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Objective: To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA). Data Sources: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English‐language studies containing original data on sociodemographic and healthcare system barriers to PAP‐alternative treatments for adult OSA. Review Methods: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines. Title and abstract screening, full‐text review, and data collection were conducted by two investigators independently. Results: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP‐alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea. Conclusion: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 134:3903–3909, 2024 [ABSTRACT FROM AUTHOR]

In this work, green method to synthesize chromium-doped zinc oxide (ZnO) nanorods (NRs) using an aqueous flower extract from Rhododendron arboretum is explored. Herein, chromium-doped ZnO NRs were prepared with different amount of chromium doping, varied as 2–10%. The green synthesized products underwent substantial analysis through X-ray diffraction (XRD), spectroscopic such as ultraviolet spectroscopy(UV-Vis) and scanning electron microscopy (SEM) methods. All samples were found to have hexagonal wurtzite ZnO, with average particle sizes of 52.41, 56.6, 54.44, 53.05, and 56.99 nm, respectively, for 2, 4, 6, 8, and 10% chromium doping in ZnO NRs. The Cr-doped ZnO NRs exhibited remarkable photocatalytic degradation activity of cationic dyes under UV-light, i.e., Malachite Green and Fuchsin Basic with degradation of 99.604 and 99.881%, respectively in 90 min. The reusability tests for these green synthesized Cr-doped ZnO NRs have also been carried out, showed 9–11 cycles with 85% of degradation efficiency. In addition, the Cr-doped ZnO NRs exhibited high selectivity for cationic dyes when experiments against mixture of dyes were performed. Photodegradation kinetics followed the pseudo-first-order model. The flower-extract-stabilized chromium-doped ZnO NRs demonstrated high photocatalytic activity toward malachite green and fuchsin basic dyes, potential material for pollution remediation. Cr-doped ZnO NRs by green method using flower extract of Rhododendon arboretum were prepared for the first time under ambient reaction conditions. Effect of Dopant i.e. Cr on Photocatalytic activity have been exploited. Selective photocatalytic degradation of cationic dyes i.e. MG, and FB has been achieved in 60–90 minutes. Optimization of reaction condition and various parameters has also been carried out. Recyclability of Cr-doped ZnO NRs was also evaluated and were found to be reusable for 11 cycles for degradation. [ABSTRACT FROM AUTHOR]

Pi (π) interactions originating from the N-H bond of amine and ethylene moiety have been explored on the mechanism of aromatic nucleophilic substitution (ArSN) of the nitro group of 4-methylene-5,7-dinitroquinazoline with methylamine in the gas phase and solvent media within DFT framework. The free energy profiles confirmed that the amination should take place at peri-position and calculations support the one-step mechanism through a transition state with no intermediate in the reaction route. Stabilisation of peri-transition state by intramolecular weak interaction akin to hydrogen bonding N-H—CH2 = C leads to the regioselective amination at peri-position of 4-methylene-5,7-dinitroquinazoline. The intramolecular hydrogen bond interactions at N-H—CH2 = C in the peri-transition state are strongly supported by a red shift in N-H stretching vibrations in simulated IR spectra and are confirmed by studying energetics of amination of structural/electronic analogues of 4-methylene-5,7-dinitroquinazoline. The present study established that ethylene plays an important role as an efficient H-bond acceptor in fixing the regioselectivity at peri-position in the amination of 4-methylene-5,7-dinitroquinazoline. This is the first-ever report for the exploration of the role of ethylene moiety as a hydrogen bond acceptor in mediating the regioselectivity of organic reactions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Polyps are tumorous growths in the colon or rectal area which can turn into cancer at later stages, thus detection of polyps is very important for timely prevention of colorectal cancer. The aim of the study is to develop a framework to accurately detect polyp images in colonoscopy images. OBJECTIVE: Development of an intelligent framework for classification of colorectal cancer from colon and rectal images. The standard machine learning, convolutional neural networks and ensemble models with nature inspired approach were implemented for this study. Model optimization was performed by varying hyper parameters. The main objective was to find an optimal model with high accuracy, optimized weights and less parameters. METHODS: The deep learning Convolutional Neural Network (CNN) models such as VGG19, ResNet50, EfficientNet, Ensemble Model (EM), and Modified Ensemble CNN with Genetic Algorithm (MEGANET) were implemented for the classification of colon images. RESULTS: Ensemble model was also created with two best performing deep learning models to further achieve higher accuracy of 96%. The ensemble model outperformed the other models in terms of accuracy, precision, recall, and F1 score. But this model has more complexity. The MEGANET, nature inspired evolutionary ensemble CNN model was implemented with transfer learning and genetic algorithms for weights optimization and parameter reduction. It achieved accuracy of 95%, on training data. CONCLUSION: The MEGANET performed similar to EM with less number of parameters on training, validation and test dataset. In future different methods will be implemented to further reduce the parameters and attain reasonable accuracy using MEGANET. [ABSTRACT FROM AUTHOR]

Named Data Networking (NDN) has gained importance in today's era due to a paradigm shift in the Internet usage pattern which revolves around the content rather than the respective host addresses. Three important data structures in NDN are Content Store (CS), Pending Interest Table (PIT) and Forwarding Information Base (FIB). The search time of PIT is quite high since its size grows with the addition of new content names, and the Interest packets which are not served by CS are searched in millions of existing entries in the PIT. Hence, lookup time can be improved if, instead of checking all the available entries, initial scanning is done to determine whether the required content name exists in the PIT or not. In this paper, we propose a Stable Bloom Filter (SBF) based PIT called S-PIT, to minimize the PIT search time by identifying the existence of query content through SBF. The various experiments performed show that S-PIT outperforms existing data structures in terms of memory consumption, content insertion time, average search time and false positive rate. [ABSTRACT FROM AUTHOR]

Mental disorders are major problems and influence the thought of suicide, so it needs to be diagnosed and treated earlier. Detecting the symptoms of mental disorders is highly significant as they are considered a life-threatening task. Hence, this paper plans to implement new mental depression recognition by analyzing the tweet media text to secure the lives of the affected individuals. In the standard dataset, the text tweet data is collected. The gathered text data are used in the bags of n-grams and glove embedding for extracting the text features. Here, the extracted features are considered for the weighted feature selection, where the weight optimization takes place using the Awareness Probability-based Crow Black Widow Search algorithm. Finally, the weighted features are used for the recognition phase using the Convolutional Neural Network-Ensemble learning, where the final layer of CNN is replaced by the "Support Vector Machine (SVM), Random Forest (RF), Long Short Term Memory (LSTM) and Artificial Neural Network (ANN)" for classification. Here, parameter optimization occurs in the classifiers to improve the evaluation of the designed method. The experimental outcomes show the efficient performance of the developed method when compared with the other baseline approaches. [ABSTRACT FROM AUTHOR]

Intratumoral multi-injection strategy enhances the efficacy of magnetic nanoparticle hyperthermia therapy (MNPH). In this study, criteria for the selection of injections and their location depending on the tumor shape/geometry are developed. The developed strategy is based on the thermal dosimetry results of different invasive 3D tumor models during MNPH simulation. MNPH simulations are conducted on physical tumor tissue models encased within healthy tissue. The tumor shapes are geometrically divided into a central tumor region containing maximum tumor volume and a peripheral tumor portion protruding in any random direction. The concepts of core and invasive radius are used to geometrically divide the tumor volume. Primary & secondary injections are used to inject MNP fluid into these respective tumor regions based on the invasiveness of the tumor. The optimization strategy is devised based on the zone of influence of primary & secondary injection. Results indicate that the zone of influence of secondary injection lies between 0.7 and 0.8 times the radial distance between the center of the tumor core and branch node point (extreme far endpoint on the invasive tumor surface). Additionally, the multi-injection strategy is more effective when the protrusion volume exceeds10%of the total volume. The proposed algorithm is used to devise multi-injection strategies for arbitrarily shaped tumors and will assist in pre-planning magnetic nanoparticle hyperthermia therapy., (© 2024 IOP Publishing Ltd.)

Objective: To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM., Data Sources: PubMed, Web of Science, Embase, PsychINFO, and CINAHL., Review Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality., Results: A total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test-retest reliability., Conclusion: Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This study aimed to describe trends in opioid prescriptions among US sleep surgeons between 2013 and 2021 via a retrospective analysis conducted using publicly available data., Methods: Utilizing the CMS part D database, we analyzed data from 82 sleep surgeons, focusing on metrics including number of opioid beneficiaries and claims, opioid cost, and opioid day supply per beneficiary. We employed statistical methods including ANOVA, t-tests, Fisher's exact test with Monte Carlo Simulation, and regression models., Results: There were no significant changes in the number of opioid claims (p = 0.782) or beneficiaries per provider (p = 0.590) nor was there a decrease in opioid day supply per beneficiary (p = 0.489) over time. Surgeons who graduated residency before 2000 prescribed significantly more opioids over the course of the study period compared to those graduating after 2000 with higher opioid day supply per beneficiary (13.34 vs. 7.42, p < 0.001), higher opioid beneficiaries per provider (21.62 vs. 19.36, p = 0.028), and higher opioid claims per provider (30.30 vs. 21.78, p < 0.001). A significant annual decrease in opioid cost per beneficiary (ANOVA, p = 0.006) was noted., Conclusions: This study illuminates a significant impact of provider years in practice on opioid prescribing trends, alongside a decreasing trend in opioid cost per beneficiary. Despite the evolving paradigm emphasizing opioid reduction and evidence of decreasing opioid prescriptions in other otolaryngology subspecialties, our findings depict that opioid prescriptions among sleep surgeons remained stable from 2013 to 2021., Level of Evidence: III Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Femoral neck fractures (FNF) are one of the most common fractures, with a projected increase in incidence with population growth and ageing. The Femoral Neck System (FNS) launched in 2019 was developed specifically for fixation of FNF with the purported advantages of providing both angular and rotational stability. We report our experience with the FNS and evaluate its effectiveness and associated complications., Methods: A retrospective case series of 50 patients who underwent surgical fixation for FNF from August 2020 to October 2021 using the FNS in two Singapore tertiary institutions with at least 2 years follow-up were included. Clinical data (patients' demographics, fracture classification, intra-operative and post-operative complications) were reviewed. Radiological analysis assessed the pre- and immediate post-operative garden alignment index (GAI) and presence of femoral neck shortening at 3 months., Results: The mean age was 63.5 years (SD 16.9, range 26-92). Five (10 %), 34 (68 %) and 11 (22 %) were ASA 1, 2 and 3 respectively. Twenty-four (48 %), 16 (32 %), 4 (8 %), and 6 (12 %) patients sustained Garden's 1, 2, 3 and 4 FNF respectively. The mean operative duration was 66.2 min (SD 20.5) and length of stay was 6.9 days (SD 4.6).The post-operative improvement in garden alignment index (GAI) was a mean of 9.1° (p < 0.001) on lateral view. The mean femoral neck shortening was 1.97 mm (SD 5.3) at 3 months. There were no intra-operative complications. Post-operatively, 1 (2 %) patient required blood transfusion, 1 (2 %) patient had implant cut-out and non-union managed non-operatively, 2 (4 %) patients developed avascular necrosis and required revision to total hip replacements. There were two (4 %) cases of 1-year mortality., Conclusion: The FNS achieved good outcomes with low rates of complications. The promising results justify its continued use and further evaluation in comparison to other devices., Competing Interests: The authors have no conflicts of interest to declare. (Unable to edit and save the Conflict of Interest Form provided in the link in the portal), (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Two-hundred pregnancies involving 100 women with essential thrombocythemia (ET) were accessed from Mayo Clinic databases (1990-2023). Median platelet count displayed a decline during pregnancy, nadiring at 48% of baseline, in the third trimester: 704-369 × 10 9 /L. Live birth rate was 72%. Of 53 (27%) unintentional pregnancy losses, 48 (24%) occurred in the first trimester. Other fetal complications included preterm birth 3%, intrauterine growth retardation 3%, and stillbirth 1%. Maternal complications included major hemorrhage (7%), preeclampsia (6%), thrombosis (1%), and placental abruption (0.5%). Antepartum management included no specific therapy in 52 (26%), aspirin alone in 112 (56%), aspirin combined with cytoreductive drugs or systemic anticoagulants in 23 (12%), and other permutations in the remaining. Postpartum systemic anticoagulation was documented in 29 (15%) pregnancies. Unintentional first-trimester loss was predicted by prior fetal loss (43% vs. 18%; p < .01), diabetes mellitus (DM; 67% vs. 23%; p = .02), and absence of aspirin therapy (45% vs. 14%; p < .01); the salutary effect of aspirin therapy was independent of the other two risk factors and apparent in both high (presence of ≥1 risk factor; 33% vs. 61%; p = .07) and low (absence of both risk factors; 10% vs. 34%; p < .01) risk scenarios. The benefit of aspirin therapy, in preventing first-trimester loss, was significant in both JAK2-mutated (18% vs. 50%; p < .01) and CALR-mutated (8% vs. 43%; p < .01) cases. Aspirin use was also associated with a lower risk of venous thrombosis (0% vs. 3%; p = .03). By contrast, the use of systemic anticoagulation, antepartum or postpartum, did not influence fetal or maternal complication rates. CALR mutation and DM predicted maternal hemorrhage (13% vs. 4%; p = .05) and preeclampsia (33% vs. 5%; p = .03), respectively. The current study demonstrates the protective role of aspirin in preventing first-trimester loss in ET, independent of driver mutation status or other risk factors., (© 2024 Wiley Periodicals LLC.)