Several wake-promoting medications are approved for management of persistent sleepiness despite OSA treatment; discussion of these symptomatic treatments is outside the scope of this review. Herein, the authors review the current evidence for pharmacological management of OSA and provide future directions.The splendid success of convolutional neural networks (CNNs) in computer vision is largely attributable to the availability of massive annotated datasets, such as ImageNet and Places. However, in medical imaging, it is challenging to create such large annotated datasets, as annotating medical images is not only tedious, laborious, and time consuming, but it also demands costly, specialty-oriented skills, which are not easily accessible. To dramatically reduce annotation cost, this paper presents a novel method to naturally integrate active learning and transfer learning (fine-tuning) into a single framework, which starts directly with a pre-trained CNN to seek “worthy” samples for annotation and gradually enhances the (fine-tuned) CNN via continual fine-tuning. We have evaluated our method using three distinct medical imaging applications, demonstrating that it can reduce annotation efforts by at least half compared with random selection.

Syringe services programs (SSP) are an effective strategy to reduce blood-borne infections of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) in persons who inject drugs (PWID). The objectives of this study were to determine the frequency and risk factors for loss to follow-up (LTFU) in PWID enrolled at SSPs in Kentucky.

A retrospective cohort study was conducted which included data of PWID enrolled at 32 SSP. Demographics, use of drugs, HIV testing, HCV testing, and medical services were analyzed. click here A generalized linear model (GLM), family binomial was used to determine risk factors for LTFU.

The analysis included 5742 PWID. LTFU by year of enrollment was 287/770 (37.3%) in 2017, 796/1874 (42.5%) in 2018, and 1479/3,098 (47.7%) in 2019. LTFU was significantly associated with distance to SSP from home of more than five miles (RR 1.25; 95%CI 1.09-1.43; p=0.002) and SSPs housed in rural counties (RR 1.22; 95%CI 1.06-1.40; p=0.004), adjusted by age, sex, and race. The use of buprenorphine was associated with less risk of LTFU (RR 0.79, p=0.034).

The distance to an SSP from home and SSPs in rural counties were identified as risk factors for LTFU. Initiatives that bring health services closer to PWID homes and offer opioid use disorder treatment may improve repeated participation in SSPs.

The distance to an SSP from home and SSPs in rural counties were identified as risk factors for LTFU. Initiatives that bring health services closer to PWID homes and offer opioid use disorder treatment may improve repeated participation in SSPs.In nursing, bioscience is regarded as one of the cornerstones of nursing practice. However, bioscience disciplines as anatomy, physiology and biochemistry are considered challenging for students and the failure rate is high. In this study we explore a blended learning teaching strategy in an anatomy, physiology and biochemistry course for first year Bachelor nursing students. In the blended learning teaching strategy, short narrated online digital resources of bioscientific terms and concepts were integrated into the teaching design along with digital metacognitive evaluations of learning outcomes. Results show that compared to students receiving traditional face-to-face teaching, the students with a blended learning approach performed better on their national exam with a small to medium effect size (Cohen’s d=0.23). Student course evaluations supported the blended learning delivery with small to medium effect sizes. The students reported that the digital resources supported their learning outcome achievement, that they better understood the teacher’s expectations and that they were more satisfied with their virtual learning environment. This study adds to the growing literature of blended learning effectiveness in higher education, and suggests the use of digital resources as an enrichment of teaching and enhancement of students’ study experience.

Deferral of conventional surgery for rectal cancer after neo-adjuvant chemo-radiotherapy is gaining increasing interest, particularly for patients who are too frail to undergo major surgery but also those who wish to avoid the adverse effects of major surgery. We elected to undertake a pragmatic approach to include all comers in a cohort with the aim of reflecting the clinical outcomes for patients on a deferral from conventional rectal surgery pathway, treated with neo-adjuvant chemo-radiation (CRT) with or without selective local excision (LE) offered to those who failed to demonstrate a complete clinical response (cCR).

Rectal cancer patients treated with neo-adjuvant CRT were stratified to a group of complete responders to CRT on a “watch and wait” (WW) pathway and a group who were treated with an additional local excision for persistent tumour.

Regrowth was noted in 26% (11/42) in the WW group after 2 years surveillance, disease free survival was 94.5% (80-99%) at 1 year and 74.9% (44-76.4%) at 3 years. Recurrence was noted in 45% (10/22) in the CRT+LE group, disease free survival at 1 and 3 years was 74% (53.4-88.1) and 66.2% (45.6-82.4) respectively.

A WW strategy for cCR is a viable pathway in the non-operative management of rectal cancer. We found the use of CRT+LE is a useful option for those who hope to avoid surgery but caution should be exercised due to substantially higher risk of recurrence.

A WW strategy for cCR is a viable pathway in the non-operative management of rectal cancer. We found the use of CRT + LE is a useful option for those who hope to avoid surgery but caution should be exercised due to substantially higher risk of recurrence.Microsolvation of a cation in helium quantum solvent is an attractive phenomenon leading generally to the formation of a strongly packed structure known as ‘Snowball’ feature. Here, the lowest energy structures and the relative stability of the solvated potassium cation K+ in helium clusters K+Hen up to the size n = 20 are investigated employing Density Functional Theory (DFT) and pairwise methods. The DFT calculations showed that M05-2X/6-311++G (3df, 2p) level of theory can reproduce properly the experimental data of K+He diatomic potential, whereas, in the pairwise method, the Basin-Hopping Monte Carlo (BHMC) algorithm was applied for the global optimization. The remarkable differences in the lowest energy structures computed in the frame of both methods are shown for K+He11 and K+He12 clusters. The BHMC optimization converged to an icosahedral geometry for n = 12, corresponding to the highest value of the binding energy per atom. For both methods, we have concluded that the first solvation shell is completed at the size n = 15, despite the maximum packing structure obtained at n = 17.