This article was migrated. The article was marked as recommended. Problem: Wikipedia is a ubiquitous source of information for patients, medical students and junior doctors alike. This is despite medical educators discouraging students from Wikipedia as a source of medical information. Intervention: To address this disconnect, Osmosis' Director of Open Learning Initiatives created a novel Wikipedia-editing course structured to leverage the global network of Osmosis-subscribing students. The course was entirely video-conference based and lasted 4 weeks in July 2019. Students typically worked on an article by themselves though one article was selected by two students. Towards the end of the course, each student peer-reviewed another student's edited article. Outcomes:Twelve medical students, from 11 different medical schools across 3 different continents, enrolled in the course and 11 articles were assigned. A total of 8,775 words and 119 higher quality references were added whilst 35 lower-quality references were removed. An exit survey showed students had increased confidence in their ability to contribute to Wikipedia. Students also enjoyed collaborating with a global diversity of peers. Lessons Learned: Numerous students wished that the course had a longer duration. A couple students recommended more groupwork to be incorporated into the course. The global nature of the course meant that time zones proved a challenge to scheduling. Conclusion:Decentralized courses can leverage the large user bases of medical education companies, such as Osmosis, to teach students analytical approaches to online resources as well as improve the quality of publicly available health information on Wikipedia.

Study Objectives The pedunculopontine tegmental nucleus (PPT) is implicated in many brain functions, ranging from sleep/wake control and locomotion, to reward mechanisms and learning. The PPT contains cholinergic, GABAergic and glutamatergic neurons with extensive ascending and descending axonal projections. Glutamatergic PPT (PPT vGlut2) neurons are thought to promote wakefulness, but the mechanisms through which this occurs are unknown. In addition, some researchers propose that PPT vGlut2 neurons promote locomotion, yet even though the PPT is a target for deep brain stimulation in Parkinson’s disease, the role of the PPT in locomotion is debated. We hypothesized that PPT vGluT2 neurons drive arousal and specific waking behaviors via certain projections and modulate locomotion via others. Methods We mapped the axonal projections of PPT vGlut2 neurons using conditional anterograde tracing and then photostimulated PPT vGlut2 soma or their axon terminal fields across sleep/wake states and analyzed sleep/wake behavior, muscle activity, and locomotion in transgenic mice. Results We found that stimulation of PPT vGlut2 soma and their axon terminals rapidly triggered arousals from NREM sleep, especially with activation of terminals in the basal forebrain (BF) and lateral hypothalamus (LH). With photoactivation of PPT vGlut2 terminals in the BF and LH, this wakefulness was accompanied by locomotion and other active behaviors, but stimulation of PPT vGlut2 soma and terminals in the substantia nigra triggered only quiet wakefulness without locomotion. Conclusions These findings demonstrate the importance of the PPT vGluT2 neurons in driving various aspects of arousal and show that heterogeneous brain nuclei, such as the PPT, can promote a variety of behaviors via distinct axonal projections.

Introduction The pedunculopontine tegmental (PPT) region in the brainstem is crucial for the regulation of sleep/wake states. We recently showed that chemogenetic activation of glutamatergic PPT neurons promotes wakefulness for several hours. Here we used optogenetic activation of these neurons to further investigate the mechanisms and pathways through which PPT glutamatergic neurons produce wakefulness. Methods Using vGlut2-cre mice, we transfected neurons in the PPT region with a viral vector coding for cre-dependent ChR2 tagged with fluorescent mCherry and implanted bilateral optical fibers above the PPT nuclei as well as EEG/EMG leads. Two weeks later, we administered blue laser light to activate ChR2-expressing neurons and recorded sleep/wake states. Results Activation of ChR2-expressing glutamatergic neurons during NREM sleep rapidly elicited wakefulness in a stimulation-frequency dependent manner, with higher frequencies producing wake more quickly and with longer duration. Random, automated stimulation for 10 s at 5 Hz over 24 h revealed that activation of glutamatergic PPT neurons produces rapid arousals form NREM sleep. Importantly, stimulation did not wake mice from REM sleep, suggesting that glutamatergic PPT signaling does not interfere with REM sleep. To map the target areas through which PPT glut neurons produce wakefulness, we used a viral tracer to visualize PPT glutamatergic projections, and then optogenetically stimulated terminals in 1) basal forebrain, 2) lateral hypothalamus, 3) thalamus, and 4) substantia nigra. We found that stimulating terminals in all of these regions woke mice from NREM sleep, and stimulating terminals in the basal forebrain and lateral hypothalamus produced a number of active wake behaviors such as locomotion. In contrast, stimulation of PPT glut soma and terminals in the thalamus and substantia nigra results mainly in quiet wakefulness. Conclusion Glutamatergic PPT neurons potently promote arousal from NREM sleep but not REM sleep, and the resulting wake behavior is modulated by different projection targets. Support NIH grant P01 - HL095491