Post-hoc Comparisons Research Articles

0417 Pre-sleep wakefulness in patients with insomnia: heart rate variability during sleep onset

Abstract Introduction Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. However, physiological alterations during the sleep onset period are not well-understood. We aimed to characterize heart rate variability (HRV) in patients with insomnia during sleep onset. Methods Using data from the Sleep Heart Health Study at National Sleep Research Resource, we conducted a secondary analysis exploring HRV during the sleep onset period (defined as the time between lights-off and sleep onset) in patients with insomnia (IS group; n = 68) and comorbid obstructive sleep apnea (IS + OSA group; n = 135), compared with normal sleep controls (NSC group; n = 122). Overall group differences were tested using ANOVA. Post-hoc pairwise comparisons were conducted using the least significant difference (LSD) tests. Results During sleep onset, mean heart rates of the IS group (74.4±15.0 beats/min) and IS+OSA group (72.6±11.5 beats/min) were both significantly higher than the NSC group (69.7±9.4 beats/min, p=0.007 and p=0.044 respectively). Both the IS and IS+OSA groups showed lower heart rate variability compared to the NSC group, with significant differences in both time and frequency domains of HRV analysis including SDNN (p=0.002), RMSSD (p=0.035), pNN20 (p< 0.001), pNN50 (p=0.008), LnLF (p< 0.001), LnHF (p< 0.001). For all these measures, IS+OSA group had lower HRV compared to the IS group, although differences were not significant. When controlling for age, gender and BMI, and compared to the NSC group, IS group had significantly higher heart rates (β=4.8, p=0.008), and the IS+OSA group had significantly lower pNN20 (β=-0.039, p=0.002), pNN50 (β=-0.031, p=0.017) and LnHF (β=0.007, p=0.007). Conclusion Patients with insomnia had lower vagal activity during the sleep onset period, reflected in higher heart rates and lower heart rate variability. Such altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress. Support (if any) This research project was made possible by a grant from the American Academy of Sleep Medicine Foundation (PI: Yan Ma). We acknowledge the National Sleep Research Resource as the resource through which the Data/Datasets were obtained.

0066 Continuous Theta Burst Transcranial Magnetic Stimulation for Insomnia and its Effects on Verbal Recall Performance

Abstract Introduction In this project, we studied the efficacy of focused inhibitory stimulation using continuous theta burst stimulation (cTBS) repetitive transcranial magnetic stimulation (rTMS) on an easily accessible region of the default mode network (DMN). As reported elsewhere, we found that cTBS improved brain connectivity and objectively measured sleep. However, there is little known about the side effects of rTMS in the treatment of insomnia, so here we evaluated the effects on verbal memory recall. Methods Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants conducted two overnight visits during the study; one where they received active cTBS and one where they received a sham cTBS prior to sleep. Participants completed the California Verbal Learning Test (CVLT) before stimulation and again completed the recall portion following a night of laboratory monitored sleep. We analyzed CVLT recall performance with a repeated measures ANOVA with factors of condition (active cTBS vs. sham cTBS) and session (Short Recall, Long Recall, Cued Recall, and Recognition). Results Contrary to our hypothesis, our analyses indicate there was no significant effects on recall performance due to active cTBS. There was no main effect of condition on recall scores post-TMS administration (F(1, 18)=1.162, p=.220, ηp2 = 0.082). There was no interaction effect of active or sham cTBS on recall performance (F(4, 15)=.828, p=.528, ηp2=0.181). Posthoc pairwise comparisons demonstrated that there was no significant difference post-TMS administration between active cTBS and sham cTBS conditions on long recall, cued recall, or recognition (p>.05). There was no significant difference post-TMS administration on short-term recall performance. Participants scored lower on short term recall after receiving active cTBS (M=12.632; SD=2.910) than after sham cTBS administration (M=13.42 ;SD=2.545) (p=.048). Conclusion Compared to sham, active cTBS was not associated with any significant difference in long-term recall performance after TMS administration. While the results demonstrate there are short term effects to recall after administration, recall scores bounce back shortly after. While participants didn’t necessarily improve with active cTBS, it is beneficial to know there are no long-term harmful effects of active cTBS on recall as side effect of insomnia treatment. Support (if any) W81XWH2010173

0186 Continuous Theta Burst Transcranial Magnetic Stimulation and Signal Detection Performance on a Military Go/No-Go Task

Abstract Introduction Repetitive transcranial Magnetic Stimulation (rTMS) is an emerging non-pharmacological treatment method utilized to treat multiple clinical diagnoses to include anxiety, depression, and now insomnia. As part of a larger project, we showed that a single rTMS stimulation with continuous theta burst stimulation (cTBS) to the default mode network (DMN) was associated with improved sleep. However, there is little known about potential effects on attention and vigilance because of cTBS to the DMN. We hypothesized that active cTBS would have no significant impact on signal detection tasks post-TMS administration. Methods Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants completed two overnight visits in total; one where they received active cTBS and one where they received sham cTBS over an easily accessible node of the DMN (left angular gyrus). We analyzed signal detection performance utilizing a Go-No-Go (GNG) task. Three variables were calculated as a result: hit rate, correct rejection rate, and false alarm rate. Higher scores on hit rate and correct rejection rate indicate higher correct responses. Higher scores on false alarm rate indicates a higher number of incorrect responses. We conducted a repeated measures ANOVA with factors of condition, administration, and reversal. Results There was no main effect of condition on GNG hit rate (F(1,17)=1.365, p=.259, ηp2 =.074), GNG false alarm rate (F(1,17)=.210, p=.091, ηp2 =.244), or GNG correct rejection rate (F(1, 17)=1.677, p=.213, ηp2 =.090). We also found there were no significant interaction effects of TMS condition on performance on reversal conditions for GNG hit rate (F(1,17)=0.45, p=.834, ηp2 =.003), GNG false alarm rate (F(1,17)=1.572, p=.227, ηp2 =.085), or GNG correct rejection rate (F(1, 17)=1.510, p=.236, ηp2 =.082). Posthoc pairwise comparisons demonstrated that participants did not significantly differ on GNG hit rate, false alarm rate, or correct rejection rate between their active cTBS and sham cTBS session (p>.05). Conclusion Active cTBS was not significantly associated with any decline in response inhibition or signal detection. It is helpful for future recipients to know they are not adversely affected in attention or vigilance after receiving cTBS rTMS of the DMN for treatment of insomnia. Support (if any) W81XWH2010173

0649 Sex Differences in the Effects of TMS on Depression

Abstract Introduction As part of a larger study to examine the effects of repetitive transcranial magnetic stimulation (rTMS) over a single node of the default mode network (DMN) on sleep quality, we also examined secondary effects on depression. We hypothesized that rTMS would be more effective in females, rather than males, due to previously established higher rates of depression in the female population. Methods We administered continuous theta burst stimulation (cTBS) rTMS or sham stimulation, in a counterbalanced order separated by at least 5 days, over the left inferior parietal node of the DMN in 20 participants with clinical insomnia, 8 males (Mage=31.6, SD=6.7) and 12 females (Mage=23.8, SD=4.3). Beck Depression Inventory (BDI) scores obtained immediately before and after the stimulation sessions were compared using mixed (condition x time x sex) ANOVA to determine the effectiveness of rTMS in reducing symptoms of depression between the sexes. Results Overall, there was a large effect size (ηp2=0.207, p=0.077) in BDI scores between scores after the sham cTBS TMS session (M=12.47, SD=2.54) and scores after the active cTBS TMS session (M=10.00, SD=2.01). However, when separating for sex, males did not show a statistically significant reduction in depressive symptoms for the active session compared to the sham session (ηp2=0.08, F(1,6)=19.00, p=0.508). While the treatment did not significantly change depressive symptoms in females, large effect size was observed (ηp2=0.261, F(1,7)=18.06, p=0.16), suggesting potential efficacy of the treatment. Post-hoc pairwise comparisons reveal a greater change in depression symptom scores for active vs sham cTBS TMS in women (M=-4.00, SD=2.00), than men (M=-0.71, SD=1.43). Conclusion An intervention using cTBS rTMS to improve sleep also led to a trend toward reduced depression, that was more evident among women. As reported elsewhere, this treatment significantly improved polysomnographic sleep, and the present preliminary results suggest that it may also be useful for modestly improving depressive mood, but further research will be necessary due to the limited sample size. It is not clear whether the trends toward mood among women was due simply to higher baseline depression scores in that group, but the findings suggest that additional work is warranted. Support (if any) W81XWH2010173

Improving capacity to identify, assess, and manage adolescents engaging in non-suicidal self-injury using patient avatars

Purpose We developed and evaluated a training comprising a didactic and virtual practice session with human-guided patient avatars to increase pediatric residents’ competence to identify and assess non-suicidal self-injury (NSSI) and suicide risk. Methods Thirty pediatric residents at three children’s hospitals in Florida participated in the training and completed pre-, one-month post-, and three-months post-training surveys. One-way repeated measures ANOVA with post-hoc comparisons determined changes in confidence, comfort, behavioral intentions, attitudes, knowledge, and behavior over time. Qualitative responses provided feedback on the training, especially the novel practice session with adolescent patient avatars. Results Three-months post-training residents expressed significantly greater confidence in talking to adolescents who self-injure, applying the SOARS method to assess self-injury, and assessing functions/reasons for self-injury; reported feeling significantly more comfortable asking about self-injury, well-equipped to handle the emotional aspects of self-injury, and comfortable treating adolescents who self-injure; reported greater behavioral intentions to talk to adolescents about self-injury, assess an adolescent’s stage of change for stopping self-injury, and provide brief interventions for adolescents who self-injure; and used SOARS to evaluate current NSSI with a greater proportion of adolescent patients. Qualitative feedback expressed positive perceptions, especially related to the virtual-reality role-play session. Conclusions Incorporating an interactive, human-guided virtual experience using role-playing and feedback with patient avatars represents a viable option comparable to using typical standardized patients to expand the scalability of NSSI trainings for pediatric residents, especially when they occur virtually.

(058) Acute Dorsal Genital Neuromodulation can Improve Subjective Arousal: A Pilot Study in Women With and Without Spinal Cord Injury

Abstract Introduction Female sexual dysfunction (FSD) is a potentially life altering condition that impacts an estimated 40% of women. Unfortunately, the few treatment options available have limited success due to adverse events and an inability to improve subjective arousal. One potential treatment option, neuromodulation, has improved female sexual function index (FSFI) scores in small studies. The underlying mechanisms of how neuromodulation may improve FSD are not understood. We hypothesize that neuromodulation provides benefits by increasing genital blood flow. Objective Our primary objective is to determine if a single period of dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS) directly causes a change in vaginal blood flow (VBF). Our secondary objective is to assess if subjective arousal increases during a single period of DGNS or TNS. These interventions will be compared among three cohorts of women: women with C6–T10 spinal cord injury (SCI), women with FSD (FSFI lubrication sub-score < 4), and able-bodied women without FSD. Methods Participants attended two separate visits, one for each nerve target, randomly ordered and separated by 1–5 months. We are testing two experimental paradigms: without and with erotic audio-visual materials. The first experiments measured vaginal pulse amplitude (VPA) using a vaginal photoplethysmography transducer (VPP) before, during, and after 20 minutes of nerve stimulation. After data processing, we calculated average peak to peak (p2p) amplitudes for each time period and performed an ANOVA and post-hoc pairwise comparisons within each participant. For the second experiment we measured VPA during neutral and erotic videos both without stimulation and with stimulation. In both experiments we measured subjective arousal via a Likert-type scale at 4 timepoints and made comparisons across participants with a paired t-test. The first experiments are complete and data collection for the second experiments is ongoing. Results We recruited three participants in each cohort in the first experiments, with five participants completing both sessions. All participants saw significant changes in their p2p amplitude from before stimulation to after stimulation in DGNS trials (n = 3 increased, n = 4 decreased). Three of five participants had significant p2p increases in TNS trials and one participant had significant decreases. DGNS subject arousal scores increased significantly after stimulation, but TNS scores did not (Figure 1). Most participants reported genital sensations during DGNS (7 of 8) and TNS (3 of 6) sessions. Three participants have completed both visits in the second set of experiments, with similar trends. Conclusions Acute DGNS, but not TNS, increased subjective arousal across all participants. VPA responses to stimulation were heterogeneous and although most changes were significant, there may not be physiological or clinical relevance. It is possible that repeated stimulation sessions over time may enhance changes in VPA. Disclosure No

Electromyographic and mechanomyographic responses of the biceps brachii during concentric and eccentric muscle actions to failure at high and low relative loads.

This study examined neuromuscular responses of the biceps brachii (BB) for concentric and eccentric muscle actions during bilateral, dynamic constant external resistance (DCER), reciprocal forearm flexions and extensions to failure at high (80% 1 repetition maximum [1RM]) and low (30% 1RM) relative loads. Nine women completed 1RM testing and repetitions to failure (RTF) at 30 and 80% 1RM. Electromyographic (EMG) and mechanomyographic (MMG) amplitude (AMP) and mean power frequency (MPF) signals were measured from the BB. Analyses included repeated measures ANOVAs (p < 0.05) and post-hoc pairwise comparisons with Bonferroni corrected alpha of p < 0.008 and p < 0.01 for between and within factor pairwise comparisons, respectively. EMG AMP and MPF were significantly greater for concentric than eccentric muscle actions, regardless of load or time. However, time course of change analysis revealed parallel increases in EMG AMP for concentric and eccentric muscle actions during the RTF trials at 30% 1RM, but no change at 80% 1RM. There were significant increases in MMG AMP during concentric muscle actions, but decreases or no change during eccentric muscle actions. EMG and MMG MPF decreased over time, regardless of muscle action type and loading condition. The greater EMG AMP and MPF values during concentric compared to eccentric muscle actions may reflect the difference in the efficiency characteristic of these muscle actions. The neuromuscular responses suggested that fatigue may be mediated by recruitment of additional motor units with lower firing rates during concentric muscle actions, and changes in motor unit synchronization during eccentric muscle actions.

The Value of Lipocalin-2 in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune multisystem disease predominantly affecting women in the childbearing period. The majority of the pathology in SLE is related to deposits of immune complexes in various organs, which trigger complement and other mediators of inflammation. SLE is characterized by a very large spectrum of clinical manifestations accompanied by prototypic abnormalities of the immune system. Methods: This study was conducted on thirty SLE patients who were diagnosed according to the American College of Rheumatology (ACR) revised criteria. The patient was selected from the outpatient clinic of Rheumatology and Rehabilitation of Ain Shams University Hospital. Fifteen subjects, matched for age and sex, were included in the study and served as a control group. Comparison of quantitative variables between the study groups was done using the Kruskal Wallis analysis of variance (ANOVA) test with Mann Whitney U test for independent samples as posthoc multiple 2-group comparisons. A probability value (p-value) less than 0.05 was considered statistically significant. All statistical calculations were done using computer programs Microsoft Excel 2007 (Microsoft Corporation, NY, USA) and SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 15 for Microsoft Windows. Results and Discussion: Our results come in agreement with the study done by Farzaneh and his colleagues in 2013, who studied fifty-two lupus patients; urinary lipocalin-2 levels in LN patients were significantly higher than those in non-LN patients. Also, our results were in accordance with the study done by Hammad, who studied 33 children with active SLE (22 with and 11 without LN) and compared them with 15 matched controls. Levels of urinary NGAL were higher in patients with LN than those without LN. These findings come in consistent with previous work done by Youssef and his co-worker in 2015, who studied 44 SLE patients and divided them into two groups, group I (twenty-two patients with LN) and group II (twenty-two patients without LN), the urinary lipocalin-2 had the highest mean levels in LN patients (group I) compared to group II and controls with a statistically significant difference. Also, between SLE patients without nephritis (group II) and controls. Conclusions: In this study, urinary lipocalin-2 was significantly higher in the SLE patients compared to the control group, and the lupus nephritis patients, when compared to the patients with SLE without nephritis,showed significantly higher levels of urinary lipocalin-2. The significant association of the urinary lipocalin-2 with the renal SLEDAI shows that urinary lipocalin-2 can be an early biomarker to diagnose patients with lupus nephritis and to detect renal disease activity.

Temperament and character in an Australian sample: examining cross-sectional associations of personality with age, sex, and satisfaction with life.

Personality can influence how we interpret and react to our day-to-day life circumstances. Temperament and character are the primary dimensions of personality, and both are influenced genetically. Temperament represents our emotional core, while character reflects our goals and values as we develop through life. Research shows that where people live, their social, economic, and physical environment can influence attitudes and behaviors, and these have links to variations in personality traits. There are few studies that focus on Australian personality as temperament and character. Using an Australian general population sample, we examined the psychometric properties of the Temperament and Character Inventory (TCIR140) and investigated the associations between TCIR140 traits with both sociodemographic variables and measures of well-being. In addition, we investigated differences in temperament and character between our Australian general population sample and published results of similar studies from other countries. Australians (N=1,510) completed the Temperament and Character Inventory (TCIR-140), the Positive and Negative Affect Scale and the Satisfaction with Life Scale. Cronbach's alpha and confirmatory factor analysis (CFA) examined the TCIR-140 psychometrics. Correlation analyzes, independent sample t-tests and ANOVA with post-hoc comparisons analyzed the sample. Cronbach's alphas were high, ranging from α=0.78-0.92, and the CFA confirmed two constructs of temperament and character. Females were higher in Harm Avoidance (p<0.001), Reward Dependence (p<0.001), and Cooperativeness (p<0.001) compared to males, who were higher in Self-Directedness (p<0.001). Age groups showed significant differences among all temperament and character traits (p<0.001) except for Reward Dependence (p=0.690). Young adults had the least resilient personality profile and poorest measures of well-being. Correlations with measures of temperament and character, well-being and affect were all in the expected direction. Temperament and character are related to indicators of wellbeing and differs by age and sex. This Australian sample demonstrate a temperament that is high in Persistence and a character high in Self-Directedness and Cooperativeness with an overall postive affect and a general satisfaction with life. In comparison to other countries, Australians in this sample differ in levels of several traits, demonstrating a cautious and independent temperament with a character that is cooperative, industrious, and self-reliant. Young-adults in comparison to older groups have a temperament and character profile that is prone to negative emotions and a lower satisfaction with life.

Comparison of serum metabolomics in women with breast Cancer Prior to Chemotherapy and at 1 year: cardiometabolic implications

ObjectiveEarly-stage breast cancer (BC) is the second most common malignancy in women, worldwide. Early-detection and treatment advances have led to 5-year survival rates of 90% for early-stage breast cancer. However, the long-term morbidity of breast cancer remains high, with a majority of survivors facing increased risk of cardiometabolic conditions as well as secondary cancers. In particular, African American women with breast cancer experience higher morbidity and mortality than other women. Metabolomics is the comprehensive study of metabolites in biological samples to elucidate the role of monosaccharides, amino acids, and their respective metabolic pathways. Although some studies have found differential metabolites in women with breast cancer compared to normal controls, there has been little study of women with breast cancer across time and the active treatment trajectory. This study examines and compares the serum metabolomic profile of women with BC, prior to initial chemotherapy and at 1 year after inception of chemotherapy.MethodsThis study examined serum metabolites through a secondary analysis of a longitudinal parent study (EPIGEN) of women diagnosed with early-stage BC. Participants were evaluated across 5 time points: prior to their receipt of chemotherapy (T1), at the time of their 4th chemotherapy treatment (T2), 6 months after the initiation of chemotherapy (T3), one year after the initiation of chemotherapy (T4) and two years after the initiation of chemotherapy (T5). This analysis focused on the metabolomic data from 70 participants from T1 to T4. Using ultra high-pressure liquid chromatography high resolution mass spectrometry (UHPLC-HRMS), we performed Friedman Rank Sum Test followed by Nemenyi post-hoc pairwise tests to identify which metabolite levels differed between time points, focusing on metabolites with a Benjamini-Hochberg false discovery rate (FDR) from the overall Friedman test < 0.05 and then specifically examined the p-values from the T1 vs. T4 pairwise comparison.ResultsThe untargeted serum metabolomics yielded a total of 2,395 metabolites identified on the basis of the accurate mass and MS/MS fragmentation, 1,264 of which were significant after Friedman’s test (FDR < 0.05). The analysis then focused on the levels of 124 metabolites from the T1 vs. T4 post-hoc comparison that had a combined FDR < 0.05 and fold change (FC) > 2.0. Metabolite set enrichment analysis (MSEA) as part of Metaboanalyst 3.0 was performed to identify pathways that were significantly altered. The known metabolites identified from the functional analysis were used to evaluate the up and down regulated pathways. The 40metabolites from the Functional Analysis were mainly attributed to amino acids (specifically lysine regulation), fatty acids (particularly unsaturated) and steroid hormone synthesis (lysophosphatidic acid).ConclusionThere were multiple significant changes in the serum metabolomic profile of women with breast cancer at one-year post inception of chemotherapy compared to pre-chemotherapy, most notably associated with lysine degradation, branched-chain amino acid synthesis, linoleic acid metabolism, tyrosine metabolism and biosynthesis of unsaturated fatty acids as the top 5 metabolic pathways. Some of these changes could be associated with metabolic perturbations that are consistent with heightened risk of cardiometabolic morbidity. Our results provide new insights into the mechanisms underlying potential heightened cardiovascular health risks in this population.

0207 Acute Total Sleep Deprivation Adversely Impacts Cardiovascular Measures across Long-Duration Intervals

Abstract Introduction For the first time, we comprehensively investigated the effects of repeated exposures to baseline (BL), total sleep deprivation (TSD), and recovery (REC) phases at 2, 4, and 8 months on cardiovascular (CV) measures. Methods We conducted a five-day experiment twice (at months 2 and 4) in a 4-month study (N=6 healthy adults; 3 females), and a similar five-day experiment three times (at months 2, 4, and 8) in an 8-month study (N=5 healthy adults; 2 females). During these repeated experiments, CV measures were collected via echocardiography or blood pressure monitor [systolic and diastolic blood pressure (SBP and DBP)] at three assessment time points: 1) after two baseline 8h time in bed (TIB) nights (BL); 2) after a night of total sleep deprivation (TSD); and 3) after two recovery nights of 8-10h TIB (REC). CV measures were also collected once pre and post study. Seated stroke volume (SV), cardiac index (CI), left ventricular ejection time (LVET), SBP and DBP, systemic vascular resistance index (SVRI), and mean arterial pressure (MAP) were collected. Data did not significantly differ between the two studies and therefore were pooled together for analysis (N=11). Repeated measures ANOVA and post-hoc comparisons corrected for multiple testing examined CV measures across all time points. Results SV, CI, SVRI, LVET, and SBP, but not DBP or MAP, showed significant changes across time. SV increased with TSD compared to pre-study, BL, and post-study at month 2. CI increased with TSD compared to pre-study, BL, REC, and post-study at month 2. SVRI decreased with TSD compared to pre-study, BL, and REC at month 2 and LVET and SBP increased with TSD compared to BL at month 2. In the 8-month sample subset, SBP increased with TSD compared to BL at month 8. Conclusion TSD increased SV, CI, LVET, and SBP, and decreased SVRI, compared to BL at month 2. Notably, TSD also increased SBP compared to BL at month 8, indicating a sustained adverse effect after long-duration repeated exposure to TSD. Overall, SV, CI, SVRI, LVET, and SBP are reliable biomarkers for assessing the harmful long-term cardiovascular effects of TSD. Support (if any) NASA grants NNX14AN49G and 80NSSC20K0243 (NG)

Sex Differences in the Diastolic Blood Pressure Response to Orthostasis in Obstructive Sleep Apnea

Hypertension is commonly observed with obstructive sleep apnea (OSA), partly due to dysregulation of sympathetic activity. As OSA is considered male-dominant, potential sex differences in the sympathetic regulation of BP have yet to be explored. Hemodynamic responses to an orthostatic challenge have implications for cardiovascular risk and are sympathetically-modulated. Therefore, we tested the hypothesis that females with OSA have differential BP and HR responses to orthostasis relative to males with OSA. 160 individuals not taking antihypertensive medications completed an overnight polysomnography to identify OSA (apnea-hypopnea index ≥5 events/hr). Orthostatic responses were quantified as the changes (Δ) in BP and HR (assessed via brachial cuff) from rest (10min supine) to 60sec post-standing. Females with (n=17, 42±14yrs, 30.7±6.0kg/m2) and without (n=43, 39±12yrs, 27.6±5.7kg/m2) OSA were compared to males with (n=60, 45±11yrs, 31.4±3.8kg/m2) and without (n=40, 39±13yrs, 27.4±3.1kg/m2) OSA using a one-way ANOVA. There were no between-group differences in age (p&gt;0.05 for post-hoc comparisons) and BMI was lower in both females, and males, without OSA relative to males with OSA (p&lt;0.05 for both). ΔSBP did not differ between females with (1±8mmHg) and without (2±8mmHg) OSA nor between males with (4±8mmHg) and without OSA (5±12mmHg, ANOVA p=0.37). Females with OSA had a blunted ΔDBP relative to females without OSA (5±7 vs. 10±6mmHg, p&lt;0.05), whereas males with and without OSA demonstrated similar responses (9±8 vs. 10±6mmHg, p=0.95). ΔHR did not differ between females with (8±8beats/min) and without OSA (9±11beats/min) nor between males with (13±10beats/min) and without OSA (12±10beats/min, ANOVA p=0.06). ΔDBP was not associated with the apnea-hypopnea index (Spearman's r=-0.19, p=0.47; Spearman’s r=0.23, p=0.08) nor nadir SpO2 (Spearman's r=0.27, p=0.29; Spearman’s r=0.06, p=0.64) in females or males with OSA. These data suggest that OSA influences the DBP response to orthostasis in females to a greater extent than males. As DBP is associated with sympathetic activation, this finding could indicate greater sympathetic dysregulation in females, relative to males, with OSA. This work was supported by the National Institutes of Health T32-HL007111 (JMB), HL134808 (NC), HL065176 (PS and VKS), and HL134885 (VKS). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

After scaling to body size hip strength of the residual limb exceeds that of the intact limb among unilateral lower limb prosthesis users

BackgroundHip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls.MethodsTwenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey’s Honest-Difference.ResultsA significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p < 0.001). A significant simple main effect of leg (p = 0.001) indicated peak torque differed between two or more legs per muscle group. Post-hoc comparisons revealed hip extensor, flexor, and abductor peak torque was not significantly different between the residual and control legs (p ≥ 0.067) but torques in both legs were significantly greater than in the intact leg (p < 0.001). Peak hip abductor torque was significantly greater in the control and residual legs than the intact leg (p < 0.001), and significantly greater in the residual than control leg (p < 0.001).ConclusionsOur results suggest that it is the intact, rather than the residual limb, that is weaker. These findings may be due to methodological choices (e.g., normalization), or biomechanical demands placed on residual limb hip muscles. Further research is warranted to both confirm, expand upon, and elucidate possible mechanisms for the present findings; and clarify contributions of intact and residual limb hip muscles to walking and balance in LLP users.Clinical Trial RegistrationN/A.

Indonesian Women’s Civil Service Leadership: Analysis of Career Progression Opportunity and Constraint

Women in Indonesia’s civil service ( n = 320) were surveyed about their career advancement. Analysis of variance identified differences in career progression, and post-hoc comparisons were tested using Fisher’s Least Significant Difference method. We found that family support and interpersonal relationships, paired with superior education to men, were critical to women’s successful leadership progression, especially through the echelon ranks. Qualitative results suggest that interpretations of hadith outweighed more contemporary textual readings, which required strategic maneuvering if women wanted to advance. This is because women’s own career aspirations required their ongoing loyalty to men and strategic maneuvering among filial, societal, and organizational constraints.

Measuring Readiness to Change Substance Use, Alcohol Use, and Cannabis Use: An Experimental Manipulation of Cognitive Effort

Background: The Transtheoretical Model supports that readiness to change should predict actual substance-related behavior change. This relationship is surprisingly modest. Across several behavioral domains, individuals tend to have unrealistic expectations regarding the amount of effort and time required to successfully change one’s behaviors, dubbed the False Hope Syndrome. Objectives: Based on False Hope Syndrome, we expect the standard method of measuring self-reported readiness to change is overestimated. To test this hypothesis, we experimentally manipulated level of cognitive effort prior to completing readiness to change measures. College students from a large southwestern university who reported using substances in the past 30 days (n = 345) were recruited from a psychology department participant pool and randomized to one of three conditions: 1) standard, low effort condition, 2) medium effort condition (selected likes/dislikes of substance use and negative consequences of changing one’s use), and 3) high effort condition (also provided written responses to how they would handle difficult situations related to changing their substance use). We conducted one-way ANOVAs with Tukey post-hoc comparisons to examine differences on three measures of readiness to change: the University of Rhode Island Change Assessment (URICA) scale as well as readiness and motivation rulers. Results: Contrary to our hypothesis, all significant statistical tests supported higher cognitive effort conditions reporting higher readiness to change. Although effect sizes were modest, higher cognitive effort appeared to increase self-reported readiness to change substance use. Conclusions: Additional work is needed to test how self-reported readiness to change relates to actual behavior change when assessed under the different effort conditions.

A Comparison of Basic Training Variables in the Standard and Cambered Bar Bench Press Performed to Volitional Exhaustion.

The objective of this study was to compare the impact of cambered and standard barbells used during the bench press exercise on the number of performed repetitions and mean velocity during a bench press training session that included 5 sets performed to volitional failure at 70% of one-repetition maximum (1RM) (for each barbell type). An additional objective was to determine whether there would be any difference in neuromuscular fatigue assessed by peak velocity changes during bench press throws performed 1 and 24 hours after the cessation of each session. The research participants included 12 healthy resistance-trained men. Participants performed 5 sets of the bench press exercise to volitional failure against 70% of 1RM with the cambered or standard barbell. The Friedman's test showed an overall trend of a significant decrease in the mean velocity (p < 0.001) and a number of performed repetitions (p < 0.001) from the first to the fifth set (p < 0.006 and p < 0.02, respectively for all) under both conditions, yet neither bar showed significant differences between the corresponding sets. Two-way ANOVA indicated a significant main effect of time (p < 0.001) for peak velocity during the bench press throw. The post-hoc comparisons showed significantly lower peak velocity during the bench press throw one hour after the bench press compared to pre (p = 0.003) and 24-hour post intervention (p = 0.007). Both barbells caused a similar decrease in peak barbell velocity during the bench press throw performed one hour after the bench press training session, with values returning to baseline 24 hours later. This indicates that bench press workouts with either a standard or a cambered barbell present the same training demands.

Beyond Dimorphism: Body Size Variation Among Adult Orangutans Is Not Dichotomous by Sex.

Among extant great apes, orangutans are considered the most sexually dimorphic in body size. However, the expression of sexual dimorphism in orangutans is more complex than simply males being larger than females. At sexual maturity, some male orangutans develop cheek pads (flanges), while other males remain unflanged even after becoming reproductively capable. Sometimes flange development is delayed in otherwise sexually mature males for a few years. In other cases, flange development is delayed for many years or decades, with some males even spending their entire lifespan as unflanged adults. Thus, unflanged males of various chronological ages can be mistakenly identified as "subadults." Unflanged adult males are typically described as "female-sized," but this may simply reflect the fact that unflanged male body size has only ever been measured in peri-pubescent individuals. In this study, we measured the skeletons of 111 wild adult orangutans (Pongo spp.), including 20 unflanged males, 45 flanged males, and 46 females, resulting in the largest skeletal sample of unflanged males yet studied. We assessed long bone lengths (as a proxy for stature) for all 111 individuals and recorded weights-at-death, femoral head diameters, bi-iliac breadths, and long bone cross-sectional areas (CSA) (as proxies for mass) for 27 of these individuals, including seven flanged males, three adult confirmed-unflanged males, and three young adult likely-unflanged males. ANOVA and Kruskal-Wallis tests with Tukey and Dunn post-hoc pairwise comparisons, respectively, showed that body sizes for young adult unflanged males are similar to those of the adult females in the sample (all P≥0.09 except bi-iliac breadth), whereas body sizes for adult unflanged males ranged between those of adult flanged males and adult females for several measurements (all P<0.001). Thus, sexually mature male orangutans exhibit body sizes that range from the female end of the spectrum to the flanged male end of the spectrum. These results exemplify that the term "sexual dimorphism" fails to capture the full range of variation in adult orangutan body size. By including adult unflanged males in analyses of body size and other aspects of morphology, not as aberrations but as an expected part of orangutan variation, we may begin to shift the way that we think about features typically considered dichotomous according to biological sex.

Neurocognitive effects of subanesthetic serial ketamine infusions in treatment resistant depression

IntroductionKetamine treatment prompts a rapid antidepressant response in treatment-resistant depression (TRD). We performed an exploratory investigation of how ketamine treatment in TRD affects different cognitive domains and relates to antidepressant response. MethodsPatients with TRD (N = 66; 30 M/35F; age = 39.5 ± 11.1 years) received four ketamine infusions (0.5 mg/kg). Neurocognitive function and depressive symptoms were assessed at baseline, 24 h after the first and fourth ketamine infusion, and 5 weeks following end of treatment. Mixed effect models tested for changes in seven neurocognitive domains and antidepressant response, with post-hoc pairwise comparisons between timepoints, including follow-up. Relationships between change in neurocognitive function and antidepressant response over the course of treatment were tested with Pearson's correlation and mediation analyses. Associations between baseline neurocognitive performance and antidepressant response were tested with Pearson's correlation. ResultsSignificant improvements in inhibition, working memory, processing speed, and overall fluid cognition were observed after the first and fourth ketamine infusion. Improvements in processing speed and overall fluid cognition persisted through follow-up. Significant improvements in depressive symptoms reverted towards baseline at follow-up. Baseline working memory and change in inhibition were moderately correlated with antidepressant response, however, improvements in neurocognitive performance were statistically independent from antidepressant response. ConclusionAntidepressant ketamine leads to improved neurocognitive function, which persist for at least 5 weeks. Neurocognitive improvements observed appear independent of antidepressant response, suggesting ketamine may target overlapping but distinct functional brain systems.LimitationsResearch investigating repeated serial ketamine treatments is important to determine cognitive safety. This study is a naturalistic design and does not include placebo.

Effect of translucency of CAD-CAM ceramic restorative materials and scanning aid conditions on the accuracy of intraoral scans

Background/purposeSubsurface scattering from translucent material would affect the digital scans. This study aimed to evaluate the effect of translucency of ceramic restorative materials and scanning aid conditions on the accuracy of intraoral scans. Materials and methodsIdentical anatomic contour crowns with ten ceramic restorative materials were fabricated: five zirconia, three lithium disilicate glass-ceramic, and two leucite reinforced glass-ceramic. The models with ceramic crowns were digitized with an intraoral scanner (IOS) and analyzed for accuracy (n = 10) with and without a scanning aid. Scan time efficiency was recorded. Square-shaped specimens with 1.0-mm thickness were fabricated with the same materials, and translucency parameter (TP) values were measured. One-way ANOVA, Welch ANOVA, and a post-hoc pairwise comparison or independent t-test were used for trueness and time analysis, and the F-test was used to examine the precision (α = 0.05). Pearson correlation test was conducted. ResultsSignificant differences were revealed for trueness with no scanning aid condition and for TP values (P < 0.05). In contrast, no statistically significant differences were observed for trueness with a scanning aid. A strong correlation (r = 0.854, P < 0.01) between TP value and trueness with no scanning aid was revealed. By applying a scanning aid, trueness was improved and scan time efficiency significantly increased (P < 0.05). ConclusionThe translucency of ceramic restorative materials negatively affects the accuracy of IOS scan without a scanning aid; however, the scan accuracy and time efficiency of IOS scanning for ceramic restorations can be improved by applying scanning aid, and prostheses with high quality without unnecessary labor can be produced.

Efficacy of High Dilution Medicines in combination with physiotherapy in trauma induced low back pain- A Randomized Control Clinical Trial

Background: Lower back pain can refer to a wide range of back injuries or conditions and is one of the most common musculoskeletal disorders which necessitating health care and one of the reason for which many seek a family physician which is cause for limited range of motion. Homoeopathic medicines can offer long term relief from the backache. Methods: This is a three arm randomized controlled trial. Total 30 patients with trauma-induced low backache were chosen at random and divided equally into three study groups. Group A (n=10) was given Arnica 200 twice a day for the first 15 days, after 15 days, another evaluation was performed, and the dose was repeated as needed. Group B (n=10) received constitutional medicine. The dose of constitutional medicine was repeated as needed. After careful case taking, case working, and repertorisation, Bryonia Alba Linn., Rhus Toxicodendron Linn., Nux Vomica Linn. were administered on a constitutional basis. Group C (n=10) received a placebo. All the three groups received physiotherapy to strengthen back muscles in order to reduce the likelihood of recurrenceData was anlaysed using STATA software using Chi square test, ANOVA and post-hoc Bonferroni Multiple comparison test. Results- Significant improvement in pain scores (VAS) was observed in both between the group and within the group comparisons and the effect was more pronounced in Group B. Conclusion: Hence we conclude that an individualized approach is more effective in the management of patients with trauma-induced low back pain.