bluuebunny/crossref_metadata_2025_split huggingface dataset:
P069 Sleep Restriction Impairs Integration of Multiple Information Sources in Probabilistic Decision-Making
Authors: Lim J , Boardman J , Anderson C , Dickinson D , Drummond S 
Published: November 2022

Abstract

Introduction
Sleep loss affects overall decision-making, but its effects on specific mechanisms of decision-making are less well-understood. Here, we examined the effects of sleep restriction (SR) on the ability to integrate multiple information sources on a probabilistic decision-making task.

Methods
We recruited 41 healthy participants (n=41; age=27.9±6.0years, 20F), 27 of whom underwent well-rested (

WR
4 nights of 9-hours time-in-bed) and SR (3 nights of 3-hours time-in-bed) conditions in counterbalanced order. On the last day of each lab stay, participants completed a probabilistic decision-making task twice – 2-hours after wake (AM) and 12-hours since habitual wake (PM). On each trial, participants were shown two boxes with different proportions of black/white balls. Eight balls were drawn randomly, with replacement, from an unknown box. Participants determined the selected box using easier-to-understand numerical odds and harder-to-understand draw outcome information. Mathematical modelling was used to infer weights placed on each source of information.

Results
For AM and PM sessions, participants placed significantly greater weights on odds relative to draw information during WR (p&lt;.001 for both). For AM trials, SR significantly reduced weights given to draw information (p=.041), and reduced weights given to odds at marginally significant levels (p=.062). For PM trials, SR reduced weights given to draw information at marginally significant levels (p=.059).

Conclusion
While well-rested individuals generally rely more on easier-to-understand information, SR impairs decision-making by further reducing individuals’ ability to consider more complex information. This has implications for high-risk professions where SR is common (e.g. doctors) and impaired decision-making may pose serious consequences.
P070 Does exercise reduce fat free mass loss during very low energy diet-induced rapid weight loss? A systematic review and meta-analysis
Authors: Lowrie F , Phillips C , Hogan C , Tran D , Marshall N , Gordon C , Yee B , Cayanan E 
Published: November 2022

Abstract
A bi-directional relationship exists between obstructive sleep apnoea and obesity. Very low energy diets (VLEDs) have been show to significantly reduce weight in overweight and obese patients. However, they can cause excessive fat free mass (FFM) loss, which adversely impacts health. Concurrent exercise training is a potential method of mitigating FFM loss. This systematic review and meta-analysis aims to assess the impact of exercise on FFM loss during VLED-induced weight loss in the overweight and obese.
Medline, Embase, Cochrane Register of Controlled Trials and CINAHL were searched from inception to December 2021 for studies that compared VLED groups with and without concurrent exercise in overweight and obese adults. Studies were included if they reported changes in FFM, VLED was restricted to less than 800kcal/day and exercise programmes were at least low intensity.
Following duplicate removal, 6516 studies were screened and 63 full text articles were reviewed, of which 7 were included. The primary outcome is change in FFM between groups and a meta-analysis is planned if deemed appropriate. Results will be available in September.
This review will provide evidence regarding the impact of exercise on FFM loss when undertaken concurrently with a VLED. Furthermore, it will help inform practice guidelines around exercise prescription for preserving FFM while undertaking a VLED to ensure better patient health outcomes. It will also help inform translational studies for weight reduction in overweight and obese sleep apnoeics.
P074 Three models of pulse oximeters are within specifications when assessed using a benchtop pulse oximeter simulator
Authors: McDermott E , Cuesta R , Nguy R , VanBraak E , Naughton M , Roebuck T 
Published: November 2022

Abstract
To assess possible SpO2 accuracy differences between 3 different (oximeter & software) testing techniques. Hypothesised that differences in SpO2 would be within the oximeter manufacturer’s specification.
A synthetic digit, OX-1 OxSim® Optical SpO2 Pulse Oximeter Simulator (Pronk Technologies Inc., Sun Valley, CA) can provide simulated SpO2 & HR values : 85% (80BPM), 98% (80BPM), 98% (140BPM), 99% (80BPM) at low perfusion and 95% (40BPM) low HR. Simulated SpO2 delivered for 5 minutes, average calculated from signal recorded with corresponding download software: Rad-5 (Masimo, Irvine, CA, USA, 2sec averaging time) - Visi download (Stowood Scientific, Oxford, UK), the Rad-7 (Masimo, Irvine, CA, USA, 2-4sec averaging time) - PSG 4 (Compumedics, Melbourne, Australia), Wrist-Ox2® (Nonin Medical Inc, Plymouth, MN, USA, 3sec averaging time) - Noxturnal software (Nox Medical Inc, Reykjavik, Iceland). Four devices for each model Rad-5, Rad-7 and Nox Wrist-Ox2® were examined at 5 SpO2 & HR settings. The SpO2 downloaded from each device was compared with the OxSim® values. Oximeter reading v OxSim® : at 85%, Rad-5 (y = -0.146x + 14.375, R² = 0.9627 bias 0.606), Rad-7 (y = -0.0897x + 8.737, R² = 0.5295 bias 0.295), Wrist-Ox2® (y = -0.0161x + 1.2261, R² = 0.0481 bias -0.281). At all other comparison values, including low perfusion and low HR, all values fell within +/- 2% SpO2.
Small differences in the measured SpO2 for the 3 oximeter models & paired software were noted, however all devices gave SpO2 values within 2% of simulated SpO2 values as per manufacturer specifications.
P081 Assessing the role of mental health on the prevalence of sleep complaints amongst current and retired athletes
Authors: Montero A , Adams R , Baranoff J , Drummond M 
Published: November 2022

Abstract

Introduction
Validated sleep and mental health assessments are grossly underutilised in athletic populations. Previous studies have predominantly focused on elite competitors. To form a more representative view of sleep and mental health in athletes, we conducted a large-scale survey that is more inclusive of different competition levels and playing statuses.

Methods
Current and retired athletes (N=1007) participated in an online survey. Utilising validated tools, we screened for sleep difficulty and disordered breathing (ASSQ), depression (CESD-R), anxiety (GAD-7), and poor quality of life (PWI-A). Participants were categorised as currently competing, retired, or unable to play, from an amateur, sports institute/university, semi-professional, or professional level.

Results
Retired athletes (41.7%) were more likely to report sleep apnoea symptoms than competing athletes (24.5%) and those unable to play (27.1%) (p&lt;.001). No differences in sleep difficulty were observed across playing status (p=.212). Competition level did not affect sleep difficulty (p=.595) or sleep apnoea symptomology (p=.274). Sleep apnoea symptomology was predicted by age (p&lt;.001), BMI (p&lt;.001), and quality of life (p=.002), but not anxiety (p=.544) or depression (p=.102). Sleep difficulty was predicted by the same factors, in addition to depression (p&lt;.001).

Discussion
Findings suggest that sleep problems affect all athletic populations, with most respondents (72.4%) reporting mild to severe sleep difficulty. While competition level may not affect athletes’ sleep health, we identified athletic retirement, age, BMI, depression, and poor quality of life as risk factors for disordered sleep. Therefore, protective strategies for mental health are needed for athletes from all competition levels and playing statuses.
P086 The insomnia severity index is related to the respiratory arousal threshold in people with Co-Morbid Insomnia and Sleep Apnoea (COMISA)
Authors: Zheng J , Tong B , Sweetman A , Eckert D , Osman A 
Published: November 2022

Abstract

Introduction
People with co-morbid insomnia and sleep apnoea (COMISA) have worse symptoms and require a tailored therapy approach for their sleep disorders. The relationship between the respiratory arousal threshold, a key OSA non-anatomical contributor and insomnia symptoms is unclear. This study investigated the relationship between insomnia symptoms using the insomnia severity index (ISI) and the respiratory arousal threshold in people with OSA.

Methods
46 people with OSA (11 female, age=50±15years, BMI=29±6kgm-2, AHI=33±20events/h) participated in a physiology sleep study to predict response to oral appliance therapy and completed the ISI. Standard polysomnography, an epiglottic airway pressure sensor, bipolar intramuscular electrodes inserted into the genioglossus and a nasal mask with a pneumotachograph to quantify airflow were used. The respiratory arousal threshold was measured as the nadir epiglottic pressure during a respiratory event prior to a cortical arousal. Following this, participants trialled mandibular advancement therapy.

Results
There was no relationship between ISI (average=12±6) and the arousal threshold (-24±10cmH₂O) in participants with OSA (r=0.1, p=0.42, n=46). However, in the 59% of people with COMISA (ISI ≥11), there was a positive relationship between ISI and arousal threshold, with increasing insomnia severity associated with lower arousal threshold (r=0.5, p=0.017, n=27). People with a BMI&lt;30kgm-2 (n=27), also had a positive linear relationship between ISI and improvement in oral appliance therapy (r=0.49, p&lt;0.01, n=27).

Conclusion
Greater insomnia symptoms in people with COMISA is associated with a lower respiratory arousal threshold. In non-obese people with OSA, higher ISI values are related to poor response to oral appliance therapy.
P095 Clinical and polysomnographic characteristics of Indigenous and non-Indigenous children undergoing adenotonsillectomy with clinically suspected sleep disorders at the Top End Northern Territory of Australia
Authors: Reyes-Chicuellar N , Howarth T , Crossland G , Patel H , Heraganahally S 
Published: November 2022

Abstract
Sleep apnoea and poor sleep quality are growing public health issues which may begin in childhood and progress to significant lifelong morbidity. Literature regarding the prevalence of surgery for obstructive sleep apnoea (OSA) among Indigenous Australian children however is sparse.
Children and polysomnographic (PSG) characteristics among children undergoing adenotonsillectomy (AT) for clinically suspected sleep-disordered breathing were assessed in this retrospective study. Paediatric patients Indigenous and non-Indigenous children referred for a diagnostic (PSG) via ENT service at the Top End Northern Territory of Australia for a sleep study between 2016 and 2020 were included.
Of the 375 patients referred through an ENT service for a diagnostic PSG, 115 were identified to have undergone an AT and were included.
The majority of patients were male (58%) and non-Indigenous (88%), in the normal weight category (64%) with a median age of 4.1 years. The median reported PDSS was 12, and snoring was reported in 77% of patients, with witnessed apnoeas in 31% and excessive daytime sleepiness in 23%. Most patients were identified to have OSA on PSG (65%, median AHI 1.6, 64% mild, 12% moderate, 23% severe). Median sleep efficiency was 85%, with a total sleep time of 520 minutes and WASO of 74 minutes. Total average SpO2 was a median of 93.5% and SpO2 Nadir 85%.
We discuss how our findings can translate to future service planning and delivery whilst respecting cultural safety and indigenous group engagement.
P120 Incidence, persistence and remission of co-morbid insomnia and sleep apnea (COMISA) over time in the Wisconsin Sleep Cohort data
Authors: Sweetman A , Lechat B 
Published: November 2022

Abstract

Introduction
Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating condition that is more difficult to treat compared to either disorder alone. Previous studies have investigated the cross-sectional prevalence of COMISA, however no study has investigated rates of natural incidence, persistence, or remission of COMISA over time.

Methods
We used data from 566 people in the Wisconsin Sleep Cohort (Age M = 55.6 [sd = 7.5], 46.3% female). Symptoms of insomnia (difficulties initiating, maintaining sleep and/or early morning awakenings at least 5 times/month), and sleep apnea (AHI ≥ 5) were investigated at baseline, 4-years, and 8-years. COMISA was defined if both conditions were present.

Results
The prevalence of COMISA at baseline, year-4, and year-8 was 25.1%, 29.9%, and 25.8%, respectively. Among those with COMISA at baseline, 60.6% had persistent COMISA at year-4, and among people with COMISA at year-4, 46.8% had persistent COMISA at year-8. Very few people with COMISA experienced remission of both insomnia and sleep apnea at year-4 (5.6%) or year-8 (7.7%). There were 83 cases of incident COMISA at year-4 (19.6% of people without COMISA at baseline), and 67 cases of incident COMISA at year-8 (16.9% of people without COMISA at year-4).

Discussion
COMISA symptom prevalence was ≥25% at any given follow-up in this population-based sample. Approximately half of those with COMISA experienced persistent COMISA across any two follow-up occasions. Very few people with COMISA experience complete remission of both conditions. It is important to develop targeted treatments for this prevalent and persistent condition.
P125 The effect of glucocorticoids on rate of lung function decline in Duchenne Muscular Dystrophy patients receiving Non-Invasive Ventilation
Authors: Treanor D , Howard M , Griffiths A , Davidson Z 
Published: November 2022

Abstract

Background
Duchenne Muscular Dystrophy (DMD) causes progressive muscle weakness as a result of a mutation in the X-linked gene dystrophin. Recently glucocorticoid treatment has delayed deterioration in muscle strength prolonging survival. When respiratory failure develops, Non-invasive ventilation (NIV) is used to improve symptoms and prolong life. Recent research suggests the use of glucocorticoids with concomitant NIV may be associated with accelerated lung function decline.

Methods
To evaluate this we conducted a retrospective analysis of serial lung function data in patients with DMD across two healthcare campuses in Melbourne, Australia.
A database of all patients with a coded diagnosis of DMD was collated from 1980-2010. Patient records were examined to collect data on age, lung function (FEV1/FVC/FER), glucocorticoid use (y/n), daily glucocorticoid dose, date of NIV initiation, FVC at NIV commencement, date of death (where applicable) and concomitant diagnosis of scoliosis or cardiomyopathy. This data was analysed to see if a trend for accelerated lung function decline with the use of NIV was observed.

Progress to date
A total of 356 patients were identified of which 36 had transitioned to the Austin Hospital adult Ventilation Service with available serial lung function data. There was no statistical difference in mean rate of decline in lung function post NIV initation (n=26, p=0.527) with glucocorticoid treatment.

Intended outcome and impact
Our inital results are in line with the previously observed rates of decline in lung function from other studies and do not indicate a negative synergistic effect on NIV with glucorticoid therapy.
Cash transfers and nutrition education to improve dietary diversity among children aged 6–23 months in Grand Gedeh County, Liberia: a cluster-randomized trial
Authors: Rees Chris A , Cleon Dadah , Davis Annette B , Sammy Andrew M , Britto Carl D , Massaquoi Wesley , Forkpa Oretha W , Johnson Andrew J , Hook Varla F , MaCauley Jane A , Pewu Garbie F , Gorpue Mercy , Gborie Amos , Brown Trokon T , Fannieh Augustine , Dweh Teeline , Marley Ruth B , Baysah Massaboi K , Nowine Netus N , Niescierenko Michelle , Zaizay Leela 
Published: November 2022

AbstractObjectivesTo evaluate the efficacy of a cash transfer and nutrition education program on dietary diversity among children in Liberia. We hypothesized that a multi-pronged intervention would result in improved dietary diversity among children.MethodsWe conducted a three-armed, cluster-randomized study in 42 communities (12 children per community) in Grand Gedeh County, Liberia, over a 12-month period. We randomly assigned communities to control (n = 14 communities), those that received both bimonthly cash transfers and a structured nutrition education program (n = 14 communities) and those that received bimonthly cash transfers alone (n = 14 communities). Community health assistants conducted bimonthly assessments in participants’ homes. The primary outcome was the proportion of children aged 6–23 months who met minimum dietary diversity score (i.e., ≥4 food groups consumed per day). Secondary outcomes included meal frequency and healthcare utilization for illnesses (NCT04101487).ResultsThere were 599 children enrolled; 533 (88.9%) were retained through the trial period. The proportion of children who consumed ≥4 food groups per day did not differ among the three arms. However, children randomized to receive cash transfers had higher dietary diversity scores than the control group. Children in communities that received cash transfers alone and with nutrition education consumed significantly more meals per day and were less likely to have visits to clinics or hospitals for illnesses than children in control communities.ConclusionBimonthly, unconditional cash transfers and nutrition education were associated with higher dietary diversity scores, greater meal frequency, and fewer healthcare visits for illnesses among children aged 6–23 months.
Severe acute malnutrition outcomes for children of South African compared to foreign-born parents admitted to a rural regional hospital in South Africa: a retrospective cohort study
Authors: Thomas Aldona , Engelbrecht Arnoldus L , Slogrove Amy L 
Published: November 2022

Abstract

Background
Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa.

Methods
A retrospective cohort study was conducted including children &lt;5 years admitted to Worcester Provincial Hospital during 2015–17 with SAM (WHO weight-for-height Z score &lt;−3, presence of nutritional oedema, mid-upper-arm-circumference of &lt;11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records.

Results
Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8–18) vs. 10 (8–13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13–21.06) for in-hospital SAM-associated mortality.

Conclusion
In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.
XIVModern Literature
Authors: Ross Shawna , Mourant Chris , Fischer Tiana M , Phillips Joshua , Parsons Katherine , Stringfellow Sophie , RodrÍguez MartÍn Gustavo A , Saunders Graham , Richards Joshua , Quin Jack 
Published: November 2022

AbstractThis chapter has eight sections 1. General. 2. Fiction Pre-1945; 3. Fiction Post-1945; 4. Drama Pre-1950; 5. Drama Post-1950; 6. British Poetry Pre-1950; 7. British Poetry Post-1950; 8. Modern Irish Poetry. Section 1 is by Shawna Ross; section 2(a) is by Chris Mourant; section 2(b) will resume in 2023; section 2(c) is by Tiana M. Fischer; section 2(d) will resume in 2023; section 2(e) is by Joshua Phillips; section 3(a) is by Katherine Parsons; section 3(b) will resume in 2023; section 4(a) is by Sophie Stringfellow; section 4(b) is by Gustavo A. Rodríguez Martín; section 5 is by Graham Saunders; section 6(a) will resume in 2023, section 6(b) is by Joshua Richards; section 7 will resume in 2023; section 8 is by Jack Quin.
Using Resident-Sensitive Quality Measures Derived From Electronic Health Record Data to Assess Residents’ Performance in Pediatric Emergency Medicine
Authors: Smirnova Alina , Chahine Saad , Milani Christina , Schuh Abigail , Sebok-Syer Stefanie S. , Swartz Jordan L. , Wilhite Jeffrey A. , Kalet Adina , Durning Steven J. , Lombarts Kiki M.J.M.H. , van der Vleuten Cees P.M. , Schumacher Daniel J. 
Published: November 2022

Purpose
Traditional quality metrics do not adequately represent the clinical work done by residents and, thus, cannot be used to link residency training to health care quality. This study aimed to determine whether electronic health record (EHR) data can be used to meaningfully assess residents’ clinical performance in pediatric emergency medicine using resident-sensitive quality measures (RSQMs).

Method
EHR data for asthma and bronchiolitis RSQMs from Cincinnati Children’s Hospital Medical Center, a quaternary children’s hospital, between July 1, 2017, and June 30, 2019, were analyzed by ranking residents based on composite scores calculated using raw, unadjusted, and case-mix adjusted latent score models, with lower percentiles indicating a lower quality of care and performance. Reliability and associations between the scores produced by the 3 scoring models were compared. Resident and patient characteristics associated with performance in the highest and lowest tertiles and changes in residents’ rank after case-mix adjustments were also identified.

Results
274 residents and 1,891 individual encounters of bronchiolitis patients aged 0–1 as well as 270 residents and 1,752 individual encounters of asthmatic patients aged 2–21 were included in the analysis. The minimum reliability requirement to create a composite score was met for asthma data (α = 0.77), but not bronchiolitis (α = 0.17). The asthma composite scores showed high correlations (r = 0.90–0.99) between raw, latent, and adjusted composite scores. After case-mix adjustments, residents’ absolute percentile rank shifted on average 10 percentiles. Residents who dropped by 10 or more percentiles were likely to be more junior, saw fewer patients, cared for less acute and younger patients, or had patients with a longer emergency department stay.

Conclusions
For some clinical areas, it is possible to use EHR data, adjusted for patient complexity, to meaningfully assess residents’ clinical performance and identify opportunities for quality improvement.