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Hypoglossal Nerve Stimulation Shows Promise for Treating Sleep Apnea in Children with Down Syndrome

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

Here’s a breakdown of the methods and approach used in the study, based on the provided text:

Methods/Approach:

Retrospective Review: The study analyzed data after the procedures had already been performed. They looked back at the records of 29 children. Patient Population: The study included 29 children aged 4-13 who had received hypoglossal nerve stimulator implants at two hospitals (Mass Eye and Ear, and Phoenix Children’s Hospital).
Data Collection – Sleep Studies: Children underwent sleep studies (polysomnography) at multiple time points:
 Before surgery
1-3 months post-surgery
 6 months post-surgery
1 year post-surgery
 3 years post-surgery
Multidisciplinary Team: Patients at Mass Eye and Ear were managed by a team including specialists in Down syndrome and pediatric sleep medicine (from Mass General Brigham). This was particularly important for children with Down syndrome due to their unique needs.
 Key Metric – Obstructive Apnea-hypopnea Index (OAHI): This was the primary measure used to assess treatment effectiveness.It measures the number of breathing cessation events per hour.In essence, the researchers didn’t actively assign children to receive the surgery (like in a randomized controlled trial). They observed the outcomes of children who had already received the surgery to assess safety and effectiveness.

What are the potential long-term effects of HNS on the advancement of craniofacial structures in children with Down syndrome?

Table of Contents

Hypoglossal Nerve Stimulation Shows Promise for Treating Sleep Apnea in Children with Down syndrome

Understanding Sleep Apnea and Down syndrome

Children with Down syndrome (Trisomy 21) have a considerably higher prevalence of obstructive sleep apnea (OSA) compared to their neurotypical peers. This increased risk stems from several factors inherent to the condition, including:

Craniofacial differences: These frequently enough lead to smaller upper airways and enlarged tonsils and adenoids.

Reduced muscle tone: Generalized hypotonia affects muscles crucial for maintaining airway patency during sleep.

Increased risk of obesity: Contributing to airway narrowing.

neurological factors: Affecting respiratory control.

Untreated sleep apnea in children can lead to serious health consequences,including developmental delays,behavioral problems,cardiovascular complications,and even pulmonary hypertension. Traditional treatments like tonsillectomy and adenoidectomy (T&A),while effective for some,don’t always resolve OSA,especially in children with more complex anatomical challenges. CPAP therapy (Continuous Positive Airway Pressure) is often the next line of defense, but adherence can be low, especially in young children.

The Role of Hypoglossal Nerve Stimulation (HNS)

Hypoglossal nerve stimulation (HNS) is emerging as a promising alternative treatment for OSA,particularly in cases where conventional therapies have failed. The hypoglossal nerve controls the movement of the tongue. During sleep, the tongue can relax and obstruct the airway. HNS works by delivering mild electrical stimulation to this nerve,causing the tongue to move forward,thereby opening the airway.

How HNS Works: A Closer Look

A small device, surgically implanted under the skin in the chest, delivers stimulation to the hypoglossal nerve via an electrode threaded through a small incision. The device is programmed to activate during sleep, sensing breathing patterns and delivering stimulation only when needed.

Here’s a breakdown of the process:

  1. Sensing: The device monitors the patient’s respiratory effort.
  2. Stimulation: When a drop in airflow or oxygen saturation is detected, the device sends a mild electrical pulse.
  3. Tongue Protrusion: this stimulation causes the tongue to move forward, preventing airway obstruction.
  4. Improved Breathing: The airway remains open, restoring normal breathing.

HNS in Children with Down Syndrome: Emerging Evidence

While HNS has been approved for adults with moderate to severe OSA, its use in children is still considered off-label and is an area of active research. However, early studies and clinical experiences suggest significant potential for children with Down syndrome.

Increased Success Rates: Children with Down syndrome often experience higher success rates with HNS compared to other populations, potentially due to the specific anatomical and physiological factors contributing to their OSA.

Improved AHI Scores: Several case series have demonstrated significant reductions in Apnea-Hypopnea Index (AHI) scores – a measure of sleep apnea severity – following HNS implantation.

Reduced Reliance on CPAP: HNS can potentially eliminate or significantly reduce the need for CPAP therapy, improving quality of life for both the child and their family.

Recent Research & Clinical Trials

A growing body of research is focusing on the efficacy and safety of HNS in pediatric populations with Down syndrome. Researchers are investigating optimal stimulation parameters, long-term outcomes, and potential predictors of success. Ongoing clinical trials are crucial to establishing clear guidelines for patient selection and treatment protocols. look for studies published in journals like Sleep and The Journal of Pediatrics.

Patient Selection and Evaluation

Careful patient selection is paramount for successful HNS therapy. A comprehensive evaluation is necesary to determine if a child with Down syndrome is a suitable candidate. This typically includes:

  1. Polysomnography (Sleep Study): to diagnose OSA and assess its severity.
  2. Upper Airway Evaluation: Including drug-induced sleep endoscopy (DISE) to visualize airway collapse during sleep.
  3. Cephalometric Radiographs: To assess craniofacial anatomy.
  4. Medical History review: to identify any contraindications to surgery or device implantation.
  5. Multidisciplinary Team Assessment: Involving pediatric pulmonologists, otolaryngologists (ENT specialists), neurologists, and sleep specialists.

Potential Risks and Complications

As with any surgical procedure, HNS carries potential risks and complications. These may include:

Surgical complications: Infection, bleeding, nerve damage.

Device-related complications: Lead migration, device malfunction, battery depletion.

Tongue discomfort or pain: Usually mild and temporary.

* Dysphagia (difficulty swallowing): rare, but possible.

Thorough pre-operative counseling and careful post-operative monitoring are essential to minimize these risks.

Benefits of HNS for Children with Down Syndrome

Beyond the reduction in OSA symptoms, HNS offers several potential benefits

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Entertainment

Arc Raiders: EA’s Censorship Sparks Controversy

by Marina Collins - Entertainment Editor
written by Marina Collins - Entertainment Editor

‘Arc raiders’ Launch Date Revealed: Prepare for teh Invasion this October

Table of Contents

Breaking News: The highly anticipated free-to-play cooperative third-person shooter,’Arc Raiders,’ is officially set to launch on October 30th. Developers Modifiable Games confirmed the release date, signaling the imminent arrival of a challenging new experience for players on PlayStation 5 and PC.The declaration comes as excitement builds around the game’s unique premise: Earth has fallen to a mechanized threat from outer space, and players must band together as part of the Arc Raiders to reclaim the planet. Gameplay focuses on strategic teamwork and utilizing specialized tools to dismantle the alien invaders.

What Makes ‘Arc Raiders’ Stand Out?

‘Arc Raiders’ distinguishes itself within the crowded shooter landscape through its emphasis on cooperative play. Unlike many competitive titles, success in ‘Arc Raiders’ hinges on coordinated efforts and shared strategies. This design choice fosters a strong sense of community and encourages players to rely on each other to overcome the game’s formidable challenges.

The Rise of Free-to-Play Shooters

The free-to-play model has become increasingly popular in the gaming industry, offering accessibility to a wider audience. Titles like ‘Fortnite,’ ‘Apex Legends,’ and ‘Call of Duty: Warzone’ have demonstrated the potential for massive success with this approach. ‘Arc Raiders’ joins this growing trend, aiming to attract a large player base through its no-cost entry point. However, the long-term success of free-to-play games often depends on a balanced monetization strategy that doesn’t compromise the core gameplay experience.

Where to Find ‘Arc Raiders’

Players can anticipate finding ‘arc Raiders’ available for download on the PlayStation Store and through PC gaming platforms. Several retailers, including Cdiscount, Fnac, and leclerc, are already listing the game, indicating strong consumer interest.

As the October 30th launch date approaches, gamers are encouraged to prepare for a coordinated defense against the alien onslaught. ‘Arc Raiders’ promises a thrilling cooperative experience that could redefine the free-to-play shooter genre.

What specific allegations of censorship did former Embark Studios developers make regarding EA’s interference with *Arc Raiders*?

Arc Raiders: EA’s censorship Sparks Controversy

The Cancellation and Initial Reactions

The abrupt cancellation of Arc Raiders, the free-to-play extraction shooter developed by Embark Studios and published by Electronic Arts (EA), sent shockwaves through the gaming community in March 2023. While EA cited the game failing to meet expectations during it’s closed beta as the primary reason,a deeper look reveals accusations of internal censorship and a stifling of creative vision. The initial announcement, delivered via social media, lacked specific details, fueling speculation and discontent among players who had eagerly anticipated the title. Many felt the beta, while flawed, showed promising potential, particularly in its unique gameplay loop and atmospheric world. this led to immediate calls for transparency from EA regarding the true reasons behind the cancellation.

Allegations of Creative interference & Censorship

Following the cancellation, former Embark Studios developers began to surface with claims of significant interference from EA regarding Arc Raiders‘ core design. These allegations, primarily shared on platforms like Twitter and industry forums, paint a picture of EA pushing for changes that fundamentally altered the game’s intended experience.

Monetization Concerns: Reports suggest EA heavily pressured Embark to incorporate more aggressive monetization strategies, including possibly pay-to-win elements, which clashed with Embark’s vision of a fair and skill-based experience.

Gameplay Direction: developers claim EA wanted to shift Arc Raiders towards a more conventional, live-service model, stripping away some of its unique features and focusing on predictable engagement loops. This included altering the core extraction mechanic and adding more traditional progression systems.

Marketing Restrictions: Allegations surfaced regarding limitations placed on Embark’s marketing team, preventing them from accurately representing the game’s true state and features to the public. This is seen as contributing to the negative perception surrounding the beta.

The “Fun Police”: A recurring theme in developer accounts describes a culture within EA where innovative ideas were often met with skepticism and a preference for proven, safe formulas.This internal resistance is referred to as the “fun police” by some.

These claims,while largely anecdotal,resonate with a broader narrative of EA’s history of acquiring studios and subsequently altering their projects to fit a specific corporate mold. The Arc Raiders situation has become a focal point for discussions about publisher interference and the importance of creative freedom in game progress.

The Impact on embark Studios & Future projects

The cancellation of Arc Raiders wasn’t just a blow to players; it also significantly impacted Embark Studios. The studio,founded by former DICE veterans,had poured considerable resources and passion into the project. While EA has publicly stated its continued support for Embark and its future endeavors, the cancellation undoubtedly created uncertainty and potentially led to talent attrition.

Currently, Embark is focusing on the Finals, a team-based, free-to-play shooter. The success of The Finals is now viewed as crucial, not only for the studio’s survival but also as a test case for EA’s approach to supporting independent creative visions. The pressure is on EA to allow Embark to operate with greater autonomy and avoid repeating the perceived mistakes made with Arc Raiders.

EA’s Response and the Wider Industry Debate

EA has remained largely tight-lipped regarding the specific allegations of censorship. Their official statements consistently emphasize the game’s failure to resonate with players during the beta and the need to prioritize projects with stronger potential. However, this response has done little to quell the controversy.

The Arc Raiders saga has reignited a long-standing debate within the gaming industry about the role of publishers and the balance between commercial viability and creative integrity.

Publisher control vs. Studio Autonomy: The incident highlights the inherent tension between publishers, who bear the financial risk, and developers, who possess the creative vision.

The Rise of Independent Studios: The controversy has fueled support for independent game studios that retain greater control over their projects.

Transparency and Communication: Players are increasingly demanding greater transparency from publishers regarding development decisions and cancellations.

The Future of Live Service Games: The situation raises questions about the sustainability of the live-service model and the pressure to constantly monetize games.

Real-World Examples of Publisher Interference

The Arc Raiders case isn’t isolated. Several other high-profile examples demonstrate the potential for publisher interference to derail promising game projects:

Star Wars Battlefront II (EA): The initial release of Star Wars Battlefront II* was heavily criticized

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Health

Safeguarding Seniors: A Guide to Safer Drug Alternatives

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

Here’s a unique article formatted for archyde.com, based on the provided source material:

Advancing Geriatric Care: AGS Unveils Crucial Alternatives to perhaps Inappropriate Medications

Table of Contents

New York, NY – The American Geriatrics Society (AGS) has taken a meaningful step forward in enhancing the safety and effectiveness of care for older adults with the release of “Alternative Treatments to Certain Drugs in the 2023 AGS Beers criteria®.” This vital new clinical resource is designed to equip healthcare professionals with evidence-based, safer alternatives to medications identified as potentially inappropriate for the elderly.The newly launched companion tool builds directly upon the foundation of the widely-referenced AGS Beers Criteria® for the Use of Potentially Inappropriate Medications in Older Adults. These criteria, a cornerstone in geriatric pharmacology, pinpoint medications that carry a higher risk of adverse events for seniors not receiving palliative care.”With the AGS Beers Criteria®, we’ve empowered clinicians to identify medications that might pose risks for older patients,” stated Michael Steinman, MD, AGSF, Co-chair of the AGS Beers Criteria® and the panel that developed the alternatives list. “Now, with this updated list of alternatives, we are offering concrete, evidence-based recommendations for non-pharmacological and pharmacological options that clinicians can utilize instead.”

The development of this extensive list involved a dedicated, interdisciplinary working group of experts from diverse clinical specialties and disease areas. Their collective expertise has resulted in an organized compendium of alternatives that are frequently safer and equally, if not more, effective than the medications they aim to replace.crucially, the resource also features additional resources for in-depth guidance, including patient-facing materials and practical tools to facilitate the implementation of these alternative strategies in clinical practice.

according to Todd P.Semla, MS, PharmD, Co-Chair of the alternative list panel and AGS Beers Criteria®, the team approached the task with a patient-centered focus. “We really took a step back and asked ourselves: ‘Where are clinicians likely to face challenges with the Beers Criteria® – and where would clear alternatives be most beneficial?’ The expert panel concentrated on medications where providing alternatives would be most impactful, ensuring we haven’t overlooked any critical areas and that our selections truly reflect the needs of those caring for older adults.”

Paul Mulhausen, MD, MHS, AGSF, President of the AGS, emphasized the practical design of the new resource. “This resource has been developed with the clinician’s needs in mind – from its clear institution to its practical accessibility,” he commented. “I am confident that it will become an essential tool for many of us striving to provide safer and more individualized care for our aging population.”

This initiative underscores the AGS’s unwavering commitment to promoting safer prescribing practices and improving health outcomes for older adults. The “Alternative Treatments to Certain Drugs in the 2023 AGS Beers Criteria®” (DOI: 10.1111/JGS.19500) has been published in the latest edition of the Journal of the American Geriatrics Society (JAGS) and is slated for integration into the readily accessible AGS Beers Criteria® mobile application in the near future, ensuring widespread and convenient availability for healthcare providers.

What non-pharmacological approaches can seniors utilize for pain management as alternatives to opioids?

Safeguarding Seniors: A Guide to Safer Drug alternatives

Understanding Polypharmacy & Senior Health

As we age, the complexity of health needs frequently enough increases, leading to polypharmacy – the use of multiple medications concurrently. While sometimes necessary, polypharmacy significantly elevates the risk of drug interactions, side effects, and adverse events in seniors. This is as of natural age-related changes in how the body processes medications (pharmacokinetics) and responds to them (pharmacodynamics). Understanding these risks is the first step in senior medication management and finding safer drug alternatives.

Why Seniors Are more Vulnerable to Medication Risks

Several factors contribute to increased medication vulnerability in older adults:

Physiological Changes: Kidney and liver function decline with age, impacting drug metabolism and excretion. Reduced body water can concentrate medications, increasing their effects.

Multiple Chronic Conditions: Seniors frequently enough manage several health issues (like arthritis, diabetes, heart disease), requiring multiple prescriptions.

Cognitive Impairment: Memory issues can lead to medication errors – missed doses, double doses, or incorrect administration.

Sensory Decline: Vision and hearing loss can make it arduous to read labels or understand instructions.

Increased Sensitivity: Older adults may be more sensitive to the effects of certain medications.

Non-Pharmacological Alternatives: Starting with Lifestyle

Before turning to medication,or seeking alternatives,explore lifestyle modifications. These can frequently enough effectively manage symptoms and improve quality of life.

Pain Management (Alternatives to Opioids):

Physical Therapy: Strengthens muscles, improves mobility, and reduces pain.

Acupuncture: May provide pain relief by stimulating specific points on the body.

Mindfulness & Meditation: Can definitely help manage chronic pain by altering pain perception.

Heat/Cold Therapy: Simple, effective methods for localized pain relief.

Sleep Issues (Alternatives to Sedatives):

Sleep Hygiene: Establish a regular sleep schedule,create a relaxing bedtime routine,and optimize the sleep environment.

Cognitive Behavioral Therapy for Insomnia (CBT-I): A structured program to address thoughts and behaviors that contribute to insomnia.

Regular Exercise: Promotes better sleep, but avoid strenuous activity close to bedtime.

Anxiety & Depression (Alternatives to Antidepressants/Anxiolytics):

Social Engagement: Maintaining social connections combats loneliness and isolation.

Regular Exercise: Releases endorphins, which have mood-boosting effects.

Talk Therapy: provides a safe space to process emotions and develop coping strategies.

Creative Activities: Engaging in hobbies like painting, music, or writing can reduce stress and improve mood.

Safer Medication Options & Strategies

When medication is necessary, prioritize safer options and strategies:

Deprescribing: Regularly review medications with a healthcare provider to identify and discontinue unnecessary or perhaps harmful drugs. This is a crucial aspect of geriatric pharmacology.

Start Low, Go Slow: Begin with the lowest effective dose and gradually increase it as needed, monitoring for side effects.

Choose Beers Criteria-Avoided Medications: The Beers Criteria lists potentially inappropriate medications for older adults. Your doctor shoudl be aware of this list.

Consider Drug Interactions: Always inform your doctor and pharmacist about all medications, including over-the-counter drugs, supplements, and herbal remedies. Utilize drug interaction checkers (available online through reputable sources like Drugs.com).

Simplified Regimens: Reduce the number of doses and medications to simplify the schedule and minimize errors. Consider using pill organizers.

Formulations: Explore different formulations (liquid, patch, extended-release) that may be easier to administer or have fewer side effects.

Supplements & Herbal Remedies: Proceed with Caution

While some seniors turn to dietary supplements and herbal remedies for health benefits, these are not without risks.

Lack of Regulation: Supplements are not subject to the same rigorous testing and approval process as prescription drugs.

Drug Interactions: Supplements can interact with medications, potentially causing harmful effects. St. John’s Wort, for example, can interfere with many medications.

Quality Control: The quality and purity of supplements can vary significantly.

Always discuss any supplements or herbal remedies with your doctor before use.

The Role of Pharmacists in senior Medication Safety

Pharmacists are invaluable resources for senior medication safety.

* medication Reviews: Pharmacists can conduct comprehensive medication reviews

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Entertainment

A Donkey Kong film in preparation at Universal Pictures?

by Marina Collins - Entertainment Editor
written by Marina Collins - Entertainment Editor

BREAKING: Donkey Kong Movie Officially in Development – Nintendo & Universal Team Up Again!

Hold onto your bananas, folks! The world of Nintendo is expanding beyond the Mushroom Kingdom. In a development that’s sending ripples of excitement through the gaming and film communities, a Donkey Kong movie is officially in the pipeline, according to a recent filing with the United States’ classification body. This news, hot on the heels of the phenomenal success of The Super Mario Bros. Movie, confirms what many suspected: Nintendo is serious about bringing its iconic characters to the big screen.

From Mario to Monkey: The Expansion of Nintendo’s Cinematic Universe

The project, registered with the same partnership structure as the Super Mario Bros. Movie – a collaboration between Nintendo Studios and Universal Pictures – leaves little doubt about its authenticity. This isn’t just speculation; it’s a concrete indication that Nintendo is actively building a cinematic universe based on its beloved franchises. The initial leak, quickly confirmed by official registrations, suggests a well-planned strategy to capitalize on the momentum generated by Mario’s box office triumph.

But why Donkey Kong now? The character’s enduring popularity is a major factor. First appearing in the original Donkey Kong arcade game in 1981, the character has starred in numerous successful games across multiple consoles, including the critically acclaimed Donkey Kong Country series on the Super Nintendo. This franchise boasts a rich history, vibrant characters (Diddy Kong, Dixie Kong, Cranky Kong, to name a few!), and a unique aesthetic that lends itself perfectly to a visually stunning film adaptation. The character even made a cameo appearance in The Super Mario Bros. Movie, subtly hinting at this future possibility.

Illumination Expected to Return – and What About the Release Date?

Given Illumination’s involvement in the Super Mario Bros. Movie and their current work on the sequel, it’s widely anticipated they’ll be back at the helm for Donkey Kong. The Parisian studio’s proven ability to translate the whimsical charm of Nintendo’s worlds into captivating animation makes them the logical choice. However, don’t expect to see Donkey Kong swinging onto the big screen anytime soon. With The Super Mario Bros. Movie sequel and a The Legend of Zelda film already slated for release in the next two years, a 2028 release window seems the most realistic estimate. This allows ample time for development and ensures Nintendo doesn’t oversaturate the market.

The Future of Nintendo on Film: A Growing Trend

The success of The Super Mario Bros. Movie – which grossed over $1.36 billion worldwide – fundamentally changed the landscape for video game adaptations. For years, these adaptations were plagued by critical and commercial failures. Mario proved that, with the right approach, these properties can be incredibly lucrative. This success has opened the door for other Nintendo franchises, and Donkey Kong is just the beginning. Expect further announcements in the coming years as Nintendo continues to explore the potential of its vast library of characters and worlds. The key to success will be respecting the source material while also delivering a compelling narrative that appeals to both longtime fans and newcomers. This is a golden age for Nintendo fans, and the future looks incredibly bright.

Stay tuned to archyde.com for the latest updates on the Donkey Kong movie, as well as all things Nintendo and the evolving world of video game adaptations. We’ll be following this story closely and bringing you exclusive insights and analysis as it develops. Don’t forget to check out our other gaming news and reviews for a deeper dive into the world of interactive entertainment!

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