CIMIT blog

Funding for Innovation: Harvard Catalyst/MIT X Prize

Moderator: Frederick J. Schoen, MD, PhD, Professor of Pathology and Health Sciences and Technology, Harvard Medical School; Director of Cardiac Pathology and Executive Vice-Chairman, Department of Pathology, Brigham and Women's Hospital; Director, BWH Biomedical Research Institute (BRI) Technology in Medicine Initiative; CIMIT Site Miner, BWH, fschoen@partners.org

 The X-Prize Model for Stimulating Solutions to Grand Medical Challenges

Erika Wagner, PhD, Founding Executive Director, X PRIZE Lab @ MIT, erika@MIT.EDU

In 2004 the Ansari X PRIZE for suborbital spaceflight captured the public's imagination, leveraging a $10M prize purse into over $100M in innovation. Now the X PRIZE Foundation is developing new prizes to focus on innovation around other "Grand Challenge" themes, including a number related to health and healthcare. Unlike traditional awards that only recognize success in hindsight, these incentive prizes challenge the best minds, whoever and wherever they may be, to rise to a well-defined challenge. These prizes use the powerful incentive of competition on a global stage to generate incredible leverage for the grantor and they only pay out on success. In inefficient markets and landscapes where the best road to a solution is unclear, prizes offer a valuable alternative to traditional grants and venture funding.

 

The New Harvard Clinical and Translational Science Award (CTSA): Opportunities and Challenges

Gordon H. Williams, MD, Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and Women’s Hospital, gwilliams@partners.org

The Harvard Catalyst Participant and Clinical Interaction Resources (PCIR) program allows investigators to perform cutting edge human research and facilitates human interdisciplinary research across the broad spectrum of departments and research areas through transformation and extension of the prior NIH-funded General Clinical Research Centers. Now referred to as Harvard-wide Human Research Laboratories (HRL), this resource incorporates dedicated in and out patient clinical research sites, clinical research personnel and core laboratory services at the following participating Institutions: Beth Israel-Deaconess Medical Center, Brigham and Women’s Hospital, Children’s Hospital Boston, Massachusetts General Hospital and Massachusetts Institute of Technology. Each provides resources available to assist investigators throughout within as well as across these Institutions. Selected resources are available both within space dedicated to the HRLs and in the near future off-site in other areas where patients are located such as the intensive care units and the emergency departments.

Structural Holes

                                          

Rich McLaughlin and Lynn Osborn bring this quote to our attention for a weekend thought out of Clay Shirky's Here Comes Everybody

“Most good ideas come from people who bridge “structural holes”, which is to say people whose immediate social network included employees outside their department.  Bridging these structural holes was valuable even when other variables, such as rank and age are controlled for. The highest percentage of good ideas came from people whose contacts were outside their own department.  On the other hand, managers who were highly connected, but only to others in their department, had ideas that were not ranked as highly.  Bridging predicted good ideas; lack of bridging predicted bad ones.” Clay Shirky, Here Comes Everybody

A great argument for networking more outside your team, function and organization.  Enjoy the weekend!

Rich & Lynn

A final note: Here is a nice collection of resources for online applications that help people come together and publish collaboratively Online publishing and production

Giving google a little run for their money isn't always a popular thing to do, but it's certainly interesting. Try out ZOHO! You'll see what we mean.

Virtual Personae - Simply being online is not enough

A great new blog called Virtual Personae just started up dealing with non-profits and new media/emergent media use. Regardless of your field of interest this blog will enlighten and grab you with subject matter key to the development of any online activity. It just broke ground with it's first posting and it's eloquent writing style combined with refined experience makes it an addictive read from the start.

She does subscribe to the term Generation Y, which I've railed against before, but she nails it by arguing the generational importance of philanthropy. The heart of her argument rests in a crucial fact: The internet is ubiquitous. She then goes on to close with a simple, but key statement: Being online is not enough.

And no one could say it better.

Check out Virtual Personae here

This is my current online persona:

Actually, I'm just using image and color to attract your attention to this post and to make it more dynamic. Maybe Virtual Personae will cover this topic in one of their upcoming posts.

CIMIT

Unraveling the Brain in Trauma and in Health

The Role of Diffusion Tensor Imaging in Traumatic Brain Injury
Marilyn F. Kraus, MD, Associate Professor of Psychiatry and Neurology, University of Illinois at Chicago and Researcher, Center for Cognitive Medicine, mkraus@psych.uic.edu
Moderator: Kirby G. Vosburgh, PhD, Associate Director, CIMIT and Assistant Professor, Radiology, Brigham and Women’s Hospital, Harvard Medical School, kvosburgh@partners.org

Traumatic brain injury (TBI) is a significant public health problem. Many people live with TBI-related disabilities. More recently, it has been identified as a critical problem in the military.  Mild TBI is the most common type (also referred to as concussion).  Neurobehavioral deficits (changes in cognition, mood and behavior) are very common causes of disability after TBI, and terms such as post-concussion syndrome are used to describe these changes. TBI is a multidisciplinary area that challenges artificial boundaries within medical specialties, and research is needed to better understand neuropathology and predictive factors in outcome.

Damage to the white matter tracts of the brain is a common result of TBI, and may be the primary pathology in many cases.  This injury is known as diffuse axonal injury (DAI) or traumatic axonal injury (TAI). Standard clinical neuroimaging is often not sensitive enough to detect this.  Diffusion tensor imaging (DTI) is one of the more recent tools developed using MRI technology and allows for the specific examination of the integrity of white matter tracts. Current research has shown it to be sensitive to changes following even so-called mild TBI.

Mapping Brain Connectivity with Diffusion MRI
Van Wedeen, MD, Assistant in Neuroscience, Massachusetts General Hospital and Associate Professor in Radiology, Harvard Medical School, van@nmr.mgh.harvard.edu
Moderator: Thomas J. Brady, MD, Co-Program Leader, CIMIT Cardiovascular Disease Program; Director, Cardiovascular Imaging and Intervention; Director, Nuclear Medicine and Molecular Imaging and Vice Chairman, Director of Radiology Research, Massachusetts General Hospital; L.L Robbins Professor of Radiology, Harvard Medical School, tom@nmr.mgh.harvard.edu

Neuroanatomy is difficult because brain structures overlap. Though the human brain may contain 10^14 synapses, it is equally true that it consists of only a few hundred gray matter “organs” –-cortical fields and subcortical nuclii -- connected by a few times as many fiber pathways. Unfortunately for neuroscience, the identity of theses structures has been difficult to determine. But consider: if neural structures such as fiber pathways were spatially separable, then like other anatomy, they would have been identified by dissection and microscopy centuries earlier.
            
Diffusion spectrum MRI – DSI - and related methods offer a novel solution to the problem of overlapping structure. DSI addresses the overlap of fiber pathways by using the principle that the fibers of each pathway are orientationally coherent – approximately parallel on the scale of a voxel. 

It follows that path anatomy naturally resolved in a space of 5 dimensions – the 3 spatial dimensions plus 2 auxiliary dimensions to express fiber orientations at each location. In retrospect, this solution to the problem of neoroanatomy was hiding in plain sight. MRI and x-ray tomography failed to solve the problem of neuroanatomy because each location of “white matter” and “gray matter” in conventional tomograms typically includes many neural organs. Yet just as the anatomic ambiguities of 2D projection x-ray are addressed by 3D tomography, so the ambiguity of  nueral structure in conventional 3D tomography may be resolved by DSI of auxiliary orientation dimensions.
            
As one application, Van Wedeen’s lab has recently shown that DSI can produce a credible image of the human cortical ‘connectome’ –- the totality of cortico-cortical connections in the human brain. With further analysis, the lab is able to identify the topological core of this network, showing it to be located principally on the medial surface of the cerebral hemispheres in the poster cingulate /medial parietal / retro splenial region. This region, in fact, had been recently identified by functional MRI including studies of the resting state as part of the brain’s ‘default network’ - a core functional region active when the brain is not attending to specific purposeful tasks. Quantitative connectomics is anticipated to become a rich source of biomarkers for a range of neurological and neuropsychiatric disease. Though still in its infancy, diffusion MRI is emerging as a unique technology for neuroscience, able to image the functional components of the brain quickly, objectively, at low cost, in single brains in their entirety, nondestructively, ex vivo and in vivo, in animals, and in human subjects.

Kingbridge Blog

This morning we received a note from Lisa Gilbert of Kingbridge Centre in Toronto. They have started a blog on their new website and the inaugural post is authored by our friend John Abele.

In his posting John covers the transformation of organizations and people through the internet and how profound this change has been given that the internet is only 5000 days old. His most profound point being on that of transparency, "Transparency is not a choice, but a given."

It's a great post and sure to be a powerful new blog.

Have a visit to the Kingbridge blog here

Alternative Models of Care Delivery - Saying Goodbye Through The Internet

Dr. Ron Dixon had a patient and one day Ron diagnosed that patient with lung cancer. As time went on and the disease progressed the only way Ron could communicate with his patient was through Skype remotely. It was through Skype that Ron reviewed the patients final test results. It was through Skype that Ron told the patient it wasn't good. It was through Skype that Ron last spoke with his patient.

This forum isn’t about Skype or any one technology, but all of the possibilities that exists for how we can think different about healthcare and what the impact is. Dr. Ron Dixon heads this weeks forum update.

This CIMIT Forum will explore novel and emerging methods of healthcare delivery, with a focus on primary health care. We'll address the controversial yet inevitable appearance of retail-based clinics on the Massachusetts healthcare space and discuss their potential impact from an AHC perspective. We will also explore recent entrepreneurial developments in the healthcare delivery arena, such as American Well: http://www.americanwell.com.

Moderator: Ronald Dixon, MD, MA, Associate Director Beacon Hill Associates; Project Director, MGPO; CIMIT Program Leader, Value-Based Models of Healthcare, rdixon@partners.org 

Retail Clinics -The View from an Academic Integrated Delivery System
Peter Markell, Vice President, Finance, Partners HealthCare System, Inc., pkmarkell@partners.org

Peter Markell will focus on an overview of the development of retail clinics and how PHS is evaluating the pro’s and con’s of including retail clinics in its delivery system.

Increasing Health Care Value via Technology: Enabled Simplification
Ahmed Albaiti, CEO, Medullan, Inc.,ahmed@medullan.com

How is value defined in health care? A question that is (or should be) top of mind of any serious reform activity within the health care space. Ahmed Albaiti will discuss the value of health care and how it can be improved significantly by placing the emphasis on patient-centric, differentiated services, that are measurable on the level of specific conditions and across the full cycle of care. Current industry examples will be cited in detail to paint an early look of what the healthcare ecosystem might look like in the future.

In particular, technology will be explored as a powerful enabler of shifting the delivery of care:
- from focusing innovation on the most complicated cases to fostering disruptive innovation for the most common cases
- from creating information transparency of health plan coverage to creating information transparency of provider quality and cost
- from building traditional facilities that pursue treatment of all conditions to empowering distinctive facilities that present unique models of excellence
- from managing constricted workflows dependent on physician expertise to integrating stratified workflows enabled by clinical teams of varying expertise

Additional panelists include:
Allan Goroll, MD, Professor of Medicine, Harvard Medical School, MGH, ahgoroll@partners.org
David F. Torchiana, MD, Chairman and CEO, Massachusetts General Physicians Organization (MGPO), dtorchiana@partners.org

Wii Fit Review - Illustrated

The other day we broke out the office Wii and had the opportunity to try Wii Fit for the first time. We’ve put together a review of Wii Fit and it’s potential for a healthier society and application to rehabilitation. I’m sure all of you have been able to enjoy and laugh at (or be laughed at) Wii Sports a million times by now, but with Wii Fit the laughing is less and the purpose much more important.

Wii Fit consists mainly of a white board measuring balance, pressure, weight and posture. I wouldn’t call Wii Fit the most technically accurate measuring device in the world (For instance, body fat percentage cannot be calculated), but it is perfectly suited to the wider consumer market and sleek enough to make exercise interesting. What Nintendo has done with the Fit is remarkably sharp, and their efforts make fitness something accessible from the dorm room to the elder care facility. Most importantly, it might just open the eyes of some physicians a tiny bit and change the way healthcare thinks… Just a little.

Paul photo is our model here today and he will help illustrate some of the steps we went through. The first thing you are asked to do is create your own individual user profile, password protected, so that others don’t know your private heath information. This is actually a tedious opening process, but important. The Fit walks you through calibration, your measurements, familiarizes you with the board and also asks you to define your personal goals. You can choose to become more flexible, lose weight, strength train, or increase stamina and there are more options as you go along – It’s your decision. However, its main focus is on weight loss and general aerobic activity.

It is a bit of a challenge at first to learn the way your feet and muscles register on the board. It is surprisingly sensitive and an introductory system of scales and zones help you focus attention to muscles you rarely ever think about. This is good in terms of creating general awareness of body and health in participants outside of just Wii activities. Also, and I’m not sure how it does it, it knows your posture and stance, which it uses as a measure of your general fitness. It takes a surprising amount of strength in your mid section to stand at correct posture and thus it knows how you rank on a fitness or injury scale. But most remarkable is the feedback on success and failure it gives you. You see instant and clear reflection of your success or failure as you go along. Be prepared to not like what you hear though… It’s a gentle machine, but brutally honest.

From there you pick a trainer who you feel comfortable with. Literally. You pick a digital entity that is of the sex you feel best working with. Their attitude and demeanor is very warm, welcoming and pleasant. They are a bit socially awkward like the computer from 2001: A Space Odyssey, but appropriate for all ages and interests. These trainers are, I think, the best asset of the Wii Fit because of their motivation, coaching and their ability to serve as a guide-on-the-side. Their measurements tell you when you’re doing something wrong (for the most part) and when you’re doing something right and modeling of your own behavior shows your action just like looking into a mirror (but much better).

From there it’s up to you where to go next and how your fitness program will unfold. I think most people will generally begin with Yoga and the additional sport packages customized to the Wii Fit like skiing. In skiing your feet and shift are registered as direction and degree perfectly. The additional sport packages on Wii Fit are key and will be one of the biggest gaming attributes to the system, which help it appeal to those not interested in fitness.

Now, there has been a lot of talk recently in regards to the Wii and rehabilitation. I do, however, believe that the Fit needs a more specific program directed at physical rehabilitation for injury patients or the elderly, but legal concerns will most certainly keep them from getting anywhere near that. Nintendo, after all, is not a team of licensed physical therapists or physicians and there is no way for them to know what routines may be beneficial or harmful to an individuals needs. It would be great if as part of the personalization process Nintendo let you input past and current injury problems so that it could be aware of certain exercises that would either be helpful or harmful. Though I must keep in mind that Nintendo is not trying to be a rehabilitation resource, but here in Boston we are doing some Wii-habilitation directed by physicians. Read about it here.

While I think Wii Fit and the Wii system will have a hard time replacing the physician, physicians will have a hard time finding a more effective way to get patients engaged. Physicians everywhere should go play for a few hours on a Wii fit to understand it’s true implications and that will certainly begin to change the way rehabilitation is done. It may not be the Wii Fit that makes the change, but its successors will be able to spawn that impact.

So the drawbacks are this: The Wii Fit pad is not made for big people. Paul seemed to stand comfortably on the pad for the most part, but for a better series the pad really needs to be more like a mat. I applaud Nintendo for taking the step up from Dance Dance Revolution to the Fit Pad, but size is a drawback here. If cost weren’t a factor I’m sure the pad would be more like 5’ by 3’, but it’s not. Still, this current Fit Pad is effective and programming for it is made with limitations in mind.

The other drawback I see is that it can only coach you so much and so far. It cannot actually see you, at least all of you. So if you are doing an activity incorrectly it might not know. This could produce bad fitness habits, could cause physical damage to a person (especially in rehabilitation), or create frustration if results don’t show due to incorrect performance. For serios rehabilitation a specialist is needed in person for coaching sessions.

Finally, right now the focus of Fit is favored toward weight loss, which is good, but I have yet to know anyone claiming to have lost weight thanks to the Wii Fit. Having said that, I would love to hear about it, and if anyone has interest in starting a rigorous program of weight loss with Wii Fit for themselves as an experiment, please contact us.

The giant positives: Fit is the first big step from what many of us saw with Dance Dance Revolution. Nintendo did it, and congratulations: The Wii Fit and the Wii System are tremendously powerful tools to healthcare. Their impact, application and potential could not possibly be stressed enough. For any drawback it might have the Wii Fit has ten positives in health, entertainment and philosophy.

There has clearly been careful thought put into the philosophy of such a program for the Wii and it shows. The programs are strong, entertaining and good for all ages, genders and needs. You will be amazed at how this board knows you and how you learn the board. In our testing process we saw many different age ranges and type of people jump on and give it a try, all were smiling and successful. It’s clear that the Fit works in theory, but in practice we just have to wait and see. Everyone should try this machine today.

And finally, for all of you gamers out there: Yes, you can ‘game’ the Wii Fit as you can any technology. And of course people love to game things and show their dominance over the faults and failing of circumstance or engineering. Of course you can make the Wii think you are doing exercise when really you are just wiggling your toes, but the minutes of pleasure that satisfaction may give you will not compare to the satisfaction a rehab patient will get when they do it right. You just… Get lost in the Wii and the Wii fit. Any sense of embarrassment leaves and you just get so wrapped up in a very physical activity.

Game Changer? Maybe…

Closing thought: Last year at the POVe John Abele remarked to me that things like Dance Dance Revolution need someone to explain to physicians and engineers the potential application. John explained to me how Dance Dance Revolution had potential in healthcare arenas, but people wouldn’t think of it as more than a game unless bright people explained it clearly. Well, John was right. And Nintendo has, in part, made that connection for us. Bright people.

Related Wii-Habilitation Articles:

Break a Leg?Try 'Wiihabilitation'
 

Wii are the world More seniors using video game system to stay fit

Or try our Friend Ann DeMarle's Blog from the Emergent Media Center