scholarly journals Closed-loop wearable naloxone injector system

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Justin Chan ◽  
Vikram Iyer ◽  
Anran Wang ◽  
Alexander Lyness ◽  
Preetma Kooner ◽  
...  
Keyword(s):  
Closed Loop ◽  
Hospital Environment ◽  
Opioid Overdose ◽  
Post Injection ◽  
Blood Draw ◽  
Competitive Antagonist ◽  
Concept System ◽  
Reduction Strategies ◽  
Injector System ◽  
Healthy Participants

AbstractOverdoses from non-medical use of opioids can lead to hypoxemic/hypercarbic respiratory failure, cardiac arrest, and death when left untreated. Opioid toxicity is readily reversed with naloxone, a competitive antagonist that can restore respiration. However, there remains a critical need for technologies to administer naloxone in the event of unwitnessed overdose events. We report a closed-loop wearable injector system that measures respiration and apneic motion associated with an opioid overdose event using a pair of on-body accelerometers, and administers naloxone subcutaneously upon detection of an apnea. Our proof-of-concept system has been evaluated in two environments: (i) an approved supervised injection facility (SIF) where people self-inject opioids under medical supervision and (ii) a hospital environment where we simulate opioid-induced apneas in healthy participants. In the SIF (n = 25), our system identified breathing rate and post-injection respiratory depression accurately when compared to a respiratory belt. In the hospital, our algorithm identified simulated apneic events and successfully injected participants with 1.2 mg of naloxone. Naloxone delivery was verified by intravenous blood draw post-injection for all participants. A closed-loop naloxone injector system has the potential to complement existing evidence-based harm reduction strategies and, in the absence of bystanders, help make opioid toxicity events functionally witnessed and in turn more likely to be successfully resuscitated.

scholarly journals The Reproducibility of an Abbreviated Fat Tolerance Test in Young Healthy Participants: A Pilot Study (P12-029-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Madison Dixon ◽  
Christina Sciarrillo ◽  
Nicholas Koemel ◽  
Sam Emerson
Keyword(s):  
Tolerance Test ◽  
Mean Difference ◽  
Oral Glucose ◽  
High Fat ◽  
Cvd Risk ◽  
Blood Draw ◽  
Fat Tolerance Test ◽  
The Mean ◽  
Internal Sources ◽  
Healthy Participants

Abstract Objectives Triglyceride (TG) responses following a high-fat meal are more strongly associated with cardiovascular disease (CVD) risk compared with fasting TG levels. The current protocol for assessing post-meal TG is a burdensome process, involving serial blood draws for up to 8 hours. We have developed an abbreviated fat tolerance test (AFTT) that yields highly similar TG results relative to the standard protocol. The objective of this study is to determine whether the AFTT is reproducible and how it compares to the reproducibility of the oral glucose tolerance test (OGTT), a metabolic challenge already in clinical use. Methods In a randomized crossover design, 6 healthy participants (2 M/4F, age: 25.8 ± 9.4 years, BMI: 22.6 ± 2.6 kg/m², fasting TG: 69.8 ± 9.8 mg/dL, fasting glucose: 93.5 ± 5.1 mg/dL, A1C: 5.3% ± 0.34%) completed 2 AFTT's separated by 1 week followed by 2 OGTT's separated by 1 week, or vice versa. There was a 2-week washout period between the AFTT's and OGTT's. For each AFTT and OGTT, a baseline blood draw was taken followed by either consumption of a high-fat shake (73% fat, 26% CHO; 9 kcal/kg) (AFTT) or a standard 75 g glucose drink (OGTT). Following consumption of the AFTT, participants left the lab and returned 4 hours later for a post-meal blood draw. Following consumption of the OGTT, participants remained in the lab for 2 hours and a post-meal blood draw was taken. Results The mean difference in 4-hour postprandial TG change from baseline between the 2 AFTTs was 5.2 mg/dL, while the mean difference in 2-hour glucose change between the 2 OGTTs was 17.5 mg/dL. The 4-hour TG change results from the 2 AFTT's were highly correlated (r = 0.96, P = 0.003), while the 2-hour change results from the 2 OGTTs were not (r = 0.17, P = 0.75). The within-subjects coefficient of variation (WCV) for 4-hour TG concentrations between the 2 AFTT's was 16%, suggesting moderate reproducibility, while the WCV for 2-hour glucose concentrations between the 2 OGTT's was 24%, indicating low reproducibility. Conclusions These preliminary data suggest that the AFTT response is reproducible, potentially more than the OGTT. While further assessment in a larger sample is necessary, the AFTT could advance postprandial TG testing toward greater clinical feasibility. Funding Sources Funding provided by internal sources at Oklahoma State University.

The Hospital (Not So) Quiet Zone: Creating an Environment for Patient Satisfaction Through Noise Reduction Strategies

2019 ◽  
Vol 12 (4) ◽  
pp. 197-202 ◽  
Author(s):  
Linda Walker ◽  
Cherry A. Karl
Keyword(s):  
Patient Satisfaction ◽  
Noise Reduction ◽  
Visual Cues ◽  
Online Survey ◽  
Well Being ◽  
Hospital Environment ◽  
Noise Levels ◽  
Telephone Interviews ◽  
Patient Surveys ◽  
Reduction Strategies

Purpose:To determine whether using existing noise reduction strategies improves patients’ overall satisfaction level during hospitalization on an adult outpatient cardiology unit and to assess whether noise reduction strategies were effective to decrease the ambient noise for both staff and patient environments.Background:Excessive noise is a worldwide problem facing hospitals today. Noise has been proven to be detrimental to staff and patient well-being and hospital environment satisfaction levels.Intervention:Staff noise perception online surveys, a poster presentation, and education of noise reduction strategies were completed. Two 6-week phases of pre- and postimplementation noise reduction strategies were initiated including closing of the doors, verbal and visual alarm reminders for staff, posting quiet signs, and limiting equipment through the unit. Patient telephone interviews regarding the noise environment during hospitalization in both phases and a follow-up staff noise perception online survey were completed.Results:Staff surveys identified noise as an issue on the unit with staff communication (90%) being the main source. This correlated with patient surveys of five rooms closest to the desk considering the unit “noisy.” Post-implementation patient surveys noted that strategies created in helping the unit become “quiet/mostly quiet.” Closing patient doors was most effective in noise reduction, increasing patient unit satisfaction.Conclusion:The use of visual cues and staff education are effective in reducing noise levels. Decreased noise levels improved overall patient satisfaction with their hospital experience and created a less stressful work environment.

scholarly journals Community Pharmacist Utilization of Legislation That Allows Impact on the Opioid Crisis in the State of Minnesota: A Mixed-Methods Approach

2019 ◽  
Vol 33 (6) ◽  
pp. 799-808 ◽  
Author(s):  
Laura Palombi ◽  
Amanda N. Hawthorne ◽  
Scott Lunos ◽  
Kelsey Melgaard ◽  
Ashley Dahly ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Pharmacist ◽  
The State ◽  
Opioid Overdose ◽  
Syringe Access ◽  
Mixed Methods Approach ◽  
Use Patterns ◽  
The Past ◽  
Opioid Crisis ◽  
Reduction Strategies

Background: As opioid overdose deaths climb, legislation supporting pharmacists in developing their role to address the crisis has expanded. Although Minnesota pharmacists are encouraged to utilize opiate antagonist, syringe access and authorized collector legislation, the use patterns of these tools are unknown. Methods: A mixed-methods approach was used to survey 8405 Minnesota-licensed pharmacists on their practices related to the opioid crisis. An analysis of community pharmacist utilization of opioid-related legislation was conducted. Results: The majority (88.64%) of respondents indicated that they had not dispensed naloxone in the past month using a protocol; 59.69% reported that they had not dispensed naloxone by any method in the past month. Over sixty percent (60.61%) of respondents agreed they are comfortable with dispensing syringes and would dispense noninsulin syringes in their pharmacy under the statewide Syringe Access Initiative; 25.86% reported that they are not comfortable dispensing syringes. The majority (78.64%) of respondents reported that they do not participate in collecting unwanted pharmaceuticals. Conclusion: While pharmacists have the potential to play a key role in efforts focused on addressing the opioid crisis through harm reduction strategies, this role and the use of supporting legislation is currently underutilized in the state of Minnesota.

scholarly journals Free-living use of artificial pancreas for children with type 1 diabetes: systematic review

2018 ◽  
Vol 21 (3) ◽  
pp. 206-216
Author(s):  
Klemen Dovc ◽  
Gül Yeşiltepe Mutlu ◽  
Yury I. Philippov ◽  
Dmitry N. Laptev ◽  
Evgenia M. Patrakeeva ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 1 Diabetes ◽  
Control System ◽  
Glucose Control ◽  
Closed Loop ◽  
Artificial Pancreas ◽  
Hospital Environment ◽  
Time In Range ◽  
Randomized Control

BACKGRAUND: A closed-loop glucose control system or artificial pancreas consists of three components a Continuous Glucose Monitor (CGM), infusion pumps to deliver hormone(s) and a sophisticated dosing algorithm to control hormone delivery. In the past years, numerous studies with closed-loop system devices were conducted with gradual shift to out-of-hospital environment and with lengthening study duration. AIMS: To compare efficacy and safety of closed-loop insulin pump use in children with type 1 diabetes mellitus in compare with conventional insulin treatment (continuous subcutaneous insulin infusion (CSII) with our without CGM) based on randomized control trials data (RCT). METHODS: In the systematic review we have include 28 randomized controlled trials results indexed in PubMed, Medline databases published till 15 June 2017. The efficacy on metabolic control in this study evaluated by the proportion of time within target range (preferably 70 to 180 mg/dl if reported) and mean (median) glucose based on sensor measurements, and the safety evaluated by time in hypoglycemia (below 70 mg/dl if reported). RESULTS: Increased time in range in the night period was observed in all RCT. Only 3 RCT showed decrease of the time in range within 24 h evaluation period. In one RCT the significant positive differences have been shown in the time in range for dual hormone closed-loop glucose control system in compare with insulin-only artificial pancreas. Mean glycaemia and glucose variability changes were not in the same manner in different RCT, both in the night only and in 24 h estimation period. Night hypoglycemia duration decreased in most RCT with closed-loop control in compare with CSII, and increased only in 2 RCT. When all-day estimation period the time in hypoglycemia changed not in the same manner in different RCT. Valuable methodology differences of the glycaemic control estimation within observed RCT brought significant complications in the data analysis and made impossible the results quantitative estimation to prepare a metaanalysis. CONCLUSIONS: Much work has been done to develop effective and safe artificial pancreas, but not all RCTs confirmed advantages of closed-loop glucose control in compare with CSII in children and adolescents in real life. More research with prospective randomized control design required to prove benefits of closed-loop glucose control. Further RCTs should have an uniform methodology for glycemic control assessment and long duration that will allow to use cumulative measures in a closed-loop efficacy estimation (HbA1c).

scholarly journals Cueing memory during sleep is optimal during slow-oscillatory up-states

2017 ◽  
Author(s):  
Maurice Göldi ◽  
Eva van Poppel ◽  
Björn Rasch ◽  
Thomas Schreiner
Keyword(s):  
Neural Plasticity ◽  
Closed Loop ◽  
Recall Performance ◽  
Time Windows ◽  
Sleep Spindle ◽  
Neural Basis ◽  
Slow Oscillations ◽  
Memory Reactivation ◽  
Up States ◽  
Healthy Participants

AbstractSlow oscillations play a major role in neural plasticity. It is assumed that slow oscillatory up-states represent crucial time windows for memory reactivation and consolidation during sleep. Here we experimentally tested this assumption by utilizing closed-loop targeted memory reactivation (closed-loop TMR): Healthy participants were re-exposed to prior learned foreign vocabulary during up- and down-states of slow oscillations, respectively, in a within-subject design. We show that presenting memory cues during slow oscillatory up-states robustly improves recall performance, whereas memory cueing during down-states did not result in a clear behavioral benefit. On a neural basis successful memory reactivation during up-states was associated with a characteristic power increase in the theta and sleep spindle band. Such increases were completely absent for down-state memory cues. Our findings provide experimental support for the assumption that slow oscillatory up-states represent privileged time windows for memory reactivation, while the interplay of slow oscillations, theta and sleep spindle activity promote successful memory consolidation during sleep.

scholarly journals Simple minimally-invasive automatic antidote delivery device (A2D2) towards closed-loop reversal of opioid overdose

2019 ◽  
Vol 306 ◽  
pp. 130-137 ◽  
Author(s):  
Bahar Dhowan ◽  
Jongcheon Lim ◽  
Michael D. MacLean ◽  
Alycia G. Berman ◽  
Min Ku Kim ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Closed Loop ◽  
Opioid Overdose ◽  
Delivery Device

scholarly journals Using smart speakers to contactlessly monitor heart rhythms

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Anran Wang ◽  
Dan Nguyen ◽  
Arun R. Sridhar ◽  
Shyamnath Gollakota
Keyword(s):  
Heart Rate ◽  
Correlation Coefficient ◽  
Heart Rhythm ◽  
Cardiac Patients ◽  
Concept System ◽  
Sonar System ◽  
Median Error ◽  
Measure Heart Rate ◽  
Contact Free ◽  
Healthy Participants

AbstractHeart rhythm assessment is indispensable in diagnosis and management of many cardiac conditions and to study heart rate variability in healthy individuals. We present a proof-of-concept system for acquiring individual heart beats using smart speakers in a fully contact-free manner. Our algorithms transform the smart speaker into a short-range active sonar system and measure heart rate and inter-beat intervals (R-R intervals) for both regular and irregular rhythms. The smart speaker emits inaudible 18–22 kHz sound and receives echoes reflected from the human body that encode sub-mm displacements due to heart beats. We conducted a clinical study with both healthy participants and hospitalized cardiac patients with diverse structural and arrhythmic cardiac abnormalities including atrial fibrillation, flutter and congestive heart failure. Compared to electrocardiogram (ECG) data, our system computed R-R intervals for healthy participants with a median error of 28 ms over 12,280 heart beats and a correlation coefficient of 0.929. For hospitalized cardiac patients, the median error was 30 ms over 5639 heart beats with a correlation coefficient of 0.901. The increasing adoption of smart speakers in hospitals and homes may provide a means to realize the potential of our non-contact cardiac rhythm monitoring system for monitoring of contagious or quarantined patients, skin sensitive patients and in telemedicine settings.

scholarly journals Health Monitoring System for Elderly Patients Using Intelligent Task Mapping Mechanism in Closed Loop Healthcare Environment

Symmetry ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 357
Author(s):  
Imran ◽  
Naeem Iqbal ◽  
Shabir Ahmad ◽  
Do Hyeun Kim
Keyword(s):  
Elderly Patients ◽  
Monitoring System ◽  
Health Monitoring ◽  
Closed Loop ◽  
Hospital Environment ◽  
The Internet ◽  
Task Mapping ◽  
Health Monitoring System ◽  
Biomedical Sensors ◽  
Healthcare Environment

The ageing population’s problems directly impact countries’ socio-economic structure, as more resources are required to monitor the aged population’s health. The growth in human life expectancy is increasing due to medical technologies and nutritional science innovations. The Internet of Things (IoT) is the connectivity of physical objects called things to the Internet. IoT has a wide range of health monitoring applications based on biomedical sensing devices to monitor health conditions. This paper proposes elderly patients’ health monitoring architecture based on an intelligent task mapping approach for a closed-loop IoT healthcare environment. As a case study, a health monitoring system was developed based on the proposed architecture for elderly patients’ health monitoring in the home, ambulance, and hospital environment. The system detects and notifies deteriorating conditions to the authorities based on biomedical sensors for faster interventions. Wearable biomedical sensors are used for monitoring body temperature, heart rate, blood glucose level, and patient body position. Threshold and machine learning-based approaches were used to detect anomalies in the health sensing data. The proposed architecture’s performance analysis is evaluated in terms of round trip time, reliability, task drop rate, and latency performance metrics. Performance results show that the proposed architecture of the elderly patient health monitoring can provide reliable solutions for critical tasks in IoT environments.

scholarly journals A Case Report of a Novel Harm Reduction Intervention Used to Detect Opioid Overdose in the Emergency Department

2020 ◽  
Vol 4 (4) ◽  
pp. 548-550
Author(s):  
Kraftin Schreyer ◽  
Saloni Malik ◽  
Andrea Blome ◽  
Joseph D’Orazio
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Harm Reduction ◽  
The United States ◽  
Opioid Overdose ◽  
Waiting Room ◽  
Harm Reduction Intervention ◽  
High Incidence ◽  
Reduction Strategies ◽  
Risk Areas

Introduction: As over 130 people die daily from opioid overdose in the United States, harm reduction strategies have become increasingly important. Because public restrooms are a common site for opioid overdose, emergency department waiting room restrooms (EDWRR) should be considered especially high-risk areas.  Case Report: We present the case of a patient found after a presumed opioid overdose in our EDWRR. Staff were alerted to his condition by a reverse motion detector (RMD), and rapidly treated him with naloxone.  Conclusion: The RMD is a novel intervention that can save lives and should be considered in EDs with a high incidence of opioid overdose.

scholarly journals Measuring adulterants in street drugs: Implementation of drug residue testing using portable mass spectrometry in a Northeastern U.S. harm reduction program, 2019-2020

2021 ◽  
Author(s):  
Mathieu Boulad ◽  
Atsushi Matsumoto ◽  
Claudia Santelices ◽  
Thomas J. Stopka
Keyword(s):  
Harm Reduction ◽  
Mass Spectrometer ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Portable Devices ◽  
Portable Mass Spectrometer ◽  
Harm Reduction Intervention ◽  
Reduction Strategies ◽  
Drug Checking ◽  
Fentanyl Analogues

Abstract Background: Fatal opioid overdose deaths involving illicitly manufactured fentanyl continue to escalate in the U.S. Drug checking services, as a harm reduction intervention for people who use drugs, has gained support as an effective strategy to reduce fatal overdoses. We examined implementation of drug checking services using portable devices in a syringe services program in the Northeastern U.S. Methods: Trained staff collected trace drug specimens from used paraphernalia provided by participants who requested drug checking services. All the specimens were tested using a portable mass spectrometer and sub-samples were tested for the detection of fentanyl using fentanyl testing strips. We assessed characteristics of participants who used drug checking services, self-reported types of trace specimens of substances that participants reported providing for testing, the actual mass spectrometer test results of these specimens, and agreement of the mass spectrometer and fentanyl testing strips results in detection of fentanyl and fentanyl analogues. Results: Of 155 unique participants who provided demographic information, 59% identified as male and 74.1% as White, with a mean age of 37.7 years. Based on analysis of 396 specimens tested with the portable mass spectrometer, the most common single substance detected was fentanyl (37.7%), without a trace of heroin or other adulterants, followed by methamphetamine (18.2%), and cocaine (13.6%). Fentanyl and fentanyl analogues were detected in specimens provided by participants that were reported as heroin (60.8%), cocaine (11.1%), and methamphetamine (6.7%). We found modest agreement of testing results between the mass spectrometer and fentanyl testing strips. Conclusions: Use of drug checking services within syringe services programs is in its initial test stages. Knowledge about the contents of substances purchased, and conversations between syringe services program participants and staff, have the potential to facilitate informed decisions to decrease overdose risks through engagement in harm reduction strategies. Through analysis of newly implemented drug checking services, we noted participant characteristics and dissonance between participants’ reports of the trace drug specimens submitted for testing and the actual drugs and adulterants detected by mass spectrometer results, which has implications for overdose risk, highlighting opportunities for harm reduction responses.

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