Reduced tongue muscle tone precipitates obstructive sleep apnea (OSA), and activation of the tongue musculature can lessen OSA. The hypoglossal motor nucleus (HMN) innervates the tongue muscles but there is no pharmacological agent currently able to selectively manipulate a channel (e.g., Kir2.4) that is highly restricted in its expression to cranial motor pools such as the HMN. To model the effect of manipulating such a restricted target, we introduced a “designer” receptor into the HMN and selectively modulated it with a “designer” drug. We used cre-dependent viral vectors (AAV8-hSyn-DIO-hM3Dq-mCherry) to transduce hypoglossal motoneurons of ChAT-Cre+ mice with hM3Dq (activating) receptors. We measured sleep and breathing in three conditions: (i) sham, (ii) after systemic administration of clozapine-N-oxide (CNO; 1 mg/kg) or (iii) vehicle. CNO activates hM3Dq receptors but is otherwise biologically inert. Systemic administration of CNO caused significant and sustained increases in tongue muscle activity in non-REM (261 ± 33% for 10 hrs) and REM sleep (217 ± 21% for 8 hrs), both P < 0.01 versus controls. Responses were specific and selective for the tongue with no effects on diaphragm or postural muscle activities, or sleep-wake states. These results support targeting a selective and restricted “druggable” target at the HMN (e.g., Kir2.4) to activate tongue motor activity during sleep.
Blended learning using augmented reality glasses during the COVID-19 pandemic: the present and the future.
Introduction First-year resident physicians began training in July 2020 in an environment of decreased clinical case exposure and increased feelings of insecurity secondary to the coronavirus (COVID-19) pandemic. To support resident learning, the University of Toronto Department of Otolaryngology - Head & Neck Surgery piloted a novel virtual case-based discussion series for first-year residents. Methods A weekly virtual resident-led case-based discussion series was designed. In 2020/2021, six residents (“Cohort 1”) and four staff otolaryngologists participated. A Likert survey retrospectively evaluated participant comfort level on a scale of 1 to 5, from “not well prepared or comfortable” to “very well prepared or comfortable” in seven clinical areas, at the beginning of the post-graduate year (PGY-1) August 2020, and in May 2021. Qualitative data collected assessed strengths and weaknesses of the intervention. In July 2021, the new 2021/2022 PGY-1 cohort (“Cohort 2”) also completed cross-sectional surveys in August 2021 and March 2022 to assess their comfort levels with consult management at the two separate timepoints. Results Cases presented revealed areas for practical, systemic, and cultural improvement. With respect to clinical decision making, both “Cohort 1” and “Cohort 2” residents reported increased comfort level in all areas assessed. “Cohort 1” residents reported percentage increase in comfort level addressing all consults of 28%, triaging consults overnight of 24%, pediatric consults of 30%, otology consults of 32%, airway consults of 30%, epistaxis consults of 28%, and peritonsillar abscess consults of 24%. “Cohort 2” residents reported increase in comfort level managing all consults of 32%, triaging consults overnight of 30%, pediatric consults of 38%, otology consults of 2%, airway consults of 30%, epistaxis consults of 18%, and peritonsillar abscess consults of 24%. All respondents agreed the intervention would benefit residents of other programs as a prolonged orientation to residency and a safe and confidential forum to discuss best practices. Discussion A weekly case discussion series potentially improves both resident education and patient care. It facilitated real-time discussion of topics relevant to self-perceived knowledge deficits, timely advice on management of a new and changing population of COVID patients and brought to attention hidden curriculum topics for exploration. Conclusion The case series described could be applied to benefit residents in Otolaryngology and other surgical specialty programs nationwide during, and following, the pandemic.
Background The Canadian landscape of racial diversity in academic OHNS programs is currently unknown, as to date Canadian medical organizing bodies have refrained from collecting race-based data. However, new policy guidelines by the Canadian Medical Association support the collection of data that may be used to support equity, diversity and inclusion programs. This study aims to describe the representation of visible minorities amongst academic OHNS departments and divisions in Canada at various levels of academic seniority. Methods An online survey was distributed to members of the 13 academic OHNS department in Canada in 2022. The survey collected demographic data as well as each participant’s self-reported race and gender. The primary outcome was the comparison of the racial demographics of Canadian academic OHNS programs to Canadian census data. Secondary outcome measures assessed how demographics varied based on academic position and gender. Simple descriptive statistics were tabulated for all demographic variables. Chi-square goodness of fit analysis was used to compare survey results to anticipated demographics based on 2016 Canadian census data. Results Of 545 surveys distributed, 224 surveys were completed (response rate of 41%); 67.9% or respondents were male and 32.1% were female. Of these respondents, 71 were residents, 26 lecturers, 54 assistant professors, 39 associate professors, and 34 full professors. There was significantly greater minority representation amongst residents (47.9%), assistant professors (39.6%), and lecturers (40.7%) compared to the Canadian population (25.3%) p < 0.001. Results also showed that there were significantly fewer female lecturers (25.9%, p = 0.01), assistant professors (31.5%, p = 0.006), and full professors (2.9%, p < 0.001) compared to an assumed even proportion of men and women in the population. Conclusions Academic OHNS programs in Canada are more racially diverse than the Canadian population. However, women continue to be under-represented in more senior positions, especially women who are visible minorities. Further investigation into the systemic factors that may contribute to this disparity is needed as well as effective ways to promote diversity amongst academic OHNS departments at all levels of academic seniority. Graphical abstract
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