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0262 Comparing Wrist Actigraphy to a Novel Wearable (Actigpatch): Nonparametric Activity Estimation
Introduction Wrist actigraphy is a standard for monitoring sleep in the field; however, data quality is reduced if participants remove the device. The Actigpatch is a novel, adhesive water-resistant wearable that we have previously demonstrated as comparable to wrist actigraphy for traditional sleep-wake estimation. Here we compare assessment of nonparametric activity indexes. Methods While following fixed schedules, 39 participants simultaneously wore the Micro Motionlogger actigraph (Ambulatory Monitoring Inc., Ardley, NY) on their non-dominant wrist and the Actigpatch (Circadian Positioning Systems, Newport, RI) over the triceps of their dominant arm. Our analyses included 35 participants (21F; 32.9±13.2yrs) who contributed ≥four nights of data (range: 4-14 [mean: 10] nights). After matching devices’ tri-axial actimetry in one-minute epochs, we derived key non-parametric parameters of diurnal activity and calculated intraclass correlations to measure agreement. The non-parametric parameters include interdaily stability (IS), intradaily variability (IV), timing of the five hours of lowest activity (L5onset) and ten hours of highest activity (M10onset), and overall relative amplitude (RA). Results We observed agreement ranging from good for IS (ICC=0.77 [95%CI=0.59;0.88]; [all mean differences are patch-watch] mean difference=-0.21) to poor for IV (ICC=0.43 [0.12;0.67]; mean difference=0.29). ICC showed good agreement for M10onset (ICC=0.82 [0.67; 0.90]; mean difference=-37min) and excellent agreement for L5onset (ICC=0.91 [0.82;0.95]; mean difference=-2min). Finally, we identified good agreement when estimating the activity relative amplitude (RA ICC=0.86 [0.75; 0.93]; mean difference=0.03). An example of excellent agreement was manifested in the close estimation of L5onset (patch mean=1:04am, SD=70min; watch mean=1:06am, SD=68min). Conclusion Adding to our prior evidence that these two devices offer similar sleep-wake estimation using traditional algorithms, the present data indicate the Actigpatch offers good agreement to the Motionlogger for nonparametric analyses of IS, activity timing, and RA. Agreement was not as good for IV, with the Actigpatch showing more intradaily variability than the watch, perhaps due to the triceps placement. Because the Actigpatch is unobtrusive, water-resistant, and can be worn continuously for three weeks, it has potential benefits for studies of individuals who struggle with adherence to wearing wrist worn devices. Support (if any) R01AA025593, P20GM139743. Actigpatches provided by Circadian Positioning Systems.
Journal Article
S82 How do specialists treat hypersensitivity pneumonitis in britain?
BackgroundAlthough immunosuppression is commonly used in HP, there are no studies that compare treatment regimes.Aims and objectivesThe aim of this study was to survey specialist ILD consultants to determine how HP is treated in Britain.MethodsBritish ILD consultants were provided with clinical scenarios, and asked how they would treat patients with HP. They were also asked to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ and ‘majority agreement’ were defined as at least 70% and 50% respectively of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.Results54 consultants took part in the survey from 27 centres. The choice of first line immunosuppression in progressive HP was relatively evenly split between dual therapy with corticosteroids plus a ‘steroid-sparing’ immunosuppressant (46%) and monotherapy with oral corticosteroids (39%). On average, the initial starting dose of oral prednisolone (for an 80 kg patient) was 40 mg continued for 6 weeks prior to weaning, aiming for a maintenance of 10 mg. 75% of participants reported that mycophenolate mofetil was their first choice ‘non-corticosteroid immunosuppressant’ for the long-term management of HP. A number of statements relating to the treatment of HP reached consensus or majority agreement (table 1).ConclusionsThis survey has demonstrated a degree of variation in the treatment of patients with suspected HP in Britain, but has found consensus and majority agreement for some key areas.Abstract S82 Table 1Consensus (C) and majority (M) statements with level of agreement Statement % agree HP patients with an acute onset of severe symptoms (often with hypoxia) should be treated with short courses of oral corticosteroids, to speed up the rate of clinical improvement (C). 91% In some cases of biopsy confirmed HP, fibrosis progresses despite cessation of exposure and treatment with immunosuppression (C). 96% I have had patients with progressive fibrotic HP unresponsive to immunosuppression, whom I would have treated with antifibrotic agents, had they been routinely available as standard NHS care (C). 81% In HP that progresses (despite cessation of exposure) immunosuppression should be considered (where not contraindicated):- only if there is evidence of active inflammation- in all cases irrespective of the radiological diagnosis or histological pattern (M)- in all cases unless there is a definite UIP pattern of fibrosis- other (please specify) 19%50%13%4% In HP with a predominantly fibrotic picture, immunosuppression should be stopped after a three-month trial unless there is a clear improvement or stabilisation of lung function (M). 67% In HP with a predominantly fibrotic picture, I have concerns that treating patients long-term with immunosuppression may increase mortality as in IPF (M). 61%
Journal Article
Enhancing Precision in OLT Measurements and Improving Agreement in Surgical Decision-Making: A Comprehensive Evaluation Using WBCT and Distance Mapping for Preoperative Planning
Category:
Ankle; Other
Introduction/Purpose:
WBCT enables the creation of a three-dimensional model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating OLT, allowing for the quantification of its surface area, volume, and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth, and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention
Methods:
This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface, and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis, and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured.
Results:
Interclass correlation of the lesion's depth surface produced an excellent interrater and intrareader agreement of 0.90 -0.94 p-value < 0.001. Cohen's Kappa agreement analysis of the preferable preoperative plan produced a Kappa = 0.834 P-value< 0.001, indicating a near-perfect agreement
Conclusion:
WBCT-based 3D modules and DM can be used to measure the OLT surface and depth and to calculate the lesion volume with excellent interrater and interrater reliability; using the OLT measurement and a predetermined treatment algorithm, a near-perfect interrater agreement for the preoperative planning was reached. WBCT in conjunction could help determine the type of surgery needed preoperatively and assess if additional surgeries are needed.
Journal Article
A76 WHAT'S IN THE TOOL BOX TO ASSESS LUNG FUNCTION: Correlation Of Lung Function Measurements To Assess Small Airway Disease
Damage to these airways may be present in both asthma , COPD and other bronchiolar diseases with potential limitation of exercise capacity early in the disease course. Conclusions: Lung function tests commonly used to identify isolated small airway disease are positive in 3.5-55.9% of patients with respiratory symptoms and normal spirometry.
Journal Article
