Edward Boyer

Digital Pills are a developing technology with application in a variety of medical conditions. This paper reports on interviews from a crossover clinical trial in which participants used both a novel digital pill system (ID-Capsule) and an electronic pill dispenser (Wisepill). Interviews explored user experiences, acceptability, and willingness to use both products. Data for each period of use is reported, and experiences about the two products are compared. The electronic pill dispenser was considered easy to use and convenient. The size of the pill dispenser was cited as both a facilitator and barrier to ongoing pill use. The ID-Capsule digital pill system was considered a facilitator of adherence for many users, and most found that knowing that their adherence was being monitored encouraged adherence. Using the accompanying ID-Capsule app to track days on which pills were missed was helpful. Barriers included needing to use and charge the digital pill reader. These qualitative findings provide relevant technology evaluation data for use in future iterations of this digital pill and adherence system.

New sensors, technologies, data sources, and analytics have transformed the delivery of medical care in ambulances, emergency departments, observation units and, increasingly, in the burgeoning field of 'home hospital' treatment. Clinical decisions are increasingly based upon algorithms which may be derived from biased datasets. This minitrack focuses on research and practice at the intersection of technology and acute medical care, machine learning in emergency medical environments, and the healthcare impact of bias in algorithmic medicine.

Unmanned aerial vehicles (UAVs; 'drones') deliver time-sensitive health care tools to out-ofhospital environments. Many emergency response systems struggle to deliver antidote to victims of opioid overdose before respiratory depression results in morbidity or mortality; thus, UAVs may play a useful role in antidote delivery for out-of-hospital toxicologic emergencies. We tested the feasibility of dropping simulated antidote from a UAV to a bystander in an urban environment, measuring accuracy of drop, ease of recovery, and antidote survivability. A minimum flight altitude of 40m avoided any obstacles to accurately fly to specific coordinates. Simulated antidote drifted an average of 48 feet from the intended target, was discoverable on the ground, and survived the drop. These findings imply that UAV-dropped antidote may be a potential tool in emergency response to opioid overdose. Future research should focus on mechanisms for UAV integration within existing opioid overdose emergency response systems, human-UAV interactions, and payload design.

Hospital delirium is a dangerous condition characterized by confusion and altered consciousness. Delirium is frequently missed or not recognized by hospital teams. Hypoactive delirium, the most common type of delirium in hospitals, is associated with decreased spontaneous movements. We evaluated the use of wrist accelerometers to detect an association with delirium in hospitalized patients. We found that daily mean activity count was lower in patients with delirium, even controlling for age and mechanical ventilation status. This suggests that accelerometers could be a good biosensor to assist hospital staff with delirium detection and management.

Once-daily oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but its efficacy is dependent on adherence, which can be challenging for men who have sex with men (MSM) with substance use. Digital pill systems (DPS) represent a novel tool for directly measuring adherence through ingestible radiofrequency sensors that confirm ingestions in realtime. We examined operational challenges across two studies involving DPS to measure PrEP adherence. While most participants successfully operated the system, a number of technological and sociobehavioral challenges requiring intervention were identified across both studies. Technological issues were both systemand participant-related, and were primarily addressed with technical updates and participant re-education, while sociobehavioral issues, including health and housing changes and issues with technology access, warranted innovative solutions. Future research leveraging DPS technology should develop robust supportive infrastructure and mitigation procedures to promptly identify and resolve operational issues to optimize the potential benefits of DPS use.

Introduction Adherence to HIV antiretroviral therapy (ART) remains the cornerstone of HIV treatment. For individuals with suboptimal adherence, electronic adherence monitoring (EAM) technologies have become an important component of multimodal adherence support strategies. Most EAM technologies detect pillbox opening, and therefore, assume but cannot verify actual ingestion of oral medication. In contrast, a digital pill system (ID-capsule manufactured by etectRX, here named My/Treatment/Pill) measures directly ingestion of medications. Identifying the superior method to measure ART adherence would improve virological suppression by enabling the delivery of real-time interventions to support ART adherence, particularly in high-risk populations. Methods and analysis Cross-over, randomised trial with 1:1 variable block size randomisation comparing two EAM systems in prescription opioid-using HIV+patient on once daily oral bictegravir, emtricitabine and tenofovir alafenamide regimens and detectable viral load >200 copies/mL within 30 days of screening (n=80). The primary outcome is once daily ART adherence measurement efficacy as assessed by comparing the accuracy of each EAM system as measured by concordance of the respective EAM systems to dried blood spot ART concentrations. Secondary outcomes are the identification of multilevel factors that are prevalent in the target population most closely linked to ART non-adherence and EAM non-adherence. Ethics and dissemination This protocol was approved by the institutional review boards of participating sites (The Ohio State University, The Fenway Institute and the University of Miami). Data will be presented at scientific conferences and published in peer-reviewed journals. Trial registration number NCT03978793.