bluuebunny/crossref_metadata_2025 huggingface dataset:
0710 Validation of the Predictive Utility of the Multivariable Apnea Index for Obstructive Sleep Apnea in Women
Authors: Orbell Staci , Chasens Eileen , Scott Paul , Luyster Faith , Morris Jonna
Published: May 2022

Introduction

The Multivariable Apnea Prediction (MAP) index is a commonly used screening tool for obstructive sleep apnea (OSA). Previous analyses have demonstrated higher sensitivity of the MAP in predicting OSA in men versus women and in post-menopausal versus pre-menopausal women with type 2 diabetes (T2DM) and an apnea-hypopnea index (AHI) ≥10. The purpose of this secondary analysis was to validate previous findings by comparing women with and without T2DM across all categories of OSA severity including mild (AHI ≥5).

Methods

The sample (N=386) was comprised of participants from the Diabetes Sleep Treatment Trial who were recruited because of risk for OSA with T2DM (n=279), and the EMPOWER study which examined triggers for lapses or relapse after intentional weight loss in overweight but otherwise healthy participants (n=115). AHI was assessed by in-home sleep study, ApneaLink Plus®. Descriptive statistics and binomial logistic regression and receiver operating characteristic analyses were conducted to evaluate classification of OSA diagnosis, defined as AHI ≥5 or ≥10, by MAP between sexes and by menopause status.

Results

Participants were middle aged (mean 54.09 years + 10.63), obese (mean BMI of 34.79 + 6.52 kg/m2), primarily female (67%), and white (64%). Compared to men, women were younger (52.99 years + 10.15 vs. 56.26 years + 11.25, p=0.004) and had a lower AHI (9.10 + 18.94 vs. 17.25 + 18.94, p<0.001). No significant differences, except for age, were noted between pre- and post-menopausal women. Sensitivity of MAP on OSA diagnosis was higher for men than women (AHI ≥5: 94.7% vs. 76%; AHI ≥10: 84.2% vs 29.6%). Sensitivity of MAP on OSA diagnosis was lower for pre-menopausal than post-menopausal women using AHI ≥5 (74.0% vs. 98.8%) and AHI ≥10 (19.0% vs. 32.1%).

Conclusion

This validation study corroborates previous findings that the MAP index was better at identifying OSA in men than women, and in post- versus pre-menopausal women using AHI values across all categories of OSA severity. Improved screening methods are needed to detect women at high risk for OSA.

Support (If Any)

This study was funded by the National Institutes of Health (R01-DK090628, R01-HL107370).
0722 Evaluation of Healthcare Insurance Claims Record based Artificial Intelligence Screening Tools for Undiagnosed Sleep Apnea
Authors: Rusk Sam , Turkington Fred , Fernandez Chris , Nygate Yoav , Glattard Nick , Abrahamian Melania , Vanasse Tom , Richardson Dana , Bartholow Tim , Watson Nathaniel
Published: May 2022

Introduction

Healthcare insurance claims data contain an unrecognized wealth of structured data that can be leveraged to investigate epidemiologic and economic relationships in health and disease. We studied the feasibility for machine learning algorithms to improve upon screening for obstructive and central sleep apnea (SA) at the population health level using existing health insurance claims data.

Methods

A logistic regression model was trained to predict the presence or absence of SA from an aggregated healthcare insurance claims dataset. The dataset was composed of medical and pharmacy claims between the years 2016 and 2020 from the Wisconsin All-Payor claims database which included coverage of >4,000,000 patients, >10,000 ICD codes, and >$50 billion in medical spending. A total of 1,870,000 patients and 39,712 unique federal drug identification codes were included within 91.5 million pharmacy claims in the dataset. Input features were constructed by counting the total number of claims for each unique drug in each subject resulting in a patient-level feature vector of 39,712 drug frequencies. The positive SA population was defined by individuals who had both at least one medical claim for sleep apnea diagnosis (ICD codes G4733/G4731) and an appropriate sleep test (CPT codes 9580*/9581*). The logistic regression model was evaluated using randomized 10-fold cross-validation and performance reported using ROC-AUC statistics and top-10 feature importance analysis.

Results

The logistic regression model detecting SA based solely on observed medication frequencies produced a ROC-AUC of 0.77. In a feature importance analysis, three of the Top-10 most discriminative features were medications for the treatment of diabetes, hypertension, and hyperlipidemia. We hypothesize this drug-frequency based model functions by exploiting the strong correlation of SA with specific clusters of known co-morbid conditions and corresponding medication regimens.

Conclusion

We demonstrate health insurance claims records contain predictive information that can aid in more systematic screening of undiagnosed conditions like SA. Furthermore, in a statistical analysis of feature importance, we observed medications indicative of comorbidities with known association to SA. These findings are useful to clinicians and payers in identifying undiagnosed SA populations, including those responsible for value-based payment models.

Support (If Any)
0728 Physical and Mental Health among Blacks with OSA and Insomnia: a Stakeholder-engaged community study
Authors: Rogers April , Seixas Azizi , Jin Peng , Casimir Georges , Nunes Joao , Jean-Louis Girardin
Published: May 2022

Introduction

Health consequences of co-occurring obstructive sleep apnea (OSA) and insomnia have been well documented. However, little is known about the mental and physical consequences of co-occurring OSA and insomnia among Blacks. We aimed to investigate the rate of OSA risk and insomnia symptoms and potential associations with physical and mental health in a community sample of Blacks.

Methods

Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks (n=878) were screened for OSA using the Apnea Risk Evaluation System Questionnaire; a score ≥6 denoted high OSA risk. The Sleep Disorders Questionnaire was used to assess insomnia based on three common insomnia symptoms: trouble falling asleep, difficulty staying asleep, and early morning awakening. Physical Health Composite Score (SF-12PCS) and Mental Health Composite Scores (SF-12MCS) were generated based on how the person answered the SF-12 questions. Scores range from 0 to 100, where 0 indicates the lowest level of health and 100, the highest. Logistic regression models were used to assess associations of physical and mental health among Blacks at risk for OSA, reporting insomnia symptoms, and co-occurring OSA risk and insomnia symptoms. All models adjusted for differences in age, sex, and BMI.#8232;

Results

The prevalence of OSA risk, insomnia symptoms, and co-occurring OSA risk and insomnia symptoms was 47.9%, 73.3%, and 40.2%, respectively. Logistic regression analyses showed lower physical score was positively associated with the odds of reporting insomnia symptoms (OR=1.03, p=0.007) and co-occurring OSA risk and insomnia symptoms (OR=1.02, p=0.001). Lower mental score was positively associated with the odds of OSA risk (OR=1.04, p=0.001), insomnia symptoms (OR=1.04, p=0.001), and co-occurring OSA risk and insomnia symptoms (OR=1.04, p=0.001). Individuals with OSA were less likely to report higher physical scores compared with those with co-occurring OSA risk and insomnia symptoms.

Conclusion

Results demonstrate that blacks with insomnia symptoms are more likely to endorse worse physical and mental health. Future research should investigate further the mechanism underlying co-occurring OSA and insomnia in this population using objective measurements.

Support (If Any)

Support: NIH R01MD007716
0742 Characteristics of the Low ArTH phenotype in patients with OSA
Authors: Aiyer Ishan , Taweesedt Pahnwat , Gill Yash , Choudhury Saiara , Sharma Munish , Surani Salim
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is a heterogenous disease with both anatomic and nonanatomic factors contributing to the pathophysiology. Recently low arousal threshold (ArTH) has been described in some patients with sleep apnea and there is early evidence emerging that it could be a clinical phenotype. The aim of this study was to characterize this phenotype in a large cohort of patients with sleep apnea confirmed by overnight polysomnography

Methods

The setting was a community sleep center. We performed a retrospective review of patient charts. We included patients who underwent full-night diagnostic PSG. OSA was defined as an apnea hypopnea index (AHI) of > 5. Epworth score, body mass index (BMI), neck circumference, and upper airway size using Modified Friedman (MF) were recorded. Low ArTH was calculated using AHI, fraction of hypopneas and O2 nadir.Abnormal airway narrowing was defined by MF >2. Large neck was defined by neck circumference ≥ 17 inches in males or ≥ 16 in females. Obesity was defined by BMI>30 kg/m2.

Results

652 patients were included - 421(65%) were male, and 230 (35%) female. 299 (46%) of patients had a low ArTH phenotype. Mean age was similar in both groups 54 +/- 14 vs 55 +/- 13 years. Male % was less pronounced in the low ArTH group (57% of patients with low ArTH male vs 71% of without low ArTH; p<0.05). Patients with a low ArTH had lower percentage of abnormal airway narrowing (53.5 vs 62.6%, p<0.001), large neck circumference ( 64.6 vs 78.8%, p<0.001) and obesity (65.6 vs 77.9%, p<0.001). Average BMI was lower in the low ArTH group (34.8 +/- 8 vs 36.9 +/- 8; p < 0.005), and neck circumference was also lower in low ArTH group (NC 16.5 +/- 1.8 vs 17.4 +/- 1.8 respectively). Epworth sleepiness scale was lower in low ArTh group (10 +/- 8 vs 11 +/- 9; p 0.007)

Conclusion

We describe the phenotypic characteristics of low ArTH phenotype in a large cohort of patients with OSA. Patients with low ArTH have lower BMI, lower neck circumference, and lower Modified Friedman. Further research studies should focus on whether there are differences in therapeutic responses to this phenotype, and what clinical characteristics might help clinicians more effectively detect this phenotype.

Support (If Any)

NA
0744 A Comparison of Visual and Physiologic Assessments of Upper Airway Collapse during Drug-Induced Sleep Endoscopy (DISE)
Authors: Seay Everett , Dedhia Raj , Thuler Eric , Jafari Niusha , Keenan Brendan , Troske Kendra , Schwartz Alan
Published: May 2022

Introduction

The VOTE score, critical closing pressure (Pcrit), and therapeutic CPAP levels are assessments that quantify upper airway collapse by either subjective visual scoring or objective pressure-flow analysis. We hypothesized that there would be an association between collapse severity and physiologic metrics (VOTE versus Pcrit and PAP levels, respectively) acquired during drug-induced sleep endoscopy (DISE).

Methods

This prospective cohort study evaluated 100 consecutive patients with obstructive sleep apnea (OSA) who underwent DISE with application of nasal positive airway pressure between June 3rd, 2020 and June 11th, 2021. Patients were assigned a VOTE score of 0, 1, or 2 indicating no collapse, partial collapse, or complete collapse at the velum, oropharynx, tongue base, and epiglottis, respectively. We assessed two metrics of pharyngeal collapsibility with progressive increases in nasal pressure: (1) the pressure at which inspiratory airflow commences (critical pressure, Pcrit), and (2) the pressure at which inspiratory flow limitation is abolished (pharyngeal opening pressure, PhOP). Our analysis examined the association between the composite VOTE score [0-8 units] and collapsibility metrics.

Results

Ninety-one patients met inclusion criteria for VOTE scoring; of these, 87 were included for PhOP analysis and 79 for Pcrit analysis. The cohort was 76% male, mean (SD) age was 54.7 (14.1) years, body-mass index was 29.7 (4.9), and AHI was 30.3 (20.9). Composite VOTE score was positively associated with Pcrit (β = 0.88 ± 0.38 cm H2O per unit, standardized estimate = 0.26, p=0.023). We found no significant association between the composite VOTE score and PhOP (β = 0.57 ± 0.40 cm H2O per unit, standardized estimate = 0.15, p=0.162).

Conclusion

Our findings suggest that visual and physiological assessments of upper airway collapsibility provide both overlapping and complementary information in characterizing upper airway mechanics. Measures of pharyngeal collapsibility during DISE can be used to model the ultimate impact of therapeutic maneuvers on OSA. Future studies investigating the utility of each assessment both in isolation and in combination for predicting OSA therapy outcomes are indicated.

Support (If Any)

National Institutes of Health: 1R01HL144859
0762 Baseline characteristics: Solriamfetol’s effect on cognitive Health in Apnea participants during a Randomized Placebo-controlled study (SHARP)
Authors: Van Dongen Hans , Dronamraju Nalina , Macfadden Wayne , Leary Eileen
Published: May 2022

Introduction

Patients with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) may experience cognitive impairment. Solriamfetol (Sunosi®) is a dopamine/norepinephrine reuptake inhibitor approved in the US and EU to treat EDS associated with OSA. The objective of this study is to assess whether solriamfetol reduces cognitive impairment in patients with EDS associated with OSA.

Methods

This phase 4, randomized, double-blind, placebo-controlled, crossover trial (NCT04789174) is enrolling adults with OSA and associated EDS (Epworth Sleepiness Scale score >10) and impaired cognitive function defined by an age-adjusted scaled score ≤8 on the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Coding subtest and a score ≥9 on the British Columbia–Cognitive Complaints Inventory (BC-CCI). Participants are randomized (1:1) to 2 weeks of placebo or solriamfetol (75 mg/day for 3 days, then 150 mg/day) during treatment period 1. After a 1-week washout, participants crossover to receive 2 weeks of the opposite treatment during treatment period 2. Assessments at baseline and after each treatment period include Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Coding administered 2, 4, 6, and 8 hours post-dose and the BC-CCI. The primary endpoint is change from baseline after each treatment period in the average of 2- and 4-hour post-dose RBANS Coding scores. A secondary endpoint is change from baseline after each treatment period in BC-CCI score. Target enrollment range is 116‒164 participants, pending interim analysis. Enrollment is ongoing; baseline characteristics to date are reported.

Results

As of October 20th, 2021, 33 participants have been randomized across 20 study sites in North America and Europe. In the intent-to-treat population to date (n=33), mean±SD age is 53.0±10.4, mean±SD BMI is 31.6±4.5, 64% are male, 70% are White (Black or African American, 24%; Asian, 6%), and most (91%) are not Hispanic or Latino. The mean±SD WAIS-IV Coding subtest age-correct scaled score is 6.7±1.3 at baseline, which is below previously observed scores in healthy individuals.

Conclusion

This ongoing study is the first to examine solriamfetol’s impact on cognitive impairment in participants with OSA. Participants enrolled to date reflect the typical demographics of patients with OSA and demonstrate substantial cognitive impairment.

Support (If Any)

Jazz Pharmaceuticals
0770 The effect, compliance, and side effect of acetazolamide in obstructive sleep apnea patients with high loop gain: a retrospective study
Authors: Ni Yuenan , Thomas Robert
Published: May 2022

Introduction

Acetazolamide (AZT) has beneficial effects on central, high altitude sleep apnea, or residual apnea on CPAP, high loop gain obstructive sleep apnea (HLGSA is general). Data on intermediate and long-term real world effectiveness of AZT is lacking.

Methods

Patients with HLGSA (mostly HLG OSA) and using AZT were included. The auto-machine estimated (aREIFLOW) and manually scored respiratory events(mREIFLOW), compliance to PAP, and excessive sleepiness scale were compared prior to, and after 3 months of AZT.

Results

The total study sample size of Diamox users was 325 patients; 43 stopped AZT in one month. Automated and/or manual efficacy parameters were available in 109 for before-after comparison, but not available in the rest of them due lack of waveforms (manufacturer limitation) or not using PAP before AZT (i.e., started simultaneously). AZT reduced aREIFLOW (2.60 [1.70-5.35] vs. 5.10[2.90-10.25], p<0.001). and the percentage of patients whose aREI-FLOW >5 times/hour (50.5% vs. 27.5%, p<0.001). AZT did not influence mean daily usage of PAP (372.53 [295.26-444.22] vs. 368.50 [273.00-438.87] minutes, p=0.275) or the percentage of the day using the machine >4 hours (87.50[75.00-100.00] vs. 87.50 [62.50-100.00], p=0. 999). In the 75 patients with manually scored waveform data, AZT reduced the mREIFLOW (21.11[15.07-28.14] vs. 28.55[21.92-35.45], p<0.001), and the percentage of patients whose mREIFLOW >20 times/hour (78.7% % vs. 52.0%, p<0.001 ). AZT decreased the Epworth sleepiness scale (5[4-8] vs. 6.5[4-12], p=0.009). Among 282 patients who used AZT long term, 60 reported side effects. The most common side effect was paresthesia (7.09%). .

Conclusion

Chronic use of AZT can reduce the REIFLOW in HLG sleep apnea (HLGSA, predominantly obstructive) treated by PAP. Adherence to AZT was good, and the most common side effect even at low doses was distal paresthesia.

Support (If Any)

This study was supported by American Academy of Sleep Medicine Foundation, category-I award to RJT
0771 Artificial Intelligence Based Mask Fit Algorithm Application in the Pittsburgh Veteran Population
Authors: Chan Megan , Soreca Isabella , Ali Mazen El , Chakravorty Sangeeta , Gulla Aaron , Shroyer Brian , Atwood Charles
Published: May 2022

Introduction

Positive airway pressure (PAP) therapy has been used for obstructive sleep apnea (OSA) since 1980 and remains the treatment of choice for moderate to severe OSA. Proper mask fitting for patient comfort is essential to continued success on PAP therapy, as early adherence rates are strong predictors of future use. Mask selection continues to be challenging given the significant heterogeneity in craniofacial phenotypes and the rapidly growing mask options. Artificial intelligence software has combined survey data and digital photography to algorithmically predict PAP masks for best fit. This study aimed to describe mask failure rates in the Pittsburgh Veteran population with OSA following mask selection utilizing this specialized software.

Methods

Retrospective chart review was performed on 124 patients who underwent mask fitting with AI software May through November 2021. The primary outcome was to determine the rate of mask success within 1-3 months of fitting as defined by absence of mask switching. Mask switch was identified when patients underwent re-evaluation for new mask selection either by the AI software or had evidence of new mask selection from supply orders.

Results

Of the 124 patients who underwent evaluation with AI mask fit software, 96% were male with an average AHI 35/hr, BMI 34 and average age of 58 years. Of the 65 patients who were new to PAP therapy, 14 patients required refitting, yielding an initial mask acceptance rate of 78%. Of the 59 patients established on PAP, 8 required subsequent mask switches, yielding a refit mask acceptance rate of 86%. Overall mask acceptance rate after first exposure to fitting software across both groups was 82%.

Conclusion

AI software appears to result in successful mask fitting in a high proportion of VA patients. Higher mask acceptance rate was noted in the refit group, suggesting a particular use-case for this software. Most importantly, this software allows for remote mask fitting. This is ideal given recent telehealth growth and can save time and visits, leading to expedited therapy and increased access.

Support (If Any)
0848 Two Are Better Than One: Treatment of Complex Sleep Apnea with Two Distinct Sleep Neurostimulators
Authors: BalbiCaruso Nicolas , Goss Deborah , Ashtyani Fariborz , Ashtyani Laura , Simons Grant
Published: May 2022

Introduction

Complex sleep apnea refers to the emergence of central apnea when obstructive apneas have been adequately treated. While a combination of medications and noninvasive positive airway pressure ventilation is frequently used in patients with this syndrome, the optimal treatment has not yet been fully elucidated. With the advent of nerve stimulation therapy, it is now possible to target specific physiologic mechanisms and provide precise and adjustable therapy. We present a case in which two distinct nerve stimulators were used to successfully treat a patient with complex sleep apnea.

Report of Cases: We present a case in which a ptient with complex slepe apnea was successfully treated by implantation of two distinct nerve stimulators: hypoglossal nerve stimulation therapy for obstructive sleep apnea and phrenic nerve stimulation therapy for concomitant central sleep apnea.

Conclusion

Complex sleep apnea was successfully treated in this patient with the combination of hypoglossal and phrenic nerve stimulation therapy as evidenced by a reduction in both the obstructive and central apnea hypopnea indices. This patient also had significant clinical improvement with decreased excessive daytime sleepiness and improved daytime functioning as evidenced by decreased Epworth Sleepiness Score, improved patient reported daytime activity, decreased apnea hypopnea index, and increased total sleep time. This case provides evidence for the efficacy and safety of the simultaneous use of hypoglossal and phrenic nerve stimulation for the treatment of complex sleep apnea. Is also highlights the importance of obtaining a laboratory polysomnographic evaluation in all patients prior to any sleep device implantation. Further study is needed, however, to establish the long-term efficacy of this approach to treatment.

Support (If Any)

I am seeking financial support and assistance for meeting attendance and travel for the June sleep meeting from Inspire Sleep Apnea and other travel assistance funds.
Cerebro-cerebellar interactions in nonhuman primates examined by optogenetic functional magnetic resonance imaging
Authors: Goda Naokazu , Hasegawa Taku , Koketsu Daisuke , Chiken Satomi , Kikuta Satomi , Sano Hiromi , Kobayashi Kenta , Nambu Atsushi , Sadato Norihiro , Fukunaga Masaki
Published: May 2022

Functional magnetic resonance imaging (fMRI) is a promising approach for the simultaneous and extensive scanning of whole-brain activities. Optogenetics is free from electrical and magnetic artifacts and is an ideal stimulation method for combined use with fMRI. However, the application of optogenetics in nonhuman primates (NHPs) remains limited. Recently, we developed an efficient optogenetic intracortical microstimulation method of the primary motor cortex (M1), which successfully induced forelimb movements in macaque monkeys. Here, we aimed to investigate how optogenetic M1 stimulation causes neural modulation in the local and remote brain regions in anesthetized monkeys using 7-tesla fMRI. We demonstrated that optogenetic stimulation of the M1 forelimb and hindlimb regions successfully evoked robust direct and remote fMRI activities. Prominent remote activities were detected in the anterior and posterior lobes in the contralateral cerebellum, which receive projections polysynaptically from the M1. We further demonstrated that the cerebro-cerebellar projections from these M1 regions were topographically organized, which is concordant with the somatotopic map in the cerebellar cortex previously reported in macaques and humans. The present study significantly enhances optogenetic fMRI in NHPs, resulting in profound understanding of the brain network, thereby accelerating the translation of findings from animal models to humans.
Limited accumulation of high-frequency somatic mutations in a 1700-year-old Osmanthus fragrans tree
Authors: Duan Yifan , Yan Jiping , Zhu Yue , Zhang Cheng , Tao Xiuhua , Ji Hongli , Zhang Min , Wang Xianrong , Wang Long
Published: May 2022

Lifespan varies greatly between and within species. Mutation accumulation is considered an important factor explaining this life-history trait. However, direct assessment of somatic mutations in long-lived species is still rare. In this study, we sequenced a 1700-year-old sweet olive tree and analysed the high-frequency somatic mutations accumulated in its six primary branches. We found the lowest per-year mutation accumulation rate in this oldest tree among those studied via the whole-genome sequencing approach. Investigation of mutation profiles suggests that this low rate of high-frequency mutation was unlikely to result from strong purifying selection. More intriguingly, on a per-branching scale, the high-frequency mutation accumulation rate was similar among the long-lived individuals such as oak, wild peach and sweet olive investigated here. We therefore suggest the possibility that the accumulation of high-frequency somatic mutations in very long-lived trees might have an upper boundary due to both the possible limited number of stem cell divisions and the early segregation of the stem cell lineage.
Differences in the metabolic and functional mechanisms used to tolerate flooding inGuazuma ulmifolia(Lam.) from flood-prone Amazonian and dry Cerrado savanna populations
Authors: Ribeiro Isadora M , Vinson Christina C , Coca Guilherme C , Ferreira Cristiane da S , Franco Augusto C , Williams Thomas C R
Published: May 2022

Flood tolerance is crucial to the survival of tree species subject to long periods of flooding, such as those present in the Amazonian várzea. Tolerance can be mediated by adjustments of metabolism, physiology and morphology, reinforcing the need to investigate the physiological and biochemical mechanisms used by tropical tree species to survive this stress. Moreover, such mechanisms may vary between populations that are subjected to differences in the frequency of flooding events. Here, we aimed to identify the mechanisms used by two populations of the tropical tree Guazuma ulmifolia (Lam.) to tolerate flooding: an Amazonian population frequently exposed to flooding and a Cerrado population, adapted to a dry environment. Young plants were subjected to a flooding of the roots and lower stem for 32 days, followed by 17 days of recovery. Amazonian plants exhibited greater increases in shoot length and higher maximum photosynthetic rate (Amax) compared with non-flooded plants from 7 days of flooding onwards, whereas increased Amax occurred later in flooded Cerrado plants and was not accompanied by increased shoot length. Lactate accumulated in roots of Cerrado plants after 24 h flooding, together with transcripts coding for lactate dehydrogenase in roots of both Cerrado and Amazonian plants. After 7 days of flooding, lactate decreased and alcohol dehydrogenase activity increased transiently, together with concentrations of alanine, γ-aminobutyric acid and succinate, indicating activation of metabolic processes associated with low oxygen availability. Other amino acids also increased in flooded Cerrado plants, revealing more extensive metabolic changes than in Amazonian plants. Wetland and dryland populations of G. ulmifolia revealed the great capacity to tolerate flooding stress through a suite of alterations in photosynthetic gas exchange and metabolism. However, the integrated physiological, biochemical and molecular analyses realized here indicated that wetland plants acclimatized more efficiently with increased shoot elongation and more rapid restoration of normal metabolism.
The Feasibility of Accelerating to Practice™ for Senior Baccalaureate Nursing Students’ Capstone Experience
Authors: Patterson Barbara J. , Rogers Meagan R. , Forneris Susan Gross , Allard Patti
Published: May 2022

With the ongoing debate on transition-to-practice gaps and lack of readiness for practice by novice nurses, curricular enhancements and innovation are imperative. A feasibility study was undertaken to inform and assess the integration of an Accelerating to Practice (A2P) curriculum in an academic context. Data from senior capstone students, faculty, and clinical preceptors provide evidence of the usefulness and applicability of A2P to provide intentional learning outcomes targeted at new graduates’ areas of weakness. This experience was aimed at clinical decision-making with psychomotor skill-laden activities deemphasized. A2P scaffolding aided in deeper learning and resulted in improved student learning.
NAL-NL2 Prescriptive Targets for Bone Conduction Devices With an Adaptation to Device Constraints in the Low Frequencies
Authors: Toll Martijn , Dingemanse Gertjan
Published: May 2022

Objectives:

To study the effectivity of a transformed NAL non-linear version 2 (NAL-NL2) gain prescription for percutaneous bone conduction devices (BCDs) and to investigate how to take into account output constraints for the lower frequencies.

Design:

The NAL-NL2 prescription was converted to a bone conduction prescription rule. Adaptations were needed, as this converted rule prescribes more output at low frequencies than the device delivers. Three adaptations with different audibility and compression were compared. Setting 1 (S1, “optimal audibility”) had most audibility due to adapted frequency-dependent compression, setting 2 (S2, “moderate audibility”) had moderate output reduction below 1 kHz, and setting 3 (S3, “reduced audibility, least distortion”) had most output reduction. Eighteen experienced BCD users rated their relative sound quality in paired comparisons for different sounds (own voice, mixed voices, traffic noise, and music). In addition speech intelligibility in quiet and noise were assessed.

Results:

The relative sound quality rating for the adapted prescriptions varied between the stimuli: more low-frequency sound was preferred for music (S1 over S3), and less low-frequency sound was preferred for the own voice (S2 and S3 over S1). No differences in quality rating were found for mixed voices or traffic noise. Speech intelligibility in quiet scores at 45 dB SPL was significantly lower for S3 than for S1. Speech intelligibility in noise was significantly reduced in all settings and S3 yielded significantly better speech intelligibility in noise than S1.

Conclusions:

With a moderate gain reduction for low frequencies to comply with device constraints the transformed NAL-NL2 prescription was found suitable for fitting BCDs. Perceived sound quality depended on the gain settings, but also on the sound spectra and how the sound was appreciated. A moderate gain reduction below 1 kHz seems to be the optimal adaptation as it has a neutral or positive relative sound quality for all stimuli without negative effects on Speech intelligibility. The NAL-NL2-BC prescribed a sufficient amount of gain, as indicated by the speech tests.
Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: a systematic review
Authors: Forogh Bijan , Karimzad Yousef , Babaei-Ghazani Arash , Janbazi Lobaneh , Bagherzadeh Cham Masumeh , Abdolghaderi Siavash
Published: May 2022

Introduction:

This systematic review evaluates the available evidence for extracorporeal shockwave therapy (ESWT) use in the treatment of medial tibial stress syndrome (MTSS).

Method:

PubMed, EMBASE, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) database searches were performed without a time limit in August 2021. Two independent researchers performed the search, screening, and final eligibility of the articles. Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by two reviewers using the Physiotherapy Evidence Database scale (PEDro).

Results:

Three studies were identified that compared 23, 12, and 22 participants in the intervention group with 19, 12, and 20 participants in the control group, respectively. The mean age of participants in these studies was 26.51 yr, and the mean duration of symptoms in the two studies that reported this was 16.36 mo. All studies used focus shockwave therapy.

Conclusions:

Extracorporeal shockwaves reduced pain and time to recovery and increased patient satisfaction. No study reported adverse effects. Based on the limited studies, ESWT may reduce pain and shorten recovery duration in MTSS. Further randomized clinical trials with sham control may substantiate these findings in other patient populations.

Level of Evidence:

Level I.
Influenza Vaccination in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis
Authors: Tsiakos Konstantinos , Kyriakoulis Konstantinos G. , Kollias Anastasios , Kyriakoulis Ioannis G. , Poulakou Garyphallia , Syrigos Konstantinos
Published: May 2022

The safety and efficacy of influenza vaccination is not well-studied in cancer patients receiving immune checkpoint inhibitors (ICIs). A systematic review and meta-analysis was performed aiming to summarize available data regarding influenza vaccination in ICI-treated cancer patients. Peer-reviewed studies or nonpeer-reviewed conference abstracts including ICI-treated cancer patients who received at least 1 dose of influenza vaccine were deemed eligible. A systematic search in PubMed/EMBASE was performed until October 26, 2021. Endpoints of interest included mortality as the primary outcome and secondary safety outcomes such as the incidence of immune-related adverse events (irAEs). Twenty-five studies were included in the systematic review, among which 9 were included in the meta-analysis. Meta-analysis of 3 studies (n=589, weighted age 64 y, men 61%, influenza vaccinated 32%) showed pooled odds ratio for death in influenza vaccinated versus nonvaccinated patients at 1.25 [(95% confidence intervals (CI): 0.81–1.92), P=non significant (NS)]. Meta-analysis of 6 studies studies (n=1285, weighted age 60 y, men 59%, influenza vaccinated 48%) showed pooled odds ratio for any irAEs in influenza vaccinated versus nonvaccinated patients at 0.82 [95% CI: 0.63–1.08, P=NS]. Similar results were observed in sensitivity analyses for serious irAEs, as well as when only peer-reviewed studies were included. Influenza vaccination appears to be a safe and reasonable intervention for cancer patients receiving ICIs. Most data are derived from retrospective observational studies. Randomized studies are needed to provide high-quality evidence.
Radon-222 Charcoal Canister Steady State Model Calibrations Performed in a Highly Controlled Environmental Chamber and a Natural Indoor Environment
Authors: Kennings Thomas W. , Noey Jordan D. , Mata Loren A. , Kearfott Kimberlee J.
Published: May 2022

Charcoal canisters are a common method of 222Rn screening. The calibrations of different batches of activated charcoal used in different canister designs are typically performed in large volume controlled environmental chambers with known and controlled radon concentration, temperature, and humidity. Radon screening could be facilitated in locations without ready access to environmental chambers if canisters could be accurately calibrated and undergo quality control in less controlled environments. This study compares charcoal canister calibrations from a highly controlled radon chamber with calibrations from a basement storage area experiencing temporally varying radon. In addition, the impacts of exposure time and spectral region of interest selection on calibration accuracy are investigated by comparing calibrations calculated using three different choices. Approximately 30 mo after calibrations were completed, groups of canisters were exposed for different durations of time to investigate measurement accuracy and calibration validity over an extended time. A digital simulation of charcoal canister kinetics was also performed to establish limits on how stable radon must be in a space for equilibrium-based calibration to be performed there. Overall, the accuracy of measurements using calibrations from each space differed by less than 10% after 2 d exposure time, showing that carefully controlled conditions are not necessary for the accurate calibration of charcoal canisters. Measurement accuracy differed by less than 2% for different spectral region selections. Accuracy improved slightly with canister exposure duration. Simulations suggest that radon instability is most tolerable near the beginning of canister calibration exposures, but this merits further experimental study.
Sex-specific brain microstructural reorganization in irritable bowel syndrome
Authors: Labus Jennifer S. , Wang Chencai , Mayer Emeran A. , Gupta Arpana , Oughourlian Talia , Kilpatrick Lisa , Tillisch Kirsten , Chang Lin , Naliboff Bruce , Ellingson Benjamin M.
Published: May 2022

Preliminary evidence suggests that there are sex differences in microstructural brain organization among individuals with irritable bowel syndrome (IBS). The aim of this study was to further investigate sex-dependent differences in brain microstructure and organization in a large sample of well-phenotyped participants with IBS compared with healthy controls. We hypothesized that female patients with IBS would show evidence for increased axonal strength and myelination within and between brain regions concerned with pain and sensory processing, when compared with males with IBS. We also hypothesized that female compared with male IBS subjects show greater levels of somatic awareness and sensory sensitivity consistent with multisystem sensory sensitivity. Diffusion tensor images and clinical assessments were obtained in 100 healthy controls (61 females) and 152 IBS (107 females) on a 3T Siemens Trio. Whole brain voxel-wise differences in fractional anisotropy, mean, radial and axial diffusivity, and track density as differences in somatic awareness and sensory sensitivity were assessed using the general linear model. Female compared with male IBS participants showed extensive microstructural alterations in sensorimotor, corticothalamic, and basal ganglia circuits involved in pain processing and integration of sensorimotor information. Together with the observed increases in symptom severity, somatic awareness, and sensory sensitivity, the findings support the hypotheses that the etiology and maintenance of symptoms in females with IBS may be driven by greater central sensitivity for multiple sensory stimuli.
Structured Interventions to Optimize Polypharmacy in Psychiatric Treatment and Nursing Homes
Authors: Stötzner Philip , Ferrebus Abate Rodolfo Enrique , Henssler Jonathan , Seethaler Magdalena , Just Sandra Anna , Brandl Eva Janina
Published: May 2022

Background

Polypharmacy is a common clinical issue. It increases in prevalence with older age and comorbidities of patients and has been recognized as a major cause for treatment complications. In psychiatry, polypharmacy is also commonly seen in younger patients and can lead to reduced treatment satisfaction and incompliance. A variety of structured polypharmacy interventions have been investigated. This systematic review provides a comprehensive overview of the field and identifies research gaps.

Methods

We conducted a systematic review on structured interventions aimed at optimizing polypharmacy of psychotropic and somatic medication in psychiatric inpatient and outpatient settings as well as nursing homes. A search protocol was registered with PROSPERO (CRD42020187304). Data were synthesized narratively.

Results

Fifty-eight studies with a total of 30,554 participants met the inclusion criteria. Interventions were most commonly guided by self-developed or national guidelines, drug assessment scores, and lists of potentially inappropriate medications. Tools to identify underprescribing were less commonly used. Most frequently reported outcomes were quantitative drug-related measures; clinical outcomes such as falls, hospital admission, cognitive status, and neuropsychiatric symptom severity were reported less commonly. Reduction of polypharmacy and improvement of medication appropriateness were shown by most studies.

Conclusions

Improvement of drug-related outcomes can be achieved by interventions such as individualized medication review and educational approaches in psychiatric settings and nursing homes. Changes in clinical outcomes, however, are often nonsubstantial and generally underreported. Patient selection and intervention procedures are highly heterogeneous. Future investigations should establish standards in intervention procedures, identify and assess patient-relevant outcome measures, and consider long-term follow-up assessments.
Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians
Authors: Ma Yanlei , Armstrong David , Forte Gaetano J. , Yu Hao
Published: May 2022

Background:

It is well-documented that the Affordable Care Act Medicaid expansion increased health care utilization by low-income Americans. Emerging studies also found that the expansion changed the geographical distribution of new physicians. However, the effect of the expansion on physician compensation has not been studied.

Objectives:

We aimed to assess how the Medicaid expansion affected the compensation of new primary care physicians (PCPs) and whether the effect differed by specialty, gender, and geography.

Research Design:

We used a quasiexperimental difference-in-differences design to assess changes in compensation for new PCPs from before to after the Medicaid expansion in states that expanded Medicaid compared with states that did not expand.

Subjects:

Our study included 2003 new PCPs who responded to the Survey of Residents Completing Training in New York between 2009 and 2018.

Measures:

Our primary outcome was respondents’ self-reported starting salary for their first year of practice. Our secondary outcomes were respondents’ self-reported additional anticipated income and incentives they received for accepting the job offer.

Results:

We found that starting salaries for new PCPs, especially new general internists and family physicians, grew faster in expansion states than in nonexpansion states. In addition, we found that the expansion was associated with a statistically significant increase in receiving additional anticipated income as part of the compensation package for new PCPs practicing in rural areas.
The 3-m backward walk test: reliability and validity in ambulant people with multiple sclerosis
Authors: Söke Fatih , Demirkaya Şeref , Yavuz Numan , Gülşen Elvan Özcan , Tunca Öznur , Gülşen Çağri , Karakoç Selda , Koçer Bilge , Aydin Fatma , Yücesan Canan
Published: May 2022

To investigate: (a) the interrater and test–retest reliability of the 3-m backward walk test (3MBW) in ambulant people with multiple sclerosis (PwMS); (b) minimal detectable change (MDC); (c) concurrent and known-groups validity; and (d) the cutoff time to best discriminate fallers from nonfallers with multiple sclerosis (MS). Forty-nine PwMS and 36 healthy people were included in this cross-sectional study. The 3MBW was administered with the timed up and go test, Berg Balance Scale, four square step test, Falls Efficacy Scale-International, and Expanded Disability Status Scale. The 3MBW was simultaneously performed by two independent raters to examine the interrater reliability while was repeated after 7–10 days to examine the test–retest reliability. The 3MBW showed good interrater reliability [intraclass correlation coefficient (ICC) = 0.987–0.989] and excellent test–retest reliability (ICC = 0.854–0.889). The MDC was found to be 1.69 s. The 3MBW had moderate-to-strong correlations with the other measures. For the 3MBW, PwMS had worse performance than healthy people (P < 0.001), whereas fallers with MS had worse performance than nonfallers with MS (P < 0.001). The 3MBW time of 7.86 s was determined to best discriminate fallers from nonfallers with MS. The 3MBW is a reliable, simple, and easy-to-administer tool for assessing backward walking among ambulant PwMS.
Moving Forward Into the Future
Authors: Cineas Natalia , Schwartz Donna Boyle , Patel Kanish
Published: May 2022

The nation's largest public health care system, New York City Health + Hospitals (NYC H + H), is engaged in a fundamental transformation of its nursing culture, actualizing many of the recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. NYC H + H and its more than 9600+ nurses and 970+ social workers share a common public health mission, vision, and values to deliver essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. This mission dovetails with all of the recommendations in the Future of Nursing report. Systemwide implementation of these recommendations is proceeding, with some programs further advanced than others. This article highlights the system's diversity, equity, and inclusion initiatives; nursing professional development; collaboration with academic partners; labor contract provisions to support recruitment and retention campaigns; technological advances to remove barriers to patient care; and nurse residency program and professional-shared governance implementation. NYC H + H safeguards 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post–acute care facilities, more than 70 community centers, and correctional health services in city jails.
How Can Framed Mammography Screening Messages Be Optimally Persuasive for Foreign-Born Chinese American Women?
Authors: Sun Yiyuan , Moyer Anne , White Jane H.
Published: May 2022

Background

Foreign-born Chinese American women (FBCAW) have the lowest mammography rates compared with other racial groups despite the overwhelming evidence of the benefits of screening. Message framing based on the prospect theory has shown significant but inconsistent effects on mammogram screening among ethnic minority groups.

Objective

Using data from a randomized controlled trial, this secondary analysis aims to identify factors that interact with message framing to improve mammography screening in FBCAW.

Methods

In the parent study, participants were randomized to receive either a gain- or loss-framed brochure that encouraged mammography screening. Data were collected at baseline and 2 months using validated questionnaires. For this secondary analysis, ordinal logistic regression was performed to identify moderation effects using both per-protocol and intention-to-treat principles.

Results

Participants predominantly had low income, a low level of English proficiency, and no insurance. Lack of access to mammography services, knowledge of making a mammogram appointment, knowledge of insurance coverage for breast cancer treatment, education levels, and mammogram history were significant moderators of the framing effects. Overall, the moderation effects were larger when using per-protocol analysis. Some moderation results under intention-to-treat analysis were different from those using per-protocol analysis.

Conclusions

The persuasive effects of the loss- or gain-framed messages depend on the characteristics of FBCAW. Future studies can identify algorithms to select tailored messages that match individual FBCAW’s characteristics to optimize the effects of framed messages.

Implications for Practice

Findings of this study can guide healthcare providers, especially nurses, to choose different wording when communicating with their clients.