Countless campaigns have been launched to steer schoolchildren toward healthy habits, and yet rates of childhood obesity and diabetes continue to soar. Celebrity endorsements, catchy catchphrases, and food pyramid redesigns have struggled to combat the allure of fast food and television in the battle for child health in the United States. But with childhood obesity rates tripling in the last 30 years and type 2 diabetes showing up earlier in life, there’s an urgent need for more effective programs to promote nutrition and exercise in kids. One strategy is to create more relevant programs, locally focused and tailored to the culture of the children the program is trying to help.

That approach inspired not one but two child diabetes prevention programs created by Medical Center researchers and tested with our neighbors on Chicago’s South Side. The two programs - called Reach-Out and Power-Up - are siblings, with similar designs, goals, and measures, but in slightly different populations and venues. The pilot studies, both published in recent months, demonstrate the challenges faced by researchers in creating effective, reproducible programs with a local focus…and also offer hope that a successful intervention is possible.

Before the programs could be designed, the first step was to listen. The research team, led by Deborah Burnet, professor of medicine and pediatrics, organized focus groups with overweight children and their parents to learn about their specific obstacles to improving health and gather ideas about the types of physical activity and classes that would appeal to them. For example, the African-American children said they would like to try martial arts and yoga, so instructors for those activities were recruited. The conversations laid the groundwork for programs that would take the unique circumstances of families on the South Side of Chicago into account.

“Nutrition and exercise are both behaviors we do in a social context; in a place, in a neighborhood, in the context of certain social mores and expectations and cultural factors,” Burnet said. “Food, especially - who cooks, where we learn how to cook, how do our tastes get shaped in what we like to eat - those occur in social and cultural contexts.”

While both programs were designed to improve the health and behavior of children, the targets were both the kids and their parents. In Reach-Out, families gathered at a local YMCA for 14 weeks, splitting into separate parent and child groups for the first part of each session and then reconvening for a combined activity. Sessions included grocery store tours, exercise training, cooking classes, and even a family basketball game. Scavenger hunts, relay races, and Family Feud-style review quizzes were used to keep the kids and their parents engaged. But addressing the family’s cooking and eating habits could also be a sensitive topic.

“Feeding is all bound up with caring and love, so it’s very complicated - if you tell grandma she’s not cooking for her grandchildren right, her feelings get hurt,” Burnet said. “So how do you do that in a constructive way so that grandma is valued, but also moves in this healthy direction?”

At the end of the Reach-Out pilot study, published in the Journal of the National Medical Association, the program earned glowing reviews from participants, who said that it helped reduce food intake, steered them toward new fruits and vegetables, and encouraged increased physical activity. However, the clinical improvements were modest, including slight dips in BMI z-score (which scales the measure to child age) and glucose-to-insulin ratio. The incremental changes might mean that very heavy kids need more help to get back to healthy habits, Burnet said: “Kids who are this big probably need a more intensive treatment and intervention than a weekly community-based program.”

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More and more Americans are working at least a portion of their jobs from home, facilitated by technological advances and encouraged by soaring gas prices. Even physicians, enabled by the spread of electronic health records (EHR), are increasingly able to perform some of their tasks at home, including updating patient records, checking lab results, and submitting orders for their patients. But for residents - the doctors-in-training who log the longest hours in the hospital - the ability to work at home can add even more burden to an already overstuffed schedule. In light of new national duty hour restrictions which limit residents to 80 hours a week, there could be increased pressure to push even more of their work to the home office.

However, few studies have looked at just how often these clinical activities already occur from home. To fill this gap, a team of Medical Center residents recently conducted a survey about the frequency of clinical and educational work done at home by their peers. The results of that study, published yesterday in the Archives of Internal Medicine, depict the double-edged sword of EHR home access: greater convenience and surveillance mixed with the potential for danger and abuse - especially as the new rules go into effect on July 1st.

“There are constantly new restrictions on duty hours but additions and new requirements in our training, which include more clinic time,” said Allison DeKosky, one of the study’s authors. “So we’re constantly logging in from home, not just to look up information for our research and education on our own time, but also to follow up on patient information that we simply couldn’t do in the hospital because we had to leave.”

The survey, conducted at two Chicago hospitals, found that performing clinical duties at home is commonplace. A majority of residents reported checking and ordering labs, reviewing records, e-mailing or paging staff at the hospital, and conducting clinic phone calls and orders at least once per month. Of more concern, significant numbers reported performing such activities at least once on their post-call day - when residents are supposed to be recovering from a grueling 30-hour hospital shift.

“Working from home is not necessarily always bad,” said Vineet Arora, associate professor of medicine and faculty advisor on the study. “After all, with electronic health records, working remotely is part of modern-day physician practice. The key question for residency programs is where do you have to draw the line and say that’s unsafe.”

The potential missteps are many: sleep deprivation could interfere with medical decision-making, the information received via EHR may be incomplete or out-of-date, and orders from the resident at home and the team working in the hospital could be redundant or conflicting. So why do residents have such a tough time leaving their work at work? DeKosky said that it’s a combination of responsibility, communication concerns, and looking out for their fellow residents. When shifts change after a call shift, the resident must turn their patients over to another resident to cover in addition to the incoming resident’s own patient load. Not wanting to over-burden the cross-cover resident or worried that an important test result or order might get lost in the shuffle, the post-call resident may feel compelled to check in via the EHR from home.

“It’s hard for us to relinquish responsibility for our patients, we all care very much about them,” DeKosky said. “It is a balance between getting out of the hospital and maintaining your ownership of the patient.”

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By Meghan Sullivan

That there even was a luncheon at Crerar library last week to welcome Nancy Hopkins was a sign of progress. Speaking of a committee formed at MIT in 1995 to explore gender discrimination among tenured faculty, she commented that their meetings were generally held off campus since “having that many women in one room at MIT was so unusual that we were afraid to be seen meeting on campus…it was sure to arouse suspicion.”

Fifteen years later, the packed luncheon in the middle of Crerar was hard to miss. A few dozen women - and a few men - had gathered to discuss her work uncovering and fighting gender discrimination at MIT. More than a relaxed opportunity to ask Hopkins questions before her afternoon lecture, the lunch was a chance for graduate students and post-docs to discuss their experiences and ask for advice. While the prevalence of gender discrimination in the sciences and elsewhere tends to incite strong emotion, Hopkins carried herself with sensibility and humor that was contagious.

Hopkins, a professor of biology at MIT and accomplished cancer biologist, is the first to admit that she never intended to be a feminist. It wasn’t until pervasive and arguably unconscious barriers at MIT began to impede her research in 1995 that she took action against the status quo. Science, she pointed out, has always been touted as a meritocracy, yet she saw her female colleagues repeatedly passed over for tenure, funding, even lab space. In the early stages of her work on gender discrimination, Hopkins perused the MIT staff listings looking for other women in science. She was shocked to learn that out of 274 faculty positions, only 22 were filled by women. “I said check the back of the catalog,” she laughed, “Perhaps they list them separately.”

But why was science losing women? By the nineties the percentages of male and female graduate students in the sciences were about equal, yet that equality failed to emerge in tenured faculty positions. To explain this, Hopkins described a well-established phenomenon known as “the Leaky Pipeline.” In essence, while the proportions of male and female students entering science are comparable, women are more likely to leave (or leak out of) the scientific career path due to issues which primarily affect women.

Like many, Hopkins believed the Civil Rights Act and affirmative action policies were the answer to getting more women in science. But over the next thirty years, less obvious issues proved serious barriers, including sexual harassment, connecting with an empowering mentor, and managing a successful family-work balance. The last was especially frustrating, as high level science can often require more than 70 hours of work a week, leaving little time for family and children. As Hopkins put it, many were required to be “nuns of science,” working in an environment where talking about family and children was far from the norm.

However, it wasn’t until one of the more insidious barriers to women in science began to interfere with Hopkins work that she got involved. Called unconscious gender bias, this subconscious undervaluation of work done by women has been studied for years by psychologists. For example, when people are shown work done by a man or a woman and asked to rate it, the panel will value the man’s work over the woman’s, even if the objective quality of both is identical. Such undervaluation of women’s work not only directly impedes their progress up the academic hierarchy, but also self-selects female researchers out of science, caving to feelings of inadequacy and disappointment. As Hopkins said, she felt that “no matter what I discovered, I wouldn’t be accepted in this field.”

Rather than give up a career she’d already sacrificed so much for, Hopkins and 16 other tenured female faculty members drafted a letter to MIT’s Dean of Science at the time, Robert Birgeneau, concerning the unfair gender biases prevalent in the MIT system. Birgeneau responded immediately and impressively to the committee’s report, instituting an aggressive hiring campaign designed to recruit top female researchers from around the world. The resulting increase in the percentage of women faculty was fondly called “the Birgeneau bump.” In addition to the hiring of more women, MIT set to work on increasing day care options and set up committees that would oversee equality in working conditions and institutional policy. These institutional changes would go on to become a standard in the academic world and be adopted by institutions throughout the country.

Yet problems remain.

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Teaching with Treadmills

Inside the Biological Sciences Learning Center on the Medical Center campus is a laboratory that looks more like a gymnasium. Six state-of-the-art treadmills and six futuristic exercise bikes sit around the room, each connected to a computer alongside modified oxygen masks and suction cup sensors. Instead of dissecting frogs or mixing chemicals, students show up to lab sections in shorts and running shoes, prepared to sweat for science. In Mark Osadjan’s “Metabolism and Exercise” course, part of a two-quarter Exercise and Nutrition sequence, there’s no sitting on the sidelines.

Since joining the University of Chicago as a senior lecturer in 2003, Osadjan has designed courses that teach undergraduates about biology by connecting with what most college students care about: keeping fit, and sex. As part of the UChicago core curriculum, every undergraduate must fulfill a biology requirement, even if their interests lie in political science, music theory, or philosophy. With his “Metabolism and Exercise” and “The Biology of Gender” courses, Osadjan has met these science-shy students halfway, filtering instruction on evolution, physiology, and genetics through their own personal hobbies and interests. The efforts have been such a success that Osadjan’s courses fill up soon after registration is opened.

Today, Osadjan was announced as one of this year’s recipients of the Quantrell Award for Excellence in Undergraduate Teaching, an esteemed UChicago honor that goes back to 1938. Last week I met with Mark to talk about his award and his career path, from a graduate student studying Antarctic fish to an instructor of graduate-level science to his current position, teaching predominantly undergraduate non-biology majors.

“It’s always a trick to figure out how to teach with enough enthusiasm, such that it spills over to the students,” Osadjan said. “It’s our challenge not only to teach these students a certain number of facts, but to show them why those facts are important, relevant, and worth thinking about throughout life.”

You can read more about Osadjan and the other Quantrell winners in the award package at The University of Chicago news site.

Elsewhere…

Most college students spend their summers traveling the country or working an internship, but 20-year-old Rachel Garneau had other plans: donating a kidney. On Tuesday morning, Garneau came to the Medical Center and made the rare gift of an altruistic kidney donation, triggering a kidney swap chain that helped patients in need of the organ in New York and Madison. Neil Steinberg at the Chicago Sun-Times followed the story before and during the surgery, and got some great play-by-play commentary from Yolanda Becker, professor of surgery and director of the kidney and pancreas program.  For instance: “‘The pancreas is the bitch of the abdomen,” she confided.’”

Are clinical trials handicapped by their own success? A new analysis from Anup Malani and Tomas Philipson of the University of Chicago Law School finds that trial enrollment for a given disease plummets when a treatment is found to be effective, using AIDS clinical trials after the approval of anti-retroviral therapy to illustrate the point. Richard Schilsky, professor and section chief of hematology/oncology at the Medical Center, agreed with the findings at Nature News: “There are so many options that patients are not flocking to get into clinical trials like they used to.”

Read how turtles move to warm areas to bask - even in their own eggs as embryos. Adorable photos and interesting commentary (are they determining their own sex?) at Not Exactly Rocket Science.

That news about the World Health Organization adding cell phones to their list of possible carcinogens? Here’s an article from Cancer Research UK to reassure your fears. Another reassuring fact: it was placed by the WHO into the same risk category [pdf] as coffee, dry cleaning, and pickled vegetables.

Can jazz musicians tell the difference between another musician improvising or following composed music? A new study finds the answer, and a ScienceNOW article gives you the chance to test yourself.

Did you know UChicago evolutionary biologist Neil Shubin does a regular science news roundup on local newsmagazine show Chicago Tonight called Scientific Chicago? Well he does, and the latest edition discussed a story familiar to readers of the blog: the mass extinction 360 million years ago that ended “The Age of Fishes.” Watch the video here.

Anyone with a video game console at home can simulate  a variety of occupations: airplane pilot, race car driver, baseball player, Old West zombie hunter. As technology improves, the experience that can be created for these tasks grows ever more accurate and immersive, causing some experts to wonder whether simulation can be used for actual education as well as vicarious thrills. In the aeronautics field, this is old news - pilots have been trained on flight simulators for decades, gaining experience on high-risk, low-frequency tasks such as landing a damaged plane on a river. But in medicine, the use of simulation has only started picking up speed in the last decade, employing a mix of high-tech and low-tech to prepare doctors and nurses for both the usual and unusual.

In their Department of Medicine Grand Rounds presentation last week, Ernest Wang and Morris Kharasch from our partners at NorthShore University HealthSystem described the current state of simulation in medicine on the eve of their state-of-the-art simulation center’s grand opening. But while the idea might sound modern, it’s actually been around for more than 40 years, as Wang illustrated using a clip from the 1972 film Future Shock, narrated by Orson Welles.

Welles’ portentous warnings were a bit premature, it turned out. Never mind the leap from medical simulation dummy to humanoid robot, a generation would pass from when the first dummies were engineered in the late 1960’s before the broader field would accept simulators as a valid training tool for doctors.

“It looked pretty much what our current high-fidelity simulators look like, but didn’t have traction,” said Wang, a clinical associate professor at NorthShore. “There’s a Chinese saying: ‘When the student is ready the teacher will appear,’ and clearly they were too far ahead of their time and the conditions weren’t right.”

However, since 2000 the use of simulation in medicine has gathered momentum. A wide range of technologies are currently used for teaching sessions, from complex simulation environments that fully recreate the experience of being in an operating room to computer programs and table-top gadgets that rehearse medical decision-making and the performance of specific tasks. Medical simulation has grown to the point where a new specialty - the simulationist - may need to be created, Wang said.

“This would be a practitioner of simulation, who takes a recipe of clinically important cases, lessons learned from other industries, computer-driven full body simulators, realistic task trainers, and a dash of theater, to create a memorable learning experience that can be transferred directly to patient care,” Wang said. “In the end, that’s what this is about: education and patient care.”

Winning acceptance for medical simulation involves proving its success and determining its most effective uses. At the NorthShore center, educators have focused on designing simulation courses around “high-liability, low-frequency” events, said Kharasch, clinical director of the Center for Simulation Technology & Academic Research. The students in these courses might be residents encountering these situations for the first time, or older doctors who need a refresher on tasks they haven’t performed in many years before serving as an attending on the wards or in the emergency room.

“We’ve learned that as the years go on after you come out of residency, you are less able to do things that you once did as residents,” Kharasch said. “We spend a lot of time training on simple tasks that can be life-saving.”

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More Honors for Shubin

In 1863, in the midst of the Civil War, Abraham Lincoln signed an order creating the National Academy of Sciences, an organization bringing together the country’s most esteemed scientists to “investigate, examine, experiment, and report upon any subject of science or art.” From the original 50 members, the group has blossomed to 2,100 today, with roughly 200 of those Nobel Laureates. Any club with a 10 percent Nobel ratio is pretty exclusive, so being elected to the Academy’s lifetime membership is a thrilling honor for a scientist.

This week, evolutionary biologist Neil Shubin was the latest UChicago scientist given the honor of NAS membership, part of this year’s class of 72 new members and 18 “foreign associates.” Shubin becomes the 40th current member of the NAS located at the University of Chicago, and joins Medical Center faculty such as Janet Rowley, Martin Weigert, Donald Steiner, Bernard Roizman, Robert Haselkorn, and David Jablonski, who was elected last year (Fermilab director and professor of physics Pier Oddone was also elected in this year’s class). Election is no simple matter - each new member must pass a 10-step process [pdf] and be voted in to the academy by their potential peers.

Shubin is most famous for the discovery of the pivotal fossil named Tiktaalik roseae, a transitional species between ancient fish and the first limbed creatures to walk the land. But Shubin’s research is more than just fossil-hunting, as he studies the genetic programs that control development of limbs in the embryos of species such as sharks and salamanders. On the blog, we recently featured a paper by Shubin and former graduate student Andrew Gillis, where the embryos of strange creatures called holocephalons revealed some of the earliest steps in limb evolution.

In all likelihood, Shubin’s election was helped by his scientific communication skills as well. From his book about the discovery of Tiktaalik and the story of human evolution, Your Inner Fish: A Journey Through the 3.5-Billion-Year History of the Human Body, to his appearances as a correspondent on WTTW, to his anatomy teaching duties at Pritzker Medical School, Shubin has proven himself eager to educate the public at large about science. Appropriately enough, a second honor announced for Shubin this week was the Distinguished Service Award for Enhancing Education through Biological Research from the National Association of Biology Teachers. Once again, he finds himself in good company, as previous recipients include James Watson, Stephen Jay Gould, and Richard Dawkins.

“I am deeply honored to receive the NABT Distinguished Service Award. In an age where the ideas and tools of biology are increasingly playing a role in our lives, it is a deep honor to be recognized by those who are at the front lines of educating the next generation,” Shubin said.

The Science of Killing Bin Laden

A news story as big as the killing of Osama Bin Laden spares no beats, and there were plenty of science stories written this week in the aftermath of Sunday night’s surprise news. The most direct scientific angle was in the identification of the terrorist leader’s body, a step U.S. officials wanted to prove beyond a doubt before going public with the news. Like many of the events surrounding the raid, many of the details remain classified. But that hasn’t stopped science writers from writing explainers on how biometrics and DNA matching likely would have been used to make sure the Navy SEALS really had killed Bin Laden. President Obama himself confirmed that DNA testing was used to confirm they had the right body, but one fascinating mystery is where the DNA used to make the comparison was gathered. Nature blog The Great Beyond describes the candidates - from Bin Laden’s half-brothers and half-sister to one of his purported 26 children - and talks a bit about the recent history of using DNA identification techniques in criminal matters, including one crook busted by DNA he left on a slice of pizza.

Elsewhere…

The creation of new drugs, and the death of old drugs - Medical Center researchers commented on both sides of the pharmaceutical life cycle in newspaper stories this week. In the New York Times blog Fixes, reporter David Bornstein looks at the “valley of death” in developing new drugs for less-than-common diseases, and focused on the Myelin Repair Foundation and researchers such as Brian Popko (who we have featured twice). Then yesterday, the Chicago Tribune’s Bruce Japsen wrote about the upcoming patent expirations on the popular drugs Plavix, Lipitor, and Actos, and talks to our Caleb Alexander about the implications for health care.

How do you make a new species in the lab? It’s easier if you find a lizard species that is entirely female and can reproduce by cloning. Ed Yong at Not Exactly Rocket Science describes genome mash-ups, asexual reproduction, and the trickiness of species-naming in this great post.

A retired nurse and research coordinator at the Medical Center talks with Dawn Turner Trice about her experiences working with a small rural clinic in Ghana.

The benefits of measuring body mass index (BMI) are clear: a physician who knows a patient’s BMI is more likely to counsel her on lifestyle changes, and people are more likely to try diet and exercise on a doctor’s advice. But in the often-rushed environment of the clinic, even the quick calculations required to know a patient’s BMI can get lost in the shuffle.

Internal medicine residents at the Medical Center noticed that almost none of their patients had a BMI recorded on their charts, but many of their patients seemed overweight and obese.

“They initially wanted to improve obesity rates in patients,” said Vineet Arora, MD, who participates in teaching a quality improvement curriculum to residents and is senior author of a study. “But we needed something feasible. Recording and calculating most patients’ BMI was something they could change.”

Their quality improvement initiative and a study about it, published online in March in the American Journal of Medical Quality, grew out of the quality improvement education that all residents now receive at the University of Chicago.

Neda Laiteerapong, MD, was an internal medicine resident at the University of Chicago Medical Center when she decided that measuring BMI was vital to improving patient care. “We couldn’t even identify who was obese in our clinic. If you don’t identify it, you’re not going to treat it on a patient-by-patient basis,” she said.

Laiteerapong and nine of her fellow residents looked at the triage of patients in the clinic, and decided that they could easily make a few small changes to the vital signs that nurses record when a patient is checked in. “Most clinics weigh people, but they don’t measure height,” Laiteerapong said, noting that the combination of height and weight is usually only measured in children. She also said that asking a patient his height isn’t an accurate way to calculate BMI, since people often overestimate how tall they are.

The residents added rulers in the clinics, height and weight charts in the patient rooms, and a slot on the patient intake form for BMI. The nurses took the measurements, and the residents were responsible for calculating BMI. Within a month, the number of patients with a recorded BMI jumped from 4% to 80%.

Julie Oyler, MD, assistant professor of medicine and associate program director for the internal medicine residency, implemented the quality improvement curriculum for residents in 2006. “I would consider this a successful project,” she said. “Instead of complaining about poor practices in a clinic, the residents are getting experience changing and fixing the clinics.”

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TED Comes to Campus

This weekend, the students of the University of Chicago are putting together a local edition of the renowned TED conference called TEDxUChicago. The theme, “Reinventing the Life of the Mind,” nicely blends the goals of TED and the University, the idea-sharing mission of the conference sutured to the intellectual spirit of our campus. Among the talks taking place at the Reynolds Club this Sunday are a few UChicago scientists: paleontologist and educator Paul Sereno (speaking on the topic of “Art In Science”), psychologist and child language expert Susan Goldin-Meadow (”What Our Hands Can Tell Us About Our Minds”), and student speaking contest winner Bruno Cabral (“The Life of the Mind Lived Through Noise”), an undergraduate working in the laboratory of psychologist Howard Nusbaum. Other speakers include Mark Inglis, the first double amputee to climb Mount Everest, Jonathan Greenblatt, the former CEO of GOOD magazine, and cybernetics expert Kevin Warwick giving probably the talk with the coolest title: “The Last Remaining Hurdles to Cyborg Technology.” Tickets are still for sale on the TEDxUChicago website, but if you can’t make it down to Hyde Park, the talks will be webcast live at the UChicago Facebook page.

The Rules of Language

Last week, the Joseph P. Kennedy Intellectual and Developmental Diabetes Research Center held a symposium called “Variations in Language Learning,” a series of talks about how languages are acquired by children, adults, and cultures. Elissa Newport, a professor of brain & cognitive sciences and linguistics at the University of Rochester, presented fascinating data on the concept of “statistical learning,” the theory that the brain uses mathematical tricks to learn the arcane rules of a new language. To test this idea, Newport and her colleagues played a made-up language of nonsense syllables for 20 minutes (!) to volunteers, showing that combinations of syllables that show up more frequently (such as “dutaba” or “babupu”) are eventually perceived as “words” by the listener. The researchers also went on to show that children are better at this “statistical learning” than adults when confronted with a new language, offering an explanation for why languages are easier to pick up when learned at a younger age.

The idea of a universal foundation for learning and developing language echoes the “universal grammar” theories of Noam Chomsky and others, if peripherally so - Newport’s experiments showing that the same statistical learning can be used for tones and visual sequences implies that it’s a universal learning mechanism, not specific to language. But a new phylogenetic analysis of the world’s languages appearing in Nature this week argues against innate rules for language, demonstrating deep grammatical differences between “families” of languages go against the idea of a universal human grammar. Most linguists seem skeptical or underwhelmed about the result, and the debate smacks of a false dichotomy, with the truth about language development less a battle between cognition and culture than a combination of the two forces. Discover, the LA Times’ Amina Khan, and Ars Technica’s John Timmer all weigh in on the study.

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The unsung heroes of scientific research are the graduate students*. Graduate students provide the enthusiasm to run experiments 7 days a week and all hours of the day and night to generate data for publications and their own thesis projects. The fresh perspective a graduate student brings to an area of research can also provide new ideas to their mentors and collaborators, spotting connections or opportunities that might have been missed by those with more experience. In even the biggest discoveries, graduate students play a critical role.

That was the take-home message from Neil Shubin’s keynote lecture at last week’s Scientific Diversity: People, Research, Careers Symposium organized by the Biological Sciences Division. Following talks by graduate students, post-docs, and young professors, Shubin delivered a characteristically fascinating and funny tale about his laboratory’s discovery in 2004 of Tiktaalik, an important transitional fossil between sea and land animals. The story of Tiktaalik may have been familiar if you’ve read Shubin’s excellent Your Inner Fish or seen him speak before. But this time around, Shubin put added emphasis on the critical role of his graduate students and collaborators, both in setting the stage for the fossil’s excavation and in the continued quest to learn from Tiktaalik’s remains.

In fact, Shubin said the very spark for Tiktaalik’s discovery came from a friendly argument between him and his former graduate student at the University of Pennsylvania, Ted Daeschler. Shubin and Daeschler had found many Devonian era fossils of fish with primitive limb-like structures in their home state, but wanted to find even earlier examples of the transition from fins to limbs. So they had to pick the right place for an expedition, with exposed rocks of the right age for finding such an elusive fossil.

“Everything changed for us in a conversation in my office in 1998. We were having an argument, as graduate students and their advisors typically do, and we settled the debate with a college geology textbook,” Shubin said. “I was thumbing through the book, and I hit a diagram that changed the course of my career.”

The diagram showed the three areas where the ancient deltas Shubin was seeking were known to be exposed. Two of them had already been the site of expeditions, but the third - a cluster of islands in the Canadian arctic - was largely unexplored. Shubin and Daeschler “ran to the library,” he said, and found a paper that confirmed the region held the exact type of rock they were looking for.

“It was truly exciting; here was a whole part of the world that was unexplored,” Shubin said. “After we saw this, we went to Chinese food for lunch, and my fortune cookie said, ‘Soon you will be at the top of the world.’”

It took six more years for an expedition to find Tiktaalik, embedded in the rocks of Ellesmere Island. It took a further two years for the fossil to be prepared sufficiently (by preparator Robert Masek) for analysis and publication. The rest is history - massive media coverage, a book, and even The Colbert Report. But the story of Tiktaalik isn’t over, and it is graduate students that are writing the newest chapters.

“It’s really a nice system, because so many bones are so well preserved, for us to ask new kinds of questions, and this is where graduate students come in,” Shubin said.

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Photo by Bruce Powell

Yesterday wasn’t just St. Patrick’s Day for fourth-year medical students around the country - it was also Match Day, the tense and celebratory day when aspiring doctors learn the residency program where they will spend their next 3-7 years. At the Pritzker School of Medicine, green-clad students and supporters absolutely packed the hospital’s Billings Auditorium for the big event Thursday morning, cheering their peers as they were called one by one at random to collect their match envelope. In a local tradition, it literally pays to go last, as students throw into an informal prize pot for whoever has to wait and squirm the longest to pick up their envelope (second-to-last gets a Hershey bar as consolation). In the video below, you can see some of that process - including the outcry when the last envelopes are miscounted - followed by the amazing tension-release of the countdown and unison envelope opening.

The numbers from the day are just as exciting as the video. At Pritzker (recently ranked #12 among medical schools by US News and World Report), 110 students were matched in 24 specialties at 46 institutions, including 23 students who will stay with us here at the Medical Center. The most popular specialties for Pritzker students were internal medicine (25% of the class), general surgery (11%), and pediatrics (11%). Nationally, trends continued to shift for the second consecutive year toward primary care specialties such as internal medicine, family medicine, and pediatrics, according to the National Residency Matching Program, a step in the right direction to meet some of the increased demand for primary care doctors expected in the wake of health care reform. MedPageToday’s Kristina Fiore breaks down the numbers.

Podcast 0.3: Transplants, Rock-Paper-Scissors Ecology, and More

We have settled on a name for our young research podcast: Bench to Bedside. However, we are still keeping the training wheels on as we work out the technical kinks and explore the best ways to deliver audio versions of our latest research and medical stories. Please enjoy the third installment of our podcast, featuring a recent coast-to-coast kidney transplant chain that involved the Medical Center, how Rock-Paper-Scissors can explain biodiversity, the fight against indoor air pollution in Nigeria, and the new numbers on the eating disorders epidemic in the United States. As always, we would love to hear feedback on what we’re doing right and wrong at robert.mitchum@uchospitals.edu or dianna.douglas@uchospitals.edu.

Bench to Bedside Episode #0.3 by robmitchum

Elsewhere…

Some people keep ant farms, some people keep multiple flasks of bacteria growing for 13 years (and counting) to study evolution. Ed Yong writes about experiments from Michigan State University that show “tortoise” bacteria can beat out “hare” bacteria over the long run. (And if you’re a science communicator of any sort, do listen to Ed and Carl Zimmer’s “Death to Obfuscation” session from January’s Science Online meeting)

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In a famous 1999 study, 700 physicians were given a simple case-study task. Each watched a video of a patient-actor describing chest pain and were given basic test results for that patient. Each doctor was then asked whether they would recommend the patient for cardiac catheterization, an additional diagnostic procedure. The patient cases varied in terms of type of chest pain, stress test results, and heart history, influencing the physician’s eventual decision. But when all of those clinical factors were controlled for, two other factors remained: race and sex. With everything else equal, black patients and female patients were 40 percent less likely to be recommended for catheterization; black, female patients were 60 percent less likely to be sent to advanced care.

“People assume that when physicians take the Hippocratic oath that somehow there is a miraculous, magic process that makes us free from any inherent stereotypes or biases that we may have had through our whole lives,” said Monica Peek, assistant professor of medicine in her MacLean Center for Clinical Medical Ethics seminar. “We want to be good physicians and give good care and be unbiased in our assumptions. But there’s not really any magic that happens just because you get a medical degree.”

Many studies of the health effects of discrimination focus on the world outside the doctor’s office, where the cumulative effects of sexism and racism negatively affect clinical measures such as hypertension and cardiovascular disease. Less attention is paid to discrimination within the healthcare system, Peek said, the often subconscious biases that physicians and other caregivers may use to make snap judgments about patients. Discrimination in this setting might directly affect preventative measures such as vaccination or screening, lower adherence to prescribed medications, and decrease patient satisfaction.

One way to combat discrimination within healthcare is to elevate the patient’s role in their treatment, creating a patient-centered and shared decision-making model. Research suggests that when the patient is an active participant in their care rather than a passive recipient of doctor’s orders, measures of trust, understanding, and satisfaction improve - and chronic disease measures such as glucose levels and blood pressure are better controlled. But for many African-Americans, shared decision-making in a healthcare setting is a foreign concept.

A 2008 focus group study led by Peek found that many African-American patients wanted to be involved in the decision-making process with their doctor, but many told stories that showed a less than equal relationship:

• “We make decisions together and she gives me what I’m suppose to take and she knows what I’m suppose to take.”
• “She told me I need to go to the dermatologist … Now the lady up there at the check out desk. I told her that I didn’t want to go.”
• “See, when the doctor tells me what to do, then I can make up my mind whether or not to do [it].”

“Basically African-Americans…wanted shared decision-making as much as their non-hispanic white counterparts when we adjusted for class and education - and maybe a little more so,” Peek said.

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Photo by "BankingBum" - Wikimedia Commons

The leading cause of death for American black men between the ages of 15 and 34 isn’t cancer, AIDS, heart disease, or even accidents. It’s homicide, which accounted for more than half of the deaths of black 15 to 24-year-olds and more than a third of those aged 25 to 34. In Chicago, African-American males aged 15-24 are 10 times more likely to be killed in a homicide than white males, and in 2004, more African-Americans died from homicide than diabetes, HIV, or stroke. Genetic predisposition, access to health care, diet and exercise - all pale in comparison to bullets and knives.

Those numbers clearly argue that any discussion of health disparities between white and black populations in the United States can’t be limited to disease, said Harold Pollack in his MacLean Center for Clinical Medical Ethics seminar in late January. Urban, minority populations bear the brunt of the consequences of crime, he demonstrated, including not only homicides but also non-fatal injuries, incarcerations, economic damage, and stress. So while a project like the University of Chicago Crime Lab, for which Pollack serves as co-director, is rooted in the social sciences, the success or failure of its mission will surely have an impact upon medicine and community health.

“If you actually count up the number of dead bodies and in particular the number of life-years lost, homicide is a significant public health threat and it requires a systematic, determined response,” Pollack said.

The most shocking graph Pollack showed during his talk had nothing to do with cancer rates or disease mortality, but instead with incarceration. While the proportion of Americans behind bars remained stable from 1920 to 1970 at roughly 1 in 1,000, from there the numbers took an upward spike to make the climate change “hockey stick” graph jealous, increasing fivefold to today’s rate. As the numbers of jailed Americans skyrocketed, the prison population also became significantly less white, Pollack said, with the white incarcerated population dropping from 60 percent to 30 percent of the whole.

The “incarceration epidemic” causes significant public health ripples, both direct (through violence, HIV transmission, and drug addiction) and indirect. Disparities of incarceration have strained relations between minority communities and police, Pollack argued, making crime prevention in dangerous neighborhoods more difficult. Hiring biases against applicants with criminal records make it hard for convicted felons to find jobs (not to mention health insurance) after their release, steering them back toward illegal activity. For those jailed as juveniles, the lost time in school only intensifies the struggle to find legit work.

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Last weekend, I was one of the fortunate 300 who gathered in Research Triangle Park, North Carolina for the 2011 edition of Science Online. The simplest way to describe Science Online is as a science blogging conference, but the real topic on the table was the broad future of science communication, be it through blogs, podcasts, ebooks, twitter, or plain old paper. Through “unconference” sessions led by panels but driven by audience discussion, workshops, field trips to labs and museums, and good old-fashioned bar conversation, scientists, journalists, and scientist-journalists dissected how science can be best defended and explained in a time where mass media coverage is increasingly scant or poor.

I could spill literally thousands of words on what I learned and discovered at Science Online, but for the sake of my audience, I’ll restrict myself to three subjects most relevant to an academic medical center in the new media environment. For more coverage, see the Columbia Journalism Review’s 30,000-foot view, Ed Yong of Not Exactly Rocket Science on the science-blog echo chamber, and Chris Rowan at geology blog Highly Allochthonous on the elephants of the conference. Or you can wade through the over 10,000 tweets sent from and about the conference.

1) Patients Can Blog Too

The majority of the bloggers who attended Science Online cover science through the lens of peer-reviewed research, government policy, or media criticism. Many of these blogs deal with the long-term picture: how will this laboratory study impact medical treatment in 10 years, or how will climate change policy affect our planet’s future. But a corner of the science-writing world is written by people particularly engaged in what science can do for them immediately: patients fighting serious disease.

As a session on “Patient Blogging as Therapy” proved, social media is a natural fit for patients to share information and support. Dave deBronkart, known on the web as e-Patient Dave, called in via Skype to talk about how his own fight against advanced kidney cancer exposed him to the online world of patient engagement, including the technically-primitive but still-functioning listservs of ACOR. Now, having beat his cancer, he’s the hub of an electronic patient advocacy community that includes other panelists like David Seidman (blogging about his kidney disease and need for a transplant) and Alberto Rocca, who started a website for families of children with the rare lung cancer pleuropulmonary blastoma. deBronkart’s motto of “potent information simply portrayed empowers people” was an inspiring reminder of a different way people use blogs or any other media at their disposal to seek knowledge and truth, and the opportunity for online conversations about health that are two-way streets.

2) A Calm Voice in a Shouting Match

But where will patients, of the blogging or non-blogging sort, receive that potent information? The internet is all about easy access to info on virtually any topic, but the quality of that information often leaves much to be desired. Like the search engine TV commercial, a simple search can be easily drowned out by nonsense and falsities - often, in the case of medical advice, dangerous ones. The magnitude of this problem could be read from the beleaguered company accurate medical information kept in the “Defending Science Online” session: evolution and climate change, two other areas where misinformation very noisily tries to shout down evidence-based knowledge.

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Sarah-Anne Schumann with the first community health clerkship students.

Facing rising medical costs and shortages of physicians in rural and urban areas, a government calls for health care reform. Experts warn that more primary care and family medicine physicians are needed to meet the surging demand for first-line treatment, chronic disease management, and the promotion of prevention. In response, medical schools look for ways to adjust their programs to prepare new doctors for careers in family medicine and community health.

It’s a familiar story for Americans, but the same drama is playing out half the world away in China. With their population soaring past the 1.3 billion mark, the community health crisis is on an even larger scale than the one here in the United States. But in many ways, the country is farther away from a solution, with a national medical curriculum that heavily prioritizes inpatient care and specialization. In response, the Chinese government recently issued a mandate redirecting schools to start producing more front-line doctors.

But it’s no simple matter to create a new curriculum from scratch, and the University of Chicago Medical Center is helping one Chinese medical school with that process. Wuhan University, a school in the central Chinese province of Hubei, is working with Renslow Sherer, professor of medicine, and other faculty to revise their curriculum over five years. A key part of that collaboration - the creation of a family medicine department - recently reached a landmark in October as the first six Wuhan medical students began a one-month community health rotation designed by Wuhan and Chicago doctors.

Sarah-Anne Schumann and Mari Egan, assistant professors of family medicine, have spearheaded Wuhan’s construction of a new family medicine program, visiting the country three times between them in the last year. As leaders of the family medicine and community health programs at the University of Chicago’s Pritzker School of Medicine, both are experienced in creating partnerships between a hospital and the surrounding neighborhoods. But despite Wuhan’s original plan to import their Pritzker program wholesale to China, it became quickly apparent during the visits that a custom-fitting was necessary.

“We were constantly saying ‘You can’t create a community clerkship for the South Side of Chicago in China,’” Schumann said. “You have to look at what your patients need and design the clerkship around that. They needed to take ownership and make it work for their students.”

The pricelist at a community health center.

The main challenge was connecting the Wuhan medical school with the community health centers in the city, which are actually very impressive facilities, Schumann and Egan said. Care for chronic diseases such as diabetes or asthma, rehabilitation medicine, traditional Chinese medicine, and specialized care are all available at the centers, and doctors and nurses do home visits for those who can’t make it into the clinic. Physicians use electronic medical records to keep track of patients, statistics about blood pressure and glucose levels are posted on the wall, and a “menu” of procedures is prominently displayed in the front (pictured at right).

“You walk into the health center, and it’s like McDonald’s - there’s a neon sign that’s rotating, and it has all the treatments and how much they cost,” Schumann said.

But until now, students from Wuhan University did not have an opportunity to experience medical care in this environment. Nearly all of their patient encounters took place in the hospital, and the community health education amounted to hearing lectures about the neighborhood clinics without ever visiting them. That format is similar to what was commonly seen in American medical schools until the relatively recent push for more hands-on community health experience, Egan said.

“Until about 40 years ago in the United States, most of medical education was taught in the hospital, and we needed to learn how to teach students in the outpatient community setting,” Egan said. “Now we’re starting to do the same thing in China.”

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(photo by Lloyd DeGrane)

Here in Chicago, we’re entering the second of our two seasons: transitioning from “Construction” into “Winter.” The rampant highway repair that happens during warm weather months is largely due to the stresses of the cold weather months, which leave our roads cracked and potholed. But perhaps we’ll be saved from all that misery if a team of Dutch researchers are successful in their efforts to create biologically self-healing concrete. The process embeds calcite-precipitating bacteria into concrete paste, so that when cracks occur, the microorganisms can secrete a mineral that will fill those fractures. It’s a cool example of biology-inspired engineering, and was mentioned as part of the New York Times’ interesting “What’s Next in Science?” feature this week.

Two exciting studies from the other side of the University of Chicago campus came out in this week. In the first, Chuan He in the Department of Chemistry helped characterize the activity of “the most exciting protein family now in biology,” a DNA repair protein called AlkB. In charge of demethylating DNA, AlkB has the power to re-activate silenced genes, a valuable epigenetic function that could someday be harnessed to treat diabetes, obesity, and cancer. The study also utilizes a delightful science word to describe one of the protein’s intermediate states: “zwitterionic,” when an object has a neutral charge, but acts positive or negative when interacting with other objects.

In another study, University of Chicago psychologist Susan Levine found that a child’s early exposure to mathematics can influence later success in the subject. Researchers videotaped interactions between parents and their children when they were between the ages of 14 and 30 months, counting how many “number words” were used by the parents. When the children were given a simple math test at the end of the experiment, those that heard more about math from their parents tended to perform better.

Today and tomorrow, the MacLean Center for Clinical Medical Ethics will hold its 22nd annual conference, a two-day festival of ethical lectures and discussion. Today’s session will expand upon the local, national, and global health disparities theme of the center’s weekly seminar series, while the second day takes a broader approach with topics such as pediatric ethics, palliative care, transplant medicine, and a session dedicated to the memory of faculty member Stephen Toulmin. The schedule is available here (pdf), and we’ll have coverage of the conference next week.

ScienceLife is very excited to have gotten in during the very brief window that registration for Science Online 2011 was open this week. The “unconference,” held in North Carolina in January brings together a dream team of science bloggers for open discussions and workshops on the growing field of internet science journalism. Expect to hear more about it.