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Addiction, Mental Health, Pain, Public Health, Technology

Student engineers unveil tamper-proof pill bottle

Student engineers unveil tamper-proof pill bottle

Pill-dispenserThe United States has been battling a prescription painkiller epidemic for years. The statistics from the Centers for Disease Control and Prevention are chilling: The number of painkillers prescribed has quadrupled since 1999; more than two million people abused painkillers in 2013; every day, 44 people die from a prescription opioid overdose.

In response, faculty at the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health issued a challenge to seniors in the university’s mechanical engineering program: build a pill bottle that would protect against theft and tampering.

One team of students came up with a design that worked so well that their team’s mentors Andrea Gielen, ScD, and Kavi Bhalla, PhD, submitted a proposal to the National Institutes of Health for further testing.

The device is about the size of a can of spray paint, much larger than the average pill bottle. It can only be opened with a special key, which pharmacists can use to refill with a month’s supply of OxyContin. A fingerprint sensor ensures only the prescribed patient can access the pills at prescribed intervals and doses. In a story on the Johns Hopkins website earlier this month, Megan Carney, one of the student engineers described how the pill dispenser works:

The device starts to work when the patient scans in his or her fingerprint. This rotates a disc, which picks up a pill from a loaded cartridge and empties it into the exit channel. The pill falls down the channel and lands on a platform where the patient can see that the pill has been dispensed. The patient then tilts the device and catches the pill in their hand.

A short video about the pill dispenser shows it in action, too. The dispenser still has to undergo additional testing, but the team hopes to bring it to market soon — and help prevent future opioid overdoses.

Previously: Unmet expectations: Testifying before Congress on the opioid abuse epidemic, The problem of prescription opioids: “An extraordinarily timely topic”, Assessing the opioid overdose epidemic, Why doctors prescribe opioids to patients they know are abusing them and Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse
Photo courtesy of Johns Hopkins University

Behavioral Science, Health and Fitness, Mental Health, Public Health, Research, Stanford News

Exposure to nature helps quash depression – so enjoy the great outdoors!

Exposure to nature helps quash depression - so enjoy the great outdoors!


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Walking is good for your health. But walking somewhere natural is even better, according to a new Stanford-led study.

Study participants who walked in a natural area for 90 minutes showed less activity in a brain region associated with depression than those who walked through a city or other urban area, a Stanford News story states. From the piece:

“These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world,” said co-author Gretchen Daily, the Bing Professor in Environmental Science and a senior fellow at the Stanford Woods Institute for the Environment. “Our findings can help inform the growing movement worldwide to make cities more livable, and to make nature more accessible to all who live in them.”

Even further, the research supports — but does not prove — a link between urbanization and growing rates of mental illness, said co-author James Gross, PhD, a professor of psychology.

The researchers had one group of participants walk in a grassland with oak trees and shrubs. The other group walked along a traffic-clogged four-lane road. They then measured heart and respiration rates, performed brain scans and had the participants answer a series of questions. The results showed that:

Neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.

Evidence that supports the knowledge you’ve had since grade school: The outdoors really can make you feel better.

Previously: To get your creative juices flowing, start movingA look at the effects of city living on mental health and Out-of-office autoreply: Reaping the benefits of nature
Photo by Linda A. Cicero/Stanford News Service

Mental Health, Neuroscience, Research, Women's Health

When dementia hits home: The global impact of dementia on women

When dementia hits home: The global impact of dementia on women

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A report released last week by Alzheimer’s Disease International calls attention to the disproportionate effects of dementia on women worldwide.

As noted in the report, women are more at risk for dementia than men for two primary reasons: age and genetics. Women’s longer lifespans leave them more vulnerable to the age-related condition. In addition, there are biological factors that make women more likely to suffer from dementia.

Women are also more likely to be the caregivers to those with the disease. Women care not only for family members — they’re often also employed in low-paid caregiving professions. This is particularly true in lower income countries, where as many as 62 percent of people with dementia live, according to the report.

The burden of dementia strains family structures and community dynamics in these disadvantaged nations. In the report, Faraneh Farin, who is involved with the Iran Alzheimer Association, describes the situation in countries like Iran:

Nowadays, more women are working to support their families but should they need to care for a family member, then it is expected that they quit their jobs resulting in their marginalization. It seems that either way, whether a woman has dementia or she cares for a loved one, she is trapped in the cycle which has been constructed by the society. Dementia is an issue that engages a woman’s entire life.

The global costs of dementia amount to more than $600 billion, yet many sufferers, caregivers and programs lack adequate funds. The report calls for additional resources for female dementia victims and caregivers, and it highlights the need for additional research on dementia’s effects, especially in countries with lower incomes. These countries also need to develop national strategies that consider the needs of women, the report states.

Alzheimer’s Disease International aims to elevate the awareness of dementia’s impact on women globally and to spur national efforts to improve care. As Executive Director Mark Wortmann wrote in the Foreward: “I hope the report will find its way onto the desks of policy makers to help improve the quality of life for women living with dementia, as well as the millions of women all around the world who provide care and support for them.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: Study suggests yoga may help caregivers of dementia patients manage stressStanford neuroscientist discusses the coming dementia epidemic, and Science Friday explores women’s heightened risk for Alzheimer’s
Photo by Valerie Everett

Mental Health, Research, Science, Technology

Fear factor: Using virtual reality to overcome phobias

Fear factor: Using virtual reality to overcome phobias

3493601806_7f5512fe6d_zPast research has shown that virtual reality can be effective in treating phantom limb syndrome, helping smokers kick their nicotine habit, easing patients’ pain and reducing post-traumatic stress disorder symptoms, among other things. Now a pair of engineering students at Santa Clara University in California are exploring the potential of the technology to assist individuals in overcoming their fear of heights and other anxiety-related conditions.

The design duo behind the project are undergrads Paul Thurston and Bryce Mariano. The students partnered with Kieran Sullivan, PhD, a psychology professor at Santa Clara, to develop a simulation tool that guides patients through a controlled virtual environment populated with phobia-triggering features. More details about the system were provided in this recent university story:

They started with a fear of heights simulation. As the patient takes in a 360-degree view from atop a building, the therapist can alter the virtual height and the resultant view—backing off or increasing exposure as needed according to the patient’s emotional response. While the team stresses that their tool is for use by trained therapists, not for sufferers to use on their own, Thurston notes that just knowing you can take the goggles off while immersed in the experience may make this form of treatment more approachable for some.

“Another aspect of our project that has been very important to us is to keep it affordable as well as accessible for future development,” said Mariano. “By using economical hardware and developing the simulation using the Unity Game Engine, which is 100 percent free and readily available, we hoped to create a platform that would allow others to easily pick up the project where we left off and continue expanding on the library of simulations to treat the widest possible range of phobia patients.”

Previously: From “abstract” to “visceral”: Virtual reality systems could help address pain and Can behavioral changes in virtual spaces affect material world habits?
Via CBS San Francisco
Photo by Amber Case 

Behavioral Science, Events, Mental Health, Research, Videos

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

777423808In 2012, President Obama issued an Executive Order calling for better prevention, diagnosis and treatment of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and other mental health conditions. Third-year doctoral student Russell Toll is one of many who is doing research in these areas, and he brings a unique perspective to his work: He’s both a bioengineer and an Army combat veteran.

In 2006, Toll was in charge of a combined tank and infantry platoon stationed in the Diyala River Valley, about an hour northeast from Baghdad, Iraq.

His unit deployed with 14 tanks; they came back with four. Within 15 months, 28 men in his batallion were killed and 132 were severely wounded. A third of his men earned the Purple Heart and his unit — the 1-12 CAV in the 1st Cavalry Division — earned the Valorous Unit Citation for extraordinary heroism.

Now, Toll is working with his graduate advisor, Amit Etkin, MD, PhD, an assistant professor in the Department of Psychiatry and Behavioral Sciences, to identify biomarkers associated with TBI and PTSD. Toll and Etkin will discuss their work at the West Coast preview of the film “Searching for Home: Coming Back from War” next Saturday, June 20, at Stanford’s Cubberley Auditorium.

Recently, I spoke with Toll to learn more about his experience in Iraq and his research.

How did your experience in Iraq inform your understanding of PTSD?

As a platoon leader, all of your thoughts and efforts are focused on keeping your unit safe and getting them home. Only after you get home and decompress do you realize how much [weight] you were carrying.

This is a common experience for many soldiers and people that have lived through a traumatic experience.

At what point in your military career did you become interested in bioengineering and research on TBI and PTSD?

The pivotal point was in 2009 when I visited Walter Reed [National Military Medical Center] to check in on my men. The care they received at the center was excellent, but some of the equipment and technology that was being used to diagnose and treat them seemed like it hadn’t changed since Vietnam.

When I returned to my hotel room at night, I found myself drawing up ways we could address this problem on the backs of napkins. I have a bachelors degree in systems engineering from West Point, and I decided to apply these skills as a graduate student in bioengineering.

What was it like to come to Stanford after spending 15 months in Iraq?

It was a stark transition from the Army to Stanford; I felt like I had just climbed off the tank and stepped straight into systems biology. It sounds funny, but in a way I was able to apply my military training to my graduate studies: I developed cooperative relationships with the “indigenous experts” so I could get help from my classmates. As evidenced by my friends, I’m good at surrounding myself with excellent people. Their tutoring, coaching and friendship — especially that of Shrivats Iyer — was a major reason I was able to make it this far.

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Medical Education, Mental Health, Nutrition, Stanford News, Surgery

Keeping an even keel: Stanford surgery residents learn to balance work and life

Keeping an even keel: Stanford surgery residents learn to balance work and life

med students in sailboat

Residency is one of the most intense times in a surgeon’s training, and it can take a toll physically and mentally on newly minted medical school graduates as they learn to cope.

To help them counter that stress, Stanford’s Department of Surgery started the Balance in Life Program for its residents. The program, and one of its team-building exercises – a sailing lesson in one of the world’s best sailing spots, the San Francisco Bay – were highlighted in a recent Inside Stanford Medicine story.

As described in the piece, the program is dedicated to the memory of Greg Feldman, MD, a former chief surgical resident at Stanford who committed suicide in 2010. The program provides basics like easy-to-access healthy meals, group therapy sessions and social activities, and Ralph Greco, MD, the program’s director said of it:

A lot of people would argue with the notion that such a program is necessary… I know our day of sailing may raise some eyebrows, but our faculty decided that we should do whatever we could to give these young people the tools they need to help them deal with the vicissitudes of life and medicine through the rest of their careers.

The article also notes that the program attracts residents interested in work-life balance to Stanford:

“The fact that we have this Balance in Life Program is great for recruitment of like-minded individuals,” [resident Micaela Esquivel, MD,] said. “I can tell medical students considering us that they would be hard-pressed to find another program that cares enough about their well-being to offer what we do.”

Previously: A call to action to improve balance and reduce stress in the lives of resident physicians, Surgeon offers his perspective on balancing life and work, Program for residents reflects “massive change” in surgeon mentality and New surgeons take time out for mental health
Photo by Norbert von der Groeben

Health and Fitness, Mental Health, Public Health

Not just for kids: A discussion of play and why we all need to do it

Not just for kids: A discussion of play and why we all need to do it

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All work and no play makes everyone a dull boy. Recognizing this, the California-based National Institute for Play focuses on shining light on the importance of the practice of play in everyday life. BeWell@Stanford recently spoke with its founder and president, Stuart Brown, MD, who here talks about play’s role in human function:

Play is a survival drive that is necessary for adaptation, flexibility and social learning. Play helps us belong in the community, develop the ability to suppress unwanted urges, and regulate our emotions.

He goes on to talk about play’s importance for adults in particular:

Most people tend to think that play is confined primarily to childhood, and my sense of the paleo-anthropological design of being human is that we are neotenist creatures.  We are designed to be juveniles until we die and that is part of our primate design as Homo sapiens. When we honor that design, we tend to be less violent, more communal and healthier.

Taking time off to play does not mean you shirk your responsibilities, or that you aren’t a good parent or a good productive citizen. In fact, it’s just the opposite: your level of agitation drops when you get playful, which tends to increase perseverance and mastery. Play has a real payoff.

Brown also speaks about the importance of play in childhood development, and how we can learn about play’s impact on behavioral patterns from other animals such as social rats. Lastly, he provides advice as to how to reconnect with the childlike fun of play and incorporate it into adult life.

The piece is an intriguing conversation that might make readers slow down, think about their life, and remember that fun isn’t just for kids.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: Workaholics vs work engagement: The difference is playExercise and relaxation techniques may help ease social anxiety, study finds and Exercise may boost heart failure patients’ mental and physical health
Photo by kilgarron

Behavioral Science, Ethics, Events, Medicine and Society, Mental Health

Anger: The most evil emotion or a natural impulse?

Anger: The most evil emotion or a natural impulse?

5846841745_f2f620c5d3Anger isn’t good for your health. It spikes your heart rate, exacerbating heart conditions and anxiety. It leaves an ugly residue, a sensation of unease and aggression and it can lead to violence against others or oneself.

But in the west, we have an uneasy relationship with this powerful emotion, said Owen Flanagan, PhD, co-director of the Center of Comparative Philosophy at Duke University and speaker at the annual Meng-Wu lecture hosted by the Stanford Center for Compassion and Altruism Research and Education last week.

In the United States and Europe, some anger is considered justified, even necessary for healing after one is wronged, Flanagan said. It’s natural, just a part of our constitution. An appropriate amount of anger is expected, a sign that you care. Flipping out because your barrista took too long making your latte? Probably not okay. But yelling at a driver who rear-ended you while texting? Certainly.

Not in Asia, Flanagan said. There, in accordance with Buddhist traditions, anger is right up there with hatred as the worst emotion, something that should be eliminated as soon as it arises.

Flanagan said he and other academic colleagues posed a question to the Dalai Llama several years ago: If you find yourself in a public place with a very bad person, like Hitler, before the atrocities have started, what should you do? Westerners would say anger was AOK, as was perhaps even murder. After conferring with his colleagues, the Dalai Llama said yes, murdering Hitler would be justified to prevent a very bad karmic causal chain. But anger? Absolutely not.

One could argue that even Hitler’s behavior was a byproduct of his genes, his upbringing, the surrounding society, Flanagan told the audience.

Flanagan said he still hasn’t figured out his own views toward anger. “Anger is a destructive emotion, but it might be a necessary emotion. I’m still not sure about that.”

But in the U.S., we don’t always live in accordance with our own traditions, Flanagan said. “We give ourselves sloppy permissions all over the place to be very angry people. That’s something that’s just not good.”

To counter anger, Flanagan offers several tips, drawn from both western and eastern traditions. First, embrace an emotion that is incompatible with anger, such as gratitude. Or reflect on your own insignificance and the transitory nature of the harm: This too will pass. “Astronomy is a good antidote to taking yourself too seriously,” Flanagan said.

In a longer term, Seneca suggests that it helps to “live among people who teach the children that anger is always bad.”

But is it even possible to completely eliminate anger? Some argue no, even babies express a form of frustration or discontent that could be a sign of inner anger. Or, we could all be conditioned by society, learning to be angry as soon as we’re born.

Previously: Bright lights breed stronger emotions, study finds, Is it possible to control one’s emotions? and Study suggests emotions may trump mind in matters of self-control while meditating
Photo by katmary

Medical Education, Medical Schools, Mental Health, Stanford News

A call to action to improve balance and reduce stress in the lives of resident physicians

A call to action to improve balance and reduce stress in the lives of resident physicians

4086639111_a7e7a56912_zIn November of 2010, those in Stanford’s general surgery training program experienced an indescribable loss when a recently graduated surgical resident, Greg Feldman, MD, committed suicide. His death wound up being a call to action that brought about the Balance in Life program at Stanford, according to program founder Ralph S. Greco, MD.

With the Balance in Life program now in its fourth year, Greco; chief surgical resident Arghavan Salles, MD, PhD; and general surgery resident Cara A. Liebert, MD, have learned much about the daily stresses that resident physicians face. In a recent published JAMA Surgery opinion piece they wrote:

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health.

A recent national survey found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.

Greco, Salles and Liebert explain that the Balance in Life program is specifically designed to help resident physicians cope with these stresses by addressing the well-being of their professional, physical, psychological and social lives. To accomplish this goal, the program offers mentorship and leadership training activities; dining and health-care options that are tailored to the residents’ busy schedules and needs; confidential meetings with an expert psychologist; and social events and outdoor activities that foster support among residents.

The authors concede that the program may not fix every stressful problem that their residents face, but it does let the residents know that their well-being is important and valued. “This may be the most profound, albeit intangible, contribution of Balance in Life,” the authors write.

Although the program (and the JAMA article) is geared for people in the medical field, it’s not much of a stretch to see how its core principles can apply to any work setting. Learning how to manage stress and reach out to colleagues for support is a valuable skill and, as the authors write, to provide expert care for others you must first take good care of yourself.

Previously: After work, a Stanford surgeon brings stones to lifeSurgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentality, New surgeons take time out for mental health and Helping those in academic medicine to both “work and live well”
Photo by Gabriel S. Delgado C.

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

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