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Abstract Hypoglossal nerve stimulation (HNS) therapy is now an established and widely-available obstructive sleep apnea (OSA) treatment alternative for continuous positive airway pressure (CPAP)-intolerant patients. Additionally, the HNS body of literature is robust with strong data on safety, efficacy, and durability—from the 5-year STAR Trial outcomes, to post-approval studies of independent institutions, to the multicenter ADHERE registry which recently reported outcomes on over 1,000 patients and is poised to enroll 5,000 HNS patients total. Nevertheless, now with thousands of implanted patients across hundreds of certified centers, and that number growing rapidly, the post-implant management of the HNS patient represents the next critical frontier. Post-implant patient management (therapy titration, troubleshooting, adjustments, and adherence monitoring) across a longitudinal care model is key to ensuring long-term therapy success and optimizing patient outcomes and health benefits. As with CPAP, patient education and close clinical monitoring are often essential to successful long-term management. Although many HNS patients are clear responders with excellent comfort and adherence as well as effective improvement in symptomatic and objective outcome measures, and even a smaller subset is clear non-responders, there is a growing body of patients somewhere in the middle: good outcomes but not great; partial but incomplete response. These are the patients in whom a standardized best-practice approach to treatment monitoring and targeted therapy modifications is likely critical to optimizing long-term outcomes.

Using solvent-nonsolvent method, study on the preparation and composition of ultrafine CL-18/HNS. Scanning electron microscopy (SEM) was used to characterize the particle size and morphology. The FTIR spectra (IR), differential scanning calorimetry (DSC) and X-ray diffraction (XRD) were utilized to determine whether the cocrystal explosive was prepared. Furthermore, the impact sensitivity and short pulse slapper sensitivity of cocrystal explosive was tested. Results show that the prepared samples are the mix of CL-18 and HNS but rather changed cocrystal appearance of ultrafine CL-18/HNS. The average particle size of cocrystal explosives are 0.98μ. The peak temperatures of exothermic decomposition are 205.36 °C, The impact probability of CL-18/HNS cocrystal explosives is 56 percent, and minimum initiation energy is 0.12J.

Ultra-fine 2,2’,4,4’,6,6’- Hexanitrostilbene (HNS-IV) was obtained by HNS-II by vibration cavity comminute. This method uses only alcohol and deionized water, which can be viewed as a green technology. The morphology, particle size, specific surface area, thermal decomposition property and the threshold energy for slapper detonator were compared between HNS-IV and HNS-II in this paper. Results show that after HNS pulverizing, the particle size decreased from 27.18μm to 1.44μm, the specific surface area increased from 0.73m 2• g −1 to 9.10m 2• g −1 . DSC analysis shows that the decomposition peak temperature T d decreases and the melting temperature T m increases after pulverizing. It is speculated that in the explosive reaction with very high heating rate, the enthalpy of decomposition will be increased by pulverizing, which will be more conducive to detonation growth and explosive reaction. According to the calculation of thermal decomposition kinetics, the decomposition and activation energy Ea of HNS decreases after pulverizing, and the thermal decomposition reaction rate of HNS-IV increases when the temperature is less than 409.6°C. The initiation threshold test of the impact plate shows that the 50% initiation threshold energy of HNS- II is 1.242J, and the 50% initiation threshold energy of HNS-IV is 0.558J, and the initiation threshold for slapper detonatorer is significantly reduced by 55%. This means that the ultra-fine HNS-IV is very suitable as the main ingredient in the booster in the EFI initiation.

We studied electrochemical sensors using printed carbon nanotubes (CNT) film on a polyethylene telephtalate (PET) substrate. The mechanical stability of the printed CNT film (PCF) was confirmed by using bending and Scotch tape tests. In order to determine the optimum sensor structure, a resistance-type PCF sensor (R-type PCF sensor) and a comb-type PCF sensor (C-type PCF sensor) were fabricated and compared using a diluted NH3 droplet with various concentrations. The magnitude of response, response time, sensitivity, linearity, and limit of detection (LOD) were compared, and it was concluded that C-type PCF sensor has superior performance. In addition, the feasibility of PCF electrochemical sensor was investigated using 12 kinds of hazardous and noxious substances (HNS). The detection mechanism and selectivity of the PCF sensor are discussed.

Nickel-free high nitrogen stainless steel (HNS) is having great demand in cryogenic industries, biomedical instruments and various medical implants and stents. This is also being used in electronic industries and defense like armored battlefield vehicles. In this paper, efforts have been put to prepare butt welded 5 mm thickness HNS by spattering free highly efficient cold metal transfer (CMT) process using multi-pass welding to study the material characterization, microstructural evolution, ferrite content and furthermore residual stresses. The addition of nitrogen is found to be economical with better mechanical results. Results show that nitrogen plays a significant role in enhancing mechanical properties. Low heat input welding effectively welds HNS with substantial tensile strength. Due to the development of martensite, the higher heat input welded sample (710.40 J/mm) has the maximum tensile strength, microhardness, joint efficiency, and compressive residual stress with the lowest ductility. Due to heat accumulation between multiple passes and high ferrite concentration at the center of the weld bead, the microhardness value of the weld bead is decreased. Grain size is 36.49 µm at the junction of weld bead (WB) and heat-affected zone (HAZ), 31.87 µm at HAZ, 23.74 µm at junction of HAZ and base metal (BM), and 15.61 m at BM, with microhardness of 317.76, 336.72, 347.28, and 362.05 HV, respectively. Grain size evolution from base metal to weld bead shows a significant impact on the mechanical properties.

Background Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic. Methods An anonymous 29-question electronic survey was created using the program “Qualtrics.” Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada. Results Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program. Conclusions Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs.

2,2′,4,4′,6,6′-hexanitrostilbene (HNS) is a heat-resistant, low-sensitivity energetic material with widespread applications in pliable linear-shaped charges, high-temperature-resistant oil well perforating charges, and rocket propellants. However, the presence of highly toxic and mutagenic nitroaromatic compounds in HNS wastewater necessitates efficient and accurate detection methods. Unfortunately, the existing analytical methods for HNS detection are outdated and incompatible with modern equipment. This limits their application due to issues with detection range, accuracy, and cost. To address this gap, an improved method was developed using an Ultimate 3000 UHPLC system with methanol and water as the mobile phase and UV-Vis detection at 271 and 226 nm wavelengths. The results indicate that the optimal detection conditions are achieved with a methanol-to-water ratio of 70:30 and a flow rate of 0.5 mL/min, providing high accuracy and efficiency. Compared to traditional methods, this approach reduced the detection time by nearly 70%, with the shortest analysis time ranging from 6 to 6.5 min, significantly lowering the cost of HNS detection. The method demonstrated excellent linearity (R2 > 0.9999) and high sensitivity within the concentration range of 0.50–150.00 mg/L, with precise and reliable results. This work provides both theoretical insights and experimental validation for the detection and analysis of HNS in wastewater.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

Nowadays, ultrafine explosives are widely used in military fields. Ultrafine 2,2′,4,4′,6,6′-hexanitrostilbene (HNS) has emerged as an optimal primer for explosion foil initiators due to its excellent thermal stability and high-voltage short-pulse initiation performance. However, the solid phase ripening of ultrafine HNS leads to a degradation in its impact detonation performance. Previous studies have indicated that residual dimethyl formamide (DMF), which is present in ultrafine HNS prepared using the recrystallization method, affects ultrafine HNS ripening. The mechanism of residual solvent effects on solid phase ripening of ultrafine HNS is unclear. In this work, the specific surface area (SSA) derived from small angle X-ray scattering (SAXS) was utilized for kinetic fitting analysis to explore the mechanism by which residual solvents enhance the solid phase ripening of ultrafine HNS. The results of the SSA measured by in-situ SAXS under conditions of 150 °C for 40 h revealed that the sample with 0.2% residual DMF exhibited a 21.51% decrease in SSA, whereas the sample with only 0.04% residual DMF showed a decrease of 15.66%. Furthermore, the higher amounts of residual DMF accelerated the reduction in SSA with time. Kinetic fitting analysis demonstrated that reducing residual DMF would lower both the activation energy and the pre-exponential factor, consequently decreasing the rate constant of solid phase ripening. The mechanism was speculated that it primarily facilitated the Ostwald ripening (OR). Additionally, contrast variation small angle X-ray scattering (CV-SAXS) confirmed that coating of ultrafine HNS particles is an effective method for inhibiting ripening, significantly reducing both the rate and extent of ripening of ultrafine HNS. This study predicts how residual solvents impact the solid phase ripening process of ultrafine HNS and proposes strategies for enhancing the long-term stability of ultrafine explosives.

A new organic energetic compound 6,6′-(diazene-1,2-diyl)bis(4,5,7-trinitrobenzo[c][1,2,5]oxadiazole 1-oxide) (DADBTNBO) is introduced where its computational assessments show that it is a thermally stable explosive with high detonation performance. Herein, the DADBTNBO explosive with high yield and purity is synthesized in 2 steps. The synthesis mechanisms of these steps were investigated. The products of these steps are identified using infrared spectroscopy, nuclear magnetic resonance, and elemental analysis. The high purity of DADBTNBO was confirmed by the results of 1 HNMR, 13 CNMR, and elemental analysis. The characterization of the DADBTNBO explosive was determined using X-ray diffraction, scanning electron microscopy, and transmission electron microscopy analyses. Then, significant properties of DADBTNBO including heat of detonation, detonation pressure and velocity, adiabatic exponent, Gurney velocity of explosives, specific impulse, and impact sensitivity were calculated by reliable predictive methods. The predicted results show that introducing the furoxan group in DADBTNBO can provide higher density, detonation, and combustion performance in comparison with hexanitrostilbene (HNS) as a heat-resistant high explosive. The predicted detonation velocity, detonation pressure, heat of detonation, and specific impulse of DADBTNBO are 8.8 km s −1 , 375 kbar, 5.64 kJ g −1 and 2.46 N s g −1 , respectively, which are greater than those estimated for HNS, i.e., 7.6 km s −1 , 244 kbar, 3.12 kJ g −1 and 2.24 N s g −1 , respectively. Thus, DADBTNBO may give better detonation and combustion performance than that of the HNS. Moreover, the thermal stability and impact sensitivity of DADBTNBO are predicted to be slightly lower than HNS. Thus, it is expected to use DADBTNBO instead of HNS for application in military ordnance, aeronautic and astronautic areas, and puncturing deep petroleum wells. Graphical abstract