The photo was done last year just before the first snow came to Helsinki. I live near the street in this photo and I always admire how beautiful the street and the trees look in autumn. As a child, I was very impressed by the symbolism in Finnish paintings of winter, and wanted to make my own interpretation of the subject whilst capturing the beauty of the scene and the feeling of oncoming winter.

All my light art photos are straight from the camera, no post processing of any kind has been done to them.

Photo by Janne Parviainen

The five most-read stories this week on Scope were:

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.

Researchers explain how “cooling glove” can improve exercise recovery and performance: The “cooling glove,” a device that helps people cool themselves quickly by using their hand to dissipate heat, was created more than a decade ago by Stanford biologists Dennis Grahn and Craig Heller, PhD. This video demonstrates the device and explains how it can be used to dramatically improve exercise recovery and performance.

The mystery surrounding lung-transplant survival rates: A 2012 article in the San Francisco Chronicle offered a look at the challenges facing lung transplant patients and explored why a significant number don’t live beyond the five-year mark, despite improvements in survival rates.

The science of willpower: The popular Stanford Continuing Studies course “The Science of Willpower” served as inspiration for a 2011 book from Stanford health psychologist Kelly McGonigal, PhD. In this entry, she offers a scientific framework for understanding willpower and explains how stress, sleep deprivation and nutrition can lessen our ability to resist temptations.

Using the “flipped classroom” model to re-imagine medical education: In the video featured here, Charles Prober, MD, senior associate dean for medical education at the School of Medicine, medical school colleagues, and Silicon Valley-based online learning pioneer Salman “Sal” Khan talk about their vision for a new medical curriculum.

As director of the Stanford Persuasive Technology Lab, BJ Fogg, PhD, studies human behavior and designs ways to influence it, whether on the computer, on a mobile phone or in other areas of life. In this video on the Robert Wood Johnson Foundation website, Fogg discusses what makes a good candidate to implement healthy behavior change for the long term. In an ideal situation, a person is “triggered to do something that they want to do and they’re able to do.” With these three elements – the trigger, motivation and ability – comes the highest likelihood of success in behavior change that contributes to a culture of health.

Previously: Study shows short, daily jogs boost longevity, Live tweeting Medicine 2.0 Congress keynote speeches, Persuasive technology expert BJ Fogg to deliver a Medicine 2.0 keynote and Stanford conference addresses mobile applications in health care

I’ve written before about research studies on yoga, as well as components of my yoga teacher-training program. Delighted to find connections between the two worlds, I was interested recently to attend a workshop on yoga for osteoporosis and osteoarthritis with Loren Fishman, MD, an assistant clinical professor of rehabilitation and regenerative medicine at Columbia University Medical Center, and Annie Carpenter, founder of SmartFLOW® yoga.

Fishman is a physiatrist, dedicated yogi and proponent of yoga as a non-surgical, non-pharmaceutical approach to healing and preventive medicine. He’s published books on yoga for back pain, arthritis, and sciatica, among others, and he’s conducting a study of yoga in people who have osteoporosis.

Based on a 2009 pilot (.pdf) that showed improvement in bone density over a two-year period for the group of yoga practitioners versus a slight loss of bone in the control group, the current study prescribes a sequence of 12 yoga poses designed to place stress on the bones to generate cells and strengthen the bone’s dynamic support system. Participants track the poses they complete using an online scorecard, and their bone density is measured before and after practice is introduced. So far, he recently reported, in 65,000 hours of practice among 575 participants worldwide, no yoga-related fractures have been documented.

It’s essential for a patient to have a physician’s diagnosis of his condition before beginning yoga or any treatment program, Fishman and Carpenter emphasized in their workshop. And the most important job of a yoga teacher or therapist, Carpenter said, is being able to see the problems people are dealing with in their practice. She provided instruction on how to look at bodies in all three planes, find imbalances, examine the patterning in structure and movement and determine what to offer students as tools to improve their own well-being.

Previously: Ask Stanford Med: Pain expert responds to questions on integrative medicine, Exercise programs shown to decrease pain, improve health in group of older adults, Moderate physical activity not a risk factor for knee osteoarthritis, study shows, Treatments to reduce fractures for children with brittle-bone disease and New genetic regions associated with osteoporosis and bone fracture
Photo by Tiffany Caronia

As recently written about on Scope, new guidelines on statin use, and an accompanying risk-assessment calculator, have generated much conversation in the medical community. In a new Viewpoint piece in the Journal of the American Medical Association, Stanford professor and health research and policy expert John Ioannidis, MD, DSc, discusses potential implications of the guidelines, which could lead to more widespread use of statins for primary prevention. “It is uncertain whether this would be one of the greatest achievements or one of the worst disasters of medical history,” he writes of potential worldwide “statinization.” Read on to get more of his thoughts.

Previously: Stanford expert weighs in on new guidelines for statin use, The exercise pill: A better prescription than drugs for patients with heart problems?, “U.S. effect” leads to publication of biased research, says Stanford’s John Ioannidis and A call for mega-trials for blockbuster drugs

As previously reported here, a group of Stanford physicians and medical responders are in the Philippines to provide care to survivors of Typhoon Haiyan, which hit early last month. In a blog entry, Kim Woolley, mental health specialist with the Stanford Emergency Medicine Program for Emergency Response, describes what she has observed during her time in the country:

The area of destruction has no epicenter and is not isolated to Tacloban and the seaside communities – the 200 mph winds destroyed homes and took lives for many miles. The best way for me to describe it… It is as if the entire southern half of the State of Iowa, from west to east, was destroyed by a 60 mile wide tornado with 200 mph winds. Every tree is snapped or uprooted, every roof is missing, and many slabs of cement are standing where a home once was.

As for the condition of people there, she writes:

We are… seeing compound leg fractures with homemade bamboo splints, infected wounds from wood and metal falling on people, untreated asthma, and our miracle baby Joas who was brought in with a parietal skull fracture from the roof falling on his head… He survived the previous weeks because the fracture gave his brain room to swell. He was laughing and smiling, while his Mom was crying tears of joy when Dr. Barbie & Dr. Julieta both agreed he looked to be okay.

The mental health needs are starting to present and are critical at this time. How people are attended to 3-4 weeks in will determine their overall recovery. It is far enough in that people are no longer talking as much about their emotional, spiritual, physical, and mental devastation but wondering if they should buck up and ignore their tremendous loss. A group of women including the clinic midwife who was helping me with some translation said, “The first week was a blur, the second week we got to work and worked nonstop with sleeping when possible, but now in the third week it is all becoming real and sinking in.” Trouble sleeping, high anxiety, elderly very worried and crying, are the signs that people are having difficulty coping. We encourage that people continue talking about their anxiety with family, not isolating, using simple relaxation deep breathing techniques, attending church and praying. People are deeply touched and feel loved by our caring presence.

Previously: Providing medical care to typhoon survivors in the Philippines and Stanford emergency-response team heads to the Philippines
Photo courtesy of SEMPER

Decades of measles and rubella vaccinations for U.S. children are paying off. A new Centers for Disease Control report published today in JAMA Pediatrics confirms that the United States has eliminated endemic transmission of three potentially devastating diseases: measles, rubella (also known as German measles) and congenital rubella syndrome, which causes serious birth defects.

The report is part of a larger effort by the World Health Organization to certify the entire Western hemisphere free of endemic measles and rubella, which are chains of transmitted cases that continue for 12 months or more. Today, the large majority of measles cases seen in the U.S. are clearly linked to international travel or contact with travelers, and genetic evidence suggests that uniquely American strains of the measles and rubella viruses no longer exist. All other countries in the Americas are also reporting elimination of endemic transmission of these diseases.

The findings confirm the value of high rates of measles and rubella vaccination. Nearly 95 percent of U.S. children have had the two vaccine doses needed to confer lasting immunity by the time they enter kindergarten. Because measles is still endemic in other parts of the world, it’s important not to let up on vaccination here, the report notes. In spite of the good news about the elimination of endemic infections, 2013 has been a relatively bad year for imported infections, as CNN reported today.

An editorial accompanying the JAMA Pediatrics report offers interesting perspective on the need to continue with vaccinations:

Prior to 1990, Mexico was the leading source of measles importations into the United States, but this year, half of all importations into the United States were from Europe. Since 2008, there has been a resurgence of measles cases in Western European countries. The majority of these outbreaks have been in unimmunized populations in countries where national immunization programs are being challenged by a combination of public and political complacency regarding the value of immunization and by the rising influence of antivaccination groups. After 500 years, we have now returned to a situation where the Americas are free from indigenous measles and rubella with Europe once again a source of importations.

The elimination of endemic measles from the Western hemisphere raises hope that global eradication of measles is on the horizon, an important public health goal since measles is most likely to kill impoverished children in developing countries. Already, the increase in vaccination in African countries has led to a 91 percent decrease in measles deaths there, with 550,000 fewer annual deaths than a decade ago.

Previously: Measles are on the rise; now’s the time to vaccinate, says infectious-disease expert, Tips for parents on back-to-school vaccinations, A look at the causes and potential cost of the U.S. measles outbreaks and Unvaccinated children may pose a public health risk

Our Ask Stanford Med series is taking a break until the New Year. But there’s still opportunity to interact with a health expert this month – thanks to Open Office Hours on the Stanford University Facebook page. Over the next several days, health psychologist Kelly McGonigal, PhD, is taking readers’ questions on managing stress, maintaining willpower and cultivating compassion during the holiday season. She’ll provide responses via video later this month.

Considering that McGonigal’s Scope Q&A on willpower is one of our most popular entries of 2013, this is a topic that should resonate with many.

Previously: Ask Stanford Med: Answers to your questions about willpower and tools to reach our goals, Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression, Stanford health psychologist Kelly McGonigal discusses how stress shapes us and Stanford health psychologist offers tips for increasing your willpower
Photo by CaptBrando

Mark down October 30 and November 20, 2013, as medical mileposts.

On Oct. 30, a Stanford surgical team led by neurosurgeon Jaimie Henderson, MD, implanted a next-generation deep-brain-stimulation (or DBS) device into a Parkinson’s disease patient’s brain. On the order of 100,000 nearly but not quite identical procedures have been performed worldwide in the past decade or so, to relieve symptoms of not only Parkinson’s but epilepsy, chronic pain and more. Making what took place just over a month ago unique wasn’t the surgery itself but, rather, the nature of the device that was implanted – the first time ever in the United States. (In August, a patient in Germany received such a next-generation DBS device, although for a different indication.)

With current DBS technology, a fine, insulated wire is threaded into the brain so that its lead, containing four electrodes, impinges on the relevant brain area. (In Parkinson’s, for instance, the targeted area would be key brain regions that participate in the generation of spontaneous involuntary tremors characteristic of that disease). In a second procedure, a pacemaker-like device called a neurostimulator is placed under the skin, typically near the collarbone. The neurotransmitter transmits signals – at frequencies, amplitudes and durations programmed by a neurologist – to the leads, which accordingly fire electrical impulses counteracting the aberrant brain signals producing the physical symptoms in question. Over time, the neurostimulator’s impulse-transmission pattern is optimized via a trial-and-error process involving extensive patient-neurologist interaction.

Stanford neurologist and Parkinson’s specialist Helen Bronte-Stewart, MD, routinely sees patients a few weeks after their DBS devices have been implanted. They come in having not taken their medications for a while, so she can observe their symptoms and watch how they respond to different DBS frequencies and intensities.

But the new device, manufactured by the same company (Medtronic, Inc.) that makes the existing one, has an additional capability. It can not only transmit signals to the brain but, in addition, monitor and record the brain region of interest’s electrical output.

This will let Bronte-Stewart remotely capture vast amounts of information about a particular patient’s brain-firing patterns to discern that patient’s “neural signature” – and ultimately, it is hoped, be able to develop algorithms for automating the device’s signaling program so that it changes in response to changes in brain activity. (The goal, in engineering vocabulary, is a “real-time negative-feedback loop.”)

On Nov. 20, after recovering from the surgery, the patient and Bronte-Stewart, a noted expert in movement disorders, embarked on the first of a series of groundbreaking sessions during which Bronte-Stewart will download data from the implanted device for thorough analysis. While brain-activity data has been downloaded from Parkinson’s patients while they’re lying still on the operating table after the initial electronic-lead implantation, the recorded data has by necessity reflected only activity in the brain while the patient is at rest. Now Bronte-Stewart will be able to identify the neural signatures of not only the resting state but also voluntary movement, task performance and the tremor itself, and to see how those neural signatures change in response to her manipulations of DBS frequency and voltage output.

Stanford has received 10 of the new “two-way” DBS devices from Medtronic, and is recruiting Parkinson’s patients who, while they may not benefit directly from the ongoing study, wish to make a difference in how this disease’s symptoms are treated.

Previously: Revealed: The likely role of Parkinson’s protein in the healthy brain, Mind-reading in real life: Study shows it can be done (but they’ll have to catch you first), Positive results for deep-brain stimulation trial for epilepsy and Stanford neurologist discusses advances in research on movement disorders
Photo courtesy of Jaimie Henderson

Some encouraging news about rheumatoid arthritis (RA), a systemic autoimmune disease that causes painful, swollen joints: A new study out of The Netherlands has shown that people recently diagnosed with the disorder have an easier time with daily functioning than patients who were diagnosed 20 years ago, as measured by levels of depressed mood, anxiety and physical disability associated with the condition.

Earlier diagnosis, prescription of physical exercise, and more aggressive drug interventions are responsible for patient improvements, according to the study, which was published in the journal Arthritis Care & Research. From a press release:

For the present study, researchers recruited 1151 with newly diagnosed RA between 1990 and 2011. Participants were 17 to 86 years of age with 68% being female. Each participant was assessed at the time of diagnosis and monitored for the following three to five years.

Findings indicate that after the first four years of treatment 20 years ago, 23% of RA patients reported anxiety, 25% depressed mood, and 53% had physical disability compared to 12%, 14% and 31%, respectively, today. The decrease in physical disability remained significant even after adjusting for reduced disease activity. Results suggest that the downward trend in physical disability, anxiety, and depressed mood may be due in part to reduced disease activity.

…

“Our study determined that currently, 1 out of 4 newly diagnosed RA patients are disabled after the first four years of treatment; while 20 years ago, that figure was higher at 2 out of 4 patients,” concludes [Cécile L. Overman, a Ph.D. Candidate with the Department of Clinical and Health Psychology, Utrecht University]. “Today, RA patients have a better opportunity of living a valued life than patients diagnosed with this autoimmune disease two decades ago.”

Previously: Important metabolic defect identified in immune cells of rheumatoid arthritis patients, Many lupus patients on Medicaid fail to take medication as prescribed, study shows and Collaboration between Stanford and UCSF aims to advance arthritis research