Correction to: Who meets national early childhood sleep guidelines in Aotearoa New Zealand? A cross-sectional and longitudinal analysis

[This corrects the article DOI: 10.1093/sleepadvances/zpac002.].

Who meets national early childhood sleep guidelines in Aotearoa New Zealand? A cross-sectional and longitudinal analysis

Study Objectives

To investigate the proportion of children in Aotearoa New Zealand (NZ) who do or do not meet sleep duration and sleep quality guidelines at 24 and 45 months of age and associated sociodemographic factors.

Methods

Participants were children (n = 6490) from the Growing Up in New Zealand longitudinal study of child development with sleep data available at 24 and/or 45 months of age (48.2% girls, 51.8% boys; 22.4% Māori [the Indigenous people of NZ], 12.9% Pacific, 13.4% Asian, 45.2% European/Other). Relationships between sociodemographic factors and maternally reported child sleep duration (across 24 hours) and night wakings were investigated cross-sectionally and longitudinally. Estimates of children in NZ meeting sleep guidelines were calculated using a range of analytical techniques including Bayesian linear regression, negative binomial multiple regression, and growth curve models.

Results

In NZ, 29.8% and 19.5% of children were estimated to have a high probability of not meeting sleep duration guidelines and 15.4% and 8.3% were estimated to have a high probability of not meeting night waking guidelines at 24 and 45 months respectively, after controlling for multiple sociodemographic variables. Factors associated cross-sectionally with children's sleep included ethnicity, socioeconomic deprivation, material standard of living, rurality, and heavy traffic, and longitudinal sleep trajectories differed by gender, ethnicity, and socioeconomic deprivation.

Conclusions

A considerable proportion of young children in NZ have a high probability of not meeting sleep guidelines but this declines across the ages of 24 and 45 months. Sleep health inequities exist as early as 24 months of age in NZ.

Ethnography and medicine: the utility of positivist methods in research

This commentary discusses the methodological utility of ethnography within the medical space. Whilst a general consensus affirms that ethnography aligns with qualitative approaches, as identified within the existing medical literature, here, we demonstrate how quantitative [positivist] methods can also be incorporated. This paper begins by contextualising ethnographic approaches within medical contexts by demonstrating its empirical value within the existing literature. Next, we discuss the interconnection between the practice of 'doctoring' and ethnographic research, whereby doctors themselves use forms of inductive and deductive reasoning to treat and manage patients in their everyday context. This philosophical discussion not only links to the everyday practice of medical practitioners, but also critically reflects on the role of the first author, as a diagnostic radiographer. Lastly, this paper identifies the virtues of ethnographic research for medical students and/or medical doctors whereby the combination of qualitative and quantitative methods (within an ethnographic methodology) can lead to new empirical and methodological insights, enabling the creation of alternate research strategies and evidence. This methodological strategy may be best considered amongst medical students and/or early career medical researchers, but we also anticipate it to resonate and open further discussion with experienced medical practitioners and researchers transnationally.

Ultrastructural Evidence for a Role of Astrocytes and Glycogen-Derived Lactate in Learning-Dependent Synaptic Stabilization

Long-term memory formation (LTM) is a process accompanied by energy-demanding structural changes at synapses and increased spine density. Concomitant increases in both spine volume and postsynaptic density (PSD) surface area have been suggested but never quantified in vivo by clear-cut experimental evidence. Using novel object recognition in mice as a learning task followed by 3D electron microscopy analysis, we demonstrate that LTM induced all aforementioned synaptic changes, together with an increase in the size of astrocytic glycogen granules, which are a source of lactate for neurons. The selective inhibition of glycogen metabolism in astrocytes impaired learning, affecting all the related synaptic changes. Intrahippocampal administration of l-lactate rescued the behavioral phenotype, along with spine density within 24 hours. Spine dynamics in hippocampal organotypic slices undergoing theta burst-induced long-term potentiation was similarly affected by inhibition of glycogen metabolism and rescued by l-lactate. These results suggest that learning primes astrocytic energy stores and signaling to sustain synaptic plasticity via l-lactate.

Comparison of geographic workflow preferences with real-time dynamic regional mapping data during catheter ablation

Funding Acknowledgements

Type of funding sources: None.

Introduction

The clinical benefit of multielectrode high-density (HD) mapping during catheter ablation has been an area of active research. One advantage of HD mapping is improved sensitivity which can lead to better visualization and substrate delineation during the procedure. In addition to the advantages offered by the multielectrode grid mapping catheter (HD Grid), a novel software enable the display of beat-to-beat, dynamic regional mapping data from the current location of HD Grid in real-time (LiveView). The optimal settings and workflows to incorporate the dynamic data into routine ablation procedures have not been explored.

Purpose

To examine the common settings and workflow patterns among operators from different geographies when using dynamic mapping.

Methods

Observational procedural data including procedure time, total RF time, workflow preference, and fluoroscopy time, were prospectively collected from operators across Europe, the U.S., and Asia Pacific countries from May to September 2020. Cases from both catheter ablation of atrial and ventricular arrhythmias were included in the analysis.

Results

A total of 754 cases were collected (428, 133, and 193 cases from Europe, the U.S., and the Asia Pacific region, respectively). The most commonly reported indication across all three geographies was de novo paroxysmal atrial fibrillation (223/754, 30.0%). A steerable sheath was more frequently used with the mapping catheter in Europe and U.S. compared to Asia Pacific countries. Contrary to cases from the U.S. and Asia Pacific countries where the double transseptal approach was the preferred technique for left atrial procedures (78.8% and 55.3%, respectively), the single transseptal approach was more commonly observed in European cases (233/428, 54.4%). Visualization of real-time mapping data after creation of traditional full-chamber maps were commonly observed in all three geographies. Regardless of geography, the CS catheter was commonly used a reference electrode; and the most common map appearance settings for interior projection, exterior projection, and interpolation was 7, 7, and 7 respectively. Voltage cutoff of 0.1 mV, range from 0.01 to 1.5 mV, was most frequently observed for delineating scar in atrial arrhythmia cases analyzed in this dataset.

Conclusions

While there is a geographical difference in ablation workflow, common settings and patterns can be observed in all three regions. This data suggests that minimal workflow changes are required to incorporate the use of dynamic data into routine procedures. Adaptation of LiveView can help improve procedure efficiency and efficacy by reducing the need for full chamber maps, identifying areas that were under ablated, and confirming ablation endpoints. Further control study examining procedure efficiency and efficacy associated with dynamic mapping may be warranted.

Workflows and clinical utilization of dynamic mapping data in radiofrequency catheter ablation of cardiac arrhythmias

Funding Acknowledgements

Type of funding sources: None.

Introduction

Previous publications suggest that the use of high-density (HD) mapping leads to better substrate visualization and may lead to improved procedural outcomes. A novel dynamic mapping software, utilizes the HD grid mapping catheter (HD Grid) to display beat-to-beat, dynamic regional mapping data (LiveView). Incorporation of real-time dynamic mapping data into routine mapping/ablation workflows may further enhance the clinical benefits of HD mapping during radiofrequency (RF) catheter ablation procedures.

Purpose

 To examine the clinical utility and common workflows when dynamic mapping data was used during RF ablation procedures among operators with various experience levels.

Methods

Observational procedural data including procedure time, total RF time, and workflow preference were prospectively collected in catheter ablation cases utilizing LiveView from May to September 2020. Mapping and ablation strategies were determined at the operator’s discretion. Total percentage exceed 100% when multiple usage were reported.

Results

A total of 428 cases were collected from over 25 operators in 11 European countries. LiveView was used in a variety of cases including atrial fibrillation (paroxysmal and persistent), atrial flutter (typical and atypical), and VT (ischemic, non-ischemic, and idiopathic). Visualization of real-time mapping data from the current location of the HD Grid was commonly used after creation of traditional full-chamber maps (319/428, 74.5%). While operators in over 55% of the cases indicated that the use of dynamic display during mapping helped identify areas that were under ablated (238/428, 55.6%), using LiveView did not affect the lesion delivery strategies in those regions. LiveView was also used as a primary method for confirmation of pulmonary vein isolation (PVI) in 213 cases (49.8%). The most common reported usage of LiveView among the 428 cases analyzed was PVI confirmation/gap identification (75.2%), ablation line gap identification (41.1)%, and identification of breakthrough activation (23.6%)

Conclusions

This initial analysis demonstrated the diverse clinical utilization of LiveView dynamic display during RF catheter ablation procedures, including atrial and ventricular arrhythmias. Without causing significant changes to normal workflow, dynamic display of regional signals allows for rapid identification of ablation targets. When used during RF delivery, real-time assessment of regional activation patterns helped improve outcomes by rapidly identifying critical ablation location and ensuring successful lesion delivery. A further study that examines the impact of dynamic display on procedure efficacy may be warranted.

Left ventricular remodeling after transcatheter mitral valve replacement with Tendyne

Background

Data on changes in left atrial (LA) and left ventricular (LV) volumes after transcatheter mitral valve replacement (TMVR) are limited.

Purpose

This study sought to describe the anatomical and functional changes in left-sided cardiac chambers by computed tomography angiography (CTA) from baseline to 1-month after TMVR with Tendyne prosthesis.

Methods

We analyzed patients who underwent TMVR with Tendyne prosthesis (Abbott Structural, Menlo Park, CA) between 2015 and 2018. Changes in LV end-diastolic volume (LVEDV), ejection fraction (LVEF), mass (LV mass), LA volume and global longitudinal strain (GLS) were assessed at baseline and at 1-month after TMVR with CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes.

Results

A total of 36 patients (mean age 73±8 years, 78% men, 86% secondary MR) were studied. There were significant decreases in LVEDV (268±68 vs. 240±66ml, p<0.001), LVEF (38±10 vs. 32±11%, p<0.001), LV mass (126±37 vs. 117±32g, p<0.001), LA volume (181±74 vs. 174±70 ml, p=0.027) and GLS (−12.6±5.1 vs. −9.5±4.0%, p<0.001) from baseline to 1-month follow-up. Favorable LVEDV reverse-remodeling occurred in the majority (30 of 36 patients, or 83%). Closer proximity of the Tendyne apical pad to the true apex was predictive of favorable remodeling (pad distance: 25.0±7.7 vs. 33.5±8.8mm, p=0.02 for those with and without favorable remodeling).

Conclusions

TMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1-month after implantation. CTA identifies the favorable post-TMVR changes, which could be related to specific characteristics of the device implantation.

Funding Acknowledgement

Type of funding source: None

Prognostic significance of extranodal extension in oral cavity squamous cell carcinoma with occult neck metastases

A grade of extranodal extension (ENE) may advance risk stratification related to survival in patients with metastatic oral cavity squamous cell carcinoma (OCSCC). Pathological examination of 174 OCSCC patients who were primarily surgically treated with tumour resection and elective neck dissection was performed. Data of ENE presence, its extent (in millimetres), patients and tumour characteristics were statistically analysed with respect to disease-free survival (DFS) and overall survival (OS). Ninety patients (51.7%) were identified with occult nodal disease, with 41 patients (23.6%) presenting with ENE. Receiver operating characteristics (ROC) curve analysis set the threshold at 1.9 mm as an optimal ENE cut-off regarding both DFS and OS. Patients were divided by extent into minor ENE (≤1.9 mm) and major ENE (>1.9 mm) subgroups. The subgroup with minor ENE had significantly higher DFS and OS rates compared with major ENE. ENE cut-off threshold at 1.9 mm discriminates low and high-risk subgroups of patients with occult OCSCC in terms of DFS and OS.

0356 Associations Between Ethnicity, Socioeconomic Deprivation and Preschoolers’ Sleep Health in Aotearoa/New Zealand

Introduction

In Aotearoa/New Zealand (NZ) ethnic and socioeconomic inequities exist in adult sleep health but less is known about relationships between ethnicity, socioeconomic position and sleep in early childhood.

Methods

Maternally-completed questionnaire data from a pregnancy-birth cohort were analysed cross-sectionally. Log-binomial regression models investigated independent associations between ethnicity, socioeconomic position and sleep of 340 Māori (Indigenous) and 570 non-Māori 3-4 year olds. Independent variables included child ethnicity, gender, area-level deprivation (NZDep quintiles; 5=most deprived) and individual-level deprivation (NZiDep scores 1-5; 5=most deprived). Dependent variables included typical weekday and weekend sleep duration (<10hrs/10-13hrs), difference in week/weekend sleep duration (>1hr/≤1hr) and midsleep time (≥1hr/<1hr), problems falling asleep and problematic sleep patterns (no vs. moderate/large problem).

Results

Māori preschoolers were more likely to have short sleep (weekdays: PR=2.23, 95% CI 1.31-3.82; weekends: PR=2.04, 95% CI 1.24-3.36), week/weekend sleep duration difference >1hr (PR=2.47, 95% CI 1.59-3.84), week/weekend midsleep difference ≥1hr (PR=2.38, 95% CI 1.30-4.36) and a moderate/large problem falling asleep (PR=1.43, 95% CI 1.00-2.06) than non-Māori preschoolers. Preschoolers living in most deprived areas were more likely to have short sleep on weekdays (NZDep quintile 4: PR=3.91, 95% CI 1.43-10.72; NZDep quintile 5: PR=4.14, 95% CI 1.54-11.12) and week/weekend sleep duration difference >1hr (NZDep quintile 4: PR=2.34, 95% CI 1.23-4.43) than preschoolers in least deprived areas. Children with higher individual-level deprivation scores were more likely to have short sleep on weekends (NZiDep 5: PR=2.38, 95% CI 1.21-4.67) and a moderate/large problem falling asleep (NZiDep 3: PR=1.72, 95% CI 1.10-2.67) compared to children with lowest scores.

Conclusion

Ethnic and socioeconomic sleep health inequities exist as early as 3 years of age in NZ. Socio-political drivers of social and economic disadvantage experienced by Māori children and children from families who hold low socioeconomic position must be addressed to achieve equitable sleep health early in the lifecourse.

Support

Funding support was provided by Massey University New Zealand (Massey University Strategic Innovation Fund; Massey University Research Fund; and Massey University Doctoral Scholarship) and the Health Research Council of New Zealand (HRC 09/233, 08/547).