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Global Health, Pediatrics, Public Safety, Research, Stanford News, Women's Health

Working to prevent sexual assaults in Kenya

Working to prevent sexual assaults in Kenya

Kenyan slumsThe little girl bounded up to us, wearing a filthy pink sweater, with a beaming smile on her face, and gave me a huge hug. Surprised at the reception, I hugged her back and swung her gently back and forth. She giggled and ran to hug my colleagues, then, hopping over an open sewer, darted into an alley that lead to her home. We followed as quickly as we could over the slippery mud, down one alleyway than another. Within a few minutes we reached her house, a 5’ by 10’ structure made of mud and wood, without windows, electricity, or locks. The girl, named Lianna*, lives here with her two year-old brother, who calls her “Mama”, as she is his primary caretaker. Their mother is a bartender and likely also a sex worker, and returns home only occasionally. The home is filthy, smells bad, and is without food or water. Yet this beautiful child, brimming with energy and intelligence, is proud to show it to us and to introduce us to her sibling.

Lianna is a resident of Korogocho, one of the poorest informal settlements (known to many as slums) in the Nairobi region of Kenya. Korogocho itself has about 52,000 residents, and it borders on other, larger informal settlements such as Dandora. Poverty and lack of sanitation are the norm in these communities, and crime is extremely high. Girls in these settlements may be especially vulnerable, with 18-25 percent of adolescent girls reporting being sexually assaulted each year, often by friends and relatives.

A multidisciplinary team at Stanford has been working in these communities on a sexual assault prevention project with two Kenyan non-governmental organizations (NGOs), Ujamaa and No Means No Worldwide (NMNW), for about two years. This past July, my colleague Mike Baiocchi, PhD, and I traveled to Kenya to meet the local NGO staff, become familiar with the communities they work in, and advance their research capacity.

Ujamaa, led by Jake Sinclair, MD, a pediatrician from John Muir Hospital, has been working in these and other settlements, including Kibera, Mathare, Huruma, Kariobangi, for more than 14 years, and has partnered with NMNW for several years. NMNW, led by Lee Paiva Sinclair, developed a curriculum to reduce sexual assault by teaching empowerment and self-defense, and works with Ujamaa to implement this curriculum in the slums. The Stanford team became involved in order to research the effectiveness of this intervention.

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Genetics, Neuroscience, Research, Science, Stanford News

Yeast advance understanding of Parkinson’s disease, says Stanford study

Yeast advance understanding of Parkinson's disease, says Stanford study

It’s amazing to me that the tiny, one-celled yeast can be such a powerful research tool. Now geneticist Aaron Gitler, PhD, has shown that the diminutive organism can even help advance the understanding of Parkinson’s disease and aid in identifying new genes involved in the disorder and new pathways and potential drug targets. He published his findings today in Neuron and told me in an email:

Parkinson’s disease is associated with many genetic and environmental susceptibility factors. Two of the newest Parkinson’s disease genes, EIF4G1 and VPS35, encode proteins involved in protein translation (the act of making protein from RNA messages) and protein sorting (shuttling proteins to the correct locations inside the cell), respectively. We used unbiased yeast genetic screens to unexpectedly discover a strong genetic interaction between these two genes, suggesting that the proteins they encode work together.

The proteins, EIF4G1 and VPS35, have changed very little from yeast to humans. Gitler and his colleagues showed that VPS35 interacts functionally with another protein implicated in Parkinson’s disease, alpha-synuclein, in yeast, round worms and even laboratory mice. As Gitler described:

Together, our findings connect three seemingly distinct Parkinson’s disease genes and provide a path forward for understanding how these genes might contribute to the disease and for identifying therapeutic interventions. More generally, our approach underscores the power of simple model systems for interrogating even complex human diseases.

Previously: Researchers pinpoint genetic suspects in ALS and In Stanford/Gladstone study, yeast genetics further ALS research

Biomed Bites, In the News, Research, Stem Cells, Technology, Videos

“It gives me the chills just thinking about it”: Stanford researcher on the potential of stem cells

"It gives me the chills just thinking about it": Stanford researcher on the potential of stem cells

Welcome to the last Biomed Bites of 2014. We’ll be continuing this series next year — check each Thursday to meet more of Stanford’s most innovative biomedical researchers. 

If you watch this video and aren’t moved by the passion and conviction of Stanford biologist Margaret Fuller, PhD, then email me. Seriously, I’ll try to talk some sense into you. Because Fuller’s enthusiasm for biomedicine is downright contagious. This is a professor who you want to teach biology.

Fuller, a professor of developmental biology and of genetics, works with adult stem cells, and she’s palpably gleeful about their potential to improve the health of millions.

“I was really struck and inspired by a recent article in the New York Times,” Fuller says in the video above. She’s talking about “Human Muscle Regenerated with Animal Help,” a 2012 piece that told the story of Sgt. Ron Strang, a Marine who lost part of his quadriceps in Afghanistan. Yet here is Strang, walking, thanks to the donation of a extracellular matrix from a pig. This paper-like sheet secreted signals instructing his stem cells to come to the rescue and build new muscle. “It was amazing,” Strang told the Times reporter. “Right off the bat I could do a full stride, I could bend my knee, kick it out a little bit…”

“This is really amazing,” Fuller agrees. “It gives me the chills just thinking about it. This is the kind of knowledge and advances of the basic work that I do… The hope is that understanding those underlying mechanisms will allow people to design small molecules and other strategies that can be used to induce our own adult stem cells to be called into action for repair.”

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Center for Reproductive and Stem Cell Biology receives NIH boost, Why the competition isn’t adult vs. embryonic stem cells and Induced pluripotent stem cell mysteries explored by Stanford researchers

Behavioral Science, Health and Fitness, Nutrition, Obesity, Public Health, Research

Perceptions about progress and setbacks may compromise success of New Year’s resolutions

3336185391_60148a87fa_zMy physical therapist is constantly telling me to pause during the workday and take stretch breaks to counter act the damage of being hunched over a computer for hours on end. After every visit to his office, I vow to follow his advice, but then life gets busy and before I know it I’ve forgotten to keep my promise.

So I decided that one of my New Year’s resolutions will be to set an alarm on my phone to serve as a reminder to perform simple stretches throughout the day. Keeping in mind that a mere eight percent of people who make resolutions are successful, I began looking for strategies help me accomplish my goal. My search turned up new research about how the perception of setbacks and progress influence achievement of behavior change. According to a University of Colorado, Boulder release:

New Year’s resolution-makers should beware of skewed perceptions. People tend to believe good behaviors are more beneficial in reaching goals than bad behaviors are in obstructing goals, according to a University of Colorado Boulder-led study.

A dieter, for instance, might think refraining from eating ice cream helps his weight-management goal more than eating ice cream hurts it, overestimating movement toward versus away from his target.

“Basically what our research shows is that people tend to accentuate the positive and downplay the negative when considering how they’re doing in terms of goal pursuit,” said Margaret C. Campbell, lead author of the paper — published online in the Journal of Consumer Research — and professor of marketing at CU-Boulder’s Leeds School of Business.

Given these findings, researchers suggest you develop an objective method for measuring your progress and monitor it regularly.

Previously: Resolutions for the New Year and beyond, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, To be healthier in the new year, resolve to be more social and Helping make New Year’s resolutions stick
Photo by Laura Taylor

Pediatrics, Research, Stanford News

Silicon Valley entrepreneur Sean Parker establishes allergy center at Stanford

Silicon Valley entrepreneur Sean Parker establishes allergy center at Stanford

DrKariNadeau-Dec2014Here at Scope, we’ve often written about the life-threatening nature of allergic reactions and the work that Stanford scientists are doing to understand dangerous allergies. For instance, Stanford immunologist Kari Nadeau, MD, PhD, (pictured at right) leads research to combat children’s food allergies with oral immunotherapy, a treatment in which patients consume tiny but gradually increasing doses of their allergy triggers under a doctor’s supervision.

Today, the efforts of Nadeau and other Stanford allergy researchers are receiving a big boost. Silicon Valley entrepreneur and philanthropist Sean Parker has announced that he’s donating $24 million to establish an allergy research center at Stanford, which Nadeau will lead. Parker has a personal interest in the topic because of his own experience with severe food allergies. Scientists at the Sean N. Parker Center for Allergy Research at Stanford University will study the underlying mechanisms of all types of allergies in children and adults and will aim to develop lasting allergy cures.

From the press release about the center’s launch:

“We are excited about the center because there is enormous clinical need for better understanding of and treatment for allergies,” said Lloyd Minor, MD, dean of Stanford University School of Medicine. “For instance, the recent profound increase in the incidence of serious food allergy is fascinating and deeply concerning at the same time. Sean Parker’s generous gift will enable Stanford Medicine experts, under Dr. Nadeau’s leadership, to collaborate and innovate across academic disciplines for the benefit of millions of people with allergies.”

“I am thrilled and honored to direct the Sean N. Parker Center for Allergy Research at Stanford University,” said Dr. Nadeau, associate professor of pediatrics at the medical school and an immunologist at Lucile Packard Children’s Hospital Stanford and Stanford Health Care. “Sean is well-versed in immunology, and has been a fantastic partner to work with. He’s an entrepreneur and visionary, and we look forward to using this gift and center as the springboard to improve the lives of those adults with allergies through immunotherapy that goes beyond oral therapy.”

Previously: Taking a bite out of food allergies: Stanford doctors exploring new ways to help sufferers, Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research and Researchers show how DNA-based test could keep peanut allergy at bay

Cardiovascular Medicine, Events, Research, Stanford News

At Stanford Cardiovascular Institute’s annual retreat, a glimpse into the future of cardiovascular medicine

At Stanford Cardiovascular Institute’s annual retreat, a glimpse into the future of cardiovascular medicine

doctor listening to heartWhat will the future of cardiovascular medicine look like?

A group of scientists, engineers, educators, surgeons, physicians and students explored this question at the Stanford Cardiovascular Institute’s annual retreat earlier this month. More than 100 attendees crowded into Stanford’s Li Ka Shing Center for Learning and Knowledge to learn about the research and advances that will transform cardiovascular care.

“For this year’s retreat we’ve  asked selected members to dig deep into the past and project the future of their specialties,” institute director Joseph Wu, MD, PhD, told the audience.

Talks presented during the day – on topics including sports medicine, stem cells, women’s health and biodesign – reflected the breadth of the institute’s scholarship and the diversity of its members.

Stem cell scientist Hiromitsu Nakuchi, MD, PhD, spoke about recent advances in stem cell biology and regenerative medicine. Only a few years ago, stem cell-based regenerative medicine was widely perceived as the province of science fiction. No more, Nakuchi said. His lab has been working on a new technique to transform human skin cells into induced pluripotent stem cells, or iPS cells, which can then be used to develop organs. The ultimate goal of this research: To create genetically matched human organs in large animals.

Researchers like geneticist Michael Snyder, PhD, envision a day when an “omics” profile will be sequenced before birth, and Snyder took to the stage to discuss the potential of personalized medicine. “I’m a believer in the future,” he said. “Genomics will move medicine from diagnose-and-treat to predict-and-prevent.” After sequencing his own genome and thousands of other biomarkers to create an integrated personal omics profile, Snyder learned that he was at risk for Type 2 diabetes. This knowledge allowed him to transform his diet and ramp up his physical activity, and it provided him a first hand glimpse of the diagnostic power of genomics. Genomic sequencing has the potential to change the way physicians care for patients, Snyder told the audience, resulting in more effective, patient-tailored therapies and a greater focus on disease prevention.

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Research, Sleep

Holiday nightcap? Drinking before bed may be counterproductive

Holiday nightcap? Drinking before bed may be counterproductive

nightcap2

If you’ve ever taken a drink of alcohol before bed to help you fall asleep, you’re not alone – approximately 20 percent of Americans do so regularly. But new research from the University of Missouri shows that while a nightcap can make you sleepy in the short term, regular alcohol consumption before bed interferes with the body’s sleep regulator and can actually cause insomnia.

A study published last month in Alcohol helps us understand alcohol’s effects in a new way. It was previously thought that alcohol shifts the circadian rhythm, the body’s “internal clock,” resulting in simply being sleepy sooner; in fact, it disrupts the mechanism by which the brain “feels” tired. Alcohol increases the production of adenosine, a naturally occurring chemical that accumulates outside cells when you’ve been awake for a long time; it signals the need for sleep by blocking “wakefulness” receptors in the basal forebrain. Adenosine levels decrease during sleep, maintaining the brain’s sleep/wake homeostasis.

Alcohol-induced adenosine wears off too quickly, which makes for less restful sleep in the short term, and can compromise the brain’s ability to maintain homeostasis in the long term (i.e., insomnia).

I asked Stanford sleep expert Brandon Peters, MD, to weigh in and he told me:

I concur that alcohol should not be used as a sleep aid. Though alcohol may induce sleepiness, as it quickly wears off it fragments sleep, leading to awakenings. Alcohol also can relax the muscles of the upper airway and contribute to obstructive sleep apnea and snoring. It is recommended that alcohol not be consumed for the several hours preceding bedtime.

What to do instead? Peters suggests:

Rather than relying on an alcohol-containing nightcap, insomnia can be improved with changes as part of a structured cognitive-behavioral therapy for insomnia (CBTI) program. Sleeping pills are also not a preferred option; you don’t need medication to feel hungry, so why would you need medication to feel sleepy? Sleep is a natural process that can be enhanced with simple interventions. If difficulty falling or staying asleep persists beyond 3 months, assistance should be sought from a board-certified sleep specialist.

Photo by Stephen Janofsky

Clinical Trials, Emergency Medicine, Neuroscience, Research

Clinical trial shows progesterone doesn’t improve recovery from head trauma

Clinical trial shows progesterone doesn't improve recovery from head trauma

800px-thumbnailResearchers had high hopes that progesterone, that multipurpose endogenous steroid, could stave off some of the worst effects of head injuries. A quick injection soon after a blunt trauma and  — wa-zam — marked improvement on the widely used Glasgow Outcome Scale, which measures brain injuries on a scale from death to low disability. Or so they thought.

Instead, a nationwide clinical trial was called off after early analyses showed no benefit. The findings were published last week in The New England Journal of Medicine.

“These results are plainly disappointing,” said lead investigator David Wright, MD, an emergency medicine physician at Emory University, in an Emory release.

Stanford, in partnership with Santa Clara Valley Medical Center and the Regional Medical Center of San Jose, enrolled approximately 80 patients in the study between 2008 and 2013, said James Quinn, MD, a Stanford emergency medicine physician. Quinn said there were many benefits to the study even though the results didn’t suggest an improvement.

“The patients all got great care,” Quinn said.  The care teams worked to ensure the care was standardized and top notch for study participants, he said. In addition, there’s still a possibility that progesterone administered closer to the time of injury might help patients. To adhere with study protocols, the teams had to wait one hour after the patient arrived at the emergency room before providing the progesterone or placebo, Quinn said.

The study had a unique design, in part because emergency trauma patients can often not provide consent. Instead, the research team publicized the study before starting and gave participants the opportunity to opt out when they were able.

Quinn also made note of an observation made by he and his colleagues:  Although nationwide most injuries stemmed from vehicle crashes, the Stanford-led teams saw an abundance of bicycle accidents.

Previously: For prolonged seizures, a quick shot often does the trick, study finds, Stanford Medicine story on surviving brain injury wins health journalism award and Estradiol — but not Premarin — prevents neurodegeneration in women at heightened dementia risk
Photo by U.S. Navy

Fertility, Men's Health, Research, Sleep

Sleep apnea linked with male infertility

Sleep apnea linked with male infertility

14258396551_0d3b8edb81_zOver the past two decades, there have been a number of studies suggesting that men’s sperm counts have been steadily declining. Now research out of Spain and published in the journal Sleep suggests a connection between sleep apnea and decreased sperm production.

Michael Eisenberg, MD, a Stanford expert in male fertility, thinks the results are important but inconclusive. When reached for comment he told me:

My research focuses on the links between a man’s overall health and his reproductive health, so this study has a lot of connections. I think it shows another health factor that can impact fertility; we are seeing sleep apnea more and more commonly, and here’s something showing a link with decreased sperm production. A big drawback of the study is that before we can incorporate it in clinical practice the research needs to be replicated in humans.

The research, conducted collaboratively by research institutions in Spain, induced intermittent hypoxia (lack of oxygen) in male mice to mimic sleep apnea. These mice, along with a control group who had been experiencing normal oxygen levels, were mated, and researchers compared the numbers of pregnant females and fetuses, which were significantly lower for the hypoxic group.

Previously: Male infertility can be warning of hypertension, Stanford study finds, Poor semen quality linked to heightened mortality rate in men and Low sperm count can mean increased cancer risk
Photo by Kelsey

Health Costs, Health Policy, Patient Care, Research

Medicare payment reform shown to cut costs and improve patient care

Medicare payment reform shown to cut costs and improve patient care

PT got Margie practicing on crutches, including going up and down a step.A few years back, the Centers for Medicare and Medicaid Services (CMS) made a straightforward change: No longer would it pay for easily preventable conditions that develop in the hospital. A care-team fails to help ambulate a patient following a hip or knee surgery and the patient develops deep-vein thrombosis? Unfortunate for the patient and unfortunate for the hospita, which now has to absorb the cost of that care.

It seems obvious, yet slightly disturbing, that this approach would be successful. In my idealized worldview, all patients are treated the same, regardless of who’s picking up the tab.

But when you change the financial incentives, change happens. Stanford health economist Jay Bhattacharya, MD, PhD, and health economist Risha Gidwani,DrPH, who is affiliated with the VA and Stanford, found the prevalence of two preventable conditions – deep-vein thrombosis and pulmonary embolisms – for patients with a recent hip or knee surgery dropped after Medicare stopped paying. The study was published today in the Journal of General Internal Medicine.

From our press release on the work:

When CMS stopped paying for treating deep-vein thromboses and pulmonary embolisms, the incidence of those conditions after hip or knee replacement surgery dropped 35 percent in the Medicare population, Gidwani said. In the younger, non-Medicare population, the incidence of these two conditions increased, although they also decreased in the patients over age 65 who had private insurers. There are more than 1 million hip or knee replacements performed in the United States each year, and over 60 percent of them are paid for by Medicare.

“We have a win-win,” Gidwani told me. “We have patients who are avoiding adverse events while Medicare saves money.”

Previously: Beyond Berwick brouhaha: Medicare chief another step to health-care reform, Experts discuss high costs of health-care — and what it will take to change the system and Competition keeps health-care costs low, Stanford study finds
Photo by Dave & Margie Hill

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