Stories about: CHIP

Think you have strep? Answer two questions and check the big data

shutterstock_141722230Do you have a fever?

Do you have a cough?

If you’re sitting at home with a sore throat, your answers to those two questions could be enough to tell whether you should see a doctor for a strep test, thanks to a new risk measure created by Kenneth Mandl, MD, MPH, and Andrew Fine, MD, MPH, at Boston Children’s Hospital.

Called a “home score,” the measure combines the two questions above, your age, and data on the level of strep activity in your geographic area. The basic idea is that your symptoms, plus the big picture of what’s happening in your neighborhood, is a strong enough predictor to for you to go to the doctor for a throat swab.

Thought it’s just a research tool for now, if it were it were packaged into an app and fed the right data (localized strep test results from a health center or medical testing company, for example), the home score could allow someone with a sore throat to make an informed decision about whether they should consider going to the doctor.

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Tweeting and more for public health: Q&A with a digital disease detective

Screenshot of H7N9 patient record posted to Weibo
A photo of the record of a Chinese patient with H7N9 flu. Posted to Chinese social media site Weibo, the photo has spread like wildfire over Twitter and other social media. (Weibo user @phoenix via Twitter user @Laurie_Garret)

From the flu to cholera, obesity to vaccine concerns, data from Twitter, Facebook, mobile phones, search engine queries and other web-based sources are changing the nature of epidemiology, public health surveillance and outbreak preparation and response.

John Brownstein, PhD, director of the Computational Epidemiology Group in Boston Children’s Informatics Program and co-founder of HealthMap, recently co-authored an opinion piece in the New England Journal of Medicine (NEJM) highlighting the roles of social media and other Internet data sources in what he calls “digital epidemiology” or “digital disease detection,” He and his collaborators argue that, in their opinion:

“Since the [2003] SARS outbreak, the world has seen substantial progress in transparency and rapid reporting. The extent of these advancements varies, but overall, digital disease surveillance is providing the global health community with tools supporting faster response and deeper understanding of emerging public health threats.”

Vector sat down with Brownstein to discuss digital epidemiology’s evolution over the 10 years since SARS, especially in light of the rise and spread of avian H7N9 influenza in China and Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) in Jordan and the Arabian Peninsula.

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Mapping obesity with Facebook

What you like on Facebook might say something about how obese your neighborhood is. (Dry Martini/Wikimedia Commons)
If one of my Facebook friends were to look through my list of “likes,” they’d find that I’m interested in music, cars, science and photography, among other things (and not necessarily in that order).

But if a researcher were to look across Boston at what people who are like me like—and post and share—on Facebook, a snapshot of data could tell them something else: roughly how obese metro Boston is.

That’s essentially what John Brownstein, PhD, and Rumi Chunara, PhD, concluded in a study recently published in the journal PLoS ONE. In it, they combined Facebook interest data—an aggregate of what people “like,” post on their timeline or share on others’ timelines—with health survey data to geographically correlate activity or television interests with obesity rates. 

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SHRINE: Clinical & population research by the numbers

Clinical research is all about numbers. A new informatics network called SHRINE could help make it easier to get find out if the numbers of patients are there to answer complex questions. (victoriapeckham/Flickr)
Ed. note: This morning at 8:15 EDT, Isaac Kohane, MD, PhD, will tell the audience at TEDMED 2013 about his goal of using every clinical visit to advance medical science. 

To preview his talk, we’ve updated a past Vector story about SHRINE, a system Kohane helped develop to allow scientists to use clinical data from multiple hospitals for research.

Clinical research really comes down to a numbers game. And those numbers can be the bane of the clinical researcher. If there aren’t enough patients in a study, its results could be statistically meaningless. But getting enough patients for a study, particularly for rare diseases, can be a daunting challenge.

The Shared Research Information Network (or SHRINE) could help solve this vexing problem. Developed through Harvard Catalyst by a team led by Isaac “Zak” Kohane, MD, PhD, director of Boston Children’s Hospital’s Informatics Program, SHRINE links the clinical databases of participating Harvard-affiliated hospitals—currently Boston Children’s Hospital, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Massachusetts General Hospital—letting researchers at those hospitals see how many patients from those hospitals meet selected criteria.

Why is this important?

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Could “jumping genes” contribute to cancer?

Transposons, or "jumping" genes, helped our cells evolve, but they might also help cancer develop. (Evil Erin/Flickr)

Our cells’ nuclei aren’t exactly what you’d call calm, quiet places. They’re more like busy city squares, filled with a constant bustle of activity: DNA folds and unfolds, proteins zip in and out to read genes and tag histones and whole chromosomes duplicate themselves while the cell preps for its next round of division.

Now add one more ingredient to this mix: genes that don’t sit still. Our genome is full of what are called transposons, the remnants of ancient viruses that bound themselves within our DNA over evolutionary time. Transposons pretty much do just one thing—copy and insert themselves all over the genome, cutting in on other genes like suitors at a debutantes’ ball.

You might think that having pieces of DNA randomly jumping into and out of genes wouldn’t be a very good thing. And you’d be right: members of Boston Children’s Hospital’s Informatics Program (CHIP) recently reported in Science the first evidence that transposons may directly contribute to the development of some cancers. But the story isn’t that simple.

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Mind the gap in drug research for children

Diseases like malaria strike children harder than adults, but clinical trials for these diseases rarely include or focus on children. Why? (WHO/P. Virot)

We’re pretty focused on the safety of the things around us. Our drinking water gets checked for chemicals, bacteria and other things that could make us sick. Kids’ car seats are tested to make sure they’ll keep children safe in an accident.

But there’s one surprising arena where this focus on safety and testing often falls short: the medications we give our children. Not just in the United States, but globally.

There are lots of reasons why fewer drugs get tested for safety and efficacy in children than in adults. It’s time-consuming, expensive and, frankly, risky. The ethics of testing new medications in children are pretty thorny.

And, overall, the market for pediatric drugs is much, much smaller than that for drugs for adults, since children fortunately don’t get sick as often as us grown-ups.

But for some diseases like asthma and diarrheal diseases, children bear a greater burden than adults—one that’s not matched by the amount of research done on drugs for kids.

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Worried where the flu is? There’s an app for that

Photo: @alviseni/Flickr

Before you know it, flu season – that miserable time of sneezing, snuffling, coughing, and generally feeling blah – will be upon us again. And as with anything, the best way to deal with the flu is to be prepared for it.

But when, exactly, is the right time to start stocking up on tissues and looking for vaccination clinics? You could go with the conventional wisdom: Get the annual flu vaccine in the fall and spend the next five months avoiding anyone with bleary eyes and a runny nose.

Or, to try to get a more targeted read on when the flu will appear in your town, you could turn to the power of the web. In 2008 – a few months before H1N1 influenza appeared on the scene – Google launched Google Flu Trends, which mined user search data to gauge flu activity on a national, state, and even (in some cases) city level.

The H1N1 outbreak proved to be a tipping point for online disease tracking tools. Recognizing this, the US Center for Disease Control and Prevention (CDC) is getting into the act with the CDC Flu App Challenge. A contest run through Challenge.gov, the Flu App Challenge encourages developers to come up with “an innovative use of technology to raise awareness of influenza and/or educate consumers on ways to prevent and treat the flu.” Submitted apps – for the web, for desktop computers, for mobile devices – use publicly available data feeds, including at least one maintained by the CDC, to promote healthy behavior for flu prevention. All of the submitted apps are eligible for several awards, including a People’s Choice Award chosen by public vote.

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