bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuromuscular Electrical Stimulation–Enhanced Physical Therapist Intervention for Functional Posterior Shoulder Instability (Type B1): A Multicenter Randomized Controlled Trial
Authors: Moroder Philipp , Karpinski Katrin , Akgün Doruk , Danzinger Victor , Gerhardt Christian , Patzer Thilo , Tauber Mark , Wellmann Mathias , Scheibel Markus , Boileau Pascal , Lambert Simon , Porcellini Giuseppe , Audige Laurent 
Published: October 2023

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Conclusions
Discrepancies in SpO2 measurement do occur between devices and may have important clinical implications especially when it comes to the measurement of hypoxemic burden during sleep.
1.Blanchet MA et al. Accuracy of Multiple Pulse Oximeters in Stable Critically Ill Patients. Respir Care. 2023 May;68(5):565-574.
O026 Concordance between a home sleep apnoea test based on peripheral artery tonometry and laboratory polysomnography
Authors: Nair A , Turton A , Stupar D , Mansfield D 
Published: October 2023

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Discussion
This study's data will help us understand how dreams and spirituality can help alleviate death anxiety, offering new insights for mental health interventions.