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Medical Education, Medical Schools, Mental Health, SMS Unplugged

Free from school

Free from school

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

girls running

Summer. It beckons with strawberry warm rays of sunlight, afternoons spent splashing in a pool, and the joys of watermelon-flavored popsicles. We, second-year medical students around the country, look out our windows and see children, newly freed from school, frolicking in the playground next door – and feel miserable. For this is the time when we are experiencing the worst of medical school.

We have completed the pre-clinical curriculum, some of us barely crawling across the finish line. We have spent weeks cramming for the USMLE, an exam described in no softer terms than “the most important exam you will take in your life.” And we are becoming familiar with a new kind of anxiety as we prepare to enter clinics for the first time. Or, rather, my classmates are – I chose to take time off between second and third year.

In the midst of Stanford-high expectations for our professional performance, we are seldom taught exactly how to take care of ourselves. I knew that I needed to change something halfway through second year when I found myself outlining a novel instead of studying during finals week. I nearly failed two exams. But I was happy.

I felt satisfied.

And so, I set about finding a way to incorporate more of writing into my medical school experience. Stanford has funding called Medical Scholars, which is set aside for every medical student to take a year off to work on a significant project or research experience. Their office willingly helped me apply for and receive this funding to work on my novel full-time for a year. I can’t imagine this level of support for an artistic endeavor from any other medical school. And so very soon, I too will be frolicking in the grass, newly freed from school.

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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

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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

Autism, Mental Health, Neuroscience, Research, Science, Stanford News, Stem Cells

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

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Mental disorders like autism and schizophrenia are notoriously difficult to study at the molecular level. Understandably, people are reluctant to donate pieces of living brain for study, and postmortem tissue lets researchers see the structure, but not the function, of the cells.

Now researchers in the laboratories of psychiatrist Sergiu Pasca, MD, and neurobiologist Ben Barres, PhD, have found a way to make balls of cells that mimic the activity of the human cortex. They use a person’s skin cells, so the resulting “human cortical spheroid” has the same genetic composition as the donor. The research was published in Nature Methods yesterday.

According to our release:

Previous attempts to create patient-specific neural tissue for study have either generated two-dimensional colonies of immature neurons that do not create functional synapses, or required an external matrix on which to grow the cells in a series of laborious and technically difficult steps.

In contrast, the researchers found they were able to easily make hundreds of what they’ve termed “human cortical spheroids” using a single human skin sample. These spheroids grow to be as large as 5 millimeters in diameter and can be maintained in the laboratory for nine months or more. They exhibit complex neural network activity and can be studied with techniques well-honed in animal models.

The researchers, which include neonatology fellow Anca Pasca, MD, and graduate student Steven Sloan, hope to use the technique to help understand how the human brain develops, and what sometimes goes wrong. As described by Barres:

The power and promise of this new method is extraordinary. For instance, for developmental brain disorders, one could take skin cells from any patient and literally replay the development of their brain in a culture dish to figure out exactly what step of development went awry — and how it might be corrected.

The research is starting to garner attention, including this nice article from Wired yesterday. Pasca’s eager to note, however, that he’s not working to create entire brains, which would be ethically and technically challenging, to say the least. But simply generating even a few of the cell types in the cortex will give researchers a much larger canvas with which to study some devastating conditions. As Pasca notes in our release:

I am a physician by training. We are often very limited in the therapeutic options we can offer patients with mental disorders. The ability to investigate in a dish neuronal and glial function, as well as network activity, starting from patient’s own cells, has the potential to bring novel insights into psychiatric disorders and their treatment.

Previously: More than just glue, glial cells challenge neuron’s top slot and Star-shaped cells nab new starring role in sculpting brain circuits
Photo of spheroid cross-section by Anca Pasca

Bioengineering, Research, Science, Stanford News

Fly-snatching robot speeds biomedical research

Fly-snatching robot speeds biomedical research

The drosophila hangs unharmed lifted by the robot’s suction tube.

It looks like nothing so much as a miniature UFO hovering over a plate of unsuspecting flies. When it’s ready to strike, it flashes a brief infrared blast of light that reflects off the animals’ backs, indicating the location of each insect. Then, a tiny, narrow suction tube strikes an illuminated thorax, painlessly sucking onto the fly and carrying it away.

It’s not the greatest new gadget to rid your kitchen of unwelcome pests, it’s the latest biomedical research tool from applied physicist Mark Schnitzer, PhD.

The flies in question are commonly studied in biology labs as a proxy for our own harder-to-access cells and organs. As I wrote in a press release:

Although flies and humans have obvious differences, in many cases our cells and organs behave in similar ways and it is easier to study those processes in flies than in humans. The earliest information about how radiation causes gene mutations came from fruit flies, as did an understanding of our daily sleep/waking rhythms. And many of the molecules that are now famous for their roles in regulating how cells communicate were originally discovered by scientists hunched over microscope staring at the unmoving bodies of anesthetized flies.

Until now, scientists have had to anesthetize the flies and painstakingly assess them by microscope. The robot and its machine vision can assess physical features more quickly and in finer detail than lab personnel and can carry out behavioral studies of awake flies.

I spoke with Joan Savall, PhD, a visiting scientist from the Howard Hughes Medical Foundation, who led the development of the robot. He says it will speed research because the robot is both faster and less sleepy that your average graduate student, but what’s really cool is that it opens up entirely new areas of research.

“In the end you can really push many fields at the same time,” he told me.

Previously: Thoughts light up with new Stanford-designed tool for studying the brain and New tool for reading brain activity of mice could advance study of neurodegenerative diseases
Image by Linda Cicero

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

Scope Announcements

A Memorial Day break

A Memorial Day break

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We’re off today in honor of Memorial Day. Scope will resume publication tomorrow.

Photo by Vjeran Pavic

Big data, BigDataMed15, Events, Precision health, Research, Stanford News, Technology

At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health

At Big Data in Biomedicine, Stanford's Lloyd Minor focuses on precision health

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In the next decade, Stanford Medicine will lead the biomedical revolution in precision health, Dean Lloyd Minor, MD, told attendees of the final day of the Big Data in Biomedicine conference.

Involving all aspects of Stanford Medicine — including research and patient care — the focus on precision health will draw on Stanford’s existing strengths while propelling the development of new discoveries and transforming health-care delivery, Minor explained.

The choice of “precision health” rather than “precision medicine” is deliberate and a distinction that is reflective of Stanford’s leadership role. While both precision health and precision medicine are targeted and personalized, precision health is proactive, with an emphasis on maintaining health. In contrast, precision medicine is reactive, with a focus on caring for the sick. Precision health includes prediction and prevention; precision medicine involves diagnosis and treatment.

Minor used the model of a tree to describe Stanford’s focus on precision health.

Basic research and biomedical data science form the trunk, the foundation that supports the entire endeavor. Nine “biomedical platforms” form the major branches; these platforms include immunology, cancer biology and the neurosciences, among others. The tree’s leaves are its clinical core, with treatment teams in cardiac care, cancer and maternal and newborn health, for example.

The growth of the tree, its tippy top, is fueled by predictive, preventative and longitudinal care — where innovations in knowledge and care drive further changes in the future of health-care.

Minor made two key points about the tree, and its implications for research and care at Stanford.

First, the tree is big and growing. “There is room for everyone on the tree,” he said. “That is one thing that will make this plan — this tree — so powerful.”

Secondly, the tree is ever-changing. “Care will be analyzed and fed back. That’s really the true heart and meaning of the learning health-care system,” Minor said. “Every encounter is part of a much bigger whole.”

The entire effort will be fueled by big data, Minor said. To recognize its importance, and help train future leaders, Stanford Medicine also plans to create a new biomedical data science Department.

“We’re poised to lead,” Minor said. “We build upon a history of innovation, an entrepreneurial mindset, visionary faculty and students and a culture of collaboration.”

Previously: Big Data in Biomedicine conference kicks off todayStanford Medicine’s Lloyd Minor on re-conceiving medical education and Meet the medical school’s new dean: Lloyd Minor
Photo by Saul Bromberger

Cardiovascular Medicine, Events, Patient Care, Stanford News

Honoring doctors, nurses of the early days of Stanford’s coronary care unit

Honoring doctors, nurses of the early days of Stanford’s coronary care unit

image.img.320.highWhen I was in the hospital recently to give birth to my daughter, I saw my doctors briefly during their rounds, but it was the nurses and nurse midwives who primarily cared for me. So when I read in a recent Inside Stanford Medicine feature story that 50 years ago, nurses weren’t even allowed to perform tasks like start IVs, I was shocked.

In the 1960s, Stanford was home to one of the earliest coronary care units, led by Alfred Spivack, MD. Spivack taught the nurses working on the unit to take on tasks that were, at the time, mainly done by physicians. Joan Fair, PhD, RN, who was one of the unit’s original nurses and is now a cardiovascular researcher, recalls:

“Some doctors were totally against nurses doing these kinds of things… It also took time for some doctors to accept our opinions about how their patients were doing, or if we saw a problem and called them and asked them to take a different line of treatment.”

Joan Mersch, MSN, the unit’s former nurse coordinator, described in the piece how beneficial this extra training was to patients. “When you know how to read electrocardiograms, recognize lethal cardiac rhythms, perform resuscitation and defibrillation — it saves patient lives,” she said. “You understand what needs to be done, and you can take action.”

A big proponent of using technology to improve care, Spivack depended on the nurses to learn how to use the devices and incorporate them in the daily care of patients. And he also encouraged the nurses to pursue their research interests; many, like Fair, went on to obtain graduate degrees.

Last month, almost two dozen former nurses from the unit came together for a dinner celebrating a major gift from Spivack, which will pay for the nurses’ station in the new heart acute care unit when the new adult hospital opens in 2018.

Photo by Steve Fisch

Big data, BigDataMed15, Events, Medicine and Society, Microbiology, Research, Technology

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

Levitt2Nobel laureate Michael Levitt, PhD, has been using big data since before data was big. A professor of structural biology at Stanford, Levitt’s simulations of protein structure and movement have tapped the most computing power he could access in his decades-long career.

Despite massive advances in technology, key challenges remain when using data to answer fundamental biological questions, Levitt told attendees of the second day of the Big Data in Biomedicine conference. It’s hard to translate gigabytes of data capturing a specific biological problem into a form that appeals to non-scientists. And even today’s supercomputers lack the ability to process information on the behavior of all atoms on Earth, Levitt pointed out.

Levitt’s address followed a panel discussion on computation and crowdsourcing, featuring computer-science specialists who are developing new ways to use computers to tackle biomedical challenges.

Kunle Olukotun, PhD, a Stanford professor of electrical engineering and computer science, had advice for biomedical scientists: Don’t waste your time on in-depth programming. Instead, harness the power of a domain specific language tailored to allow you to pursue your research goals efficiently.

Panelists Rhiju Das, PhD, assistant professor of biochemistry at Stanford, and Matthew Might, PhD, an associate professor of computer science at the University of Utah, have turned to the power of the crowd to solve problems. Das uses crowdsourcing to answer a universal problem (folding of RNA) and Might has used the crowd for a personal problem (his son’s rare genetic illness).

For Das, an online game called Eterna – and its players – have helped his team develop an algorithm that much more accurately predicts whether a sequence of RNA will fold correctly or not, a key step in developing treatments for diseases that use RNA such as HIV.

And for Might, crowdsourcing helped him discover other children who, like his son Bertrand, have an impaired NGLY1 gene. (His story is told in this New Yorker article.)

Panelist Eric Dishman, general manager of the Health and Life Sciences Group at Intel Corporation, offered conference attendees a reminder: Behind the technology lies a human. Heart rates, blood pressure and other biomarkers aren’t the only trends worth monitoring using technology, he said.

Behavioral traits also offer key insights into health, he explained. For example, his team has used location trackers to see which rooms elderly people spend time in. When there are too many breaks in the bathroom, or the person spends most of the day in the bedroom, health-care workers can see something is off, he said.

Action from the rest of the conference, which concludes today, is available via live-streaming and this app. You can also follow conversation on Twitter by using the hashtag #bigdatamed.

Previously: On the move: Big Data in Biomedicine goes mobile with discussion on mHealthGamers: The new face of scientific research?, Half-century climb in computer’s competence colloquially captured by Nobelist Michael Levitt and Decoding proteins using your very own super computer
Photo of Michael Levitt by Saul Bromberger

Events, Mental Health, Sexual Health, Stanford News, Women's Health

Women’s health experts tackle mood disorders and sexual assault

Women's health experts tackle mood disorders and sexual assault

3131235412_fa7f528735_zEarlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.

Among the many sessions, the two that most piqued my interest focused on women’s mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school’s Department of Psychiatry and Behavioral Sciences.

Williams’ talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum – above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their “hormones.” Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to “normal” fluctuations: pre-menstrual, perinatal, and perimenopausal.

Technically speaking, “PMS” is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman’s cycle, usually the two weeks after ovulation – this is a big chunk of time we’re talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general – when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).

Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.

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