bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P390: Associations of Sleep Quality With Body Mass Index and Obesity: The Health Needs Assessment Study of Macao Residents
Authors: Xie Yao Jie , Loke Alice Yuen , Cheung Daphne , Lam Nogueira Bernice O.C. , Liu Karry , Leung Angela , Fung Olivia , Tsang Alice , Leong Cindy , Cheong Joe , Van Florence , Molasiotis Alex
Published: December 2020

Background:
There were inconsistent results in the relationship between poor sleep quality and obesity among different population in previous studies. Our study evaluated the association between sleep quality and obesity in a representative adult population of Chinese subjects living in the Macao Special Administrative Region, China.

Methods:
This cross-sectional study was an analysis of 1426 participants aged 18 to 90 years from a community-based health needs assessment study titled “Healthy Living, Longer Lives”. Recruitment was conducted in seven districts of Macao from 2017 to 2018. Stratified sampling by age and gender strata was adopted. The Chinese version of Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. Higher score of PSQI indicates worse sleep quality. Height, weight, and other covariates were collected by self-administered questionnaire. Obesity was defined as body mass index (BMI) ≥ 25 kg/m
2
according to the WHO standard.

Results:
Of all participants, 263 (18.4%) were obese and 285 (20.0%) were overweight. The average BMI and global score of PSQI were 22.9±3.0 kg/m
2
and 4.48±2.58 for men, 22.1±3.3 kg/m
2
and 5.05±2.92 for women, respectively. After adjustment of age, sex, income, marital status, education, smoking, and drinking, a significant negative relationship was found between sleep quality and BMI: higher PSQI global score was associated with higher BMI (β = 0.09, 95% CI: 0.03 - 0.15; P < 0.01). Within the 7 domains of PSQI, higher sleep disturbance score (β = 0.63, 95% CI: 0.34 - 0.93) and daytime dysfunction score (β = 0.41, 95% CI: 0.13 - 0.68) predicted higher BMI (both P < 0.01). The poor sleep status (global PSQI score > 5) was associated with 39.2% greater odds of being obese (95% CI: 1.04-1.87; P < 0.05).

Conclusions:
In a population of young to older adult Macao residents, we found an inverse linear association between sleep quality and BMI. People with sleep disturbance and daytime dysfunction were more likely to be fat. Poor sleep quality was strongly associated with greater obesity.
Abstract P406: Atrial Fibrillation (AF) and Stroke Symptoms in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Reading Turchioe Meghan , Soliman Elsayed Z , Kamel Hooman , Cushman Mary , Soroka Orysya , Masterson Creber Ruth M , Safford Monika M
Published: December 2020

Background:
AF-related thromboembolism increases risk of stroke. Stroke symptoms in the absence of a stroke diagnosis may represent “whispering strokes,” but their association with AF has not been well explored.

Objective:
To examine cross-sectionally the association between AF and self-reported stroke symptoms in the absence of a stroke diagnosis, and whether associations differ by anticoagulant use.

Methods:
We examined data from 27,072 REGARDS participants without a history of stroke or transient ischemic attack (TIA) at baseline. The presence, type, and cumulative number of self-reported stroke symptoms were compared between participants with and without self-reported history or ECG evidence of AF. Logistic regression models examined associations between AF and stroke symptoms, adjusting for sociodemographic, socioeconomic, stroke risk factors, and geographic characteristics. To investigate the possibility of stroke symptoms representing embolic stroke, results were stratified by anticoagulant or antiplatelet agent use.

Results:
The mean age of the sample was 64.4(±9.4), 55.3% were women, and 59.2% were black; 2,124 had evidence of AF. Twenty-nine percent of adults with AF and 17% of those without AF reported at least one stroke symptom. Compared to those without AF, the odds ratio (OR) of any stroke symptom was 2.21 (95% CI 1.88-2.58) among adults with AF not using an anticoagulant or antiplatelet agent and 1.93 (95% CI 1.62-2.30) for those on Aspirin or Plavix only (
Table 1
). Associations were non-significant for those using Warfarin. Similar patterns were observed by each type and cumulative number of stroke symptoms.

Conclusion:
The association between AF and stroke symptoms suggests that some stroke symptoms in the absence of a stroke diagnosis may represent sub-clinical or “whispering strokes.” The attenuation of this association with Warfarin use but not antiplatelet agents supports the possibility that stroke symptoms in the absence of a stroke diagnosis represent undiagnosed embolic stroke.
Abstract P410: Association of Sarcopenia, Low Muscle Mass and Low Muscle Strength With Coronary Artery Calcium Scores
Authors: Szlejf Claudia , Suemoto Claudia K , Bittencourt Marcio S , Santos Itamar S , LOTUFO Paulo A , Bensenor Isabela M
Published: December 2020

Introduction:
Low muscle mass and low muscle strength, the defining components of sarcopenia, are associated with increased risks of cardiovascular disease and mortality. However, little is known about the association of sarcopenia with markers of subclinical atherosclerosis, such as coronary artery calcium (CAC). We assessed the hypothesis that sarcopenia and its defining components are associated with higher CAC scores in middle-aged and older adults.

Methods:
In this cross-sectional analysis we included 2700 participants from the São Paulo site of the Brazilian Longitudinal Study of Adult Health second wave, aged ≥ 50 years, who were submitted to CAC assessment, with no previous history of coronary artery disease and stroke, and with complete data on exposure, outcome and covariates. CAC was measured by noncontrast computed tomography scans and the Agatston method was adopted to calculate CAC scores. Muscle mass was assessed by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. The association of sarcopenia and its defining components with CAC score > 0 or > 100 was investigated with logistic regression. We also investigated the association of continuous appendicular lean mass standardized by body mass index and handgrip strength with CAC score > 0 and > 100. Possible confounders included sociodemographic characteristics, clinical conditions, lifestyle and laboratory parameters.

Results:
Sarcopenia was found in 1% (23 out of 2700) of participants, 23% (609 out of 2700) with low muscle mass and 2% (40 out of 2700) with low muscle strength. CAC > 0 and CAC > 100 were found in 35% (952 out of 2700) and 13% (357 out of 2700) of participants, respectively. After adjustment for sociodemographic characteristics, clinical conditions, lifestyle and laboratory parameters, low muscle mass was associated with CAC > 100 (OR = 1.37, 95%CI 1.03-1.80), but not with CAC > 0 (OR = 1.17, 95% CI = 0.94-1.46). Sarcopenia and low muscle strength were not associated with CAC scores. Additionally, continuous appendicular leans mass standardized by body mass index was associated with lower odds of CAC > 100 (OR = 0.15, 95% CI = 0.05-0.50), although it was not associated with CAC > 0. Finally, continuous handgrip strength was not associated with CAC scores.

Conclusion:
In conclusion, low muscle mass is associated with higher odds of CAC score > 100 in middle-aged and older adults.
Abstract P421: Alternate Health Eating Index & Cognitive Function Among Middle-aged and Older Hispanics/ Latinos: The Hispanic Community Health Study/ Study of Latinos
Authors: Estrella Mayra L , lamar melissa , Durazo-Arvizu Ramon A , Mattei Josiemer , Mossavar-Rahmani Yasmin , Perreira Krista M , Siega-Riz Ana M , Sotres-Alvarez Daniela , Gonzalez Hector M , Gallo Linda C , Daviglus Martha L
Published: December 2020

Introduction:
A healthy diet may promote healthy cognitive aging; however, little is known about associations between diet quality and cognition in Hispanics/Latinos.

Hypothesis:
Higher diet quality (2010 Alternative Healthy Eating Index; AHEI-2010) is associated with better global cognition and performance on specific cognitive tests (verbal learning, memory, verbal fluency, and processing speed) in Hispanics/Latinos.

Methods:
Data from HCHS/SOL Visit 1 (2008-2011; n=8461; ages 45-74 years) were analyzed. The global cognition score was computed as the sum of z-scores for the individual tests. Dietary intake was assessed via two 24-hour recalls. Total AHEI-2010 score was categorized into quintiles (Q); higher Q represents higher diet quality. Cross-sectional associations between AHEI-2010 and each cognitive test were examined using survey-weighted linear regression models adjusted for age, sex, education, and total daily energy intake (Model 1); and Model 1 plus Hispanic/Latino heritage, annual household income, language preference, type 2 diabetes, smoking, and depressive symptoms (Model 2).

Results:
In minimally-adjusted models (Table 1), global cognition, verbal learning, verbal memory, verbal fluency, and processing speed scores were significantly higher by 1.32, 2.38, 1.40, 2.33, and 1.34 units for Q5 (vs. Q1). In fully-adjusted models, global cognitive function scores were significantly higher by 0.28, 0.52, and 0.48 units for Q2 through Q4 (vs. Q1;
p
-trend= 0.042). Verbal learning scores were significantly higher by 0.60, 0.62, 0.92, and 0.88 units for Q2 through Q5 (vs. Q1;
p
-trend= 0.020). Verbal memory scores were significantly higher by 0.33, 0.40, 0.52, and 0.46 units for Q2 through Q5 (vs. Q1;
p
-trend= 0.007). AHEI-2010 was not associated with verbal fluency and processing speed in Model 2.

Conclusions:
Among middle-aged and older Hispanics/Latinos, higher diet quality was associated with better global cognition, verbal learning, and memory, but not with verbal fluency, or processing speed.
Abstract P422: Nonalcoholic Fatty Liver Disease and Cognitive Function in Middle-aged Adults: The CARDIA Study
Authors: Gerber Yariv , Vanwagner Lisa B , Terry James G , Rana Jamal S , Reis Jared P , Yaffe Kristine , Sidney Stephen
Published: December 2020

Background:
Nonalcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular disease (CVD) and its major risk factors. The latter have been linked to accelerated cognitive decline. Whether NAFLD is associated with decreased cognitive performance in midlife remains uncertain.

Methods:
Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study with CT-measured NAFLD and cognitive function assessment at year 25 (2010-2011; n=2,835) were included. Cognitive function was reassessed at year 30 (2015-2016; n=2,388). NAFLD was defined according to liver attenuation and categorized into 3 groups: none [>51 Hounsfield Units (HU)], probable (>40-51 HU), and definite (≤40 HU). Cognitive tests, including the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and Stroop were analyzed with standardized z scores. Linear models were constructed to examine (a) the cross-sectional association between NAFLD and cognitive scores (year 25) and (b) the predictive role of NAFLD in subsequent (year 30) cognitive scores.

Results:
The mean age at baseline was 50.1 (SD, 3.6) years (58% women; 48% blacks), with 398 (14%) and 286 (10%) having probable and definite NAFLD, respectively. In unadjusted models, an inverse association was shown between NAFLD and all cognitive tests. For DSST (
P
interaction
=.047) and RAVLT (

P
interaction

=.033), the association was stronger in whites than blacks. The association was attenuated after age and sex adjustment, and practically eliminated after further adjustment for sociodemographic and CVD risk factors (Table). NAFLD was not predictive of subsequent cognitive performance in any of the measures once baseline scores were adjusted for (all
P
>.10). Using liver attenuation as a continuous variable yielded similar results.

Conclusion:
Among middle-aged adults, an inverse association of NAFLD with cognitive function -evident in whites only- was attenuated by sociodemographic and CVD risk factor adjustment.
Abstract P423: Lactation Duration is Associated With Favorable Cognitive Function in Women During Midlife: The 30-year Cardia Study
Authors: Gunderson Erica P , Lewis Cora E , Lui Jennifer , Yaffe Kristine , Sidney Stephen
Published: December 2020

Introduction:
Lactation has been associated with lower incidence of the metabolic syndrome, type 2 diabetes, hypertension, and early atherosclerosis in women across the childbearing years. The lower risk of cardiometabolic diseases related to higher lifetime lactation may also extend to levels of cognitive function during midlife.

Hypothesis:
We tested the hypothesis that lactation duration is associated with better cognitive function in women during midlife independent of antecedent risk factors, as well as obesity, diabetes, and hypertension.

Methods:
We included 904 women aged 18-30 years at baseline (1985-86) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study without no diabetes before ≥1 birth(s) after baseline, reported lactation duration for each post-baseline birth, and had 6 measures of cognitive function assessed at Year 30 (2015-16) including the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), Stroop Test, Montreal Cognitive Assessment (MoCA), Letter Fluency Test, and Category Fluency Test. Linear regression models estimated mean (95%CI) cognition scores by lactation duration (none, >0 to 6 mos, > 6 to <12 mos, ≥12 mos) adjusted for race, age, BMI, blood pressure, parity, and follow up covariates (Table 1).

Results:
Among parous women (46% black, 54% white) at 30-year follow up, average age was 54 yrs and 47% had obesity, 61% delivered ≥2 births since baseline, 29% used anti-hypertensive medications and 16% developed overt diabetes. Black women were less likely to report >6 mos of total lactation for all births than white women (23% vs. 58%). Unadjusted and fully adjusted mean scores for 3 cognitive function measures had graded direct associations with increasing lactation duration; specifically, the RAVLT, MoCA and Category Fluency Test scores (all p-trend < 0.01).

Conclusions:
In this prospective study, longer lactation duration was associated with more favorable cognition scores among women during midlife.
Abstract P494: Association of Lipid Components With Mortality,Myocardial Infarction, and Stroke in Statin-Naïve Young Adults: A Nationwide Cohort Study
Authors: Lee Heesun , Park Jun-bean , Park Hyo Eun , Choi Su-yeon , Han Kyungdo , Kim Hyung-Kwan
Published: December 2020

Background:
Dyslipidemia is a modifiable cardiovascular risk factor with prognostic implications. Current strategies for lipid management in young adults are largely based on expert recommendations. We sought to investigate the risk of death and cardiovascular disease in relation to lipid components to establish evidence for primary prevention in young adults.

Methods:
In a nationwide cohort using the National Health Insurance claims database, we analyzed 5,688,055 statin-naïve subjects, aged 20-39 years, undergoing health check-up between 2009 and 2014. The study endpoint was a composite of clinical events, including death, myocardial infarction (MI), and stroke. We compared the incidence and the risk of clinical events according to lipid variables, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides.

Results:
During follow-up (median 7.1 years), clinical events occurred in 30,330 subjects (0.53%); 16,262 deaths (0.29%), 8,578 MIs (0.15%), and 5,967 strokes (0.10%). The risk of clinical events gradually increased with increasing TC and triglycerides, and decreasing HDL-C, with a great contribution by MI. LDL-C had a J-shaped association with the study endpoint, showing the lowest risk in LDL-C of 84-101 mg/dL. Among lipid variables, triglycerides remained the sole independent predictor (adjusted HR 1.20,
p
<0.001), after adjusting for conventional risk factors.

Conclusions:
In ‘statin-naïve’ young adults aged 20-39 years, the risk of clinical events was proportional to lipid levels; positively with TC and triglycerides, negatively with HDL-C, and J-shaped with LDL-C. Triglycerides had the strongest and independent association with clinical events. Screening and intervention of abnormal lipid levels, particularly triglycerides, from an early age might be required.
Abstract P498: Association of Steps Per Day With Diabetes, Hypertension, and Obesity Over 10 Years: Results From the Coronary Artery Risk Development in Young Adults Study
Authors: Paluch Amanda E , Pettee Gabriel Kelley , Fulton Janet E , Siddique Juned , Whitaker Kara M , Lewis Cora E , Carlson Susan A , SCHREINER Pamela , Sternfeld Barbara , Sidney Stephen , Carnethon Mercedes R
Published: December 2020

Introduction:
Step counts are an easy way for individuals to quantify their physical activity; there is limited data relating accelerometer-derived step counts with the onset of cardiovascular risk factors. We hypothesized that steps/day are inversely associated with type 2 diabetes, stage 2 hypertension, and obesity 10 years later.

Methods:
Data are from 1,923 CARDIA study participants with valid (≥4 days with ≥10 hours/day) accelerometer wear (ActiGraph 7164) in 2005-2006 with at least one follow-up visit 5- or 10- years later. Multivariable Cox models calculated hazard ratios (HR) and 95% confidence intervals (CI) for incidence of type 2 diabetes, stage 2 hypertension, and obesity.

Results:
The analytic sample (45.3±3.6 years; 58% women, 41% black) had a mean follow-up of 9.7±1.3 years. After adjusting for demographics and lifestyle characteristics, every 1000 higher steps/day was associated with a 10% lower risk of diabetes and 5% lower risk of hypertension. When adding comorbidities to the model, the HRs were slightly attenuated, and remained significant for diabetes [0.93 (95% CI, 0.87-0.99)]. Compared to the lowest step quartile, the highest quartile was at a 43% lower risk of diabetes and a 31% lower risk of hypertension. When testing for interactions by race or sex, the only significant interaction was for sex with obesity as the outcome. Steps were only associated with obesity in women, where every 1000 higher steps/day were associated with a 13% lower risk, and the highest quartile was 61% less likely to develop obesity compared to the lowest quartile.

Conclusions:
Among middle age adults, accumulating a higher volume of steps/day was associated with a lower risk of type 2 diabetes and stage 2 hypertension. In women, higher steps/day was associated with lower risk of obesity. Encouraging the accumulation of steps/day may be an effective public health strategy to lower the burden of cardiovascular risk factors.
Abstract P548: Poorer Objective Sleep is Associated With Greater Arterial Stiffness and Worsening Cardiac Diastolic Function
Authors: Petrov Megan E , Youngstedt Shawn , Mookadam Farouk , Jiao Nana , Lim Lance M , Angadi Siddhartha S
Published: December 2020

Aim:
Few studies have examined the association between objective sleep metrics and arterial and echocardiographic (left ventricular systolic/diastolic function) markers of sub-clinical cardiovascular disease (CVD). The present study examined the association of wrist actigraphy-assessed sleep metrics with arterial stiffness, endothelial dysfunction, and left ventricular systolic/diastolic function.

Methods:
Fifteen young, healthy adults (21-39y; 60% women) with no history of CVD, and no current sleep-disordered breathing (WatchPat200, Itamar Medical) or sleep complaints wore Actiwatch Spectrum Plus actigraphs for eight nights (Philips Respironics, Bend OR) with accompanying sleep logs. Participants underwent fasting vascular testing including central augmented aortic pressure (AP), carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL
TM
), brachial artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300
TM
). Left ventricular function was assessed by ejection fraction (EF%), left atrial volume index (LAVI), deceleration time (DT), and mitral valve E/e’ ratio (MVE/e’) using standardized methods. Bivariate correlations investigating the association between mean total sleep time (TST), sleep efficiency % (SE), sleep-onset latency (SOL), and wake after sleep time (WASO) with cardiovascular indices were conducted. Curvilinear regression models examining quadratic relationships between TST and the cardiovascular indices were conducted.

Results:
On average, participants obtained 6 hrs 44 min of TST (SD=29.1), with 86.0% SE (SD=3.1), 10.6 min SOL (SD=8.5), and 37.0 min WASO (SD=11.6). cfPWV (range: 4.8-7.5), EF% (range: 60.0-72.0), LAVI (range: 15.0-26.7 mL/m
2
), and MVE/e’ (range: 3.2-7.8) were all within normal ranges according to age and sex normative standards. Mean FMD was 9.2% (SD=4.62, range: 4.3-19.8). Correlations indicated that greater SOL was associated with greater cfPWV (r=.63, p=0.01), and AP (r=.57, p=0.03). Lower SE (r= -.70, p=0.003) and higher WASO (r=.71, p=0.003) were associated with higher MVE/e’. WASO was associated with higher DT (r=.57, p=0.04). Curvilinear regression models revealed a quadratic relationship between TST and cfPWV (F[2,11]=9.78, p=0.004) such that shorter and longer TST were associated with greater cfPWV. No sleep metrics were associated with FMD, EF%, or LAVI.

Conclusions:
Among normal sleeping, apparently healthy young adults, with no history of CVD, lower levels of objective sleep quality and both shorter and longer sleep duration were associated with greater arterial stiffness, whereas only lower levels of objective sleep quality were related to worsening left ventricular diastolic dysfunction. These data may have implications for CVD risk reduction in young, healthy adults.
Abstract P554: Multiple Social Determinants of Health and Incident Stroke in the Reasons for Geographic and Racial Differences in Stroke Study
Authors: Reshetnyak Evgeniya , Pinheiro Laura C. , Safford Monika M. , Ntamatungiro Mariella , Carson April P. , Martin Kimberly , Kleindorfer Dawn O
Published: December 2020

Introduction:
Although social determinants of health (SDOH) were shown to be
individually
associated with incident stroke, few studies explored the effect of
multiple
SDOH within the same individuals on incident stroke. To address this limitation, we operationalized SDOH as a count and examined its association with incident stroke. This approach is practically appealing in clinical settings - it is easy to calculate and interpret.

Hypothesis:
We hypothesized that a greater number of SDOH within individuals would be significantly associated with a higher risk of incident stroke.

Methods:
REGARDS is a prospective cohort of 30,239 black and white adults aged
>
45 years recruited in 2003-2007. Sociodemographic, medical history, and stroke risk factors were collected at baseline. To define exposure, we followed the Healthy People 2020 framework, and initially used 10 SDOH to represent 5 domains: education, health, social, economic and neighborhood factors. We selected SDOH that were significantly associated with incident stroke: race, education, income, zip code poverty, health insurance, social isolation, and residence in states with poor public health infrastructure. We then created a primary exposure - a count of SDOH for each individual. The outcome was expert adjudicated incident strokes. Cox proportional hazards models examined associations between a count of SDOH (0, 1, 2, 3+) and incident stroke, adjusting for confounders.

Results:
This study included 27,813 individuals free from stroke at baseline. We observed 1470 incident strokes during the follow-up. A significant interaction between SDOH count and age resulted in stratification at 75 years. In fully adjusted Cox models, among individuals <75 years, risk of stroke amplified with each increase in number of SDOH. This pattern was not observed among those 75+ years (Table 1).

Conclusions:
Individuals <75 years with a greater number of SDOH had higher risk of stroke. Targeting individuals with multiple SDOH, especially those <75 years, may help reduce risk of stroke.
Abstract P561: Fall in the Proportion of Atherothrombotic Stroke in the Last Decade. Success of Current Medical Treatment?
Authors: rosales julieta S , Alet Matias , Pujol Lereis Virginia , Ameriso Sebastian F
Published: December 2020

Background and Purpose:
Etiologic subtypes of ischemic strokes are influenced by the vascular risk factors profile of patients. Strict management of hypertension and dyslipidemia may have an impact on the prevalence of atherosclerosis. We evaluated changes in the proportion of different ischemic stroke etiologies during the last 22 years.

Methods:
We studied patients with acute ischemic strokes admitted to a single institution between 1997 and 2018. Demographics, VRF, treatments prior to admission and TOAST subtypes of ischemic strokes were assessed. These variables were compared between 2 periods: 1997-2007 (P1) and 2008-2018 (P2).

Results:
There were 2747 patients (64% men, aged 66.6 ±14.9 years), 920 subjects in P1 and 1827 in P2. Age and gender distribution did not change over time. Proportion of large artery atherothrombotic strokes decreased from 29% in P1 to 14% in P2 (p <0.0001) and small vessel strokes from 15% in P1 to 11% in P2 (p <0.05). Cardioembolic and undetermined strokes increased from 17 to 25% (p <0.0001) and from 30% to 41% (p <0.0001), respectively. Detection of atrial fibrillation increased from 10% to 19% (p<0.00001). Use of medication prior to stroke increased for aspirin from 27% in P1 to 45% in P2 (p <0.0001), for antihypertensive drugs from 26% to 62% (p <0.0001), for statins from 14% to 42% (p <0.0001) and for anticoagulants from 4% to 9% (p<0.0001).

Conclusion:
The proportion of strokes associated to large and small vessel atherosclerosis is declining with a substantial increase in the proportion of cardioembolic and undetermined strokes. Higher rates of use of preventive medications and higher prevalence and/or better screening for atrial fibrillation could explain, at least in part, these findings.
Abstract P563: Association of Regularly Skipping Meals With Employees’ Workplace Food Choices and Overall Dietary Quality
Authors: McCurley Jessica L , Levy Douglas E , Dashti Hassan S , Rimm Eric B , Gelsomin Emily D , Thorndike Anne N
Published: December 2020

Introduction:
Breakfast skipping has been associated with poor diet, obesity, and risk of diabetes, but less is known about skipping lunch and dinner. We hypothesized that regular meal skipping by employees is associated with less healthy workplace food purchases, poorer dietary quality, and higher body mass index (BMI).

Methods:
This is a secondary analysis of baseline data from 602 hospital employees who regularly purchased from workplace cafeterias and enrolled in a workplace health promotion study in 2016-18. Hospital cafeterias used traffic-light labels (green = healthy, yellow = less healthy, red = unhealthy) for all foods. We calculated a Healthy Purchasing Score (HPS) using 3 months of employees’ purchases and weighting the proportion of items purchased (red=0, yellow=0.5, green=1; range 0-1, higher=healthier purchases). Healthy Eating Index (HEI; range 0-100, higher=healthier diet) was estimated using 24-hour dietary recalls. Meal skipping frequency was self-reported via questionnaire. Linear regression analyses examined differences in HPS, HEI, and BMI by meal skipping frequency (never skip, 1-2 days/week, 3+days/week), adjusting for age, sex, race, ethnicity, education, job type, shift work, marital status, and number of purchases.

Results:
Participants’ mean age was 43.6 years; 79% (N=478) were female and 81% (N=488) white. Mean BMI was 28.3 kg/m
2
(SD: 6.5), and 63% (N=377) were overweight/obese. Mean number of items purchased was 146 (SD: 71); mean HPS was .69 (SD .14) and mean HEI was 60.4 (SD: 12.5). The table shows that frequent meal skippi was associated with less healthy purchases at work, and breakfast skipping was associated with lower dietary quality. Meal skipping was not associated with BMI.

Conclusions:
Employees who skipped meals purchased less healthy food at work and breakfast skippers had poorer overall dietary intake. Results suggest that meal skipping may be an important factor in unhealthy eating habits of employees and should be considered in workplace health promotion efforts.
Multimodal Assessment of the Motor System in Patients With Chronic Ischemic Stroke
Authors: Nazarova Maria , Kulikova Sofya , Piradov Michael A. , Limonova Alena S. , Dobrynina Larisa A. , Konovalov Rodion N. , Novikov Pavel A. , Sehm Bernhard , Villringer Arno , Saltykova Anastasia , Nikulin Vadim V.
Published: December 2020

Background and Purpose:

Despite continuing efforts in the multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the ipsilesional corticospinal tract integrity and the role of the contralesional hemisphere are still lacking. This research aimed to find the best combination of motor system metrics, allowing the classification of patients into 3 predefined groups of upper limb motor recovery.

Methods:

We enrolled 35 chronic ischemic stroke patients (mean 47 [26–66] years old, 29 [6–58] months poststroke) with a single supratentorial lesion and unilateral upper extremity weakness. Patients were divided into 3 groups, depending on upper limb motor recovery: good, moderate, and bad. Nonparametric statistical tests and regression analysis were used to investigate the relationships among microstructural (fractional anisotropy (FA) ratio of the corticospinal tracts at the internal capsule (IC) level (classic method) and along the length of the tracts (Fréchet distance), and of the corpus callosum) and functional (motor evoked potentials [MEPs] for 2 hand muscles) motor system metrics. Stratification rules were also tested using a decision tree classifier.

Results:

IC FA ratio in the IC and MEP absence were both equally discriminative of the bad motor outcome (96% accuracy). For the 3 recovery groups’ classification, the best parameter combination was IC FA ratio and the Fréchet distance between the contralesional and ipsilesional corticospinal tract FA profiles (91% accuracy). No other metrics had any additional value for patients’ classification. MEP presence differed for 2 investigated muscles.

Conclusions:

This study demonstrates that better separation between 3 motor recovery groups may be achieved when considering the similarity between corticospinal tract FA profiles along its length in addition to region of interest-based assessment and lesion load calculation. Additionally, IC FA ratio and MEP absence are equally important markers for poor recovery, while for MEP probing it may be important to investigate more than one hand muscle.
Quantifying shape similarity between prey and uninteresting models to study animal masquerade
Authors: Xiao Fanrong , Bu Rongping , Shi Haitao
Published: December 2020

Masquerade occurs when an organism resembles an inedible or uninteresting object (model), such as a leaf, stick, or stone. The shapes of many species are described as similar to those of models in their microhabitats, but these similarities have not been quantified effectively. To describe the shape similarity between an animal and a model, we applied a shape description method in a field study of the four-eyed turtle (Sacalia quadriocellata). Our results showed that shape similarity between turtles and stones in the Hezonggou River was significantly higher midstream than that upstream and downstream. In line with these findings, masquerade efficiency was highest for turtles in the midstream area, with both inexperienced and experienced human ‘predators’. Masquerade efficiency was positively correlated with shape similarity in all stream sections. Shape similarity ranged from 0 to 1, with <0.65 indicating low masquerade efficiency and >0.80 indicating high masquerade efficiency. Our quantitative method was able to provide data that could be used to form an ecologically plausible argument; thus, shape similarity can be used to assess animal’s masquerade efficiency. This method will be of considerable use in future animal masquerade research.
Consumer Protection in the EU Conflict-of-Laws Framework
Authors: Llorente Carlos
Published: December 2020

Consumer law nowadays pervades all areas of activity where consumers are present. The EU, along with its Member States, is probably one of the leading actors in promoting consumer protection. Also, in a globalized world, where the fact of being a consumer is a valuable asset (given their purchasing power), the cross-border implications of consumer contracts need to be effectively tackled by legislators. The EU has tried to address global legal concerns concerning consumer contracts by producing conflict-of-law rules such as article 6 of the Rome I Regulation and others contained in specifically-focused directives. This article reviews the scope and application of those rules and offers some insight into the not-so-well construed interaction between them all, keeping in mind that article 6 of the Rome I Regulation should be the centre of rotation of all EU PIL law in this field.
Biological Prospecting in Antarctica – A Solution-Based Approach to Regulating the Collection and Use of Antarctic Marine Biodiversity by Taking the BBNJ Process into Account
Authors: Heinrich Katharina
Published: December 2020

Areas beyond national jurisdiction (ABNJ) are covering nearly two-thirds of the world’s oceans and are rich in biological diversity. These also include the Polar Regions, where marine organisms adapted to extreme environments and led to increased scientific interest and activities, including bioprospecting activities. As a result, marine biodiversity is increasingly threatened. Thus, the Convention on Biodiversity (CBD) was established to ensure the conservation and sustainable use of biodiversity but left ABNJ and bioprospecting activities widely unregulated. In Antarctica, for instance, bioprospecting has raised concerns, and the matter has been discussed since 2002. As a result, the United Nations General Assembly (UNGA) Resolution 69/292 concluded the establishment of a new international legally binding instrument (ILBI) on the conservation and sustainable use of marine biological diversity for ABNJ. However, the inclusion of the Antarctic Treaty Area remains unclear. In light of the current BBNJ negotiations, the Antarctic Treaty Consultative Meeting (ATCM) only acknowledges the Antarctic Treaty System (ATS) as the appropriate framework to regulate these activities in Antarctica. Further, it seems to aim for regulation under the ATS, if at all. Therefore, this paper discusses a solution-based approach for possible regulation of the collection and use of Antarctic marine biodiversity. The negotiations and achievements of the current BBNJ process will be taken into account, as they might provide support for the regulation of these issues in Antarctica and the Southern Ocean.
Legal Issues concerning DROMLAN under the Antarctic Treaty System
Authors: Inagaki Osamu
Published: December 2020

The purpose of this paper is to explore possible legal issues concerning the Dronning Maud Land Air Network (DROMLAN) under the Antarctic Treaty system. By examining the recent discussion concerning DROMLAN within the Antarctic Treaty Consultative Meeting (ATCM) and relevant State practice, this paper argues that States parties have difficulty in fully complying with the obligations of advanced notice under Article VII (5) of the Antarctic Treaty and Environmental Impact Assessment under Article VIII (2) of the Madrid Protocol for DROMLAN’s operation. Finally, this paper suggests that good communication among relevant States parties and private actors is important for enhancing compliance with these obligations.
The Déjà vu System of International Trusteeship in Continental Antarctica: A Textual Analysis
Authors: Li Xueping
Published: December 2020

In the name of environmental protection, the Antarctic Treaty Consultative Meeting seems to have borrowed the paradigm of international trusteeship of the United Nations for managing the Antarctic land-based protected areas. By comparing and analysing the critical questions highly concerned, this paper offers preliminary thoughts on the development and refinement of the conception of land-based protected areas as a déjà vu system of international trusteeship and its surrounding legal applications and implications in continental Antarctica, and challenges the direction followed by this system in protecting Antarctic intrinsic values in legal discourse.
Assessing Japan’s Arctic Engagement during the ArCS Project (2015–2020)
Authors: Chuffart Romain , Hataya Sakiko , Inagaki Osamu , Arthur Lindsay
Published: December 2020

As Japan is considered a non-regional actor in Arctic governance, this paper begins with analysing how Japan navigates the web of Arctic governance and how it manages to create a coherent Arctic narrative and engages with the Arctic both inside and outside the region. The present research argues that the construction of an Arctic identity is a praxis performed through time that needs to be constantly reaffirmed. To illustrate this point, the paper then uses a lateral rather than linear approach to assess the influence of the Arctic on Japan at present. This paper assesses Japan’s engagement on the main stage where Arctic governance is performed (i.e. The Arctic Council) since the release of Japan’s Arctic Policy and under the Arctic Challenge for Sustainability project, Japan’s flagship program for Arctic research. Looking to the future, countries such as Japan who are willing to be involved in all parts of Arctic governance will have to make a choice about what kind of Arctic relationships they want to create and in which of these relationships Japan could invest more.
Reducing Language Barriers in Science for Students with Special Educational Needs
Authors: Boyle Susannah , Rizzo Karen L. , Taylor Jonte C.
Published: December 2020

An increased focus on science instruction and science learning for students with special education needs has been growing over the past decade. Research studies, particularly meta-analyses focused on science for students with disabilities, show investigators are interested in what science strategies and approaches (e.g., graphic organizers, inquiry-based instruction,) work for students regardless of identified need (e.g., learning disabilities). However, researchers have noted that science instruction can often rely heavily on text and have burdensome reading demands that may cause students with disabilities to struggle. Research suggests that incorporating Universal Design for Learning (UDL), multimodal representation, the arts, and communicative technologies can reduce the language load for learning science content and phenomena for students with special education needs. The purpose of this paper is to provide resources and suggestions for reducing the language barriers in science for students with special education needs through the use of multimodal representation and communication technologies.
Greening the BRI in ASEAN
Authors: Baird Matthew , Thomas Brendon
Published: December 2020

Infrastructure projects, particularly investments in road, rail, and energy, can significantly impact ecological integrity and overall environmental quality. The Belt and Road Initiative (BRI), given its focus on large-scale infrastructure and energy projects, poses significant threats to ecosystems in BRI member countries. These environmental and social risks can, however, be assessed and mitigated by using tools such as Environmental Impact Assessment (EIA). Through examining the EIA process of a large-scale hydropower development project in Myanmar—the Myitsone dam project—the main aim of this article is to show why it is necessary to apply the concept of ecological civilization to Chinese foreign investment projects in Myanmar and other Association of Southeast Asian Nations (ASEAN) member countries. Analysis of the project’s EIA illustrates significant shortcomings for both the public participation process and the overall report’s ability to adhere to good practice and include the full extent of project impacts. Projects, such as this, that cause community conflict and environmental and social harm, do not fall within the stated ‘win-win-win’ objective of the BRI. The article concludes that, unlike the flawed Myitsone process, EIA combined with other requisite public participation processes associated with BRI projects have the potential to foster improved community relations and a green BRI that results in more equitable development in ASEAN. A series of significant opportunities to further green the BRI are identified.
Three new species of Cayratia-like genera (Vitaceae) from Zhejiang, East China

Authors: CHEN ZHENG-HAI , CHEN FENG , LU YI-FEI , XIE WEN-YUAN , JIN XIAO-FENG
Published: December 2020

Cayratia s. l. is not a monophyletic genus and is now divided into four genera worldwide, with three genera (Cayratia s. s., Causonis and Pseudocayratia) occurring in China. Recent morphological and molecular analyses of the Cayratia-like species from Zhejiang, East China, revealed three new species. Causonis wentsiana sp. nov. differs from C. japonica in having multicellular-pilose branchlets, leaves, peduncles and petals, petals long-corniculate at the apex. Causonis montana sp. nov. differs from C. japonica in having thick, papery leaf blades, central leaflet with lateral veins 9–12 pairs, margin 12–22-toothed on each side, and seeds acutely rugate both adaxially and abaxially. Pseudocayratia orientalisinensis sp. nov. differs from P. speciosa in having non-branched stems, papery leaf blades with central leaflet broadly obovate-elliptic, broadly elliptic or rhombic-elliptic and short-acuminate to acute apices.
The Brazilian Atlantic Forest genus Bocagea (Annonaceae) revisited, with two new species

Authors: MELLO-SILVA RENATO , DE CARVALHO LOPES JENIFER
Published: December 2020

Bocagea, a distinctive genus of tribe Bocageeae (Annonaceae), is revisited here. It is endemic to the Brazilian Atlantic Forest and has been for almost 200 years represented by only two species, B. longepedunculata and B. viridis. Recent collections from Espírito Santo and São Paulo States produced two new species, described here. The species of Bocagea are rare plants, all of them classified at least as endangered.
The Australian Lymexylidae (Coleoptera: Tenerionoidea) with one new genus and two genera new to Australia
Authors: LAWRENCE JOHN F.
Published: December 2020

The generic classification of Lymexylidae is reexamined, particularly with reference to the Australian fauna. The transfer of the Madagascar genus and species Alcestoma serropalpoides Fairmaire (1895) from Melandryidae to Lymexylidae, proposed by Nikitsky in Nikitsky et al. (1998), is confirmed and the genus is considered to be a senior synonym of Protomelittomma Wheeler (1986), syn. n. The occurrence of the genus Alcestoma in Australia is noted and a new species, Alcestoma queenslandicum, sp. n. is described from northern Queensland. The genus Arractocetus Kurosawa (1985) is also recorded for the first time from Australia, but the species is not described. A new genus, Leptonetron, gen. n., is described, based on the type species Atractocerus victoriensis Blackburn, 1891, which is considered to be a senior synonym of Atractocerus tasmaniensis Lea, 1917, syn. n. A key is provided for the Australian genera and species of Lymexylidae and the evolution of the family is briefly discussed.
Synopsis of the Castniidae (Lepidoptera) from Honduras and Nicaragua, Central America
Authors: VAN DEN BERGHE ERIC , MAES JEAN-MICHEL , HERNÁNDEZ-BAZ FERNANDO , GONZÁLEZ JORGE M.
Published: December 2020

We present a catalog of nine taxa of Castniidae reported for Nicaragua and Honduras including Prometheus zagraea salvina, a first record for Nicaragua. We also include general and field observations of behavior to help explain why members of this family are poorly represented in collections.
A new species Ophichthus chennaiensis sp. nov. (Anguilliformes: Ophichthidae) from the southeast coast of India
Authors: DAS MRINAL KUMAR , MOHAPATRA ANIL , RAJENDAR KUMAR R. , BHASKAR RANJANA
Published: December 2020

A new species of snake eel, Ophichthus chennaiensis sp. nov. (Anguilliformes: Ophichthidae: Ophichthinae), is described on the basis of a specimen collected from dumped fish disposed of by bottom trawlers at Kasimedu fishing harbour, Chennai. Ophichthus chennaiensis sp. nov is distinguished from its congeners by having its dorsal-fin origin one pectoral-fin length behind the pectoral-fin tip, preanal length 2.4 in TL, biserial maxillary, uniserial mandibular teeth, biserial to uniserial vomerine teeth, and its vertebrae (predorsal 19, preanal 53, and total vertebrae 154).
Influence of the Pacific Meridional Mode on ENSO Evolution and Predictability: Asymmetric Modulation and Ocean Preconditioning
Authors: Fan Hanjie , Huang Bohua , Yang Song , Dong Wenjie
Published: December 2020

This study investigates the mechanisms behind the Pacific meridional mode (PMM) in influencing the development of El Niño–Southern Oscillation (ENSO) events and their seasonal predictability. To examine the relative importance of various factors that may modulate the efficiency of the PMM influence, a series of experiments is conducted for selected ENSO events with different intensity using the Community Earth System Model, in which ensemble predictions are made from slightly different ocean initial states but under a common prescribed PMM surface heat flux forcing. Overall, a PMM forcing matched to ENSO—that is, a positive or negative PMM prior to an El Niño or a La Niña, respectively—plays an enhancing role, whereas a mismatched PMM forcing plays a damping role. For the matched cases, a positive PMM event enhances an El Niño more strongly than a negative PMM event enhances a La Niña. This asymmetry in influencing ENSO largely originates from the asymmetry in intensity between the positive and negative PMM events in the tropics, which can be explained by the nonlinearity in the growth and equatorward propagation of the PMM-related anomalies of sea surface temperature (SST) and surface zonal wind through both wind–evaporation–SST feedback and summer deep convection response. Our model results also indicate that the PMM acts as a modulator rather than a trigger for the occurrence of ENSO event. Furthermore, the response of ENSO to an imposed PMM forcing is modulated by the preconditioning of the upper-ocean heat content, which provides the memory for the coupled low-frequency evolution in the tropical Pacific Ocean.