Cerebellar Coordination of Neuronal and Behavioral Rhythms

Long known for its role in motor control, it is increasingly clear that the cerebellum is also involved in numerous cognitive and affective behaviors. Though the neuronal mechanism for the role of the cerebellum in cognition is still unclear, there is a consensus that it involves cerebellar interactions with the cerebral cortex. Recent studies suggest that the cerebellum monitors, and possibly coordinates, the precise phase alignment or coherence of neuronal oscillations in cerebral cortical areas. Here, we asked how loss of cerebellar function affects respiratory rhythms and the interactions of local field potential (LFP) oscillations between the lobulus simplex (LS) in the cerebellum, medial prefrontal cortex (mPFC), and dorsal CA1 (dCA1) using multisite in vivo extracellular recordings in freely moving mice. We compared a mouse model of cerebellar ataxia and their littermate controls. The ataxic mice were designed to have a genetically induced loss of Purkinje cell neurotransmission, resulting in an expected repertoire of cerebellar motor deficits. Here we asked whether these mice also have neurophysiological defects that are indicative of cognitive circuit dysfunction. We quantified respiratory interval regularity and rhythmicity, power spectra of LFP oscillations in each structure, the magnitudes of coherence of oscillations and Granger causality between each pair of structures using a nonparametric spectral method, and the phase amplitude coupling (PAC) of LFP oscillations within and between each structure. Resting-state coherence of gamma oscillations between LS and mPFC was significantly increased in ataxic mice relative to their controls. Ataxic animals also showed significantly larger Granger causality from the mPFC to cerebellar LS in gamma frequencies compared to littermate controls. Significant PAC within LS was observed at very high gamma frequencies. Our findings reveal that Purkinje cell neurotransmission is required for normal functional interactions between the cerebellum and cerebral cortex and between cerebral cortical areas involved in cognitive functions, suggesting an involvement of the cerebellum in the modulation or coordination of functional communication between brain areas

Identifying Opioid Withdrawal Using Wearable Biosensors

Wearable biosensors can be used to monitor opioid use, a problem of dire societal consequence given the current opioid epidemic in the US. Such surveillance can prompt interventions that promote behavioral change. Prior work has focused on the use of wearable biosensor data to detect opioid use. In this work, we present a method that uses machine learning to identify opioid withdrawal using data collected with a wearable biosensor. Our method involves developing a set of machine-learning classifiers, and then evaluating those classifiers using unseen test data. An analysis of the best performing model (based on the Random Forest algorithm) produced a receiver operating characteristic (ROC) area under the curve (AUC) of 0.9997 using completely unseen test data. Further, the model is able to detect withdrawal with just one minute of biosensor data. These results show the viability of using machine learning for opioid withdrawal detection. To our knowledge, the proposed method for identifying opioid withdrawal in OUD patients is the first of its kind

Perceptions on the Opioid Epidemic: A Qualitative Study

Background: Opioid use disorder (OUD) and resultant opioid overdoses have amplified over the last 20 years, despite efforts to identify best practices for treatment. Little research has focused on the disconnect between individuals with OUD and their healthcare providers. Hypothesis: We hypothesize that discrepancies exist between individuals with OUD and their healthcare providers with respect to perceptions of and experiences with medical care, the opioid antidote naloxone, and current treatment paradigms. Highlighting these discrepancies will inform future healthcare models. Methods: Using electronic surveys and semi-structured interviews, we will collect qualitative data from both individuals with OUD and emergency providers to assess knowledge, attitudes, and perceptions towards OUD, and to identify perceived barriers and facilitators to OUD treatment. A sampling methodology geared toward hidden populations, respondent driven sampling (RDS), will be used to recruit individuals with OUD. The initial participants will be enrolled from the emergency department (seeds) and will be asked to recruit three individuals in their social network from the community (waves). Results: Recruitment to date has focused on individuals with OUD: we have enrolled six seeds. Recruitment of additional waves by the seeds has been a challenge; there has only been one response out of a total of fifteen possible referrals. Community Engagement: We seek to enhance our emergency department-based seed recruitment strategy by expanding into the Worcester community. We are specifically looking to partner with community based-harm reduction agencies and other groups that engage individuals with active or past OUD

Objective Measurement of Physician Stress in the Emergency Department Using a Wearable Sensor

Physician stress, and resultant consequences such as burnout, have become increasingly recognized pervasive problems, particularly within the specialty of Emergency Medicine. Stress is difficult to measure objectively, and research predominantly relies on self-reported measures. The present study aims to characterize digital biomarkers of stress as detected by a wearable sensor among Emergency Medicine physicians. Physiologic data was continuously collected using a wearable sensor during clinical work in the emergency department, and participants were asked to self-identify episodes of stress. Machine learning algorithms were used to classify self-reported episodes of stress. Comparing baseline sensor data to data in the 20-minute period preceding self-reported stress episodes demonstrated the highest prediction accuracy for stress. With further study, detection of stress via wearable sensors could be used to facilitate evidence-based stress research and just-in-time interventions for emergency physicians and other high-stress professionals

Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak

Objective: To describe injection-related HIV risk behaviors preimplementation and postimplementation of an emergency syringe services program (SSP) in Scott County, Indiana, after an HIV outbreak among persons who inject drugs (PWID). Design: Mixed methods retrospective pre–post intervention analysis. Methods: We analyzed routine SSP program data collected at first and most recent visit among clients with ≥2 visits, ≥7 days apart from April 4 to August 30, 2015, to quantify changes in injection-related risk behaviors. We also analyzed qualitative data collected from 56 PWID recruited in Scott County to understand factors contributing to these behaviors. Results: SSP clients included in our analysis (n = 148, 62% of all SSP clients) reported significant (P < 0.001) reductions over a median 10 weeks (range 1–23) in syringe sharing to inject (18%–2%) and divide drugs (19%–4%), sharing other injection equipment (eg, cookers) (24%–5%), and number of uses of the same syringe [2 (interquartile range: 1–4) to 1 (interquartile range: 1–1)]. Qualitative study participants described access to sterile syringes and safer injection education through the SSP, as explanatory factors for these reductions. Injection frequency findings were mixed, but overall suggested no change. The number of syringes returned by SSP clients increased from 0 at first visit to median 57. All qualitative study participants reported using sharps containers provided by the SSP. Conclusions: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks

Respiratory Rate Monitoring in Clinical Environments with a Contactless Ultra-Wideband Impulse Radar-based Sensor System

Respiratory rate is an extremely important but poorly monitored vital sign for medical conditions. Current modalities for respiratory monitoring are suboptimal. This paper presents a proof of concept of a new algorithm using a contactless ultra-wideband (UWB) impulse radar-based sensor to detect respiratory rate in both a laboratory setting and in a two-subject case study in the Emergency Department. This novel approach has shown correlation with manual respiratory rate in the laboratory setting and shows promise in Emergency Department subjects. In order to improve respiratory rate monitoring, the UWB technology is also able to localize subject movement throughout the room. This technology has potential for utilization both in and out of the hospital environments to improve monitoring and to prevent morbidity and mortality from a variety of medical conditions associated with changes in respiratory rate

Federal Funding in Emergency Medicine: Demographics and Perspectives of Awardees

INTRODUCTION: Emergency physicians face multiple challenges to obtaining federal funding. The objective of this investigation was to describe the demographics of federally-funded emergency physicians and identify key challenges in obtaining funding. METHODS: We conducted a retrospective database search of the National Institutes of Health (NIH) Research Portfolio Online Reporting Tool (NIH RePORTER) to collect data regarding the distribution and characteristics of federally-funded grants awarded to emergency medicine (EM) principal investigators between 2010-2017. An electronic survey was then administered to the identified investigators to obtain additional demographic data, and information regarding their career paths, research environment, and perceived barriers to obtaining federal funding. RESULTS: We identified 219, corresponding to 51 unique, mentored career development awardees and 105 independent investigators. Sixty-two percent of investigators responded to the electronic survey. Awardees were predominantly White males, although a larger portion of the mentored awardee group was female. Greater than half of respondents reported their mentor to be outside of the field of EM. The most common awarding institution was the National Heart Lung and Blood Institute. Respondents identified barriers in finding adequate mentorship, time to gather preliminary data, and the quality of administrative support. CONCLUSION: The last five years have showed a trend toward increasing grants awarded to EM investigators; however, we identified several barriers to funding. Initiatives geared toward support and mentorship of junior faculty, particularly to females, minorities, and those in less heavily funded areas of the country are warranted

Oxycodone Ingestion Patterns in Acute Fracture Pain: a Pilot Study Using a Digital Pill

Background: Opioids are prescribed for acute pain as needed, but no data exists on how patients take opioids after discharge from the ED. This places the onus of dosing on the patient and contributes to variable prescribing by ED physicians. ED opioid prescriptions serve as a source for unintentional exposure and contribute to the opioid epidemic. We deployed a digital pill to measure opioid ingestion patterns in individuals discharged after acute fractures. Methods: This pilot study involved individuals without chronic opioid use (i.e. prescribed opioids \u3e 1 week) who were discharged from the ED following acute fracture. Participants were trained to use a digital pill system comprising a single pill (5 mg oxycodone tablet + radiofrequency emitter) and a hip mounted receiver. Upon contact with gastric contents, the digital pill transmitted a radio signal to the receiver, which relayed time of ingestion via cellular 3G signal in real-time to a cloud based server. Participants were instructed to take 1-2 oxycodone digital pills as needed every 8 hours for pain. Participants returned unused medication at orthopedic follow up or 1 week post discharge where any discrepancies between digital pill data and pill counts were reconciled. Results: We enrolled 10 participants (mean age 42). 50% of fractures were managed operatively and 50% were managed nonoperatively. The system recorded ingestions with 85% accuracy. Participants ingested a mean 43 mg oxycodone during the 1 week study period with dose de-escalation occurring after 24 hours. Participants ingested a mean 75.8% of their 1 week total dose in the first 72 hours. 40% of participants stopped taking opioids by 96 hours. 40% of participants remained on opioids 1 week after injury; all required operative treatment. Conclusions: This is the first study to determine opioid ingestion patterns in ED patients discharged with acute fracture pain. Participants self-tapered opioids after 24 hours, most ingestion occurred in the first 72 hours, and a substantial proportion (40%) stopped ingesting oxycodone by 96 hours. Our data shows individuals may require less opioid analgesics than previously considered for acute fracture pain. Additional studies should address ingestion patterns in other painful conditions and development of ED-based interventions to minimize outpatient opioid use while controlling pain

A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose

The opioid epidemic is a growing public health emergency in the United States, with deaths from opioid overdose having increased five-fold since 1999. Emergency departments (EDs) are the primary sites of medical care after near-fatal opioid overdose but are poorly equipped to provide adequate substance use treatment planning prior to discharge. In many underserved locales, limited access to clinicians trained in addiction medicine and behavioral health exacerbates this disparity. In an effort to improve post- overdose care in the ED, we developed a telemedicine protocol to facilitate timely access to substance use disorder evaluations. In this paper, we describe the conception and refinement of the telemedicine program, our experience with the first 20 participants, and potential implications of the platform on health disparities for individuals with opioid use disorder

Low-energy Bluetooth for Detecting Real-world Penetrance of Bystander Naloxone Kits: A Pilot Study

Opioid overdose is a growing public health emergency in the United States. The antidote naloxone must be administered rapidly after opioid overdose to prevent death. Bystander or take-home naloxone programs distribute naloxone to opioid users and other community members to increase naloxone availability at the time of overdose. However, data describing the natural history of take- home naloxone in the hands of at-risk individuals is lacking. To understand patterns of naloxone uptake in at-risk users, we developed a smart naloxone kit that uses low-energy Bluetooth (BLE) to unobtrusively detect the transit of naloxone through a hospital campus. In this paper, we describe development of the smart naloxone kit and results from the first 10 participants in our pilot study