bluuebunny/crossref_metadata_2025 huggingface dataset:
Staging a Monarchical-federal Order: Wilhelm I as German Emperor
Authors: Sterkenburgh Frederik Frank
Published: October 2021

This article argues that the German emperor Wilhelm I drew on self-staging, symbolic acts and monarchical federalism to establish himself as the new polity’s figurehead after 1871. By drawing on cultural approaches to political history, this article demonstrates that because the imperial office was embedded in a federal context and institutional and geographical dominance was therefore ruled out, Wilhelm used travel, ceremonial and speeches to appeal to the German population via their regional monarchs for popular support. In so doing, Wilhelm deliberately cultivated the empire’s monarchical-federal political structure to accommodate the German states’ differing responses to the king of Prussia now being German emperor and the nascent popular cult around his persona. In addition, this article argues that Wilhelm’s aim was not just to generate popular support for himself, but also to provide a monarchical understanding of the polity and oppose other political centres of gravity, in particular the Reichstag and its parliamentary understanding of the German Empire. As such, this article demonstrates that self-staging and symbolic acts provided the first Kaiser with a distinct political agency, thereby challenging scholars’ assumptions of Bismarck’s personal and political dominance. It shows that Germany’s composite nationhood was not a limitation to Wilhelm’s establishing the Hohenzollern dynasty as Germany’s imperial monarchy, but rather that his self-staging, symbolic acts and monarchical federalism were crucial for this purpose. It thus questions the historiographical notion that this shift did not happen until Wilhelm II’s 1888 accession and his German-national conception of his public persona, the office and the German Empire.
Retirement Type and Cognitive Functioning in Japan
Authors: Mizuochi Masaaki , Raymo James M
Published: October 2021

Objectives

A growing literature examines the effect of retirement on cognitive function, but pays little attention to how this relationship may depend upon the nature of retirement. Of particular importance is the growing prevalence of gradual retirement characterized by continued employment—either with a new employer or with the same employer—after retiring from a career job.

Methods

We use data from men and women aged 50 or older in the Japanese Study of Aging and Retirement to examine the effects of full retirement, partial retirement with the same employer, and partial retirement with a new employer on cognitive function. Our analyses consider the moderating role of career job complexity and exploit distinctive features of the Japanese public pension and mandatory retirement systems to estimate the causal effect of retirement type on cognition.

Results

Results indicate that partial retirement with the same employer has a significant and adverse effect on cognitive function (relative to those not yet retired). In contrast, those who experienced either full retirement or partial retirement with a new employer were, on average, no different from those still in their career job. Partial retirement with a new employer has a beneficial effect on cognition among those who had a high-complexity career job.

Discussion

Results are consistent with the idea that novel work exposures and experiences have a beneficial effect on cognition. They also suggest that ongoing policy efforts to promote partial retirement with the same employer may have unexpected adverse implications for cognitive health.
Denoising modulo samples: k-NN regression and tightness of SDP relaxation
Authors: Fanuel Michaël , Tyagi Hemant
Published: October 2021

Many modern applications involve the acquisition of noisy modulo samples of a function $f$, with the goal being to recover estimates of the original samples of $f$. For a Lipschitz function $f:[0,1]^d \to {{\mathbb{R}}}$, suppose we are given the samples $y_i = (f(x_i) + \eta _i)\bmod 1; \quad i=1,\dots ,n$, where $\eta _i$ denotes noise. Assuming $\eta _i$ are zero-mean i.i.d Gaussian’s, and $x_i$’s form a uniform grid, we derive a two-stage algorithm that recovers estimates of the samples $f(x_i)$ with a uniform error rate $O\big(\big(\frac{\log n}{n}\big)^{\frac{1}{d+2}}\big)$ holding with high probability. The first stage involves embedding the points on the unit complex circle, and obtaining denoised estimates of $f(x_i)\bmod 1$ via a $k$NN (nearest neighbor) estimator. The second stage involves a sequential unwrapping procedure which unwraps the denoised mod $1$ estimates from the first stage. The estimates of the samples $f(x_i)$ can be subsequently utilized to construct an estimate of the function $f$, with the aforementioned uniform error rate. Recently, Cucuringu and Tyagi proposed an alternative way of denoising modulo $1$ data, which works with their representation on the unit complex circle. They formulated a smoothness regularized least squares problem on the product manifold of unit circles, where the smoothness is measured with respect to the Laplacian of a proximity graph $G$ involving the $x_i$’s. This is a nonconvex quadratically constrained quadratic program (QCQP) hence they proposed solving its semidefinite program (SDP) based relaxation. We derive sufficient conditions under which the SDP is a tight relaxation of the QCQP. Hence under these conditions, the global solution of QCQP can be obtained in polynomial time.
The role of IL-4 derived from follicular helper T (TFH) cells and type 2 helper T (TH2) cells
Authors: Kubo Masato
Published: October 2021

IL-4 is known to be the quintessential regulatory cytokine, playing a role in a vast number of immune and non-immune functions. This cytokine is commonly secreted by type 2 helper T (TH2) cells and follicular helper T (TFH) cells after antigenic sensitization. TH2 cells have been classically thought to be the major contributor to B-cell help as a source of IL-4 responsible for class-switch recombination to IgG1 in mice (IgG4 in humans) and to IgE in mice and humans. Recent in vivo observations have shown that IgE and IgG1 antibody responses are mainly controlled by IL-4-secreting TFH cells but not by classical TH2 cells. IL-4 is distinctively regulated in these two T-cell subsets by the GATA-3-mediated HS2 enhancer in TH2 cells and the Notch-mediated conserved non-coding sequence 2 (CNS-2) enhancer in TFH cells. Moreover, the IL-4 derived from TFH cells has an essential role in germinal center (GC) formation in the secondary lymphoid organs during humoral immune responses.
Evaluation of the in vitro activity of ceftaroline, ceftazidime/avibactam and comparator antimicrobial agents against clinical isolates from paediatric patients in Kuwait: ATLAS data 2012–19
Authors: Al-Sweih Noura , Jamal Wafaa , Mokaddas Eiman , Habashy Nervana , Kurdi Ayman , Mohamed Naglaa
Published: October 2021

Objectives

To report antimicrobial resistance data for Gram-positive and Gram-negative pathogens isolated from paediatric patients in three hospitals in Kuwait during 2012–19.

Methods

In vitro activity of antimicrobials against isolates from documented infections was determined using CLSI broth microdilution method and breakpoints at a central laboratory. Enterobacterales and Pseudomonas aeruginosa isolates were screened for β-lactamases using multiplex PCR assays. Phenotypic determination of resistance in Haemophilus influenzae and Gram-positive isolates was performed using standard methodologies.

Results

Among 515 Enterobacterales isolates, 29.3% were ESBL-positive; susceptibility was highest to amikacin, ceftazidime/avibactam and meropenem (≥97.4%), regardless of ESBL status. CTX-M-15 was identified in 87.1% of ESBL-positive Escherichia coli and 84.2% of ESBL-positive Klebsiella pneumoniae isolates. Of 111 P. aeruginosa isolates, 9.9% were MDR and 12.6% meropenem-resistant (MEM-R). Amikacin and ceftazidime/avibactam had the highest susceptibility rates in the overall group (≥92.8%), with reduced rates among MDR and MEM-R isolates. All 269 MRSA and 180 MSSA isolates were susceptible to daptomycin, linezolid, teicoplanin, tigecycline and vancomycin. All MSSA and 99.3% of MRSA were ceftaroline susceptible. All 168 pneumococcal isolates were susceptible to ceftaroline, linezolid, tigecycline and vancomycin. H. influenzae and Streptococcus pyogenes ceftaroline susceptibility rates were ≥93.3% and ≥95.6%.

Conclusions

Most isolates of Enterobacterales (including resistant phenotypes) and P. aeruginosa from Kuwait during 2012–19 were susceptible to ceftazidime/avibactam. Ceftaroline was active against most Gram-positive isolates, including resistant phenotypes, and ESBL-negative Enterobacterales. These results indicate that novel antibiotics such as ceftazidime/avibactam and ceftaroline represent valuable treatment options for paediatric infections, including those caused by MDR organisms.
Three Smart and Original Spectrophotometric Data Processing Ratio Techniques for Resolving the Partial Overlapped Spectra of the Binary Antiviral Mixture Daclatasvir/Sofosbuvir: Application to Combined Dosage Form Darvoni® Tablets
Authors: Fayed Ahmed S , Hegazy Maha A , Kamel Ebraam B , Eissa Maya S
Published: October 2021

Background

The combination of daclatasvir (DCV) and sofosbuvir (SFV) is now widely used as an ideal treatment for hepatitis C virus (HCV) infection. For this purpose, simple, sensitive, rapid, and smart spectrophotometric methods were developed and validated for the determination of these drugs in their combined dosage form.

Objective

Development of smart, sensitive, low-cost spectrophotometric methods for the determination of DCV and SFV in their combined dosage form.

Methods

Ratio subtraction (RS), amplitude modulation (AM), and mean-centering spectrophotometric methods were established and validated for the estimation of SFV in the presence of DCV without previous separation, using a unified regression equation.

Results

A linearity range of 2.5–25.0 µg/mL was confirmed for the direct measurement of DCV at 316 nm (because there is no interference from SFV. Linearity was confirmed over a concentration range of 10.0–80.0 µg/mL for SFV. The current methods were established according to the ICH recommendations, and specificity was examined by testing synthetic mixtures of both drugs. They were tested on their tablet dosage form, and a good recovery was obtained.

Conclusion

The current methods proved to be simple, specific, and economical. A statistical study of the current ratio approaches and published methods showed there was no apparent statistical variation.

Highlights

Both antiviral agents can be quantified in the presence of each other by the current methods, which is a significant time- and cost-saving benefit of the developed methods. This benefit is even more important in the case of the combined dosage form (Darvoni® tablets) for the pharmaceutical market.
Predictive simulation for the design of robotic solution to mobility aid
Authors: Yin ChengXin , Benali Abderraouf , Kratz Frédéric
Published: October 2021

Maintaining substantial mobility is essential for those who suffer from reduced mobility to regain their independence in daily motion tasks. In recent years, robotic solutions to human mobility aid have been functionally verified by various applications. Moreover, with the emergence of new robots and systems, the robot design theory is also under rapid evolution. This paper proposes a methodology to enhance the design of robotic exoskeleton. The aim was to help the designer to select adequate dynamical behaviors to the development of control scheme for the human motions assisted by a robotic assistance device. The main contribution of this work resides in the proposition of optimized impedance parameters for a particular human movement via neuromusculoskeletal (NMS) modelization and predictive simulation. The technique of NMS modeling that represents the motions of human upper limb was applied to study the underlying mechanisms of human movements. Predictive simulation integrated with the NMS model was formulated and solved for generating a series of optimized human dynamic parameters. In this paper, a case study of human–robot interface has been proposed to exemplify our methodology. The modeling and simulation processes were validated with experimental tools. According to the simulated human dynamics, the optimized stiffness and damping coefficients of one degree of freedom were calculated. Results show that our methods are promising and allowed to specify the human movement for a given task, and can provide the design parameters to control scheme of a robotic exoskeleton.
“You Can Connect with Like, the World!”: Social Platforms, Survival Support, and Digital Inequalities for People Experiencing Homelessness
Authors: Marler Will
Published: October 2021

This study examines how people experiencing homelessness invest their efforts in locating survival support over social media and crowdfunding and the barriers they experience along the way. Reporting on ethnographic fieldwork with unstably housed adults in Chicago, the study introduces the concept of connective ambition to describe how platform narratives take hold in a context of deep exclusion, informing a view of social media as a vast terrain of untapped support from strangers. Digital inequality emerges in the failure of campaigns to raise money for rent from virtual ties, but also in how limited skills and heightened concerns over privacy and safety discourage most people living on the street from ever seeking out support over social media. Ethnography can help better illustrate the interlocking features of offline and digital inequalities, showing how status-specific uses of social platforms emerge and shape unequal outcomes of digital participation for members of marginalized communities.
Management of broncho-esophageal fistula after button battery ingestion
Authors: Ott Katherine C , Harris Jamie C , Barsness Katherine A , Arseneau Jesse , Ghadersohi Saied , Raval Mehul V
Published: October 2021

Button battery ingestion can cause serious injury or death in young children who cannot communicate symptoms. An 18-month-old male presented after his mother noted drooling, nonbilious emesis and a metallic smell to his breath. He underwent rigid esophagoscopy and a 3-V 20-mm button battery was removed. Subsequent bronchoscopy after a 1-week interval revealed progression to a large broncho-esophageal fistula on the posterior wall of the right mainstem bronchus past the carina. A fenestrated nasogastric tube for local control of secretion and a feeding jejunostomy was placed. Six weeks later, the patient underwent a right thoracotomy for division and repair of the fistula and intercostal muscle flap interposition. Utilizing a well-placed fenestrated nasogastric tube to manage secretions can help reduce fistula size and improve conservative management results. When surgical repair is required, an intercostal muscle flap can reinforce fistula closure while simultaneously buttressing the bronchus and esophagus.
Cervicofacial necrotizing fasciitis after topical application of herbal medicine
Authors: Almaguer Acevedo Fernando Miguel , Hernandez Cervantes Barbara Yordanis , Ketemepi Gabriel Victor Doe , Martinez Lopez Duniesky
Published: October 2021

Cervical necrotizing fasciitis represents an aggressive form of deep neck space infection with a high mortality rate. The origin is generally odontogenic, in most cases, resulting from a dental abscess. A series of three cases developed after local application of herbal medicine in patients with no co-morbidities and with a history of a toothache in the lower quadrants for >2 weeks is presented. All patients were managed with antibiotics, extraction of offending tooth and serial wound debridement. Two patients recovered with a resultant skin defect on the neck and one died due to multiple organ failure. This case series demonstrated that early diagnosis, prompt surgical intervention and appropriate medical treatment are very important to increase patient survival. Late report to hospital because of financial constraints and over-reliance on herbal preparation could lead to the development of serious complication in patients with dental infections and could even lead to death of the patient.
Complete thoracoscopic surgery for extensive emphysema in the right upper and middle lobes caused by right B5 bronchial atresia
Authors: Sumiya Ryusuke , Nagasaka Satoshi , Ikeda Takeshi , Suyama Yuto , Miyazaki Hideki
Published: October 2021

Bronchial atresia is a rare congenital condition that may lead to infectious complications. Almost all patients with this condition are diagnosed early in life with normal lungs, making them particularly suitable candidates for thoracoscopic surgery. A 30-year-old man was referred to our hospital due to an abnormal shadow on chest radiography taken 7 years prior. Despite being diagnosed with B5 bronchial atresia, he refused to undergo surgical resection. Seven years later, he developed right chest pain. Computed tomography showed B5 bronchial occlusion, mucoid impaction and emphysematous changes. Treatment with thoracoscopic right middle lobectomy and S3 partial resection using four ports resulted in good lung expansion after discharge. This study highlights that thoracoscopic surgical resection should be considered in patients with bronchial atresia.
Visualizing Pausanias’s Description of Greece with contemporary GIS
Authors: Foka Anna , Demiroglu Osman Cenk , Barker Elton , Mostofian Nasrin , Konstantinidou Kyriaki , Kiesling Brady , Talatas Linda , Palm Kajsa
Published: October 2021

This progress article focuses on an overview of the potential and challenges of using contemporary Geographic Information System (GIS) applications for the visual rendering and analysis of textual spatial data. The case study is an ancient traveling narrative, Pausanias’s Description of Greece (Periegesis Hellados) which was written in the second century CE. First, we describe the process of converting the volumes to spatial data using a customized version of the open-source digital semantic annotation platform Recogito. Then the focus shifts to the implementation of collected and organized spatial data to a number of GIS applications: namely Google Maps, DARIAH Geo-Browser, Gephi, Palladio and ArcGIS. Through empirical experimentation with spatial data and their implementation in different platforms, our paper charts the ways in which contemporary GIS applications may be implemented to cast new light on ancient understandings of identity, space, and place.
Rural versus urban fiction in contemporary Chinese literature - Quantitative approach case study
Authors: Chen Xinying , Kubát Miroslav
Published: October 2021

The study examined contemporary Chinese novels that depicted the social changes in rural and urban areas. We analyzed the texts using several quantitative methods of stylometry (lexical richness, activity, descriptivity, nominality, cluster analysis of the most frequent words) and corpus linguistics (keywords). We focused on the differences (both in style and in content) between contemporary fiction depicting life in Chinese rural and urban areas. The results revealed that rural stories are more dynamic (active), focusing more on the plot with a simpler description and a smaller vocabulary.
Graded Administration of Second Dose of Moderna and Pfizer-BioNTech COVID-19 mRNA Vaccines in Patients With Hypersensitivity to First Dose
Authors: Tuong Linh-An C , Capucilli Peter , Staicu Mary , Ramsey Allison , Walsh Edward E , Shahzad Mustafa S
Published: October 2021

Two mRNA coronavirus disease 2019 (COVID-19) vaccines, Moderna and Pfizer-BioNTech, require 2 doses for maximum efficacy. This case series reports the safety and immunogenicity of a graded administration of the second dose of the Moderna and Pfizer-BioNTech COVID-19 vaccines in patients with immediate hypersensitivity reactions to the first dose.
Progress with Parliamentary ‘Power over the Purse’: The Case of South Africa
Authors: Makanya Nokwazi
Published: October 2021

Renewed interest in legislative ‘power over the purse’ has seen a growing demand in modern democracies for parliaments to strengthen their authority over national budgets. However, weaknesses in legislative and institutional reforms intended to bring about more assertive parliaments with powers to amend budgets raise issues on how parliament’s role in influencing the budget differs from what formally conferred powers anticipate. Specifically, to what extent can formal parliamentary institutions be expected to advance the aspiration of greater legislative influence on the budget? This article critically considers the institutional arrangements of the South African parliament that inhibit effective execution of its role in budget decision-making. In particular, it explores three determinants: extent of formal powers, institutional capacity, and incentives facing individual MPs.
Cell biology of the leaf epidermis: Fate specification, morphogenesis, and coordination
Authors: Zuch Daniel T , Doyle Siamsa M , Majda Mateusz , Smith Richard S , Robert Stéphanie , Torii Keiko U
Published: October 2021

As the outermost layer of plants, the epidermis serves as a critical interface between plants and the environment. During leaf development, the differentiation of specialized epidermal cell types, including stomatal guard cells, pavement cells, and trichomes, occurs simultaneously, each providing unique and pivotal functions for plant growth and survival. Decades of molecular-genetic and physiological studies have unraveled key players and hormone signaling specifying epidermal differentiation. However, most studies focus on only one cell type at a time, and how these distinct cell types coordinate as a unit is far from well-comprehended. Here we provide a review on the current knowledge of regulatory mechanisms underpinning the fate specification, differentiation, morphogenesis, and positioning of these specialized cell types. Emphasis is given to their shared developmental origins, fate flexibility, as well as cell cycle and hormonal controls. Furthermore, we discuss computational modeling approaches to integrate how mechanical properties of individual epidermal cell types and entire tissue/organ properties mutually influence each other. We hope to illuminate the underlying mechanisms coordinating the cell differentiation that ultimately generate a functional leaf epidermis.
Genome-wide association of the metabolic shifts underpinning dark-induced senescence in Arabidopsis
Authors: Zhu Feng , Alseekh Saleh , Koper Kaan , Tong Hao , Nikoloski Zoran , Naake Thomas , Liu Haijun , Yan Jianbing , Brotman Yariv , Wen Weiwei , Maeda Hiroshi , Cheng Yunjiang , Fernie Alisdair R
Published: October 2021

Dark-induced senescence provokes profound metabolic shifts to recycle nutrients and to guarantee plant survival. To date, research on these processes has largely focused on characterizing mutants deficient in individual pathways. Here, we adopted a time-resolved genome-wide association-based approach to characterize dark-induced senescence by evaluating the photochemical efficiency and content of primary and lipid metabolites at the beginning, or after 3 or 6 days in darkness. We discovered six patterns of metabolic shifts and identified 215 associations with 81 candidate genes being involved in this process. Among these associations, we validated the roles of four genes associated with glycine, galactinol, threonine, and ornithine levels. We also demonstrated the function of threonine and galactinol catabolism during dark-induced senescence. Intriguingly, we determined that the association between tyrosine contents and TYROSINE AMINOTRANSFERASE 1 influences enzyme activity of the encoded protein and transcriptional activity of the gene under normal and dark conditions, respectively. Moreover, the single-nucleotide polymorphisms affecting the expression of THREONINE ALDOLASE 1 and the amino acid transporter gene AVT1B, respectively, only underlie the variation in threonine and glycine levels in the dark. Taken together, these results allow us to present a very detailed model of the metabolic aspects of dark-induced senescence, as well as the process itself.
Anomaly and superconnection
Authors: Kanno Hayato , Sugimoto Shigeki
Published: October 2021

We study anomalies of fermions with spacetime-dependent mass. Using Fujikawa’s method, it is found that the anomalies associated with the U(N)+ × U(N)− chiral symmetry and U(N) flavor symmetry for even and odd dimensions, respectively, can be written in terms of superconnections. In particular, the anomaly for a vector-like U(1) symmetry is given by the Chern character of the superconnection in both even- and odd-dimensional cases. It is also argued that the non-Abelian anomaly for a system in D-dimensional spacetime is characterized by a (D + 2)-form part of the Chern character of the superconnection which generalizes the usual anomaly polynomial for the massless case. These results enable us to analyze anomalies in the systems with interfaces and spacetime boundaries in a unified way. Applications to index theorems, including the Atiyah–Patodi–Singer index theorem and a Callias-type index theorem, are also discussed. In addition, we give a natural string theory interpretation of these results.
Humanitarian Accountability in Displacement Contexts: Five Years on from the Grand Bargain
Authors: Martin Diana , Singer Sarah , Mathias Bethan
Published: October 2021

Humanitarian accountability has been the subject of increased attention in recent years. However, examination of how its principles and practices play out in displacement contexts is an under-explored area. In this Editorial, we outline the development of humanitarian accountability standards and practice, with particular focus on their applicability to displacement contexts. As we refer to and introduce the papers of this special issue, we reflect on positive developments and the challenges remaining. It is a particularly prescient time to reflect on the ‘state of play’ of accountability in this sector, given it is five years since the adoption of the Grand Bargain and the “Participation Revolution”, through which stakeholders undertook to increase the relevance and efficiency of humanitarian response by giving prominence to affected populations’ participation in decisions which affect their lives. Despite these commitments, however, true progress is hampered by entrenched power imbalances. In the pyramid of power relations which denote the power to influence programming, displaced populations remain at the bottom, often unheard and silenced. Yet, only when displaced communities are able to influence the kind of aid they receive, can humanitarian responses truly address their needs and pave the way for more secure, protected and resilient communities.
Light enhanced cognitive behavioral therapy for insomnia and fatigue during chemotherapy for breast cancer: a randomized controlled trial
Authors: Bean Helena R , Diggens Justine , Ftanou Maria , Alexander Marliese , Stafford Lesley , Bei Bei , Francis Prudence A , Wiley Joshua F
Published: October 2021

Study Objectives

Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I + Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes).

Methods

We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index, to 6-week CBT-I + Light or TAU+. CBT-I + Light included 1 in-person session, 1 telephone call, 7 emails, and 20 min bright light (BL) each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6), and 3-month follow-up.

Results

Women (N = 101) were randomly assigned to CBT-I + Light or TAU+. The CBT-I + Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (−5.06 vs −1.93, p = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, p = .56). CBT-I + Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (p = .05) and significantly greater improvement in fatigue (between-group ES = .59, p = .013) and daytime sleep-related impairment (between-group ES = .61, p = .009) than the TAU+ group.

Conclusions

CBT-I + Light had a clinically significant impact on insomnia and fatigue with moderate ESs. Results support offering cognitive behavioral therapy for insomnia and BL therapy during chemotherapy for BC to help manage sleep and fatigue.

Clinical Trial

Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/). Registration number: ACTRN12618001255279.
O005 Cognitive behavioural therapy and light dark therapy for postpartum insomnia symptoms: a randomised controlled trial
Authors: Verma S , Quin N , Astbury L , Wellecke C , Wiley J , Davey M , Rajaratnam S , Bei B
Published: October 2021

Introduction

Symptoms of postpartum insomnia are common however interventions remain scarce. Cognitive Behavioural Therapy (CBT) and Light Dark Therapy (LDT) target distinct mechanisms to improve sleep. This randomised controlled superiority trial compared CBT and LDT against treatment-as-usual (TAU) in reducing maternal postpartum insomnia symptoms.

Methods

Nulliparous females 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores >7) were included; excluded were those at risk or with high medical/psychiatric needs. Eligible participants were randomised 1:1:1 to 6 weeks of CBT, LDT (gaining light upon awakening, night-time light avoidance) or TAU. Interventions were therapist-assisted through two telephone calls and included automated self-help emails over six weeks. Symptoms of insomnia (ISI; primary outcome), sleep disturbance, fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Latent growth models were used.

Results

114 participants (mean age=32.2±4.6 years) were randomised. There were significantly greater reductions in insomnia and sleep disturbance in both intervention groups with very large effect sizes (d>1·4, p<0·0001) from baseline to post-intervention compared to TAU; improvements were maintained at one-month follow-up. There were greater reductions in fatigue symptoms in the CBT group (d=0.85, p<.0001) but not LDT (p=0.11) compared to TAU; gains were maintained for CBT at follow-up. Changes in sleepiness, depression and anxiety over time were non-significant compared to TAU (p-values>0.08).

Conclusion

Therapist-assisted CBT and LDT are both efficacious for reducing postpartum insomnia symptoms. Findings were mixed for fatigue, sleepiness and mood. Future research is needed on predictors of treatment response.
O009 The Good Sleeper Scale-13 Items: a standardised questionnaire for the assessment of good sleepers
Authors: Manners J , Appleton S , Reynolds A , Melaku Y , Gill T , Micic G , Lovato N , Sweetman A , Bickley K , Adams R , Lack L , Scott H
Published: October 2021

Introduction

Good sleep is not merely the absence of sleep disorder symptoms, yet this criterion is commonly applied in research studies. We developed the Good Sleeper Scale-13 (GSS-13) to standardise identification of good sleepers.

Methods

We conducted a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N = 2,044, aged 18–90 years). Possible GSS-13 items were chosen collaboratively with co-authors. Exploratory factor analysis (EFA) was conducted on 10% of the dataset chosen at random (N = 191) for factor identification and item reduction. Confirmatory factor analysis (CFA) on the remaining 90% (N = 1,853) tested model fit. Associations with sleep concerns, health, and daytime functioning tested validity of the final version.

Results

From EFA, six factors were identified: Adequate Sleep; Insomnia; Regularity; Timing; Sleep Duration; Perceived Sleep Problem. On CFA, model fit was comparable to other sleep instruments, X² (67) = 387.34, p < .001, CFI = .95, TLI = .92, RMSEA = .05. Cronbach’s alpha was largely acceptable (≥.7) across subscales. Consistent correlations were found between GSS-13 global scores and outcomes, including “a good night’s sleep” (r = .65, p < .001), feeling un-refreshed (r = -.53, p < .001), and general health rating (r = .44, p < .001). Classification accuracy for insomnia symptoms was also high (AUC = .84).

Conclusions

The GSS-13 is psychometrically sound, correlated well with sleep, health, and daytime functioning, and can be used to identify good sleepers for research. Future work will test relationships with other sleep measures.
O017 Parents’ experiences of having a child with Down Syndrome and sleep difficulties
Authors: Miguel M , Cooke E , Chawla J
Published: October 2021

Introduction

This qualitative study that investigates parents’ experiences of having a child with Down Syndrome (DS) and sleep difficulties is a part of a broader mixed-method study entitled Sleep Difficulties in Children with Down Syndrome: An Evaluation of Parent/Carer and Family Quality of Life.

Methods

We conducted semi-structured interviews with 26 parents (fathers n = 4 and mothers n = 22), and reflexive Thematic Analysis (TA) was operationalised for data analysis. The interviews covered the following key topics: DS diagnosis; timeline of their child’s sleep patterns and difficulties; implications for parental sleep, day-time function, and well-being; family dynamics; and access to supports.

Results

Most participants described negative experiences at time of diagnosis, including not feeling listened to, and receiving inconsistent, insensitive and inadequate information and/or treatment. Most strikingly, no parents recall receiving sleep specific information. Most participants described their child’s sleep difficulties affecting their own sleep, day-time function and family dynamics, yet they commonly normalised these experiences. Such normalisation was a recurring theme across their experiences of having a child with DS and is contextualised by their accounts of resisting prejudiced attitudes towards their child since diagnosis.

Discussion

This is the first qualitative study to investigate parents’ experiences of having a child with DS and sleep difficulties. Implications include professional development for health care workers focusing on sleep as a significant comorbidity for these children, and awareness of families’ tendencies to normalise their experiences when delivering care.
O019 Mobile phone use at night, cyber-bullying, sleep, and mental wellbeing in young people aged 7 to 19 years
Authors: Lushington K , Dorrian J , Centofanti S , Wicking A , Wicking P
Published: October 2021

Introduction

Children commonly have access to mobile devices that allow them to send and receive texts at night when they should be sleeping. This may contribute to an increase in cyber-bullying and sleep problems, with negative effects on mental wellbeing.

Methods

Young children (7-11y, n = 22,597), early adolescents (12-14y, n = 19,470) and late adolescents (15-19y, n = 14,156) completed a survey examining mental wellbeing and the frequency of obtaining 8h sleep, texting at night and cyber-bullying.. Generalised structural equation modelling was used to investigate the effects of texting at night on mental wellbeing, directly, and indirectly via effects on sleep. Cyber-bullying was also specified as a moderator of the effect of texting at night on sleep.

Results

Text messaging at night in the last week was reported by 51% and cyber-bullied in the last school term by 15% of children. For all children, obtaining at least 8h of sleep increased the odds of better mental wellbeing, Conversely, texting messaging and cyber-bullied reduced the odds of obtaining 8h sleep in both male and female young children and female early and late adolescents. In all cohorts except late adolescent males, obtaining less than 8h sleep and cyber-bullied accounted for a large proportion of the effects of text messaging on mental wellbeing.

Conclusion

Mobile phone use at night impairs sleep which contributes to poor mental wellbeing. The effect on sleep is exacerbated by cyber-bullying. Strategies to discourage small screen use at night, promote adequate sleep and reduce cyber-bullying are needed.
O023 Impact of weight loss of OSA pathophysiology
Authors: Wong A , Landry S , Yang K , Joosten S , Thomson L , Mansfield D , Sands S , Patel S , Cistulli P , Sutherland K , Hamilton G , Edwards B
Published: October 2021

Introduction

Obesity is a major risk factor for developing obstructive sleep apnoea (OSA), however, the underlying mechanisms are not fully understood. We aimed to assess the impact of weight loss on all OSA endotypes (i.e. upper airway collapsibility, muscle compensation, respiratory arousal threshold, and loop gain).

Methods

We analysed data from 40 OSA patients (collated from 3 centres) who underwent bariatric surgery. Demographics and clinical polysomnograms (PSG) were performed at baseline and at between 6–18 months post-surgery. OSA endotypes were measured during sleep using non-invasive endotyping methods (derived from clinical PSG).

Results

Participants lost 28±14 kg and had a post-surgery reduction in the AHI of 19.6 (Interquartile range[IQR] -9.8 to -35.4) events/hr [from baseline 39.9 (24.3 to 65.6) events/hr to 17.0 (9.9 to 33.3) events/hr]. Following surgical weight loss, there was significant improvement in collapsibility (∆6.2 [IQR -1.4 to 13]%Veupnoea, p<0.0001), as well as significant reduction in loop gain and arousal threshold (∆-0.06 [-0.17 to 0.009], p<0.001 and ∆-13.7 [-24.8 to -1.8]%Veupnoea, p<0.001 respectively). There was no significant change in muscle compensation.

Conclusion

Our findings suggest that weight loss improves upper airway collapsibility and reduces loop gain and the arousal threshold, providing novel insights about the mechanisms by which obesity causes OSA. Further analysis is underway to determine whether knowledge of the baseline OSA endotypes (in isolation and/or in combination) can predict which individuals will have a response to weight loss alone.
O027 The combination of mandibular advancement devices (MAD) and supplemental oxygen dramatically improves OSA severity: preliminary results from the MADOX trial
Authors: Edwards B , Vena D , Thomson L , Gikas A , Radmand R , Calianese N , Hess L , Landry S , Joosten S , Hamilton G , Wellman A , Sands S
Published: October 2021

Introduction

Patients with obstructive sleep apnoea (OSA) considered ‘non-responders’ to mandibular advancement device (MAD) therapy, typically have a high loop gain contributing to their OSA physiology. While MAD does not improve loop gain, other treatments such as supplemental oxygen can have a strong effect on this pathogenic trait. Therefore, we conducted a randomised controlled trial (RCT) to determine whether the administration of supplemental oxygen in combination with a MAD, was associated with greater improvements in OSA severity compared to MAD therapy alone.

Methods

Patients recently diagnosed with OSA underwent an initial screening sleep study to confirm the presence of moderate-severe OSA (Apnoea-hypopnoea index [AHI]>20events/hr). Eligible patients were then enrolled in a randomised single-blind cross-over trial involving 4 sleep studies with the following treatments; MAD, oxygen (4L/min), MAD+oxygen and room-air/sham (control). The primary outcome was the reduction in AHI (%baseline).

Results

Of the 57 participants screened, 35 met the eligibility criteria (Baseline/Screening AHI = 52±22 events/hr). Compared to the sham night, all treatments significantly reduced the AHI; a 35% [CI: 18–48] was seen with oxygen (p<0.0002), a 53% [CI: 40–64] was seen with MAD (p<0.0001) and a 67% [CI: 56–76] was seen with MAD+oxygen (p<0.0001). Importantly, the combination of MAD+oxygen was associated with a significant reduction in AHI relative to MAD alone (15% [CI:4–24] p=0.01).

Discussion

In a population with moderate-severe OSA, preliminary analyses from this trial suggests that the addition of supplemental oxygen in combination with MAD therapy provided greater reductions in OSA severity than either treatment alone.
O040 Sleep restriction impairs the ability to integrate multiple pieces of information into a decision
Authors: Drummond S , Lim J , Boardman J , Anderson C , Dickinson D
Published: October 2021

Introduction

Sleep deprivation impacts overall decision-making, though the impact on specific components of decision-making are less well studied, especially outside of total sleep deprivation. Here, we examine the effects of sleep restriction on the ability to integrate multiple pieces of information into a decision.

Methods

Healthy adults (n=41; age=27.9±6.0 years, 20F) lived in the sleep lab for 2 counterbalanced conditions: well-rested (WR: 9-hour sleep opportunity for 4 nights) and sleep restriction (SR: one 9-hour night, followed by three 3-hour nights). Following the last night of each condition, participants performed the decision task. Across 48 trials, participants first saw two containers, with different numbers of black and white balls. Eight balls were randomly drawn, with replacement, from one unknown container. Participants decided which container was used, based on the “odds” each container was used and draw results (“evidence”). Mathematical modelling determined the amount of weight given to odds/evidence. The “best” decisions integrate both pieces of information.

Results

When WR, participants utilised both pieces of information to make their decisions, though odds were given slightly more weight. During SR, the amount of weight given to the odds did not change, and the weight given to the evidence decreased significantly.

Conclusion

SR impaired the ability to integrate multiple pieces of information into a decision. Instead, participants focused on a single piece of easy-to-understand information and did not fully utilise a harder-to-understand piece of information. This has implications for complex applied environments where individuals have large amounts of information with which to make decisions.
O049 Sleep quality and its impact on children with primary ciliary dyskinesia
Authors: Ewert I , Robinson P , Adams A , Vandeleur M
Published: October 2021

Background

PCD is a rare, progressive disease resulting in upper respiratory manifestations and abnormal lung mechanics that increase one’s risk of obstructive sleep apnoea. This study aims to characterise the sleep quality of children with PCD and its impacts on mood and HRQOL.

Methods

Children with PCD aged 0–19 years with stable respiratory symptoms were recruited. Subjective sleep quality was assessed by the Sleep Disturbance Scale for Children (SDSC), OSA-18, and Paediatric Daytime Sleepiness Scale (PDSS). Mood and depressive symptoms were assessed via QOL-PCD and Children’s Depressive Inventory (CDI) as age-appropriate. Pulmonary function testing was performed via spirometry and Multiple Breath Washout. Patients underwent an ENT assessment. All children completed one night of polysomnography including transcutaneous CO2 and video monitoring.

Progress to date: Twenty participants (45% female) have been recruited with a mean age of 8.5 years. Mean (±SD) FEV1 is 76.5±22.9%. 73% of children assessed have chronic rhinosinusitis. Clinically significant scores for SDSC were observed in 79% of patients and in 30% of patients for OSA-18. 38% of children reported clinically significant scores for PDSS. To date, 7 children have completed polysomnography.

Intended outcome and impact: This is the first study to characterise sleep quality and the impact of sleep disturbance in Australian children with PCD. We aim to identify clinical markers of poor sleep quality to better inform the development of a sleep screening program for use in paediatric PCD clinics.
O050 Hypersomnolence in children: the diagnostic dilemma
Authors: Anantharajah A , Nixon G , Davey M
Published: October 2021

Background

Excessive daytime sleepiness (EDS) is reported to affect up to 20% of pre-pubertal children and 50% of adolescents. EDS can be due narcolepsy and idiopathic hypersomnolence (IH). Currently diagnosis is by a multiple sleep latency test (MSLT) with protocols adapted from adults. The aim of this study was to describe the results of MSLTs in a paediatric population and assess whether a 5th nap altered diagnosis.

Methods

Retrospective analysis of 253 MSLTs at a single tertiary paediatric centre from May 2004 – Jan 2021 with consent obtained in 214 patients. Narcolepsy defined as a mean sleep latency (MSL) <8min with ≥2 sleep onset REM (SOREM). IH defined as a MSL < 8 minutes with <2 SOREMs. Results outside these parameters were grouped as hypersomnolence not otherwise specified (HNOS), with ambiguous HNOS defined as MSL 8–12 minutes or ≥2 SOREM.

Progress to date

There were 108 (50%) females, 132 (62%) >12 years old (range 3.3–19.4 years) and 17 patients had repeat studies. Narcolepsy was diagnosed in 48 (22%) and IH in 22 (10%). Criteria for ambiguous HNOS were met by 43 (20%) patients including 11 (5%) with MSL >12 minutes with ≥2 SOREMs. A 5th nap was performed in 58 (27%) MSLTs which did not change the diagnosis. Obstructive sleep apnoea was diagnosed in 48 (22%) patients and 27 (13%) had elevated periodic limb movement index.

Intended outcome and impact

Applying current MLST criteria in children may significantly under-estimate diagnostic categories for paediatric EDS as evidenced by the ambiguous HNOS.
P003 The impact of forced wake from overnight polysomnography on multiple sleep latency test results
Authors: Amaranayake A , Frenkel S , Lyell P , Southcott A
Published: October 2021

Introduction

The multiple sleep latency test (MSLT) is used to diagnose disorders of hypersomnolence. Although internationally-recognised protocols do not stipulate whether patients should be woken from the preceding overnight polysomnography (PSG), many labs wake their patients for logistic reasons. This study analyses the impact on PSG and MSLT parameters of forced wake (FW) from the overnight PSG compared with unrestricted sleep (US).

Methods

400 consecutive patients (FW=200; US=200) undergoing PSG/MSLT were included and the following parameters were compared: Epworth Sleepiness Scale (ESS), Morningness-Eveningness Questionnaire score (MEQ), PSG total sleep time (TST), wake-up time from the PSG, overall MSLT sleep latency (MSL), individual nap latencies (SLNap 1–4), number of MSLT naps with sleep-onset REM periods (#SOREMP), and percentage of MSLTs with overall MSL<8 minutes (%MSLT<8).

Results

The 2 groups were well-matched for ESS and MEQ. The FW group had more males (49% vs 39%). When compared to FW, patients with US had longer TST (+38 minutes; p=<0.0001), later wake-up time (+52 minutes; p<0.0001), longer MSL (+1.9 minutes; p=0.0049), 50% fewer #SOREMP (p=0.0224), and 16% fewer %MSLT<8 (p=0.0018). SLNap1 increased by 1.5 minutes (p=0.0623), SLNap2 increased by 2.0 minutes (p=0.0067), SLNap3 increased by 0.75minutes (p=0.0533) and SLNap4 increased by 2.5 minutes (p=0.0059).

Discussion

Allowing patients to have unrestricted sleep on the night prior to the MSLT resulted in significantly longer TST, longer sleep latencies during the MSLT, fewer SOREMP and fewer tests with MSL<8 minutes. International protocols should stipulate unrestricted sleep on the PSG prior to the MSLT to improve diagnostic accuracy.