University Times

Fat-fighting button tracks food, exercise

Pitt researchers have developed a wearable, picture-taking device called the eButton that could make tracking food intake a thing of the past for dieters.

Worn on the chest like a pin, it contains a miniature camera, accelerometer, GPS and other sensors to capture data and information on health activities, eliminating the need for daily self-reporting. The eButton prototype was the result of research from a four-year National Institutes of Health (NIH) Genes, Environment and Health Initiative grant that ended this year.

Although not available commercially, the device is being used in a pilot study estimating the caloric intake and physical activity levels of the participants. Findings of the eButton monitoring system were featured in Eat Right, a publication of the American Dietetic Association.

“eButton was created to combat obesity, which has become a widespread problem in the United States,” said Mingui Sun, lead investigator and a faculty member in neurosurgery and electrical and computer engineering at the Swanson School of Engineering. “This disease affects 60 percent of people and costs our country upwards of $225 billion in direct and indirect costs.”

The eButton’s reporting extends beyond monitoring food and exercise: It can determine the amount of time wearers spend watching TV or sitting in front of a computer screen and how much time they spend outdoors. It tracks where food is bought, how meals are prepared, which restaurants are visited and what items are ordered. The device analyzes how long the wearer spends eating, which foods and beverages are consumed and how the wearer interacts with family or friends at the dining table. According to Sun, all of these factors determine participants’ caloric intake and expenditure.

“This multidimensional approach looks at the overall health of eButton wearers, which is more important than just food and exercise alone,” said Sun. “We have to take into account how people live, not only what they eat or how they exercise at the gym.”

Math, medicine probe Parkinson’s

Mathematicians at Pitt have been collaborating with the School of Medicine to find ways to stop the symptoms of Parkinson’s disease, thanks in part to a four-year, $1.86 million grant from the National Science Foundation (NSF) and a five-year $1.2 million grant from NIH. The NSF grant began in 2007 and has funded a number of research projects within the Department of Mathematics; the NIH grant is in its first year.

In conjunction with neurobiology researchers, the mathematicians are using computational models, experiments and analysis of models and data to study the way that signals are transferred between the basal ganglia, a collection of nuclei found in the brain that helps with motor control, and the thalamus, its downstream target in the brain. Although scientists can’t yet prevent the cell death associated with Parkinson’s, their study of mathematical patterns could guide the development of less-invasive treatments that block the motor symptoms of the disease.

“For Parkinson’s patients, there are more spurts and pauses in neural activity, and the firing of groups of neurons becomes more coordinated, leading to tremor and other symptoms,” said mathematics faculty member Jonathan Rubin, one of the principal investigators on the project. “The neuronal activity is like a woodpecker knocking on a tree outside your window; it distracts you when it first starts pecking, and then the silence grabs your attention when the pecking suddenly stops. Similarly, the starts and stops in the neuronal activity can become disruptive to signal processing in the brain.”

Rubin said this firing pattern might be what leads those with Parkinson’s to experience shaking, rigid muscles and difficulty in making quick movements. Currently, if side effects of drug treatments become too strong, surgeons fight these symptoms with deep brain stimulation, an aggressive but commonly used surgical treatment in which an implanted electrode literally penetrates the brain and sends out electrical impulses. “It’s not quite understood how deep brain stimulation works,” said Rubin. “But it may be similar to the white noise of a window fan: It’s right there in your window next to you, so it’s potentially more distracting than a woodpecker. But actually, the regularity of the rhythm is less disruptive for you and your brain.”

The researchers are trying to understand the neuronal activity patterns so they can improve the deep brain stimulation procedure, making it more individualized and efficient.

Other PIs on the NIH grant are Robert Turner, neurobiology, and Brent Doiron, mathematics.

Other PIs on the NSF award for the study of complex biological systems across multiple space and time scales are mathematics department chair Ivan Yotov and math faculty members G. Bard Ermentrout, who also is Distinguished University Professor of Computational Biology, and David Swigon.

The NSF grant partially funded the work of mathematics graduate student Pamela Reitsma, who carried out preliminary computational studies on the flow of signals from the basal ganglia.

EMS safety research published

Two Pitt studies on safety among emergency medical services workers appear online in the journal Prehospital Emergency Care and will be published in its January-March 2012 print edition.

Tired EMS workers jeopardize safety

A study by researchers in the School of Medicine and Graduate School of Public Health (GSPH) has found that fatigue and poor sleep quality, which affect many emergency medical services (EMS) workers, are linked to higher reported rates of injuries, medical errors and safety-compromising behaviors.

Lead author P. Daniel Patterson, a faculty member in the Department of Emergency Medicine, said, “Emergency medical technicians and paramedics work long hours in a demanding occupation with an unpredictable workload, which can easily lead to fatigue and poor sleep. Our study is one of the first to show that this may jeopardize patient and provider safety in the EMS setting.”

Patterson and his colleagues surveyed EMS workers from across the country, receiving complete data from 511 respondents. A previously tested tool called the Pittsburgh Sleep Quality Index was used to evaluate sleep quality, including such factors as sleep duration and use of sleep medication.

A questionnaire measuring fatigue and adapted for the EMS environment was used to assess physical and mental fatigue. The researchers also developed a new 44-item survey tool to elicit self-reported safety outcomes data, including provider injury, medical errors or adverse events and safety-compromising behaviors, such as excessive speeding.

In the survey sample, more than half of the respondents were classified as fatigued; 18 percent reported an injury, 41 percent reported a medical error or adverse event and 90 percent reported a safety-compromising behavior. After controlling for extraneous variables, the researchers found the odds of injury were 1.9 times greater for fatigued respondents compared to their non-fatigued peers; the odds of medical errors or adverse events were 2.2 times greater, and the odds of safety-compromising behavior were 3.6 times greater.

Most survey respondents reported working between six and 15 shifts per month, and half reported regular shift lengths of 24 hours. One-third of the respondents were working regularly at more than one EMS agency.

In the sample, the number of shifts worked monthly was linked to reported errors and adverse events but not to injury or perceptions of compromised safety. Longer shifts were not associated with higher odds of negative safety outcomes, perhaps because the study did not measure the varying workloads and ability to rest during each shift, the researchers speculated.

“While further research is needed to examine the association between self-reported and actual safety outcomes, our findings provide preliminary evidence that sleep quality and fatigue are important indicators of EMS safety,” said Patterson.

Other Pitt authors were Clifton W. Callaway, Rachel C. Frank, Francis X. Guyette, David Hostler, Christian Martin-Gill, Charles W. Warner and Matthew D. Weaver of the Department of Emergency Medicine, and Thomas J. Songer and Sheryl F. Kelsey of GSPH’s  Department of Epidemiology.

The research was supported by grants from the Pittsburgh Emergency Medicine Foundation and North Central EMS Institute.

EMS safety perception reflects reality

Poor perceptions about workplace safety culture among emergency medical services (EMS) workers is associated with negative patient and provider safety outcomes, a study led by P. Daniel Patterson has found.

“There are sometimes drastic differences in how workers perceive their workplace safety from one EMS agency to the next,” Patterson said. “What we have found is that perceptions about safety may be reality.”

Prior studies of the in-hospital setting and of high-risk occupations outside of health care have linked safety culture scores to such outcomes as injuries and accidents, but this is the first time that such a connection has been found in the EMS setting, Patterson noted.

The investigators measured EMS safety culture by surveying emergency medical technicians and paramedics at 21 EMS agencies across the United States on safety climate, teamwork climate, perceptions of management, working conditions, stress recognition and job satisfaction. Safety outcomes were measured through a survey designed by EMS physician medical directors and investigators to identify provider injuries, patient care errors and safety-compromising behavior.

The analysis of 412 surveys showed that individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes.

Notably, the researchers found that 16 percent of all respondents reported experiencing an injury in the past three months; four of every 10 reported an error or adverse event, and 89 percent reported safety-compromising behavior. Respondents reporting injury scored lower on five of the six areas of safety culture, while those reporting an error or adverse event scored lower for four of six, and those reporting safety-compromising behavior had lower scores for five of the six domains.

Matthew D. Weaver of emergency medicine was among the study co-authors.

The study was supported by the National Center for Research Resources, the North Central EMS Institute and Pittsburgh Emergency Medicine Foundation.

Comments sought for body cooling trial

Public comments are being sought for a study in which trauma experts from the School of Medicine and UPMC seek to determine whether therapeutic hypothermia will improve survival rates for patients who have suffered cardiac arrest due to massive bleeding.

Trauma, such as car accidents and gunshot wounds, causes more than 150,000 deaths annually in the United States.

Standard care includes the rapid administration of intravenous fluids and blood products. If the patient suffers a cardiac arrest, surgeons may open the left side of the chest to perform open cardiopulmonary resuscitation and quickly attempt to repair the injuries. Despite these efforts, fewer than 10 percent of patients who suffer a cardiac arrest from trauma survive.

The research protocol, set to begin early in 2012, will be performed at UPMC Presbyterian and at the University of Maryland.

Because individuals likely will not be able to learn about and consent to participation when they sustain these severe injuries, the Emergency Preservation and Resuscitation for Cardiac Arrest From Trauma (EPR-CAT) study will be conducted under a federally authorized exception-from-informed consent process that includes opportunities for public comment and a means to opt out of inclusion.

Sponsored by the U.S. Department of Defense in conjunction with the University and UPMC, EPR-CAT builds on findings that therapeutic hypothermia, or body cooling, improves survival in non-trauma cardiac arrest patients, explained principal investigator Samuel Tisherman, a faculty member in critical care medicine and surgery, and associate director of the Safar Center for Resuscitation Research at Pitt.

“In that group of patients, blood loss was not the reason why the heart stopped beating,” he explained. “But when blood loss is the cause of cardiac arrest, restarting the heart does little good if the bleeding is not under control. The brain can be permanently damaged if it doesn’t get sufficient oxygen for more than a few minutes even if the rest of the resuscitation is successful.”

Rapid cooling might sustain the patient long enough to buy time to find and treat the source of blood loss, Tisherman said. In EPR, body temperature is lowered to about 50 degrees by administering a large volume of cold fluid through a large tube placed into the aorta, which is the largest artery in the body. A heart-lung bypass machine would be used to restore blood circulation and oxygenation as part of the resuscitation process.

The first two public meetings, in which researchers will describe the study and answer questions, are set for noon on Dec. 7 and 8 in 527 William Pitt Union.

Other times and locations of forums in which community members can learn more about the study and ask questions about it will be posted at acutecareresearch.org. Those who do not wish to participate in these research studies can obtain a bracelet to opt out via that web site or by contacting Tina Vita at 412/647-9652.

An interview with Tisherman and simulation of the EPR-CAT protocol can be viewed at www.youtube.com/watch?v=I3jXktFMaSM&feature=youtu.be.

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The University Times Research Notes column reports on funding awarded to Pitt researchers as well as findings arising from University research.

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