PHIND Seminar Series: Impact of the Veterans Affairs National Abdominal Aortic Screening Program
Manuel Garcia-Toca, M.D.
Clinical Professor of Surgery
Chief, Division of Vascular Surgery
Santa Clara Valley Medical Center (SCVMC)
Oliver O. Aalami, M.D.
Clinical Associate Professor of Surgery, Vascular Surgery
Lucile Packard Children’s Hospital
Location: Zoom
Webinar URL: https://stanford.zoom.us/s/98417624095
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 984 1762 4095
Passcode: 111283
11:00am – 12:00pm Seminar & Discussion
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ABSTRACT
Background: The U.S. Federal Government enacted the Screen for Abdominal Aortic Aneurysms Very Efficiently Act in January 2007. Simultaneously, the Department of Veterans Affairs (VA) implemented a more inclusive AAA screening policy for veteran beneficiaries shortly afterwards.
Our study aimed to evaluate the impact of the VA program on AAA detection rate and all-cause mortality compared to a cohort of patients whose aneurysms were identified by other abdominal imaging.
Methods: We identified veterans with an AAA screening study using the two existing Current Procedural Terminology (CPT) codes (G0389 and 76706). In the comparison group, eligible abdominal imaging studies included ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) queried according to CPT codes between 2001 and 2018.
We used a difference-in-differences regression model to evaluate the change in aneurysm detection rate and all-cause mortality five years before and eleven years after the VA implemented the screening policy in 2007.
We calculated survival estimates after AAA screening or non-screening imaging of patients with or without AAA diagnosis and used multivariate Cox regression model to evaluate mortality in patients with a positive AAA diagnosis adjusting for patient characteristics and comorbidities.
Results: We identified 3.9 million veterans with abdominal imaging, a total of 303,664 of whom were coded has having an AAA US screening between 2007 and 2018. An AAA diagnosis was made in 4.84% of the screening group vs. 1.3% in the non-screening imaging group P<0.001, yet more aneurysms were found with general imaging studies (50,730 vs.15,449) (Fig 1).
On Kaplan-Meier survival analysis, patients with an AAA diagnosis had higher overall mortality than patients who screened normal; patients with aneurysms found with non-screening imaging had the highest mortality, log-rank P<0.001 (Fig 2).
The difference in differences regression analysis, showed that the absolute AAA detection rate was 1.55% higher (95% CI 1.2- 1.8), and the mortality was 13.89 % lower (95% CI 10.18 %-16.66 %) after the introduction of the screening program in 2007.
Multivariate Cox regression analysis in patients with AAA diagnosis (65-74-year-old) demonstrated a significantly lower 5-year mortality [HR 0.45 (95% CI 0.43-0.48)] for patients in the US Screening group P<0.001.
Conclusions: In a nationwide analysis of VA patients, implementation of AAA screening was associated with improved survival and a higher rate of AAA diagnosis. These findings provide further support for this program’s continuation versus defaulting to incidental recognition following other abdominal imaging.
ABOUT MANUEL GARCIA-TOCA
Dr. Garcia-Toca earned his medical degree at the Universidad Anahuac in Mexico 1999. He has a master’s degree in Health Policy from Stanford University.
He received his general surgery training at the Massachusetts General Hospital and Brown University in 2008. He then completed a Vascular Surgery fellowship at Northwestern University in 2010. Dr. Garcia-Toca is board certified in both surgery and vascular surgery.
Dr. Garcia-Toca joined Stanford Vascular Surgery in 2015. He is currently Clinical Professor of Surgery in the Division of Vascular Surgery. Dr. Garcia-Toca had previously served as an Assistant Professor of Surgery at Brown University. Dr. Garcia Toca is a Staff Surgeon at Santa Clara Valley Medical Center in San Jose.
His research interests include new therapeutic strategies and outcomes for the management of vascular trauma, cerebrovascular diseases, dialysis access, aortic dissection and aneurysms.
ABOUT OLIVER O. AALAMI
Dr. Aalami is a Clinical Associate Professor of Vascular & Endovascular Surgery at Stanford University and the Palo Alto VA and serves as the Lead Director of Stanford’s Biodesign for Digital Health. He is the course director for Biodesign for Digital Health, Building for Digital Health and co-founder of the open source project, CardinalKit, developed to support sensor-based mobile research projects. His primary research focuses on clinically validating the sensors in smartphones and smartwatches in patients with cardiovascular disease to further precision health implementation.
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Multi-Cancer Early Detection Screening Tests – “Liquid Biopsy Tests” – Are Here – But Will Payers Provide Insurance Coverage?
Patricia A. Deverka, MD, MS, MBE
Executive Director
Deverka Consulting, LLC
Kathryn A. Phillips, PhD
Professor of Health Economics and Health Services Research
Founding Director, UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS)
Location: Zoom
Webinar URL: https://stanford.zoom.us/s/99194110894
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 991 9411 0894
Passcode: 044958
11:00am – 12:00pm Seminar & Discussion
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ABSTRACT
The emergence of Multi-Cancer Early Detection Screening Tests (MCED) – “liquid biopsy screening tests” – has generated enormous interest because they could fundamentally shift how cancer screening is done. One company is already offering an MCED test for clinical use as a “lab developed test” (LDT) – and thus addressing the question of “who will pay” has become urgent. These tests offer potentially transformative screening and clinical benefits, but their characteristics present unique challenges to payer coverage decision-making and generate concerns about the potentially high cost of widespread adoption.
We will present our ongoing work on examining the unique challenges that MCED present for payer coverage decision-making, drawing on our extensive experience with coverage and reimbursement for new technologies. We will focus on identifying the evidence generation strategies that could be pursued now to inform payer decision-making so that coverage policies can be developed that are appropriate and equitable for this ground-breaking technology.
ABOUT PATRICIA A. DEVERKA
Dr. Deverka is the Executive Director at Deverka Consulting, LLC where she focuses on helping biotechnology companies and start-ups develop evidence to support payer coverage and clinical adoption of innovative technologies. Her most recent projects have focused on breakthrough tests and drugs focused on population genomic screening, cancer, and ultra-rare disorders. Prior to starting her consulting practice, Dr. Deverka has worked in the fields of health economics and outcomes research in both non-profit and for-profit settings as a researcher, educator, and department head. She has extensive experience with patient-centered outcomes research, drug and diagnostic reimbursement planning, cost- effectiveness analysis, and bioethical issues surrounding the use of new technologies. While working in academia and several non-profit firms, she has participated in numerous NIH-funded studies to evaluate policy barriers to clinical integration of new genomic technologies and has published extensively on strategies to promote evidence generation and data sharing. She is a member of the National Human Genome Research Institute (NHGRI)’s Genomic Medicine Work Group and serves as a member of NHGRI’s Advisory Council. Deverka has a medical degree from the University of Pittsburgh and is board certified in General Preventive Medicine and Public Health. She also has a master’s degree in bioethics from the University of Pennsylvania and completed a policy fellowship at Duke University’s Institute for Genome Sciences and Policy.
ABOUT KATHRYN A. PHILLIPS
Kathryn A. Phillips founded and leads the UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), which focuses on developing objective evidence on how to effectively, efficiently, and equitably implement precision/personalized medicine into health care. Kathryn has published over 150 peer-reviewed articles in major journals including JAMA, New England Journal of Medicine, Science, and Health Affairs. She has had continuous funding from NIH as a PI for over 25 years and was recently awarded a 5-year NIH grant to examine payer coverage and economic value for emerging genomic technologies (cell-free DNA tests and tests based on polygenic risk scores). Kathryn serves on the editorial boards for Health Affairs, Value in Health, JAMA Internal Medicine, Genetics in Medicine; is a member of the National Academy of Medicine Roundtable on Genomics and Precision Health; and has served on the governing Board of Directors for GenomeCanada and as an advisor to the FDA, CDC, and the President’s Council of Advisors on Science and Technology. She has also served as an advisor to many diagnostics, sequencing, and pharmaceutical companies. Kathryn is Chair of the Global Economics and Evaluation of Clinical Sequencing Working Group, and a member of an evidence review committee for the Institute for Clinical and Economic Review (ICER).
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Pervasive Computing With Everyday Devices To Build & Sustain Resilience & Wellbeing
Pablo E. Paredes, PhD
Clinical Assistant Professor, Psychiatry and Behavioral Sciences and, by courtesy, Epidemiology and Population Health
Stanford University
Zoom Webinar Details
Webinar URL: https://stanford.zoom.us/s/99098874758
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 990 9887 4758
Passcode: 784858
11:00am – 12:00pm Seminar & Discussion
12:00pm – 12:15pm Reception
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ABSTRACT
As society progresses towards increasing pervasive computing levels, I design and build technology-enabled solutions to repurpose everyday devices to help people build resilience and grow wellbeing. I leverage biological and behavioral knowledge to design systems that balance user needs and health outcomes while mitigating surveillance and agency risks. In this talk, I present my research on efficacious and engaging sensors and interventions necessary in the population and public health domains. I share a series of research projects exploring and validating novel ideas on passive sensors – less dependent on subjective surveys or wearables – and subtle interventions that minimize workflow disruption. I show the promise of repurposing existing signals from computing peripherals (i.e., mouse and trackpad) or cars (steering wheel) into “sensorless” sensors and repurposing existing media as just-in-time micro-interventions that can work across multiple scenarios and populations. I discuss how these data could be used in collaboration with domain experts to study topics as varied as the interaction between stress and productivity in office workers, burnout prevention among clinical practitioners, or the prevention of depression among rural health workers. Finally, grounded in theories from neuroscience and behavioral economics, I propose the evolution of everyday “mundane” devices, such as chairs, desks, cars, or even urban lights, into adaptive and autonomous wellbeing-optimizing interventions. I close with a discussion of the research needed to systematically study ethics in pervasive technology for resilience, and wellbeing.
ABOUT
Pablo Paredes earned his Ph.D. in Computer Science from the University of California, Berkeley, in 2015 with Prof. John Canny. He is currently a Clinical Assistant Professor in the Psychiatry and Behavioral Sciences Department and the Epidemiology and Population Health Department (by courtesy) at the Stanford University School of Medicine. He leads the Pervasive Wellbeing Technology Lab, which houses a diverse group of students from multiple departments such as computer science, electrical engineering, mechanical engineering, anthropology, neuroscience, and linguistics. Before joining the School of Medicine, Dr. Paredes was a Postdoctoral Researcher in the Computer Science Department at Stanford University with Prof. James Landay. During his Ph.D. career, he held internships on behavior change and affective computing at Microsoft Research and Google. He has been an active associate editor for the Interactive, Mobile, Wireless, and Ubiquitous Technology Journal (IMWUT) and a reviewer and editor for multiple top CS and medical journals. Before 2010, he was a senior strategic manager with Intel in Sao Paulo, Brazil, a lead product manager with Telefonica in Quito, Ecuador, and an entrepreneur in his native Ecuador and, more recently, in the US. In these roles, he has had the opportunity to hire and closely evaluate designers, engineers, business people, and researchers in telecommunications and product development. During his academic career, Dr. Paredes has advised close to 40 mentees, including postdocs, Ph.D., master’s, and undergraduate students, collaborated with colleagues from multiple departments across engineering, medicine, and the humanities, and raised funding from NSF, NIH, and large multidisciplinary intramural research projects.
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND & CDH Seminar: “The Invisible Future of Health Monitoring”
Join Stanford CDH and PHIND on Wednesday, June 23rd at 3:15 PM PDT to hear some of the industry’s leading experts talk about embedded sensors, longitudinal data collection, the future of remote monitoring, and real-world applications of precision health technologies. The panel will feature: Nicolas Genain, MS, Withings; John O Moore MD, PhD, Fitbit Health Solutions at Google; Pablo Paredes, PhD, MBA, MS, Stanford University; and Michael Synder, PhD, Stanford University. The discussion will be moderated by Jun (Alex) Gao, MS, Samsung America.
Zoom Webinar Details
Webinar URL: https://stanford.zoom.us/s/96984014176
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 969 8401 4176
Passcode: 375941
3:15pm – 4:15pm: Panel Discussion
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Sponsored by the PHIND Center and Center for Digital Health
PHIND Seminar Series: Plastic-based sensors for wearable technologies: fundamentals and applications
Alberto Salleo, Ph.D.
Professor of Material Sciences and Engineering
Stanford University
Zoom Webinar Details
Webinar URL: https://stanford.zoom.us/s/92646686705
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 926 4668 6705
Passcode: 270341
11:00am – 12:00pm Seminar & Discussion
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ABSTRACT
The continuous monitoring of human health can greatly benefit from devices that can be worn comfortably or seamlessly integrated in household objects, constituting “health-centered” domotics. One of the key aspects for these devices to be successful is to be invisibly integrated and disappear in the background of our lives. Our group works on thin film devices made with plastic materials that can be used for electrochemically sensing of common analytes from easily accessible bodily fluids (e.g. sweat, saliva, urine) and can be easily multiplexed. I will describe electrochemical transistors that detect ionic species either directly present in body fluids or resulting from a selective enzymatic reaction (e.g. ammonia from creatinine) at physiological levels. I will also show that non-charged molecules can be detected by making use of custom-processed polymer membranes that act as “synthetic enzymes”. Using these membranes in conjunction with electrochemical transistors we demonstrate that we are able to measure physiological levels of cortisol in real human sweat. Importantly, transistors can amplify signals and I will show what architectures must be used to observe 1000x amplification of sensing currents.
Finally we have developed a process that allows us to fabricate sensor arrays on flexible substrates thereby opening the door towards ultra-thin, flexible sensor arrays for wearable technologies.
ABOUT
Alberto Salleo is currently Full Professor of Materials Science and Department Chair at Stanford University. Alberto Salleo holds a Laurea degree in Chemistry from La Sapienza and graduated as a Fulbright Fellow with a PhD in Materials Science from UC Berkeley in 2001. From 2001 to 2005 Salleo was first post-doctoral research fellow and successively member of research staff at Xerox Palo Alto Research Center. In 2005 Salleo joined the Materials Science and Engineering Department at Stanford as an Assistant Professor in 2006. Salleo is a Principal Editor of MRS Communications since 2011.While at Stanford, Salleo won the NSF Career Award, the 3M Untenured Faculty Award, the SPIE Early Career Award, the Tau Beta Pi Excellence in Undergraduate Teaching Award, and the Gores Award for Excellence in Teaching, Stanford’s highest teaching award. He has been a Thomson Reuters Highly Cited Researcher since 2015, recognizing that he ranks in the top 1% cited researchers in his field.
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Peace of mind for those affected by stroke
Orestis Vardoulis, Ph.D.
Co-Founder & CEO
ZeitMedical
Zoom Webinar Details
Webinar URL: https://stanford.zoom.us/s/94427469356
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 944 2746 9356
Passcode: 999031
11:00am – 12:00pm Seminar & Discussion
12:00pm – 12:15pm Reception
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ABSTRACT
There is a growing population of over 10 million Americans that live with an elevated risk of having a stroke.
Each year approximately 1 million Americans survive a stroke or a ministroke, often severely affected by its debilitating effects. A more disabling stroke frequently occurs after the seminal events, leaving patients and their families scarred for life.
TIME = BRAIN. Early hospital presentation is the most critical determinant in good stroke outcomes. However, most patients arrive at the hospital often hours after the event, with less than 10% receiving any form of treatment (thrombolysis / thrombectomy).
As a result, at risk individuals struggle daily with the fear, a stroke might happen during night-time or when they are alone. Unfortunately a stroke that goes unnoticed for hours, is most often not treatable due to the lack of salvageable tissue.
To alleviate that fear, we are creating an AI-powered, smart-headband that analyzes brain waves to detect the onset of an event immediately, and alert the patient, caregivers and 911.
Our stroke detection AI has already been shown to detect ischemia during high-risk surgeries with 90% sensitivity and no false positives.
We have received FDA breakthrough designation for our solution and are currently running a pilot human factors and signal quality study.
Our vision is to provide peace of mind and optimal brain health for everyone.
ABOUT
Orestis is the CEO and Co-founder of Zeit Medical, a telehealth company that offers at home monitoring and alert solutions for patients at risk for stroke. Prior to starting Zeit, Orestis was a Stanford Biodesign Innovation Fellow where his team developed the initial idea about at-home stroke detection. Orestis trained as a Mechanical Engineer, at Aristotle University, Greece, earned his PhD in Biotechnology and Bioengineering at EPFL, Switzerland and conducted cutting edge research in flexible wearable electronics with the Bao Group at Stanford Chemical Engineering. He has authored more than twenty publications in prestigious journals and has filed for a variety of patents at the intersection of materials technology and medical devices. Orestis currently lives in San Francisco, where he also contributes to the UCSF-Stanford pediatric device consortium as a technology advisor. He also maintains close ties with the med-tech and health-tech communities in Switzerland and Greece, contributing to regional Biodesign educational workshops.
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Towards precision diagnostic and prediction of food allergy
Sindy KY Tang, Ph.D.
Associate Professor of Mechanical Engineering, Senior Fellow at the Woods Institute for the Environment and Professor, by courtesy, of Radiology – PHIND Center
Stanford University
Location: Zoom
Webinar URL: https://stanford.zoom.us/s/91932966334
Dial: US: +1 650 724 9799 or +1 833 302 1536 (Toll Free)
Webinar ID: 919 3296 6334
Passcode: 383071
11:00am – 12:00pm Seminar & Discussion
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ABSTRACT
Food allergy has reached epidemic proportions. Accurate in vitro methods that are efficient and easy to use to identify offending food allergens are lacking. Oral food challenge, the gold standard for food allergy assessment, is often not performed as it places the patient at risk of anaphylaxis. As such, food allergy is often identified only after an adverse reaction that could be life-threatening. Our long-term goal is to develop a food allergy diagnostic test that is accurate, safe, rapid, and accessible, so that food allergy can be easily identified prior to the occurrence of an adverse reaction, and that the efficacy of immunotherapy for food allergy can be tracked more effectively. This talk will discuss our recent work on developing such a test. Our approach is based on the Basophil Activation Test (BAT), which measures the activation of basophils in whole blood after stimulation with specific food allergens ex vivo. The BAT has been shown to be highly predictive of allergic reactions. However, the need for flow cytometry has limited its broader use. We are developing a miniaturized, standalone version of the BAT. We envision that the test can be used at the point of care, such as the doctor’s office or at a local pharmacy.
ABOUT
Prof. Sindy KY Tang is the Kenneth and Barbara Oshman Faculty Scholar and Associate Professor of Mechanical Engineering and by courtesy of Radiology (Precision Health and Integrated Diagnostics) at Stanford University. She received her Ph.D. from Harvard University in Engineering Sciences under the supervision of Prof. George Whitesides. Her lab at Stanford works on the fundamental understanding of fluid mechanics and mass transport in micro-nano systems, and the application of this knowledge towards problems in biology, rapid diagnostics for health and environmental sustainability. The current areas of focus include the flow physics of confined micro-droplets using experimental and machine learning methods, interfacial mass transport and self-assembly, and ultrahigh throughput opto-microfluidic systems for disease diagnostics, water and energy sustainability, and single-cell wound healing studies. She was a Stanford Biodesign Faculty Fellow in 2018. Dr. Tang’s work has been recognized by multiple awards including the NSF CAREER Award, 3M Nontenured Faculty Award, the ACS Petroleum Fund New Investigator Award, and invited lecture at the Nobel Symposium on Microfluidics in Sweden. Website: http://web.stanford.edu/group/tanglab/
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Topic TBA
Christina Curtis, Ph.D.
Associate Professor of Medicine (Oncology) and of Genetics
Stanford University
Location: Venue coming soon!
11:00am – 12:00pm Seminar & Discussion
12:00pm – 12:15pm Reception
RSVP coming soon!
ABSTRACT
Coming soon!
ABOUT
Coming soon!
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
PHIND Seminar Series: Male Infertility and the Future Risk of Vascular and CV Disease
Michael Eisenberg, M.D.
Associate Professor of Urology and, by courtesy, of Obstetrics and Gynecology
Stanford University Medical Center
Gary M. Shaw, Ph.D.
NICU Nurses Professor and Professor, by courtesy, of Health Research and Policy (Epidemiology) and of Obstetrics and Gynecology (Maternal Fetal Medicine)
Stanford University
Location: Venue coming soon!
11:00am – 12:00pm Seminar & Discussion
12:00pm – 12:15pm Reception
RSVP coming soon!
ABSTRACT
Coming soon!
ABOUT
Coming soon!
Hosted by: Garry Gold, M.D.
Sponsored by the PHIND Center and the Department of Radiology
Roxana Daneshjou, MD, PhD
Assistant Professor, Biomedical Data Science & Dermatology
Assistant Director, Center of Excellence for Precision Heath & Pharmacogenomics
Director of Informatics, Stanford Skin Innovation and Interventional Research Group
Stanford University
Title: Building Fair and Trustworthy AI for Healthcare
Abstract: AI for healthcare has the potential to revolutionize how we practice medicine. However, to do this in a fair and trustworthy manner requires special attention to how AI models work and their potential biases. In this talk, I will cover the considerations for building AI systems that improve healthcare.