Designing buildings to improve health

Are the buildings that we live and work in stressing us out?

The answer is probably yes, according to Stanford engineer Sarah Billington, PhD, and her colleagues. They also believe this stress is taking a significant toll on our mental and physical health because Americans typically spend almost 90% of their lives indoors.

During a recent talk at a Stanford Reunion Homecoming alumni celebration, Billington described a typical noisy office cut off from nature and filled with artificial light and artificial materials. This built environment makes workers feel stress, anxiety and distraction, which reduces their productivity and their ability to collaborate with others, she explained.

Now, Billington’s multidisciplinary research team is working to design buildings that instead reduce stress and increase a sense of belonging, physical activity and creativity.

Their first step is to measure how building features — such as airflow, lighting and views of nature — affect human well-being. They are quantifying well-being by measuring levels of stress, belonging, creativity, physical activity and environmental behavior.

In a preliminary online study, the team showed about 300 participants pictures of different office environments and asked them to envision working there at a new job. Across the board, the fictitious work environment was viewed as important to well-being.

“In eight out of the nine things that we were looking at, there were statistically significant increases in their sense of belonging, their self-efficacy and their environmental efficacy when they believed they were going to be working in an environment that had natural materials, natural light or diverse representations,” said Billington.

The researchers are now expanding this work by performing larger lab studies and designing future field studies. They plan to collect data from “smart buildings,” which use high-tech sensors to control the heating, air conditioning, ventilation, lighting, security and other systems. The team also plans to collect data from personal devices such as smartwatches, smartphones and laptops.

By analyzing all of this data, they plan to infer the participants’ behaviors, emotions and physiological states. For example, the researchers will use the building’s occupancy sensors to detect if a worker is interacting with other people who are nearby. Or they will figure out someone’s stress level based on how he or she uses a laptop trackpad and mouse, Billington said.

Stanford computer scientist Pablo Paredes, PhD, who collaborates on the project, explained in a paper how their simple model of arm-hand dynamics can detect stress from mouse motion. Basically, your muscles get tense and stiff when you’re stressed, which changes how you move a computer mouse.

Next, the team plans to use statistical modeling and machine learning to connect these human states to specific building features. They believe this will allow them to design better buildings that improve the occupants’ health.

The researchers said they intend to bring nature indoors by engineering living walls with adaptable acoustic and thermal properties.

They also plan to incorporate dynamic digital displays — such as a large art display on the wall or a small one on an individual’s personal devices — that reflect occupant activity and well-being. For example, a digital image of a flower might represent the energy level of a working group based on how open the petals are, and this could nudge their behavior, Billington said in the talk.

“Our idea is, what if we could make our buildings shape us in a positive way and keep improving over time?” Billington said.

Photo by Nastuh Abootalebi

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

Eponym debate: The case for biologically-descriptive names

Naming a disease after the scientist who discovered it, like Hashimoto’s thyroiditis or Diamond-Blackfan anemia, just doesn’t work anymore, some physicians say.

A main argument against eponyms is that plain-language names — which describe the disease symptoms or underlying biological mechanisms —  are more helpful for patients and medical trainees. For example, you can probably out a bit about acquired immunodeficiency syndrome (AIDS), whooping cough or pink eye just from their names.

“The more obscure and opaque the name — whether due to our profession’s Greek and Latin fetish or our predecessors’ narcissism — the more we separate ourselves from our patients,” says Caitlin Contag, MD, a resident physician at Stanford.

Stanford endocrinologist Danit Ariel, MD, agrees that patients are often confused by eponyms.

“I see this weekly in the clinic with autoimmune thyroid disease. Patients are often confusing Graves’ disease with Hashimoto’s thyroiditis because the names mean nothing to them,” says Ariel. “So when I’m educating them about their diagnosis, I try to use the simplest of terms so they understand what is going on with their body.”

Ariel says she explains to her patients that the thyroid is overactive in Graves’ disease and underactive in Hashimoto’s.

Ariel says she believes using biological names also helps medical students better understand the underlying mechanisms of diseases, whereas using eponyms relies on rote memorization that can hinder learning. “When using biologically-descriptive terms, it makes inherent sense and students are able to build on the concepts and embed the information more effectively,” Ariel says.

Medical eponyms are particularly confusing when more than one disease is named after the same person, Contag argues. For example, neurosurgeon Harvey Williams Cushing, MD, has 12 listings in the medical eponym dictionary. 

Stanford resident physician Angela Primbas, MD, agrees that having multiple syndromes named after the same person is confusing. She says it’s also confusing to have diseases named differently in different countries. In fact, the World Health Organization has tried to address this, along with other issues, by providing best-practice guidelines for naming infectious diseases. (Genetic disorders, however, lack a standard convention for naming.)

In addition, Primbas said she thinks naming a disease after a single person is an oversimplification of a complex story. “Often many people contribute to the discovery of a disease process or clinical finding, and naming it after one person is unfair to the other people who contributed,” she says. “Plus, it’s often disputed who first discovered a disease.”

Also, few disease names recognize the contributions (or suffering) of women and non-Europeans. And some eponyms are decidedly problematic, like those named after Nazi doctors. A famous example is Reiter’s syndrome named for Hans Reiter, MD, who was convicted of war crimes for his medical experiments performed at a concentration camp.

“Reiter’s syndrome is now called reactive arthritis for the simple reason that Reiter committed atrocities on other human beings to conduct his ‘science.’ Such people should not have their name tied to a profession that espouses the principles of beneficence and nonmaleficence,” says Vishesh Khanna, MD, a resident physician at Stanford. He says medicine is swinging away from using these controversial eponyms to describe them on the basis of their biology instead.

Personally, Khanna also admits that naming a disease after himself wouldn’t sit well.

“Receiving credit for discovering something can certainly be a wonderful feather in a physician’s career cap, but the thought of actually naming a disease after myself makes me cringe,” says Khanna. “Patients and doctors would utter my name every time they had to bring up a disease.”

Such sentiments may be why Contag’s example of a good disease name — cyclic vomiting syndrome — is in plain English. Was no one eager to lend his or her name to it?

While the debate over medical eponyms continues, Khanna suggests a potential solution. “Perhaps a reasonable approach to naming going forward is to allow the use of already established eponyms without dubious histories, while only naming newly discovered diseases based on pathophysiology,” he says.

Everyone I spoke with agrees that changing the medical eponyms will only happen slowly, if at all, since it is difficult to change language. However, it can be done, according to Dina Wang-Kraus, MD, a Stanford resident in psychiatry and behavioral sciences.

“I looked through our diagnostic manual and we do not have diseases named after people in psychiatry. This shift happened quite some time ago so as to avoid confusion and to allow clinicians from all over the world to have a unified language,” says Wang-Kraus. “In psych, we often say that we wish other specialties would adopt a universal nomenclature too.”

This is the conclusion of a series on naming diseases. The first part is available here.

Photo by 4772818

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

Citizen science research investigates neighborhoods’ effects on well-being

Image courtesy of Ben Chrisinger

When walking through different parts of a neighborhood, how do you feel? Comfortable and relaxed, or stressed and on-alert? And how do these different environments — over days or even years — impact your well-being?

A new Stanford study explores how to answer these kinds of questions using citizen scientists, as recently reported in International Journal of Health Geographics. To learn more, I spoke with lead author Ben Chrisinger, PhD, a postdoctoral research fellow at the Stanford Prevention Research Center.

What inspired you to study the built environment and health?

“I’ve always been fascinated by how and why we perceive different neighborhoods as safe or unsafe, welcoming or unwelcoming, and attractive or unattractive. If we can develop a more granular understanding of where we feel certain ways, and why, it’s possible that we can improve urban design.

Chronic stress contributes to a number of negative health outcomes, ranging from decreased immune function to cardiovascular disease.

Understanding what exactly contributes to stress in different places can be valuable information for individuals. But we also think there’s great potential in pooling these stress data across many individuals to see if common themes exist. Urban planners, policymakers and developers could learn from these themes to better promote health in their communities.”

How did you conduct your recent citizen scientist study?  

“We partnered with an urban design and planning non-profit, Place Lab, in San Francisco. They recruited eight women and six men in their 20s and 30s who lived locally. We had all the volunteers do the same 20-minute walk in a Hayes Valley neighborhood.

We used a citizen-science method called Our Voice, developed by the Healthy Aging Research and Technology Solutions Stanford research group led by Abby King, PhD. Individuals use a smartphone app to take pictures and record audio narratives of their neighborhoods.

We asked people to document things along the walk that they thought were contributing or detracting from their well-being. Their phone app recorded where they took their pictures and audio narratives. Everyone also wore a sensor on their wrist that measured time-stamped biometric data — including blood volume pressure, heart rate, skin temperature and electrodermal activity as a proxy for stress — to show how their bodies responded to different environments.

We then created a web platform to share back the participants’ photos, transcribed audio and biometric data superimposed on a map.”

What did you find?

“The phone app data showed that participants often talked about traffic, noise and whether they felt safe as a pedestrian. Even in high volume areas, people also talked about the aesthetic qualities of streets and historic buildings. It appears that it’s not just parks that are stress reducing — quiet areas might also be important. We need to do more research to understand the elements that provide a break from the urban environment.

Our exploratory statistical analyses revealed that, on average at the group level, there were significant associations between participants’ electrodermal activity and the built-environment characteristics. However, it’s clear that these models explain some participants’ data much better than others. One possible explanation is that we’re leaving out some influential neighborhood variables.”

 What’s next?

“We want to do this again with more people all walking a smaller section — like one alley or a pair of streets — so we can dig deeper into what explains the differences between people’s perceptions of specific places.

We also want more diversity in the age, race and ethnicity of our participants. We know this is important from earlier citizen scientist projects. For example, a previous study showed that kids take pictures of graffiti and see it as a good thing, as art, whereas older adults see it as vandalism.”

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