bluuebunny/crossref_metadata_2025_split huggingface dataset:
Energetic Cost of Walking and Brain Atrophy in Mid-to-Late Life
Authors: Dougherty Ryan J , Liu Fangyu , An Yang , Wanigatunga Amal A , Tian Qu , Davatzikos Christos , Simonsick Eleanor M , Ferrucci Luigi , Resnick Susan M , Schrack Jennifer A 
Published: October 2021

AbstractBackgroundHigher energetic costs for mobility are associated with declining gait speed, and slow gait is linked to cognitive decline and Alzheimer’s disease. However, the physiological underpinnings of gait and brain health have not been well explored. We examined the associations of the energetic cost of walking with brain volume in cognitively unimpaired adults from the Baltimore Longitudinal Study of Aging.MethodsWe used brain magnetic resonance imaging (MRI) data from 850 participants (mean baseline age 66.3 ± 14.5 years), of whom 451 had longitudinal MRI data (2.8 ± 1.0 MRI scans over 4.0 ± 2.0 years). The energetic cost of walking was assessed as the average energy expended (V̇O2) during 2.5 minutes of customary-paced overground walking. Multivariable linear mixed-effects models examined the associations between baseline energetic cost of walking and regional brain volumes adjusting for covariates.ResultsAt baseline, higher energetic cost of walking was cross-sectionally associated with lower gray and white matter volumes within the frontal, parietal, and temporal lobes, as well as hippocampal, total brain, and larger ventricular volumes (all false-discovery rate [FDR] p &lt; .05). A baseline energetic cost of walking × time interaction demonstrated that participants with higher energetic cost of walking had faster annual decline in hippocampal volume (FDR p = .02) and accelerated annual increase in ventricular volumes (FDR p = .02).ConclusionsThe energetic cost of walking is associated with gray and white matter volumes and subsequent hippocampal atrophy and ventricular enlargement. Collectively, these data suggest the energetic cost of walking may be an early marker of neurodegeneration that contributes to the gait brain connection.
Becoming a normative power? China's Mekong agenda in the era of Xi Jinping
Authors: Song Yao , Qiao-Franco Guangyu , Liu Tianyang 
Published: October 2021

Abstract
Maintaining robust diplomatic relationships with neighbouring countries in the Mekong region has become strategically critical to China. Since President Xi Jinping took office, China has been renovating normative power in the Mekong region, endeavouring to socialize the Mekong countries into accepting normative Chinese concepts, such as ‘community of shared destiny’, by mobilizing and reconfiguring their material and normative recourses. This article argues that China's normative power stems from two primary mechanisms: 1) an organized, top-down diffusion driven by political elites, involving inter-governmental dialogues, socialization via bilateral and multilateral cooperation mechanisms, and negotiations with countries co-opted into China-led connectivity and infrastructure initiatives; 2) a bottom-up diffusion of ideas from practices (i.e. exchange of goods, trade, aid) and the physical presence of China in the Mekong region, exemplified by the massive scale of infrastructure widely constructed in the region. Taken together, China's expanded normative engagement in the Mekong subregion is comprised of multiple, oscillating modes of normative production that have been ‘synchronized’ across riparian countries with varied geoeconomic and geopolitical circumstances. Our findings suggest that while normative Chinese discourses have been accepted by the ruling classes of certain Mekong countries, China's attempts to build normative power have been largely shunned by the civil societies in the region.
Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review
Authors: Yu Natalie , Basnayake Chamara , Connell William , Ding Nik Sheng , Wright Emily , Stanley Annalise , Fry Stephanie , Wilson-O’Brien Amy , Niewiadomski Ola , Lust Mark , Schulberg Julien , Kamm Michael A 
Published: October 2021

Abstract

Background
Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling.

Methods
We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes.

Results
In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians.

Conclusions
A range of interventions—targeted at gastroenterologists, patients, or both—were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.
The Tropical Symplectic Grassmannian
Authors: Balla George , Olarte Jorge Alberto 
Published: October 2021

AbstractWe launch the study of the tropicalization of the symplectic Grassmannian, that is, the space of all linear subspaces isotropic with respect to a fixed symplectic form. We formulate tropical analogues of several equivalent characterizations of the symplectic Grassmannian and determine all implications between them. In the process, we show that the Plücker and symplectic relations form a tropical basis if and only if the rank is at most 2. We provide plenty of examples that show that several features of the symplectic Grassmannian do not hold after tropicalizing. We show exactly when do conormal fans of matroids satisfy these characterizations, as well as doing the same for a valuated generalization. Finally, we propose several directions to extend the study of the tropical symplectic Grassmannian.
The Expected Number of Roots over The Field of p-adic Numbers
Authors: Shmueli Roy 
Published: October 2021

Abstract
We study the roots of a random polynomial over the field of $p$-adic numbers. For a random monic polynomial with i.i.d. coefficients in ${\mathbb{Z}}_p$, we obtain an estimate for the expected number of roots of this polynomial. In particular, if the coefficients take the values $\pm 1$ with equal probability, the expected number of $p$-adic roots converges to $(p-1)/(p+1)$ as the degree of the polynomial tends to $\infty $.
Real Eigenvalues of Elliptic Random Matrices
Authors: Byun Sung-Soo , Kang Nam-Gyu , Lee Ji Oon , Lee Jinyeop 
Published: October 2021

Abstract
We consider the real eigenvalues of an $(N \times N)$ real elliptic Ginibre matrix whose entries are correlated through a non-Hermiticity parameter $\tau _N\in [0,1]$. In the almost-Hermitian regime where $1-\tau _N=\Theta (N^{-1})$, we obtain the large-$N$ expansion of the mean and the variance of the number of the real eigenvalues. Furthermore, we derive the limiting densities of the real eigenvalues, which interpolate the Wigner semicircle law and the uniform distribution, the restriction of the elliptic law on the real axis. Our proofs are based on the skew-orthogonal polynomial representation of the correlation kernel due to Forrester and Nagao.
UNMASC: tumor-only variant calling with unmatched normal controls
Authors: Little Paul , Jo Heejoon , Hoyle Alan , Mazul Angela , Zhao Xiaobei , Salazar Ashley H , Farquhar Douglas , Sheth Siddharth , Masood Maheer , Hayward Michele C , Parker Joel S , Hoadley Katherine A , Zevallos Jose , Hayes D Neil 
Published: October 2021

Abstract
Despite years of progress, mutation detection in cancer samples continues to require significant manual review as a final step. Expert review is particularly challenging in cases where tumors are sequenced without matched normal control DNA. Attempts have been made to call somatic point mutations without a matched normal sample by removing well-known germline variants, utilizing unmatched normal controls, and constructing decision rules to classify sequencing errors and private germline variants. With budgetary constraints related to computational and sequencing costs, finding the appropriate number of controls is a crucial step to identifying somatic variants. Our approach utilizes public databases for canonical somatic variants as well as germline variants and leverages information gathered about nearby positions in the normal controls. Drawing from our cohort of targeted capture panel sequencing of tumor and normal samples with varying tumortypes and demographics, these served as a benchmark for our tumor-only variant calling pipeline to observe the relationship between our ability to correctly classify variants against a number of unmatched normals. With our benchmarked samples, approximately ten normal controls were needed to maintain 94% sensitivity, 99% specificity and 76% positive predictive value, far outperforming comparable methods. Our approach, called UNMASC, also serves as a supplement to traditional tumor with matched normal variant calling workflows and can potentially extend to other concerns arising from analyzing next generation sequencing data.
O004 Obstructive sleep apnoea severity is associated with parasympathetic withdrawal in coronary artery disease
Authors: Ucak S , Dissanayake H , Sutherland K , Bin Y , Skilton M , Patel S , Yee B , Bhindi R , Allahwala U , de Chazal P , Cistulli P 
Published: October 2021

Abstract

Introduction
Patients with Coronary Artery Disease (CAD) are exposed to myocardial ischemia and hypoxia, resulting in altered autonomic function. Obstructive sleep apnoea (OSA) is highly prevalent in CAD and is associated with increased sympathetic activity which could further exacerbate cardiovascular risk. We aimed to determine whether OSA severity is associated with altered autonomic function in CAD patients.

Methods
Patients presenting to the coronary care unit with CAD underwent level 2 portable polysomnography to assess the presence and severity of OSA. Autonomic function was calculated from continuous blood pressure and 3-lead ECG 5 minute recordings while awake. Mean spontaneous baroreceptor sensitivity (sBRS msec/mmHg); vagally mediated heart rate variability (HRV) markers (pNN50%, RMSSD, HF-HRV); and, sympathetically mediated vascular autonomic function (LF-BPV) were measured. Autonomic function was assessed in relation to OSA severity (Apnoea Hypopnea Index, AHI; oxygen desaturation index, ODI).

Results
OSA was present in 49/51 (96%) participants with CAD (age 54±9 years; BMI 28.9±5.4 kg/m2; male 41(77%)). No association was found between sBRS and AHI. There was a modest inverse correlation between AHI and vagally mediated HRV (RMSSD, r= -0.28 p=0.04; HF, r= -0.31 p=0.03). AHI positively correlated with LF-SBP (r=0.29, p=0.04) suggesting upregulation of sympathetic modulation. Linear regression analyses, adjusted for age, sex, and BMI, showed AHI was a determinant of parasympathetically modulated HRV measures (pNN50% -0.25(0.12), p=0.05).

Conclusions
In patients with CAD, increased AHI was associated with parasympathetic withdrawal suggesting that OSA could increase poor cardiovascular prognosis in this population.
O015 Upper airway collapsibility measurement under anaesthesia in children: feasibility and utility in predicting perioperative respiratory adverse events
Authors: Ohn M , Julie J , Salerno S , Herbet H , Bumbak P , Hillman D , Khan N , Maddison K , Walsh J , von Ungern-Sternberg B , Eastwood P 
Published: October 2021

Abstract

Background
Perioperative respiratory adverse events (PRAE) pose significant risk in paediatric anaesthesia, and identifying risk is vital. Perioperative measurement of pharyngeal closing pressure (PCLOSE) is a quick, objective method of assessing upper airway collapsibility that may identify PRAE risk.

Aim
To investigate if PCLOSE measurement is feasible and predictive of PRAE in children.

Method
Fifty-six children (1-8years, 34 male, without significant co-morbidities) underwent PCLOSE measurements immediately preceding (pre-PCLOSE) and following (post-PCLOSE) adenotonsillectomy. Measurement was performed under anaesthesia while breathing spontaneously in supine posture with head/jaw neutral.
After application of a face mask, inspiratory flow was occluded with an associated decrease in mask/nasal pressure seen with each inspiratory effort. With airway collapse, a plateau developed in minimum pressure observed (= PCLOSE): less collapsible airways occluded at more negative pressures. PCLOSE was averaged over 5–6 sequential efforts, at least 3 times on each occasion.

Results
Both pre-and post-PCLOSE were successfully measured in 94.6% children without affecting procedure. Pre-PCLOSE and change in PCLOSE from pre- to post- were associated with an increased incidence of PRAE (Poisson regression coefficient 0.083(0.03) (mean, SE); p=0.0054 and 0.03(0.01); p=0.018, respectively). There was no significant association between post-PCLOSE and PRAE. The odd of PRAE occurrence during recovery was 1.5 times higher than in other phases.

Conclusion
This study demonstrated the feasibility of obtaining PCLOSE. A more collapsible airway before surgery and an increase in collapsibility with surgery were both associated with increased PRAE. PCLOSE measurement could be a valuable risk assessment tool for PRAE in children undergoing surgery.
Pharyngeal enlargement via tongue advancement differs with mandibular advancement therapy response and improves treatment prediction
Authors: Jugé L , Knapman F , Humburg P , Burke P , Lowth A , Brown E , Butler J , Eckert D , Ngiam J , Sutherland K , Cistulli P , Bilston L 
Published: October 2021

Abstract

Introduction
Mandibular advancement splint (MAS) treatment outcome prediction for obstructive sleep apnoea (OSA) is currently unreliable. Lower baseline AHI has been associated with better MAS response but is a poor predictor on its own. Imaging markers may enhance prediction. We investigate how the upper airway enlarges via posterior tongue advancement, using tagged MRI during mandibular advancement, as a potential predictor of MAS treatment response.

Methods
101 untreated OSA participants (AHI 10–102 events/hr) underwent an MRI scan wearing a MAS. Mid-sagittal tagged MRI images were collected to quantify tongue movement during passive jaw advancement. Upper airway cross-sectional areas were measured with the mandible in a neutral position and advanced to 70% of the maximum protrusion. Treatment outcome was determined after a minimum of 9 weeks of therapy.

Results
71 participants completed the study: 33 were responders (AHI&lt;5 or AHI≤10 events/hr with &gt;50% AHI reduction), 11 were partial responders (&gt;50% AHI reduction but AHI&gt;10 events/hr), and 27 non-responders (AHI reduction&lt;50% and AHI≥10 events/hr). Responders had the greatest naso- and oropharyngeal tongue advancement (0.40±0.08 and 0.47±0.13mm, respectively) and oropharynx enlargement (6.41±2.12%) per millimetre of mandibular advancement. The inclusion of these imaging markers along with baseline AHI in a multivariate model classified more patients in the right MAS response group (69.2%) than a model based only on baseline AHI (50.0%) when the mandible was advanced by at least 4 mm.

Conclusions
Tongue advancement and upper airway enlargement with mandibular advancement in conjunction with baseline AHI improves MAS treatment response categorisation to a satisfactory level.
P001 Safety, tolerability, and efficacy of 1 month of atomoxetine plus oxybutynin in obstructive sleep apnoea
Authors: Aishah A , Loffler K , Tonson B , Mukherjee S , Adams R , Altree T , Ainge-Allen H , Yee B , Grunstein R , Taranto-Montemurro L , Carberry J , Eckert D 
Published: October 2021

Abstract

Introduction
Single-night studies with noradrenergic and anti-muscarinics have recently been shown to improve upper-airway function and reduce obstructive sleep apnoea (OSA) severity. This study aimed to determine the safety, tolerability, and efficacy profile of longer-term use of different doses of the noradrenergic agent atomoxetine combined with the anti-muscarinic oxybutynin (ato-oxy) in people with OSA.

Methods
Thirty-nine people with predominantly severe OSA received either 80/5mg ato-oxy, 40/5mg ato-oxy, 40/2.5mg ato-oxy or placebo nightly for 30 days according to a double-blind, randomised, parallel design. Safety and tolerability were assessed via weekly phone calls for adverse events, vital signs and objective measures of alertness and memory. Participants completed 3 in-laboratory sleep studies (baseline, night 1 and night 30) to assess efficacy.

Results
Side effects were generally mild and consistent with the known side-effect profile of each drug alone (e.g. dose-dependent increases in dry mouth with oxybutynin). Heart rate increased by night 30 in two of the drug arms versus placebo (e.g. 80/5mg ~9 beats/min, p=0.01). Blood pressure and measures of alertness and memory did not change between conditions. AHI4 and hypoxic burden decreased by ~50% in the 80/5mg arm on night 1 with similar magnitude reductions at night 30. ~50% of participants indicated willingness to continue taking the medication post-study.

Discussion
1 month of nightly noradrenergic and anti-muscarinic combination therapy is generally well-tolerated with a side effect profile consistent with each agent alone. These findings also further highlight the potential to target noradrenergic and anti-muscarinic mechanisms for OSA pharmacotherapy development.
P002 Targeted non-CPAP combination therapy resolves obstructive sleep apnoea
Authors: Aishah A , Tong B , Osman A , Donegan M , Pitcher G , Kwan B , Brown L , Altree T , Adam R , Mukherjee S , Eckert D 
Published: October 2021

Abstract

Introduction
Mandibular advancement splint (MAS) therapy is an effective alternative to CPAP for many people with obstructive sleep apnoea (OSA) but ~50% have residual OSA. This study aimed to resolve OSA in these individuals by combining MAS with other targeted therapies based on OSA endotype characterisation.

Methods
Eleven people with OSA (apnoea-hypopnoea index (AHI): 35±13 events/h), not fully resolved with MAS alone (AHI&gt;10 events/h) were recruited. Initially, OSA endotypes were assessed via a detailed physiology night. Step one of combination therapy focused on anatomical interventions including MAS plus an oral expiratory positive airway pressure valve (EPAP) and a supine-avoidance device. Participants with residual OSA (AHI&gt;10 events/h) following the anatomical combination therapy night, were then given one or more targeted non-anatomical therapies according to endotype characterisation. This included oxygen (4L/min) to reduce unstable respiratory control (high loop gain), 10mg zolpidem to increase arousal threshold, or 80/5mg atomoxetine-oxybutynin (ato-oxy) for poor pharyngeal muscle responsiveness.

Results
OSA was successfully treated (AHI&lt;10 events/h) in all participants with combination therapy. MAS combined with EPAP and supine-avoidance therapy resolved OSA in ~65% of participants (MAS alone vs. combination therapy: 17±4 vs. 5±3, events/h, n=7). For the remaining participants, OSA resolved with the addition of oxygen (n=2), one with 80/5mg ato-oxy and another required both oxygen and 80/5mg ato-oxy.

Discussion
Targeted combination therapy may be a viable treatment alternative for people with OSA who cannot tolerate CPAP or for those who have an incomplete therapeutic response with monotherapy.
P030 The effects of continuous positive airway pressure (CPAP) therapy in moderate to severe obstructive sleep apnea (OSA): A high-density electroencephalography (EEG) study
Authors: D’Rozario A , Kao C , Mullins A , Memarian N , Yee B , Duffy S , Banerjee D , Cho G , Wong K , Kremerskothen K , Chapman J , Haroutonian C , Bartlett D , Naismith S , Grunstein R 
Published: October 2021

Abstract

Introduction
A previous high-density EEG investigation in OSA showed regional sleep EEG deficits particularly slow wave activity (SWA) in the parietal region. It is unclear whether CPAP treatment can reverse local sleep EEG abnormalities, and whether any recovery is related to improved cognitive function.

Methods
Fifteen males with moderate-severe OSA (age 50.4±6.5yrs, AHI 51.7±23.5/h) underwent polysomnography with 256-channel high-density EEG at baseline and following 3 months of CPAP. Tasks assessing cognitive performance and sleep-dependent memory were administered. Topographical spectral power maps were calculated for standard frequency ranges for sleep stages. Differences in normalized power between baseline and treatment were determined by statistical nonparametric mapping.

Results
In 11 CPAP compliant patients (data loss: intolerant of CPAP[n=3]/high-density EEG [n=1]), total sleep time did not change after CPAP but N1 (baseline vs. treatment: 66.9 vs. 39.5 mins, p=0.008) and N2 (195.0 vs. 150.6 mins, p=0.002) sleep was lower and N3 (89.8 vs. 128.7 mins, p=0.003) was higher. Topographic high-density EEG analysis revealed a regional increase in SWA (1–4.5Hz) during N3 sleep in a cluster of 22 electrodes overlying the parietal cortex (paired t-test, t(10)=-3.9, p=0.0029). The change in N3 SWA in the parietal cluster after CPAP was correlated with improved overnight procedural memory on the motor sequence task (rho=0.79, p=0.03) and better executive functioning (Stroop accuracy, rho=0.73, p=0.01).

Conclusion
CPAP treatment reduces localised deficits in sleep EEG, and specific regional recovery relates to short-term improvements in memory and executive function. These data also highlight the potential for long-term therapeutic effects on cognitive outcomes.