Flindthollis1421

Sleep medicine is a multidisciplinary field that includes otolaryngology. After 2011, sleep medicine board eligibility required completion of a dedicated sleep medicine fellowship. The objective of our study is to describe the characteristics and geographic distribution of the dual board-certified sleep otolaryngology workforce and to assess the impact of the 2011 change.

A cross-sectional analysis of sleep-certified otolaryngologists registered with the American Board of Otolaryngology-Head and Neck Surgery in 2019 was performed to characterize the sleep otolaryngology workforce. County and regional analysis of provider density was conducted by comparing provider characteristics with county-level data from the United States Census Bureau.

There were 275 active dual board-certified sleep otolaryngologists, or approximately 1 for every 1.12million Americans. 77.8% were in private practice and 2.9% had American Society of Pediatric Otolaryngology membership. Eighty-eight percent were male, with females more likely than males to be in an academic setting (36.4% for females compared to 20.2% for males; P=.045). The South Atlantic and South Central regions had the highest number of sleep board-certified otolaryngologists per capita. Before 2011, an average of 75.7 otolaryngologists took the sleep board exam per 2-year cycle, compared to 14.3 otolaryngologists after 2011 (P=.029).

There are few dual board-certified sleep otolaryngologists across the country, which may affect care for patients with sleep-disordered breathing. Increased resident exposure and otolaryngology training in sleep medicine can strengthen the otolaryngology contribution to the multidisciplinary care of these patients.

IV Laryngoscope, 2021.

IV Laryngoscope, 2021.Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media (OM) characterized by eosinophilic accumulation in the middle ear mucosa and secretion. Associated sensorineural hearing loss can eventually lead to (functional) deafness. EOM is strongly associated with type 2 inflammation driven respiratory disease, i.e. asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), for which biological treatment is available. This case report discusses a patient suffering from EOM with severe mixed hearing loss, nearing functional deafness. Dupilumab treatment resulted in complete and enduring remission of the EOM, enabling adequate hearing rehabilitation. Concurrent control of the comorbid asthma and CRSwNP was obtained. Laryngoscope, 2021.Lichenoid reactions are one of the many cutaneous immune-related adverse events seen with the use of immune checkpoint inhibitors, particularly anti-PD1 inhibitors. We present a rare care of severe lichen planopilaris secondary to pembrolizumab, with progression even after cessation of immunotherapy. It is important to recognise the significant long-term impact of these cutaneous adverse effects on patient's quality of life.Polygenic risk scores (PRS) are becoming increasingly available in clinical practice to evaluate cancer risk. However, little is known about health professionals' knowledge, attitudes, and expectations of PRS. An online questionnaire was distributed by relevant health professional organisations predominately in Australia, Canada and the US to evaluate health professionals' knowledge, views and expectations of PRS. Eligible participants were health professionals who provide cancer risk assessments. Results from the questionnaire were analysed descriptively and content analysis was undertaken of free-text responses. In total, 105 health professionals completed the questionnaire (genetic counsellors 84%; oncologists 6%; clinical geneticists 4%; other 7%). Although responses differed between countries, most participants (61%) had discussed PRS with patients, 20% had ordered a test and 14% had returned test results to a patient. Confidence and knowledge around interpreting PRS were low. Although 69% reported that polygenic testing will certainly or likely influence patient care in the future, most felt unprepared for this. If scaled up to the population, 49% expect that general practitioners would have a primary role in the provision of PRS, supported by genetic health professionals. These findings will inform the development of resources to support health professionals offering polygenic testing, currently and in the future.

Severe diarrhoea, a common gastrointestinal manifestation of anticancer treatment with irinotecan, might involve single nucleotide polymorphisms (SNPs) of toll-like receptors (TLRs), described as critical bacterial sensors in the gut. Here, colorectal cancer patients carrying missense TLR4 A896G (rs4986790) or C1,196T (rs4986791) SNPs and Tlr4 knockout (Tlr4-/-) mice were given irinotecan to investigate the severity of the induced diarrhoea.

Forty-six patients treated with irinotecan-based regimens had diarrhoea severity analysed according to TLR4 genotypes. In the experimental setting, wild-type (WT) or Tlr4-/- mice were given irinotecan (45 or 75 mg·kg

, i.p.) or saline (3 ml·kg

). Diarrhoea severity was evaluated by measuring intestinal injury and inflammatory markers expression after animals were killed.

All patients with TLR4 SNPs chemotherapy-treated presented diarrhoea, whereas gastrointestinal toxicity was observed in 50% of the wild homozygous individuals. Mice injected with irinotecan presented systemic bacterial translocation and increased TLR4 immunostaining in the intestine. In line with the clinical findings, Tlr4 gene deficiency enhanced irinotecan-related diarrhoea and TLR9 expression in mice. An increased myeloperoxidase activity and Il-18 expression along with IL-10 decreased production in Tlr4-/- mice also indicated an intensified intestinal damage and inflammatory response.

TLR4 deficiency upregulates TLR9 expression and enhances intestinal damage and the severity of late-onset diarrhoea during irinotecan-based treatment. Identifying patients genetically predisposed to chemotherapy-associated diarrhoea is a strategy toward precision medicine.

TLR4 deficiency upregulates TLR9 expression and enhances intestinal damage and the severity of late-onset diarrhoea during irinotecan-based treatment. Identifying patients genetically predisposed to chemotherapy-associated diarrhoea is a strategy toward precision medicine.

Fibromyalgia (FM) is characterized by chronic widespread pain and both physical and emotional alterations, which in turn may affect the individual's quality of life. Thus, interventions aimed at treating such symptoms, without increasing fatigue, are needed. The aim of this study was to explore the effect of high-frequency transcranial magnetic stimulation (HF-TMS) and physical exercise (PE) on pain, impact of FM, physical conditioning, and emotional status in people with FM.

Forty-nine women with FM were randomly allocated to a PE group (PEG, n = 16), who underwent an 8-week (two 60-minute sessions/week) low intensity PE program; TMS group (TMSG, n = 17), receiving a 2-week (five 20-minute sessions/week) HF-TMS intervention and a control group (CG, n = 16). Pain (ie, perceived pain and average pressure pain threshold (PPT), perceived impact of FM (ie, overall impact, symptoms, and perceived physical function), physical conditioning (ie, endurance and functional capacity, fatigue, gait velocity, and power) and emotional status (ie, anxiety, depression, stress, and satisfaction) were assessed at baseline (T1) and after the intervention (T1, at 2weeks for TMSG and at 8weeks for PEG and CG).

TMSG showed to significantly improve all studied variables after the intervention except for satisfaction, whereas PEG improved average PPT, perceived overall impact of FM and total score, endurance and functional capacity, velocity and power, anxiety, depression, and stress. In contrast, the CG showed no improvements in any variable.

Both PE and HF-TMS are effective in improving pain, impact of FM, physical conditioning, and emotional status in people with FM, while HF-TMS achieved larger improvements in emotional status than PE.

Both PE and HF-TMS are effective in improving pain, impact of FM, physical conditioning, and emotional status in people with FM, while HF-TMS achieved larger improvements in emotional status than PE.School-based programs are widely implemented to combat childhood obesity, but these programs have mixed results. Dissemination and implementation science approaches to evaluation using qualitative methods can provide more robust details about program functioning that may be able to help explain the variation in the impact of these programs. Fourteen in-depth interviews were conducted with classroom teachers implementing a school-based program, the Integrated Nutrition Education Program (INEP), to explore their experience. Factors related to organization, individual and intervention levels emerged as facilitators and barriers to program implementation. Key factors were school culture at the organization level, individual perception and belief in the intervention at the individual level and program content, perceived complexity and adaptability at the intervention level. Socioeconomic status of the community and family involvement were contextual factors identified across all levels. Findings from this qualitative evaluation can be used for the quality improvement of INEP, but beyond this these can also be informative for other school-based programs to promote adoption, implementation and maintenance.Early adolescence is a critical period for eating behavior as children gain autonomy around food choice and peer influences increase in potency. From a neurodevelopmental perspective, significant structural changes take place in the prefrontal cortex during this time, including the orbitofrontal cortex (OFC), which is involved in socially contextualized decision making. We examined morphological features of the OFC in relation to food choice in a sample of 10,309 early adolescent children from the ABCD study. Structural parameters of the OFC and insula were examined for relationships with two important aspects of food choice limiting consumption of fast/fried food and maximizing consumption of nutritious foods. Raw, partially and fully adjusted models were evaluated. Findings revealed that larger surface area of the lateral OFC was associated with higher odds of limiting fast/fried food consumption in raw (OR=1.07, CI1.02,1.12, p=.002, pFDR=.012), partially adjusted (OR=1.11, CI1.03,1.19, p=.004, pFDR=.024), and fully adjusted models (OR=1.11, CI1.03,1.19, p=.006, pFDR=.036). In contrast, larger insula volume was associated with lower odds of maximizing healthy foods in raw (OR=0.94, CI.91,0.97, p less then .001, pFDR=.003) and partially adjusted (OR=0.93, CI 0.88-0.98, p=.008, pFDR=.048) models. These findings refine understanding of the OFC as a network node implicated in socially mediated eating behavior.

Diffuse light is ubiquitous in biomedical optics and imaging. Understanding the process of migration of an initial photon population entering tissue to a completely randomized, diffusely scattered population provides valuable insight to the interpretation and design of optical measurements.

The goal of this perspective is to present a brief, unifying analytical framework to describe how properties of light transition from an initial state to a distributed state as light diffusion occurs.

First, measurement parameters of light are introduced, and Monte Carlo simulations along with a simple analytical expression are used to explore how these individual parameters might exhibit diffusive behavior. Tanespimycin ic50 Second, techniques to perform optical measurements are considered, highlighting how various measurement parameters can be leveraged to subsample photon populations.

Simulation results reinforce the fact that light undergoes a transition from a non-diffuse population to one that is first subdiffuse and then fully diffuse.