Insulin Secretion Predicts the Response to Antidiabetic Therapy in Patients With New-onset Diabetes

CONTEXT

The results of the present study demonstrate that beta cell function in newly diagnosed T2DM patients is the key predictor of response to glucose lowering medications and provides a practical tool (C-Pep120 /C-Pep0) to guide the choice of glucose lowering agent.

OBJECTIVE

This work aims to identify predictors for individualization of antidiabetic therapy in patients with new-onset type 2 diabetes mellitus (T2DM).

METHODS

A total of 261 drug-naive participants in the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT) study, with new-onset diabetes, were randomly assigned in a single-center study to receive 1) metformin followed by glipizide and then insulin glargine on failure to achieve glycated hemoglobin A1c (HbA1c) less than 6.5%, or 2) initial triple therapy with metformin/pioglitazone/exenatide. Each patient received a 75-g oral glucose tolerance test (OGTT) prior to start of therapy. Factors that predicted response to therapy were identified using the area under the receiver operating characteristic curve method.

RESULTS

Thirty-nine patients started and maintained the treatment goal (HbA1c < 6.5%) on metformin only, and did not require intensification of antihyperglycemic therapy; 54 patients required addition of glipizide to metformin; and 47 patients required insulin addition to metformin plus glipizide for glucose control. The plasma C-peptide concentration (C-Pep)120/C-Pep0 ratio during the OGTT was the strongest predictor of response to therapy. Patients with a ratio less than 1.78 were more likely to require insulin for glucose control, whereas patients with a ratio greater than 2.65 were more likely to achieve glucose control with metformin monotherapy. In patients started on initial triple therapy, the HbA1c decreased independently of the C-Pep120/C-Pep0 ratio.

CONCLUSION

The increase in C-Pep above fasting following glucose load predicts the response to antihyperglycemic therapy in patients with new-onset diabetes. C-Pep120/C-Pep0 provides a useful tool for the individualization of antihyperglycemic therapy in patients with new-onset T2DM.

The impact of psychiatric diagnoses on two-year outcomes in patients with ventricular assist devices

Background

A multi-specialty approach is required during patient selection for left ventricular assist device (LVAD) implantation. In addition to a comprehensive medical evaluation, patients undergo an extensive psychiatric work up to ensure their candidacy when pursuing durable support devices. We aim to analyze the impact of psychiatric illnesses on 2-year outcomes after VAD implantation.

Methods

This study was a single center, retrospective analysis of 263 patients who underwent durable LVAD implantation between 2015 and 2017. All patients were evaluated by a single specialist during their work up for LVAD implantation. Patients who had a pre-existing diagnosis defined by criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were assigned to the History of Psychiatric Diagnosis group. Statistical analysis was performed using Chi-Square and Student's t-tests, wherein p&lt;0.05 was considered statistically significant.

Results

Of the 263 patients, 68 patients were found to have a history of psychiatric illness compared to 195 who had no previous diagnosis. Of those with a psychiatric history, 30.8% had Depression, 1.5% had Bipolar disorder, 22.1% had Anxiety, 1.5% had PTSD, and 16.2% had more than one diagnosis. 19.5% of patients with no history went on to be transplanted compared to 22.1% of patients with a psychiatric history (p=0.65). No significant difference was found between length of stay, days to readmission, 30-day survival, and 2-year survival. Patients without a psychiatric history were found to have fewer number of readmissions over 2 years (p&lt;0.01) (See Table). No significant difference was seen in complications including driveline infections, bacteremia, cerebrovascular accidents, pump thromboses, pump hemolysis, or major bleeding events (See Table).

Conclusion

Psychosocial characteristics play a significant role in determining a patient's candidacy for LVAD implantation. Although patients with a history of psychiatric illness were found to have a greater number of readmissions, this did not correlate to poorer outcomes or increased morbidity and mortality over 2 years. This study highlights the importance of taking a multi-faceted approach when determining patient eligibility for mechanical support devices. Future studies with larger population models should be conducted.

Funding Acknowledgement

Type of funding sources: None.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

Role of inpatient coronary CT angiography on clinical decision making during COVID- 19 pandemic

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 pandemic has had a profound effect on healthcare delivery. Here we describe the effect of repurposing of a research Computed Tomography scanner on clinical care of cardiology patients in an urban academic medical centre which did not have routine access to CCTA prior to the pandemic. 

Patients requiring invasive coronary angiography require transfer to a regional cardiac centre (no ICA available on site).

Purpose

We investigated the effect of CCTA on i) diagnostic certainty ii) avoidance of clinician defined unnecessary invasive angiography in hospitalised patients.

Methods

This was a prospective, longitudinal cohort study involving hospitalized patients admitted to an urban academic medical centre (catchment population 650 000) between March 29 and September 21, 2020. Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. High-sensitivity Troponin-I was measured on admission and 3- and 6– hours after if mandated (Abbott Architect TnI assay).

A 320-detector scanner (Aquilon ONE, Canon) was used. Intravenous metoprolol was used where required to control the heart rate (target 60 b.p.m.) and sublingual glyceryl trinitrate will be given to all patients immediately before the scan acquisition.

Results

Forty-three patients underwent inpatient CCTA, mean age: 61 ± 13 years (range 30-88y), 54% female. The presenting complaint was typical chest pain in 28 (65%), atypical chest pain in 10 (23%), and a variety of symptoms in 5 (12%) including palpitations, syncope, breathlessness.

Thirty-six (84%) of patients had a detectable TnI above the 99% centile. Median(IQR) peak TnI was 127 (33-635)ng/L.

CCTA was carried out on average 1 day post request. 

CCTA resulted in an improvement in clinician diagnostic certainty (Initial review: 21% yes, 79% probable, post-CCTA review: 84% yes, 16% probable) in providing a diagnosis.

21 (49%) of invasive coronary angiograms were avoided due to CCTA, whilst an inpatient invasive coronary angiogram (ICA) was performed in 4(9%) due to CCTA demonstrating significant disease, and in 2(%) the ICA was changed from out-patient to in-patient. Three ICA tests were requested as OP due to CCTA findings. CCTA did not overestimate disease severity in this cohort. 

We saved 21 inter hospital transfers for ICA during this time period. 

Using NHS England cost tariffs, a cost saving of &gt;£36,000 was made for using CCTA instead of ICA in these 21 patients who would have required ICA.

Conclusion

Inpatient CCTA resulted in greater clinician diagnostic confidence, avoidance of unnecessary invasive angiograms and a significant cost saving. This also reduced the duration of patient stay, reducing the potential exposure of patients to COVID-19.

Scanning Thermal Microscopy and Ballistic Phonon Transport in Lateral Spin Valves

Using scanning thermal microscopy, we have mapped the spatial distribution of temperatures in an operating nanoscale device formed from a magnetic injector, an Ag connecting wire, and a magnetic detector. An analytical model explained the thermal diffusion over the measured temperature range (2-300 K) and injector-detector separation (400-3000 nm). The characteristic diffusion lengths of the Peltier and Joule heat differ remarkably below 60 K, a fact that can be explained by the onset of ballistic phonon heat transfer in the substrate.

Physical activity recommendations for cancer survivors living with bony metastases: views of oncologic healthcare providers

PURPOSE

The potential of physical activity to improve function and quality of life of an individual with advanced cancer is now established. The purpose of this survey of oncologic healthcare providers (OHPs) is to understand their attitude towards physical activity for individuals living with bony metastases and to assess requirements to confidently provide physical activity recommendations.

METHODS

A web-based survey administered through Qualtrics™ included questions on participant demographics and attitude questions ranked on a Likert scale. Eligibility was a physician or nurse practitioner currently providing care in the cancer care system of a public healthcare system in Canada. 338 participants were identified and invited to participate in this survey.

RESULTS

The response rate was 34.6%. The majority of OHPs believed physical activity is important (89%) and safe (82%) in individuals living with bony metastases. OHPs agreed that these individuals looked to them for physical activity recommendations (74%) and that these recommendations would be followed (58%). Yet, 86% of OHPs felt they required more information before they could recommend physical activity to individuals living with bony metastases, and less than half (43%) of OHPs felt confident enough to prescribe physical activity.

CONCLUSIONS

OHPs agree that physical activity for individuals living with bony metastatic cancer is beneficial and safe. However, OHPs are not confident in their ability to recommend physical activity to this population.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need to create physical activity guidelines for individuals living with bony metastases and improve access to rehabilitation services.

Characteristics of global naturopathic education, regulation, and practice frameworks: results from an international survey

BACKGROUND

This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined.

METHODS

This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 - Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate.

RESULTS

Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous.

CONCLUSION

Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.

Efficacy of novel aqueous photo-chlorine dioxide against a human norovirus surrogate, bacteriophage MS2 and Clostridium difficile endospores, in suspension, on stainless steel and under greenhouse conditions

AIMS

The efficacy of a novel photochemical method for generating chlorine dioxide (photoClO₂ ) was evaluated against human noroviruses (HuNoV) surrogate, bacteriophage MS2, and Clostridium difficile endospores.

METHODS AND RESULTS

Chlorine dioxide was generated by mixing 1% sodium chlorite with 10 parts-per-million (ppm) Eosin Y and irradiating with a photo-activator-excitable light. PhotoClO₂ efficacy was assessed against bacteriophage MS2 and C. difficile endospores in suspension, on hard surfaces and greenhouse conditions under soiled and unsoiled conditions. The estimated effective photoClO₂ produced and consumed was 20·39 ± 0·16 ppm at a rate of 8·16 ppm per min in a 1% sodium chlorite solution. In suspension, MS2 phage was reduced by 3·35 and >5·10 log₁₀ PFU per ml in 120 and 90 min, with and without soil, respectively. At the same time, when dried on stainless steel surface, MS2 phage was reduced by >4·53 log₁₀ PFU per carrier in 30 min under both conditions. On the other hand, C. difficile endospores in suspension were reduced by 2·26 and 3·65 log₁₀ CFU per ml in 120 min with and without soiling, respectively. However, on stainless steel surface, maximal reductions of the C. difficile endospores were 0·8 and 1·5 log₁₀ CFU per carrier with and without soiling, respectively, and a maximal reduction of 2·97 log₁₀ CFU per carrier under greenhouse conditions at 24 h.

CONCLUSIONS

Overall, photoClO₂ showed promise as a technology to control HuNoV contamination on environmental surfaces but requires further optimization and testing against C. difficile endospores.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results from this investigation will serve as a model for how to generate and quantify photoClO₂ and how to appropriately evaluate this new class of disinfectants against environmentally resilient pathogens: viruses and bacterial endospores.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

Estimating effectiveness of speed reduction measures for decreasing whale-strike mortality in a high-risk region

Recent estimates of blue (Balaenoptera musculus) and humpback (Megaptera novaeangliae) whale ship-strike deaths on the US west coast are above the Potential Biological Removal limit determined by the National Marine Fisheries Service. Beginning in 2015, the National Oceanographic and Atmospheric Administration requested voluntary Vessel Speed Reductions (VSR) in the designated shipping routes off San Francisco, California, USA, in order to decrease whale mortality from ship strikes. We applied a ship strike model based on whale density and Automatic Identification System (AIS) vessel data. We bootstrapped speeds from vessels that transited when no VSR was in place to assess the effect of the VSR on strike mortality rates. Finally, we calculated the expected mortality for hypothetical compliance scenarios by programmatically imposing speed caps. Average predicted mortality for the region was 2.7 blue whales and 7.0 humpback whales in a 4 month period. Compared to years prior to the VSR (2012-2014), vessel speeds during the VSR were slower. This lowered blue whale deaths within the shipping lanes by 11-13% and humpback whale deaths by 9-10% in 2016-2017. If 95% of mariners adhered to recommended 10 knot (kn) limits in the shipping lanes alone, we predicted twice as many blue whale and 3 times as many humpback whale deaths would be avoided relative to current adherence. Adding a 10 kn speed limit (with 95% cooperation) at the ends of each of the lanes would result in about 5- and 4-fold reductions in blue whale and humpback whale mortality, respectively, relative to current practices. Our approach can evaluate ship strikes and mitigation measures for whale populations around the globe.

Characteristics of the Diffuse Astrophysical Electron and Tau Neutrino Flux with Six Years of IceCube High Energy Cascade Data

We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010-2015. Assuming standard oscillations, the astrophysical neutrinos in this dedicated cascade sample are dominated (∼90%) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ=2.53±0.07 and a flux normalization for each neutrino flavor of ϕ_{astro}=1.66_{-0.27}^{+0.25} at E_{0}=100  TeV, in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ≤2.28 at ≥3σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100  TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥0.06). The sizable and smooth flux measured below ∼100  TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.

Post-release survival of fallout Newell’s shearwater fledglings from a rescue and rehabilitation program on Kaua‘i, Hawai‘i

Light attraction impacts nocturnally active fledgling seabirds worldwide and is a particularly acute problem on Kaua‘i (the northern-most island in the main Hawaiian Island archipelago) for the Critically Endangered Newell’s shearwaterPuffinus newelli. The Save Our Shearwaters (SOS) program was created in 1979 to address this issue and to date has recovered and released to sea more than 30500 fledglings. Although the value of the program for animal welfare is clear, as birds cannot simply be left to die, no evaluation exists to inform post-release survival. We used satellite transmitters to track 38 fledglings released by SOS and compared their survival rates (assessed by tag transmission duration) to those of 12 chicks that fledged naturally from the mountains of Kaua‘i. Wild fledglings transmitted longer than SOS birds, and SOS birds with longer rehabilitation periods transmitted for a shorter duration than birds released immediately or rehabilitated for only 1 d. Although transmitter durations from grounded fledglings were shorter (indicating impacts to survivorship), some SOS birds did survive and dispersed out to sea. All surviving birds (wild and SOS) traveled more than 2000 km to the southwest of Kaua‘i, where they concentrated mostly in the North Pacific Equatorial Countercurrent Province, revealing a large-scale annual post-breeding aggregation zone for fledgling Newell’s shearwaters. While there was reduced survival among birds undergoing rehabilitation, SOS remains an important contribution toward the conservation of Newell’s shearwater because a proportion of released birds do indeed survive. However, light attraction, the root cause of fallout, remains a serious unresolved issue on Kaua’i.

How to increase the value of self-reported health service data by using data linkage: a case study

Background

This is a case study for recurrent stroke prevention. Lifestyle factors account for about 80% of the risk of recurrent stroke. Most health services studies examining stroke prevention rely on stroke survivors' self-reported lifestyle behaviour data. How can researchers increase the value of collected self-reported data to provide additional information for more comprehensive assessments?

Methods

45 and Up Study is the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. This case study linked self-reported longitudinal lifestyle data in the 45 and Up Study, with corresponding mortality data (i.e. NSW Registry of Births, Deaths and Marriages & NSW Cause of Death Unit Record File) and hospital data (i.e. NSW Admitted Patient Data Collection) via the Centre for Health Record Linkage (CHeReL). The main outcome measures are health services, clinical outcomes, and mortality rates for stroke care. The analyses will include descriptive analysis, multivariate regression analysis, and survival analysis.

Results

A total of 8410 stroke survivors who participated in the 45 and Up Study were included in this data linkage study. From January 2006 to December 2015, 99249 hospital claims (mean: 13 times admission to hospital per person) and 2656 death registration records have been linked to these participants. The mean age of the stroke survivors was 72 (SD = 11) years, with 56% being males. These results are preliminary and more analyses will be conducted by using quality of life status, clinical diagnosis, comorbidities, and procedures.

Conclusions

Data linkage enables researchers to generate comprehensive findings on health services studies and gain a more holistic understanding of the determinants and outcomes of stroke prevention with lower data collection costs and less burden on participants.

Key messages

Data linkage brings about a new opportunity for self-reported data on health services utilisation. It is a cost-effective way to enhance existing self-reported data via the data linkage approach to increase its usefulness for informing health service planning.

Person-centred care in complementary medicine for individuals with chronic conditions in Australia

Background

Increasing chronic condition diagnoses burden public health systems, individuals and communities. The duration and complexity of chronic conditions require ongoing, multifaceted care - such as person-centred care (PCC) - to address the individual needs and quality of life for patients. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines the extent of PCC being experienced by patients with chronic conditions who consult CM practitioners.

Methods

Cross-sectional survey (n = 191), conducted nationally, November 2018 to March 2019, in clinics of the five CM professions most commonly consulted by individuals with chronic conditions in Australia (massage, chiropractic, osteopathy, acupuncture, naturopathy). Participants with chronic conditions (n = 153) were surveyed about experiences of PCC during CM consultation, and regarding consultation with medical doctors, using four validated measures.

Results

During consultation with CM practitioners, patient perceptions of PCC were consistently high. Ratings of PCC were consistently higher for consultations with any CM practitioners (summary mean 3.33) than consultations with medical doctors (summary mean 2.95). The highest mean scores for PCC were reported by patients of naturopaths (summary mean 4.04). Variations in perceived PCC for different items between professions indicate nuance in the experience of consultation across different CM professions.

Conclusions

This study indicates PCC is characteristic of CM consultation, which may reflect CM philosophies such as holism. CM practitioners may present an existing resource of PCC. Further attention should be given to CM professions regarding the potential to address unmet needs of individuals with chronic conditions, and subsequently to better manage the public health burden associated with chronic conditions.

Key messages

Person-centred care appears to be a consistent characteristic of complementary medicine clinical care for individuals with chronic conditions. Due to rising rates of chronic conditions and the associated burden on public health systems, complementary medicine professions should be considered as a resource to optimise chronic illness care.

The role of complementary medicine health literacy in health communication and decision-making

Background

Globally, complementary medicine (CM) product use is high-including vitamins, minerals and herbal medicines. The overuse of CM raises concerns about medicine sustainability that are critical considerations for human and planetary health. Poor CM health literacy may lead to the unnecessary use of CM. This is the first study to explore associations between CM use, CM health literacy, and concurrent use of CM with conventional health care in an Australian population with a view to identifying priority areas for intervention.

Methods

Cross-sectional online study of Australian adults (N = 2019). A 50-item survey measured demographic and health characteristics, health care and treatment use, medicine use disclosure to health care providers, and CM health literacy. Descriptive statistics, Spearman's correlations and Chi-square analysis were used to analyse preliminary findings.

Results

In the previous year 49.1% of participants used a CM product. A greater proportion of those who used CM products (88.7%, &lt;0.001), compared to those who did not, used a prescription or over-the-counter pharmaceutical. Lower levels of CM health literacy were associated with herbal supplement use (not vitamin/mineral supplement use) and with disclosing CM use to a medical doctor or pharmacist (p &lt; 0.01). Those who consulted with a GP, specialist or pharmacist, who self-prescribed CM, or used both CM and pharmaceutical medicines had better CM health literacy (p &lt; 0.001) than those who did not. Conversely, those who consulted a CM practitioner had lower CM health literacy than those who did not (p &lt; 0.001).

Conclusions

The findings suggest that people with lower CM health literacy may be unsure about using CM products, while those with better CM health literacy may have more self-efficacy for making treatment decisions. Interventions are needed to improve public CM health literacy and encourage shared decision-making to ensure safe, effective and sustainable treatment decisions.

Key messages

People with higher levels of CM health literacy appear to have greater self-efficacy for making treatment decisions, while those with lower CM health literacy are more likely to seek treatment advice. Interventions are needed to ensure people using CM products are communicating with health practitioners about their treatment choices to facilitate safe, effective and sustainable treatment decisions.

The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts

INTRODUCTION

Invasive coronary angiography (ICA) is associated with higher complication rates in patients following coronary artery bypass surgery (CABG). CT coronary angiography (CTCA) has emerged as an attractive alternative. We assessed the impact of CTCA on subsequent ICA.

METHODS

We identified 213 CABG patients undergoing CTCA between 2015 and 2018. In 151 the indication was suspected recurrence of angina. We then identified patients undergoing ICA within 1 year of CTCA.

RESULTS

CTCA obviated the need for ICA in 115 cases (76%). CTCA was better at identifying targets for percutaneous coronary intervention (PCI) to saphenous vein grafts (SVG's) than to native vessels (89% vs 47%). 7 out of 10 lesions of "probable" significance by CTCA proved flow-limiting, and 4 out of 13 "indeterminate" lesions. CTCA concordance was 97% for left internal mammary (LIMA) grafts.

CONCLUSION

CTCA directed management in a majority of patients without ICA. It identified a cohort of patients likely to be candidates for SVG PCI, but was less effective in identifying PCI targets in the native vessels. CTCA renders invasive LIMA cannulation redundant unless a target lesion is suspected.

1098 Altered Actigraphic Behavioral Activity Rhythm In Depression

Introduction

Disturbances in sleep and behavioral activity rhythms (BAR) are frequently observed in individuals with depression. However, it remains unclear how activity variability across the 24-hour period is specifically associated with this disorder. The present study aimed to examine actigraphy-measured sleep and BAR in depression.

Methods

As part of a larger study, fourteen patients with DSM-5 major depressive episode (27.8±7.7 years, 69.2% female) and 13 healthy controls (21.8±1.2 years, 76.5% female) were evaluated with 7-14 days of wrist-actigraphy. Actigraphy-derived sleep parameters included total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). Minute-by-minute activity counts were aggregated into hour-by-hour bins; hourly mean activity levels were then generated to depict 24-hour activity patterns (i.e., BAR). Factorial (GroupxTime) mixed models were conducted to examine whether BAR differed between patients with MDD and controls. Generalized Additive Models (GAM), by fitting smoothed nonlinear curves to log-transformed aggregated activity, were performed as exploratory analyses to characterize onset (UP slope) and offset (DOWN slope) of BAR.

Results

Compared to healthy controls, patients with MDD exhibited greater actigraphic TST (p=.026); no other between-group differences were detected for the remaining sleep parameters. Significant between-group differences were observed for mean activity during wakefulness (p&lt;.001). Mixed models assessing hour-by-hour daily activity revealed a significant GroupxTime interaction (p=.001) with significant main effects of group (p=.017) and time (p&lt;.001); patients with MDD had lower activity from 6 to 9 pm (ps&lt;.005). Exploratory GAMs results showed an attenuated DOWN slope in patients with MDD (p=.014), indicating a slower decrease in activity during the evening.

Conclusion

Altered BAR, characterized by an overall dampened activity pattern that was most prominent during the evening, was associated with depression. Furthermore, patients with MDD took longer to wind down in the evening. Future studies are needed to explore the potential benefits of adjunctive interventions addressing both BAR along with sleep in mitigating symptoms of depression.

Support

Research supported by National Institutes of Health R01 MH102392.