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>> GOOD MORNING AND WELCOME BACK

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TO THE FIFTH ANNUAL NIH HEAL

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INITIATIVE SCIENTIFIC MEETING.

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I'M HAIRK TI'LL BE YOUR EMCEE AE

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TAMARA FROM THE NATIONAL

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INSTITUTE ON DRUG ABUSE.

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FOR THOSE WHO COULD NOT JOIN US

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YESTERDAY MORNING, WE ARE

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EXCITED TO HAVE ATTENDEES

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SPANNING THE FULL HEAL

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COMMUNITY, INCLUDING

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PRE-CLINICAL BASIC RESEARCHERS

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TO IMPLEMENTATION SCIENCE

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RESEARCHERS, ALL WORKING TO

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ADDRESS THE OPIOID USE DISORDER

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AND CHRONIC PAIN CRISES.

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WE ARE ALSO JOINED BY NIH

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LEADERSHIP AND STAFF, AS WELL AS

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COMMUNITY PARTNERS, ADVISING

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HEAL PROJECTS, AND THE HEAL

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INITIATIVE AS A WHOLE.

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MANY WITH LIVED AND LIVING

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EXPERIENCE.

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WE ARE HONORED TO HAVE SO MANY

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CRITICAL PERSPECTIVES AT THIS

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MEETING AND AN EAGERNESS TO COME

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TOGETHER.

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THIS IS A HYBRID MEETING.

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MOST SESSIONS WILL BE

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LIVESTREAMED TO VIRTUAL

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ATTENDEES VIA THE VIRTUAL EVENT

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PLATFORM.

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BOTH VIRTUAL AND IN-PERSON

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ATTENDEES HAVE ACCESS TO THIS

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PLATFORM.

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YOU RECEIVED THE ACCESS LINK VIA

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EMAIL EARLIER THIS WEEK.

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THE PLATFORM INCLUDES ADDITIONAL

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RESOURCES INCLUDING ALL RESEARCH

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POSTERS AND THEIR ABSTRACTS.

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ALL MEETING SESSIONS ARE BEING

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RECORDED, AND WILL BE AVAILABLE

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ON THE PLATFORM FOLLOWING THE

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MEETING.

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THE PLENARY SESSIONS IN THIS

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ROOM WILL ALSO BE LIVESTREAMED

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TO THE PUBLIC VIA NIH VIDEOCAST.

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RECORDINGS WILL BE AVAILABLE ON

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THE HEAL WEBSITE.

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IN ADDITION TO ATTENDING

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SESSIONS, WE ENCOURAGE YOU TO

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PARTICIPATE DURING Q & A AND

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SUGGEDISCUSSION SESSIONS.

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FEEL FREE TO STEP UP TO A

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MICROPHONE AND THE MODERATOR

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WILL CALL ON YOU.

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THERE WILL ALSO BE MICROPHONES

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IN THE BREAKOUT ROOMS.

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PLEASE ALWAYS USE THEM TO ENSURE

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YOU CAN BE HEARD.

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VIRTUAL PARTICIPANTS, PLEASE USE

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THE CHAT FUNCTION TO ASK YOUR

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QUESTIONS.

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WHILE THERE ARE NO FORMAL POSTER

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SESSIONS TODAY, ALL OF THE

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RESEARCH POSTERS WILL REMAIN IN

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SALONS E THROUGH H UNTIL THE END

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OF THE MEETING.

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FEEL FREE TO GO IN AND VIEW THE

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POSTERS AS YOU HAVE TIME.

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ALSO BE SURE TO CHECK OUT THE

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VIRTUAL ATTENDEE POSTER ON THE

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VIRTUAL MEETING PLATFORM.

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THERE ARE SEVERAL PROGRAM BOOST

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BOOTHS SET UP IN THE FOYER

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OUTSIDE THIS ROOM.

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BE SURE TO VISIT THE HEAL DATA

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ECOSYSTEM BOOTH, WHERE THEY CAN

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ASSIST YOU IN COMPLETING KEY

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STEPS FOR MAKING YOUR DATA

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HEAL-COMPLIANT AND PREPARING

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DATA FOR PUBLICATION AND

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DISSEMINATION.

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COMPLEATING STUDY REGISTRATION

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AND THE CDER STUDY LEVEL

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METADATA FORM WILL AUTOMATICALLY

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ENTER YOU INTO THE RAFFLE FOR A

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CHANCE TO WIN EXCITING PRIZES.

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HEAL CONNECTIONS ALSO HAS A

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BOOTH WHERE YOU CAN LEARN MORE

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ABOUT HOW THEY ARE CREATING

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PATHWAYS TO BUILD AND SUSTAIN

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COMMUNITY PARTNERSHIPS AND

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SUPPORTING RESEARCHERS IN

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MEANINGFULLY SHARING RESULTS

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WITH THOSE THAT WILL BENEFIT

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MOST FROM THE RESEARCH FINDINGS.

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WE WILL ALSO HEAR FROM HEAL

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CONNECTIONS ABOUT THE COMMUNITY

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ENGAGEMENT WORK THEY ARE DOING

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LATER THIS AFTERNOON.

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THE PURPOSE NETWORK IS ALSO

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AVAILABLE TO DISCUSS HOW THEY

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ARE CONNECTING PAIN RESEARCHERS

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ACROSS THE CONTINUUM OF PAIN

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RESEARCH FROM ALL DISCIPLINES

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AND CAREER STAGES.

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AS ALWAYS, IF YOU HAVE

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QUESTIONS, PLEASE VISIT THE

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REGISTRATION AND INFORMATION

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DESK IN THE FOYER.

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SO TO KICK OFF OUR SECOND DAY,

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WE HAVE A SESSION TITLED

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"ENGINEERING TREATMENTS FOR PAIN

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AND OPIOID USE DISORDER."

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DR. ALL ALI REZAI FROM WEST VIRA

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UNIVERSITY AND DR. PRASAD

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SHIRVALKAR FROM UNIVERSITY OF

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CALIFORNIA SAN FRANCISCO WITH

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EDWARD MOWERY WILL SHARE.

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DR. AKLIN OF THE NATIONAL

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INSTITUTE ON DRUG ABUSE WILL

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MODERATE THE SESSION.

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SO PLEASE JOIN ME IN WELCOMING

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DRS. AKLIN, REZAI, SHIRVALKAR

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AND MR. MOWERY.

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>> THANK YOU VERY MUCH, AND

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WELCOME.

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I'M EXCITED TO INTRODUCE MY

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PANEL TODAY.

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VERY EXCITING ON ENGINEERING

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TREATMENTS FOR PAIN AND OPIOID

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USE DISORDER.

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DR. PRASAD SHIRVALKAR IS

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ASSOCIATE PROFESSOR OF

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ANESTHESIOLOGY, NEUROLOGY AND

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NEUROLOGICAL SURGERY AT UCSF.

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HIS FOCUS AS A NEUROLOGIST AND

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PAIN MEDICINE SPECIALIST IS TO

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TREAT THE WHOLE SPECTRUM OF

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CHRONIC PAIN SYNDROMES.

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PRASAD'S LAB RECENTLY DISCOVERED

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THE FIRST DIRECT BRAIN

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BIOMARKERS TO TRACK PAIN

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SEVERITY, AND A LOT OF THIS WORK

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NOW IS BEING USED TO DEVELOP

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NEUROMODULATION TECHNIQUES TO

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TREAT PAIN.

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MR. ED MOWERY, TO HIS IMMEDIATE

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RIGHT, IS A CLINICAL TRIAL

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PARTICIPANT.

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ED IS A COMMUNITY PARTNER ON

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PRASAD'S STUDY.

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ED IS A MUSICIAN FROM

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ALBUQUERQUE NEW MEXICO, AND

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PREVIOUSLY SUFFERED FROM CHRONIC

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PAIN OVER 18 YEARS.

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ED HAS UNDERGONE OVER 32 SPINAL

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SURGERIES WITHOUT MEANINGFUL

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BENEFIT.

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HE ALSO HAD SHARP, STABBING PAIN

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IN HIS LEGS AND FEET FROM

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COMPLEX REGIONAL PAIN SYNDROMES

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THAT PREVENTED HIM FROM WORKING

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OR PLAYING MUSIC.

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SINCE ENROLLING IN PRASAD'S

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STUDY AT UCSF, HE IS NEARLY

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PAIN-FREE AND HAS STARTED

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WORKING FULL TIME AND PLAYING

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MUSIC AGAIN.

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LAST BUT NOT LEAST, DR. ALI

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REZAI IS ASSOCIATE DEAN OF

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NEUROSCIENCE AT WEST VIRGINIA

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UNIVERSITY AND EXECUTIVE CHAIR

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AND DIRECTOR AT WEST VIRGINIA

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UNIVERSITY ROCKEFELLER

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NEUROSCIENCE INSTITUTE.

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DRHE IS AN EXPERT IN

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NEUROMODULATION FOR MOVEMENT

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DISORDERS, CHRONIC PAIN, AND

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OTHER NEUROBEHAVIORAL DISORDERS.

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WITH RESEARCH SPANNING

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PARKINSON'S DISEASE, CHRONIC

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PAIN, ADDICTION, AND

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ALZHEIMER'S.

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HE HAS OVER 200 SCIENTIFIC

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PUBLICATIONS WITH AN H INDEX OF

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92, AND THE CURRENT P.I. ON A

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NIDA-FUNDED UG3 UH3 GRANT TO

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FOCUS ON DEEP BRAIN STIMULATION

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AND FOCUS ULTRASOUND FOR OPIOID

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USE DISORDER.

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DR. REZAI IS PAST PRESIDENT OF

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THE CONGRESS OF NEUROLOGICAL

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SURGEONS AND NORTH AMERICAN

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NEUROMODULATORY SOCIETY.

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THANK YOU VERY MUCH, GENTLEMEN,

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AND LOOKING FORWARD TO A

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FRUITFUL PRESENTATION.

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THANK YOU.

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>> THANKS SO MUCH, WILL, AND

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THANKS, DR. VOLKOW,

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DR. KOROSHETZ AND ALL OF US FOR

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BEING HERE.

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THANKS ESPECIALLY, ED, FOR

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MAKING IT ALL THE WAY HERE FROM

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ALBUQUERQUE.

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I'M A NEUROLOGIST AND PAIN

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PHYSICIAN AND GOING TO TALK TO

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YOU TODAY ABOUT OUR EFFORTS TO

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DEVELOP A NEW TREATMENT, AS WELL

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AS UNDERSTAND MECHANISMS IN THE

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BRAIN FOR CHRONIC PAIN.

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IT'S BEEN KNOWN FOR SOME TIME

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THAT CHRONIC PAIN IS VERY

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PREVALENT.

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IN A NEW STUDY, IT ACTUALLY

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DEMONSTRATES THAT INCIDENCE IS

219
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HIGHER THAN DEPRESSION OR

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DIABETES IN A SINGLE-YEAR STUDY.

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THE URGENCY OF CHRONIC PAIN WAS

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COMMUNICATED OR AN ATTEMPT WAS

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MADE TO COMMUNICATE IT IN THE

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90s BY CALLING CHRONIC PAIN AS

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THE FIFTH VITAL SIGN.

226
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BUT AS OPPOSED TO THE OTHER FOUR

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VITAL SIGNS, THERE'S NO

228
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OBJECTIVE MEASURE OF PAIN.

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WHEN I TALKED TO A MENTOR OF

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MINE AND TOLD HIM, HOW CAN WE

231
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ONTIVELY MEASURE PAIN, HE ASKED

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ME, OH, YOU MEAN A K3 INDICATOR?

233
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>> I'VE NEVER SEEN ANYTHING LIKE

234
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IT EITHER, RIGHT?

235
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ONE THING THEY GOT RIGHT WAS

236
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THAT I THINK THE K3 INDICATOR,

237
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IF ONE EXISTS, IS PROBABLY GOING

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TO COME FROM THE BRAIN.

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SO THAT WAS PRETTY PRESCIENT.

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I'M GOING TO TALK TO YOU TODAY

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ABOUT OUR ATTEMPTS TO DECODE

242
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PAIN FROM THE BRAIN OR

243
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UNDERSTAND OBJECTIVE CORRELATES

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OF SUBJECTIVE PAIN PERCEPTION,

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AND THEN TALK ABOUT THE CLINICAL

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TRIAL THAT ED IS IN, AND HE'LL

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COME AFTERWARDS AND SHARE SOME

248
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OF HIS EXPERIENCE.

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WE'VE KNOWN FOR MANY DECADES

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THAT THERE ARE SIGNALS OF PAIN

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IN THE BRAIN THAT TRACK

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SUBJECTIVE EXPERIENCE.

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MOST OF HISTORICAL RESEARCH, I

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WOULD ARGUE, HAS BEEN DONE IN

255
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HEALTHY PEOPLE, USING

256
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EXPERIMENTAL PAIN.

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NONETHELESS, WE'VE LEARNED A LOT

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ABOUT KEY BRAIN REGIONS OR

259
00:08:47,927 --> 00:08:50,897
CIRCUITS THAT ARE IMPORTANT

260
00:08:50,963 --> 00:08:52,331
USING MAYBE A HEAT PROBE ON A

261
00:08:52,398 --> 00:08:54,467
PATIENT'S HAND.

262
00:08:54,533 --> 00:08:57,370
MOST NOTABLY, RECENTLY THE WORK

263
00:08:57,436 --> 00:08:59,672
FROM WAGER'S NEUROLOGIC PAIN

264
00:08:59,739 --> 00:09:01,974
SIGNATURE WAS PRECEDED BY WORK

265
00:09:02,041 --> 00:09:04,911
BY ROBERT COGHILL AND CATHY

266
00:09:04,977 --> 00:09:07,546
BUSHNELL'S GROUP ALSO USING FMRI

267
00:09:07,613 --> 00:09:09,515
AND PET WHICH HAD SOME

268
00:09:09,582 --> 00:09:10,383
CONCORDANCE IN TERMS OF AREAS

269
00:09:10,449 --> 00:09:11,484
THAT WERE IMPORTANT FOR PAIN,

270
00:09:11,550 --> 00:09:13,052
SUCH AS ANTERIOR SINK LAT

271
00:09:13,119 --> 00:09:16,055
CORTEX, AREAS LIKE THE INSULA,

272
00:09:16,122 --> 00:09:17,290
MEDIAL PREFRONTAL CORTEX.

273
00:09:17,356 --> 00:09:20,126
HOWEVER, I WILL SAY SOME OF THE

274
00:09:20,192 --> 00:09:21,260
MOST IMPORTANT WORK IN ACTUALLY

275
00:09:21,327 --> 00:09:25,164
LOOKING AT REAL WORLD CHRONIC

276
00:09:25,231 --> 00:09:26,265
PAIN IN WORK DONE IN CHICAGO

277
00:09:26,332 --> 00:09:28,634
WHERE THEY LOOK AT PATIENTS WHO

278
00:09:28,701 --> 00:09:30,836
HAVE ACUTE OR SHORT TERM LOW

279
00:09:30,903 --> 00:09:32,605
BACK PAIN, WHAT BRAIN REGIONS OR

280
00:09:32,672 --> 00:09:34,907
WHAT ACTIVITY ACROSS THE BRAIN

281
00:09:34,974 --> 00:09:35,908
MIGHT DISTINGUISH THOSE PATIENTS

282
00:09:35,975 --> 00:09:38,945
WHO RECOVER FROM THOSE PATIENTS

283
00:09:39,011 --> 00:09:41,347
WHO PERSIST TO HAVE DEBILITATING

284
00:09:41,414 --> 00:09:44,517
CHRONIC PAIN.

285
00:09:44,583 --> 00:09:46,319
USING TIME POINT OF FOUR MRIs

286
00:09:46,385 --> 00:09:47,586
OVER ONE YEAR, THERE'S CERTAIN

287
00:09:47,653 --> 00:09:49,555
AREAS THAT SHOW DEGENERATION OR

288
00:09:49,622 --> 00:09:50,756
DECREASE IN GREY MATTER VOLUME

289
00:09:50,823 --> 00:09:53,826
AND THERE'S OTHER AREAS THAT IN

290
00:09:53,893 --> 00:09:55,261
THE PREFRONTAL CORTEX THAT

291
00:09:55,328 --> 00:09:57,229
APPEAR TO HAVE FUNCTIONAL

292
00:09:57,296 --> 00:09:58,264
CHANGES BUT I THINK THE QUESTION

293
00:09:58,331 --> 00:09:59,732
STILL REMAINS, WHAT SIGNALS

294
00:09:59,799 --> 00:10:01,934
MIGHT TRACK THE SPONTANEOUS

295
00:10:02,001 --> 00:10:03,235
NATURE OF FLUCTUATING CHRONIC

296
00:10:03,302 --> 00:10:06,405
PAIN OVER DAYS, HOURS, ET CET

297
00:10:06,472 --> 00:10:07,340
CETERA.

298
00:10:07,406 --> 00:10:08,641
SO WE TEND TO TALK ABOUT CHRONIC

299
00:10:08,708 --> 00:10:10,876
PAIN OR CONCEPTUALIZE IT IN

300
00:10:10,943 --> 00:10:12,578
THREE DIMENSIONS AS THE

301
00:10:12,645 --> 00:10:14,213
SOMATOSENSORY, THE PHYSICAL, HOW

302
00:10:14,280 --> 00:10:16,549
SEVERE IS IT, WHERE IS IT, THE

303
00:10:16,615 --> 00:10:18,050
EMOTIONAL OR MOTIVATIONAL, AS

304
00:10:18,117 --> 00:10:20,353
WELL AS THE EFFECT THAT IT HAS

305
00:10:20,419 --> 00:10:21,988
ON ATTENTION AND MEMORY.

306
00:10:22,054 --> 00:10:24,156
THAT'S THE COGNITIVE.

307
00:10:24,223 --> 00:10:26,125
IN A REDUCTIONIST WAY, WE CAN

308
00:10:26,192 --> 00:10:27,126
MAP THESE DIFFERENT DIMENSIONS

309
00:10:27,193 --> 00:10:28,361
ON TO DIFFERENT BRAIN CIRCUITS,

310
00:10:28,427 --> 00:10:30,730
BUT I THINK IT'S CLEAR THAT NO

311
00:10:30,796 --> 00:10:34,000
BRAIN REGION DOES ANYTHING,

312
00:10:34,066 --> 00:10:34,200
RIGHT?

313
00:10:34,266 --> 00:10:35,668
IT'S IN CONCERT WITH OTHER BRAIN

314
00:10:35,735 --> 00:10:37,503
REGIONS THAT THERE'S A NETWORK

315
00:10:37,570 --> 00:10:40,339
FLOW OF INFORMATION THAT LEADS

316
00:10:40,406 --> 00:10:42,541
TO BEHAVIOR AND LIKELY

317
00:10:42,608 --> 00:10:43,976
SUBJECTIVE PERSONAL EXPERIENCE.

318
00:10:44,043 --> 00:10:45,311
AND SO NONETHELESS, I THINK IT'S

319
00:10:45,378 --> 00:10:46,712
IMPORTANT TO AT LEAST TRY TO

320
00:10:46,779 --> 00:10:48,781
IDENTIFY WHAT ARE CIRCUITS THAT

321
00:10:48,848 --> 00:10:50,182
MIGHT BE MORE IMPORTANT FOR

322
00:10:50,249 --> 00:10:54,787
CERTAIN EXPERIENCES THAN OTHERS.

323
00:10:54,854 --> 00:10:56,088
THIS MIGHT HELP US TO TRACK AND

324
00:10:56,155 --> 00:10:57,089
MORE IMPORTANTLY TREAT CHRONIC

325
00:10:57,156 --> 00:10:57,289
PAIN.

326
00:10:57,356 --> 00:10:59,091
SO WE USE THE APPROACH OF DEEP

327
00:10:59,158 --> 00:11:01,694
BRAIN STIMULATION AS AN ATTEMPT

328
00:11:01,761 --> 00:11:03,329
TO ENGINEER A TREATMENT FOR

329
00:11:03,396 --> 00:11:04,964
CHRONIC PAIN.

330
00:11:05,031 --> 00:11:06,665
DBS HAS BEEN ESTABLISHED AS A

331
00:11:06,732 --> 00:11:08,367
TOOL FOR MANY DISORDERS WHERE

332
00:11:08,434 --> 00:11:09,769
CERTAIN TARGETS, SINGLE TARGETS

333
00:11:09,835 --> 00:11:13,706
IN THE BRAIN HAVE BEEN SHOWN TO

334
00:11:13,773 --> 00:11:14,840
WORK ACROSS PATIENTS WITH

335
00:11:14,907 --> 00:11:15,674
SURPRISING EFFICACY.

336
00:11:15,741 --> 00:11:18,310
BUT THERE'S STILL NO BEST SINGLE

337
00:11:18,377 --> 00:11:20,513
TARGET FOR PAIN.

338
00:11:20,579 --> 00:11:22,348
THERE'S NO BRAIN REGION OR PAIN

339
00:11:22,415 --> 00:11:25,317
CENTER IN THE BRAIN, RIGHT?

340
00:11:25,384 --> 00:11:26,719
IT SEEMS TO BE MORE OF A

341
00:11:26,786 --> 00:11:27,720
DISTRIBUTED NETWORK THAN MANY

342
00:11:27,787 --> 00:11:29,288
OTHER DISEASES WHICH IS MORE

343
00:11:29,355 --> 00:11:31,991
CHALLENGING TO FIND SOMETHING

344
00:11:32,058 --> 00:11:32,758
THAT GENERALIZES.

345
00:11:32,825 --> 00:11:34,560
SO ACROSS THE YEARS, STARTING IN

346
00:11:34,627 --> 00:11:37,463
1960 AND THEN IN THE 70s AT

347
00:11:37,530 --> 00:11:38,964
UCSF ACTUALLY, FOLKS HAVE TRIED

348
00:11:39,031 --> 00:11:42,134
TO USE DBS AT VARIOUS TARGETS TO

349
00:11:42,201 --> 00:11:42,701
TREAT CHRONIC PAIN.

350
00:11:42,768 --> 00:11:44,103
THERE WAS A BIG INDUSTRY TRIAL

351
00:11:44,170 --> 00:11:48,707
IN THE 1990s THAT THEN KIND OF

352
00:11:48,774 --> 00:11:51,243
INSPIRED YET ANOTHER TRIAL USING

353
00:11:51,310 --> 00:11:53,879
THE ANTERIOR CINGULATE DBS, BUT

354
00:11:53,946 --> 00:11:54,947
THE MAIN MESSAGE HAS BEEN,

355
00:11:55,014 --> 00:11:56,282
ANYTHING THAT WORKS IN THE SHORT

356
00:11:56,348 --> 00:11:58,017
TERM SEEMS TO FADE.

357
00:11:58,084 --> 00:12:01,320
AND MOREOVER, EVEN THE SINGLE

358
00:12:01,387 --> 00:12:04,590
DOUBLE BLINDED RANDOMIZED TRIAL

359
00:12:04,657 --> 00:12:05,891
HAD A NEGATIVE OUTCOME.

360
00:12:05,958 --> 00:12:07,960
SO THE MAIN PROBLEMS ARE, YOU

361
00:12:08,027 --> 00:12:09,195
KNOW, MOST PATIENTS ARE FAILED

362
00:12:09,261 --> 00:12:09,929
BY ALL THERAPIES.

363
00:12:09,995 --> 00:12:11,263
THE EFFECTIVE TARGETS ARE

364
00:12:11,330 --> 00:12:13,732
UNKNOWN, AND IT WEARS OFF AFTER

365
00:12:13,799 --> 00:12:14,600
TIME.

366
00:12:14,667 --> 00:12:17,670
SO WE ASKED CAN WE BUILD CLOSED

367
00:12:17,736 --> 00:12:18,871
DBS SOLUTIONS, SPECIFICALLY, CAN

368
00:12:18,938 --> 00:12:23,375
WE TRY TO ENGINEER A SYSTEM THAT

369
00:12:23,442 --> 00:12:25,344
LOOKS LIKE A THERMOSTAT?

370
00:12:25,411 --> 00:12:26,745
JUST LIKE A THERMOSTAT MIGHT

371
00:12:26,812 --> 00:12:28,047
TURN ON AND OFF IN RESPONSE TO

372
00:12:28,114 --> 00:12:29,515
THE MEASUREMENTS OF AMBIENT

373
00:12:29,582 --> 00:12:30,916
HEAT, CAN WE MEASURE CHRONIC

374
00:12:30,983 --> 00:12:31,383
PAIN?

375
00:12:31,450 --> 00:12:33,519
THAT'S KIND OF THE FIRST STEP.

376
00:12:33,586 --> 00:12:36,255
SO WE PUBLISHED A STUDY RECENTLY

377
00:12:36,322 --> 00:12:38,657
IN FOUR PATIENTS, THREE OF WHOM

378
00:12:38,724 --> 00:12:40,960
HAD POST STROKE PAIN AND ONE HAD

379
00:12:41,026 --> 00:12:41,627
PHANTOM LIMB PAIN.

380
00:12:41,694 --> 00:12:42,495
THESE PATIENTS WERE IMPLANTED

381
00:12:42,561 --> 00:12:44,563
WITH A NOVEL DEVICE THAT ALLOWED

382
00:12:44,630 --> 00:12:47,733
US TO STIMULATE BUT ALSO RECORD

383
00:12:47,800 --> 00:12:49,068
ACTIVITY FROM BRAIN REGIONS.

384
00:12:49,135 --> 00:12:51,137
WE RECORDED FROM ELECTRODES

385
00:12:51,203 --> 00:12:52,438
IMPLANTED IN THE ANTERIOR

386
00:12:52,505 --> 00:12:55,975
CINGULATE CORTEX AS WELL AS TH

387
00:12:56,041 --> 00:12:57,510
THE -- FRONTAL CORTEX WHILE

388
00:12:57,576 --> 00:13:00,212
PATIENTS REPORTED THEIR PAIN

389
00:13:00,279 --> 00:13:02,414
MULTIPLE TIMES A DAY OVER MANY

390
00:13:02,481 --> 00:13:02,848
MONTHS.

391
00:13:02,915 --> 00:13:04,483
HERE IS AN EXAMPLE PATIENT OVER

392
00:13:04,550 --> 00:13:06,018
FOUR MONTHS AND EACH BLACK DOT

393
00:13:06,085 --> 00:13:07,219
REFLECTS A PAIN REPORT THEY GAVE

394
00:13:07,286 --> 00:13:09,054
US, BUT ALSO THEY WOULD HIT A

395
00:13:09,121 --> 00:13:10,055
BUTTON ON THE REMOTE AND WE

396
00:13:10,122 --> 00:13:13,559
WOULD GET A BRAIN READING OR A

397
00:13:13,626 --> 00:13:14,994
SNAPSHOT OF BRAIN ACTIVITY.

398
00:13:15,060 --> 00:13:17,997
SO USING THIS BRAIN ACTIVITY,

399
00:13:18,063 --> 00:13:20,666
ESSENTIALLY USED A TRANSFORM

400
00:13:20,733 --> 00:13:22,434
WHERE WE DECOMPOSED THE NEURAL

401
00:13:22,501 --> 00:13:24,270
SIGNALS INTO CONSTITUENT

402
00:13:24,336 --> 00:13:25,504
WAVELENGTHS KIND OF LIKE AN

403
00:13:25,571 --> 00:13:27,006
EQUALIZER WOULD DO FOR MUSIC.

404
00:13:27,072 --> 00:13:29,542
SO BY TAKING THE FREQUENCY

405
00:13:29,608 --> 00:13:32,144
CHARACTERISTICS OF THESE BRAIN

406
00:13:32,211 --> 00:13:33,579
SIGNAL, WE ASKED CAN WE PREDICT

407
00:13:33,646 --> 00:13:34,580
AT LEAST WHEN PATIENTS ARE GOING

408
00:13:34,647 --> 00:13:36,649
TO BE IN HIGH VERSUS LOW PAIN.

409
00:13:36,715 --> 00:13:38,050
USING ACTIVITY FROM EITHER THE

410
00:13:38,117 --> 00:13:41,587
ANTERIOR CINGULATE OR THE

411
00:13:41,654 --> 00:13:43,422
ORBITOFRONTAL CORTEX WE COULD

412
00:13:43,489 --> 00:13:44,623
PREDICT IN ALL PATIENTS, AND I

413
00:13:44,690 --> 00:13:46,058
THINK THIS WAS VERY SURPRISING

414
00:13:46,125 --> 00:13:51,197
BUT REASSURING TO US, THAT IT IS

415
00:13:51,263 --> 00:13:52,932
IT IS FEASIBLE TO TRACK

416
00:13:52,998 --> 00:13:55,568
SUBJECTIVE HIGH VERSUS LOW

417
00:13:55,634 --> 00:13:56,435
STATES IN THE BRAIN.

418
00:13:56,502 --> 00:14:00,039
HERE'S A MAP OF EACH PATIENT'S

419
00:14:00,105 --> 00:14:01,540
NEURAL SIGNATURE THAT WE USED TO

420
00:14:01,607 --> 00:14:04,009
DECODE THEIR PAIN.

421
00:14:04,076 --> 00:14:06,078
AND SPECIFICALLY WHAT I THOUGHT

422
00:14:06,145 --> 00:14:07,213
WAS INTERESTING IS THAT THERE'S

423
00:14:07,279 --> 00:14:10,149
A LOT OF INTRAINDIVIDUAL

424
00:14:10,216 --> 00:14:10,449
VARIABILITY.

425
00:14:10,516 --> 00:14:12,284
THIS IS REAL WORLD CHRONIC PAIN.

426
00:14:12,351 --> 00:14:15,888
WHEN WE LOOKED AT EXPERIMENTAL

427
00:14:15,955 --> 00:14:17,122
PAIN, WE FOUND SIGNATURES IN TWO

428
00:14:17,189 --> 00:14:18,757
PATIENTS WHERE WE COULD

429
00:14:18,824 --> 00:14:19,925
SUCCESSFULLY DECODE ACUTE PAIN,

430
00:14:19,992 --> 00:14:21,827
IT DID NOT GENERALIZE.

431
00:14:21,894 --> 00:14:23,429
SO THIS IS AN IMPORTANT PROOF OF

432
00:14:23,495 --> 00:14:25,331
PRINCIPLE, I THINK, THAT DIRECT

433
00:14:25,397 --> 00:14:27,266
BRAIN SIGNALS CAN ACTUALLY TRACK

434
00:14:27,333 --> 00:14:28,901
CLINICAL CHRONIC PAIN STATE, THE

435
00:14:28,968 --> 00:14:30,669
BIOMARKERS APPEAR TO BE

436
00:14:30,736 --> 00:14:31,870
DISTINCT, REINFORCING OUR

437
00:14:31,937 --> 00:14:33,305
INTUITION CLINICALLY, BUT AN

438
00:14:33,372 --> 00:14:35,708
IMPORTANT NOTE, YOU KNOW, THAT

439
00:14:35,774 --> 00:14:37,243
BIOMARKERS OF PAIN SHOULD NOT BE

440
00:14:37,309 --> 00:14:44,350
USED TO UNDERMINE OR -- I THINK

441
00:14:44,416 --> 00:14:45,751
THEY CAN ADD VALIDATION FOR PAIN

442
00:14:45,818 --> 00:14:47,186
WHEN MRIs ARE NEGATIVE, BLOOD

443
00:14:47,253 --> 00:14:48,153
TESTS ARE NEGATIVE.

444
00:14:48,220 --> 00:14:50,456
IT MIGHT BE ACTUALLY AN

445
00:14:50,522 --> 00:14:52,124
OPPORTUNITY TO HELP DIAGNOSE OR

446
00:14:52,191 --> 00:14:53,959
MONITOR DISEASE.

447
00:14:54,026 --> 00:14:55,060
BUT I THINK DAVIS SAID IT BEST,

448
00:14:55,127 --> 00:14:57,263
THAT PAIN IS DEFINED BY AN

449
00:14:57,329 --> 00:14:58,030
INDIVIDUAL AS THEIR TBROWND

450
00:14:58,097 --> 00:15:00,332
TRUTH.

451
00:15:00,399 --> 00:15:00,566
GROUND

452
00:15:00,633 --> 00:15:01,834
TRUTH.

453
00:15:01,900 --> 00:15:03,369
SO WE APPLY THEM IN A CLINICAL

454
00:15:03,435 --> 00:15:04,703
TRIAL TO TRY TO IDENTIFY WHAT IS

455
00:15:04,770 --> 00:15:06,205
THE BEST REGION NOW TO

456
00:15:06,272 --> 00:15:07,973
STIMULATE, TO ACTUALLY ACHIEVE

457
00:15:08,040 --> 00:15:09,174
PAIN RELIEF.

458
00:15:09,241 --> 00:15:10,476
SO HERE, WHAT WE DID, IF YOU

459
00:15:10,542 --> 00:15:12,244
LOOK ON THE BOTTOM LEFT, FOR 10

460
00:15:12,311 --> 00:15:15,080
DAYS, WE USED AN APPROACH USING

461
00:15:15,147 --> 00:15:18,250
STEREO EEGs WHERE WE IMPLANT

462
00:15:18,317 --> 00:15:19,118
PATIENTS' BRAIN TARGETING

463
00:15:19,184 --> 00:15:20,185
SPECIFIC BRAIN REGIONS THAT WE

464
00:15:20,252 --> 00:15:21,420
BELIEVE ARE IMPORTANT IN PAIN,

465
00:15:21,487 --> 00:15:23,622
AND WE SYSTEMATICALLY STIMULATE

466
00:15:23,689 --> 00:15:25,024
OVER 10 DAYS TO IDENTIFY THE

467
00:15:25,090 --> 00:15:26,792
BEST TARGET FOR PAIN RELIEF.

468
00:15:26,859 --> 00:15:30,963
ONCE WE ACTUALLY ACHIEVE, MAYBE,

469
00:15:31,030 --> 00:15:33,232
A HINT OF RELIEF, WE PERFORM

470
00:15:33,299 --> 00:15:35,000
DOUBLE BLINDED SHAM CONTROLLED

471
00:15:35,067 --> 00:15:36,402
TESTING IN THE HOSPITAL.

472
00:15:36,468 --> 00:15:37,803
SO MY TEAM IS IN THE ROOM FOR

473
00:15:37,870 --> 00:15:39,571
EIGHT HOURS A DAY, FOR 10 DAYS,

474
00:15:39,638 --> 00:15:41,540
WE GOT TO KNOW ED REAL WELL

475
00:15:41,607 --> 00:15:42,541
DURING THIS TIME.

476
00:15:42,608 --> 00:15:44,943
AND SO IF THE PATIENTS GET 50%

477
00:15:45,010 --> 00:15:47,446
RELIEF OR MORE, WHAT WE DO IS WE

478
00:15:47,513 --> 00:15:50,082
IMPLANT A PERMANENT BRAIN

479
00:15:50,149 --> 00:15:51,317
IMPLANT AND WE FOLLOW THEM FOR

480
00:15:51,383 --> 00:15:52,484
TWO YEARS.

481
00:15:52,551 --> 00:15:56,088
WE IMPLANT THE PERMANENT DEVICE

482
00:15:56,155 --> 00:15:56,755
CONNECTING ELECTRODES THAT

483
00:15:56,822 --> 00:15:58,624
TARGET THE BEST SITE THAT WE

484
00:15:58,691 --> 00:16:00,859
OBTAINED IN THE DISCOVERY TRIAL

485
00:16:00,926 --> 00:16:01,226
PERIOD.

486
00:16:01,293 --> 00:16:03,662
SO WE THEN USED AGAIN A

487
00:16:03,729 --> 00:16:05,631
PERSONALIZED APPROACH TO DERIVE

488
00:16:05,698 --> 00:16:07,366
BIOMARKERS AND TRY TO IMPLEMENT

489
00:16:07,433 --> 00:16:10,235
A SIMPLE SCHEME, THE SIMPLEST

490
00:16:10,302 --> 00:16:12,071
THING IS CAN WE TURN THE DEVICE

491
00:16:12,137 --> 00:16:14,039
ON AND OFF IN RESPONSE TO

492
00:16:14,106 --> 00:16:14,707
ONGOING BIOMARKERS.

493
00:16:14,773 --> 00:16:16,308
TO DATE, WE'VE HAD SEVEN

494
00:16:16,375 --> 00:16:17,109
PATIENTS ENROLLED.

495
00:16:17,176 --> 00:16:18,410
SIX PATIENTS HAVE UNDER DTS GONE

496
00:16:18,477 --> 00:16:21,246
THE EXPLORATORY TRIAL PERIOD.

497
00:16:21,313 --> 00:16:23,215
OF THOSE SIX, FIVE OF THEM HAVE

498
00:16:23,282 --> 00:16:25,084
PROCEEDED TO A PERMANENT BRAIN

499
00:16:25,150 --> 00:16:25,751
IMPLANT.

500
00:16:25,818 --> 00:16:26,819
SO FIVE OUT OF SIX PATIENTS SO

501
00:16:26,885 --> 00:16:29,888
FAR HAVE HAD CLINICALLY

502
00:16:29,955 --> 00:16:30,456
MEANINGFUL RELIEF.

503
00:16:30,522 --> 00:16:31,757
I WANT TO TALK VERY BRIEFLY

504
00:16:31,824 --> 00:16:33,959
ABOUT ED MOWERY HERE.

505
00:16:34,026 --> 00:16:35,894
AND THEN, YOU KNOW, LET YOU HEAR

506
00:16:35,961 --> 00:16:38,330
FROM HIM DIRECTLY.

507
00:16:38,397 --> 00:16:40,733
SO ED WAS RCS05.

508
00:16:40,799 --> 00:16:43,369
THAT'S HOW WE WOULD REFER TO

509
00:16:43,435 --> 00:16:46,705
HIM, PHI SAFE MANNER.

510
00:16:46,772 --> 00:16:48,941
HE WAS 51 YEARS OLD WHEN HE MET

511
00:16:49,007 --> 00:16:51,210
US, THAT WAS BACK IN 2021.

512
00:16:51,276 --> 00:16:52,544
HEAVY METAL MUSICIAN FROM

513
00:16:52,611 --> 00:16:52,978
NEW MEXICO.

514
00:16:53,045 --> 00:16:54,947
HE HAD CHRONIC PAIN SINCE THE

515
00:16:55,013 --> 00:16:55,481
AGE OF 15.

516
00:16:55,547 --> 00:16:56,949
HE TOLD ME HAD A KNEE SURGERY

517
00:16:57,015 --> 00:16:58,884
WHEN HE WAS 15, AND AT THIS

518
00:16:58,951 --> 00:17:01,387
TIME, I MEAN, YOU CAN ONLY

519
00:17:01,453 --> 00:17:02,488
IMAGINE, HE'S BEEN LIVING WITH

520
00:17:02,554 --> 00:17:03,922
PAIN FOR THIS WHOLE TIME, BUT

521
00:17:03,989 --> 00:17:05,758
HE'S HAD OVER 32 SURGERY,

522
00:17:05,824 --> 00:17:09,762
INCLUDING IN HIS NECK, LOW BACK,

523
00:17:09,828 --> 00:17:10,028
JOINTS.

524
00:17:10,095 --> 00:17:12,765
HIS PAIN IS ALL OVER THE LIMBS,

525
00:17:12,831 --> 00:17:14,967
BUT HE WAS DIAGNOSED WITH CRPS,

526
00:17:15,033 --> 00:17:16,301
COMPLEX REGIONAL PAIN SYNDROME,

527
00:17:16,368 --> 00:17:18,670
WHICH IS PARTICULARLY HARD TO

528
00:17:18,737 --> 00:17:19,204
TREAT SYNDROME.

529
00:17:19,271 --> 00:17:21,640
IT INTERFERED WITH HIS LIFE

530
00:17:21,707 --> 00:17:22,708
OBVIOUSLY.

531
00:17:22,775 --> 00:17:24,576
BUT NOTABLY, LIKE MANY PATIENTS,

532
00:17:24,643 --> 00:17:26,779
HE'S TRIED OVER 20 MEDICATIONS,

533
00:17:26,845 --> 00:17:28,914
STEROID INJECTIONS, SPINAL CORD

534
00:17:28,981 --> 00:17:31,483
STSTIMULATOR, PHYSICAL THERAPY D

535
00:17:31,550 --> 00:17:33,118
STILL WAS DISABLED.

536
00:17:33,185 --> 00:17:34,219
HERE ARE SOME PISHTS THAT I

537
00:17:34,286 --> 00:17:35,421
THINK MANY PEOPLE ARE FAMILIAR

538
00:17:35,487 --> 00:17:37,222
WITH BUT CLEARLY YOU'VE BEEN

539
00:17:37,289 --> 00:17:38,357
THROUGH A LOT, ED, RIGHT?

540
00:17:38,424 --> 00:17:40,526
SO WHEN WE MET ED IN JUNE 2021,

541
00:17:40,592 --> 00:17:41,326
THIS WAS THE PICTURE THAT HE

542
00:17:41,393 --> 00:17:44,163
DREW US.

543
00:17:44,229 --> 00:17:45,264
HIS BRAIN, YOU COULD SEE RIGHT

544
00:17:45,330 --> 00:17:47,232
HERE, I'M GOING TO SHOW YOU,

545
00:17:47,299 --> 00:17:48,867
IT'S FINISHING UP IN THE LAST

546
00:17:48,934 --> 00:17:50,169
MINUTE, AND AS WE PEEL AWAY, YOU

547
00:17:50,235 --> 00:17:52,471
CAN SEE THE ELECTRODES THAT WERE

548
00:17:52,538 --> 00:17:53,906
IN HIS BRAIN.

549
00:17:53,972 --> 00:17:56,208
AND IN THE HOSPITAL, HE

550
00:17:56,275 --> 00:17:57,743
UNDERWENT TESTING AND YOU COULD

551
00:17:57,810 --> 00:17:59,378
SEE THE PAIN MAPS HE STARTED

552
00:17:59,445 --> 00:18:00,579
DRAWING, HE COULD SEE PAIN

553
00:18:00,646 --> 00:18:01,980
APPEARS TO EVEN REALLY HAVE

554
00:18:02,047 --> 00:18:03,282
MELTED OFF HIS BODY, WHICH WE

555
00:18:03,348 --> 00:18:05,050
WERE AMAZED, RIGHT?

556
00:18:05,117 --> 00:18:06,585
SO JUST TO SHOW YOU WHAT THAT

557
00:18:06,652 --> 00:18:09,555
LOOKED LIKE DIRECTLY FROM ED'S

558
00:18:09,621 --> 00:18:10,889
MOUTH, THIS WAS IN THE HOSPITAL

559
00:18:10,956 --> 00:18:15,527
WHEN WE WERE TESTING.

560
00:18:50,462 --> 00:18:55,801
>> SO, OF COURSE, YOU KNOW, I'M

561
00:18:55,868 --> 00:18:56,768
BIASED BECAUSE HE'S IN THE ROOM

562
00:18:56,835 --> 00:18:58,537
BUT HE GOT A PERMANENT IMPLANT

563
00:18:58,604 --> 00:18:58,837
EVENTUALLY.

564
00:18:58,904 --> 00:19:00,506
WE WENT ON TO DO TESTING FOR THE

565
00:19:00,572 --> 00:19:02,908
LAST TWO YEARS AND ESSENTIALLY

566
00:19:02,975 --> 00:19:05,644
HERE YOU CAN SEE HIS CLOSED LOOP

567
00:19:05,711 --> 00:19:07,813
PERFORMANCE ON THE Y AXIS, PAIN

568
00:19:07,880 --> 00:19:08,380
SEVERITY SCORES.

569
00:19:08,447 --> 00:19:10,249
HIS OPEN LOOP STIMULATION, YOU

570
00:19:10,315 --> 00:19:12,718
KNOW, HE WAS HITTING ZEROs

571
00:19:12,784 --> 00:19:14,186
VERY OFTEN.

572
00:19:14,253 --> 00:19:15,921
CLOSED LOOP, WE'RE CONTINUING

573
00:19:15,988 --> 00:19:17,022
THE ANALYSIS NOW BUT IT LOOKS

574
00:19:17,089 --> 00:19:20,859
LIKE HE HAS LESS PAIN SPIKES IN

575
00:19:20,926 --> 00:19:22,060
COMPARISON TO SHAM AND BASELINE.

576
00:19:22,127 --> 00:19:24,563
LAST BUT NOT LEAST, I WANTED TO

577
00:19:24,630 --> 00:19:26,031
SHOW A VIDEO BUT IN THE INTEREST

578
00:19:26,098 --> 00:19:27,299
OF TIME I'M GOING TO PASS IT ON

579
00:19:27,366 --> 00:19:30,102
TO YOU, ED, AND JUST SAY THANKS

580
00:19:30,168 --> 00:19:32,204
AGAIN FOR ED FOR BEING HERE, AND

581
00:19:32,271 --> 00:19:33,739
OUR WHOLE TEAM.

582
00:19:33,805 --> 00:19:35,173
THERE WE GO.

583
00:19:35,240 --> 00:19:37,576
FOR BEING ABLE TO, YOU KNOW --

584
00:19:37,643 --> 00:19:38,577
BEING ABLE TO LEARN A LOT ABOUT

585
00:19:38,644 --> 00:19:39,645
THE BRAIN AND HELP FOLKS LIKE

586
00:19:39,711 --> 00:19:49,721
YOU.

587
00:19:49,788 --> 00:19:51,356
>> HI, EVERYBODY.

588
00:19:51,423 --> 00:19:52,024
I'M EDWARD MOWERY.

589
00:19:52,090 --> 00:19:56,161
I AM THE FOUNDER, VOCALIST AND

590
00:19:56,228 --> 00:20:03,068
BASSIST OF METAL BAND TWINAKU.

591
00:20:03,135 --> 00:20:06,238
OUR LABEL -- FROM MILAN, ITALY.

592
00:20:06,305 --> 00:20:07,973
THE SAME ALBUM RECORDED DURING

593
00:20:08,040 --> 00:20:12,711
THE MEDICAL TRIAL IS ABOUT TO BE

594
00:20:12,778 --> 00:20:13,912
RELEASED ON VINYL AND DC.

595
00:20:13,979 --> 00:20:16,949
I AM ALSO AN AUDIO RECORDING AND

596
00:20:17,015 --> 00:20:18,917
ELECTRONIC AND COMPUTER ENGINEER

597
00:20:18,984 --> 00:20:20,252
BEFORE I WENT TO SCHOOL, I

598
00:20:20,319 --> 00:20:22,554
WORKED IN RESTAURANTS, I STARTED

599
00:20:22,621 --> 00:20:24,056
AS A DISHWASHER AND BECAME A

600
00:20:24,122 --> 00:20:25,257
CHEF AND THEN DECIDED IT WAS

601
00:20:25,324 --> 00:20:27,092
TIME TO GO TO SCHOOL.

602
00:20:27,159 --> 00:20:30,963
I GREW UP AND GRADUATED IN

603
00:20:31,029 --> 00:20:31,296
NEW MEXICO.

604
00:20:31,363 --> 00:20:33,031
I'M SURE YOU HAVE ALL SEEN

605
00:20:33,098 --> 00:20:34,433
OPPENHEIMER RIGHT NOW AND ARE

606
00:20:34,499 --> 00:20:36,868
FAMILIAR WITH OPPY'S TOWN.

607
00:20:36,935 --> 00:20:39,171
MOM WAS PART OWNER OF REALTY AND

608
00:20:39,237 --> 00:20:42,441
MY FATHER WAS IN THE ARMY AND

609
00:20:42,507 --> 00:20:43,342
NUCLEAR ENGINEER.

610
00:20:43,408 --> 00:20:45,510
I'M MARRIED TO MY BEAUTIFUL WIFE

611
00:20:45,577 --> 00:20:47,245
STEPHANIE AND WE LIVE IN

612
00:20:47,312 --> 00:20:49,114
ALBUQUERQUE, NEW MEXICO.

613
00:20:49,181 --> 00:20:51,883
WE ARE REUNITED HIGH SCHOOL

614
00:20:51,950 --> 00:20:54,386
SWEET HEARTS MARRIED IN 2012

615
00:20:54,453 --> 00:20:55,354
AFTER 22 YEARS APART.

616
00:20:55,420 --> 00:20:56,655
SHE'S THE ONLY ONE THAT TRULY

617
00:20:56,722 --> 00:20:58,190
KNOWS WHAT I'VE BEEN THROUGH.

618
00:20:58,256 --> 00:20:59,625
SHE'S LIVED IT WITH ME.

619
00:20:59,691 --> 00:21:01,460
SO SHE HAS ALSO BEEN THROUGH IT.

620
00:21:01,526 --> 00:21:02,694
IMAGINE THE PERSON YOU LOVE

621
00:21:02,761 --> 00:21:03,862
SCREAMING IN THE MIDDLE OF THE

622
00:21:03,929 --> 00:21:05,864
NIGHT IN PAIN, NIGHT AFTER

623
00:21:05,931 --> 00:21:07,499
NIGHT, NOT KNOWING WHEN IT'S

624
00:21:07,566 --> 00:21:08,800
EVER GOING TO END.

625
00:21:08,867 --> 00:21:11,103
MY DAD ALSO HAS STOOD IN FRONT

626
00:21:11,169 --> 00:21:13,405
OF CONGRESS DURING ANOTHER

627
00:21:13,472 --> 00:21:16,241
CRISIS YEARS AND YEARS AGO AND

628
00:21:16,308 --> 00:21:17,476
TOMORROW I'LL BE STANDING IN

629
00:21:17,542 --> 00:21:19,077
FRONT OF CONGRESS FOR A WHOLE

630
00:21:19,144 --> 00:21:21,380
NEW CRISIS, THE OPIOID CRISIS.

631
00:21:21,446 --> 00:21:22,681
I DRIVE FOR A RIDESHARING

632
00:21:22,748 --> 00:21:23,782
COMPANY PART-TIME AND I SEE THE

633
00:21:23,849 --> 00:21:24,783
RESULTS OF THE CRISIS EVERY TIME

634
00:21:24,850 --> 00:21:25,751
I WORK.

635
00:21:25,817 --> 00:21:26,852
OPIATES HAVE THEIR PLACE BUT

636
00:21:26,918 --> 00:21:27,719
THEY DON'T BELONG ON THE

637
00:21:27,786 --> 00:21:30,889
STREETS.

638
00:21:30,956 --> 00:21:32,090
IN MY FINAL DECISION TO GO

639
00:21:32,157 --> 00:21:34,393
THROUGH WITH THE TRIAL, WITH

640
00:21:34,459 --> 00:21:36,795
PRASAD'S KEEM AND UCSF, WHAT I

641
00:21:36,862 --> 00:21:37,896
WANTED MOST WAS, OF COURSE, TO

642
00:21:37,963 --> 00:21:39,031
BE OUT OF PAIN.

643
00:21:39,097 --> 00:21:41,066
BUT I ALSO WANTED TO GET OFF THE

644
00:21:41,133 --> 00:21:45,237
MEDICATIONS.

645
00:21:45,303 --> 00:21:47,673
AND AT ONE TIME, I WILL START

646
00:21:47,739 --> 00:21:48,640
WEANING WITHIN THE NEXT COUPLE

647
00:21:48,707 --> 00:21:52,044
MONTHS, I START WEANING OFF

648
00:21:52,110 --> 00:21:53,679
MORPHINE, LYRICA AND CYMBALTA.

649
00:21:53,745 --> 00:21:59,251
MY PAIN SPECIALIST IS READY.

650
00:21:59,317 --> 00:22:01,787
THAT'S VERY RARE WHEN ANYONE ON

651
00:22:01,853 --> 00:22:03,522
HIS PRACTICE ARE TRYING TO WEAN

652
00:22:03,588 --> 00:22:05,290
OFF THE DRUGS, AND THEY'RE

653
00:22:05,357 --> 00:22:06,258
EXCITED TO HELP ME GET GOING

654
00:22:06,324 --> 00:22:09,428
WITH ALL OF THAT.

655
00:22:09,494 --> 00:22:10,529
DR. NARIN WAS THE ONE WHO

656
00:22:10,595 --> 00:22:12,831
DIAGNOSED ME WITH CRPS IN 2017.

657
00:22:12,898 --> 00:22:16,001
I USED TO BE A PRETTY HARD CORE

658
00:22:16,068 --> 00:22:17,969
DOWNHILL SKIER AND A SOCCER

659
00:22:18,036 --> 00:22:18,837
GOALIE.

660
00:22:18,904 --> 00:22:20,372
AFTER MY FIRST KNEE INJURY ON

661
00:22:20,439 --> 00:22:21,740
THE SOCCER FIELD REQUIRING

662
00:22:21,807 --> 00:22:23,008
SURGERY THE A 14 YEARS OLD, I

663
00:22:23,075 --> 00:22:24,710
FOUND THE GUITAR AND WAS

664
00:22:24,776 --> 00:22:26,178
INSTANTLY HOOKED.

665
00:22:26,244 --> 00:22:28,246
SINCE 14 YEARS OLD, I'VE HAD 29

666
00:22:28,313 --> 00:22:29,881
SURGERIES, BOTH FEET, BOTH

667
00:22:29,948 --> 00:22:31,750
KNEES, I'VE HAD MY KNEE REPLACED

668
00:22:31,817 --> 00:22:34,586
AND REVISED, MY RIGHT KNEE.

669
00:22:34,653 --> 00:22:36,788
MY LUMBAR SPINE AND CERVICAL

670
00:22:36,855 --> 00:22:40,659
SPINE, C3 TO T1, L4 TO S1 DISKS

671
00:22:40,726 --> 00:22:42,227
HAVE BEEN REPLACED AND FUSED.

672
00:22:42,294 --> 00:22:44,963
WHEN I FIRST FOUND OUT ABOUT THE

673
00:22:45,030 --> 00:22:47,399
UCSF TRIAL ENTAILING THREE BRAIN

674
00:22:47,466 --> 00:22:48,333
SURGERIES, IT SCARED THE HELL

675
00:22:48,400 --> 00:22:48,934
OUT OF ME.

676
00:22:49,000 --> 00:22:49,668
I RAN AT FIRST.

677
00:22:49,735 --> 00:22:53,505
BUT THEN MY PAIN GOT SO BAD AND

678
00:22:53,572 --> 00:22:54,940
SO BRUTAL THAT I HAD NO OTHER

679
00:22:55,006 --> 00:22:57,008
CHOICE BUT TO GO THROUGH WITH

680
00:22:57,075 --> 00:22:58,643
THE TRIAL, AND NOW I WISH I

681
00:22:58,710 --> 00:22:59,311
WOULDN'T HAVE WAITED.

682
00:22:59,377 --> 00:23:01,480
I WAITED A YEAR AND A HALF

683
00:23:01,546 --> 00:23:02,380
BEFORE ACTUALLY GOING THROUGH

684
00:23:02,447 --> 00:23:04,750
WITH IT, AND I WISH I WOULD HAVE

685
00:23:04,816 --> 00:23:07,385
DONE IT A LOT SOONER.

686
00:23:07,452 --> 00:23:10,355
THE DESCRIPTION OF MY PAIN AT

687
00:23:10,422 --> 00:23:12,858
ITS WORST, THIS IS ALL ON THE

688
00:23:12,924 --> 00:23:14,292
INSIDE, NO ONE CAN SEE IT UNLESS

689
00:23:14,359 --> 00:23:15,160
THEY SEE ME IN IT.

690
00:23:15,227 --> 00:23:17,996
I HAVE WHAT I CALL TWO LIGHTNING

691
00:23:18,063 --> 00:23:19,331
BOLT RAZOR SNAKES THAT COME OUT

692
00:23:19,397 --> 00:23:21,633
OF MY BIG TOES AND WREAK HAVOC

693
00:23:21,700 --> 00:23:23,135
ALL UP AND DOWN MY LEGS AND INTO

694
00:23:23,201 --> 00:23:23,468
MY LOW BACK.

695
00:23:23,535 --> 00:23:25,670
I WOULD LITERALLY REACH DOWN TO

696
00:23:25,737 --> 00:23:28,640
SEE IF I WAS CUT AND BLEEDING

697
00:23:28,707 --> 00:23:30,709
WHEN THE SNAKES CAME OUT IN MY

698
00:23:30,776 --> 00:23:31,243
LEGS.

699
00:23:31,309 --> 00:23:32,477
I BELIEVE THAT WAS THE WORST OF

700
00:23:32,544 --> 00:23:34,646
MY CRPS PAIN.

701
00:23:34,713 --> 00:23:36,047
BRAIN MANUFACTURED PAIN, NO

702
00:23:36,114 --> 00:23:38,350
CUTS, NO BRUISES, NOTHING AT ALL

703
00:23:38,416 --> 00:23:39,551
TO SEE, WITH THE EXCEPTION OF

704
00:23:39,618 --> 00:23:41,920
HOW I REACTED TO IT.

705
00:23:41,987 --> 00:23:43,722
AT ONE POINT, JUST BEFORE PRASAD

706
00:23:43,789 --> 00:23:45,991
AND DR. SHANE GAVE ME MY FIRST

707
00:23:46,057 --> 00:23:48,093
PERMANENT -- MY IMPLANTS, I WAS

708
00:23:48,160 --> 00:23:49,294
IN THE WORST PAIN OF MY LIFE,

709
00:23:49,361 --> 00:23:50,495
WHICH IS WHAT I'M DESCRIBING

710
00:23:50,562 --> 00:23:51,696
NOW.

711
00:23:51,763 --> 00:23:53,598
I ALSO DEAL WITH RADICULAR

712
00:23:53,665 --> 00:23:56,201
LUMBAR PAIN, RADICULAR NECK

713
00:23:56,268 --> 00:24:00,138
CERVICAL PAIN, PERIPHERAL

714
00:24:00,205 --> 00:24:01,173
NEUROPATHY, FIBROMYALGIA AND

715
00:24:01,239 --> 00:24:01,439
GOUT PAIN.

716
00:24:01,506 --> 00:24:04,476
I DON'T WISH CRPS ON ANY HUMAN

717
00:24:04,543 --> 00:24:06,912
IN THE PLANET, NOT EVEN MY WORST

718
00:24:06,978 --> 00:24:07,245
ENEMY.

719
00:24:07,312 --> 00:24:08,613
THE BRAIN DISEASE HAS BEEN HELL

720
00:24:08,680 --> 00:24:11,383
TO DEAL WITH FOR MY WIFE AND ME.

721
00:24:11,449 --> 00:24:12,918
IT'S NOT JUST THE ONES THAT ARE

722
00:24:12,984 --> 00:24:15,554
IN PAIN, IT'S YOUR LOVED ONES

723
00:24:15,620 --> 00:24:17,622
AND COLLEAGUES TOO.

724
00:24:17,689 --> 00:24:21,126
I'M IN A FACEBOOK GROUP CALLED

725
00:24:21,193 --> 00:24:23,295
POSITIVITY WITH RSD OR CSRP.ORG.

726
00:24:23,361 --> 00:24:24,629
THERE ARE SEVERAL OTHER SUPPORT

727
00:24:24,696 --> 00:24:27,666
GROUPS FOR CRPS PATIENTS BUT FOR

728
00:24:27,732 --> 00:24:28,733
ME, THIS WAS THE ONE, AND

729
00:24:28,800 --> 00:24:29,634
THERE'S THOUSANDS OF US THAT

730
00:24:29,701 --> 00:24:32,604
NEED HELP.

731
00:24:32,671 --> 00:24:34,339
RECENTLY I WENT BACK TO WORK FOR

732
00:24:34,406 --> 00:24:35,540
A RIDESHARING COMPANY WHEN I

733
00:24:35,607 --> 00:24:36,675
CALLED MY DISABILITY LAWYER TO

734
00:24:36,741 --> 00:24:39,077
FIND OUT THE DETAILS OF LEAVING

735
00:24:39,144 --> 00:24:39,377
DISABILITY.

736
00:24:39,444 --> 00:24:40,812
SHE WAS IMMEDIATELY TAKEN BACK.

737
00:24:40,879 --> 00:24:42,547
I DIDN'T HEAR ONE WORD OUT OF

738
00:24:42,614 --> 00:24:43,748
HER FOR ABOUT 20 SECONDS AND

739
00:24:43,815 --> 00:24:45,383
THEN SHE SAYS, YOU'RE THE FIRST

740
00:24:45,450 --> 00:24:48,687
ONE IN 25 YEARS TO EVER CALL AND

741
00:24:48,753 --> 00:24:51,756
ASK HOW TO GET OFF DISABILITY,

742
00:24:51,823 --> 00:24:53,592
NOT GET ON.

743
00:24:53,658 --> 00:24:55,994
DURING THE 10-DAY TRIAL, I

744
00:24:56,061 --> 00:24:58,230
BROUGHT MY GUITAR WITH ME, MY

745
00:24:58,296 --> 00:24:59,297
LAPTOP AND A SMALL RECORDING

746
00:24:59,364 --> 00:24:59,731
INTERFACE.

747
00:24:59,798 --> 00:25:00,932
I'M WRITING A METAL SONG ABOUT

748
00:25:00,999 --> 00:25:02,334
THE TRIAL ACTUALLY.

749
00:25:02,400 --> 00:25:04,769
I WAS IN USCF HOSPITAL FOR 10

750
00:25:04,836 --> 00:25:06,171
DAYS LIKE PRASAD SAID.

751
00:25:06,238 --> 00:25:09,574
EVERY DAY WE TESTED THE

752
00:25:09,641 --> 00:25:13,745
TEMPORARY 144 POINTS IN MY HEAD.

753
00:25:13,812 --> 00:25:15,714
THE KAY AFTER THAT MY FIRST

754
00:25:15,780 --> 00:25:16,915
TEMPORARY BRAIN SURGERY.

755
00:25:16,982 --> 00:25:18,116
MY THOUGHTS WERE STAY POSITIVE

756
00:25:18,183 --> 00:25:19,517
AND DO EVERYTHING THEY ASK OF

757
00:25:19,584 --> 00:25:20,085
ME, AND I DID.

758
00:25:20,151 --> 00:25:26,091
I CALLED THE WIRE ON MY HEAD MY

759
00:25:26,157 --> 00:25:26,858
PREDATOR BRAID.

760
00:25:26,925 --> 00:25:28,493
I MADE JOKES ABOUT IT AND GOT

761
00:25:28,560 --> 00:25:29,995
THROUGH IT THE BEST I POSSIBLY

762
00:25:30,061 --> 00:25:30,262
COULD.

763
00:25:30,328 --> 00:25:31,897
THEY HAD ME PACING UP AND DOWN

764
00:25:31,963 --> 00:25:34,332
THE HALLWAY IN THE HOSPITAL

765
00:25:34,399 --> 00:25:35,600
WHILE I WAS TESTING.

766
00:25:35,667 --> 00:25:37,836
WE HAD A HOT SAUCE TEST, WE HAD

767
00:25:37,903 --> 00:25:39,004
SHAM TESTING.

768
00:25:39,070 --> 00:25:40,872
MY PAIN JUMPED ALL OVER THE MAP

769
00:25:40,939 --> 00:25:44,142
DURING SHAM TESTING.

770
00:25:44,209 --> 00:25:45,443
THEN IN THE LAST TWO DAYS OF

771
00:25:45,510 --> 00:25:47,112
TESTING, THE SIGNAL STARTED

772
00:25:47,178 --> 00:25:48,179
WORKING AND KILLING MY PAIN.

773
00:25:48,246 --> 00:25:49,381
I WAS BESIDE MYSELF.

774
00:25:49,447 --> 00:25:51,149
IT WAS LIKE I'D LOST A BEST

775
00:25:51,216 --> 00:25:54,519
FRIEND, AND THAT WAS THE PAIN.

776
00:25:54,586 --> 00:25:56,388
I STILL HAVE PAIN SPIKES POP UP

777
00:25:56,454 --> 00:25:57,522
SOMETIMES -- I DON'T HAVE ANY IN

778
00:25:57,589 --> 00:25:59,090
A DAY, SOMETIMES I'LL HAVE THREE

779
00:25:59,157 --> 00:26:02,594
OR FOUR, FIVE IN A WEEK.

780
00:26:02,661 --> 00:26:04,596
AND I CAN FEEL THE ADAPTIVE

781
00:26:04,663 --> 00:26:05,997
PROGRAM KICK ON AND TURN OFF THE

782
00:26:06,064 --> 00:26:07,632
PAIN IN MY FEET.

783
00:26:07,699 --> 00:26:09,801
I'M LIKE, IT STARTS TO GO UP AND

784
00:26:09,868 --> 00:26:11,136
I'M LIKE, OH, HERE COMES THE

785
00:26:11,202 --> 00:26:13,338
PAIN, AND THEN -- OOP, IT'S

786
00:26:13,405 --> 00:26:13,638
GONE.

787
00:26:13,705 --> 00:26:16,608
IT'S REALLY COOL.

788
00:26:16,675 --> 00:26:17,709
I'M STANDING HERE RIGHT IN FRONT

789
00:26:17,776 --> 00:26:20,545
OF YOU ALL AS LIVING PROOF THAT

790
00:26:20,612 --> 00:26:21,846
DBS WORKS FOR PAIN.

791
00:26:21,913 --> 00:26:24,716
PRASAD AND HIS TEAM AT UCF HAVE

792
00:26:24,783 --> 00:26:26,551
GIVEN ME MY LIFE BACK, AND I'M

793
00:26:26,618 --> 00:26:27,986
NOT SQUANDERING MY SECOND CHANCE

794
00:26:28,053 --> 00:26:28,954
AT LIFE.

795
00:26:29,020 --> 00:26:31,056
THANK YOU GUYS, AND THANK YOU,

796
00:26:31,122 --> 00:26:41,266
PRASAD.

797
00:26:49,040 --> 00:26:50,842
>> DR. ALI REZAI.

798
00:26:50,909 --> 00:26:53,244
>> GOOD MORNING.

799
00:26:53,311 --> 00:26:54,346
ED, YOU'RE WHY WE'RE ALL HERE,

800
00:26:54,412 --> 00:26:55,347
SO THANK YOU FOR SHARING YOUR

801
00:26:55,413 --> 00:26:56,414
EXPERIENCE.

802
00:26:56,481 --> 00:26:58,249
FIRST SLIDE, IF I MAY, PLEASE.

803
00:26:58,316 --> 00:27:01,152
SO I'D LIKE TO GIVE THE RESULTS

804
00:27:01,219 --> 00:27:05,724
OF OUR DEEP BRAIN STIMULATION

805
00:27:05,790 --> 00:27:08,460
AND FOCUSED ULTRASOUND

806
00:27:08,526 --> 00:27:09,995
PROCEDURES FOR OPIOID USE

807
00:27:10,061 --> 00:27:10,428
DISORDER.

808
00:27:10,495 --> 00:27:13,898
I WANT TO THANK DR. VOLKOW,

809
00:27:13,965 --> 00:27:17,869
DR. AKLIN, KEVIN WALTON, AND

810
00:27:17,936 --> 00:27:18,837
JENNIFER WONG FOR THEIR SUPPORT.

811
00:27:18,903 --> 00:27:22,340
IF IT WASN'T FOR KEVIN AND WILL

812
00:27:22,407 --> 00:27:23,875
AND DR. VOLKOW, WE WOULD NOT BE

813
00:27:23,942 --> 00:27:24,542
HERE.

814
00:27:24,609 --> 00:27:26,177
SO FIVE YEARS AGO, THEY BELIEVED

815
00:27:26,244 --> 00:27:27,579
IN THIS OPPORTUNITY TO PUSH

816
00:27:27,645 --> 00:27:30,315
FORWARD THE FRONTIERS OF

817
00:27:30,382 --> 00:27:30,949
NEUROMODULATION.

818
00:27:31,016 --> 00:27:31,983
SO WE APPRECIATE THAT.

819
00:27:32,050 --> 00:27:37,655
WITHOUT YOU, WE COULD NOT DO IT.

820
00:27:37,722 --> 00:27:41,159
SO CAN YOU GET THE SLIDES GOING,

821
00:27:41,226 --> 00:27:45,096
BY ANY CHANCE?

822
00:27:45,163 --> 00:27:46,398
WILL YOU GIVE ME EXTRA TIME?

823
00:27:46,464 --> 00:27:47,065
JUST KIDDING.

824
00:27:47,132 --> 00:27:47,699
I'LL JUST START.

825
00:27:47,766 --> 00:27:50,769
SO BASICALLY, THERE ARE MANY

826
00:27:50,835 --> 00:27:52,103
NETWORKS IN THE BRAIN, CORTICAL

827
00:27:52,170 --> 00:27:54,172
AND SUBCORTICAL NETWORKS IN THE

828
00:27:54,239 --> 00:27:56,908
BRAIN THAT ARE INVOLVED IN THE

829
00:27:56,975 --> 00:27:59,544
REWARD CIRCUITRY OF ADDICTION,

830
00:27:59,611 --> 00:28:03,148
AND NEUROMODULATION CAN BE USED

831
00:28:03,214 --> 00:28:04,549
FOR POTENTIAL ADJUNCTIVE

832
00:28:04,616 --> 00:28:06,217
TREATMENT IN ADDITION TO

833
00:28:06,284 --> 00:28:08,053
MEDICATIONS AND BEHAVIORAL

834
00:28:08,119 --> 00:28:08,386
THERAPY.

835
00:28:08,453 --> 00:28:10,789
SO YOU DELIVER MAGNETIC ENERGY

836
00:28:10,855 --> 00:28:12,223
TO DIFFERENT NODES IN THE BRAIN

837
00:28:12,290 --> 00:28:15,160
WITH TMS, YOU DELIVER ELECTRICAL

838
00:28:15,226 --> 00:28:17,695
ENERGY WITH TDCS, AND WITH DEEP

839
00:28:17,762 --> 00:28:19,664
BRAIN STIMULATION, AND YOU

840
00:28:19,731 --> 00:28:22,067
DELIVER ULTRASOUND ENERGY.

841
00:28:22,133 --> 00:28:25,570
SO ONE OF THE KEY ASPECTS FOR

842
00:28:25,637 --> 00:28:27,205
DBS AND FOCUSED ULTRASOUND IS

843
00:28:27,272 --> 00:28:28,406
THAT WE CAN DELIVER THE ENERGY

844
00:28:28,473 --> 00:28:30,442
DEEP INTO THE BRAIN INTO THE

845
00:28:30,508 --> 00:28:32,010
NUCLEUS ACCUMBENS.

846
00:28:32,077 --> 00:28:34,512
SO THIS IS WHY WE STARTED THIS

847
00:28:34,579 --> 00:28:37,916
STUDY, DECADES OF WORK WITH ABUM

848
00:28:37,982 --> 00:28:41,853
KENS THAT SHOWS THE CIRCUITRY.

849
00:28:41,920 --> 00:28:45,123
WE DECIDED TO EXPLORE DEEP BRAIN

850
00:28:45,190 --> 00:28:45,757
STIMULATION FIRST OF THE NUCLEUS

851
00:28:45,824 --> 00:28:47,325
ACCUMBENS FOR SEVERE OPIOID USE

852
00:28:47,392 --> 00:28:47,659
DISORDER.

853
00:28:47,725 --> 00:28:52,230
THIS IS BASED ON YEARS OF

854
00:28:52,297 --> 00:28:53,465
RESEARCH PRECLINICALLY AND ALSO

855
00:28:53,531 --> 00:28:56,534
SEVERAL PAPERS FROM GROUPS IN

856
00:28:56,601 --> 00:28:58,736
EUROPE, IN CHINA, IN CANADA,

857
00:28:58,803 --> 00:29:01,773
THAT THEY LOOKED AT DEEP BRAIN

858
00:29:01,840 --> 00:29:04,843
STIMULATION FOR ALCOHOLISM,

859
00:29:04,909 --> 00:29:08,880
SEVERE AUD AND OPIOID COCAINE

860
00:29:08,947 --> 00:29:09,848
AND OTHER DISORDERS.

861
00:29:09,914 --> 00:29:13,017
SO THAT'S LED TO NIDA SPONSORING

862
00:29:13,084 --> 00:29:16,654
IN 2018 A UG STUDY LOOKING AT

863
00:29:16,721 --> 00:29:17,856
DEEP BRAINSTEM LAITION

864
00:29:17,922 --> 00:29:19,591
FEASIBILITY AND SAFETY STUDY OF

865
00:29:19,657 --> 00:29:22,794
THE -- IN THE NUCLEUS ACCUMBENS.

866
00:29:22,861 --> 00:29:25,964
AND WE STARTED THAT WITH A

867
00:29:26,030 --> 00:29:26,931
FOUR-PATIENT -- ARE THE SLIDES

868
00:29:26,998 --> 00:29:28,566
GOING TO GO OR SHOULD I JUST

869
00:29:28,633 --> 00:29:29,334
CONTINUE?

870
00:29:29,400 --> 00:29:30,001
OKAY.

871
00:29:30,068 --> 00:29:31,769
SO WE DID A FOUR-PATIENT SAFETY

872
00:29:31,836 --> 00:29:32,637
AND FEASIBILITY LOOKING AT

873
00:29:32,704 --> 00:29:38,209
PEOPLE WITH SEVERE OPIOID USE

874
00:29:38,276 --> 00:29:39,744
DISORDER AND THOSE WHO HAVE

875
00:29:39,811 --> 00:29:41,379
FAILED MULTIPLE TREATMENTS,

876
00:29:41,446 --> 00:29:43,148
MULTIPLE OVERDOSES AND WERE VERY

877
00:29:43,214 --> 00:29:44,449
DISABLED AND THEY UNDERWENT THIS

878
00:29:44,516 --> 00:29:46,217
STUDY.

879
00:29:46,284 --> 00:29:49,921
FOUR PARTICIPANTS, YEARS OF

880
00:29:49,988 --> 00:29:52,257
MEDICATION USE, THEY ALL HAD

881
00:29:52,323 --> 00:29:54,959
MEDICATIONS FOR OPIOIDS.

882
00:29:55,026 --> 00:29:57,395
SUBOXONE, METHADONE, AND

883
00:29:57,462 --> 00:30:00,798
MULTIPLE OVERDOSES AND VERY

884
00:30:00,865 --> 00:30:01,633
SEVERE.

885
00:30:01,699 --> 00:30:02,934
AND THEIR RESULTS WERE VERY

886
00:30:03,001 --> 00:30:04,502
PROMISING IN TERMS OF ACUTELY

887
00:30:04,569 --> 00:30:09,407
BEING ABLE TO -- NO, I'M JUST

888
00:30:09,474 --> 00:30:10,175
GOING -- IT'S OKAY.

889
00:30:10,241 --> 00:30:12,143
BUT IT WAS WORKING EARLIER,

890
00:30:12,210 --> 00:30:12,810
SO -- OKAY.

891
00:30:12,877 --> 00:30:14,445
I'M OKAY, I'M OKAY.

892
00:30:14,512 --> 00:30:16,181
I'M JUST GOING BY MEMORY.

893
00:30:16,247 --> 00:30:16,514
SORRY.

894
00:30:16,581 --> 00:30:17,715
WE'LL JUST IMPROVISE.

895
00:30:17,782 --> 00:30:18,917
IS THAT OKAY?

896
00:30:18,983 --> 00:30:21,119
SO BASICALLY, WHAT WE -- ONE

897
00:30:21,186 --> 00:30:22,954
IMPORTANT THING WAS THAT DURING

898
00:30:23,021 --> 00:30:24,989
THE SURGERY WITH THE BRAIN --

899
00:30:25,056 --> 00:30:25,924
THANK YOU VERY MUCH!

900
00:30:25,990 --> 00:30:27,225
OH, NO, I SEE IT THERE BUT I

901
00:30:27,292 --> 00:30:27,992
DON'T SEE IT HERE.

902
00:30:28,059 --> 00:30:28,326
OKAY.

903
00:30:28,393 --> 00:30:29,427
THERE WE GO.

904
00:30:29,494 --> 00:30:30,862
DO I GET THAT TIME BACK?

905
00:30:30,929 --> 00:30:32,096
NO, I'M JUST KIDDING.

906
00:30:32,163 --> 00:30:33,831
CAN I SEE IT HERE AS WELL IF

907
00:30:33,898 --> 00:30:34,365
POSSIBLE?

908
00:30:34,432 --> 00:30:36,568
CAN THEY SHOW IT ON THIS MONITOR

909
00:30:36,634 --> 00:30:37,535
AS WELL?

910
00:30:37,602 --> 00:30:40,939
OKAY, SO BASICALLY LOOKING AT AS

911
00:30:41,005 --> 00:30:42,340
POTENTIAL ADJUNCTIVE TREATMENT,

912
00:30:42,407 --> 00:30:48,046
MULTIPLE ENERGIES, TMS, TDCS,

913
00:30:48,112 --> 00:30:49,147
DBS -- DEEP BRAIN STIMULATION WE

914
00:30:49,214 --> 00:30:51,115
TALKED ABOUT STUDIES ACROSS THE

915
00:30:51,182 --> 00:30:51,449
WORLD.

916
00:30:51,516 --> 00:30:53,518
FEW PATIENTS, NOT RANDOMIZED

917
00:30:53,585 --> 00:30:54,285
CONTROL TRIAL.

918
00:30:54,352 --> 00:30:58,022
INITIAL UG NIDA SPONSORED STUDY,

919
00:30:58,089 --> 00:31:02,493
2018, SEVERE OUD AND LIFE THREAT

920
00:31:02,560 --> 00:31:03,261
LIFE-THREATENING OVERDOSES.

921
00:31:03,328 --> 00:31:05,230
THIS IS THE PROTOCOL, INVOLVED

922
00:31:05,296 --> 00:31:06,197
INPATIENT ASSESSMENTS.

923
00:31:06,264 --> 00:31:08,600
AT BASELINE, AND THEN THE FDG

924
00:31:08,666 --> 00:31:10,802
PET TO LOOK AT BRAIN METABOLISM

925
00:31:10,868 --> 00:31:15,607
AND THEN LONG-TERM FOLLOW LN UPS

926
00:31:15,673 --> 00:31:18,876
OUTPATIENTS IN THEIR NATURAL

927
00:31:18,943 --> 00:31:20,745
ENVIRONMENT.

928
00:31:20,812 --> 00:31:22,313
FOUR PATIENTS, MULTIPLE YEARS OF

929
00:31:22,380 --> 00:31:25,883
DRUG USE, AND ON AVERAGE, THEY

930
00:31:25,950 --> 00:31:27,552
TOOK SUBSTANCES ONE WEEK BEFORE

931
00:31:27,619 --> 00:31:29,187
THEY WERE ENROLLED.

932
00:31:29,254 --> 00:31:31,923
MANY, MANY SUBSTANCES.

933
00:31:31,990 --> 00:31:33,358
TARGETING THE BRAIN, BILATERAL

934
00:31:33,424 --> 00:31:34,759
NUCLEUS ACCUMBENS SEEN ON

935
00:31:34,826 --> 00:31:36,928
IMAGING AND TRACTOGRAPHY.

936
00:31:36,995 --> 00:31:41,099
HERE'S AN EXAMPLE, ACUTE

937
00:31:41,165 --> 00:31:44,168
REDUCTIONS IN CREW INDUCED

938
00:31:44,235 --> 00:31:46,004
CRAVING WITH ELECTROSTIMULATION

939
00:31:46,070 --> 00:31:47,005
TURNED ON.

940
00:31:47,071 --> 00:31:48,339
I HOPE THE VIDEO PLAYS.

941
00:31:48,406 --> 00:31:49,874
CAN YOU TURN ON THE AUDIO,

942
00:31:49,941 --> 00:31:52,610
PLEASE?

943
00:31:52,677 --> 00:32:02,654
THANK YOU.

944
00:32:02,720 --> 00:32:09,460
[INAUDIBLE]

945
00:32:09,527 --> 00:32:12,063
>> SO ACUTELY, WITHIN SECONDS,

946
00:32:12,130 --> 00:32:13,931
CRAVING DECREASED FOR THE

947
00:32:13,998 --> 00:32:14,899
SUBSTANCE WITH Q INDUCTION.

948
00:32:14,966 --> 00:32:16,367
THIS WAS VERY CONSISTENT ACROSS

949
00:32:16,434 --> 00:32:17,769
THE SUBJECTS.

950
00:32:17,835 --> 00:32:20,271
SO THE OUTCOMES, WELL-TOLERATED,

951
00:32:20,338 --> 00:32:22,874
NO SERIOUS ADVERSE EFFECTS.

952
00:32:22,940 --> 00:32:23,908
REDUCTION OF CRAVINGS AND

953
00:32:23,975 --> 00:32:25,510
ANXIETY IN ALL PARTICIPANTS.

954
00:32:25,576 --> 00:32:29,247
TWO PATIENTS HAD COMPLETE

955
00:32:29,314 --> 00:32:30,648
ABSTINENCE, 1700 DAYS AND 1100

956
00:32:30,715 --> 00:32:33,718
DAYS POST DBS, AND FDG-PET IN

957
00:32:33,785 --> 00:32:35,253
THESE TWO INDIVIDUALS REVEALED

958
00:32:35,320 --> 00:32:36,287
INCREASED GLUCOSE METABOLISM IN

959
00:32:36,354 --> 00:32:37,555
THE FRONTAL REGION BEFORE AND

960
00:32:37,622 --> 00:32:39,857
AFTER DBS, SMALL NUMBER.

961
00:32:39,924 --> 00:32:40,925
CAUTION ABOUT CONCLUSIONS ON

962
00:32:40,992 --> 00:32:41,392
THAT.

963
00:32:41,459 --> 00:32:43,995
ONE PATIENT HAD DRUG RECURRENCE

964
00:32:44,062 --> 00:32:45,697
USE, NO OVERDOSES BUT ACHIEVED

965
00:32:45,763 --> 00:32:48,266
FOUR MONTHS OF ABSTINENCE AND

966
00:32:48,333 --> 00:32:50,134
DISCONTINUED PARTICIPATION THREE

967
00:32:50,201 --> 00:32:51,769
YEARS DUE TO PROTOCOL FATIGUE

968
00:32:51,836 --> 00:32:54,939
AND NOT WANTING TO COME BACK AND

969
00:32:55,006 --> 00:32:55,707
UNDERGO EVALUATIONS.

970
00:32:55,773 --> 00:32:57,675
AND THE LAST PARTICIPANT WAS

971
00:32:57,742 --> 00:32:59,744
EXPLANTED DUE TO PERSISTENT

972
00:32:59,811 --> 00:33:02,280
NONCOMPLIANCE WITH THE STUDY.

973
00:33:02,347 --> 00:33:04,782
SO DBS, THE UGUH PHASE INITIALLY

974
00:33:04,849 --> 00:33:07,852
IS SAFE AND FEASIBLE FOR SEVERE

975
00:33:07,919 --> 00:33:08,252
OUD.

976
00:33:08,319 --> 00:33:10,388
RESULTS ARE ENCOURAGING OF

977
00:33:10,455 --> 00:33:11,356
REDUCED CRAVING AND USE.

978
00:33:11,422 --> 00:33:13,524
IT IS AN INVASIVE BRAIN

979
00:33:13,591 --> 00:33:13,958
PROCEDURE.

980
00:33:14,025 --> 00:33:16,394
BRAIN SURGERY HAS SIGNIFICANT

981
00:33:16,461 --> 00:33:17,595
REQUIREMENTS FOR MAINTENANCE OF

982
00:33:17,662 --> 00:33:19,997
THE IMPLANTS, BAT REAS CHANGES

983
00:33:20,064 --> 00:33:21,733
AND PROBLEMS MANAGEMENT OF THE

984
00:33:21,799 --> 00:33:24,268
DEVICE, HAVE TO COME BACK A LOT.

985
00:33:24,335 --> 00:33:25,336
INTENSE PROTOCOL DEMANDS THAT

986
00:33:25,403 --> 00:33:26,971
MADE THE STUDY RETENTION

987
00:33:27,038 --> 00:33:27,872
PROBLEMATIC.

988
00:33:27,939 --> 00:33:30,174
RECRUITMENT WAS A CHALLENGE,

989
00:33:30,241 --> 00:33:30,975
RECRUITED FOUR PATIENTS OVER TWO

990
00:33:31,042 --> 00:33:34,078
YEARS, SO IT WAS VERY DIFFICULT

991
00:33:34,145 --> 00:33:35,613
TO FIND A LARGE POPULATION.

992
00:33:35,680 --> 00:33:36,381
SCALING POTENTIAL IS LIMITED.

993
00:33:36,447 --> 00:33:38,716
SO WE WANT TO EXPLORE OTHER

994
00:33:38,783 --> 00:33:38,950
ASPECTS.

995
00:33:39,016 --> 00:33:40,218
IN THE SAME TIME, THERE'S BEEN

996
00:33:40,284 --> 00:33:42,520
CHANGES GOING ON WITH FOCUSED

997
00:33:42,587 --> 00:33:44,155
ULTRASOUND IN THE WORLD OF

998
00:33:44,222 --> 00:33:49,093
NEUROSURGERY, WHICH IS REA HAS Y

999
00:33:49,160 --> 00:33:50,194
DRAMATICALLY CHANGED THE

1000
00:33:50,261 --> 00:33:51,496
LANDSCAPE OF PROCEDURES WE'RE

1001
00:33:51,562 --> 00:33:52,397
DOING AS NEUROSURGEONS.

1002
00:33:52,463 --> 00:33:53,865
IT'S A FOCUSED ULTRASOUND

1003
00:33:53,931 --> 00:33:54,232
SYSTEM.

1004
00:33:54,298 --> 00:33:56,300
YOU LIE IN MRI, HELMET COMES

1005
00:33:56,367 --> 00:33:59,137
OVER YOUR HEAD, IT HAS 1,000

1006
00:33:59,203 --> 00:33:59,837
ULTRASOUND PROBES THAT YOU CAN

1007
00:33:59,904 --> 00:34:01,439
BEAM AND TARGET ANYWHERE YOU

1008
00:34:01,506 --> 00:34:04,942
PRESCRIBE IN MRI CORTICALLY,

1009
00:34:05,009 --> 00:34:06,244
SUBCORTICALLY, THALAMUS.

1010
00:34:06,310 --> 00:34:07,678
15,000 PROCEDURES DONE

1011
00:34:07,745 --> 00:34:08,346
FDA-APPROVED STANDARD OF CARE

1012
00:34:08,413 --> 00:34:10,314
FOR PEOPLE WITH SEVERE TREMOR

1013
00:34:10,381 --> 00:34:10,748
AND PARKINSON'S.

1014
00:34:10,815 --> 00:34:13,117
IN FACT, LAST YEAR THERE WERE

1015
00:34:13,184 --> 00:34:14,485
MORE FOCUSED ULTRASOUNDS FOR

1016
00:34:14,552 --> 00:34:15,453
TREMOR THAN DBS.

1017
00:34:15,520 --> 00:34:17,088
SO THE FIELD IS CHANGING

1018
00:34:17,155 --> 00:34:17,989
DRAMATICALLY.

1019
00:34:18,055 --> 00:34:18,623
APPLICATIONS.

1020
00:34:18,689 --> 00:34:22,093
THE MOST COMMON STANDARD IS FOR

1021
00:34:22,160 --> 00:34:23,361
TREMOR IN PARKINSON'S, YOU MAKE

1022
00:34:23,428 --> 00:34:25,930
A SMALL LESION IN THE BRAIN.

1023
00:34:25,997 --> 00:34:28,466
SECOND APPLICATION, RAPIDLY

1024
00:34:28,533 --> 00:34:30,768
EXPLODING, IS TARGETED BLOOD

1025
00:34:30,835 --> 00:34:32,703
BRAIN OPENING WITH FOCUSED

1026
00:34:32,770 --> 00:34:33,938
ULTRASOUND FOR DRUG DELIVERY.

1027
00:34:34,005 --> 00:34:35,139
AND THEN THE ONE THAT WE HAVE

1028
00:34:35,206 --> 00:34:37,108
LOOKED AT MORE IS

1029
00:34:37,175 --> 00:34:38,176
NEUROMODULATION WITH LOW

1030
00:34:38,242 --> 00:34:40,511
INTENSITY FOCUSED BEAM DELIVERY.

1031
00:34:40,578 --> 00:34:42,480
SO THIS HAS BEEN SHOWN IN 100

1032
00:34:42,547 --> 00:34:46,651
PROCEDURES SO FAR, SO WE USED

1033
00:34:46,717 --> 00:34:48,719
INSIGHTEC HELMET, YOU LIE IN THE

1034
00:34:48,786 --> 00:34:50,221
MRI, HELMET COMES OVER YOUR

1035
00:34:50,288 --> 00:34:51,589
HEAD, IT'S A LOW INTENSITY

1036
00:34:51,656 --> 00:34:52,790
SYSTEM AND WE DELIVER THE

1037
00:34:52,857 --> 00:34:53,858
THOUSAND ULTRASOUND PROBES TO

1038
00:34:53,925 --> 00:34:55,927
THE PINPOINT AREA IN THE

1039
00:34:55,993 --> 00:34:58,096
ACCUMBENS AND DELIVER ULTRASOUND

1040
00:34:58,162 --> 00:34:58,529
ENERGY.

1041
00:34:58,596 --> 00:35:00,965
WHEN YOU'RE LOOKING AT THE HEART

1042
00:35:01,032 --> 00:35:02,400
OR -- THIS IS A THOUSAND OF THEM

1043
00:35:02,467 --> 00:35:03,367
BEING CONVERGED ON A POINT.

1044
00:35:03,434 --> 00:35:04,669
SO THIS LED US TO DO A SAFETY

1045
00:35:04,735 --> 00:35:05,002
STUDY.

1046
00:35:05,069 --> 00:35:06,971
WE DID NOT KNOW IF ULTRASOUND

1047
00:35:07,038 --> 00:35:08,940
HAS ANY IMPACT SAFETY OR OTHERS,

1048
00:35:09,006 --> 00:35:11,676
SO WE STARTED A SAFETY STUDY

1049
00:35:11,742 --> 00:35:12,343
WITH FDA.

1050
00:35:12,410 --> 00:35:13,644
FOUR PARTICIPANTS FROM

1051
00:35:13,711 --> 00:35:15,947
OUTPATIENT PROGRAM, UNILATERAL,

1052
00:35:16,013 --> 00:35:17,248
LET'S DO ONE SIDE AT A TIME TO

1053
00:35:17,315 --> 00:35:18,783
MAKE SURE IT'S SAFE ON THE

1054
00:35:18,850 --> 00:35:19,917
ACCUMBENS AND WE DEMONSTRATED IT

1055
00:35:19,984 --> 00:35:21,519
WAS SAFE AND WELL TOLERATED WITH

1056
00:35:21,586 --> 00:35:22,720
THE POTENTIAL SIGNAL FOR

1057
00:35:22,787 --> 00:35:24,789
REDUCING CRAVINGS IN 90 DAYS,

1058
00:35:24,856 --> 00:35:26,457
AND THAT GAVE US A DOSE-RESPONSE

1059
00:35:26,524 --> 00:35:29,227
CURVE AS WELL, SO WE OP OPTIMIZD

1060
00:35:29,293 --> 00:35:29,927
THE DOSE.

1061
00:35:29,994 --> 00:35:31,028
WHICH LED TO THE NEXT STUDY,

1062
00:35:31,095 --> 00:35:33,898
WITH IS LOOKING AT SAFETY AND

1063
00:35:33,965 --> 00:35:35,266
FEASIBILITY AND TOLERABILITY FOR

1064
00:35:35,333 --> 00:35:38,569
INDIVIDUALS WITH SEVERE OUD

1065
00:35:38,636 --> 00:35:41,038
THROUGH 90 DAYS PRIMARY END

1066
00:35:41,105 --> 00:35:42,206
POINT SAFETY, AND THEN LOOKING

1067
00:35:42,273 --> 00:35:44,308
AT SECONDARY OBJECTIVE

1068
00:35:44,375 --> 00:35:46,143
SUBSTANCE, CRAVING SUBSTANCE

1069
00:35:46,210 --> 00:35:47,578
USE, FUNCTIONAL CONNECTIVITY

1070
00:35:47,645 --> 00:35:49,213
WITH FMRI, AND THESE ARE

1071
00:35:49,280 --> 00:35:51,516
PATIENTS WHO WERE ALL ON

1072
00:35:51,582 --> 00:35:55,219
MEDICATIONS, SUBOXONE,

1073
00:35:55,286 --> 00:35:56,954
METHADONE, AND RECRUITED FROM

1074
00:35:57,021 --> 00:36:00,458
OUR 28-DAY RESIDENTIAL PROGRAM.

1075
00:36:00,525 --> 00:36:04,095
AND THIS STUDY, WE'RE GOING TO

1076
00:36:04,161 --> 00:36:05,096
REPRESENT EIGHT PATIENTS 90 DAYS

1077
00:36:05,162 --> 00:36:05,630
PLUS OUT COME.

1078
00:36:05,696 --> 00:36:07,098
BUT WE HAVE OVERALL 16 PATIENTS

1079
00:36:07,164 --> 00:36:08,799
IN THE STUDY.

1080
00:36:08,866 --> 00:36:10,902
THE DESIGN.

1081
00:36:10,968 --> 00:36:13,404
BASELINE, WE OBTAINED SAFETY

1082
00:36:13,471 --> 00:36:15,606
QUEUE INDUCED SUBSTANCE CRAVING

1083
00:36:15,673 --> 00:36:16,707
MOOD, EMOTIONAL FUNCTIONING,

1084
00:36:16,774 --> 00:36:19,644
COGNITIVE AND SUBSTANCE USE TOX,

1085
00:36:19,710 --> 00:36:20,177
URINE TOX.

1086
00:36:20,244 --> 00:36:22,046
CRAVING IS VERY IMPORTANT, QUEUE

1087
00:36:22,113 --> 00:36:24,348
INDUCED CRAVING, VISUAL CUES,

1088
00:36:24,415 --> 00:36:25,883
PROVIDE BASELINE AT MULTIPLE

1089
00:36:25,950 --> 00:36:27,618
TIME LINES AND PERSONALIZE TO

1090
00:36:27,685 --> 00:36:29,287
THE PATIENT'S INDIVIDUAL CRAVING

1091
00:36:29,353 --> 00:36:30,955
PROFILE.

1092
00:36:31,022 --> 00:36:32,990
AND THEN DURING THE PROCEDURE

1093
00:36:33,057 --> 00:36:36,694
NOW, WE DO BEHAVIORAL CRAVINGS

1094
00:36:36,761 --> 00:36:38,129
AS WE SHOWED AND NOW WE HAVE

1095
00:36:38,195 --> 00:36:39,864
GOGGLES THAT WE BEAM THE IMAGES,

1096
00:36:39,931 --> 00:36:41,198
PERSONALIZED TO THAT PATIENT, TO

1097
00:36:41,265 --> 00:36:43,034
GET THEIR DIGITAL SCALE AND

1098
00:36:43,100 --> 00:36:45,136
OBSERVE WHAT HAPPENS TO THEIR

1099
00:36:45,202 --> 00:36:47,538
CRAVINGS, AND THEN WE DO SHAM,

1100
00:36:47,605 --> 00:36:48,005
FIVE MINUTES.

1101
00:36:48,072 --> 00:36:51,375
WE DO FOUR 5-MINUTE BLOCKS FOR

1102
00:36:51,442 --> 00:36:52,944
TREATMENT AND ONE BLOCK OF

1103
00:36:53,010 --> 00:36:54,011
5-MINUTE SHAM FOR FDA

1104
00:36:54,078 --> 00:36:54,579
REQUIREMENTS, AND THEN WE

1105
00:36:54,645 --> 00:36:57,982
DELIVER THE ULTRASOUND TO THE

1106
00:36:58,049 --> 00:36:59,283
BILATERAL NUCLEUS ACCUMBENS, AND

1107
00:36:59,350 --> 00:37:02,219
THEN WE MONITOR DURING THE

1108
00:37:02,286 --> 00:37:04,422
TREATMENT SAFETY, CRAVINGS,

1109
00:37:04,488 --> 00:37:06,190
MOOD, COGNITIVE FUNCTION AND

1110
00:37:06,257 --> 00:37:07,191
FUNCTIONAL NEUROIMAGING, AND

1111
00:37:07,258 --> 00:37:09,660
THEN AFTERWARDS FROM DAY ONE, 7,

1112
00:37:09,727 --> 00:37:10,761
ALL THE WAY TO LONG TERM.

1113
00:37:10,828 --> 00:37:11,996
INITIALLY THE STUDY WAS ONLY 30

1114
00:37:12,063 --> 00:37:12,196
DAYS.

1115
00:37:12,263 --> 00:37:14,065
WE DID NOT EXPECT TO SEE CHANGES

1116
00:37:14,131 --> 00:37:14,632
AFTER 30 DAYS.

1117
00:37:14,699 --> 00:37:17,134
BUT BECAUSE OF THE RESPONSE, WE

1118
00:37:17,201 --> 00:37:18,469
EXTENDED IT TO NOW ONE YEAR AND

1119
00:37:18,536 --> 00:37:20,838
LONGER.

1120
00:37:20,905 --> 00:37:22,306
SO, PROCEDURE.

1121
00:37:22,373 --> 00:37:23,841
OUTPATIENT MRI SUITE, PATIENT

1122
00:37:23,908 --> 00:37:25,376
LIES IN MRI, HELMET COMES OVER

1123
00:37:25,443 --> 00:37:27,478
YOUR HEAD, WE USE A DENTAL MOLD

1124
00:37:27,545 --> 00:37:28,446
OR HEAD FRAME.

1125
00:37:28,512 --> 00:37:29,981
PATIENT PREFERENCE.

1126
00:37:30,047 --> 00:37:32,583
WE DO ANATOMICAL TARGETING OF

1127
00:37:32,650 --> 00:37:34,251
THE ACCUMBENS LIKE WE'VE DONE

1128
00:37:34,318 --> 00:37:35,252
FOR DEEP BRAIN STIMULATION THAT

1129
00:37:35,319 --> 00:37:38,289
REALLY GUIDED AN FOCUSED OUR

1130
00:37:38,356 --> 00:37:39,857
TARGETING TO THE MEDIAL

1131
00:37:39,924 --> 00:37:40,858
PREFRONTAL CORTEX.

1132
00:37:40,925 --> 00:37:41,993
PERSONALIZED CUES THAT THEY GET

1133
00:37:42,059 --> 00:37:43,828
ON THE TABLE ONCE THE CRAVINGS

1134
00:37:43,894 --> 00:37:45,563
ARE UP, THEN WE GIVE THE

1135
00:37:45,630 --> 00:37:46,130
ULTRASOUND TREATMENT.

1136
00:37:46,197 --> 00:37:47,765
IT TAKES ONE HOUR AND THEN THEY

1137
00:37:47,832 --> 00:37:48,966
GET OFF THE TABLE AND EAT FOOD

1138
00:37:49,033 --> 00:37:50,067
AND THEN THEY GO HOME.

1139
00:37:50,134 --> 00:37:53,270
THAT'S THE BASIC PROCEDURE.

1140
00:37:53,337 --> 00:38:00,144
CHARACTERISTICS OF THIGHS EIGHTT

1141
00:38:00,211 --> 00:38:01,145
SUBJECTS, SIGNIFICANT USE OF

1142
00:38:01,212 --> 00:38:03,114
HEROIN AND FENTANYL, 14 YEARS,

1143
00:38:03,180 --> 00:38:04,482
AND PRESCRIPTION OPIOIDS, 14

1144
00:38:04,548 --> 00:38:06,384
YEARS MEDIAN, AND THEN THEY ALSO

1145
00:38:06,450 --> 00:38:08,586
WITH THESE SEVERE PATIENTS HAVE

1146
00:38:08,653 --> 00:38:10,221
CO-MORBID METH, COCAINE, BENZO

1147
00:38:10,287 --> 00:38:11,555
AND OTHER PROFILES OF USE OF

1148
00:38:11,622 --> 00:38:12,223
MANY YEARS.

1149
00:38:12,289 --> 00:38:15,393
SEVEN OF THESE EIGHT HAD

1150
00:38:15,459 --> 00:38:16,360
MULTIPLE UNSUCCESSFUL ATTEMPTS

1151
00:38:16,427 --> 00:38:18,663
WITH INPATIENT, OUTPATIENT,

1152
00:38:18,729 --> 00:38:19,897
RESIDENTIAL, MEDIAN OF 4.

1153
00:38:19,964 --> 00:38:21,966
AND THEN THEY WOULD RELAPSE

1154
00:38:22,033 --> 00:38:22,299
OFTEN.

1155
00:38:22,366 --> 00:38:25,603
ONE PERSON, DESPITE 23 YEARS OF

1156
00:38:25,670 --> 00:38:26,470
USE, NEVER SOUGHT TREATMENT

1157
00:38:26,537 --> 00:38:28,005
UNTIL WHEN THEY CAME TO THE

1158
00:38:28,072 --> 00:38:29,674
OUTPATIENT TREATMENT CENTER

1159
00:38:29,740 --> 00:38:31,842
BASED ON THEIR FAMILY'S

1160
00:38:31,909 --> 00:38:33,844
INSISTENCE.

1161
00:38:33,911 --> 00:38:37,214
SO WHAT'S THE OUTCOME?

1162
00:38:37,281 --> 00:38:38,215
SAFETY MOST IMPORTANT THING.

1163
00:38:38,282 --> 00:38:41,185
SAFE AND WELL TOLERATED, 16

1164
00:38:41,252 --> 00:38:42,720
PATIENTS SO FAR BUT THIS FIRST

1165
00:38:42,787 --> 00:38:46,657
EIGHT, NO EXPECTED AEs OR

1166
00:38:46,724 --> 00:38:47,992
SAEs.

1167
00:38:48,059 --> 00:38:49,727
NO BRAIN CHANGES, NOT SEEING

1168
00:38:49,794 --> 00:38:50,594
HEMORRHAGE, HE DEME OR ANYTHING

1169
00:38:50,661 --> 00:38:52,697
THAT WE OBSERVED ON ANY OF THE

1170
00:38:52,763 --> 00:38:53,898
MULTIPLE MR SEQUENCE THAT WE DO.

1171
00:38:53,964 --> 00:38:55,966
AND THEN WE'RE NOT KNOCKING OUT

1172
00:38:56,033 --> 00:38:56,867
THE ACCUMBENS.

1173
00:38:56,934 --> 00:39:00,271
IT'S NOT A LESION, SO BASED ON

1174
00:39:00,337 --> 00:39:01,806
SHAPS, QUALITY OF LIFE AND OTHER

1175
00:39:01,872 --> 00:39:03,441
SCALES, WE'RE NOT SEEING THEY'RE

1176
00:39:03,507 --> 00:39:08,379
HAVING CHANGES WITH SATISFACTION

1177
00:39:08,446 --> 00:39:10,181
WITH SOCIAL ROLES, POSITIVE

1178
00:39:10,247 --> 00:39:12,750
AFFECT AND WELL-BEING, SO ARE WE

1179
00:39:12,817 --> 00:39:15,186
SOMEHOW LESIONING OR IMPACTING

1180
00:39:15,252 --> 00:39:16,487
THE ACCUMBENS ADVERSELY, BUT

1181
00:39:16,554 --> 00:39:17,822
WE'RE NOT, IT SEEMS LIKE, AT

1182
00:39:17,888 --> 00:39:18,789
THIS POINT.

1183
00:39:18,856 --> 00:39:19,890
WHAT ABOUT THE CUE INDUCED

1184
00:39:19,957 --> 00:39:20,157
CRAVINGS?

1185
00:39:20,224 --> 00:39:21,959
THAT WAS ONE OF OUR OUTCOMES

1186
00:39:22,026 --> 00:39:26,664
AFTER SAFETY, LOOKING AT

1187
00:39:26,731 --> 00:39:29,667
BASELINE, BASELINE EIGHT

1188
00:39:29,734 --> 00:39:31,102
PARTICIPANTS AND THIS IS SCALE,

1189
00:39:31,168 --> 00:39:34,672
ZERO TO 10.

1190
00:39:34,739 --> 00:39:36,907
THIS IS THE FUS PROCEDURE, DAY

1191
00:39:36,974 --> 00:39:39,977
1, 7, 30, 60 AND 90 DAYS WITH

1192
00:39:40,044 --> 00:39:41,045
REDUCTIONS IN CRAVINGS AND

1193
00:39:41,112 --> 00:39:42,046
THERE'S THE OUTLIERS RIGHT THERE

1194
00:39:42,113 --> 00:39:42,480
IN PLUSES.

1195
00:39:42,546 --> 00:39:44,682
THIS IS OPIOID KRIEFING,

1196
00:39:44,749 --> 00:39:46,217
BASELINE VERSUS POST-OP.

1197
00:39:46,283 --> 00:39:48,652
WHAT ABOUT METH AND COCAINE AND

1198
00:39:48,719 --> 00:39:50,488
BENZOS?

1199
00:39:50,554 --> 00:39:52,189
THIS IS THEIR AVERAGES, THIS IS

1200
00:39:52,256 --> 00:39:56,427
THE MEDIAN SORRY.

1201
00:39:56,494 --> 00:39:58,829
BASELINE, FUS AND UP TO 90 DAYS

1202
00:39:58,896 --> 00:40:00,464
AND COUNTING METH, COCAINE AND

1203
00:40:00,531 --> 00:40:01,899
BENZOS AND THEIR CRAVINGS FOR

1204
00:40:01,966 --> 00:40:03,200
THESE SUBSTANCES.

1205
00:40:03,267 --> 00:40:04,969
WHAT ABOUT CANNABIS, ALCOHOL AND

1206
00:40:05,035 --> 00:40:06,604
NICOTINE, WHICH ARE READILY

1207
00:40:06,670 --> 00:40:09,907
AVAILABLE VERSUS OTHER DRUGS?

1208
00:40:09,974 --> 00:40:10,775
BASICALLY SAME, INTERESTING

1209
00:40:10,841 --> 00:40:13,944
PROFILE THAT WE SAW REDUCTIONS.

1210
00:40:14,011 --> 00:40:15,246
NICOTINE WAS MORE RESISTANT BUT

1211
00:40:15,312 --> 00:40:16,280
THESE ARE INTERESTING

1212
00:40:16,347 --> 00:40:16,614
OBSERVATIONS.

1213
00:40:16,680 --> 00:40:19,884
OBSERVATIONS.

1214
00:40:19,950 --> 00:40:21,118
WE'RE REPORTING 90 DAYS RIGHT

1215
00:40:21,185 --> 00:40:24,054
NOW FOR OUR PROTOCOL.

1216
00:40:24,121 --> 00:40:26,457
EMOTIONAL OUTCOMES.

1217
00:40:26,524 --> 00:40:27,258
ANXIETY, DEPRESSION AND MOOD AT

1218
00:40:27,324 --> 00:40:28,793
THIS TIME WE CAN SEE AT BASELINE

1219
00:40:28,859 --> 00:40:29,994
FOR THESE INDIVIDUALS BOX PLOTS

1220
00:40:30,060 --> 00:40:32,997
AND THEN PROCEDURE AND THEN 90

1221
00:40:33,063 --> 00:40:34,165
DAYS PRIMARY -- SECONDARY

1222
00:40:34,231 --> 00:40:35,800
OUTCOME THAT WE LOOKED AT IN

1223
00:40:35,866 --> 00:40:37,201
THESE INDIVIDUALS FOR DEPRESSION

1224
00:40:37,268 --> 00:40:38,636
AND ANXIETY.

1225
00:40:38,702 --> 00:40:40,738
AND THEN WHAT ABOUT SUBSTANCE

1226
00:40:40,805 --> 00:40:41,505
USE?

1227
00:40:41,572 --> 00:40:43,474
URINE TOX SUBSTANCE USE, EIGHT

1228
00:40:43,541 --> 00:40:45,109
PARTICIPANTS, SO WE CAN SEE

1229
00:40:45,176 --> 00:40:47,645
GREEN INDICATES NEGATIVE, RED IS

1230
00:40:47,711 --> 00:40:50,915
POSITIVE, SO THEY HAD

1231
00:40:50,981 --> 00:40:53,217
PARTICIPANT 3, 5 AND 7 -- 6,

1232
00:40:53,284 --> 00:40:57,288
RATHER, HAD ISOLATED USE.

1233
00:40:57,354 --> 00:40:58,722
INTERESTING THE USE WAS REDUCED

1234
00:40:58,789 --> 00:41:00,090
SIGNIFICANTLY BUT THEY DID USE,

1235
00:41:00,157 --> 00:41:02,326
3 OUT OF 8.

1236
00:41:02,393 --> 00:41:04,428
-- PROTOCOL ALLOWED US TO DO

1237
00:41:04,495 --> 00:41:05,196
REPEAT ULTRASOUND.

1238
00:41:05,262 --> 00:41:06,831
SO PARTICIPANT NUMBER 6, WE

1239
00:41:06,897 --> 00:41:08,732
TREATED HIM AGAIN, AND THEN HIS

1240
00:41:08,799 --> 00:41:10,568
CRAVINGS WENT DOWN AND SO FAR

1241
00:41:10,634 --> 00:41:11,669
HE'S ALSO ABSTINENT.

1242
00:41:11,735 --> 00:41:13,370
SO THOSE ARE THE URINE TOX

1243
00:41:13,437 --> 00:41:14,572
RESULTS.

1244
00:41:14,638 --> 00:41:16,841
WHAT ABOUT SUBJECTIVE OUTCOMES?

1245
00:41:16,907 --> 00:41:19,109
POST FUS PARTICIPANT FEEDBACK.

1246
00:41:19,176 --> 00:41:24,748
THIS IS PATIENT RESPONSES AND

1247
00:41:24,815 --> 00:41:25,749
PROVIDER OBSERVATIONS.

1248
00:41:25,816 --> 00:41:27,918
ON THE TABLE EVERY PARTICIPANT

1249
00:41:27,985 --> 00:41:29,053
SAYS I AM NOT CONNECTING TO THE

1250
00:41:29,119 --> 00:41:29,620
CUES.

1251
00:41:29,687 --> 00:41:32,790
THE IMAGES OF HEROIN, OF PILLS,

1252
00:41:32,857 --> 00:41:34,425
OF COCAINE, IT'S NOT MAKING

1253
00:41:34,491 --> 00:41:35,192
SENSE TO THEM.

1254
00:41:35,259 --> 00:41:36,894
SO IT SEEMS LIKE ACUTE

1255
00:41:36,961 --> 00:41:38,062
DISCONNECTION TO THEM, AND

1256
00:41:38,128 --> 00:41:39,663
THEY'RE ALL CONFUSED, THEY SAY

1257
00:41:39,730 --> 00:41:40,164
WHAT HAPPENED?

1258
00:41:40,231 --> 00:41:42,032
I'M NOT UNDERSTANDING WHAT'S

1259
00:41:42,099 --> 00:41:42,900
GOING ON.

1260
00:41:42,967 --> 00:41:44,001
SIGNIFICANT DECREASE IN

1261
00:41:44,068 --> 00:41:45,436
CRAVINGS, ACUTELY ON THE TABLE,

1262
00:41:45,502 --> 00:41:45,970
COMPARED TO SHAM.

1263
00:41:46,036 --> 00:41:47,404
WE DID NOT HAVE AS MUCH WITH

1264
00:41:47,471 --> 00:41:48,205
SHAM.

1265
00:41:48,272 --> 00:41:51,308
AND THEN REDUCED THOUGHTS AND

1266
00:41:51,375 --> 00:41:52,176
DREAMS RELATED TO ALCOHOL AND

1267
00:41:52,243 --> 00:41:55,012
MANY OTHER ASPECTS THAT ARE

1268
00:41:55,079 --> 00:41:55,779
IMPROVED WE'RE OBSERVING RIGHT

1269
00:41:55,846 --> 00:41:55,946
NOW.

1270
00:41:56,013 --> 00:41:57,214
THIS IS JUST INITIAL RESULTS.

1271
00:41:57,281 --> 00:41:59,950
AND STABLE DESIRE, NO CHANGE IN

1272
00:42:00,017 --> 00:42:01,619
PLEASURES OF LIFE, FOOD, THIS IS

1273
00:42:01,685 --> 00:42:03,254
VERY IMPORTANT TO MAKE SURE

1274
00:42:03,320 --> 00:42:05,456
WE'RE NOT IMPACTING THOSE.

1275
00:42:05,522 --> 00:42:07,224
ENHANCED MOOD, SHARPER FOCUS,

1276
00:42:07,291 --> 00:42:09,960
AND MANY ARE ENGAGING WITH THEIR

1277
00:42:10,027 --> 00:42:10,494
FAMILIES, CHILD PROTECTIVE

1278
00:42:10,561 --> 00:42:11,161
SERVICES GIVING THEIR KIDS BACK

1279
00:42:11,228 --> 00:42:14,265
TO THEM, AND LIFE ENGAGEMENT,

1280
00:42:14,331 --> 00:42:15,432
EDUCATION, OTHER -- SO IT SEEMS

1281
00:42:15,499 --> 00:42:18,402
INTERESTING IN TERMS OF THEIR

1282
00:42:18,469 --> 00:42:18,736
RESPONSE.

1283
00:42:18,802 --> 00:42:20,070
I'LL GIVE YOU TWO QUICK VIDEOS

1284
00:42:20,137 --> 00:42:20,871
IF I MAY.

1285
00:42:20,938 --> 00:42:22,606
THIS IS TWO PARTICIPANTS TALKING

1286
00:42:22,673 --> 00:42:23,908
ABOUT THEIR CRAVINGS BEFORE AND

1287
00:42:23,974 --> 00:42:24,942
AFTER THE FUS PROCEDURE.

1288
00:42:25,009 --> 00:42:26,443
CAN YOU TURN THE VOLUME UP,

1289
00:42:26,510 --> 00:42:28,078
PLEASE.

1290
00:42:48,999 --> 00:42:50,834
AFTER THE PROCEDURE, IT WAS JUST

1291
00:42:50,901 --> 00:42:53,570
LIKE I FELT BAD FOR THE PERSON

1292
00:42:53,637 --> 00:42:59,043
THAT I WAS TO BE IN THAT

1293
00:42:59,109 --> 00:42:59,310
SITUATION.

1294
00:42:59,376 --> 00:43:02,613
>> AND I COULD NOT CONNECT WITH

1295
00:43:02,680 --> 00:43:06,317
THE PHOTOS ANYMORE, LIKE, I'M

1296
00:43:06,383 --> 00:43:07,851
TRYING TO ELICIT SOME TYPE OF

1297
00:43:07,918 --> 00:43:09,820
FEELING THAT I KNEW, LIKE,

1298
00:43:09,887 --> 00:43:11,455
PREVIOUSLY WOULD EXCITE ME OR

1299
00:43:11,522 --> 00:43:13,757
ENTICE ME TO USE, AND I REALLY

1300
00:43:13,824 --> 00:43:16,627
JUST COULDN'T CONNECT WITH IT.

1301
00:43:16,694 --> 00:43:17,728
YOU KNOW, I THINK THIS IS --

1302
00:43:17,795 --> 00:43:19,596
THIS IS LIKE AN EXTRA TOOL FOR

1303
00:43:19,663 --> 00:43:20,264
ME, YOU KNOW?

1304
00:43:20,331 --> 00:43:30,774
I THINK THIS IS -- --

1305
00:43:30,841 --> 00:43:32,643
>> I DON'T KNOW WHAT TO DO HERE

1306
00:43:32,710 --> 00:43:37,181
BUT ANYHOW, SORRY.

1307
00:43:37,247 --> 00:43:38,716
THEN HOW ABOUT FUNCTIONAL MRI?

1308
00:43:38,782 --> 00:43:39,917
I'LL BE DONE IN TWO MINUTES.

1309
00:43:39,984 --> 00:43:41,552
SO BASICALLY I WANT TO CAUTION

1310
00:43:41,618 --> 00:43:43,620
IS ONLY SEVEN PARTICIPANTS AND

1311
00:43:43,687 --> 00:43:46,623
IT'S OBSERVATIONAL, SO WE'RE

1312
00:43:46,690 --> 00:43:47,691
ASSESSING IT LOOKING AT CHANGES

1313
00:43:47,758 --> 00:43:50,894
IN FUNCTIONAL CONNECTIVITY WITH

1314
00:43:50,961 --> 00:43:53,764
THE SEED AND THE BILATERAL

1315
00:43:53,831 --> 00:43:54,631
ACCUMBENS TO LOOK AT

1316
00:43:54,698 --> 00:43:55,399
CORRELATIONS IN THE REST OF THE

1317
00:43:55,466 --> 00:43:56,266
BRAIN BEFORE AND AFTER

1318
00:43:56,333 --> 00:43:56,567
ULTRASOUND.

1319
00:43:56,633 --> 00:43:58,369
YOU CAN SEE HERE A BASELINE

1320
00:43:58,435 --> 00:44:00,337
PROFILE OF POSITIVE CONNECTIVITY

1321
00:44:00,404 --> 00:44:01,105
AND CORRELATIONS WITH THE

1322
00:44:01,171 --> 00:44:02,639
DIFFERENT PARTS OF THE NETWORK.

1323
00:44:02,706 --> 00:44:06,410
SEVEN DAYS LATER, WE SAW AN

1324
00:44:06,477 --> 00:44:07,911
INCREASE OBSERVATION OF ACTIVITY

1325
00:44:07,978 --> 00:44:09,713
OF ACCUMBENS BILATERAL WITH ACC

1326
00:44:09,780 --> 00:44:14,084
AND REDUCTIONS OF PFC AND

1327
00:44:14,151 --> 00:44:15,085
POSTERIOR CORTEX.

1328
00:44:15,152 --> 00:44:19,456
30 DAYS WE SAW REDUCTION IN NAC

1329
00:44:19,523 --> 00:44:20,557
CONNECTIVE WITH ACC AND

1330
00:44:20,624 --> 00:44:21,325
SIGNIFICANT REDUCTION GOING DOWN

1331
00:44:21,392 --> 00:44:22,326
IN THE PFC.

1332
00:44:22,393 --> 00:44:24,962
SO WE'RE ANALYZING, DOING A

1333
00:44:25,029 --> 00:44:26,063
60-DAY ANALYSIS AS WELL BUT

1334
00:44:26,130 --> 00:44:26,830
THERE SEEMS TO BE CHANGES IN

1335
00:44:26,897 --> 00:44:28,065
SOME OF THE NETWORKS WHICH WE

1336
00:44:28,132 --> 00:44:29,266
NEED TO UNDERSTAND BETTER BUT

1337
00:44:29,333 --> 00:44:30,901
THESE ARE OBSERVATIONS WITH THE

1338
00:44:30,968 --> 00:44:32,369
FUNCTIONAL CONNECTIVITY, CON

1339
00:44:32,436 --> 00:44:33,437
COME AT THAT PARTICULAR TIME

1340
00:44:33,504 --> 00:44:34,872
REDUCTION IN CRAVINGS AND USE.

1341
00:44:34,938 --> 00:44:36,640
COUPLE OTHER THINGS.

1342
00:44:36,707 --> 00:44:37,608
WEARABLES IS IMPORTANT, WE ALSO

1343
00:44:37,674 --> 00:44:40,277
LOOKED AT ANOTHER STUDY WITH

1344
00:44:40,344 --> 00:44:41,478
THESE PATIENTS.

1345
00:44:41,545 --> 00:44:43,313
HEART RATE AUTONOMIC NERVOUS

1346
00:44:43,380 --> 00:44:44,548
SYSTEM, WHAT HAPPENS OVER TIME

1347
00:44:44,615 --> 00:44:46,417
TO THEIR HEART RATE, HEART RATE

1348
00:44:46,483 --> 00:44:47,951
VARIABILITY AND SUBJECTIVE

1349
00:44:48,018 --> 00:44:49,486
ELEMENTS LINKED TO AN APP THAT

1350
00:44:49,553 --> 00:44:51,355
THEY USE AND AGAIN CAUTION EARLY

1351
00:44:51,422 --> 00:44:53,891
RESULTS, BUT WE'RE SEEING

1352
00:44:53,957 --> 00:44:54,558
STATISTICALLY SIGNIFICANT

1353
00:44:54,625 --> 00:44:56,960
INCREASE IN HEART RATE

1354
00:44:57,027 --> 00:44:59,163
VARIABILITY OVER THE 60 TO 90

1355
00:44:59,229 --> 00:45:00,431
DAYS AS COMPARED TO BASELINES

1356
00:45:00,497 --> 00:45:03,567
FOR HRV, AND ALSO SUBJECTIVE

1357
00:45:03,634 --> 00:45:05,102
IMPROVEMENTS OF SLEEP QUALITY

1358
00:45:05,169 --> 00:45:06,470
AND WE'RE ANALYZING MUCH MORE

1359
00:45:06,537 --> 00:45:07,971
DATA BUT THIS IS JUST AN INITIAL

1360
00:45:08,038 --> 00:45:09,973
PEAK INTO THIS DATA, WHICH IS

1361
00:45:10,040 --> 00:45:10,407
VERY EXTENSIVE.

1362
00:45:10,474 --> 00:45:11,942
JUST ANOTHER CONCEPT ABOUT METH.

1363
00:45:12,009 --> 00:45:14,244
THERE IS NO MEDICATION FOR METH.

1364
00:45:14,311 --> 00:45:14,678
BIG PROBLEM.

1365
00:45:14,745 --> 00:45:17,314
WE DID ONE PATIENT WHERE WE HAD

1366
00:45:17,381 --> 00:45:19,316
A 26-YEAR-OLD MALE WITH 13 YEAR

1367
00:45:19,383 --> 00:45:20,918
HISTORY OF METH.

1368
00:45:20,984 --> 00:45:23,153
SEVERAL UNSUCCESSFUL INPATIENT,

1369
00:45:23,220 --> 00:45:24,154
OUTPATIENT, RESIDENTIAL.

1370
00:45:24,221 --> 00:45:25,355
PAST HISTORY OF EXCESSIVE

1371
00:45:25,422 --> 00:45:27,991
ALCOHOL USE AND CAN SEE CRAVINGS

1372
00:45:28,058 --> 00:45:28,892
SUBSTANTIALLY DECREASED 90 DAYS

1373
00:45:28,959 --> 00:45:30,661
AND IS STILL COUNTING BEYOND

1374
00:45:30,727 --> 00:45:32,062
THAT AND URINE TOX HAS BEEN

1375
00:45:32,129 --> 00:45:33,831
NEGATIVE, AND THIS INDIVIDUAL

1376
00:45:33,897 --> 00:45:35,432
TOOK METH EVERY WEEK SINCE AGE

1377
00:45:35,499 --> 00:45:35,833
13.

1378
00:45:35,899 --> 00:45:37,334
SO IT'S ONE CASE, WE WANT TO DO

1379
00:45:37,401 --> 00:45:38,836
A LARGER STUDY WITH METH BUT IT

1380
00:45:38,902 --> 00:45:40,971
SEEMS TO BE COVERING MULTIPLE

1381
00:45:41,038 --> 00:45:43,273
SUBSTANCES SO FAR.

1382
00:45:43,340 --> 00:45:44,975
SUMMARY.

1383
00:45:45,042 --> 00:45:46,243
BILATERAL ACCUMBENS ULTRASOUND

1384
00:45:46,310 --> 00:45:49,213
SEEMS TO BE SAFE AND WELL

1385
00:45:49,279 --> 00:45:50,214
TOLERATED FOR THREE YEARS WE'VE

1386
00:45:50,280 --> 00:45:54,051
BEEN DOING IT WITH NO UNEXPECTED

1387
00:45:54,118 --> 00:45:55,486
EA ES OR SAEs.

1388
00:45:55,552 --> 00:45:58,088
WE OBSERVED IMMEDIATE REDUCTIONS

1389
00:45:58,155 --> 00:45:59,223
IN CRAVINGS THAT YOU DON'T SEE

1390
00:45:59,289 --> 00:46:03,427
WITH SHAM, AFTER ONE 20-MINUTE

1391
00:46:03,494 --> 00:46:04,495
TREATMENT, REDUCTION WAS NOT

1392
00:46:04,561 --> 00:46:05,829
OBSERVED CONSISTENTLY WITH SHAM,

1393
00:46:05,896 --> 00:46:06,830
AND WE'RE SEEING WHAT WAS

1394
00:46:06,897 --> 00:46:07,798
SURPRISING TO US THE NEXT DAY

1395
00:46:07,865 --> 00:46:09,766
AND CONTINUING VERY SUSTAINED

1396
00:46:09,833 --> 00:46:11,768
REDUCTIONS OF CRAVINGS FOR

1397
00:46:11,835 --> 00:46:13,437
OPIOID AND METH AND COCAINE AND

1398
00:46:13,504 --> 00:46:14,872
BENZO AND OTHER SUBSTANCES AND

1399
00:46:14,938 --> 00:46:16,807
COUNTING.

1400
00:46:16,874 --> 00:46:18,375
URINE TOX CONFIRMED NO DRUG USE

1401
00:46:18,442 --> 00:46:20,444
IN FIVE OF EIGHT PARTICIPANTS.

1402
00:46:20,511 --> 00:46:24,214
AND WITH PRIMARY OUD AT 90 DAYS

1403
00:46:24,281 --> 00:46:25,415
OUTCOMES AND WE'RE CONTINUING

1404
00:46:25,482 --> 00:46:26,316
OBSERVATIONS, SO FAR THE

1405
00:46:26,383 --> 00:46:28,051
PATTERNS ARE CONSISTENT FOR

1406
00:46:28,118 --> 00:46:31,054
THESE INDIVIDUALS, WE'RE GOING .

1407
00:46:31,121 --> 00:46:35,526
NO AEs, NO ADVERSE REDUCTIONS

1408
00:46:35,592 --> 00:46:40,297
IN NATURALLY RY REINFORCING AND

1409
00:46:40,364 --> 00:46:42,900
PLEASURABLE BEHAVIORS --

1410
00:46:42,966 --> 00:46:44,168
OBSERVED BY THEIR PATIENTS AND

1411
00:46:44,234 --> 00:46:44,535
CARE PROVIDERS.

1412
00:46:44,601 --> 00:46:47,237
NEXT STEPS, LONG TERM FOLLOW-UP

1413
00:46:47,304 --> 00:46:47,971
ASSESSMENT, 16 PATIENTS, WE'LL

1414
00:46:48,038 --> 00:46:49,239
CONTINUE TO FOLLOW THEM UP

1415
00:46:49,306 --> 00:46:51,208
6 MONTHS AND 12 MONTHS, AND

1416
00:46:51,275 --> 00:46:53,043
WE'RE INITIATING WITH NIDA

1417
00:46:53,110 --> 00:46:54,611
SUPPORT A RANDOMIZED DOUBLE

1418
00:46:54,678 --> 00:46:56,480
BLIND SHAM CONTROLLED CLINICAL

1419
00:46:56,547 --> 00:46:58,015
TRIAL, WE RECEIVED FDA APPROVAL

1420
00:46:58,081 --> 00:46:59,650
IN DECEMBER, IRB APPROVAL IN

1421
00:46:59,716 --> 00:47:03,086
JANUARY AND ENROLLING THE FIRST

1422
00:47:03,153 --> 00:47:03,854
PATIENT NEXT MONTH.

1423
00:47:03,921 --> 00:47:04,721
WE NEED TO UNDERSTAND WHAT'S

1424
00:47:04,788 --> 00:47:05,923
GOING ON WITH THE MECHANISMS OF

1425
00:47:05,989 --> 00:47:07,291
THIS.

1426
00:47:07,357 --> 00:47:09,693
ONE 15, 20 MINUTE TREATMENT IS

1427
00:47:09,760 --> 00:47:11,328
OBTAINING SUSTAINED CRAVING AND

1428
00:47:11,395 --> 00:47:12,429
USE REDUCTIONS.

1429
00:47:12,496 --> 00:47:14,231
SO OVERALL SUMMARY.

1430
00:47:14,298 --> 00:47:16,567
BOTH DBS AND FUS METHODS MAY

1431
00:47:16,633 --> 00:47:19,036
HAVE A UTILITY AS AN ADJUNCTIVE

1432
00:47:19,102 --> 00:47:20,938
TREATMENT FOR OPIOID USE.

1433
00:47:21,004 --> 00:47:22,906
DBS, WHILE EFFECTIVE, HAS

1434
00:47:22,973 --> 00:47:23,440
LIMITATIONS.

1435
00:47:23,507 --> 00:47:24,975
AND SCALABILITY IS A PROBLEM,

1436
00:47:25,042 --> 00:47:26,210
AND IT'S INVASIVE.

1437
00:47:26,276 --> 00:47:28,178
FOUR PATIENTS IN TWO YEARS, WE

1438
00:47:28,245 --> 00:47:28,812
ENROLLED 16 PATIENTS FOR

1439
00:47:28,879 --> 00:47:30,914
ULTRASOUND IN TWO YEARS.

1440
00:47:30,981 --> 00:47:32,616
FUS MAY CIRCUMVENT THESE

1441
00:47:32,683 --> 00:47:33,917
LIMITATIONS WITH GREATER SAFETY

1442
00:47:33,984 --> 00:47:35,552
PROFILE AND POTENTIAL FOR

1443
00:47:35,619 --> 00:47:36,853
WIDESPREAD USE, BUT WE NEED TO

1444
00:47:36,920 --> 00:47:37,788
DO MORE RESEARCH.

1445
00:47:37,854 --> 00:47:40,090
THIS CANNOT BE DONE WITHOUT

1446
00:47:40,157 --> 00:47:41,925
DR. MAHONEY RIGHT THERE AND

1447
00:47:41,992 --> 00:47:42,526
DR. THOMPSON-LAKE, THEY'RE THE

1448
00:47:42,593 --> 00:47:44,061
ONES THAT DO ALL THE HEAVY LIFT,

1449
00:47:44,127 --> 00:47:45,162
AND WE APPRECIATE VERY MUCH THE

1450
00:47:45,229 --> 00:47:48,532
SUPPORT AND GUIDANCE FROM DRS.

1451
00:47:48,599 --> 00:47:59,276
VOLKOW, AKLIN, WANG AND WONG A.

1452
00:48:00,277 --> 00:48:01,812
THANK YOU VERY MUCH.

1453
00:48:01,878 --> 00:48:03,213
>> SO THANK YOU VERY MUCH.

1454
00:48:03,280 --> 00:48:05,082
WE HAVE TIME FOR QUESTIONS, IF

1455
00:48:05,148 --> 00:48:06,116
THERE ARE ANY QUESTIONS, THERE

1456
00:48:06,183 --> 00:48:09,620
ARE MICROPHONES ALONGSIDE THE

1457
00:48:09,686 --> 00:48:09,953
WALL HERE.

1458
00:48:10,020 --> 00:48:11,822
THANK YOU, GENTLEMEN, FOR THAT

1459
00:48:11,888 --> 00:48:12,289
FASCINATING SET OF

1460
00:48:12,356 --> 00:48:12,623
PRESENTATIONS.

1461
00:48:12,689 --> 00:48:14,691
IT REALLY HIGHLIGHTS HOW

1462
00:48:14,758 --> 00:48:16,526
IMPORTANT THESE TREATMENT

1463
00:48:16,593 --> 00:48:17,527
MODALITIES ARE ACROSS THE

1464
00:48:17,594 --> 00:48:19,196
CONTINUUM.

1465
00:48:19,263 --> 00:48:20,163
SO VERY NICELY DONE.

1466
00:48:20,230 --> 00:48:22,366
WE DO HAVE A QUESTION.

1467
00:48:22,432 --> 00:48:24,668
>> THAT WAS AMAZING.

1468
00:48:24,735 --> 00:48:27,204
WONDERFUL DATA.

1469
00:48:27,271 --> 00:48:29,940
SO JUST WONDERING IF YOU MIGHT

1470
00:48:30,007 --> 00:48:32,509
WANT TO CHALLENGE THE

1471
00:48:32,576 --> 00:48:36,947
INDIVIDUALS WITH A STRESSOR, AND

1472
00:48:37,014 --> 00:48:38,181
NOT NECESSARILY A DRUG CHALLENGE

1473
00:48:38,248 --> 00:48:39,283
BUT OF COURSE THE CIRCUITS ARE A

1474
00:48:39,349 --> 00:48:40,684
LITTLE DIFFERENT FOR THOSE.

1475
00:48:40,751 --> 00:48:42,052
THE OTHER THING IS, I WONDERED

1476
00:48:42,119 --> 00:48:44,888
IF YOU MEASURED BODY WEIGHT IN

1477
00:48:44,955 --> 00:48:46,423
YOUR PATIENTS FROM THE BEGINNING

1478
00:48:46,490 --> 00:48:49,293
TO THE END OF YOUR STUDY.

1479
00:48:49,359 --> 00:48:50,260
>> GREAT QUESTION.

1480
00:48:50,327 --> 00:48:51,261
BODY WEIGHTS, I HAVE TO GET BACK

1481
00:48:51,328 --> 00:48:51,595
TO YOU.

1482
00:48:51,662 --> 00:48:53,230
WE HAVE IT, I HAVE TO GET BACK

1483
00:48:53,297 --> 00:48:54,364
TO TO SEE IF THERE'S ANY CHANGE.

1484
00:48:54,431 --> 00:48:55,766
I DON'T THINK THERE'S BEEN ANY

1485
00:48:55,832 --> 00:48:56,433
SIGNIFICANT CHANGE IN THAT

1486
00:48:56,500 --> 00:48:56,967
REGARD.

1487
00:48:57,034 --> 00:48:59,303
BUT REGARDING THE STRESSORS, WE

1488
00:48:59,369 --> 00:49:01,004
DID CUE-INDUCED ACTIVATION, SO

1489
00:49:01,071 --> 00:49:02,239
THAT WAS A STRESSOR FOR THEM.

1490
00:49:02,306 --> 00:49:06,443
IN FACT, ONE PATIENT WHO REAL

1491
00:49:06,510 --> 00:49:08,512
RELAPSED, WE DECIDE FOR SAFETY

1492
00:49:08,578 --> 00:49:10,914
NOT TO DO CUES ANYMORE, BECAUSE

1493
00:49:10,981 --> 00:49:12,282
THEY WERE RELAPSING WE DIDN'T

1494
00:49:12,349 --> 00:49:14,685
WANT TO GET THEM FURTHER

1495
00:49:14,751 --> 00:49:18,422
AMPLIFIED SO CUES WERE

1496
00:49:18,488 --> 00:49:18,689
STRESSORS.

1497
00:49:18,755 --> 00:49:20,290
>> GREAT PRESENTATIONS.

1498
00:49:20,357 --> 00:49:21,525
REALLY SPECTACULAR, EXTREMELY

1499
00:49:21,591 --> 00:49:21,958
EXCITING.

1500
00:49:22,025 --> 00:49:24,061
MY QUESTION IS GOING TO GO FOR

1501
00:49:24,127 --> 00:49:24,928
OPIOID USE DISORDER.

1502
00:49:24,995 --> 00:49:26,663
YOU HAD I THINK IT WAS TWO OR

1503
00:49:26,730 --> 00:49:28,465
THREE PATIENTS THAT DID RELAPSE.

1504
00:49:28,532 --> 00:49:30,200
DID YOU ASK THEM WHEN THEY WERE

1505
00:49:30,267 --> 00:49:34,171
TAKING THE DRUGS, DID THEY FEEL

1506
00:49:34,237 --> 00:49:35,806
DIFFERENTLY ON THE EFFECTS OF

1507
00:49:35,872 --> 00:49:36,139
INTOXICATION?

1508
00:49:36,206 --> 00:49:38,942
>> IB DE INDEED THEY DID.

1509
00:49:39,009 --> 00:49:39,910
A COUPLE OF THEM BASICALLY SAID

1510
00:49:39,976 --> 00:49:41,011
THEY JUST WENT THROUGH IT, THEY

1511
00:49:41,078 --> 00:49:42,112
WERE PARTYING WITH FRIENDS AND

1512
00:49:42,179 --> 00:49:44,548
THEY WERE INTERACTING, SO THE

1513
00:49:44,614 --> 00:49:45,882
CRAVING WAS REDUCED IN THEM,

1514
00:49:45,949 --> 00:49:47,617
WHICH IS INTERESTING.

1515
00:49:47,684 --> 00:49:51,254
SO IT WAS MAYBE BEHAVIORAL BUT

1516
00:49:51,321 --> 00:49:52,289
THEY DID SAY THAT THEY DID TO

1517
00:49:52,356 --> 00:49:54,324
THE FEEL THE SAME.

1518
00:49:54,391 --> 00:49:55,859
SO WE NEED TO EXPLORE THAT

1519
00:49:55,926 --> 00:49:56,526
FURTHER.

1520
00:49:56,593 --> 00:49:58,962
BUT THEIR CRAVINGS IS THE MOST

1521
00:49:59,029 --> 00:49:59,963
CONSISTENT REDUCTION THAT WE SEE

1522
00:50:00,030 --> 00:50:00,697
IN THEM.

1523
00:50:00,764 --> 00:50:02,466
AND THEY ALL SAID THAT I TOOK IT

1524
00:50:02,532 --> 00:50:07,003
BUT I DON'T KNOW WHY I TOOK IT.

1525
00:50:07,070 --> 00:50:08,305
>> I HAVE A QUESTION OVER HERE

1526
00:50:08,372 --> 00:50:11,141
IF THAT'S OKAY.

1527
00:50:11,208 --> 00:50:12,042
GREAT PRESENTATIONS AND SPECIAL

1528
00:50:12,109 --> 00:50:13,477
THANK YOU TO EDWARD FOR SHARING

1529
00:50:13,543 --> 00:50:13,810
YOUR STORY.

1530
00:50:13,877 --> 00:50:16,179
IT WAS AMAZING, A MOTIVATING

1531
00:50:16,246 --> 00:50:18,515
STORY.

1532
00:50:18,582 --> 00:50:19,883
DR. REZAI, YOUR THOUGHTS ABOUT

1533
00:50:19,950 --> 00:50:21,184
SCALABILITY OF FOCUSED

1534
00:50:21,251 --> 00:50:21,518
ULTRASOUND.

1535
00:50:21,585 --> 00:50:23,286
DO YOU SEE THIS AS A PROCEDURE

1536
00:50:23,353 --> 00:50:24,721
THAT WILL ALWAYS HAVE TO BE DONE

1537
00:50:24,788 --> 00:50:27,023
BY NEUROSURGEONS, AND ALSO CAN

1538
00:50:27,090 --> 00:50:28,892
IT BE SCALED OUT TO SMALLER

1539
00:50:28,959 --> 00:50:30,227
HOSPITALS AND OUTPATIENT

1540
00:50:30,293 --> 00:50:30,494
CLINICS?

1541
00:50:30,560 --> 00:50:31,795
>> GREAT QUESTION.

1542
00:50:31,862 --> 00:50:34,097
I DO THINK THIS NEEDS TO BE DONE

1543
00:50:34,164 --> 00:50:37,167
ULTIMATELY BY NON-NEUROSURGEONS

1544
00:50:37,234 --> 00:50:37,667
TO SCALE.

1545
00:50:37,734 --> 00:50:39,169
THERE ARE DIFFERENT TYPES OF

1546
00:50:39,236 --> 00:50:40,270
ULTRASOUND UNITS LIKE A TMS

1547
00:50:40,337 --> 00:50:40,637
UNIT.

1548
00:50:40,704 --> 00:50:42,272
SO I THINK THIS NEEDS TO BE

1549
00:50:42,339 --> 00:50:43,273
EXPLORED, AND THIS NEEDS TO BE

1550
00:50:43,340 --> 00:50:44,474
DONE, IN OUR OPINION, IN THE

1551
00:50:44,541 --> 00:50:46,777
CLINIC BY ADDICTION SPECIALISTS.

1552
00:50:46,843 --> 00:50:49,546
SO I THINK THE KEY THING IS IT'S

1553
00:50:49,613 --> 00:50:50,647
NONINVASIVE, AND IT CAN BE LIKE

1554
00:50:50,714 --> 00:50:52,949
A TMS SYSTEM.

1555
00:50:53,016 --> 00:50:54,751
SO WE SHOULD MOVE IT AWAY FROM

1556
00:50:54,818 --> 00:50:55,852
NEUROSURGEONS OVER TIME.

1557
00:50:55,919 --> 00:50:58,488
>> THANK YOU.

1558
00:50:58,555 --> 00:50:59,456
>> HI.

1559
00:50:59,523 --> 00:51:00,924
I FIRST WANT TO JUST THANK ED

1560
00:51:00,991 --> 00:51:03,193
FOR SHARING YOUR STORY.

1561
00:51:03,260 --> 00:51:05,195
IT WAS VERY MOVING, AND I REALLY

1562
00:51:05,262 --> 00:51:06,062
APPRECIATE YOU SHARING IT WITH

1563
00:51:06,129 --> 00:51:07,631
US.

1564
00:51:07,697 --> 00:51:09,933
AND THEN I HAD A QUESTION ABOUT

1565
00:51:10,000 --> 00:51:12,769
THE USE OF THE FOCUSED

1566
00:51:12,836 --> 00:51:14,004
ULTRASOUND ON OPIOID USE

1567
00:51:14,070 --> 00:51:14,471
DISORDER.

1568
00:51:14,538 --> 00:51:16,773
DID YOU HAVE ANY REPORTED

1569
00:51:16,840 --> 00:51:20,043
CHANGES IN LIKE FOOD CRAVINGS OR

1570
00:51:20,110 --> 00:51:20,944
APPETITE?

1571
00:51:21,011 --> 00:51:22,045
>> GREAT QUESTION.

1572
00:51:22,112 --> 00:51:24,347
WE SHOWED THOSE OUTCOMES.

1573
00:51:24,414 --> 00:51:24,915
THOSE WERE IMPORTANT.

1574
00:51:24,981 --> 00:51:26,450
WE WANT TO MAKE SURE WE'RE NOT

1575
00:51:26,516 --> 00:51:29,519
KNOCKING OUT THE ACCUMBENS OR

1576
00:51:29,586 --> 00:51:31,188
LESIONS IT, ALTHOUGH WE DIDN'T

1577
00:51:31,254 --> 00:51:31,588
ANYTHING.

1578
00:51:31,655 --> 00:51:33,590
WE DID NOT SEE CHANGES IN THOSE

1579
00:51:33,657 --> 00:51:34,624
OR OTHER PLEASURABLE ACTIVITIES.

1580
00:51:34,691 --> 00:51:36,393
ALL OF THEM, THEY WERE NPO FOR

1581
00:51:36,460 --> 00:51:37,561
THE PROCEDURE, WITHOUT FOOD, AND

1582
00:51:37,627 --> 00:51:38,662
THEY WALKED OFF THE TABLE AND

1583
00:51:38,728 --> 00:51:40,030
THEY SAID, GIVE ME A CUP OF

1584
00:51:40,096 --> 00:51:41,131
COFFEE AND A SANDWICH.

1585
00:51:41,198 --> 00:51:43,133
SO WE HAVE NOT OBSERVED THAT,

1586
00:51:43,200 --> 00:51:45,101
WHICH IS VERY IMPORTANT FOR US.

1587
00:51:45,168 --> 00:51:46,470
IT'S A GREAT QUESTION BUT WE

1588
00:51:46,536 --> 00:51:53,243
HAVE NOT OBSERVED THOSE IMPACTS.

1589
00:51:53,310 --> 00:51:54,845
>> I HAVE A QUESTION OVER HERE.

1590
00:51:54,911 --> 00:51:56,079
THANK YOU FOR YOUR PRESENTATION.

1591
00:51:56,146 --> 00:51:58,982
MY NAME IS ANNA FROM UNIVERSITY

1592
00:51:59,049 --> 00:52:00,250
OF PITTSBURGH.

1593
00:52:00,317 --> 00:52:02,552
ED, YOU HAD KIND OF HINTED AT

1594
00:52:02,619 --> 00:52:03,653
THIS AND ALSO SOME OF THE

1595
00:52:03,720 --> 00:52:05,655
RESEARCHERS TOO, BUT YOU TALKED

1596
00:52:05,722 --> 00:52:06,990
ABOUT HOW LOSING THE PAIN SO

1597
00:52:07,057 --> 00:52:08,191
QUICKLY WAS LIKE LOSING A

1598
00:52:08,258 --> 00:52:14,698
FRIEND, AND THEN SOME OF THE

1599
00:52:14,764 --> 00:52:16,099
OUDs HAD ALSO TALKED ABOUT

1600
00:52:16,166 --> 00:52:16,433
THAT.

1601
00:52:16,500 --> 00:52:18,635
LIKE IT WAS A QUICK -- SOMETHING

1602
00:52:18,702 --> 00:52:19,970
VERY QUICK THAT DISAPPEARED ALL

1603
00:52:20,036 --> 00:52:21,238
OF A SUDDEN, AND THEY COULDN'T

1604
00:52:21,304 --> 00:52:22,806
FEEL THE CONNECTION TO THE CUES

1605
00:52:22,873 --> 00:52:23,607
ANYMORE, LIKE YOU DIDN'T HAVE

1606
00:52:23,673 --> 00:52:25,408
YOUR PAIN ANYMORE.

1607
00:52:25,475 --> 00:52:27,711
DO YOU, ED, AND THEN ALSO FROM A

1608
00:52:27,777 --> 00:52:30,547
RESEARCH PE PERSPECTIVE THE OTHS

1609
00:52:30,614 --> 00:52:31,781
SEE THAT BEING SOMETHING WITH

1610
00:52:31,848 --> 00:52:32,883
THESE TYPES OF INTERVENTIONS

1611
00:52:32,949 --> 00:52:35,285
THAT YOU'LL HAVE TO DEAL WITH IN

1612
00:52:35,352 --> 00:52:38,788
TERMS OF LIKE HELPING TO KIND OF

1613
00:52:38,855 --> 00:52:42,559
CREATE A NEW SELF VERY QUICKLY,

1614
00:52:42,626 --> 00:52:44,628
WHICH MIGHT NOT HAPPEN IN A

1615
00:52:44,694 --> 00:52:45,629
TRADITIONAL INTERVENTION?

1616
00:52:45,695 --> 00:52:48,532
>> IT WAS -- IT WAS ALMOST

1617
00:52:48,598 --> 00:52:49,699
DEPRESSING AT FIRST.

1618
00:52:49,766 --> 00:52:51,134
IT WAS REALLY STRANGE FOR PAIN

1619
00:52:51,201 --> 00:52:53,537
TO BE GONE, BECAUSE I'D BEEN IN

1620
00:52:53,603 --> 00:52:56,540
PAIN SINCE I WAS 14 YEARS OLD.

1621
00:52:56,606 --> 00:52:59,376
AND WHEN IT WAS GONE, IT WAS

1622
00:52:59,442 --> 00:52:59,709
EUPHORIC.

1623
00:52:59,776 --> 00:53:03,046
I MEAN, I LITERALLY FELT OUT OF

1624
00:53:03,113 --> 00:53:04,247
BODY AT THE BEGINNING.

1625
00:53:04,314 --> 00:53:09,286
BUT IT PASSED, AND WENT AWAY.

1626
00:53:09,352 --> 00:53:11,187
IT WAS DEFINITELY AN UNEXPECTED

1627
00:53:11,254 --> 00:53:16,459
FEELING.

1628
00:53:16,526 --> 00:53:16,993
>> HI.

1629
00:53:17,060 --> 00:53:18,328
I'D LIKE TO THANK EDWARD AS

1630
00:53:18,395 --> 00:53:18,728
WELL.

1631
00:53:18,795 --> 00:53:20,297
I THINK IT'S BEEN REALLY

1632
00:53:20,363 --> 00:53:20,630
HELPFUL.

1633
00:53:20,697 --> 00:53:22,399
I'M JUST WONDERING WITH THE

1634
00:53:22,465 --> 00:53:23,266
INVESTIGATORS BOTH FROM THE

1635
00:53:23,333 --> 00:53:25,802
STANDPOINT OF SUBSTANCE USE

1636
00:53:25,869 --> 00:53:28,905
DISORDER AND CRPS, THERE ARE SO

1637
00:53:28,972 --> 00:53:31,207
MANY POTENTIAL MENTAL HEALTH

1638
00:53:31,274 --> 00:53:33,376
COMORBIDITIES OR PHYSICAL

1639
00:53:33,443 --> 00:53:34,144
COMORBIDITIES THAT COULD GO

1640
00:53:34,210 --> 00:53:35,712
ALONG WITH THESE PROBLEMS, AND

1641
00:53:35,779 --> 00:53:36,379
I'M WONDERING IN THE PATIENTS

1642
00:53:36,446 --> 00:53:38,381
THAT YOU HAVE STUDIED OR

1643
00:53:38,448 --> 00:53:40,917
ENROLLED SO FAR, WHAT KIND OF A

1644
00:53:40,984 --> 00:53:41,918
PROFILE OR WHAT KIND OF A

1645
00:53:41,985 --> 00:53:45,055
SCREENING DID YOU DO IN ORDER TO

1646
00:53:45,121 --> 00:53:46,289
COME UP WITH THE INDIVIDUALS, OR

1647
00:53:46,356 --> 00:53:47,757
ARE YOU CONSIDERING THAT WHEN

1648
00:53:47,824 --> 00:53:48,525
YOU LOOK AT THE PATIENTS THAT

1649
00:53:48,592 --> 00:53:53,363
YOU'RE TREATING?

1650
00:53:53,430 --> 00:53:54,531
>> THANKS, THAT'S A GREAT

1651
00:53:54,598 --> 00:53:55,298
QUESTION.

1652
00:53:55,365 --> 00:53:57,233
OUR INCLUSION CRITERIA WAS, YOU

1653
00:53:57,300 --> 00:53:58,768
WANT TO INCLUDE A LARGE

1654
00:53:58,835 --> 00:53:59,636
POPULATION OF PEOPLE BUT YOU

1655
00:53:59,703 --> 00:54:02,539
WANT TO BE SPECIFIC AND

1656
00:54:02,606 --> 00:54:04,507
GENERALIZABLE, SO WE FOCUSED ON

1657
00:54:04,574 --> 00:54:06,576
NEUROPATHIC PAIN.

1658
00:54:06,643 --> 00:54:09,279
SO ANYONE WITH AN IDENTIFIABLE

1659
00:54:09,346 --> 00:54:10,814
NERVE INJURY CAUSING PAIN.

1660
00:54:10,880 --> 00:54:12,248
NONETHELESS THAT'S STILL

1661
00:54:12,315 --> 00:54:13,984
HETEROGENEOUS BUT EVERY PATIENT

1662
00:54:14,050 --> 00:54:15,585
UNDERWENT A FULL PSYCHOLOGICAL

1663
00:54:15,652 --> 00:54:16,419
EVALUATION TO MAKE SURE THERE

1664
00:54:16,486 --> 00:54:18,622
WERE NO OTHER UNTREATED

1665
00:54:18,688 --> 00:54:19,222
PSYCHOLOGICAL COMORBIDITIES.

1666
00:54:19,289 --> 00:54:22,058
IF SO, THEY COULD HAVE THAT

1667
00:54:22,125 --> 00:54:22,892
OPTIMIZED.

1668
00:54:22,959 --> 00:54:24,461
THEY UNDERWENT ALSO BRAIN MRI TO

1669
00:54:24,527 --> 00:54:26,162
MAKE SURE IT WAS SAFE TO TARGET,

1670
00:54:26,229 --> 00:54:27,897
IF THEY HAD ANY OTHER IMPLANTED

1671
00:54:27,964 --> 00:54:28,999
HARDWARE, THEY WERE NOT A

1672
00:54:29,065 --> 00:54:30,033
CANDIDATE UNFORTUNATELY.

1673
00:54:30,100 --> 00:54:31,234
WELL, THAT'S NOT TRUE BECAUSE ED

1674
00:54:31,301 --> 00:54:33,536
HAS A SPINAL CORD STIMULATOR,

1675
00:54:33,603 --> 00:54:38,708
BUT IF THEY'D HAD ANY PAIN BRAIN

1676
00:54:38,775 --> 00:54:40,043
HARDWARE OR PACEMAKER.

1677
00:54:40,110 --> 00:54:42,112
I THINK THE BIGGEST CRITICISM I

1678
00:54:42,178 --> 00:54:43,480
WOULD HAVE OF MYSELF AND OUR

1679
00:54:43,546 --> 00:54:45,448
STUDY IS WE'RE LOOKING FOR FOLKS

1680
00:54:45,515 --> 00:54:48,618
THAT VO CHRO HAVE CHRONIC PAIN E

1681
00:54:48,685 --> 00:54:50,086
STILL ACTIVE AND ABLE ENOUGH TO

1682
00:54:50,153 --> 00:54:51,621
PARTICIPATE IN A CLINICAL TRIAL,

1683
00:54:51,688 --> 00:54:52,489
WHICH SEEMS LIKE A

1684
00:54:52,555 --> 00:54:52,822
CONTRADICTION.

1685
00:54:52,889 --> 00:54:54,190
SO I THINK IT'S IMPORTANT TO

1686
00:54:54,257 --> 00:54:55,558
STUDY A LARGER POPULATION, BUT

1687
00:54:55,625 --> 00:54:57,060
TO DO SO IN A WAY THAT WE CAN

1688
00:54:57,127 --> 00:54:59,129
GENERALIZE.

1689
00:54:59,195 --> 00:55:01,698
>> FOR US IT'S SIMILAR BUT I

1690
00:55:01,765 --> 00:55:03,767
THINK IT WAS THE STANDARD DSM

1691
00:55:03,833 --> 00:55:05,702
CRITERIA, NO OTHER ONES EXCEPT

1692
00:55:05,769 --> 00:55:06,770
ANXIETY AND DEPRESSION, AND

1693
00:55:06,836 --> 00:55:08,972
THESE WERE INDIVIDUALS THAT WERE

1694
00:55:09,039 --> 00:55:10,607
KNOWN TO THE BEHAVIORAL TEAM, TO

1695
00:55:10,674 --> 00:55:11,641
THE ADDICTION MANAGEMENT TEAM.

1696
00:55:11,708 --> 00:55:13,276
THEY KNEW THEM REALLY WELL.

1697
00:55:13,343 --> 00:55:14,811
THAT'S VERY IMPORTANT.

1698
00:55:14,878 --> 00:55:17,914
AND WE ALSO RULED OUT PEOPLE

1699
00:55:17,981 --> 00:55:19,049
WITH PERSONALITY DISORDERS AT

1700
00:55:19,115 --> 00:55:20,450
THIS POINT.

1701
00:55:20,517 --> 00:55:22,419
SO UNDERGOING THIS.

1702
00:55:22,485 --> 00:55:24,621
SO VERY SIMILAR, BUT IT WAS

1703
00:55:24,688 --> 00:55:26,322
MANAGED BY A VERY EXPERT TEAM

1704
00:55:26,389 --> 00:55:27,323
THAT KNEW THESE PATIENT REALLY

1705
00:55:27,390 --> 00:55:29,492
WELL.

1706
00:55:29,559 --> 00:55:32,328
>> ONE FINAL QUESTION.

1707
00:55:32,395 --> 00:55:32,629
DR. VOLKOW.

1708
00:55:32,696 --> 00:55:34,030
>> I APOLOGIZE FOR ASKING AGAIN,

1709
00:55:34,097 --> 00:55:35,999
I WAS LOOKING TO SEE SOMEONE

1710
00:55:36,066 --> 00:55:38,501
ELSE, BUT I ALSO WANT TO THANK

1711
00:55:38,568 --> 00:55:40,970
YOU, EDWARD, FOR COMING HERE AND

1712
00:55:41,037 --> 00:55:42,706
SPEAKING TO US OF YOUR

1713
00:55:42,772 --> 00:55:43,039
EXPERIENCE.

1714
00:55:43,106 --> 00:55:46,543
AND REALLY COMMEND YOU FOR YOUR

1715
00:55:46,609 --> 00:55:49,312
COURAGE AND CONGRATULATIONS.

1716
00:55:49,379 --> 00:55:51,081
THIS IS QUITE REMARKABLE, SO

1717
00:55:51,147 --> 00:55:51,781
BEST OF SUCCESS.

1718
00:55:51,848 --> 00:55:52,315
>> THANK YOU.

1719
00:55:52,382 --> 00:55:55,719
>> I WILL SAY SOMETHING THAT

1720
00:55:55,785 --> 00:55:57,053
ACTUALLY LED ME TO A QUESTION

1721
00:55:57,120 --> 00:55:58,254
FOR DR. REZAI.

1722
00:55:58,321 --> 00:55:59,389
YOU MENTIONED THAT YOU WERE

1723
00:55:59,456 --> 00:56:01,591
THINKING THE PROCESS OF BRINGING

1724
00:56:01,658 --> 00:56:03,760
DOWN YOUR ANALGESIC DRUGS, SO

1725
00:56:03,827 --> 00:56:06,463
THAT LED ME TO ASK THE QUESTION

1726
00:56:06,529 --> 00:56:08,865
TO DR. REZAI, IN THOSE PATIENTS

1727
00:56:08,932 --> 00:56:10,600
THAT ARE STABLE, IS THERE A

1728
00:56:10,667 --> 00:56:11,701
DISCUSSION OF BRINGING DOWN

1729
00:56:11,768 --> 00:56:13,603
THEIR MEDICATIONS FOR OPIOID USE

1730
00:56:13,670 --> 00:56:13,870
DISORDERS?

1731
00:56:13,937 --> 00:56:15,371
WHAT ARE THE PLANS?

1732
00:56:15,438 --> 00:56:16,906
>> THAT'S A GREAT QUESTION.

1733
00:56:16,973 --> 00:56:19,275
I THINK AT THIS POINT, WHEN THEY

1734
00:56:19,342 --> 00:56:20,810
WERE ENROLLED, THEY WERE STABLE

1735
00:56:20,877 --> 00:56:23,646
ON THEIR MEDICATIONS FOR OPIOID

1736
00:56:23,713 --> 00:56:25,882
USE, BUT WE HAVE NOT MADE

1737
00:56:25,949 --> 00:56:27,383
CHANGES AT THIS POINT BUT WE'RE

1738
00:56:27,450 --> 00:56:28,718
IN ACTIVE DISCUSSIONS WITH THE

1739
00:56:28,785 --> 00:56:31,154
ADDICTION MANAGEMENT TEAM, SO

1740
00:56:31,221 --> 00:56:32,722
THERE'S OPPORTUNITIES TO REDUCE

1741
00:56:32,789 --> 00:56:32,889
IT.

1742
00:56:32,956 --> 00:56:34,257
BUT AT THIS POINT, WE HAVE NOT.

1743
00:56:34,324 --> 00:56:35,792
WE KEPT THEM IN THE SAME DOSES.

1744
00:56:35,859 --> 00:56:37,093
WE FOLLOWED THE CLINICAL

1745
00:56:37,160 --> 00:56:38,161
GUIDELINES OF THE ADDICTION

1746
00:56:38,228 --> 00:56:39,028
SPECIALISTS AT THIS POINT.

1747
00:56:39,095 --> 00:56:40,363
WE HAVE NOT DONE THAT.

1748
00:56:40,430 --> 00:56:40,997
BUT GREAT QUESTION.

1749
00:56:41,064 --> 00:56:42,265
WE NEED TO MAYBE LOOK AT THAT AS

1750
00:56:42,332 --> 00:56:45,135
WELL.

1751
00:56:45,201 --> 00:56:46,436
>> WELL, WE ARE AT TIME.

1752
00:56:46,503 --> 00:56:48,571
I WANT TO THANK THE PANELISTS, I

1753
00:56:48,638 --> 00:56:50,240
WANT TO THANK THE ORGANIZERS FOR

1754
00:56:50,306 --> 00:56:51,307
TODAY'S MEETING AND PLENARY

1755
00:56:51,374 --> 00:56:52,175
SESSION.

1756
00:56:52,242 --> 00:56:53,743
THANK YOU VERY MUCH.

1757
00:56:53,810 --> 00:56:54,544
AND THANK YOU FOR YOUR

1758
00:56:54,611 --> 00:57:04,854
PARTICIPATION.

1759
00:58:20,129 --> 00:58:23,166
>> I WANTED TO THANK AGAIN DRS.

1760
00:58:23,233 --> 00:58:27,837
AKLIN, REZAI, SHIRVALKAR AND

1761
00:58:27,904 --> 00:58:28,638
MR. MOWERY.

1762
00:58:28,705 --> 00:58:29,472
WHAT A POWERFUL TESTIMONY.

1763
00:58:29,539 --> 00:58:31,107
I HOPE YOU CAN SEE OUR HEAL

1764
00:58:31,174 --> 00:58:32,642
RESEARCH CAN HAVE A REAL IMPACT

1765
00:58:32,709 --> 00:58:34,310
AND I HOPE YOU TAKE THAT AWAY AS

1766
00:58:34,377 --> 00:58:35,545
MORE MOTIVATION FOR YOUR OWN

1767
00:58:35,612 --> 00:58:35,879
RESEARCH.

1768
00:58:35,945 --> 00:58:38,214
SO NOW WE HAVE A RESEARCH

1769
00:58:38,281 --> 00:58:39,649
PROGRAM UPDATE FROM THE BACK

1770
00:58:39,716 --> 00:58:41,384
PAIN CONSORTIUM OR BACPAC.

1771
00:58:41,451 --> 00:58:48,391
WELCOME TO THE STAGE DRS. SOWA,

1772
00:58:48,458 --> 00:58:49,893
TORRES ESPIN, MAUCK AND ANSTROM

1773
00:58:49,959 --> 00:58:50,627
TO PRESENT THEIR WORK.

1774
00:58:50,693 --> 00:58:51,294
>> THANK YOU SO MUCH.

1775
00:58:51,361 --> 00:58:53,363
IT IS AN HONOR AND A PRIVILEGE

1776
00:58:53,429 --> 00:58:55,932
TO OPEN THIS UP ON BEHALF OF THE

1777
00:58:55,999 --> 00:58:57,700
BACPAC INVESTIGATORS.

1778
00:58:57,767 --> 00:59:00,870
I'M GOING TO START OFF BY GIVING

1779
00:59:00,937 --> 00:59:05,541
AN OVERVIEW OF WHAT WE HAVE

1780
00:59:05,608 --> 00:59:07,443
ACCOMPLISHED AND WHAT WE HAVE

1781
00:59:07,510 --> 00:59:09,045
SET OUT TO DO IN THE CONSORTIUM,

1782
00:59:09,112 --> 00:59:10,280
BUT ALSO IMPORTANTLY, WHAT WE

1783
00:59:10,346 --> 00:59:11,381
HAVE THAT WE WILL BE ABLE TO

1784
00:59:11,447 --> 00:59:13,316
SHARE WITH THE HEAL COMMUNITY AS

1785
00:59:13,383 --> 00:59:15,785
WELL AS THE COMMUNITY AT LARGE.

1786
00:59:15,852 --> 00:59:17,353
I THINK WHAT YOU'LL SEE AND

1787
00:59:17,420 --> 00:59:18,121
APPRECIATE IS THERE IS GOING TO

1788
00:59:18,187 --> 00:59:20,957
BE A MASSIVE AMOUNT OF

1789
00:59:21,024 --> 00:59:21,958
PHENOTYPING INFORMATION THAT

1790
00:59:22,025 --> 00:59:24,861
HELPS US BETTER UNDERSTAND THE

1791
00:59:24,928 --> 00:59:25,428
EXPERIENCE CHRONIC LOW BACK

1792
00:59:25,495 --> 00:59:27,163
PAIN.

1793
00:59:27,230 --> 00:59:31,000
SO THE BACPAC MISSION WITHIN THE

1794
00:59:31,067 --> 00:59:32,969
HEAL UMBRELLA IS TRANSLATIONAL

1795
00:59:33,036 --> 00:59:35,104
PATIENT-CENTERED TO ADDRESS

1796
00:59:35,171 --> 00:59:36,306
EFFECTIVE AND PERSONALIZED

1797
00:59:36,372 --> 00:59:37,307
THERAPIES FOR CHRONIC LOW BACK

1798
00:59:37,373 --> 00:59:38,141
PAIN.

1799
00:59:38,207 --> 00:59:39,742
SO EACH OF THESE PIECES OF THE

1800
00:59:39,809 --> 00:59:41,177
MISSION IS VERY, VERY

1801
00:59:41,244 --> 00:59:41,611
INTENTIONAL.

1802
00:59:41,678 --> 00:59:44,113
WE HAVE TAKEN THE OPPORTUNITY TO

1803
00:59:44,180 --> 00:59:46,082
ENSURE THAT WE HAVE PEOPLE WITH

1804
00:59:46,149 --> 00:59:47,583
LIVED EXPERIENCES CONTRIBUTING

1805
00:59:47,650 --> 00:59:50,219
TO THE DESIGN OF THE WAY WE

1806
00:59:50,286 --> 00:59:52,188
COLLECT ALL OF THE INFORMATION,

1807
00:59:52,255 --> 00:59:53,723
AND NOW MORE RECENTLY, THE WAY

1808
00:59:53,790 --> 00:59:55,625
WE ARE ANALYZING AND

1809
00:59:55,692 --> 00:59:56,492
INTERPRETING THE INFORMATION

1810
00:59:56,559 --> 00:59:57,493
THAT WE HAVE.

1811
00:59:57,560 --> 00:59:59,329
SO THAT WAS VERY INTENTIONAL.

1812
00:59:59,395 --> 01:00:01,264
IT'S ALSO BEEN VERY INTENTIONAL

1813
01:00:01,331 --> 01:00:03,466
TO MAKE SURE THAT WE ARE

1814
01:00:03,533 --> 01:00:04,534
APPROACHING PERSONALIZED

1815
01:00:04,600 --> 01:00:05,001
THERAPIES.

1816
01:00:05,068 --> 01:00:06,636
AS YOU'RE PROBABLY FAMILIAR,

1817
01:00:06,703 --> 01:00:08,104
CHRONIC LOW BACK PAIN BEING A

1818
01:00:08,171 --> 01:00:09,772
MAJOR DRIVER OF DISABILITY AS

1819
01:00:09,839 --> 01:00:13,476
WELL AS SUBSTANCE USE, OUR

1820
01:00:13,543 --> 01:00:15,611
APPROACH FROM THE BEGINNING IN

1821
01:00:15,678 --> 01:00:19,115
THE CONSORTIUM WAS TO ENSURE

1822
01:00:19,182 --> 01:00:20,984
THAT WE DID NOT SET OUT TO PROVE

1823
01:00:21,050 --> 01:00:21,851
WHAT WE THINK WE KNEW.

1824
01:00:21,918 --> 01:00:23,453
THIS WAS A THEME THAT CAME UP

1825
01:00:23,519 --> 01:00:24,654
AGAIN AND AGAIN AS WE WERE

1826
01:00:24,721 --> 01:00:27,490
SETTING UP OUR DATA COLLECTION

1827
01:00:27,557 --> 01:00:28,725
METHODS.

1828
01:00:28,791 --> 01:00:30,660
INSTEAD, WE REALIZE THAT MUCH OF

1829
01:00:30,727 --> 01:00:32,528
THE CLINICAL FAILURE IN THE

1830
01:00:32,595 --> 01:00:33,629
TREATMENT OF CHRONIC LOW BACK

1831
01:00:33,696 --> 01:00:35,198
PAIN IS NOT NECESSARILY BECAUSE

1832
01:00:35,264 --> 01:00:37,000
WE DON'T HAVE GOOD TREATMENTS.

1833
01:00:37,066 --> 01:00:38,401
BUT IT'S WE DON'T KNOW IN WHOM

1834
01:00:38,468 --> 01:00:43,006
TO USE WHAT TREATMENTS WHEN.

1835
01:00:43,072 --> 01:00:45,708
SO THE REAL KEY FOR BACPAC IS TO

1836
01:00:45,775 --> 01:00:47,110
IDENTIFY THE RIGHT TREATMENT FOR

1837
01:00:47,176 --> 01:00:48,544
THE RIGHT PATIENT AT THE RIGHT

1838
01:00:48,611 --> 01:00:50,179
TIME, BECAUSE WHEN WE DON'T DO

1839
01:00:50,246 --> 01:00:52,315
THAT, THERE'S A LOT OF

1840
01:00:52,382 --> 01:00:53,516
FRUSTRATION OF BOTH THE PATIENT

1841
01:00:53,583 --> 01:00:56,919
AND THE CLINICIAN AND THINGS GO

1842
01:00:56,986 --> 01:00:57,687
DOWN THE WRONG DIRECTION.

1843
01:00:57,754 --> 01:00:59,188
SO THAT'S THE PRIMARY GAP.

1844
01:00:59,255 --> 01:01:00,823
OUR OBJECTIVES ARE SHOWN HERE TO

1845
01:01:00,890 --> 01:01:03,192
DEVELOP A THEORETICAL MODEL,

1846
01:01:03,259 --> 01:01:05,561
IDENTIFY FACTORS THAT ARE

1847
01:01:05,628 --> 01:01:07,330
PREDICTIVE OF TREATMENT

1848
01:01:07,397 --> 01:01:08,197
EFFECTIVENESS, AND THEN

1849
01:01:08,264 --> 01:01:09,932
ULTIMATELY TO DEVELOP AN

1850
01:01:09,999 --> 01:01:10,500
ALGORITHM.

1851
01:01:10,566 --> 01:01:13,169
SO WE INTENTIONALLY CAST THE NET

1852
01:01:13,236 --> 01:01:15,571
VERY BROADLY.

1853
01:01:15,638 --> 01:01:19,842
THERE ARE CERTAINLY

1854
01:01:19,909 --> 01:01:21,044
HYPOTHESIS-DRIVEN DATA

1855
01:01:21,110 --> 01:01:22,245
COLLECTION PROCEDURES AND TRIALS

1856
01:01:22,311 --> 01:01:23,513
WITHIN BACPAC, BUT THERE WAS

1857
01:01:23,579 --> 01:01:25,281
AGREEMENT EARLY ON TO LET THE

1858
01:01:25,348 --> 01:01:27,683
DATA TELL US THINGS WE DIDN'T

1859
01:01:27,750 --> 01:01:29,385
KNOW OR COULDN'T HAVE

1860
01:01:29,452 --> 01:01:32,655
ANTICIPATED LOOKING FOR IN THE

1861
01:01:32,722 --> 01:01:32,989
PAST.

1862
01:01:33,056 --> 01:01:34,424
AND WE'RE REALLY THANKFUL REALLY

1863
01:01:34,490 --> 01:01:36,325
TO NIH FOR GIVING US THE FREEDOM

1864
01:01:36,392 --> 01:01:37,760
AND THE OPPORTUNITY TO DO THIS

1865
01:01:37,827 --> 01:01:39,395
SO THAT WE IDENTIFY THINGS THAT

1866
01:01:39,462 --> 01:01:40,897
ARE TRULY PARADIGM CHANGING.

1867
01:01:40,963 --> 01:01:41,964
AND THAT IS VERY MUCH OUR

1868
01:01:42,031 --> 01:01:44,500
INTENT.

1869
01:01:44,567 --> 01:01:45,601
AND THIS HELPED FORM THE

1870
01:01:45,668 --> 01:01:46,502
QUESTIONS AND THE WAY THAT WE

1871
01:01:46,569 --> 01:01:47,970
HAVE APPROACHED THINGS

1872
01:01:48,037 --> 01:01:48,938
THROUGHOUT THE ENTIRETY OF

1873
01:01:49,005 --> 01:01:50,940
BACPAC.

1874
01:01:51,007 --> 01:01:52,875
WE ALSO WERE VERY INTENTIONAL IN

1875
01:01:52,942 --> 01:01:53,943
REACHING OUT TO COMMUNITIES THAT

1876
01:01:54,010 --> 01:01:57,880
WERE HISTORICALLY UNDERREP

1877
01:01:57,947 --> 01:02:01,451
RESENTED IN PAIN RESEARCH AND

1878
01:02:01,517 --> 01:02:03,853
BACK PAIN RESEARCH IN GENERAL.

1879
01:02:03,920 --> 01:02:04,520
DR. CHRIS KEL MENTIONED THIS

1880
01:02:04,587 --> 01:02:06,789
YESTERDAY BUT WE DID A LOT OF

1881
01:02:06,856 --> 01:02:07,957
DEDICATED OUTREACH TO MAKE SURE

1882
01:02:08,024 --> 01:02:09,392
THE DATA WE COLLECTED AND

1883
01:02:09,459 --> 01:02:10,927
PHENOTYPING WE WERE DOING WAS

1884
01:02:10,993 --> 01:02:11,494
TRULY REPRESENTATIVE OF THE

1885
01:02:11,561 --> 01:02:12,528
COMMUNITY WE WERE LOOKING TO

1886
01:02:12,595 --> 01:02:12,862
SERVE.

1887
01:02:12,929 --> 01:02:14,397
AND FINALLY, WE WERE LOOKING

1888
01:02:14,464 --> 01:02:16,466
VERY MUCH TO FIGURE OUT WHAT OF

1889
01:02:16,532 --> 01:02:20,036
THESE DEEP PHENOTYPING ASPECTS

1890
01:02:20,103 --> 01:02:21,671
ARE IMPORTANT, AND WHAT CAN BE

1891
01:02:21,737 --> 01:02:22,538
INCORPORATED IN THE CLINICAL

1892
01:02:22,605 --> 01:02:22,872
PRACTICE.

1893
01:02:22,939 --> 01:02:24,407
WHAT YOU'LL SEE IS WE'RE

1894
01:02:24,474 --> 01:02:25,775
COLLECTING A MASSIVE AMOUNT OF

1895
01:02:25,842 --> 01:02:27,543
DATA, AND THERE'S NO INTENT THAT

1896
01:02:27,610 --> 01:02:29,245
THIS WILL BE THINGS THAT CAN BE

1897
01:02:29,312 --> 01:02:30,379
DONE WITH EACH AND EVERY PERSON

1898
01:02:30,446 --> 01:02:34,083
THAT IS SEEKING CARE.

1899
01:02:34,150 --> 01:02:34,750
CARE INSTEAD,

1900
01:02:34,817 --> 01:02:35,585
WE'RE LOOKING FOR THE SIGNALS

1901
01:02:35,651 --> 01:02:36,586
AND WHAT ARE THE THINGS THAT ARE

1902
01:02:36,652 --> 01:02:37,653
GOING TO DIRECT US IN A

1903
01:02:37,720 --> 01:02:39,522
DIFFERENT DIRECTION.

1904
01:02:39,589 --> 01:02:41,891
SO THESE ARE THE BACPAC RESEARCH

1905
01:02:41,958 --> 01:02:42,258
SITES.

1906
01:02:42,325 --> 01:02:43,759
WE'RE WELL REP RESENTED ACROSS

1907
01:02:43,826 --> 01:02:44,427
THE COUNTRY.

1908
01:02:44,494 --> 01:02:46,062
THERE ARE THREE MECHANISTIC

1909
01:02:46,129 --> 01:02:47,997
RESEARCH CENTERS THAT ARE DOING

1910
01:02:48,064 --> 01:02:49,432
DEEP PHENOTYPING, CASTING THAT

1911
01:02:49,499 --> 01:02:51,167
NET BROAD AND DOING A MAJOR

1912
01:02:51,234 --> 01:02:52,568
MASSIVE AMOUNTS OF DATA

1913
01:02:52,635 --> 01:02:54,437
COLLECTION ON ALL ASPECTS OF THE

1914
01:02:54,504 --> 01:02:57,507
EXPERIENCE OF LOW BACK PAIN.

1915
01:02:57,573 --> 01:02:58,574
THOSE ARE AT THE UNIVERSITY OF

1916
01:02:58,641 --> 01:02:59,575
MICHIGAN, THE UNIVERSITY OF

1917
01:02:59,642 --> 01:03:00,910
PITTSBURGH AND THE UNIVERSITY OF

1918
01:03:00,977 --> 01:03:01,711
CALIFORNIA-SAN FRANCISCO.

1919
01:03:01,777 --> 01:03:03,579
WE ALSO HAVE SEVEN TECHNOLOGY

1920
01:03:03,646 --> 01:03:04,947
RESEARCH SITES THAT ARE

1921
01:03:05,014 --> 01:03:06,716
DEVELOPING NOVEL TECHNOLOGIES

1922
01:03:06,782 --> 01:03:08,784
FOR BOTH DIAGNOSIS AND

1923
01:03:08,851 --> 01:03:09,819
TREATMENT, AS WELL AS THREE

1924
01:03:09,886 --> 01:03:11,888
CLINICAL TRIALS.

1925
01:03:11,954 --> 01:03:15,558
WE'VE ALSO HAD THE OPPORTUNITY

1926
01:03:15,625 --> 01:03:17,426
TO DESIGN A VERY NOVEL

1927
01:03:17,493 --> 01:03:18,194
INNOVATIVE SMART TRIAL.

1928
01:03:18,261 --> 01:03:22,331
THE DESIGN OF THIS TRIAL WAS

1929
01:03:22,398 --> 01:03:24,066
CONFORMED BY CONSORTIUM MEMBERS

1930
01:03:24,133 --> 01:03:25,368
THROUGH CONSENSUS BUILDING BUT

1931
01:03:25,434 --> 01:03:26,669
ALSO WITH THE INPUT OF

1932
01:03:26,736 --> 01:03:27,770
STAKEHOLDERS WITH LIVED

1933
01:03:27,837 --> 01:03:28,738
EXPERIENCES.

1934
01:03:28,804 --> 01:03:30,239
AND THAT DEFINED THE WAY WE

1935
01:03:30,306 --> 01:03:31,574
APPROACH THIS TRIAL AND THE

1936
01:03:31,641 --> 01:03:33,543
TREATMENTS WE CHOSE TO STUDY.

1937
01:03:33,609 --> 01:03:36,746
WE CHOSE FOUR DIFFERENT TRE

1938
01:03:36,812 --> 01:03:37,747
TREATMENTS, NOT BECAUSE WE WERE

1939
01:03:37,813 --> 01:03:38,648
TRYING TO DETERMINE WHETHER THEY

1940
01:03:38,714 --> 01:03:39,515
WERE EFFECTIVE OR NOT.

1941
01:03:39,582 --> 01:03:40,716
WE KNEW THEY WERE EFFECTIVE.

1942
01:03:40,783 --> 01:03:42,785
WE WERE TRYING TO DETERMINE IN

1943
01:03:42,852 --> 01:03:47,256
WHOM THEY WOULD BE EFFECTIVE.

1944
01:03:47,323 --> 01:03:48,558
SO WE CHOSE THESE FOUR

1945
01:03:48,624 --> 01:03:50,393
TREATMENTS AND DID DEEP

1946
01:03:50,459 --> 01:03:51,494
PHENOTYPING OF ALL OF THE

1947
01:03:51,561 --> 01:03:52,595
PARTICIPANTS IN THE TRIAL TO

1948
01:03:52,662 --> 01:03:53,796
UNDERSTAND WHO WOULD RESPOND

1949
01:03:53,863 --> 01:03:54,363
BETTER.

1950
01:03:54,430 --> 01:03:55,164
THE FOUR TREATMENTS ARE SHOWN

1951
01:03:55,231 --> 01:03:56,132
HERE.

1952
01:03:56,199 --> 01:03:57,800
ENHANCED SELF-CARE, ACCEPTANCE

1953
01:03:57,867 --> 01:03:58,901
AND COMMITMENT THERAPY, A FORM

1954
01:03:58,968 --> 01:04:02,939
OF COGNITIVE BEHAVIORAL THERAPY,

1955
01:04:03,005 --> 01:04:03,673
EVIDENCE-BASED EXERCISE AND

1956
01:04:03,739 --> 01:04:07,076
MANUAL THERAPY, ESSENTIALLY

1957
01:04:07,143 --> 01:04:13,282
ENHANCED -- WE USED A PRAGMATIC

1958
01:04:13,349 --> 01:04:14,584
APPROACH TO IDENTIFY HOW

1959
01:04:14,650 --> 01:04:15,585
PATIENTS WERE DOING ON THAT

1960
01:04:15,651 --> 01:04:16,185
TREATMENT.

1961
01:04:16,252 --> 01:04:17,520
SO MUCH LIKE WE WOULD DO IN

1962
01:04:17,587 --> 01:04:18,521
CLINICAL PRACTICE, WE SAID IF

1963
01:04:18,588 --> 01:04:20,022
THE PATIENT IS DOING WELL, WE

1964
01:04:20,089 --> 01:04:22,091
MAINTAIN THEM ON THAT FIRST

1965
01:04:22,158 --> 01:04:23,092
RANDOMIZED TREATMENT.

1966
01:04:23,159 --> 01:04:25,795
IF THEY ARE DOING OKAY, WE MAY

1967
01:04:25,861 --> 01:04:27,096
AUGMENT THAT WITH ONE OF THE

1968
01:04:27,163 --> 01:04:28,064
OTHER THREE TREATMENTS, AND IF

1969
01:04:28,130 --> 01:04:31,801
THEY'RE DOING POORLY, THEN WE

1970
01:04:31,867 --> 01:04:33,736
WOULD RE-RANDOMIZE THEM TO ONE

1971
01:04:33,803 --> 01:04:34,170
OF THE OTHERS.

1972
01:04:34,237 --> 01:04:36,072
SO AGAIN, A PRAGMATIC APPROACH

1973
01:04:36,138 --> 01:04:37,340
THAT WOULD MIMIC WHAT WE WOULD

1974
01:04:37,406 --> 01:04:38,741
DO IN CLINICAL PRACTICE AND THEN

1975
01:04:38,808 --> 01:04:39,375
FOLLOWED THEM OUT.

1976
01:04:39,442 --> 01:04:40,576
WHAT YOU'LL HEAR ABOUT LATER IN

1977
01:04:40,643 --> 01:04:42,345
THE SESSION TODAY IS HOW WE'RE

1978
01:04:42,411 --> 01:04:45,448
STARTING TO PLACE PEOPLE WITHIN

1979
01:04:45,514 --> 01:04:46,782
THOSE SPACES AND THOSE

1980
01:04:46,849 --> 01:04:48,217
PHENOTYPES TO DEFINE WHO'S GOING

1981
01:04:48,284 --> 01:04:49,518
TO RESPOND BETTER TO DIFFERENT

1982
01:04:49,585 --> 01:04:49,819
TREATMENTS.

1983
01:04:49,885 --> 01:04:51,687
THESE ARE THE BEST TRIAL SITES,

1984
01:04:51,754 --> 01:04:53,222
AGAIN, WELL REPRESENTED ACROSS

1985
01:04:53,289 --> 01:04:54,957
THE COUNTRY, AND IT HAS BEEN AN

1986
01:04:55,024 --> 01:04:56,692
AMAZING COLLABORATION GETTING

1987
01:04:56,759 --> 01:04:57,793
EVERYONE TO ROW IN THE SAME

1988
01:04:57,860 --> 01:04:59,528
DIRECTION AND WORK TOGETHER IN

1989
01:04:59,595 --> 01:05:01,464
BOTH THE WAY WE COLLECT THE DATA

1990
01:05:01,530 --> 01:05:02,898
AND IN THE WAY THAT WE ARE

1991
01:05:02,965 --> 01:05:05,101
RECRUITING AND PARTNERING

1992
01:05:05,167 --> 01:05:07,837
TOGETHER.

1993
01:05:07,903 --> 01:05:09,338
IN TERMS OF HOW WE'RE

1994
01:05:09,405 --> 01:05:10,973
PHENOTYPING ACROSS THE

1995
01:05:11,040 --> 01:05:11,841
CONSORTIUM, WE'VE DONE A LOT OF

1996
01:05:11,907 --> 01:05:12,942
WORK TO HARMONIZE THIS.

1997
01:05:13,009 --> 01:05:14,443
WE'RE VERY MUCH USING THE

1998
01:05:14,510 --> 01:05:15,444
BIOBEHAVIORAL CONTEXT OF THE

1999
01:05:15,511 --> 01:05:17,613
PERSON WITH LOW BACK PAIN BY

2000
01:05:17,680 --> 01:05:18,247
COLLECTING INFORMATION ABOUT

2001
01:05:18,314 --> 01:05:19,448
SOCIAL DETERMINANTS, BEHAVIORS

2002
01:05:19,515 --> 01:05:21,951
AND LIFESTYLES, PAIN-RELATED

2003
01:05:22,018 --> 01:05:23,586
PSYCHOSOCIAL FACTORS, GENERAL

2004
01:05:23,653 --> 01:05:25,855
PSYCHOSOCIAL FACTORS, AND

2005
01:05:25,921 --> 01:05:27,290
INFORMATION ABOUT THE PAIN

2006
01:05:27,356 --> 01:05:28,924
CHARACTERISTICS AND QUALITIES

2007
01:05:28,991 --> 01:05:29,925
THEMSELVES, AND PUTTING THIS ALL

2008
01:05:29,992 --> 01:05:31,260
TOGETHER.

2009
01:05:31,327 --> 01:05:32,895
THIS JUST GIVES YOU A SENSE OF

2010
01:05:32,962 --> 01:05:33,996
THE PATIENT-REPORTED OUTCOMES

2011
01:05:34,063 --> 01:05:37,333
THAT WE ARE COLLECTING.

2012
01:05:37,400 --> 01:05:38,434
IN THE FIRST COLUMN THERE, YOU

2013
01:05:38,501 --> 01:05:39,835
CAN SEE WE'RE COLLECTING ALL OF

2014
01:05:39,902 --> 01:05:41,270
THE HEAL MINIMUM DATASET

2015
01:05:41,337 --> 01:05:42,772
PATIENT-REPORTED OUTCOMES.

2016
01:05:42,838 --> 01:05:44,540
IN ADDITION TO THAT, WE

2017
01:05:44,607 --> 01:05:47,777
HARMONIZED ACROSS THE CONSORTIUM

2018
01:05:47,843 --> 01:05:48,644
ADDITIONAL PATIENT-REPORTED

2019
01:05:48,711 --> 01:05:50,613
OUTCOMES THAT ARE RELEVANT

2020
01:05:50,680 --> 01:05:51,714
EITHER TO BACK PAIN OR THINGS

2021
01:05:51,781 --> 01:05:54,750
THAT ARE ADJACENT TO BACK PAIN

2022
01:05:54,817 --> 01:05:56,285
THAT WE WANTED TO MAKE SURE

2023
01:05:56,352 --> 01:05:57,153
EVERYONE WAS COLLECTING SO THAT

2024
01:05:57,219 --> 01:05:58,988
WE HAVE A CONSISTENT DATASET

2025
01:05:59,055 --> 01:06:02,591
THAT WAS HARMONIZED.

2026
01:06:02,658 --> 01:06:04,026
THIS GIVES YOU AN EXAMPLE OF

2027
01:06:04,093 --> 01:06:05,194
THAT HARMONIZATION OF

2028
01:06:05,261 --> 01:06:09,098
PATIENT-REPORTED OUTCOMES

2029
01:06:09,165 --> 01:06:10,499
BETWEEN WHAT WE'RE CONNECTING IN

2030
01:06:10,566 --> 01:06:11,967
THE MECHANISTIC RESEARCH CENTERS

2031
01:06:12,034 --> 01:06:13,169
AND ALSO COLLECTING IN THE BEST

2032
01:06:13,235 --> 01:06:14,670
TRIAL, SO THAT DEEP PHENOTYPING

2033
01:06:14,737 --> 01:06:17,206
WILL HAVE OVERLAP SO THAT WE CAN

2034
01:06:17,273 --> 01:06:18,874
COMPARE APPLES TO APPLES AS WE

2035
01:06:18,941 --> 01:06:20,242
LOOK AT THE DATA COMING OUT OF

2036
01:06:20,309 --> 01:06:25,047
ALL OF THESE DIFFERENT CENTERS.

2037
01:06:25,114 --> 01:06:25,915
SIMILARLY, THINGS ABOUT THE

2038
01:06:25,981 --> 01:06:27,516
EXPERIENCE OF PAIN AND

2039
01:06:27,583 --> 01:06:29,051
QUANTITATIVE MEASURES, THINGS

2040
01:06:29,118 --> 01:06:30,686
LIKE QUANTITATIVE SENSORY

2041
01:06:30,753 --> 01:06:33,022
TESTING, MONITORING PATIENTS AT

2042
01:06:33,089 --> 01:06:34,390
HOME, WE HARMONIZED THE WAY WE

2043
01:06:34,457 --> 01:06:35,925
WERE COLLECTING THAT DATA SO,

2044
01:06:35,991 --> 01:06:37,893
AGAIN, WE COULD COMPARE DATA

2045
01:06:37,960 --> 01:06:42,998
ACROSS THE CONSORTIUM.

2046
01:06:43,065 --> 01:06:46,268
I SEEM TO BE STUCK.

2047
01:06:46,335 --> 01:06:48,904
SO IF SOMEONE CAN HELP ADVANCE

2048
01:06:48,971 --> 01:06:51,640
THE SLIDES?

2049
01:06:51,707 --> 01:06:52,675
THE NEXT SLIDE THAT I'LL SHOW

2050
01:06:52,742 --> 01:06:55,111
YOU IS REPRESENTING THE THREE

2051
01:06:55,177 --> 01:06:57,279
MECHANISTIC RESEARCH CENTERS.

2052
01:06:57,346 --> 01:06:58,681
SO THE THREE MECHANISTIC

2053
01:06:58,748 --> 01:07:00,483
RESEARCH CENTERS, AGAIN, ARE

2054
01:07:00,549 --> 01:07:01,450
UNIVERSITY OF PITTSBURGH,

2055
01:07:01,517 --> 01:07:03,919
UNIVERSITY OF MICHIGAN, AS WELL

2056
01:07:03,986 --> 01:07:04,587
AS UCSF.

2057
01:07:04,653 --> 01:07:08,724
AND WHAT WE DID -- SORRY, IT'S

2058
01:07:08,791 --> 01:07:09,692
NOT WORKING AT ALL.

2059
01:07:09,759 --> 01:07:13,863
SO WHAT WE DID WAS WE HARMONIZED

2060
01:07:13,929 --> 01:07:19,101
OUR DATASETS WITHIN THE THREE

2061
01:07:19,168 --> 01:07:21,137
CONSORTIA, AND WE ALSO HAD

2062
01:07:21,203 --> 01:07:23,239
CERTAIN SEGMENTS OF THE

2063
01:07:23,305 --> 01:07:24,974
CONSORTIA WHERE WE WOULD

2064
01:07:25,040 --> 01:07:25,841
HARMONIZE BETWEEN TWO.

2065
01:07:25,908 --> 01:07:26,275
FOR EXAMPLE.

2066
01:07:26,342 --> 01:07:27,676
IN THE UNIVERSITY OF MICHIGAN,

2067
01:07:27,743 --> 01:07:28,778
THE UNIVERSITY OF PITTSBURGH, WE

2068
01:07:28,844 --> 01:07:30,513
WERE DOING ADDITIONAL

2069
01:07:30,579 --> 01:07:31,580
BIOSAMPLING IN ADDITION TO THE

2070
01:07:31,647 --> 01:07:33,883
PATIENT-REPORTED OUTCOMES.

2071
01:07:33,949 --> 01:07:35,484
UCSF AND MICHIGAN ARE

2072
01:07:35,551 --> 01:07:37,887
COLLABORATING DOING ADVANCED

2073
01:07:37,953 --> 01:07:39,221
IMAGING ANALYSIS AND COLLECTING

2074
01:07:39,288 --> 01:07:41,490
RICH DATASETS RELATED TO THAT.

2075
01:07:41,557 --> 01:07:45,428
NOW THAT THAT INFRASTRUCTURE IS

2076
01:07:45,494 --> 01:07:46,962
BUILT ACROSS THE MECHANISTIC

2077
01:07:47,029 --> 01:07:48,497
RESEARCH CENTERS, WE ARE VERY

2078
01:07:48,564 --> 01:07:49,465
HOPEFUL THAT NOW THAT WE HAVE

2079
01:07:49,532 --> 01:07:50,866
DONE THE BASELINE COLLECTION ON

2080
01:07:50,933 --> 01:07:52,234
ALL THESE HARMONIZED MEASURES,

2081
01:07:52,301 --> 01:07:53,602
THAT WE'LL BE ABLE TO FOLLOW

2082
01:07:53,669 --> 01:07:56,972
THIS VERY VALUABLE COHORT

2083
01:07:57,039 --> 01:08:05,948
FORWARD AS WE -- THERE YOU GO.

2084
01:08:06,015 --> 01:08:07,183
SO WE'LL BE ABLE TO FOLLOW THIS

2085
01:08:07,249 --> 01:08:11,153
VERY VALUABLE COHORT FORWARD AND

2086
01:08:11,220 --> 01:08:13,155
COLLECT DATA BEYOND THE ONE YEAR

2087
01:08:13,222 --> 01:08:14,657
FOLLOW-UP THAT WE'RE CURRENTLY

2088
01:08:14,723 --> 01:08:17,493
COLLECTING.

2089
01:08:17,560 --> 01:08:20,129
SO ROBUST DATA COLLECTION, AT

2090
01:08:20,196 --> 01:08:21,764
PITT WE NOW HAVE OVER 950

2091
01:08:21,831 --> 01:08:24,900
PARTICIPANTS AT UCSF, THEY HAVE

2092
01:08:24,967 --> 01:08:25,968
OVER 450 PARTICIPANTS, AS WELL

2093
01:08:26,035 --> 01:08:27,570
AS A REMOTE COHORT THAT IS NOW

2094
01:08:27,636 --> 01:08:30,039
MORE THAN 2400 PARTICIPANTS WITH

2095
01:08:30,105 --> 01:08:32,007
PATIENT-REPORTED OUTCOMES AND

2096
01:08:32,074 --> 01:08:33,075
ELECTRONIC MEDICAL RECORD DATA

2097
01:08:33,142 --> 01:08:35,177
AND AT MICHIGAN THEY'RE NOW WELL

2098
01:08:35,244 --> 01:08:37,980
OVER 420 PARTICIPANTS THAT HAVE

2099
01:08:38,047 --> 01:08:39,415
THE DEEP PHENOTYPING DATA AS

2100
01:08:39,482 --> 01:08:40,616
WELL AS PARTICIPATING IN THE

2101
01:08:40,683 --> 01:08:41,951
CLINICAL TRIAL.

2102
01:08:42,017 --> 01:08:44,787
I'LL GIVE YOU JUST A BIT OF A

2103
01:08:44,854 --> 01:08:47,590
SENSE OF THE PITT COHORT TO GIVE

2104
01:08:47,656 --> 01:08:50,125
YOU A SENSE OF WHO THESE PEOPLE

2105
01:08:50,192 --> 01:08:51,427
ARE WHO HAVE ENTERED INTO OUR

2106
01:08:51,494 --> 01:08:52,094
COHORT.

2107
01:08:52,161 --> 01:08:53,162
THE FIRST GRAPH THERE JUST PAIN

2108
01:08:53,229 --> 01:08:53,395
SCORE.

2109
01:08:53,462 --> 01:08:54,797
SO YOU CAN SEE A MODERATE RANGE

2110
01:08:54,864 --> 01:08:57,066
OF PAIN THAT IS RELATIVELY

2111
01:08:57,132 --> 01:08:57,867
CONSISTENT OVER TIME.

2112
01:08:57,933 --> 01:08:59,935
THAT Y AXIS IS EXPANDED THERE SO

2113
01:09:00,002 --> 01:09:01,437
THAT THAT DROP OR REGRESSION TO

2114
01:09:01,504 --> 01:09:02,872
THE MEAN THAT OCCURRED AFTER THE

2115
01:09:02,938 --> 01:09:04,874
BASELINE IS REALLY ONLY ABOUT A

2116
01:09:04,940 --> 01:09:08,077
POINT IN CHANGE AN IN PAIN SCOR.

2117
01:09:08,143 --> 01:09:09,545
SO MODERATE PAIN.

2118
01:09:09,612 --> 01:09:11,380
SIMILARLY, DISABILITY AS

2119
01:09:11,447 --> 01:09:13,015
MEASURED BY THE DISABILITY

2120
01:09:13,082 --> 01:09:14,450
INDEX, ALSO MODERATE AND

2121
01:09:14,517 --> 01:09:15,985
RELATIVELY CONSISTENT OVER THE

2122
01:09:16,051 --> 01:09:17,386
ONE-YEAR FOLLOW-UP.

2123
01:09:17,453 --> 01:09:19,021
WE ALSO DO HARMONIZATION OF HOW

2124
01:09:19,088 --> 01:09:20,422
WE ARE COLLECTING INFORMATION

2125
01:09:20,489 --> 01:09:21,524
ABOUT TREATMENTS.

2126
01:09:21,590 --> 01:09:22,591
WE RECOGNIZE THAT PEOPLE WITH

2127
01:09:22,658 --> 01:09:24,460
CHRONIC LOW BACK PAIN RECEIVE

2128
01:09:24,527 --> 01:09:25,861
DIFFERENT TYPES OF TREATMENTS,

2129
01:09:25,928 --> 01:09:26,962
AND SOMETIMES MULTIPLE

2130
01:09:27,029 --> 01:09:27,496
TREATMENTS AT ONCE.

2131
01:09:27,563 --> 01:09:28,931
SO WE HAVE HARMONIZED THE WAY

2132
01:09:28,998 --> 01:09:31,767
THAT WE'RE COLLECTING THAT

2133
01:09:31,834 --> 01:09:33,736
INFORMATION ACROSS THE

2134
01:09:33,802 --> 01:09:35,070
CONSORTIUM SO WE CAN COMPARE AND

2135
01:09:35,137 --> 01:09:35,804
CONTRAST.

2136
01:09:35,871 --> 01:09:38,073
AT PITT, WE SEE A VERY HIGH

2137
01:09:38,140 --> 01:09:40,376
PREDOMINENCE OF EXERCISE AS

2138
01:09:40,442 --> 01:09:41,410
BEING THE MAJOR TREATMENT THAT

2139
01:09:41,477 --> 01:09:43,646
PEOPLE ARE ENGAGING IN, FOLLOWED

2140
01:09:43,712 --> 01:09:46,048
BY NSAIDS, AND QUITE A BIT OF

2141
01:09:46,115 --> 01:09:47,016
MINDFULNESS AND MEDITATION IN

2142
01:09:47,082 --> 01:09:47,816
OUR COHORT AS WELL.

2143
01:09:47,883 --> 01:09:49,318
SO IT WILL BE INTERESTING AS THE

2144
01:09:49,385 --> 01:09:50,719
FULL DATASETS COME IN TO BE ABLE

2145
01:09:50,786 --> 01:09:52,388
TO SEE ALL OF THE DIFFERENT

2146
01:09:52,454 --> 01:09:53,255
TREATMENTS THAT PEOPLE ARE

2147
01:09:53,322 --> 01:09:55,758
RECEIVING.

2148
01:09:55,824 --> 01:09:57,593
WE'VE ALSO HARMONIZED THE

2149
01:09:57,660 --> 01:09:59,662
PHYSICAL EXAM MANEUVER SO WE

2150
01:09:59,728 --> 01:10:00,462
CREATED STANDARD OPERATING

2151
01:10:00,529 --> 01:10:00,763
PROCEDURES.

2152
01:10:00,829 --> 01:10:02,097
SO THAT THE WAY WE WERE

2153
01:10:02,164 --> 01:10:03,499
MEASURING RANGE OF MOTION WAS

2154
01:10:03,566 --> 01:10:05,568
THE SAME ACROSS ALL OF THE

2155
01:10:05,634 --> 01:10:06,535
DIFFERENT SITES IN THE

2156
01:10:06,602 --> 01:10:08,404
CONSORTIUM.

2157
01:10:08,470 --> 01:10:10,940
THIS IS WORK THAT IS LED BY

2158
01:10:11,006 --> 01:10:12,908
KEVIN BELL IN PITTSBURGH LACKING

2159
01:10:12,975 --> 01:10:18,547
AT LOOKINGAT USING SKIN SURFACEN

2160
01:10:18,614 --> 01:10:22,051
SENSORS THAT ARE WIRELESS WHERE

2161
01:10:22,117 --> 01:10:23,385
WE CAN COLLECT RANGE OF MOTION

2162
01:10:23,452 --> 01:10:27,723
OF MOTION, VELOCITY AND

2163
01:10:27,790 --> 01:10:29,458
ACCELERATION WITHIN SPINE

2164
01:10:29,525 --> 01:10:30,626
MOVEMENTS AND MEASURE ACTIVITY

2165
01:10:30,693 --> 01:10:30,960
IN THE FIELD.

2166
01:10:31,026 --> 01:10:32,861
SO THIS IS ONE EXAMPLE OF THE

2167
01:10:32,928 --> 01:10:34,029
BIOMECHANICAL DATA THAT WE ARE

2168
01:10:34,096 --> 01:10:34,496
COLLECTING.

2169
01:10:34,563 --> 01:10:36,599
ANOTHER EXAMPLE IS THAT OF THE

2170
01:10:36,665 --> 01:10:39,969
UCSF GROUP THAT IS MAKING USE OF

2171
01:10:40,035 --> 01:10:43,439
THE AZURE CONNECT CAMERA CYST

2172
01:10:43,505 --> 01:10:45,074
TELL AS WELL AS A CUSTOMIZED

2173
01:10:45,140 --> 01:10:46,308
FLOOR MATT WHERE THEY CAN LOOK

2174
01:10:46,375 --> 01:10:48,143
AT JOINT MOVEMENTS AS WELL AS

2175
01:10:48,210 --> 01:10:49,578
OVERALL POSTURE, AGAIN

2176
01:10:49,645 --> 01:10:51,046
VELOCITIES AND ACCELERATIONS,

2177
01:10:51,113 --> 01:10:52,281
JOINT FORCES AND MECHANICAL

2178
01:10:52,348 --> 01:10:52,848
ENERGY ESTIMATES.

2179
01:10:52,915 --> 01:10:54,149
AGAIN, THESE ARE JUST EXAMPLES

2180
01:10:54,216 --> 01:10:55,784
OF THE VERY, VERY RICH DATASETS

2181
01:10:55,851 --> 01:10:57,653
THAT WE'RE COLLECTING BASED ON

2182
01:10:57,720 --> 01:10:59,288
THE BIOMECHANICS.

2183
01:10:59,355 --> 01:11:00,789
WE ALSO ARE COLLECTING DATA ON

2184
01:11:00,856 --> 01:11:02,558
THE IMAGING, AND THIS IS A GREAT

2185
01:11:02,625 --> 01:11:04,526
EXAMPLE OF THE COLLABORATION

2186
01:11:04,593 --> 01:11:05,194
BETWEEN SITES.

2187
01:11:05,260 --> 01:11:06,462
IN PITTSBURGH, WE ARE COLLECTING

2188
01:11:06,528 --> 01:11:08,230
OUR CLINICAL IMAGING AND SENDING

2189
01:11:08,297 --> 01:11:10,933
TO UCSF FOR ADVANCED ANALYSIS,

2190
01:11:11,000 --> 01:11:12,434
LOOKING AT DIFFERENT COMPONENTS

2191
01:11:12,501 --> 01:11:13,669
AND DIFFERENT WAYS WE CAN

2192
01:11:13,736 --> 01:11:16,071
ANALYZE THE CLINICAL IMAGES, AND

2193
01:11:16,138 --> 01:11:17,706
SEVERAL OF THE SITES ARE ALSO

2194
01:11:17,773 --> 01:11:20,542
COLLECTING ADVANCED IMAGES, LIKE

2195
01:11:20,609 --> 01:11:21,844
T1 ROW THAT CAN GIVE INFORMATION

2196
01:11:21,910 --> 01:11:23,412
ABOUT EARLY DEGENERATIVE CHANGES

2197
01:11:23,479 --> 01:11:27,316
IN THE INTERVERTEBRAL DISKS, FOR

2198
01:11:27,383 --> 01:11:28,951
EXAMPLE, OR EVEN SPECTROSCOPY,

2199
01:11:29,018 --> 01:11:34,523
WHICH SHOWS THE CHEMICAL EXOA

2200
01:11:34,590 --> 01:11:36,392
COMPOSITION ACROSS THE

2201
01:11:36,458 --> 01:11:37,826
INTERVERTEBRAL DISKS IN A VERY

2202
01:11:37,893 --> 01:11:42,598
SENSITIVE FASHION.

2203
01:11:42,665 --> 01:11:44,266
WE'RE BIOSAMPLING ALL OF THE

2204
01:11:44,333 --> 01:11:46,101
PARTICIPANTS IN THE STUDY WITH

2205
01:11:46,168 --> 01:11:47,636
SALIVA, BLOOD, SPINAL TISSUES

2206
01:11:47,703 --> 01:11:49,271
FOR THOSE THAT UNDERGO SPINE

2207
01:11:49,338 --> 01:11:50,906
SURGERY DURING THE ONE-YEAR

2208
01:11:50,973 --> 01:11:53,075
FOLLOW-UP PERIOD, STOOL SAMPLES

2209
01:11:53,142 --> 01:11:56,145
AND URINE SO THAT WE CAN LOOK AT

2210
01:11:56,211 --> 01:11:59,214
GENOMICS, EP  EPIGENOMICS,

2211
01:11:59,281 --> 01:12:00,649
MICROBIOME, TRANSCRIPTOMICS,

2212
01:12:00,716 --> 01:12:01,350
METABOLOMICS, AND THERE'S BEEN A

2213
01:12:01,417 --> 01:12:03,485
LOT OF WORK TO HARMONIZE THE WAY

2214
01:12:03,552 --> 01:12:05,387
THAT THE SAMPLES ARE COLLECTED

2215
01:12:05,454 --> 01:12:07,089
AT ALL OF THE SITES AS WELL, SO

2216
01:12:07,156 --> 01:12:08,957
THAT THE CREATION OF THIS

2217
01:12:09,024 --> 01:12:11,460
BIOREPOSITORY CAN BE USED BY

2218
01:12:11,527 --> 01:12:13,495
OTHERS.

2219
01:12:13,562 --> 01:12:15,230
AND I'LL END BY JUST TELLING YOU

2220
01:12:15,297 --> 01:12:16,598
A BIT ABOUT HOW WE'RE STARTING

2221
01:12:16,665 --> 01:12:17,966
TO THINK ABOUT PULLING ALL OF

2222
01:12:18,033 --> 01:12:19,068
THIS DATA TOGETHER.

2223
01:12:19,134 --> 01:12:22,571
AND SO THIS IS AN EXAMPLE THAT

2224
01:12:22,638 --> 01:12:30,312
CAROL GRECKO AND HER TEAM, WE

2225
01:12:30,379 --> 01:12:31,747
LOOKED AT 10 DIFFERENT FACTORS

2226
01:12:31,814 --> 01:12:33,816
OR DOMAINS BASED ON

2227
01:12:33,882 --> 01:12:35,017
PATIENT-REPORTED OUTCOMES,

2228
01:12:35,084 --> 01:12:35,784
DEMOGRAPHICS AS WELL AS SOCIAL

2229
01:12:35,851 --> 01:12:37,319
DETERMINANTS OF HEALTH, AND BY

2230
01:12:37,386 --> 01:12:40,689
USING LATENT CLASS ANALYSIS,

2231
01:12:40,756 --> 01:12:42,224
WERE ABLE TO IDENTIFY FOUR

2232
01:12:42,291 --> 01:12:44,193
DIFFERENT PHENOTYPES OF PATIENTS

2233
01:12:44,259 --> 01:12:45,494
FROM THE ENTIRE COHORT.

2234
01:12:45,561 --> 01:12:48,097
JUST BASED ON THOSE 10 FACTORS.

2235
01:12:48,163 --> 01:12:49,531
IT'S PRETTY ROBUST.

2236
01:12:49,598 --> 01:12:53,335
DOING THE SAME THING WITH A

2237
01:12:53,402 --> 01:12:55,204
CLUSTER ANALYSIS, A DIFFERENT

2238
01:12:55,270 --> 01:12:56,939
MATHEMATICAL APPROACH SHOWS VERY

2239
01:12:57,005 --> 01:12:58,140
SIMILAR PATTERNS, THOUGH IT

2240
01:12:58,207 --> 01:12:59,675
COLLAPSED INTO THREE DIFFERENT

2241
01:12:59,742 --> 01:13:00,008
PHENOTYPES.

2242
01:13:00,075 --> 01:13:01,410
SO WE'RE VERY BULLISH ON THIS

2243
01:13:01,477 --> 01:13:02,377
AND THINK THAT AS WE START TO

2244
01:13:02,444 --> 01:13:04,379
LAYER IN THE BIOMECHANICS AND

2245
01:13:04,446 --> 01:13:08,851
THE BIOLOGY ON TOP OF ALL OF THE

2246
01:13:08,917 --> 01:13:09,418
PATIENT-REPORTED INFORMATION

2247
01:13:09,485 --> 01:13:10,586
THAT WE HAVE THAT WE WILL REALLY

2248
01:13:10,652 --> 01:13:12,554
BE ABLE TO TEASE OUT DIFFERENT

2249
01:13:12,621 --> 01:13:14,389
TYPES OF PATIENTS AND DIFFERENT

2250
01:13:14,456 --> 01:13:17,459
PHENOTYPES OF PATIENTS AND HOW

2251
01:13:17,526 --> 01:13:18,026
THEY RESPOND.

2252
01:13:18,093 --> 01:13:20,195
SO HOW WE'RE MAKING SENSE OF

2253
01:13:20,262 --> 01:13:22,898
THAT SOUP OF DATA, WE HAVE

2254
01:13:22,965 --> 01:13:24,433
PREPROCESSED IN PITTSBURGH OVER

2255
01:13:24,500 --> 01:13:26,401
600 OF OUR DATA PARTICIPANTS.

2256
01:13:26,468 --> 01:13:28,771
WE HAVE PAINSTAKINGLY HAD DATA

2257
01:13:28,837 --> 01:13:30,272
RETREATS WHERE WE SIT IN A ROOM

2258
01:13:30,339 --> 01:13:33,175
FOR SEVERAL HOURS AT A TIME AND

2259
01:13:33,242 --> 01:13:35,577
GO THROUGH ITEM BY ITEM WHAT

2260
01:13:35,644 --> 01:13:36,545
FEATURES WE'RE GOING TO PULL OUT

2261
01:13:36,612 --> 01:13:39,515
OF EACH DATA COLLECTION.

2262
01:13:39,581 --> 01:13:40,916
SO FOR EXAMPLE, ARE WE GOING TO

2263
01:13:40,983 --> 01:13:43,418
INCLUDE LEFT HIP RANGE OF MOTION

2264
01:13:43,485 --> 01:13:44,086
AND RIGHT HIP RANGE OF MOTION OR

2265
01:13:44,153 --> 01:13:45,053
ARE WE GOING TO COME UP WITH

2266
01:13:45,120 --> 01:13:46,488
SOMETHING THAT IS GOING TO

2267
01:13:46,555 --> 01:13:50,192
HARMONIZE THAT FEATURE?

2268
01:13:50,259 --> 01:13:51,627
THEN STARTING TO DO SOME MACHINE

2269
01:13:51,693 --> 01:13:52,060
LEARNING.

2270
01:13:52,127 --> 01:13:53,629
AGAIN WE'RE VERY EXCITED, THE

2271
01:13:53,695 --> 01:13:54,463
EARLY MACHINE LEARNING, YOU CAN

2272
01:13:54,530 --> 01:13:56,331
SEE SOME OF THE CORRELATION

2273
01:13:56,398 --> 01:13:57,833
COEFFICIENTS HERE AT THE BOTTOM,

2274
01:13:57,900 --> 01:13:59,501
BUT LOOKING VERY, VERY GOOD AND

2275
01:13:59,568 --> 01:14:04,540
THIS INCLUDES SO FAR JUST THE

2276
01:14:04,606 --> 01:14:05,407
PATIENT-REPORTED OUT COME AND

2277
01:14:05,474 --> 01:14:06,708
DEMOGRAPHIC DATA, SO AGAIN AS WE

2278
01:14:06,775 --> 01:14:08,443
LAYER OTHER THINGS ON, WE THINK

2279
01:14:08,510 --> 01:14:09,878
WE'RE GOING TO HAVE A GREAT

2280
01:14:09,945 --> 01:14:10,646
ABILITY TO LOOK AT THE

2281
01:14:10,712 --> 01:14:12,648
ASSOCIATION WITH PAIN, AS WELL

2282
01:14:12,714 --> 01:14:13,048
AS DISABILITY.

2283
01:14:13,115 --> 01:14:14,583
AND YOU'LL HEAR MORE ABOUT THAT

2284
01:14:14,650 --> 01:14:19,188
AS I PASS TO MY PARTNER.

2285
01:14:19,254 --> 01:14:22,591
I'LL JUST END BY THANKING OUR

2286
01:14:22,658 --> 01:14:22,991
PITT TEAM.

2287
01:14:23,058 --> 01:14:24,660
THIS IS AN AMAZING

2288
01:14:24,726 --> 01:14:26,094
MULTIDISCIPLINARY TEAM OF

2289
01:14:26,161 --> 01:14:27,930
BIOLOGISTS, CLINICIAN,

2290
01:14:27,996 --> 01:14:28,931
ENGINEERS, BIOSTATISTICIAN, ALL

2291
01:14:28,997 --> 01:14:30,732
APPROACHING THIS PROBLEM

2292
01:14:30,799 --> 01:14:30,999
TOGETHER.

2293
01:14:31,066 --> 01:14:32,701
WE HAVE MULTIPLE

2294
01:14:32,768 --> 01:14:33,869
CO-INVESTIGATORS INVOLVED IN THE

2295
01:14:33,936 --> 01:14:35,404
PROJECT WHO BRING THEIR CONTENT

2296
01:14:35,470 --> 01:14:37,906
EXPERTISE TO THE TABLE IN BOTH

2297
01:14:37,973 --> 01:14:40,209
DESIGNING AND INTERPRETING THE

2298
01:14:40,275 --> 01:14:41,777
DATA, AS WELL AS OUR CHAMPIONS

2299
01:14:41,844 --> 01:14:43,178
WHO ARE THE MACHINE THAT MAKE

2300
01:14:43,245 --> 01:14:45,781
THE ENGINE RUN ESSENTIALLY.

2301
01:14:45,848 --> 01:14:49,751
I'M VERY THANKFUL FOR THE

2302
01:14:49,818 --> 01:14:51,053
CONSORTIUM IN GENERAL.

2303
01:14:51,119 --> 01:14:54,957
I THINK EVERYONE HAS COME IN TO

2304
01:14:55,023 --> 01:14:55,958
BACPAC BY LEAVING THEIR

2305
01:14:56,024 --> 01:14:58,026
INDIVIDUAL RESEARCH AGENDAS ONE

2306
01:14:58,093 --> 01:14:59,895
TIER BELOW THE OVERARCHING

2307
01:14:59,962 --> 01:15:01,597
MISSION OF BACPAC, WHICH HAS

2308
01:15:01,663 --> 01:15:04,700
BEEN REALLY, REALLY AMAZING TO

2309
01:15:04,766 --> 01:15:07,102
SEE HOW EVERYONE HAS KIND OF

2310
01:15:07,169 --> 01:15:09,304
CHECKED THEIR OWN EGOS AT THE

2311
01:15:09,371 --> 01:15:10,939
DOOR AND COLLABORATED AND AT

2312
01:15:11,006 --> 01:15:11,840
TIMES COMPROMISED TO MAKE SURE

2313
01:15:11,907 --> 01:15:13,675
THAT WE ARE DOING SOMETHING THAT

2314
01:15:13,742 --> 01:15:15,777
IS WELL REPRESENTING THE PEOPLE

2315
01:15:15,844 --> 01:15:18,180
THAT WE ARE LOOKING TO HELP WITH

2316
01:15:18,247 --> 01:15:21,149
THE TREATMENTS THAT WE'RE

2317
01:15:21,216 --> 01:15:22,017
DESIGNING.

2318
01:15:22,084 --> 01:15:23,218
WE'VE LEARNED FROM EACH OTHER,

2319
01:15:23,285 --> 01:15:24,953
WE'VE SYNERGIZED, AND TRULY IT'S

2320
01:15:25,020 --> 01:15:26,221
BEEN THE GREATEST JOY OF MY

2321
01:15:26,288 --> 01:15:28,023
PROFESSIONAL YEAR, AND I REMAIN

2322
01:15:28,090 --> 01:15:29,458
HOPEFUL THAT WE'LL KEEP THE BAND

2323
01:15:29,524 --> 01:15:30,759
TOGETHER AS WE MOVE FORWARD WITH

2324
01:15:30,826 --> 01:15:31,426
THINGS.

2325
01:15:31,493 --> 01:15:36,231
SO I'LL PASS IT ON TO ABEL TO

2326
01:15:36,298 --> 01:15:37,766
TALK ABOUT HOW WE MAKE SENSE OF

2327
01:15:37,833 --> 01:15:39,735
ALL THIS DATA.

2328
01:15:39,801 --> 01:15:42,137
>> THAT WAS GREAT.

2329
01:15:42,204 --> 01:15:43,438
THANK YOU, GWEN.

2330
01:15:43,505 --> 01:15:46,074
I LOVE DATA, SO I'M GOING TO TRY

2331
01:15:46,141 --> 01:15:49,611
TO ECK PLAIP  EXPLAIN WHAT WE AO

2332
01:15:49,678 --> 01:15:51,647
DO AT UCSF TO MAKE SENSE OF ALL

2333
01:15:51,713 --> 01:15:52,648
OF THIS DATA.

2334
01:15:52,714 --> 01:15:53,615
THE ULTIMATE GOAL IS TO

2335
01:15:53,682 --> 01:15:54,983
UNDERSTAND THIS QUESTION THAT WE

2336
01:15:55,050 --> 01:15:56,551
HAVE UP HERE ON THE SCREEN, CAN

2337
01:15:56,618 --> 01:15:58,086
WE KNOW ALL THE FACTORS THAT

2338
01:15:58,153 --> 01:16:00,188
ACTUALLY ARE CAUSING CHRONIC LOW

2339
01:16:00,255 --> 01:16:01,156
BACK PAIN?

2340
01:16:01,223 --> 01:16:03,358
AND I'M GOING TO START PREMISING

2341
01:16:03,425 --> 01:16:06,628
THIS BY THE IDEA THAT MOST CASES

2342
01:16:06,695 --> 01:16:08,163
OF CHRONIC PAIN, WE DON'T KNOW

2343
01:16:08,230 --> 01:16:09,598
THE EXACT CAUSE, AND IF WE DON'T

2344
01:16:09,665 --> 01:16:10,999
KNOW THE CAUSE, WELL, FINDING

2345
01:16:11,066 --> 01:16:13,869
THE TREATMENT BECOMES VERY

2346
01:16:13,936 --> 01:16:14,503
DIFFICULT.

2347
01:16:14,569 --> 01:16:16,271
WE ALL HEARD ABOUT THE TRIAL AND

2348
01:16:16,338 --> 01:16:19,041
ERROR THAT GOES INTO DECIDING

2349
01:16:19,107 --> 01:16:20,742
WHAT TREATMENT WORKS BEST FOR A

2350
01:16:20,809 --> 01:16:21,410
PATIENT.

2351
01:16:21,476 --> 01:16:22,711
SO WHY WE DON'T KNOW THE CAUSE?

2352
01:16:22,778 --> 01:16:24,713
WELL, THIS IS BECAUSE OF THE

2353
01:16:24,780 --> 01:16:25,580
COMPLEXITY OF CHRONIC PAIN.

2354
01:16:25,647 --> 01:16:27,416
WE KNOW A LOT OF THE DIFFERENT

2355
01:16:27,482 --> 01:16:32,321
FACTORS AND T THAT MAY POTENTIAY

2356
01:16:32,387 --> 01:16:33,322
CONTRIBUTE AND INTERACT TO EACH

2357
01:16:33,388 --> 01:16:34,656
OTHER TO MAKE THE APPEARANCE OF

2358
01:16:34,723 --> 01:16:35,924
PAIN BUT ALSO THE PROGRESSION OF

2359
01:16:35,991 --> 01:16:36,925
CROCK PAIN AND THE RESPONSE TO

2360
01:16:36,992 --> 01:16:39,895
TREATMENT.

2361
01:16:39,962 --> 01:16:40,529
CHRONIC PAIN.

2362
01:16:40,595 --> 01:16:43,899
SO TO UNDERSTAND THAT COMPL

2363
01:16:43,966 --> 01:16:45,233
COMPLEXITY, GWEN MENTIONED THIS

2364
01:16:45,300 --> 01:16:47,736
ALREADY, THE BACPAC CONSORTIUM

2365
01:16:47,803 --> 01:16:49,705
DECIDED TO BUILD A THEORETICAL

2366
01:16:49,771 --> 01:16:51,340
MODEL, AND SO THEORETICAL

2367
01:16:51,406 --> 01:16:52,641
MODELS, YOU HAVE AN EXAMPLE HERE

2368
01:16:52,708 --> 01:16:58,580
ON THE SCREEN, IT'S CALLED THE

2369
01:16:58,647 --> 01:16:59,448
CONCEPTUAL.

2370
01:16:59,514 --> 01:17:00,649
THE EXPERTS HAVE TO DECIDE THESE

2371
01:17:00,716 --> 01:17:02,050
ARE THE DIFFERENT FACTORS, HOW

2372
01:17:02,117 --> 01:17:03,585
THEY ARE GOING TO INTERACT AND

2373
01:17:03,652 --> 01:17:06,321
WHAT ARE THE BASIC MECHANISMS

2374
01:17:06,388 --> 01:17:08,957
THAT PAIN SHALL APPEAR, PROGRESS

2375
01:17:09,024 --> 01:17:09,825
AND SO ON.

2376
01:17:09,891 --> 01:17:12,794
NOW, MODELS ARE A SIMPLIFICATION

2377
01:17:12,861 --> 01:17:13,462
OF REALITY.

2378
01:17:13,528 --> 01:17:16,331
IT ALLOWS US TO UNDERSTAND

2379
01:17:16,398 --> 01:17:19,468
COMPLEX SYSTEMS IN A MUCH MORE,

2380
01:17:19,534 --> 01:17:20,902
I GUESS, APPROACHABLE WAY, AND

2381
01:17:20,969 --> 01:17:24,072
WE CAN THEN START THINKING OR

2382
01:17:24,139 --> 01:17:24,973
SHARE UNDERSTANDING OF WHAT ARE

2383
01:17:25,040 --> 01:17:27,242
THE MECHANISMS OF THAT COMPLEX

2384
01:17:27,309 --> 01:17:28,577
PHENOMENON, IN THIS PARTICULAR

2385
01:17:28,643 --> 01:17:29,011
CASE, PAIN.

2386
01:17:29,077 --> 01:17:30,312
NOW WE CAN BUILD MODELS IN

2387
01:17:30,379 --> 01:17:30,712
DIFFERENT WAYS.

2388
01:17:30,779 --> 01:17:32,614
WE CAN BUILD MODELS FROM DATA

2389
01:17:32,681 --> 01:17:33,815
ITSELF, WE CAN BUILD MODELS FROM

2390
01:17:33,882 --> 01:17:34,349
THE LITERATURE.

2391
01:17:34,416 --> 01:17:36,651
YOU CAN THINK ABOUT A SYSTEMATIC

2392
01:17:36,718 --> 01:17:38,954
REVIEW, FOR INSTANCE, STARTING

2393
01:17:39,021 --> 01:17:40,255
TO BUILD THAT MODEL.

2394
01:17:40,322 --> 01:17:41,823
WE CAN BUILD MODELS FROM ASKING

2395
01:17:41,890 --> 01:17:45,961
THE EXPERTS, LAKE THE MODEL THAI

2396
01:17:46,028 --> 01:17:46,728
JUST SHOWED.

2397
01:17:46,795 --> 01:17:48,597
I'M GOING TO TALK ABOUT THE DATA

2398
01:17:48,663 --> 01:17:49,364
MODEL TRYING TO MAKE SENSE OF

2399
01:17:49,431 --> 01:17:53,835
ALL THAT.

2400
01:17:53,902 --> 01:17:57,773
SO AT UCSF, WE HAVE THE COMEBACK

2401
01:17:57,839 --> 01:17:59,408
STUDY, OBSERVATIONAL STUDY, AND

2402
01:17:59,474 --> 01:18:01,810
THE GOAL IS DEEP PHENOTYPING AS

2403
01:18:01,877 --> 01:18:03,145
GWEN WAS TALKING ABOUT, SO

2404
01:18:03,211 --> 01:18:04,012
THERE'S A LOT OF DATA FROM

2405
01:18:04,079 --> 01:18:05,981
DIFFERENT DOMAINS THAT ARE

2406
01:18:06,048 --> 01:18:08,483
COLLECTING, AND EACH ONE OF THE

2407
01:18:08,550 --> 01:18:09,985
COMPLEX SPECIALIZED DATASETS

2408
01:18:10,052 --> 01:18:16,391
THAT ARE BEING COLLECTED, THERE

2409
01:18:16,458 --> 01:18:18,794
IS A LOT OF WORK THAT GOES INTO

2410
01:18:18,860 --> 01:18:20,095
GENERATING EVERYONE'S FAVORITE

2411
01:18:20,162 --> 01:18:20,462
VARIABLES.

2412
01:18:20,529 --> 01:18:26,134
BUT THE POINT IS, HOW DO WE BIND

2413
01:18:26,201 --> 01:18:27,235
ALL THIS INFORMATION SO WE CAN

2414
01:18:27,302 --> 01:18:27,869
MAKE SENSE OF IT.

2415
01:18:27,936 --> 01:18:29,104
ONE OF THE THINGS WE'RE DOING IS

2416
01:18:29,171 --> 01:18:30,639
USING SOME MODELING TECHNIQUES

2417
01:18:30,705 --> 01:18:32,174
FROM MACHINE LEARNING WITH THE

2418
01:18:32,240 --> 01:18:34,776
IDEA TO BE ABLE TO MAKE SENSE OF

2419
01:18:34,843 --> 01:18:37,412
ALL THAT INFORMATION.

2420
01:18:37,479 --> 01:18:40,282
SO, SO FAR WE ARE WORKING WITH

2421
01:18:40,348 --> 01:18:41,683
679 VARIABLES IN THOSE 450

2422
01:18:41,750 --> 01:18:44,419
PATIENTS THAT ARE IN THE

2423
01:18:44,486 --> 01:18:45,087
COMEBACK STUDY.

2424
01:18:45,153 --> 01:18:48,590
SO THE WAY THAT WE DO THIS IS BY

2425
01:18:48,657 --> 01:18:50,025
USING SOME ANALYTICAL PIPELINES

2426
01:18:50,092 --> 01:18:53,195
THAT WE CALL MULTIDOMAIN

2427
01:18:53,261 --> 01:18:54,162
INTEGRATION, DATA INTEGRATION.

2428
01:18:54,229 --> 01:18:56,565
THE IDEA HERE IS TO TEASE APART

2429
01:18:56,631 --> 01:18:59,101
THE ACTUAL SIGNALS FROM -- THAT

2430
01:18:59,167 --> 01:18:59,835
ARE IMPORTANT FOR THE

2431
01:18:59,901 --> 01:19:01,269
PHENOTYPING OF PAIN AND

2432
01:19:01,336 --> 01:19:02,471
UNDERSTANDING THE COMPLEXITY OF

2433
01:19:02,537 --> 01:19:04,806
PAIN VERSUS WHAT IS NOISE IN ALL

2434
01:19:04,873 --> 01:19:05,907
THAT DATA.

2435
01:19:05,974 --> 01:19:07,442
WITH THE IDEA THAT WE CAN ANSWER

2436
01:19:07,509 --> 01:19:08,610
TWO DIFFERENT QUESTIONS.

2437
01:19:08,677 --> 01:19:11,012
THE COMPLEXITY PROBLEM, OR THE

2438
01:19:11,079 --> 01:19:13,215
QUESTION OF WHAT ARE THE COMPLEX

2439
01:19:13,281 --> 01:19:14,516
RELATIONSHIPS BETWEEN ALL THESE

2440
01:19:14,583 --> 01:19:16,751
FACTORS THAT REMIND CHRONIC LOW

2441
01:19:16,818 --> 01:19:19,221
BACK PAIN, BUT ALSO A

2442
01:19:19,287 --> 01:19:20,655
SUBGROUPING PROBLEM OF WHAT ARE

2443
01:19:20,722 --> 01:19:21,623
THE DIFFERENT POTENTIAL

2444
01:19:21,690 --> 01:19:24,359
SUBGROUPS OF PATIENTS THAT HAVE

2445
01:19:24,426 --> 01:19:26,928
DIFFERENT CHARACTERISTICS OF

2446
01:19:26,995 --> 01:19:27,529
THOSE PHENOTYPES.

2447
01:19:27,596 --> 01:19:28,530
WE'RE GOING TO BE USING

2448
01:19:28,597 --> 01:19:29,397
DIFFERENT TYPES OF MACHINE

2449
01:19:29,464 --> 01:19:30,499
LEARNING FOR THIS, BUT WHAT I

2450
01:19:30,565 --> 01:19:31,666
WANT TO POINT OUT IS THAT THESE

2451
01:19:31,733 --> 01:19:32,801
TWO QUESTIONS ARE RELATED TO

2452
01:19:32,868 --> 01:19:33,902
EACH OTHER.

2453
01:19:33,969 --> 01:19:38,540
SO THE COMPLEXITY OF THE -- OF

2454
01:19:38,607 --> 01:19:39,608
THE POPULATION IS HIGHLY RELATED

2455
01:19:39,674 --> 01:19:42,644
TO THE UNDERLYING MECHANISTIC

2456
01:19:42,711 --> 01:19:45,213
REASONS FOR WHY PAIN SHOWS UP IN

2457
01:19:45,280 --> 01:19:46,848
THOSE POPULATIONS.

2458
01:19:46,915 --> 01:19:49,784
SO WHAT YOU HAVE HERE IS AN

2459
01:19:49,851 --> 01:19:52,187
EXAMPLE OF -- THAT SUMMARIZES

2460
01:19:52,254 --> 01:19:57,592
ONE OF THE MODELS THAT WE HAVE.

2461
01:19:57,659 --> 01:20:00,929
SO UNDERNEATH IS A MODEL WITH

2462
01:20:00,996 --> 01:20:03,098
679 VARIABLES AND MORE THAN 2000

2463
01:20:03,165 --> 01:20:05,133
DIFFERENT RELATIONSHIPS.

2464
01:20:05,200 --> 01:20:07,669
AND SO THIS ILLUSTRATES THAT

2465
01:20:07,736 --> 01:20:08,403
COMPLEXITY, AND WHAT YOU HAVE IS

2466
01:20:08,470 --> 01:20:09,738
THE NAME OF THE DIFFERENT

2467
01:20:09,804 --> 01:20:12,040
DOMAINS OF DATA THAT GWEN WAS

2468
01:20:12,107 --> 01:20:13,775
TALKING ABOUT, AND ALL THE

2469
01:20:13,842 --> 01:20:15,143
VARIABLES, HOW DO THEY RELATE TO

2470
01:20:15,210 --> 01:20:15,544
EACH OTHER.

2471
01:20:15,610 --> 01:20:18,280
SO TO GIVE YOU AN EXAMPLE, THIS

2472
01:20:18,346 --> 01:20:20,782
IS A VERY COMPLEX MODEL BUT WE

2473
01:20:20,849 --> 01:20:22,250
VIEW AN EXAMPLE OF HOW THAT

2474
01:20:22,317 --> 01:20:24,319
LOOKS LIKE, WE CAN TAKE A LOOK

2475
01:20:24,386 --> 01:20:26,488
AT THESE THREE DIFFERENT

2476
01:20:26,555 --> 01:20:27,689
DOMAINS:  PAIN CHARACTERISTICS,

2477
01:20:27,756 --> 01:20:28,590
SYMPTOMS, AND THOUGHTS AND

2478
01:20:28,657 --> 01:20:28,924
BELIEFS.

2479
01:20:28,990 --> 01:20:31,760
AND BASICALLY, UNDERNEATH THIS

2480
01:20:31,826 --> 01:20:33,295
MODEL IS A NETWORK.

2481
01:20:33,361 --> 01:20:35,363
AND THESE NETWORKS ARE BASICALLY

2482
01:20:35,430 --> 01:20:36,131
RELATIONSHIPS BETWEEN THE

2483
01:20:36,198 --> 01:20:37,899
DIFFERENT FACTORS THAT ARE THE

2484
01:20:37,966 --> 01:20:39,734
VARIABLES THAT YOU HAVE THERE IN

2485
01:20:39,801 --> 01:20:42,170
THE DOTS, AND THE ARROWS POINTS

2486
01:20:42,237 --> 01:20:44,439
OUT WHAT ARE THE CAUSAL

2487
01:20:44,506 --> 01:20:45,106
RELATIONSHIPS BETWEEN ALL OF

2488
01:20:45,173 --> 01:20:47,509
THOSE.

2489
01:20:47,576 --> 01:20:49,945
NOW WE CAN DO A LOT OF THINGS

2490
01:20:50,011 --> 01:20:51,479
WITH THESE MODELS BUT ONE I'M

2491
01:20:51,546 --> 01:20:53,215
VERY FOND OF IS THAT WE CAN

2492
01:20:53,281 --> 01:20:57,252
START SIMULATING HYPOTHESIS

2493
01:20:57,319 --> 01:20:59,154
ABOUT THE COMPLEXITY AND

2494
01:20:59,221 --> 01:21:00,222
BEHAVIOR OF CHRONIC PAIN.

2495
01:21:00,288 --> 01:21:01,856
SO FOR INSTANCE, WE CAN DO A

2496
01:21:01,923 --> 01:21:04,292
SIMULATION AND SAY, WHAT WILL

2497
01:21:04,359 --> 01:21:06,595
HAPPEN IF WE TREAT PEOPLE FOR

2498
01:21:06,661 --> 01:21:08,663
ANXIETY IN THIS POPULATION?

2499
01:21:08,730 --> 01:21:10,198
AND WHAT HAPPENED IS THAT ALL

2500
01:21:10,265 --> 01:21:11,533
THAT INFORMATION POPULATES IN

2501
01:21:11,600 --> 01:21:16,438
THE NETWORK SO WE CAN TRY TO

2502
01:21:16,504 --> 01:21:21,276
UNDERSTAND AND GENERATE A NEW

2503
01:21:21,343 --> 01:21:23,144
HYPOTHESIS THAT CAN BE BROUGHT

2504
01:21:23,211 --> 01:21:28,383
INTO CLINICAL TRIALS.

2505
01:21:28,450 --> 01:21:31,686
SO THAT'S WHEN IT COMES TO THE

2506
01:21:31,753 --> 01:21:33,188
COMPLEXITY PROBLEM, PHENOTYPING

2507
01:21:33,255 --> 01:21:34,522
WITHOUT GETTING MUCH INTO THE

2508
01:21:34,589 --> 01:21:37,692
DETAIL OF THE SUBGROUPING, WE'VE

2509
01:21:37,759 --> 01:21:40,061
DONE SOME PIPELINES ON THESE AND

2510
01:21:40,128 --> 01:21:43,598
YOU HAVE HERE A REPRESENTATION

2511
01:21:43,665 --> 01:21:45,133
OF SIX DIFFERENT GROUPS.

2512
01:21:45,200 --> 01:21:46,568
SO WE CAN TAKE A LOOK AT WHAT

2513
01:21:46,635 --> 01:21:48,436
THEY ARE BASED ON THEIR CLINICAL

2514
01:21:48,503 --> 01:21:48,803
CHARACTERISTICS.

2515
01:21:48,870 --> 01:21:49,738
FOR INSTANCE, THAT GROUP UP

2516
01:21:49,804 --> 01:21:57,112
THERE WOULD HAVE MOSTLY FEMALES,

2517
01:21:57,178 --> 01:21:59,281
COMORBIDITIES, PAIN INTENSITY,

2518
01:21:59,347 --> 01:22:02,584
PAIN INTERFERES, IN COMPARISON

2519
01:22:02,651 --> 01:22:05,086
TO THIS GROUP DOWN HERE THAT

2520
01:22:05,153 --> 01:22:07,389
HAVE COMORBIDITIES YOUNG AND

2521
01:22:07,455 --> 01:22:08,923
HIGH LEVELS OF ANXIETY.

2522
01:22:08,990 --> 01:22:10,392
WE CAN ALSO LOOK AT THE NETWORKS

2523
01:22:10,458 --> 01:22:12,861
THAT CAPTURE THE MECHANISTICS OF

2524
01:22:12,927 --> 01:22:14,062
THESE PATIENTS SO WE CAN START

2525
01:22:14,129 --> 01:22:15,163
UNDERSTANDING WHAT ARE THE

2526
01:22:15,230 --> 01:22:18,233
CAUSAL MECHANISMS OF THE

2527
01:22:18,300 --> 01:22:20,735
APPEARANCE OR WHAT MAKES THESE

2528
01:22:20,802 --> 01:22:21,236
PATIENTS DIFFERENT.

2529
01:22:21,303 --> 01:22:22,871
SO WE'RE STILL WORKING ON THIS

2530
01:22:22,937 --> 01:22:24,739
BECAUSE WE CAN ALSO THEN START

2531
01:22:24,806 --> 01:22:26,074
COMPARING ALL THESE NETWORKS

2532
01:22:26,141 --> 01:22:31,212
ACROSS THE DIFFERENT CLUSTERS.

2533
01:22:31,279 --> 01:22:32,147
SO I'LL LEAVE YOU WITH SOMETHING

2534
01:22:32,213 --> 01:22:33,281
WE'RE TRYING TO THINK ABOUT,

2535
01:22:33,348 --> 01:22:34,949
BECAUSE WHEN WE TALK ABOUT

2536
01:22:35,016 --> 01:22:35,984
MODELING, ONE OF THE PROBLEMS IS

2537
01:22:36,051 --> 01:22:39,187
THAT MODELING FROM DATA, OR

2538
01:22:39,254 --> 01:22:42,157
MODELING FROM THE EXPERT

2539
01:22:42,223 --> 01:22:44,793
LITERATURE BRINGS UP CHALLENGES

2540
01:22:44,859 --> 01:22:46,461
AND THEIR BIASES FOR EACH ONE OF

2541
01:22:46,528 --> 01:22:47,662
THESE TYPES OF MODELS.

2542
01:22:47,729 --> 01:22:49,297
SO THE QUESTION OF WHAT IS

2543
01:22:49,364 --> 01:22:51,499
TRUTH, ON ALL THIS, WE TEND TO

2544
01:22:51,566 --> 01:22:53,335
THINK ABOUT HAVING DIFFERENT

2545
01:22:53,401 --> 01:22:55,337
MODELS THAT COMES FROM THESE

2546
01:22:55,403 --> 01:22:56,638
DIFFERENT PERSPECTIVES, AND THEY

2547
01:22:56,705 --> 01:22:58,940
CAN SHARE INFORMATION, WITH THE

2548
01:22:59,007 --> 01:23:00,275
IDEA THAT THE MODELS FROM THE

2549
01:23:00,342 --> 01:23:03,445
DATA GIVES US WHAT ARE THE

2550
01:23:03,511 --> 01:23:04,746
PATTERNS THAT WE CAN SEE AND THE

2551
01:23:04,813 --> 01:23:05,680
MODELS FROM THE LITERATURE AND

2552
01:23:05,747 --> 01:23:07,182
EXPERTS GIVES US THE MECHANISTIC

2553
01:23:07,248 --> 01:23:08,149
UNDERSTANDING WITH THE GOAL THAT

2554
01:23:08,216 --> 01:23:12,320
THEN WE CAN BUILD A MODEL THAT

2555
01:23:12,387 --> 01:23:17,258
IS REAL, BUT ALSO CAPTURED THOSE

2556
01:23:17,325 --> 01:23:18,126
MECHANISMS, THEN WE COULD PUT

2557
01:23:18,193 --> 01:23:19,794
THAT MODEL TO ACTION, DO SOME OF

2558
01:23:19,861 --> 01:23:23,098
THOSE SIMULATIONS, AND SO ON.

2559
01:23:23,164 --> 01:23:26,267
SO I'M GOING TO LEAVE THIS HERE

2560
01:23:26,334 --> 01:23:27,469
AND THIS IS WORK WE'VE BEEN

2561
01:23:27,535 --> 01:23:30,105
DOING AT UCSF WITH THE REACH

2562
01:23:30,171 --> 01:23:30,305
TEAM.

2563
01:23:30,372 --> 01:23:37,011
THANK YOU.

2564
01:23:37,078 --> 01:23:38,213
>> GOOD MORNING, EVERYONE.

2565
01:23:38,279 --> 01:23:39,914
MY NAME IS MATT MAUCK FROM THE

2566
01:23:39,981 --> 01:23:41,082
UNIVERSITY OF NORTH CAROLINA.

2567
01:23:41,149 --> 01:23:42,384
I'M HERE TO TALK TO YOU TODAY

2568
01:23:42,450 --> 01:23:43,818
ABOUT THE BIOMARKERS FOR

2569
01:23:43,885 --> 01:23:44,652
EVALUATING SPINE TREATMENTS

2570
01:23:44,719 --> 01:23:46,755
TRIAL.

2571
01:23:46,821 --> 01:23:48,089
THAT GWEN INTRODUCED.

2572
01:23:48,156 --> 01:23:50,158
THE GOAL WITH THIS TRIAL IS TO

2573
01:23:50,225 --> 01:23:52,293
DEVELOP A PRECISION MEDICINE

2574
01:23:52,360 --> 01:23:53,795
ALGORITHM TO HELP ASSIGN THE

2575
01:23:53,862 --> 01:23:56,731
BEST SEQUENCE OF TREATMENTS FOR

2576
01:23:56,798 --> 01:23:57,565
INDIVIDUALS WITH CHRONIC LOW

2577
01:23:57,632 --> 01:23:58,166
BACK PAIN.

2578
01:23:58,233 --> 01:24:00,268
WE ALSO HOPE TO DISCOVER

2579
01:24:00,335 --> 01:24:02,003
BIOMARKERS THAT PREDICT

2580
01:24:02,070 --> 01:24:02,670
TREATMENT RESPONSE AND

2581
01:24:02,737 --> 01:24:04,105
CONTRIBUTE TO OUR UNDERSTANDING

2582
01:24:04,172 --> 01:24:05,507
OF THE PATHOGENESIS OF CHRONIC

2583
01:24:05,573 --> 01:24:08,243
LOW BACK PAIN.

2584
01:24:08,309 --> 01:24:09,677
WE'VE SUCCESSFULLY RECRUITED OUR

2585
01:24:09,744 --> 01:24:14,616
COHORT INTO THE STUDY, AND HAVE

2586
01:24:14,682 --> 01:24:16,484
RECRUITED OVER A THOUSAND

2587
01:24:16,551 --> 01:24:20,522
PATIENTS INTO BEST.

2588
01:24:20,588 --> 01:24:22,490
THERE ARE SEVERAL INTERVENTIONS

2589
01:24:22,557 --> 01:24:23,725
THAT WE KNOW HELP PATIENTS WITH

2590
01:24:23,792 --> 01:24:24,359
LOW BACK PAIN.

2591
01:24:24,426 --> 01:24:25,994
THESE ARE LISTED HERE AND ARE

2592
01:24:26,060 --> 01:24:27,629
THE INTERVENTIONS THAT WE'RE

2593
01:24:27,695 --> 01:24:30,398
USING IN THE BEST TRIAL.

2594
01:24:30,465 --> 01:24:33,001
FOR EXAMPLE, DULOXETINE MIGHT

2595
01:24:33,067 --> 01:24:34,335
WORK REALLY WELL FOR SOME

2596
01:24:34,402 --> 01:24:37,572
PATIENTS BUT NOT FOR OTHERS.

2597
01:24:37,639 --> 01:24:39,774
THAT'S WHY WE DEVELOPED THE BEST

2598
01:24:39,841 --> 01:24:41,409
TRIAL AS A CONSORTIUM TO HELP US

2599
01:24:41,476 --> 01:24:43,511
UNDERSTAND AND DISENTANGLE WHY

2600
01:24:43,578 --> 01:24:44,412
SOME PATIENT RESPOND AND OTHERS

2601
01:24:44,479 --> 01:24:44,946
DON'T.

2602
01:24:45,013 --> 01:24:46,548
THE BIOMARKERS FOR EVALUATING

2603
01:24:46,614 --> 01:24:47,749
SPINE TREATMENTS TRIAL, WE CALL

2604
01:24:47,816 --> 01:24:49,751
IT THE BEST TRIAL, AND IT'S THE

2605
01:24:49,818 --> 01:24:51,286
COLLABORATIVE CENTERPIECE OF THE

2606
01:24:51,352 --> 01:24:51,953
BACK PAIN CONSORTIUM.

2607
01:24:52,020 --> 01:24:53,254
WE ALL CAME TOGETHER AS A TEAM

2608
01:24:53,321 --> 01:24:54,589
AND DEVELOPED THE PROTOCOL AND

2609
01:24:54,656 --> 01:24:56,124
THE ALGORITHM AND THE

2610
01:24:56,191 --> 01:24:56,658
PHENOTYPING THAT WE'RE

2611
01:24:56,724 --> 01:25:01,396
DEVELOPING IN THIS TRIAL.

2612
01:25:01,463 --> 01:25:04,365
WE SETTLED ON AN ADAKTIVE

2613
01:25:04,432 --> 01:25:10,205
DESIGN, A SMART TRIAL DESIGN.

2614
01:25:10,271 --> 01:25:11,773
THIS IS ONE OF THE LARGEST

2615
01:25:11,840 --> 01:25:13,441
SMARTS TO BE PERFORMED IN

2616
01:25:13,508 --> 01:25:14,209
MEDICINE.

2617
01:25:14,275 --> 01:25:19,414
IT'S ALIGNED WITH -- WE HAVE TWO

2618
01:25:19,481 --> 01:25:20,949
3-MONTH TREATMENT PERIODS VERY

2619
01:25:21,015 --> 01:25:22,050
MUCH ALIGNED WITH PATIENTS IN

2620
01:25:22,116 --> 01:25:22,951
THE CLINICAL SETTING.

2621
01:25:23,017 --> 01:25:25,687
WE USE A BROAD INCLUSION

2622
01:25:25,753 --> 01:25:25,954
CRITERIA.

2623
01:25:26,020 --> 01:25:28,022
THE GOAL IS TO MAKE THE RESULTS

2624
01:25:28,089 --> 01:25:29,224
MOST GENERALIZABLE TO THE U.S.

2625
01:25:29,290 --> 01:25:30,091
POPULATION THAT EXPERIENCES

2626
01:25:30,158 --> 01:25:31,759
CHRONIC LOW BACK PAIN.

2627
01:25:31,826 --> 01:25:34,596
WE ENROLLED THESE PARTICIPANTS

2628
01:25:34,662 --> 01:25:35,897
ACROSS 12 CLINICAL SITES.

2629
01:25:35,964 --> 01:25:37,665
THESE SITES ARE OUT STANDING,

2630
01:25:37,732 --> 01:25:39,567
AND REALLY WORK TOGETHER TO

2631
01:25:39,634 --> 01:25:42,537
ACCOMPLISH THE ENROLLMENT WITH

2632
01:25:42,604 --> 01:25:44,038
THE LEADERSHIP FROM THE DAK,

2633
01:25:44,105 --> 01:25:45,273
WHICH YOU'LL HEAR ABOUT A LITTLE

2634
01:25:45,340 --> 01:25:47,442
BIT LATER.

2635
01:25:47,509 --> 01:25:50,411
WHAT MAKES BEST INNOVATIVE AND

2636
01:25:50,478 --> 01:25:52,380
UNIQUE IS THE RICH MULTIMODAL

2637
01:25:52,447 --> 01:25:53,381
PHENOTYPING THAT WE'RE

2638
01:25:53,448 --> 01:25:56,784
PERFORMING IN THE BEST TRIAL.

2639
01:25:56,851 --> 01:25:58,086
WE'RE COLLECTING INFORMATION ON

2640
01:25:58,152 --> 01:25:59,320
PATIENT-REPORTED MEASURES,

2641
01:25:59,387 --> 01:26:00,855
BIOMECHANICS AND ACTIVITY,

2642
01:26:00,922 --> 01:26:04,225
BIOLOGICAL MARKERS, AND GWEN

2643
01:26:04,292 --> 01:26:05,326
MENTIONED FROM THE STOOL AND

2644
01:26:05,393 --> 01:26:05,793
FROM BLOOD.

2645
01:26:05,860 --> 01:26:09,397
WE'RE ALSO COLLECTING BIOMEDICAL

2646
01:26:09,464 --> 01:26:11,032
IMAGING, WE'RE COLLECTING

2647
01:26:11,099 --> 01:26:11,966
FUNCTIONAL NEUROIMAGING AS WELL

2648
01:26:12,033 --> 01:26:13,334
AS BASELINE CLINICAL SPINE

2649
01:26:13,401 --> 01:26:14,769
MRIs AT THE BASELINE, WHICH

2650
01:26:14,836 --> 01:26:19,707
I'LL TELL YOU ABOUT IN A MOMENT.

2651
01:26:19,774 --> 01:26:23,211
TO BUILD OFF OF WHAT ABEL WAS

2652
01:26:23,278 --> 01:26:23,978
DISCUSSING, PATIENTS WITH

2653
01:26:24,045 --> 01:26:25,847
CHRONIC LOW BACK PAIN ARE VERY

2654
01:26:25,914 --> 01:26:26,714
COMPLEX.

2655
01:26:26,781 --> 01:26:28,383
THESE REPRESENT THREE PROFILES

2656
01:26:28,449 --> 01:26:29,617
OF PATIENTS THAT I WAS ABLE TO

2657
01:26:29,684 --> 01:26:31,986
TAKE CARE OF AT BASELINE IN THE

2658
01:26:32,053 --> 01:26:38,059
BEST TRIAL.

2659
01:26:38,126 --> 01:26:38,793
DR. MARRAS' GROUP AT THE OHIO

2660
01:26:38,860 --> 01:26:40,161
STATE SPINE RESEARCH INSTITUTE

2661
01:26:40,228 --> 01:26:41,195
PUT THIS TOGETHER FOR US.

2662
01:26:41,262 --> 01:26:43,631
ON THE TOP ROW ARE SOME DETAILS

2663
01:26:43,698 --> 01:26:45,600
ABOUT THESE INDIVIDUALS'

2664
01:26:45,667 --> 01:26:46,167
BIOMECHANICS.

2665
01:26:46,234 --> 01:26:48,036
DOWN BELOW DESCRIBE THE

2666
01:26:48,102 --> 01:26:49,671
INDIVIDUALS' PAIN EXPERIENCE,

2667
01:26:49,737 --> 01:26:50,572
DESCRIBES THE LOCATIONS WHERE

2668
01:26:50,638 --> 01:26:52,540
THEY'RE HAVING PAIN, AS WELL AS

2669
01:26:52,607 --> 01:26:53,741
THE PROMIS MEASURES THAT

2670
01:26:53,808 --> 01:26:56,010
REPRESENT ANXIETY, DEPRESSION,

2671
01:26:56,077 --> 01:26:56,411
FATIGUE.

2672
01:26:56,477 --> 01:26:57,612
YOU CAN SEE THAT EACH OF THESE

2673
01:26:57,679 --> 01:26:59,581
PATIENTS ARE VERY UNIQUE, BUT

2674
01:26:59,647 --> 01:27:00,548
LIKELY FIT SOMEWHERE WITHIN

2675
01:27:00,615 --> 01:27:02,650
THESE CLUSTERS THAT ABEL

2676
01:27:02,717 --> 01:27:03,985
DESCRIBED IN HIS TALK, AND

2677
01:27:04,052 --> 01:27:05,286
CHECKING THESE PHENOTYPING

2678
01:27:05,353 --> 01:27:06,688
MEASURES WILL HELP US PLACE

2679
01:27:06,754 --> 01:27:08,022
THESE INDIVIDUALS WITHIN THESE

2680
01:27:08,089 --> 01:27:09,457
CLUSTERS, AND HOPEFULLY WILL

2681
01:27:09,524 --> 01:27:11,192
LEARN ABOUT WHAT IS CAUSATIVE

2682
01:27:11,259 --> 01:27:13,494
AND WHAT CAUSES CHRONIC LOW BACK

2683
01:27:13,561 --> 01:27:14,495
PAIN AS PART OF DOING THIS

2684
01:27:14,562 --> 01:27:18,666
TRIAL.

2685
01:27:18,733 --> 01:27:19,834
I'D LIKE TO TAKE YOU ON A TOUR

2686
01:27:19,901 --> 01:27:23,037
OF THE BEST TRIAL BY DISCUSSING

2687
01:27:23,104 --> 01:27:23,838
TWO PATIENTS THAT I WAS ABLE TO

2688
01:27:23,905 --> 01:27:27,308
TAKE CARE OF THROUGH THIS TRIAL.

2689
01:27:27,375 --> 01:27:28,643
THE FIRST ON THE LEFT IS A

2690
01:27:28,710 --> 01:27:29,978
67-YEAR-OLD FEMALE WITH A

2691
01:27:30,044 --> 01:27:30,979
20-YEAR HISTORY OF CHRONIC LOW

2692
01:27:31,045 --> 01:27:31,412
BACK PAIN.

2693
01:27:31,479 --> 01:27:32,947
YOU CAN SEE THIS INDIVIDUAL ON

2694
01:27:33,014 --> 01:27:35,149
THE MICHIGAN BODY MAP, THE AREAS

2695
01:27:35,216 --> 01:27:36,584
IN BLUE DENOTE AREAS WHERE THE

2696
01:27:36,651 --> 01:27:38,219
INDIVIDUAL IS HAVING PAIN, AS

2697
01:27:38,286 --> 01:27:41,022
PRIMARILY AXIAL LOW BACK PAIN.

2698
01:27:41,089 --> 01:27:42,123
ALL THE PATIENTS IN THE BEST

2699
01:27:42,190 --> 01:27:43,958
TRIAL HAD PREDOMINANTLY LOW BACK

2700
01:27:44,025 --> 01:27:44,392
PAIN.

2701
01:27:44,459 --> 01:27:45,827
AND THIS PATIENT PRIMARILY HAD

2702
01:27:45,893 --> 01:27:47,829
AXIAL LOW BACK PAIN WITH A FEW

2703
01:27:47,895 --> 01:27:49,030
EXTRA AXIAL SITES OF PAIN YOU

2704
01:27:49,097 --> 01:27:50,231
CAN SEE IN THE RIGHT KNEE AND

2705
01:27:50,298 --> 01:27:52,533
WRIST.

2706
01:27:52,600 --> 01:27:53,801
THAT'S IN CONTRAST TO THE

2707
01:27:53,868 --> 01:27:55,937
PATIENT ON THE RIGHT, WHO'S A

2708
01:27:56,004 --> 01:27:57,271
41-YEAR-OLD MALE WITH A 10-YEAR

2709
01:27:57,338 --> 01:27:58,373
HISTORY OF CHRONIC LOW BACK

2710
01:27:58,439 --> 01:27:59,907
PAIN, AND THIS INDIVIDUAL HAS

2711
01:27:59,974 --> 01:28:01,643
MORE WIDESPREAD FEATURES OF

2712
01:28:01,709 --> 01:28:02,977
PAIN, EXPERIENCES CHRONIC LOW

2713
01:28:03,044 --> 01:28:04,312
BACK PAIN AS THE MAJORITY OF

2714
01:28:04,379 --> 01:28:06,614
THIS INDIVIDUAL'S PAIN, BUT ALSO

2715
01:28:06,681 --> 01:28:09,217
HAS OTHER EXTRA AXIAL SITES OF

2716
01:28:09,283 --> 01:28:10,885
PAIN, MUCH GREATER THAN THE

2717
01:28:10,952 --> 01:28:14,389
PATIENT ON THE LEFT.

2718
01:28:14,455 --> 01:28:15,723
I WANTED TO SHOWCASE AN EXAMPLE

2719
01:28:15,790 --> 01:28:18,459
OF SOME OF THE BIOMARKERS THAT

2720
01:28:18,526 --> 01:28:19,260
WE'RE COLLECTING IN THE BEST

2721
01:28:19,327 --> 01:28:19,661
TRIAL.

2722
01:28:19,727 --> 01:28:22,296
THIS IS AN EXAMPLE BIOMECHANICAL

2723
01:28:22,363 --> 01:28:23,197
MEASURE THAT WAS COLLECTED BY

2724
01:28:23,264 --> 01:28:25,400
THE OHIO STATE UNIVERSITY ACROSS

2725
01:28:25,466 --> 01:28:26,834
ALL OF THE CENTERS THAT

2726
01:28:26,901 --> 01:28:28,903
PARTICIPATED IN THIS.

2727
01:28:28,970 --> 01:28:30,638
AND THIS SHOWS THE BIOMECHANICAL

2728
01:28:30,705 --> 01:28:32,940
ASSESSMENT FOR THESE TWO

2729
01:28:33,007 --> 01:28:34,075
PATIENTS.

2730
01:28:34,142 --> 01:28:35,276
I'VE SHOWN YOU A COMPOSITE

2731
01:28:35,343 --> 01:28:37,679
MEASURE ON THE BOTTOM

2732
01:28:37,745 --> 01:28:40,214
DEMONSTRATING THE OVERALL LOW

2733
01:28:40,281 --> 01:28:41,549
BACK PAIN MOTION LISTED AS AN

2734
01:28:41,616 --> 01:28:41,849
INDEX.

2735
01:28:41,916 --> 01:28:43,951
YOU CAN SEE THE PATIENT ON THE

2736
01:28:44,018 --> 01:28:47,789
LEFT HAD MUCH HIGHER RANGE OF

2737
01:28:47,855 --> 01:28:49,757
MOTION, VELOCITY, ACCELERATION

2738
01:28:49,824 --> 01:28:51,092
IN ALL PLANES COMPARED TO THE

2739
01:28:51,159 --> 01:28:54,696
PATIENT ON THE RIGHT.

2740
01:28:54,762 --> 01:28:56,130
DR. MARRAS' TEAM HAS PUT

2741
01:28:56,197 --> 01:28:57,999
TOGETHER A VIDEO THAT SHOWS US

2742
01:28:58,066 --> 01:28:59,534
THE INDIVIDUAL SPINE MOTION

2743
01:28:59,600 --> 01:29:00,935
BETWEEN THESE TWO INDIVIDUALS TO

2744
01:29:01,002 --> 01:29:03,604
A LATERAL BENDING TASK WHERE HE

2745
01:29:03,671 --> 01:29:05,373
ASKS PARTICIPANTS TO MOVE SIDE

2746
01:29:05,440 --> 01:29:07,975
TO SIDE AS FAST AS THEY CAN.

2747
01:29:08,042 --> 01:29:10,445
AND DR. MARRAS' TEAM WAS ABLE TO

2748
01:29:10,511 --> 01:29:11,846
USE THE CLINICAL SPINE IMAGING

2749
01:29:11,913 --> 01:29:14,682
TO MAP A THREE-DIMENSIONAL MODEL

2750
01:29:14,749 --> 01:29:15,450
AND PLOT, DATA THAT WAS

2751
01:29:15,516 --> 01:29:16,751
COLLECTED BY SENSORS THAT WERE

2752
01:29:16,818 --> 01:29:17,885
PLACED ON INDIVIDUALS WHILE

2753
01:29:17,952 --> 01:29:20,088
DOING THIS TASK ON TO THESE

2754
01:29:20,154 --> 01:29:21,823
CLINICAL SPINES, AND THEN NOW

2755
01:29:21,889 --> 01:29:23,024
MADE A VIDEO SHOWING YOU THEIR

2756
01:29:23,091 --> 01:29:26,461
MOTION.

2757
01:29:26,527 --> 01:29:30,398
HOPEFULLY WE CAN PLAY THE VIDEO.

2758
01:29:30,465 --> 01:29:32,333
WELL, SUFFICE IT TO SAY, THE

2759
01:29:32,400 --> 01:29:34,802
SPINE ON THE LEFT MOVES A LOT

2760
01:29:34,869 --> 01:29:37,438
WITH A LOT GREATER ACCELERATION.

2761
01:29:37,505 --> 01:29:38,606
IF YOU CAN PLAY IT, THAT WOULD

2762
01:29:38,673 --> 01:29:39,273
BE GREAT.

2763
01:29:39,340 --> 01:29:39,807
THANKS.

2764
01:29:39,874 --> 01:29:41,375
SO YOU CAN SEE THE PATIENT ON

2765
01:29:41,442 --> 01:29:42,944
THE LEFT HAS MUCH GREATER SPINE

2766
01:29:43,010 --> 01:29:44,112
MOTION THAN THE PATIENT ON THE

2767
01:29:44,178 --> 01:29:45,413
RIGHT.

2768
01:29:45,480 --> 01:29:47,415
HAS GREATER RANGE OF MOTION,

2769
01:29:47,482 --> 01:29:49,951
VELOCITY, AND ACCELERATION.

2770
01:29:50,017 --> 01:29:51,352
I THINK THIS GIVES YOU A

2771
01:29:51,419 --> 01:29:52,820
SNAPSHOT ABOUT HOW DIFFERENT

2772
01:29:52,887 --> 01:29:53,688
PATIENTS ARE THAT PRESENT WITH

2773
01:29:53,755 --> 01:29:56,758
CHRONIC LOW BACK PAIN, AND ALSO

2774
01:29:56,824 --> 01:29:58,993
GIVES US AS CLINICIANS USEFUL

2775
01:29:59,060 --> 01:30:00,161
BIOMARKERS THAT MIGHT PREDICT

2776
01:30:00,228 --> 01:30:06,300
TREATMENT RESPONSE.

2777
01:30:06,367 --> 01:30:09,504
THE FISHES PATI FIRST PATIENT I,

2778
01:30:09,570 --> 01:30:14,542
THE FEMALE PATIENT, RECEIVED T

2779
01:30:14,609 --> 01:30:16,077
THE -- THIS INDIVIDUAL WAS

2780
01:30:16,144 --> 01:30:17,845
RANDOMIZED TO EVIDENCE-BASED

2781
01:30:17,912 --> 01:30:19,046
EXERCISE AND MANUAL THERAPY,

2782
01:30:19,113 --> 01:30:20,414
WHICH IS OUR ENHANCED PHYSICAL

2783
01:30:20,481 --> 01:30:23,351
THERAPY TREATMENT.

2784
01:30:23,417 --> 01:30:25,219
THE OTHER PATIENT, THE

2785
01:30:25,286 --> 01:30:26,420
41-YEAR-OLD MALE, WAS ASSIGNED

2786
01:30:26,487 --> 01:30:30,057
TO ENHANCE SELF-CARE, WHICH IS A

2787
01:30:30,124 --> 01:30:32,126
SELF-DIRECTED DIGITALLY

2788
01:30:32,193 --> 01:30:32,894
DELIVERED BIOBEHAVIORAL

2789
01:30:32,960 --> 01:30:34,328
MANAGEMENT TREATMENT THAT

2790
01:30:34,395 --> 01:30:36,097
INVOLVED A WALKING PROGRAM, AS

2791
01:30:36,164 --> 01:30:37,298
WELL AS GUIDANCE ON OVER THE

2792
01:30:37,365 --> 01:30:41,035
COUNTER MEDICATIONS.

2793
01:30:41,102 --> 01:30:42,937
SO THESE INDIVIDUALS UNDERWENT

2794
01:30:43,004 --> 01:30:44,338
12 ADDITIONAL WEEKS OF TREATMENT

2795
01:30:44,405 --> 01:30:45,873
AND THEN RE-PRESENTED TO CLINIC

2796
01:30:45,940 --> 01:30:47,341
FOR ADDITIONAL PHENOTYPING AS

2797
01:30:47,408 --> 01:30:50,645
WELL AS RANDOMIZATION TO A

2798
01:30:50,711 --> 01:30:51,813
SECOND INTERVENTION.

2799
01:30:51,879 --> 01:30:54,148
WE RANDOMIZED PATIENTS TO THE

2800
01:30:54,215 --> 01:30:55,750
SECOND INTERVENTION BASED ON

2801
01:30:55,817 --> 01:30:57,084
THEIR RESPONSE TO THE FIRST

2802
01:30:57,151 --> 01:30:57,418
INTERVENTION.

2803
01:30:57,485 --> 01:30:59,821
PATIENTS THAT DID VERY WELL WERE

2804
01:30:59,887 --> 01:31:00,922
MAINTAINED ON THE FIRST STAGE

2805
01:31:00,988 --> 01:31:03,124
INTERVENTION FOR THE SECOND

2806
01:31:03,191 --> 01:31:03,324
STAGE.

2807
01:31:03,391 --> 01:31:05,560
INDIVIDUALS THAT HAD A MODERATE

2808
01:31:05,626 --> 01:31:07,094
RESPONSE WERE AUGMENTED WITH AN

2809
01:31:07,161 --> 01:31:08,596
ADDITIONAL TREATMENT FOR THE

2810
01:31:08,663 --> 01:31:09,897
SECOND STAGE AND CONTINUED THE

2811
01:31:09,964 --> 01:31:12,700
FIRST STAGE OF TREATMENT.

2812
01:31:12,767 --> 01:31:18,406
YOU FINALLY, INDIVIDUALS THAT DT

2813
01:31:18,472 --> 01:31:20,608
RESPOND AT ALL WERE RANDOMIZED

2814
01:31:20,675 --> 01:31:29,183
TO A NEW INTERVENTION FOR THE

2815
01:31:29,250 --> 01:31:30,918
SECOND TREATMENT PERIOD.

2816
01:31:30,985 --> 01:31:32,620
IN ADDITION TO CONTINUING THE

2817
01:31:32,687 --> 01:31:34,956
FIRST INTERVENTION THEY WERE

2818
01:31:35,022 --> 01:31:36,057
ASSIGNED.

2819
01:31:36,123 --> 01:31:37,625
THIS IS A 67-YEAR-OLD FEMALE

2820
01:31:37,692 --> 01:31:39,694
THAT WE DISCUSSED.

2821
01:31:39,760 --> 01:31:42,430
THIS INDIVIDUAL WAS ASSIGNED TO

2822
01:31:42,496 --> 01:31:44,065
PHYSICAL THERAPY FOR THE FIRST

2823
01:31:44,131 --> 01:31:45,099
INTERVENTION, WENT THROUGH THAT

2824
01:31:45,166 --> 01:31:48,035
INTERVENTION, AND HAD A MODERATE

2825
01:31:48,102 --> 01:31:49,804
RESPONSE.

2826
01:31:49,871 --> 01:31:51,672
WAS THEN AUGMENTED WITH ENHANCED

2827
01:31:51,739 --> 01:31:53,975
SELF-CARE AND RANDOMIZED

2828
01:31:54,041 --> 01:31:55,409
ENHANCED SELF-CARE FOR THE

2829
01:31:55,476 --> 01:31:57,578
SECOND 12-WEEK PERIOD AND WHEN

2830
01:31:57,645 --> 01:31:59,847
THEY CAME BACK TO CLINIC, HAD A

2831
01:31:59,914 --> 01:32:00,815
REALLY REMARKABLE CLINICAL

2832
01:32:00,882 --> 01:32:01,115
RESPONSE.

2833
01:32:01,182 --> 01:32:01,782
IT'S POSSIBLE THAT THIS

2834
01:32:01,849 --> 01:32:03,551
INDIVIDUAL RECEIVED THE BEST

2835
01:32:03,618 --> 01:32:04,752
SEQUENCE OF TREATMENTS TO TREAT

2836
01:32:04,819 --> 01:32:05,753
THEIR LOW BACK PAIN.

2837
01:32:05,820 --> 01:32:08,155
THE QUESTION WE HOPE TO ANSWER

2838
01:32:08,222 --> 01:32:09,223
WITH THE DATA WE'RE COLLECTING

2839
01:32:09,290 --> 01:32:11,259
IN THE BEST TRIAL IS WHAT

2840
01:32:11,325 --> 01:32:12,793
BIOMARKERS WOULD HAVE PREDICTED

2841
01:32:12,860 --> 01:32:16,831
THAT AND COULD WE REPRODUCIBLY

2842
01:32:16,898 --> 01:32:18,199
ASSIGN INTERVENTIONS BASED ON

2843
01:32:18,266 --> 01:32:22,436
THOSE BIOMARKERS.

2844
01:32:22,503 --> 01:32:23,671
THE SECOND PATIENT I DISCUSSED

2845
01:32:23,738 --> 01:32:25,306
RECEIVED THE ENHANCED SELF-CARE

2846
01:32:25,373 --> 01:32:26,741
FOR THE TREATMENT PERIOD WAS

2847
01:32:26,807 --> 01:32:27,608
AUGMENTED WITH PHYSICAL THERAPY

2848
01:32:27,675 --> 01:32:30,211
FOR THE SECOND STAGE TREATMENT.

2849
01:32:30,278 --> 01:32:32,213
THIS INDIVIDUAL DIDN'T RESPOND

2850
01:32:32,280 --> 01:32:34,415
SO WELL TO THE ENHANCED

2851
01:32:34,482 --> 01:32:37,218
SELF-CARE.

2852
01:32:37,285 --> 01:32:38,653
BUT HAD A ROBUST RESPONSE TO

2853
01:32:38,719 --> 01:32:42,056
PHYSICAL THERAPY.

2854
01:32:42,123 --> 01:32:43,291
IN THIS CASE, THE QUESTION

2855
01:32:43,357 --> 01:32:44,292
BECOMES, IF WE WOULD HAVE

2856
01:32:44,358 --> 01:32:45,493
ASSIGNED PHYSICAL THERAPY TO

2857
01:32:45,559 --> 01:32:46,360
THIS INDIVIDUAL FIRST, WOULD

2858
01:32:46,427 --> 01:32:47,495
THEY HAVE HAD THAT GREAT

2859
01:32:47,561 --> 01:32:49,363
RESPONSE RIGHT AWAY?

2860
01:32:49,430 --> 01:32:50,665
AND ARE THERE BIOMARKERS THAT

2861
01:32:50,731 --> 01:32:51,799
WOULD HAVE PREDICTED THAT?

2862
01:32:51,866 --> 01:32:53,000
I WANTED TO SHARE THESE CASES TO

2863
01:32:53,067 --> 01:32:54,535
GIVE YOU A FLAVOR OF HOPEFULLY

2864
01:32:54,602 --> 01:32:57,338
WHAT WE'RE ABLE TO DO WITH THE

2865
01:32:57,405 --> 01:32:58,306
DATA WE COLLECT FROM THE BEST

2866
01:32:58,372 --> 01:32:59,707
TRIAL, AND OUR VISION IS THAT

2867
01:32:59,774 --> 01:33:00,942
WE'LL BE ABLE TO GIVE PHYSICIANS

2868
01:33:01,008 --> 01:33:04,779
AND CLINICIANS AT THE BEDSIDE A

2869
01:33:04,845 --> 01:33:05,780
PRECISION ALGORITHM THAT WILL

2870
01:33:05,846 --> 01:33:06,948
GUIDE THEIR TREATMENT.

2871
01:33:07,014 --> 01:33:15,323
THANKS.

2872
01:33:15,389 --> 01:33:16,290
>> THANK YOU.

2873
01:33:16,357 --> 01:33:17,191
I'M KEVIN ANSTROM.

2874
01:33:17,258 --> 01:33:18,492
I WORK AT UNIVERSITY OF NORTH

2875
01:33:18,559 --> 01:33:19,794
CAROLINA WITH MATT, AND I'M PART

2876
01:33:19,860 --> 01:33:23,764
OF A LARGER GROUP CALLED THE DAC

2877
01:33:23,831 --> 01:33:24,765
THAT WE'LL DISCUSS A LITTLE BIT

2878
01:33:24,832 --> 01:33:27,835
LATER.

2879
01:33:27,902 --> 01:33:29,136
SO THERE ARE REALLY TWO THINGS

2880
01:33:29,203 --> 01:33:31,839
THAT I'LL BE PRESENTING HERE.

2881
01:33:31,906 --> 01:33:34,642
ONE IS AROUND A TOOL THAT WE'VE

2882
01:33:34,709 --> 01:33:37,611
DEVELOPED OR A SET OF TOOLS, THE

2883
01:33:37,678 --> 01:33:40,715
BACPAC DATA PORTAL, AND THEN THE

2884
01:33:40,781 --> 01:33:43,451
SECOND WILL BE JUST A VERY BRIEF

2885
01:33:43,517 --> 01:33:44,986
UPDATE OF WHERE WE STAND ON THE

2886
01:33:45,052 --> 01:33:49,056
BEST TRIAL THAT GWEN AND MATT IT

2887
01:33:49,123 --> 01:33:50,057
HAD OUTLINED EARLIER.

2888
01:33:50,124 --> 01:33:51,525
SO IN TERMS OF DATA SHARING,

2889
01:33:51,592 --> 01:33:53,694
DATA WORKING GROUP, THERE'S A

2890
01:33:53,761 --> 01:33:55,329
COMMITTEE THAT PUT TOGETHER A

2891
01:33:55,396 --> 01:33:58,733
SET OF PROCESSES OR PLANS.

2892
01:33:58,799 --> 01:33:59,967
ADDITIONALLY, WE HAVE A DATA

2893
01:34:00,034 --> 01:34:03,738
PORTAL THAT'S BEEN PUT TOGETHER,

2894
01:34:03,804 --> 01:34:05,206
AND WHAT YOU SEE FROM THIS

2895
01:34:05,272 --> 01:34:06,474
SCWEEM HERE IS EACH OF THE

2896
01:34:06,540 --> 01:34:07,441
RESEARCH SITES, AND AGAIN, THERE

2897
01:34:07,508 --> 01:34:08,642
ARE MANY SITES, THEY INTERACT

2898
01:34:08,709 --> 01:34:12,313
WITH A TEAM AT THE DAC, AND

2899
01:34:12,380 --> 01:34:13,180
ESSENTIALLY GOING BACK AND FORTH

2900
01:34:13,247 --> 01:34:14,482
TO MAKE SURE THAT THE DATA

2901
01:34:14,548 --> 01:34:17,318
STANDARDS ARE MET.

2902
01:34:17,385 --> 01:34:18,886
AGAIN, THOSE WOULD BE THE HEAL

2903
01:34:18,953 --> 01:34:20,121
DATA STANDARDS AS WELL AS THE

2904
01:34:20,187 --> 01:34:21,522
BACPAC DATA STANDARDS, AND THEN

2905
01:34:21,589 --> 01:34:24,291
THE DATA IS STORED IN A

2906
01:34:24,358 --> 01:34:27,294
COMMONPLACE.

2907
01:34:27,361 --> 01:34:28,095
THE BOTTOM PART OF THE FIGURE

2908
01:34:28,162 --> 01:34:29,630
HERE WOULD BE AN INDIVIDUAL

2909
01:34:29,697 --> 01:34:30,297
RESEARCHER THAT WOULD BE

2910
01:34:30,364 --> 01:34:33,167
INTERESTED IN ACCESSING THOSE

2911
01:34:33,234 --> 01:34:34,368
POOLED RESOURCES FROM ACROSS THE

2912
01:34:34,435 --> 01:34:37,104
STUDY, AND THEY BASICALLY WOULD

2913
01:34:37,171 --> 01:34:38,072
HAVE TO GAIN AUTHORIZATION TO

2914
01:34:38,139 --> 01:34:40,341
USE THE SYSTEM ONCE THEY HAD

2915
01:34:40,408 --> 01:34:42,843
AUTHORIZATION AND HAD THE RIGHT

2916
01:34:42,910 --> 01:34:46,680
APPROVAL, THEY WOULD GO IN AND

2917
01:34:46,747 --> 01:34:47,681
ESSENTIALLY LOG IN TO THE

2918
01:34:47,748 --> 01:34:47,915
SYSTEM.

2919
01:34:47,982 --> 01:34:49,250
THIS GOES THROUGH SOME OF THE

2920
01:34:49,316 --> 01:34:50,317
STEPS THAT ARE REQUIRED BEFORE

2921
01:34:50,384 --> 01:34:51,919
DOING THE TRANSFERS, AND AGAIN,

2922
01:34:51,986 --> 01:34:54,622
THIS IS A PROCESS THAT OBVIOUSLY

2923
01:34:54,688 --> 01:34:55,790
REQUIRES THE CORRECT

2924
01:34:55,856 --> 01:35:01,028
PERMISSIONS, ET CETERA.

2925
01:35:01,095 --> 01:35:02,696
THIS IS ANOTHER SCHEME, WE DON'T

2926
01:35:02,763 --> 01:35:03,764
HAVE TIME TO GO THROUGH THE

2927
01:35:03,831 --> 01:35:05,099
DETAILS, BUT ESSENTIALLY

2928
01:35:05,166 --> 01:35:06,967
EVERYONE THAT WOULD GET

2929
01:35:07,034 --> 01:35:09,203
PERMISSION WOULD HAVE THE PROPER

2930
01:35:09,270 --> 01:35:09,970
AUTHORITIES, ET CETERA.

2931
01:35:10,037 --> 01:35:11,305
AND HERE JUST MAYBE A COUPLE

2932
01:35:11,372 --> 01:35:12,373
SCREEN SHOTS OF WHAT IT WOULD

2933
01:35:12,440 --> 01:35:13,941
ACTUALLY LOOK LIKE FOR THE

2934
01:35:14,008 --> 01:35:17,778
SYSTEM ITSELF.

2935
01:35:17,845 --> 01:35:22,583
AND THEN AT THE SORT OF END OF

2936
01:35:22,650 --> 01:35:24,652
THE PROJECTS, WE'LL BE COMPLYING

2937
01:35:24,718 --> 01:35:26,087
WITH OTHER HEAL REQUIREMENTS.

2938
01:35:26,153 --> 01:35:29,190
WE WILL LIKELY USE MORE THAN A

2939
01:35:29,256 --> 01:35:30,925
SINGLE REPOSITORY, AND WE CAN GO

2940
01:35:30,991 --> 01:35:31,926
INTO DETAILS IF PEOPLE HAVE

2941
01:35:31,992 --> 01:35:35,262
QUESTIONS LATER.

2942
01:35:35,329 --> 01:35:38,666
NOW QUICKLY JUMPING TO WHAT HAD

2943
01:35:38,732 --> 01:35:40,935
BEEN DESCRIBED EARLIER, THE BEST

2944
01:35:41,001 --> 01:35:42,803
TRIAL, AGAIN, THE BEST TRIAL IS

2945
01:35:42,870 --> 01:35:44,505
ONE OF THE CENTER PIECES OF THE

2946
01:35:44,572 --> 01:35:47,341
OVERALL BACPAC WORK.

2947
01:35:47,408 --> 01:35:50,644
IT'S A LARGE PRECISION MEDICINE

2948
01:35:50,711 --> 01:35:54,281
DESIGN STUDY, AND AGAIN, THERE'S

2949
01:35:54,348 --> 01:35:56,350
TWO TREATMENT PERIODS.

2950
01:35:56,417 --> 01:35:59,520
EACH OF THOSE WOULD BE THREE

2951
01:35:59,587 --> 01:36:00,521
MONTHS LONG.

2952
01:36:00,588 --> 01:36:03,958
IT'S A TYPE OF STUDY THAT

2953
01:36:04,024 --> 01:36:06,026
STATISTICIANS AND OTHERS CALL

2954
01:36:06,093 --> 01:36:08,329
THIS A SMART SEQUENTIAL MULTIPLE

2955
01:36:08,395 --> 01:36:09,463
ASSIGNMENT RANDOMIZED TRIAL.

2956
01:36:09,530 --> 01:36:12,433
AGAIN, WE START WITH FOUR

2957
01:36:12,500 --> 01:36:15,803
INDIVIDUAL INTERVENTIONS, AND

2958
01:36:15,870 --> 01:36:16,804
OBVIOUSLY WE COLLECT A

2959
01:36:16,871 --> 01:36:17,638
TREMENDOUS AMOUNT OF

2960
01:36:17,705 --> 01:36:17,938
INFORMATION.

2961
01:36:18,005 --> 01:36:19,807
THERE'S A SUBSET, WE COLLECT A

2962
01:36:19,874 --> 01:36:21,208
LOT OF INFORMATION, AND THEN A

2963
01:36:21,275 --> 01:36:22,776
SUBSET WE COLLECT EVEN MORE,

2964
01:36:22,843 --> 01:36:26,080
THAT WOULD BE THE DEEP PHENOTYPE

2965
01:36:26,147 --> 01:36:28,182
SUBSET.

2966
01:36:28,249 --> 01:36:30,117
JUST IN TERMS OF PRECISION

2967
01:36:30,184 --> 01:36:32,253
MEDICINE FOR DEFINITION,

2968
01:36:32,319 --> 01:36:32,920
ESSENTIALLY IT'S SOME VERSION OF

2969
01:36:32,987 --> 01:36:34,121
GETTING THE RIGHT TREATMENT FOR

2970
01:36:34,188 --> 01:36:35,422
THE RIGHT PERSON AT THE RIGHT

2971
01:36:35,489 --> 01:36:35,856
TIME.

2972
01:36:35,923 --> 01:36:37,992
AND ESSENTIALLY IT'S CALLED LOTS

2973
01:36:38,058 --> 01:36:40,194
OF DIFFERENT THINGS IN THE

2974
01:36:40,261 --> 01:36:42,897
LITERATURE, IN THE STATISTICAL

2975
01:36:42,963 --> 01:36:44,098
LITERATURE IT'S OFTEN CALLED

2976
01:36:44,165 --> 01:36:49,970
DYNAMIC TREATMENT JE REGIME.

2977
01:36:50,037 --> 01:36:51,172
WE'LL JUST GO THROUGH A COUPLE

2978
01:36:51,238 --> 01:36:51,939
LITTLE EXAMPLES HERE.

2979
01:36:52,006 --> 01:36:56,243
SO THIS IS SORT AFTER VERY

2980
01:36:56,310 --> 01:36:57,344
COMMON SCHEMA THAT WOULD BE

2981
01:36:57,411 --> 01:36:59,180
USED, AND JUST IN GENERAL HERE,

2982
01:36:59,246 --> 01:37:00,781
WE COULD DO THINGS LIKE COUNT

2983
01:37:00,848 --> 01:37:03,951
THE NUMBER OF EMBEDDED TREATMENT

2984
01:37:04,018 --> 01:37:04,385
REGIMES.

2985
01:37:04,451 --> 01:37:06,487
SO HERE IT'S A CASE WHERE THE

2986
01:37:06,554 --> 01:37:09,590
Rs STAND FOR POINTS OF

2987
01:37:09,657 --> 01:37:14,061
RANDOMIZATION, AND THE B, C, D

2988
01:37:14,128 --> 01:37:15,729
AND E, THOSE STAND FOR DIFFERENT

2989
01:37:15,796 --> 01:37:16,397
INTERVENTIONS.

2990
01:37:16,463 --> 01:37:17,665
AND SO IN THIS CASE, YOU SEE

2991
01:37:17,731 --> 01:37:19,567
SORT OF AS YOU MOVE FROM LEFT TO

2992
01:37:19,633 --> 01:37:22,002
RIGHT OVER TIME, A PARTICULAR

2993
01:37:22,069 --> 01:37:23,804
INDIVIDUAL WOULD BE RANDOMIZED

2994
01:37:23,871 --> 01:37:24,872
AT TWO TIME POINTS.

2995
01:37:24,939 --> 01:37:26,941
HERE THERE WOULD BE ESSENTIALLY

2996
01:37:27,007 --> 01:37:28,209
FOUR EMBEDDED TREATMENT REGIMES.

2997
01:37:28,275 --> 01:37:30,611
YOU WOULD HAVE B TO D, THAT

2998
01:37:30,678 --> 01:37:31,378
WOULD BE ONE.

2999
01:37:31,445 --> 01:37:32,980
YOU WOULD HAVE B TO E, THAT

3000
01:37:33,047 --> 01:37:34,715
WOULD BE TWO.

3001
01:37:34,782 --> 01:37:36,784
C TO D, THREE.

3002
01:37:36,850 --> 01:37:38,619
AND THEN C TO E, FOUR.

3003
01:37:38,686 --> 01:37:42,223
SO AGAIN, THAT'S A SIMPLE

3004
01:37:42,289 --> 01:37:45,159
STRUCTURE WHERE THERE ARE SORT

3005
01:37:45,226 --> 01:37:50,130
OF NO TAILORING VARIABLES.

3006
01:37:50,197 --> 01:37:51,465
HERE'S A SITUATION THAT'S

3007
01:37:51,532 --> 01:37:53,000
SLIGHTLY MORE COMPLICATED BUT IT

3008
01:37:53,067 --> 01:37:54,635
TURNS OUT IN THIS SETTING THERE

3009
01:37:54,702 --> 01:37:56,103
ARE ONLY THREE EMBEDDED

3010
01:37:56,170 --> 01:37:56,971
TREATMENT REGIMES.

3011
01:37:57,037 --> 01:37:58,505
PROBABLY THE EASIEST TO TAKE

3012
01:37:58,572 --> 01:38:00,541
CARE OF IS THE ONE ON THE BOTTOM

3013
01:38:00,608 --> 01:38:01,508
WHERE A PERSON WOULD START ON C

3014
01:38:01,575 --> 01:38:03,477
AND IF THEY RESPONDED AT KIND OF

3015
01:38:03,544 --> 01:38:04,578
THE INTERMEDIATE TIME POINT,

3016
01:38:04,645 --> 01:38:05,846
THEY WOULD CONTINUE ON C, OR

3017
01:38:05,913 --> 01:38:07,047
THEY WOULD START ON C IF THEY

3018
01:38:07,114 --> 01:38:09,016
DID NOT RESPOND, THEY WOULD GO

3019
01:38:09,083 --> 01:38:10,517
TO C PLUS SOMETHING LIKE AN

3020
01:38:10,584 --> 01:38:12,453
AUGMENTATION.

3021
01:38:12,519 --> 01:38:13,554
THAT WOULD BE SORT OF ONE OF

3022
01:38:13,621 --> 01:38:14,922
THESE EMBEDDED TREATMENT

3023
01:38:14,989 --> 01:38:15,356
REGIMES.

3024
01:38:15,422 --> 01:38:17,891
ON THE TOP, IT TURNS OUT THERE'S

3025
01:38:17,958 --> 01:38:18,959
ACTUALLY TWO DIFFERENT EMBEDDED

3026
01:38:19,026 --> 01:38:19,960
TREATMENT REGIMES.

3027
01:38:20,027 --> 01:38:22,863
A PERSON COULD START WITH B AND

3028
01:38:22,930 --> 01:38:24,732
IF THEY RESPOND THEY CONTINUE ON

3029
01:38:24,798 --> 01:38:26,200
B, OR IF THEY DIDN'T RESPOND,

3030
01:38:26,267 --> 01:38:27,601
THEY COULD GO TO B WITH SOME

3031
01:38:27,668 --> 01:38:29,370
SORT OF AUGMENTATION, THAT WOULD

3032
01:38:29,436 --> 01:38:32,673
BE THE SECOND OF THESE EMBEDDED

3033
01:38:32,740 --> 01:38:33,574
TREATMENT REGIMES.

3034
01:38:33,641 --> 01:38:34,908
THE-1/3 WOULD BE ESSENTIALLY THE

3035
01:38:34,975 --> 01:38:36,877
CASE WHERE A PERSON STARTS WITH

3036
01:38:36,944 --> 01:38:38,512
B, THEY DO NOT RESPOND AND THEN

3037
01:38:38,579 --> 01:38:40,314
YOU WOULD ESSENTIALLY AUGMENT

3038
01:38:40,381 --> 01:38:42,383
THEM WITH C, SO THEY'D END UP

3039
01:38:42,449 --> 01:38:43,717
WITH B PLUS C.

3040
01:38:43,784 --> 01:38:45,085
SO AGAIN THAT'S THE SORT OF

3041
01:38:45,152 --> 01:38:46,287
SETUP WE'RE DOING FOR THIS

3042
01:38:46,353 --> 01:38:52,026
COMPLICATED STUDY.

3043
01:38:52,092 --> 01:38:53,127
I WON'T SPEND TIME GOING THROUGH

3044
01:38:53,193 --> 01:38:54,595
THE NUMBER OF EMBEDDED TREATMENT

3045
01:38:54,662 --> 01:38:57,464
REGIMES HERE.

3046
01:38:57,531 --> 01:38:58,465
MY DAUGHTER SAID IT'S ROUGHLY

3047
01:38:58,532 --> 01:39:01,168
THE NUMBER OF TIMES WE EXPECT TO

3048
01:39:01,235 --> 01:39:03,404
SEE TAYLOR SWIFT MENTIONED AT

3049
01:39:03,470 --> 01:39:03,971
THE SUPER BOWL.

3050
01:39:04,038 --> 01:39:05,606
THAT'S PROBABLY NOT QUITE RIGHT.

3051
01:39:05,673 --> 01:39:09,043
BUT JUST SORT OF A FUN FACT, A

3052
01:39:09,109 --> 01:39:10,711
TYPICAL PROFESSIONAL FOOTBALL

3053
01:39:10,778 --> 01:39:12,746
GAME, NFL GAME, THERE ARE ABOUT

3054
01:39:12,813 --> 01:39:16,550
153 PLAYS PER GAME, SO 153.

3055
01:39:16,617 --> 01:39:18,485
THE NUMBER OF EMBEDDED TREATMENT

3056
01:39:18,552 --> 01:39:20,054
REGIMES IS ABOUT ROUGHLY THAT

3057
01:39:20,120 --> 01:39:20,421
NUMBER.

3058
01:39:20,487 --> 01:39:23,023
IN ADDITION, YOU THINK OF WHAT

3059
01:39:23,090 --> 01:39:24,725
ABEL SHOWED EARLIER IN TERMS OF

3060
01:39:24,792 --> 01:39:26,293
THE PHENOTYPIC DATA THAT WE'RE

3061
01:39:26,360 --> 01:39:26,727
CAPTURING.

3062
01:39:26,794 --> 01:39:27,995
THIS ENDS UP BEING A VERY

3063
01:39:28,062 --> 01:39:30,831
COMPLICATED PROCESS.

3064
01:39:30,898 --> 01:39:32,666
IN ADDITION TO THAT, THIS IS

3065
01:39:32,733 --> 01:39:34,168
SORT OF HITTING ON SOME OF THE

3066
01:39:34,234 --> 01:39:34,868
OBJECTIVES EARLIER.

3067
01:39:34,935 --> 01:39:37,905
SO AGAIN, THIS IS A PRECISION

3068
01:39:37,971 --> 01:39:39,673
MEDICINE -- THAT WILL BE

3069
01:39:39,740 --> 01:39:40,941
DEVELOPED AND THE FORMAL

3070
01:39:41,008 --> 01:39:42,343
OBJECTIVE HERE IS WE'RE TAKING

3071
01:39:42,409 --> 01:39:43,877
THESE SORT OF TWO DIFFERENT

3072
01:39:43,944 --> 01:39:45,346
SEQUENCES, WE HAVE THE DIFFERENT

3073
01:39:45,412 --> 01:39:47,214
INTERVENTIONS AND WE'RE GOING TO

3074
01:39:47,281 --> 01:39:49,483
USE THE BIOMARKER INFORMATION TO

3075
01:39:49,550 --> 01:39:50,718
IMPROVE THAT.

3076
01:39:50,784 --> 01:39:55,356
SEEMS TO HAVE ITS OWN MIND HERE.

3077
01:39:55,422 --> 01:39:56,557
SO -- TIMELINES, AWESOME.

3078
01:39:56,623 --> 01:39:59,426
SO WHERE WE ARE IN TERM OF TIME

3079
01:39:59,493 --> 01:40:02,896
LINES -- I SWEAR I'M NOT DOING

3080
01:40:02,963 --> 01:40:07,568
THIS.

3081
01:40:07,634 --> 01:40:09,336
MATT MENTIONED WE'D COMPLETED

3082
01:40:09,403 --> 01:40:10,404
SCREENING AND ENROLLMENT WITH

3083
01:40:10,471 --> 01:40:11,305
JUST OVER A THOUSAND

3084
01:40:11,372 --> 01:40:12,573
PARTICIPANTS.

3085
01:40:12,639 --> 01:40:14,241
IN TERMS OF RANDOMIZATION, AGAIN

3086
01:40:14,308 --> 01:40:16,076
THERE WAS A RUN-IN PERIOD AND A

3087
01:40:16,143 --> 01:40:16,710
FEW OTHER THINGS.

3088
01:40:16,777 --> 01:40:18,746
IN TERMS OF RANDOMIZATION, WE

3089
01:40:18,812 --> 01:40:21,148
HAVE SLIGHTLY OVER 800 PEOPLE

3090
01:40:21,215 --> 01:40:22,850
RANDOMIZED TO THE FIRST OF THESE

3091
01:40:22,916 --> 01:40:25,352
INDIVIDUAL TREATMENTS.

3092
01:40:25,419 --> 01:40:32,593
WE ANTICIPATE -- WE ANTICIPATE

3093
01:40:32,659 --> 01:40:33,560
HAVING TWO DESIGN PAPERS

3094
01:40:33,627 --> 01:40:35,696
SUBMITTED OVER THE NEXT MONTH OR

3095
01:40:35,763 --> 01:40:38,098
SO, ONE FOCUSED ON CLINICAL

3096
01:40:38,165 --> 01:40:40,033
ISSUES, HOW THE INDIVIDUAL

3097
01:40:40,100 --> 01:40:40,701
INTERVENTIONS WERE SELECTED, ET

3098
01:40:40,768 --> 01:40:41,101
CETERA.

3099
01:40:41,168 --> 01:40:42,536
ONE DEALS WITH SOME OF THE

3100
01:40:42,603 --> 01:40:45,105
STATISTICAL ISSUES AROUND

3101
01:40:45,172 --> 01:40:45,706
RANDOMIZATION BALANCING, ET

3102
01:40:45,773 --> 01:40:45,939
CETERA.

3103
01:40:46,006 --> 01:40:47,007
IN TERMS OF THE PARTICIPANTS IN

3104
01:40:47,074 --> 01:40:50,377
THE STUDY, THE FINAL STUDY

3105
01:40:50,444 --> 01:40:52,546
VISITS WILL HAPPEN LATER IN

3106
01:40:52,613 --> 01:40:53,680
2024.

3107
01:40:53,747 --> 01:40:55,983
DATABASE LOCK IS ANTICIPATED TO

3108
01:40:56,049 --> 01:40:59,253
BE LATE THIS CALENDAR YEAR.

3109
01:40:59,319 --> 01:41:01,188
AND IN TERMS OF THE TEAM, AGAIN,

3110
01:41:01,255 --> 01:41:03,257
THIS IS PART OF THE DAC AS WELL

3111
01:41:03,323 --> 01:41:06,660
AS THE OVERALL BACPAC TEAM, AND

3112
01:41:06,727 --> 01:41:07,995
AGAIN, THIS IS A PHOTOGRAPH THAT

3113
01:41:08,061 --> 01:41:10,030
WAS TAKEN FROM -- I THINK IT WAS

3114
01:41:10,097 --> 01:41:11,331
SPRING OF LAST YEAR.

3115
01:41:11,398 --> 01:41:14,935
AND AGAIN, THIS IS MANY OF THE

3116
01:41:15,002 --> 01:41:16,203
PEOPLE PART OF THE PROJECT,

3117
01:41:16,270 --> 01:41:17,404
AGAIN, THERE ARE MORE.

3118
01:41:17,471 --> 01:41:18,372
THAT'S ALL WE HAVE TO PRESENT

3119
01:41:18,439 --> 01:41:19,673
TODAY, AND AGAIN, THANK YOU FOR

3120
01:41:19,740 --> 01:41:29,917
HAVING US.

3121
01:41:40,928 --> 01:41:43,730
>> I'M KATHLEEN SLOKA,

3122
01:41:43,797 --> 01:41:44,565
UNIVERSITY OF IOWA.

3123
01:41:44,631 --> 01:41:46,934
YOU HAVE A LOT OF BIOMARKERS

3124
01:41:47,000 --> 01:41:50,471
WHICH IS GREAT.

3125
01:41:50,537 --> 01:41:52,005
I DIDN'T GATHER -- YOU'RE

3126
01:41:52,072 --> 01:41:54,942
LOOKING AT THEM CLEARLY PRIOR TO

3127
01:41:55,008 --> 01:41:56,610
RANDOMIZATION AND TREATMENT.

3128
01:41:56,677 --> 01:41:59,847
ARE YOU LOOKING AT THEM AT EACH

3129
01:41:59,913 --> 01:42:01,915
TIME PERIOD AS WELL TO SEE IF

3130
01:42:01,982 --> 01:42:04,151
THERE ARE CHANGES IN THOSE AND

3131
01:42:04,218 --> 01:42:06,453
THEN TO ME, THAT GETS AT WHETHER

3132
01:42:06,520 --> 01:42:08,755
OR NOT THAT'S IMPORTANT IN TERMS

3133
01:42:08,822 --> 01:42:10,290
OF MECHANISM OR IS IT JUST

3134
01:42:10,357 --> 01:42:12,860
SOMETHING THAT HELPS US PREDICT?

3135
01:42:12,926 --> 01:42:14,061
IF YOU UNDERSTAND WHAT I'M

3136
01:42:14,127 --> 01:42:14,294
SAYING.

3137
01:42:14,361 --> 01:42:15,929
>> I THINK IT'S A GREAT

3138
01:42:15,996 --> 01:42:17,965
QUESTION, AND SOMETHING WE'VE

3139
01:42:18,031 --> 01:42:18,398
WRESTLED A LOT WITH.

3140
01:42:18,465 --> 01:42:21,668
AND THE ANSWER IS REALLY BOTH.

3141
01:42:21,735 --> 01:42:22,870
SO JUST TO SEPARATE THIS OUT A

3142
01:42:22,936 --> 01:42:25,472
LITTLE BIT, SOME OF THIS IS

3143
01:42:25,539 --> 01:42:27,374
OBSERVATIONAL, SO TWO OF THE

3144
01:42:27,441 --> 01:42:28,408
THREE MECHANISTIC RESEARCH

3145
01:42:28,475 --> 01:42:29,610
CENTERS ARE COLLECTING

3146
01:42:29,676 --> 01:42:31,111
OBSERVATIONAL DATA AND FOLLOWING

3147
01:42:31,178 --> 01:42:34,181
PATIENTS LONGITUDINALLY, AND

3148
01:42:34,248 --> 01:42:35,782
THEN THERE'S THE CLINICAL TRIAL

3149
01:42:35,849 --> 01:42:37,551
DOING DEEP PHENOTYPING AT

3150
01:42:37,618 --> 01:42:38,418
MICHIGAN AS WELL AS THE BEST

3151
01:42:38,485 --> 01:42:38,619
TRIAL.

3152
01:42:38,685 --> 01:42:39,920
EACH OF THOSE HAVE TOUCH POINTS

3153
01:42:39,987 --> 01:42:43,490
THROUGHOUT THE CONTINUUM.

3154
01:42:43,557 --> 01:42:45,626
THE ENTIRETY OF THE DEEP

3155
01:42:45,692 --> 01:42:47,761
PHENOTYPING IS NOT OCCURRING AT

3156
01:42:47,828 --> 01:42:49,062
EVERY TIME POINT BUT MUCH OF IT

3157
01:42:49,129 --> 01:42:49,630
IS REPEATED.

3158
01:42:49,696 --> 01:42:54,167
SO IN PARTICULAR, THE

3159
01:42:54,234 --> 01:42:55,135
PATIENT-REPORTED OUTCOMES ARE

3160
01:42:55,202 --> 01:42:56,136
COLLECTED LONGITUDINALLY IN ALL

3161
01:42:56,203 --> 01:42:57,337
OF THEM.

3162
01:42:57,404 --> 01:42:58,772
ELECTRONIC MEDICAL RECORD DATA

3163
01:42:58,839 --> 01:42:59,640
COLLECTED LONGITUDINALLY IN ALL

3164
01:42:59,706 --> 01:43:02,009
OF THEM.

3165
01:43:02,075 --> 01:43:03,744
WE HAVE BIOSAMPLING AT DIFFERENT

3166
01:43:03,810 --> 01:43:04,711
POINTS IN THE BEST TRIAL, WE

3167
01:43:04,778 --> 01:43:07,214
ALSO HAVE IMAGING TIME POINTS AT

3168
01:43:07,281 --> 01:43:10,050
MULTIPLE POINTS WITHIN THE BEST

3169
01:43:10,117 --> 01:43:10,617
TRIAL.

3170
01:43:10,684 --> 01:43:12,152
NOT IN THE OBSERVATIONAL TRIAL.

3171
01:43:12,219 --> 01:43:13,520
SO THERE'S A LITTLE BIT OF BOTH

3172
01:43:13,587 --> 01:43:15,923
TRYING TO USE THE DATA AS

3173
01:43:15,989 --> 01:43:16,990
PREDICTIVE TOOLS AND THEN USE

3174
01:43:17,057 --> 01:43:19,259
THE DATA AS MECHANISTIC

3175
01:43:19,326 --> 01:43:20,360
INFORMATION OF WHO IS RESPONDING

3176
01:43:20,427 --> 01:43:22,763
AND HOW DID THINGS CHANGE.

3177
01:43:22,829 --> 01:43:25,499
AS WE TALK ABOUT THIS AMONGST

3178
01:43:25,566 --> 01:43:26,833
THE CONSORTIUM, AND I WELCOME

3179
01:43:26,900 --> 01:43:28,068
OTHERS TO CHIME IN HERE, THE WAY

3180
01:43:28,135 --> 01:43:29,369
WE'RE THINKING ABOUT IT IS,

3181
01:43:29,436 --> 01:43:35,576
WE'RE REALLY DEVELOPING THOSE

3182
01:43:35,642 --> 01:43:39,513
NOVEL MECHANISTIC THINGS WE NEED

3183
01:43:39,580 --> 01:43:40,480
TO STUDY GOING FORWARD.

3184
01:43:40,547 --> 01:43:41,615
>> ARE YOU STORING THE TISSUE IN

3185
01:43:41,682 --> 01:43:43,283
THE SAMPLES FOR FUTURE ANALYSES

3186
01:43:43,350 --> 01:43:45,018
BUT YOU'RE NOT ACTUALLY

3187
01:43:45,085 --> 01:43:47,721
COLLECTING THE PROTEOMICS

3188
01:43:47,788 --> 01:43:48,288
METABOLOMICS?

3189
01:43:48,355 --> 01:43:56,630
>> OH, NO, WE'RE DOING MA SICK E

3190
01:43:56,697 --> 01:43:58,632
OMICS AND ADDITIONALLY --

3191
01:43:58,699 --> 01:44:00,867
>> I MISSED THAT, I DIDN'T KNOW

3192
01:44:00,934 --> 01:44:02,603
YOU HAD THE WHOLE GROUPS DOING

3193
01:44:02,669 --> 01:44:03,170
IT.

3194
01:44:03,236 --> 01:44:03,737
THAT'S WONDERFUL.

3195
01:44:03,804 --> 01:44:04,004
THANK YOU.

3196
01:44:04,071 --> 01:44:06,673
>> SO, HI, LINDSAY CRISWELL,

3197
01:44:06,740 --> 01:44:07,274
DIRECTOR OF NIAMS.

3198
01:44:07,341 --> 01:44:08,609
I DIDN'T WANT TO MISS THIS VERY

3199
01:44:08,675 --> 01:44:09,810
PUBLIC OPPORTUNITY TO EXPRESS

3200
01:44:09,876 --> 01:44:11,211
THE SUPPORT AND ENTHUSIASM FOR

3201
01:44:11,278 --> 01:44:13,380
THIS PROGRAM ON BEHALF OF MY

3202
01:44:13,447 --> 01:44:14,581
COLLEAGUES.

3203
01:44:14,648 --> 01:44:15,983
EVERYTHING FROM THE EXTENT TO

3204
01:44:16,049 --> 01:44:19,019
WHICH YOU'RE PRACTICING PATIENT

3205
01:44:19,086 --> 01:44:21,421
ENGAGEMENT, THE EFFORTS DIRECTED

3206
01:44:21,488 --> 01:44:24,157
AT DATA HARMONIZATION, THE

3207
01:44:24,224 --> 01:44:25,125
THEORETICAL MODEL THAT YOU

3208
01:44:25,192 --> 01:44:26,093
DEVELOPED THAT'S REALLY

3209
01:44:26,159 --> 01:44:28,495
INSPIRING US TO THINK ABOUT THAT

3210
01:44:28,562 --> 01:44:29,696
ACROSS HEAL AND IN OTHER

3211
01:44:29,763 --> 01:44:31,965
PROGRAMS, AND SOMETHING THAT YOU

3212
01:44:32,032 --> 01:44:34,134
DIDN'T MENTION, WHICH WERE THE

3213
01:44:34,201 --> 01:44:35,268
OBSTACLES THAT YOU OVERCAME

3214
01:44:35,335 --> 01:44:36,136
RELATED TO THE FACT THAT THE

3215
01:44:36,203 --> 01:44:39,673
BEST TRIAL RECRUITMENT OVERLAPS

3216
01:44:39,740 --> 01:44:40,974
OVERLAPPED SOME WITH THE COVID

3217
01:44:41,041 --> 01:44:42,542
PANDEMIC AND YOU EXCEEDED YOUR

3218
01:44:42,609 --> 01:44:42,909
ENROLLMENT.

3219
01:44:42,976 --> 01:44:44,344
THAT REALLY SPEAKS TO YOUR

3220
01:44:44,411 --> 01:44:45,212
COMMITMENT HERE.

3221
01:44:45,278 --> 01:44:45,979
LASTLY, SOMETHING ELSE THAT

3222
01:44:46,046 --> 01:44:47,481
DIDN'T COME OUT IN THIS SESSION

3223
01:44:47,547 --> 01:44:48,949
BUT WE'RE REALLY EXCITED TO SEE

3224
01:44:49,016 --> 01:44:51,518
THE EXTENT TO WHICH THE BACPAC

3225
01:44:51,585 --> 01:44:53,286
PROGRAM IS ALSO BEGINNING TO

3226
01:44:53,353 --> 01:44:55,222
HAVE CROSSTALK AND COLLABORATION

3227
01:44:55,288 --> 01:44:58,258
WITH SOME OF THE OTHER PROGRAMS

3228
01:44:58,325 --> 01:45:01,228
ACROSS HEAL REJOIN PRECISION

3229
01:45:01,294 --> 01:45:02,729
MYOFASCIAL PAIN, SO WE'RE REALLY

3230
01:45:02,796 --> 01:45:04,164
EXCITED ABOUT HOW WE CAN BUILD

3231
01:45:04,231 --> 01:45:05,499
UPON YOUR CONTRIBUTIONS TOWARDS

3232
01:45:05,565 --> 01:45:07,000
A MUCH GREATER UNDERSTANDING OF

3233
01:45:07,067 --> 01:45:08,168
THIS COMPLEX PROBLEM.

3234
01:45:08,235 --> 01:45:09,603
SO THANK YOU SO MUCH FOR YOUR

3235
01:45:09,670 --> 01:45:12,406
HARD WORK AND DEDICATION.

3236
01:45:12,472
>> THANK YOU.