Archive for January 2017

Too few woman scientists are invited to review academic journal manuscripts

January 31, 2017

As a researcher at Lawrence Berkeley National Laboratory, I reviewed manuscripts for several academic science journals and acted as an editor for an engineering journal.

This makes me an exception, according to a commentary recently published in Nature that reveals a gender bias in the review of scholarly publications. Journals invite too few women to referee, write commentary authors Jory Lerback, a graduate student at the University of Utah, and Brooks Hanson, PhD, director of publications at the American Geophysical Union (AGU).

The peer review process plays a critical role in the validation of research by allowing experts to scrutinize the work of their peers before research results are published. Participating in this review process is also critical to a scientist’s career. The commentary explains:

“Participation as a reviewer for papers and grants has many benefits, particularly for early-career scientists. It is a chance to develop a relationship and make a positive impression with an editor, review-panel member or programme manager, who are typically senior scientists and are in turn likely to be involved in evaluating the reviewer’s future papers and grants.”

Unfortunately, Lerback and Hanson found that women of all ages have fewer opportunities to act as a reviewer for AGU journals.

Using membership and editorial databases, they identified the age and gender of authors, reviewers and editors for AGU manuscripts from 2012 to 2015 — creating a dataset that included more than 24,000 authors, nearly 15,000 reviewers, nearly 100,00 reviewer suggestions by authors and 119,000 reviewer requests by editors.

Analysis of this dataset showed that only 20 percent of reviewers were women, proportionally less than expected as 28 percent of AGU members were female and 27 percent of first authors were female. This difference was observed across all ages, so it was not due to editors seeking more senior reviewers who are predominantly male.

The problem, they found, was due to a gender bias in reviewer selection. At AGU, authors suggest reviewers at submission and editors prepare a final list. However, both authors and editors nominated fewer women to review. Female first authors suggested female reviewers 21 percent of the time, whereas male first authors suggested women just 15 percent of the time. Similarly, female editors recommended female reviewers 22 percent of the time compared to 17 percent for male editors.

Is this just a problem for AGU journals? The authors don’t think so. As the largest Earth and space science society and publisher, they argue that AGU is a good proxy for STEM demographics in the United States. In addition, they suggest that similar problems exist for funding agencies.

The researchers recommend that publishers hire more female editors and train their staff to combat this gender bias.

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

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Reimagining Nutrition Education: Doctor-chefs teach Stanford medical students how to cook

January 30, 2017
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Photograph courtesy of Michelle Hausman

Stanford medical students still learn traditional topics like anatomy, genetics and neuroscience. But now, they can also learn how to cook, thanks to a new hands-on course developed in part by Stanford’s Michelle Hauser, MD.

A former Le Cordon Bleu chef, Hauser is currently an internal medicine-primary care attending for Stanford residents and a postdoctoral research fellow at the Stanford Prevention Research Center. She teamed up with Stanford pediatrics instructor Maya Adam, MD; physician Tracy Rydel, MD; nutrition researcher Christopher Gardner, PhD; physician-chef Julia Nordgren, MD; and Stanford chef, David Iott, to launch the new class, which is featured in a video.

Hauser said the course aims to teach future clinicians how to cook healthy food, so they can more effectively counsel their patients on nutrition and diet. Intrigued, I spoke with her recently.

Why did you introduce this course?

“Diet is the most significant risk factor for disability and premature death in the US. However, less than one-third of medical school and residency programs offer a dedicated nutrition course to their students. When courses are available, many schools use outdated, overly long and complicated online modules rather than in-person nutrition instruction. They often just focus on nutrients, whereas patients think of nutrition in terms of food. And most schools don’t teach how to effectively counsel patients to change their behavior around eating — people know it is healthy to eat more vegetables, but how do they accomplish this? We need to better prepare physicians to treat the underlying causes of disease and to prevent diet and lifestyle-related diseases from occurring in the first place.”

How can your course help?

“Teaching kitchens are the perfect, hands-on medium to help doctors learn about food. By learning to prepare delicious, healthy food for ourselves, we become healthier — and studies show that physicians with healthy habits are more likely to counsel patients on those habits. Additionally, it’s more fun and memorable to learn about food and nutrition while cooking and sharing meals together than it is to sit in a lecture hall.

As a platform to teach about nutrition, our new teaching kitchen elective focuses on how to prepare healthy meals based on plants and whole foods, a diet that is ideal for the majority of the population. We also teach a concept called the “protein flip” — instead of having the center of your plate be a large piece of meat, you use meat as a garnish for a plate full of plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts and seeds. Think veggie chicken stir-fry with brown rice or a main course salad with a small portion of grilled salmon.

Our sessions use a flipped classroom format. Before class, students view engaging preparatory videos online (and many of these are available through Stanford’s Food and Health series). At Stanford’s teaching kitchen, they watch the chefs’ cooking demonstrations and then lace up their aprons and start chopping and cooking. In addition, Tracy Rydel, Maya Adam, Christopher Gardner and faculty from other medical programs are cooking alongside the medical students to represent the lay cook’s perspective, as well as spread the idea of using teaching kitchens to others in the Bay Area and beyond. At the end of each session, we all share and eat together.”

How do you make healthy food appealing?

“Healthy food has gotten a bad rap for far too long. We need to make sure that healthy food is delicious if we expect people — including ourselves — to eat it so that it can nourish our bodies and prevent nutrition-related chronic diseases. Food is a huge part of all of our cultural identities and is intricately linked with many of our fondest memories. I often see medical professionals in training and in practice tell patients to stop eating a whole variety of things — many with personal and cultural significance — without helping them figure out what and how to eat differently. And these conversations often make it sound like the patient needs a ‘special’ diet inappropriate for the whole family. Instead, we need to celebrate the togetherness of sharing healthy food.

 For the final project, the students will make favorite healthy foods that mean something to them. For instance, I would make hummus, tabouli and falafel wraps (falafels rolled up in warm whole-wheat pita bread with chopped tomatoes, scallions, cucumbers and spring mix drizzled with lemon-tahini sauce). As a vegetarian with a dairy allergy, my Irish-immigrant family’s traditional Christmas dinner normally left me with a lonely potato and a few token veggies. However, a few years back I cooked this Middle Eastern meal for my family and it was a hit. And this year, my mom requested that we make the meal as the centerpiece of our Christmas spread!”

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

Stanford researcher travels to Qatar to discuss how behavior changes can improve global health

January 27, 2017
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Photo courtesy of Jodi Prochaska

About 1400 health-care experts and government officials from over a 100 countries recently attended the World Innovation Summit for Health (WISH) in Doha, Qatar. WISH aims to create a global community to tackle health-care challenges, such as the global burden of autism spectrum disorder and the rise in cardiovascular disease mortality.

The summit included a Behavioral Insights Forum to investigate how new findings on behavior change can lead to better health outcomes at a lower cost. Jodi Prochaska, PhD, an associate professor of medicine with the Stanford Prevention Research Center, was a member of the behavioral insights team. We recently discussed the WISH summit and her involvement.

What was accomplished at the WISH Summit?

“The WISH meeting — in an intensely focused 2-day period — engaged and fostered collaborations among academic researchers, health professionals, public policy officials and entrepreneurs. The meeting showcased innovations that can make a difference for health-care communities globally.

The program content included nine panel forums on: accountable care, autism, cardiovascular disease, population health, health economics, precision medicine, health profession education, genomics and behavioral insights. Each collaborative panel generated a white paper centered on its particular area of expertise. In addition, there were several inspiring keynote speakers.”

Why did you get involved with the behavioral insights panel? How did you participate?

“The behavioral insights team sounded novel, and I was able to help shape the white paper and participate at the WISH meeting. Oftentimes in academic research, behavior change is siloed — you have your tobacco control experts, your nutrition experts and your physical activity experts. The WISH panel focused on bridging across behaviors to identify key principles of change at the individual, social, organizational and policy levels for supporting wellness and wellbeing. We identified case studies from around the globe and covered a range of health behaviors: exercise, diet, tobacco, cancer screening, suicide and accident prevention, medication adherence and patient safety.

For instance, the panel showcased research I am doing with the University of California, Irvine using Twitter to facilitate peer-to-peer support groups for quitting smoking, which has doubled quit rates relative to usual care. The meeting also showcased a trial to paint reference lines on the rail track in Mumbai to improve pedestrians’ ability to judge speed, which led to a 75 percent decline in trespassing deaths at the test location. Also, we discussed the success of a project to send letters to the highest antibiotic prescribers in the U.K., which resulted in 75,000 fewer doses being prescribed across 800 practices.”

What was Qatar like?

“Doha, Qatar was striking. It was modern and pristine, as well as easy and safe to navigate. The people of Qatar were hospitable and kind. During my stay, I had a chance to go in the Persian Gulf and to visit a local market with traditional food, spices and live animals.

I was thrilled to represent Stanford in Doha, Qatar and to bring back the knowledge gained and connections made for future collaborations.”

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

Computer identifies skin cancer as well as dermatologists, Stanford researchers report

January 25, 2017

When I was a kid, I spent all summer swimming and lying out by the pool without sunscreen. Now, I go to a dermatologist annually because I know early detection of melanoma is critical.

But not everyone has easy access to a dermatologist. So Stanford researchers have created an artificially intelligent computer algorithm to diagnose cancer from photographs of skin lesions, as described in a recent Stanford News release.

The interdisciplinary team of computer scientists, dermatologists, pathologists and a microbiologist started with a deep learning algorithm developed by Google, which was already trained to classify 1.28 million images into 1,000 categories — such as differentiating pictures of cats from dogs. The Stanford researchers adapted this algorithm to differentiate between images of malignant versus benign skin lesions.

They trained the algorithm for the task using a newly acquired database of nearly 130,000 clinical images of skin lesions corresponding to over 2,000 different diseases. The algorithm was given each image with an associated disease label, so it could learn how to classify the lesions.

The effectiveness of the algorithm was tested with a second set of lesion images with biopsy-proven diagnoses. The algorithm identified the lesions as benign, malignant carcinomas or malignant melanomas. The same images were also diagnosed by 21 board-certified dermatologists. The algorithm matched the performance of the dermatologists, as recently reported in Nature.

The researchers now plan to make their algorithm smartphone compatible to broaden its clinical applications. “Everyone will have a supercomputer in their pockets with a number of sensors in it, including a camera,” said Andre Esteva, a Stanford electrical engineering graduate student and co-lead author of the paper. “What if we could use it to visually screen for skin cancer? Or other ailments?”

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

Targeting protein may help researchers improve pain medication

January 24, 2017

headache-1910649_1280For many people, living with chronic pain is a way of life. Unfortunately, existing pain medications are not always effective and can be addictive, which has led to an opioid epidemic in the United States.

In their search for better therapies to manage pain, researchers are investigating the underlying mechanisms that signal and control pain in the body. A central component of this pain pathway is a protein called Nav1.7, which is present at the endings of pain-sensing nerves. Nav1.7 is known to help alert your brain when your body encounters potentially harmful stimuli, like when your hand touches a hot pan.

Past research demonstrated that people with non-functioning Nav1.7 don’t feel pain. This discovery led to the development of drugs that block Nav1.7 activity. Unfortunately, these drugs didn’t really work. It turns out that the role of Nav1.7 is more complicated than first thought.

“It seemed so obvious and simple, but it was not so simple,” said Tim Hucho, PhD, a neuroscientist at the University Hospital Cologne in Germany, in a recent Science News story.

Researchers have now found that Nav1.7 plays a second role — triggering the production and release of natural opioid compounds, like endorphins, that suppress the transmission of pain signals to the brain. People with non-functioning Nav1.7 do not feel pain and have increased expression of the genes in charge of making natural opioids.

The news story explains:

“An investigation of rat and mice nerve cells reveals the tug-of-war between Nav1.7’s pain-promoting and pain-relieving powers. Cells with nonfunctioning Nav1.7 have amped up activity in the cellular machinery that kicks off pain relief, Hucho and colleagues report. They suggest that Nav1.7 acts like the axis point in a playground seesaw. When the pain-promoting side is dialed down, the pain-relieving side becomes more dialed up than usual, and cells make more of their in-house opioids.”

This research suggests a new approach to pain management: using opiates in combination with a Nav1.7 blocker to make opiates more effective and reduce their associated side effects. However, a lot more research is needed before this work can be translated into treating people with chronic pain.

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

Snails can travel far, spreading disease, researchers find

January 20, 2017

I would expect it to take all day for a snail to get across my backyard and its entire life to get around my neighborhood.

But according to a new study led by a researcher from the University of California, Berkeley, certain types of freshwater snails can travel distances of almost 30 miles, spreading a potentially deadly parasitic disease as they go.

“We don’t think of snails as particularly mobile, but the genetic evidence we found — that snails can traverse substantial distances — is a reminder of just how difficult it is to contain and control infectious diseases carried by animals and insects,” said Justin Remais, PhD, an associate professor of environmental health sciences at UC Berkeley and lead author of the study, in a recent news story.

These snails carry parasites that cause schistosomiasis — a disease that affects more than 200 million people worldwide, most of whom live in rural communities in developing countries. The parasites develop and multiply inside the infected snails, then enter the water and penetrate the skin of people who are swimming or bathing. Within several weeks, the parasites mature into adult worms that infect the body’s blood vessels, bladder and intestines.

The movement of one parasite-carrying snail can spread the disease to a new area. That’s why the multi-institutional research team studied snail migration in the rural region of Sichuan, China, where schistosomiasis incidence has increased in recent years. The researchers collected and analyzed the genetic makeup of over 800 snails from 29 sites in Sichuan, as recently reported in PLOS Neglected Tropical Diseases.

The study found that between 14 to 33 percent of sampled snails had recently migrated from another location, and some had traveled as far as 27 miles. How did these slow-moving animals get that far, when their average lifespan is only 171 days? Researchers discovered the shelled creatures can grab a ride on vegetation in waterways, cling to agricultural products such as rice, or get carried by birds or other animals.

The authors hope that an improved understanding of how and where these snails migrate will help others design better control measures to limit their movement and the spread of schistosomiasis.

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

Researchers investigate new targeted therapy for metastatic prostate cancer

January 17, 2017
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Image by Nephron

Men with localized prostate cancer face good odds: Their relative five-year survival rate is nearly 100 percent. However, men with metastatic disease — prostate cancer that has spread to another organ like the lungs — have a relative five-year survival rate of only 29 percent.

Currently, the mainstay treatment for metastatic prostate cancer is hormone therapy, which uses drugs to lower the levels of male sex hormones like testosterone in the body to slow the growth of prostate cancer. Two of the latest hormonal agents, abiraterone acetate and enzalutamide, have shown some improvements in overall survival. Unfortunately, hormone therapy isn’t a cure and most patients become resistant to the drugs.

As an alternative, researchers are now investigating more targeted therapies, such as therapies that seek out prostate specific membrane antigen (PSMA). PSMA is present on the surface of nearly all prostate cancer cells as well as new blood vessels that supply nutrients to cancers, but PSMA is present on only a few healthy tissues in the body — making it an excellent potential target for drugs that selectively attack tumors while sparing healthy cells.

One such agent is PSMA-617 labeled with the radioactive element lutetium-177, which preferentially binds to PSMA on the surface of prostate cancer cells and delivers a toxic level of radiation to the disease sites.

A group of researchers recently investigated the safety and efficacy of lutetium-177-PSMA-617 for the treatment of metastatic prostate cancer. At 12 centers across Germany, a total of 145 patients, between 43 and 88 years in age, were treated with one to four cycles of the therapy. All the patients had metastatic drug-resistant prostate cancer that was continuing to progress. Receiving lutetium-177-PSMA-617 was their last therapeutic option.

As described in a paper appearing in the January issue of the Journal of Nuclear Medicine, the researchers found that 45 percent of the patients responded positively to lutetium-177-PSMA-617 following all therapy cycles, while 40 percent responded positively after a single cycle. Unfortunately, there were some adverse side effects, such as anemia and dry mouth, but these were considered to be manageable.

Other research groups are developing alternative PSMA targeted therapies, including researchers at Weill Cornell Cancer Center who are investigating a targeted radionuclide therapy called lutetium-177-J591.

So far the results have all been modest, but these PSMA targeted therapies may still have an important role in treating patients who are resistant to other drug therapies. Further studies are needed to determine the survival benefit of these treatments before they can be approved by the U.S. Food and Drug Administration for clinical use.

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


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