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Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that can increase the risk of hypertension, diabetes, obesity, and cardiovascular diseases. Hypoglossal nerve stimulation (HGNS) is an alternative therapy for OSA in patients who cannot tolerate continuous positive airway pressure. Understanding the impact of HGNS on blood pressure, hemoglobin A1C (A1C), and body mass index (BMI) currently remains limited. Methods: A retrospective review study of HGNS outcomes at a single practice from January 2020 to November 2022 was conducted. Inclusion/exclusion criteria were based on HGNS eligibility and postoperative titration study. Statistical analysis and data management were performed using statistical software, R (v.4.2.1; R Core Team). Paired Student's T test, Fisher's exact test, and McNemar's exact test were utilized for statistical analysis. P values less than .05 were considered statistically significant. Results: Sixty-three patients were included in this study. A significant decrease in mean apnea-hypopnea index was noted following HGNS (mean change -28; P  < .0001). Similar significant decreases were also seen in mean arterial pressures (mean change -8.4, P  < .0001). There was a significant change in overall antihypertensive medication requirements and in requirements ≥3 medications ( P  < .0005, P  = .03). There was a trend toward reduction in A1C; however, there was no change in BMI or number of diabetes medications taken. Conclusions: Our results reinforce previous findings that HGNS is an effective treatment option for carefully selected patients with OSA. In addition, our findings suggest that HGNS may improve patients' quality of life while minimizing OSA associated morbidity., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties., Materials and Methods: Seven infants with isolated upper lip tie and breastfeeding difficulty were taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers were surveyed regarding their experiences with breastfeeding since the frenotomy was performed., Results: In this article, we present seven infants with isolated upper lip tie and breastfeeding difficulty who were treated with labial frenotomy. Subsequently, these infants demonstrated improved weight gain, and all mothers reported increased ease of breastfeeding., Conclusion: These findings implicate lip tie as an underrecognized cause of breastfeeding difficulty and suggest that labial frenotomy is an effective treatment in these patients. Larger-scale randomized controlled studies are necessary to further evaluate this topic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Freeman et al.)

Objectives: We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence-based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines., Methods: Standardized, procedure-specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented., Results: Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented., Conclusion: Implementation of opioid-prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction., Level of Evidence: 2., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Introduction: Despite the presence of a growing body of literature suggesting cost-ineffectiveness of routine pathologic analysis of tonsillectomy specimens, little is known about common institutional policies and practice patterns of pediatric otolaryngologists. The objectives of this study were to determine the prevalence of routine pathological evaluation of tonsillectomy specimens for uncomplicated pediatric adenotonsillectomy procedures and to evaluate opinions regarding this controversy among board-certified pediatric otolaryngologists., Methods: This was a cross-sectional survey study sent to board-certified pediatric otolaryngologists currently practicing and registered with the American Society of Pediatric Otolaryngology (ASPO) assessing their institutions' or practices' current policies on sending routine tonsillectomy specimens for pathology, their experience with this practice, and their opinions on whether routine pathologic analysis should be employed. Basic statistical analysis was then conducted., Results: Respondents mostly practiced in an academic setting (68.4%), with the next most common being academically affiliated private practice (21.8%), and private practice was the least common (9.8%). Most respondents (85.1%) did not agree with routine pathologic analysis of otherwise uncomplicated pediatric tonsillectomy specimens., Conclusion: Most pediatric otolaryngologists who responded to this survey do not support routine pathological analysis of otherwise uncomplicated pediatric tonsillectomy specimens. However, the results are likely biased and should be interpreted carefully, since only a small percentage of pediatric otolaryngologists responded to the survey. Potential cost savings could be seen by patients, payers, and hospital systems with judicious use of surgical pathology, specifically in cases with concurrent signs or symptoms suspicious for malignancy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: New consumer health devices are being developed to easily monitor multiple physiological parameters on a regular basis. Many of these vital sign measurement devices have yet to be formally studied in a clinical setting but have already spread widely throughout the consumer market., Objective: The aim of this study was to investigate the accuracy and precision of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) measurements of 2 novel all-in-one monitoring devices, the BodiMetrics Performance Monitor and the Everlast smartwatch., Methods: We enrolled 127 patients (>18 years) from the Thomas Jefferson University Hospital Preadmission Testing Center. SBP and HR were measured by both investigational devices. In addition, the Everlast watch was utilized to measure DBP, and the BodiMetrics Performance Monitor was utilized to measure SpO 2 . After 5 min of quiet sitting, four hospital-grade standard and three investigational vital sign measurements were taken, with 60 seconds in between each measurement. The reference vital sign measurements were calculated by determining the average of the two standard measurements that bounded each investigational measurement. Using this method, we determined three comparison pairs for each investigational device in each subject. After excluding data from 42 individuals because of excessive variation in sequential standard measurements per prespecified dropping rules, data from 85 subjects were used for final analysis., Results: Of 85 participants, 36 (42%) were women, and the mean age was 53 (SD 21) years. The accuracy guidelines were only met for the HR measurements in both devices. SBP measurements deviated 16.9 (SD 13.5) mm Hg and 5.3 (SD 4.7) mm Hg from the reference values for the Everlast and BodiMetrics devices, respectively. The mean absolute difference in DBP measurements for the Everlast smartwatch was 8.3 (SD 6.1) mm Hg. The mean absolute difference between BodiMetrics and reference SpO 2 measurements was 3.02%., Conclusions: Both devices we investigated met accuracy guidelines for HR measurements, but they failed to meet the predefined accuracy guidelines for other vital sign measurements. Continued sale of consumer physiological monitors without prior validation and approval procedures is a public health concern., (©Christina Hahnen, Cecilia G Freeman, Nilanjan Haldar, Jacquelyn N Hamati, Dylan M Bard, Vignesh Murali, Geno J Merli, Jeffrey I Joseph, Noud van Helmond. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 12.02.2020.)

Objectives : Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor. Methods : We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP. Results : Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP. Conclusions : The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.

The size-weight illusion (SWI) pertains to the experience of perceiving the smaller of two equally weighted objects as heavier. Competing theories to explain the illusion can be generally grouped into cognitive and sensory theories, which place more importance on top-down processing of cognitive expectations and bottom-up processing of sensory information about the size and weight of objects, respectively. The current study examined the relative contribution of these two general explanations. This was done by varying the amounts of cognitive load in a dual-task and the quality of somatosensory feedback by wearing or not wearing gloves. Participants placed their hands through a curtain inside a box so they could not see the test objects. Inside the box, they were presented with either a small or large sphere of varying weights, which they explored manually without vision. Participants provided magnitude estimates about each object's weight in four experimental conditions (no-load with gloves, no-load without gloves, low-load without gloves, and high-load without gloves). The dual-task involved the visual presentation of a cross on a computer monitor that changed in both colour and orientation. With foot pedals, the participants responded to a target colour and / or orientation, which varied across conditions, while they hefted an object. Some conditions were designed to be more cognitively taxing than others (high-load > low-load > no-load conditions). The results revealed that the strength of the SWI diminished when participants wore the gloves but did not change as cognitive load increased on the dual-task. We conclude that the illusion is more influenced by bottom-up sensory than top-down cognitive processes., Competing Interests: The authors have declared that no competing interests exist.

Recent findings on the role of circulating histone proteins in mediating acute lung injury prompted us to investigate whether there is a specific mechanism for accumulation of histones in the lungs. Binding sites for polycations are already known in the vasculature of the lungs, and we postulated that these could also be involved in histone accumulation, since histones have a high content of positively charged amino acids. Using a histone-coated colloid of a radiolabelled nanocomposite to track histone biodistribution with imaging techniques, it was found that histones bind avidly in the lungs of rabbits after intravenous injection. Blocking experiments with competing polycations in vivo characterised histone lung binding as dependent on a charge interaction with microvessel polyanions. Pretreatment of rabbits with a specific heparinase confirmed that the lung binding sites consist of heparan sulphate in the endothelial glycocalyx. A range of heparan sulphate analogues was accordingly shown to prevent histone accumulation in the lungs by neutralising histones in blood. These findings provide a rational basis for the design of polyanions that can prevent accumulation of cytotoxic histones in the lungs and thereby intervene at an early key step in the development of acute lung injury., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

Collection of representative samples of debris following inertial confinement fusion implosions in order to diagnose implosion conditions and efficacy is a challenging endeavor because of the unique conditions within the target chamber such as unconverted laser light, intense pulse of x-rays, physical chunks of debris, and other ablative effects. We present collection of gas samples following an implosion for the first time. High collection fractions for noble gases were achieved. We also present collection of solid debris samples on flat plate collectors. Geometrical collection efficiencies for Au hohlraum material were achieved and collection of capsule debris (Be and Cu) was also observed. Asymmetric debris distributions were observed for Au and Be samples. Collection of Be capsule debris was higher for solid collectors viewing the capsule through the laser entrance hole in the hohlraum than for solid collectors viewing the capsule around the waist of the hohlraum. Collection of Au hohlraum material showed the opposite pattern: more Au debris was collected around the waist than through the laser entrance hole. The solid debris collectors were not optimized for minimal Cu backgrounds, which limited the conclusions about the symmetry of the Cu debris. The quality of the data limited conclusions on chemical fractionation effects within the burning, expanding, and then cooling plasma.

A Thomson parabola ion spectrometer has been designed for use at the Multiterawatt (MTW) laser facility at the Laboratory for Laser Energetics (LLE) at the University of Rochester. This device uses parallel electric and magnetic fields to deflect particles of a given mass-to-charge ratio onto parabolic curves on the detector plane. Once calibrated, the position of the ions on the detector plane can be used to determine the particle energy. The position dispersion of both the electric and magnetic fields of the Thomson parabola was measured using monoenergetic proton and alpha particle beams from the SUNY Geneseo 1.7 MV tandem Pelletron accelerator. The sensitivity of Fujifilm BAS-TR imaging plates, used as a detector in the Thomson parabola, was also measured as a function of the incident particle energy over the range from 0.6 MeV to 3.4 MeV for protons and deuterons and from 0.9 MeV to 5.4 MeV for alpha particles. The device was used to measure the energy spectrum of laser-produced protons at MTW.

The oxidants produced by radiolysis and photolysis in the icy surface of Europa may be necessary to sustain carbon-based biochemistry in Europa's putative subsurface ocean. Because the subduction of oxidants to the ocean presents considerable thermodynamic challenges, we examine the formation of oxygen and related species in Europa's surface ice with the goal of characterizing the chemical state of the irradiated material. Relevant spectral observations of Europa and the laboratory data on the production of oxygen and related species are first summarized. Since the laboratory data are incomplete, we examine the rate equations for formation of oxygen and its chemical precursors by radiolysis and photolysis. Measurements and simple rate equations are suggested that can be used to characterize the production of oxidants in Europa's surface material and the chemical environment produced by radiolysis. Possible precursor molecules and the role of radical trapping are examined. The possibility of oxygen reactions on grain surfaces in Europa's regolith is discussed, and the earlier estimates of the supply of O(2) to the atmosphere are increased.

The new technique of selected ion flow tube-mass spectrometry (SIFT-MS) has been applied to the measurement of Henry's Law constants for the volatile organic chemicals o-xylene and trichloroethylene that both have low solubility in aqueous solvents. The method is validated by measurements in water at 298 K using the equilibrium partitioning in closed systems (EPICS) methodology in which the equilibrium headspace concentrations for the volatile organic compounds (VOCs) are measured in two sealed bottles containing different liquid volumes of very dilute solutions of the VOC. The range of solvents is then extended to human body fluids at 309 K including urine, saline, whole blood, red cells in saline, and plasma. The dimensionless distribution coefficients for these solvents vary markedly in the different fluids. For o-xylene they range from k(H) = 0.12-0.15 for water, saline, and urine; 0.53 for red cells in saline; 1.9 for whole blood; to 2.4 for plasma. For trichloroethylene the distribution coefficients range from k(H) = 0.070-0.091 for water, saline, and urine; 0.28 for red cells in saline; 0.35 for plasma; to 0.48 in whole blood. The very different solubilities of organic solvents in body fluids influence the uptake of solvents in workers exposed to VOCs. Some implications of these measurements are briefly discussed.

We report the results of a flowing afterglow ion source-selected ion flow tube study (FA-SIFT) of the reactions of the methoxymethyl cation, CH3OCH2+. Rate coefficients and product branching ratios are reported for twenty nine reagent molecules including those that constitute the major ingredients of air, the hydrocarbons CH4, C2H6, C3H8, n-C4H10, C2H2, C2H4, C3H4 (allene and propyne), C6H6, and the S-containing molecules H2S, CH3SH, C2H5SH, (CH3)2SH, and (C2H5)2SH. In addition, we examined the reactions with the N-containing molecules NH3, CH3NH2, (CH3)2NH, (CH3)3N, pyrrole, pyridine as well as CH3COCH3. The results can be summarized under three general reaction types: Reaction at the CH3 carbon, reaction at the CH2 carbon, and association. The results also indicate that the methoxymethyl cation can be used as a chemical ionization source for the detection of trace levels of S-containing compounds in saturated hydrocarbons.

A new technique is presented for the rapid, high-resolution identification and quantification of multiple trace gases above soils, at concentrations down to 0.01 microL L(-1) (10 ppb). The technique, selected ion flow tube mass spectrometry (SIFT-MS), utilizes chemical ionization reagent ions that react with trace gases but not with the major air components (N2, O2, Ar, CO2). This allows the real-time measurement of multiple trace gases without the need for preconcentration, trapping, or chromatographic separation. The technique is demonstrated by monitoring the emission of ammonia and nitric oxide, and the search for volatile organics, above containerized soil samples treated with synthetic cattle urine. In this model system, NH3 emissions peaked after 24 h at 2000 nmol m(-2) s(-1) and integrated to approximately 7% of the urea N applied, while NO emissions peaked about 25 d after urine addition at approximately 140 nmol m(-2) s(-1) and integrated to approximately 10% of the applied urea N. The monitoring of organics along with NH3 and NO was demonstrated in soils treated with synthetic urine, pyridine, and dimethylamine. No emission of volatile nitrogen organics from the urine treatments was observed at levels >0.01% of the applied nitrogen. The SIFT method allows the simultaneous in situ measurement of multiple gas components with a high spatial resolution of < 10 cm and time resolution <20 s. These capabilities allow, for example, identification of emission hotspots, and measurement of localized and rapid variations above agricultural and contaminated soils, as well as integrated emissions over longer periods.

We report measurements of residual vapour levels of xylenes and trimethylbenzenes, present following a floor re-surfacing procedure, using the technique of selected ion flow tube mass spectrometry (SIFT-MS). A subject exposed to controlled amounts of xylene and mesitylene was monitored by direct breath exhalation over a 4-hour period after exposure to the volatile organic compounds (VOCs) had stopped. The headspace gases above 5 mL blood samples taken over this period were also monitored. The decays of the solvent levels with time were fitted to a two-compartment model with residence times for xylene and mesitylene of 0.37 h and 0.38 h, respectively (compartment one) and 2.5 h and 2.8 h, respectively (compartment two)., (Copyright 2002 John Wiley & Sons, Ltd.)

The ion-molecule reactivity of the products formed in the association reactions of HCNH+ with C2H2 (C3H4N+) and C2H4 (C3H6N+) has been investigated to provide information on the structures of the adducts thus formed. The C3H4N+ and C3H6N+ adducts were formed in the reaction flow tube of a flowing afterglow sourced-selected ion flow tube (FA-SIFT) and their reactivity with a neutral molecular "probe" examined. The reactivity of possible known structural isomers for the C3H4N+ and C3H6N+ ions was investigated in both the FA-SIFT and an ion cyclotron resonance spectrometer (ICR). Ab initio investigations of the potential energy surfaces for both structures at the G2(MP2) level have also been performed and structures corresponding to local minima on both surfaces have been identified and evaluated. The results of these experimental and theoretical studies show that at room temperature, the C3H4N+ adduct ion contains two isomers; a less reactive one that is likely to be a four-membered cyclic covalent isomer (approximately 70%) and a faster reacting component that is probably an electrostatic complex (approximately 30%). The C3H6N+ adduct ion formed from HCNH+ + C2H4 at room temperature is a single isomer that is likely to be the four-membered covalently bound cyclic CH2CH2CHNH+ species.

In this paper we compare the amounts of ethanol in breath and in blood after ingestion of whisky using analysis by selected ion flow tube mass spectrometry (SIFT-MS). Blood ethanol concentrations were also obtained using standard hospital forensic procedures for blood alcohol analyses. We demonstrate the quantitative nature of SIFT-MS analysis by correlating the observed alcohol content of the headspace above 5-mL amounts of venous blood and aqueous solution to which known trace amounts of alcohol have been added. This procedure provides a Henry's Law coefficient for ethanol in aqueous solution at 298 +/- 3 K of 209 +/- 7 mol/kg*bar. We also demonstrate that measurement of the ethanol concentration in the alveolar portion of a single breath using the SIFT-MS technique gives an accurate measure of blood alcohol and could obviate the need for blood samples in forensic processing. The storage performance of breath samples in Mylar bags with a volume greater than 1 L has been shown to maintain the mixture integrity for ethanol but not for some other species.

The selected ion flow tube mass spectrometry (SIFT-MS) technique enables real time analysis of trace volatiles at ppb levels without preconcentration steps or chemical derivatization. Most previous studies of trace compounds on the breath were analyzed using gas chromatography where enhanced detection sensitivity was achieved by concentrating the breath using cryogenic or adsorption trapping techniques. In this paper, we have examined volatile organic substances, isoprene, acetone, ammonia and ethanol in breath before and after smoking a cigarette. It is interesting that isoprene levels increased in all the subjects after smoking one cigarette with a mean increase of 70%. The mean increase for acetone was found to be 22%. In contrast to isoprene, a decreasing ethanol level was observed in all the subjects except one with the negative mean decrease of 28%. Further SIFT-MS studies also have high-lighted some organic substances produced even by unburned cigarettes, US and New Zealand products. Certain US brands have shown much higher levels of volatile species than cigarettes produced in New Zealand.

It is contended that the most comprehensive collection of data on the visible and near-ultraviolet spectrum of pure liquid water can still be found [Appl. Opt. 38, 1216 (1999)]. The data produced [Appl. Opt. 36, 8710 (1997)] from the integrated light loss in a light-scattering cavity containing water produces a useful set of data, although the error bars presented are underestimated. Furthermore, an oxidative purification step was not incorporated into the water purification procedure to remove residual traces of light-absorbing organic impurities.

We show how the concentration of the breath gases ammonia, acetone, and isoprene vary with time during exercise using the new selected ion flow tube mass spectrometry (SIFT-MS) technique. The expired breath concentrations of ammonia, acetone and isoprene were observed within the range of 50-500, 100-1400 and 5-400 ppb, respectively. Increasing acetone levels were observed for most subjects during the exercise period. However, isoprene levels decreased with time during exercise. Older subjects showed higher levels of isoprene compared with younger subjects. The ammonia time profile with exercise showed both decreasing and increasing patterns for different subjects.

The optical absorption of pure liquid water in the 300-700-nm region has been measured by use of a long (1.5-m) path-length cell. The absorption spectrum coincides well with the edge of previous data in the 200-320-nm region and provides reliable data in the 320-420-nm region that has until now been a region of considerable unreliability. The data obtained for the 420-700-nm region agree quite well with the means of the existing literature in that well-studied region. The absorptions in the 550-700-nm region show evidence for the overtones and combination tones of the well-known OH stretching frequency at 3500 cm(-1).

Reactivities of the structural isomers CCN+ and CNC+ were examined in a selected-ion flow tube at 300 +/- 5 K. The less reactive CNC+ isomer was identified as the product of the reactions of C(+) + HCN and C(+) + C2N2; in these reactions only CNC+ can be produced because of energy constraints. Rate coefficients and branching ratios are reported for the reactions of each isomer with H2, CH4, NH3, H2O, C2H2, HCN, N2, O2, N2O, and CO2. Ab initio calculations are presented for CCN+ and CNC+; a saddle point for the reaction CCN+ --> CNC+ is calculated to be 195 kJ mol-1 above the CNC+. The results provide evidence that the more reactive CCN+ isomer is unlikely to be present in measurable densities in interstellar clouds.

Eight imidazo[1,2-alpha] pyrimidine derivatives and six cyclic guanidine derivatives were synthesized in order to study their physiological activity. Mutagenic effects were not detected with any compound in a modified Ames' Salmonella test using TA100, TA98, and TA1537, with or without S9. No inhibition of growth was observed with any test compound. Positive and negative controls behaved as expected.