Archive for the ‘Technology’ category

Local knowledge key to building healthier communities

October 9, 2017

Photo by Chris Waits

Your zip code is just a number meant to guide mail delivery, but studies show that it predicts your lifespan better than your genetic code. For instance, the average life expectancy in New Orleans varies by as much as 25 years in communities only a few miles apart.

This health disparity is driving health care providers, researchers, urban planners and community members to work together to build healthier, more equitable communities — addressing the key factors that determine health and well-being outside the clinic.

““It’s not enough to ask how we can build healthier, happier and greener communities without first addressing the real inequalities that are impacting the design of our cities,” said Antwi Akom, PhD, an associate professor of environmental sociology, public health and STEM education at San Francisco State University, at Stanford Medicine X earlier this month.

However, this design movement depends on access to reliable data, which led the Obama administration to launch The Opportunity Project to “unleash the power of data and technology to expand economic opportunity in communities nationwide.” The project released 12 smartphone apps to provide easy access to governmental data on housing, transportation, schools, neighborhood amenities and other critical community resources.

One of these apps, called Streetwyze, was developed by Akom and Aekta Shah, a PhD candidate at Stanford University, through the Institute for Economic, Educational and Environmental Design. Streetwyze is a mobile, mapping and SMS platform that collects real-time information about how people are experiencing cities and local services, so the data can be turned into actionable analytics.

“The real challenge of the 21st century health data revolution is how do you bridge this gap between official knowledge and local knowledge in ways that make the data more reliable, valuable, authentic and meaningful from the perspective of everyday people?” said Akom at Medicine X. “We think the missing link is real-time two-way communication with every day people so they can participate in the design solutions that meet their every day needs.”

Streetwyze harnesses local knowledge to address questions like: How walkable is my neighborhood? Where can I buy affordable healthy food? How safe is my local park?

For example, a map of East Oakland based on county and city business permits shows many grocery stores in the area. But the reality, according to Akom and Streetwyze, is that most of these supposed grocery stories are actually liquor or corner stores, where you can’t find fresh vegetables or food.

In addition to providing more reliable data to design healthier communities in the future, the Streetwyze data already plays a critical role for community members and some organizations. “Every community has assets,” said Shah. “The Streetwyze platform actually helps lift those up, so that communities can better share those resources and organize around those assets that already exist.”

At Stanford, Shah is using Streetwyze to research how this digital technology may impact youth self-esteem, civic engagement, environmental stewardship and more.

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

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Stanford researcher explores use of meditation app to reduce physician burnout

September 28, 2017

Photo courtesy of Louise Wen

Slammed by long and unpredictable hours, heavy clinical workloads, fatigue and limited professional control, many medical residents experience stress and even burnout. And surveys indicate this burnout can seriously impact physician well-being and patient care outcomes.

How do you combat burnout? Studies show that meditation can improve well-being, but jamming one more thing into a resident’s hectic day is tough, as Louise Wen, MD, a clinical instructor at Stanford’s Department of Anesthesiology, Perioperative and Pain Medicine, points out. So Wen joined a team of Stanford researchers to test the effectiveness of a mindfulness app, and there work was published this summer in Academic Psychiatry.

I recently spoke with her about the pilot study.

What inspired your study?

“I experienced burnout as a resident, and meditation was a key aspect to my recovery. Growing up, I had been introduced to meditation by my family. In college, I trained to become a yoga teacher and therapist. However, once residency started, my mediation practice essentially stopped.

My low point in residency was precipitated by a HIV needle-stick injury. The month-long antiretroviral prophylactic therapy was effective, but I struggled with the medication’s side effects. My mother advised me to meditate, and afterwards, I felt like my brain had been rebooted. Surprised by the effect of such a brief intervention, I wanted to explore ways to introduce this technique to other time-strapped and stressed residents.”

Why did you use a mindfulness app?

“The gold standard for mindfulness studies is a Mindfulness Based Stress Reduction course developed by Jon Kabat-Zinn, PhD. This eight-week course entails a two-hour group class weekly and 45 minutes of individual home practice daily, plus one full-day silent retreat. This excellent and evidence-based intervention is unfortunately not a feasible format for residents. Instead, the Headspace app on a smart phone delivers guided meditations in an efficient and accessible format.

For the study, we recruited 43 residents from general surgery, anesthesia and obstetrics and gynecology. They were asked to use the app at least two times per week for a month. The app provided 10-minute guided audio meditations, animated videos and longer focused meditations.”

How did you measure whether the app improved wellness?

“Our participating residents were asked to complete surveys measuring their stress, mindfulness and app usage — at enrollment, week 2 and week 4. We found that residents benefitted from using the app and this benefit correlated with increasing app usage.”

Are you doing any follow-up studies?

“A significant challenge of our app study was motivating people to practice the intervention. We’re now working on a study based on the concept of the popular opinion leader. We have developed a four-week, video-based curriculum for anesthesia residents. These videos feature interviews with attendings from our department, where they share their personal meditation and gratitude practices. We showed the videos to the intervention group of residents, whereas the control group watched a boring video of me saying that they should meditate. We are now analyzing the data.”

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

Researchers develop technology capable of real-time drug level monitoring and maintenance

May 10, 2017

Photo courtesy of Soh Lab

Doctors often struggle to choose the best dose of a drug for each patient — the dose that worked for patient A isn’t enough for patient B, or it is way too much for patient C. The response is governed by a host of factors, including genetics, age, body size, the use of other medications, the presence of diseases and the development of drug tolerances.

Now, Stanford researchers are developing new technology to help deliver an optimal, personalized drug dose. Using their drug delivery system, they were able to automatically administer chemotherapy at the desired concentration in mice, as reported today in Nature Biomedical Engineering.

“This is the first time anyone has been able to continuously control the drug levels in the body in real time. This is a novel concept with big implications because we believe we can adapt our technology to control the levels of a wide range of drugs,” said H. Tom Soh, PhD, senior author and a Stanford professor of radiology, of electrical engineering and of chemical engineering, in a recent news release.

The new technology uses three basic elements to create a closed-loop drug delivery system that continuously monitors and adjusts the infusion rate of the drug as needed.

First, a real-time biosensor measures the concentration of the drug in the bloodstream, using aptamer molecules that bind to a specific target molecule. (Aptamers are like antibodies made out of nucleotides.) When the drug of interest is present in the bloodstream, the aptamers bind to the drug, change shape and cause an electrochemical signal that is detected by an electrode. The more drug present, the more aptamers bind and the larger the detected signal.

Second, a controller with sophisticated software uses this detected signal to determine the optimal drug delivery rate to maintain the desired drug concentration. Third, a programmable infusion pump delivers the drug at the rate specified by the controller.

Although the initial results are very promising, many years of additional research will be needed before the system can be tested on humans. The team also plans to make many improvements, including miniaturizing the device. Currently their system is suitable for chemotherapy drug delivery — using a biosensor the size of a microscope slide, as shown in the photograph — but it is too large to be worn by a patient for continual use.

Still, the authors believe their system could be safely used in humans in the future. They stated in the paper that it would be especially useful for the controlled delivery of chemotherapy drugs to pediatric cancer patients, who are particularly difficult to dose correctly since their drug response varies widely with age and degree of physical development.

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

Low-cost “magic box” could decontaminate water in rural communities

April 4, 2017

Photo by Shawn

More than a billion people drink water that is contaminated and can spread deadly diseases such as cholera, dysentery, hepatitis A, typhoid, polio and diarrhea.

Most contaminated water could be purified by adding hydrogen peroxide, which safely kills many of the disease-causing organisms and oxidizes organic pollutants to make them less harmful. Hydrogen peroxide disinfects water in a similar way as standard water chlorination, but it leaves no harmful residual chemicals. Unfortunately, it’s difficult to make or obtain hydrogen peroxide in rural settings with limited energy sources.

Now, researchers from Stanford University and SLAC National Accelerator Laboratory have developed a portable device that produces hydrogen peroxide from oxygen gas and water — and it can be powered by a battery or conventional solar panels. You can hold the small device in one hand.

“The idea is to develop an electrochemical cell that generates hydrogen peroxide from oxygen and water on site, and then use that hydrogen peroxide in ground water to oxidize organic contaminants that are harmful for humans to ingest,” said Christopher Hahn, PhD, a SLAC associate staff scientist, in a recent news release.

First, the researchers designed and synthesized a catalyst that selectively speeds up the chemical reaction of converting oxygen gas into hydrogen peroxide. For this application, standard platinum-mercury or gold-plated catalysts were too expensive, so they investigated cheaper carbon-based materials.

Next, they used their carbon-based material to build a low-cost, simple and robust device that generates and stores hydrogen peroxide at the concentration needed for water purification, which is one-tenth the concentration of the hydrogen peroxide you buy at the drug store for cleaning a cut. Although this device uses materials not available in rural communities, it could be cheaply manufactured and shipped there.

Their results were recently reported in Reaction Chemistry and Engineering. However, more work needs to be done before a higher-capacity device will be available for use.

“Currently it’s just a prototype, but I personally think it will shine in the area of decentralized water purification for the developing world,” said Bill Chen, first author and a chemistry graduate student at Stanford. “It’s like a magic box. I hope it can become a reality.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine. For more details, please read my SLAC news release.

Saliva tests may help identify marijuana-impaired drivers

November 22, 2016
Photo by ashton

Photo by ashton

As of the recent election, seven states and the District of Columbia have now legalized marijuana for recreational use and 19 other states have legalized medical marijuana. And this legalization has raised concerns about driving under the influence of marijuana.

A number of research groups are now focusing on ways to identify drivers impaired by marijuana. As recently reported by KQED, the Center of Medicinal Cannabis Research at the University of California, San Diego, are working to “gather data about dosages, time and what it takes to impair driving ability — and then create a viable roadside sobriety test for cannabis.” And a group of Stanford engineers have created a test called a ‘potalyzer.’

The Stanford effort was led by Shan Wang, PhD, a Stanford professor of materials science and engineering and of electrical engineering. He and his colleagues developed a mobile device that detects the amount of tetrahydrocannabinol (THC) molecules in saliva. (THC is the main psychoactive agent in marijuana.)

The test would allow police officers to collect a saliva sample from the driver’s mouth with a cotton swab, analyze it with the new device, and then read the results on a smartphone or laptop in as little as three minutes.

The technology combines magnetic nanotechnology with a competitive immunoassay. During the test, saliva is mixed with antibodies that bind to both THC molecules and magnetic nanoparticles. The mixture is placed on a disposable test chip, inserted into the handheld device and the THC-antibody-nanoparticles are detected by magnetic biosensors. The biosensor signal is then displayed on a Bluetooth-enabled device.

Wang’s group focused on developing a THC saliva test because it is less invasive and may correlate better with impairment than THC urine or blood tests. Also key is the need for a very sensitive test. A Stanford news release explains:

“Wang’s device can detect concentrations of THC in the range of 0 to 50 nanograms per milliliter of saliva. While there’s no consensus on how much THC in a driver’s system is too much, previous studies have suggested a cutoff between 2 and 25 ng/ml, well within the capability of Wang’s device.”

There is still a lot to do before police can deploy this ‘potalyzer’ device, including making it more user-friendly, getting it approved by regulators and investigating whether there is a better biomarker to detect marijuana impairment than THC. In addition, the test may not work well for THC edibles, the researchers wrote in a recent paper published in Analytical Chemistry.

On the upside, the Stanford technology could also be used to test for morphine, heroin, cocaine or other drugs — and for multiple drugs at the same time.

More research is needed, but there is now a new funding source in California: Proposition 64 allots millions of dollars per year to research marijuana and develop ways to identify impaired drivers.

This is an expanded version of my Scope blog story, courtesy of Stanford School of Medicine.

Can social media shed light on cardiovascular disease? Possibly, Stanford journal editors write

October 6, 2016
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Illustration by Clker-Free-Vector-Images

Clearly social media is part of our every day lives, recording our personal communications in a way previously unimaginable.

Researchers are now analyzing this wealth of social media data to better understand what people think and say about their health. Recently, researchers at the University of Pennsylvania sifted through 10 billion English-language tweets to identify and study more than 550,000 US-based tweets related to cardiovascular disease, as reported in JAMA Cardiology.

The research team found that people who tweeted about five cardiovascular conditions — high blood pressure, heart attack, diabetes, heart failure and cardiac arrest — were more likely to be older and female compared to the general population of Twitter users. They also tweeted within minutes or hours in response to events, such as celebrity deaths or to mark World Diabetes Day. 

This study was discussed in the issue’s Editor’s Note by Stanford journal editors Mintu Turakhia, MD, an assistant professor of medicine, and Robert Harrington, MD, a professor and the chair of the Department of Medicine. In the editorial, they acknowledged that the Penn Twitter study was atypical research to include in JAMA Cardiology but noted that digital health is now a major priority for the journal. They explained:

“We accepted [the paper] because it highlights the potential for using these emerging data sources such as Twitter for cardiovascular research, in this case to evaluate public communication about cardiovascular medicine in a manner not previously possible on such a scale.”

Turakhia, the journal’s associate editor of digital health, elaborated in an email: “Twitter and other social media data allow us to examine daily interactions in a connected life in ways not possible before,” he said. “Previously, in order to gain insight on the public’s perception or interest in cardiovascular disease, we were limited to examine historical news and media archives or direct surveys.”

Although the editors believe that Twitter is a new and important research tool, they raised a few questions about future studies. They wrote in the editorial, “The use of Twitter and other social media platforms for cardiovascular research is in an early, proof-of-concept stage. Many important questions remain: Is there signal in the noise? Are these data or results… from the ‘Twitterverse’ generalizable to a broader population?” They also emphasized the need to establish analysis standards and overcome any ethical issues in linking the data with medical or clinical information. Turakhia added:

“Twitter users do not represent the broader population, but that’s not really its purpose. Twitter allows us to examine a highly connected subset of society and learn how cardiovascular disease might manifest in their connected world.”

Ultimately, researchers hope to use this new information to improve their patients’ health, but the research is in its infancy, he said, adding:

“We haven’t yet figured out how Twitter or social media can be definitely used to improve health and health care. The obvious avenues would be through social and community engagement. Although sharing of personal information is at the cornerstone of the success of social media, I’m not sure that society is ready to be as open with posting health information, as they are with selfies or pictures of kids. However social media could be used to gamify health care behavior by providing incentives, and that won’t need disclosure.”

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

To battle mosquito-borne disease, SLAC x-ray laser provides new view of insecticides

October 4, 2016
Illustration, of LCLS x-ray pulses blasting BinAB nanocrystals composed of protein BinA (yellow) and BinB (blue), courtesy of SLAC National Accelerator Laboratory.

Illustration of LCLS x-ray pulses blasting BinAB nanocrystals composed of protein BinA (yellow) and BinB (blue), courtesy of SLAC National Accelerator Laboratory.

Mosquitoes continue to spread devastating diseases such as malaria, West Nile virus, dengue fever and Zika virus throughout the world. Sadly, there are no medications or vaccines for many of these deadly diseases, so it’s critical to prevent mosquito bites.

A cost effective way to eliminate these disease-bearing insects is the use of specialized insecticides that target against the larval stage of a mosquito. These larvicides, like BinAB, kill some mosquito species, but they are currently ineffective against Aedes mosquitoes that transmit Zika and dengue fever. Now, an international team of researchers is working to develop a new toxin that will kill a broader range of mosquito species, including Aedes.

The existing larvicide BinAB is composed of two proteins, BinA and BinB, which pair together to form nanocrystals inside Lysinibacillus sphaericus soil bacteria. When these bacteria are distributed on the surface of stagnant water locations where mosquitoes breed, the mosquito larvae eat the bacteria — dissolving the nanocrystals that bind to their gut, activating the deadly BinAB toxin and killing the larvae.

The proteins are toxic to the mosquitoes, but harmless to humans and other animals. Unfortunately, previous research has shown that BinAB is also harmless to an Aedes mosquito, because the protein never binds to the insect’s gut so the toxin isn’t activated.

“Part of the appeal is that the larvicide’s safe because it’s so specific, but that’s also part of its limitation,” said Michael Sawaya, PhD, a scientist at the UCLA-DOE Molecular Biology Institute, in a recent news release.

Now, the researchers are adapting the BinAB toxin to attack mosquito species that are insecticide resistant. In order to do this, they needed to understand the 3-D structure of the BinAB proteins and how they work. This was a challenge, because the nanocrystals were so tiny and their structural details were a mystery.

The research team increased the size of the nanocrystals using genetic engineering, and then blasted them with an intense beam of bright, fast pulses of light using the Linac Coherent Light Source (LCLS) at the SLAC National Accelerator Laboratory. This allowed the team to collect detailed structural data from the tiny crystals and create 3-D maps of the electron density of the BinAB protein, as reported in a recent paper in Nature.

The LCLS experiments helped the researchers fully understand how the BinAB protein forms and functions. They are now engineering a modified version of the protein that will kill a broader range of mosquito species.

“The most immediate need is to now expand the spectrum of action of the BinAB toxin to counter the progression of Zika, in particular,” said Jacques-Philippe Colletier, PhD, a scientist at the Institut de Biologie Structurale in France, in the news release. “BinAB is already effective against Culex [carrier of West Nile encephalitis] and Anopheles [carrier of malaria] tos. With the results of the study, we now feel more confident that we can design the protein to target Aedes mosquitoes.”

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


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