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Behavioral Science, In the News, Mental Health, Public Health, Research

Green roofs are not just good for the environment, they boost productivity, study shows

Green roofs are not just good for the environment, they boost productivity, study shows

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Boosting productivity can be as simple as looking at a grassy roof for just forty seconds, conclude researchers at the University of Melbourne. It’s been shown that contact with nature can relieve stress and improve concentration and mood, but this is one of the first studies to see if novel urban manifestations of greenery can have the same effect.

The study, published in the Journal of Environmental Psychology and led by Kate Lee of Melbourne’s Green Infrastructure Research Group, involved giving students a mindless computer task to do in a city office building with a brief break spent looking at a picture of either a lush green roof or bare concrete roof. Those who looked at the green one made significantly fewer mistakes and showed better concentration in the second half of the task. The study was based on the idea of “attention restoration” through microbreaks lasting under a minute, which happen spontaneously throughout the work day.

Lee is quoted in a press release:

We know that green roofs are great for the environment, but now we can say that they boost attention too. Imagine the impact that has for thousands of employees working in nearby offices… It’s really important to have micro-breaks. It’s something that a lot of us do naturally when we’re stressed or mentally fatigued. There’s a reason you look out the window and seek nature, it can help you concentrate on your work and to maintain performance across the workday.

Certainly this study has implications for workplace well-being and adds extra impetus to continue greening our cities. City planners around the world are switching on to these benefits of green roofs and we hope the future of our cities will be a very green one.

She and her team next plan to see if city greening makes people more helpful and creative, as well as productive.

Previously: Nature is good for you, right? and Out of office auto-reply: Reaping the benefits of nature
Photo by Jeremy Reding

In the News, Medical Education, Research, Science, Stanford News

Medical students explore the wide, wide world of research at annual Stanford symposium

Medical students explore the wide, wide world of research at annual Stanford symposium

Research SymposiumTraining medical students in research skills has long been a focus at Stanford. To get an inside glimpse of how this works, read my story on the Stanford Medical Student Research Symposium, an annual event where students present poster boards of their research for judging by faculty.

The depth and breadth of individual research accomplished by medical students who, at the same time are juggling classroom and clinical education, is impressive. The faculty representative at the event explained the educational process to me:

“Stanford tries really hard to open doors in the area of scientific research and give students a little nudge to go through,” said Laurence Baker, PhD, director of the Scholarly Concentration program, a required program of study for medical students that promotes in-depth learning and scholarship. Each of Stanford’s medical students are required to complete at least one quarter’s worth of research, but most do more, he said.

“We train the kind of doctors who become leaders,” Baker said. “Whether that involves publishing, clinical work, research or patenting — education in scientific research is a key element of training.”

My story also provides a taste of the conversation between one of the students who used the Veterans Administration database to conduct his research of opioid drug use and a judge of the event, who plays the dual role of evaluator and teacher. She provides both constructive criticism and encouragement to the budding physician-scientist:

In a dress shirt and tie, Raymond Deng, a third-year medical student, stood next to a poster describing his research on opioid use among veterans. “I’m interested in addiction medicine,” he said. “Prescription drug abuse is huge.” He was discussing his findings with Sonoo Thadaney, director of the Program in Bedside Medicine… Thadaney, the symposium judge, listened intently to his description, nodding her head in encouragement. “Why did you pick this study?” she said, clipboard in hand. “Personal reasons,” Deng said, adding that someone in his life has a heroin addiction, and that an epidemic in prescription drug abuse has been shown to have contributed to an increase in heroin use. She nodded again. “The great thing with data like this is that the data itself can bring up questions that we didn’t think of,” she said. “If the Googles and the Yahoos of the world can use data like this for research, so can we. Great work. Go crazy with it.”

Previously: Contemporary health issues focus of Stanford med students research presentation, As part of annual tradition, budding physician-scientists display their work and New class of physician-scientists showcase research.
Photo by Norbert von der Groeben

Cancer, Health Policy, In the News, Public Health, Women's Health

Health hazards in nail salons: Tips for consumers

Health hazards in nail salons: Tips for consumers

3044578995_fe5151de75_zAfter exercise class the other day, my friend asked if I wanted to grab coffee and get our nails done. With nail salons on what seems like every block, having a manicure or pedicure is as easy as grabbing a latte. You don’t need an appointment and you’re done in less than an hour.

But this convenience comes at a cost. A recent investigative report in the New York Times exposed the not-so-bright side of nail salons. The articles have raised awareness of poor working conditions and health risks, and they’ve generated a vigorous public dialogue.

“It got people talking and that’s a good thing,” said Thu Quach, PhD, MPH, a research scientist at the Cancer Prevention Institute of California and research director at Asian Health Services.

An epidemiologist, Quach has spent much of her career studying harmful chemicals in nail care products and their health impacts on nail salon workers, a vulnerable workforce that is mainly comprised of low-income immigrants. In research studies she has conducted over time, Quach identified symptoms commonly experienced by salon workers, including dizziness, rashes, and respiratory difficulties, and more serious reproductive health effects and cancer.

“Unfortunately, the risks associated with chronic, long-term exposure to chemicals used in nail products have been little studied,” Quach said. “We know workers are exposed every day and their health is at risk – this is an important focus of my ongoing research.”

The California Healthy Nail Salon Collaborative (CHNSC), convened through Asian Health Services, educates salon owners, workers and consumers about health and safety issues, and advocates for stronger protections for all. Quach, who has been a CHNSC member since its inception, works closely with other members to address worker health and safety using an integrated approach of community outreach, research, and policy advocacy to address health and safety. The CHNSC has worked at the local, state, and federal level to promote changes.

Encouraging counties and cities to adopt the healthy nail salon program is a first step in their local approach. Participation is voluntary and to date three counties and one city have committed: Alameda, San Francisco, San Mateo, and Santa Monica. These counties provide training and formal recognition for salons that participate. Santa Clara has the program in the works and many salons throughout the state participate in healthy initiatives on their own.

In addition to local municipalities taking action, some manufacturers have stepped up to omit the “toxic trio” – dibutyl phthalate, toluene and formaldehyde – from their formulations. But despite rising awareness of the health hazards posed by these chemicals, many products still contain them and there is no regulatory oversight.

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Cancer, In the News, Research

Cancer cells spread by “disguising themselves,” study shows

Cancer cells spread by "disguising themselves," study shows

2364853112_480ccc3519_zA team of Swedish researchers discovered what may be a key component in how cancer spreads throughout the body: by masquerading as immune cells! Sneaky little rogues.

The study was published yesterday in the journal Oncogene and was conducted primarily by researchers from the Karolinska Institutet in Stockholm. The researchers were investigating the links between inflammation and metastasis when they learned that an inflammation protein called TGF-beta, normally found only on white blood cells, attaches itself to the surface of cancer cells. The protein both attracts them to the lymphatic system and gains them entrance into it.

Scientists have known that cancer often uses the lymphatic system (a network of nodes and vessels that is part of the immune system) to travel to different regions of the body during metastasis, which is the primary way cancer becomes fatal. Swollen lymph nodes, which can be felt on the neck, can indicate metastasis in cancer patients. For breast cancer, which the researchers focused on, infiltration of the lymph system is the earliest sign of metastasis and the most powerful prognostic factor.

Do the cancer cells supplement their masquerade with other characteristics of immune cells? That’s the subject for future research, says Jonas Fuxe, PhD, a study author quoted in a press release. He also notes the significance of the results: “The possibility of preventing or slowing down the spread of cancer cells via the lymphatic system is an attractive one, as it could reduce the risk of metastasis to other organs.”

Previously: New ‘decoy’ protein blocks cancer from spreading, Studying the drivers of metastasis to combat cancer, and Using photo acoustics technology to increase accuracy of lymph node screens for cancer
Photo by Daniel Horatio Augustini

Behavioral Science, In the News, Mental Health, Neuroscience, Research, Science

Inside the brain of optogenetics pioneer Karl Deisseroth

Inside the brain of optogenetics pioneer Karl Deisseroth

brain-494152_1280Lighting the brain,” a recent New Yorker profile, offers insight into the brain of Karl Deisseroth, MD, PhD, the well-known innovator of both optogenetics and CLARITY. (Optogenetics is a genetic engineering feat that allows researchers to control neurons in living animals using light. CLARITY is a technique that makes individual neural connections visible.)

Deisseroth, readers of the article learn, is a guy who shows up to his leading scientific laboratory wearing jeans and a t-shirt and who doesn’t let a little fender bender tweak his mood.

Yes, he’s brilliant. His ability to instantly memorize information morphed into a “circus act” of sorts when he was in elementary school. He began medical school at age 20. But, he’s also driven and hard working. When optogenetics encountered early resistance and doubt after its initial publication in 2005, Deisseroth “began working furiously,” the article states. Into work before 6 a.m., Deisseroth slaved over his brainchild often until 1 a.m., his wife, Michelle Monje, MD, PhD, reported.

It took a few more papers — and demonstrations of the applicability of optogenetics to examine real diseases — for the scientific community to catch on. But then, like a contagion of scientific glee, optogenetics rocked the neuroscience community.

Monje realized its popularity at a recent scientific conference:

“People were stopping us at the airport asking to take a picture with him, asking for autographs,” she said. “He can’t walk through the conference hall—there’s a mob. It’s like Beatlemania. I realized, I’m married to a Beatle. The nerdy Beatle.”

For more on the “nerdy Beatle,” and the science behind both optogenetics and CLARITY, check out the article for yourself. It’s well worth your brain power.

Previously: Stanford’s Karl Deisseroth awarded prestigious Albany Prize, Lightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact and New York Times profiles Stanford’s Karl Deisseroth and his work in optogenetics
Image by Tumisu

Big data, In the News, Technology

Vinod Khosla shares thoughts on disrupting health care with data science

Vinod Khosla shares thoughts on disrupting health care with data science

14252833785_63316bba75_zProminent Silicon Valley venture capitalist Vinod Khosla is a strong believer that data science will reinvent health care as we know it – and it’s position he has reiterated on a number of occasions, including at the 2014 Big Data in Biomedicine conference at Stanford. In a recently published Washington Post Q&A, Khosla expands on his comment that over the next ten years “data science and software will do more for medicine than all of the biological sciences together.”

On the topic of books and papers that have influenced his views, Khosla said:

A lot of what I’ve been thinking about started with articles by Dr. John Ioannidis at Stanford School of Medicine. What he found through decades of meta-research is that half of what’s in medical studies is just plain wrong… His research is focused on why they are wrong and why all sorts of biases are introduced in medical studies and medical practice.

He also explains one of the reasons he believes innovation in data science and software is outpacing the biological sciences:

The pace of innovation in software, across all industries, has consistently been much faster than anything else. Within traditional health-care innovation (which intersects with “biological sciences”) such as the pharma industry, there are a lot of good reasons those cycles of innovation are slow.

It takes 10 to 15 years to develop a drug and actually be in the marketplace, with an incredibly high failure rate. Safety is one big issue, so I don’t blame the process. I think it’s warranted and the [Food and Drug Administration] is appropriately cautious. But because digital health often has fewer safety effects, and iterations can happen in 2- to 3-year cycles, the rate of innovation goes up substantially.

Previously: Countdown to Big Data in Biomedicine: Leveraging big data technology to advance genomicsCountdown to Big Data in Biomedicine: Mining medical records to identify patterns in public health, Collecting buried biomedical treasure – using big data, Big data used to help identify patients at risk of deadly high-cholesterol disorder and Examining the potential of big data to transform health care
Photo of Khosla at the 2014 Big Data in Biomedicine conference by Saul Bromberger

Ethics, In the News, Patient Care, Pediatrics

Study of outcomes for early preemies highlights complex choices for families and doctors

Study of outcomes for early preemies highlights complex choices for families and doctors

3363144800_8c4c7ee6a5_zA tiny fraction of babies born at 22 weeks of gestation survive to childhood without major impairments or disabilities, according to a study recently published in the New England Journal of Medicine. But, although some of these babies can do well, there is variation between hospitals in the rate at which they are resuscitated after birth.

As was widely reported late last week, the results add to the existing debate about providing the earliest-born preemies with intensive medical care. I talked with Henry Lee, MD, a neonatologist at Lucile Packard Children’s Hospital Stanford, to get his take on the new findings. Doctors who work with tiny preemies and their families aren’t surprised by the study’s results, Lee told me, since the generally poor outcomes for 22-week babies are consistent with other studies. But they are carefully considering what to do next.

“We already knew, to a large extent, that there is variation in how different practitioners and hospitals manage patients in this peri-viable range,” Lee said. “Some hospitals tend to be more aggressive at resuscitating and actively treating these babies, others less so.”

The study’s findings highlight that doctors may have difficulty letting parents make the choice about how to handle the birth of a very early preemie, Lee noted. “We’re supposed to be communicating with parents, and they’re supposed to be making an informed decision,” he said. The variation between hospitals suggests that’s not what is actually happening; if parents were deciding what to do, the rate of resuscitation would be more consistent across hospitals. “This data is telling us that we as medical professionals are making the decision for parents, especially at really young gestational ages,” Lee said. “It’s an area that we need to continue to learn to deal with better.” Hospitals also vary in their capacity to care for such babies, he added.

Physicians from several Bay Area hospitals have already begun meeting to discuss their approaches to the earliest-born preemies, he told me. “We might not practice exactly the same, but we want to understand the rationale for what everyone is doing,” Lee said. “If one group is doing something that makes sense, we could learn from them.”

And the study also brings into focus the difficulty of balancing statistics against an individual family’s situation, Lee added. “These larger population studies help us to counsel families, but one thing I always have to say to them is that there’s uncertainty,” he said. “I tell parents that we don’t know what is going to happen to their baby – ultimately their baby is an individual and we don’t know yet. There is that very huge uncertainty.”

Previously: Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges, Stanford-led study suggests changes to brain scanning guidelines for preemies and Talk to her (or him): Study shows adult talk to preemies aids development
Photo by Sarah Hopkins

Health Disparities, In the News, NIH, Research, Science, Women's Health

Research for All: Congressional bill aims to bring gender equality to medical research

Research for All: Congressional bill aims to bring gender equality to medical research

Gender matters in medical research. That’s the reasoning behind the Research for All Act (.pdf), a recently introduced Congressional bill that would require scientists conducting NIH-funded research to look at male and female animals and cells. The legislation would also require the FDA “to guarantee that clinical drug trials for expedited drug products are sufficient to determine safety and effectiveness for both men and women.”

As noted in a press release on the bill from U.S. Rep. Jim Cooper (D-Tenn.):

Women compose more than half the U.S. population, but most medical research focuses exclusively on men…

For example, the unique way women metabolize drugs was ignored when researchers determined the dosage for Ambien sleeping pills; as a result, the initial recommended dosage was double what it should have been for women.

Additionally, cardiovascular disease is the leading killer of all Americans, but only one-third of subjects in cardiac clinical trials are women.

In a Nature piece published last spring, Londa Schiebinger, PhD, director of Stanford’s Gendered Innovations in Science, Health & Medicine, Engineering, and Environment, highlighted the “male default” in science and outlined the benefits of taking gender into account during research:

Including gender analysis in research can save us from life-threatening errors… and can lead to new discoveries. Gender analysis has led to better treatments for heart disease in women. Identifying the genetic mechanisms of ovarian determination has enhanced knowledge about testis development. Analysing how sex affects donor–recipient matching is improving stem-cell therapies. And exploring how sex-specific biological factors and gender-specific behaviours interact has helped researchers to understand how nutrients trigger cell functions, and may assist in the fight against obesity.

Previously: Stanford professor encourages researchers to take gender into account, A look at NIH’s new rules for gender balance in biomedical studies, Why it’s critical to study the impact of gender differences on diseases and treatments, Stanford Gendered Innovations program offers tools for improving scientific research and Women underrepresented in heart studies
Via The Hill
Photo by Benita Denny/Wellcome Images

Global Health, Health Disparities, Health Policy, In the News, Medicine and Society

Why millions lack access to surgery: A conversation with Stanford surgeon Thomas Weiser

Why millions lack access to surgery: A conversation with Stanford surgeon Thomas Weiser

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In the United States, many routine surgeries are just that: routine. They may or may not correct the condition, but the likelihood of death or of life-changing complications are minimal.

But if you live in a poorer nation, surgery — even a cesarean birth — is quite risky and hard to procure. For as many as 5 billion people, these basic procedures are out of reach, according to a recent report by the Lancet Commission, the focus of a recent Scope post and many other news articles.

There are numerous reasons for this surgical gap, as Stanford surgeon Thomas Weiser, MD, who contributed to the report, explains in an Inside Stanford Medicine Q&A.

First, surgery “requires a strong and continuous supply chain, highly technical skills and ongoing training, and intensive management to organize such services,” Weiser said. In addition, most aid programs focus on a specific disease, while surgery is a therapy, leaving it outside the bounds of most international development programs, he said.

So what does the future hold? Weiser is optimistic:

I hope that these findings and the new data presented in the commission report will increase attention and awareness of the vital role surgical care plays in a health system. Ideally, we will see increased leadership from organizations like the WHO and the World Bank in the form of attempts to standardize data collection, identify high-performing health systems, publicize successful programs and promote their adoption and replication in other health settings, and support improved investments in surgical capacity and quality improvement as a way to strengthen the health system more generally.

Previously: Billions lack surgical care; report calls for change, Stanford Medicine magazine opens up the world of surgery and Global health expert: Economic growth provides opportunity to close the “global health gap”
Photo by skeeze

In the News, Medical Education, Medical Schools

Soon-to-be medicine resident reflects on what makes a good teacher

Soon-to-be medicine resident reflects on what makes a good teacher

doctors talkingIlana Yurkiewicz, a fourth-year student at Harvard Medical School, will begin an internal medicine residency at Stanford in June, and she hopes to bring teaching to the forefront of her time here. She recently wrote a post for her blog, Unofficial Prognosis, hosted by Scientific American, in which she discusses how grateful she is for the teachers who mentored her, and what she would like to improve as she takes on teaching responsibilities as a resident:

As a third and fourth-year medical student, I sometimes felt like a dolt on the wards. The thing is – and forgive my self-assurance here – I don’t think I’m a dolt in real life. Just like the students Dr. Fitzgerald described who had interesting lives outside of medicine and suddenly became dull on the wards, so, too, I could relate.

…Sometimes the most negative experiences for me weren’t the result of any particular individual, but a culture that treated me in certain ways – that set certain expectations for who a medical student was and how she should be treated, and then acted to mold me toward those expectations. It was these unspoken pressures that made me feel my most dolt-like – or at least, didn’t do much to counteract it.

She lists five specific ways she thinks the culture of teaching medical students can be improved, and she reflects on the teachers who positively impacted her experience:

The compassionate internal medicine resident who not only served as a role model in patient interactions, but who also recognized the effects that witnessing mortality might have on students, frequently checking in on how we were doing. The anesthesia nurse who patiently taught me how to place IV’s, going over each step meticulously, and not judging or pulling the equipment from me when I did not succeed, but instead offering specific tips that enabled me to get it right the next time. The intern who gave us third-year medical students full responsibility over our patients, letting us direct the conversations and treatment plans, but never absent, always sending resources and offering feedback to help us improve. And there were many more.

What did they have in common? They were patient. They focused on what matters. They put the patient at the center of care. They created cultures where everyone was respected and open communication was welcome. They were enthusiastic about having medical students active and involved. And the educational glue: they made medical students feel autonomous yet supported at the same time. That’s how you learn; by doing, supplemented with regular feedback. That’s how you get better.

Previously: Stanford Medicine’s Lloyd Minor on reconceiving medical education, What’s it like to be an internal medicine resident at Stanford? and Program for residents reflects “massive change” in surgeon mentality
Photo courtesy of Office of MD Admissions

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