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Cardiovascular Medicine, Medical Apps, Precision health, Research, Stanford News, Technology

MyHeart Counts shows that smartphones are catching on as new research tool

MyHeart Counts shows that smartphones are catching on as new research tool

using iPhone - 560

In the three months since Stanford researcher and cardiologist Michael McConnell, MD, told ABC’s Nightline that the new MyHeart Counts iPhone app would give scientists “a whole new way to do research,” the number of users has continued to steadily climb.

“Traditionally reaching many people to participate in research studies is quite challenging,” McConnell told business correspondent Rebecca Jarvis in March. “The ability to reach people through their phone is one major advance.”

The number of iPhone owners who have downloaded the app and consented to participate in a large-scale study of the human heart has now reached 40,000. In an effort to keep updated on how the app is progressing as a new research method, I reached out to McConnell, the lead investigator of the study, with a few questions. The MyHeart Counts study continues to break ground as a new method for reaching large numbers of research participants in a short amount of time, McConnell told me. Comparing it to traditional research trials, he said:

There have been larger research studies, particularly national efforts to study their populations, but we believe enrolling this many participants in such a short time frame is unprecedented.

The app, which was launched in early March, collects data about users’ physical activity using the smartphone’s built-in motion sensors. Participants also answer surveys concerning their cardiac-risk factors. In return, they get coaching tips and feedback on their chances of developing heart disease.

McConnell says that the next phase of the project, which will use behavior-modification methods to encourage healthy behaviors, is about to be launched. App users will be given more personalized feedback about their individual behaviors and risk, based on the American Heart Association’s Life’s Simple 7 guidance. Future tips will include messages on everything from how to manage blood pressure, eat better, lose weight and control blood sugar. Part of the study is to determine whether these type of “pings” used through apps are actually successful at changing human behavior, McConnell told me:

Healthy behaviors are critical to preventing heart disease and stroke, so the MyHeart Counts app will study which motivational tools are most helpful. This will follow the second activity and fitness assessment… The initial approach will be empowering participants with more personalized feedback about their individual behaviors and risk.

To sign up for the MyHeart Counts study, visit the iTunes store.

Previously: Lights, camera, action — Stanford cardiologist discusses MyHeart counts on ABC’s Nightline, Build it (an easy way to join research studies) and the volunteers will comeMyHeart Counts app debuts with a splash and Stanford launches iPhone app to study heart health
Photo by Japanexperterna (CC BY-SA)

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 

Bioengineering, Global Health, Stanford News, Technology

Success breeds success: Early innovators in India created a sense of possibility

Success breeds success: Early innovators in India created a sense of possibility

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.

MATERNAL & INFANT MORTALITY IN DEVELOPING COUNTRIESAnurag Mairal, PhD, MBA, director of global exchange programs, joined Stanford-India Biodesign in 2008 to help fellows navigate challenges in designing new medical technology in India, which at the time had great need but little infrastructure for developing and marketing new technologies. I recently spoke with him about the program.

What were the challenges for Biodesign in India when you started?

When I joined Stanford-India Biodesign I felt it was going to be a difficult ride knowing India at that time. The mindset in India is very traditional and doesn’t allow people to step out of the box. Here in the United States what is remarkable is that we have everything across the street. Design, prototypes, animal labs, testing facilities, venture capital — they are all easily accessible. In India none of that existed. We needed to build all of that because it was going to be important to the success of Biodesign.

I had experience in emerging markets and was able to step in when the fellows needed to start thinking about markets for their products. I had a good understanding of the needs and also what challenges a typical medical device would face.

Have things changed?

One of the remarkable things that happened is that not only was the program successful, it affected other institutions in India in both the private sector and academia. A lot of innovators are now working on new technologies across India. Now we need to help all of them with commercializing the technology.

Success breeds success. When one group has success developing a medical technology it makes other people believe it is possible. That sense of possibility and reality has been a major accomplishment. The success of the early fellows and the ecosystem we built around them brought people together and energized the following batches of innovators. Now there is no doubt that medical device innovation is a real thing in India. It’s a remarkable shift in tone in that marketplace.

What is next for Stanford-India Biodesign now that fellows won’t be spending extensive time at Stanford?

Phase 1 of Stanford-India Biodesign was training fellows in the Biodesign process. Most of those previous fellows are in development mode now, and we see challenges in commercializing their products. I think there is a lot of work that needs to happen before these technologies are successful in the marketplace in India. Phase 2 will focus on training entrepreneurs and innovators on the entire process of developing and commercializing a product.

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Bioengineering, Global Health, Medicine and Society, Research, Stanford News, Technology

National Geographic: “Emerging Explorer” Manu Prakash helping “lead a new age of discovery”

National Geographic: "Emerging Explorer" Manu Prakash helping "lead a new age of discovery"

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As I’ve gotten busier, and my life has moved online, I’ve let most of my magazine subscriptions lapse. All except for National Geographic, which both my husband and I continue to enjoy each month.

With its storied history, familiar yellow cover, knock-your-socks-off photography and carefully crafted science and social science features, I consider it a good use of precious paper (and pennies).

So I was psyched to hear that Stanford’s own Manu Prakash, PhD, has been named by the publication as one of 14 2015 National Geographic Emerging Explorers. Prakash is most well-known for the Foldscope, a low-cost paper microscope that has been sent to 130 countries, but he’s also working on constructing a small-scale chemistry kit and on a variety of other projects. As summarized in a National Geographic article, he “specializes in what he calls ‘frugal science,’ designing inexpensive laboratory instruments that can spread science and medical opportunity around the world.”

Thanks to the Explorers program, he’ll gain $10,000 to support his research and a year in the international spotlight. As indicated in the article, expectations of him and the other winners are high:

“Our Emerging Explorers are inspiring young visionaries who are looking at ways to remedy global problems and are undertaking innovative research and exploration,” said Terry Garcia, National Geographic’s chief science and exploration office. “They will help lead a new age of discovery.”

Here’s to looking forward to year of innovative “frugal sciences” creations from the Prakash lab.

Previously: Microscopes for the masses: How a Stanford bioengineer is helping everyone “think like scientists”, Miniature chemistry kit brings science out of the lab and into the classroom or field, Stanford bioengineer among Popular Science magazine’s “Brilliant 10″Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur and Stanford bioengineer develops a 50-cent paper microscope
Photo, of Manu Prakash and a group of children in Nigeria, courtesy of Prakash

Ethics, Imaging, Medicine and Society, Neuroscience, Research, Stanford News, Technology

Hidden memories: A bit of coaching allows subjects to cloak memories from fMRI detector

Hidden memories: A bit of coaching allows subjects to cloak memories from fMRI detector

11501949224_dac2b41c91_zImagine the usefulness of knowing if someone is drawing on a memory or experiencing something for the first time. “No, officer, I’ve never seen that person before.” 

That’s possible, using an algorithm that interprets brain scans developed by a team of Stanford researchers led by psychology professor Anthony Wagner, PhD. But according to a Stanford Report articleit’s also possible to fool that same program when subjects are coached to hide their memory.

The program, or decoder, capitalizes on the complexity of memory, which taps many different regions of the brain. They use functional magnetic resonance imaging (fMRI) to view which parts of the brain are active.

Hoping to illustrate the limits of their own creation, the researchers asked 24 study participants to study a series of faces. The next day, they exposed them to some of the same faces mixed with entirely new faces:

“We gave them two very specific strategies: If you remember seeing the face before, conceal your memory of that face by specifically focusing on features of the photo that you hadn’t noticed before, such as the lighting or the contours of the face, anything that’s novel to distract you from attending to the memory,” said Melina Uncapher, PhD, a research scientist in Wagner’s lab. “Likewise, if you see a brand-new face, think of a memory or a person that this face reminds you of and try to generate as much rich detail about that face as you can, which will make your brain look like it’s in a state of remembering.”

With just two minutes of coaching and training, the subjects became proficient at fooling the algorithm: The accuracy of the decoder fell to 50 percent, or no better than a coin-flip decision.

The new study shows that imaging technology alone will not be able to “pull about the truth about memory in all contexts,” Wagner said. And, as pointed out in the article, he “sees [the results] as potentially troubling for the goals of one day using fMRI to judge ‘ground truth’ in law cases.”

Previously: Memory of everyday events may be compromised by sleep apnea, The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learningResearchers explore the minds of man’s best friend using fMRI technology, Using fMRI for lie detection and Brain scan used in court in potential fMRI first
Photo by David Schiersner

Bioengineering, Microbiology, Research, Technology

Basic biochemical puzzles that help diagnose and treat disease

Basic biochemical puzzles that help diagnose and treat disease

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

Pehr Harbury, PhD, has made a career out of solving biochemical puzzles. An associate professor of biochemistry, Harbury and his team are juggling quite a few challenges, including an effort to assemble a library of small molecules. Here’s Harbury in the video above:

One central area has been to develop techniques to perform the directed evolution of small molecules in much the same way that nature has produced the vast collection of natural products that are central to medicine.

Team members then examine the molecules to search for ones that interact with natural compounds, potentially conferring beneficial properties.

Harbury is also working to understand the shapes that proteins make when they’re in solution – “a problem that remains largely unsolved.” He describes several other projects – some which he said could lead to an earlier diagnosis for pulmonary hypertension or cancer – in the video above.

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

Previously: Getting a glimpse of the shape molecules actually take in the cell, New painkiller could tackle pain, without risk of addiction and Another piece of the pulmonary-hypertension puzzle gets plugged into place

Bioengineering, Cardiovascular Medicine, Stanford News, Surgery, Technology

A jugaad for keeping pacemakers in place

A jugaad for keeping pacemakers in place

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.

IMG_6308After months of observing clinics and winnowing down the most pressing (and commercially viable) medical needs, the Stanford-India Biodesign team has developed what looks like nothing so much as a very elaborate clothespin. It is intended to help doctors ensure that coiled pacemaker leads that screw into heart tissue stay put. Currently, about five percent of those leads fall out, requiring costly additional surgery. Worldwide, the number of people whose leads fall out is estimated at 80,000 to 100,000.

Debayan Saha says their prototype is a perfect example of Indian Jugaad. It’s made of what looks like the contents of a scrap pile, and he says could both work and be cheap to produce in it’s current low-tech form. But just because it’s inexpensive doesn’t mean it’s not cleverly designed. That’s what the Indian team brings to Biodesign, he said – smart technology at low cost.

“Getting the prototype exactly right made use of all the resources we have here at Stanford,” Saha said. “But the final product is something we could produce at very low cost.” Creating technology in a developing country requires creative solutions to keep that technology affordable.

IMG_6326The group has a provisional patent on their device and they will present their it to the entire biodesign team June 8. Until that presentation they are keeping it’s exact function under wraps. They did recently test the prototype in a lamb heart, with good results. They were consistently able to screw the pacemaker lead more securely into the heart tissue.

Harsh Sheth, MD, said the team (which also includes Shashi Ranjan, PhD) will be heading back to India at the end of June and will repeat the same process there – visiting clinics, assessing needs, and prototyping a solution. He said they might later return to their Stanford prototype or keep working on whatever they design in India.

Previously: From popsicle sticks to improved medical careThe next challenge for biodesign: constraining health-care costs and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photos, of Debayan Saha screwing a pacemaker lead into a lamb heart using their prototype, and of the coiled screw going into the heart, courtesy of Amy Adams

Health Policy, In the News, Patient Care, Stanford News, Technology

Exploring electronic health reminders’ effect on quality of care

Exploring electronic health reminders' effect on quality of care

It’s not every day that the director of the National Institutes of Health blogs about your research. But that’s the day that David Chan, MD, PhD, assistant professor of medicine, recently had when NIH Director Francis Collins, MD, PhD, highlighted his work.

Chan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research, is exploring the impact of electronic health record reminders on the quality of primary care. He received an NIH Early Independence Award last year for his work in this area.

Collins writes:

Is 5 too few and 40 too many? That’s one of many questions that… Chan is asking about the clinical reminders embedded into those electronic health record (EHR) systems increasingly used at your doctor’s office or local hospital. Electronic reminders, which are similar to the popups that appear when installing software on your computer, flag items for healthcare professionals to consider when they are seeing patients. Depending on the type of reminder used in the EHR—and there are many types—these timely messages may range from a simple prompt to write a prescription to complex recommendations for follow-up testing and specialist referrals.

More details on Chan’s work can be found in the full post.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research.

Previously: A new tool for tracking harm in hospitalized childrenAutomated safety checklists prevent hospital-acquired infections, Stanford team finds and Can sharing patient records among hospitals eliminate duplicate tests and cut costs?

Big data, BigDataMed15, Events, Medicine and Society, Research, Stanford News, Technology

A look back at Stanford’s Big Data in Biomedicine

A look back at Stanford's Big Data in Biomedicine

Ashley - 560

We reported many of the happenings at last week’s Big Data in Biomedicine here on Scope. Writer Bruce Goldman was also in attendance for the three-day event, and he captured the conversation in a just-published Inside Stanford Medicine piece.

Previously: At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision healthAt Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcingExperts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patientsOn the move: Big Data in Biomedicine goes mobile with discussion on mHealth and Big Data in Biomedicine panelists: Genomics’ future is bright
Photo of Euan Ashley, MD, welcoming conference attendees last Wednesday, by Saul Bromberger

Medical Education, Medical Schools, Stanford News, Technology, Videos

Using the “flipped classroom” model to bring medical education into the 21st century

Using the "flipped classroom" model to bring medical education into the 21st century

To make better use of the fixed amount of instructional time available to train doctors, Stanford and four other institutions are collaborating with the Robert Wood Johnson Foundation on an initiative to dramatically change medical education. They’re doing this by reversing the traditional teaching method of classroom time being reserved for lectures and problem-solving exercises being completed outside of school as homework. This “flipped classroom” model aims to help students engage with the material that they’re learning and create a foundational context for this new knowledge so they’re more prepared to apply it at the bedside.

The above video describes the initiative and how educators are creating new interactive teaching tools to integrate the basic science curricula with the diseases, infections and conditions that students will see during their clinical training. As mentioned in a previous post on Scope, students have been involved in every step of the process to make sure the new curriculum is clear, compelling and relevant. “It’s really rewarding to have this opportunity to impact the education of other medical students all across the country,” Jennifer DeCoste-Lopez, a final-year Stanford medical student, comments.

Stanford is partnering on the initiative with Duke University, the University of Michigan, the University of California at San Francisco, and the University of Washington.

Previously: Stanford Medicine’s Lloyd Minor on re-conceiving medical educationFlip it up: How the flipped classroom boosts faculty interest in teaching, A closer look at using the “flipped classroom” model at the School of MedicineUsing technology and more to reimagine medical education and Using the “flipped classroom” model to re-imagine medical education

Stanford Medicine Resources: