TAG: "Innovation"

$10M grant to bring online respite to dementia caregivers

UCSF, UNMC to offer education, support and care.

Katherine Possin, UC San Francisco

UC San Francisco and the University of Nebraska Medical Center have been awarded a $10 million grant from the Centers for Medicare & Medicaid Innovation to create a new Web-based model of dementia care. It will provide around-the-clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.

The Dementia Care Ecosystem will not replace clinicians, but rather bring educational resources developed over the last decade by the UCSF Memory and Aging Center (MAC) to patients and their families, while enabling clinicians to monitor their patients from afar.

“Our hope is this is going to radically improve the way dementia patients are cared for,” said Katherine Possin, Ph.D., who is an assistant professor of neuropsychology at UCSF. “We hope we’ll show this works, and that it can be adopted nationwide.”

Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard, created with the help of Salesforce. Navigators will be people without a formal medical degree and will be supervised closely by nurses, social workers and pharmacists with expertise in dementia care.

These navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall. Meanwhile, patients and their families will be able to get training online to help make financial plans and work through tough medical decisions before their loved ones have reached a crisis stage.

Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs. If caregivers learn to cope better, patients may be able to remain at home longer before moving into assisted living. Last year, according to the Alzheimer’s Association, about 15.5 million people in the United States were caring for friends and family members with dementia. Nearly 60 percent said the work was highly stressful and more than a third reported symptoms of depression.

Bruce Miller, UC San Francisco

“Our ecosystem will have wisdom and experience continuously piped in every day to caregivers who are overwhelmed,” said Bruce Miller, M.D., director of the MAC, who holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at UCSF. “Typically, these people have a hard time getting through to anyone in the medical system.”

Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home. And a small number will have sensors placed inside their homes to detect behavior changes that could signal the onset of a health problem, like being up all night, staying in bed all day or going to the bathroom more times than usual.

“If someone, instead of getting up two times a night, is getting up four or five times a night, we might send a nurse the next morning to their home to get a urine sample, and if it’s bad start the patient on antibiotics,” said Steve Bonasera, M.D., Ph.D., an associate professor of geriatrics at UNMC, who did his fellowship at UCSF. “We’re going to be monitoring people who are a seven- or eight-hour drive from my office in Omaha.”

The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.

Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months. This is projected to save $4.3 million over the three years of the grant.

The MAC already has a well developed website that attracts traffic from around the world. Some of the center’s recorded lectures on caring for people with dementia have been viewed hundreds of thousands of times. Researchers said that once families have easy access to educational resources, office visits will become less pressured and patients and their families will be able to take more time to absorb information and make important decisions.

“The idea of 24/7 telephone access to clinicians with expertise in dementia has really resonated with caregivers,” said Jennifer Merrilees, R.N., Ph.D., a clinical nurse specialist at the MAC who will oversee the care that is dispensed online. “That’s what’s really made their faces light up when I’ve described it to them.”

Beginning this fall, 2,100 patients, all diagnosed with varying stages of dementia, will be enrolled through San Francisco General Hospital and Trauma Center, UCSF Medical Center and the UCSF MAC clinics and Chinatown Clinics, as well as UNMC and other service organizations in Nebraska serving the elderly.

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UCLA spotlights cost-effective health care programs

Innovation event shares what many agencies are doing to help community residents.

Dr. Mimi Choi, medical director for St. John's Well Child and Family Center, staffs an exhibit on the Healthy Homes, Healthy Families program, one of a dozen highlighted by the Institute for Innovation in Health at UCLA for using resources effectively. (Photo by Reed Hutchinson)

Health care innovators gathered last week to share ideas about how to provide the best care for Los Angeles County area patients, use resources effectively, and reduce preventable hospitalizations and emergency room visits in order to lower health care costs.

A dozen agencies attended “Los Angeles Innovates — Meeting New Demands for Access to Healthcare,” an event sponsored by the Institute for Innovation in Health at UCLA to share what many agencies and institutions are doing to help community residents.

“The goal is to make sure we quickly adopt what is working,” said Dr. David Feinberg, president of UCLA Health System and chief executive officer for the UCLA Hospital System, who spoke to health care administrators and staff at the event. “We need to copy shamelessly from each other.”

The event was held in the new Martin Luther King Jr. Community Hospital in South Los Angeles, which is set to open next year and features a variety of innovations, including “smart beds” that alert a nurse’s mobile device if a patient lowers the rail on a hospital bed.

Dr. Elaine Batchlor, chief executive officer of the new hospital, said she was proud to host the gathering as “innovation is the cornerstone of the work we’re doing to launch this hospital,” which is being opened in a partnership between Los Angeles County and the University of California.

“We want to transform health care for the community, and we’re here to learn from each other the best ways to improve our operations,” Batchlor said.

Molly Coye, UCLA’s chief innovation officer, stressed that if a program is working well at UCLA, for example, the strategy should be openly available so that health care agencies are not constantly reinventing the wheel.

“What innovation is about is taking something new that is not widely spread and spreading it further,” Coye said, adding that one such innovation designed to make end-of-life care better for the elderly also reduces health care costs by 30-45 percent.

“We want to be able to ask in five years: Are people doing better? Are they getting more able to manage their own lives? Are they staying in their own homes longer? Do they have better access to care?” Coye said. “If we can decrease emergency room visits and hospitalizations and decrease health care costs, we’ll be able to reach more people who need help because we’re spending less on the patients we’re treating now.”

One such innovation shared at the event was UCLA’s Alzheimer’s and Dementia Care Program, which provides comprehensive and coordinated care and services for patients. A nurse practitioner develops an individualized care plan for each patient, with referrals to neurologists, psychiatrists and geriatric specialists for consultation and medication adjustments. The goal is to help caregivers navigate the health care system and avoid costly hospitalization and emergency room visits.

The program has helped more than 700 patients to date, said Leslie Chang Evertson, a care manager in the program.

“We’ve found that the program makes patients and caregivers feel supported,” she said. “We help improve their ability to provide quality care within the home for as long as possible.”

Other programs highlighted at the event include:

  • Talking Survey and Tablet Health Coach by L.A. Net. This allows physician practices to collect and securely transmit survey data electronically from patients in their waiting rooms and provides individualized health education and coaching videos based on the responses to survey questions. Low literacy and non-English-speaking patients benefit from the surveys and patient education materials given to them on tablets and via headphones while they’re in the waiting room.
  • Clinical Pharmacy Services Integrated into a Safety Net Clinic by USC and AltaMed. This program provides on-site pharmacist consultation for chronic care patients with diabetes, hypertension, asthma, heart failure and hyperlipidemia. Integrating clinical pharmacy services improves the health outcomes of chronic care patients and decreases high-cost emergency room visits and hospitalizations.
  • EConsults by the Los Angeles County Department of Health Services and L.A. Care. This is a Web-based, secure communication portal that allows primary care practitioners to initiate and receive electronic consultations from specialists. The program results in a 20-40 percent decrease of in-person specialist visits and enables the safe peer-to-peer exchange of clinical information.
  • Healthy Homes, Healthy Families from St. John’s Well Child and Family Center. This program provides holistic medical care, education and social advocacy to help children who suffer from illnesses such as asthma and lead poisoning as a result of slum housing conditions. The program provides clinical treatment for affected children and addresses conditions in the home environment that cause the illnesses.
  • Heart Failure Automated Remote Monitoring System and Depression Automated Remote Monitoring System in the Los Angeles County Department of Health Services. These systems use automated voice-recognition telephone monitoring to track patients. For heart failure patients, it allows nurses to intervene before complications require a lengthy hospital stay. The system results in earlier detection, intervention and management of deterioration from stable chronic patients at a 95 percent lower cost compared to having nurses make the calls. For a patient with depression, it allows for monitoring and immediate intervention when necessary.  The system frees up nurses to provide more direct patient care.
  • Home Palliative Care developed with support from Partners in Care Foundation. This program provides multispecialty teams to deliver home-based palliative care to patients who have late-stage chronic conditions and pain-management needs that often are addressed in hospitals. Care teams include physicians, nurses, aides, social workers and therapists.
  • Inpatient Frailty Project by Cedars-Sinai Health System. This program identifies high-risk elderly patients once they’re admitted to a hospital and follows them with more in-depth assessment using clusters of risk factors found to be predictors of adverse events, extended hospital stays and readmissions. The program identifies and mitigates risk factors both in the hospital and in the home after a patient is discharged.
  • Vets to Home: VA Project 120 by the VA Greater Los Angeles Healthcare System. Serving the severely mentally ill and chronically homeless veteran population, the program uses a “street to home” model that enables the delivery of comprehensive psychiatry, primary care, social work and transportation to medical appointments to address the needs of the veterans whether in their residences or on the street.
  • VA Homeless Patient-aligned Care Team from the VA Greater Los Angeles Healthcare System. To reduce emergency room visits and hospitalization, this program brings primary care service to homeless veterans, who are high users of emergency room and hospital services.
  • Community Health Detailing by HealthBegins. This program allows community residents to learn about and map resources and then update an online Yelp-like database to help clinics quickly find resources for patients with health-related social needs. In a pilot program with a South Los Angeles high school, more than 100 students mapped more than 500 local resources for use by community clinics.

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UC participating in Innovation HealthJam

Free online event to take place June 17-19.

UC Davis, UC San Francisco and UC’s Center for Information Technology Research in the Interest of Society (CITRIS) are among the sponsors of Innovation HealthJam, a three-day virtual conference, which starts June 17. It is hosted by Panasonic Corp. of North America with eight health care-related topic areas.

The virtual conference will engage health care experts from academia, private industry and the nonprofit sector.

UC Davis is bringing together experts from its Center for Health and Technology and a variety of other state and national organizations to lead a three-day series of interactive discussions dedicated to telehealth and telemedicine.

UCSF is hosting an online discussion of how to use technology to serve the health care needs of the underserved, both abroad and at home.

Anyone can participate. Real-time text analysis and data mining will highlight emerging trends and identify potential actions. The event is free, but attendees must register to participate. Details on specific discussion times and participants are available at www.innovationhealthjam.com/innovation-healthjam-complete-schedule.

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Redesigning the well-child checkup

UCLA study suggests new models for improving preventive care to low-income families.

Sandra Contreras, a parent coach, meets with Kioki Johnson and her family during a well-child checkup at Wee Care Associates. (Photo by Sandra Chacon)

Well-child visits are the foundation of pediatric primary care in the U.S. Accounting for more than one-third of all outpatient visits for infants and toddlers, the appointments are intended to give doctors the opportunity to identify health, social, developmental and behavioral issues that could have a long-term impact on children’s lives.

However, several studies have shown that the current system of well-child care leaves room for improvement. One major concern is that well-child care guidelines issued by the American Academy of Pediatrics call for physicians to provide more services than can realistically be completed within a 15-minute office visit. As a result, many children do not get all of the preventive care services that they need — and the problem is more acute for low-income families, thanks largely due to their greater psychosocial and developmental needs for and greater need for parenting education.

In a yearlong study led by Dr. Tumaini Coker, an assistant professor of pediatrics at Mattel Children’s Hospital UCLA, researchers developed a new design for preventive health care for children from birth through age 3 from low-income communities. The team partnered with two community pediatric practices and a multisite community health center in greater Los Angeles.

“The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices,” said Coker, who also is a researcher with the hospital’s UCLA Children’s Discovery and Innovation Institute. “Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventive care that is more family-centered, effective and efficient.”

The researchers created two working groups of pediatric clinicians, staff, clinic leadership and parents to design the new models of care. One working group was at South Bay Family Health Care, and another working group combined the efforts of two pediatric practices, the Yovana Bruno Pediatric Clinic in Duarte and Wee Care Associates (led by Dr. Toni Johnson-Chavis), in Compton and Norwalk.

To design the new models of care, researchers gathered input from two sources. First, they solicited ideas from pediatricians, parents and health plan representatives about topics such as having non-physicians provide routine preventive care and using “alternative visit formats” — meeting with health care providers in alternative locations, meeting in groups as opposed to one-on-one, or getting providers’ advice electronically instead of in person, for example. Secondly, the teams surveyed existing literature on alternative providers, locations and formats for well-child care.

Using that input, the clinic working groups developed four possible new models of care that it submitted for review by a panel of experts on preventive care practice redesign. Based on the panel’s rankings, the working groups selected two models to implement and test — one for the private practices and the other for the community clinic.  The private practices adopted a one-on-one visit format while the community clinic used a group-visit format, but the two models shared several characteristics:

  • A trained health educator, or “parent coach,” at each facility who relieves the physician of some of the more routine services and provides preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns.
  • A considerably longer preventive care visit.
  • A website that enables parents to customize their child’s specific needs prior to their visit.
  • Scheduled text messages or phone calls enabling the health care team to communicate with parents.

These findings were reported online today (June 16) in the journal Pediatrics.

The next stage of research is already under way: The team is testing the model selected by the two private practices in those clinical settings, with families randomly chosen to receive the care using either the new delivery model and or the old one. Researchers will compare outcomes for the two groups of children by the end of 2014. The community clinic is currently implementing its selected model, and testing will begin there in July.

“For clinics and practices that provide child preventive health care to families living in low-income communities, the process we used to develop the new models — or the new models themselves — could help them bring innovation to their own practices,” Coker said.

The study was funded by grants from the National Institutes of Health’s National Institute of Child Health and Development and the Health Resources and Service Administration.

The study’s other authors were Dr. Paul Chung and Dr. Paul Shekelle of UCLA, Candice Moreno of the University of Illinois College of Medicine and Dr. Mark Schuster of Harvard Medical School. The authors have no financial ties relevant to this article to disclose.

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UCLA physicians use Google Glass to teach surgery abroad

Teaching surgeons can watch operation and comment via this tech tool.

Imagine watching a procedure performed live through the eyes of the surgeon. That’s exactly what surgical leaders in the United States were able to do while overseeing surgeons training in Paraguay and Brazil with the help of UCLA doctors and Google Glass.

UCLA surgeon Dr. David Chen and surgical resident Dr. Justin Wagner have made it their mission to teach hernia surgery around the world and are harnessing the latest technologies to help.

“Hernia repair is the most common operation performed worldwide,” said Chen, assistant clinical professor of general surgery at the David Geffen School of Medicine at UCLA. “From a global health perspective, it is as cost-effective as immunizations because it allows patients to regain function and resume work and other daily activities.”

It is also an easily teachable procedure that lends itself to the advent of this kind of technology, according to Chen, associate director of surgical education and clinical director of the Lichtenstein Amid Hernia Clinic at UCLA.

The team used Google Glass, which is worn like conventional glasses, but houses a tiny computer the size of a Scrabble tile outfitted with a touch-pad display screen and high-definition camera that can connect wirelessly to stream live.

With Chen and Wagner’s help, local surgeons at a hospital in Paraguay in late May wore Google Glass while performing adult surgeries to repair a common type of hernia in which an organ or fatty tissue protrudes through a weak area of the abdominal wall in the groin. This type of hernia is commonly found in both children and adults.

Through Google Glass, the surgeries were viewed “live” via wireless streaming in the United States to a select group of leading surgeons who could watch and oversee the procedures. The experts could also transmit their comments to the surgeon, who could read them on the Google Glass monitor. The surgeries are also being archived for later training purposes as well. Chen added that the educational program ensures competency and quality of the operations.

“We are one of the first to use Google Glass in teaching and training surgeons from outside a country,” said Chen. And he says hernia surgery is just the beginning.

“Our goal is to utilize the latest technologies like Google Glass, Facebook and Twitter in connecting everyone in medicine worldwide for educational purposes that can help improve medical care in resource-poor countries,” said Chen. “These cost-effective applications can ultimately be used for other surgical procedures and medical training as well.”

The UCLA team also visited Brazil, where they used Google Glass during three hernia surgeries and also streamed a live debriefing session afterwards. The team plans to train 15 surgeons from around the country in September. These surgeons will then become trainers to teach other surgeons at several regional hospitals for underserved patients. Similar programs will be implemented in Haiti, the Dominican Republic, Guatemala and Ecuador this fall.

These training projects are part of an educational arm of Hernia Repair for the Underserved, a nonprofit organization dedicated to providing free hernia surgery to children and adults in the Western Hemisphere. Chen, who serves on the organization’s board, is spearheading these educational projects with the UCLA team to help “train the trainers” and increase the number of surgeons performing this procedure in underprivileged countries in the Western Hemisphere.

Chen and Wagner also work closely with UCLA’s Center for Advanced Surgical and Interventional Technology (CASIT) in developing new ways to help educate doctors remotely.

They have even streamed surgical lectures to Haiti from UCLA Medical Center, Santa Monica.

“We are developing practical applications for these technologies so that surgeons in any setting can have access to the global surgical community from within their own operating rooms,” said Wagner. “Even after the training is over, local surgeons can be teleproctored remotely so they will remain connected to experts worldwide.”

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World Cup shines spotlight on exoskeletons

UC Berkeley, UC Davis advancing the field. The goal: Help paraplegics walk again.

By Susan Suleiman

When soccer’s World Cup — the most-watched sports event on Earth — kicks off June 12, UC Berkeley professor Hamayoon Kazerooni and his research assistants won’t be watching the players. They’ll be staring at the person with wires taped to his skull.

An estimated 1 billion people are expected to see a bravura performance: a paraplegic teenager in a robotic suit kicking a soccer ball. Kazerooni will be comparing the Brazilian’s performance to the one videotaped on a UC Berkeley playing field last week, when Steve Sanchez and Daniel Fukuchi, two paraplegic men in their 20s, played a brief but memorable pickup game with a videographer’s 4-year-old son.

In contrast to the complex array of sensors, gyroscopes and hydraulics worn in Brazil, the Berkeley test pilots wore a robotic system called an exoskeleton that costs about $20,000, weighs just 22 pounds, and can be worn under clothing. With 2 million paraplegics in the U.S., Kazerooni’s goal was to use state-of-the-art robotics to give as many people as possible the chance to walk again — and do it quickly.

“Many paraplegics are not in a situation to afford a $100,000 device, and insurance companies don’t pay for these devices,” Kazerooni said. “Our job as engineers is to make something people can use.”

In the past decade, scientists have adopted a wide range of approaches to something that once would have been called a miracle. The World Cup exoskeleton controller developed by Brazilian neuroscientist Miguel Nicolelis and Gordon Cheng of the Technical University in Munich, Germany, is at the most high-tech end of the spectrum. The device, which required more than six months of virtual reality training to operate, transmits electrical impulses from the user’s brain using electrodes in a rubber cap to a robotic exoskeleton. While TV sports commentators are bandying about the claim that the brain-controlled exoskeleton will make wheelchairs obsolete, research is still in an early stage, said Sanjay Joshi, a professor of mechanical and aerospace engineering at UC Davis, who contributed crucial know-how to the project. While the technology holds promise, particularly for quadriplegics, Cheng estimates that it could take 10 to 20 years before a brain-activated exoskeleton is available.

High tech for ordinary living

At UC Berkeley’s Robotics and Human Engineering Laboratory, Kazerooni was working on a more down-to-earth miracle, concentrating on affordable robotics to allow paraplegics and other people with impaired motor skills to live ordinary lives.

“The key is independence for these people,” he said. “I want them to get up in the morning and go to work, go to the bathroom, stand at a bar and have a beer.”

To make his exoskeleton affordable, he used the simplest possible technology: a computer and batteries in a backpack, actuators at the hips, and a pair of crutches with buttons that activate an exoskeleton that fits around the legs. The crutches provide stability, an important consideration for paraplegics navigating streets and sidewalks.

“The signals from the brain are uncertain, and they aren’t always read and computed appropriately,” Kazerooni said.  “If the user is paraplegic, there’s potential for him to fall. You have a person in there who’s already hurt and we cannot afford for him to fall.”

Kazerooni’s voluble empathy and his sense of urgency — passion is the word he uses — are rare. An inventor who holds more than 50 patents, Kazerooni has been conducting exoskeleton research at UC Berkeley for more than 20 years. If his life had been different, he said, he might have been an artist.

“I make things,” he said. “When I was a kid I used to create things from zero. I made sculptures and little machines. I painted. I use mathematics to make things now.” ‘

In his 50s, Kazerooni still has a baby boomer’s idealism, but his research is notable for its practical applications. In the early 1990s, he and his team developed robotic devices to make the upper body and arms stronger, a technology now used in distribution centers and factories around the world. More recently, with funding from the U.S. Department of Defense, Kazerooni developed the Human Universal Load Carrier (HULC), a real-life version of the super-strong Robocop that gives wearers the ability to carry 200-pound weights over rough terrain for extended periods. At Berkeley Bionics (now called Ekso Bionics), a company he co-founded with two partners, Kazerooni adapted the HULC for paraplegics, developing three exoskeletons, including a $130,000 model the firm is marketing to rehabilitation facilities.

But there were clear benefits to using the exoskeleton on a regular basis, and Kazerooni believed the device was safe and simple enough to be used outside a medical setting. His work with paraplegics had shown him the psychological benefits of being able to stand and walk, even with crutches. More important, walking can stave off serious health problems linked to paraplegia and quadriplegia, including deep vein thrombosis, osteoporosis, muscle spasticity, bedsores and urinary tract problems.

Shaving off ounces — and dollars

In Europe, some companies were already selling exoskeletons directly to consumers, but they cost anywhere from $50,000 to more than $100,000.  To make a low-cost and lightweight exoskeleton that could be used by a wide range of people, Kazerooni realized he would have to depart from standard robotics technology.

He started by using as many off-the-shelf components as possible, including “the kind of computer you have in your washing machine.”  Researchers at his lab, affectionately called Kazlab, shaved off every possible ounce until they came up with a lightweight version that someone of slight stature could use without tiring quickly. The process has been intensive and, at times, all-consuming.

“It’s harder to make a Honda than a Porsche,” Kazerooni said. “It’s not that difficult to keep adding more sensors or more hardware. The question is, can you get performance with as little as possible.”

Steve Sanchez, a 27-year-old machinist, has been working with researchers at Kazerooni’s lab for the past two years. Injured nearly a decade ago in a BMX bicycle accident, Sanchez developed a close relationship with Ph.D. students Michael McKinley, Jason Reid, Wayne Tung, Minerva Pillai and Yoon Jeong. Working together, they not only whittled down the device’s weight, but also fine-tuned its gait. For Sanchez, the Eureka moment came when, as he recalled, “I was able to walk back into the hospital I rolled out of.”

Kazerooni often expresses frustration that it has taken so long to improve the lives of people like Sanchez. But on July 16, his new company, U.S. Bionics, will unveil the lightweight exoskeleton in Italy for the European market. Sanchez will fly to Italy to demonstrate the exoskeleton, along with his girlfriend, a travel writer who also is a test pilot at the lab.

But Kazerooni won’t slow down until the exoskeleton is available to Americans. Even as Sanchez and the others were preparing for the trip to Italy, he ran out to a sporting goods store to buy a soccer ball to find out if his test pilots could duplicate the World Cup kickoff. It was a reminder that in the hyper-competitive world of science, the stakes can be even higher than in professional sports.

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Culturing for cures

UCSF scientists explore the bacterial communities that live in and on our bodies.

Illustration by Charis Tsevis

Long ago, when Andrew Goldberg, M.D., was a resident, the ear, nose and throat specialist had a patient who came in repeatedly with a chronic infection in one ear. The man had been prescribed all manner of treatments – from vinegar drops to antibiotics to antifungals to steroids – none of which provided lasting relief. Then one morning, the patient walked into the office and asked Goldberg to take a look in his ear – the infection was wiped out. “Don’t you want to know what I did?” Goldberg recalls the patient asking, with a grin.

“So he tells me,” Goldberg continues, “I took some wax from my healthy ear and stuck it in my bad ear. Within a few days, my problem was gone and never came back.’ Of course I laughed it off, thinking that the infection had spontaneously cleared and that the guy was crazy,” reflects Goldberg, who is now the director of rhinology and sinus surgery at UC San Francisco.

Decades later, when he began investigating the myriad bacterial communities thriving in the human body, Goldberg realized what a clever, if not desperate, move his patient had made. His good ear hosted an abundant and stable microbial community, while his bad ear had a depleted population of microbes that left it in a chronic inflammatory state. The bacteria in the wax from his good ear had brought the other ear back to healthy harmony.

That patient’s recovery hints at the enormous therapeutic potential of the human microbiome – the 100 trillion bacterial cells living in and on our bodies. Such cells outnumber the body’s own cells 10:1. They are housed primarily in our gut, where roughly 70 percent of the components of our immune system reside. Scientists are hard at work trying to leverage the extraordinary healing powers of the microbiome, mining it for treatments of a variety of conditions, including asthma, irritable bowel syndrome and obesity.

Michael Fischbach, UC San Francisco (Photo by Cindy Chew)

And for good reason, according to microbiologist Michael Fischbach, Ph.D. “One-third of all human medicines are made by bacteria,” he says. “Clearly, they are the best chemists on the planet.” His lab studies how simple microorganisms create drugs with such proficiency. “Over the past 20 years, people have done seminal work uncovering which genes enabled microorganisms to synthesize wildly complex drugs,” he says. “For me, the trick is to be able to find other genes that look similar enough that I know they are there to make a drug.” The process used to be an arduous one, involving a great deal of luck while combing for bacteria through the soil or the ocean, where the vast majority of such drugs have traditionally been found.

That all changed with improvements in genetic sequencing and computational technology. Now, Fischbach uses his computer to scan every bacterium whose genome has been sequenced for drug-producing genes. As expected, his searches have turned up many drug-producing genes in ground- and marine-dwelling bacteria. “But I was shocked to see so many in the human microbiota. You used to have to travel to the coast of Palau to mine the ocean sediment for drugs,” says Fischbach, an assistant professor of bioengineering and therapeutic sciences. “Now we can just check our gut!”

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Tackling tomorrow’s health challenges

Stanley Prusiner among UC participants at New York Times health conference.

New York Times correspondent Elisabeth Rosenthal and Nobel laureate Stanley Prusiner discuss developments in Alzheimer's research at the Health for Tomorrow conference at UCSF Mission Bay. (Photos by Susan Merrell, UC San Francisco)

By Alec Rosenberg

Nobel Prize winner Stanley Prusiner is not resting on his laurels.

Instead, the 72-year-old UC San Francisco neurologist has set his sights on solving one of the biggest challenges facing health care today: Alzheimer’s disease.

Prusiner made a passionate plea for tackling Alzheimer’s and other neurodegenerative diseases Thursday (May 29) at the New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center. The conference, which featured experts from the University of California and across the country, addressed the changing landscape of health care.

Alzheimer’s already has a large impact on health care: It’s the sixth-leading cause of death in the U.S. — more than breast cancer and prostate cancer combined — and nearly half of people age 85 and older have the disease, Prusiner said. Without action, it will get worse — the prevalence of the disease is projected to triple by 2050 to as many as 16 million Americans.

“This is a huge, huge problem, and we’re not doing nearly enough,” said Prusiner, a UC San Francisco professor of neurology and director of the Institute for Neurodegenerative Diseases. “This is such an important area. There is no substitute for research. That’s going to really make a difference.”

Stanley Prusiner, UC San Francisco

Filling the pipeline

The National Institutes of Health provides only $500 million in research funding for Alzheimer’s, compared with more than $5 billion for cancer research, even though each costs society about $200 billion a year, Prusiner noted.

While many drugs treat cancer and hundreds more are in the pipeline, no single drug today halts or slows neurodegenerative diseases, he said. Prusiner, who just wrote a memoir, “Madness and Memory,” about his Nobel Prize-winning discovery of prions — infectious proteins that could be at the root of neurodegenerative diseases such as Alzheimer’s and Parkinson’s — aims to change that.

In April, UCSF formed a new collaboration with Japan-based pharmaceutical company Daiichi Sankyo Co. Ltd. This joint venture, capitalizing on Prusiner’s research, is focusing on developing drugs and molecular diagnostics for multiple neurodegenerative diseases, including Alzheimer’s and Parkinson’s.

“I’m very optimistic now that we are going to get there,” Prusiner said. “This is a huge step forward. We need 10 more of these around the world.”

UC President Janet Napolitano

Making progress

UC is conducting research on health’s most pressing problems, teaching the next generation of health professionals and working to improve health care quality, access and affordability, said UC President Janet Napolitano, who delivered welcoming remarks at the conference.

“There are no quick fixes, but I think working together we can make steady progress,” Napolitano said.

Indeed, research is being conducted throughout UC on Alzheimer’s and many other health issues. Napolitano noted that UC San Francisco leads a team that was just awarded a $26 million federal grant — part of President Obama’s Brain Initiative — to create an implantable device that will retrain the brain to recover from mental illness. She also pointed to research by conference speakers David Kilgore of UC Irvine and Michael Fischbach of UC San Francisco.

David Kilgore, UC Irvine

Countering ‘diabesity’

Kilgore, a clinical professor of family medicine, talked about the problem of “diabesity”: Diabetes rates have tripled in the last 20 years, while more than two-thirds of adults are considered to be overweight or obese. Among Kilgore’s patients at a UC Irvine clinic, 70 percent have diabetes, often in combination with other chronic diseases.

“The challenge of chronic disease has completely changed what it’s like to be a primary care physician,” Kilgore said.

More prevention is needed, Kilgore said. He started group medical visits for patients with diabetes. They receive extra information about nutrition, exercise and receive a healthy cooking lesson.

“They love it,” Kilgore said.

UC San Francisco's Michael Fischbach and Stanford's Justin Sonnenburg discuss research into gut bacteria.

Going with the gut

Fischbach, a UC San Francisco assistant professor of bioengineering and therapeutic sciences, discussed his research on the gut with collaborator Justin Sonnenburg, a Stanford University microbiologist who has a bachelor’s degree from UC Davis and a doctorate from UC San Diego. They are studying gut bacteria and how it could help reveal the causes and new treatments for Crohn’s disease and obesity.

“The beauty of being in basic research is you don’t know where you’re going to end up,” Fischbach said after their panel presentation. “It’s nice to be on a journey where you don’t know where the ship lands. I hope it’s going to improve human health.”

Seeking solutions

The Health for Tomorrow conference addressed issues ranging from the impacts of the Affordable Care Act to rethinking how to deliver care in the 21st century to issues of access, affordability and applying technology. Speakers included Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services; Diana Dooley, secretary of the California Health and Human Services Agency; New York Times correspondent Elisabeth Rosenthal; CEOs Toby Cosgrove of the Cleveland Clinic and Bernard Tyson of Kaiser Permanente; and several with UC ties.

As part of the conference, five entrepreneurs were invited to give short talks about their health-related startup companies. Three of them studied at UC:

  • Erik Douglas, CEO of CellScope, has a doctorate degree from UC Berkeley and UC San Francisco. The company’s first product, CellScope Oto, turns a smartphone into a digitally connected otoscope, enabling remote care for ear infections, the leading reason for pediatric visits.
  • Anupam Pathak, Lift Labs founder and CEO, has B.S. and M.S. degrees from UC Berkeley. Lift Labs makes active stabilization tools for people living with tremor. Its pocket-sized Liftware, which has a spoon and other attachments, is a “Swiss Army knife for people with tremors.”
  • Joanna Strober, founder and CEO of Kurbo Health, has a J.D. from UCLA. She founded Kurbo after becoming concerned about the consequences of her middle son being overweight. Kurbo has developed a mobile app designed for children and their families to help them lose weight and live healthier lives.

The Health for Tomorrow conference can be viewed on demand, broken down by panel, at www.nythealthfortomorrow.com.

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UC leaders to speak at Health for Tomorrow conference

Event, May 28-29, will be webcast live.

University of California President Janet Napolitano and Nobel laureate Stanley Prusiner will be among several UC participants in the New York Times Health for Tomorrow conference, May 28-29, which will be webcast live at www.nythealthfortomorrow.com.

The event, which will take place at UCSF Mission Bay Conference Center in San Francisco, will address the changing landscape of health care and highlight UC’s role in fostering a dialogue around important issues.

The conference is invitation-only, but the live webcast is free and open to all.

It kicks off with a keynote talk at 5:30 p.m. Wednesday, May 28, by New York Times correspondent Elisabeth Rosenthal, who will present findings from her yearlong special series “Paying Till It Hurts.”

On Thursday, May 29, Napolitano will deliver welcoming remarks at 8:25 a.m. A day full of discussions will follow with health care experts from across the nation. UC participants include: a panel on the gut at 2:05 p.m. with UC San Francisco assistant professor of bioengineering and therapeutic sciences Michael Fischbach; a panel on the physician/patient relationship in the 21st century at 3:40 p.m. with UC Irvine clinical professor of family medicine David Kilgore; and a Nobel Prize panel at 4:35 p.m. with Prusiner, a UC San Francisco professor of neurology and director of the Institute for Neurodegenerative Diseases.

As part of the conference, some UC entrepreneurs have been invited to give very short talks about their health-related startup companies. The “Three Minutes to Launch” presentations will be interspersed throughout the day to spotlight emerging innovators in health. Those with UC ties include Anupam Pathak, Lift Labs founder and CEO, who has B.S. and M.S. degrees from UC Berkeley; Erik Douglas, CEO of CellScope, who has a doctorate degree from UC Berkeley and UC San Francisco; and Joanna Strober, founder and CEO of Kurbo Health, who has a J.D. from UCLA.

Learn more about the conference agenda at www.nythealthfortomorrow.com/agenda. A full speaker list is available at www.nythealthfortomorrow.com/speakers. Join the conversation at @NYTconf #nythft.

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Innovative medical device startup wins UC Davis business competition

Big Bang! competition winner Nevap aims to help prevent ventilator-associated pneumonia.

A UC Davis graduate whose startup has patented a potentially life-saving device that prevents hospital-acquired infections won the top prize of $10,000 in this year’s UC Davis Big Bang! Business Competition.

Nevap Inc. founder Benjamin Wang has been working on the startup since 2011 when he graduated from medical school. He earned a bachelor’s degree in biochemistry and molecular biology from UC Davis in 2005.

Wang said Big Bang! helped him develop as an entrepreneur. The competition also taught him about the important role that business takes in linking innovation and commercialization.

“The Big Bang! competition gets you ready to hit the pavement,” Wang said.

A total of $28,000 in prize money was handed out Thursday night before a crowd of more than 120 attending the awards ceremony at the UC Davis Conference Center. A record 66 teams representing more than 200 aspiring entrepreneurs participated in the 14th annual competition, with five finalist teams selected to make their pitches at the ceremony.

The UC Davis Child Family Institute for Innovation and Entrepreneurship organizes and hosts the competition, which provides workshops, mentorship, financing and networking to accelerate commercialization and advance the startup process. The institute is a center at the UC Davis Graduate School of Management.

“The competition has helped many entrepreneurs make the critical connections that have transformed their ideas into reality,” said Cleveland Justis, executive director of the institute.

Nevap’s product improves on existing tracheal devices used in chronically intubated hospital patients. The company’s device will help prevent ventilator-associated pneumonia, which is a $12 billion-a-year problem in the United States, Wang said.

Nevap, which is based in the Bay Area, has filed a utility patent for its third-generation functional prototype. The device will require approval from the U.S. Food and Drug Administration. Wang is seeking investors to manufacture the product.

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UCSF 2.0: Creating new partnerships

Collaborations on brain diseases point to promising possibilities.

UC San Francisco's Adam Gazzaley and colleagues are reporting in the journal Nature that they have found a way to reverse some of the negative effects of aging on the brain, using a video game designed to improve cognitive control.

No single institution can address the next decade’s health, research and education challenges on its own. As players from a wide range of industries continue to venture into health and health care, it will be imperative for UC San Francisco to form new partnerships to address familiar health challenges in creative, novel ways.

UCSF has actively increased its portfolio of partnerships in the past few years, announcing several major projects this year alone.

Most recently, UCSF formed a new collaboration between the Institute for Neurodegenerative Diseases and the Japan-based global pharmaceutical company Daiichi Sankyo Co. Ltd. This joint venture, capitalizing on the Nobel Prize-winning research of Stanely Prusiner, M.D., is focusing on developing therapeutics and molecular diagnostics for multiple neurodegenerative diseases.

The collective feedback from faculty and staff who participated in the planning initiative known as UCSF 2.0 calls on the University to “amplify its network of collaborators.” One big idea is for UCSF to lead the creation of a Bio Silicon Valley, taking advantage of its close proximity to the Bay Area’s innovation milieu by bridging biological, social, and technological sciences to revolutionize biomedical research.

Making the right connections

Neuroscientist Adam Gazzaley, M.D., Ph.D., director of the UCSF Neuroscience Imaging Center and a faculty member since 2004, is among a group of innovators who are doing just that. He partnered with Swartz Center at UC San Diego and Nvidia, which makes high-end computational computer chips, to create a new imaging technology called GlassBrain. The technology allows him to view the brain without using a big imaging machine or wiring the patient to a computer with the ultimate aim to find treatments for a variety of brain diseases, including Alzheimer’s and multiple sclerosis.

Gazzaley, an associate professor of neurology, physiology and psychiatry, says UCSF can help faculty make the right connections with partners across sectors.

“We need to know what companies are looking for and how to align our goals,” he said. “We just have to point in same direction and appeal to their public interests. What I found in my experience doing this is that we have to demonstrate our value as a real partner and not just be a charity case.”

UCSF also can help by embracing the entrepreneurial spirit by providing opportunities for faculty and students to share ideas and tools.

“I want us to have a platform that enables us to be more creative and aggressive in thinking how software and hardware can be a new medicine to improve brain health,” Gazzaley said. “Often, high-tech innovations take a decade to move beyond the entertainment industry and reach science and medicine. That needs to change.”

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Big Ideas@Berkeley launches new generations of social innovators

Winning entries demonstrate strategic blend of technology, social innovation.

Berkeley Ph.D. student Pablo Rosado, part of a team that developed ReMaterials to bring roofing systems to impoverished communities, explains the project at last week’s awards celebration.

Every year, thousands of students come to Berkeley with vague ambitions to change the world. The annual Big Ideas@Berkeley competition is inspiring some of them to do just that — by launching globally life-changing innovations even before they graduate. Last week, the program honored this year’s winning projects with an awards celebration at the Blum Center for Developing Economies.

From building Africa’s first wind- and solar-powered radio station to promoting yogurt for improved child nutrition in Nepal to creating an app to show the safest nighttime routes on the Berkeley campus, the competition’s winning entries all demonstrated a strategic blend of technology and social innovation.

“We’re teaching our students to face a challenge, take a risk and use their educations for real-world impact and social good,” said Phillip Denny, Big Ideas program manager and chief administrative officer at the Blum Center. “We’re helping them to get ideas out of their heads and to put actionable plans on paper.”

In contrast to most other business-plan competitions, Big Ideas@Berkeley is focused on social change. The yearlong program, started in 2006, offers training and mentoring for teams of undergraduate and grad students. They learn critical thinking, market analysis and presentation skills to develop real-world projects that are both feasible and scalable.

The competition is supported by several Berkeley centers and institutes, as well as key sponsors such as the Andrew and Virginia Rudd Family Foundation, the Charles Schwab Foundation and the Center for Information Technology Research in the Interest of Society, or CITRIS. This year, the program also formed a new partnership with the crowdfunding site Indiegogo to better promote and fund the projects.

“It’s a very Berkeley-esque idea,” said sponsor and judge Andrew Rudd, who earned his MBA at the Haas School of Business. “These students are doing something positive with what they’ve learned, to bring the 21st century to parts of the world that don’t share our good fortune.”

The competition drew proposals from 187 teams of more than 600 students from 75 different majors, five UC campuses and four other universities nationwide. Judges recognized a total of 40 projects with awards from $1,000 to $10,000 across nine categories including open data, human rights, clean and sustainable energy alternatives, social justice and information technology.

“The diversity, quality and overall execution were really extraordinary this year,” said Denny. “The winning entries were chosen based on the combination of personal passion and a commitment to improving the world.”

Advancing the lives of those in poverty

First place in the “global-poverty alleviation” category went to ElectroSan, a system that improves public health and the environment by converting human waste into income-producing by-products. The process applies electrochemical cells to recover nitrogen from human urine and to disinfect feces, bringing affordable sanitation to poverty-stricken communities.

Inspired by a visit to the urban slums of Nairobi in 2013, Ph.D. student William Tarpeh seeks to introduce waste treatment to the 4.6 billion people in the developing world who currently can’t afford adequate sanitation facilities. The project is in the technology- development phase to ensure maximum nitrogen recovery.

“Connecting technology and international development was a great part of this experience,” explained Tarpeh, who’s working toward a doctorate in environmental engineering. “Big Ideas helped me to think at both the molecular level and the business-model scale to bring this to fruition.”

Rami Ariss, a junior in chemical and biomolecular engineering, and Othmane Benkirane, a junior in energy engineering and structural engineering, won first place in the “clean and sustainable-energy alternatives” category. Their project, Solidge, is a solar-powered refrigeration system that doesn’t rely on an electricity grid. Refrigerators are the most sought-after appliance in low-income communities; by integrating energy generation, storage and use into the same appliance, Solidge enables users to store food, unsold crops or vaccines for longer periods. The project will initially launch in Benkirane’s native Morocco, but will ultimately be deployed in developing countries globally.

Benkirane credits the Big Ideas competition with changing his career focus from new technologies to pressing energy needs in developing countries. “The Solidge project taught us to really listen to the end user,” he said. “Whether they’re graduates of prestigious universities, blue-collar workers or rural farmers in eastern Morocco, all of these people have equal insights, and Solidge taught me to look for the hidden ones.”

Scaling up

“Scaling up Big Ideas” was the category for previous contest winners who are further along in implementing their projects. First place went to a team led by Charles Salmen, a recent graduate of UC San Francisco’s medical school, for a wind- and solar-powered radio station that reaches 200,000 listeners across Kenya, Uganda and Tanzania. An all-Berkeley team of Pablo Rosado and Hasit Ganatra, both Ph.D. students in mechanical engineering, and Caitlin Touchberry, a master’s student in development practice, took second place for ReMaterials, which provides roofing systems for communities in poverty.

More than a billion people currently live in slums worldwide, and adequate roofing is a critical issue for public health and comfort. The team has already developed a natural, recycled material mix and manufacturing process at the prototype level, and is now working on scaling up the manufacturing process, improving the supply chain and developing a sales and marketing strategy to attract investors and key partners.

“Last year we were focused on the engineering side, developing the materials and building small-scale roofs,” explained Rosado. “Now we’re looking for a mentor in law and finance to help us get the product to market. We’re going to India this summer to do a first round with our target audience.”

Participants uniformly credited mentorship as a critical component of the Big Ideas ecosystem. Tony Stayner, an angel investor and nonprofit board member, served as a Big Ideas judge and as a mentor to the ReMaterials project. He credited the program with increasing his own body of experience and his interest in social entrepreneurship.

“If you ever get depressed about the future of the world, go spend some time with the Big Ideas students,” he said. “They’re bright, creative, big-hearted and very passionate about making the world a better place.”

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