MRI use flushes gadolinium into San Francisco Bay

Posted February 5, 2016 by Jennifer Huber
Categories: Health

Tags: , , ,

The levels of gadolinium in the San Francisco Bay have been steadily increasing over the past two decades, according to a study recently published in Environmental Science & Technology. Gadolinium is a rare-earth metal and the potential long-term effects of its exposure have not been studied in detail.

Russell Flegal, PhD, and his research team at UC Santa Cruz collected and analyzed water samples throughout the San Francisco Bay from 1993 to 2013, as part of the San Francisco Bay Regional Monitoring Program.

They found the gadolinium levels to be much higher in the southern end of the Bay, which is home to about 5 million people and densely populated with medical and industrial facilities, than in the central and northern regions. They also observed a sevenfold rise in gadolinium concentration in the South Bay over that time period.

The study attributes the rising level of gadolinium contamination largely to the growing number of magnetic resonance imaging (MRI) scans performed with a gadolinium contrast agent. A gadolinium contrast agent is used for about 30 percent of MRI scans to improve the clarity of the images. It is injected into the patient then excreted out of the body in urine within 24 hours.

Lewis Shin, MD, assistant professor of radiology and a MRI radiologist, explained to me the importance of using intravenous gadolinium contrast agents:

“Gadolinium contrast agents allow us to detect abnormalities that would otherwise be hidden from view and to improve our characterization of the abnormalities that we do find. Gadolinium is not always used; for example, if a physician is just concerned about identifying a herniated disk in the spine, an MRI without contrast agent is sufficient.

However, gadolinium is routinely administered to detect and characterize lesions if there is a clinical concern of cancer. Also, if a patient was previously treated for cancer, gadolinium administration is often extremely helpful to detect early recurrences. In summary, MRI with a gadolinium contrast agent greatly improves our ability to make an accurate diagnosis not only for cancer but for many other disease processes as well.”

According to UCSC researchers, gadolinium is not removed by standard wastewater treatment technologies, so it is discharged by wastewater treatment plants into surface waters that reach the Bay.

Shin expressed some surprise when he learned about this study:

“The majority of radiologists probably don’t even think about gadolinium once it’s excreted out of a patient’s body. Of course it’s concerning that there is a rise in gadolinium levels in the environment, but the next questions are how is this impacting the environment and whether there is a safe level or not? Since most of the gadolinium contrast agents used for MRI studies are excreted through the urine within 12 to 24 hours, one strategy to reduce environmental release of gadolinium could be to collect patients’ urine for a brief period of time for proper disposal or even recycling of the gadolinium itself.”

The UCSC researchers assert that the current levels of gadolinium observed in San Francisco Bay are well below the peak concentrations that could pose harmful effects on the aquatic ecosystem. However, they recommend in their paper, “new public policies and the development of more effective treatment technologies may be necessary to control sources and minimize future contamination.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

SPARKing a global movement

Posted February 3, 2016 by Jennifer Huber
Categories: Health

Tags: , , ,

browser-98386_1280Many academic researchers are tenacious, spending years in the lab studying the processes that lead to human diseases in hopes of developing treatments. But they often underestimate how difficult it is to translate their successful discovery into a drug that will be used in the clinic.

That’s why Daria Mochly-Rosen, PhD, founded SPARK, a hands-on training program that helps scientists move their discoveries from bench to bedside. SPARK depends on a unique partnership between university and industry experts and executives to provide the necessary education and mentorship to her academic colleagues.

In recent years, Stanford’s program has sparked identical programs throughout the world; at TEDMED 2015, Mochly-Rosen described this globalization. I recently spoke with her about the SPARK Global program, which she co-directs with Kevin Grimes, MD, MBA.

How has SPARK inspired similar programs throughout the world?

We’ve found our solution for translational research to be particularly powerful. Of the 73 completed projects at Stanford, 60 percent entered clinical trials and/or were licensed by a company. That’s a very high accumulative success rate. So I think it has showed other groups that we have a formula that really works – a true partnership with academia and industry. It’s the combination of industry people coming every week to advise us and share lessons learned and our out-of-the-box, risk-taking academic ideas that makes SPARK so successful.

We feel that what we’ve learned is applicable to others. Kevin and I also feel very strongly that universities need to take responsibility to make sure inventions are benefitting patients. So we’re trying to do our part.

How do you and Dr. Grimes help develop the global programs?

When a university asks about our program, we invite them to come visit us for a couple of days so they can talk to SPARKees (SPARK participants), meet SPARK advisors and watch our weekly meeting. Sometimes they also ask Kevin and I to come to their country to help set up a big event or assist in other ways. If they begin a translational research program at their institution, we offer for them to be affiliated with SPARK Global. Everyone is invited.

There are now SPARK programs throughout the world, including the United States, Taiwan, Japan, Singapore, South Korea, Australia, Germany and Brazil. We are also working with other countries, including Norway, Israel, Netherlands, Poland and Finland to help them start a program.

Do researchers in other countries face the same challenges as those in the US when developing new drugs?

There are many common challenges. And there are also some advantages and challenges that are different in other places. So it’s a mix, both within and outside the US.

There are several key components to the success of translation research. It’s important to have a good idea. It’s even more important to have good advisors from industry to help develop the idea. And it’s very important that the people involved are open-minded and are not inhibited by hierarchical structures. In some places, there is a big problem with hierarchy – particularly in parts of Europe and East Asia. In some cultures, it’s also difficult to get experts to volunteer and academics can’t afford to pay multiple advisors. Also, some universities don’t have a good office of technology to help with patent licensing, which can be a major challenge.

You recent held the first International SPARK conference. Do you have future events planned?

The first international SPARK conference was held last summer in Taiwan. We only invited those with an existing SPARK program, because it was an organizational meeting. We spent a lot of time discussing what we want to do together.

The next SPARK Global meeting will be open to every university and will be held at Stanford this fall. There will be half a day for those thinking about starting a new SPARK program at their institution, and then one-and-a-half days for those already involved. We’ll celebrate SPARK’s 10-year anniversary and the formation of SPARK Global. Our overall agenda is to continue to promote SPARK-like programs in universities, as well as come up with ideas that the global network can work on together.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Fertility quiz: How well do you know your body?

Posted January 29, 2016 by Jennifer Huber
Categories: Health, Science Education

Tags: , ,
2364734203_937bfdfe48_z_Flickr_ScottMaxwell

Photo by Scott Maxwell

Remember all the rumors that you heard about sexuality and fertility as a teen (or even a 20-something or a 30-something)? It’s hard to sort out fact from fiction.

According to the Institute for Reproductive Health (IRH) at the Georgetown University Medical Center, an accurate understanding of sexuality and fertility is surprisingly low around the world. That’s why IRH has created an online quiz to probe fertility awareness, called “Know Your Bod,” which poses the challenge: “You live with your body everyday. Do you really know it? Find out.”

The online quiz asks ten questions including the true-or-false query, “A woman will get pregnant only if she has sex on the same day she ovulates?” After you select an answer, the quiz provides a simple educational summary that explains the correct answer. At the end, it shows your score and how you compare to the general population.

The quiz was officially introduced this week at the International Conference on Family Planning in Indonesia. It was developed as part of IRH’s Fertility Awareness for Community Transformation Project, which strives to increase fertility awareness and the use of family planning.

Victoria Jennings, PhD, director of IRH, explained in a recent Georgetown press release:

Accurate understanding and awareness about human fertility is surprisingly low around the world, regardless of age, sex or education level. If we could lift the taboos and improve fertility awareness, would people be informed and empowered to make better sexual and reproductive health decisions? At IRH, we believe the answer to this question is ‘yes.’

So why not take the challenge? How well do you know your bod?

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Superheroes to the rescue: a creative approach to educating patients about asthma

Posted January 21, 2016 by Jennifer Huber
Categories: Health, Science Education

Tags: , ,

Video by © 2015 Booster Shot Media

Asthma affects over 6 million children and leads to approximately 1.8 million visits to the emergency room annually in the United States, according to the Centers for Disease Control and Prevention.

In order to effectively manage asthma and help eliminate trips to the emergency room, physicians must identify the correct daily control and emergency rescue medications for their patients. However, educating young patients and their families is also critical.

“Patient education needs to be done at every visit,” Richard Moss, MD, professor of pediatrics, emeritus at Lucile Stanford Packard Children’s Hospital Stanford, recently told me. “This includes a review of the asthma symptoms, proper use of medications, written action plan, test results, and educational handouts. The key is continuity of care and reiteration of important information at every visit.”

Last month, NBC News featured the work of an Illinois physician who has taken a non-traditional approach to patient education. Alex Thomas, MD, a cartoonist and pediatric allergist at the Center for Asthma and Allergies, created a multimedia asthma education program called Iggy and the Inhalers, which includes comic books, YouTube videos, posters, trading cards and stickers. I recently spoke with Thomas about this program and Booster Shot Comics, a partnership between Thomas and a health-communication specialist.

What motivated you to create the Iggy and the Inhalers comic book?

I started drawing Iggy characters when I was 11 years old. I grew up with asthma myself, so I drew as a way to understand my medications – turning them into superhero characters. My Mom is an allergist and she had a patient support group for kids with asthma. So I started drawing little comic strips about Iggy in the support group newsletter.

An interest in asthma and asthma education ultimately led me to go to medical school and become a pediatric allergist. When I was working on the pediatric wards, I noticed that a lot of kids were being admitted and readmitted to the hospital for asthma exacerbation due to confusion about their medications. So I eventually revisited my Iggy characters to create educational materials for physicians and patients, with the help of health communication specialist Gary Ashwal.

Can you describe the characters in Iggy and the Inhalers?

Iggy the Inhaler is the main character that teaches kids about the physiology of asthma. He has two teammates. One is Broncho the Bronchodilator, a rescue inhaler for quick relief of symptoms. The other partner is Coltron the Controller, a control inhaler that kids with persistent asthma need to take on a daily basis. There are also asthma trigger villains: Smokey Joe, Moldar, Pollenoid, Dust Mite, Roach and Hairy.

We wanted to create dynamic characters that embodied the mechanism of the medications that they represent, so kids can intuitively understand how the medications actually work. When kids look at a rescue inhaler, they imagine Broncho loosening the muscle bands around the airway because he’s a cowboy with a lasso. Whereas when they look at a control inhaler, they imagine Coltron decreasing inflammation inside the airways using his fire extinguisher arm.

How have families responded to Iggy and the Inhalers?

It has been very effective.

There was one family that really stuck with me. A mother came with a 3-year old son for an initial visit with a bag full of medications prescribed by an emergency room physician and subsequently doctors in urgent care. They were frazzled and overwhelmed, and the child was still coughing. I had them watch the basic Iggy video, while the Mom flipped through the comic book. When we talked afterwards, she said she finally understood the basic differences between the medications. She was very relieved and they went home with the Iggy stickers, comic book and trading cards.

The next week, the family returned for a follow-up. The son specifically asked to watch the Iggy video. He was reciting the words, wanting to play it again and again like an Elmo video. He was responding to the characters and the live actions in the video on how to use an inhaler. Since then, he’s done great. Every time I see him, he asks for more Iggy stickers.

What other projects is Booster Shot Comics working on?

We have plans for future issues of the Iggy comics and animated videos that will cover more specific topics on asthma and allergies, such as how to eliminate allergy triggers from the home. We are also working with physicians at the Children’s Hospital of Wisconsin to turn discharge instructions for a concussion into a comic book, as well as a comic book to teach kids and their parents how to treat pain.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Reducing cesarean delivery rates, without jeopardizing safety

Posted January 14, 2016 by Jennifer Huber
Categories: Health

Tags: , , ,

166471938_0c0f8ca48b_b_Flickr_SalimFadhley_560x375

Approximately one-third of all babies born in the United States are currently delivered by cesarean section, according to the Centers for Disease Control and Prevention. Although cesarean delivery can be life saving for both the mother and child, the rapid increase in the cesarean birth rate between 1996 and 2011 raised significant concern that cesarean delivery is being overused.

This concern has led to initiatives to lower the c-section rates, including a new plan funded by the Oakland-based California HealthCare Foundation (CHCF) to lower California’s c-section rate for low-risk mothers to 23.9% in the next five years — in alignment with the Healthy People 2020’s national target.

A recent KQED Science article describes these efforts to reduce the state’s c-section rates. The story also explores the controversial issue that a healthy pregnant woman’s likelihood of having a cesarean birth varies depending on the hospital, based on a recent analysis of maternity care. For instance, the assessment report found that Lucille Packard Children’s Hospital Stanford has a c-section rate of 23.0 percent and the Coastal Communities Hospital in Santa Ana has a rate of 42.9 percent.

Deirdre Lyell, MD, professor of obstetrics and gynecology, clarified the issue in a recent email:

Nationally and internationally, there is concern that cesarean rates as a whole are too high. CHCF and others have shown a wide rage in cesarean rates by hospital around the country, and even within hospitals among individual physicians. Hospitals with very high rates should examine the underlying reasons. However, the “ideal rate” depends on the characteristics of the patient population, and it would be inappropriate to apply one goal to all women. For example, a pregnant, non-obese 25-year old who has had a prior vaginal delivery has a better likelihood of delivering her baby vaginally than does a pregnant, obese 45-year old first time mom.

At Stanford, we follow the “Safe Prevention of the Primary Cesarean Delivery” guidelines outlined by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. We care for a higher-risk maternal and higher-risk fetal population, and share with our patients a common goal for delivery: a safe mom and a safe baby, while not performing cesareans unnecessarily. Avoidance of the first cesarean helps reduce the potential risks in the future.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Education reduces anxiety about mammography

Posted January 8, 2016 by Jennifer Huber
Categories: Health

Tags: , ,
Woman received mammogram (Rhoda Baer)

Woman receives mammogram (Rhoda Baer)

My close childhood friend Kelly died from breast cancer when she was only 32 years old. This inspired me to choose a research position at Berkeley Lab to help develop new breast-imaging scanners to improve early detection. Given my expertise in this field, my friends come to me with their confusion and ask, “At what age and how frequently should I get a mammogram?”

There has been a lot of debate surrounding mammography screening since 2009 when the United States Preventive Services Task Force revised their guidelines for average-risked women, limiting routine screening to biennial mammography for women 50 to 74 years of age.

The task force recommended increasing the screening age in part due to the harmful anxiety caused by false-positive results, which are more common in younger women. The American Cancer Society recently released a new set of guidelines that recommends yearly mammograms starting at age 45, but they also considered the pain, anxiety and other potential side effects of mammography.

A recent article published in the Journal of the American College of Radiology describes a successful intervention to reduce this anxiety. The authors provided interactive one-hour educational sessions on mammography, which were led by a trained breast radiologist.

Before the lecture, a questionnaire was administered to the participants to identify their anxiety and previous mammography experience — 117 responded. Those respondents who reported having anxiety about mammography screening indicated “unknown results” and “anticipation of pain” as the primary sources of their anxiety.

A follow-up questionnaire measured the effectiveness of the informational sessions. Virtually all participants were able to correctly answer key facts that were covered in the lecture, such as recognizing that it is important to have your prior mammogram available to the radiologist for comparison.

The journal article concludes:

Attendees of these sessions reported high levels of satisfaction in their participation, with a strongly favorable impact on increased knowledge and decreased anxiety (“harm”). Education can enable women to share in informed decision making regarding if, when, and how often to attend screening mammography. Attendees also reported encouragement to attend screening mammography.

The authors hope to encourage other radiologists to provide similar proactive, public outreach education.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Working towards a life-long, universal flu vaccine

Posted January 6, 2016 by Jennifer Huber
Categories: Health

Tags: ,

To prepare for holiday socializing, I always roll up my sleeve to get an annual flu shot. I would much rather share food and gifts than a virus with my friends and family. And I don’t want to spend my precious vacation time sick.

However, seasonal flu vaccines are not always effective. There are thousands of strains of influenza virus and each can mutate over the course of the flu season. Seasonal vaccines only protect against a few of the most likely strains. As a result, flu-associated deaths range from 3,000 to 49,000 Americans per flu season, according to the Centers for Disease Control and Prevention.

Scientists have long-sought a life-long vaccine that would be effective against any variety of influenza, and they are now making significant progress towards this goal.

I recently spoke with Ian Wilson, PhD, a leading structural and computational biologist at the Scripps Research Institute, about his team’s universal flu vaccine research. He told me:

Our research has identified a good target for such a vaccine on a protein called hemagglutinin (HA) that is present on the surface of all influenza viruses. The HA protein has two major components: the head portion, which mutates and varies from strain to strain, and the stem, which is similar across most flu strains. We know that the HA stem is the virus’s most vulnerable spot, and provokes the greatest breadth of immune response. So a synthetic version of the stem was designed, called a mini-HA that mimicked the HA stem.

A key part of Wilson’s flu research took place at the Stanford Synchrotron Radiation Lighsource at the SLAC National Accelerator Laboratory, where the scientists used a technique called X-ray crystallography to look at the atomic structure of the mini-HA at each stage of its development. I wrote a recent news article about the work.

Though this is important research, more work needs to be done. “We still need to perform human trials and also want to develop a vaccine that protects against all types of influenza that cause human pandemics,” said Wilson.

The is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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