bluuebunny/crossref_metadata_2025 huggingface dataset:
A data mining-based cross-industry process for predicting major bleeding in mechanical circulatory support
Authors: Felix Susanne E A , Bagheri Ayoub , Ramjankhan Faiz R , Spruit Marco R , Oberski Daniel , de Jonge Nicolaas , van Laake Linda W , Suyker Willem J L , Asselbergs Folkert W
Published: October 2021

Aims

Over a third of patients, treated with mechanical circulatory support (MCS) for end-stage heart failure, experience major bleeding. Currently, the prediction of a major bleeding in the near future is difficult because of many contributing factors. Predictive analytics using data mining could help calculating the risk of bleeding; however, its application is generally reserved for experienced researchers on this subject. We propose an easily applicable data mining tool to predict major bleeding in MCS patients.

Methods and results

All data of electronic health records of MCS patients in the University Medical Centre Utrecht were included. Based on the cross-industry standard process for data mining (CRISP-DM) methodology, an application named Auto-Crisp was developed. Auto-Crisp was used to evaluate the predictive models for a major bleeding in the next 3, 7, and 30 days after the first 30 days post-operatively following MCS implantation. The performance of the predictive models is investigated by the area under the curve (AUC) evaluation measure. In 25.6% of 273 patients, a total of 142 major bleedings occurred during a median follow-up period of 542 [interquartile range (IQR) 205–1044] days. The best predictive models assessed by Auto-Crisp had AUC values of 0.792, 0.788, and 0.776 for bleedings in the next 3, 7, and 30 days, respectively.

Conclusion

The Auto-Crisp-based predictive model created in this study had an acceptable performance to predict major bleeding in MCS patients in the near future. However, further validation of the application is needed to evaluate Auto-Crisp in other research projects.
The Josquin canon at 500
Authors: Rodin Jesse
Published: October 2021

No less contentious today than a generation ago, the Josquin canon has sparked confusion since well before the composer’s death. Although modern scholars have repeatedly confronted the problem, until recently it has not been possible to tackle it from the ground up. This essay proposes a practical methodology for doing so. An Appendix classifying music attributed to Josquin by degrees of confidence can serve as a starting point for future research.
Rapid conversion of replicating and integrating Saccharomyces cerevisiae plasmid vectors via Cre recombinase
Authors: Nickerson Daniel P , Quinn Monique A , Milnes Joshua M
Published: October 2021

Plasmid shuttle vectors capable of replication in both Saccharomyces cerevisiae and Escherichia coli and optimized for controlled modification in vitro and in vivo are a key resource supporting yeast as a premier system for genetics research and synthetic biology. We have engineered a series of yeast shuttle vectors optimized for efficient insertion, removal, and substitution of plasmid yeast replication loci, allowing generation of a complete set of integrating, low copy and high copy plasmids via predictable operations as an alternative to traditional subcloning. We demonstrate the utility of this system through modification of replication loci via Cre recombinase, both in vitro and in vivo, and restriction endonuclease treatments.
Genome report: a draft genome of Alliaria petiolata (garlic mustard) as a model system for invasion genetics
Authors: Alabi Nikolay , Wu Yihan , Bossdorf Oliver , Rieseberg Loren H , Colautti Robert I
Published: October 2021

The emerging field of invasion genetics examines the genetic causes and consequences of biological invasions, but few study systems are available that integrate deep ecological knowledge with genomic tools. Here, we report on the de novo assembly and annotation of a genome for the biennial herb Alliaria petiolata (M. Bieb.) Cavara and Grande (Brassicaceae), which is widespread in Eurasia and invasive across much of temperate North America. Our goal was to sequence and annotate a genome to complement resources available from hundreds of published ecological studies, a global field survey, and hundreds of genetic lines maintained in Germany and Canada. We sequenced a genotype (EFCC3-3-20) collected from the native range near Venice, Italy, and sequenced paired-end and mate pair libraries at ∼70 × coverage. A de novo assembly resulted in a highly continuous draft genome (N50 = 121 Mb; L50 = 2) with 99.7% of the 1.1 Gb genome mapping to scaffolds of at least 50 Kb in length. A total of 64,770 predicted genes in the annotated genome include 99% of plant BUSCO genes and 98% of transcriptome reads. Consistent with previous reports of (auto)hexaploidy in western Europe, we found that almost one-third of BUSCO genes (390/1440) mapped to two or more scaffolds despite <2% genome-wide average heterozygosity. The continuity and gene space quality of our draft assembly will enable molecular and functional genomic studies of A. petiolata to address questions relevant to invasion genetics and conservation strategies.
Design synthesis and optimization of a 4-SPS intrinsically compliant parallel wrist rehabilitation robotic orthosis
Authors: Hussain Shahid , Jamwal Prashant K , Van Vliet Paulette
Published: October 2021

Neuroplasticity allows the human nervous system to adapt and relearn motor control following stroke. Rehabilitation therapy, which enhances neuroplasticity, can be made more effective if assisted by robotic tools. In this paper, a novel 4-SPS parallel robot has been developed to provide recovery of wrist movements post-stroke. The novel mechanism presented here was inspired by the forearm anatomy and can provide the rotational degrees of freedom required for all wrist movements. The robot design has been discussed in detail along with the necessary constructional, kinematic, and static analyses. The spatial workspace of the robot is estimated considering various dimensional and application-specific constraints besides checking for singular configurations. The wrist robot has been further evaluated using important performance indices such as condition number, actuator forces, and stiffness. The pneumatic artificial muscles exhibit varying stiffness, and therefore, workspace points are reached with different overall stiffness of the robot. It is essential to assess robot workspace points that can be reached with positive forces in actuators while maintaining a positive definite overall stiffness matrix. After the above analysis, design optimization has been carried out using an evolutionary algorithm whereby three critical criteria are optimized simultaneously for optimal wrist robot design.
The statistical properties of protostellar discs and their dependence on metallicity
Authors: Elsender Daniel , Bate Matthew R
Published: October 2021

We present the analysis of the properties of large samples of protostellar discs formed in four radiation hydrodynamical simulations of star cluster formation. The four calculations have metallicities of 0.01, 0.1, 1, and 3 times solar metallicity. The calculations treat dust and gas temperatures separately and include a thermochemical model of the diffuse interstellar medium. We find that the radii of discs of bound protostellar systems tend to decrease with decreasing metallicity, with the median characteristic radius of discs in the 0.01 and 3 times solar metallicity calculations being ≈20 and ≈65 au, respectively. Disc masses and radii of isolated protostars also tend to decrease with decreasing metallicity. We find that the circumstellar discs and orbits of bound protostellar pairs, and the two spins of the two protostars are all less well aligned with each other with lower metallicity than with higher metallicity. These variations with metallicity are due to increased small-scale fragmentation due to lower opacities and greater cooling rates with lower metallicity, which increase the stellar multiplicity and increase dynamical interactions. We compare the disc masses and radii of protostellar systems from the solar metallicity calculation with recent surveys of discs around Class 0 and I objects in the Orion and Perseus star-forming regions. The masses and radii of the simulated discs have similar distributions to the observed Class 0 and I discs.
Neural Indicator of Altered Mismatch Detection Predicts Atypical Cognitive-Perceptual Experiences in Psychotic Psychopathology
Authors: Pokorny Victor J , Sponheim Scott R
Published: October 2021

Background

Atypical auditory processing (AAP) in psychotic psychopathology is evident in early (N1), mid-latency (P2/N2/mismatch negativity), and late (P3) neural responses. The influence of attention on AAP, and how temporal stages of AAP are associated with phenomenology of psychotic psychopathology are not well understood.

Methods

We used a directed attention oddball task to characterize stages of AAP in psychosis and to examine the influence of selective attention. Ninety patients with schizophrenia (SCZ), 53 patients with bipolar disorder (BP), 90 healthy controls and 72 first-degree relatives of SCZ (SREL) were studied. We used principal components analysis to decompose average-reference 64-channel subject-level ERPs.

Results

Altered attentional modulation was evident in SCZ at early (N1 factor) and late (P3 factor) stages of AAP, but not at mid-latency P2 factor. Irrespective of condition, N1 and P3 were reduced in SCZ, which predicted greater psychopathology and schizotypal personality traits. Diminished mid-latency mismatch detection (P2 factor) was evident in SCZ, BP, and SREL and was associated with greater positive symptoms of psychosis as well as self-reported atypical cognitive-perceptual experiences.

Conclusions

Attentional modulation of early N1, and later P3 neural responses was atypical in patients, but the degree of attentional modulation did not relate to symptom severity or schizotypal traits. Our findings suggest the link between mid-latency mismatch detection and atypical cognitive/perceptual experiences is not driven by attentional deficits alone and point to the promise of mid-latency mismatch detection as a candidate endophenotype and intervention target.
O048 The CF elephant in the adolescent room: a cross sectional study of sleep and mood in adolescents with cystic fibrosis
Authors: Pham H , Ranganathan S , Vandeleur M
Published: October 2021

Background

Mental health issues are of increasing burden within the adolescent CF population, with known impacts from sleep disturbance. There are limited studies examining mediators of this relationship. We aimed to investigate the relationship between sleep quality and mood in adolescents with CF alongside a range potential mediating factors including socioeconomic and family influences in adolescents.

Study Design

Adolescents with CF aged 10–18 and their parents at a Victorian tertiary paediatric CF centre were eligible. Adolescents-parent pairs cross sectionally completed age appropriate online questionnaires assessing sleep (Pediatric Daytime Sleepiness Scale, Sleep Disturbance Scale for Children), mood (Global Anxiety Disorder-7, Patient Health Questionnaire-9, Beck’s Depression Inventory, Brigid Jordan CF screen), health-related quality of life (CF Questionnaire-Revised), family dynamics (Family Assessment Device, Family Management Measure), CF respiratory symptoms (CF Respiratory Symptom Score), and treatment adherence. Socioeconomic status and impacts from pandemic lockdowns were also surveyed.

Progress to date

45 CF adolescents-parent pairs have been recruited. Questionnaires have been distributed and awaiting return of results for analysis.

Intended outcome and impact

We anticipate demonstrating the known association between impaired sleep quality and elevated mood scores. We will also make commentary on associations with a range of social factors (family dynamics, socioeconomic status) as well as parental mental health. Discussion will also include impacts on treatment adherence, HRQOL and respiratory symptom scores. Results from this pilot will inform the upcoming AREST CF prospective longitudinal study where the bidirectional relationships between factors studied can be further explored.
P004 Non-Invasive Ventilation - Partnering with Paediatric NDIS participants and their families
Authors: Angliss M , Leclerc M , Jackman S
Published: October 2021

To discuss a new funding pathway for Non-Invasive ventilation (NIV) in Paediatrics.

Since October 2019, the National Disability Insurance Scheme (NDIS) introduced funding for NDIS participants in the category ‘Disability-related Health Supports - Respiratory Support’.

From August 2020, a nursing project was funded by the Hospital Executive to facilitate the transfer of NIV consumable costs to the NDIS. A retrospective review of 256 NIV patients (Bi-Level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP)) and the patients NDIS eligibility status.

110 patients were identified as potential NDIS eligible patients by Primary diagnosis and their families contacted and supported to access NDIS funding for NIV device and consumables. By May 2021, 163 patients were NDIS participants on NIV therapy.

Formal Assistive Technology (Respiratory ventilation) requests were developed with Key stakeholder input and supplier quotes obtained for machines and consumables.

Nursing support, whilst labour intensive has shown to benefit Paediatric patients and their families accessing NDIS funding for NIV therapy in the future. Furthermore, the purchasing of disability-related health supports through NDIS funding is an alternative funding model for NIV in Paediatrics.
P032 Adequate health literacy predicts adherence to continuous positive airway pressure in adults with Obstructive Sleep Apnoea
Authors: Ellender C , Le Feuvre S , Boyde M , Winter S , Duce B , Hukins C
Published: October 2021

Study Objectives

Obstructive sleep apnoea (OSA) is a chronic disease with significant health implications and adequate adherence to continuous positive airway pressure (CPAP) is essential for effective treatment. In many chronic diseases, health literacy has been found to predict treatment adherence and outcomes. In this study, the aim was to determine the health literacy of a sleep clinic population and evaluate the association between health literacy and CPAP adherence.

Methods

A prospective cohort study was undertaken, recruiting 104 consecutive patients with a variety of sleep diagnoses attending the clinic. The Short Form Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a validated questionnaire was administered to measure health literacy. In a sub-group of 91 patients prescribed CPAP for OSA, CPAP usage was measured, with adequate usage defined as greater than 4hrs/night CPAP therapy.

Results

71% of the sleep clinic cohort was found to have adequate health literacy as measured by the REALM-SF. In those prescribed CPAP for OSA, inadequate health literacy was associated with a two fold increase risk for inadequate CPAP usage (adjusted odds ratio 2.75, 95% CI: 1.00 - 7.6, p = 0.05). There was a 1.7hr/night difference in median CPAP usage comparing those with adequate to inadequate health literacy (4.6hrs versus 6.3hrs/night).

Conclusions

The majority of this sleep disorders cohort had adequate health literacy as measured by the REALM-SF questionnaire. However inadequate health literacy appears to be an independent predictor of treatment adherence, and may represent a potentially modifiable risk factor of poor treatment outcomes in OSA.
P040 Night Shift Work and Disease: A Systematic Review of the Role of Oxidative Stress
Authors: Gibson M
Published: October 2021

Night shift workers make up an essential part of the modern workforce. However, night shift workers have higher incidences of late in life diseases and earlier mortality. Night shift workers are exposed to constant light and experience circadian rhythm disruption. Sleep disruption is thought to increase oxidative stress, defined as an imbalance of excess pro-oxidative factors and reactive oxygen species over anti-oxidative activity. Oxidative stress can damage cells, proteins and DNA and can eventually lead to varied chronic diseases such as cancer, diabetes, cardiovascular disease, Alzheimer’s and dementia. This review aimed to understand whether night shift workers were at greater risk of oxidative stress and to contribute to a consensus on this relationship. Twelve studies published in 2001–2019 examining 2,081 workers were included in the review. Studies compared both the impact of working a single shift and in comparisons between those who regularly work night shifts and only day shifts. All studies had evidence to support this relationship across a range of oxidative stress indicators, including: increased DNA damage, reduced DNA repair capacity, increased lipid peroxidation, higher levels of reactive oxygen species, and to a lesser extent, a reduction in antioxidant defence. This research supports the theory that melatonin and the sleep wake cycle mediate the relationship between shift work and oxidative stress. It is concluded that night shift work increases the risk for oxidative stress and therefore future disease. Recommendations are made to promote the long-term health of shift workers considering these findings.
P054 The effect of head up bed-tilt (HUT) on sleep disordered breathing (SDB) in patients with supine dominant sleep apnoea (SDOSA): an exploratory study
Authors: Horadagoda C , Kairaitis K , Amis T
Published: October 2021

SDB severity is reduced in SDOSA when posture changes from supine to lateral. Sleeping with a head up bed-tilt(HUT) is known to reduce SDB in some OSA patients. In this exploratory study, we tested whether HUT could be used to reduce SDB in SDOSA patients who had refused continuous positive airway pressure therapy(CPAP).

We studied 5 male patients (age: 60 to 72years, BMI: 25.8 to 32.2kg/m2). Standard, in-laboratory, overnight-polysomnography was performed (Compumedics Ltd, Australia). Posture was monitored, but not restricted, and bed position was set at horizontal(HB) for half the night and at 7° HUT for the remainder (randomised). Polysomnograms were scored by a sleep technician using AASM criteria. SDB severity was quantified using the apnoea hypopnoea index(AHI) and apnoea index(AI). For this analysis, we focus on periods of supine, stage 2 sleep (S2S) only.

Participants spent 23 to 60minutes (range) in S2S with HB and 11 to 36minutes with HUT. AHI was 49 to 138events/hr with HB and 24 to 120events/hr with HUT, representing a fall of 2 to 62events/hr across all patients. AI was 19 to 111events/hr with HB and 0 to 48 events/hr with HUT, a fall of 15 to 96events/hr across all patients.

In these CPAP non-compliant, SDOSA patients, S2S in HUT was associated with a reduction in SDB severity that varied between individuals. Notably apnoeic events were reduced in all patients and eliminated in two patients. We conclude that HUT warrants further investigation as a potential alternative therapy for SDOSA patients intolerant of CPAP.
P057 Virus aerosol propagation by CPAP is proportional to mask leak and can be prevented by use of a hood and air filtration system
Authors: Landry S , Barr J , MacDonald M , Hamilton G , Mansfield D , Edwards B , Joosten S
Published: October 2021

Introduction

Nosocomial transmission of SARS-CoV-2 has caused significant morbidity/mortality in the COVID-19 pandemic. Because patients auto-emit aerosols containing viable virus, these aerosols can be further propagated when patients undergo certain treatments including continuous positive airway pressure (PAP) therapy. This study aimed to assess the degree of viable virus propagated from mask leak in a PAP circuit.

Methods

Bacteriophage PhiX174 (108copies/mL) was nebulised into a custom PAP circuit. Mask leak was systematically varied to 0, 7, 21, 28 and 42 L/min at the mask interface. Plates containing Escherichia coli assessed the degree of viable virus settling on surfaces around the room. In order to contain virus spread a ventilated headboard and high efficiency particulate air (HEPA) filter was tested.

Results

Increasing mask leak was associated with virus contamination in a dose response manner (χ2= 58.24, df=4, p<0.001). Clinically relevant levels of leak (≥21 L/min) were associated with virus counts equivalent to using PAP with a standard vented mask. Viable viruses were recorded on all plates (up to 3.86m from source). A plastic hood with HEPA filtration significantly reduced viable viruses on all plates. HEPA exchange rates of 170 and 470m3/hr eradicated all evidence of virus contamination.

Discussion

Mask leak from PAP circuits may be a major source of environmental contamination and nosocomial spread of infectious respiratory diseases. Subclinical levels of leak should be treated as an infectious risk. Cheap and low-cost patient hoods with HEPA filtration are an effective countermeasure.
P058 Neural aperiodic activity as a novel objective measure of daytime somnolence
Authors: Kang T , Sarkar P , Cross Z , Chatburn A , Singh P , Johnston S , Lushington K , Yeo A
Published: October 2021

Background

Current assessment of excessive daytime somnolence (EDS) requires subjective measurements like the Epworth Sleepiness Scale (ESS), and/or resource heavy sleep laboratory investigations. Electroencephalographic (EEG) measures index intrinsic properties of the central nervous system. One such component is aperiodic neural activity which is thought to reflect excitation/inhibition ratios of neural populations and is altered in various states of consciousness. From this perspective, resting-state aperiodic activity may be a potential biomarker for hypersomnolence. We aim to analyse retrospective EEG data from patients who underwent a Multiple Sleep Latency Test (MSLT) and determine if aperiodic activity is predictive of subjective and objective measures of EDS.

Methods

Participants having undergone laboratory polysomnogram (PSG) and next day MSLT will be grouped into those with and without sleepiness (mean sleep latency (MSL) of < 8min and > 10min respectively). Forty patients in each group (n=80) will be assessed. The primary objective is to compare the aperiodic slope between these groups, and secondary objectives comparing aperiodic activity with ESS and time of day.

Data will be analysed using linear mixed-effect models. Simple linear regressions will be performed between the aperiodic slope and MSL and ESS, with R2 values used to estimate of effect size.

Progress: Formal ethics approval has been submitted and is pending.

Intended Outcome and Impact

In this exploratory study we hypothesise that EDS is associated with a lower aperiodic exponent/flatter slope, and hope to provoke further investigation of this metric as a novel biomarker for sleepiness.
P061 The effect of anxiety on symptom burden in patients with obstructive sleep apnoea
Authors: Kelley L , Hamilton G
Published: October 2021

Background

There is a high prevalence of anxiety in patients with obstructive sleep apnoea and such patients often describe fatigue in addition to sleepiness. We currently use the Epworth Sleepiness Scale (ESS) to quantify sleepiness in our patients, but we do not have useful tools for assessing fatigue. Fatigue is a common symptom in patients with many medical conditions but has not been well studied in patients presenting to sleep services.

Our hypothesis is that patients with obstructive sleep apnoea who have a comorbid anxiety disorder, as measured by the Hospital Anxiety and Depression Scale (HADS) are likely to have increased symptom burden such as fatigue or poorer functional outcomes of sleep.

Methods

Analysis of prospectively collected data from 128 adult patients referred for suspected obstructive sleep apnea to Monash University Health Sleep Clinic. All patients have completed a comprehensive questionnaire prior to their first clinical review assessing their symptom burden at baseline. Questionnaires completed include extensive symptom and medical history assessment, the Fatigue Severity Scale (FSS), ESS, HADS, Functional Outcomes of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI) and Global Fatigue Score. All patients were subsequently reviewed by a clinician and have overnight polysomnography data available.

Progress to date; Data collected for all 128 participants. Preliminary analysis currently underway.

Intended outcome & impact; We intend to examine whether the comorbidity of anxiety results in an increased or different symptom burden in patients referred for suspected obstructive sleep apnoea when compared to patients without a history of anxiety.
P113 An Exploration of Factors that Affect Perceived Onset Latency during the MSLT Test
Authors: Puglia M , Turton A , Stonehouse J , Rossely A , Grbic A , Packer K , Stupar D , Lemarrec J , Howes J , Hamilton G
Published: October 2021

It is assumed that during the MSLT test, the sleep laboratory environment will be appropriately resourced to facilitate sleep. However, anecdotal evidence suggests that a variety of factors may actually hinder sleep onset, although this possibility has not been formally investigated in the literature. Thirty-four MSLT participants, who attended the sleep unit between 2018 and 2019, completed a questionnaire that was designed to test perception of sleep onset latency by asking them how easy/difficult it was for them to fall asleep on 17 items that came from four categories. The four categories were the 1. sleep unit environment, e.g. noise/ room temperature; 2. the MSLT procedure, e.g. wires/fixed nap times; 3. the MSLT staff e.g. manner/ clarity of explanations and 4. pain/distress unrelated to the test. All items were rated on a five-point Likert scale. Space was provided for written comments for each category. Overall, the relationship with staff had the greatest impact on perceived sleep onset latency. Forty-one percent of participants reported that the provision of a thorough explanation of the day’s procedure helped them fall asleep in naps. Thirty-five percent reported that their own pain and discomfort affected their ability to sleep. Light and noise had little impact. This research indicates that the staff-patient relationship plays a significant role in patient’s experience of the MSLT and may potentially affect test outcomes.
P121 Comparison of Actigraphy versus PSG and Perception of Sleep in Patients with Excessive Daytime Sleepiness
Authors: Roebuck T , McDermott E , Cuesta R , Nguy R , Spiteri M , van Braak E , Ho S , Davies S
Published: October 2021

Actigraphy is used as a validated measure of rest and sleep, however, there are reported differences in WASO in healthy individuals (Chinoy, 2021).

Methods

This study compares the sleep parameters from PSG with simultaneous overnight actigraphy on patients the night prior to MSLT. We also compare the actigraphy data collected on the week prior to the PSG with the patient’s sleep diary.

22 subjects, age 38.7 ± 3.1 years, BMI 23.5 ± 1.4 kg/m2, 40.1% male, 4 participants were treated with CPAP.

Results

WASO was found to be under estimated by actigraphy versus PSG (y=-0.957x+18.014, R2=0.51), there is an increase in underestimation beyond 18minutes. Our data also show on overestimation of sleep onset latency by actigraphy versus PSG when sleep latency is longer than 12 minutes (y=0.27x-12.04, R2=0.08). Total sleep time was perceived to be longer on the PSG night than the PSG data shows (y=0.68x-4.65, R2=0.21). Data demonstrated participants to overestimate their sleep period in their sleep diary compared to the actigraphy data (y=-0.87x+6.58, R2=0.21). T-tests showed a significant difference between WASO (minutes) detected by PSG and the actigraphy data (67.4 ± 8.9 vs 33.3 ± 3.9 p=0.0007). There were no other significant differences in the datasets.

Conclusion

Actigraphy uses activity data and light detection to estimate rest and sleep periods in wearers. Our data reflects expected differences reported in the literature of actigraphy data versus PSG due to the limitation of actigraphy being able to differentiate between sleep and motionless wakefulness.
P146 Assessing the Performance of Automatic Analysis During Routine Polysomnography
Authors: Teuwen P , Eriksson N , Mateus E , Denovan T , Scott A
Published: October 2021

Introduction

This study aims to retrospectively assess the performance of automatic analysis (AA) during routine type 1 & 2 PSG studies. A literature review identified a gap in the current research for assessing the use of automatic analysis in routine clinical practice. Routine scientific practice often involves multiple scorers analysing data sets from a variety of study types with varied signal derivations and signal quality.

Methods

Retrospective study (2018–2020). All PSG data were analysed by experienced scientists (ES). The automatic analysis system used was Somnolyzer 24x7. All relevant parameters were analysed using paired T-tests with significance level of α = 0.05. PSG data sets included: Type 1 studies (n = 1370) split into two groups: Group 1 (n= 1148) included studies with automatic analysis only and Group 2 (n = 222) which included studies with automatic analysis and scientist review (SR) overnight. Type 2 studies (n = 235) included studies only with automatic analysis.

Results

Significant differences were found in 13 parameters between AA and ES in type 1 PSG (including total RDI), but with only 4 parameters in type 2 PSG studies.

Conclusions

There were statistically significant differences between automatic analysis and human scoring with routine scientific practice, however there were no differences when involving interscorer variances. These differences may have clinical significance, particularly with medical interpretation and practice.
P168 Pre and postnatal factors associated with periodic breathing in preterm infants
Authors: Yee A , Siriwardhana L , Nixon G , Wong F , Horne R
Published: October 2021

Introduction

Immature cardio-respiratory control in preterm infants often manifests as periodic breathing (PB). A number of pre- and postnatal demographic and clinical factors, such as exposure to maternal smoking, respiratory support and medications may affect respiratory control. We aimed to identify specific factors affecting the frequency of PB in preterm infants before hospital discharge.

Methods

32 healthy preterm infants (14M, 18F) born between 28–32 weeks of gestational age were studied for 2–3 hours with daytime polysomnography at 31–36 weeks (when they had been off respiratory support for ≥ 3 days). % sleep time spent in PB was calculated. Variables are reported as median (IQR) and were compared with Mann-Whitney U and Chi square tests, between infants who spent greater or less than the median time in PB.

Results

29 infants (91%) exhibited at least one episode of PB. Median sleep time in PB was 9.6% (IQR 0.6, 15.6%). Infants with time in PB above the median spent fewer days on respiratory support (4.0 days (1.0, 7.5) vs 9.0 (6.5, 21.5) days, p=0.035), and were younger (post-menstrual age 33.8 (IQR 32.1, 34.5) vs 35.1 (IQR 32.4, 35.6) weeks, p= 0.039).

Conclusions

Of the large number of maternal and infant demographic and clinical variables examined, we found few associations with the time preterm infants spent in PB. Greater % time spent in PB was associated with earlier discontinuation of respiratory support, however larger studies are required to confirm these findings and to investigate if there are any long-term consequences.
Jurassic mammaliaform petrosals from Western Siberia (Russia) and implications for early mammalian inner-ear anatomy
Authors: Schultz Julia A , Ruf Irina , Averianov Alexander O , Schellhorn Rico , Lopatin Alexey V , Martin Thomas
Published: October 2021

Five partially preserved mammaliaform petrosals recovered from Middle Jurassic sediments of the Berezovsk coal mine (Krasnoyarsk Krai, Russia) show similarities to other early mammaliaforms like the morganucodontan Morganucodon and the docodontan Haldanodon in having an inflated promontorium and a curved and apically inflated cochlear canal, but they are distinct from dryolestoid and derived mammalian petrosals by the weak coiling of the cochlear duct and the presence of a perilymphatic foramen with an open perilymphatic sulcus. The two larger and robust specimens exhibit striking similarities to docodontan petrosals. Inside the bone an intricate circumpromontorial venous plexus was discovered, as recently described for the docodontan Borealestes, confirming that this structure is consistently present in basal non-mammalian mammaliaforms. The three smaller and slender petrosals probably belong to haramiyidans and are unique in showing a septum-like structure medially along the cochlear nerve entrance. The protruding perforated bony bar, which is preserved in two of the three, is interpreted here to be a remnant of a bony septum with multiple foramina for cochlear nerve fibres, representing an autapomorphic feature of Haramiyida. This newly described passageway for nerve fibres shows that the formation of the osteological structure surrounding the nervous pathways of the cochlea is more plastic among the non-mammalian mammaliaforms than previously thought.
Comparison of Radiation Exposure Between Anterior, Lateral, and Posterior Interbody Fusion Techniques and the Influence of Patient and Procedural Factors
Authors: Striano Brendan M. , Xiong Grace X. , Lightsey Harry M. , Crawford Alexander M. , Pisano Alfred J. , Schoenfeld Andrew J. , Simpson Andrew K.
Published: October 2021

Study Design.

Retrospective cohort.

Objective.

The aim of this study was to elucidate the relative influence of multiple factors on radiation usage for anterior, lateral, and posterior based lumbar interbody fusion techniques.

Summary of Background Data.

There has been substantial global growth in the performance of lumbar interbody fusions, due to evolution of techniques and approaches and increased attention to sagittal alignment. Utilization of intraoperative imaging guidance has similarly expanded, with a predominance of fluoroscopy and consequent increased radiation exposure. There have been no larger-scale studies examining the role of patient and procedural factors in driving radiation exposure across different interbody techniques.

Methods.

We used a clinical registry to review all single-level lumbar interbody fusions performed between January 2016 and October 2020. Operative records were reviewed for the amount of radiation exposure during the procedure. Patient age, biologic sex, body mass index (BMI), operative surgeon, surgical level, surgical time, and fusion technique were recorded. Multivariable adjusted analyses using negative binomial regression were used to account for confounding.

Results.

We included 134 interbody fusions; 80 performed with a posterior approach (TLIF/PLIF), 43 via an anterior approach (ALIF) with posterior pedicle fixation, and 9 performed with a lateral approach (LLIF/XLIF). Average radiation per case was 136.4 mGy (SE 17.3) for ALIF, 108.6 mGy (16.9) for LLIF/XLIF, and 60.5 mGy (7.4) for TLIF/PLIF. We identified lateral approaches, increased BMI, minimally invasive techniques, and more caudal operative levels as significantly associated with increased radiation exposure.

Conclusion.

We identified several novel drivers of radiation exposure during interbody fusion procedures, including the relative importance of technique and the level at which the fusion is performed. More caudal levels of intervention and lateral based techniques had significantly greater radiation exposure.

Level of Evidence: 4
Association and Risk of Axial Spondyloarthritis of Scoliosis Patients
Authors: Yong Jocelyn Huan , Hong Jia-Pei , Lee Yu-Hao , Huang Chi-Chang , Huang Shih-Wei , Lin Hui-Wen
Published: October 2021

Study Design.

Retrospective longitudinal cohort study.

Objective.

To investigate the incidence and risk of axial spondyloarthritis (axSpA) in patients with scoliosis in Taiwan.

Summary of Background Data.

Scoliosis and axSpA causes back pain which reduces quality of life in many patients. Both scoliosis and axSpA had attracted numerous research attention, but the association between the two was hardly known.

Methods.

In this retrospective study, the data of 25,566 patients were obtained from Taiwan's National Health Insurance Research Database. We identified patients diagnosed with scoliosis and included them in the study cohort. We included age- and sex-matched patients without scoliosis in the control cohort. The total follow-up period was 7 years. Cox proportional hazards models were used to analyze the retrieved data. Hazard ratios (HRs) and adjusted HRs were calculated.

Results.

The study and control cohorts included 4261 and 21,305 patients, respectively. The incidences of axSpA were 141 and 46 per 100,000 person-years in the study and control cohorts, respectively. The crude HRs and adjusted HRs for patients with scoliosis were 2.98 (95% confidence interval, 1.87–4.73; P < 0.001) and 2.78 (95% confidence interval, 1.74–4.43; P < 0.001), respectively. The prevalence of comorbidities such as chronic obstructive pulmonary disease, osteoporosis, depression, autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus), and thyroid disease was significantly higher in the study cohort.

Conclusion.

Our findings indicate an association between scoliosis and axSpA. Additional studies should be performed to explain this phenomenon.

Level of Evidence: 3
A Web-based System to Assist With Etiology Differential Diagnosis in Children With Arterial Ischemic Stroke
Authors: Karthik Anjini , Jiang Bin , Li Ying , Hills Nancy K. , Kuchherzki Maria , deVeber Gabrielle A. , Barkovich A. James , Fullerton Heather J. , Wintermark Max
Published: October 2021

Background and Purpose:

The diagnosis of childhood arteriopathy is complex. We present a Web-based, evidence-backed classification system to return the most likely cause(s) of a pediatric arterial ischemic stroke. This tool incorporates a decision-making algorithm that considers a patient's clinical and imaging features before returning a differential diagnosis, including the likelihood of various arteriopathy subtypes.

Methods:

The Vascular Effects of Infection in Pediatric Stroke study prospectively enrolled 355 children with arterial ischemic stroke (2010–2014). Previously, a central panel of experts classified the stroke etiology. To create this tool, we used the 174 patients with definite arteriopathy and spontaneous cardioembolic stroke as the “derivation cohort” and the 34 with “possible” arteriopathy as the “test cohort.” Using logistic regression models of clinical and imaging characteristics associated with each arteriopathy subtype in the derivation cohort, we built a decision framework that we integrated into a Web interface specifically designed to create a probabilistic differential diagnosis. We applied the Web-based tool to the “test cohort.”

Results:

The differential diagnosis returned by our tool was in complete agreement with the experts’ opinions in 20.6% of patients. We observed a partial agreement in 41.2% of patients and an overlap in 29.4% of patients. The tool disagreed with the experts on the diagnoses of 3 patients (8.8%).

Conclusions:

Our tool yielded an overlapping differential diagnosis in most patients that defied definitive classification by experts. Although it needs to be validated in an independent cohort, it helps facilitate high-quality, and timely diagnoses of arteriopathy in pediatric patients.
Surgical Correction of Lower Lid Epiblepharon With Skin-Only Resection Using a Novel Design
Authors: Chae Woojung , Kim Chang Hoi , Park Jongyeop , Kim Hochang
Published: October 2021

This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4–13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13–31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.
Transfer functions: learning about a lagged exposure-outcome association in time-series data
Authors: Mamiya Hiroshi , Schmidt Alexandra M. , Moodie Erica E. M. , Buckeridge David L.
Published: October 2021

Many population exposures in time-series analysis, including food marketing, exhibit a time-lagged association with population health outcomes such as food purchasing. A common approach to measuring patterns of associations over different time lags relies on a finite-lag model, which requires correct specification of the maximum duration over which the lagged association extends. However, the maximum lag is frequently unknown due to the lack of substantive knowledge or the geographic variation of lag length. We describe a time-series analytical approach based on an infinite lag specification under a transfer function model that avoids the specification of an arbitrary maximum lag length. We demonstrate its application to estimate the lagged exposure-outcome association in food environmental research: display promotion of sugary beverages with lagged sales.
Is the impact of adiposity on taste perceptions moderated by chronic physical activity? An overview of the data from NHANES 2013-2014
Authors: Gauthier Alexandre-Charles , Mathieu Marie-Eve
Published: October 2021

Introduction

Taste is a key sensory modulator of eating behaviour and thus energy intake. The effects of acute exercise has recently been confirmed especially regarding sweet and salty tastes. Physical activity is a safe and effective countermeasure to certain types of chemosensory losses, especially in older populations. Knowing that taste can be impaired with increased adiposity, it is unknown if the adoption of an active lifestyle on a regular basis can mitigate such impairments.

Methods

Data were extracted from NHANES 2013-2014 database. Perception of salt and bitter tastes for Tongue Tip Test and Whole Mouth Test, physical activity levels over an 8-9-day period and adiposity were analyzed. Moderation analyses were used to study the impact of adiposity on taste perceptions, with physical activity level as the moderator.

Results

The 197 participants (130 males) included in this project had a mean±standard deviation age of 49.1±5.2 years, a mean body fat percentage of 31.7±7.6% and mean daily physical activity levels of 11 084±3531 Monitor-Independent Movement Summary unit (MIMS). The positive association between adiposity and both bitter Tongue Tip Test and overall result (salt+bitter) of Tongue Tip Test were moderated by the adoption of an active lifestyle, with better taste scores observed in individuals achieving higher physical activity levels. When moderation analysis were stratified by gender, the effect of physical activity was no longer significant.

Perspectives

This study is the first to evaluate the influence of an active lifestyle on the preservation of some taste perceptions across a wide range of adiposity levels. While differences in taste can be observed regarding body fat percentage, physical activity moderates that relation only when men and women are analysed together.
Open Imputation Server provides secure Imputation services with provable genomic privacy
Authors: Harmanci Arif O. , Kim Miran , Wang Su , Li Wentao , Song Yongsoo , Lauter Kristin E. , Jiang Xiaoqian
Published: October 2021

As DNA sequencing data is available for personal use, genomic privacy is becoming a major challenge. Nevertheless, high-throughput genomic data analysis outsourcing is performed using pipelines that tend to overlook these challenges.

Results

We present a client-server-based outsourcing framework for genotype imputation, an important step in genomic data analyses. Genotype data is encrypted by the client and encrypted data are used by the server that never observes the data in plain. Cloud-based framework can benefit from virtually unlimited computational resources while providing provable confidentiality. We demonstrate server’s utility from several aspects using genotype dataset from the 1000 Genomes datasets. First, we benchmark the accuracy of common variant imputation in comparison to BEAGLE, a state-of-the-art imputation method. We also provide the detailed time requirements of the server to showcase scaling of time usage in different steps of imputation. We also present a simple correlation metric that can be used to estimate imputation accuracy using only the reference panels. This is important for filtering the variants in downstream analyses. As a further demonstration and a different use case, we performed a simulated genomewide association study (GWAS) using imputed and known genotypes and highlight potential utility of the server for association studies. Overall, our study present multiple lines of evidence for usability of secure imputation service.

Availability

Server is publicly available athttps://www.secureomics.org/OpenImpute. Users can anonymously test and use imputation server without registration.

Contact

Arif.O.Harmanci@uth.tmc.edu
Fundamentals of Vaping-Associated Pulmonary Injury Leading to Severe Respiratory Distress
Authors: Esquer Carolina , Echeagaray Oscar , Firouzi Fareheh , Savko Clarissa , Shain Grant , Bose Pria , Rieder Abigail , Rokaw Sophie , Witon-Paulo Andrea , Gude Natalie , Sussman Mark A.
Published: October 2021

Vaping of flavored liquids has been touted as safe alternative to traditional cigarette smoking with decreased health risks. The popularity of vaping has dramatically increased over the last decade, particularly among teenagers who incorporate vaping into their daily life as a social activity. Despite widespread and increasing adoption of vaping among young adults there is little information on long term consequences of vaping and potential health risks. This study demonstrates Vaping-Induced Pulmonary Injury (VAPI) using commercial JUUL pens with flavored vape juice using an inhalation exposure murine model. Profound pathological changes to upper airway, lung tissue architecture, and cellular structure are evident within 9 weeks of exposure. Marked histologic changes include increased parenchyma tissue density, cellular infiltrates proximal to airway passages, alveolar rarefaction, increased collagen deposition, and bronchial thickening with elastin fiber disruption. Transcriptional reprogramming includes significant changes to gene families coding for xenobiotic response, glycerolipid metabolic processes, and oxidative stress. Cardiac contractile performance for systemic output is moderately but significantly impaired, and the shows severe pulmonary side structural remodeling with chamber enlargement. This VAPI model with pulmonary circuit failure demonstrates mechanistic underpinnings of vaping-related pathologic injury.