bluuebunny/crossref_metadata_2025_split huggingface dataset:
P152 Poor sleep quality, individual experiences and increased risk of self-harm – A multi-method study
Authors: Varma P , Burge M , Meaklim H , Junge M , Jackson M 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk.

Methods
N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score &gt;8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm.

Results
Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps&lt;.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps&lt;.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p&lt;.0001) after controlling for demographic variables.

Discussion
Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.
P155 Effects of upper airway muscle training on upper airway physiology in people with obstructive sleep apnea
Authors: Wallace E , Eckert D , Osman A , Naik G , Carberry J 
Published: October 2021

Abstract

Introduction
Previous studies demonstrate that oropharyngeal exercises can reduce obstructive sleep apnoea (OSA) severity. However, the physiological mechanisms underlying this improvement are unknown. Thus, this study aimed to evaluate the effects of a speech-pathology led, targeted upper airway muscle training protocol on upper airway physiology.

Methods
People with mild-moderate OSA (n=12 studied to date, 5 females, 7 males) completed 12 weeks of daily upper airway muscle training targeting the muscles of the tongue and soft palate. Pre- and post-training outcome measures included anterior and posterior tongue muscle strength and endurance and upper airway collapsibility via the upper airway collapsibility index.

Results
Preliminary findings indicate that 12 weeks of targeted exercise training improved anterior and posterior tongue muscle strength, respectively (54.3±12.7 vs. 61.5±7.7kPa, p&lt;0.01, 50.1±8.5 vs. 58.0±8.5kPa, p&lt;0.01), and anterior and posterior tongue muscle endurance, respectively (15.7±10.9 vs. 24.1±8s, p&lt;0.01, 9.5±4.2 vs. 23.3±17.7s, p&lt;0.01). The upper airway collapsibility index improved post-training (25.5±18.9 vs. 12.26±12.11 %, p=0.03).

Conclusions
Twelve weeks of upper airway muscle training improved tongue muscle strength, endurance and upper airway collapsibility in people with mild-moderate OSA. These physiological changes provide insight into the potential mechanisms mediating reductions in OSA severity with oropharyngeal exercises.
This research was supported by the 2019 Phillips/ASA Sleep Research grant.
P156 Global sleep health surveillance of adults: A scoping review
Authors: Way J , Cistulli P , Bin Y 
Published: October 2021

Abstract

Introduction
The monitoring of sleep health is an emerging but globally under-recognised public health opportunity to help address poor health and social outcomes in the general population. This scoping review aims to identify the existing national surveillance systems monitoring sleep health and to describe the sleep indicators used in the questionnaires.

Methods
We systematically searched the grey and peer-reviewed literature for cross-sectional national health surveys that included measurement of the sleep of adults aged 18+. Countries screened were the 194 Member States of the World Health Organization (WHO). Searches included 1) targeted searches of the websites of national and international health agencies and statistics departments, 2) customised internet search, and 3) search of electronic databases (PubMed and EMBASE).
Progress to date
Searches of targeted websites and the internet have been completed. Preliminary analysis shows that 49 (25%) countries have national surveys that include at least one sleep health-related question. Breakdown by the WHO defined regions reveal the European Region (45%) with the highest sleep health surveillance and the African Region (6%) with the lowest. An electronic database search is currently being conducted.
Intended outcome and impact
This scoping review will provide an overview of the current status of global sleep health surveillance including how sleep is measured in population health surveys. The results will raise awareness about the need to monitor sleep at a national level to improve health and social outcomes.
P165 Use of Initiation checklist to improve compliance with BPAP & CPAP
Authors: Wood C , Morris L , Raths K , Waters K , Gray K 
Published: October 2021

Abstract

Introduction
Studies have shown that processes used during initiation of non-invasive respiratory (NIV) therapies (including CPAP and BPAP) for children, can influence subsequent compliance with therapy.

Methods
We implemented a structured checklist as a way of standardising a number of the steps during initiation of NIV in our paediatric sleep medicine service. This study retrospectively reviewed the medical records of children initiated on NIV between Nov 2018 and Dec 2020. We hypothesised that our use of a structured approach to the initiation process, with electronic documentation, would indicate areas in the initiation process that are associated with improved compliance with the therapy, in the long term.

Results
Initial results revealed that 220 children were commenced on therapy during the 2-year study period (51 BPAP & 169 CPAP). Total numbers with forms present 136 (62%) and complete forms 56 (41%). Forty-six (90%) children commenced on BPAP had forms present and 34 (74%) were completed. Ninety (53%) children commenced on CPAP had forms present and 22 (25%) were completed. Further analyses will evaluate whether sections of the initiation process and checklist (day (of week) of discharge, in-patient vs HITH, attendance at 1st follow-up appointment, financial assistance, severity of disease, eligibility for government-funded equipment) influence compliance when monitored by download at the first, subsequent sleep study.

Discussion
Use of standardised processes during initiation of NIV therapies can aid in evaluation of the factors that positively influence subsequent compliance with therapy.
Excluding Criminals or Mothers? How Vicarious Experiences Shape Legal Attitudes on Immigration Enforcement
Authors: Ramirez Blanca A 
Published: October 2021

AbstractLiterature provides insights as to how interior immigration enforcement can foment legal cynicism among those it targets. Yet scholars know little about individuals’ evaluative judgments after a secondhand experience, such as when a relative is apprehended, detained, or deported by immigration enforcement. Drawing on data from 26 interviews with individuals who had a family member apprehended by immigration enforcement, I examine how people evaluate a relative’s immigration case and immigration law more broadly. I argue that a gendered legal attitude formation process occurs as family members make and express their evaluative judgments. Respondents often had limited information about the case, and they turned to available gendered discourses to express their legal attitudes. As a result, with a male relative, individuals invoked criminalization discourses, whereas with a female relative, they invoked motherhood discourses. Thus, family members of males who delegitimized immigration enforcement did so via a limited challenging of criminalization discourses, whereas the family members of females tended to delegitimize immigration enforcement via motherhood discourses. Other family members of males also drew from criminalization discourses to legitimize some aspects of immigration enforcement. I argue that this process of gendered legal attitude formation demonstrates the far-reaching consequences of a men’s criminalization.
Daughters of War: Girl Guides and Service after the First World War
Authors: Proctor Tammy M 
Published: October 2021

Abstract
Using the lens of the largest female youth organization in interwar Britain, the Girl Guides, I argue girls became important to the rebuilding of the post-war world as future wives, mothers, and keepers of the hearth. Yet this message of return to home was complicated by a wartime message of patriotic service, citizenship, and adventure. Thus, uniformed clubs such as the Guides tried to balance these ideals, with female war veterans leading the way. Guiding taught homemaking skills in the 1920s while also offering alternative ways for girls and young women to continue to maintain a meaningful service to the nation. Such groups became a haven both for those who had performed war work and for a new generation of girls who longed to be patriots and active public-minded women. Finally, the Guides performed an exemplary role in enacting gender roles for a postwar generation, especially given the group’s connection as a complementary ‘sister’ group to Boy Scouting, which created a symmetrical training program for boys and girls.
Association between maternal serum 25-hydroxyvitamin D concentrations and the risk of pre-eclampsia in central Sudan: a case-control study
Authors: Abdelrahiem Somia K , Ahmed Abdel B A , Sharif Manal E , Adam Ishag 
Published: October 2021

Abstract

Background
There are few published data on the role of vitamin D concentrations during pregnancy in sub-Saharan Africa. Thus, the aim of the current study was to investigate the association between 25-hydroxyvitamin D (25[OH)]D) levels and pre-eclampsia.

Method
A case-control study, with 60 women in each arm, was conducted in Medani Hospital in Sudan. The cases were women with pre-eclampsia and healthy pregnant women as controls. The medical and obstetric history was obtained using a questionnaire. The serum 25(OH)D concentrations were measured using ELISA.

Results
The median (IQR) of 25(OH)D concentration was significantly lower in women with pre-eclampsia than in the controls (10.0 [6.5] vs 18.3 [22.1] ng/mL). Fifty-three cases with pre-eclampsia (88%) and 36 cases in the control group (60%) had vitamin D deficiency (25(OH)D level≤20 ng/mL). Multivariate logistic regression showed that the 25(OH)D levels were negatively associated with pre-eclampsia (adjusted OR [AOR]=0.87, 95% CI 0.81 to 0.92). Vitamin D-deficient women were at a higher risk of pre-eclampsia (AOR=4.51, 95% CI 1.70 to 11.94).

Conclusion
Low 25(OH)D levels were reported in women with pre-eclampsia and were an independent risk factor for pre-eclampsia.
The Scope of Social Mission Content in Health Professions Education Accreditation Standards
Authors: Orban Julie , Xue Crystal , Raichur Shalini , Misak Monika , Nobles Autumn , Casimir Jaileessa , Batra Sonal 
Published: October 2021

Purpose
Health professions education accreditation standards influence institutional practices and policies and ensure high-quality education that meets the needs of patients and society. Social mission is the contribution of a school in its mission, programs, and the performance of its graduates, faculty, and leadership to advancing health equity and addressing the health disparities of the society in which it exists. This study examined the scope of social mission content in major U.S. and Canadian health professions education accreditation standards.

Method
The authors analyzed publicly available accreditation standards documents from 9 accreditors across 5 disciplines—dental, medical, nursing, pharmacy, and physician assistant schools—with effective years from 2016 to 2020. They created a codebook from the previously published social mission metrics survey, which includes 18 social mission activity areas and 79 indicators within those areas. The authors then conducted detailed document reviews to identify the presence of the social mission areas and indicators within the accreditation standards.

Results
Across all 18 activity areas and 9 accreditors, the authors identified 93 instances of social mission. Curriculum was the most well-represented area with 34 instances. Interprofessional education in curriculum was the most prevalent indicator with 17 instances. The Committee on Accreditation of Canadian Medical Schools included more social mission areas and indicators than the other accreditors.

Conclusions
There is substantial variability in the social mission content in accreditation standards across accreditors and disciplines. The authors found little representation of key aspects of social mission, including community collaborations, faculty training, and pipeline programs. These findings highlight areas of potential interdisciplinary collaboration to enhance the social mission content of health professions education.
A Systematic Review on the Association Between Vestibular Dysfunction and Balance Performance in Children With Hearing Loss
Authors: Singh Anisha , Heet Hannah , Guggenheim Dana S. , Lim Margaret , Garg Bhavika , Bao Matthew , Smith Sherri L. , Garrison Doug , Raynor Eileen M. , Lee Janet W. , Wrigley Jordan , Riska Kristal M. 
Published: October 2021

Objectives:
The objective of this study was to understand the functional impact of vestibular dysfunction on balance control in children with hearing loss. The vestibular system is an important contributor to maintaining balance. In adults, vestibular dysfunction is known to lead to unsteadiness and falls. Considerably less is known about the effects of vestibular dysfunction in children with hearing loss.

Design:
We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included articles on children with hearing loss who underwent vestibular and balance testing. The Downs and Black checklist was used to assess the risk of bias.

Results:
A total of 20 articles were included in this systematic review, of which, 17 reported an association between vestibular dysfunction and balance abnormalities in children with hearing loss. Bias (as measured by the Downs and Black Checklist) was a concern, as most studies were nonblinded cohort studies or case series selected through convenience sampling.

Conclusions:
Research to date has predominantly found that children with concomitant hearing loss and vestibular impairment tend to perform more poorly on balance measures than either children with hearing loss and normal vestibular function or children with both normal-hearing and normal vestibular function. A standardized approach to assessing both vestibular function and balance would better characterize the impact of vestibular dysfunction in children with hearing loss at the population level.
Magnetically Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF) Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS) Patients
Authors: Mackey Catherine , Hanstein Regina , Lo Yungtai , Vaughan Majella , St. Hilaire Tricia , Luhmann Scott J. , Vitale Michael G. , Glotzbecker Michael P. , Samdani Amer , Parent Stefan , Gomez Jaime A. 
Published: October 2021

Study Design.
Retrospective review of prospective data from multicenter registry.

Objective.
Compare outcomes of posterior spinal fusion (PSF) versus magnetically controlled growing rods (MCGR) versus vertebral body tethers (VBT) in 8- to 11-year-old idiopathic early onset scoliosis (EOS) patients.

Summary of Background Data.
In EOS, it is unclear at what age the benefit of growth-sparing strategies outweighs increased risks of surgical complications, compared with PSF.

Methods.
One hundred thirty idiopathic EOS patients, 81% female, aged 8–11 at index surgery (mean 10.5 yrs), underwent PSF, MCGR, or VBT. Scoliosis curve, kyphosis, thoracic and spinal height, complications, and Quality of Life (QoL) were assessed preoperatively and at most recent follow-up (prior to final fusion for VBT/MCGR).

Results.
Of 130 patients, 28.5% received VBT, 39.2% MCGR, and 32.3% PSF. The VBT cohort included more females (P < 0.0005), was older (P < 0.0005), more skeletally mature (P < 0.0005), and had smaller major curves (P < 0.0005). At follow-up, scoliosis curve corrected 41.1 ± 22.4% in VBT, 52.2 ± 19.9% in PSF, and 27.4 ± 23.9% in MCGR (P < 0.0005), however, not all VBT/MCGR patients finished treatment. Fifteen complications occurred in 10 VBTs, 6 requiring unplanned surgeries; 45 complications occurred in 31 MCGRs, 11 requiring unplanned surgeries, and 9 complications occurred in 6 PSFs, 3 requiring unplanned revisions. Cox proportional hazards regression adjusted for age, gender, and preoperative scoliosis curve revealed that MCGR (hazard ratio [HR] = 21.0, 95% C.I. 4.8–92.5; P < 0.001) and VBT (HR = 7.1, 95% C.I. 1.4–36.4; P = 0.019) patients were at increased hazard of requiring revision, but only MCGR patients (HR = 5.6, 95% C.I. 1.1–28.4; P = 0.038) were at an increased hazard for unplanned revisions compared with PSF. Thoracic and spinal height increased in all groups. QoL improved in VBT and PSF patients, but not in MCGR patients.

Conclusion.
In older idiopathic EOS patients, MCGR, PSF, and VBT controlled curves effectively and increased spinal height. However, VBT and PSF have a lower hazard for an unplanned revision and improved QoL.

Level of Evidence: 3
Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
Authors: Routsi Christina , Kokkoris Stelios , Siempos Ilias , Magira Eleni , Kotanidou Anastasia , Zakynthinos Spyros 
Published: October 2021

OBJECTIVES:
Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubation and mortality of intubated patients in our ICUs between the first and second waves of the pandemic.

DESIGN:
Single-center, observational.

SETTING:
Four coronavirus disease 2019 designated ICUs at an urban Greek teaching hospital.

PATIENTS:
All adult patients with coronavirus disease 2019 consecutively admitted to ICU during the first (n = 50) and second (n = 212) waves of the pandemic.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The percentage of intubated ICU patients dropped from 82% during the first wave to 66% during the second wave (p = 0.042). However, the absolute number of intubated ICU patients was lower during the first than the second wave (41 vs 140 patients). ICU or hospital mortality of intubated patients increased from 39% during the first wave to 60% during the second wave (p = 0.028). The binary logistic regression for hospital mortality as the dependent variable in intubated patients and covariates the age, Acute Physiology and Chronic Health Evaluation II score, cardiovascular comorbidity, lactate, positive end-expiratory pressure, Sequential Organ Failure Assessment score, and wave, distinguished only Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.40 with 95% CI, 1.14—1.72; p = 0.001) as the sole independent predictor of hospital mortality.

CONCLUSIONS:
Pharmacological adaptations and other measures may have led to fewer intubations over time. However, these changes do not seem to be translated into improved outcomes of intubated patients. Perhaps the same change in the use of drugs and protocols that could cause fewer intubations of ICU patients might be a reason of increased mortality in those patients who are eventually intubated. Furthermore, the relative staff inexperience and overall increase in patients’ comorbidities during the second wave could have contributed to increased Acute Physiology and Chronic Health Evaluation II score and mortality of intubated patients.
Criteria for Pediatric Sepsis—A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce*
Authors: Menon Kusum , Schlapbach Luregn J. , Akech Samuel , Argent Andrew , Biban Paolo , Carrol Enitan D. , Chiotos Kathleen , Jobayer Chisti Mohammod , Evans Idris V. R. , Inwald David P. , Ishimine Paul , Kissoon Niranjan , Lodha Rakesh , Nadel Simon , Oliveira Cláudio Flauzino , Peters Mark , Sadeghirad Benham , Scott Halden F. , de Souza Daniela C. , Tissieres Pierre , Watson R. Scott , Wiens Matthew O. , Wynn James L. , Zimmerman Jerry J. , Sorce Lauren R. ,   for the Pediatric Sepsis Definition Taskforce of the Society of Critical Care Medicine
Published: October 2021

Objective:
To determine the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with: 1) sepsis, severe sepsis, or septic shock in children with infection and 2) multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock.

Data Sources:
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2004, and November 16, 2020.

Study Selection:
Case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms “sepsis,” “septicemia,” or “septic shock” in the title or abstract.

Data Extraction:
Study characteristics, patient demographics, clinical signs or interventions, laboratory values, organ dysfunction measures, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed.

Data Synthesis:
One hundred and six studies met eligibility criteria of which 81 were included in the meta-analysis. Sixteen studies (9,629 patients) provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies (154,674 patients) for the mortality outcome. In children with infection, decreased level of consciousness and higher Pediatric Risk of Mortality scores were associated with sepsis/severe sepsis. In children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score each demonstrated significant and consistent associations with mortality. Pooled mortality rates varied among high-, upper middle-, and lower middle-income countries for patients with sepsis, severe sepsis, and septic shock (p < 0.0001).

Conclusions:
Strong associations of several markers of organ dysfunction with the outcomes of interest among infected and septic children support their inclusion in the data validation phase of the Pediatric Sepsis Definition Taskforce.