Continuous Activity Monitoring Research Articles

Mice with deficiency in Pcdh15, a gene associated with bipolar disorders, exhibit significantly elevated diurnal amplitudes of locomotion and body temperature

Genetic factors significantly affect the pathogenesis of psychiatric disorders. However, the specific pathogenic mechanisms underlying these effects are not fully understood. Recent extensive genomic studies have implicated the protocadherin-related 15 (PCDH15) gene in the onset of psychiatric disorders, such as bipolar disorder (BD). To further investigate the pathogenesis of these psychiatric disorders, we developed a mouse model lacking Pcdh15. Notably, although PCDH15 is primarily identified as the causative gene of Usher syndrome, which presents with visual and auditory impairments, our mice with Pcdh15 homozygous deletion (Pcdh15-null) did not exhibit observable structural abnormalities in either the retina or the inner ear. The Pcdh15-null mice showed very high levels of spontaneous motor activity which was too disturbed to perform standard behavioral testing. However, the Pcdh15 heterozygous deletion mice (Pcdh15-het) exhibited enhanced spontaneous locomotor activity, reduced prepulse inhibition, and diminished cliff avoidance behavior. These observations agreed with the symptoms observed in patients with various psychiatric disorders and several mouse models of psychiatric diseases. Specifically, the hyperactivity may mirror the manic episodes in BD. To obtain a more physiological, long-term quantification of the hyperactive phenotype, we implanted nano tag® sensor chips in the animals, to enable the continuous monitoring of both activity and body temperature. During the light-off period, Pcdh15-null exhibited elevated activity and body temperature compared with wild-type (WT) mice. However, we observed a decreased body temperature during the light-on period. Comprehensive brain activity was visualized using c-Fos mapping, which was assessed during the activity and temperature peak and trough. There was a stark contrast between the distribution of c-Fos expression in Pcdh15-null and WT brains during both the light-on and light-off periods. These results provide valuable insights into the neural basis of the behavioral and thermal characteristics of Pcdh15-deletion mice. Therefore, Pcdh15-deletion mice can be a novel model for BD with mania and other psychiatric disorders, with a strong genetic component that satisfies both construct and surface validity.

Multi-interface Engineering of MXenes for Self-Powered Wearable Devices.

Self-powered wearable devices with integrated energy supply module and sensitive sensors have significantly blossomed for continuous monitoring of human activity and the surrounding environment in healthcare sectors. The emerging of MXene-based materials has brought research upsurge in the fields of energy and electronics, owing to their excellent electrochemical performance, large surface area, superior mechanical performance, and tuneable interfacial properties, where their performance can be further boosted via multi-interface engineering. Herein, a comprehensive review of recent progress in MXenes for self-powered wearable devices is discussed from the aspects of multi-interface engineering. The fundamental properties of MXenes including electronic, mechanical, optical, and thermal characteristics are discussed in detail. Different from previous review works on MXenes, multi-interface engineering of MXenes from termination regulation to surface modification and their impact on the performance of materials and energy storage/conversion devices are summarized. Based on the interfacial manipulation strategies, potential applications of MXene-based self-powered wearable devices are outlined. Finally, proposals and perspectives are provided on the current challenges and future directions in MXene-based self-powered wearable devices. This article is protected by copyright. All rights reserved.

Supplementation with autologous adipose stem cell-derived mitochondria can be a safe and promising strategy for improving oocyte quality.

In our previous study, we confirmed that the supplementation of vitrified-warmed murine oocytes with autologous adipose stem cell (ASC)-derived mitochondria during intracytoplasmic sperm injection enhances post-fertilization developmental competence in mice. To ensure the safety of this technology, we conducted a thorough study in mice to investigate the potential presence of specific malformations in offspring developed from this approach. A transgenerational comparative analysis was conducted on founder mice from embryos that developed after mitochondrial supplementation, and two subsequent generations. Reproductive performance, body growth rate, histopathological parameters, hematological parameters, daily activity patterns, and daily body temperature changes in male and female mice across these three generations were assessed in comparison to wild-type mice of the same age. Both male and female animals in all three generations showed comparable reproductive performance to the control group. Additionally, body growth rate by the age of 8weeks were found to be comparable to controls across all three generations. Notably, no significant histopathological abnormalities were detected in vital organs, including the brain, heart, liver, kidneys, lungs, ovaries, and testes, in any individuals from the studied cohorts. The blood parameters were consistent with the control data. The continuous monitoring of activity and body temperature changes (both day and night) over a 1-week period revealed a pattern closely resembling that observed in the control animals. Injection of ASC-mitochondria into oocytes may be a promising technique to support developmental potential without causing adverse epigenetic events in the offspring in mice. However, before considering clinical application, additional safety screening using larger animals or non-human primates is essential.

Wearable Sensors for Physiological Condition and Activity Monitoring

Rapid technological advancements have transformed the healthcare sector from traditional diagnosis and treatment to personalized health management. Biofluids such as teardrops, sweat, interstitial fluids, and exhaled breath condensate offer a rich source of metabolites that can be linked to the physiological status of an individual. More importantly, these biofluids contain biomarkers similar to those in the blood. Therefore, developing sensors for the noninvasive determination of biofluid‐based metabolites can overcome traditionally invasive and laborious blood‐test‐based diagnostics. In this context, wearable devices offer real‐time and continuous physiological conditions and activity monitoring. The first‐generation wearables included wristwatches capable of tracking heart rate variations, breathing rate, body temperature, stress responses, and sleeping patterns. However, wearable sensors that can accurately measure the metabolites are needed to achieve real‐time analysis of biomarkers. In this review, recent progresses in wearable sensors utilized to monitor metabolites in teardrops, breath condensate, sweat, and interstitial fluids are thoroughly analyzed. More importantly, how metabolites can be selectively detected, quantified, and monitored in real‐time is discussed. Furthermore, the review includes a discussion on the utility of, multifunctional sensors that combine metabolite sensing, human activity monitoring, and on‐demand drug delivery system for theranostic applications.

Monitoring underground hydrogen storage migration and distribution using time-lapse acoustic waveform inversion

The ongoing global energy shift from fossil fuels to renewable sources highlights the importance of underground hydrogen storage (UHS) as a sustainable mechanism to counterbalance the seasonal inconsistencies of renewable energy. Comparable to geological CO2 sequestration, UHS necessitates precise subsurface imaging and a thorough understanding of hydrogen behavior within geological formations, including its location and migration patterns. Since direct subsurface measurement is unattainable, there is a pronounced need for robust subsurface characterization and monitoring techniques. This research focuses on UHS feasibility in enduring storage scenarios, employing seismic monitoring strategies adapted from CO2 storage practices. Specifically, we integrate Continuous Active Source Seismic Monitoring (CASSM) and Time-Lapse Full Waveform Inversion (TLFWI) to scrutinize UHS. The study employs synthetic crosshole surveys that initially model the coexistence of hydrogen and water within fractured reservoirs, aiming to pinpoint hydrogen-related velocity alterations in acoustic waveforms. Subsequently, we utilize a time-lapse synthetic model of hydrogen injection to emulate CASSM observations. Utilizing TLFWI in conjunction with White's model, we successfully process the CASSM data to discern and quantify temporal variations in velocity and saturation, which effectively maps the spatial and temporal distribution of mobile hydrogen. The results affirm the capabilities of TLFWI and CASSM as proficient monitoring systems for UHS. This study aspires to offer a dependable methodology for the administration of large-scale and long-term geological hydrogen storage.

Remote Continuous Monitoring of Tree Physiological Activity using Four-point Electrical Resistance Measurement

Remote Continuous Monitoring of Tree Physiological Activity using Four-point Electrical Resistance Measurement

Implementation of an epicardial implantable MEMS sensor for continuous and real-time postoperative assessment of left ventricular activity in adult minipigs over a short- and long-term period.

The sensing of left ventricular (LV) activity is fundamental in the diagnosis and monitoring of cardiovascular health in high-risk patients after cardiac surgery to achieve better short- and long-term outcome. Conventional approaches rely on noninvasive measurements even if, in the latest years, invasive microelectromechanical systems (MEMS) sensors have emerged as a valuable approach for precise and continuous monitoring of cardiac activity. The main challenges in designing cardiac MEMS sensors are represented by miniaturization, biocompatibility, and long-term stability. Here, we present a MEMS piezoresistive cardiac sensor capable of continuous monitoring of LV activity over time following epicardial implantation with a pericardial patch graft in adult minipigs. In acute and chronic scenarios, the sensor was able to compute heart rate with a root mean square error lower than 2 BPM. Early after up to 1 month of implantation, the device was able to record the heart activity during the most important phases of the cardiac cycle (systole and diastole peaks). The sensor signal waveform, in addition, closely reflected the typical waveforms of pressure signal obtained via intraventricular catheters, offering a safer alternative to heart catheterization. Furthermore, histological analysis of the LV implantation site following sensor retrieval revealed no evidence of myocardial fibrosis. Our results suggest that the epicardial LV implantation of an MEMS sensor is a suitable and reliable approach for direct continuous monitoring of cardiac activity. This work envisions the use of this sensor as a cardiac sensing device in closed-loop applications for patients undergoing heart surgery.

HARDWARE AND SOFTWARE COMPLEX FOR STABILITY CONTROL OF QUARRY SIDES USING OPTICAL FIBER

This article explores solutions to address the issue of implementing a shift monitoring system in quarries, which is the primary cause of collapsing sides and edges. For guaranteed safety and continuous monitoring of the quarry's activities, advanced fiber-optic sensors have been integrated. Their design is based on the use of single-mode optical fibers, which provides the most accurate assessment of displacements in mountainous terrain up to a distance of 30 km. Extensive laboratory studies have been carried out to deeply analyze the deformation and shear processes occurring in this geographical area. The results obtained from these analyses bode well for a significant improvement in quarry performance and a reduction in the likelihood of emergency situations.

Wireless and Catheter-Free Bladder Pressure and Volume Sensor.

Continuous monitoring of bladder activity during normal daily activities would improve clinical diagnostics and understanding of the mechanisms underlying bladder function, or help validate how differing neuromodulation strategies affect the bladder. This work describes a urological monitor of conscious activity (UroMOCA). The UroMOCA included a pressure sensor, urine impedance-sensing electrodes, and wireless battery recharge and data transmission circuitry. Components were assembled on a circuit board and encapsulated with an epoxy/silicone molded package that allowed Pt-Ir electrode feedthrough for urine contact. Packaged UroMOCAs measured 12 × 18 × 6 mm. UroMOCAs continuously transmitted data from all onboard sensors at 10 Hz at 30 cm range, and ran for up to 44 hours between wireless recharges. After in vitro calibration, implantations were performed in 11 animals. Animals carried the device for 28 days, enabling many observations of bladder behavior during natural, conscious behavior. In vivo testing confirmed the UroMOCA did not impact bladder function after a two-week healing period. Pressure data in vivo were highly correlated to a reference catheter used during an anesthetized follow-up. Static volume sensor data were less accurate, but demonstrated reliable detection of bladder volume decreases, and distinguished between voiding and non-voiding bladder events.

Impact of head-down-tilt body position on abdomen resistance for urinary bladder monitory applications

Tissue electrical impedance (or bioimpedance) is a quantity related to the passive, frequency-dependent electrical properties of a biological tissue and is a promising modality for continuous monitoring of relative bladder volume and bladder activity. In this study, the impact of body position [specifically 6° head-down tilt (HDT)] intended to induce fluid redistribution and, therefore, result in a change in the electrical resistance of the abdomen is evaluated. The abdomen resistance (10 kHz–100 kHz) of nine healthy young adults was measured before and after 240 min in a 6° HDT position. Over this period, the resistance increase was not statistically significant even though the average bladder volume increased by 506 mL. It was expected that the abdomen resistance would decrease with an increase in bladder volume over this period. The masking of the expected resistance decrease is attributed to the shift in the fluid from the legs/abdomen to the neck/chest caused by the HDT body position over this period. Overall, this suggests that methods to differentiate bladder volume changes from other types of fluid shifts in the body are needed for resistance-based monitoring under free-living conditions.

Kairos study protocol: a multidisciplinary approach to the study of school timing and its effects on health, well-being and students' performance.

Recent evidence from chronobiology, chssronomedicine and chronopsychology shows that the organisation of social time (e.g., school schedules) generally does not respect biological time. This raises concerns about the impact of the constant mismatch between students' social and internal body clocks on their health, well-being and academic performance. The present paper describes a protocol used to investigate the problem of (de) synchronisation of biological times (chronotypes) in childhood and youth in relation to school times. It studies the effects of student chronotype vs. school schedule matches/mismatches on health behaviours (e.g., how many hours students sleep, when they sleep, eat, do physical activity, spend time outdoors in daylight) and learning (verbal expression, spatial structuring, operations) and whether alert-fatigue levels mediate this effect alignments/misalignments on learning (verbal expression, spatial structuring, operations) and their mediation by alert-fatigue levels. The novelty of our protocol lies in its multidisciplinary and mixed methodology approach to a relevant and complex issue. It draws on up-to-date knowledge from the areas of biology, medicine, psychology, pedagogy and sociology. The methods employed include a varied repertoire of techniques from hormonal analysis (cortisol and melatonin), continuous activity and light monitoring, self-registration of food intake, sleep timings, exercise and exposure to screens, alongside with systematic application of cognitive performance tests (e.g., memory, reasoning, calculation, attention) and self-reported well-being. This comprehensive and interdisciplinary protocol should support evidence-based education policy measures related to school time organisation. Appropriate and healthier school timetables will contribute to social change, healthier students and with more efficient learning. The results of studies using a similar methodology in other countries would ensure replication and comparability of results and contribute to knowledge to support policy making.

Phytoplankton Dynamics in an Oligo-mesotrophic Environment along the Montenegrin Coast (South-East Adriatic Sea)

The dynamics of the phytoplankton community were studied along the Montenegrin coast, in the mesotrophic area of Boka Kotorska Bay and the oligotrophic coastal open sea area. This two year study investigates differences in dynamics of phytoplankton assemblages and abundances in the Bay area, which is highly impacted from the land, and the open coastal part of the Montenegrin coast, which is highly influenced by Levantine water masses but less affected by anthropogenic influence.` Regarding phytoplankton diversity, the microplankton species detected are those that prefer areas rich in inorganic nutrients, such as Chaetoceros affinis, Dactyliosolen fragilissimus, Leptocylindrus danicus, Pseudo-nitzschia spp., and Thalassionema nitzschioides. These species used both new and regenerated nutrients which regenerated at each grazing level of the microbial loop and are thus made available to the primary producers. The potentially toxic Pseudo-nitzschia spp. reached an abundance of 105 cells/L. Among the potentially toxic dinoflagellates, Dinophysis acuminata, D. acuta, D. caudata, D. fortii, D. tripos, Gonyaulax spinifera, Lingulodinium polyedra, Phalacroma rotundatum were recorded (the abundance reached values up to 102 cells/L). The detected presence of several potentially toxic and toxic phytoplankton species warrants the need to raise awareness for the necessity of continuous monitoring activities and preventive measures.

Continuous genetic monitoring of transient mesenchymal gene activities in distal tubule and collecting duct epithelial cells during renal fibrosis.

Epithelial cells (ECs) have been proposed to contribute to myofibroblasts or fibroblasts through epithelial-mesenchymal transition (EMT) during renal fibrosis. However, since EMT may occur dynamically, transiently, and reversibly during kidney fibrosis, conventional lineage tracing based on Cre-loxP recombination in renal ECs could hardly capture the transient EMT activity, yielding inconsistent results. Moreover, previous EMT research has primarily focused on renal proximal tubule ECs, with few reports of distal tubules and collecting ducts. Here, we generated dual recombinases-mediated genetic lineage tracing systems for continuous monitoring of transient mesenchymal gene expression in E-cadherin+ and EpCAM+ ECs of distal tubules and collecting ducts during renal fibrosis. Activation of key EMT-inducing transcription factor (EMT-TF) Zeb1 and mesenchymal markers αSMA, vimentin, and N-cadherin, were investigated following unilateral ureteral obstruction (UUO). Our data revealed that E-cadherin+ and EpCAM+ ECs did not transdifferentiate into myofibroblasts, nor transiently expressed these mesenchymal genes during renal fibrosis. In contrast, in vitro a large amount of cultured renal ECs upregulated mesenchymal genes in response to TGF-β, a major inducer of EMT.

Quantitative data and indicators on agricultural activity

Statistical coverage and quantitative presentation of agricultural activity are of particular importance for planning agricultural, strategic, and production activities. Food production is a fundamental existential condition, that is, the essence of the existence and development of the human population, as well as animal and plant life on Earth. For all the reasons mentioned above, it is utterly important to have adequate, valid, up-to-date, and comprehensive data and indicators. Obtaining such data is a complex, difficult, time-consuming, and relatively expensive process. If the data are missing, inaccurate, out-of-date, or if they are not collected properly, then all the analyses, estimates, forecasts, and plans are bound to contain errors, resulting in wrong conclusions, decisions, and ultimately leading to wrong solutions. The problem of missing data and the presence of outliers - atypical values is particularly emphasized. In this text the most important aspects of the quantitative (statistical) coverage of agricultural activity are presented. This primarily refers to the method of obtaining the data, which can be done as a complete or a partial observation, that is, sampling. The two methods are presented through censuses, surveying and sampling, with special reference to the upcoming comprehensive census of agriculture. The process of obtaining of indicators is presented in the text, with a special focus on descriptive statistical measures. Data and indicators according to the Global Strategy for the Improvement of Agricultural and Rural Statistics, as well as data and indicators of the Food and Agriculture Organization (FAO), indicators of the Common Agricultural Policy (CAP), and indicators of the World Bank and Eurostat are presented. Based on all the means of obtaining data, while respecting the constant need to align and harmonize the system of our agricultural statistics with the requirements of the European Union, as well as considering the experiences of all the mentioned (and most important) institutions for the production of statistical data in Europe and the world, a proposal of indicators and required data for quantitative presentation of agricultural activity in the Republic of Srpska is given. In addition, the need to introduce statistical registers of agriculture, that should enable continuous quantitative monitoring of agricultural activity, was particularly emphasized.

Species and habitat specific changes in bird activity in an urban environment during Covid 19 lockdown.

Covid-19 lockdowns provided ecologists with a rare opportunity to examine how animals behave when humans are absent. Indeed many studies reported various effects of lockdowns on animal activity, especially in urban areas and other human-dominated habitats. We explored how Covid-19 lockdowns in Israel have influenced bird activity in an urban environment by using continuous acoustic recordings to monitor three common bird species that differ in their level of adaptation to the urban ecosystem: (1) the hooded crow, an urban exploiter, which depends heavily on anthropogenic resources; (2) the rose-ringed parakeet, an invasive alien species that has adapted to exploit human resources; and (3) the graceful prinia, an urban adapter, which is relatively shy of humans and can be found in urban habitats with shrubs and prairies. Acoustic recordings provided continuous monitoring of bird activity without an effect of the observer on the animal. We performed dense sampling of a 1.3 square km area in northern Tel-Aviv by placing 17 recorders for more than a month in different micro-habitats within this region including roads, residential areas and urban parks. We monitored both lockdown and no-lockdown periods. We portray a complex dynamic system where the activity of specific bird species depended on many environmental parameters and decreases or increases in a habitat-dependent manner during lockdown. Specifically, urban exploiter species decreased their activity in most urban habitats during lockdown, while human adapter species increased their activity during lockdown especially in parks where humans were absent. Our results also demonstrate the value of different habitats within urban environments for animal activity, specifically highlighting the importance of urban parks. These species- and habitat-specific changes in activity might explain the contradicting results reported by others who have not performed a habitat specific analysis.

Species and habitat specific changes in bird activity in an urban environment during Covid 19 lockdown

Covid-19 lockdowns provided ecologists with a rare opportunity to examine how animals behave when humans are absent. Indeed many studies reported various effects of lockdowns on animal activity, especially in urban areas and other human-dominated habitats. We explored how Covid-19 lockdowns in Israel have influenced bird activity in an urban environment by using continuous acoustic recordings to monitor three common bird species that differ in their level of adaptation to the urban ecosystem: (1) the hooded crow, an urban exploiter, which depends heavily on anthropogenic resources; (2) the rose-ringed parakeet, an invasive alien species that has adapted to exploit human resources; and (3) the graceful prinia, an urban adapter, which is relatively shy of humans and can be found in urban habitats with shrubs and prairies. Acoustic recordings provided continuous monitoring of bird activity without an effect of the observer on the animal. We performed dense sampling of a 1.3 square km area in northern Tel-Aviv by placing 17 recorders for more than a month in different micro-habitats within this region including roads, residential areas and urban parks. We monitored both lockdown and no-lockdown periods. We portray a complex dynamic system where the activity of specific bird species depended on many environmental parameters and decreases or increases in a habitat-dependent manner during lockdown. Specifically, urban exploiter species decreased their activity in most urban habitats during lockdown, while human adapter species increased their activity during lockdown especially in parks where humans were absent. Our results also demonstrate the value of different habitats within urban environments for animal activity, specifically highlighting the importance of urban parks. These species- and habitat-specific changes in activity might explain the contradicting results reported by others who have not performed a habitat specific analysis.

Non-invasive detection of narcolepsy type I phenotypical features and disease progression by continuous homecage monitoring of activity in two mouse models: the HCRT-KO and DTA model

Non-invasive detection of narcolepsy type I phenotypical features and disease progression by continuous homecage monitoring of activity in two mouse models: the HCRT-KO and DTA model

Standardizing Continuous Physical Activity Monitoring in Patients with Cervical Spondylosis.

Prospective cohort study. To use a commercial wearable device to measure real-life, continuous physical activity in patients with CS and to establish age- and sex-adjusted standardized scores. Patients with cervical spondylosis (CS) often present with pain or neurologic deficits that results in functional limitations and inactivity. However, little is known regarding the influence of CS on patient's real-life physical activity. This study included 100 English-speaking adult patients with cervical degenerative diseases undergoing elective spine surgery at Stanford University who owned iPhones. Patients undergoing surgery for spine infections, trauma, or tumors, or with lumbar degenerative disease were excluded. Activity two weeks before surgery was expressed as raw daily step counts. Standardized z-scores were calculated based on age- and sex-specific values of a control population. Responses to patient-reported outcome measures (PROMs) surveys assessed convergent validity. Functional impairment was categorized based on predetermined z-score cut-off values. 30 CS with mean(±SD) age of 56.0(±13.4) years wore an Apple Watch for ≥8 hours/day in 87.1% of the days. Mean watch wear time was 15.7(±4.2) hours/day, and mean daily step count was 6,400(±3,792). There was no significant difference in activity between 13 patients (43%) with myelopathy and 17 (57%) without myelopathy. Test-Retest reliability between wearable step count measurements was excellent (ICC β=0.95). Physical activity showed a moderate positive correlation with SF36-PCS, EQ5D VAS, and PROMIS-PF. Activity performance was classified into categories of "no impairment" (step count=9,640(±2,412)), "mild impairment" (6,054(±816)), "moderate impairment" (3,481(±752)), and "severe impairment" (1,619(±240)). CS patients' physical activity is significantly lower than the general population, or the frequently stated goals of 7,000-10,000 steps/day. Standardized, continuous wearable physical activity monitoring in CS is a reliable, valid, and normalized outcome tool that may help characterize functional impairment before and after spinal interventions.

THE IMPORTANCE OF PATIENT ENGAGEMENT IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASE (IBD)

Abstract BACKGROUND IBD constitutes a diverse and progressive spectrum of chronic illnesses, presenting formidable management challenges for both patients and healthcare providers. Due to the inherent unpredictability of disease progression, proactive monitoring strategies are crucial for optimal IBD management. The linchpin of proactive monitoring in IBD is patient engagement, which is necessary for continuous monitoring of disease activity. GI practices using SonarMD, a technology-driven care coordination company specializing in IBD, have consistently maintained an enrollment and engagement rate exceeding 80%. This study demonstrates the disparity in clinical outcomes between an engaged patient population utilizing SonarMD’s platform and an unengaged cohort within a single large gastrointestinal (GI) practice under a value-based agreement with a major health plan. METHODS The study cohort was composed of a population of 1173 patients attributed by the heallth plan on the basis of ICD-10 Codes who had a diagnosis of Crohn's Disease (K50) or ulcerative colitis (K51). 939 (80%) enrolled in the program and 234 (20%) remaining unenrolled. Demographic and clinical characteristics of the patient groups are detailed in Table 1. The enrolled and unenrolled groups exhibited similar metrics with regard to: age, gender, average risk score (AVG), disease type, stricturing/fistulizing disease, and history of behavioral health diagnoses. The enrolled group did demonstrate a 10% higher utilization of biologics. The SonarMD platform was only deployed into the enrolled group. Claims data (including pharma claims) from a single health plan, which insured all cohort patients, was the source for the utilization data analysis. The study period was the calendar year 2022 with a claim runoff period of 3 additional months. RESULTS The IBD specific Inpatient hospitalization rate and ED Visit rate for each group is shown in table 2. There is a 10X statistically significant difference in both hospital inpatient admission rate and ED visit rate between the engaged and unengaged populations. (p = 0.02). Two thirds of the INPT/ED admissions for the entire attributed population were driven by the unenrolled group. CONCLUSIONS This study highlights the influential role of proactive patient engagement in the management of IBD, exemplified by the utilization difference for inpatient care and ED usage and its potential to optimize clinical outcomes. Proactive patient engagement is critical in population management of symptomatic chronic disease. An unengaged population represents a significant risk for unnecessary morbidity and healthcare cost. Provider-payer-industry partnerships can help build the infrastructure necessary to accomplish high rates of engagement. You can’t manage the patient you don’t engage.

Framework Development: Standardizing Definition of Advanced Practice Radiation Therapy Activities for Clinical Workload Quantification

PurposeAdvanced practice (AP) in radiation therapy (RT) is being implemented around the globe. In an effort to advance the understanding of the similarities and differences in APRT roles in Ontario, Canada, a community of practice (CoP) sought ways to provide quantitative data on the nature of APRT clinical activities and the frequency with which these activities were being executed. MethodsIn 2017, a consensus building project involving 20 APRTs and 14 radiation therapy (RT) department managers in Ontario was completed to establish a mechanism to quantify APRTs’ clinical impact. In Round 1 & 2, expert feedback was gathered to generate an Advanced Practice (AP) Activity List. In Round 3: 20 APRTs completed an online survey to assess the importance and applicability of each AP Activity to their role using Likert scale (0–5). A final AP Activity List & Definitions was generated. Results & discussionRound 1: Forty-seven AP activities were identified. Round 2: 3/14 RT managers provided 145 feedback statements on Round 1 AP Activity List. The working group used RT managers’ feedback to clarify AP activities and definitions, specifically merging 33 unique AP activities to create 11 inclusive AP activities and eliminating 8 activities identified from Round 1. The most inclusive AP activity created was #1 New Patient Consultation, this AP Activity is merged from 7 unique AP activities. Incorporating RT managers’ feedback with the internal AP clinical workload lists from 2 Ontario cancer centres resulted in a revised AP Activity List with 20 AP inclusive activities. Round 3: 14/20 APRTs provided Likert scores on this revised list. The most applicable AP activities (mean score) were #16 Technical Consultation (4.0), #15 Contouring Target Volume (3.8) and #2 Planning Consultation (3.8); the least applicable was #18 MR Applicator Assessment (0.9). ConclusionsThis is the first systematic attempt to build consensus on AP clinical activities. Non-clinical APRT activities related to research, education, innovation, and program development were not in the scope of this project.The Final AP Activity List & Definitions serves as a framework that allows standardized and continuous monitoring of AP clinical activities and impact.