CRISPR: Good or Bad?

    Diseases such as cancer, arthritis, diabetes, and so many more have caused pain and struggles that so many have to endure when they are faced with one of these diseases. Today, scientists have now made strides towards a future without any of these diseases through a technology called CRISPR. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, which is simply repetitive DNA sequences in bacteria that allow scientists to cut out certain sections of DNA that may be mutated and replace them with a new DNA sequence aiming to reverse or fix what the previous DNA sequence was causing (Harvey 2014). How exactly does CRISPR work? As mentioned previously, CRISPR is made up of repetitive DNA sequences in bacteria. This bacteria, once it has infected a body, can transcribe its DNA elements to RNA. Once converted to RNA, it guides a nuclease to the specific DNA sequence to cut (Jax.com 2020). 

The possibilities of CRISPR seem to be endless, as we may be able to change any part of our genome ultimately changing ourselves forever. Currently, human clinical studies are already being run on the effects of CRISPR for cancer therapy and for editing retinal cells to rid the human body of leber’s congenital amaurosis 10 (Jax.com 2020). 

Although these clinical trials give hope to those with a chronic disease that someday soon there may be a solution for riding their bodies of that certain disease, there are limitations and ethical issues that arise with CRISPR. For example, changing the genome of a person alters their body forever and also changes the DNA of future generations. The ethical dilemma is if it is morally correct to in some ways “play God” and change the DNA of generations to come. Secondly, CRISPR is also able to edit the genomes of gametes affecting the embryo and future generations. Lastly, CRISPR is not yet 100% accurate and any changes to the genome will be permanent and may cause serious problems if it were to cut the wrong sequence of DNA 

Science and technology are more advanced than ever and it is only becoming better. Although CRISPR has been revolutionary in offering a solution for so many of the world’s diseases, scientist and society should be careful with the decisions that will soon be made on CRISPR (Shwartz 2018). Regulations on what CRISPR can specifically be used for need to be clearly written out as we do not want anyone to take advantage of this technology. The sky is the limit with CRISPR, but we need to have a clear and ethical approach, only helping those who truly are in need of this technology and not for those looking to enhance the human body. 

References: 

Harvey, Paul et al. “CRISPR: A Game-Changing Genetic Engineering Technique.” Science in the News, 31 July 2014, sitn.hms.harvard.edu/flash/2014/crispr-a-game-changing-genetic-engineering-technique/.

Stanford Medicine. “CRISPR Is a Gene-Editing Tool That's Revolutionary, Though Not without Risk.” Stanford Medicine, 2018, stanmed.stanford.edu/2018winter/CRISPR-for-gene-editing-is-revolutionary-but-it-comes-with-risks.html.

“What Is CRISPR?” The Jackson Laboratory, www.jax.org/personalized-medicine/precision-medicine-and-you/what-is-crispr.

Caloric restriction for living longer

     

    Since a young age, the majority of us have been told to eat all of our food so that we could live long and healthy lives. Scientists have now found that this belief may not be completely true. It is important to first note that the theory of aging is still highly debated, with its two main theories being, an accumulation of free radicals which cause aging, and the rate of living theory which states that larger animals live longer than smaller animals due to slower metabolic rates. 

    Since a slower metabolic rate is thought to be correlated with a long life, it would make complete sense that a calorie deficit would increase lifespan. As a person reduces their food intake it will also reduce their metabolic rate. A decrease in the metabolic rate would then be correlated with a longer life. Looking at the second theory of aging, scientists have also found that multiple species are known to produce less free radical when in a calorie deficit which in turn may also delay aging in an organism. With that being said, no matter which theory is correct, we see that among rhesus monkeys restricting calories improves health and increases lifespan (Kumlien 2017). Although this was an incredible study that showed promising results, it is not the first study to suggest a caloric deficit. In 1935, Clive McCay, found that rats who had a severely restricted diets lived 33% longer than the expected life span (Grabski 2020). Lastly, scientist at the salk institute in California conducted a study with rats where a control group ate whatever they liked and the second group had a calorie deficit of 30%. This was maintained for 9 months which is the equivalent of 20 human years. Researchers concluded that 57% of age-related changes in the cells of normal rats were not seen in rats that were on a calorie deficit (Neuro 2020). 

    Although the majority of these studies have shown promising results, some scientists fear that a long-term caloric deficit could do more harm than good. One argument is that the control groups in the majority of these studies are allowed to eat as much as they want. Grabski argues that this may cause the control group to consume more calories than needed which in turn leads to weight gain and poorer overall health (Grabski 2020). 

    Research studies on caloric deficits are still fairly new and have not been examined enough to give a definitive answer. One limitation in this research is the ability to control the diets of human subjects as it may be much harder to control than in animals. Eating at a caloric deficit may show promising results but there may be better alternatives while the science is still being researched. 

References: 

“Calorie Restriction Lets Monkeys Live Long and Prosper.” News, 17 Jan. 2017, news.wisc.edu/calorie-restriction-lets-monkeys-live-long-and-prosper/.

FeaturedPsychology·October 22, 2020·2 min read, et al. “Eat Less, Live Longer.” Neuroscience News, 28 Feb. 2020, neurosciencenews.com/caloric-restriction-longevity-15812/.

Jan Wolitzky, et al. “Can Calorie Restriction Extend Your Lifespan?” Science in the News, 2 Aug. 2020, sitn.hms.harvard.edu/flash/2020/can-calorie-restriction-extend-your-lifespan/.

Who’s to Blame? The Oocyte or the Spermatocyte?

 

Increased oxidative stress inhibit the electron transport chain leading to free radical build up in spermatocytes (Aitken et al., 2014). The sperm cell’s unique compartmentalization prevents apoptosis from occurring, but cannot offer complete protection from mutations (Aitken et al., 2014). Reactive oxygen species lead to DNA damage in spermatocytes, particularly in repair proteins (Aitken et al., 2014). The spermatocyte is uncappable of self-repair and is in need of the oocyte’s reparative abilities (Aitken et al., 2014). The mutated spermatocyte still remains capable of fertilization and if fertilization does occur the mechanisms of the oocyte are responsible for fixing this mutation prior to the first round of cell division (Aitken et al., 2014). If this mutation is not corrected the mutation will be past to the offspring (Aitken et al., 2014).

Aitken RJ, Smith TB, Jobling MS, Baker MA, De Iuliis GN. Oxidative stress and male reproductive health. Asian J Androl. 2014 Jan-Feb;16(1):31-8. doi: 10.4103/1008-682X.122203. PMID: 24369131; PMCID: PMC3901879.5.

Is Alexa Always Listening?

 We always joke about how the government is listening to every one of our conversations through our devices. What if it really is true? Is someone listening to our deepest desires and fears? Is someone feeding us products that we tell ourselves that we shouldn't buy? Is someone feeding us information and news that only support our personal views?

A few years ago, Amazon's Echo Dot became a popular product for consumers. According to Ford and Palmer, there are about 8 million Echo family devices sold since 2014 (Ford & Palmer, 2019). Its popularity came to be because the Amazon Alexa Voice (AVS) offers voice-activated services in devices, such as thermostats, security cameras, refrigerators, and even automobile systems. While it seems great at first, a lot of people began to question if there is an invasion of privacy and if these devices are worth the expense of convenience. Obviously, this is an ongoing ethical issue that needs to be addressed. In Ford and Palmer's study, they discovered that consumers can disable the microphone feature. However, it takes away the purpose of having an Echo Dot in the first place because you can't use Alexa's hands-free features, such as playing music or controlling the home features. In addition, they found that the Echo Dot does not have a voice training setting, but rather listens for "Alexa" (Ford & Palmer, 2019). It is very unclear on whether or not the device is only able to recognize this wake word, "Alexa," or records the audio 24/7. 

This also leads to another question about social media. I recently heard about the Netflix documentary, "The Social Dilemma." I have not seen it yet, but I heard that your phone knows everything about you, starting from what you like to shop for to your political views. It is terrifying how you have one conversation about your best friend's wishlist and having ads about those products pop up everywhere. 

References

Ford, M., Palmer, W. (2019). Alexa, Are You Listening to Me? An Analysis of Alexa Voice Service Network Traffic. Pers Ubiquit Comput 23, 67–79. https://doi-org.dml.regis.edu/10.1007/s00779-018-1174-x.

Penicillin Allergy - The Root of the Cause

A recent study published this year reported they may have found a connection between penicillin allergies and a vulnerability on the HLA-B gene. This information is particularly useful, as approximately 10% of people report having an allergic reaction to penicillin to varying degrees. Symptoms can include rash, breathing difficulty, and abnormal heart rhythms. The immune system gene in question - HLA-B - is a major histocompatibility complex gene that aids in detecting self from foreign entities. HLA-B mutations have also been associated with adverse reactions to the HIV/AIDS drug abacavir and allopurinol used to treat gout. 

The study in question reviewed over 600,000 electronic health records that included genetic data with self-reported penicillin allergies.  The specific variant, HLA-B*55:01, was found on chromosome 6. They then cross-referenced over 1.1 million people of European ancestry in the 23andMe (that's a soapbox for another day lol) and found the same genetic connection. Other ethnicities were evaluated, but a similar mutation was not found in the small population sample sizes. 

Further research will need to evaluate data from ethnic minorities and verify actual penicillin allergies versus misreported allergies.  One posed issue regarded the distinction between verified penicillin allergies and reported.  Many people either have or have been told they had a childhood penicillin allergy that was either misreported or no longer an allergy.  This affects clinical decision-making, as less appropriate antibiotics may be prescribed in lieu of first generation antibiotics. Increased medication costs could potentially burden patients when they could safely take a lower cost antibiotic. 

Krebs, K., Bovijn, J., Zheng, N., Lepamets, M., Censin, J. C., Jürgenson, T., Särg, D., Abner, E., Laisk, T., Luo, Y., Skotte, L., Geller, F., Feenstra, B., Wang, W., Auton, A., 23andMe Research Team, Raychaudhuri, S., Esko, T., Metspalu, A., Laur, S., … Fadista, J. (2020). Genome-wide Study Identifies Association between HLA-B∗55:01 and Self-Reported Penicillin Allergy. American journal of human genetics, 107(4), 612–621. https://doi.org/10.1016/j.ajhg.2020.08.008

Gummy Bears and Muscle Recovery

One of the most popular candies that we have, gummy bears, may not only satisfy someone’s sweet tooth. Gummy bears have the potential to be considered high-quality carbohydrates that can help with muscle recovery (Kanter 2017). Many athletes have always looked at which foods and supplements could give them the edge in any sport, today we focus much of that attention on nutrition. The focus on nutrition has brought scientists to think about the fastest ways to replenish our bodies of the glycogen that is depleted when taking part in any form of exercise. Replenishing this glycogen storages immediately would then allow our body to focus on the muscle recovery and repair after an intense workout. Gummy bears are made up of a simple sugar known as dextrose. Eating gummy bears as a post-work out supplement would allow our bodies to quickly replenish the glycogen that was used during the work-out, this is because dextrose is just another name for glucose, which would mean that our body does not need to break down the ingredients within the gummy bear and can use them immediately. 

Dr. Ziengenfuss from the Pinnacle Institute of Health and Human Performance, found that ingesting carbohydrates postexercise can increase muscle protein synthesis by 350% (Ziengenfuss 2004). Although these results may be promising we do see some studies that have found this not to be as beneficial as it may seem. In one study, Dr. Juha Hulmi, tested the effects of protein with or without carbohydrates after a workout. The study found that there was a significant difference in abdominal fat loss, showing that the group ingesting only protein had increased abdominal fat loss when compared to the group ingesting a combination of protein and carbohydrates. However, the study found no significant difference in muscle growth or protein synthesis in either of the two groups. 

In conclusion, it may be beneficial to consume high quality carbohydrates to increase protein synthesis after a workout, yet it should be taken with a grain of salt. 

References: 

Hulmi, Juha J., et al. “The Effects of Whey Protein with or without Carbohydrates on Resistance Training Adaptations.” Journal of the International Society of Sports Nutrition, vol. 12, no. 1, 2015, doi:10.1186/s12970-015-0109-4.

Kanter, Mitch. “High-Quality Carbohydrates and Physical Performance.” Nutrition Today, vol. 53, no. 1, 2018, pp. 35–39., doi:10.1097/nt.0000000000000238.

Ziegenfuss, Tim N. “Postworkout Carbohydrate and Protein Supplementation.” Strength and Conditioning Journal, vol. 26, no. 3, 2004, pp. 43–44., doi:10.1519/00126548-200406000-00012.

Coffee addictions are real!

 

Watching your breath might just save your life

 It isn’t until recently I recognized the positive impact meditation had to my overall health. Managing my anxiety in an unprecedented time like this seemed to be the key to my success in my professional as well as personal life. After a conversation with one of my professors, I decided to give it a shot and I am so glad I did. 

Mindfulness is one of the most popular meditation techniques. It typically involves directing your awareness to your breath, your thoughts, the physical sensations in your body and the feelings you are experiencing (Mindfulness Meditation, 2019). Yongey Mingyur Rinpoche is a mindfulness meditation protege who has the brain of a 33 year old while he was 41 years old. How can the simple practice of watching your own breath change the way your brain works? 

Scientists have shown that most of the time most people don’t know what they are doing, we are pulled by all kinds of forces around us, and we do things we just aren’t aware of. So part of the practice of mindfulness is bringing awareness to what it is that our minds are actually doing. This practice is similar to going to the gym. When we go to the gym, the exercises we do will develop our muscles and help us become more fit. Similarly, mindful meditation requires practice and consistency. During a session of meditation, it is natural for our minds to wander but recognizing when this happens and bringing out attention back to our breath is the moment of awakening. Scientists have shown that when we bring our attention back to our breath, a part of the brian lights up, called the dorsolateral prefrontal cortex (dlPFC). This is the region in the brain that helps us focus. Meditation strengthens its connection to the DMN so this could be the mental muscle that meditation sessions develop. 

So, something as simple as watching your breath could keep your brain healthy, young, and strong. 

Mindfulness meditation: A research-proven way to reduce stress. (2019). Retrieved November 21, 2020, from https://www.apa.org/topics/mindfulness-meditation

A Laughing Matter?

 

Does your day feel better when you laugh more throughout the day? Has there ever been a moment where you laughed so hard, you can't breath? Have you ever laughed until you cried? Or until your stomach hurts? 

Like many people, all of these instances has happened to me before. Unfortunately, I cannot recall a moment why I laughed so hard, but I do remember the feeling of happiness and satisfaction. I've heard that laughing makes you live longer, which caused me to wonder if laughing is actually healthy.

In today's society, stress is very damaging to an individual's mental health. According to Yim, there is societal standards of competition and socio-economic interactions lead to stress (Yim, 2016). I found it amusing that Yim mentioned how laughter therapy improves the quality of life as non-pharmacological, alternative treatment for your mental health as well as your immune system. I didn't know this was a thing! Laughter decreases levels of cortisol, epinephrine, growth hormone, and a type of dopamine catabolite. In addition, it alters dopamine and serotonin activity (Yim, 2016). For instance, if you are in an awkward situation, laughter causes your body to secrete endorphins, which ultimately helps you feel better about the situation mentally.

According to the study by Zander-Schellenberg et al., the researchers tested the effect of laughter on the stress responses of college students using an intensive longitudinal method. The frequency as well as the intensity of laughter is monitored. This study is non-invasive because the researchers created an app with a questionnaire about that is prompted randomly at eight times a day. The students answered questions about the physical and mental stress symptoms, the amount of times they laughed, the intensity of their laugh, and the reason for their laughter. In conclusion, the effects of the stress symptoms decreased as the frequency of laughter increased. However, the intensity of laughter did not significantly impact the stress response (Zander-Schellenberg et al., 2020). This is interesting because I expected the intensity of laughter to decrease stress, but how would you measure the intensity of my laugh, for example, as opposed to my dad's laugh? The intensity of laughter is varied among different individuals. This study is a good starting point for more extensive research on the psychological and physiological impacts that laughter may have on stress. 

Despite the fact that we are stuck inside with minimal social interactions during this time, technology allows us to pull out our phones to watch some funny videos or facetime our friends and family. Therefore, I encourage you to keep on laughing even though we are at an awkward situation in our lives with the pandemic. Laughing is free therapy after all. :)

References

Yim J. (2016). Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. The Tohoku journal of experimental medicine, 239(3), 243–249. https://doi.org/10.1620/tjem.239.243.

Zander-Schellenberg T., Collins I.M., Miché M., Guttmann C., Lieb R., et al. (2020). Does Laughing have a Stress-Buffering Effect in Daily Life? An Intensive Longitudinal Study. PLOS ONE 15(7):e0235851. https://doi.org/10.1371/journal.pone.0235851

My Brother is a Mushroom Farmer

 

My younger brother has recently picked up a strange hobby… mushroom farming. He has turned our empty loft upstairs into a small mushroom farm growing oyster, shitake, and lion’s mane fungi. At first, I thought he was crazy for becoming a mushroom farmer, however, after doing some research, mushrooms have more benefits than I thought.

Historically, mushrooms have been part of our diet since the days of hunter-gatherer societies. Ancient texts show mushrooms being used medicinally in ancient Egypt and China where they were believed to promote health and longevity (Jayachandran et al., 2017). Now with modern-day technology, we can really find out why mushrooms are so beneficial. Evolutionarily, fungi have evolved rapidly resulting in a large range of biodiversity and fungi that can survive, even in extreme environments (Gostinčar et al., 2009). With over 100,000 known species of fungi, not all are good for consumption and some may even be harmful, however, the mushrooms that are edible have a multitude of advantages. Mushrooms play important roles as decomposers in ecosystems because they do not have leaves or chlorophyll like other plants, they break down dead matter as a source of energy. This is why mushrooms contain polysaccharides, amino acids, minerals, carbohydrates, and protein (Jayachandran et al., 2017). While mushrooms are an excellent food source nutritionally, they also provide various health benefits as well. A European study found that eating mushrooms consistently can help to lower the risks and effects of type II diabetes (Mehrotra et al., 2014). In addition, mushrooms can also serve as antioxidants against free radical damage in the body and promote a healthy gut microbiome (Jayachandran et al., 2017). Eating mushrooms has even been shown to help fight cancer. 

So while I may not become a full-blown mushroom farmer like my brother anytime soon, I will be happy to take some of his produce and add it into my dinner!

Gostinčar, C., Grube, M., De Hoog, S., Zalar, P., & Gunde-Cimerman, N. (2009). Extremotolerance in fungi: Evolution on the edge. FEMS Microbiology Ecology, 71(1), 2-11. doi:http://dx.doi.org.dml.regis.edu/10.1111/j.1574-6941.2009.00794.x

Jayachandran, M., Xiao, J., & Xu, B. (2017). A critical review on health promoting benefits of edible mushrooms through gut microbiota. International Journal of Molecular Sciences, 18(9), 1934. doi:http://dx.doi.org.dml.regis.edu/10.3390/ijms18091934

Mehrotra, A., Calvo, M. S., Beelman, R. B., Levy, E., Siuty, J., Kalaras, M. D., & Uribarri, J. (2014). Bioavailability of vitamin D2 from enriched mushrooms in prediabetic adults: A randomized controlled trial. European Journal of Clinical Nutrition, 68(10), 1154-60. doi:http://dx.doi.org.dml.regis.edu/10.1038/ejcn.2014.157

Learning How to Hang My Hat

I am not going to lie. This year has been a whirlwind of chaos! Trying to complete an expedited program is difficult enough, throw a pandemic in the mix and some would declare it game over. Despite all its challenges, I believe that our cohort has accomplished amazing things and I am so lucky to have met and gotten to work with these people. Additionally, in the first semester of this program, I have learned a lot about myself and what is going on around me as well as how my actions and words impact others. One subject touched upon this semester that has helped round me out as a person is the ethical principles of biomedicine. Integrating ethics into TBLs and case studies is important and very useful for future healthcare providers as it  allows us to hone our “ethical vocabulary”, per say, and begin to practice these important modes of thinking.

This semester, it hit me just how important it was to be aware of these ethical principles when we started working on our physiology project. This was my first human subject study and it comes with a lot more preparation (as many of you recall the laborious IRB approval process). Albeit hard work, it is very rewarding and exciting. Our study focused on the physiological response to taking a stress-inducing COVID-19 survey where our researchers wore full PPE (gowns, gloves, face shields) to further invoke a physiological response. One of the participants was so shaken up that they were trembling as they flipped the pages of the survey. Their blood pressure was much higher than her initial baseline and their heart rate fluctuated throughout the experiment. They were debriefed and were monitored until  they returned to baseline, however I could not help but feel guilty that we affected them in that way. Of course the data is good for us scientists, as it correlated to our hypothesis and in the end the participant was fine, but is there a line that should not be crossed?

After reading an article by a scientist from the University of Berne, I found that this is a phenomenon that is constantly present in the field of physiological research. Since physiologists are essentially bound to testing their experiments on living matter, it is a constant struggle to address the ethical dilemmas present that come with research. He continues to say that the respect for human life must be the guiding ethical principle when it comes to physiological research and that it is a constant factor that we need to keep in mind when making advances in the field (Weibel, 2002).  Although not specifically mentioned, I could not help but think about beneficence and nonmaleficence discussed in class. I believe that if research is to be done, it needs to be backed by how it can benefit society as a whole and cause the least amount of damage to its participants. I was also reminded of justice, and how these participants are giving up their time and their bodies in order to learn new things and it is our duty to make sure that they are treated fairly throughout the whole process. 

I enjoyed reading the article written by Weibel and it solidified the importance of always keeping in mind the ethical principles we have learned so far in this program. We should use them to help form every decision we make so that we never fall victim to ignorance or malpractice. As the Jesuits say Cura Personalis, care of the whole person, and I am glad that I was able to take care of that participant that might have been slightly traumatized by our experiment and I am glad that I did not let science get in the way of taking care of our participant. By learning how to hang my hat on certain ethical principles I feel more confident as a researcher and as an aspiring  future healthcare professional. I hope to continue to be vigilant in exercising these ethical principles in the future as well as learning more since it stems so much further than physiology!

References:

Weibel, E. R. (2002). News From Iups. Physiology, 12(6), 294-295.doi:10.1152/physiologyonline.1997.12.6.294

Ethical concerns in the COVID-19 era

The intensivists are responsible for admission or non-admission of patients to the ICU, to withhold or not withhold life support, and to communicate with families. The decision of an intensivist to refuse admission to an ICU bed is part of regular intensivists'  work to triage patients, and it is done so by following the guidelines that ensure fairness, respect for the patient's wishes, and transparency with the patient's family (Robert et al., 2020). Theoretically, these same principles should apply even during a pandemic; however, in this pandemic, the number of ICU admission requests increased dramatically, and so did the scarcity of ICU beds. Decision-making is no longer based on individual ethics but on utilitarian ethics, to maximize benefit for the greatest number of people (Robert et al., 2020). This approach to triage may bot be the best course of action because it ignores other relevant ethical considerations. Essentially, the new strategies that have been proposed and are implemented right now are there to justify prioritizing based on the likelihood to survive the illness and to live the longest after recovery (Robert et al., 2020). This would justify the youngest individuals to receive priority. Moreover, how they calculate the probability of death is by giving the SOFA score; the problem is that this lacks specificity at the individual level. Another problem is that the score for the ratio of true positive rate to false positive rate for the SOFA score is 0.753, which means that out of four patients, one will receive an inappropriate decision (Robert et al., 2020). How they calculate life expectancy or risk of mortality is generally poor and a lot of patients can be wrongly predicted. These are ethically flawed approaches; therefore, what should be done to improve on these decision-making techniques is to incorporate a frailty score, comorbidities, and quality of life evaluations, as well as to leave room for physician judgement and offer these options to the intensivists in order for them to make the best decisions.

When we look at what other countries have done, such as China, we see that they overcame the problem of ICU bed shortage by simply setting up new ICU beds wherever there were any available rooms or by quickly constructing new units outside hospital walls (Robert et al., 2020). Although it solves the problem of admission decision-making, the problem this creates is that there is a significant risk of reduced quality of care for multiple reasons. First of all, these new ICUs are not adequately designed for all the equipment and organization critical care requires. They also lack highly sophisticated devices such as ventilators, which patients with severe symptoms of COVID-19 desperately need. In their place, other devices might be used, which are not appropriate for a patient in acute respiratory distress (Robert et al., 2020). Moreover, this type of organization favors those who arrive first to receive care, and when in-hospital ICUs are no longer available, the rest of the patients who did not arrive in time must be placed inside downgraded quality care ICUs. This is more like "first-come, best-served" type of situation (Robert et al., 2020).

Another solution to the lack of ICU beds could be transferring of patients to a different facility with more available ICUs, or to regions less affected by the outbreak. Such transfers require special helicopters or trains adapted to the care of the critically ill patients. It would not be ethical to charge the patient or the patient's family for such as service; nevertheless, this is not the only problem. The most important ethical issue would be the benefit/risk balance (Robert et al., 2020). For the patient, the benefit of being cared for by highly qualified healthcare workers is counterbalanced by the risk of worsening clinical symptoms during the transfer. Another ethical concern is about bringing an infected patient to an area less affected by COVID-19 and increase the risk of spreading the virus there (Robert et al., 2020). There is always a risk of infection, despite all the protective equipment used.

In conclusion, there is a lot to be learned from these experiences and a lot of ethical dilemmas need to be addressed and reflected upon so that we may better serve those who fall ill to COVID-19, as well as the families of the patients. Let's no also forget the healthcare workers who are undergoing immense psychological stress. The uncertainty of the duration of the pandemic, the lack of an effective treatment, the risk of transmitting the disease to their friends or families, and being under strict containment are experiences that healthcare workers need to constantly adapt to and must cope with the situation of feeling powerless and ineffective (Robert et al., 2020). A COVID-19 vaccine would lift this burden and solve the crisis that is currently happening. Who should receive the vaccine first is another ethical dilemma that needs to be discussed, now that two potential vaccines are about to enter the market for the general population.

Sources:

Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical    dilemmas due to the Covid-19 pandemic. Annals of intensive care, 10(1), 84. https://doi.org/10.1186/s13613-020-00702-7

L-Type Calcium Channels: Small Release with Big Potential

 

L-type Ca²⁺ channels in the sarcoplasmic reticulum of skeletal muscles release small amounts of calcium, but this calcium release does not seem to be important for the contraction of a skeletal muscle. Skeletal muscle obviously needs ATP in order to properly relax and contract. This source of ATP can be made through multiple pathways, but the majority of ATP in skeletal muscles is supplied by the Tricyclic acid cycle (TCA) (Hargreaves et al., 2018). The TCA cycle, being the main supplier for ATP in skeletal muscle is greatly influenced by the presents of Ca²⁺ (Hargreaves et al., 2018). Is the small amount of calcium release from the L-type Ca²⁺channels playing a role in the activation of ATP synthesis? Metabolic pathways in the skeletal muscle cell are regulated by levels of ATP and it would make sense for the muscle itself to prime its own metabolic pathway.

The small amount of calcium release from the L-type Ca²⁺ channel is not necessary for muscle contraction, but may play an important role the longevity of muscle contraction and muscle ATP Levels. When inhibiting the L-type Ca²⁺ channel the muscle still contracts, however there is evidence that other mechanisms are affected.  Mutating the L-type Ca²⁺ channel can result in accelerated muscle fatigue and altered metabolism (Beqollari et al., 2018). The small amount of calcium release from L-type Ca2+ channels reduce muscle fatigue by activate calmodulin kinase type II (Georgiou et al., 2015). Calmodulin kinase type II influences fatty acid metabolism (Georgiou et al., 2015) that can also be a huge energy source for skeletal muscle (Hargreaves et al., 2018). The calcium levels released by the L-type Ca²⁺ channels may be small, but appears to be a big determinant in fuel choice and metabolic activation.

Hargreaves M, Spriet LL. Exercise Metabolism: Fuels for the Fire. Cold Spring Harb Perspect Med. 2018 Aug 1;8(8):a029744. doi: 10.1101/cshperspect.a029744. PMID: 28533314; PMCID: PMC6071548.

Beqollari D, Dockstader K, Bannister RA. A skeletal muscle L-type Ca2+ channel with a mutation in the selectivity filter (CaV1.1 E1014K) conducts K. J Biol Chem. 2018 Mar 2;293(9):3126-3133. doi: 10.1074/jbc.M117.812446. Epub 2018 Jan 11. PMID: 29326166; PMCID: PMC5836107.

Georgiou DK, Dagnino-Acosta A, Lee CS, Griffin DM, Wang H, Lagor WR, Pautler RG, Dirksen RT, Hamilton SL. Ca2+ Binding/Permeation via Calcium Channel, CaV1.1, Regulates the Intracellular Distribution of the Fatty Acid Transport Protein, CD36, and Fatty Acid Metabolism. J Biol Chem. 2015 Sep 25;290(39):23751-65. doi: 10.1074/jbc.M115.643544. Epub 2015 Aug 5. PMID: 26245899; PMCID: PMC4583036.

The Cons of PROcrastination

Guilty as charged! As I sit here writing this blog post at the last minute, I once again fall victim to the not-so-good habit of procrastination. Judging from the other posts popping up here and there, I suspect some of my colleagues are susceptible to these tendencies as well. In fact, about twenty percent of the population are chronic procrastinators (Jaffe, 2013), so luckily us frantically-typing-blog-posters are not alone in our woes. As with many chronic things, however, procrastinating for a prolonged period of time could actually prove to be harmful. 

Chronic procrastination can lead to a variety of detrimental physiological responses. Putting off a project, could cause your amygdala to be on constant high alert affecting your nervous and endocrine systems. The pituitary gland will then send out signals like ACTH and TTH which stand for adrenocorticotropic hormone and thyrotropic hormone respectively. TTH will make your thyroid gland pump out thyroid hormones affecting your metabolism and causing your heart and lungs to work harder, while ACTH will head to the adrenal glands signaling for cortisol to flood throughout your body (this can cause a multitude of health issues including inflammation caused by decreased sensitivity to cortisol). While this is all happening, the hormone vasopressin tells your body to horde water causing blood pressure to increase. Since the liver has to work so much harder, visceral fat cells begin to surround the liver causing more inflammation and potentially fatty liver disease (Seidu, 2017). See video below for a quick synopsis, it is quick and quite cute! https://www.youtube.com/watch?v=ROh5TLC8jzM&feature=youtu.be&ab_channel=Men%27sHealth

In a study done at the University of Sheffield, participants who self reported as having hypertension (HT) and/or cardiovascular disease (CVD) were compared to a control group in order to find out what personality factors might have a causal effect. Results suggested procrastination is a vulnerability factor for poor adjustment to and management of HT/CVD (Sirosis, 2015). This data shows that there is a correlation between these diseases/conditions and procrastination which is quite worrisome!

All in all, what I have found shows that chronic procrastination, as with many chronic exposure to things, is not a good thing. It is all about balance and time management (something that I have learned is very important in this program, which also translates to everyday life). Although I have fallen victim to procrastination this time, I will try harder to not put things off until the last minute. As a wise man once said it is all about growth mindset! Now onto the next post…(:

References:

Jaffe, E. (2013, March 29). Why Wait? The Science Behind Procrastination. Retrieved November 21, 2020, from https://www.psychologicalscience.org/observer/why-wait-the-science-behind-procrastination

Seidu, F. (2017, October 26). The Physiological Response to Procrastination. Retrieved November 21, 2020, from https://fonnatasha.com/blog/2017/10/15/the-physiological-response-to-procrastination

Sirois, F. M. (2015). Is procrastination a vulnerability factor for hypertension and cardiovascular disease? Testing an extension of the procrastination–health model. Journal of Behavioral Medicine, 38(3), 578-589. doi:10.1007/s10865-015-9629-2

      

Come to the Dark (chocolate) Side

 What is your favorite chocolate? For me personally, I cannot recall a time that I favored milk chocolate, white chocolate, or any kind of other chocolate over dark chocolate. I have always heard that dark chocolate is "healthier" or better for you than other chocolates, due to its high cacao content, but in what ways does that benefit our health?

Historically, dark chocolate has been used (in its natural cacao form) to augment performance and alleviate disease for thousands of  years, dating back to 1000 B.C. in Mesoamerica when they would ferment cacao seed and mix them into a liquid to drink (Higginbotham & Taub, 2015). In some earlier studies, researchers tested the effects of dark chocolate on populations at higher risk for cardiovascular disease using a high-flavanol cocoa drink and found significant improvement in vascular function as well as improved platelet adhesion in heart transplant patients (Higginbotham & Taub, 2015). In a 2015 study, Rull et al. conducted a single center randomized double-blind placebo controlled investigation with a crossover design to compare the effects of high flavanol dark chocolate and low flavanol dark chocolate on blood pressure, heart rate, vascular function and platelet aggregation (Rull et al., 2015). The participants of the study were men with pre-hypertension or mild hypertension. Compared to the baseline values of the participants, the low flavanol dark chocolate significantly increased heart rate, likely due to methylxanthines which cause sympathetic activation through adenosine receptor blockades; however, even though the high flavanol dark chocolate has similar components, it did not increase heart rate, indicating that flavanols modulate sympathetic activation (Rull et al., 2015). In regard to platelet aggregation, both types of dark chocolate contained similar levels of theobromine and caffeine which can act as phosphodiesterase inhibitors, which inhibit platelet aggregation (Rull et al., 2015). The threobromine plays a key role in significantly reducing platelet aggregation, though this may just be due to the fact that threobromine is a PDE inhibitor, as opposed to a direct effect of flavanols (Rull et al., 2015). Even though threobromine may not have a direct effect on heart rate, blood pressure, etc., it is still a component of dark chocolate that may aid in cardiovascular health, such that it can help reduce blood clots. 

There is room for more studies on the extent to which flavanols alter cardiovascular risks, though there has been progress so far as to say that flavanols present beneficial effects to cardiovascular health such as lowered heart rate and blood pressure in patients with mild hypertension and risk for blood clots. So next time you're buying some dark chocolate, because it is good for you of course, compare some options and make sure the one you choose has higher levels of flavanol in it! 

Higginbotham, E., & Taub, P. R. (2015). Cardiovascular Benefits of Dark Chocolate? Current Treatment Options in Cardiovascular Medicine, 17(12). doi:10.1007/s11936-015-0419-5

Rull, G., Mohd-Zain, Z. N., Shiel, J., Lundberg, M. H., Collier, D. J., Johnston, A., Warner, T. D., & Corder, R. (2015). Effects of high flavanol dark chocolate on cardiovascular function and platelet aggregation. Vascular pharmacology, 71, 70–78. https://doi.org/10.1016/j.vph.2015.02.010

Love feels so good it literally hurts.

If you have fallen madly in love with someone, you might have said “I can’t physically survive without them” and you were probably telling the truth. About 10 years ago, a few researchers at Johns Hopkins University reported a rare but lethal heart condition caused by acute emotional distress. While the public likes to call this the “broken heart syndrome”, it is technically known as “stress cardiomyopathy”. There is some truth to the metaphorical phrases comparing love to pain. In the past, researchers have shown, via neuroimaging, that the brain regions involved in processing physical pain overlap with those tied to social agony (Jaffe, E. 2013). Love may actually hurt, like hurt hurt, after all. 

Who would have thought to take acetaminophen for a broken heart, not me. But, a group of psychological researchers at the University of Kentucky tested whether acetaminophen could relieve the pain of emotional distress as effectively as it relieves bodily aches (Jaffe, E. 2013). They had participants who received acetaminophen and the placebo twice a day for three weeks. The participants provided self-reports on a “hurt feelings” scale designed to measure social exclusion. The results showed that those who took acetaminophen showed significantly lower levels of hurt feelings than those who took the placebo. While I wouldn’t recommend Tylenol after a breakup, I would challenge you to think about who we associate pain with love. 

Jaffe, E. (2013, January 30). Why Love Literally Hurts. Retrieved November 21, 2020, from https://www.psychologicalscience.org/observer/why-love-literally-hurts

How do we know when we're full?

 You know when you’re eating and you feel your stomach getting full and you start to slow down? The reason we are able to do that is because our stomach has innervations from both the sympathetic and parasympathetic nervous system. 

Our stomach sends and receives information via the vagus nerve (Dr. Campisi’s favorite), dorsal root ganglion (DRG), and enteric neurons (Umans, 2018). Enteric neurons come from our enteric nervous system, which is the nervous system that works independently from our central nervous system and helps control gastrointestinal functions. The vagus nerve plays an important role in detecting the stretch of our stomach. These sensors can activate neural responses that decrease appetite and control our digestion. The sensory transduction at the molecular level is not yet well understood, but with further research it is possible that it could provide some therapeutic targets to help curb appetite (Umans, 2018). 

Some of the gut hormones that communicate with our brain when we are full include cholecystokinin (CCK) and peptide YY (PYY) and are considered satiety hormones (Umans, 2018). The nutrients that our intestines absorb are what triggers CCK release but surprisingly do not activate gastric mechanoreceptors that would detect the stretch. It turns out that the gastric mechanoreceptors and the intestinal chemoreceptors are different populations of cells (Umans, 2018). It is hypothesized that the mechanoreceptors have a certain threshold to activate the satiety signals during a meal before the intestines can register the intake of nutrients (Umans, 2018). 

It’s interesting to see how our body works together but also independently of other systems in order to tell us what exactly we need to know. 

Umans, B. D., & Liberles, S. D. (2018). Neural Sensing of Organ Volume. Trends in neurosciences, 41(12), 911–924. https://doi.org/10.1016/j.tins.2018.07.008

Should Adderall be taken to increase academic success?

 

Ethics and Covid-19

For this, I wanted to discuss ethics and how our understanding of ethics has changed during the COVID-19 pandemic. In any pandemic who do we decide to save when there are not enough resources? How do we allocate medicine and vaccines? These are just a few of the questions that come up and it puts medical professionals in a tough situation. In this situation, they may literally have to decide who lives and who dies. In the future, I hope to go into the medical field, and the thought of dealing with a pandemic scares me, but I know that I will have to. This is due to the increasing prevalence of zoonotic virus because of human population growth, development of land for human use, and climate change. I wanted to specifically look at an article written during the pandemic to learn what others think of these ethical questions.

When Rosenbaum explains who people would want to save, she says that people first wanted to save the people with the greatest chance of short term survival and then those who have the greatest chance of long term survival. They also indicated that age should not be the only factor to consider but stage of life may need to be considered. Also deciding based on the perceived quality of life after covid-19 may be difficult because there is no actual way to decide this. Would you save a healthy older individual that may die otherwise or a younger individual with a preexisting condition? We don’t know the quality of life they may have after COVID-19 or how long they may live so it makes this question almost impossible to answer. The author suggested some sort of algorithm to decide based on how long one normally recovers among other factors and I agree that this would be a fair way to approach this problem.

Beyond these ethical dilemmas that those in medicine would have to deal with, the pandemic showed me the importance of well-funded scientific research even if it seems like a waste of money to some. People had to learn the hard way that science is not a magic process that works instantaneously, it requires time and a wealth of former research. I have hope for the future now that we have a new administration in the white house that is willing to trust science and fund it.

For an area of future study, it would be interesting to see specifically how the pandemic has impacted medical professionals. Have any physiological or psychological changes occurred? What was the impact of the stress on these medical professionals and how can we better provide for them to mitigate this stress during a future pandemic without compromising the care of patients?

Rosenbaum, L. (2020). Facing Covid-19 in Italy—ethics, logistics, and therapeutics on the epidemic’s front line. New England Journal of Medicine, 382(20), 1873-1875.

It's ok to not be ok

As future healthcare professionals, I would feel comfortable in believing that one of our top goals is to “help as many people as possible”.  But what about ourselves?

During these stressful and traumatizing months (especially during this COVID-19 pandemic), it can often feel like a losing battle when your efforts to become the best doctor/nurse/assistant possible for your patients doesn’t seem enough.  Burnout is a real thing in the medical community: long working hours, little sleep, crushing financial debt, the list goes on and on…. The most depressing aspect about this type of working environment is a physician’s belief that suicide is the answer, but even more so is the idea that seeking help is viewed as a sign of weakness.

Instead, asking for help shouldn’t be penalized.  Mental health shouldn’t be underestimated.  Suicide is the 10th leading cause of death in the United States, and healthcare workers make up a large percentage of that population (physicians take their own lives at twice the rate of the general population).  Working in the healthcare community will often put us in close proximity with other like-minded individuals, and its important to recognize, even critical, that we pay attention to others with compassion and empathy when things may not be in the best position.  Beyond the working environment, a big component to avoid burnout is to also partake in activities that help keep your mood elevated and positive.  Daily journaling, exercise, hanging out with friends are just a few of the ways that I like to preoccupy my time with—and I’m just a graduate student trying to get my Master’s degree! 

Livingston, D. J. (2020, September 30). Physician Suicide; Here is How We Prevent the Tragic Loss of Doctors and Nurses. Medium. https://elemental.medium.com/physician-suicide-here-is-how-we-prevent-the-tragic-loss-of-doctors-and-nurses-fd77afa13382

Dutheil, F., Aubert, C., Pereira, B., Dambrun, M., Moustafa, F., Mermillod, M., Baker, J. S., Trousselard, M., Lesage, F.-X., & Navel, V. (2019). Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS ONE, 14(12). https://doi.org/10.1371/journal.pone.0226361

The deepest cut

It's a decision that every mother and father have to to make for their new baby boy—to circumcise or not circumcise?  For some couples, reasons to circumcise stem from religious or cultural backgrounds, while other couples continue with the practice based on tradition or statements such as “if I look this way, my son is going to look the same.”  Needless to say, out of the many reasons given to circumcise, proponents against circumcision have frequently attacked the “ease for personal hygiene and reduced risk for STD infections” statement above other any reason.  

For those against circumcision in the United States, arguments have criticized the discrepancy between the high rates of the procedure, while the country still remains among the top in STD infection rates.   Furthermore, if these statistics continue to hold true, should parents continue to circumcise or could other healthcare interventions be taken to help reduce the susceptibility of STD’s.  

Speaking from personal experience, I had felt that my sex education course during elementary school could have been way more comprehensive.  Could offering better education protocols to teach students about sexuality, puberty, pregnancy, and contraceptives lead to a decline in STD cases across America?  I believe so.  

As for the hygiene dilemma, it should be noted that sanitation methods and products have readily improved over the last several years in the United States.  Compared to other less fortunate countries, the availability of Clorox wipes, hand soaps, detergents, and other items have given American individuals greater access to live healthier lifestyles.

What do the professionals think?  According to the American Academy of Pediatrics, a policy statement stated that “systematic evaluation of peer-reviewed literature indicates that preventative health benefits of elective circumcision of male newborns outweigh the risks of the procedure,” but concluded that the decision for having a baby boy undergo the procedure should be made by the parents after careful consideration of all medical benefits and risks along with “any significant ethical and moral principles”.  

But in the end, regardless of what decision is made, I believe that “do no harm” should be priority number one when making medical decisions, especially for those who do no yet have a voice in the matter. 

Weber, L. (2018, August 28). America Can Blame Its Sky-High STD Rates On A Crumbling Health System. HuffPost. https://www.huffpost.com/entry/highest-std-rates-sexually-transmitted-diseases_n_5b85856de4b0162f471cf805

United States - Improved Sanitation Facilities (% Of Population With Access) - 1990-2015 Data | 2020 Forecast. (n.d.). Retrieved November 21, 2020, from https://tradingeconomics.com/united-states/improved-sanitation-facilities-percent-of-population-with-access-wb-data.html

Circumcision, T. F. O. (2012). Circumcision Policy Statement. Pediatrics, 130(3), 585–586. https://doi.org/10.1542/peds.2012-1989

Can you hear me now?

Imagine yourself in your room, studying physiology, a computer in front of you, with headphones in ear … Do you have a mellow, Beethoven piano symphony or an adrenaline-fueled  electronic beat pulsating through you ears? Given the options, which do you feel would lead to a more productive study session?

Studies showed that even when subjects were exposed to their preferred type of music when attempting a study session, results indicated that participants performed worse when listening to some level of auditory stimuli.  In contrast, subjects actually performed better when listening to no music.  But more importantly, results revealed that music often served as a distracting factor when one was consciously engaged in a cognitively demanding task.  Neurocognitive function seemed to actually decrease due to the “distracting” aspect when one was involved in another cognitively demanding task; i.e. fewer mental resources were available to be used for other tasks.  Instead, attention seemed to be more drawn to the lyrics and the associated memories and emotions that they evoked—stimulative music seemed to be a strong inhibitor towards cognitive processing mechanisms.

Yet, why do individuals who go the gym for workouts consistently feel that they are able to lift more, run longer, and perform better in physical activity overall when listening to some type of music?  After all, physical activity still requires a certain level of coordination and focus, right?

Could the specific type of task needed to be finished be more important than the external stimuli itself? Researchers were curious enough to investigate and they discovered that music influenced workout performance through psychological effects (better mood led to better quality of exercise as perceived by the individuals).  More importantly, the results should highlight the importance of deciding when to introduce acoustic stimuli to the brain in order to maximize intended results depending on the type of task at hand.

Dolegui, A. S. (2013). The Impact of Listening to Music on Cognitive Performance. Inquiries Journal, 5(09). http://www.inquiriesjournal.com/articles/1657/the-impact-of-listening-to-music-on-cognitive-performance

Jabr, F. (n.d.). Let’s Get Physical: The Psychology of Effective Workout Music. Scientific American. Retrieved November 21, 2020, from https://www.scientificamerican.com/article/psychology-workout-music/