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Applied Biotechnology, Bioengineering, Ophthalmology, Research, Science, Technology

New retinal implant could restore sight

New retinal implant could restore sight

2618400441_c19946dff4_zIf your car battery runs out of juice, the car won’t run, but that doesn’t mean it’s time to scrap the car. Similarly (at least slightly), if your photoreceptors are worn out due to a disease such as retinitis pigmentosa or macular degeneration, then you might not be able to see, but your eyes still have a lot of functioning parts.

That’s the principle behind a new retinal implant developed by team of Stanford-led researchers. Unlike previous devices, which require wires and unwieldy surgeries, the new implant is wireless and needs only a minimally invasive surgery to inject a small, photovoltaic chip inside the eye. The team published their results in Nature Medicine.

That chip capitalizes on the remaining capabilities of existing retinal cells known as bipolar and ganglion cells and produces more refined images than existing devices. The chip responds to signals from special glasses worn by the recipient.

“The performance we’re observing at the moment is very encouraging,” Georges Goetz, a lead author of the paper and graduate student in electrical engineering at Stanford, said in our press release. “Based on our current results, we hope that human recipients of this implant will be able to recognize objects and move about.”

The implant has only been used in animal studies, but a clinical trial is planned next year in France.

“Eventually, we hope this technology will restore vision of 20/120,” co-senior author Daniel Palanker, PhD, told me. “And if it works that well, it will become relevant to patients with age-related macular degeneration.”

Previously: Stanford researchers develop solar powered wireless retinal implant, Factors driving prescription decisions for macular degeneration complex — and costly and Tiny size, big impact: Ultrasound powers miniature medical implant 
Photo by Ali T

Ask Stanford Med, Bioengineering, Cardiovascular Medicine, Stanford News, Technology

The next challenge for biodesign: constraining health-care costs

The next challenge for biodesign: constraining health-care costs

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

5445002411_0f22229afd_z 300Founder and director of the Stanford Biodesign Program Paul Yock, MD, describes himself as a “gismologist.” His inventions include a balloon angioplasty system that is in widespread use and many other devices primarily related to ultrasound imaging of the vascular system. I recently spoke with him about the program he helped found, the iterative biodesign process, and the ongoing relationship with the Stanford-India Biodesign Program.

What’s next for the Stanford Biodesign Program?

We’ve been really pleased with the results of the Biodesign Program so far in terms of being able to take newcomers into the process, then repeatedly and reliably seeing good ideas coming out and seeing patients getting treated from those good ideas.

The challenge is that the world has changed profoundly since we founded this program. There’s no question that new technologies – despite being good for patients – contribute to escalation of health-care costs. We are in a phase of reinventing our process to take into account the fact that the sickest patient in the system is the system itself. We have to invent technologies that help constrain costs. We will need to modify the process of needs-finding not only to look for important clinical needs but important value needs as well. Inventors in general don’t like thinking about economics and so we have to not only figure out how to update the process but also figure out how to make it attractive for our fellows to learn and practice.

Could the India fellows help you incorporate affordability into the process?

One of the big reasons we decided to do the India program in the first place was to shock our system into thinking about really affordable technology innovation. It is remarkable how good our fellows from India are at thinking this way and how immersed they have been from an early age with value-based design and invention.

Affordability is very much a part of the Indian culture and technology innovation is clearly something that we are very good at here. I think we have only started to capitalize on the fusion of their culture and ours. I think there is a hybridization here that really is going to be cool. Our grand strategy is to have a number of different platforms – it could be companies, incubators, or other experiences – where our fellows can get a deep exposure in India. We aren’t fans of parachuting people in for two weeks to invent something good to give to India. What we really want to do is have trainees get a deep experience in what it’s like to invent and develop technologies in that setting to influence the way we invent here.

How did you arrive at the drawn out, iterative process the fellows use to identify medical needs they want to address?

There’s a long tradition of what is called user centered design that says if you want to design a product you need to talk to the user and understand what their needs are. That’s essentially where our process starts. What’s fundamentally different with health care is that there isn’t just one user. There’s this really complex network of stakeholders who influence whether a technology will actually make it into patient care. You can’t just design for the patient because there are also the doctors, nurses, hospitals, insurance companies, regulatory agencies and financers to name a few. To make it all still more complex, this whole system is in tremendous flux because of health-care reform.

So what we’ve done is blow out the needs characterization stage to take all these stakeholders into account in a rigorous way, up front, before any inventing happens.  There’s also a bit of psychology at play here. In health care it is really easy to fall in love with the first need that comes your way. Looked at in isolation, pretty much any clinical need looks compelling. You need to put in a disciplined process, a semi-quantitative way of weighing one need against the other in order to make a good decision about which need to pursue. It is easier to get rid of the one you thought you loved if it really doesn’t meet the criteria you set out.

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Neuroscience, Research, Stanford News, Technology

Stanford’s Karl Deisseroth awarded prestigious Albany Prize

Stanford's Karl Deisseroth awarded prestigious Albany Prize

Karl D with light - 560

Prizes abound for the most skillful of scientists, but a few stand out as particularly significant ones. The Albany Medical Center Prize in Medicine and Biomedical Research, which honors top biomedical researchers, is one of those prizes.

And today, before the sun rose over Stanford University, Karl Deisseroth, MD, PhD, was awarded the 2015 Albany Prize for his pioneering work in optogenetics. He will share the $500,000 cash award with Sunney Xie, PhD, a professor of chemistry and chemical biology at Harvard.

Deisseroth commented in our release:

It’s a great honor to receive this prize. The recognition of optogenetics is not only a testament to the creativity and vigor of everyone in the lab and our collaborators over the last decade or more, but also a signal to the world beyond the scientific community regarding the importance of basic science research to understanding the biology of health and disease.”

Optogenetics is a technique that enables researchers to control neurons in living animals.

The Albany Prize was founded in 2000 with a $50 million gift from New York philanthropist Marty Silverman. It is the United States’ highest value prize in medicine and biomedical research.

Previously: New York Times profiles Stanford’s Karl Deisseroth and his work in optogenetics, An in-depth look at the career of Stanford’s Karl Deisseroth, “a major name in science” and Optogenetics: Offering new insights into brain disorders
Photo by Lee Abel

Imaging, Research, Stanford News, Stroke, Technology

Image-interpretation software could open window of treatment for stroke

Image-interpretation software could open window of treatment for stroke

open windowRestoring blood flow to the brain quickly after a stroke is key to damage control as well as to optimal recovery. But restoring blood flow to brain tissue that is already dead can cause problems, like swelling and hemorrhage.

That makes the treatment of choice – an intravenous dose of a substance called tPA, which dissolves clots – a double-edged sword. The consensus in the medical community is that tPA is not a good idea once 4-1/2 hours have elapsed since a patient has suffered a stroke.

But the consensus is based on averages, derived from numerous studies. Clinicians have tended to treat that 4-1/2 hour time-point as analogous to a window slamming shut. Yet every stroke, and every patient who experiences one, is unique.

A new study published in the New England Journal of Medicine joins three earlier ones that show improved results when tPA administration is combined with the insertion of a device – a so-called stent retriever – that can mechanically break up clots in the brain.

Even more exciting, two of the four studies, including the new one, employed software called RAPID – designed and developed at Stanford at the instigation of Stanford neurologist Greg Albers, MD – that quickly interprets brain scans of patients and helps clinicians decide which patients will benefit from supplementing the standard intravenous tPA infusion with the stent retrieval procedure. In both of these two studies, substantial majorities of patients selected as good candidates for the combination had extremely high rates of solid recovery as measured three months after their stroke – the best results ever obtained in stroke studies.

Albers, who is also one of the co-authors of the new NEJM study, hopes to move stroke care away from the clock on the wall and instead focus on a biological clock – what the brain image shows to be going on inside this patient’s brain, now – so that each patient’s care can be individualized and optimized. It could turn out that for some patients, 4-1/2 hours after a stroke is already too late for aggressive clot-busting treatment, while for others the window remains wide open for 6, 7, 8 hours or longer.

Previously: Targeted stimulation of specific brain cells boosts stroke recovery in mice, Calling all pharmacologists: Stroke-recovery mechanism found, small molecule needed and Stanford neuroscientists uncover potential drug treatment for stroke
Photo by glasseyes view

Biomed Bites, Immunology, Research, Science, Technology, Videos

Not immune from the charms of the immune system

Not immune from the charms of the immune system

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

Once upon a time, a researcher named Holden Maecker, PhD, met flow cytometry, a technique used to examine cells by suspending them in fluid and then passing them by an electronic detector.

A match that could only be made in a science lab, Maecker was hooked. Maecker tells the tale in the video above:

Flow cytometry is a great technique for looking at the immune system and it’s also a little bit of an art, which also attracted me. It’s something that not everybody can do perfectly well and I got a little bit good at it and decided it was a fun thing to do and a good way to look at the immune system.

Maecker and flow cytometry haven’t parted, yet he’s broadened his mastery of a variety of other techniques to study the immune system as the director of Stanford’s Human Immune Monitoring Center.

“It’s a very interesting position because it allows me to collaberate with a lot of different peopel doing projects that have to do wiht human immune responses — everything from sleep apnea and wound healing to flu vaccines and HIV infections,” Maecker said. “It’s amazing the breadth we have here [at Stanford].”

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

Previously: Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology’s Holy Grail, Immunology meets infotech and Stanford Medicine magazine traverses the immune system

Biomed Bites, Imaging, Neuroscience, Research, Technology, Videos

Peering under the hood – of the brain

Peering under the hood - of the brain

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

Fixing a broken brain is much like fixing a malfunctioning car, misbehaving computer or most anything else that isn’t working as it should.

“Whenever we’re trying to fix something that’s broken, it can be very helpful indeed to understand how that thing works,” says Stephen Smith, PhD, in the video above. “I believe the brain does not pose an exception to this rule.”

That’s why Smith, a professor of molecular and cellular biology, emeritus, has spent his career developing better ways to understand — and see — the brain.

Currently, he’s most excited about a technique called array tomography that allows researchers to observe the brain’s wiring, the linkages between neurons, and gain a better understanding of how it functions.

That technique, as well as others, offers real hope for fixing brains broken by autism, Alzheimer’s disease or other brain disorders. Here’s Smith:

I think the progress we’re making today in understanding basic brain mechanisms is likely to help us greatly as we develop new drugs that can help lessen or reverse the wide array of neurodegenerative or neurodevelopmental or injury-related disorders of the brain.

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

Previously: Visualizing the brain as a Universe of synapses, Examining the potential of creating new synapses in old or damaged brains and Fantastic voyage: Stanford researcher offers a virtual flight through the brain

Big data, Imaging, Neuroscience, Research, Science, Stanford News, Technology, Videos

All data – big and small – informs large-scale neuroscience project

All data - big and small - informs large-scale neuroscience project

The thought of gaining access to data from thousands of brains would make most neuroscientists salivate. But now, a team of Stanford and Oxford researchers is able to do just that. Led by Jennifer McNab, PhD, assistant professor of radiology, the group compares magnetic resonance images from as many as 100,000 people with in-depth 3-D scans developed using CLARITY, a technique developed at Stanford that visualizes intact tissue.

“This is a tremendous resource in terms of scientists being able to look and see who develops a particular disease and who does not and why that may be,” McNab said in the video above.

Her team — which includes Karl Deisseroth, MD, PhD; Michael Zeineh, MD, PhD and Michael Greicius, MD, MpH — is tapping the U.K. Biobank, which has about 500,000 participants. It also uses data from the NIH Human Connectome Project, which could include up to 1,200 MRI images. The project received a 2014 Big Data for Human Health Seed Grant and is part of Stanford Medicine’s Biomedical Data Science Initiative (BDSI), which strives to make powerful transformations in human health and scientific discovery by fostering innovative collaborations among medical researchers, computer scientists, statisticians and physicians.

The project uses two distinct types of “big data.” The large databases with hundreds of entries clearly falls under this umbrella, but even one dataset from CLARITY, which produces extremely high-resolution images, produces big data, she said.

The project may make it possible to glean more diagnostic information from MRIs, McNab said. “Then we can hopefully develop early biomarkers of disease that will ultimately help to guide treatment plans and preventative measures,” she said.

This project offers just a glimpse at the potential of data science. For more on important work being done in this area, mark your calendars for Stanford’s Big Data in Biomedicine conference May 20-22. More information is available here.

Previously: Registration for the Big Data in Biomedicine Conference now open, How CLARITY offers an unprecedented 3-D view of the brain’s neural structure and Euan Ashley discusses harnessing big data to drive innovation for a healthier world

Events, Medicine X, Patient Care, Stanford News, Technology, Videos

Medicine X conference to focus on the theme of “Great eXpectations”

Medicine X conference to focus on the theme of "Great eXpectations"

Known for its powerful patient stories and candid on-stage conversations, the Medicine X conference returns to campus on Sept. 25-27. This year’s program will focus on the theme “Great eXpectations” and explore five key areas, including the challenges associated with accessing health care as you age, the misconceptions and misperceptions faced by patients and population health from the patient perspective.

In a press release about the upcoming conference, Lloyd Minor, MD, dean of the School of Medicine, noted, “The brightest minds and the most innovative thinking converge at Stanford Medicine X — the intersection of medicine and technology… This is one of the most thought-provoking and important events in health care today and will help pave the way for how technology enables patient-centered and patient-driven care in the years to come.”

During the three-day event, Peter Bach, MD, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, will deliver a keynote address. Bach is a physician and health-policy expert whose research focuses on the cost and value of anti-cancer drugs. An accomplished writer, he has authored numerous op-eds on health care, but is perhaps most well-known for his New York Magazine essay “The Day I Started Lying to Ruth” about losing his wife to cancer. Other confirmed speakers include cellist and composer Zoë Keating; Robert Pearl, MD, executive director and CEO of The Permanente Medical Group; and 91-year-old IDEO designer Barbara Beskind.

Registration for Medicine X is now open. More details about the program can be found on the Medicine X website.

More news about the conference is available in the Medicine X category.

Previously: Registration now open for the inaugural Stanford Medicine X|ED conference, Stanford Medicine X: From an “annual meeting to a global movement” and A doctor recounts his wife’s battle with cancer: “My knowledge was too clear-eyed”

Pediatrics, Research, Technology, Videos

Monitoring patients’ vital signs using a touch-free video system

Monitoring patients’ vital signs using a touch-free video system

When Rice University graduate student Mayank Kumar and colleagues visited Texas Children’s Hospital in 2013 they took note of the tangle of wires attached to premature infants to monitor their vitals. The wires frequently had to be removed or adjusted, which can potentially damage the preemies’ delicate skin, whenever mothers fed or cared for the babies.

So Kumar and Rice University professors Ashok Veeraraghavan, PhD, and Ashutosh Sabharwal, PhD, developed a video camera-based system that measures patients’ pulse and breathing by analyzing the changes in their skin color over time.

The system, called DistancePPG, corrects for challenges that have caused similar technology to be unreliable such as low-light conditions, dark skin tones and movement. According to a university release:

The Rice team solved these challenges by adding a method to average skin-color change signals from different areas of the face and an algorithm to track a subject’s nose, eyes, mouth and whole face.

“Our key finding was that the strength of the skin-color change signal is different in different regions of the face, so we developed a weighted-averaging algorithm,” Kumar said. “It improved the accuracy of derived vital signs, rapidly expanding the scope, viability, reach and utility of camera-based vital-sign monitoring.”

By incorporating tracking to compensate for movement — even a smile — DistancePPG perceived a pulse rate to within one beat per minute, even for diverse skin tones under varied lighting conditions.

Kumar said he expects the software to find its way to mobile phones, tablets and computers so people can reliably measure their own vital signs whenever and wherever they choose.

There’s more about how the system works in the above video.

Previously: Ultra-thin flexible device offers non-invasive method of monitoring heart health, blood pressure and Researchers develop mirror that reflects your vital signs

Bioengineering, Cardiovascular Medicine, Stanford News, Technology

Defining a new way of thinking: Slower decisions could result in better medical devices

Defining a new way of thinking: Slower decisions could result in better medical devices

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

2331754875_e6a2a81429_zIt’s now early April – half way through the six-month fellowship – and the Stanford-India Biodesign fellows are still figuring out what medical need they’re going to address during their time at Stanford. On June 8 they’ll be revealing prototypes. For many past students in this program, those prototypes have gone on to launch successful companies.

That’s not to say that the fellows are slow, it’s just to say that the Biodesign process the fellows are learning takes time – more time than I, for one, had expected.

I asked the fellows if they thought they would be able to take this painstaking approach into the real world, where people make much faster and often less careful decisions when developing medical devices.

“We hope this will define a new way of thinking,” Debayan Saha, one of the fellows, told me. As a group they also said they were learning a lot about the value of slow decisions.

As an example, they pointed to one of the 35 medical needs still on the “maybe” list, down from more than 300 they had identified during clinical visits. This one had to do with measuring levels of molecules in the blood. At each step, they’d scored the medical needs on their list against a criterion, like the number of people it applied to or the cost of letting that need go untreated. That allowed them to strategically eliminate needs that seemed worth addressing at first blush, but that wouldn’t make business sense.

At each round, this one medical need scored near the top. It had been looking like a real contender for the one they might eventually chose to address.

Then came today, when the fellows were scoring whether other devices already address the need and the cost spent each year if the need wasn’t addressed. That gave them a sense of whether there was a market for any device they might develop. That need, which had seemed so strong, scored low, much to the team’s surprise.

“This had been a favorite but this is the first time we are seeing that it is maybe not a great need,” Shashi Ranjan, PhD, told me. Harsh Sheth, MD, emphasized that in other settings where people make much faster decisions they might have ended up wasting time prototyping a device that would never find a place in the market.

To my eye, this careful approach makes the final selection almost seem inevitable (though not obvious at the outset). The team knows the criteria they have to meet (good market size, few competing devices, no patents standing in the way of eventually marketing their device) and they have a list of options.

From there, it’s a matter of slowly assessing which option best fits the criteria, which seems like a lesson that goes well beyond designing medical devices: Choosing health insurance. Buying cars. They are learning a lesson in good decision-making along with how to develop and market devices.

Previously: Following the heart and the mind in biodesignWriting a “very specific sentence” is critical for good biodesign and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photo by John Morgan

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