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Medical Education, Medicine and Literature

MeDesign Human Health Book: human anatomy diagrams with sleek new look

MeDesign Human Health Book: human anatomy diagrams with sleek new look


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For many people, the topic of human anatomy evokes feelings of both marvel and dismay. The workings of the body may be a wonder to behold, but their intricacies can be a pain to sort out, remember and explain.

To make human anatomy easier to learn and understand, Bruce Ian Meader, an associate professor at the Rochester Institute of Technology’s Vignelli Center for Design Studies, and his class of 13 first-year graduate students tackled the task of streamlining diagrams of human anatomy in 2014 as part of the School’s Medicine+Design initiative.

For this assignment, the class was given 10 weeks to design several short book chapters that explain systems of the human body for a general audience. To accomplish the task, the class split into small groups to research, write, and design simplified layouts of body systems, such as the brain, eyes, joints and nervous system. Once the book chapters were complete, the students worked together to assemble the chapters into a book they called the MeDesign Human Health Book.

The book is already earning praise and has sparked a second phase for the Medicine+Design initiative in 2015. You can view the entire book online for free at the school’s website.

Previously: University of Glasgow medical student makes learning anatomy a feast for the sensesImage of the Week: A playful take on the human respiratory systemImage of the Week: VeggieanatomyImage of the Week: Quilled anatomyKitchen anatomy: Brain carved from a watermelon
Via Street Anatomy
Artwork courtesy of Bruce Ian Meader and artist Cai Jai

Emergency Medicine, Nutrition, Pediatrics, Rural Health

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Malnutrition is a leading cause of mortality in children under the age of five, contributing to approximately 3.5 million child deaths worldwide each year. Currently, the World Health Organization and Doctors Without Borders recommend using calculations based on the patient’s body weight or arm circumference to assess their nutritional status. But, it’s not known if they are reliable measures of malnutrition in children that suffer from diarrhea and dehydration — two symptoms that can affect body weight and are common in undernourished kids.

Now, a study (subscription required) published this month in the Journal of Nutrition shows that mid-upper arm circumference can accurately assess malnutrition in children with diarrhea and dehydration and it’s better at assessing malnutrition than weight-based measures.

In the study, Rhode Island Hospital emergency medicine physician Adam Levine, MD, and his team analyzed 721 records of children (under the age of five) who were examined at an urban hospital in Dhaka, Bangladesh for acute diarrhea. They found that measurements based on a child’s mid-upper arm circumference accurately diagnosed malnutrition, but measurements based on weight were unreliable and misdiagnosed about 12-14 percent of the cases when the patient had diarrhea and dehydration.

“Because dehydration lowers a child’s weight, using weight-based assessments in children presenting with diarrhea may be misleading,” Levine said in a press release. “When children are rehydrated and returned to a stable, pre-illness weight, they may still suffer from severe acute malnutrition.”

Since poor nutrition is a common problem in areas where medical resources are limited, the best tools to diagnose malnutrition are effective and inexpensive. Tape measures are cheaper and are often easier to come by than scales, so the results of this study are especially encouraging for people who want the best and most affordable way to measure malnutrition in children. “Based on our results, clinicians and community health workers can confidently use the mid-upper arm measurement to guide nutritional supplementation for children with diarrhea,” said Levine.

Previously: Stanford physician Sanjay Basu on using data to prevent chronic disease in the developing worldMalnourished children have young guts and Seeking solutions to childhood anemia in China
Photo by European Commission DG ECHO

Cancer, Dermatology, FDA, Health Policy, In the News, Public Health

Experts call on FDA for a “tanning prevention policy”

Experts call on FDA for a "tanning prevention policy"

6635416457_a62bfeb09d_zIndoor UV tanning beds are known carcinogens that are responsible for many cases of skin cancer, which is the most commonly diagnosed form of cancer in the U.S. A recently issued Call to Action to Prevent Skin Cancer from the U.S. Surgeon General states that “more than 400,000 cases of skin cancer [8% of the total], about 6,000 of which are melanomas, are estimated to be related to indoor tanning in the U.S. each year” while “nearly 1 out of every 3 young white women engages in indoor tanning each year,” making indoor tanning a serious public health issue.

In a JAMA opinion piece published yesterday, Darren Mays, PhD, MPH, from the Georgetown University Medical Center‘s Department of Oncology, and John Kraemer, JD, MPH, from Georgetown’s School of Nursing and Health Studies, argued that the FDA needs to step up its regulatory approach and restrict access to this technology – due to its limited therapeutic benefits and known damaging effects.

In 2011, California was the first state to ban access to indoor UV tanning beds to minors. The authors assert that “state-level policies restricting a minor’s access to indoor tanning devices are effectively reducing the prevalence of this cancer risk behavior among youth,” but argue that regulation at the federal level is in order:

Like tobacco products, a national regulatory framework designed to prevent and reduce indoor tanning could reduce public health burden and financial costs of skin cancer. …from a public health perspective the indoor tanning device regulations are not commensurate to those of other regulated products that are known carcinogens with very little or no therapeutic benefit.

However, the likelihood of this regulation taking place is questionable:

FDA did not leverage its authority last year to put a broader regulatory framework in place, which could have included a national minimum age requirement and stronger indoor tanning device warning labels… Critical factors seem to be aligning for such policy change to take place, but additional momentum is needed to promote change at a national scale. The US national political environment makes more expansive regulation by either FDA or Congress seem unlikely in the near future.

The authors concluded with a call for organizations other than governments to help build momentum on toward a “national indoor tanning prevention policy.” For example, they said, universities could implement “tan-free” campus policies similar to the “tobacco-free” campaign.

Previously: More evidence on the link between indoor tanning and cancers, Medical experts question the safety of spray-on tanning productsTime for teens to stop tanning?, Senator Ted Lieu weighs in on tanning bed legislation and A push to keep minors away from tanning beds
Photo by leyla.a

Emergency Medicine, Global Health, Haiti, Stanford News

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

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Nepal’s 7.8 earthquake in late April killed 8,000 people and displaced thousands more. Paul Auerbach, MD, a professor of emergency medicine at Stanford, spent about a week caring for the people of Kathmandu and recently sat down for a Q&A session with Shana Lynch of Stanford’s Graduate School of Business, where Auerbach earned a master’s degree in 1989.

Auerbach was also part of the medical response team in Haiti after the 2010 earthquake there killed hundreds of thousands. While talking with Lynch, he compares the two earthquakes and the very different medical responses they needed:

When you come in, you need to find the victims. You need to treat them. You need medical supplies. You need adequate personnel in order to manage the life- and limb-threatening injuries in the first few days. From the moment of the earthquake and forward, there’s a need for water and food. In Haiti, the supplies initially weren’t there. Everything needed to be carried in. In Kathmandu, for the most part, the supplies were available. Of course, they needed supplementation, and that happened and will continue to happen. In Kathmandu, they never were in a situation where they had nothing, which was unfortunately the situation in Port-au-Prince.

He also discusses some of the challenges of coordinating an appropriate disaster response plan:

There comes a point when you have enough people and enough supplies. At that point, you need to start storing things and sending people home.

The responses are never perfect because you discover that you need more of something and less of something else. The same holds true for people. For example, the changing nature of medical conditions following an earthquake causes you to need emergency medicine specialists early on, but then orthopedic surgeons and reconstructive surgeons later during the response.

Lynch and Auerbach’s conversation also touches on why community leaders need to plan for disasters, regardless of where they are. It’s an interesting inside look into how medical teams think about and respond to natural disasters.

Previously: “Still many unknowns”: Stanford physician reflects on post-earthquake Nepal, Day 6: Heading for home after treating Nepal earthquake victims, Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims, Day 2: “We have heard tales of miraculous survival” following Nepal earthquake, Day 1: Arriving in Nepal to aid earthquake victims and Reports from Stanford medical team in Haiti
Photo courtesy of Paul Auerbach

Evolution, Genetics, HIV/AIDS, Immunology, Infectious Disease, Research, Stanford News

Study: Chimps teach people a thing or two about HIV resistance

Study: Chimps teach people a thing or two about HIV resistance

I, personally, have never had trouble distinguishing a human being from a chimp. I look, and I know.

But I’m not a molecular biologist. Today’s sophisticated DNA-sequencing technologies show that the genetic materials of the two species, which diverged only 5 million or so years ago (an eye-blink in evolutionary time), are about 98 percent identical. Think about that next time you eat a banana.

One major exception to that parallelism: a set of three genes collectively called the major histocompatibility complex, or MHC. These genes code for proteins that sit on the surfaces of each cell in your body, where they serve as jewel cases that display bits of proteins that were once inside that cell but have since been chopped into pieces by molecular garbage disposals, transported to the cell surface and encased in one or another of the MHC proteins. That makes the protein bits highly visible to roving immune cells patrolling our tissues to see if any of the cells within are harboring any funny-looking proteins. If those roving sentry cells spot a foreign-looking protein bit, they flag the cell on whose surface it’s displayed as possibly having been infected by a virus or begun to become cancerous.

Viruses replicate frequently and furiously, so they evolve super-rapidly. If they can evade immune detection, that’s groovy from their perspective. So our MHC has to evolve rapidly, too, and as a result, different species’ MHC genes  diverge relatively quickly.  To the extent they don’t, there’s probably a good reason.

Stanford immunologist and evolutionary theorist Peter Parham, PhD, pays a lot of attention to the MHC genes. In a new study in PLOS Biology, he and his colleagues have made a discovery that may prove relevant to AIDS research, by analyzing genetic material found in chimp feces. Not zoo chimps. Wild Tanzanian chimps. As I noted in a news release about the study:

The wild chimps inhabit Gombe Stream National Park, a 13.5-square-mile preserve where they have been continuously observed from afar since famed primatologist Jane Goodall, PhD, began monitoring them more than 50 years ago.

One thing that sets the Gombe chimps apart from captive chimps, unfortunately, is a high rate of infection by the simian equivalent of HIV, the virus responsible for AIDS.

The study’s lead author, postdoc Emily Wroblewski, PhD, set up shop in a corner of Parham’s lab and extracted DNA from fecal samples legally obtained by other researchers (close contact with the animals is prohibited). Each sample could be tied to a particular Gombe-resident chimp. RNA extracted from the same sample indicated that chimp’s infection status.

Parham, Wroblewski and their colleagues found that one particular MHC gene came in 11 different varieties – astounding diversity for such a small collection of chimps (fewer than 125 of them in the entire Gombe). Surprisingly, one small part of one of those 11 gene variants was nearly identical to a piece of a protective version of its human counterpart gene, a version that seems to protect HIV- infected people slowing HIV progression to full-blown AIDS.

Why is that important? Because any piece of an MHC gene that has maintained its sequence in the face of 5 million years of intense evolutionary pressure must be worth something.

Sure enough, fecal samples from chimps with that MHC gene variant, so strikingly analogous to the protective human variant, had lower counts of virus that those from infected chimps carrying other versions of the gene.

You can believe that scientists will be closely examining the DNA sequence contained in both the human and chimp gene variant, as well as the part of the MHC protein that DNA sequence codes for. Because it must be doing something right.

Previously: Revealed: Epic evolutionary struggle between reproduction and immunity to infectious disease, Our species’ twisted family tree and Humans share history – and a fair amount of genetic material – with Neanderthals
Photo by Emily Wroblewski

Behavioral Science, Imaging, Neuroscience, Research, Stanford News

Stanford researchers tie unexpected brain structures to creativity – and to stifling it

Stanford researchers tie unexpected brain structures to creativity - and to stifling it

EinsteinHow often does the accountant turn out to be the life of the party? How often do the Nike sneakers, rather than the Armani suits, call the shots? Yet that may be the case when it comes to – of all things! – creativity.

As I wrote in this news release about an imaging study just published in Scientific Reports:

[Stanford scientists] have found a surprising link between creative problem-solving and heightened activity in the cerebellum, a structure located in the back of the brain and more typically thought of as the body’s movement-coordination center… The cerebellum, traditionally viewed as the brain’s practice-makes-perfect, movement-control center, hasn’t been previously recognized as critical to creativity.

That’s putting it mildly. And that’s not the only bizarre outcome of the study, whose findings also suggest that shifting the brain’s higher-level, executive-control centers into higher gear impairs, rather than enhances, creativity.

When I interviewed neuroscientist Allan Reiss, MD, the study’s senior author, about the research, he told me:

We found that activation of the brain’s executive-control centers – the parts of the brain that enable you to plan, organize and manage your activities – is negatively associated with creative task performance.

Creativity is one of the most valuable human attributes, as well as one of the hardest to measure. Tying it to activity in particular brain structures in a living, thinking human brain is a brainteaser in itself.

Continue Reading »

Biomed Bites, Neuroscience, Research, Videos

The inner engineer: One researcher’s quest to understand the brain

The inner engineer: One researcher's quest to understand the brain

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

For Jennifer Raymond, PhD, associate professor of neurobiology, the decision to devote her career to deciphering how the brain operates was, well, a no-brainer.

“I think we’re all curious about how our brains work,” Raymond says in the video above. “It’s really fundamental to who we are.”

She’s on a hunt for the brain’s “inner engineer,” the “actor” that decides how the brain should rewire itself to operate more efficiently. And now is a good time for the field, she says:

In neuroscience, we’re poised to start making some fundamental breakthroughs in understanding how the building blocks of the brain, the neurons, work together to perform computations and to learn.

Those insights will have big implications for society and medicine, Raymond explains:

If we can better understand how the brain learns, this will help us design better treatments for people with learning disabilities or people recovering from stroke…

It will help us design better education systems and it will help us design better machines that can more closely mimic the abilities of the human brain.

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

Previously: Peering under the hood — of the brain, New findings on exactly why our “idle” brains burn so much fuel and A little noise in the brain’s wiring helps us learn

Behavioral Science, Health and Fitness, Obesity, Public Health, Sleep

How insufficient sleep can lead to weight gain

How insufficient sleep can lead to weight gain

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I don’t think I’ve ever met a person who hates sleep and can’t wait to get less of it. Yet, even though most people want more sleep and know it’s important for their health, few people get as much shut-eye as they need. If you’re one of the many who needs a bit more motivation to get to bed earlier, a recent BeWell@Stanford article on how sleep can affect your weight may do the trick.

In the Q&A, sleep expert Emmanuel Mignot, MD, PhD, director of the Stanford Center for Sleep Sciences and Medicine, explains why and how insufficient sleep can increase your risk of weight gain:

It is very clear that if you’re not sleeping enough, you’re putting yourself at risk for increasing your weight.  If you sleep less than six hours a night, you’re likely to have a higher BMI (body mass index). Longitudinal data — and the evidence is quite strong — shows that if you sleep more over time, you’ll lower your BMI, which correlates with weight reduction.

In the first centuries of human life on earth, if humans weren’t sleeping they were probably looking for food or fleeing a predator. Not sleeping enough was a sign that we were in danger or that we were under stress. When we are sleep deprived, we feel hungry. Data indicates that if you sleep less, you eat more, and it disrupts your hormones. This problem is magnified in today’s world because food is too available!

Mignot also discusses the top reasons why people sleep so little, the importance of naps, and how being sleep-deprived skews our perception of doing and performing well. “[W]e have to make sure we don’t burn the candle at both ends, Mignot said. “Sleeping brings creativity, productivity and the ability to perform at a higher level.”

The piece is a quick, and informative, read.

Previously: Exploring the history and study of sleep with Stanford’s William Dement“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep wellStanford doc gives teens a crash course on the dangers of sleep deprivation, Narcoleptic Chihuahua joins Stanford sleep researcher’s family and More evidence linking sleep deprivation and obesity
Photo by Goodiez

Medical Education, Medical Schools, Mental Health, Stanford News

A call to action to improve balance and reduce stress in the lives of resident physicians

A call to action to improve balance and reduce stress in the lives of resident physicians

4086639111_a7e7a56912_zIn November of 2010, those in Stanford’s general surgery training program experienced an indescribable loss when a recently graduated surgical resident, Greg Feldman, MD, committed suicide. His death wound up being a call to action that brought about the Balance in Life program at Stanford, according to program founder Ralph S. Greco, MD.

With the Balance in Life program now in its fourth year, Greco; chief surgical resident Arghavan Salles, MD, PhD; and general surgery resident Cara A. Liebert, MD, have learned much about the daily stresses that resident physicians face. In a recent published JAMA Surgery opinion piece they wrote:

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health.

A recent national survey found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.

Greco, Salles and Liebert explain that the Balance in Life program is specifically designed to help resident physicians cope with these stresses by addressing the well-being of their professional, physical, psychological and social lives. To accomplish this goal, the program offers mentorship and leadership training activities; dining and health-care options that are tailored to the residents’ busy schedules and needs; confidential meetings with an expert psychologist; and social events and outdoor activities that foster support among residents.

The authors concede that the program may not fix every stressful problem that their residents face, but it does let the residents know that their well-being is important and valued. “This may be the most profound, albeit intangible, contribution of Balance in Life,” the authors write.

Although the program (and the JAMA article) is geared for people in the medical field, it’s not much of a stretch to see how its core principles can apply to any work setting. Learning how to manage stress and reach out to colleagues for support is a valuable skill and, as the authors write, to provide expert care for others you must first take good care of yourself.

Previously: After work, a Stanford surgeon brings stones to lifeSurgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentality, New surgeons take time out for mental health and Helping those in academic medicine to both “work and live well”
Photo by Gabriel S. Delgado C.

Behavioral Science, In the News, Mental Health, Public Health, Research

Green roofs are not just good for the environment, they boost productivity, study shows

Green roofs are not just good for the environment, they boost productivity, study shows

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Boosting productivity can be as simple as looking at a grassy roof for just forty seconds, conclude researchers at the University of Melbourne. It’s been shown that contact with nature can relieve stress and improve concentration and mood, but this is one of the first studies to see if novel urban manifestations of greenery can have the same effect.

The study, published in the Journal of Environmental Psychology and led by Kate Lee of Melbourne’s Green Infrastructure Research Group, involved giving students a mindless computer task to do in a city office building with a brief break spent looking at a picture of either a lush green roof or bare concrete roof. Those who looked at the green one made significantly fewer mistakes and showed better concentration in the second half of the task. The study was based on the idea of “attention restoration” through microbreaks lasting under a minute, which happen spontaneously throughout the work day.

Lee is quoted in a press release:

We know that green roofs are great for the environment, but now we can say that they boost attention too. Imagine the impact that has for thousands of employees working in nearby offices… It’s really important to have micro-breaks. It’s something that a lot of us do naturally when we’re stressed or mentally fatigued. There’s a reason you look out the window and seek nature, it can help you concentrate on your work and to maintain performance across the workday.

Certainly this study has implications for workplace well-being and adds extra impetus to continue greening our cities. City planners around the world are switching on to these benefits of green roofs and we hope the future of our cities will be a very green one.

She and her team next plan to see if city greening makes people more helpful and creative, as well as productive.

Previously: Nature is good for you, right? and Out of office auto-reply: Reaping the benefits of nature
Photo by Jeremy Reding

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