bluuebunny/crossref_metadata_2025 huggingface dataset:
Literary Multilingualism in the Age of the Vernacular
Authors: Orsini Francesca
Published: October 2023

Despite the powerful reimagining of the multilingual landscape of South Asia into monolingual regions beginning in the early 19th century, and the aspiration toward one overarching national language, multilingualism has continued to inform South Asian literatures in visible and invisible ways. This chapter explores how. At an individual level, education usually predicts one’s reading and writing language(s), but family history, politics, and personal inclination may add other languages. Aural access leads to a multilingual familiarity that may or may not translate onto the written page, while poetic literacy can be acquired and transmitted orally with only a tenuous grasp of the language, as the enduring popularity of Urdu poetry/sha‘iri shows. Cities and borderlands often act as multilingual “contact zones” (Pratt), though they can also gather authors and publics in networks and spaces segmented by language. When we see modern Indian literary history solely through the efflorescence of the vernaculars from the 19th century onward, or through the hierarchy between English and the bhashas, we overlook the intense multilingualism across bhashas and across the English-bhasha divide, which in fact constitutes modern Indian literary history.
Irom Sharmila’s Poetry and the Politics of Anthologizing Indian Literature
Authors: Haripriya Soibam
Published: October 2023

Hailed as an “Iche” (elder sister), Irom Sharmila is the subject of many genres—poetry, songs, documentary films, and artwork. This chapter looks at the activist-poet’s collection Fragrance of Peace (2010) to examine the paradoxical way her body is seen as a site of resistance, her naming and identification through the kin term “sister,” and her status within Manipuri literature. It is significant that Irom is a rarely anthologized poet. Her work cannot be found in any anthologies on the literature of Northeast India, while, ironically, writings about her activism abound. Though her oeuvre is much more than protest poetry, this collection of poems foregrounds the political role of her poetry. The chapter juxtaposes Irom’s own self-representation through her poetry with works written about her. Through this exercise, the intention is to explore the place of women in the construction of a collective resistance and its conscious self-representation in literature.
Indian Literary History
Authors: Satyanarayana K.
Published: October 2023

The canons of modern Indian literature and Indian writing in English are formed of texts and perspectives that are shaped by an anticolonial nationalism that is actually Gandhian nationalism. In such writing, the glory of Indian civilization, national pride, and national independence are the principal themes. But these texts evade addressing the internal contradictions and complexities in the life of the colonized. Canonical Indian writers do not, for the most part, discuss class, caste, gender, and other inequalities in a radical way. We rarely find Ambedkar as an ideological influence or autonomous Dalit characters in modern Indian literatures, including Indian writing in English. It was in the 1960s that Babasaheb Ambedkar and Ambedkarite characters began to appear as powerful symbols in Dalit literature, first in Maharashtra and later in other regions of the country. This chapter examines how Dalit critics and writers propose and elaborate Ambedkarism as an alternative ideological framework for Indian literary history through an analysis of the Marathi Dalit writer Baby Kamble’s autobiography The Prisons We Broke (originally published in 1982; English translation in 2008).
Adivasi Poetry
Authors: John Joya
Published: October 2023

What does “Adivasi literature” signify in a literary field marked by the erasure of Adivasi languages and the dominance of languages like Hindi? As Adivasi writers take to writing in the vernacular, why is poetry a prominent genre in which they express themselves? How is a distinct claim to orality produced within writing and the print medium? This chapter seeks to answer these questions by situating Adivasi poets in a multilingual literary field in which they employ an “ethnopoetic modality.” This modality includes lexical borrowings, modes of lyric address, various linguistic strategies such as indexicality, and a politics of nature whereby different poetic languages are combined to produce a distinct poetics of indigeneity.
Ananda Devi’s Laughing Goddesses and the Limitless Possibilities of Transnational Fiction
Authors: Ravi Srilata
Published: October 2023

This chapter examines acclaimed francophone Mauritian novelist Ananda Devi’s novel, Le rire des déesses (2021), which sets out to expose religious bigotry and the oppression of women in Hindu society. The Indo-Mauritian writer’s critique of goddess worship and the patriarchal structure of Hindu society in Le rire des déesses expands on her own sharp criticism of island Hinduism in her other novels set in her native Mauritius, where diasporic links to India are a central focus of national politics. The chapter argues that the novel’s questioning of Hindu religiosity translates as an act of cultural decolonization from a diasporic Hindu hegemony and poses a literary challenge to the centrality of an imagined Indo-Hindu-Mauritian worldview.
Historical Materialism
Authors: Wigger Angela
Published: October 2023

Historical materialism is probably the only grand theory within International Political Economy (IPE) that is ontologically equipped to analyze all aspects of social life without losing sight of “the big picture.” As a theory of history, power, and emancipatory praxis, historical materialism not only seeks to explain and critique social inequalities in and through global capitalism, but also to formulate a transformative agenda toward a more equitable future. The chapter first introduces the core ontological and epistemological premises of historical materialism and then outlines its theorization of capitalism and recurring capitalist crises. On the basis of showcasing some contributions on the state-economy and state-society relations and the production-reproduction relation under neoliberal capitalism, the chapter points to critique from within and beyond its own theoretical confines as a key stimulus for theoretical advancements. The chapter, by way of conclusion, invites IPE scholars to engage more with historical materialism, as dialogue and critique lead to productive tensions that allow for expanding the ontological reach of IPE. And in the spirit of emancipatory praxis, such a critical engagement also has the potential of stimulating new radical imaginaries for a post-capitalist future.
Anthropogenic Effects on Animal Cultures
Authors: Gruber Thibaud
Published: October 2023

Recent decades have seen a steady increase in studies looking at the impact of human activities on wild animals. Many describe behavioural changes that concern traits that have been considered, or have the potential to be considered, as cultural, leading to the question of whether we are witnessing cultural evolution in other animals as a direct result of our own activities. Results indicate that human activities influence animal cultural repertoires through a variety of mechanisms: they can lead to the modification and, in extreme cases, the disappearance of existing cultural traits, but they can also foster the invention of novel traditions that have themselves the potential to become cultural. These examples are often found in the domain of food acquisition, where animals modify their diet to include new resources, adopt novel foraging strategies to avoid or, in contrast, establish long-lasting relationships with humans or human products or artefacts. Understanding these new cultural patterns in relation to humans is crucial for two reasons: as wildlife is increasingly exposed to humans and their activities, studying how animal cultures are impacted and how they change in response to anthropogenic factors is important for conservation purposes. Second, the current resulting situation for other animals, with drastic environmental changes in a short amount of time leading to behaviour change, may reflect past ecological pressures on human cultures and hence be informative for models of cultural evolution.
Evolving and Emerging Perspectives on the Transfer of Learning
Authors: Hickey Daniel , Lam Diane
Published: October 2023

This chapter considers the phenomenon of transfer of learning in light of heightened concerns over power, privilege, equity, gender, and race in education. The authors argue that assumptions about transfer have a tremendous impact on education via classroom assessments and achievement tests and that discriminatory and racist practices in education are often produced and reproduced via inappropriate assessment and testing practices. The chapter is organized around four dimensions of assessments as they relate to transfer. These dimensions are format, level, function, and theory. The authors consider each dimension with a particular eye on contemporary “asset-based” responses to historical educational inequities. The authors consider how these dimensions are currently represented in research on culturally responsive educational practices (or not) and speculate about the ways that these dimensions might be used to organized more culturally responsive assessment and testing. The authors specifically explore the synergies between two situative transfer mechanisms and several contemporary asset-based responses to historical inequities. They conclude by arguing that a situative multilevel approach to assessment and new models of research-practice partnership offer a coherent means of applying these synergies to educational practice.
Explicit Instruction
Authors: Evans Paul , Martin Andrew J.
Published: October 2023

Explicit instruction is an approach to teaching characterized by high levels of guidance and support from the teacher, extension of learners’ prior knowledge, consideration of the capacities and limits of human cognitive architecture, an emphasis on learning as the primary priority for instructional activity, and active student engagement throughout the learning process. The lineage of the principles of explicit instruction can be traced from research on large-scale school reform projects through a range of research and theoretical approaches based on cognitive, information-processing models of how the mind learns. Cognitive load theory provides a highly informative theoretical framework in which explicit instruction can be embedded. In relating explicit instructional practices to cognitive load theory, explicit instruction can be operationalized in terms of the load reduction instruction framework and is associated with reduced intrinsic and extraneous loads. A robust evidence base supports the effects of explicit instruction on learning, as well as other educational outcomes such as motivation and engagement, metacognition and self-regulated learning, problem-solving, critical thinking, and creativity. The effectiveness of explicit instruction depends on changing the amount and type of explicit instruction throughout the learning process. Explicit instruction contrasts with constructivist perspectives, but under certain circumstances, explicit instructional approaches can and should incorporate elements of strategies typically regarded as constructivist principles and strategies.
Neuromuscular Electrical Stimulation–Enhanced Physical Therapist Intervention for Functional Posterior Shoulder Instability (Type B1): A Multicenter Randomized Controlled Trial
Authors: Moroder Philipp , Karpinski Katrin , Akgün Doruk , Danzinger Victor , Gerhardt Christian , Patzer Thilo , Tauber Mark , Wellmann Mathias , Scheibel Markus , Boileau Pascal , Lambert Simon , Porcellini Giuseppe , Audige Laurent
Published: October 2023

Objective

Functional posterior shoulder instability (FPSI) (type B1) is a severe type of instability, mainly in teenagers and young adults, that leads to loss of function, pain, and stigmatization among peers. An experimental nonsurgical treatment protocol based on neuromuscular electrical stimulation (NMES) showed very promising early results in the treatment of FPSI. The hypothesis of this study was that NMES-enhanced physical therapy leads to better outcomes than physical therapy alone as the current gold standard of treatment in patients with FPSI.

Methods

In this multicenter randomized controlled trial, patients with FPSI were randomly allocated in a 1:1 ratio to either 6 weeks of physical therapy or 6 weeks of physical therapy with simultaneous motion-triggered NMES. Baseline scores as well as outcome scores at 6 weeks, 3 months, 6 months, and 12 months after the intervention were obtained. The predefined primary outcome of this trial was the Western Ontario Shoulder Instability Index (WOSI) at the 3-month time point.

Results

Forty-nine patients were randomized and eligible for the trial. The group that received physical therapy with simultaneous motion-triggered NMES showed a significantly better main outcome measurement in terms of the 3-month WOSI score (64% [SD = 16%] vs 51% [SD = 24%]). Two-thirds of the patients from the physical therapist group crossed over to the group that received physical therapy with simultaneous motion-triggered NMES due to dissatisfaction after the 3-month follow-up and showed a significant increase in their WOSI score from 49% [SD = 8%] to 67% [SD = 24%]. The frequency of instability episodes showed a significant improvement in the group that received physical therapy with simultaneous motion-triggered NMES at the 3-month follow-up and beyond, while in the physical therapist group, no significant difference was observed.

Conclusion

The current study shows that NMES-enhanced physical therapy led to statistically significant and clinically relevant improvement in outcomes in the treatment of FPSI compared to conventional physical therapy alone—from which even patients with prior unsatisfactory results after conventional physical therapy can benefit.

Impact

Based on the results of this study, NMES-enhanced physical therapy is an effective new treatment option for FPSI, a severe type of shoulder instability. NMES-enhanced physical therapy should be preferred over conventional physical therapy for the treatment of patients with FPSI.
HBV reactivation in patients with rheumatoid arthritis treated with anti-interleukin-6: a systematic review and meta-analysis
Authors: Katelani Stamatia , Fragoulis George E , Bakasis Athanasios-Dimitrios , Pouliakis Abraham , Nikiphorou Elena , Atzeni Fabiola , Androutsakos Theodoros
Published: October 2023

Objective

The objective of this study was to assess the possibility of HBV reactivation (HBVr) in patients with RA under anti-IL-6 treatment.

Methods

Using PubMed, Scopus and EMBASE, we performed a systematic literature search for articles related to HBVr in RA patients under anti-IL-6 treatment. The search was performed with no date limits and was last updated 28 January 2023. The results from all the databases were combined and duplicates were excluded, as were non-English articles, case reports, position articles, comments, and paediatric studies.

Results

Our initial search led to 427 articles; 28 were duplicates, 46 non-English, 169 reviews, 31 books/letters, 25 case reports, and 88 irrelevant to the meta-analysis aim; 21 were excluded due to inadequate information, leaving 19 articles, with a sum of 372 RA patients with chronic HBV (CHB) or resolved HBV infection, for further analysis. The overall risk for HBVr in RA patients with CHB was 6.7%, increasing to 37% when only RA patients with CHB and no antiviral prophylaxis were included. On the contrary, HBVr was close to 0% in RA patients with resolved HBV infection, irrespective of antiviral prophylaxis. All RA patients experiencing HBVr in these studies were successfully managed with antiviral treatment and/or drug withdrawal.

Conclusion

Overall, anti-IL-6 treatment comes with a significant risk of HBVr in RA patients with CHB; risk is diminished when antiviral prophylaxis is used. In contrast, in RA patients with resolved HBV infection, the risk of HBVr seems to be extremely low. Large, well-designed studies (either controlled trials or multicentre/international observational studies) are warranted to further validate these results.
The Multimorbidity Web in rheumatoid arthritis
Authors: England Bryant R
Published: October 2023

Multimorbidity, the presence of multiple chronic conditions, is highly prevalent in people with RA. An essential characteristic of multimorbidity is the interrelatedness of the different conditions that may develop in a multimorbid person. Recent studies have begun to identify and describe the Multimorbidity Web by elucidating unique multimorbidity patterns in people with RA. The primary multimorbidity patterns in this web are cardiopulmonary, cardiometabolic, and mental health and chronic pain multimorbidity. Once caught in the Multimorbidity Web, the consequences can be devastating, with reduced quality of life, physical function, survival, and treatment responses observed in multimorbid RA persons. The development of effective management and preventive approaches for multimorbidity in people with RA is in its infancy. Determining how best to assess, intervene, and prevent multimorbidity in RA is crucial to optimize long-term outcomes in people with RA.
Viewpoint: Supporting mental health in the current management of rheumatoid arthritis: time to act!
Authors: Doumen Michaël , Pazmino Sofia , Verschueren Patrick , Westhovens René
Published: October 2023

Although clinical outcomes of RA have vastly improved in recent years, the disease’s mental health impact has seemingly not decreased to the same extent. Even today, learning to live with RA is an active process involving several psychological, cognitive, behavioural and emotional pathways. Consequently, mental health disorders are more common in the context of RA than in the general population, and can be particularly detrimental both to patients’ quality of life and to clinical outcomes. However, mental health is a spectrum and represents more than the absence of psychological comorbidity, and supporting patients’ psychological wellbeing should thus involve a more holistic perspective than the mere exclusion or specific treatment of mental health disorders. In this viewpoint article, we build on mechanistic and historical insights regarding the relationship between RA and mental health, before proposing a practical stepwise approach to supporting patients’ mental health in daily clinical practice.
Neuropathologic evaluation of cerebrovascular disease in patients with rheumatoid arthritis
Authors: Larsen Rachel A , Constantopoulos Eleni , Kodishala Chanakya , Lovering Edward , Kumar Rakesh , Hulshizer Cassondra A , Lennon Ryan J , Crowson Cynthia S , Nguyen Aivi T , Myasoedova Elena
Published: October 2023

Objectives

Active RA has been associated with an increased risk of both cardiovascular and peripheral vascular disease. We aimed to compare cerebrovascular changes in patients with and without RA, both with and without a neuropathologic diagnosis of neurodegenerative disease.

Methods

Patients with RA (n = 32) who died and underwent autopsy between 1994 and 2021 were matched to non-RA controls (n = 32) on age, sex and level of neurodegenerative proteinopathy. Routine neuropathologic examination was performed at the time of autopsy. Cerebrovascular disease severity was evaluated using modified Kalaria and Strozyk scales. Clinical dementia diagnoses were manually collected from patients’ medical records.

Results

Prior to death, 15 (47%) RA patients and 14 (44%) controls were diagnosed with dementia; 9 patients in each group (60% and 64%, respectively) had Alzheimer’s disease. The prevalence of cerebral amyloid angiopathy, microinfarcts, infarcts or strokes was found to be similar between groups. Patients with RA were more likely to have more severe vascular changes in the basal ganglia by Kalaria scale (P = 0.04), but not in other brain areas. There were no significant differences in the presence of large infarcts, lacunar infarcts or leukoencephalopathy by Strozyk scale. Among patients with RA and no clinical diagnosis of dementia, the majority had mild–moderate cerebrovascular abnormalities, and a subset of patients had Alzheimer’s disease neuropathologic changes.

Conclusion

In this small series of autopsies, patients with and without RA had largely similar cerebrovascular pathology when controlling for neurodegenerative proteinopathies, although patients with RA exhibited more pronounced cerebrovascular disease in the basal ganglia.
O009 Are there Differences in SpO2 Recordings from Two Oximeters on the same hand during an Overnight Sleep Study Significant?
Authors: McDermott E , Cuesta R , van Braak E , Spiteri M , Davis S , Beranek R , Kaur-Bains S , Slater B , Naughton M , Roebuck T , Nguy R
Published: October 2023

Background

Accurate non-invasive oxygen saturation (SpO2) measurement is crucial in healthcare, however is challenged by numerous devices using variable algorithms1. We compared two commonly used oximeter devices worn simultaneously in patients during an overnight polysomnogram.

Aim

To assess (1) differences between two SpO2 recording devices and (2) SpO2 accuracy against SaO2.

Methods

SpO2 data of two devices were recorded, downloaded and analysed with corresponding software: device 1 (Rad7 [Masimo, Irvine, CA, USA] set at 2-4sec averaging time) with software 1 (PSG 4 [Compumedics, Melbourne, Australia]) and device 2 (Wrist-Ox2® [Nonin Medical Inc, Plymouth, MN, USA] set at 3 sec averaging time) with software 2 (Noxturnal [Nox Medical Inc, Reykjavik, Iceland]). Responsiveness of each oximeter to changes in the patients’ desaturations associated with apnoeas and hypopnoeas overnight was assessed. In addition, both device SpO2 values were compared with SaO2 from simultaneous arterial blood gas sampling.

Preliminary Results

7 patients (age 56.4±7.1 years, BMI 31.6±2.2 kg/m2, 100% male, 87% light skinned) were studied. The mean SpO2 with RAD7 was higher than the Nonin (95.9±1.6 vs 94.2±1.4%, mean difference 1.6±1.0%). Differences in the responsiveness of the oximeters during overnight desaturations were also observed. However, both device SpO2 values were found to be within ±2% of SaO2.

Conclusions

Discrepancies in SpO2 measurement do occur between devices and may have important clinical implications especially when it comes to the measurement of hypoxemic burden during sleep.

1.Blanchet MA et al. Accuracy of Multiple Pulse Oximeters in Stable Critically Ill Patients. Respir Care. 2023 May;68(5):565-574.
O026 Concordance between a home sleep apnoea test based on peripheral artery tonometry and laboratory polysomnography
Authors: Nair A , Turton A , Stupar D , Mansfield D
Published: October 2023

Introduction

Limited channel home sleep apnoea test (HSAT) devices are an emerging alternative to laboratory-based PSG. Despite increasingly commercially availability, there is limited external validation of their diagnostic performance. We recently independently validated the Night Owl Mini HSAT (NOM) against in-lab PSG and demonstrated a satisfactory level of agreement (LOA) of 63.8% overall. However, lower rates of agreement were observed for severe OSA. We speculated that signal artefact may have contributed to reduced concordance.

Methods

Data was drawn from our previously published prospective cohort of 100 participants undergoing PSG for suspected OSA, simultaneously fitted with the NOM. PSG and NOM studies were re-processed, manually remarking artefact. LOA was recalculated comparing only temporally aligned data segments for which both devices provided intact signals, this allowed direct comparison of pulse oximetry data and software algorithms that generated the ODI3%. Two new datasets were generated for PSG and NOM for which combined artefact was deleted (COM-PSG, COM-NOM).

Results

To date, datasets from 12 participants have been assessed. The mean difference in ODI3% between PSG and NOM was 5.25/hr (95% limits of agreement -0.73 – 11.23), while the mean difference in ODI3% between COM-PSG and COM-NOM was 2.53/hr (95% limits of agreement -1.77 – 6.83). In our previous study, the overall mean difference in ODI3% was –0.21/hr (95% limits of agreement -18.1 – 17.7).

Conclusion

Preliminary results may indicate signal artefact contributes to reduced level of agreement between PSG and NOM.
O031 The Inter-stimulus Interval Effect in the Psychomotor Vigilance Task
Authors: Lack L , Hartland B
Published: October 2023

Introduction

The Psychomotor Vigilance Task (PVT) is a widely used measure of the effects of sleep deprivation on vigilant attention. The test requires a rapid response to a stimulus occurring at random inter-stimulus intervals (ISIs) between 2 and 10 seconds following a previous response. A few studies have found an ISI effect where shorter ISIs (2-4s) have slower reaction times (RTs) than longer ISIs (8-10s). How this ISI effect is impacted by circadian timing has yet to be investigated.

Method

This study compared the ISI effect at 3 time points coinciding with 5, 23 (circadian trough), and 29 hours of wakefulness. Data were taken from 16 healthy participants during a 30 hour period of sleep deprivation.

Results

A repeated-measures (3 x 3) ANOVA (3 time points, 3 ISIs) found that RTs were slower and lapses (RT>500msec) more frequent in short ISIs compared with medium and long ISIs. RTs were also slower and lapses more frequent at the circadian trough compared to both the early testing session and after 29h of total sleep deprivation.

Discussion

Increased lapses in shorter ISIs could be explained by an involuntary mental “rest period” after responding, that gets longer and more frequent under sleep pressure from both circadian and homeostatic sleep pressure. These findings have implications for interpreting PVT results and their application to everyday tasks, such as driving. Further research could involve neuroimaging the brain’s responses during different ISIs to confirm the mental ‘rest period’ following a response in the PVT task.
O066 The Lived Experience of Narcolepsy - From Symptoms to Stigma
Authors: Schokman A , Cheung J , Milton A , Naehrig D , Thornton N , Bin Y , Kairaitis K , Glozier N
Published: October 2023

Introduction

Narcolepsy is a rare neurological sleep disorder with a substantial adverse impact on health-related quality of life and psychological well-being. Few studies have qualitatively explored how persons with narcolepsy perceive their symptoms and illness experience. Understanding how those with narcolepsy conceptualise and communicate their experience is important if we are to identify/meet their healthcare needs.

Method

127 self-reported persons with narcolepsy were recruited from an Australian support group. Saturation was reached after 24, 1hr semi-structured interviews (mean age=33 (SD11), 44% reporting cataplexy). A multidisciplinary team of researchers/clinicians analysed interview transcripts using thematic analysis.

Results

Several key findings include: 1. participants identified fatigue, sleepiness, and two separate experiences of 'falling asleep/sleep attacks' as distinct symptoms often grouped as excessive daytime sleepiness. 2. Participants attributed their own meaning to commonly used medical terminology that differed from the literature (e.g. describing a sleep attack but calling it cataplexy). 3. ‘well-managed’ narcolepsy was determined by the level of functional impairment rather than symptom frequency. 4. Almost all participants experienced frequent anticipated and internalised- or self-stigma, likely stemming from societal devaluation of sleep and conflation of sleepiness with laziness.

Conclusion

Our findings suggest a needed shift in narcolepsy management that focuses on functional impairment, rather than just symptom treatment. They also highlight the need for clarification around common narcolepsy terms, as patients/physicians may use the same terminology to try and communicate different concepts. Having identified the type of stigmas experienced, future research is needed to explore if stigma-reduction reduces psychological comorbidity in narcolepsy.
O067 Comparison of Sleep Quantity and Quality during Watchkeeping Schedules
Authors: Marando I , Owen M , Lushington K , Matthews R , Yates C , Banks S
Published: October 2023

Watchkeeping schedules expose workers to sleep and wake opportunities which are not at biologically ideal times, thus impacting sleep quantity and quality. This study investigated the impact of different watchkeeping schedules on sleep. N=29 healthy participants (16F; aged 18-34y) took part in a 10-day laboratory study. Participants were allocated to one of four schedules; 8h-on/8h-off/4h-on/4h-off (day-sleep 09:30-16:00; n=8; Condition A), 6h-on/6h-off (day-sleep 08:30h-12:30, nap 21:30-00:00; n=7; Condition B), and 4h-on/4h-on-call/4h-off/4h-on/8h-off (evening-sleep 18:00-00:30; n=7; Condition C; or night-sleep 01:30h-08:00; n=7; Condition D). Participants had 8h time in bed (TIB) for sleep at baseline and recovery. Every 24h during the schedule, participants received a 6.5h TIB. Sleep was measured using standard polysomnography and scored by a trained sleep technician. Linear mixed models found that Condition D (night sleep) had significantly longer total sleep time (TST) than Condition B (p=.003; split sleep). Participants obtained significantly less TST on Day 2 compared to remaining experimental days (Day 3 to Day 8; p<.05). Sleep onset latency was longer on Day 8, than Days 2 and 3 (p<.01). Time spent in REM sleep was shorter on Days 2 and 3 than any other days (p<.05). There were no differences in sleep stages between conditions, except for TST. The split sleep in Condition B resulted in less sleep. Shorter TST at the beginning of the study may indicate the adjustment period of the new sleep/wake schedule. These results reveal that there are implications for sleep when sleep periods are reduced during watchkeeping.
P005 Decolonizing measures of sleep and wellbeing to assess the outcomes of a MĀORI-led sleep intervention in Aotearoa whānau (New Zealand families).
Authors: Fangupo L , Haszard J , Ellison-Collins T , Russell-Camp T , Taylor R , Richards R , Camp J
Published: October 2023

Introduction

The creation of culturally relevant questionnaires is an important step towards decolonizing research methodologies to ensure that they are appropriate for use in diverse populations. Our team aimed to develop and test a new questionnaire about sleep, wellbeing and whānau connection for use in Aotearoa whānau with 0-2 year old infants.

Methods

Our ethnically diverse research team co-designed with relevant communities a new 56-item questionnaire. Some items were adapted from existing questionnaires, with others newly developed through a Māori worldview. The new questionnaire was disseminated online for testing by caregivers of 0-2 year old children. Quantitative and qualitative findings about, and associations between three dimensions of children’s sleep health and caregiver and whānau wellbeing and connection, were examined to determine their acceptability as key outcome measurements for an upcoming trial.

Results

957 caregivers completed the new questionnaire. Small, yet consistent positive associations were observed between children’s sleep quality, and caregivers’ perceptions of children’s sleep, and caregiver wellbeing, whānau wellbeing, and connection. Conversely, children’s nocturnal sleep duration was not related to caregiver or whānau wellbeing or connection. Only 14% of caregivers found questions about their perception of their children’s sleep difficult to answer. Qualitative feedback indicated that questions about wellbeing and connection were culturally relevant and acceptable to diverse whānau.

Discussion

Caregiver perception of children’s sleep, children’s sleep quality, caregiver wellbeing, whānau wellbeing and connection can be measured in a culturally relevant manner when a collaborative team work together to create, and consciously decolonize, new and existing questionnaire items.
P015 Dreams, Nightmares and the Relationship with Death Anxiety and Spiritual practices
Authors: Dunican I , Meaklim H , Turner M , Menzies R , Cunnington D
Published: October 2023

Introduction

Dreams that evoke intense negative emotions and anxiety, called nightmares, are often linked to mental health conditions like trauma, anxiety disorders, and death anxiety. Historically, people turned to religious and spiritual practices to address anxieties about death, but there has been a decline in such practices in recent years. This study presents preliminary data investigating the relationship between dreams, nightmares, religious/spiritual practice, and death anxiety.

Methods

Participants >18 years completed a 20-minute survey via REDCap. The survey collected demographic data and validated questionnaires investigating dreams, nightmares, sleep, insomnia symptoms, religious/spiritual practice, mental health, and death anxiety.

Results

Preliminary data shows that 67% of the sample were married or in a de facto relationship, consisted of primarily female participants (66%), and only 11% had a diagnosed sleep disorder. 56% had a high engagement in the distinct forms of spiritual/religious practice; this was more evident in females (59% vs 48%). The most common dream for males and females was being chased or pursued. 19% of the sample have a potential nightmare disorder, consistent between the sexes. 25% of people have poor sleep quality (PSQI ≥5); this was more prevalent in males (43% vs 22%). 16% of people had clinical insomnia, which was consistent between the sexes. Finally, 16% of people have clinical death anxiety, with a higher prevalence in females (18% vs 10%).

Discussion

This study's data will help us understand how dreams and spirituality can help alleviate death anxiety, offering new insights for mental health interventions.
P020 Exploring the Roles of Individual Rapid Eye Movement Sleep Parameters in Emotional Memory Processing
Authors: Zeng Z , Schenker M , Jordan A
Published: October 2023

Background

Maladaptive emotional memory processing is thought to underpin intrusion symptoms experienced by individuals with post-traumatic stress disorder (PTSD). Curtailment of rapid eye movement sleep (REMS) impairs emotional memory consolidation (EMC) and is proposed to contribute to the development of PTSD. However, the effects of altered REMS quality remain less explored. The present study aims to investigate the potential ability of REM percentage, REM latency, and REMS fragmentation to predict EMC.

Methods

The study forms part of a larger study investigating the effects of suvorexant and temazepam on REMS and EMC. Healthy participants view a series of emotionally positive, negative and neutral images, undergo overnight polysomnography with a study drug or placebo, and are assessed for recognition 48 hours after viewing the images. REMS architecture metrics are derived from polysomnographic data. EMC is calculated based on signal detection theory (d′ = z(hit rate) − z(false alarm rate)).

Results

Data collection is ongoing with 11 participants’ data being collected. A one-way ANOVA reveals a main effect of valence, with positive and negative images being recognised better than the neutral (p(positive-neutral) = .039, p(negative-neutral) = .039). REMS parameters do not significantly predict EMC when accounting for image valence, possibly due to low statistical power.

Discussion

Given existing literature supporting the contribution of REMS on emotional memory processing, promoting high-quality REMS may help facilitate adaptive EMC. Further data is required to examine this effect.
P023 Patient experience and care needs within a Motor Neurone Disease Multidisciplinary Clinic
Authors: Goffinet C , Erigadoo S
Published: October 2023

Background

The Sunshine Coast Hospital and Health Service (SCHHS) Motor Neurone Disease (MND) Multidisciplinary Clinic has been running since early 2020 and is the only one of its kind north of Brisbane. Patients with MND have complex care needs and are thought to benefit from the collaborative nature of such clinics. We seek to directly assess the patient experience of our MND Clinic through the use of a patient questionnaire, which addresses both access to appropriate health professionals at Clinic appointments as well as whether specific MND care needs are being addressed through the multidisciplinary team, with reference to the National Institute for Health and Care Excellence (NICE) MND Assessment and Management Guidelines.

Methods

This is a prospective quality assurance project designed to collect anonymous responses from patients currently attending the SCHHS MND Multidisciplinary Clinic. Questionnaires will be distributed to patients both via e-mail and when attending their clinic appointment, and the results will be collated into a password protected database for analysis.

Progress to date

Ethics approval is in progress and questionnaires are expected to be distributed in the next few months.

Intended outcome and impact

This quality assurance project will be used as part of an audit of the SCHHS MND Multidisciplinary Clinic, in order to assess patient satisfaction and identify priority areas for expansion.
P025 Atypical N3 Sleep: A Biomarker for Altered Mental Status in Lewy Body Disease?
Authors: Levendowski D , Neylan T , Lee-Iannotti J , Tsuang D , Walsh C , Berka C , Mazeika G , Boeve B , St. Louis E
Published: October 2023

Introduction

Atypical N3 sleep (AN3=delta waves with limited theta and sigma) has been associated with ICU delirium and sepsis and averaged 25% of sleep time in Japanese ICU patients. We were interested in exploring whether AN3 might be a marker of cerebral dysfunction in ambulatory patients across a range of neurodegenerative disorders, including those with a dementia diagnosis.

Methods

After ethics review and with informed consent, patients with Lewy body disease (DLB/PDD: n=20,male=90%,age=70 + 6.2), Alzheimers disease dementia (AD: n=29,male=79%,age=75 + 6.7), Parkinson disease (PD: n=16,male=69%,age=67 + 8.7), mild cognitive impairment (MCI: n=41,male=63%,age=70 + 8.5), isolated REM sleep behavior disorder (iRBD: n=19,male=74%,age=64 + 9.6) and a control group (CG: n=61,male=47%,age=65 + 8.3) were studied with the Sleep Profiler and auto-detected AN3 computed. Between-group comparisons were assessed with Mann-Whitney U and Chi-square tests.

Results

The mean percentages of sleep time with AN3 were significantly greater in DLB/PDD (8 + 12.3) vs. PD (4 + 10.8), AD (2 + 3.7), MCI (2 + 2.3), iRBD (1 + 1.6), and CG (1 + 2.4)(all p<0.02). The proportions of records with abnormal AN3 (>5% of sleep time) were significantly greater in those with DLB/PDD=35% vs. MCI=10%, iRBD=5% and CG=5% (all p<0.05), but not AD=17% and PD=13%.

Conclusions

Further investigations are needed to determine if abnormal AN3 may be a biomarker that distinguishes patients with Lewy body spectrum diseases from alternative pathologies and/or could be helpful in monitoring the side effects of CNS-acting medications
P035 Investigating the Relationship Between Dietary Timing and Obstructive Sleep Apnoea.
Authors: Huddle S , Young A , Bonham M , Choi T , O'Driscoll D
Published: October 2023

Introduction

Late night eating is associated with obstructive sleep apnoea (OSA) and may increase obesity risk. Time Restricted Eating (TRE) involves shifting the eating window to 8-12 continuous hours per day, prompting energy intake to earlier in the day without any complex dietary prescription, and has metabolic benefits. We aimed to investigate timing of food intake in patients with OSA and assess their openness to trial TRE.

Methods

Adults undergoing in-laboratory diagnostic polysomnography (PSG, n=138, 67 male) completed a dietary questionnaire outlining typical eating habits, including timing of meals, frequency of getting up overnight, and frequency of eating/drinking overnight. Questionnaire responses were reviewed with demographics and PSG variables. Proportions of responses were compared across categories of OSA severity using z-tests.

Results

Patients with moderate/severe OSA (AHI>15events/h, n=77) were more likely to report getting up at night “often” or “always” compared to patients with no/mild OSA (n=61) (63.6% v 47.5%, p=0.08), more likely to report getting up multiple times (66.2% v 47.5%, p=0.04), and more likely to report eating/drinking overnight (42.9% v 18.0%, p=0.003). 71.0% of all patients indicated they would consider trying a TRE diet, and 71.7% could incorporate a TRE diet into their lifestyle.

Conclusion

Moderate/severe OSA is associated with an increased likelihood of getting up multiple times overnight, and getting up to eat and drink. Patients in this clinical cohort reported a willingness to trial TRE. Future research should investigate the efficacy of implementing TRE in OSA and evaluating its effect on weight loss and sleep quality.
P037 The Big Sleep ACT Project: Developing a Modern Dataset to Support Sleep Research
Authors: Malagutti N , Chen L , Miller S
Published: October 2023

Background

Limitations in scale, population diversity, technical quality, data curation methods and accessibility of existing data resources have been recognised as limiting factors for the advancement of sleep clinical research through big data approaches. To bridge this gap, this study introduces a new sleep dataset which seeks to capture a data-rich, longitudinal snapshot of a representative Australian clinical sleep cohort.

Methods

Retrospective collation of de-identified sleep clinical records from adult patients who underwent at least one in-lab Type-1 polysomnography between 2012 and 2018 at Canberra Sleep Clinic. We extracted polysomnography raw signals and annotations, as well as medical record information including basic demographics, comorbidities, medications, examination findings, diagnoses, therapy settings and follow-up observations throughout subjects’ time in the Clinic’s care. Records were organised according to a graph database structure, embedding SNOMED terminology encodings wherever possible.

Results

N=6,777 subjects were included. Gender split (M/F: 62%/38%) and age (51.7±15.3 years) distribution were consistent with typical clinical sleep cohorts. Polysomnography recordings included diagnostic (n=6,635) and non-invasive ventilation titration/therapy (n=2,834), as well as MSLT (n=270) and MWT (n=25) studies. Clinical subgroups featured healthy, Obstructive Sleep Apnea (OSA) and non-OSA dyssomnia patients, as well as small cohort of parasomnia cases. Follow-up duration varied among cases (<3 months to >5 years).

Discussion

Despite limitations associated with retrospective data extraction, the data-richness and scale of Big Sleep ACT compare favourably with world-leading sleep datasets. Careful data organisation makes this dataset well placed to support innovative data-driven research into precise diagnoses, personalised interventions, and automation in sleep medicine.
P048 Does Sleep Reduce Intrusive Memories after Analogue Trauma? Recent findings of Experimental Sleep Manipulations using the Trauma Film Paradigm
Authors: Ogden J , Jobson L , Drummond S
Published: October 2023

Introduction

Intrusive memories are common in the aftermath of trauma, and these can develop into a pervasive, distressing symptom of posttraumatic stress disorder (PTSD). Sleep disturbances have also been shown to contribute to later development and maintenance of overall PTSD symptoms. Recent evidence suggests there is a relationship between sleep disturbance and intrusive memories following experimental analogue trauma. However there has been conflicting findings regarding the direction of the effect; whether sleep following analogue trauma results in increased or decreased frequency of later intrusive memories.

Methods

We conducted a narrative review summarising research examining the role of sleep in the development of trauma-related intrusive memories, using the trauma film paradigm. This included recent meta-analyses of experimental studies.

Results

While there have been initial conflicting results across a small number of studies, meta-analytic results suggest sleep following exposure to analogue trauma leads to a reduced number of intrusive memories in the following week.

Discussion

The relationship between sleep following experimental analogue trauma and reduction in intrusive memory frequency may be due to the role of sleep in the consolidation and integration of traumatic memories into existing autobiographical knowledge. However, more research is needed to investigate the mechanism of action for this relationship. Future studies should attempt to disentangle to what degree consolidation, executive control over spontaneous cognition, or other mechanisms are affected by sleep and contribute to the development of intrusive memories.
P050 Process O (onset/offset) cause of the 90-min sleep cycle
Authors: Lack L
Published: October 2023

The ubiquitous sleep cycles across a normal sleep of approximately 90 minute period length were originally suggested to be a reflection of a 90-minute basic rest-activity cycle (BRAC) operating across the full circadian cycle of wakefulness and sleep. The evidence for a BRAC during the wakeful period is sparce requiring other explanations for the prominent 90min cycles during sleep.

Recently another process, Process O (onset/offset), has been suggested in addition to Processes S (homeostatic) and C (circadian). It was hypothesised in order to account for the recuperative effects of a brief power nap, inexplicable by the other two processes.

Process O hypothesises a development of inhibition to any ongoing state (wake, NREM, REM). The inhibition develops rapidly over 1-2 hours to a plateaued limited level and then, following the cessation of that state, dissipates rapidly (5-15 minutes). Thus, a “power” nap brings improved alertness because of the short break from wakefulness allowing the dissipation of wakefulness Process O inhibition. It is suggested that Process O inhibition accumulates also to periods of NREM sleep and REM sleep.

The ‘sleep switch’ accounting for bi-stable states of sleep or awake is hypothesised to include REM and NREM as separate states accounting for stability and mutual inhibition between 3 rather than just 2 states. Thus Process O inhibition developing to an ongoing state tips the balance to other states (REM or NREM) resulting in the alternation between them of the sleep cycles and allowing longer sleep epochs after brief awakenings.