An initial and potentially sufficient look at the question.

ObjectivesTo determine the effect of blowing shankh (conch shell) on sleep related outcomes in individuals with moderate obstructive sleep apnea (OSA).MethodsA prospective open-label randomised control trial with parallel groups including individuals with daytime sleepiness and recent moderate OSA diagnosis. Participants received either intervention of shankh blowing or a sham procedure (deep breathing exercise) for 6 months. Primary outcome included Daytime sleepiness (Epworth Sleepiness scale, ESS) with two secondary outcomes: sleep quality (Pittsburgh quality of sleep index, PSQI) and apnea-hypopnea index (AHI). Linear mixed effects models were used to assess outcomes.ResultsAmong 30 individuals with moderate OSA, 16 were randomised to the control group and 14 to the intervention group using unrestricted randomisation. Participants in intervention group observed greater improvement in sleepiness with 34% reduction in ESS (change, −5.0 points; 95% CI, (−8.06 to −1.93), and there is significant change in mean difference of ESS score (−4.69 points [95% CI, −8.39 to −1.007; p=0.0145]) between the groups at end of intervention. Sleep quality (PSQI score; change, −1.8 points [95% CI, −3.3 to −0.26]) and AHI (change, −4.4 events·h−1 [95% CI, −7.6 to −1.2]) were more reduced in intervention group at 6 months with mean between-group difference of −3.1 points for PSQI score and −5.62 events·h−1 for AHI respectively.ConclusionsThe observed improvements in daytime sleepiness, sleep quality, and AHI suggest that respiratory muscle training through shankh blowing may emerge as a novel therapeutic option for managing OSA symptoms in the future.

Phone-free school is a sensible goal, but policy should be set by schools and school districts, not state legislatures.

Obstetricians and gynecologists (OB-GYNs) provide essential health care to women across their lifespan. Yet nearly half of US counties have no OB-GYNs, with nonmetropolitan communities disproportionately affected. Targeted Regulation of Abortion Providers (TRAP) laws, spurred by the 1992 US Supreme Court decision in Planned Parenthood v. Casey, impose regulatory burdens on abortion providers and may have influenced whether and where OB-GYNs choose to practice, which has not yet been comprehensively studied. Using a staggered difference-in-differences design and county-level data, we found that TRAP laws were associated with an average reduction of 4.67 percent in the density of OB-GYNs per 100,000 women ages 15–44 during the period 1993–2021, between Casey and the Dobbs v. Jackson Women’s Health Organization decision in 2022. TRAP laws affected both general and fellowship-trained OB-GYNs, as well as counties without abortion facilities. Concerningly, TRAP laws led to lower physician density in nonmetropolitan counties—a difference that persisted for a decade. As OB-GYN shortages are projected to worsen and TRAP laws are still in effect in twenty-four states, policy makers should consider the long-run effects of TRAP laws on women’s access to health care and their potential to exacerbate geographic disparities in access to care.

Why are insurers even in this position to begin with?