bluuebunny/crossref_metadata_2025_split huggingface dataset:
P090 The Effect of Workload, Sleep Deprivation and Time of Day on Simulated Driving Performance
Authors: Marando I , Matthews R , Grosser L , Yates C , Banks S 
Published: October 2021

Abstract
Sustained operations expose individuals to long work periods, which deteriorates their ability to sustain attention. Biological factors, including sleep deprivation and time of day, have been shown to play a critical role in the ability to sustain attention. However, a gap in the literature exists regarding external factors, such as workload. Therefore, the aim of this study was to investigate the combined effect of sleep deprivation, time of day, and workload on sustained attention. Twenty-one participants (18–34y, 10 F) were exposed to 62 hours of sleep deprivation within a controlled laboratory environment. Every 8 hours, sustained attention was measured using a 30-minute monotonous driving task, and subjective workload was measured using the NASA-Task Load Index (TLX). Workload, defined as time on task was assessed by splitting the drive into two 15-minute loops. A mixed model ANOVA revealed significant main effects of day (sleep deprivation) and time of day on lane deviation, number of crashes, speed deviation and time outside the safe zone (all p&lt;.001). There was a significant main effect of workload (time on task) on lane deviation (p=.042), indicating that a longer time on task resulted in greater lane deviation. NASA-TLX scores significantly increased with sleep deprivation (p&lt;.001), indicating that subjective workload increased with sleep loss even though the task remained constant. Workload, sleep deprivation and time of day produced a deterioration in sustained attention. With this, countermeasures that not only consider sleep deprivation and time of day, but also workload (time on task) can be considered.
P094 CPAP Service Patient Experience Survey
Authors: Mihai R , Ellis K , Verginis N , Davey M , Nixon G 
Published: October 2021

Abstract

Introduction
Increasing numbers of children with obstructive sleep apnoea require continuous positive airway pressure (CPAP) treatment. We aimed to collect feedback from parents/carers about our CPAP education and follow-up programme.

Methods
An online survey link was texted to families of children starting outpatient CPAP from Jan 2019 -Feb 2021. Questions assessed satisfaction with the CPAP initiation process, including education by our nurse educator (NE), mask fitting, using equipment, accessing help, confidence using CPAP and follow up. Open-ended feedback was invited.

Results
17/55 (31%) of eligible families responded. “Very satisfied” responses regarding CPAP education ranged from 76% (discussion of costs) to 94% (machine use and maintenance). All families felt confident starting CPAP at home. Two reported issues starting CPAP, but reported feeling fully supported by staff remotely to troubleshoot. All families were “somewhat” or “very satisfied” with NE follow-up, with 2 families more neutral about physician follow-up. Two families reported lower satisfaction (“somewhat dissatisfied” or neutral) with the range of paediatric masks, rather than with the mask fitting process itself. Of 14 general comments, 64% were positive (most common theme was high standard of care from the NE); 21% negative (lack of mask choices, location of consulting suites); and 15% neutral. Suggestions for improvement included financial support information, support groups and online consumable ordering.

Discussion
Families feel confident and well supported to commence outpatient CPAP, highlighting the care, knowledge and support provided by our team. Findings emphasize the importance of a dedicated NE. Suggestions provided will inform future service improvements.
P096 Subjective ratings of medication strength of lemborexant over 6 months in subjects with moderate or severe insomnia
Authors: Drake C , Yardley J , Pinner K , Moline M 
Published: October 2021

Abstract

Introduction
In Study 303 (SUNRISE-2), significantly more subjects reported a positive effect of lemborexant (LEM), a dual orexin receptor antagonist, versus placebo (PBO) on their sleep at 1mo, 3mo and 6mo, as assessed by items 1–3 of the Patient Global Impression–Insomnia (PGI-I). LEM-treated subjects also reported larger and statistically significant decreases in the Insomnia Severity Index (ISI) versus PBO. This analysis examined potential LEM tolerance via patient-reported ratings of medication strength on PGI-I item 4 in subjects with moderate/severe insomnia.

Methods
In this 12mo double-blind, PBO-controlled (first 6mo), phase 3 study, subjects ≥18y with insomnia disorder and ISI scores ≥15 were randomized to PBO (n=318) or LEM (5mg, [LEM5], n=316; 10mg, [LEM10], n=315). The ISI and PGI-I were administered at 1mo, 3mo and 6mo.

Results
The percentage of subjects with moderate (ISI=15–21; n=692) or severe (ISI=22–28; n=223) insomnia at baseline who rated LEM as “just right” increased from 1mo (moderate: LEM5=46.4%; LEM10=43.3%; PBO=31.3%; severe: LEM5=35.8%; LEM10=40.6%; PBO=15.0%) to 6mo (moderate: LEM5=56.5%; LEM10=53.9%; PBO=39.7%; severe: LEM5= 54.8%; LEM10=55.4%; PBO=21.6%). Ratings of “too weak” decreased over 6 months in both ISI severity groups. PBO group ratings of “too weak” always exceeded the LEM groups by &gt;15%. Ratings of “too strong” were low and stable over time.

Conclusions
Findings suggest that LEM tolerance does not occur over 6mo with either LEM dose since patient perceptions of LEM treatment being “too weak” did not increase over the study period. These data support the persistent efficacy of long-term LEM treatment for chronic insomnia.
P124 Chronotype and OSA combine to modify risk of hypertension
Authors: Sansom K , Walsh J , Eastwood P , Maddison K , Singh B , Reynolds A , McVeigh J , Mazzotti D , McArdle N 
Published: October 2021

Abstract

Introduction
There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population.

Methods
Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension.

Results
After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004).

Discussion
Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.
P128 Sleep Need is more Strongly Associated with Self-rated Health and Daytime Function than Sleep Duration
Authors: Scott H , Appleton S , Reynolds A , Gill T , Melaku Y , Adams R , Catcheside P , Perlis M 
Published: October 2021

Abstract

Introduction
Most studies examining associations between sleep and health outcomes focus on sleep duration or efficiency, ignoring individual differences in sleep need. We investigated whether sleep need is a more influential correlate of self-rated daytime function and health than sleep duration.

Methods
This study is a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N=2,044, aged 18–90 years). Hierarchical multiple linear regressions assessed variance explained by demographics (Model 1: age, sex, BMI), self-reported sleep duration (Model 2: Model 1 + weighted variable of weekday/weekend sleep duration), and individual sleep need (Model 3: Model 2+ how often they get enough sleep to feel their best the next day, on a 5-point scale) on daytime function items for fatigue, concentration, motivation, and overall self-rated health (EQ-5D, VAS 0–100).

Results
Sleep need explained an additional 17.5–18.7% of the variance in fatigue, concentration, motivation, and health rating (all p &lt; 0.001 for R² change) in Model 3. Model 2 showed that sleep duration alone only explained 2.0–4.1% of the variance in these outcomes. Findings were similar when stratified by sex. Sleep need also explained greater variance for older adults than for younger and middle-aged adults, especially on health rating (Model 3: R² change = 0.11 for ages 18-24y, 0.14 for 45-54y, 0.27 for 75y+).

Conclusions
Sleep need explains more variance in daytime function and self-rated health than sleep duration. The role of sleep need on other daytime consequences, and in clinical populations, needs further exploration.
P132 Research in the time of COVID-19: Recruitment to a clinical trial comparing models of NIV implementation in people with MND
Authors: Sheers N , Howard M , Hannan L , Retica S , Berlowitz D 
Published: October 2021

Abstract

Introduction
A pilot randomised controlled trial (RCT) examining the feasibility of a new model of non-invasive ventilation (NIV) implementation was due to commence in early 2020. Based on previous research, it was anticipated that 100% of people with motor neurone disease (MND) would be eligible, 60% would consent to participate and 20 people would be randomised in five months. The aim of this report is to describe the impact of COVID-19 pandemic contingencies on trial recruitment.

Methods
Report of project progress, participant screening and recruitment.

Results
First reports of COVID-19 coincided with study commencement and changed usual healthcare delivery. Lockdowns meant telehealth substituted for face-to-face assessment, respiratory function testing was limited and/or patients were reluctant to seek medical treatment. This modified pathway impacted evaluation of diagnosis, timing of need for NIV and procedural safety, with patients then referred specifically for a single-day hospital NIV implementation to enable face-to-face multidisciplinary assessment to aid decisions. Of 81 potential participants screened in an 8-month period, 64% were ineligible for the RCT. Despite this shift in eligibility rate, 16 people with MND have been recruited as of May 2021.

Conclusion
The current climate has amplified the significance of this research trial; people with MND have had reduced access to face-to-face services globally and clinicians have had to quickly adapt to a changing landscape of telemedicine and remote monitoring of patients. This trial’s screening data suggest that COVID-19 hasn’t stopped people with MND being implemented on NIV, but it has altered assessment pathways.
P148 Solriamfetol Titration & AdministRaTion (START): Dosing and titration strategies in patients with narcolepsy starting solriamfetol
Authors: Thorpy M , Hyman D , Parks G , Chen A , Foley C , Ito D , Singh H 
Published: October 2021

Abstract

Introduction
Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnoea (OSA) (37.5–150 mg/day). This study characterised real-world dosing and titration with solriamfetol in patients with narcolepsy.

Methods
A retrospective patient chart review was conducted among US-based physicians prescribing solriamfetol. Initiation strategies were de novo (no prior EDS medication), transition (switched/switching from existing EDS medications to solriamfetol), or add-on (adding solriamfetol to current EDS medication).

Results
Twenty-three physicians entered data from 70 patients with narcolepsy (type 1, 24/70; type 2, 46/70; mean+/-SD age, 40+/-11 years; 57% female; 6 also had OSA). EDS was mainly moderate (59%) or severe (36%). Nineteen patients (27%) initiated de novo, 31 (44%) transitioned, and 20 (29%) were add-on. Most patients started solriamfetol at 75 mg (86%) and were stable at 150 mg (76%). Most (67%) had 1 dose adjustment; median (range) time to a stable dose was 14 (1–60) days. EDS severity (44% of patients) was frequently considered when titrating. Fourteen of 22 (64%) transitioning from wake-promoting agents (WPAs) stopped them abruptly; 5/9 (56%) using stimulants tapered off.

Discussion
In a real-world study, most physicians prescribing solriamfetol to patients with narcolepsy started at 75 mg, tapered stimulants, abruptly discontinued WPAs, and made 1 dose adjustment.

Support
Jazz Pharmaceuticals
P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum
Authors: Verma S , Pinnington D , Manber R , Bei B 
Published: October 2021

Abstract

Introduction
Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points.

Methods
Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24.

Results
163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p&lt;.001); chronotype shifted progressively towards more morningness (p&lt;.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values&lt;.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values&gt;0.65).

Conclusions
Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.
Synthetic Amorphous Silica Nanoparticles Promote Human Dendritic Cell Maturation and CD4+ T-Lymphocyte Activation
Authors: Feray Alexia , Guillet Éléonore , Szely Natacha , Hullo Marie , Legrand François-Xavier , Brun Emilie , Rabilloud Thierry , Pallardy Marc , Biola-Vidamment Armelle 
Published: October 2021

Abstract
Innate immune cells such as dendritic cells (DCs) sense and engulf nanomaterials potentially leading to an adverse immune response. Indeed, as described for combustion-derived particles, nanomaterials could be sensed as danger signals, enabling DCs to undergo a maturation process, migrate to regional lymph nodes and activate naive T lymphocytes. Synthetic amorphous silica nanoparticles (SAS-NPs) are widely used as food additives, cosmetics, and construction materials. This work aimed to evaluate in vitro the effects of manufactured SAS-NPs, produced by thermal or wet routes, on human DCs functions and T-cell activation. Human monocyte-derived DCs (moDCs) were exposed for 16 h to 3 endotoxin-free test materials: fumed silica NPs from Sigma-Aldrich (no. S5505) or the JRC Nanomaterial Repository (NM-202) and colloidal LudoxTMA NPs. Cell viability, phenotypical changes, cytokines production, internalization, and allogeneic CD4+ T-cells proliferation were evaluated. Our results showed that all SAS-NPs significantly upregulated the surface expression of CD86 and CD83 activation markers. Secretions of pro-inflammatory cytokines (CXCL-8 and CXCL-12) were significantly enhanced in a dose-dependent manner in the moDCs culture supernatants by all SAS-NPs tested. In an allogeneic coculture, fumed silica-activated moDCs significantly increased T-lymphocyte proliferation at all T-cell: DC ratios compared with unloaded moDCs. Moreover, analysis of coculture supernatants regarding the production of T-cell-derived cytokines showed a significant increase of IL-9 and IL-17A and F, as well as an upregulation of IL-5, consistent with the pro-inflammatory phenotype of treated moDCs. Taken together, these results suggest that SAS-NPs could induce functional moDCs maturation and play a role in the immunization process against environmental antigens.
Molecular Mechanisms Associated with the Resistance of Rhizoctonia solani AG-4 Isolates to the Succinate Dehydrogenase Inhibitor Thifluzamide
Authors: Zhao Can , Li Yuting , Liang Zhijian , Gao Lihong , Han Chenggui , Wu Xuehong 
Published: October 2021

Thifluzamide, a succinate dehydrogenase (SDH) inhibitor, possesses high activity against Rhizoctonia. In this study, 144 Rhizoctonia solani AG-4 (4HGI, 4HGII, and 4HGIII) isolates, the predominate pathogen associated with sugar beet seedling damping-off, were demonstrated to be sensitive to thifluzamide with a calculated mean median effective concentration of 0.0682 ± 0.0025 μg/ml. Thifluzamide-resistant isolates were generated using fungicide-amended media, resulting in four AG-4HGI isolates and eight AG-4HGII isolates with stable resistance and almost no loss in fitness. Evaluation of cross-resistance of the 12 thifluzamide-resistant isolates and their corresponding parental-sensitive isolates revealed a moderately positive correlation between thifluzamide resistance and the level of resistance to eight other fungicides from three groups, the exception being fludioxonil. An active efflux of fungicide through ATP-binding cassette and major facilitator superfamily transporters was found to be correlated to the resistance of R. solani AG-4HGII isolates to thifluzamide based on RNA-sequencing and quantitative reverse transcription-PCR analyses. Sequence analysis of sdhA, sdhB, sdhC, and sdhD revealed replacement of isoleucine by phenylalanine at position 61 in SDHC in 9 of the 12 generated thifluzamide-resistant isolates. No other mutations were found in any of the other genes. Collectively, the data indicate that the active efflux of fungicide and a point mutation in sdhC may contribute to the resistance of R. solani AG-4HGI and AG-4HGII isolates to thifluzamide in vitro. This is the first characterization of the potential molecular mechanism associated with the resistance of R. solani AG-4 isolates to thifluzamide and provides practical guidance for the use of this fungicide.
Factors That Affect the Success of Ethnically Diverse Nursing Students: An Integrative Review of the Literature
Authors: Everett Michele C. 
Published: October 2021

Abstract

AIM
The purpose of this research was to review nursing student retention literature to better understand how to help ethnically diverse undergraduate nursing students succeed.

BACKGROUND
Nursing student retention continues to be a major challenge. Additional research is needed to improve the retention of students from diverse ethnic and cultural backgrounds.

METHOD
An integrative literature review was conducted. Qualitative analysis of 10 studies was used to identify emergent themes.

RESULTS
Analyses of the studies reveal the magnitude, complexity, and distinctiveness of the challenges ethnically diverse nursing students face.

CONCLUSION
The findings have implications for developing strategies for helping this important at-risk population of students complete their nursing degrees.
The Otolaryngology Residency Program Preference Signaling Experience
Authors: Pletcher Steven D. , Chang C.W. David , Thorne Marc C. , Malekzadeh Sonya 
Published: October 2021

Problem
In the 2021 residency application cycle, the average otolaryngology applicant applied to more than half of programs. Increasing application numbers make it difficult for applicants to stand out to programs of interest and for programs to identify applicants with sincere interest.

Approach
As part of the 2021 Match, otolaryngology applicants could participate in a preference signaling process, signaling up to 5 programs of particular interest at the time of application submission. Programs received a list of applicants who submitted signals to consider during interview offer deliberations. Applicants and program directors completed surveys to evaluate the signaling process and assess the impact of signals on interview offers.

Outcomes
All otolaryngology residency programs participated in the signaling process. In total, 611 students submitted applications for otolaryngology residency programs, 559 applicants submitted a Match list including an otolaryngology program, and 558 applicants participated in the signaling process. The survey response rate was 42% for applicants (n = 233) and 52% for program directors (n = 62). The rate of receiving an interview offer was significantly higher from signaled programs (58%) than from both nonsignaled programs (14%; P < .001) and the comparative nonsignal program (23%; P < .001) (i.e., the program an applicant would have signaled given a sixth signal). This impact was consistent across the spectrum of applicant competitiveness. Applicants (178, 77%) and program directors (53, 91%) strongly favored continuing the program.

Next Steps
Many specialties face high residency application numbers. Programs have difficulty identifying applicants with sincere interest, and applicants face limited opportunities to identify programs of particular interest. Applicants to these specialties may benefit from a preference signaling process like that in otolaryngology. Additional evaluation is needed to determine the impact of signals across racial and demographic lines and to validate these early outcomes.