Oral Appliance Therapy for the Management of Obstructive Sleep Apnea

In recent years, the medical profession has begun to recognize the role of sleep hygiene as it pertains to patient health. Types of sleep disordered breathing (SDB) include snoring, obstructive sleep apnea (OSA), central sleep apnea and a mix of obstructive and central apnea. OSA is the most common category of SDB. The apneas are now known affect cardiovascular health and neuro-behavioral issues. In recent years, the dental profession has become involved in managing snoring and certain OSA problems using oral appliance therapy (OAT). This treatment by dentists is now well accepted by the medical profession. This paper will review the basics of OSA, and how the dentist may be involved in providing OAT for these patients

Non-invertible Symmetries and Higher Representation Theory II

In this paper we continue our investigation of the global categorical symmetries that arise when gauging finite higher groups and their higher subgroups with discrete torsion. The motivation is to provide a common perspective on the construction of non-invertible global symmetries in higher dimensions and a precise description of the associated symmetry categories. We propose that the symmetry categories obtained by gauging higher subgroups may be defined as higher group-theoretical fusion categories, which are built from the projective higher representations of higher groups. As concrete applications we provide a unified description of the symmetry categories of gauge theories in three and four dimensions based on the Lie algebra $\mathfrak{so}(N)$, and a fully categorical description of non-invertible symmetries obtained by gauging a 1-form symmetry with a mixed 't Hooft anomaly. We also discuss the effect of discrete torsion on symmetry categories, based a series of obstructions determined by spectral sequence arguments.Comment: 56 pages + appendix, v2: clarifications and citations adde

Outcomes of early and interval laparoscopic cholecystectomy for acute cholecystitis at a teaching hospital in Kerala: A prospective observational comparative study

Timing of laparoscopic cholecystectomy, a widely used treatment modality for acute cholecystitis remains controversial. This prospective observational comparative study investigated patient outcomes for early (ELC) and interval laparoscopic cholecystectomy (ILC) in patients with acute cholecystitis admitted to the General Surgery Department at a tertiary care centre in Thrissur, Kerala, between December 2018 and June 2020. Of 67 patients, 34 were assigned to ELC and 33 to ILC groups and followed up for 2 weeks post-surgery. Patient characteristics, clinical features, investigations, intra operative details and post operative outcomes were tabulated. Comparison of age was statistically analyzed using student’s ‘t’ test, demographics and morbidity data using Fisher’s exact test/ Chi-square test and length of hospital stay using Mann Whitney U test. Mean age was significantly higher in the ILC group. 66% of study participants were females with a higher proportion of females observed in the ILC group. Post-surgical complications were not significantly higher in ELC group compared to ILC group. Total length of hospital stay was significantly longer in the ILC group than in ELC group (10.2 ±4.5 vs. 7.1 ±3.0) days, p value: 0.001). Duration of hospital stay for the laparoscopic cholecystectomy procedure taken separately, was longer in ELC group comparatively, 7 ±3.01 versus 4 ±-2.38, (p value: <0.001). There was no mortality. It was observed in the present study that ELC is preferable to ILC for acute cholecystitis with added benefit of shorter hospital stay. Further large randomized trials would be valuable to make recommendations for future management

Quantitative and qualitative assessment of exploitation of juvenile cephalopods from the Arabian Sea and Bay of Bengal and determination of minimum legal sizes

Using the minimum size at maturity (MSM) as a biological reference point and relatively low reproductive loads and generation times of the studied animals, the minimum legal sizes (MLS) for the Indian squid Loligo duvauceli, the pharaoh cuttlefish Sepia pharaonis and for the webfoot octopus Octopus membranaceous was fixed at 80, 115 and 45 mm Dorsal Mantle Length (DML) respectively with corresponding minimum legal weights at 25, 150 and 15 g. For L. duvauceli, during 1997-2001, 12.8% of the average catch was constituted by juveniles, the proportion being higher along the west coast. In 2002-05, the proportion of juveniles was lower at 5.3% and the total weights were also much less (1817 t as compared to 5354 t). In the case of S. pharaonis, 6.9% (2281 t) of the catch was constituted by juveniles, but the proportion was very high (22.4%) along the east coast. In O. membranaceous during 2002-04, an estimated 527 t (5.9%) of the total catch comprised of juveniles. The present Lmean in the fishery is lower than the Lopt and their difference is considerably high at 60 mm for L. duvauceli. However, in the case of S. pharaonis this difference is only 10 mm and in the case of O. membranaceous the Lmean is higher than the Lopt. If the juveniles are permitted to grow to Lmean by implementing the MLS, the estimated economic gain is to the tune of Rs. 426 crores per annum. The present study shows that harvest weights can be improved by up to 34 times and would result in higher incomes to trawl fishers

Effect of Mechanical Stimuli on the Sensitivity of Mimosa Pudica Plant

'Touch me not' plant is o herb that shows sensation on touch, which is taxonomically called as Mimosa pudica. The fern like leaves close up and droop when touched; usually re-open within few minutes as a response to stimuli. Mimosa pudica reacts to mechanical stimuli with help of mechanosensitive channels. They are ideal transducers of physiologically relevant mechanical forces. The present study focus on the effect of mechanical stimuli in terms of various touch viz., human, plastic, cotton, fiber and wood on the sensitivity of Mimosa pudico plant whose leaves are at tender stage. Time taken for the leaflets to close and reopen was noted for each of the above mentioned stimuli. The t-test has shown the significant result for various mechanical stimuli. The rote of sensitivity was very high in Mimosa pudica as result of plastic touch

Brightness, distribution, and evolution of sunspot umbral dots

We present a 106-minute TiO (705.7nm) time series of high spatial and temporal resolution that contains thousands of umbral dots (UDs) in a mature sunspot in the active region NOAA 10667 at $\mu$=0.95. The data were acquired with the 1-m Swedish Solar Telescope on La Palma. With the help of a multilevel tracking (MLT) algorithm the sizes, brightnesses, and trajectories of 12836 umbral dots were found and analyzed. The MLT allows UDs with very low contrast to be reliably identified. Inside the umbra we determine a UD filling factor of 11%. The histogram of UD lifetimes is monotonic, i.e. a UD does not have a typical lifetime. Three quarters of the UDs lived for less than 150s and showed no or little motion. The histogram of the UD diameters exhibits a maximum at 225km, i.e. most of the UDs are spatially resolved. UDs display a typical horizontal velocity of 420m/s and a typical peak intensity of 51% of the mean intensity of the quiet photosphere, making them on average 20% brighter than the local umbral background. Almost all mobile UDs (large birth-death distance) were born close to the umbra-penumbra boundary, move towards the umbral center, and are brighter than average. Notably bright and mobile UDs were also observed along a prominent UD chain, both ends of which are located at the umbra-penumbra boundary. Their motion started primarily at either of the ends of the chain, continued along the chain, and ended near the chain's center. We observed the splitting and merging of UDs and the temporal succession of both. For the first time the evolution of brightness, size, and horizontal speed of a typical UD could be determined in a statistically significant way. Considerable differences between the evolution of central and peripheral UDs are found, which point to a difference in origin

Evaluation of pedometry as a patient-centered outcome in patients undergoing hematopoietic cell transplant (HCT): A comparison of pedometry and patient-reports of symptoms, health, and quality of life.

Aims We evaluated pedometry as a novel patient-centered outcome because it enables passive continuous assessment of activity and may provide information about the consequences of symptomatic toxicity complementary to self-report. Methods Adult patients undergoing hematopoietic cell transplant (HCT) wore pedometers and completed PRO assessments during transplant hospitalization (4 weeks) and 4 weeks post-discharge. Patient reports of symptomatic treatment toxicities (single items from PROCTCAE, http://healthcaredelivery.cancer.gov/pro-ctcae) and symptoms, physical health, mental health, and quality of life (PROMIS Global-10, http://nih.promis.org), assessed weekly with 7-day recall on Likert scales, were compared individually with pedometry data, summarized as average daily steps per week, using linear mixed models. Results Thirty-two patients [mean age 55 (SD = 14), 63 % male, 84 % white, 56 % autologous, 43 % allogeneic] completed a mean 4.6 (SD = 1.5, range 1–8) evaluable assessments. Regression model coefficients (β) indicated within-person decrements in average daily steps were associated with increases in pain (β = -852; 852 fewer steps per unit increase in pain score, p<0.001), fatigue (β = -886, p<0.001), vomiting (β = -518, p<0.01), shaking/chills (β = -587, p<0.01), diarrhea (β = -719, p<0.001), shortness of breath (β = -1018, p<0.05), reduction in carrying out social activities (β = 705, p<0.01) or physical activities (β = 618, p<0.01), and global physical health (β = 101, p<0.001), but not global mental health or quality of life. Conclusions In this small sample of HCT recipients, more severe symptoms, impaired physical health, and restrictions in the performance of usual daily activities were associated with statistically significant decrements in objectively measured daily steps. Pedometry may be a valuable outcome measure and validation anchor in clinical research