Published by
Stanford Medicine


July, 2012

HIV/AIDS, Infectious Disease, Stanford News

International AIDS conference ends on an optimistic note

International AIDS conference ends on an optimistic note

Last week, some 24,000 people from 183 countries attended the International AIDS Conference in Washington D.C., including my colleague and Scope contributor Ruthann Richter who posted periodic updates from the biannual gathering. (You can read her past updates in our HIV/AIDS category.)

The conference ended Friday and acknowledged a turning point in the fight against the epidemic. As Richter explains in a news story today, scientists and policy makers are optimistic about achieving the goal of an “AIDS-free generation” in the future despite a multitude of economic, social and scientific challenges. She writes:

The world is gaining ground against AIDS, with more people now on treatment (8 million) than those who need it (7 million), said Michel Sidibe, executive director of the Joint United Nations Program on HIV/AIDS, also known as UNAIDS. Worldwide infections have declined 20 percent since 2011, and in hard-hit Africa, AIDS-related deaths have fallen from 1.8 million in 2005 to 1.2 million today, he said.

Still, there are 34 million people living today with HIV, and for every person on treatment, two more become infected, highlighting the need for stepped-up prevention efforts, speakers said. And though 100,000 fewer babies were born HIV-positive in 2010, there were still some 330,000 infants who became infected at birth or through breastfeeding in 2011. [Secretary of State Hillary Clinton], who announced an $80 million initiative to prevent mother-to-child transmission, said the goal is to reduce this number to zero by 2015.

The advancing science of AIDS, meanwhile, has produced a plethora of new treatments and prevention strategies that could help drive down AIDS prevalence. These include voluntary male circumcision, use of anti-AIDS drugs in infected individuals to reduce their chance of passing on the virus to others, as well as use of these drugs as preventives in uninfected people.

Previously: International AIDS Conference Day Four: Focusing on a vaccine, International AIDS Conference Day Three: Daring to talk about a cure, International AIDS Conference Day Two: Sir Elton John calls for compassion, International AIDS Conference Day Two: Hillary Clinton envisions AIDS-free generation and International AIDS Conference: Day One
Photo by Paula Bailey

Obesity, Parenting, Pediatrics, Research

Study: When discussing childhood obesity, words carry weight

Study: When discussing childhood obesity, words carry weight

“Obese” and “overweight” are common terms used by doctors to describe excess weight in children, but according to recent findings published in Pediatric Obesity, physicians may want to choose their words more wisely. Researchers from the University of Alberta in Canada report that parents often consider these terms off-putting and judgmental and may be less likely to follow doctor’s recommendations when the words were used.

“Health professionals probably shouldn’t use terms like fat, chubby, overweight or obese,” said researcher Geoff Ball, PhD, in a release. He also noted that parents were less likely to feel blamed for their children’s weight issues if neutral and less stigmatizing terms like “large” or “gaining too much weight” were used.

It tears your heart out when a child starts talking about being picked on because of his or her weight.

As director of the Center for Healthy Weight at Lucile Packard Children’s Hospital, Thomas Robinson, MD, sees families struggling with a child’s weight on a daily basis. I wanted to find out what he thought about the study and about confronting sensitive topics with parents and children. He told me:

I believe the specific terms we use – overweight, obesity, heavy for their age, etc. – are less important than the context in which we use them, and how well we are able to build a supportive relationship and alliance with a child and his or her parents. In my opinion, it is most important to understand what a child’s weight means to him or her, and their family, and to take that into account when speaking with them about a child’s weight.

He also emphasized the importance of physicians to address the problem – regardless of language:

It tears your heart out when a child starts talking about being picked on because of his or her weight, having trouble fitting into a school uniform, or not wanting to take their shirt off even in front of their own parents… I think it is our role to speak plainly with children and families about these issues, give them permission to let us know what they are experiencing, and not to pretend they don’t exist or play them down. Instead, frank discussions can help uncover a child’s or parent’s motivation and help empower them to start making changes.

Previously: Children and obesity – what can parents do to help?Obesity in kids: A growing epidemicStanford pediatrician discusses developing effective program to curtail childhood obesity and Major effort launched to prevent, treat childhood obesity

Dermatology, Health Policy, Public Health, Research, Science, Science Policy

The latest twist on compact fluorescent bulbs: They may be UV emitters

Compact fluorescent bulbs (often referred to as CFLs) burn less energy per unit of emitted light. That’s something pretty much everbody can agree on. But that’s about it.

As some readers may know, the U.S. government effectively banned the production of incandescent bulbs going forward by mandating energy-consumption standards no incandescent bulb is likely to meet. At least for the short term, this has tilted the playing field in favor of CFLs.

You either love the temperamental twisted tubes, presumably because they’re energy efficient, or hate them for any of a number of reasons. First, they’re expensive. Worse, because they contain mercury, CFLs have to be disposed of carefully – and should you, heaven forbid, drop one and have it smash into smithereens on the floor, the Environmental Protection Agency says you are supposed to open the windows immediately and clear the room.

I’ve got one in my kitchen. When I turn it on, it takes a while to warm up – and when it finally does, the light it gives off is, well, dirty. It’s depressing. I hate it.

Now, it turns out, there could be a medical reason to hate CFLs too: A recent study in the journal Photochemistry and Photobiology by researchers at the State University of New York, Stony Brook, indicates that, despite advocates’ claims to the contrary, these bulbs give off significant amounts of ultraviolet light, namely in the UVA and UVC range. The SUNY investigators explain that stresses introduced in the bulbs’ X-ray-absorbing coatings during the tubes’ manufacture cause minute cracks or lapses in those coatings:

Closer examination of some of these commercially available bulbs showed multiple defects in their coating, thus allowing UV-light emission. . . . These data are particularly disturbing as the UVC emission is even larger than ambient sunlight on a mountain.

To see if these emissions were physiologically harmful to human skin, the researchers used various biological assays on two kinds of human skin cells: keratinocytes and dermal fibroblasts. For example, the cells were exposed to CFLs so that they got the same UV doses a person’s skin would get from the bulbs after 45 hours at the typical working distance from a desk lamp. The damage to the cells was noticeable and was similar to the kind that occurs in the aging process. (It took only five hours at that distance from a CFL to get UV exposure exceeding recognized safety standards, the scientists noted.)

Ironically, adding either of two forms of titanium oxide (the chief UV-absorbing component of commercial sunscreens) to the skin cells made the damage that CFLs inflicted on them even worse.

Photo by Nioxxe

Pediatrics, Stanford News

Cochlear implants could help developmentally delayed infants, says Stanford/Packard study

Cochlear implants could help developmentally delayed infants, says Stanford/Packard study

A new Stanford/Packard Children’s study examined the benefits of cochlear implants – sometimes called “bionic ears” – for deaf children with developmental delays. The implants feed sound from a microphone outside the head directly to the auditory nerve, but typically require intensive speech and language therapy to be helpful for the recipient. In the past, many doctors have opted not to use cochlear implants in developmentally delayed infants and toddlers – who are expected to later meet criteria for mental retardation – because they have doubted whether the implants would benefit these children.

The new study (subscription required) shows this approach may be wrong. The researchers, led by John Oghalai, MD, studied the few developmentally delayed deaf kids who do get cochlear implants. They found that these children get implants an average of 11 months later than typically developing children, meaning that they miss 11 months of potentially valuable sensory input at a time when brain development should be racing along. The late implantation took a toll, as our press release describes:

Not only did the delayed children start with lower intelligence, they also had slower intellectual development, perhaps because they spent more time unable to hear, the researchers reported. When the scientists statistically adjusted for the delay in implantation, the difference in rates of development disappeared, suggesting that lack of hearing plays a role in causing developmentally delayed children to fall further behind their peers.

“There is synergism between different sensory inputs,” Oghalai said. “And some of these kids are missing more than just hearing; they’re often having trouble with vision or touch as well. If you can fix one of the sensory problems, it might help to mitigate the effects of the other disabilities.”

Oghalai’s team is now conducting more comprehensive studies to assess the value of cochlear implantation in a large cross-section of deaf children with developmental delays.

Previously: In people born deaf, auditory cortex takes on touch and vision, study finds
Photo by Chris & Shelley Mallinson

Addiction, In the News, Mental Health, Stanford News

A discussion of the history and effectiveness of Alcoholics Anonymous

A discussion of the history and effectiveness of Alcoholics Anonymous

On KQED’s Forum this morning, Stanford addiction expert Keith Humphreys, PhD, joined a discussion on alcoholism and the birth of Alcoholics Anonymous. He offered some interesting nuggets – noting, for example, that Iran is the fastest-growing country in terms of newly formed AA groups – and provided a breakdown of alcoholics’ response to AA:

What I’ve observed and [seen] in the research: For about a third of people, when they first go, they take to it like ducks to water, and a year later they’re still in AA and they are doing much much, much better. There’s another third of people who hate it and never go back, and say “It’s worthless” or even “I was damaged by that – that was so rotten and I’ll never go back to AA.” And then there’s an interim group that will often go for a bit and then kind of drift in and out and derive some benefit. And they may be people [who] are not there a year later, but they’re there five years later.

I also particularly liked what Humphreys had to say about the organization’s oft-discussed twelve steps (.pdf):

I’ve been studying it for 25 years, and I frankly think a lot of it is just very good wisdom about how to live. One of the things that strikes you about the twelve steps is the word ‘alcohol’ only appears in one of them. The other eleven are about things like admitting when you’re wrong, atoning for the bad things you do, not being selfish, being considerate of others. That’s just good living.

Education, Science, Stanford News

Stanford's RISE program gives high-schoolers a scientific boost

Stanford's RISE program gives high-schoolers a scientific boost

While a solution to low test scores and lackluster interest in science and engineering careers among schoolchildren nation-wide remains elusive, outreach initiatives can effect change at the local level. A Stanford Report article today describes the university’s Raising Interest in Science and Engineering (RISE) program, which matches select low-income and under-represented minority high-school students with expert guidance, work experience in laboratories, and exposure to a variety of academic and industry experiences. From the piece:

In many cases, minority and lower-income students who are particularly unprepared for and underrepresented in the sciences don’t even see a science or engineering degree as an option.


“These are kids who may not have scientists or engineers in their networks,” said Kaye Storm, MA, director of Stanford’s Office of Science Outreach, which runs RISE. “They know they like science or engineering, but they don’t really know what that might mean in terms of an internship or career.”

By exposing the students to an academic laboratory environment and introducing them to potential scientific contacts, RISE aims to bridge that gap between student talent and access to a college degree in the sciences.

All 89 students who have participated in RISE since the program’s 2006 inception have gone on to college or will enter it this year, and 12 have attended Stanford. RISE alumna Alison Logia tells writer Max McClure:

“In school, I’d end up in science classes with predesigned labs,” said Logia. “But when I came to Stanford it was different. When you get your results, you can’t look them up in a book to see if they’re correct, because no one’s ever done this experiment before.”

Logia, a graduate of Sequoia High School in Redwood City, worked for two summers in the lab of chemical engineering Professor Gerald Fuller [PhD]. Although she knew she was interested in math and science in high school, her experiences in the Fuller Lab taught her “how to work in a lab, how to talk to a professor,” and solidified her desire to go into engineering.

Previously: Stanford science program for teens receives Presidential Award, I know what you did this summer: High-school interns share their experiences at Stanford, A look at the Stanford Medical Youth Science Program and A prescription for improving science education
Photo by L.A. Cicero

Infectious Disease, Science, Stanford News

Bio-art gone viral: Cantor Arts Center displays models of human viruses

Bio-art gone viral: Cantor Arts Center displays models of human viruses

Gold pipe cleaners, pillow stuffing, Play-Doh, tampons, painted dried pasta, purple beads, Q-tips, plastic balls, construction paper, syringes and glitter. Supply crafty hands with these items and a hot-glue gun and you could have a costume fit for Trannyshack. Or, give them to science-minded Stanford students and watch artistic renderings of viruses emerge through origami, whittling, collage and more.

On display at the university’s Cantor Arts Center through October 28, Adventures in the Human Virosphere: The Use of Three-Dimensional Models to Understand Human Viral Infections explores the awesome and terrible properties of, as a wall text describes, “the complete pantheon of viral predators that use humans as their hosts.”

Art works depicting smallpox, hepatitis B, rabies, herpes simplex, polio, rubella and other troublemakers are divided into two categories in the show curated by Judy Koong Dennis: icosahedral and helical viruses, and viruses surrounded by an envelope. The enveloped kind feature shapes that don’t fit categories such as cube or sphere; rather, the asymmetrical figures differ wildly from one another.

The pieces are select assignments from Humans and Viruses, a multidisciplinary Stanford course that Robert Siegel, MD, PhD, began teaching in 1983. Students with other backgrounds may take the class, but most are undergraduates studying human biology. Siegel first assigned the model project in the late 1980s, explaining, “Various structures and processes are best understood in three dimensions and from the kinesthetic learning associated with model building.”

Clean edges and symmetry characterize the many faces of the icosahedral and helical structures; several of the geometric pieces use traditional materials such as ceramics, paper or wood. Yu-Jin Lee, who contributed three icosahedral viruses to the show, told me, “As a student and origami enthusiast, I was excited with the challenge to create a virus out of paper. This project has allowed me to have a greater understanding of how objects come together and the importance of models in offering insight into the complex nature of medicine.”

I wavered on whether these contained, efficient structures of the icosahedral and helical varieties felt more intimidating than the exploded treasure chest titled HIV-1, or more dangerous than SARS, the hanging sparkly baby mobile, which could double as a jellyfish with puffball-topped tentacles and ribbons spilling out split sides. The flashy, translucent wrappings of HIV and SARS hint at their interior contents in a manner both dreadful and seductive, and they illustrate a displayed quotation from Nobel prize-winning biologist Sir Peter Medawar, OM CBE FRS, who described the composition of a virus as “a piece of bad news wrapped in protein.”

An electron micrograph of a virus accompanies each object. However faithful to form or radically offbeat each student’s imagining may be, seeing the microscopic made visible, colorful and even humorous (once recognized, the tampons got a laugh) left this viewer curious to know exactly how the immune-system pirates pillage. That something so small as an actual virus could cause so much harm to a comparatively giant human resonated equally scary and impressive. It also made me want to attend the next of Siegel’s Model Marathons, wherein students share their work with each other in “a celebration of infection including costumes, poetry, music and surprises – a clear example of learning gone viral.”

Previously: Science, apps and wonder and Rodin: Real art, but not real anatomy
Photo of Elena Jordan’s Model of SARS Virus, 2011 (fabric with glitter, puff balls, pipe cleaners, ribbon, pillow fill, hot glue) by Cantor Arts Center

Events, Patient Care, Sports

For Olympic doctors, the experience of the games outweigh the sacrifices

For Olympic doctors, the experience of the games outweigh the sacrifices

The opening of the Olympic games marked the beginning of a special experience not just for the athletes competing, but also for the doctors that care for them. Like the athletes, volunteer Olympic doctors make many sacrifices to fulfill Olympic dreams. An American Medical News story today provides a closer look at the dedication of several U.S. team physicians, who all agree that sacrifices are worth the rewards. Carolyne Krupa writes:

Among them are physicians from around the country who are volunteering their time to support the U.S. team. To do so, they must be willing to leave their practices for weeks at a time, to work long shifts under grueling, high-stakes conditions for little or no pay.

Physicians working the games say it’s all worth it for the chance to be part of a global event and work with some of the world’s most elite athletes.

“It’s worth the sacrifices,” said Peter Donaldson, MD, a U.S. team physician, sports medicine specialist and assistant professor at Oakland University William Beaumont School of Medicine in Rochester, Mich. “I’ll be grinding away in clinic for the rest of my life, but there are few opportunities that come up in life that are as unique as this.”

Previously: U.S. Olympic team switches to electronic health records and Olympic health concerns – for the spectators

Medicine and Society, Medicine X, Videos

XX in Health: Women Leading Healthcare conversation begins today

XX in Health: Women Leading Healthcare conversation begins today

Name your ten favorite female leaders in health care. Need a hand? Now begins a week spotlighting women who are hospital and health-care company executives, venture partners, professors, government leaders and other decision-makers, as XX in Health: Women Leading Healthcare launches. Watch the video above to meet some of the women driving health-care innovation as they speak about challenges they’ve faced and choices they’ve made to help other women thrive. Among those you’ll hear from are Amy Lockwood, MBA, MS, deputy director for Stanford’s Center for Innovation in Global Health; Naheed Misfeldt, MPH, venture partner at Aberdare Ventures; and Donna Cryer, JD, chief executive officer of Cryer Health.

Sponsored by Rock Health, a digital health seed-accelerator based in San Francisco, the initiative to promote gender diversity in health care examines barriers in the workplace and efforts to promote female leadership. According to a Rock Health report, women comprise 73 percent of medical and health services managers and 47 percent of medical school graduates but only 4 percent of health-care company CEOs. Making visible women’s successes, providing mentorship opportunities and balancing domestic responsibilities by providing family leave for fathers account for just a few of the ways health-care businesses can boost these numbers and make better use of women’s talents in executive capacities.

It should be noted that Rock Health’s co-founder and medical director, Nate Gross, MD, will be speaking at the upcoming Stanford Medicine X.

Previously: Stanford Gendered Innovations program offers tools for improving scientific researchHannah Valantine: Leading the way in diversifying medicine, Pioneers in science and Advancing the careers of women in academic medicine

Bioengineering, In the News, Research, Technology

Beetle wing design inspires ultra-sensitive electronic skin

Researchers around the globe, including a team at Stanford, are making progress on developing artificial electronic skin that rivals the sensitivity of human skin for use in prosthetic limbs, robots and a range of medical applications.

The latest development in the effort comes from Seoul National University, where engineers turned to the beetle’s wing design to create a flexible electronic sensor made from interlocking hairs capable of feeling the lightest of touches. A paper (subscription required) describing their work was published today in Nature Materials.  More details about the technology are provided in a Nature News piece:

In [the] sensors, the ‘hairs’ are sheets of polymer fibres that are 100 nanometres in diameter and one micrometre long, and coated with metal to make them electrically conductive. When the sheets are sandwiched together, the nanohairs are attracted to one another and locked in, just like the beetle hairs. The device is then wired up so that an electrical current can be applied, and covered in a layer of soft, protective polymer.

When the sensor sheet is pressed, twisted or brushed, the squishy, metal-coated hairs change position, generating changes in the sensor’s electrical resistance. The design is sensitive to pressures of just five pascals — gentler than the lightest of touches. By analysing how the resistance changes in response to mechanical stress and then recovers when the stress is removed, [Seoul National University engineer Kahp-Yang Suh, PhD] and his colleagues can distinguish between three types of mechanical strain: pressure, which comes straight down on the sensor; shear, a frictional slide along the surface; and torsion, a twisting motion.

At Stanford, Zhenan Bao, PhD, associate professor of chemical engineering, and colleagues have developed a stretchable, transparent skin-like sensor using carbon nanotubes bent to act as springs. Bao comments on the significance of the Korean researchers’ findings in the article:

Human skin can distinguish between these types of strain, but most artificial sensors cannot. “Sensing shear and torsion is difficult,” says Zhenan Bao, a materials scientist at Stanford University in Palo Alto, California, who is developing other flexible strain sensors. Other sensors detect only the total applied force, they can’t say anything about its direction, says Suh The methods for teasing out the nature of the strain from the electrical readings in Suh’s sensors need some work, says Bao, but getting this type of information from a flexible sensor is unique.

Previously: Stanford researchers develop transparent, stretchable skin-like sensor and Stretchable solar cells could power electronic ‘super skin’
Photo by Jason Evans

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