to experience PVCs, often without awareness or a clear understanding of the triggering factors. With the increasing availability and popularity of both scuba and apnoea diving, more people, including those with a predisposition to PVCs, are engaging in these activities. The underwater environment, with its unique stressors, may increase the risk of arrhythmogenic events, particularly PVCs. Here, we review the prevalence, pathophysiology, and aggravating factors of PVCs in divers, emphasising the need for a comprehensive cardiovascular assessment. Evidence suggests a higher prevalence of PVCs in divers compared with the general population, influenced by factors such as age, dive depth, gas bubbles, cold water immersion, pre-existing cardiovascular diseases, and lifestyle factors. The change in environment during diving could potentially trigger an increased frequency of PVCs, especially in individuals with a pre-existing tendency. We discuss diagnostic strategies, management approaches, and preventive measures for divers with PVCs, noting that although guidelines for athletes can be adapted, individual assessment is crucial. Significant knowledge gaps are identified, highlighting the need for future research to develop evidence-based guidelines and understand the long-term significance of PVCs in divers. This work aims to evaluate potential contributing factors to PVCs in divers and identify individuals who may be at higher risk of experiencing major adverse cardiovascular events (MACEs). This work aims to improve diver safety by promoting collaboration between cardiologists and diving medicine specialists and by identifying key areas for future investigation in this field. This work aims to improve the safety and well-being of divers by understanding the cardiovascular challenges they face, including pressure changes, cold water immersion, and hypoxia. We seek to elucidate the relationship between these challenges and the occurrence of PVCs. By synthesising current evidence, identifying knowledge gaps, and proposing preliminary recommendations, we aim to encourage collaboration between cardiologists and diving medicine specialists to optimise the screening, management, and risk stratification of PVCs in the diving population.

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Underwater acoustic sensor networks (UASNs) are fundamental assets to enable discovery and utilization of sub-sea environments and have attracted both academia and industry to execute long-term underwater missions. Given the heightened significance of battery dependency in underwater wireless sensor networks, our objective is to maximize the amount of harvested energy underwater by adopting the TDMA time slot scheduling approach to prolong the operational lifetime of the sensors. In this study, we considered the spatial uncertainty of underwater ambient resources to improve the utilization of available energy and examine a stochastic model for piezoelectric energy harvesting. Considering a realistic channel and environment condition, a novel multi-agent reinforcement learning algorithm is proposed. Nodes observe and learn from their choice of transmission slots based on the available energy in the underwater medium and autonomously adapt their communication slots to their energy harvesting conditions instead of relying on the cluster head. In the numerical results, we present the impact of piezoelectric energy harvesting and harvesting awareness on three lifetime metrics. We observe that energy harvesting contributes to 4% improvement in first node dead (FND), 14% improvement in half node dead (HND), and 22% improvement in last node dead (LND). Additionally, the harvesting-aware TDMA-RL method further increases HND by 17% and LND by 38%. Our results show that the proposed method improves in-cluster communication time interval utilization and outperforms traditional time slot allocation methods in terms of throughput and energy harvesting efficiency.

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Industrial processes generate huge volumes of oily saline wastewater. Instead of being sent to the drainage system immediately, extracting osmotic energy from these effluents represents a promising means to reuse these wastes and contributes to mitigate the ever-growing energy crisis. Herein, an MOF-decorated PTFE membrane is engineered to extract osmotic energy from oily wastewaters. Copper hydroxide nanowires (CHNs) are intertwined with polystyrenesulfonate sodium (PSS), deposited onto a poly(tetrafluoroethylene) (PTFE) membrane, and thereafter used as metal precursors to in situ generate HKUST-1 doped with negative charges. The resulting HKUST-1PSS@PTFE hybrid membrane possesses abundant angstrom-scale channels capable of transporting cations efficiently and features a hierarchically structured surface with underwater superoleophobicity. The energy conversion performance of the HKUST-1PSS3.5@PTFE membrane can reach an output power density of 6.21 W m-2 at a 50-fold NaCl gradient, which is superior to those of pristine PTFE membranes. Once exposed to oily saline wastewater, the HKUST-1PSS@PTFE membrane can exhibit an excellent oil-repellent ability, thus contributing to sustain its osmotic energy harvesting. This work may promote the development of antifouling osmotic energy harvesters with a long working life and pave the way to fully exploit oily wastewater effluents as valuable energy sources.

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Optical camouflage offers an effective strategy for enhancing the survival chances of underwater flexible electronic devices akin to underwater organisms. Photochromism is one of the most effective methods to achieve optical camouflage. In this study, antiswelling hydrogels with photochromic properties were prepared using a two-step solvent replacement strategy and explored as underwater optically camouflaged flexible electronic devices. The hydrophobic network formed upon polymerization of hydroxyethyl methacrylate (HEMA) ensured that the hydrogels possessed outstanding antiswelling properties. Internetwork hydrogen bonding interactions allowed the hydrogels to exhibit tissue-adaptable mechanical properties and excellent self-bonding capabilities. The introduction of polyoxometalates further enhanced the hydrogels' mechanical and self-bonding properties while imparting photochromic capability. The hydrogels could be rapidly and reversibly colored under 365 nm UV irradiation. The bleaching rate of the colored hydrogels increased with temperature, bleaching within 12 h at 60 °C but maintaining the color for more than 5 days at room temperature. The self-bonding and photochromic properties enabled the hydrogels to be easily assembled into optically camouflaged underwater flexible electronic devices for underwater motion sensing and wireless information transmission. An optically camouflaged strain sensor was first assembled for underwater limb motion sensing. Additionally, an underwater optically camouflaged wireless information exchange device was assembled to enable wireless communication with a smartphone. This work provided an effective strategy for the optical camouflage of underwater flexible electronic devices, presenting opportunities for next-generation underwater hydrogel-based flexible devices.

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The underwater sound distribution generated by natural sources, shipping and trawling activities has been computed by the Quonops© modelling webservice for the Northern Adriatic Sea (NAS) during 2020, a year characterized by the COVID-19 lockdown restrictions. Modelling has been calibrated by using a year-long time series of field measurements covering the domain of interest. Sound levels (50th percentile) ranged between 75 and 90 dB re 1µPa for all the considered frequencies (63 Hz, 125 Hz, 250 Hz third octave bands). Noisier NAS areas match with the shipping lanes and the distribution of trawling activity. Pressure sound indices based on masking effect were computed for two Ecologically/Biologically Significant Marine Areas (EBSA) located in the NAS. Results indicated a significant contribution of vessel and fishery-generated noise to the local soundscape and provide a basis for addressing NAS underwater noise pollution, with special reference to the Marine Spatial Planning approach.

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Conductive hydrogel is considered to be one of the most potential sensing materials for wearable strain sensors. However, both the hydrophilicity of polymer chains and high water content severely inhibit the potential applications of hydrogel-based sensors in extreme conditions. In this study, a multicross-linked hydrogel was prepared by simultaneously introducing a double-network matrix, multiple conductive fillers, and free-moving ions, which can withstand an ultralow temperature below -80 °C. A superhydrophobic Ecoflex layer with a water contact angle of 159.1° was coated on the hydrogel using simple spraying and laser engraving methods. Additionally, the smart glove integrating five hydrogel strain sensors with a microprocessor was developed to recognize 12 types of diving gestures and synchronously transmit recognition results to smartphones. The superhydrophobic and antifreezing hydrogel strain sensor proposed in this study emerges promising potentials in wearable electronics, human-machine interfaces, and underwater applications.

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The research work presents a novel voxel-type soft amphibious robot based on an assembly of origami flexiballs. The geometric and elastic constitutive models of the origami flexiball are theoretically established to elucidate its intricate deformation mechanism. Especially, the zero-energy storage phenomenon and the quasi-zero-stiffness characteristic are revealed to prove that the origami flexiball is suitable for serving as soft robotic components. As a proof of concept, fourteen origami flexiballs are interconnected to form a quadruped robot capable of walking or crawling in both underwater and terrestrial environments, including flat surfaces and sandy terrain. Its adaptability across multiple environments is enhanced by the origami polyhedra-inspired hollow structure, which naturally adjusts to underwater conditions such as hydrostatic pressure and currents, improving stability and performance. Other advantages of the voxel-type soft amphibious quadruped robot include its ease of manufacture using 3D printing with accessible soft elastic materials, ensuring rapid and cost-effective fabrication. We anticipate its potentially versatile applications, including underwater pipeline inspections, offshore maintenance, seabed exploration, ecological monitoring, and marine sample collection. By leveraging metamaterial features embodied in the origami polyhedra, the presented voxel-type soft robot exemplifies an innovative approach to achieving complex functionalities in soft robotics.

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INTRODUCTION: Cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) have been developed recently, in addition to conventional methods, but adverse events of each method have not been fully clarified. We compared the outcomes of each method for the appropriate choice. METHODS: Patients who underwent CSP, endoscopic mucosal resection (EMR)/hot snare polypectomy (HSP), or UEMR for small and intermediate-sized colorectal polyps between April 2017 and June 2020 were retrospectively examined. The rate of adverse events and recurrences due to each method were determined as the main outcomes. Clinical factors related to adverse events were examined. RESULTS: A total of 1,025 patients with 3,163 polyps underwent polypectomy using any of the methods. CSP, EMR/HSP, and UEMR were performed for 704 (22.2%), 2,145 (67.8%), and 314 polyps (9.9%), and the median size for each method was 4, 6, and 7 mm, respectively. Delayed bleeding for CSP, EMR/HSP, and UEMR was 0%, 0.2%, and 0.6% (p = 0.15), and perforation was 0%, 0.1%, and 0%, respectively (p = 0.62). Recurrence after CSP, EMR/HSP, and UEMR was 0.3%, 0.09%, and 1.3%, respectively (p < 0.01). Recurrence for UEMR was significantly higher in the early stage of procedure introduction (p = 0.015). Oral anticoagulants were the risk factor for delayed bleeding (p < 0.01, respectively). CONCLUSION: There was no significant difference regarding adverse events among each method for small and intermediate-sized polyps, although the recurrence rate after UEMR was higher than other methods.

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Head out water immersion (HOWI) induces ventilatory and hemodynamic changes, which may be a result of hydrostatic pressure, augmented arterial CO2 tension, or a combination of both. We hypothesized that the hydrostatic pressure and elevated CO2 tension that occur during HOWI will contribute to an augmented ventilatory sensitivity to CO2 and an attenuated cerebrovascular reactivity to CO2 during water immersion. Twelve subjects (age: 24±3 y, BMI: 25±3 kg/m2) completed HOWI, waist water immersion with CO2 (WWI+CO2), and WWI where a rebreathing test was conducted at baseline, 10, 30, and 60 minutes, and post. PETCO2, minute ventilation, expired gases, blood pressure, heart rate, and middle cerebral artery blood velocity were recorded continuously. PETCO2 increased throughout all visits (p£0.011), was matched during HOWI and WWI+CO2 (p³0.264), and was greater during WWI+CO2 vs. WWI at 10, 30, and 60 minutes (p<0.001). When HOWI vs. WWI+CO2 were compared, the change in ventilatory sensitivity to CO2 was different at 10 (0.59±0.34 vs. 0.06±0.23 L/min/mmHg, p<0.001), 30 (0.58±0.46 vs. 0.15±0.25 L/min/mmHg, p<0.001), and 60 minutes (0.63±0.45 vs. 0.16±0.34 L/min/mmHg, p<0.001), while there were no differences between conditions for cerebrovascular reactivity to CO2 (p³0.163). When WWI+CO2 vs. WWI were compared, ventilatory sensitivity to CO2 was not different between conditions (p³0.642), while the change in cerebrovascular reactivity to CO2 was different at 30 minutes (-0.56±0.38 vs. -0.30±0.25 cm/s/mmHg, p=0.010). These data indicate that during HOWI ventilatory sensitivity to CO2 increases due to the hydrostatic pressure, while cerebrovascular reactivity to CO2 decreases due to the combined effects of immersion.

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Modular reconfigurable robots exhibit prominent advantages in the reconnaissance and exploration tasks within unstructured environments for their characteristics of high adaptability and high robustness. However, due to the limitations in locomotion mechanism and integration requirements, the modular design of miniature robots in the aquatic environment encounters significant challenges. Here, a modular strategy based on the synthetic jet principle is proposed, and a modular reconfigurable robot system is developed. Specialized bottom and side jet actuators are designed with vibration motors as excitation sources, and a motion module is developed incorporating the jet actuators to realize three-dimensional agile motion. Its linear, rotational, and ascending motion speeds reach 70.7 mm s-1, 3.3 rad s-1, and 28.7 mm s-1, respectively. The module integrates the power supply, communication, and control system with a small size of 48 mm × 38 mm × 38 mm, which ensures a wireless controllable motion. Then, various configurations of the multi-module robot system are established with corresponding motion schemes, and the experiments with replaceable intermediate modules are further conducted to verify the transportation and image-capturing functions. This work demonstrates the effectiveness of synthetic jet propulsion for aquatic modular reconfigurable robot systems, and it exhibits profound potential in future underwater applications.

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Anthropogenic noise has been identified as one of the most harmful forms of global pollutants impacting both terrestrial and aquatic ecosystems. As global populations continue to increase, coastlines are seeing substantial increases in the level of urbanisation. Although measures are in place to minimise stress on fauna, they rarely consider the impact of anthropogenic noise. In Australia, New South Wales (NSW) estuaries have seen extensive increases in urbanisation in recent years. Yet, there remains minimal baseline data on their soundscapes to determine if noise pollution is a threat. This research provides a first assessment of baseline sounds across a temporal and seasonal scale. Recreational boating was the primary soundscape contributor in estuaries, and estuaries with higher urbanisation levels contained higher sound levels. This research provides useful information for managers of NSW estuaries and is of global relevance in an era of increasing generation of anthropogenic noise in estuarine and coastal systems.

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Hydrophones play a crucial role in underwater target detection within sonar systems. However, existing hydrophones often encounter challenges such as low sensitivity and poor signal-to-noise ratio (SNR) in the detection of low-frequency acoustic signals. This work introduces a capacitive hydrophone (CH) designed for highly sensitive detection of low-frequency underwater sound signals. Comprising a latex film/silver electrode and a structured hydrogel as the electrolyte layer, the CH is enclosed in a cylindrical casing. By strategically integrating a carbon nanotube (CNT) topology network within a pyramid microarray in the hydrogel, the sensor efficiently forms the electric double layer (EDL), enhancing sensitivity and precision. The CH showcases exceptional low-pressure sensitivity across a wide frequency spectrum (20 to 800 Hz), achieving a receiving sensitivity of up to -159.7 dB in the critical low-frequency band (20 to 125 Hz), surpassing the performance of the commercial hydrophone (RHC-14) by a substantial margin of 33.29 dB. Furthermore, the CH maintains a superior SNR, enabling the detection of sound waves as faint as 0.3 Pa. This study demonstrates the capabilities of the CH in detecting maritime vessels and underwater sounds, underscoring the potential of the CNT-enhanced EDL sensing mechanism for future low-frequency hydrophone design.