Published by
Stanford Medicine

Bioengineering, Research, Stanford News, Technology

New Stanford-developed technology bypasses “virtual reality sickness”

New Stanford-developed technology bypasses "virtual reality sickness"

headset_newsResearchers in the Stanford Computational Imaging Group have developed a new virtual reality headset that takes into account how the human eye focuses and processes depth.

Current display technologies are essentially two-dimensional and don’t present images the way our eyes were designed to see them, which can cause “virtual reality sickness,” or VR sickness for short, after only a few minutes.

The new system involves two transparent LCD displays with a spacer in between, which is called “light field technology.” A Stanford News article describes a light field as creating “multiple, slightly different perspectives over different parts of the same pupil. The result: you can freely move your focus and experience depth in the virtual scene, just as in real life.”

Gordon Wetzstein, PhD, assistant professor of electrical engineering, developed the technology along with researchers Fu-Chung Huang and Kevin Chen. In the news piece, Wetzstein listed the variety of applications this advance could have, robotic surgery top among them: “If you have a five-hour [robotic] surgery, you really want to try to minimize the eye strain that you put on the surgeon and create as natural and comfortable a viewing experience as possible.”

But the applications aren’t limited to what has already been imagined. Wetzstein explains, “Virtual reality gives us a new way of communicating among people, of telling stories, of experiencing all kinds of things remotely or closely. It’s going to change communication between people on a fundamental level.”

You can access a short video on the new development here.

Previously: Fear factor: Using virtual reality to overcome phobias, From “abstract” to “visceral”: Virtual reality systems could help address pain, Double vision: How the brain creates a single view of the world, Discover magazine looks at super human vision and Augmented reality iOS app for color vision deficiency
Photo by Vignesh Ramachandran

Medical Education, Research, Stanford News

Study examines high costs of maintaining medical certification

Study examines high costs of maintaining medical certification

stethoscope-448614_1280After you’ve got an MD and passed your board exams, you’re all set, right?

Well, not quite. Physicians must meet new requirements for maintaining medical board certifications – and doing so can be costly. A new study from a team at Stanford and University of California-San Francisco explored the costs of the American Board of Internal Medicine (ABIM) requirements, as described in a UCSF article:

The researchers developed a mathematical simulation model of the entire ABIM-certified workforce of internists, hospitalists and internal medicine subspecialists in the United States and estimated total societal costs over 10 years – including ABIM fees and the monetary value of physician time spent on fulfilling [maintenance-of-certification (MOC)] requirements. They calculated that costs to individual physicians would average $23,607 over 10 years, with costs in some subspecialties exceeding $40,000. Subspecialists face higher costs than general internists in the program, primarily because they take additional certification examinations that generate more fees and a greater time outlay.

“We found that 9 out of every 10 dollars in MOC costs were related to the program’s demands on physician time,” said Alexander Sandhu, MD, the lead author of the study and the Veterans Affairs Health Services Research and Development fellow at the Center for Health Policy/Center for Primary Care and Outcomes Research at Stanford University, and a clinical instructor for the Department of Medicine…

The study comes after the ABIM increased its requirements and fees in 2014. Following protest, the ABIM revised the requirements earlier this year but retained the fees and number of modules required. The February changes are “a step in the right direction,” the authors write, but further examination is needed:

Whether the costs of MOC ultimately will be borne by physicians or will be passed on to employers, payers, or patients is uncertain. Furthermore, unless balanced by improved efficiency downstream, the increased demand on physician time in a period of anticipated physician workforce shortfalls may have a deleterious effect on access to care, particularly elective care.

Dhruv Kazi, MD, an assistant professor of medicine at UCSF, was senior author of the study.

Previously: Clinical informatics gains recognition as new medical sub-speciality, A call for extended bedside-manner training and The next challenge for biodesign: constraining health-care costs 
Photo by HolgersFotografie

Global Health, Medical Education, Surgery

Bringing surgical training to female medical students in Zimbabwe

Bringing surgical training to female medical students in Zimbabwe

IMG_1468Earlier this summer, I shared the story of how two pioneering women are challenging the status quo in Zimbabwe by saying it’s okay for women take up careers in surgery. Now, this professor-student duo – Stanford surgeon Sherry Wren, MD, and surgeon-in-training Annete Bonigwe Moyo – have launched the first surgical skills training for female medical students at the University of Zimbabwe’s College of Health Sciences.

For a girl growing up in Zimbabwe like Moyo, expressing interest in surgery can be met with ridicule and doubt. But when Moyo met Wren two years ago, Moyo was inspired to change this perception.

She founded DREAM (Dedicated to Reach, Empower And Mentor women in surgery) to empower her female peers and increase participation in the profession. Wren has been a core advisor since the organization’s inception, helping to achieve their mission by providing mentorship and new educational opportunities for the women of DREAM.

“Surgery is a core subject in our medical undergraduate curriculum requiring the acquisition of cognitive diagnostic demands, as well as procedural skills,” Moyo, a senior medical student at the University of Zimbabwe, told me. “However, in spite of the advent of skills laboratories and simulators, undergraduate trainees are barely exposed to the procedural aspect of training. For many graduating medical students in these circumstances, surgery is a far-off thought, and few have the confidence to carry out basic surgical procedures as they go through their internship.”

IMG_1473In an effort to help medical students translate the knowledge gained in the classroom to the operating table, Wren recently facilitated a basic surgical skills training session hosted by DREAM – a first for medical students in Zimbabwe. The training was attended by 21 third, fourth and fifth year MBChB students – all of them women.

Moyo reported to me:

[Wren] began the session by helping the women appreciate standard operating room etiquette and protocol, sterile procedures, sharps and fluid safety, scrubbing, gowning and gloving. For most of the students present, this was the first time they were being walked through these important basic principles of surgery.

Excitement grew as [Wren] began teaching the women some basic surgical sutures on sterile towels… Soon the ladies were ready to apply their newly learned skills on loops of bowel procured to give a more real feel to the exercise. It was amazing to see how quickly what was initially a barely discernible pattern of uneven sutures transformed into neat even sutures…

By the end of the 3-hour session, the timid girl who was clueless as to how to handle the most basic of surgical instruments, or let alone tie a surgical knot, had become a confident future surgeon raring to do whatever it took to realize her dream.

Continue Reading »

Grand Roundup

Grand Roundup: Top posts of July

Grand Roundup: Top posts of July

It’s time to look back at this month’s five-most read stories on Scope. They were:

Eating for good blood: Tips for boosting iron levels and hemoglobin: This entry from the Stanford Blood Center discusses hemoglobin levels and offers ways to boost levels prior to blood donation.

Genetic study supports single migratory origin for aboriginal Americans: An international team of geneticists, evolutionary biologists, and statisticians have concluded that all Native Americans descended from a single immigration event out of Siberia.

“This is probably one of the last major diseases we know nothing about”: A look at CFS: A recent issue of Palo Alto Weekly focused on chronic fatigue syndrome (also known as systemic exertion intolerance disease) and the work of Ronald Davis, PhD, director of Stanford’s Chronic Fatigue Syndrome Research Center and others here.

The worst disease you’ve never heard of: Stanford researchers and patients battle EB: An article in Stanford Medicine magazine describes the toll of a devastating skin disease called epidermoloysis bullosa on two young men and their families, as well as the determined efforts of a dedicated team of doctors and scientists to find a treatment.

Physician-monk leads Stanford doctors in meditation: This post highlighted a recent campus talk by Barry Kerzin, MD, a Buddhist monk who provides medical care to His Holiness the Dalai Lama.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Autism, Behavioral Science, Medical Apps, Nutrition, Stanford News, Technology

Stanford grad students design new tools for learning about nutrition, feelings

Stanford grad students design new tools for learning about nutrition, feelings

2789442655_1f5c33ac51_zMushrooms and tomatoes, veggies that are often reviled by preschoolers, star in a new app designed by a Stanford graduate student that aims to involve children in preparing, and eating, healthy meals.

“Children are more likely to try food that they’ve helped cook,” explained Ashley Moulton, a graduate student in the School of Education’s Learning, Design and Technology Program, in a recent Stanford News story.

Moulton’s iPad app, Nomster Chef, is one of several student projects featured in the article and accompanying video:

Before cooking, children receive an educational video about a food they’ll be working with – for example, a video on how mushrooms grow. The app also incorporates food information in the recipe steps, like the fact that tomatoes are actually a fruit.

After user-testing the app prototype, “I heard from parents that they noticed differences in how their kids are eating,” Moulton said. The app also kept kids engaged throughout the cooking process.

For her project, fellow student Karen Wang developed an iPad app called FeelingTalk that helps children with autism interpret facial expressions:

…[I]n the first level of FeelingTalk, kids choose the one face that’s different (a sad face) from the three happy faces on the screen. The app will then label the different face “sad.”

“My app will be utilizing learning mechanics that directly work with the autistic brain to help them work on something that they’re having difficulty with,” Wang said. “By leveraging something they’re good at, we’re going to teach them to get comfortable looking at people’s faces, examining the key features, and eventually understanding emotions.”

Moulton, Wang and other students will present their work this afternoon at the LDT Expo at the Stanford Graduate School of Education.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health and No bribery necessary: Children eat more vegetables when they understand how food affects their bodies
Photo by Peter Weemeeuw

Big data, BigDataMed15, Precision health, Public Health, Research, Videos

How the FDA is promoting data sharing and transparency to support innovations in public health

How the FDA is promoting data sharing and transparency to support innovations in public health

Keynote talks and presentations from the 2015 Big Data in Biomedicine conference at Stanford are now available on the Stanford YouTube channel. To continue the discussion of how big data can be harnessed to improve the practice of medicine and enhance human health, we’re featuring a selection of the videos on Scope.

At the 2014 Big Data in Biomedicine conference, Taha Kass-Hout, MD, chief health informatics officer for the U.S. Food and Drug Administration, announced that the federal agency was launching OpenFDA, a scalable search and big-data analytics platform. In May, he returned to the Big Data in Biomedicine stage to offer an update on the initiative and discuss how the FDA is continuing to foster access and transparency of big data in government.

During his talk, Kass-Hout shared some eye-popping statistics about the information available through OpenFDA. The platform houses close to 70,000 product labels for pharmaceuticals; nearly four million reports on adverse events or malfunctions of medical devices; 41,000 records on recalls of foods, pharmaceuticals or devices and over four and a half million reports of adverse events or side-effects of drugs.

He outlined future plans to build a similar public, cloud-based platform to compliment the Obama Administration’s Precision Medicine Initiative. Watch the full talk to learn more about these exciting efforts to unlock the rapidly growing reservoir of biomedical data and spur innovation in public health.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health, Discussing patient participation in medical research: “We had to take this into our own hands,” A look at aging and longevity in this “unprecedented” time in history, Mining Twitter to identify cases of foodborne illness and Discussing access and transparency of big data in government

Public Health, Public Safety, Research, Sports

Study shows football helmet safety tests may not capture common cause of concussions

Study shows football helmet safety tests may not capture common cause of concussions

boy-164286_1280The football helmet is perhaps the most iconic piece of safety equipment there is, but we’re just now beginning to understand how helmets can — and should — protect the brain.

Blows that rotate the head are known to cause brain trauma, yet a new Stanford study (subscription required) has found that this kind of movement isn’t included in the tests currently used to evaluate a football helmet’s safety.

In the study, bioengineer David Camarillo, PhD, and his team investigated the types of head movements that cause concussions using computer models of the brain and data collected from Stanford football players wearing mouthguards instrumented with accelerometers (device that measures changes in velocity).

Using the computer model, they found that the brain’s movement increases when the head oscillates (moves back and forth) at 15-20 hertz and it completes a single oscillation in about 50 milliseconds. The field data from the accelerometers showed that the players typically experience head oscillations around 20 hertz.

When the research team compared these results to the scenarios used to test the safety of football helmets, they found a mismatch. The standard tests used to evaluate football helmet safety (acceleration tests and a test that drops a helmet-wearing dummy head from various heights) fail to include the rotational movements known to cause concussions; they also generate faster head oscillations (100 hertz); and measure head acceleration for only 15-36 milliseconds.

“The problem with having a model that doesn’t re-create what players actually experience in the field, is that you could optimize a helmet to perform well in the drop test that unintentionally performs poorly in the field,” said Fidel Hernandez, a doctoral candidate in mechanical engineering and one of the study’s lead authors, in a Stanford News story.

This is a big deal because roughly 70 percent of football players in the United States who rely on helmets to keep their head’s precious cargo safe are under the age of 14, and they receive, on average, a whopping 240 hits to the head each season.

Camarillo and his team hope their findings can be used to make more realistic and useful helmet tests.

Previously: Stanford bioengineers and clinicians team up to shed light on how concussions affect the brainForces at work in concussions more complicated than previously thought, new Stanford study revealsNow that’s using your head: Bike-helmet monitor alerts emergency contacts after a crash and Study shows concussion recovery may take longer for female, younger athletes
Image courtesy of Pixbay

Behavioral Science, In the News, Infectious Disease, Research, Stanford News

Irrational fear of contagion fuels xenophobia, Stanford study shows

Irrational fear of contagion fuels xenophobia, Stanford study shows

face-mask-98640_1280I have a very distinct memory of my grandfather dying from leukemia in an Iowa hospital. I peered in through a glass window, too scared to don the white mask and gown to visit him myself, even though the protections were for him, not me. Granted, I was eight. But fear of disease, and fear of those who have disease, makes perfect sense to me, even now.

But, that realization is tempered by knowledge of the harmful effects of irrational fear, the topic of a recent study by a team of Stanford researchers. As described in a recent Graduate School of Business story:

Throughout history, minority or “out” groups have been blamed for the spread of infectious disease. In medieval Europe, for instance, Jews and gypsies were among those accused of spreading the deadly bubonic plague. In 1793, during the yellow fever epidemic in Philadelphia, local officials singled out actors, vaudevillians, and artists for transmitting the disease. But what is it about the fear of contagion that makes otherwise rational people buy into rumors about those they consider to be outsiders?

Organizational behavior researchers Hayagreeva Rao, PhD, and recent graduate Sunasir Dutta, PhD, developed an online pilot study where one group was told a new strain of flu had emerged, then asked about their views on immigration. The control group was simply asked about immigration.

Not surprisingly, the group told about the flu was less likely to support immigrant legalization. Dutta said he is convinced the results would be even more striking in the real world:

Practically speaking, the implications are clear: “Don’t do immigration reform during flu season,” says Rao.

The study also demonstrates the power of rumors to spur fear, even ethnic violence, Dutta said. And it illustrates the need for proactive, responsive communications, particularly in the beginning stage of epidemics when irrational fears can germinate.

Previously: Fear factor: Using virtual reality to overcome phobias, Fear of recurrence an issue for some cancer survivors and Looks of fear and disgust help us to see threats, study shows
Image by Openicons

Events, Medical Education, Medical Schools, Stanford News

Aspiring young doctors learn the ropes during Stanford summer program

Aspiring young doctors learn the ropes during Stanford summer program

CSI participants - 560

Deep in the basement laboratory of Stanford’s Falk Cardiovascular Research Center, 31 high-school and college students stood in awed silence as surgeon Paul Chang, MD, demonstrated on the room’s large screen how to dissect a pig’s heart. After a moment of watching him point out the valves, atria, ventricles and arteries of the organ, students excitedly grabbed the surgical tools in front of them and began their work.

“This is so cool,” exclaimed Daria Arzy, a student at Harvard-Westlake High School in Los Angeles. “I’m more of a hands-on person, so I really enjoy this kind of thing.”

Heart dissection is just one sliver of the Stanford Medicine Clinical Summer Internship, a new program by the Division of General Medical Disciplines that was designed to provide a diverse group of students with an up-close and personal look at the field of medicine.

Department of Medicine Chair Bob Harrington, MD, greeted the participants on their first day and encouraged them to enjoy their time on the Stanford campus. “This is an amazing place,” he shared. “I’m still excited to come to work each day.”

Throughout the course of the two-week program, students learned the foundations of patient care, including how to take a patient’s medical history and vital signs, how to perform a physical exam, and how to administer ultrasounds and injections; practiced surgical techniques; and heard from cardiologists, neurologists, and other experts. “We encountered so many different perspectives,” said Kathy Zhang, a premed student at Vanderbilt University. “It was wonderful to meet medical professionals from different backgrounds and career pursuits.”

The students also had the opportunity to travel to the roof of Stanford Hospital to tour the school’s 50-foot Life Flight helicopter and to visit Stanford’s Center for Immersive and Simulation-based Learning, where they learned how to manage and treat infectious diseases.

During a guest lecture, Chloe Chien, MD, a Stanford medical student graduate and the COO of Homemade, a social healthy cooking program, shared her journey from medical student to startup co-founder. “When I was training to become a surgeon, I suddenly realized that I wanted to help prevent and heal lifestyle diseases like obesity and diabetes,” she said. “So I spoke to patients with chronic diseases to better understand what they were going through.” Chien later engaged the students in a lively discussion about the barriers to healthy lifestyle change, and offered three principles for healthy living: “Cook your own food, listen to your body, and eat whole, natural ingredients.”

On the final day, program organizers handed out certificates and offered their closing remarks to the group: “6 hours in the Stanford anatomy lab, 20 injected oranges, and 31 dissected sheep brains and pig hearts. By any numerical measure, this week has been impressive,” said Program Manager Misty Mazzara. “But this week was never about numbers.  It was about bringing bright young students together to introduce them to the practice of medicine.” Eva Weinlander, MD, who co-organized the internship with Sarita Khemani, MD, agreed, adding: “We have been lucky to spend time with all of you. You’ve all been so enthusiastic, professional, and supportive of each other during this journey.”

As the ceremony came to a close, participants lingered in the auditorium — hugging, taking photos, and exchanging contact information. One student echoed the sentiments of many when she yelled: “Don’t worry everyone, I’m coming back next year!”

Lindsey Baker is the communications manager for Stanford’s Department of Medicine. More photos from the internship program can be found on this Flickr page.

Previously: What’s it like to be an internal medicine resident at Stanford?At Stanford Cardiovascular Institute’s annual retreat, a glimpse into the future of cardiovascular medicine and A look at one high-school student’s summer internship experience at Stanford
Photo by Lindsey Baker

Cancer, Chronic Disease, Dermatology, Stanford News, Surgery, Transplants

Rebuilding Cassie’s smile: A lung transplant patient’s struggle with skin cancer

lung patientWhen I first met Cassie Stockton, she was seated in an exam chair in Stanford’s dermatology clinic, getting cosmetic skin treatments. Lovely and young, just 21 years old, it seemed a bit silly. How could she possibly need injectable lip fillers or laser skin treatments?

I knew Stockton had a lung transplant at 15 and that the immunosuppressant drugs she was required to take to keep her body from rejecting the donated lungs had made her susceptible to skin cancer. But it wasn’t until I researched her story in depth that I truly understood how she ended up needing regular cosmetic treatments here.

As I explain in my recently published Stanford Medicine article, her story began at birth:

Born premature, [Cassie] was intubated the first two weeks of life, then sent home with her mother and an oxygen tank. She remained on oxygen 24 hours a day for the first two years of her life. Eventually, she was diagnosed with bronchopulmonary dysplasia, a chronic lung disorder …

Sixteen years later, the donated gift of new lungs saved her life – but it left scars, both emotional and physical:

The day Stockton woke up out of the anesthesia six years ago after a 13-hour surgery at the Transplant Center at Lucile Packard Children’s Hospital Stanford, she breathed in oxygen with newly transplanted lungs, and breathed out sobs. Tears streamed down her face. “At first, I thought she was in pain,” says her mother, Jennifer Scott, who stood by her side. But that wasn’t it. Stockton was overwhelmingly sad because she now knew her new lungs were the gift of a child. It was Dec. 6, 2009, just before Christmas. The death of someone else’s child had given her a whole new life.

And now:

Every four months, she and her fiancé make the four-hour drive from their home in Bakersfield, California, past the oil rigs and cattle farms to Stanford’s Redwood City-based dermatology clinic for her skin cancer screening. It’s been two years of treatments: freezings, laserings, a total of eight outpatient skin surgeries — the most significant resulting in the removal of the left half of her lower lip. The dermatologic surgeon removes the skin cancers, and then gets to work to repair the damage. “It’s heart-breaking to have to remove the lip of a 21-year-old woman,” says Tyler Hollmig, MD, clinical assistant professor of dermatology and director of the Stanford Laser and Aesthetic Dermatology Clinic, who leads Stockton’s treatment and keeps her looking like the young woman she is, restoring her skin, rebuilding her lip, making sure she keeps her smile.

Stockton doesn’t complain about any of the struggles she’s had post transplant. She knows she got a second chance at life. And, she tells me, it’s her job to take care of the lungs given to her by that child who died.

Previously: This summer’s Stanford Medicine magazine shows some skin
Photo by Max Aguilera-Hellweg

Stanford Medicine Resources: