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Cancer, Clinical Trials, Pediatrics, Public Health, Research

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Findings published today in the Lancet Oncology highlight the need to increase the flexibility of age limits for cancer trials so that more teenage patients have access to experimental treatments. “Right now too many of our young patients are needlessly falling through the gap between paediatric and adult cancer trials,” said Lorna Fern, PhD, who led the study and co-ordinates research for the Teenage and Young Adult Clinical Studies Group of the UK-based National Cancer Research Institute.

In the study (subscription required), researchers examined strategies to boost participation of teens and young adults diagnosed with cancer in clinical trials. The study involved 68,275 patients, aged 0-59 years, who were diagnosed with cancer within a five-year window. According to a release:

The study showed [trials designed with broader age limits] led to a 13 per cent rise in 15-19 year old cancer patients taking part in clinical trials between 2005 and 2010 (from 24 to 37 per cent), and a five per cent rise in 20-24 year olds (from 13 to 18 per cent). Children under 14 taking part in trials rose by six per cent (from 52 to 58 per cent).

This rise was due to the increase in availability and access to trials for young people, increased awareness from healthcare professionals, patients and the public about research and importantly the opening of trials with broader age limits which allow older teenagers and young adults to enter trials.

Fern added, “By encouraging doctors to take into account the full age range of patients affected by individual types of cancer, we’ve shown that it’s possible to design trials that include teenage cancer patients and, importantly, that better match the underlying biology of the disease and the people affected.”

Previously: High rates of incarceration among black men could be skewing study results, Stanford researchers examine disparities in use of quality cancer centers and NPR explores the need for improving diversity in clinical trials

Behavioral Science, Health and Fitness, Obesity, Research, Stanford News

The behavioral consequences of overindulgence

The behavioral consequences of overindulgence

sundae_070714In today’s world of Big Gulps and supersized portions, one giant question looms: How does overindulgence affect our pleasure of food?

To provide an answer, Baba Shiv, MBA, PhD, a professor at the Stanford Graduate School of Business, and colleagues performed a series of experiments investigating how your feeling of satiety impacts the likelihood that you’ll soon eat the same food again. Their findings offer insights for both individuals that have trouble eating and drinking in moderation and those who are picky eaters.

During the first study, students tried three different flavors of crackers, selected their favorite and then were instructed to eat a specific number. They rated their enjoyment after eating each one. According to a business school release:

The students who ate the larger portion (15 crackers) reported significantly lower enjoyment than those who ate the smaller portion (3 crackers).

These findings replicate previous ones on “sensory-specific satiety”: Each bit of the same food is less pleasant than the one before it. Thus, the bigger the portion, the less enjoyment you get out of the last few bites.

More importantly, participants’ enjoyment of the last cracker (manipulated by portion size) seemed to influence how soon the students wanted to eat the crackers again: Participants who ate a small portion typically opted to receive a giveaway box of [crackers] sooner than did participants who ate the larger portion.

In another study exploring behaviors of finicky eaters, study authors gave one group of participants sips of juice and two crackers to eat. A second group was also given the juice and crackers, but had the added distractor task of counting “e’s” in a series of passages before drinking more juice. Results showed that the crackers partially reset their satiety level, allowing students to find the second sip of juice as enjoyable as the first. Shiv notes in the release how these findings could be useful for parents trying to get their little ones to eat more veggies:

Parents of picky eaters could keep this lesson to heart, says Shiv. Rather than insisting that your child eat every last bite of broccoli, introduce another taste in the middle of the serving of broccoli, to reset levels of satiety. Next time there’s broccoli on the plate, your youngster may be more willing to eat it again.

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Scope Announcements

Happy Fourth of July from Stanford Medicine

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Happy Fourth of July! Our office is closed in honor of the holiday, and we’ll resume posting Monday.

Photo by Ryan

Cancer, Research, Stanford News

Tool to identify the origin of certain types of cancer could be a “boon to doctors prescribing therapies”

Tool to identify the origin of certain types of cancer could be a "boon to doctors prescribing therapies"

A team of Stanford scientists has developed a tool to identify the biological signatures in cancer cells that can be traced back to the original cancer gene. As noted today in a Stanford Report story, the tool could help unravel the secrets of cancer and be “a boon to doctors prescribing therapies for their patients.”

For the study, researchers examined an oncogene that is related to lymphoma and responsible for roughly 50 percent of all human cancers. An oncogene is a gene that can cause a normal cell to become cancerous when mutated, or be expressed at abnormally high levels. The team hoped to find a biological signature that would trace the mutating cancer cells back to the original oncogene. More from the article about the work:

Using an elegant statistical method from Robert Tibshirani, [PhD,] professor of health research and policy (biostatitstics) and of biostatistics, the team was able to identify not just one but 86 lipids that can be traced back to the oncogene.

“It’s not just diagnostic,” [postdoctoral researcher Livia Eberlin, PhD,] said. “It gives extra information that could be prognostic.”

Depending on the bio-signature of the cancer cells, physicians will have a better idea of the aggressiveness of a patient’s cancer. In the future, this research may lead to a better knowledge of cancer in general.

“The next step,” said [Dean Felsher, MD, PhD,] professor of medicine (oncology) and of pathology, one of the team members from Stanford School of Medicine, “is to use this as a way to figure out the causal mechanism.” Though the connection between the cancer cells and their origin is clear, the actual cause of cancer – the biological trigger that pushes cancer to progress – is still mysterious.

The study is scheduled to be published in Proceedings of the National Academy of Sciences.

Previously: Smoking gun or hit-and-run? How oncogenes make good cells go bad, Cellular culprit identified for invasive bladder cancer, according to Stanford study and Blood will tell: In Stanford study, tiny bits of circulating tumor DNA betray hidden cancers

Medical Apps, Mental Health

Smartphone app detects changes in mental health patients’ behavioral patterns in real time

texting_070214In an effort to improve diagnosis, treatment and monitoring for mental health patients, researchers have developed a smartphone application that detects changes in patients’ behavioral patterns and transmits them to medical professionals in real time. PsychCentral reports on researchers’ findings showing the app can provide useful insights to health-care providers about patients’ daily activity and mood:

Researchers conducted two clinical trials in which the application was installed on the smartphones of 20 patients suffering from bipolar, unipolar/depressive, or schizoaffective disorders, as well as on the phones of 20 healthy participants.

Over the course of six months, the app acquired data from patients’ phones and sent the information to distant computers, where advanced algorithms analyzed the data to detect changes in patients’ sleep, communication, mobility, and vocal patterns.

The researchers further developed a visualization system that displayed the summarized information to psychiatrists, providing them with instant insight into the behavioral trends of their patients.

Psychiatrists in the trials reported that the system has already positively affected their interaction with patients, offering a useful objective “window” into the patient’s daily routine.

Patients have full control over who is allowed to access the app and information it collects. The system does not acquire or record the content of calls or texts and any identifying parameters of the patient or of his contacts are irreversibly masked and are obviously not used, according to a release.

Photo by jDevaun

Applied Biotechnology, Stanford News, Videos

Drew Endy discusses the potential to program life and future of genetic engineering at TEDxStanford

Drew Endy discusses the potential to program life and future of genetic engineering at TEDxStanford

In 2013, Drew Endy, PhD, assistant professor of bioengineering, was honored as a Champion of Change by the White House. A leader in the field of synthetic biology, Endy founded BioBricks Foundation, which has underwritten an open technical-standards-setting process for synthetic biology and developed a legal contract for making genetic materials free to share and use. He spoke at TEDxStanford about his work with designers, social scientists and others to transcend the industrialization of nature. Watch the above video to learn more about the potential for making life programmable and the future of genetic engineering.

Previously: Programming cells for chemical production and disease detection, The “new frontier” of synthetic biology, Drew Endy discusses developing rewritable digital data storage in DNA and Researchers create rewritable digital storage in DNA

Big data, Cancer, Research, Science, Stanford News, Videos

Will hypothesis or data-driven research advance science? A Stanford biochemist weighs in

Will hypothesis or data-driven research advance science? A Stanford biochemist weighs in

The 2014 Big Data in Biomedicine conference was held here last month, and keynote speakers, panelists, moderators and attendees are now available on the Stanford Medicine YouTube channel. To continue the discussion of how big data can be harnessed to benefit human health, we’ll be featuring a selection of the videos this month on Scope.

Julia Salzman, PhD, a Stanford assistant professor of biochemistry, is concerned that significant amount of data is being thrown in the trash “because the data don’t fit our sense of what they should look like.” At Big Data in Biomedicine 2014, she explained how giving her computers a long leash led her down an unexpected path and the discovery of a new, and probably noteworthy, biological entity. My colleague Bruce Goldman highlighted her findings in a news release:

Using computational pattern-recognition software, her team discovered numerous instances in which pieces of RNA that normally are stitched together in a particular linear sequence were, instead, assembled in the “wrong” order (with what’s normally the final piece in the sequence preceding what’s normally the first piece, for example). The anomaly was resolved with the realization that what Salzman and her group were seeing were breakdown products of circular RNA — a novel conformation of the molecule.

In its circular form, she noted, an RNA molecule is much more impervious to degradation by ubiquitous RNA-snipping enzymes, so it is more likely than its linear RNA counterparts to persist in a person’s blood. Every cell in the body produces circular RNA, she said, but it seems to be produced at greater levels in many human cancer cells. While its detailed functions remain to be revealed, these features of circular RNA may position it as an excellent target for a blood test, she said.

In the above Behind the Scenes at Big Data video, Salzman discusses her work and addresses a question asked during the Single Cells to Exacycles panel: In this next era of science, will science advance mainly through hypothesis or data driven research? She comments, “I think that’s a fundamental question moving forward, whether the scientific method is dead or whether it’s still alive and kicking. I think that’s a really important question for us as to answer and deal with as scientists.” Watch the interview to find out the rest of Salzman’s thoughts on the issue.

Previously: Rising to the challenge of harnessing big data to benefit patients, Discussing access and transparency of big data in government and U.S. Chief Technology Officer kicks off Big Data in Biomedicine

Global Health, Public Health, Stanford News

NIH Director “particularly impressed by the practicality” of Stanford-developed Foldscope

During the White House’s first-ever Maker Faire, Francis Collins, MD, director of the National Institutes of Health, was among those vying for a chance to test out a Foldscope, the 50-cent origami microscope invented by Stanford bioengineer Manu Prakash, PhD. In a post published yesterday on his blog, Collins said, “While I saw many amazing inventions and met many incredible inventors at this event, I came away particularly impressed by the practicality of this device and the ingenuity of its maker.”

Collins goes on to explain the design components of the Foldscope, his experience testing out the device and Prakash’s plans to open up the wonders of the microscopic world to future generations of scientists and engineers. He writes in the piece:

So, how do you use the Foldscope? It turns out that this bookmark-size device uses the same glass slides that one uses in a regular microscope. So, the preparation of blood or tissue samples remain the same. In the simplest version of the scope, the slide is inserted between the microscope’s paper layers and the user, with a thumb and forefinger grasping either end of the microscope strip, holds the lens close to one eye and flexes the strip to find the target object and bring it into focus. I had the chance to try this at the White House event, and found that learning how to use it is very easy. In more advanced versions, the device can project the image onto a wall or any other flat surface—a great, low-cost tool for educating healthcare workers and others in low-income nations about various infectious diseases.

Prakash is currently fine-tuning Foldscopes so they can be field tested in Ghana, Uganda, Nigeria, and Peru for diagnosis of malaria, microfilariasis, leishmaniasis, schistosomiasis, and sleeping sickness. His team at Stanford is also busy designing Foldscopes to help diagnose 30 other diseases, and drawing up plans for a next generation of Foldscopes that will utilize microfluidic components rather than glass slides—a step that should make sample collection and analysis even easier.

Not only will Foldscope give healthcare workers around the globe better ways to detect, and thereby treat, disease, it will also place magnifying power within the reach of all the world’s students, enabling them to ask and answer a great many scientific questions. To this end, Prakash has launched the Ten Thousand Microscopes Project to entice inquiring minds to beta test these devices and design experiments that can then be compiled into a crowd-sourced microscopy text. Imagine a world in which every kid carries around a 50-cent portable microscope, and brings science out of the lab and into real-world biology.

Previously: Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur, Dr. Prakash goes to Washington and Stanford microscope inventor invited to first White House Maker Faire and The pied piper of cool science tools

Pain, Pregnancy, Stanford News, Women's Health

Study shows women prefer less-intense pain at the cost of a prolonged labor

Study shows women prefer less-intense pain at the cost of a prolonged labor

child_birthAs a friend’s due date approached, she confided in me that the thought of going into labor was terrifying. It was her first pregnancy and we debated at length the pros and cons of having an epidural for pain management. Her main concern, like others, was that the common method of pain relief could prolong labor. Recent findings have shown that an epidural can lengthen the second-stage of labor for more than two hours.

In the end, she decided her birth plan needed to be flexible and include the option of an epidural, regardless of how it may impact the length of her labor. New research shows many would agree. Brendan Carvalho, MBBCh, chief of obstetric anesthesia at Stanford and lead author of the study, told Reuters that “Interestingly, intensity is the driver” behind women’s labor preferences.

More from the article:

For the study, Carvalho and his colleagues gave a seven-item questionnaire to expectant mothers who had arrived at the hospital to have labor induced but were not yet having painful contractions. The women took the survey a second time within 24 hours of giving birth.

The questionnaire pitted hypothetical pain level, on a scale of zero to 10, against hours of labor.

A sample question asked, “Would you rather have pain intensity at two out of 10 for nine hours or six out of 10 for three hours?”

Both pre- and post-labor, women on average preferred less intense pain over a longer duration, according to results published in the British Journal of Anaesthesia.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby
Photo by Mamma Loves

Chronic Disease, Public Health, Stanford News

Stanford alums aim to bring back a community approach to treating chronic disease

Inspired by shared medical appointments and Blue Zones, areas in the world where people live measurably longer lives, fourth-year medical student Sohan Japa, MBA, and Stanford alumna Bansi Shah are striving to bring back a community approach to treating chronic disease and enable better care that is efficient and evidence-based.

Japa and Shah partnered with Stanford physician Bryant Lin, MD, earlier this year on a small study to test the effectiveness of using a private social network for diabetic patients and their care teams. Based on this pilot they developed HealthCrew, a secure online platform to help clinicians more effectively manage patient populations. In the following Q&A, Japa discusses the results from the pilot, the technology behind the platform and the next phase of the study.

What about the group health visit setting did you find particularly inspiring?

The way patients leaned on each other for support and guidance was very powerful. A doctor or nurse may remind you over and over about your diet, but when it comes from a peer, it is just much more convincing and impactful. And, every group had an unofficial leader who would do an amazing job in inspiring the group and mentoring others who may not be as empowered about the condition.

What did the preliminary results of the pilot show?

In this initial pilot, we were curious how patients would respond and whether they would see the value in it. And the overwhelming response was yes. Patient engagement and satisfaction rates were higher than we expected. We are doing a second pilot to test the results with a larger group and also start tracking the software’s impact on actual health outcomes. The participants in the initial pilot also gave us great feedback on how to make the platform even better.

Can you briefly explain how the platform works?

The platform is designed to deliver tailored education, which is something doctors don’t have time to provide in a typical 15-minute visit.

There are three key components to our platform. The first is a medical intake tool, which is able to assess a patient’s health literacy and social/emotional capacity. The second component is a content engine that takes the results of the medical intake to tailor education and materials. For example, a patient who scored low on our empowerment scale will get materials to help raise their confidence and skill set to tackle their condition. The last component of our platform is a peer-to-peer mentoring tool, which allows patients to confer securely with similar patients both online and offline.

The Affordable Care Act, in addition to healthcare reform at the state level, has put new attention on patient outcomes. Increasingly hospitals and clinics are on the hook for the health outcomes of their patients. So a platform like this is timely. Because it helps patients in between those semi annual visits they have with their doctors.

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