July 2017 – Scientists Talk Funny

Training anesthesiologists to handle emergencies using simulation

Most anesthesiologists excel at routine procedures. But how do they fare when faced with an emergency, such as a sudden cardiorespiratory arrest, a severe allergic reaction or a massive hemorrhage?

“Like airline pilots, it’s the ability to handle the unexpected that patients, or passengers, are really paying for,” said David Gaba, MD, a professor of anesthesiology, perioperative and pain medicine at Stanford.

Gaba helped pioneer mannequin-based simulation tools used to hone the skills of both novice and highly-experienced physicians. During a simulation, a computerized mannequin fills in for the patient. “The mannequin has pulses and eyes that blink. It breathes, talks and provides all the waveforms and numbers to the clinical monitor displays that physicians and nurses are used to seeing,” said Gaba. “The instructor can tell the system to do all sorts of things, and can recreate many situations.”

These mannequins are particularly useful to practice how to handle unexpected life-threatening situations, he said. “We can allow medical students and residents in training to be the final decision-maker in simulation, whereas fully-experienced physicians will take over to protect a real patient,” Gaba said.

Since practicing teamwork is critical, the simulations are sometimes done with a full team of anesthesiologists, surgeons, nurses and technicians. Sometimes, teams members such as nurses are following the instructor’s directions; in other situations, all participants are new to the scenario,” Gaba said.

In a recent study, 263 board-certified anesthesiologists participated in simulated crisis scenarios with team members who were working with the instructor. In one scenario scripted by Stanford, the simulated patient undergoing an urgent belly surgery had a severe heart attack, causing an abnormal heart rhythm and dangerous drop in blood pressure.

The study identified different types of performance deficiencies: lack of knowledge, reluctance to use more aggressive treatments or failure to fully engage the surgeon. However, the most important lesson may be the need to call for help sooner. “When help was called, it almost always improved the overall performance of the team,” Gaba said.

In the scenario described above, for example, the unstable patient’s dangerously low blood pressure necessitated the aggressive treatment of shocking the heart with a defibrillator, he told me. “Although most anesthesiologists know this, they are more familiar with using a variety of medications and some participants were reluctant to do the appropriate, but more invasive action,” Gaba said.

Gaba identified various ways to overcome these performance gaps, such as using role-playing, verbal simulations with a colleague, full simulations and emergency manuals.

During the 30 years he has been researching mannequin-based simulations, Gaba said he’s witnessed many changes:

“When we started, people thought that simulation was a ‘nice toy,’ but they couldn’t see all of its applications. They thought that it was good just for simple technical things like CPR. But, we saw the cognitive parallels between our world in anesthesiology and worlds like aviation. Similarly, 30 years ago the notion of emergency manuals would have been called ‘a cheat sheet’ or ‘a crutch.’ It is now recognized that smart people use such cognitive aids because no one can remember everything, especially in the heat of a crisis. That’s why pilots and others use them – just common sense.”

Despite this progress, Gaba said that simulations are still not fully embedded in health care training. He estimates that only about five percent of practicing physicians have been through a meaningful simulation, beyond the basic life support or advanced CPR courses.

But he is still hopeful. “We’re pretty sure that there are hearts, brains and lives that have been saved due to our work, and I’m not retiring any time soon,” he said.

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

Study shows link between playing football and neurodegenerative disease

You’ll likely hear quite a bit this week about a new study that suggests football players have an increased risk of developing chronic traumatic encephalopathy, or CTE, which is a progressive degenerative brain disease associated with repetitive head trauma.

As reported today in JAMA, researchers from the Boston University CTE Center and the VA Boston Healthcare System found pathological evidence of CTE in 177 of the 202 former football players whose brains were donated for research — including 117 of the 119 who played professionally in the United States or Canada. Their study nearly doubles the number of CTE cases described in literature.

The co-first author, Daniel Daneshvar, MD, PhD, is a new resident at Stanford in the orthopaedic surgery’s physical medicine and rehabilitation program, which treats traumatic brain injury and sports injury patients. He recently spoke with me about the study that he participated in while at BU.

“I really enjoyed playing football in high school. I think it’s an important sport for team building, learning leadership and gaining maturity,” he explained. “That being said, I think this study provides evidence of a relationship between playing football and developing a neurodegenerative disease. And that is very concerning, since we have kids as young as 8 years old potentially subjecting themselves to risk of this disease.”

The researchers studied the donated brains of deceased former football players who played in high school, college and the pros. They diagnosed CTE based on criteria recently defined by the National Institutes of Health. Currently, CTE can only be confirmed postmortem.

The study found evidence of mild CTE in three of the 14 former high school players and severe CTE in the majority of former college, semiprofessional and professional players. However, the researchers are quick to acknowledge that their sample is skewed, because brain bank donors don’t represent the overall population of former football players. Daneshvar explained:

“The number of NFL players with CTE is certainly less than the 99 percent that we’re reporting here, based on the fact that we have a biased sample. But the fact that 110 out of the 111 NFL players in our group had CTE means that this is in no way a small problem amongst NFL players.”

The research team also performed retrospective clinical evaluations, speaking with the players’ loved ones to learn their athletic histories and disease symptoms. Daneshvar worked on this clinical component — helping to design the study, organize the brain donations, conduct the interviews and analyze the data. The clinical assessment and pathology teams worked independently, blind to each other’s results.

“It’s difficult to determine after people have passed away exactly what symptoms they initially presented with and what their disease course was,” he told me. “We developed a novel mechanism for this comprehensive, retrospective clinical assessment. I was one of the people doing the phone interviews with the participant’s family members and friends to assess cognitive, behavioral, mood and motor symptoms.”

At this point, there aren’t any clinical diagnosis criteria for CTE, Daneshvar said. Although the current study wasn’t designed to establish these criteria, the researchers are going to use this data to correlate the clinical symptoms that a patient suffers through in life and their pathology at time of death, Daneshvar said. He went on to explain:

“The important thing about this study is that it isn’t just characterizing disease in this population. It’s about learning as much as we can from this methodologically rigorous cohort going forward, so we can begin to apply the knowledge that we’ve gained to help living athletes.”

Daneshvar and his colleagues are already working on a new study to better understand the prevalence and incidence of CTE in the overall population of football players. And they have begun to investigate what types of risk factors affect the likelihood of developing CTE.

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

The skinny on how chickens grow feathers and, perhaps, on how humans grow hair

How do skin cells make regularly spaced hairs in mammals and feathers in birds? Scientists had two opposing theories, but new research at the University of California, Berkeley surprisingly links them.

The first theory contends that the timing of specific gene activation dictates a cell’s destiny and predetermines tissue structure — for example, in the skin, gene activation determines whether a skin cell becomes a sweat gland cell or hair cell, or remains a skin cell. The second theory asserts that a cell’s fate is determined instead by interacting with other cells and the material that it grows on.

Now, Berkeley researchers have found that the creation of feather follicles (like hair follicles) is initiated by cells exerting mechanical tension on each other, which then triggers the necessary changes in gene expression to create the follicles. Their results were recently reported in Science.

“The cells of the skin in the embryo are pulling on each other and eventually pull one another into little piles that each go on to become a follicle,” said first author Amy Shyer, PhD, a post-doctoral fellow in molecular and cell biology at the University of California, Berkeley, in a recent news release. “What is really key is that there isn’t a particular genetic program that sets up this pattern. All of these cells are initially the same and they have the same genetic program, but their mechanical behavior produces a difference in the piled-up cells that flips a switch, forming a pattern of follicles in the skin.”

The research team grew skin taken from week-old chicken eggs on different materials with varying stiffness. They found that the stiffness of the substrate material was critical to forming feather follicles — material that was too stiff or too soft yielded only one follicle, whereas material with intermediate stiffness resulted in an orderly array of follicles.

“The fundamental tension between cells wanting to cluster together and their boundary resisting them is what allows you to create a spaced array of patterns,” said co-author Alan Rodgues, PhD, a biology consultant and former visiting scholar at Berkeley.

The researchers also showed that when the cells cluster together, this activated genes in those cells to generate a follicle and eventually a feather.

Although the study used chicken skin, the researchers suggest that they have discovered a basic mechanism, which may be used in the future to help grow artificial skin grafts that look like normal human skin with hair follicles and sweat pores.

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

Mindset about personal activity correlated with lifespan, new Stanford research shows

The mind is a powerful thing — a simple thought can have an immediate physiological effect. For instance, just thinking about something stressful can make you sweat or increase your heart rate.

Now, Stanford researchers have found that mindsets about exercise can influence health and longevity. Namely, people that think they are less active than their peers tend to have shorter life spans, even if their activity levels are similar.

“Our findings fall in line with a growing body of research suggesting that our mindsets — in this case, beliefs about how much exercise we are getting relative to others — can play a crucial role in our health,” said Alia Crum, PhD, an assistant professor of psychology at Stanford, in a recent Stanford news release.

As outlined in a paper in Health Psychology, the researchers analyzed surveys from more than 61,000 U.S. adults from three national databases, which documented participants’ health, physical activity levels and personal demographics. The research team focused on the question: “Would you say that you are physically more active, less active, or about as active as other persons your age?”

Using statistical models to control for factors like physical activity, age, body mass index and chronic illnesses, they then correlated the results with death records. The researchers found that people who thought they were less active than their peers were up to 71 percent more likely to die during the follow-up period (of up to 21 years) than those who perceived themselves as more active — even when both groups had similar activity levels.

A possible explanation suggested by the researchers is that perception can positively or negatively affect motivation. People who see themselves as unfit are more likely to remain inactive, which then increases their feelings of stress and depression to reinforce the negative cycle.

Although the research identifies a correlation between perceived amounts of exercise and health outcomes, it does not show that perceptions of inactivity cause an earlier death. However, it suggests that Americans should feel good about the healthy activities that they do every day — such as taking the stairs, walking or biking to work, or cleaning the house — instead of only valuing vigorous exercise at a gym, the authors said.

“It’s time that we start taking the role of mindset in health more seriously,” Crum said in the release. “In the pursuit of health and longevity, it is important to adopt not only healthy behaviors, but also healthy thoughts.”

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

The implications of male and female brain differences: A discussion

Men and women are equal, but they and their brains aren’t the same, according to a growing pile of scientific evidence. So why is most research still performed on only male animals and men? A panel of researchers explored this question and its implications on a recent episode of KALW’s City Visions radio show.

“It’s important to study sex differences because they are everywhere affecting everything,” said panelist Larry Cahill, PhD, a professor of neurobiology and behavior at the University of California, Irvine. “Over the last 20 years in particular, neuroscientists and really medicine generally have discovered that there are sex differences of all sizes and shapes really at every level of brain function. And we can’t truly treat women equally if we continue to essentially ignore them, which is what we’ve been doing.”

Neuropsychiatrist and author Louann Brizendine, MD, went on to say that many prescription medicines are only tested on male animals and men, even birth control pills designed for women. This is because the researchers don’t want the fluctuations of hormones associated with the menstrual cycle to “mess up” the research data, she said.

However, this practice can lead to dangerous side effects for women, she explained. For example, the U.S. Food and Drug Administration determined that many women metabolized the common sleep aid, Ambien, more slowly than men so the medication remained at a high level in their blood stream in the morning, which impaired activities like driving. After reassessing the clinical data on Ambien, Brizendine said, the FDA reset the male dose to 10 mg and the female dose down to 5 mg.

Niaro Shah, MD, PhD, a professor of psychiatry and behavioral sciences and of neurobiology at Stanford, said this action by the FDA was a sign of progress. “Decisions like what were made about Ambien represent people starting slowly to wake up and realize that we’ve been assuming that we don’t have to worry fundamentally about sex. And in not worrying about it, we are disproportionally harming women. Bare in mind, women absolutely, clearly and disproportionally bear the brunt of side effects of drugs and medicine.” In fact, he explained, eight out of ten drugs are withdrawn from the market due to worse side effects in women. He later added, “This issue is deeply affecting medical health, especially for women.”

So why are most researchers still studying only male animals or men?

According to Cahill, researchers have a deeply ingrained bias against studying sex differences, believing that sex differences aren’t fundamental because they aren’t shared by both men and women. He also said that resistance to this research boils down to the implicit and false assumption that equal has to mean the same. “If a neuroscientist shows that males and females (be that mice or monkeys or humans) are not the same in some aspect of brain function, then [many people think] the neuroscientist is showing that they are not equal — and that is false.”

Cahill offered advice for consumers: “You can go to the FDA website and for almost any approved drug you can get the essentials on how the testing was done. You’re going to find a mixed bag. For some drugs, you’re going to find there is pretty darn good evidence that the drug probably has roughly equal effects in men and women. On the other hand, you’re going to find a lot of cases when the testing was done mostly or exclusively in males and basically people don’t know [the effects in women].”

“You should be discerning and do your homework,” Brizendine agreed.

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

FemInEM blog facilitates conversations about women in emergency medicine

As a female PhD physicist, I was often the only woman in the room as an undergraduate and graduate student and as a research scientist. I faced sexism, unwanted attention and personal criticism — particularly early in my career. So I can relate to the gender equity issues that prompted Dara Kass, MD, an emergency medicine physician at New York University, to found FemInEM.

FemInEM is a blog that explores a variety of issues centered on the development and advancement of women in emergency medicine. Kass said their overarching goal is to make it easier for women in medicine to stay at work, despite conflicting priorities like family commitments, career objectives and personal health issues.

“I started FemInEM because I wanted to build a community amongst the women in emergency medicine,” Kass told me. “I had seen so many women solve their own problems around the expected life changes — like maternity leave, lactation and promotion — but they weren’t talking to each other. FemInEM seemed like a way to solve that problem. I didn’t want others to have to figure it out on their own, like I did.”

In addition to the blog, Kass said they use the power of social media — Facebook, Twitter, Instagram, and Snapchat — to amplify the conversation. “There are about 12 to 15 thousand women practicing in emergency medicine in our country, and we probably reach about half of them on a regular basis. The coolest part is that we reach all levels of learners from all over the world,” Kass said.

Kass explained that the online medium is important because it is “extraordinarily accessible and inclusive.” She emphasized that when discussing something like gender equity and the careers of women in medicine, it can never be only about the women. The conversation has to include men and allow them to reflect on their careers as well.

“We do this in a very inclusive way, so it’s really never about ‘us verses them,’” said Kass. “We’re talking about things like parental leave or salary equity. We base our discussions on data, but more importantly we focus on needing to all work together towards real solutions. Men are cool with it.”

Given the goal of inclusion, the blog uses an open-access submission process. “We take submissions from men, from people not in emergency medicine and from people around the world who have very different issues,” Kass said. “Anyone that wants to write for us just needs to submit an interesting piece that somehow speaks to the issue around gender equity in medicine.”

Kass particularly enjoys writing and reading posts on the struggles of having “multiple personalities.” One of her favorite posts is titled, “They call me #badassdoctormom.” “The #badassdoctormom post was written by a woman physician who talked about her daughter,” she told me. “This woman saved a guy at a train accident by cutting off his leg in the field, which is extraordinary. Her friend called her a bad ass. That night, during a bedtime story, her daughter asked whether she should call her doctor or Mommy. In her mind, she thought ‘How about bad ass doctor mom?’ In reality, her 5-year-old daughter now calls her a real-life superhero — that’s a really cool story.”

However, Kass told me that this blog post and others have gotten backlash from the female spouses of male physicians. This may be because the wives feel like they are being judged if they don’t work outside the home. Kass hopes this will change. Her advice to all women: “Just be who you are. Be happy. Our goal is to make people feel centered about the life they have in front of them and the choices they’ve made.”

Today Kass is spreading her message on how to support women in medicine when she gives grand rounds to Stanford’s emergency medicine residents. She is also expanding beyond online conversations to an in-real life event called the FemInEm Idea Exchange. Kass said this conference, being held in October in NYC, will make in-person conference networking more accessible to help develop women’s careers quickly and provide motivation.

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

Detecting single cancer cells with light: A podcast

When cancer is spotted early, it’s much easier to thwart. So researchers, including Stanford’s Jennifer Dionne, PhD, are working to detect cancer more effectively. Dionne, an associate professor of materials science and engineering, is developing a nanomaterial-based probe that may be able to detect a single cancer cell.

She described her work in a recent episode of the Future of Everything radio show, hosted by Russ Altman, MD, PhD, a Stanford professor of bioengineering, of genetics, of medicine and of biomedical data science.

“What our lab is trying to do is create light-emitting nanoparticles that change their color when there is an applied force on the nanoparticles. So that way we can make mechanical forces visually perceptible,” she explained to Altman. These nanoparticle already change color in response to the tiny forces generated by cells and groups of cells, she said, and cancer cells are known to exert more force on their environment than healthy cells.

Dionne explained: “Generally a cancer cell wants to take up a lot of nutrients and it’s basically growing and dividing more quickly than a healthy cell. You can imagine given the speed of replication that it’s going to exert a higher force on its environment than a healthy cell. So our nanoparticles offer the ability to detect even a single cancer cell based on the forces that that cancer cell is exerting on its environment.”

That could help pathologists spot abnormal cells in a biopsy sample, she said. “This could be a really cool in vitro probe of whether or not in a biopsy [sample] you have even one cancer cell, which you can tell just by looking at the color the nanoparticles are emitting,” she told Altman.

Although their primary focus was on the development of nanomaterials with energy and biomedical applications, the conversation did take a few interesting twists. I particularly enjoyed their discussion on the design challenges behind making a Harry Potter invisibility cloak. Hint: Like water waves flowing around a rock, you need to create a cloak that allows light waves to flow smoothly around the hidden object so they emerge on the other side as if they hadn’t passed through the object — it’s difficult, but they’re working on it.

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

Stanford headache specialist demystifies migraine auras

I have close friends who get debilitating migraines so I knew a bit about auras, which are sensory disturbances that often precede migraine headaches. But experiencing one myself was still quite frightening.

It snuck up on me: I was happily reading a novel in bed when a spot on the page became blurry, even when I closed one eye. It quickly expanded in size, turning into a flickering, zig-zag pattern. After checking online and guessing that I probably had a migraine aura, I tried to go to sleep — and that’s when it really got weird. Suddenly I saw the geometric pattern in color moving across my field of vision, even when I had my eyes closed.

Luckily, my aura lasted less than 30 minutes, so I was eventually able to go to sleep. I was also very happy to avoid the unbearable headache pain common in migraines. But my experience inspired me to learn more about auras.

According to Stanford neurologist Nada Hindiyeh, MD, about 30 percent of people that suffer from migraines get an aura before their headache pain. However, migraine auras can also occur without a headache. This used to be called an ocular migraine, but it is now classified by the International Headache Society as a “typical aura without headache,” she said.

“Aura is a term used to describe focal neurological disturbances that precede a migraine headache and typically develop over a 5 to 60 minute period and last less than an hour. The most common neurological symptoms include visual changes,” said Hindiyeh, who works at the Stanford Headache Clinic. “During a visual aura, people may describe a blind spot in part of their field of vision, sparkles or stars, colored spots, zig-zag lines, flashes of light or tunnel vision.”

A migraine aura is thought to be initiated by a phenomena in the brain known as cortical spreading depression — a self-propagating wave of electrical silence in which cortical neurons stop firing and go quiet. This starts a chain of reactions in the brain that causes the various symptoms of a migraine attack, Hindiyeh explained.

A long list of factors can trigger migraines, she said, including stress, changes in sleep patterns, hormonal changes in women, skipping meals, and eating certain foods and beverages such as high processed foods and excessive caffeine.

“Migraine symptoms can change throughout a person’s lifetime. Attacks of migraine aura without a headache are more common as migraine sufferers get older,” Hindiyeh said. “However, if you are older than the age of 40 and develop a migraine with aura for the first time, you should be evaluated by a neurologist. If needed, you may then be referred to a headache specialist.”

And it turns out I’m not the only one who finds auras frightening. “Having an aura can be quite a scary experience,” Hindiyeh said. “Talk to your doctor about what steps to take when you do have one, such as pulling over if you’re driving, taking deep breathes, lying in a dark room or taking specific medication. That way you have an action plan in place and are prepared when an aura comes on.”

Hindiyeh said she has focused her research and practice on migraines because she believes it to be an underdiagnosed and undertreated disease. “Migraine affects 36 million people nationwide and is the seventh leading cause of disability worldwide. These statistics are staggering. I felt that this was a field in neurology where I could hopefully provide care for many patients, and raise awareness about this disabling disease.”

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

Stanford medical student juggles his studies, graphic art and numerous extracurriculars

I’m a freelance science writer adept at multi-tasking. But I feel like I’ve been sitting on both hands when I read the jam-packed resume of Stanford medical student Ryan Brewster.

For nearly two decades Brewster competed as a nationally ranked mogul skier, but knee Injuries led to his retirement in 2011 and a new career in medicine. While studying molecular biology and biochemistry at Middlebury College, he kept himself busy as an EMT, an advocate of sustainable agriculture in Rwanda, a Spanish-English medical interpreter at a community health center, a senior admissions fellow and the co-founder and graphic designer of Ron’s Closet Apparel Company — and that’s just a few highlights. After working as a research assistant at Harvard Medical School, he headed to Stanford for medical school last fall.

Intrigued, I spoke with Brewster about what he’s doing now. I admit that I was hoping to learn his multitasking secrets, but I was also really interested in his graphic art.”

How did you get started as a graphic artist?

“For as long as I can remember, visual art has been an important tool for self-expression. An engineer, architect and carpenter, my father encouraged me from a young age to communicate ideas in creative ways. I spent most of my childhood drawing before teaching myself computer software, such as Photoshop, in high school. It soon became clear that this interest could be applied to all my activities — from biomedical research to community service.

My skills in graphic design and illustration have been honed experientially rather than through any formal training. Starting a clothing brand, creating visual aids for community health workers in Rwanda and maintaining a healthy habit of doodling, among so many other opportunities, has allowed me to develop technically and stylistically. My style has largely been informed by Owen Davies, Chip Kidd, Jorgen Grotdal, Frank Netter and Mary Kate McDevitt. Furthermore, I have benefitted tremendously at Stanford from the support of Samuel Rodriguez, MD; Audrey Shafer, MD; Jacqueline Genovese; and artist Lauren Toomer, who have provided many opportunities to further my training in the arts.”

What have you been working on recently?

“I was the student coordinator for this year’s Medicine and the Muse symposium. I designed the marketing and branding materials, and exhibited a collection of anatomy-inspired illustrations (shown above).

Another first year MD candidate, Jacob Blythe, and I were fortunate to be selected as recipients of the Stanford MashUp Grant. It awarded us $600 to produce an art installment. We created a 3-D collage of the humerus and associated vasculature encased in glass. The piece is based on the novel Blood of the Lamb, which concerns a young girl who passes away from leukemia. Jacob and I wanted to capture this narrative of illness using related ‘artifacts,’ including blood smears, medical charts and actual pages from the book.

Also, earlier this year, James Lock, MD, approached me on behalf of a Stanford Medicine-wide diversity committee. They wanted to make a pin to be worn by physicians as a mark of LGBTQ alliance. The design features a DNA molecule with the traditional pride colors. This was a particularly rewarding project and we hope to have the pins fabricated and distributed by the end of the summer.”

And you sing, too?

“Another important artistic passion has been acoustic guitar and songwriting. The same imperatives that motivate me as a graphic designer similarly motivate me as a musician. Composing and performing a song challenges you to not only bear your emotions and feelings, but also to communicate them in a way that is relatable to your audience. Knowing that so many students held identities beyond that of future physician, Stanford medical students Shay Aluko, Andrea Garofalo and I founded the Stanford Medicine Open Mic to create a space for musicians, dancers, poets and other artists to showcase their talents.”

Are there other interests you’d like to mention?

“In the fall quarter, I completed the course Biodesign for Mobile Health, which exposes students to the emerging field of mobile technology. My project team — comprising two medical students, an undergraduate product designer and a bioengineering PhD student — developed a platform targeting users of the Supplemental Nutrition Assistance Program. Specifically, our NuLeaf team aims to provide individualized nutritional recommendations based on one’s health condition, budget, location and cultural preference. As Biodesign NEXT fellows, we have developed a functional prototype and have established strong partnerships with the Second Harvest Food Bank, physicians and other stakeholders. We hope to pilot the product with a local user population by the end of the summer.

Athletics also remain central to my wellness and extracurricular activities. Since retiring as a skier and college baseball player, I took up distance running and have struggled through several half- and full-length marathons. I am also an avid backpacker and camper. In fact, a major reason for choosing Stanford was the allure of the many outdoor playgrounds found in the state.”

How do you balance your different interests?

“Each of my activities serves as a reprieve from the other. Art balanced by science. The outdoors and fitness balanced by studying (unfortunately the latter wins out more often than not). Self-care balanced by community. That said, the past months have been a tremendous exercise in time management. ‘Triaging’ my commitments has not been easy, but it has allowed me to continue the things I value most.”

What are your career plans as an artist and physician?

“On one hand, I hope my career will marry the arts and medicine in direct ways, through medical illustration and data visualization. Perhaps of greater importance is the ethic of the artist carried by the physician. Doctors must be storytellers. They must be able to enter the patient’s world, listening, absorbing and acting on his/her narrative to inform treatment. The humanistic orientation in medicine requires the strengths of an artist — the observational skills to examine details beyond how they superficially appear, the perspective to understand information in isolation and in its broader context, and the empathy to acknowledge the human life that stands before them. It is in this framework where I see the noblest goals in medicine.”

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

Taking steps to learn more about obesity with smartphones

Many of my friends use smartphones to track their steps as they walk about town to grocery shop, grab lunch or just take a break from the computer. Their daily goal is typically 10,000 steps. Now researchers are using this type of data to study public health.

Stanford researchers used step data captured by smart phones to analyze the activity levels of over 700,000 men and women from 111 countries during a 3-month period. Although the data was anonymized, it included key health demographics such as age, gender, height and weight so the research team could calculate each person’s body mass index.

The investigator’s goal was to figure out why obesity is a bigger health problem in some countries than others. As outlined in a paper in Nature, they found that people walked a similar amount each day in countries with little obesity, whereas there was a big activity gap in countries with high levels of obesity — and they dubbed this phenomenon the “activity inequality.”

“If you think about some people in a country as ‘activity rich’ and others as ‘activity poor,’ the size of the gap between them is a strong indicator of obesity levels in that society,” said Scott Delp, PhD, a Stanford professor of bioengineering and of mechanical engineering, in a Stanford news release.

Delp and his colleagues also found a gap in activity levels between genders — men walked more than women — that varied from country to country. Overall, their research identified strong correlations between activity inequality, the gender-activity gap and obesity levels.

How did the United States rank? It was ranked near the bottom for activity inequality due to a large gap between the activity rich and activity poor. It also has a large gender-activity gap and high levels of obesity.

The researchers hope their results will inspire designers to make cities more walkable and pedestrian-friendly. “In cities that are more walkable everyone tends to take more daily steps, whether male or female, young or old, healthy weight or obese,” explained Jennifer Hicks, director of data science for Stanford’s Mobilize Center.

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

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