bluuebunny/crossref_metadata_2025_split huggingface dataset:
P091 Timing Efficiencies in Tertiary Care of Patients on Non-invasive Ventilation
Authors: Hartnett C , Angliss M , Leclerc M 
Published: October 2023

Abstract

Introduction
A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and any areas that may be considered wasted time. This LSS approach was used to find areas of improvement in a tertiary care hospital for patients on non-invasive ventilation. The solution developed was to implement a remote download service.

Methods
Root cause analysis, current state process and effects analysis, staff surveys and time and motion work sampling studies were conducted. There was a post implementation time and motion work sampling study for the remote download service introduced in 2023.

Results
Motion, transportation, inventory and waiting time and reporting software were found to impact workflow. Time efficiencies were found for non-invasive ventilation download reports with a mean time of 14.8 mins (std 6.7min) pre-implementation down to 2.5 mins (std 0.6min) with remote software. There was an additional time saving due to batch processing prior to clinics of 2.5 mins (std 0.4mins) per patient. Staff reported workload capacity and documentation as two key barriers to effective processes.

Discussion
LSS identified areas to improve value and flow for staff in sleep clinics and patients on non-invasive ventilation.
P099 Use of Digital Technology During Child Bedtime Routines: A qualitative investigation
Authors: McKenzie J , Pattinson C , Rossa K , Edmed S , Loeffler A , Smith S 
Published: October 2023

Abstract

Introduction
The Child Bedtime Routines Study (CBRT) sets out to examine patterns and attitudes towards sleep in daily life in a novel and detailed way, by constructing personal timelines of 5–8-year-old children’s sleep routines in their homes, their digital technology use, and parental attitudes and behaviours surrounding sleep and digital technology use.

Methods
This project involved individual semi-structured interviews with 30 parents of 5–8-year-old children via zoom. During the interview parents completed a novel visualisation of their home environment and the visual diagramming tasks for afternoon and evening, sleep and wake routines at home via the online interactive platform Mural.

Results
Thirty parents (Female = 86.7%) of 30 children (66.7% boys) aged between 5 and 8 years participated in the study. The most common description of their child using technology was watching shows or videos via tv or tablet. Over 76% of parents identified having rules or regulations regarding digital technology use. There was little technology use reported around bed-time routines, however, the use of apps to listen to bedtime stories was reported by some.

Discussion
The interviews allowed for greater description and nuance regarding the parenting decisions around technology use in the home. Household rules around the use of digital technology by children were not specifically oriented around bedtime or the potential impact of technology on sleep quality, duration, or timing. The use of technology-based sleep aids may increase, and a better understanding of the potential benefits and costs of those technologies needs to be understood.
P108 Obstructive Sleep Apnoea in Acute Coronary Syndrome: An Observational Study
Authors: Tong B , Dissanayake H , Patel S , Ucak S , Skilton M , McClintock S , Sutherland K , Yee B , Sarkissian N , Cistulli P 
Published: October 2023

Abstract
Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular disease. CPAP therapy is the primary treatment for OSA and is known to improve long term cardiovascular health outcomes. Recent neutral findings of randomised clinical trials have created uncertainty about whether effective CPAP therapy can improve cardiovascular health in patients with OSA. We conducted a cross-sectional observational study in patients with acute coronary syndrome (ACS) diagnosed with OSA. We aimed to characterise key surrogate markers of cardiovascular health in this cohort to inform a future intervention study of personalised OSA therapy.
70 patients with ACS (age (IQR):58[52,63]years, BMI:27[24,30]kg/m2) were recruited. A level 2 sleep study was conducted to confirm OSA diagnosis within 6 months after discharge. Carotid femoral pulse wave velocity(cfPWV), pulse wave analysis, endothelial function, heart rate variability, and baroreflex sensitivity were measured. Patients were categorised as no-mild OSA(AHI&lt;15events/h) and moderate-severe OSA(AHI≥15events/h) for analysis.
67% of patients were found to have moderate-severe OSA(AHI≥15events/h) and 40% of patients had severe (AHI≥30events/h). cfPWV was elevated in moderate-severe OSA compared to no-mild OSA (7.4[6.6,8.5] vs. 6.1[4.7,7.1]m/s, p=0.003). This was no longer significant after adjusting for age (p=0.296) and BMI (p=0.053). cfPWV correlated with AHI (rs = 0.35, P=0.0069). Measures of pulse wave analysis, flow mediated dilatation, heart rate variability, and baroreflex sensitivity did not differ between patient groups (data not shown).
OSA is highly prevalent in patients with ACS. Arterial stiffness measured by cfPWV appears to show best promise as an outcome measure for a future intervention trial of personalised OSA therapy.
P109 Paediatric Limited Channel Sleep Monitoring Alternate Sleep Scoring Compared with Type 1 PSG
Authors: Verginis N , Davey M , Mihai R , Nixon G 
Published: October 2023

Abstract

Introduction
Obstructive sleep apnoea (OSA) has deleterious effects on children’s cognition, behaviour and cardiovascular system. Early diagnosis and treatment may improve long-term outcomes. Attended polysomnography (PSG) is the gold standard for OSA diagnosis, however access is limited with prolonged wait times. Home based limited channel sleep monitoring (LCSM) offers a more accessible alternative but may result in inaccurate sleep staging. We aimed to evaluate sleep scoring using a single channel combined EEG/EOG compared with full PSG.

Methods
Sample size calculations indicated 1000 epochs would be sufficient to demonstrate a kappa statistic of at least 0.7 for sleep stage comparison. Four patients undergoing in-laboratory PSG for suspected OSA gave consent for placement of an additional combined EEG/EOG simulating our LCSM montage. A single senior scientist scored sleep using full PSG montage, and after a minimum of 2 weeks, using the abbreviated montage.

Results
Epoch-by-epoch comparisons were made for 3,930 epochs. When comparing awake, N1, N2, N3 and REM, kappa=0.77 (p&lt;0.001). Using the abbreviated montage, N1 was mostly misclassified as awake (28% of epochs) or REM (32% of epochs). When comparing awake, NREM and REM, kappa = 0.79 (p&lt;0.001). When comparing awake and sleep, kappa = 0.82 (p&lt;0.001).

Discussion
Accurate total sleep time is important for accurate respiratory index calculation. The abbreviated montage was reliable compared with PSG for scoring sleep versus awake (kappa &gt;0.8). The addition of an EMG signal may correct misclassification of N1 as wake or REM and improve intra-rater agreement. EMG will be included in future studies.
P110 How do Night-time Awakenings, Assistive Technologies, and Help-seeking Behaviours Impact Australian Carers Sleep? A Cross-sectional Study
Authors: Vincent G , Commins H , Owen P , Paterson J , Thomas M , Sprajcer M , Gupta C , Gibson R , Ferguson S , Reynolds A 
Published: October 2023

Abstract

Introduction
Carers who provide support for those living with a disability or long-term health conditions have been recognised as being at increased risk of negative health outcomes due to the demands of caregiving. In particular, carers are much more likely than their non-carer counterparts to experience poor sleep outcomes such as lower sleep quality and inadequate sleep duration. The aim of this study is to examine how nighttime awakenings, assistive technology use and help-seeking behaviours impact sleep quality among Australian adult carers.

Methods
A cross-sectional online survey was conducted with a sample of Australian carers aged 18 to 64 years. Participants were required to answer questions regarding their sleep, caregiving duties, night-time-awakenings and completed the 9-item self-report Pittsburgh Sleep Quality Index (PSQI). They also answered questions regarding their use of assistive technologies and help-seeking behaviours. Participants were eligible if they reported sleep time &lt;7 h or dissatisfaction with their sleep.

Results
Participants (n=352) completed the online survey. Analyses of these data have just begun and will be presented in full at the conference.

Conclusion
The results of this study aim to extend current literature and provide valuable information in the formulation of sleep recommendations and interventions for Australian carers.
Unveiling the Diversity: Plant Parasitic Nematode Effectors and Their Plant Interaction Partners
Authors: Bali Sapinder , Gleason Cynthia 
Published: October 2023

Root-knot and cyst nematodes are two groups of plant parasitic nematodes that cause the majority of crop losses in agriculture. As a result, these nematodes are the focus of most nematode effector research. Root-knot and cyst nematode effectors are defined as secreted molecules, typically proteins, with crucial roles in nematode parasitism. There are likely hundreds of secreted effector molecules exuded through the nematode stylet into the plant. The current research has shown that nematode effectors can target a variety of host proteins and have impacts that include the suppression of plant immune responses and the manipulation of host hormone signaling. The discovery of effectors that localize to the nucleus indicates that the nematodes can directly modulate host gene expression for cellular reprogramming during feeding site formation. In addition, plant peptide mimicry by some nematode effectors highlights the sophisticated strategies the nematodes employ to manipulate host processes. Here we describe research on the interactions between nematode effectors and host proteins that will provide insights into the molecular mechanisms underpinning plant–nematode interactions. By identifying the host proteins and pathways that are targeted by root-knot and cyst nematode effectors, scientists can gain a better understanding of how nematodes establish feeding sites and subvert plant immune responses. Such information will be invaluable for future engineering of nematode-resistant crops, ultimately fostering advancements in agricultural practices and crop protection. [Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2024.
Ipsilateral Healthy-segment Response to Leg Length Discrepancy
Authors: Birch John G. , Makarov Marina R. , Jo Chan-Hee 
Published: October 2023

Background:
Few studies address frequency or magnitude of healthy lower-extremity segment response to ipsilateral companion segment shortening. We sought to document and quantify this occurrence in a variety of pediatric etiologies.

Methods:
We reviewed the medical record and radiographs of patients undergoing epiphysiodesis to manage leg length discrepancy. Inclusion criteria for this study were leg length discrepancy of a single lower-extremity segment by identifiable cause and adequate scanograms to allow accurate measurement of all 4 lower-extremity segments before any surgical treatment for the discrepancy. We recorded the etiology of shortening, age of onset of disorder, the length of the lower-extremity segments on scanograms, and age at the time of radiographs. We considered ipsilateral healthy-segment difference from the contralateral ≥ 0.5 cm. as clinically significant.

Results:
Two hundred nine patients met inclusion criteria (126 boys, 83 girls). The average age was 12.5 years. 16/60 patients with avascular necrosis of the hip demonstrated ipsilateral tibial shortening averaging 1.2 cm whereas 6/60 demonstrated ipsilateral tibial overgrowth averaging 0.6 cm. 11/30 Legg-Perthés patients demonstrated ipsilateral tibial shortening averaging 0.7 cm; none had ipsilateral tibial overgrowth. 10/42 posteromedial bow patients had ipsilateral femoral shortening averaging 0.8 cm, whereas 6/42 had ipsilateral overgrowth averaging 0.8 cm. 13/48 with distal femoral physeal injury demonstrated ipsilateral tibial shortening averaging 1.2 cm, whereas 6/48 demonstrated ipsilateral tibial overgrowth averaging 0.8 cm. 8/29 tibial physeal injuries (proximal or distal) demonstrated ipsilateral femoral shortening averaging 1.1 cm. whereas 7/29 demonstrated ipsilateral femoral overgrowth averaging 0.7 cm.

Conclusions:
Although there are individual exceptions, the ipsilateral healthy segment does not grow appreciably more than the contralateral in patients with avascular necrosis of the hip, Legg-Perthés disease, or physeal trauma. The femur is not a significant component of shortening in patients with posteromedial bow.

Level of Evidence:
Level III, retrospective review.
Development of Fibro-PeN, a clinical prediction model for moderate-to-severe fibrosis in children with nonalcoholic fatty liver disease
Authors: Wang Andrew , Blackford Amanda L. , Behling Cynthia , Wilson Laura A. , Newton Kimberly P. , Xanthakos Stavra A. , Fishbein Mark H. , Vos Miriam B. , Mouzaki Marialena , Molleston Jean P. , Jain Ajay K. , Hertel Paula , Harlow Adams Kathryn , Schwimmer Jeffrey B. ,   for the NASH CRN
Published: October 2023

Background and Aims:
Liver fibrosis is common in children with NAFLD and is an important determinant of outcomes. High-performing noninvasive models to assess fibrosis in children are needed. The objectives of this study were to evaluate the performance of existing pediatric and adult fibrosis prediction models and to develop a clinical prediction rule for identifying moderate-to-severe fibrosis in children with NAFLD.

Approach and Results:
We enrolled children with biopsy-proven NAFLD in the Nonalcoholic Steatohepatitis Clinical Research Network within 90 days of liver biopsy. We staged liver fibrosis in consensus using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. We evaluated existing pediatric and adult models for fibrosis and developed a new pediatric model using the least absolute shrinkage and selection operator with linear and spline terms for discriminating moderate-to-severe fibrosis from none or mild fibrosis. The model was internally validated with 10-fold cross-validation. We evaluated 1055 children with NAFLD, of whom 26% had moderate-to-severe fibrosis. Existing models performed poorly in classifying fibrosis in children, with area under the receiver operator curves (AUC) ranging from 0.57 to 0.64. In contrast, our new model, fibrosis in pediatric NAFLD was derived from fourteen common clinical variables and had an AUC of 0.79 (95% CI: 0.77–0.81) with 72% sensitivity and 76% specificity for identifying moderate-to-severe fibrosis.

Conclusion:
Existing fibrosis prediction models have limited clinical utility in children with NAFLD. Fibrosis in pediatric NAFLD offers improved performance characteristics for risk stratification by identifying moderate-to-severe fibrosis in children with NAFLD.
Heartbreak From Puppy Love: A Case of Pasteurella multocida Endocarditis and Review of the Literature
Authors: Vo Phuong-Uyen , Chaffee Roger B. , Myers Joseph P. 
Published: October 2023

Background

Pasteurella multocida, a gram-negative coccobacillus associated with dog, cat, and other animal contact, often causes human bite infection, cellulitis, and osteomyelitis, but infective endocarditis is rare. We present a patient with P. multocida aortic valve endocarditis whose animal exposure was contact with his dog's saliva from frequent licking of patient's skin in the perioral area.

Case Presentation
A 62-year-old man with successfully treated hepatitis C presented to hospital after a syncopal episode while chasing his dog. He had previously noted night sweats, fever, generalized weakness, and dyspnea on exertion. He denied bites or scratches but admitted allowing his dog to lick around his mouth. On presentation, he was in septic shock with lactic acidosis. White blood cell count was 20,000/μL. Pasteurella multocida was isolated from both admission blood cultures. The patient was treated with antimicrobial therapy and resuscitated. Transthoracic echocardiogram revealed critical bicuspid aortic valve stenosis with root abscess and ascending aortic aneurysm. Transesophageal echocardiogram showed reduced ejection fraction and severe aortic stenosis but no definitive vegetations. At surgery, there were nodular lesions on the aortic valve, left ventricular outflow tract perforation, and annular abscess of aortic valve. He had mechanical aortic valve replacement, annular reconstruction, and aortic aneurysm repair. The patient received 6 weeks of postoperative intravenous ceftriaxone and remained infection-free at 1-year follow-up visit.
Effects of high-profile crossover feet on gait biomechanics in 2 individuals with Syme amputation
Authors: Slater Conrad , Hafner Brian J. , Morgan Sara J. 
Published: October 2023

Background:
Prosthetic treatment options for people with ankle disarticulation (i.e., Syme amputation) are limited. Prosthetic feet designed for people with Syme amputation are often low profile to accommodate build-height restrictions, resulting in decreased energy return during gait. High-profile crossover feet that attach to the posterior proximal aspect of the prosthetic socket can bypass these restrictions and may promote a more physiologic gait pattern.

Objectives:
To compare level-ground gait biomechanics and patient-reported outcomes between crossover and traditional energy-storing feet in people with Syme amputation.

Study Design:
Within-participant pilot study.

Methods:
Both participants were fit with energy-storing and crossover feet and were randomized to the order they used the feet. Participants used each foot for 2 weeks before assessment. Step length symmetry, prosthetic ankle range of motion, prosthetic-side energy return, and peak sound-side loading were determined from motion capture data obtained in a laboratory. Mobility and balance confidence were measured using standardized patient-reported outcome measures. Foot preference was assessed with an ad hoc survey.

Results:
Two participants with Syme amputations completed the study. Prosthetic ankle peak dorsiflexion and push-off power increased with the crossover foot compared with the energy-storing foot for both participants. Both participants reported an overall preference of the crossover foot. Changes in patient-reported outcomes did not exceed published minimum detectable change values.

Conclusion:
Crossover feet increased prosthetic ankle range of motion and energy return compared with traditional energy-storing feet in this pilot investigation of 2 participants. Crossover feet seem to promote physiologic gait and may be a promising alternative to traditional low-profile feet for people with Syme amputation.
The Effect of Duration of Antibiotic Prophylaxis on Infections Following Open Reduction and Internal Fixation of Mandibular Fractures: A Prospective Randomized Clinical Trial
Authors: Rikhotso Risimati E. , Mohotlhoane Gontse P. 
Published: October 2023

Aim:
To evaluate the benefits of a long-term prophylactic antibiotic regimen following treatment of fractured mandibles with open reduction and internal fixation.

Material and Methods:
A prospective, randomized controlled trial was undertaken at Wits Oral Health Centre. Patients with mandibular fractures who were managed with open reduction and internal fixation using miniplates were randomized into 2 groups. The control group, the perioperative antibiotic (POA) group, was composed of patients who received intravenous (IV) antibiotic cover intraoperatively and a further 3 IV doses 24 hours postoperatively. The study group, the extended postoperative antibiotic (EPOA), was composed of patients who received similar doses as the control group but with an additional 5 days of oral antibiotics upon discharge. The patients were then evaluated for evidence of infection 1, 4, and 6 weeks postoperatively.

Results:
A total of 77 patients were included in the study, 41 in the POA and 36 in the EPOA groups. Fourteen patients had evidence of infection noted within the 6-week follow-up period (10 in the POA and 4 in the EPOA groups). Statistical analysis with the Pearson Chi-square and Student t test showed no statistically significant difference (P=0.399) between POA and EPOA groups. There were no significant differences between the groups with respect to site and etiology of fracture, duration of operation, and presence of infection (P>0.05) during the 6-week review period.

Conclusions:
The extended use of antibiotic prophylaxis when managing mandibular fractures with open reduction and internal fixation offers no additional benefit in reducing postoperative infections.
Multicenter Evaluation of Financial Toxicity and Long-Term Health Outcomes After Injury
Authors: Scott John W. , Anderson Geoffrey A. , Conatser Amelia , de Souza Cairo , Evans Emily , Goodwin Zachary , Jakubus Jill L. , Kelm Julia , Mekled Iman , Monahan Janessa , Oh Esther J. , Oliphant Bryant W. , Hemmila Mark R. 
Published: October 2023

ABSTRACT

Background
Despite the growing awareness of the negative financial impact of traumatic injury on patients' lives, the association between financial toxicity and long-term health-related quality of life (hrQoL) among trauma survivors remains poorly understood.

Methods
Patients from nine trauma centers participating in a state-wide trauma quality collaborative had responses from longitudinal survey data linked to inpatient trauma registry data. Financial toxicity was defined based on patient-reported survey responses regarding medical debt, work or income loss, non-medical financial strain, and forgone care due to costs. A financial toxicity score ranging from 0 to 4 was calculated. HrQoL was assessed using the EuroQol 5 Domain (EQ-5D) tool. Multivariable regression models evaluated the association between financial toxicity and hrQoL outcomes while adjusting for patient demographics, injury severity and inpatient treatment intensity, and health systems variables.

Results
Among the 403 patients providing 510 completed surveys, rates of individual financial toxicity elements ranged from 21% to 46%, with 65% of patients experiencing at least one element of financial toxicity. Patients with any financial toxicity had worse summary measures of hrQoL and higher rates of problems in all five EQ-5D domains (p < 0.05 for all). Younger age, lower household income, lack of insurance, more comorbidities, discharge to a facility, and air ambulance transportation were independently associated with higher odds of financial toxicity (p < 0.05 for all). Injury traits and inpatient treatment intensity were not independently associated with financial toxicity.

Conclusion
A majority of trauma survivors in this study experienced some level of financial toxicity, which was independently associated with worse risk-adjusted health outcomes across all hrQoL measures. Risk factors for financial toxicity are not related to injury severity or treatment intensity, but rather to sociodemographic variables and measures of pre- and post-hospital healthcare resource utilization. Targeted interventions and policies are needed to address financial toxicity and ensure optimal recovery for trauma survivors.

Study Type/Level of Evidence
Observational Cohort Study / Level III