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Big data, BigDataMed15, Events, Precision health, Research, Stanford News, Technology

At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health

At Big Data in Biomedicine, Stanford's Lloyd Minor focuses on precision health

Minor talking - 560

In the next decade, Stanford Medicine will lead the biomedical revolution in precision health, Dean Lloyd Minor, MD, told attendees of the final day of the Big Data in Biomedicine conference.

Involving all aspects of Stanford Medicine — including research and patient care — the focus on precision health will draw on Stanford’s existing strengths while propelling the development of new discoveries and transforming health-care delivery, Minor explained.

The choice of “precision health” rather than “precision medicine” is deliberate and a distinction that is reflective of Stanford’s leadership role. While both precision health and precision medicine are targeted and personalized, precision health is proactive, with an emphasis on maintaining health. In contrast, precision medicine is reactive, with a focus on caring for the sick. Precision health includes prediction and prevention; precision medicine involves diagnosis and treatment.

Minor used the model of a tree to describe Stanford’s focus on precision health.

Basic research and biomedical data science form the trunk, the foundation that supports the entire endeavor. Nine “biomedical platforms” form the major branches; these platforms include immunology, cancer biology and the neurosciences, among others. The tree’s leaves are its clinical core, with treatment teams in cardiac care, cancer and maternal and newborn health, for example.

The growth of the tree, its tippy top, is fueled by predictive, preventative and longitudinal care — where innovations in knowledge and care drive further changes in the future of health-care.

Minor made two key points about the tree, and its implications for research and care at Stanford.

First, the tree is big and growing. “There is room for everyone on the tree,” he said. “That is one thing that will make this plan — this tree — so powerful.”

Secondly, the tree is ever-changing. “Care will be analyzed and fed back. That’s really the true heart and meaning of the learning health-care system,” Minor said. “Every encounter is part of a much bigger whole.”

The entire effort will be fueled by big data, Minor said. To recognize its importance, and help train future leaders, Stanford Medicine also plans to create a new biomedical data science Department.

“We’re poised to lead,” Minor said. “We build upon a history of innovation, an entrepreneurial mindset, visionary faculty and students and a culture of collaboration.”

Previously: Big Data in Biomedicine conference kicks off todayStanford Medicine’s Lloyd Minor on re-conceiving medical education and Meet the medical school’s new dean: Lloyd Minor
Photo by Saul Bromberger

Cardiovascular Medicine, Events, Patient Care, Stanford News

Honoring doctors, nurses of the early days of Stanford’s coronary care unit

Honoring doctors, nurses of the early days of Stanford’s coronary care unit

image.img.320.highWhen I was in the hospital recently to give birth to my daughter, I saw my doctors briefly during their rounds, but it was the nurses and nurse midwives who primarily cared for me. So when I read in a recent Inside Stanford Medicine feature story that 50 years ago, nurses weren’t even allowed to perform tasks like start IVs, I was shocked.

In the 1960s, Stanford was home to one of the earliest coronary care units, led by Alfred Spivack, MD. Spivack taught the nurses working on the unit to take on tasks that were, at the time, mainly done by physicians. Joan Fair, PhD, RN, who was one of the unit’s original nurses and is now a cardiovascular researcher, recalls:

“Some doctors were totally against nurses doing these kinds of things… It also took time for some doctors to accept our opinions about how their patients were doing, or if we saw a problem and called them and asked them to take a different line of treatment.”

Joan Mersch, MSN, the unit’s former nurse coordinator, described in the piece how beneficial this extra training was to patients. “When you know how to read electrocardiograms, recognize lethal cardiac rhythms, perform resuscitation and defibrillation — it saves patient lives,” she said. “You understand what needs to be done, and you can take action.”

A big proponent of using technology to improve care, Spivack depended on the nurses to learn how to use the devices and incorporate them in the daily care of patients. And he also encouraged the nurses to pursue their research interests; many, like Fair, went on to obtain graduate degrees.

Last month, almost two dozen former nurses from the unit came together for a dinner celebrating a major gift from Spivack, which will pay for the nurses’ station in the new heart acute care unit when the new adult hospital opens in 2018.

Photo by Steve Fisch

Big data, BigDataMed15, Events, Medicine and Society, Microbiology, Research, Technology

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

Levitt2Nobel laureate Michael Levitt, PhD, has been using big data since before data was big. A professor of structural biology at Stanford, Levitt’s simulations of protein structure and movement have tapped the most computing power he could access in his decades-long career.

Despite massive advances in technology, key challenges remain when using data to answer fundamental biological questions, Levitt told attendees of the second day of the Big Data in Biomedicine conference. It’s hard to translate gigabytes of data capturing a specific biological problem into a form that appeals to non-scientists. And even today’s supercomputers lack the ability to process information on the behavior of all atoms on Earth, Levitt pointed out.

Levitt’s address followed a panel discussion on computation and crowdsourcing, featuring computer-science specialists who are developing new ways to use computers to tackle biomedical challenges.

Kunle Olukotun, PhD, a Stanford professor of electrical engineering and computer science, had advice for biomedical scientists: Don’t waste your time on in-depth programming. Instead, harness the power of a domain specific language tailored to allow you to pursue your research goals efficiently.

Panelists Rhiju Das, PhD, assistant professor of biochemistry at Stanford, and Matthew Might, PhD, an associate professor of computer science at the University of Utah, have turned to the power of the crowd to solve problems. Das uses crowdsourcing to answer a universal problem (folding of RNA) and Might has used the crowd for a personal problem (his son’s rare genetic illness).

For Das, an online game called Eterna – and its players – have helped his team develop an algorithm that much more accurately predicts whether a sequence of RNA will fold correctly or not, a key step in developing treatments for diseases that use RNA such as HIV.

And for Might, crowdsourcing helped him discover other children who, like his son Bertrand, have an impaired NGLY1 gene. (His story is told in this New Yorker article.)

Panelist Eric Dishman, general manager of the Health and Life Sciences Group at Intel Corporation, offered conference attendees a reminder: Behind the technology lies a human. Heart rates, blood pressure and other biomarkers aren’t the only trends worth monitoring using technology, he said.

Behavioral traits also offer key insights into health, he explained. For example, his team has used location trackers to see which rooms elderly people spend time in. When there are too many breaks in the bathroom, or the person spends most of the day in the bedroom, health-care workers can see something is off, he said.

Action from the rest of the conference, which concludes today, is available via live-streaming and this app. You can also follow conversation on Twitter by using the hashtag #bigdatamed.

Previously: On the move: Big Data in Biomedicine goes mobile with discussion on mHealthGamers: The new face of scientific research?, Half-century climb in computer’s competence colloquially captured by Nobelist Michael Levitt and Decoding proteins using your very own super computer
Photo of Michael Levitt by Saul Bromberger

Events, Mental Health, Sexual Health, Stanford News, Women's Health

Women’s health experts tackle mood disorders and sexual assault

Women's health experts tackle mood disorders and sexual assault

3131235412_fa7f528735_zEarlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.

Among the many sessions, the two that most piqued my interest focused on women’s mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school’s Department of Psychiatry and Behavioral Sciences.

Williams’ talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum – above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their “hormones.” Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to “normal” fluctuations: pre-menstrual, perinatal, and perimenopausal.

Technically speaking, “PMS” is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman’s cycle, usually the two weeks after ovulation – this is a big chunk of time we’re talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general – when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).

Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.

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Big data, BigDataMed15, Events, Patient Care, Research, Stanford News, Technology

Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patients

Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patients

population health panelThe explosion of big data is transforming the way those in health care are diagnosing, treating and preventing disease, panelists at the Big Data in Biomedicine said on its opening day.

During a five-member panel on population health, experts outlined work that is currently being done but said even bigger datasets and better technology are needed to ramp up the benefits from digital data and to save lives.

“Using the end-of-millions to inform care for the end-of-one – that is exactly where we’re going,” said Tracy Lieu, MD, MPH, director of research at Kaiser Permanente Northern California, a health-care network that includes 21 hospitals, 8,000 physicians and 3.6 million patients. “And we think that in a population like ours, in an integrated system like ours, we are in an ideal setting to do personalized medicine.”

Stanford Medicine professor Douglas Owens, MD, director of the Center for Health Policy and Center for Primary and Outcomes Research, led the panel on Wednesday. He said that big data is also changing how research is being conducted.

“There’s been an explosion of data of all kinds: clinical data, genomics data, data about what we do and how we live,” said Owens. “And the question is how can we best use that data to improve the health of the individual and to improve the health of populations.”

Lieu said two key trends are central to medical researchers: informatics and genomics. She told attendees that Kaiser utilizes a “virtual data warehouse” with the digital data of 14 million patients dating back to 1960. But Lieu cautioned that the data are not always the means to an end, particularly if the findings are not tested and implemented.

“Sometimes we fail. And we fail when we identify a problem of interest, we make a decision to study it, we assemble the data, we analyze and interpret the results – and then we send them off to journals. So we fail to close the loop,” she said, because researchers typically don’t go beyond the publication of data.

Lieu said Kaiser is now focused on trying to close that loop. “To do that, we need the kinds of tools that you in this group and the speakers at this conference are developing,” she explained. “We need better and better technology for rapidly analyzing and aggregating data.”

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Events, Stanford News

Stanford Medicine’s Health Matters event, in pictures

Stanford Medicine's Health Matters event, in pictures

Last weekend’s Health Matters, an annual event, drew more than 750 people to the Stanford Medicine campus. Along with hearing about the latest medical and health advances, participants were offered the chance to talk one-on-one with some of our experts and to participate in a dizzying array of hands-on activities.

For those of you who missed out (and even those who didn’t), save the date for next year’s event: May 14, 2016.

Previously: Stanford’s Health Matters happening on Saturday
Photos by CM Howard Photography

Global Health, LGBT, Public Health, Public Safety, Women's Health

Advocating for the rights of women and LGBT individuals in the developing world

Advocating for the rights of women and LGBT individuals in the developing world

Randy Barry - smallLast spring, I traveled to Washington, D.C. for my first experience as a citizen-activist, lobbying in Congress for the rights and well-being of women and LGBT individuals in the developing world. I recently returned there to see some of the impact of that work – crucial new appointees, new legislators in support of key issues and new words of encouragement from both sides of the political aisle.

I visited Washington as part of a 170-person delegation from the American Jewish World Service (AJWS), an international organization that promotes human rights and seeks to end poverty in developing countries. Our goal was to advance several initiatives, including passage of the International Violence Against Women Act, and changes to ensure that U.S. foreign contracts and foreign aid programs do not discriminate against LGBT individuals.

I was thrilled to hear a talk by Randy Berry, the State Department’s first-ever Special Envoy for the Human Rights of LGBT Persons, who assumed the new post in February. Just a year ago, AJWS had made the appointment of a special envoy one of its priority issues, and many of us, myself included, had met with our Congressional representatives to push for the position. I had been motivated by my experiences as an AJWS Global Justice Fellow in Uganda in 2014, when we met with LGBT activists who were living in a climate of terror because of the country’s impending anti-gay law. We heard stories of people who had been raped, beaten, harassed, evicted from homes and jobs and subjected to summary arrest.

I realized it was important to make LGBT rights a priority issue for U.S. foreign policy. Berry, the new U.S. envoy, said AJWS had been a “prime mover” in the creation of his new office – gratifying news indeed. He said he views LGBT rights as a “core human rights issue.”

“We are talking about equality, and it should go hand-in-hand with what we are doing in gender equality and in the disabled community,” he told us. “One of the most disturbing elements of discrimination is that it’s the first step to denying one’s humanity.”

He acknowledged that he has a daunting job ahead; while the U.S. is making swift progress on gay rights, these rights are just as swiftly being eroded in other parts of the world. Nearly 80 countries now criminalize same-sex behavior, with penalties that include death or life in prison. Yet the fact that the U.S. has made so much progress in recent decades suggests it’s possible to change the climate elsewhere as well, he said.

“Who would have dreamed 20 years ago that we would be where we are today in the United States,” he said. “I am sitting here today with the support of the State Department, the president and members on both sides of the aisle.”

We also saw progress on the International Violence Against Women Act, which would make ending violence against women worldwide a top U.S. diplomatic and development priority. Violence against women and girls is alarmingly pervasive, with as many as one in three being beaten, coerced into sex or subjected to other abuse in her lifetime.

The legislation was reintroduced in the House of Representatives in March with a record 18 co-sponsors, including many more Republicans than in the past. On the morning of our lobbying visits, we heard from seven Members of Congress, including Chris Gibson (R-NY), Richard Hanna (R-NY) and Lee Zeldin (R-NY), all of whom expressed strong support for the bill. David Cicilline (D-RI) described a trip to Liberia in which he met a group of young girls who had been subjected to “hideous, indescribable sexual violence.”

“It made me realize we need to do everything we can to change the lives of these young girls,” he told us.

I couldn’t agree more.

Previously: Stanford study shows many LGBT med students stay in the closetChanging the prevailing attitude about AIDS, gender and reproductive health in southern AfricaLobbying Congress on bill to stop violence against womenPreventing domestic violence and HIV in Uganda and Sex work in Uganda: Risky business
Photo of Randy Berry by Ruthann Richter

Biomed Bites, Cancer, Genetics, Microbiology, Research, Videos

Packed and ready to go: The link between DNA folding and disease

Packed and ready to go: The link between DNA folding and disease

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

In cells, DNA doesn’t make a lovely, languid helix as popularly depicted. It’s scrunched up, bound with proteins that smoosh one meter of DNA into just one micrometer, a millionth of its size. DNA wound around proteins form a particle called a nucleosome.

Yahli Lorch, PhD, associate professor of structural biology, has studied nucleosomes since they were first discovered more than 20 years ago, as she mentions in the video above:

When I began working on the nucleosome, it was a largely neglected area since most people considered it just a packaging and nothing beyond that.

Since I discovered that it has a role and a very important role in the regulation of gene expression, the field has grown many fold and it’s one of the largest areas in biology now.

Many diseases have been linked to the packaging of DNA, including neurodegenerative diseases, autoimmune diseases and several types of cancer such as some pancreatic cancers. Enhancing the understanding of the basic biology of DNA folding is leading to new and improved treatments for these conditions, Lorch says.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: DNA origami: How our genomes fold, DNA architecture fascinates Stanford researcher — and dictates biological outcomes and More than shiny: Stanford’s new sculpture by Alyson Shotz

Big data, BigDataMed15, Events, Medicine and Society, Research, Technology

On the move: Big Data in Biomedicine goes mobile with discussion on mHealth

On the move: Big Data in Biomedicine goes mobile with discussion on mHealth

17910585102_33293fefe7_zIda Sim, MD, PhD, would like to prescribe data as easily as she orders a blood test or a prescription for antibiotics. Sim, a professor of medicine at the University of California-San Francisco, told attendees of a Big Data in Biomedicine panel on mHealth yesterday afternoon that she doesn’t want access to data collected willy-nilly, with little regard for the patient’s health condition or needs.

Instead, she wants to tailor data collection to the individual patient. For example, there’s no need to collect activity data for a competitive marathoner, but it would be useful for a sedentary computer programmer.

And she doesn’t care how patients collect their data; they can “bring their own device,” Sim, who also co-directs of biomedical informatics at the UCSF Clinical and Translational Sciences Institute, said.

The design of those devices is integral to the quality of the data developed, pointed out panelist Ram Fish, vice president of digital health at Samsung. He said his team starts with “small data,” making sure devices such as their Simband watch accurately records biomarkers such as blood pressure or heart rate in a single individual, before expanding it to the population level.

He said he’s most keen on developing tools that make a real difference in health, such as the detection of abnormal heart rhythms, a project still in the works.

And speaking of new tools, Stanford’s Euan Ashley, MD, PhD, associate professor of medicine and of genetics, shared some early results from the cardiovascular app MyHeart Counts, which Stanford introduced in March to great acclaim.

Ashley reported that the study has yielded information about the link between sleep patterns and happiness (those who go to bed late and get up late are less happy than others) and about geographic patterns of produce consumption (South Dakota users out-eat Californians when it comes to fruits and veggies). The project’s team is just starting to delve into some of its other findings, which include correlations between the 6-minute timed walk and overall health.

“We’re in a really new era and one we don’t really understand,” Ashley said.

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Media, Medicine and Society, Technology

Upset stomachs and hurting feet: A look at how people use Twitter for health information

Upset stomachs and hurting feet: A look at how people use Twitter for health information

MedCity News ran an incredibly informative article earlier this week on how people use social media – and more specifically, Twitter – to consume and discuss health information. Reporting on a recent talk from Twitter engineer Craig Hashi at Cleveland Clinic’s ePatient Experience: Empathy + Innovation Summit, Neil Versel shared:

Some 40 percent of consumers believe that information they found on social media affects how they deal with their health, [Hashi] said. A quarter of Internet users with chronic illnesses look for people with similar health issues. And 42 percent search online for reviews of health products, treatments and providers.

Twitter processes 23,000 weekly tweets with the words “feet hurt,” and the frequency naturally increases as the day and the work week go on, though many people tweet that when they get home on Saturday night as well. “Dr. Scholl’s can actually come in and reach these people,” Hashi suggested.

“Allergy” tweets mostly occur between March and June, Hashi said. “Sunscreen” also peaks in the late spring and summer. “Uncomfortable tummies” is highest on Thanksgiving, with lesser spikes at Christmas and on Super Bowl Sunday. Hashi said that Tums advertised on Twitter around Thanksgiving.

And for those who question the value of Twitter, or don’t quite understand its place in health care, these figures might give you pause: “The volume of information available on Twitter is staggering, Hashi said. There are half a billion tweets send every day. There will be more words on Twitter in the next two years than in all books ever printed. An analysis Hashi put together found that there were 44 million cancer-related tweets in the 12 months ending in March 2015, and traffic spiked in October, which happens to be Breast Cancer Awareness Month.”

Previously: Finding asthma outbreaks using Twitter: How social media can improve disease detectionAdvice for young doctors: Embrace TwitterTwitter 101 for patientsBertalan Meskó discusses how mobile technologies can improve the delivery of health care and What to think about when using social media for health information

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