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Scope Announcements, Stanford News

Scope wins award for its “creative and effective approach” to promoting academic medicine

Scope wins award for its "creative and effective approach" to promoting academic medicine

We’re happy to announce that Scope is a 2015 GIA Award for Excellence winner. The awards, given by the Association of American Medical Colleges, were designed to honor “the most creative and effective approaches used to promote academic medicine in the United States,” and we won in the electronic communications/social media category. We also received recognition from the group in 2012 and 2014.

This is a good time to also remind readers that there are several ways to consume our stories: We have a magazine on Flipboard, and all of our posts appear on Twitter in the @ScopeMedBlog feed.

Previously: Scope honored as among the best in digital health resources, Scope honored by the Association of American Medical Colleges, Five thousand blog entries – and counting, and Scope receives AAMC Award for Excellence

Events, Medicine and Literature, Stanford News

Remembering the strange vigils of war through poetry and dance

Remembering the strange vigils of war through poetry and dance

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /In his Civil War-era poem, “Vigil Strange I Kept on the Field,” Walt Whitman describes watching over a soldier dying on the battlefield as a “vigil of silence, love and death.” That phrase may still ring true for soldiers fighting around the world; it may also feel familiar to medical professionals, whether imbedded in combat or in the ordinary rooms of a medical center. Yet this common experience is one that doctors and nurses reluctantly discuss and one that many soldiers and veterans feel lies beyond their powers of expression. A recent event held at StanfordHonoring the Ghosts – provided an exploration of such strange vigils through poetry and dance.

Alexander Nemerov, PhD, a Stanford art and art history professor, began the evening with a lecture, “Walt Whitman’s Moment.” During his talk he linked Whitman’s imagery of lamplight, starlight and shadow to contemporaneous art and popular depictions of the body, discussing the ways art freezes the human body and history freezes memory. Nemerov recalled the April 14 anniversary of the day Abraham Lincoln was shot in Ford’s Theatre. He quoted another Whitman poem, “When Lilacs Last in the Dooryard Bloom’d,” which commemorates Lincoln, and explained how poetry can simultaneously express private grief and offer public opportunities to honor and remember.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The longer portion of the evening consisted of dance performances by U.S. Marine Veteran Roman Baca’s Exit 12 Dance Company. The program notes explained that after serving as a Marine in the Iraq war, Baca felt “angry, depressed and aggressive.” With his wife and fellow ballet dancer Lisa Fitzgerald, Baca formed Exit 12 as a way to help him, and other veterans, tell their stories. Sunday’s performance at Stanford (the company’s West Coast debut) included seven dances that communicated a wide range of war experiences: a mother’s love and anxiety as her sons enlist; a soldier’s confusion as the demands of battle conflicted with fears for his family in Egypt. Two pieces, performed by solo dancers, were set to music and texts created by a veteran who teaches other vets to write poetry about their experiences; the impression of mental disintegration was terrifying.

My favorite piece was a solo in which the dancer stepped out of a camouflage uniform and performed an extended parting from the pile of clothes on the floor – the dance intimated for me both a soldier’s ambivalence about leaving the military and a human soul vacating a dead body on the battlefield.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The evening ended with the company dancing in front of a large video screen which depicted Iraqi teenagers from different sects performing a dance they created under Baca’s guidance. The teens met in Arbil, Iraq, where Baca returned to share the gift of healing he had found in dance. The live dancers on the Dinkelspiel Auditorium stage repeated the movements of the Iraqi kids dancing on the screen, creating an effect of simultaneous action and memory, both in time and place, a performance both intensely personal and socially connected. The aspects of witness and healing shared between the performers and audience both honored the ghosts of the dead and acknowledged hopeful possibilities.

The event was sponsored by the Stanford Arts Institute, Stanford’s Medicine & the Muse Program in Medical Humanities and the Arts, and Stanford’s Department of Art & Art History.

Jennifer Swanton Brown, RN, MLA (’12) is manager of regulatory services and education, in Spectrum, the Stanford Center for Clinical & Translational Research & Education. She published her first poem in the Palo Alto Times when she was a fifth grader at Escondido Elementary School. Having served as a poet-teacher with California Poets in the Schools since 2001, she is currently serving as the second poet laureate for the City of Cupertino.

Previously: Prescribing a story? Medicine meets literature in “narrative medicine” and “Deconstructed Pain:” Medicine meets fine arts
Photos by by Norbert von der Groeben

Imaging, Research, Stanford News, Stroke, Technology

Image-interpretation software could open window of treatment for stroke

Image-interpretation software could open window of treatment for stroke

open windowRestoring blood flow to the brain quickly after a stroke is key to damage control as well as to optimal recovery. But restoring blood flow to brain tissue that is already dead can cause problems, like swelling and hemorrhage.

That makes the treatment of choice – an intravenous dose of a substance called tPA, which dissolves clots – a double-edged sword. The consensus in the medical community is that tPA is not a good idea once 4-1/2 hours have elapsed since a patient has suffered a stroke.

But the consensus is based on averages, derived from numerous studies. Clinicians have tended to treat that 4-1/2 hour time-point as analogous to a window slamming shut. Yet every stroke, and every patient who experiences one, is unique.

A new study published in the New England Journal of Medicine joins three earlier ones that show improved results when tPA administration is combined with the insertion of a device – a so-called stent retriever – that can mechanically break up clots in the brain.

Even more exciting, two of the four studies, including the new one, employed software called RAPID – designed and developed at Stanford at the instigation of Stanford neurologist Greg Albers, MD – that quickly interprets brain scans of patients and helps clinicians decide which patients will benefit from supplementing the standard intravenous tPA infusion with the stent retrieval procedure. In both of these two studies, substantial majorities of patients selected as good candidates for the combination had extremely high rates of solid recovery as measured three months after their stroke – the best results ever obtained in stroke studies.

Albers, who is also one of the co-authors of the new NEJM study, hopes to move stroke care away from the clock on the wall and instead focus on a biological clock – what the brain image shows to be going on inside this patient’s brain, now – so that each patient’s care can be individualized and optimized. It could turn out that for some patients, 4-1/2 hours after a stroke is already too late for aggressive clot-busting treatment, while for others the window remains wide open for 6, 7, 8 hours or longer.

Previously: Targeted stimulation of specific brain cells boosts stroke recovery in mice, Calling all pharmacologists: Stroke-recovery mechanism found, small molecule needed and Stanford neuroscientists uncover potential drug treatment for stroke
Photo by glasseyes view

Health and Fitness, In the News, Sleep, Videos

“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep well

"Father of Sleep Medicine" talks with CNN about what happens when we don't sleep well

Dement - smallA good night’s sleep is often the first thing to go when we have an important work deadline or health issue. I know this from firsthand (and recent!) experience: I let a foot injury kept me up until 4 a.m. today even though I know that cheating sleep – or getting a poor night of sleep – is bad for my health.

But is skimping out on sleep now and again really that bad? As Chief Medical Correspondent Sanjay Gupta, MD, and Stanford sleep expert William Dement, MD, PhD, explain in a recent CNN feature: yes. When we rest, our bodies go to work, Gupta explains: “When your head hits the pillow, your body doesn’t shut down. It uses that time to heal tissue, strengthen memory, even grow.”

Dement, who founded the Stanford Center for Sleep Sciences and Medicine in the 1970s and has devoted his career to understanding sleep, has lots of experience with patients who miss out on these benefits because they don’t sleep well – due to obstructive sleep apnea. (The disorder, he says, affects 24 percent of adult males in the U.S.) In the piece, he and Gupta discuss the risk factors, such as excess weight and large tonsils, linked to sleep apnea and what can be done to alleviate the problem.

If you have a few minutes, this video is worth a watch. Dement makes his first appearance at the 2.5-minute mark.

Previously: Stanford doc gives teens a crash course on the dangers of sleep deprivationWilliam Dement: Stanford Medicine’s “Sandman”Stanford docs discuss all things sleep, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and What are the consequences of sleep deprivation?
Photo, which originally appeared in Stanford Medicine, by Lenny Gonzalez

Events, Medicine and Society, Stanford News

“You just get lifted away from the earth”: Film spotlights dance program for Parkinson’s patients

“You just get lifted away from the earth": Film spotlights dance program for Parkinson’s patients

capturing grace still

Tomorrow and Saturday, “Capturing Grace,” a documentary film following participants of a dance program for people with Parkinson’s disease generated by New York’s Mark Morris Dance Group (MMDG), will be screened at Stanford. Filmmaker and former KQED Forum host Dave Iverson, and David Leventhal, previously a leading dancer of MMDG and now the director of Dance for PD, will also be on campus holding workshops and discussions.

A Stanford News piece today describes the film as “the centerpiece of a two-day exploration of the intersection of dance and medicine” and offers these details:

Since his Parkinson’s diagnosis in 2004, Stanford alumnus Iverson has been an education champion for the progressive disorder of the nervous system that affects movement. He wrote, reported, directed and co-produced the 2009 PBS Frontline documentary My Father, My Brother and Me, using his family’s saga with the disease as a starting point to explore the larger issues of scientific research, the quest for a cure and the political controversies surrounding stem cell transplants. He also works as a contributing editor for the Michael J. Fox Foundation for Parkinson’s Research.

[Said Iverson:] “One thing I’ve come to believe about Parkinson’s is that it’s a disease of subtraction. It takes things from you one by one. And one of the many things I learned from the people in the class is that if you are confronted with a disease of subtraction, you better believe in addition. You better start adding things back into your life. For the people we profiled in Capturing Grace, I think dance helped get them back on the plus side of the ledger.”

I recently talked with Iverson, who told me that, despite his Frontline documentary’s title, “Capturing Grace” has proved more personally involving. “It’s more about what happens to people when they have to respond to something that’s unwelcome in their lives,” he said. The participants featured in the film gather at the MMDG studios in Brooklyn to take classes given by professional dancers of one of the world’s leading modern dance troupes, and they learn repertory to perform, including dances by Mark Morris.

“It isn’t a miracle and it’s not a treatment,” Morris says in the film. Different from art therapy, the program provides instruction in movement and an opportunity to share what professional dancers experience daily – the heightened sense of awareness found by coordinating one’s body and mind to move freely and deliberately through space, guided by music, in communion with others – with a deadline of a performance offering additional motivation to show up, practice, and stay focused on a goal.

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Research, Science, Stanford News, Surgery

Will scars become a thing of the past? Stanford scientists identify cellular culprit

Will scars become a thing of the past? Stanford scientists identify cellular culprit

346801775_c5a1e37a6d_zI have a scar on my chin from a fall I took while rollerskating when I was about 12. One minute I was blithely zooming along to Bob Seger’s hit Against the Wind (earworm alert!), reveling in my new ability to skillfully cross one foot in front of the other and thinking about that cute boy by the snack counter, and the next I was chin down skidding across the flat, grey and (I then realized) very hard floor to come to rest against the wooden wall in an ignominious heap.

Although the experience left an impression on my psyche, as well as my skin, I can’t claim any long-lasting problem from the thin line on my chin. After all, nearly all of us have something similar. But scars can also be debilitating and even dangerous.

Now plastic and reconstructive surgeon Michael Longaker, MD, and pathologist and stem cell expert Irving Weissman, MD, have identified the cell type in mice that is responsible for much of the development of a scar. They’ve shown that blocking this cell’s activity with a small molecule can reduce the degree of scarring. Because a similar drug molecule is already approved for use in humans to treat Type 2 diabetes, the researchers are hopeful that they can begin clinical trials in humans soon. The research was published today in Science.

As Longaker explained in our release on the study:

The biomedical burden of scarring is enormous. About 80 million incisions a year in this country heal with a scar, and that’s just on the skin alone. Internal scarring is responsible for many medical conditions, including liver cirrhosis, pulmonary fibrosis, intestinal adhesions and even the damage left behind after a heart attack.

Longaker and his colleagues found that a subset of a skin cell called a fibroblast is responsible for much of the collagen deposition that leads to scarring. Inhibiting the activity of a protein on the surface of the cells significantly reduced the amount of scarring during wound healing in laboratory mice – from about 30 percent of the original wound area down to about 5 percent -the researchers found. Furthermore, they showed the cells are also involved in the thickening and darkening of skin exposed to radiation therapy for cancer, as well as the spread of melanoma cancer cells in the animals.

Longaker’s been interested in how the skin heals for decades–ever since he learned as a student that, prior to the third trimester, human fetuses heal from trauma or surgery without any scarring. Now he’s excited to learn whether there’s a way to recapture that long-lost ability as adults and at least reduce the degree of scarring during skin repair.

“I’ve been obsessed with scarring for 25 years,” Longaker told me. “Now we’re bringing together the fields of wound healing and tumor development in remarkable new ways. It’s incredibly exciting.”

Longaker and Weissman are both also members of the Stanford Cancer Institute.

Previously: New medicine? A look at advances in wound healing, Stanford-developed device shown to reduce the size of existing scars in clinical trial and Mast cells not required for wound healing, according to Stanford study
Photo by Paulo Alegria

Aging, Medicine and Society, Videos

In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues

In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues

When San Jose, Calif. residents Shirley and Eddie Jones wanted to discuss their end-of-life wishes, they encountered resistance from an unexpected source. As detailed in the video above, their beloved children refused to participate in the conversation.

As with the Jones, the people who love you the most may not be willing to help you because they care too much – and your doctors may be largely silent as they’re uncomfortable broaching this sensitive topic for fear of offending you. So, when it comes to end-of-life planning, you’re largely on your own. And it’s important that you take the first step and break this wall of silence.

Even as you’re reading this, you may be thinking that the topic of end-of-life decision making is not relevant to you right now – that it’s too early. Or it may be that you’re uncomfortable thinking about death. You may even be waiting for your doctor to broach this subject with you and lead the way. After all, as long as you do what the doctor tells you to do, you can get pretty good results with your health care. But, this ‘wait-for-your-doctor’ strategy isn’t going to serve you well when it comes to end-of-life decision making and planning.

Don’t believe me? Then just take a moment to review the evidence (link to .pdf): Eighty percent of people say that it’s important to have end-of-life wishes in writing, but only 23 percent say they have have done so. Eighty percent wish to have end-of-life conversations with their doctor but only 7 percent get to do this. Research also shows that most doctors have neither the training nor the time to skillfully conduct end-of-life conversations with their patients.

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Biomed Bites, Immunology, Research, Science, Technology, Videos

Not immune from the charms of the immune system

Not immune from the charms of the immune system

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

Once upon a time, a researcher named Holden Maecker, PhD, met flow cytometry, a technique used to examine cells by suspending them in fluid and then passing them by an electronic detector.

A match that could only be made in a science lab, Maecker was hooked. Maecker tells the tale in the video above:

Flow cytometry is a great technique for looking at the immune system and it’s also a little bit of an art, which also attracted me. It’s something that not everybody can do perfectly well and I got a little bit good at it and decided it was a fun thing to do and a good way to look at the immune system.

Maecker and flow cytometry haven’t parted, yet he’s broadened his mastery of a variety of other techniques to study the immune system as the director of Stanford’s Human Immune Monitoring Center.

“It’s a very interesting position because it allows me to collaberate with a lot of different peopel doing projects that have to do wiht human immune responses — everything from sleep apnea and wound healing to flu vaccines and HIV infections,” Maecker said. “It’s amazing the breadth we have here [at Stanford].”

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

Previously: Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology’s Holy Grail, Immunology meets infotech and Stanford Medicine magazine traverses the immune system

Research, Sports, Stanford News

Stanford bioengineers and clinicians team up to shed light on how concussions affect the brain

Stanford bioengineers and clinicians team up to shed light on how concussions affect the brain

9764280602_4d132cd012_zIn an effort to better understand and prevent concussions, bioengineers and clinicians at Stanford have turned athletic fields into laboratories to tackle fundamental questions about brain injuries. A story recently published in Stanford Magazine offers a detailed look at the ongoing research involving high-tech, data-gathering mouth guards worn by players during games to record the impact of hits and advanced imaging studies to measure subtle changes on athletes’ brain scans.

Kristin Sainani writes:

Unfortunately, after years of inattention, the science of concussions remains in its infancy. “We don’t even know what a concussion is at a basic, biological level,” says Mona Hicks, who oversaw traumatic brain injury research at the National Institutes of Health for nine years and is now chief scientific officer at One Mind, a nonprofit focused on brain disease. This scientific void creates uncertainty when it comes to addressing such controversies as how long to hold concussed athletes out of play, whether to ban heading in youth soccer and how much to change the game of football.

David Camarillo, assistant professor of bioengineering and a former football player at Princeton University, is studying the physics of such hits. His lab has outfitted most of Shaw’s team with high-tech, data-gathering mouth guards that the players wear during games. Seattle-based X2Biosystems had developed prototypes for a commercial product; Camarillo’s group customized the design for research use. The devices measure how violently a player’s head gets tossed around during collisions, falls and other impacts.

“My long-term goal is to prevent concussions,” Camarillo says. “The first step is to understand what causes them.”

Previously: Forces at work in concussions more complicated than previously thought, new Stanford study reveals, Stanford undergrad studies cellular effects of concussions, Developing a computer model to better diagnose brain damage, concussions and Stanford researchers working to combat concussions in football
Photo by West Point – The U.S. Military Academy

Parenting, Pediatrics

Overwhelmed as a mom of multiples

Overwhelmed as a mom of multiples

twin babies

My babies were three days old when my husband offered to get take-out from one of our favorite restaurants. I said, “Yes,” as I might have said it before the girls were born. But as soon as he left I realized this was my first time alone with my twins. In the small, silent room, I whispered to them, “Okay girls. It’s just you and me. Be good for mommy.”

Everything was quiet for a while, until one started crying. I picked her up and rocked slowly side to side. Just when she calmed, the other started crying. That got the first one crying again, this time louder and more distressed. I had one baby crying in my arms and the other crying in a bassinet and I didn’t know what to do.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you

Was it five minutes? Ten? It seemed like eternity. I tried putting them on the bed next to each other, and leaning over to hug them both at once. They hated it. Unable to choose one over the other, I found myself choosing neither. I felt absolutely overwhelmed.

Finally, an early Beatles song came to mind, and I sang it softly to them. “Tell me why-y-y-y you cry…” When I saw how my singing quieted them, suddenly the tears started pouring out of my eyes, but I didn’t dare stop singing: “Is there anything that I can do? ‘Cause I really can’t stand it, I’m so in love with you.”

“Hello!” My husband returned with the take-out. My face was red hot, my eyes half blind from crying, my nose uselessly stuffed, my throat caught. I was a mess. And I was singing – badly. But my babies weren’t crying anymore.

That’s when I knew – I mean really felt – that I was their mom. I could hardly believe there was a moment even a minute long when I felt so alone and helpless. Their dad took one baby, I took the other; we fed them, we changed them, we tucked them back to sleep. And after it all, the food was still warm.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you. Sometimes your babies need more of you than you have to give. You love them equally and you don’t like having to choose one to take care of first while another waits and cries for you. You will envy the single moms of single babies who complain that they must hold their baby all the time. You wish you could hold your babies all the time – the best you can do for them is one at a time.

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