Published by
Stanford Medicine


Public Safety

Pediatrics, Public Safety, Stanford News

A reminder to parents to be careful of open windows

A reminder to parents to be careful of open windows

7867279958_6d74bdf4f7_z croppedPreventing falls from windows may not be something that’s on the mind of every parent – especially this time of year. But as the Indian summer continues here in the Bay Area and elsewhere, windows in homes may be left open, leaving kids vulnerable to accidents.

Over on the Healthier, Happier Lives Blog yesterday, Daniel Imler, MD, assistant professor of pediatric emergency medicine, talked about injuries caused by falls, noting that the most common kinds are extremity fractures, traumatic brain injuries, and damage to the cervical spine. After saying that “window screens only offer minimal help,” he also outlined some preventive tips for parents:

Move furniture away from windows and prevent children from climbing over. Locking all closed doors and windows is a great preventative measure as well. If you do open a window safety locks can help keep the window open only 4 inches for safety. Some families choose to install windows that open from the top down on floors above the ground level.

Previously: A young child, a falling cabinet, and a Life Flight rescueCarseats save lives, but only if kids are buckled in and Rattled by one child’s injury, a whole family becomes accident-prone
Photo by Kalexander2010

Addiction, In the News, Myths, Patient Care, Public Health, Public Safety

“24/7 Sobriety” program may offer a simple fix for drunken driving

"24/7 Sobriety" program may offer a simple fix for drunken driving

8684229367_2826035583_zEvery now and then I read a story that takes what I think I know about a certain topic and turns it upside down. Today, my understanding of programs to reduce drunk driving were upended by an article written by Keith Humphreys, PhD, professor of psychiatry and behavioral science at Stanford.

As Humphreys explains, many people mistakenly believe that no one can overcome a drinking problem without treatment involving a professional’s help. This, he says, is a myth, and the success of the “24/7 Sobriety” program highlights the importance of exploring and adopting new ways to combat drunken driving. From the Wall Street Journal article:

Offenders in 24/7 Sobriety can drive all they want to, but they are under a court order not to drink. Every morning and evening, for an average of five months, they visit a police facility to take a breathalyzer test. Unlike most consequences imposed by the criminal justice system, the penalties for noncompliance are swift, certain and modest. Drinking results in mandatory arrest, with a night or two in jail as the typical penalty.

The results have been stunning. Since 2005, the program has administered more than 7 million breathalyzer tests to over 30,000 participants. Offenders have both showed up and passed the test at a rate of over 99%.

Counties that used the 24/7 Sobriety program also had a 12% decrease in repeat drunken-driving arrests and a 9% drop in domestic-violence arrests, according to a 2013 study.

A possible reason why this program works — when attempts to help people with drinking problems often fail — is that the twice daily breathalyzer tests have immediate consequences, Humphreys explains. “It turns out that people with drug and alcohol problems are just like the rest of us. Their behavior is affected much more by what is definitely going to happen today than by what might or might not happen far in the future, even if the potential future consequences are more serious.”

Previously: Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by: KOMUnews

Public Health, Public Safety, Research, Sports

Study shows football helmet safety tests may not capture common cause of concussions

Study shows football helmet safety tests may not capture common cause of concussions

boy-164286_1280The football helmet is perhaps the most iconic piece of safety equipment there is, but we’re just now beginning to understand how helmets can — and should — protect the brain.

Blows that rotate the head are known to cause brain trauma, yet a new Stanford study (subscription required) has found that this kind of movement isn’t included in the tests currently used to evaluate a football helmet’s safety.

In the study, bioengineer David Camarillo, PhD, and his team investigated the types of head movements that cause concussions using computer models of the brain and data collected from Stanford football players wearing mouthguards instrumented with accelerometers (device that measures changes in velocity).

Using the computer model, they found that the brain’s movement increases when the head oscillates (moves back and forth) at 15-20 hertz and it completes a single oscillation in about 50 milliseconds. The field data from the accelerometers showed that the players typically experience head oscillations around 20 hertz.

When the research team compared these results to the scenarios used to test the safety of football helmets, they found a mismatch. The standard tests used to evaluate football helmet safety (acceleration tests and a test that drops a helmet-wearing dummy head from various heights) fail to include the rotational movements known to cause concussions; they also generate faster head oscillations (100 hertz); and measure head acceleration for only 15-36 milliseconds.

“The problem with having a model that doesn’t re-create what players actually experience in the field, is that you could optimize a helmet to perform well in the drop test that unintentionally performs poorly in the field,” said Fidel Hernandez, a doctoral candidate in mechanical engineering and one of the study’s lead authors, in a Stanford News story.

This is a big deal because roughly 70 percent of football players in the United States who rely on helmets to keep their head’s precious cargo safe are under the age of 14, and they receive, on average, a whopping 240 hits to the head each season.

Camarillo and his team hope their findings can be used to make more realistic and useful helmet tests.

Previously: Stanford bioengineers and clinicians team up to shed light on how concussions affect the brainForces at work in concussions more complicated than previously thought, new Stanford study revealsNow that’s using your head: Bike-helmet monitor alerts emergency contacts after a crash and Study shows concussion recovery may take longer for female, younger athletes
Image courtesy of Pixbay

Pediatrics, Public Health, Public Safety, Sleep, Stanford News

Rolling through campus and talking sleep with famed researcher William Dement

Rolling through campus and talking sleep with famed researcher William Dement

Dement in shuttle2 (RS) - croppedRenowned sleep researcher William Dement, MD, PhD, is maneuvering his way in his “Sleep and Dreams Mobile” through the Stanford University campus, en route to the Jerry House, site of some of the early, landmark studies in sleep. The house, a sprawling Mediterranean-style dormitory, housed Stanford’s Summer Sleep Camp in the 70s and 80s, where Dement and his colleagues planted the seed for some of the most important findings in the field of sleep among adults and teens.

Three years ago, the house was immortalized with a plaque and a party in which Jeff Chimenti of Grateful Dead fame performed for a crowd of 60 celebrants (the building is named after the Grateful Dead’s Jerry Garcia). Dement, now 85, says he often passed the house on his way to his ever-popular Sleep and Dreams class and thought it was important to mark the spot.

“I’d go by this house and think, ‘What happened here is the biggest thing in sleep disorders.’ So I thought something should be done to create a memorial,” he says, leaning on the banister in the living room of the house.

I’ve asked him to give me a tour of the house as background for a story on teen sleep that I’m writing for the next issue of Stanford Medicine magazine. He points to the backyard of the house, now a barren Lake Lagunita, where young volunteers played volleyball, all the while carrying a nest of wires on their heads to monitor their brain waves. Inside, researchers would monitor the youngsters’ brain activity 24 hours a day to better understand their patterns of sleep.

“The electrodes would stay on their heads because it was too difficult to take them off,” Dement explains. When the volunteers would trudge off to Tresidder Union to go bowling or do other activities, he says, “People would say, ‘Here come the trodes.’”

Dement and his colleagues followed the youngsters for ten successive summers, observing patterns in how their sleep changed as they matured.

A major goal of the study was to confirm the popular belief that as teens get older, they need less sleep. To the researchers’ surprise, they found that as the youngsters aged, the number of hours they slept stayed the same – roughly 9 hours.

Continue Reading »

Global Health, LGBT, Public Health, Public Safety, Women's Health

Advocating for the rights of women and LGBT individuals in the developing world

Advocating for the rights of women and LGBT individuals in the developing world

Randy Barry - smallLast spring, I traveled to Washington, D.C. for my first experience as a citizen-activist, lobbying in Congress for the rights and well-being of women and LGBT individuals in the developing world. I recently returned there to see some of the impact of that work – crucial new appointees, new legislators in support of key issues and new words of encouragement from both sides of the political aisle.

I visited Washington as part of a 170-person delegation from the American Jewish World Service (AJWS), an international organization that promotes human rights and seeks to end poverty in developing countries. Our goal was to advance several initiatives, including passage of the International Violence Against Women Act, and changes to ensure that U.S. foreign contracts and foreign aid programs do not discriminate against LGBT individuals.

I was thrilled to hear a talk by Randy Berry, the State Department’s first-ever Special Envoy for the Human Rights of LGBT Persons, who assumed the new post in February. Just a year ago, AJWS had made the appointment of a special envoy one of its priority issues, and many of us, myself included, had met with our Congressional representatives to push for the position. I had been motivated by my experiences as an AJWS Global Justice Fellow in Uganda in 2014, when we met with LGBT activists who were living in a climate of terror because of the country’s impending anti-gay law. We heard stories of people who had been raped, beaten, harassed, evicted from homes and jobs and subjected to summary arrest.

I realized it was important to make LGBT rights a priority issue for U.S. foreign policy. Berry, the new U.S. envoy, said AJWS had been a “prime mover” in the creation of his new office – gratifying news indeed. He said he views LGBT rights as a “core human rights issue.”

“We are talking about equality, and it should go hand-in-hand with what we are doing in gender equality and in the disabled community,” he told us. “One of the most disturbing elements of discrimination is that it’s the first step to denying one’s humanity.”

He acknowledged that he has a daunting job ahead; while the U.S. is making swift progress on gay rights, these rights are just as swiftly being eroded in other parts of the world. Nearly 80 countries now criminalize same-sex behavior, with penalties that include death or life in prison. Yet the fact that the U.S. has made so much progress in recent decades suggests it’s possible to change the climate elsewhere as well, he said.

“Who would have dreamed 20 years ago that we would be where we are today in the United States,” he said. “I am sitting here today with the support of the State Department, the president and members on both sides of the aisle.”

We also saw progress on the International Violence Against Women Act, which would make ending violence against women worldwide a top U.S. diplomatic and development priority. Violence against women and girls is alarmingly pervasive, with as many as one in three being beaten, coerced into sex or subjected to other abuse in her lifetime.

The legislation was reintroduced in the House of Representatives in March with a record 18 co-sponsors, including many more Republicans than in the past. On the morning of our lobbying visits, we heard from seven Members of Congress, including Chris Gibson (R-NY), Richard Hanna (R-NY) and Lee Zeldin (R-NY), all of whom expressed strong support for the bill. David Cicilline (D-RI) described a trip to Liberia in which he met a group of young girls who had been subjected to “hideous, indescribable sexual violence.”

“It made me realize we need to do everything we can to change the lives of these young girls,” he told us.

I couldn’t agree more.

Previously: Stanford study shows many LGBT med students stay in the closetChanging the prevailing attitude about AIDS, gender and reproductive health in southern AfricaLobbying Congress on bill to stop violence against womenPreventing domestic violence and HIV in Uganda and Sex work in Uganda: Risky business
Photo of Randy Berry by Ruthann Richter

Emergency Medicine, Medicine and Society, Public Health, Public Safety, Research

Study: ER statistics could be used to help reduce gun violence

Study: ER statistics could be used to help reduce gun violence

ER shot

Emergency room doctors treat many patients who have been involved in violent assaults. New research shows that these patients are far more likely than other ER patients with otherwise similar demographics to seek treatment for gun-related injuries in the near future.

These findings “could help injury researchers, emergency department physicians, and social service agencies focus their intervention efforts to prevent future firearm incidents and other violent incidents among high-risk youth populations,” explains a University of Michigan press release published Monday.

The study, published in Pediatrics, followed nearly 600 drug-using youth in Flint, Mich. for two years after they were admitted to the emergency room. Nearly 60 percent of those admitted for assault-injury care became involved in a violent incident involving a firearm within the next two years, and of those, the majority did so within six months after the initial visit. Between two people with highly similar demographic factors, someone admitted for assault is 40 percent more likely to be involved in gun violence than someone admitted for a cold.

The results also calculated the statistical correlations of various markers, such as race, gender, drug abuse, PTSD, possession of a firearm, and tendency toward retaliation (see the release for the details). ERs that track such markers could identify the highest-risk youth and help them receive targeted treatment. The release quotes Patrick M. Carter, MD, an assistant professor of emergency medicine at UM, member of the UM Injury Center, and first author of the study, saying the results “support using the ER as the site for intervention, especially during the ‘teachable moment’ that immediately follows an initial assault or fight.”

Previously: Pediatricians’ role in gun control: Recommendations from the American Academy of Pediatrics, Emergency-room interventions may reduce alcohol-based violence among teens and Emergency room as soup kitchen
Photo by Military Health

Addiction, FDA, Health Policy, Medicine and Society, Public Health, Public Safety

To keep edibles away from kids, marijuana policies must be “fully baked”

To keep edibles away from kids, marijuana policies must be "fully baked"

sanfran031606_fig1_highresDepending on your position, legal marijuana might raise images of stoners on every street corner or of users enjoying a private puff in their backyards. However you probably don’t picture a child munching on a pot-laden brownie she found in her kitchen cupboard.

But as Stanford legal experts Robert MacCoun, PhD, and Michelle Mello, JD, PhD, point out in a commentary published today in the New England Journal of Medicine, the loose state regulation of marijuana edibles creates some unnecessarily and potentially serious public health risks that should concern everyone.

Packaged in brightly colored wrappers, edibles often mimic popular sweets, but they contain a powerful dollop of tetrahydrocannabinol (THC), the chemical responsible for marijuana’s psychoactive effects. Some edibles contain multiple “servings” of THC per package.

Both Colorado and Washington — the two states with legal recreational marijuana — require “child-resistant” packaging and a warning to “keep out of the reach of children.” But edibles remain quite attractive to children, who may confuse them with regular candies and snacks, and potentially deceptive to adults, who may assume one bar is a just one serving. “I look at these packages and I get hungry just looking at them,” MacCoun said.

The edibles are not regulated as either a food or a drug by the U.S. Food and Drug Administration, because the federal government considers marijuana illegal. Legalizing states have been slow to fill the gap, and have done so incompletely, Mello said. “This is sort of a weird space that’s betwixt and between federal and state oversight,” she said.

It’s time for the medical community to get involved, MacCoun said. “Most people don’t understand the brain metabolizes chemicals ingested by mouth differently than those smoked.”

Ingested marijuana offers a delayed high, so people keep eating thinking they are fine. The intoxication lasts longer and is associated with more hallucinations and perceptual distortions, he said. “It’s almost like a different drug.”

For now, the issue is most pressing in Colorado and Washington, but many other states are considering legalizing recreational marijuana, including California, MacCoun said.

“We’re not taking some strong position these products should be banned. Sensible and fairly modest regulations would reduce the risk without greatly restricting people’s freedom to consume these products,” MacCoun said.

Previously: Discussing the American Academy of Pediatrics’ call to put the brakes on marijuana legalization, To protect teens’ health, marijuana should not be legalized, says American Academy of Pediatrics and Medical marijuana not safe for kids, Packard Children’s doc says
Photo by DEA

Emergency Medicine, Medicine and Society, Patient Care, Public Safety, Stanford News

A young child, a falling cabinet, and a Life Flight rescue

A young child, a falling cabinet, and a Life Flight rescue

ticktockLife in the air rescue business is highly unpredictable. You can spend many hours idling away the time in an obscure, basement office. But when an emergency call comes, you literally don’t have a second to grab a pen on the way out the door.

So it was on one November day, when I did a ride-along with Stanford’s illustrious Life Flight air ambulance service, the oldest in California. The team graciously agreed to let me accompany them on a flight for a story for Stanford Medicine magazine, whose current issue is focused on the role of time in medicine. Life Flight, I figured, would give me a sense of the split-second timing that can sometimes make a difference between life and death in an emergency situation. I was scheduled to fly with the crew in late October, but instead I spent that day learning about the service in what proved to be a leisurely day with no calls.

On my second ride-along day, it appeared that history was about to repeat itself when, just as my shift was about to end, the emergency call came in at 3:39 p.m. I became an eye witness to the rescue of a toddler who suffered a serious head injury when a heavy, ill-secured cabinet at her preschool crashed down on her head during naptime. The story was so dramatic that it made the local news. The school was shut down several days later by local officials because of code violations.

Things could have gone poorly for little Aeshna, the 3-year-old victim of the accident, who was left dazed, not fully conscious and vomiting as a result of her injury – clear signs of head trauma. She could have suffered significant bleeding in the brain and permanent brain damage – a prospect that was a major concern for her parents and caregivers.

The two Life Flight nurses, who have a breathtaking array of skills, and their veteran U.S. Navy pilot made it to the scene at the Fremont, Ca. preschool across the bay within 23 minutes of the call and were able to bring Aeshna back to Stanford for quick assessment and treatment.

You can read the minute-by-minute scenario of Aeshna’s rescue in the the magazine, which came out last week.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Comparing the cost-effectiveness of helicopter transport and ambulances for trauma victims, Stanford Life Flight celebrates 30 years and Ask Stanford Med: Answers to your questions about wildnerness medicine
Illustration by Lincoln Agnew

Chronic Disease, Health Policy, Public Health, Public Safety, Stanford News

New uses for old polymers: Stanford Engineering team uses surgical glove material to make air filters

New uses for old polymers: Stanford Engineering team uses surgical glove material to make air filters

After visiting China and enduring the stifling air pollution, Stanford engineering professor Yi Cui, PhD, wanted to explore solutions to the problem. This week, his team published a paper in the scientific journal Nature Communications, detailing a new kind of highly effective air filter made out of polyacrylonitrile, a synthetic polymer that is used to make surgical gloves.

The researchers used a relatively new technique called electrospinning, or drawing out microscopically thin threads from a liquid to make a lightweight and fairly transparent filter out of PAN. The filter attracts particles from the air, especially those around 2.5 microns – or PM2.5 – which are among the most dangerous for the human respiratory tract.

The researchers make the case for the new PAN air filter pretty eloquently in a press release:

“It was mostly by luck, but we found that PAN had the characteristics we were looking for, and it is breathtakingly strong,” said Po-Chun Hsu, co-author on the study and a graduate student in Cui’s lab.

. . .

“The fiber just keeps accumulating particles, and can collect 10 times its own weight,” said Chong Liu, lead author on the paper and a graduate student in Cui’s lab. “The lifespan of its effectiveness depends on application, but in its current form, our tests suggest it collects particles for probably a week.”

The material collects 99 percent of air particles for up to a week, but is still 70 percent transparent, so it could be used as a window covering. “It might be the first time in years that people in Beijing can open their window and let in a fresh breeze,” Cui said in the statement.

Previously: The high cost of pollution on kids’ healthStudy shows air pollution may increase heart attack risk more than drug useContinuing pollution restrictions used during Beijing Olympics could reduce cancer rates and New insight into asthma-air pollution link
Video by Kurt Hickman

Health Policy, Medical Education, Public Health, Public Safety

Why I never walked to school: the impact of the built environment on health

Why I never walked to school: the impact of the built environment on health

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

kids walking to schoolMy California-acclimated body was a little shocked by the 15-degree weather I encountered while visiting my Kentucky hometown over winter break, but I was still determined to bundle up most days and to get outside for long walks with my mom and daughter. One day as we were struggling to catch an opening in traffic to cross the blindly curving road leading out of our subdivision, it occurred to me that the cold was the least of our barriers to getting a little exercise.

“I don’t think I could design a more dangerous place to walk if I tried,” I observed in frustration. Another car whizzed by within a couple feet of my daughter’s stroller. “This town was definitely built for cars, not people.”

For most of my childhood, my family lived right in the middle of town, within about a mile of many of the places a young family might visit on a daily basis. Grocery stores, school, church, the public library, restaurants, the park where I played softball, and my grandmother’s house were all close enough that they should have been an easy walk. But that one mile might as well have been twenty, and I can count on one hand the times I walked to those destinations. I tried a few times, but to get there on foot I’d have to navigate roads lined by steep hills or ditches with no sidewalks or crosswalks. There is one underpass that would require a pedestrian to climb onto a narrow strip of gravel and inch along the wall, close enough to the fast-moving traffic to be unbalanced by gusts from each passing car.

Because of these real physical barriers, the local cultural wisdom took it as self-evident that cars were the only reasonable way to get around. Walking and biking were recreational activities to be done in endless circles around the cul-de-sac, not viable modes of transportation. The risk of walking wasn’t just a theoretical one: Our roads were decorated with a couple of makeshift roadside altars made by the families of teenagers who had died while trying to cross the street. More recently, I was disappointed to read an article confirming my suspicions that cycling in the Southeastern U.S. is drastically more dangerous than in other regions.

Continue Reading »

Stanford Medicine Resources: