Technology

In an effort to better understand the multifaceted nature of childhood obesity, researchers are turning to geographic information systems (GIS) to analyze the role location and living environments play in whether children eat a healthy diet, get enough daily exercise or become overweight or obese.

A special report published in the May issue of American Journal of Preventive Medicine includes a collection of six studies that suggest the characteristics of the neighborhoods where children live and play could be a contributing factor to the high rate of obesity in our country and elsewhere. ABC News reports:

In one study, researchers used geographic information to determine which neighborhoods in King County, Wash. and San Diego County, Calif. rated highest in terms of physical activity and nutrition for children ages 6 through 11. A neighborhood received a high rating if there were ample opportunities to walk to places, such as stores and libraries as well as highly-rated parks.

These neighborhoods also had numerous grocery stores or supermarkets where produce and healthy foods were available.

Neighborhoods that rated poorly had few markets available or had a large number of fast food restaurants and also did not offer many chances to walk or play in high-quality parks. There were also neighborhoods rated in between good and poor.

“The biggest difference we found in rates of obesity were in the places where the environment was good for both nutrition and physical activity, the rates were less than 8 percent, but if the nutrition and physical activity were not good, the rates went up to 16 percent,” said Brian Saelens, a co-author and professor of pediatrics at Seattle Children’s Research Institute.

Saelens added that researchers controlled for other variables that could contribute to obesity, such as income, family status and parental body mass index (BMI).

Other studies in the report found notable differences in daily physical activity levels and food choices of adolescents living in rural, suburban and urban environments suggesting that further study of spatial environments may have important implications for health, education and urban planning policy.

Previously: Hopkins researchers find place, rather than race, may be greater determinant of health, Living near fast food restaurants influences California teens’ eating habits and Using GIS technology to visualize urban ‘food deserts’
Photo by Jessicizer

Updated 04-03-12: TEDMED, the conference exploring innovation in health and medicine, will stream live to the School of Medicine from April 11 to 13.

A video feed of the conference will be available each day at the Li Ka Shing Center for Learning and Knowledge. Here’s where the event will take place each day:

April 11:
Ground floor in LK005 – 5:45 a.m., 8:15 a.m., 11:15 a.m. & 2:00 p.m.

April 12:
Morning: First floor in LK130 – 5:45 a.m. & 8:15 a.m.
Afternoon: First floor in LK102 – 11:15 a.m. & 2:00 p.m.

April 13:
Ground floor in LK005 – 5:45 a.m. & 8:15 a.m.

The simulcast, which is sponsored by the Association of American Medical Colleagues and hosted at the medical school by Information Resources & Technology, is open to faculty, students, staff and members of the Stanford community.

A list of speakers and the schedule are both available from the TEDMED website.

Photo by Norbert von der Groeben

An Associated Press article on iPad use in medical education today examines some of the ways schools are training students to stay present with their future patients when using hand-held technology.

As outlined in the story, a Georgetown University program hires actors to play patients so that students can practice staying mindful, caring, and communicative while still taking advantage of the iPad’s time-saving and information-enhancing features. And:

Across the country at Stanford University this summer, medical students will bring a school-issued iPad along as they begin their bedside training – amid cautions not to get so lost in all the on-screen information that they pay too little attention to the actual patient.

Face your patient, excuse yourself to check the screen and put away the gadget when you don’t really need it, say Stanford guidelines that specialists say make sense for physicians everywhere. And, of course, no personal Internet use in front of a patient.

Previously: Can the use of devices among physicians lead to “distracted doctoring?”, School of Medicine students and staff host iPad show and tell, Is the iPad helping modernize medicine? and Stanford medical and Master of Medicine students will receive iPads
Photo by: p_a_h

Continuing organizational efforts to bring the biomedical sciences to life through casual gaming, the Wellcome Collection has launched a free game that is set inside a fetal brain and models actual biological phenomena found in neural development.

The game, titled Axon, was released in conjunction with the British organization’s upcoming exhibition ‘Brains: The mind as matter.’Brains’ exhibition curator Marius Kwint and neuroscientist Richard Wingate collaborated with developers at London-based games studio Preloaded to produce Axon. According to a Wellcome Collection release:

Taking the anatomy of the brain as a starting point, plus a video showing the microscopic growth of neurons in a chicken’s brain, the ‘Axon’ team combined scientific and games-making expertise to create a challenging, enjoyable and addictive game that has its roots in real science. A concise explanation of the science behind the game, the video and links to Wikipedia articles on neuroanatomy are included within the game.

During the game, players are given the task of making as many of the brain’s 100 trillion connections as they can and growing the neuron as long as possible. In doing so, users climb through brain tissue, compete with rival neurons and score by making connections to distant regions of the brain.

Previously: Can battling sepsis in a game improve the odds for material world wins?, Paramecia PacMan: Researchers create video games using living organisms and Mob science: Video game, EteRNA, lets amateurs advance RNA research
Photo by Wellcome Trust

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases will share their unique stories; the second in our series comes from Laura Haywood-Cory, who survived a rare and potentially fatal heart disorder.

Three years ago, when I was 40 years old, I had a heart attack, caused by a rare thing called a Spontaneous Coronary Artery Dissection, or SCAD.

Arteries are constructed in layers, and a dissection is when the inner layer tears away from the middle later. The torn flap of artery creates a blockage in blood flow to the heart, which can cause a heart attack, cardiac arrest, or death.

After two cardiac catheterizations, six stents, and a week in the hospital, I was sent home with precious little information other than: “SCADs are rare. You’re lucky you survived.”

I’m grateful to the doctors, cath lab staff and everyone at the hospital who took good care of me. I know they can’t possibly know about every long-tail edge case that walks in their doors. But the first two weeks home from the hospital were terrifying. I would keep myself awake for as long as I possibly could, because I was afraid that if I went to sleep, I might never wake up again. That’s a scared and lonely place to be at 3 AM.

As a child of the digital age, I went searching for answers online. As part of my research I came across an online support community, where I connected with other women who’d not only had a SCAD but were several years down the road of recovery and were doing well. These women have been a real lifeline for me, and if not for them, I’d still be lonely, scared, and without any real information on my condition.

Recently I was reading KevinMD and found a post of interest. In the piece, called “Saving patients from internet health information,” Stewart Segal, MD, expresses his frustration with patients who self-diagnose via Google and then decide, unilaterally, on different courses of treatment than what he has prescribed for them.

As a patient with a rare condition that most cardiologists have never encountered, I and others like me have had to become our own experts. And since our numbers are small, we aren’t able to gather for support in person; we do it online.

It seems to me that the answer isn’t to discourage people from seeking medical information from “Dr. Google,” but rather to teach people, starting in school, some critical thinking skills. How to sift the online wheat from the chaff and how to determine which sites have credible information, versus ones that are just selling the latest formula of snake oil. Snopes.com exists for a reason, after all.

As patients, we need to not expect perfection from our doctors until we achieve it in ourselves. And doctors need to give themselves permission to not know everything and to not feel threatened by empowered, educated patients. Who, yes, look things up online.

Laura Haywood-Cory lives in Durham, North Carolina. She recently received a 2012 Woman’s Day Red Dress Award for her role in a Mayo Clinic study on the feasibility of recruiting patients through the use of social media.

Stephen Wolfram, the creator of Wolfram|Alpha, has been collecting details on his intellectual and physical activity for over two decades. In a post yesterday on Wired’s Epicenter blog, Wolfram sifts through the massive volume of personal data and illustrates how such reservoirs of information can be used to teases out interesting tidbits about health and work habits.

After reflecting on the insights provided by his meticulous tracking of daily metrics, he offers his thoughts on the future for personal analytics. He says:

There is so much that can be done. Some of it will focus on large-scale trends, some of it on identifying specific events or anomalies, and some of it on extracting “stories” from personal data.

And in time I’m looking forward to being able to ask Wolfram|Alpha all sorts of things about my life and times — and have it immediately generate reports about them. Not only being able to act as an adjunct to my personal memory, but also to be able to do automatic computational history — explaining how and why things happened — and then making projections and predictions.

As personal analytics develops, it’s going to give us a whole new dimension to experiencing our lives. At first it all may seem quite nerdy (and certainly as I glance back at this blog post there’s a risk of that). But it won’t be long before it’s clear how incredibly useful it all is — and everyone will be doing it, and wondering how they could have ever gotten by before.

Previously: How one quantified-self patient is working to transform health care

Stanford inventors have developed a new sensor that uses a clever combination of antibodies, magnets and laser light to count white blood cells in tiny samples of blood and other body fluids. The device is so small and inexpensive that it could be used nearly anywhere: at doctors’ offices, disaster relief sites, battlefields or patients’ homes. (In the photo at right, the portion of the sensor that holds a blood sample is shown next to a researcher’s blue-gloved fingertip to give a sense of scale.) The inventors, who are now seeking a partner to commercialize the invention, hope it will some day be as ubiquitous as the portable glucometers that diabetics use to test their blood sugar.

A press release I wrote about the invention, which is described in a new paper in the journal Biomicrofluidics, gives details of the sensor’s potential:

“A low-cost way of counting cells could provide point-of-care diagnosis and monitoring for immune disorders, allergies, infections, AIDS, cancer and other disorders,” said Manish Butte, MD, PhD, who led the team of inventors.

…

The body has many types of white blood cells, each with different disease-fighting roles. White blood cell counts already help doctors diagnose some diseases and monitor treatment of others, including cancer and AIDS, but current cell-counting methods require fairly large blood samples and costly, slow equipment that can be operated only by trained laboratory technicians.

One possible application of the new sensor would allow doctors to solve a common, vexing problem: determining the cause of a runny nose. Instead of using the current trial-and-error method for diagnosing the problem, doctors could take a mucus sample from the patient in their office and measure the white blood cells present. Elevation of one type of white blood cells could implicate allergies, another cell type could point to a sinus infection and a third type of elevated cell count could suggest that the runny nose was simply due to the common cold.

Read the whole release for more details, including a description of how the sensor works.

Photo courtesy of Manish Butte

Online therapy could be an effective new tool for treating teens with chronic fatigue syndrome (CFS), according to findings published today in the Lancet.

In the study (subscription required), Dutch researchers assigned 135 teens, who had CFS symptoms for nearly two years, to receive Internet-based behavioral therapy, individual and group behavioral therapy or exercise-based therapy. The web-based treatment, which was developed by the research team, included a 21-module educational component and regular e-mail interactions between patients and specially-trained therapists. Treatment progression was monitored by regular e-mail contacts between therapists, patients, and their parents. Online treatment programs lasted an average of 26 weeks.

Shots reports that study results showed:

After 6 months, 85 percent of the teenagers using Internet-delivered therapy group said they no longer had severe fatigue, compared to 27 percent getting therapy in person. Three-quarters of the Internet group had returned to school, compared to 16 percent of the in-person therapy group.

Researchers speculated that the Internet-based behavioral therapy may have been more effective because it reduced barriers to delivering one-on-one care, allowed patients to work on assignments at their own pace and made therapists more accessible. While CFS is somewhat rare among teens, researchers say the same method could be used in treating children suffering from fatigue during cancer treatment or some forms of headaches.

Previously: Deciphering the puzzle of chronic fatigue syndrome, Unraveling the mystery of chronic fatigue syndrome and Free self-management program offered to people with chronic illness

There’s a fascinating profile of Larry Smarr, PhD, a physicist turned quantified-self pioneer in Technology Review today. Over the years, Smarr has scrupulously measured and tracked his own biological data using laboratory analysis services and devices that monitor his sleep, fitness and eating habits. The information not only improved his health but lead to a surprising diagnosis. Jon Cohen writes:

Smarr, who directs the California Institute for Telecommunications and Information Technology in La Jolla, dropped from 205 to 184 pounds and is now a fit 63-year-old. But his transformation transcends his regular exercise program and carefully managed diet: he has become a poster man for the medical strategy of the future. Over the past decade, he has gathered as much data as he can about his body and then used that information to improve his health. And he has accomplished something that few people at the forefront of the “quantified self” movement have had the opportunity to do: he helped diagnose the emergence of a chronic disease in his body.

…

On top of his pioneering computer science work—he advocated for the adoption of ARPAnet, an early version of the Internet, and students at his University of Illinois center developed Mosaic, the first widely used browser—Smarr spent 25 years as an astrophysicist focused on relativity theory. That gave him the expertise to chart several of his biomarkers over time and then overlay the longitudinal graphs to monitor everything from the immune status of his gut and blood to the function of his heart and the thickness of his arteries. His meticulously collected and organized data helped doctors discover that he has Crohn’s, an inflammatory bowel disease.

As the story goes on to explain, Smarr plans to go public with his personal health data and is working to convince others to do the same in hopes that crowdsourcing the information will generate new insights about the links between DNA sequences, biomarkers and disease. The article is well worth a read and both illustrates and foreshadows the ongoing digital transformation of medicine

Previously: How the C3N project is working to rewrite the medical script and empower patients and ePatient discusses how web-savvy patients are changing the practice of medicine.
Photo by Spanish Flea

In this interesting TED Talk, Lucien Engelen, the founder and curator of TEDxMaastrict, discusses several emerging technologies that he thinks have the potential to change health care, including a crowd-sourced map of defibrillators.

Engelen is also on the advisory board for the Stanford Medicine X conference this September.

A new social network called AnxietySocialNet aims to help people suffering from anxiety disorders address their symptoms, find information and network with others.

Founded by Salomon Ptasevich, a former anxiety sufferer, the site also hopes to attract friends and family members who may be watching a loved one struggle with anxiety who feel helpless or confused about how to help. In a WebWire news release, Ptasevich explains:

The whole idea behind ASN is to allow people to share their emotions in a safe place and learn from each other’s experiences. We try to encourage users to get themselves out there and conquer their anxiety.

AnxietySocialNet hopes to help sufferers of agoraphobia, social anxiety disorders, obsessive compulsive disorder or any of the other forms of anxiety affecting many. The National Institute of Mental Health estimates that anxiety disorders affect as many as 40 million Americans age 18 or older.

Photo courtesy of Thinkstock Photos

An estimated 11,000 women in the United States are diagnosed with cervical cancer each year, and more than 4,000 women die from the disease annually, according to data from the National Cervical Cancer Coalition. In an effort to reduce these figures, the Cervical Cancer-Free Kentucky Initiative introduced a new Facebook application to raise awareness of the cancer and prevention measures such as screenings and the HPV vaccine.

USA Today reports:

The app is part of the Cervical Cancer-Free Kentucky Initiative’s “Cause the Movement” campaign, which promotes education as well as prevention.

“We want to get the message (to) where we know people are getting their information, and Facebook, Twitter and websites are ‘The Thing,’ ” said Dr. Baretta R. Casey, director of the initiative, which is based at the University of Kentucky.

The Facebook application, which can be found at causethemovement.org, incorporates pictures of users’ Facebook pals into an educational video on cervical cancer. The video is viewed from users’ computer screens.

The Cervical Cancer-Free Kentucky Initiative was created through a partnership between Rural Cancer Prevention Center at the University of Kentucky’s College of Public Health to address cervical cancer rates in the state. GlaxoSmithKline provided unrestricted funding for the project.

Previously: Experts weigh in on recommendation that boys be given HPV vaccine and Only one-third of teenage girls get HPV vaccine to prevent cervical cancer
Photo by Stefan 1981

“A single human brain has more switches than all the computers, routers and Internet connections on Earth,” said Stephen J. Smith, PhD, a Stanford professor of molecular and cellular physiology, as he took a Macworld audience on a breathtaking HD video tour of the most amazing computer of all — the brain.

The audience was clearly moved by the beauty of the short film, which takes viewers on a virtual flight through the cerebral cortex of a mouse. “The finished product, titled Synaptaesthesia, was stunning,” Mauricio Grijalva wrote yesterday in a Macworld piece.

Smith and his team have pioneered a method for directly observing brain circuit development, structure and function called “array tomography.” Developed by a consortium of neuroscientists, computer scientists, and lab technicians from Stanford, Harvard, and MIT, this technique opens up a window on the brain that will provide researchers with insights on how to diagnose and treat neurological diseases such as Alzheimer’s. (Smith’s website also features an animated video of a human brain with Alzheimer’s disease.)

While the techie Macworld audience was primarily interested in the how-to aspects of the film — how his team combined electron microscopy, specialized fluorescent molecules from jellyfish, high-resolution photography, super computers and Apple Computer technologies to create the final animation — Smith also explained why he believes the film is so emotionally appealing:

Human beings are hardwired to love the sight of trees because our evolutionary ancestors survived in trees. The brain is a vast forest of hundreds of billions of tree-shaped neurons — what could be more beautiful? Modern physics and computation have finally given us the ability to glimpse this beauty.

Previously: New imaging method developed at Stanford reveals stunning details and Visualizing the brain as a universe of synapses

Can a sophisticated imaging technique be used to determine whether someone is lying? That’s the intriguing question explored in a Scienceline piece yesterday. And for those interested in more on the issue, Stanford’s Hank Greely, JD, an expert on neuroscience and the law, discussed fMRI technology and the ethical questions surrounding its use in an in-depth 2010 NPR interview.

Previously: Functional magnetic resonance imaging could serve as lie-detector test in civil trial

The challenges facing pediatric surgeons was the focus of a recent segment on KQED-FM’s QUEST. During the show, Sanjeev Dutta, MD, described such challenges as “plumbing problems:”

Dutta is a pediatric surgeon at Lucile Packard Children’s Hospital, in Palo Alto, where he operates on children with these and other problems. He says often, the instruments he uses when he does these surgeries weren’t built for tiny babies. They were made for adults.

“We struggle with instruments that were never designed for the type of patient we are working on, and we adapt.”

Dutta says the issue here isn’t safety. Most of these surgeries are, by now, pretty routine. But pediatric surgeons have to improvise in ways other surgeons don’t.

The segment also highlighted how pediatric surgeons, including Dutta, are collaborating with engineers from SRI International to create tools more appropriately sized for tiny patients.