HURJ Volume 22 - Spring 2016 by The HURJ

hurj editorial board Editor-in-Chief James Shamul Hirsh Shekhar Focus Annie Cho Lauren Pomerantz Humanities & Social Sciences Emily Karcher Harry Burke Gulnar Tuli Science & Engineering Aneek Patel Jaya Jasty Spotlight Veronica Reardon Jane Miglo Layout Sarah Sukardi Treasurer James Shamul Copy

hurj spring issue 2016 contributors Kyoung-A Cho Cindy Li Eric Guo Gugan Raghuraman

Design Specialist Aneek Patel Webmaster Alex de la Vega

Melaku Arega Ansh Bhammar Michael Chickering Anna Du Nisita Dutta Laurence Hou Yash Jain Raihan Kabir Tyler Lee

Dikshant Malla Rohil Malpani Gabriela Miller Cara Schulte Nabeel Saif Randal Serafini Katharine Shadlock Maria Belen Wu Lisa Xiao

about hurj: The Hopkins Undergraduate Research Journal provides undergraduates with valuable access to research undertaken by their peers. The journal features four sections: a main Focus, Spotlight, Science & Engineering, and Humanities & Social Sciences. Students are highly encouraged to submit their original work.

disclaimer:

The views expressed in this publication are those of the authors and do not constitute the opinion of the Hopkins Undergraduate Research Journal.

contact us: Hopkins Undergraduate Research Journal Mattin Center, Suite 210 3400 N Charles St Baltimore, MD 21218 thehurj@gmail.com thehurj.org

HOPKINS UNDERGRADUATE RESEARCH JOURNAL

Spring 2016:

Emerging Powers

table of contents spring 2016 focus: The Impact of the Haitian Revolution on Brazil Katharine Shadlock

Chinaâ&#x20AC;&#x2122;s Crackdown on the Banking Industry Lisa Xiao

The Great Escape: Why not in China? Maria Belen Wu

India-Russia Bilateral Relations Tyler Lee

spotlight: Telekinesis: Science Fiction or an Impending Reality? Melaku Arega

Medical Repurposing: A New Direction for Research Randal Serafini

table of contents humanities & social sciences: Lessons Learned from Ebola: The Future of US Global Health Security Policy Anna Du

An Academic Climate Hijacked by Melodrama Cara Schulte

The Influence of Western Hegemonic Culture on the Historical Development of Sexuality in the Middle East Dikshant Malla

A Brave New Feminist World: The Effect of Parthenogenesis Cloning On Societyâ&#x20AC;&#x2122;s Patriarchy Nisita Dutta

Evaluating Parental Involvement in the Provision of Clinical Contraception Raihan Kabir

Re-Programming Education: An Investigation of Computer Science Education Currently Available to Underprivileged Students in Baltimore, Maryland Yash Jain

table of contents science and engineering: Examining Common Links Among Neurodegenerative Diseases Ansh Bhammar

Microdeletion at 15q11.2 Causes Impaired Structural Development in Cortical Neurons Derived From Induced Pluripotent Stem Cells Neurons Michael Chickering

Over-prescription of ADHD Medication for Adolescents Challenges Best Practices for Diagnosis and Treatment Gabriela Miller

Pre-Scribes: A Potential Model for Undergraduate Volunteer Scribes Laurence Hou, Nabeel Saif

Performance Wheelchairs for Basketball: History, Developments and Future Directions Rohil Malpani

a letter from the editor

{

The Hopkins Undergraduate Research Journal was the first interdisciplinary undergraduate research journal on the Homewood campus. Within the pages of this issue, you will encounter a sampling of the incredible research engaging Hopkins students in the sciences, humanities, social sciences, and engineering. For each biannual issue of HURJ, the editorial staff selects one topic of interest to highlight in the magazine’s Focus section. This spring, we received submissions on “emerging powers,” which can be further finetuned to the member nations of BRICS (Brazil, Russia, India, China and South Africa). As you will find upon browsing the articles inside, the sprawling global economy and growing industries in these territories pave the way for tensions and cultural shifts with extensive ramifications. Our Spotlight, Science & Engineering, and Humanities & Social Sciences sections showcase research endeavors that fall outside our chosen theme. This semester, we bring you articles on a fascinating range of subjects, including telekinesis, stem cells and Title IX. The articles in this Spring 2016 issue of HURJ reveal the diverse research interests of Johns Hopkins University students. We are proud of this publication as a testament to the boundless academic and intellectual talents of my peers. We would like to give special thanks to the HURJ staff and contributors for their hard work. Enjoy and Happy Reading!

James Shamul Co-Editor-in-Chief

Hirsh Shekhar Co-Editor-in-Chief

contributors

Anna Du is a sophomore from West Bloomfield, Michigan majoring in Public Health Studies and minoring in Entrepreneurship & Management. Her research interests include health inequalities and global health policy. Anna also serves on the Johns Hopkins University Student Government Association as Class of 2018 President.

Ansh Bhammar is a freshman from Boston, Massachusetts majoring in neuroscience. He aspires to become a neurologist working with patients with neurodegenerative diseases, particularly Alzheimerâ&#x20AC;&#x2122;s disease. He has recently begun performing research on the neuroplastic changes that accompany cognitive impairment.

Melaku Arega is a junior from Addis Abeba, Ethiopia majoring in Molecular and Cell Biology & Neuroscience. After graduation he aspires to obtain MD/ MPH degrees. He currently researching Kisspeptin, a hypothalamic neuropeptide, and the reproductive role Kisspeptin plays with the metabolic role of the liver.

Cara Schulte is a senior from New Canaan, Connecticut, pursuing degrees in both Political Science and Public Health. She is enrolled in a dual BA/MA program and plans to graduate in May of 2017 with her Masters of Environmental Science. She is particularly interested in energy policy and sustainable food system development.

Dikshant Malla is a junior from Baltimore, Maryland majoring in Sociology. After he graduates, Dikshant plans to get his masters degree in public policy and work in education policy.

Gabriella Miller graduated in December 2015 from Johns Hopkins University KSAS with a BA in natural sciences and a minor in Spanish. Since graduation, Gabriella has been working as a research assistant in Baltimore, her home town. She will begin medical school in Fall of 2016.

Katharine Shadlock is a sophomore international studies major, with interests in economics and law. Katharine currently serves as the Executive Director of Finance for the Lotus Life Foundation, Chief Financial Officer for IDEAL, and a Justice for the Student Government Association.

Laurence Hou graduated from Johns Hopkins University in December 2015 with a B.A. in Public Health. He currently resides in Hillsborough, NJ and will be interning at the Johns Hopkins Hospital before hopefully matriculating into medical school. His research interests include quality of care, medical education, and health policy.

Lisa Xiao is a Chinese-Canadian sophomore International Studies major. Her passions lie at the intersection of entrepreneurship, finance, and international diplomacy. She is a Woodrow Wilson Fellow, president of Global China Connection, partner at A-Level Capital, and candidate of the BA/MA program at SAIS.

contributors

Maria Belen Wu is a sophomore from Buenos Aires, Argentina majoring in International Studies & Economics. Her current research interest is China and emerging markets relations with Latin America. She is a SAIS BA/ MA candidate, and will study International Finance and China Studies at SAIS Nanjing and Washington D.C. beginning in 2017.

Michael Chickering is a senior from the San Francisco Bay Area, majoring in Biomedical Engineering and minoring in Entreprenuership & Management. This Fall, Michael will pursue his passions in stem cell research by beginning a Ph.D. in Development, Stem Cells. and Regenerative Medicine at the University of Southern California.

Nabeel Saif is a junior at Johns Hopkins University, planning to receive a B.S. in Molecular and Cellular Biology. He currently lives in Syosset, NY and hopes to work in consulting before attending medical school after graduation. He is interested in kidney research, nutrition, and fitness.

Nisita Dutta is a freshman from East Windsor, New Jersey studying Chemical and Biomolecular Engineering. She is involved in DNA nanotechnology research in Schulman Lab and works as an English tutor for children in China. In the future, she hopes to research in immunotherapy treatments for cancer.

Raihan Kabir grew up in South Burlington, Vermont and learned early that his loud mouth could make people smile. He is currently a sophomore undergraduate in Molecular & Cellular Biology at Johns Hopkins, and heâ&#x20AC;&#x2122;s passionate about translational research and social entrepreneurship. Kabir now uses his voice to promote health equity.

Randal Serafini is a sophomore from Sunnyvale, California, majoring in Systems Neuroscience, with a minor in Entrepreneurship and Management. Randal is interested in both optogenetics and glioblastoma migratory mechanisms, and after achieving his MS in Neuroscience at Johns Hopkins, he plans on joining an MD/PhD program.

Rohil Malpani is a senior from Calcutta, India majoring biomedical engineering. His interests lie at the intersection of engineering technology and healthcare, with research interests in epigenetics, medical device development and clinical outcomes research. He will begin medical school in Fall of 2016.

Tyler Lee is a junior from New York majoring in international studies with minors in computer science and history. He will be studying at SAIS Europe as part of the 5-year BA/MA program. He enjoys playing piano in a chamber group, watching and blogging about films, playing tennis and captaining the mock trial team.

Yash Jain is a freshman from Houston, Texas majoring in Molecular and Cellular Biology. He has lived in numerous continents around the world, and his varied experiences have shaped his interest in development economics. His primary interests, however, lie in biomedical research, particularly in cancer and immunology.

focus

hurj spring 2016: issue 22

The Impact of the Haitian Revolution on Brazil Katharine Shadlock, Class of 2018 International Studies

From the advent

of the Trans-Atlan- ber of slaves disembarking in Brazil in the period after tic Slave Trade, and the Haitian Revolution to compensate for the demands continuing through the dissemination of European colo- of the European market. This continued to the point nialism in the Americas, there has existed a link between where the tribute exacted from Brazil was so great that the colonies of Saint Domingue –modern day Haiti, and the export of sugar more than doubled from 1789 to Brazil. Bahia, Brazil and Cap Français, Saint Domingue 1795, with an increase of slave labor from 20,300 slaves were among the leading locations of disembarkation in 1786-1790 to 34,300 slaves in 1791-1795 (Geggus/Fifor the millions of slaves consumed in the quest of glob- ering: 285). With an increase of over 50% in slave labor, al influence through economic expansionism during the Brazil became an economic powerhouse in Latin Amerage of imperialism. As a result of this alliance, there was ica, and the jewel of the Portuguese empire. However, a channel of social ideologies brought to Brazil from with this rise came the profound dependence upon the Saint Domingue. After reaching the shores of Brazil, labor that fueled economic expansion. Colonists feared thanks to the efficiency of Atlantic trade routes, there that should those of African descent learn not only of came a sharp divide of reaction from both the Euro- the rebellion, but also the success in the Haitian Revolution, it would embolden the slaves to action, and harken pean colonists and slaves. The radthe end of the colonial empire. ical nature of Haitian revolutionary One of the reasons that histoideology proved it was possible to The radical nature of rians today have drawn a blank as lead a successful slave uprising in a to the details of Haiti’s ideologiHaitian revolutionary European colony to achieve independence, investing in some slaves ideology proved it was cal presence in Brazil is the lack of written documentation conveying an essence of empowerment, and slave perspectives. But upon furpossible to lead a sucpotential for imitation. For the European colonists, the events of the cessful slave uprising in ther examination, the accounts left by sea captains and slave owners revolution presented one of the prove that the ideology was presa European colony to first major challenges to the asent in Brazil, and particularly so in sumed white European dominance acieve independence. the coastal trading ports like Bain Brazil, and beckoned the fear for hia. Slaves are suspected of having the security of the entire Latin and learned about Haiti from assorted Central American Empire. Through smuggled media, and eavesdropping upon conversathe passage of legislation and the formation of a new tions between Europeans. However, there also existed a resistance within the community of those of African demuch more accessible source among the working black scent, the Haitian Revolution was recognized and mepopulation. The black sailors who came to support the morialized in Brazilian history, and continued to be so booming Euro-American economy created a world “… until the end of the colonial era. connected by these sailors… (in) which news traveled During the time that preceded revolutionary with remarkable…speed between communities who activity, there existed an economic bond between the were…inspired by actions in other parts of the Atlantic colonies of Brazil and Haiti. Both satellite colonies to European metropoles, Haiti and Brazil were specialized in world” (Dubois/Scott: 8). It is even noted by historians the production of tropical commodities, such as sugar, David Geggus and Norman Fiering that within the five tobacco, and coffee. It was Haiti in particular that seized to ten years after the revolution’s conclusion, there were the lead in production for the world’s consumption, Haitian sailors specifically located in Bahia (Geggus/Figenerating thousands of pounds of sugar each year. ering: 290). With the correlation of both location and Such insatiable demand for sugar drove both colonies time of such activity, there is hardly a doubt that there to a new zenith for production, increasing the burden was a degree of first-hand communication from these on African slave labor to satiate the foreign markets. As sailors with the black communities in Bahia. a result, Bahia and Cap Français came to be the leading However, in addition to the black mariner’s stories and ports in the slave disembarkation points in each colony. position “…as roving ambassadors of the black soverWith this history in mind, it would have come as no sur- eignty they had discovered in Haitian Ports”, there was prise that there was a substantial increase in the num- also the flow of people between the nations as well

spotlight hurj spring 2016: issue 22

(Black Jacks: 145). Although there is sparse information as to the exact number of voyages taken by Brazilians to Haiti or vice versa, it is documented that the slaves took advantage of the coastal towns in seeking an avenue to the rest of the world through maritime marronage, that is, the practice of slaves running away from plantations to escape the horrors of slavery. As Bahia was pressured to develop through the ever-increasing production demands, more vessels from more diverse nations came into port, widening the avenues of possible escape for these slaves (Dubois/Scott: 57). Even as measures were put into place to hinder the runaway slaves fleeing to and from Brazil, ships under the leadership of free persons of color likely would have presented attractive opportunities for runaway slaves seeking asylum upon the high seas. As consequence of the augmenting production in Brazil, there came an economic boom that invited the infrastructure necessary to accelerate the travel of information of Haiti’s revolutionary ideas within the Caribbean, Latin America, and beyond. The disseminating Haitian ideology rapidly instilled fear in the European upper-class colonists not only because of the success of the rebellion, but also because of the independence achieved (Maxwell: 157-158). The news of the revolution brought relations to a boiling point and manifested an omnipresent paranoia, even reaching the height of “confiscation of any boats arriving from St. Domingue/Haiti and the imposition of a fine of 1,000 Rigsdaler” though ultimately accredited to little result (Dubois/Scott: 58). This alarm was further present in

focus

the letters of Brazilian colonial leader Manuel José de Novais de Almeida who felt “very worried with respect to the Americas’…what happened in [French America] demonstrates what might one day happen in [Brazil].” (Almeida: 1). Still other Europeans in Brazil echoed these sentiments that “…should the Brazilians be precipitated into a premature effort for liberty…they will certainly become prey to that species of anarchy, which now prevails in St. Domingue” (Campbell: 1). Through the increasing population and movement of slave laborers, colonists saw the potential for a growing presence of Haitian ideas within Brazil, a threat that was swiftly integrated into Brazilian national law. The acknowledgement of the Haitian revolution was tacitly woven into the formation of the 1823 Brazilian Constitution with the discussion of Haiti as an argument “both to defend and attack the proposal to grant freed-persons full civil rights” asserting the merit of mollifying dissent through acquiescence of some rights, juxtaposed with the fear of lending greater recognition to the Haitian revolution (Geggus/Fiering: 296). Negotiation and debate followed these considerations until finally, freed persons of color received civil, but not political rights. After the events of the Haitian Revolution, there was not only a visible ideological shift in Brazil, but also greater legal development for the rights of slaves and freed person of color. From the converse perspective, the events of the Haitian Revolution were perceived as an inspiration. Ideologically, the themes of liberty for all persons

focus of color and rebellion against the cruelties of slavery resonated with much of the population. One year after Haiti’s violent overthrow, soldiers in Rio de Janeiro were wearing accessory medallion portraits of Emperor Dessalines, one of the leading military figures of the Haitian Revolution and the first official ruler of independent Haiti (Avengers/Dubois: 305). This particular show of Haitian support within the armed military forces in Brazil would have easily, and justifiably, excited the terror of the European colonists. In Rio de Janeiro between 1808-1821, over three quarters of registered crimes were attributed to slaves; though likely a faire share of this was owing to paranoia of the Europeans, the percentile still portrays a startling level of anxiety (Paquette: 104). One primary source from Brazil at this time even remarked, “The secret spell that caused the Negro to tremble in the presence of the white man is in a great degree dissolved” (Barrow: 1). As in the Haitian Revolution, Brazil’s key for such rapid development was the collaboration of both slaves and freed people of color. During the 1824 Equator Confederation Revolt lead by rogue Brazilian soldiers of African descent, slaves and freed persons of color both chanted “thus I imitate Christophe (former King of Haiti) /that immortal Haitian/hey! Imitate his people/of my sovereign people!” (Geggus/Fiering: 292). Haiti was not merely an example of a nation without slavery; it was a new archetype of social revolt. Though some may attribute differences in topography as one of the leading reasons for the lack of slave rebellion in Brazil, it is actually due to the involvement of European presence in Brazil that maintained control throughout the colony. During the sweep of Napoleonic rule moving across Europe, the Portuguese Empire made a decision that not only saved its government, but also likely stopped Brazil from evolving into another Haiti. Through the Portuguese monarchy’s decision to depart Portugal in 1808, they became the first and only European power to rule directly from within a colony. This achieved level of political stability and representation of European authority in Brazil may not only have dissuaded a great number of potential revolutionaries, but also laid the groundwork for Brazil’s future place as a leader in Latin America. During these formative years, Brazil was developed into the image of a European power through the monarchy’s development of a legislature, infrastructure, and political stability, creating an unfavorable environment for violent overthrow. Although the Haitian Revolution did not inspire any uprising of the same scale and magnitude as in Brazil, it did create a shift in the discussion for both colored and white society. Fearful of a secondary Cap Français, the European colonists of Brazil were moved to create compromise within a new constitution whereby freed persons of color were endowed with some civil rights. Inspired and enlightened by the events of Haiti, African slaves and free people of color began to form an alliance, changing the rhetoric of resistance, and questioning socially enforced subservience. As such, the Haitian

hurj spring 2016: issue 22 Revolution was successful in achieving a new social and political discourse in Brazil because both persons of European and African descent realized that “if black slaves in Saint Domingue had finally achieved their goal. What would keep the same from happening in Brazil?” (Nascimento: 472) . True enough, there was very little to suggest that in this time, these events were out of the question. There was an undeniable similarity of social, cultural, and economic conditions between the two colonies, coupled with a reasonable geographic proximity. The influence of a new Haitian revolutionary ideology provoked Brazil to evolve politically, and socially into a more advanced future independent nation. Through the examination of the Haitian Revolution in the context of Brazilian colonial history, it becomes abundantly clear that not only was the power of the revolution felt within aspects of colonial society, but it also demarcated the beginning of a new era for the power of people of color in Latin America. It was in the example of Haiti that the beginnings of abolition and political rights for people of African descent became present in regional protest, as well as national politics. As a result of Haiti’s rise in the name of liberty, Brazil’s populace followed as one of the many others that were emboldened to fight for the dream of a nation independent from Europe, and independent from slavery.

References 1. de Almeida, Manuel José de Novais Auto do exame que fizerão o Dez [embargador] Ou[vidor] G[eneral] do Crime Francisco Alvarez de Andrade, e o Dr. Intendent General do Ouro, Caetano Pinto de Vasconcellos Monte Negro, em todos os Papeis do Dr. Jacinto José da Silva’, Rio de Janeiro, 8 January 1795, ABNRJ, LIX (1939) 364-370. 2. Barrow, John, Sir. A voyage to Cochinchina in the years 1792 and 1793 : containing a general view of the valuable productions and the political importance of this ... London; (London), 1806. 481pp. Sabin Americana. Gale, Cengage Learning. JOHNS HOPKINS UNIV (MSE LIBRARY). 11 December 2015 (link) 3. Black Jacks: African American Seamen in the Age of Sail. Cambridge, MA: Harvard UP, 1997. Print. 4. Campbell, Donald. London, 14 August 1804, Chatham Papers, PRO, 30/8/345 (2) f. 240. 5. Dubois, Laurent, and Julius S. Scott. Origins of the Black Atlantic. New York: Routledge, 2010. Print. 6. Dubois, Laurent. Avengers of the New World: The Story of the Haitian Revolution. Cambridge, MA: Belknap of Harvard UP, 2004. Print. 7. Geggus, David Patrick., and Norman Fiering. The World of the Haitian Revolution. Bloomington: Indiana UP, 2009. Print. 8. Nascimento, Washington Santos. “Além Do Medo: A Construção De Imagens Sobre a Revolução Haitiana No Brasil Escravista (1791 – 1840).” Além Do Medo: A Construção De Imagens Sobre a Revolução Haitiana No Brasil Escravista (1791 – 1840) 10.18 (2007): 469-88. Cadernos De Ciências Humanas-Especiaria, July 2007. Web. 11 Dec. 2015. 9. Maxwell, Kenneth. Naked Tropics: Essays on Empire and Other Rogues. New York: Routledge, 2003. Print. 10. Paquette, Gabriel B. Imperial Portugal in the Age of Atlantic Revolutions: The Luso-Brazilian World, C. 1770-1850. Cambridge: Cambridge UP, 2013. Print. Special Thanks to Guilherme Hübner for Portuguese translation services.

spotlight hurj spring 2016: issue 22

focus

China’s Crackdown on the Banking Industry Lisa Xiao, Class of 2018 International Studies

Origins

interests to lend to state-owned enterprises (SOEs) in Recently, China’s crackdown on the shadow banking in- order to minimize unemployment and instability. There dustry has been in the spotlight, but this really was not are also policy loans that favor certain industries, conthe beginning of the story. Informal economy arose in trolled from both a central and provincial level. These China in response to discriminatory government poli- heavy government controls have created a vacuum in cies and financial repression. Private entrepreneurship the SME banking sector in which banking institutions is the driving force behind China’s new economy with a have failed to address the specific needs of SME own20% annual growth rate in the private sector since the ers, for example, small- and middle-scale property destart of the reform era in 1978. Nonetheless, this rapid velopers, who are unable to obtain traditional financing growth in China is taking place in an openly hostile en- from banks and turn instead to shadow bankers to satvironment in which credit is extended mainly to state isfy their short-term funding needs. When conventional and collective enterprises rather than private ones. The bank loans out of their reach, these private enterprises growth of China’s shadow banking industry originated resort to sourcing their funds from alternative finding from the relative lack of alternative funding channels channels. Other barriers include a lack of administrafor SMEs. Even after China loosened government con- tive and technical expertise to process individual loan trols on many of its industries, banking in China has al- requests and unreasonably low interest rate ceilings ways been a tightly controlled industry. In fact, by the (restrain commercial banks to structure commercially end of 2000, the private sector received less than 1% viable loans to the private sector). When formal credit of loans from entire banking syschannels are closed to private busitem in China. This difference comnesses, nongovernmental financing pared to its western counterparts mechanisms and institution arose points to a key contrast. In the as a solution to these barriers. This United States, the primary role of Chinese banks exist to created the capital demand side the banks is to enhance the flow of within the Chinese shadow-banking protect national capital from entities with excessive industry. capital to entities that need it. ChiSecondly, on the supply side, a parinterests. nese banks, on the other hand, exist allel market is generated when the to promote national interests. In the Chinese government implements past two decades, national interstrong regulatory restrictions to est has consistently been focused cap the interest rates of fixed deon the privatization of national enterprises. When the posits, capital protection funds, and other conventional Chinese government injects them with a lot of capital, wealth management products. These restrictions were they can encourage these giants to drive China’s invest- also combined with heavy-handed property-cooling ment-driven growth model. measures by the Chinese government. As a result, ChiCompared to the rest of the world, the shadow banking nese investors find difficulty in generating returns on industry in China really does not seem to be that big of their financial capital and turn instead to higher yielding a deal when we look at the numbers. Within the $75.2 shadow banking products. trillion of global nonbank financial intermediary assets, During the first three decades of reform, state capitalonly $3 trillion are originated from China, the world’s ism and shadow banking operated as parallel modes second-largest economy by GDP. Nonetheless, many of political economy. They served the state and prianalysts believe that this poses as a systematic risk to vate sectors respectively. After 2008 stimulus, the two the Chinese economy in the next few years. Individuals, have intersected and developed areas of mutual liabiliparticularly those who are closely touching the Chinese ty. Stimulus policies produced a lot of opportunities for markets, are generally pessimistic on the current situa- state affiliated economic entities like state enterprises tion. I believe that when we take a step back, the prob- and banks, and local governments to expand their parlem lies beyond the shadow banking industry itself. We ticipation in shadow banking. The scope of informal fineed to look at the roots of the industry itself on the nance has expanded to broader scope of shadow bankdemand and supply side. ing. It is no longer simply private entrepreneurs and Firstly, informal finance arises because of discourage- private mom and pop shops, but middle-class profesment from the Chinese government to Chinese banks sionals seeking wealth management products and local to extend credit to private businesses. It is in national governments facing unfunded mandates and incentives

focus

to demonstrate economy development. We are already seeing today a decline in the real estate industry and arbitrage financing that many analysts point to for the burst of the stock market. Beijing’s leaders face the challenge of managing state capitalism and shadow banking. Reforming certain sectors of state capitalism and shadow banking is going to encounter greater resistance than earlier reforms. At the same time, relying on heightened coercion to implement these reforms is going to alienate efforts at increasing financial inclusion, which is being pursued at a strategy of “political exclusion”.

Forms of Informal Finance The informal economy is by definition unofficial and elusive. The prevalence of informal finance is difficult to explain, because it is technically illegal and that there are many variations in the mechanisms and institutions of informal financing that exist at the local level. The legacies left by the Mao era economic structural reforms have created variations in the local governments’ attitudes towards private enterprises. There are also differences in the behavior and level of entrepreneurship across China – as entrepreneurs are innovative individuals with different social and political identities and use different ways to draw on preexisting resources to create new products for the market. These two differing forces have created different degrees of implicit support for informal financial activity. Despite difficulties in identifying these forms of informal finance, Kel-

hurj spring 2016: issue 22

lee Tsai classified these forms according to degrees of legality and institutionalization, into three forms, from the least institutionalized to semi-institutionalized to fully-institutionalized forms. There are many forms that are not sanctioned and are simply registered through many creative disguises. The frequent crackdown we see on the news is simply when a particular financial product spirals out of control and local authorities crack down on them. Recently, it has become simply a game of whack-a-mole, in which authorities crack down on certain forms of informal finance only to have them later bubble back up again. The least institutionalized are interest-free, uncollateralized lending among friends, family and businesses, trade credit, moneylenders and money brokers. Semi-institutionalized are ROSCAs (huì), non-governmental investment alliances, and reciprocal loan guarantee networks. Institutionalized forms include pawnshops, trust & investment companies, credit guarantee companies, microfinance companies, rural credit unions, and financing branches. Case Studies: Wenzhou and Fujian In Wenzhou (Zhejiang province), innovations include the 挂户企业 (Guà hù qǐyè small business pays a state-owned enterprise to use its name and account numbers to evade taxes and obtain state financing) and红帽子(Hóngmàozi private businesses registering as collectives with local committees, wearing a collective label to obtain credit and avoid regulation). Despite this seemingly visible loophole, many local government officials do not discourage this innovation and have even suggested that

hurj spring 2016: issue 22 these practices are at the core of economic reform. In Fujian, the sexual division of labor influences the forms of informal finance that arose. 会 (huì) is a rotating credit association that allows individuals to pool their resources and allocate capital efficiently. This is particularly popular among women because men are more prone to migrate to wealthier areas to search for jobs while women are more often left to tend to the fields and to their children, raising the households. This form of informal finance seems to be similar to the microfinance loans and institutions set up in countries in other developing countries today. The difference, it seems, is that in China, the small sums managed by会 (huì) are regarded as demeaning to any possible male participants in a largely patriarchal society and culture. Winners and Losers of China’s Financial Repression The core challenge to deepening market reforms is that both SOEs and state banks are vested in financial repressions, maintaining wide spreads between ceilings on deposit rates and a floor on lending rates that have enabled banks to generate substantial profits. Moving forward, it is going to be hard to disentangle the returns that they have been generating in order to liberal finance and make it more available to other parts of the market.

Risks to Informal Finance While this seems simply like a quaint, harmless innovation to a currently failed system, shadow banking carries risks to the entire network. This informal system works on a loan guarantee network, which is advertised to be mutually beneficial. However, when a critical node in the network runs into difficulties, financial institutions have to worry about viability of loans that are premised on these guarantees. Furthermore, when big lenders combat weak profits by increasing investments in shadow-banking products, their financial positions can be worsened if market conditions deteriorate. When China’s earnings data in the financial industry were released at the end of October, we saw slow growth at banks for a third consecutive quarter. Borrowers are struggling to repay loans. China’s economic deceleration has amplified the troubles in the financial system. The central bank cut the interest rate several times this past year in order to stimulate the decelerating economy and see gains at Chinese banks. As a result, commercial banks see themselves competing with investments from the growing shadow banking industry, which offers more promising, higher yield investments. Therefore, despite recognizing that the shadow banking industry has historically provided the private sector with innovative means of financing their rapid growth in the past three decades, private sector cannot indefinitely rely on an informal finance. There needs to be some serious reforms. Firstly, the Chinese government needs to find a way to sustainably support the current informal finance systems on a local

focus level. Secondly, there needs to be structural reforms on today’s hostile environment towards the private sector. While China’s economic development has been unique in its magnitude and approach, this economy cannot grow indefinitely without exclusive reliance on formal institutions to protect property rights and uphold contracts. Growth in an informal economy has inefficiencies and high transaction costs. We already saw this taking place in the early 2000s, through a slowdown in the growth of the private sector and FDI.

Remedy When looking at how both sides emerged as a result of pre-existing market conditions imposed by the government, we can see that perhaps shadow banking is a solution and not a problem. With this new perspective, it may be more appropriate to see shadow banking as a financial innovation that should be regulated more effectively rather than a conventional black market that is rendered illegal with regulations and rules imposed on it. In principle, this new set of “effective regulations” would require all shadow bankers to be more transparent about their activities and setting up a sinking fundlike structure among financial intermediaries to minimize the systematic damage that would arise from loan defaults. Efforts to support a more balanced capital market growth should work alongside these new regulatory measures. In the case of the Chinese capital markets, more proper funding channels need to be made available to enhance the shadow banking system and cushion the size of any eventual systematic risk, allowing previously marginalized SMEs to have more options to consider and to reject harsher funding terms that they previously would have accepted. This allows us to eliminate the unsustainable, high-yield products of this parallel market that are the prime sources of contagion risk. The difficulty in this process is for Chinese authorities to provide the proper incentives to stakeholders to support this balanced growth within the conventional banking industry.

Peer-to-Peer Lending Peer to peer lending (P2P) has been in the spotlight lately in the past few years and has grown a lot since the mid 2000s. Briefly, they match lenders and borrowers, who are typically not known to one another, perform credit check in less rigorous manners than traditional. P2P is not a new concept and is one that is expanding in many places around the world. Originally began in the United States, it found a new purpose in China by providing cheap and quick loans to the private sector in an undisciplined manner. P2P is not subject to clear regulations, which leaves much room for mismanagement. In fact, last year over 70 peer-to-peer platforms closed down or froze withdrawals from registered users. This rapid proliferation is due in large part to the low barriers to entry – it is very easy to set it up. In October 2015 alone, the rate of return that most P2P platforms gen-

focus erate is about 12% to 24%. However, in order to attract investors, many of these platforms “guarantee” a higher than the industry average, but many of these companies with a high guaranteed return have already gone bankrupt before paying back the principal to investors. The regulators have generally embraced online financing as a new frontier of financial innovation but recognize the potential contagion risks involved with online financing and the importance of supervision. The number of P2P online lending platforms climbed from 50 in 2014 to 2520 this past October. This new form is different in that it operates without going through any traditional financial intermediaries. It carries over features of its predecessors. They bear huge systematic risks in that it operates outside the regular banking system and has no liquidity support from the central bank. P2P hasn’t really had a good reputation since it emerged. During the summer of 2015, when the stock market crashed, it hurt many fast growing shadow banks. Loans from sources such as online lenders for equity purchases surged then quickly plunged last summer, and thus have led financial analysts and regulators to blame P2P for channeling credit into the recent stock market bubble crash this past summer. As P2P became more readily available and popular, many individual investors inflated the bubble by investing large amounts of borrowed money in stocks. As a result, when Chinese regulators realized how many risks equity financing could bring, they brought them back to their original purpose to funding smaller companies and banned P2P companies from lending for stock purchases.

Moving Forward: 13th Five-Year Plan In China’s 13th five-year plan, the Chinese government expressed their attitude towards online financing as an entity in the economy as one that needed to be developed in a regulated manner. We saw them embrace online financing as a symbol of financing innovation, but nonetheless recognize the potential risks and importance of supervision. This plan also shows a desire to accelerate the transition away form the official bankbased, heavy industry-oriented financial system toward one driven more by market forces and innovative industries.

Conclusion and Next Steps This paper is a culmination of the research done during the Fall 2015 semester for the Woodrow Wilson Fellowship under Dr. Ho-Fung Hung regarding the financial system in China as it relates to those of Taiwan and Hong Kong. The situation of present-day China would be compared to that of Hong Kong in the 70s. Taiwan still holds similar characteristics as those of China, particularly the occurrence of “hui” where SMEs form a pool of money as a type of informal finance. In Taiwan, financial liberalizations began in the 1990s. Hong Kong is a different case in that it had an open financial system

hurj spring 2016: issue 22 since the beginning and has seen significant growth and changes since. By looking at the financial liberalization and regulation in Taiwan, the research aims to make predictions of where the current financial regulation leaves the Chinese economy. Information about Taiwan will be found by continuing to look at secondary literature. Taiwan in the 70s had a banking system very similar to that of China, with industrialization, the presence of small factories, and the prevalence of credit association. Taiwan’s trajectory can be tracked throughout the 1990s to present day by looking at newspapers in both Chinese and English. I aim to see if the financial liberalization in Taiwan has allowed for easier access to lower interest rate credit, or otherwise. The case of Hong Kong is different. While they have had a liberal financial system, the government is playing a more active role in targeting small- and medium-sized enterprises in order to boost the entrepreneurial ecosystem in Hong Kong, as they have noticed that even with a liberal deregulated environment, the smaller private enterprises are still disadvantaged to larger-sized companies. My hypothesis is that although it is liberal like the financial system in the United States, it is not as diverse. I hope to also bring in the case of the United States to see if a financial system would be favorable to small- and medium-sized enterprises if and only if the system is both diverse and liberal. What makes an environment hostile or benign for start-ups? These are some of the questions I aim to answer as I further my independent research.

References 1. China’s Money Exodus. (n.d.). Retrieved December 21, 2015, from http://www.bloomberg.com/news/features/2015-11-02/china-s-money-exodus 2. Tsai, K. (2002). Back-alley banking: Private entrepreneurs in China. Ithaca: Cornell University Press. 3. Chinese Crackdown: Authorities Crack Down on Shadow Banking In Jinhua. (2015, November 21). Retrieved December 21, 2015, from http:// www.insidertradingreport.org/chinese-crackdown-authorities-crackdown-on-shadow-banking-in-jinhua/6182772/ 4. China shadow banks appeal for government bailout - FT.com. (n.d.). Retrieved December 21, 2015, from http://www.ft.com/intl/cms/s/0/06cc9b9c-44c4-11e5-b3b2-1672f710807b.html#axzz3svWzI7vZ 5. Regulation of the Rate of Interest and Shadow Banking in China. (2014). China’s Economic and Social Problems, 125-128. 6. Battling the darkness. (2014, May 10). Retrieved December 21, 2015, from http://www.economist.com/news/finance-and-economics/21601872-every-time-regulators-curb-one-form-non-bank-lending-another-begins 7. Shadow Banking Is Killing China’s Stock Markets. (n.d.). Retrieved December 21, 2015, from http://foreignpolicy.com/2015/08/26/shadowbanking-is-killing-chinas-stock-markets/ 8. China’s latest five-year plan. (n.d.). Retrieved December 21, 2015, from http://www.timesofoman.com/article/72634/Opinion/Columnist/So-thefive-year-plan-is-no-longer-a-detailed-blueprint-for-industrial-expansion;-rather-it-provides-a-picture-of-what-the-Chinese-leadership-hopes-will-be-achieved-under-the-government’s-general-

hurj spring 2016: issue 22

focus

The Great Escape: Why not in China? Maria Belen Wu, Class of 2018 International Studies

Introduction The Great Escape describes the rise and eventual worldwide ascendancy of the West from the sixteenth century onwards, further propelled by the subsequent developments of science and technology in the eighteenth and nineteenth centuries that culminated in the Industrial Revolution and the transition to modernity. Traditional theories tend to approach the issue from a perspective of European exceptionalism, by emphasizing the role of the Enlightenment in the development of reason and individualism. Thus, existing scholarship frequently makes reference to a “European miracle”, meaning that “Europe possessed some unique characteristics that allowed it – and only it – to modernize first, and hence gave it the moral authority and the power to diffuse ‘modernity’ around the globe where cultural, political, or economic ‘obstacles’ prevented modern development from occurring indigenously.” Such Eurocentric explanations project a sense of inevitability of the eventual rise of the West, while overlooking the Eastern counterpart of global economic history, as well as the East-West interactions that have contributed to the present economic paradigm.

It is crucial to note that until the turn of the nineteenth century, the civilizations of China, India and Europe were comparable in terms of their level of economic development, standards of living, and life expectancy. In particular, China’s economic and population growth stimulated the entire Eurasian continent and became the economic engine driving global trade as early as 1000 AD, experiencing another upsurge in the 1400s that lasted until the 1800s. As seen in Figure 5.1, the three parts of the

world accounted for 70 percent of the globe’s economic activity in 1700, each claiming equal shares of world GDP, whereas in 1820 China’s GDP even surpassed the European share by approximately 10 percent. This initial examination casts serious doubts upon the inevitability of the rise of the West, and poses the question “why not in China” that existing theories fail to address with their Eurocentric focus. Therefore, in this paper I provide an alternative explanation of the Great Escape through the Chinese perspective, pointing out long-term as well as short-term factors that highlight the historical contingency rather than the inevitability of “the rise of the West”.

1. Long-term Factors 1.1. Institutions The institutional hypothesis claims that the economic and political structures present in a nation define its prosperity or poverty. Among the main proponents of institutional analysis, Acemoglu and Robinson classify political and economic institutions as either “inclusive” or “extractive”. They assert that inclusive economic institutions “must feature secure private property, an unbiased system of law, and a provision of public services that provides a level playing field in which people can exchange and contract; it also must permit the entry of new businesses and allow people to choose their careers.” Acemoglu and Robinson also describe the opposite case, namely the symbiotic relationship between extractive political and economic institutions. In their view, elitist control over extractive political institutions leads to unrestrained control over economic institutions, which the elites structure as extractive for their own benefit. The further enrichment of the elites in turn further bolsters their political dominance, creating a vicious cycle of economic backwardness. Upon a comparison of the relationship between agrarian economy and the ruling elite in both medieval Europe and imperial China, the extractive nature of the political and economic institutions of the latter is clearly reflected in the lack of central delegation of authority. The political unity of imperial China allowed for the implementation of a distinctive “manorialism without feudalism,” where there was no separate specialist military class and the state retained control over defense. This contrasts vastly with medieval Europe, where the division of power between the crown and local seigniorial authority yielded a decentralized feudal system based on fealty and vassalage. Hence, the Chinese imperial state’s monopoly of vio-

focus

hurj spring 2016: issue 22

lence and the military constituted the extractive politi- Precisely, the dominant philosophical and cultural cal institution that further allowed the elite ruling class teachings of Confucianism in China dictated opposite to impose extractive economic institutions on rural so- societal values to the Protestant ethic. Firstly, Confuciety. This was carried out mainly through the system cian texts place an overwhelming emphasis on filial piof land-tax collection that remained a common denom- ety and obedience to authority, which supplements the inator throughout imperial China, and even persisted traditional concept of the family as the center of life and into the warlord era in Republican China. Consequently, the unit of work. Confucian teachings not only reinforce the extractive institutions promoted economic growth these values but also expand them to a national level: out of obligation and compulsion, preventing the devel- “There are few who, being filial and fraternal, are fond opment of rural autonomy and entrepreneurship: “The of offending against their superiors. There have been state did indeed manage to increase tax revenues, but it none, who, not liking to offend against their superiors, crushed village autonomy (…) in a process of ‘state invo- have been fond of stirring up confusion.” Evidently, the lution,’ wherein the state did not precisely weaken, but linkage created by Confucian philosophy between fastate-building backfired as it extended its reach.” On milial loyalty and obedience to imperial authority enthe contrary, the feudal rulers who contested for power gendered an undisputed submission to the despotic in medieval Europe sought to grow individual revenues ruler, ultimately contributing to the lack of individualism by attracting and persuading peasants to participate: and spirit of entrepreneurship in Chinese tradition. “implicit in it was a sense of rights and contract – the Secondly, Confucianism explains the institutional strucright to negotiate as well as petition – with gains to the ture of imperial China, with an elite class comprised by freedom and security of economthe literati and a subordinate agrariic activity.” In doing so, European an class composed of landlords and feudalism was indeed the precursor peasants. “China has made literary The Confucian ethic’s education the yardstick of social to the modern inclusive economic institutions of the West. biggest difference com- prestige in the most exclusive fashWhile the institutional viewpoint ion, far more exclusively than did provides a valid explanation of Chi- pared to the Protestant Europe during the period of the huna’s economic demise with respect ethic is its inherent lack manists.” Therefore, Confucian ethto the West, it fails to address the ic disseminated the cultivation of of the concept of root causes that allowed the initial literary study as the highest societal establishment and subsequent staaspiration, contrary to the Western rationalism. bility of extractive economic and Protestant thought current that enpolitical institutions in China. At the couraged wealth-creating activities. same time, it ignores the intellectuThirdly, not only did Confucianism al developments that allowed the orient the populace’s values away flourishing of inclusive institutions in Europe. In order from enterprise and individualism, but most importantto address the institutional hypothesis’ shortcomings, ly, the doctrine itself encompassed a particular averthe framework of cultural analysis can be used to fur- sion towards industrial and commercial activities. The ther explore the long-term factors of Chinese economic teachings provided moral legitimization for a command stagnation. economy, in which economic activity was permanently under surveillance of the elite class, further discouraging wealth creation: “The [Confucian] mandarinate’s task 1.2 Culture Through the lens of cultural analysis, the Great Escape was to manage both [soldiers and merchants], recogand its absence in China can be best explained by draw- nizing that both were needed to maintain the physical ing an intellectual parallel between the Protestant ethic integrity of the empire.” As a result, it is interesting to observe this cultural imprint of Confucianism on China’s in Europe and the Confucian ethic in China. The Protestant Ethic and the Spirit of Capitalism by Max current state-market relationship, namely the legacy of Weber asserts that Protestantism in post-Reformation crony capitalism and rent-seeking that is still highly preEurope encouraged values of worldly asceticism that dominant in the present Chinese economy. dignified the previously mundane and looked down From the above, it becomes clear on a broader level upon professions of merchants, financiers and industri- that the Confucian ethic’s biggest difference compared alists, promoting the notion that capital accumulation to the Protestant ethic is its inherent lack of the concept is a blessed and morally sound profession, eventually of rationalism, which constituted the key to the emerleading to modern capitalism. In his work, Weber out- gence of modern capitalism in Europe. Nevertheless, lines that “it must be evident that the Western Euro- the lack of rationalism and the existence of extractive pean and American capitalism of the last few centuries institutions only expound the long-run characteristics constitutes our concern rather than the ‘capitalism’ that of the Chinese economy that hampered growth. In orhas appeared in China, India, the Ancient World and der to account for the chronology and the suddenness the Middle Ages, where […] just that peculiar ethic was of the Chinese economic downturn, the specific domestic and foreign historical developments around the missing in all these cases.”

hurj spring 2016: issue 22 nineteenth century must be subject to analysis.

2. Short-term Factors 2.1 Foreign encroachment The nineteenth century was the turning point that came to define the modern world economic order, drawing the line between the developed and underdeveloped countries. The fact that China became part of the “third world” and the “global South” in this new paradigm is perplexing, given its longstanding role of leadership in global trade. Since the early 1400s, China’s demand for silver was the main driver of international trade with Europe since it became the designated national currency. The creation of a triangular trade dynamic in which Europe exported silver from its colonies to China in return for Chinese imports of silk, tea and porcelain allowed China to maintain a permanent trade surplus with Europe. However, in the nineteenth century, China experienced a significant rise in demand for another commodity – opium, which gradually reversed the trade balance, as the inflow of silver towards China became an outflow of silver to Europe in exchange for the addictive drug. This development was inaugurated and greatly amplified by British colonialism in Asia. At first, in order to facilitate transportation and increase volume of trade, British India became the designated cultivation ground for extensive poppy fields for export to China, resulting in the impoverishment of India through the forced creation of an agricultural export industry. Furthermore, after Britain’s defeat of China in the First Opium War (1839-1842), Hong Kong became an official British

focus colony, as well as the hub of British drug trade. Eventually, suffering another defeat in the Second Opium War (1856-1860), the British forced China to legalize the sale of opium as well as open up more treaty-ports for international trade. By the late 1800s, “China was consuming 95 percent of the world’s opium supply, with predictable social, economic and political effects. Nearly every city had its opium dens, and the sale and use of opium had entered the fabric of Chinese life.” Figure 5.2 shows the resulting marked decline of both China and India, which is mirrored by the significant European growth from 1830 onwards. Ultimately, while the First Opium War marked the beginning of China’s “century of humiliation,” subsequent invasions from the United States, Japan, Germany and other imperialist nations further weakened China’s economy and global standing. However, despite the profound detrimental effects of foreign encroachment, the existing social problems and repression within the regime very likely constituted the primordial reason for the demand of British opium, while the empire’s internal weakness facilitated the instances of foreign invasion.

2.2 Domestic Fragmentation The Qing dynasty (1644-1911) was the last imperial dynasty of China, a period of rule under Manchurian leaders. The reign of Qianlong Emperor (1735–1796) saw the apogee and initial decline in prosperity and imperial control, setting the stage for internal uprisings and foreign invasion. On the one hand, the Qing dynasty upheld a particularly strong Sino-centric worldview: “The Celestial Empire – the name tells everything – saw itself as untouchable in its cultural achievement and sense of moral, spiritual

hurj spring 2016: issue 22

focus

constituted the ultimate reasons for the emergence of the great economic gap between China and the West.

3. Conclusion

and intellectual superiority.” This was accompanied by an overall rejection of the West. Under the reign of emperor Qianlong, international trade became restricted through increasingly protectionist policies, which not only hindered economic efficiency in world trade, but also closed China off from foreign inflows of technological innovation. On the other hand, the Qing dynasty experienced the growth of internal ethnic conflict. This was especially exacerbated by the fact that Manchurian rule over China was considered an instance of foreign encroachment by part of the populace, as Manchuria had not been part of China in previous dynasties. Moreover, the territorial expansion under the Qing dynasty signified the addition of multiple ethnic minorities to the Chinese empire, most of whom lived in peripheral locations outside the central government’s span of control. These factors, in addition to widespread famines, floods and poor social administration, led to severe internal fragmentation of the empire and a rapidly growing anti-Manchu sentiment. In 1851, the Taiping Rebellion was launched by Hong Xiuquan, who declared himself the rightful emperor and proclaimed Confucianism as the root of all evil and backwardness. During his decade of reign, Hong abolished ancient traditions such as slavery, concubinage, arranged marriage, footbinding, and religious worship. He pursued a policy of overall Westernization, envisioning China’s modernization and economic catching-up with Europe and America. However, one of Hong’s social reforms consisted of the banning of opium, which was unfavorable to British economic interests. This encouraged a British-Manchu alliance that led to a simultaneous civil and foreign war. Not only did this process crumble Chinese economy, but the domestic unrest would also lead to a radical regime change, as the restored Qing dynasty would soon be overthrown and become the Republic of China in 1911. As demonstrated above, the domestic weaknesses that plagued China throughout the Qing dynasty became fertile soil for the seeds of foreign imperialist invasions. The unfavorable combination of these particular historical occurrences since the turn of the nineteenth century

The traditional Eurocentric explanations for the Great Escape paint a picture of European exceptionalism. By emphasizing Western developments such as the Enlightenment economy and the Industrial Revolution, existing theories fail to address the question of “why not in China?” In determining the long-term factors, the institutional argument becomes valid only when complemented with the explanations of China’s economic structure and specific traits of Chinese society provided by cultural analysis: Confucian tradition accounts for the extractive nature of Chinese political and economic institutions. However, upon an examination of the short-term causes of China’s economic downturn in the 1800s, it becomes clear that the widening of the economic gap between China and the West throughout the nineteenth century was mostly brought about by a series of foreign encroachments combined with inherent domestic fragmentation. Finally, we arrive to the conclusion that the Great Escape was not an inevitable phenomenon stemming from European exceptionalism, as portrayed by traditional theories on the origins of the modern world. “The rise of the West was not inevitable but was highly contingent. The world we live in might have been different; there is nothing in the past that indicates that the world had to become one dominated by Western institutions.” At the same time, this implies that the current Western economic dominance is also contingent upon future developments, as demonstrated by the renewed challenges to the world economic order currently posed by Asia, spearheaded once again by China.

References 1. Darren Acemoglu and James Robinson, Why Nations Fail: The Origins of Power, Prosperity and Poverty, (New York: Crown Publishing Group, 2012) 2. Marie-Claire Bergère, Sun Yat-sen (Stanford: Stanford University Press, 1998) 3. Confucius, Confucian Analects: The Great Learning, and The Doctrine of the Mean, Translation by James Legge (New York: Dover Publications, 1971) 4. Deepak Lal, Unintended Consequences: The Impact of Factor Endowments, Culture, and Politics on Long Run Economic Performance (Cambridge: MIT Press, 1998) 5. Robert B. Marks, The Origins of the Modern World: A Global and Ecological Narrative (Lanham: Rowman and Littlefield Publishers Inc., 2015) 6. Max Weber, The Religion of China: Confucianism and Taoism (New York: Free Press, 1951) 7. Max Weber, The Protestant Ethic and the Spirit of Capitalism, new introduction and translation by Stephen Kalberg (Los Angeles: Roxbury Publishing Co., 2002) 8. Peter Zarrow, China in War and Revolution, 1895-1949 (London: Routledge Curzon, 2005)

hurj spring 2016: issue 22

focus

India-Russia Bilateral Relations Tyler Lee, Class of 2017 International Studies

Introduction In June of 1955, Prime Minister Jawaharlal Nehru made a historic visit to Moscow, beginning the Soviet Union’s strongest alliance in the Third World. On August 9, 1971 in the wake of the Bangladesh Liberation War, the two countries signed a twenty-year Treaty of Peace, Friendship, and Cooperation, departing from India’s longstanding policy of non-alignment. During the Cold War, India enjoyed strong economic, military, strategic, and diplomatic ties with the Soviet Union. Close ties between the two countries have persisted; at a gala dedicated to the “Year of India in Russia” in 2009, Dmitry Medvedev pronounced, “Relations with India have always been and will be one of the most important foreign policy priorities of our country.” India was of strategic importance geopolitically to the Soviet Union. The Soviet approach viewed India as a counterweight to China. Rather than seeing China as a Communist ally, Communist leadership viewed China as a potential competitor. Though officially neutral in the Sino-Indian War of 1962, Khrushchev provided India with economic and military aid. According to the former Russian Ambassador to India, Anatoly Dryukov, Russian relations are a hedge against Sino-Russian relations . As Chinese ties with the Soviet Union and India deteriorated during the 1960s, the latter two came closer to each other, leading to the landmark Treaty of Peace, Friendship and Cooperation. Both Mikhail Gorbachev and Leonid Brezhnev expressed ongoing interest in establishing an Asian collective security system with India. This indicates the continuing distrust of China and underscores the significance of the Soviet-Indian partnership in containing China’s influence. The United States had a close relationship with Pakistan, so India naturally aligned with the Soviet Union. However, after the fall of the Soviet Union, India lost its superpower ally. India felt the neglect of Russia during the later Gorbachev years and early Yeltsin years as Russia reevaluated its security and economic strategy. Granted, the Indian economy has grown significantly since the 1990s, lessening its dependence on such a partnership. Nonetheless, Boris Yeltsin attempted to repair relations with India when he visited in 1993 and replaced the old Indo-Soviet Treaty a new bilateral treaty that lacked security clauses. Putin has continued the healing process, but now Russia is competing with a more influential China and a United States vying for India’s attention.

Politics The

Indo-Russian

Inter-Governmental

Commission

(IRIGC) is the primary body that conducts governmental affairs between the two countries. It is the largest and most comprehensive governmental mechanism India has with any country. The prime focus nowadays is on trade and investment. Russia agreed to cooperate with Modi’s “Make in India” campaign to encourage foreign direct investment in India and for multinational companies to bring production in India. Putin also agreed to help fund the massive Delhi Mumbai Industrial Corridor Project, which will connect the political and business capitals of India by 2017. Russian company AFK Sistema will establish a “Smart City” in India built on modern Russian technology, continuing collaborations between India and Russia in information technology. Current trade levels are below optimal. The goal for bilateral trade is an ambitious $30 billion by 2025. In 2014, India and Russia finally agreed on negotiations for a Free Trade Agreement with the Customs Union of Belarus, Kazakhstan, and Russia, and bilateral trade is expected to increase drastically as a result . In an op-ed written by Vladimir Putin, he expressed that “deepening of friendship and cooperation with India is among the top priorities of our foreign policy.” In other words, the multilateral organizations that India and Russia are members of are potentially becoming a second eastern pole to counter the exclusively western NATO. India and Russia are partners in several multilateral organizations. Even though Russia and India meet annually at the BRICS summit, the summit itself is quite an artificial construct since these countries share few common interests and have limited trade ties. India has been much less assertive in BRICS, especially in calling for the overhaul of existing international institutions, because of India’s growing partnership with the United States. On July 10, 2015, the Shanghai Cooperation Organization (SCO) decided to finally admit India and Pakistan as full members. Russia hopes to expand SCO to give itself global political legitimacy. As the West turns away from Russia, Russia must look to Asia to confer legitimacy and reassert its hegemony. Organizations that exclude the United States, such as the SCO, are the ideal platform for Russia to find non-western partners. Economically, cooperation in SCO gives Russia another market for its goods; this is especially important while American sanctions remain on Russia. The relationship between Russia, India, and China is interesting. In 1999, Primakov put forth the idea of a strategic triangle to counterbalance western hegemony. On a visit to India, Putin said, “attempts to remake present-day civilization - which God created to be multifaceted and diverse—in accordance with the barracks prin-

hurj spring 2016: issue 22

focus ciples of a unipolar world are extremely dangerous,” attempting to reinforce the triangle as a second pole with Russia at its center to counterbalance the West. The Foreign Policy Concept of 2000 put India in a tie with China in first place for priority development and maintenance of friendly relations. However, none of those participating in this trinity believe there to be much of a future. Russia privately fears that the expansion of SCO will give China more influence in Central and South Asia. Pakistan already has close security ties with China and China is wooing India with economic opportunities. China has aspirations to use SCO in the same manner that Russia does: as a platform for regional and global leadership. This further reinforces the idea that these three powers may form strategic partnership in pairs, but real effective cooperation between all three of them together is unlikely because of conflicting interests. The triangle format is a channel for India to normalize and strengthen relations with China, and to discuss energy cooperation with Russia, but India can opt out when Russia and China attempt to impose their anti-American rhetoric on India.

Counterterrorism Russian-Indian relations have been heavily influenced by the ongoing India-Pakistan conflict. Following the attacks on September 11, 2001, Russia, along with the United States and China, pressed more urgently for a settlement in Kashmir while India claimed its right to pursue terrorists in the states that sponsor terrorism by following the example of the United States. Russia took a sympathetic stance as it saw parallels with its domestic terrorist situation in Chechnya. Together, India and Russia have a mutual understanding that they should cooperate to combat terrorism. Russia and India biannually conduct the INDRA bilateral joint military exercises, which focus on counterterrorism and counter-narcotics. In 2001, President Bush included two Pakistani organizations, Lashkar-e-Taiba and Jaish-e-Mohammed, on its list of terrorist organizations and lifted sanctions against India. These two organizations were responsible for the attack at the Parliament of India on December 13, 2001. Bush was successful in courting India, who enthusiastically joined his coalition against Islamist terrorism. In February 2003, Pakistani President Pervez Musharraf visited Moscow and joined the international anti-terrorist coalition as well, which includes Russia and India. India, Russia, and Pakistan all worry about militant Islamism spilling out of Afghanistan to threaten their own interests, and to that extent, they work together. Civil Nuclear Energy In 1997, it was revealed that Russia planned to sell two lightweight reactors for power plants in southern India. The following year, nuclear tests in India resulted in American sanctions. The sanctions were not severe, pertaining mostly to military equipment and technology, which did not particularly impede Indian exports to the United States.

India’s nuclear test effectively broke the invisible wall that stood between India and the United States. Nonproliferation became a moot point (though India has yet to sign the NPT). Once India attained nuclear weapons, there was no turning back. Having gotten past this irreversible reality, President Clinton visited India in 2000. The United States intruded on Russia’s own plans to supply India with nuclear technology. Before India’s nuclear proliferation, the United States was obligated to criticize Russia’s plans. However after India breached the threshold, there was little point in trying to do what could not be undone, so the United States was then quick to get in on the action. President Bush lifted sanctions in 2001, and the United States has provided India with nuclear fuel, signaling closer ties between Washington and New Delhi despite India’s refusal to sign the NPT. Interestingly, Bush was not as quick to lift sanctions on traditional ally Pakistan which were put in place for the same reason, officially because Pakistan was run by a military regime. This suggests that America’s strategy in India is similar to Russia’s strategy. They are going out of their way to help India as a counterbalance to the rising influence of China. On March 2, 2006, President Bush and Prime Minister Manmohan Singh signed a Civil Nuclear Cooperation Agreement, a cornerstone in Bush’s strategic partnership with India. Bush agreed to lift prohibitions against supplying India with technologies and components for peaceful nuclear programs as he acknowledged India for the first time as a “responsible” state with advanced nuclear technology . In return, India agreed not to transfer military technology to third parties, halt weapons tests, and allow IAEA inspectors into reactor sites. The United States effectively supplanted Russia as India’s main supplier of nuclear technology and this opened up Indian markets to American arms manufacturers.

Defense 70% of India’s military equipment are of Soviet origin and the essence of the Russian-Indian economic partnership is in weaponry. In recent years, India has gained many concessions including large discounts and favorable exchange rates, partially due to Russian desperation. India has the upper hand in this relationship because 60% of Russia’s military exports go to India. As India becomes richer and continues its westward shift, Pakistan may play a new role. India is outgrowing Russian weaponry, eagerly looking towards the United States for more advanced, higher quality weapons. As Russia nurses its relations with Pakistan, Russia may be using Pakistan as a hedge against India. If India decides to turn away from Russia militarily, then Russia could sell weapons to an eager Pakistan instead. The opposite view is that thawing relations with Pakistan are a warning to India that Russia is willing to arm India’s archrival if India abandons Russia. There have been reports conducted by Indian engineers

hurj spring 2016: issue 22 alleging defections in their low-quality military purchases from Russia. Indian engineers in the 1990s discovered a design defect in three quarters of the MiG-29s purchased from Moscow. The Indians were responsible for footing the bill for repairs. There has been a long history of complaints by India, alleging that Russia provided low quality, sometimes unserviceable, weapons. For such close partners, Russia seemingly did not make the effort to rectify its mistakes in aircraft design. In 1993, a $4.3 million navy contract bore no fruit when Russia refused to provide the necessary cables that they alleged were not included in the contract. As of 1997, the useless hardware remained in storage. In 1991, India purchased R-60 MK missiles that had a shelf life of eight years, but at least twenty-three missiles failed field tests. Russia then sent engineers to verify the tests and charged India for the consultation, after which eleven missiles still remained unrepaired. After much frustration, India began to look elsewhere for better weaponry, and it found willing sellers in the West. As part of India’s growing partnership with the West, India started buying weapons from the United States, France, and Israel. Russian Defense Minister Sergei Ivanov has tried new approaches to the longstanding Indo-Russian relationship to salvage their partnership. Rather than proposing the typical buyer-seller relationship, Ivanov instead proposed joint research, development, and production. This evolved relationship will keep India invested in its defense partnership with Russia. However, Russia also faces stiff competition with the Indian government, which is promoting a domestic production program One example is BrahMos, a Russian-Indian enterprise that produces ultrasonic cruise missiles. In spite of $3.5 billion in contractual commitments, India would much prefer to spend money on research and development at home. India will only procure domestically assembled ships and continues to follow a trend of assembling vehicles locally. If Russia wants to be kept in the loop, it will have to establish local production in India.

Conclusion: The Future India remains an important strategic, economic, military, diplomatic, and technological partner for Russia. Sixty years of partnership is not easily forgotten and India and Russia will remain close allies for many years to come, or at least Putin hopes. While India has alternative partners in the West, Russia is highly dependent on India. India is reliant on Russian investments, though it would not be difficult for India to find other investors, especially alternate sellers for weapons. India is interested in growing its newfound partnership with the United States. Such a relationship offers many economic opportunities for India, but India would not want to abandon Russia altogether.

focus What is interesting about India’s relationship with Russia is the double standard. There is an unspoken rule that Russia is forbidden from partnering with Pakistan, but India may partner with the United States. How close would India have to get to the United States for its connection with Russia to finally break? Russia would not cozy up to Pakistan first; it would only occur as an act of retaliation against India. India must be cautious not to ignore Russia’s interests, as India still gets a lot out of the bilateral partnership, such as a reliable source of investment. The only reason Russia is letting India play both sides because of India’s strategic importance in the region. India, Russia, and the United States all have a common interest in containing China, and Indo-Russian-American relations serve to counter China’s hegemony. The United States and Russia both hope that its partnership with India would lessen India’s reliance on China as an economic partner and make India more likely to turn on China. Yet because India is not vying for regional leadership, it is able to play all sides, benefitting from relations with Russia and the United States simultaneously. The charade of India, Russia, and China’s triangular partnership will eventually crumble because India is not interested in opposing the United States for global influence. In fact, India is not opposed to the unipolar world because it is benefitting from its partnership with the leader of that pole, the United States. In conclusion, Russia and India will not be as close as they once were due to India’s shift towards the United States, but they will remain important allies.

References 1. Robert H. Donaldson, “India: The Soviet Stake in Stability”, ASIAN SURVEY, Vol 12 No 6 (June 1972) 2. Dmitry Medvedev, “Gala Evening Dedicated to the Year of India in Russia”, THE KREMLIN, Moscow, Russia, September 3, 2009. 3. Maksim Yusin, “The Pakistani Titmouse and the Indian Crane,” IZVESTIA, December 22, 1995. 4. Steven R. Weisman, “Gorbachev in India”, NEW YORK TIMES, 1986 5. Rajeev Sharma, “India to Seek Russian Investment on April 29”, THE MOSCOW TIMES, April 17, 2013 6. Ibid 7. “Bilateral Relations: India-Russia Relations”, EMBASSY OF INDIA, Moscow, Russia, November 2015, Bilateral Documents 8. Dinakar Peri, “India, Russia Agree on Negotiations for FTA”, THE HINDU, November 6, 2014 9. Vladimir Putin, “For Russia, Deepening Friendship with India is a Top Foreign Policy Priority”, THE HINDU, December 25, 2012 10. Marcel H. Van Herpen, PUTIN’S WARS: THE RISE OF RUSSIA’S NEW IMPERIALISM (Lanham, MD; Rowman and Littlefield, 2014) 11. Vladimir Dzaguto, “Indian Podium- Vladimir Putin Defends Multifaceted Civilization”, VREMYA NOVOSTEI, December 6, 2004 12. Lilia Shevtsova, RUSSIA LOST IN TRANSITION: THE YELTSIN AND PUTIN LEGACIES 13. Aleksandr Gabuyev, “India Doesn’t Fit Into a Triangle”, KOMMERSANT, October 25, 2007, CDRP Vol 59 No 43 (2007), pages 13-14 14. Vladimir Skosyrev, “Igor Ivanov in the Line of Fire” VREMIA MN, February 5, 2002, CDPSP Vol 54 No 6 (2002), page 10 15. David E. Sanger, “Bush’s South Asia Strategy: Keep Terrorism as the Villain”, NEW YORK TIMES, January 7, 2002 16. Mark N. Katz, “Exploiting Rivalries for Prestige and Profit”, PROBLEMS OF POST-COMMUNISM. 17.Sergey Lavrov, “Russia and India: Mutually Beneficial Cooperation and Strategic Partnership”, INTERNATIONAL AFFAIRS: A RUSSIAN JOURNAL OF WORLD POLITICS.

spotlight

Imagine

Imagine a world in which you can send emails, real time videos, and emotions directly from your brain to another person’s brain! Telekinesis is the ability to move and control objects, including people, only using thoughts. Once believed to be true only in science fiction, our understanding of neuroscience and new technologies are making telekinesis a possibility in the real world. Discussed extensively in physicist Michio Kaku’s book The Future of the Mind, the applications of telekinesis are vast and extraordinarily transformative. Professors Rajesh Rao and Andrea Stocco at the University of Washington performed the first experiment to show that one individual can control the movement of the other’s through thoughts. Dr. Rao plays a video game in which the objective is to fire a cannon by moving his right hand to press a key. Dr. Rao only imagines moving his right hand, and this signal from his brain is recorded onto a computer via electroencephalography (EEG), which is a non-invasive method to record electrical activity of brain. The signal stored in the computer is then sent to another computer across UW campus to Dr. Stocco’s lab over the Internet. Dr. Stocco’s computer is connected to a transcranial magnetic stimulation, which delivers the stimulation to the left hemisphere of his brain. Stimulation resulted in the involuntary movement of Dr. Stocco’s right hand, demonstrating that telekinesis and “Vulcan mind melding” may be a possible reality in the coming decades. Scientists have shown that paralyzed individuals are able to control mechanical arms with their mind. A woman named Cathy Hutchinson suffered severe stroke that kept her quadriplegic for more than 14 years. Researchers at Brown University developed a neuroprosthetic chip called BrainGate that changed Hutchinson’s life and broke new grounds in the field of neuroscience. BrainGate, which has 96 electrodes, is placed directly on top of the brain that controls movement of limbs. Hutchinson’s thoughts are picked up by BrainGate and sent to a computer. The computer decodes the neural signals and sends this message to a mechanical arm that Hutchinson is able to move. Hutchinson sits at a table staring at a soda can and imagines her mechanical arm picking it up and bringing it close to her mouth; and the robot does exactly that! In the future, paralyzed individuals will move their once-paralyzed limbs. Scientists at Northwestern University explored this possibility in monkeys where a 100-electrode chip was implanted on the brain. Signals from the brain are recorded which are then decoded by a computer. When the monkey wants to move its arm, the computer sends these signals to the monkey’s real arm, bypassing the spinal cord. The implication of this experiment that show the ability to control the monkey’s limbs without the spinal cord is far reaching. In the future, this transformative technology could be used for some 130,000 people with spinal cord injury per year worldwide. Paralysis will be a thing of the past.

hurj spring 2016: issue 22

Telekinesis also has far reaching applications in our every day lives. Neurosky developed a videogame called Mindflex using Mindwave Mobile headsets that are essentially portable EEG sensors. They allow players to mentally control their avatars. In a few decades, we will find ourselves inside videogames fighting aliens and driving cars at 250 mph. Drs. Rao and Stocco are currently working on sending mental information in both directions to potentially develop a “Brain-net”—an Internet except with human-to-human brain communication. One will be able to send the experience of scuba diving, traveling to Paris, or playing the piano. The receiver will experience every emotion in real time. Telekinesis may also have promising use in employing surrogates. This idea was depicted in movies like Surrogates and Avatar but it may transcend into the real world in the future. Honda Corporation has constructed a robot named ASIMO that is controlled by pure thought. One’s thoughts are sent as a signal via an EEG sensor to a computer. The computer processes and transmits this as a message ASIMO understands. Robots will be invaluable for space exploration in the future because astronauts may control them from the comfort of their homes. Imagine going to places we’ve never been able to reach because humans can’t withstand the harsh environment robots are designed to do so. The most important implication of controlling machines with one’s thoughts may be the development of micro-electrical-mechanical systems (MEMS). MEMS are chips in the size scale of 1-100 micrometers—the size of a single blood cell. For example, it is possible to inject MEMS into a person to remove a clot in his/her brain by guiding MEMS using a doctor’s thoughts only. This has the potential to completely revolutionize medicine. With such advanced technology also come forth several ethical questions. It will be possible to make weapons that can be controlled by human’s thoughts. Imagine how devastating wars can be if one is able to control enemies’ weapons, even worse, minds. In fact, this is a common occurrence in history. Dynamite, invented by Alfred Nobel, was initially used for blasting tunnels and building roads before its catastrophic use in WWI. As important as its implications are, telekinesis can lead to a series of misfortunes in the wrong hands.

Telekinesis:

Science Fiction or an Impending Reality?

Melaku Arega Neuroscience and Molecular and Cellular Biology Class of 2017

Medical Repurposing:

A New Direction for Research

Randal A. Serafini Systems Neuroscience Class of 2018

hurj spring 2016: issue 22

spotlight

We live

in an era where scientific progress is defined by innovation. What’s new is better. However, as more and more advances are made, techniques become more intricate, processes more expensive, and qualified people fewer and fewer. Should this trend continue, which it is at an astonishing rate, research might not be sustainable. I believe there is a temporary solution to this dilemma that is actually quite commonplace in communities around the world today – recycling. There are so many amazing feats that have been accomplished in the last century, ranging from drugs to technology, but we have not taken the time to analyze each innovation carefully and attempt to apply it to other issues. Drug repurposing increases the number of viable options for treatment of diseases, but it also does so in a more sustainable, affordable manner. A perfect example that illustrates the brilliance of medical repurposing is a plausible new treatment for Multiple Sclerosis (MS).

Multiple Sclerosis MS is a devastating neurological disease for which few effective treatments are available. This condition demyelinates, or de-sheaths, neurons, making it difficult for one’s brain to communicate with his or her body. This can result in many different symptoms, including vision loss, pain, fatigue, and impaired coordination.1 And although a cure for this disease has evaded scientists for years now, a drug has been “discovered” that has the ability to target the heart of the disease – myelination. It is called Solifenacin, and under normal circumstances, a patient would not be prescribed this drug for a neurological disorder. One would receive it for incontinence. That’s right. A drug that helps someone with bladder control might be the key to beating one of the most devastating brain diseases we have encountered to this day.2

An Argument for Medical Repurposing Medical repurposing is already a common practice when it comes to combating bacterial infections or viruses. More and more pharmaceutical companies are beginning to opt into saving failed medical compounds and retesting them for future uses, and considering the high rate of production of these compounds, it would be safe to assume that there is a lot of untapped, life-saving potential.3 However, these actions are insignificant in comparison to the amount of resources still spent on drug innovation worldwide. To put this into perspective, in 2014 it was reported that the cost to develop a new pharmaceutical drug exceeded $2.5 billion – for one drug and one disease.4 And what does it cost to launch a repurposed drug for a different cause? Around $8.4 million.5

As shown in image b, Solifenacin injection increases oligodendrocyte progenitor differentiation and myelination (red) in mice as compared to saline (a), and in doing so, has the capability to counteract the effects of MS-based de-myelination (Abiraman et al., 2015).

If this approach to medical innovation still seems dubious, here are some other examples of how repurposing is starting to change the field of medical research. In 2014, researchers in Manchester began testing the use of Lopinavir (used in HIV treatment) as an effective therapy for HPV, the cause of most cervical cancers.6 Also, do you know what Steven Hawking might be prescribed in the near future for ALS treatment? Terbutaline sulfate - more commonly known for its anti-asthmatic capabilities.7 The possibilities for drug repurposing are nearly endless. We, as a scientific community, simply need to understand that taking a step backwards can move us in the right direction.

References 1. “What is MS?” National Multiple Sclerosis Society. Accessed 15 February 2016. <http://www.nationalmssociety.org/What-is-MS>. 2. Kavitha Abiraman, Suyog U. Pol, Melanie A. O’Bara, Guang-Di Chen, Zainab M. Khaku, Jing Wang, David A. Thorn, Bansi H. Vedia, Ezinne C. Ekwegbalu, Jun-Xu Li, Richard J. Salvi and Fraser J. Sim. Anti-Muscarinic Adjunct Therapy Accelerates Functional Human Oligodendrocyte Repair. Journal of Neuroscience, 35, 3676-3688. 3. Joe Cornicelli, Fraser McIntosh and Erik Rocheford “Industry Voices: What’s Old Is New Again--A Prescription for Drug Repurposing.” Fierce Biotech. 28 May 2014. Accessed 15 February 2016. <http://www. fiercebiotech.com/story/industry-voices-whats-old-new-again-prescription-drug-repurposing/2014-05-28>. 4. Rick Mullin. “Cost to Develop New Pharmaceutical Drug Now Exceeds $2.5B.” Scientific American. 24 November 2014. Accessed 15 February 2016. <http://www.scientificamerican.com/article/cost-to-develop-newpharmaceutical-drug-now-exceeds-2-5b/>. 5. Aris Persidis. “The benefits of drug repositioning.” Drug Discovery World. 2011. Accessed 15 February 2016. <http://www.ddw-online.com/ business/p142737-the-benefits-of-drug-repositioning-spring-11.html>. 6. Derek Lowe. “Repurposing for Cervical Cancer.” Science Translational Medicine. 10 March 2014. Accessed 15 February 2015. <http://blogs. sciencemag.org/pipeline/archives/2014/03/10/repurposing_for_cervical_cancer>. 7. Hyojung Paik, Ah-Young Chung, Hae-Chul Park, Rae Woong Park, Kyoungho Suk, Jihyun Kim, Hyosil Kim, KiYoung Lee and Atul J. Butte. Repurpose terbutaline sulfate for amyotrophic lateral sclerosis using electronic medical records. Scientific Reports, 5, 8580-8587.

humanities and social sciences

hurj spring 2016: issue 22

Lessons Learned from Ebola: The Future of US Global Health Security Policy Anna Du, Class of 2018 International Studies

Introduction The intersection between health and security is an emerging challenge for U.S. policymakers. Institutions that traditionally deal with health issues include: domestic agencies (e.g. CDC, USAID, HHS); international bureaus (e.g. WHO); and non-governmental organizations (e.g. MSF, ICRC, BMGF). However, pandemics in recent decades have led to the entry of non-traditional partners, underscoring the opportunity and responsibility of the defense community towards this field. The 2014 West Africa Ebola Outbreak proved that interagency collaboration, including the efforts of the U.S. Department of Defense (DoD), was critical towards successfully stabilizing a global health disaster. DoD’s unique capabilities (e.g. expansive geographic reach, influential partnerships with foreign governments and militaries, ability to rapidly mobilize resources) contribute to its growing role in protecting global health. Although Ebola is no longer rampant in West Africa, there will be future emergencies that necessitate proactive U.S. global health security policy.

Background The DoD primarily seeks to protect the health of U.S. military personnel through (1) medical research, (2) readiness training, and (3) disease surveillance. Throughout the department’s history, it has also been involved in broader health-related activities (Figure 1). The DoD also provides ancillary support for long-term health initiatives—like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Through PEPFAR, the DoD collaborates with both public and private partners to implement HIV prevention programs around the world1. Recently, public health concerns (e.g. anthrax threats, H5N1 avian influenza, Zika epidemic) amidst evolving global trends and U.S. interests have resulted in a closer link between health and security. National security and defense policy documents, more than ever before, reference the strategic importance of facilitating global health, revealing a growing perception among policymakers that poor health conditions accelerate conflict in unstable environments2. It is within this context that DoD operations increasingly reinforce global health priorities today.

2014 West Africa Ebola Outbreak The widespread appearance of Ebola in March 2014 exacerbated the fragile health systems of Guinea, Liberia, and Sierra Leone. For example, Liberia, a country comprised of approximately four million people, had only around sixty doctors prior to the outbreak3. At the epidemic’s height, doctors saw between eighty and one hundred twenty new cases per week4. Not only were doctors overwhelmed, but also relatives and friends of infected individuals were affected, since Ebola spreads primarily through person-to-person transmission. At the 2015 Pulitzer Center-Johns Hopkins Bloomberg Ebola Symposium, Liberia’s Deputy Minister of Health Tolbert Nyenswah remarked that the virus was “worse than war5.” The enemy in this situation was difficult to identify, and it broke down socioeconomic structures (e.g. less family caregiving due to Ebola’s contagious nature, unemployment, change in burial traditions, discontinued trade, closing of schools, decline in tourism) with lethal ferocity6. The fiscal statistics further solidify this socioeconomic collapse. According to a 2015 World Bank report, the total economic impact felt by Guinea, Liberia, and Sierra Leone in 2014 due to the epidemic was over half a billion dollars—nearly five percent of their combined GDP. Due to the confluence of such socioeconomic factors, fear and distrust spread across West Africa.

The Ebola virus

hurj spring 2016: issue 22

humanities and social sciences

Borders were closed, foreign personnel withdrew, and er, these documents largely concentrated on improving people stopped their daily routines. Unable to contain internal management and lack in-depth insight on how Ebola’s proliferation, West African governments sought the DoD could better prepare for similar crises in the international aid7. In September 2014, the United Na- future. In addition to such reports, the following recomtions Security Council established the U.N. Mission for mendations would further enhance the DoD’s position Ebola Emergency Response, its first-ever security mis- on global health security policy: sion that specifically addressed a health issue8. Even •U.S. Secretary of Defense Speech at the 2016 GHSA MSF, an organization that normally condemns military Ministerial: This action would emphasize to the interactors in humanitarian space, publicly called for U.S. national community that the DoD prioritizes the chalmilitary involvement9. Such actions made it clear that lenges of non-traditional security threats. The address the Ebola epidemic was outstripping the capacities of would convey the message that the DoD welcomes incivilian health organizations. teragency collaboration and the opportunity to be an The severity of the Ebola outbreak prompted a mas- agile, proactive, and responsible partner in the mission sive U.S. response. In addition to to protect global health. Furtherthe unprecedented number of U.S. more, no date has been announced health personnel already deployed for the 2016 GHSA Ministerial in Into West Africa, President Obama donesia, and top leadership interest also directed DoD troops there for would provide an impetus for conLiberia, a country... of firming this event. extra support, appointed an Ebola Response Coordinator, and an• Direct Patient Care Policy: U.S. approximately four nounced the Global Health Security Armed Forces should allocate more Agenda (GHSA)10. To complement million people, had only funding towards training programs President Obama’s stance, former about sixty doctors prior for military personnel regarding Secretary of Defense Chuck Hagel pandemic health care procedures. gave a unique speech at the first to the [Ebola] outbreak. U.S. soldiers would then be able GHSA meeting in late September to engage in impactful, direct pa2014 that highlighted the implicatient care and not be subjected to tions of the Ebola outbreak and controlled monitoring. This process outlined the DoD’s expanding inmay involve developing better pervolvement in global health issues at sonal protective equipment, investilarge11. gating active cases, and heightening the production or Despite the commitments of top leadership, the deci- distribution of anti-viral supplies (e.g. body bags with sion to send U.S. troops to West Africa was not without windows to see faces). opposition. Many expressed concern over the potential •Legal Policy: There was little precedent set regarding risk of infected personnel. The coordination process be- the legality of DoD involvement during health emertween the DoD and other agencies was extremely com- gencies. The DoD (particularly its Office of General plicated, since many factors—such as legal and quar- Counsel) and the U.S. Department of State should forantine measures—had not previously been formalized malize the means of providing legal protection to U.S. in U.S. policy. Ultimately through the reprogramming of personnel deployed in support of health crisis response over one billion dollars of leftover FY14 Overseas Con- operations. These actions would provide policymakers tingency Operations funds, U.S. troops were sent to Li- with greater strategic guidance and more options to beria under Operation United Assistance (OUA)12. Pol- enhance military relationships through existing defense icymakers stressed that OUA was an interim solution security cooperation policies. designed to provide what traditional health organiza- • Build Domestic Partner Support and Coordination: Betions desperately needed: speed and logistics support. sides GHSA efforts, the DoD (and other U.S. stakeholdU.S. soldiers facilitated rapid isolation of infected indi- ers) should continue convening monthly working groups viduals by building Ebola Treatment Units and moved regarding public health concerns within the U.S. In this food, medical supplies, and equipment via air, land, and way, officials can synchronize positions, stay updated ground13. Furthermore, U.S. military personnel were not on current developments, and build greater support allowed to engage in direct patient care and were quar- and trust for future coordination. These groups should antined for twenty-one days following the completion include appropriate stakeholders from across the DoD, of their deployment. OUA was terminated after WHO including assignments of lead Points of Contacts or USdeclared Liberia free of Ebola in May 2015. AID/HHS representatives within combatant commands and congressional staff. The DoD should also continue to pursue upgraded protection and access agreements Recommendations Multiple reports on lessons learned from OUA feature across Africa and elsewhere to prepare for more flexible observations regarding management of the Ebola crisis deployments in response to future health emergencies. and pinpointed certain areas for improvement. Howev-

humanities and social sciences A Turning Point for U.S. Global Health Security Policy The DoD’s presence in Liberia under OUA helped galvanize support for the counter-Ebola campaign and returned confidence to local health staff, NGOs, and foreign government representatives who had previously left the region. At a House Foreign Affairs Committee hearing, USAID Administrator Rajiv Shah commended the DoD’s “Herculean efforts”, describing how DoD labs “greatly accelerat[ed] the time it [took] to do diagnostics, from 7 or 8 days down to 5 or 6 hours.”14 Shah continued his testimony by describing how the “whole-of-government team” helped encourage more than $800 million in commitments from other countries15. These resources, Shah testified, were “essential in rapidly scaling up activities to control the outbreak at its source” and helped “strengthen global health security in the region.”16 Without DoD involvement, Shah believed that the fight against Ebola would have been much weaker and more protracted. Those opposed to expanding U.S. military involvement in the global health field argue that the work of preventing epidemics or saving lives should remain under the jurisdiction of traditional health and development organizations. In a blog by the Center for Global Development website, Director of Africa Center for Strategic Studies Kate Knopf describes several problems (e.g. mismatched commitment timelines, lack of legitimacy, and pervading cycles of violence) that could result from DoD involvement in global health and concludes: “If providing humanitarian aid and promoting development is in the United States’ national interest, then it should be done by those best-suited to do the job—civilian development experts.”17 Formally incorporating the military in such circumstances, she contends, would only contradict the DoD’s purpose and priorities. The 2014 West Africa Ebola Outbreak reveals a challenging intersection between global health and security in foreign affairs. This global health crisis demonstrates that overburdened and underfunded humanitarian organizations cannot counter similar disasters alone. The DoD has become an important stakeholder in global health and must establish the right precedence, metrics, and platforms through continual work on its global health security policy. Further policy development— beyond improvements to management—is essential. The recent Ebola outbreak not only exposed the weaknesses of West African health systems and traditional health organizations, but it also forced DoD officials to react and cooperate with other U.S. agencies in a field not yet fully defined by U.S. policy— namely, global health security. Little guidance exists in defining the DoD’s role, and the Ebola epidemic put tremendous pressure on stakeholders to pave a new path. This gap in U.S. policy must be closed in order to ensure a more robust and cohesive U.S.

hurj spring 2016: issue 22 response. At the center of this complex global health security issue is a question about future investment: should the DoD dedicate efforts and funding to prepare for health crises? The answer is yes—not only because of the DoD’s civilian-military and military-military relationships, but also because of its immense command-and-control, logistics expertise, training, and engineering support capacity. Pandemics are not likely to go away, and their unpredictable nature will continue to put U.S. personnel and security interests at risk.

References 1. Department of Defense (DoD). The United States President’s Emergency Plan for AIDS Relief website. http://www.pepfar.gov/about/ agencies/c19397.htm. Published 2011. Accessed November 20, 2015. 2. Michaud J, Moss K, Kates J. The U.S. Department of Defense and Global Health Report. The Henry J. Kaiser Family Foundation website. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8358. pdf. Published September 2012. Accessed December 2, 2015. 3. Stylianou N. How world’s worst Ebola outbreak began with one boy’s death. BBC News Africa website. http://www.bbc.com/news/ world-africa-30199004. Published November 27, 2014. Accessed December 3, 2015. 4. Pike J. Operation United Assistance – Ebola 2014. Global Security website. http://www.globalsecurity.org/military/ops/united-assistance.htm. Updated October 5, 2015. Accessed November 14, 2015. 5. In a conversation with T. Nyenswah, MPH (September 2015). 6. United Nations Development Group (UNDG) – Western and Central Africa. Socio-Economic Impact of Ebola Virus Disease in West African Countries: A call for national and regional containment, recovery and prevention. UNDG website. https://undg.org/wp-content/uploads/2015/07/ebola-west-africa.pdf. Published February 2015. Accessed March 22, 2016. 7. Muhumuza R, DiLorenzo, S. Ebola Aid For West Africa Gets A Boost from the International Community. Huffington Post website. http:// www.huffingtonpost.com/2014/10/27/ebola-aid-africa_n_6053572. html. Published October 27, 2014. Accessed November 3, 2015. 8. UN Mission for Ebola Emergency Response (UNMEER). UN Global Ebola Response website. https://ebolaresponse.un.org/un-mission-ebola-emergency-response-unmeer. Updated 2016. Accessed October 27, 2015. 9. MSF International President: United Nations special briefing on Ebola. MSF website. http://www.msf.org.uk/node/26146. Published February 9, 2014. Accessed October 15, 2015. 10. About. The Global Health Security Agenda website. https://ghsagenda.org/about.html. Accessed October 4, 2015. 11. Secretary of Defense Speech: Remarks at the Global Health Security Agenda. U.S. Department of Defense website. http://www. defense.gov/News/Speeches/Speech-View/Article/605613/remarks-at-the-global-health-security-agenda. Published September 26, 2014. Accessed October 5, 2015. 12. Epstein SB, Lister SA, Belasco A, Jansen DJ. FY2015 Budget Requests to Counter Ebola and the Islamic State (IS). Congressional Research Service. http://fas.org/sgp/crs/row/R43807.pdf. Published December 9, 2014. Accessed September 29, 2015. 13. The White House Office of the Press Secretary. FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa. The White House website. https://www.whitehouse.gov/the-press-office/2014/09/16/ fact-sheet-us-response-ebola-epidemic-west-africa. Published September 16, 2014. Accessed March 22, 2016. 14, 15, 16. Pellerin C. USAID Administrator Praises DoD Effort in Ebola Fight. U.S. Department of Defense website. http://www.defense. gov/News-Article-View/Article/603640/usaid-administrator-praises-dod-effort-in-ebola-fight. Published November 13, 2014. Accessed January 18, 2015. 17. Knopf KA. DoD and Global Health: Time for a Dose of Development Realism. Center for Global Development website. http://www. cgdev.org/blog/dod-and-global-health-time-dose-development-realism. Published May 20, 2013. Accessed March 20, 2016.

hurj spring 2016: issue 22

humanities and social sciences

An Academic Climate Hijacked by Melodrama1 Cara Schulte, Class of 2016 Political Science and Public Health

I. Title IX, Distorted Gender discrimination in American public education became an issue of public debate amidst the rise of second-wave feminism in the middle of the 20th century.2 While there existed a plethora of visible inequalities, obvious resource imbalances between men’s and women’s athletic teams seemed to garner a critical sum of public attention. This attention resulted in landmark federal action. Congress enacted Title IX of the Education Amendments of 1972 as a means of prohibiting discrimination based on sex in any federally funded education program or activity. The initial intent of Title IX was made explicitly clear by the United States Department of Justice. What was less clear, however, was the way in which Title IX’s broad oversight might be manipulated for future application. Since 1972, Title IX’s scope has become increasingly elastic.3 In many ways, the ability to assert gender equality and to prevent sexual discrimination, harassment, and violence across a variety of circumstances has been invaluable. The unforeseen consequences of Title IX’s apparent “universal” application, however, are numerous. In the hands of a generation marked by extreme political correctness, the intent of an otherwise comprehensive law has been perverted; newfound functions of Title IX have become oppressive in nature in that they are hindering candid debate – a characteristic that once defined academia – and ultimately impeding upon our First Amendment rights.4 Academic freedom is shrinking in the face of hypersensitivity. This article intends to explore the role of Title IX in relation to freedom of speech. More specifically, the piece plans to examine this relationship within the context of a case study that recently took place at Northwestern University in which a professor was charged with a violation of Title IX after publishing an opinion piece about new policy put forth by the academic institution at which she is employed. After establishing a detailed foundation of the case study at hand, the article will assess the application of Title IX in this instance. This analysis will then be used to make claims about the current value of academic freedom and the future implications of silencing controversial voices.

II. Case Study: Professor Laura Kipnis, Northwestern University Laura Kipnis, a self-proclaimed feminist, is a highly regarded and decidedly provocative film professor at

Northwestern University. About a year ago, Northwestern put forth a policy to which Kipnis refers as the “Great Prohibition.” The policy served as a formal ban on consensual romantic or sexual relationships between faculty and students. In February, Kipnis published an opinion piece in The Chronicle of Higher Education titled, “Sexual Paranoia Strikes Academe.” The piece argued against her school’s ban on sex between professors and students, but more broadly against the growing obsession with trauma and vulnerability among feminists on campus. She wrote, “If this is feminism, it’s feminism hijacked by melodrama,”5 claiming that commotion associated with the ban created an obsession with the play between students as “helpless victims” and academic superiors as “powerful predators”. She maintained that the policy both infantilized students and inappropriately increased the power of the university over affiliates’ personal lives, overtly criticizing the attempt to regulate human nature. Kipnis felt the rule established the university environment as an unrealistic sanctuary in which students were shielded from feelings of discomfort, from unequal power arrangements in romantic contexts, and from the “boorish badlands of real life”.6 Citing cases in which she felt this concept had already come to fruition, she argued that this form of protection was excessive and could only result in a striking lack of agency amongst students, as inspired by an increased sense of vulnerability. The piece, lawful or not, was indeed contentious. Protestors pounced immediately, claiming that they wanted the administration to take action against the alleged violence expressed by Kipnis’ message. They called for a “swift, official condemnation” of the article.7 This sentiment was supposedly largely related to apparent factual liberties Kipnis had taken in relation to the specific cases she had citied in her article. As previously discussed, Title IX of the Education Amendments of 1972 prohibits sex discrimination by higher education institutions receiving federal funding. It also prohibits universities from retaliating against students who file Title IX complaints.8 The text defines retaliation as specific to intimidation, threat, coercion, or discrimination against the party that has filed the complaint. In this case, complainants believed that Kipnis’s essay had a “chilling effect” and that it would therefore discourage students from reporting future occurrences of sexual discrimination, harassment, or violence.9 Under the assumption that her language could be regarded as

humanities and social science

hurj spring 2016: issue 22

intimidating or threating, complainants charged Kipnis with a violation of the law as put forth by the Title IX imperative: retaliation. Though largely irrelevant to the greater purpose of this case study, it is worth noting that during the proceedings of this allegation Kipnis was not initially informed of the specific grounds of the charges, denied the right to a lawyer, and forbidden from recording her interactions with investigators.10 Despite the aforementioned hurdles, Kipnis maintained throughout the entire process that her February op-ed was protected as free speech under the First Amendment and that she did not violate Title IX by publishing it. Investigators later determined the allegations against her were unsupported by the preponderance of evidence and the charges were dropped.

III. Unchecked Application of Federal Law Title IX was not intended to, nor should it, regulate free speech. In a 2014 guidance letter, the Education Department officially advised colleges that the law should not be used in this way, asserting that, while “Title IX protects students from sex discrimination; it does not regulate the content of speech. OCR [The Office for Civil Rights] recognizes that the offensiveness of a particular expression as perceived by some students, standing alone, is not a legally sufficient basis to establish a hostile environment under Title IX.”11 Within the context of the charges brought against Laura Kipnis, the law was quite obviously manipulated. Regardless of one’s personal estimations about the film professor’s opinion piece, it is clear that the publication was not criminal. Kipnis simply embraced one of the liberties granted unto her by the First Amendment of the U.S. Constitution. While complainants alleged Kipnis’ language was considered threatening or intimidating to students involved in cases of sexual discrimination or harassment, they again misstepped in their interpretation of the greater function of Title IX. First, it is wildly unclear how a preponderance of evidence could ever be established in support of the threatening nature of her writing. There is no quantitative measure for deduced threat. Second, Title IX relation only applies to academic institutions receiving federal funding. This means that the retaliation clause applies only to institutions or to persons acting on those institutions’ behalf. This raises a curious issue in that charges must have then been held under the assumption that Kipnis was acting on behalf of Northwestern University. While it is obviously a responsibility of employees of the school to understand that their actions represent their greater academic institution, this

responsibility should not hinder personal freedom. Title IX, when applied in this way, then, forbids employees from voicing opinions about nationally reported legal cases simply because those events occurred at their place of work. Kipnis questions if this means that “academic freedom doesn’t extend to academics discussing matters involving [professors’] own workplaces.”12 As Kipnis understands it, “Any Title IX charge that’s filed has to be investigated, which effectively empowers anyone on campus to individually decide, and expand, what Title IX covers.” In response to this, Joe Cohn, legislative and policy director at the civil liberties group for the Foundation for Individual Rights in Education, argues that academic institutions should have the ability to review cases such as this one and to dismiss complaints before an investigation takes place, analogous to a court’s ability to dismiss a lawsuit.13 Early this summer, likely a direct result of the Northwestern investigations and cases of the like, The House Subcommittee on The Constitution and Civil Justice held a hearing devoted to the issue of “First Amendment Protections on Public College and University Campuses” to address overly broad policies and the responsibility of public universities. While any clarifying action can certainly be considered a success, Title IX’s apparently ambiguous scope is an issue greater than legal confusion. The issue is one of academic freedom. The inquisition at hand, like others of its kind, sheds light upon the need for distinction between intellectual disagreement and offensive discourse. It raises questions about our generation’s obsession with “safe spaces,” the value of debate in academia, and, perhaps most importantly, the role of the university within the context of modern society.

Title IX was not intended to, not should it, regulate free speech.

IV. Academic Tyranny What does Laura Kipnis’s experience with Title IX imply about our modern academic climate? George Leef of Forbes Magazine seems to believe investigations of this nature emphasize the way in which “federal intervention in higher education has empowered bureaucrats to whittle away at free speech on (and even off) campus.”14 While the majority content of her original publication is largely irrelevant to this discussion, ultimately Kipnis’s thesis does inspire thought; what is (and should be) the role of university in the lives of students, staff, and society at large? The students at Northwestern, who filed complaints about the film professor’s publication and went so far as to press charges, were effectively demanding the university to protect its students from “the affront of someone’s ideas.”15 Once understood in this manner, the case appears ludicrous. Intellectual disagreement is

hurj spring 2016: issue 22 not a crime; in fact, it has served as a defining facet of American democracy for over two centuries. Students pursue schooling in an attempt to know what they have previously not known; this requires exposure to ideas and opinions other than the ones they hold themselves. It is the place of the university to provide an open forum for debate, and, of course, to mediate that debate to ensure the safety of all its affiliates. The scope of safety, however, should not limit exposure to intellectual commentary, nor should it facilitate widespread self-censorship. Safety should serve as a supervising mechanism through which students and professors alike should feel able to freely express their own thoughts and to engage with the thoughts of others. Let us explore this notion in relation to the concept of a “comfort zone.” Alasdair White, British management theorist, defines this as a behavioral condition in which an individual exhibits an anxiety-neutral state of being. Just beyond this comfort zone, according to White, exists an “optimal performance zone,” marked by a biological stress mechanism that both intensifies and enhances an individual’s experience.16 Body chemistry aside, higher academic learning relies on this ability of individuals to exit their comfort zones, in the colloquial sense or otherwise, and to interact with conflicting opinions and sensitive subject matters that have the potential to cause discomfort. Knowledge is fostered through a malleable relationship with, and dynamic definition of, the unknown. The unknown is, naturally, uncomfortable. By pursuing further educational training, students should understand that they are consenting to engage with minor discomforts in exchange for intellectual stimuli, for the opportunity to challenge their own beliefs, and for the acquisition of knowledge. We must, then, ask ourselves – what are the implications of our quest towards a politically correct utopia? Does such a world exist or is the concept itself oxymoronic? Does the spreading obsession with “safe spaces” and trigger warnings actually contribute to our own sense of vulnerability? What are the dangers of equating emotional discomfort to, as Kipnis puts it, material injury? A world in which students are granted the authority to dictate the expression of their professor’s viewpoints, either directly or via the pressure of self-censorship as brought on by the threat of legal action, is a world absent of academic freedom. How, then, might universities work to move away from this emerging culture of hypersensitivity and sensationalism while continuing to foster a positive learning environment? Universities serve as hubs of intellect that aim to challenge the status quo, to generate new information, and to prepare young minds with the capacity to approach the challenges their generations will inevitably face. In this sense, universities should function as microcosms of society at large, emphasizing both diversity and freedom. In an American context, university life should embody democratic ideals; all opinions should find repre-

humanities and social science sentation and all persons should feel a sense of agency through this freedom of expression. The role of Title IX, then, in relation to the creation of safe academic settings, is no less than was originally intended; it was enacted to promote equality and to foster a positive learning environment for all individuals and should continue to serve as such. The law should endure as a mechanism through which cases of sexual discrimination, harassment, and violence are addressed. Individuals have the right to be free from a hostile educational environment. Hostile, however, must then be formally defined. A review system of Title IX complaints should be put in place to ensure appropriate application of the statute; Title IX serves to ensure this form of discrimination does not impede upon an individual’s ability to activity participate in their university and should be applied in accordance with this notion. Individuals do not have the right to qualify the opinions of others as a violation of Title IX simply because they have been offended; while this is an obvious abridgement of personal freedoms, it is also important to recognize the destructive nature of this politically-correct ideal towards the foundation of academic discourse. Safe spaces cannot and should not be defined by the restriction of contentious views but rather by the ability of persons to express these views without feeling threatened, legally, sexually, or otherwise. It is the university’s role, then, to both promote and supervise the interaction of these views and to put forth experienced, thoughtful minds capable of meaningful contribution to society.

References 1, 5, 6. Kipnis, Laura. “Sexual Paranoia Strikes Academe.” The Chronicle of Higher Education 27 Feb. 2015, Opinion sec. Web. 9 Dec. 2015. Kipnis, 27 Feb. 2015 2. Anderson, Deborah J., John J. Cheslock, and Ronald G. Ehrenberg. “Gender Equity in Intercollegiate Athletics: Determinants of Title IX Compliance”. The Journal of Higher Education 77.2 (2006): 225–250. JSTOR. Web. 3. McCarthy, Martha M.. “Clarification of Title IX: The Congressional Challenge”. Educational Horizons 63.1 (1984): 32–33. Web. 4. Gavora, Jessica. “How Title IX Became a Political Weapon.” The Wall Street Journal 7 June 2015, Opinion sec. Print. 7, 9. “Petition for administrative response to Prof. Kipnis” 3 Mar. 2015. Web. 8. Title IX of The Education Amendments of 1972, 20 U.S.C. A§ 1681 ET. SEQ. 10, 12, 15. Kipnis, Laura. “My Title IX Inquisition.” The Chronicle of Higher Education 29 May. 2015, Review. Web. 10 Dec. 2015. 11. “Questions and Answers on Title IX and Sexual Violence” United States Department of Education; Office for Civil Rights. 29 April 2014. Title IX of The Education Amendments of 1972, 20 U.S.C. A§ 1681 ET. SEQ. 13. Kingkade, Tyler. “How Laura Kipnis’ ‘Sexual Paranoia’ Essay Caused A Frenzy At Northwestern University,” Huffington Post. 31 May 2015. College. 9 Dec 2015. Web. 14. Leef, George. “Free Speech Can’t Be Trumped By Title IX -- But College Officials Use It That Way” Forbes Magazine. 14 Sept. 2015. Web. 16. White, Alasdair. From Comfort Zone to Performance Management: Understanding Development and Performance. White & MacLean Publishing. 1 Dec. 2009. Print.

humanities and social sciences

hurj spring 2016: issue 22

The Influence of Western Hegemonic Culture on the Historical Development of Sexuality in the Middle East Dikshant Malla, Class of 2017 Sociology

Introduction In 2005, Iranian president Mahmoud Ahmadinejad proclaimed there were no homosexuals in his country. His remarks produced the all but familiar narrative of the Middle East as a “regressive” and “intolerant” region. However, the narrative of intolerance is based on an ahistorical analysis that is convenient for Western hegemony. In fact, a historical analysis of the Middle East would find that premodern Arabic society held more progressive views on same-sex contact than most European societies. The West’s limited knowledge of the Middle East speaks to Edward Said’s theory on orientalism, defined as the influence of Western epistemology over the East. In this paper I will discuss the influence of Western hegemonic culture on the historical development of sexuality in the Middle East: first through the emergence of Victorian attitudes, which produced hostility towards same-sex relationships. Then through the rise in Gay International, and how establishment of “gayness” as a universal sociopolitical identity has increased the marginalization of queer individuals, and finally through the discussion of “pinkwashing,” as Israel’s branding strategy to distance itself from the violence of the occupation in Palestine, and how it sanitizes colonial oppression. Through the discussion of sexual development, the reader is exposed to the consequences of applying Western ideals in Middle Eastern society, namely the increased criminalization of individuals participating in same-sex contact.

Historical Analysis In premodern Arab/Islamic society, practicing samesex contact was quite common. While the Qur’an specifically references sodomy as a criminal act punishable by death, in premodern Arab-Islamic culture same-sex relationships for men and women “were implicitly recognized cultural practices, as long as they remained discreet and respected certain conventions”. In Before Homosexuality in the Arab-Islamic World, 15001800, Khaled El-Royayheb argues that the identification of individuals as “homosexuals” is not applicable to premodern Arab/Islamic society, rather “distinctions not captured by the concept of homosexuality [are] all-important from the perspective of the culture of the period. The first distinction was between “active” and “passive” sexual roles. Similar to classical Greek and Roman culture, premodern Arab/Islamic culture

did not conflate gender to sexuality, rather relied on specification of ones sexual roles. While men assuming the “active” role in same-sex relations were viewed as natural, men who assumed the “passive” role were labeled as ma’bun, an abnormal type of person who exhibited deviant behavior, and violated gender roles. The prominence of same-sex relations was also present in Arabic literature, as Royayheb agues that there were numerous, and casual allusions to homosexual love and “much if not most of the extant love poetry of the period is pederastic in tone, portraying an adult male poet’s passionate love for a teenager boy”. Even prominent religious scholars such as Abdallah al-Shabrawi, from the Azhar College, wrote poetry about falling in love with beardless boys. Scholars relied on distinctions between falling in love with young boys, and expressing that love through their literary to committing sodomy with a boy. They also believed that their literary works had a metaphysical dimension such that their love for young boys was representative of “personally experiencing the overwhelming beauty of god”. The 19th century bought major changes in attitudes in same-sex relations in the Middle East largely due to the influence of European culture. Michael Foucault states that homosexuality as a distinct category emerged in 19th century Europe, specifically in Westphal’s 1870 article in Archiv für Neurologie “the sodomite has been a temporary aberration; the homosexual was now a species”. Foucault further argues that the emergence of homosexuality was due to the “incorporation of perversions and a new specification of individual” in the Victoria era where a sexual identity was placed in a binary. He further elaborates on the emergence of homosexuality: “Nineteenth century homosexual became a personage … in addition to being a type of life, a life form…. Nothing that went into his total composition was unaffected by his sexuality” As homosexuality gradually became a distinct category, it started to attract “disapproval” in the Middle East. Royayheb states that European travelers complained about sexual fluidity in the Ottoman Empire, and were alarmed by Arab men’s passion for younger boys. By the early 20th century, many Arab historians and literary scholars became hostile towards same-sex relations and were “clearly uncomfortable with the pederastic themes in their literary heritage”. For instance in 1925, Arabic literature designed for use in higher education stated that love poetry about boys “was a crime against literature and a disgrace to the history of

hurj spring 2016: issue 22

humanities and social sciences

Arabic poetry”. Moreover, the introduction of homosex- Orient, that contrast the progress of the West to backuality also influenced Arabic language and led to ter- wardness of non-Western cultures. minological innovation. Whereas in premodern Arabic Assertion of cultural hegemony is evident through the jinsī meant “genus” or “kind” or sometimes “biological emergence of Victorian attitude, defined by sexual resex”, the term shudhūdh jinsī was a term introduced to straint and a strict code of conduct, as progressive, raexpress contemporary European concepts of “sexual in- tional and civilized. The creation of a distinct European version” and “sexual perversion”. Beyond literary schol- identity defined by morality and virtue is then contrasted arship, the emergence of homosexuality also influenced to the “barbaric”, “uncivilized”, and “irrational” practice Arab society. In Iran during the Qajar period, the notion of same-sex in Arab-Islamic culture. The characterizaof beauty was not gender-differentiated. However be- tion of Arabic poetry as inherently vice is further proof ginning in the 19th century, male beauty as an object of of cultural hegemony as it seeks to first problematize desire was disavowed, and love was “heterosexualized” Arab-Islamic literature and later destroys that culture. as Iranians became aware that Europeans considered Additionally, the introduction of “homosexuality” is a same-sex relationships a vice. product of hegemonic discourse that destroys cultural In the second half of the 20th century, a further trans- understandings of sexuality in the Middle East. Homoformation occurred in attitudes towards homosexuality sexuality is a European concept that places sexuality in the Middle East. Dalacoura argues that homosexu- on a binary between heterosexual/homosexual, a prodality was seen both as reprehensiuct of Victorian attitudes to label ble and “the Western cultural onsame-sex relations as perversions. slaught against ‘authentic’ Middle As Royayheb states, homosexuality Eastern cultures” as a response to is a foreign concept that cannot be The persecution and the West’s gradual acceptance of applied to premodern Arab-Islamic eventual execution of society since sexuality exists within homosexuality. The rapid increase in homophobia was evident during a spectrum. The application of the two teenage boys... the 1979 Iranian Cultural Revolubinary in the Middle East destroys show the repression of the traditional distinctions adhered tion when leftist-Islamic leaders openly criticized the Shah’s gender in premodern Arab-Islamic society, sexual freedom. reforms, and prominent political and problematizes the practice of thinkers like Ali Shariati, denounced same-sex relations by labeling it Western recognition of gay lifeabnormal. Discursive hegemony is styles and the small subculture of also evident through terminological gay men in Tehran. Furthermore, the persecution and innovation as shudhūdh jinsī was added into the Arabic eventual execution of two teenage boys in 2005 and vocabulary to define European concepts of sexuality, the 2001 Queen Boat incident all show the repression of and the concept was later added into Arabic psycholsexual freedom. ogy textbooks to refer to sexual deviance. Words for homo-or heterosexuality have also been invented recently as mithliyyah or sameness refers to homosexuOrientalism The radical transformation of sexuality and the criminal- ality while, ghayriyyah or differentness refers to heteroization against homosexuality is a product of oriental- sexuality. ism. Edward Said, using Foucault’s theory on discourse, The legacy of Western cultural influence is most visible argues that orientalism is “a Western style of dominat- in the latter half of the 20th century, specifically 1980s ing, restructuring and having authority over the Orient”. and onwards, after the emergence of the Gay InternaEmploying Antonio Gramsci’s theory on hegemony, tional. Joseph Massad introduces this concept of the Said states that the West asserts its dominance through ‘Gay International’, in reference to Western white-male cultural hegemony, where “the depiction of European dominated “gay rights” organizations, and defines its identity [is] superior to non-European people and cul- mission to “defend the rights of ‘gays and lesbians’ all tures” . Therefore culture is “part of the reproduction of over the world and to advocate on their behalf”. Massocial and economic systems of power” that legitimizes sad argues the Gay International produces two kinds of hegemonic elites. The foundation of cultural hegemony literature on the Arab/Islamic world in order to propcan be traced back to Napoleon’s conquest of Egypt as agate their cause: academic literature ‘describing’ and he brought scientists with him to survey the native pop- ‘explaining’ what they call “homosexuality”, and journalulation. Said argues that the survey of Egyptians and istic account of the lives of “gays” in the contemporary the translation of that into popular text is cultural hege- Middle East. Academic scholarship describing homomony because it demonstrates “the power and prestige sexuality is limited to the understanding of white male of a modern European country that can do to the Egyp- Europeans or American gay scholars. For instance, Arno tians what the Egyptians cannot do the French”. Said Schmitt, a prominent German scholar, relies on oriental also argues that orientalism operates through legitimiz- understanding of the Middle East as a Muslim society ing power structures by constructing ‘truths’ about the to examine same-sex relationship. He justifies the use

humanities and social sciences

hurj spring 2016: issue 22

of the Qur’an to study Muslims in the 20th century by sex contact as criminal offense, so the chief prosecutor saying condemned the men’s action by emasculating them “because the behavior of Muslims today can be seen and equating gayness to a lack of manhood and calling as modifications of older behavioral patters, the study them un-Egyptian. The vilification campaign of these of …[sexuality]… should start from the old texts. Study men is a result of the emergence of gayness as a Westof modern texts, conversation, and encounters with ern concept, and while the incident resulted in internathem and observations of Arabs…help us understand tional media coverage, it was only an attempt to serve not only the modern behavior but the old text as well.” Western hegemonic interests. Again, through the trail, Schmitt’s research methods and rhetoric are heavily the Gay International constructed a narrative about influenced by orientalism. First his assertion that Musgay men engaging in gay culture, only to be repressed lim society is a “modification” of older traditions conby their regressive homophobic government. However, flates Arab/Islamic culture as one, and assumes that as Massad argues, this narrative misses the important culture is stagnant and ahistorical. Second, his use of distinction that it is not same-sex sexual practices that “us” refers exclusively to Westerns scholars, alluding are being repressed but rather “the sociopolitical idento the idea that “Arabs and Muslims can only be the tification of these practices with the Western identity objects of European scholarship and never its subjects of gayness”. While the universalization of gayness in or audience”. Additionally, Schmitt’s “encounters” the Middle East has resulted in the emergence of gay with gays in the Middle East is limited to his expericulture, this is exclusively the case with wealthy individence with wealthy, upper class individuals who have uals who live a Westernized life, for the regular, average fully assimilated into Western culture and self-identiindividual who practice same-sex contact, life has gotfied as gays , thus it does not speak to the experience ten worse: of the whole population. Schmitt’s use of orientalist “The Gay International…[is]… responsible for the intenmethods is a testament to the influence of Europesity of this repressive campaign… [it]is proving to bring an cultural hegemony, similar to the scientists during about more repression, not “liberation”, and less sexuthe Egyptian conquest; European scholars have the al freedom rather than more for Arab men practicing power to produce scholarship about the “other” that same-sex contact” mischaracterizes them. The Gay International has “hetFurthermore, the very foundation erosexualized” Middle Eastern of the Gay International is framed culture by eliminating the “active/ within the context of Western hepassive” distinction, such that Massad argues that the gemony. By introducing Western “active” participants in practicconcepts of sexuality as a binary very politicization of gay- ing same-sex contact are forced of homo/hetero, the Gay Internaness and victimization of to identity as heterosexual, while tional produces an epistemology participants “no longer the Middle Eastern popula- “passive” that universalizes the experienchave access to [their] sexual obes of individuals practicing same- tion result in more repres- ject choice”. Secondly, the sociosex contact by labeling them as sion of individuals practic- political identification of gayness gay or lesbian. Additionally, the has resulted in “… police perseing same-sex contact. emergence of gayness as a sociocution …[and] heightened social political identification “divides the denigration as…sexual practice world into those who support and becomes a topic of public disthose who oppose “gay right”. This course that transforms it from a serves the interest of the Hegemonic cultural project practice into an identity”. as it produces a narrative of the gay Muslim stuck in In the Middle East, Orientalism is also a political tool an “oppressive-and in come cases murderous-homethat attempts to create a façade of Israel as a demland” that need to be reoriented to the “more enlightocratic and liberal nation to distance itself from the ened Occident”. Massad argues that the very politreality that it is a settler colonial and apartheid state. icization of gayness and victimization of the Middle Nada Elia argues that Israel creates this façade through Eastern population result in more repression of indipinkwashing. Pinkwashing is a “manifestation of Zionist viduals practicing same-sex contact. This is not to colonialist narrative of bringing civilization to an othsay that repression is a direct result of the politicizaerwise backwards land - a narrative that sanitizes the tion of gayness, as the rise in Islamism in Iran has cerviolence of occupation while erasing indigenous expetainly led to greater persecution of same-sex contact rience, struggle, and resistance”. The Israeli governdemonstrated by the execution of two teenage boys ment participates in pinkwashing through the “Brand in 2005, but rather that the Gay International’s politIsrael” program that attempts to show Israel as a modical project exacerbates the criminalization of sameern and relevant place instead of a place of fighting and sex contact. For instance during the Queen Boat, religion. The goal of re-branding Israel is twofold: first, there was no Egyptian conduct that specified samedistract individuals from Israel’s apartheid policies and

hurj spring 2016: issue 22 second, reproduce the Western cultural hegemonic narrative of “Israel as civilized, Palestine [as] barbaric, homophobic, uncivilized, suicide-bombing fanatics”. Tallie Daniel describes this branding strategy as cosmopolitics, where Tel Aviv is “[constructed]… as a liberal space separated from the staunchly undemocratic” Arab nations in the Middle East. This creates a narrative of Israel as a modern, civilized, democratic nation where gays are welcomed and celebrated. In turn, this produces oriental trope of Palestine as sexually regressive, but also “denies the impact of colonial occupation degradation and containment of Palestinian cultural norms and values- [producing] them as being homophobic”. Brand Israel is an attempt to further legitimize Western hegemony, and specifically American hegemony. Said argues that American orientalism is distinct from European orientalism as it is overtly political. Through pinkwashing, Israel is able to construct a narrative about Tel Aviv as a progressive, democratic city, and a gay oasis that provides an escape from the turmoil in the rest of the Middle East. Similar to the Gay International, Brand Israel is able to victimize queer individuals as being inherently repressed in Palestinian settlements, while simultaneously producing a savior-complex narrative about the heroic Israel who then comes in to save these people from homophobia. Meanwhile, the Israeli government is eschewing discrimination of Israeli citizens in Tel Aviv with orthodox religious individuals, the dehumanizing treatment of Palestinians, and its apartheid policies that discriminate against non-Jewish people.

humanities and social sciences in Arabic literature in the early 20th century and the alarming rise in homophobia, policing, and criminalization in the status quo.

References Daniel B. Tallie “Zionist Geographies: Neoliberal San Francisco, Pinkwashing, and Gay Palestine.” Spaces & Flows: An International Journal of Urban & Extra Urban Studies. 2011, Vol. 1 Issue 4, p49-57. Needham, Jayesh. “After the Arab Spring: A New Opportunity for LGBT Human Rights Advocacy?” Duke Journal of Gender Law and Policy: 287-323. Print. Dalacoura, Katerina. “Homosexuality as Cultural Battleground in the Middle East: Culture and Postcolonial International Theory.” Third World Quarterly (2014): 1290-306. Print. El-Rouayheb, Khaled. Before Homosexuality in the Arab-Islamic World, 1500–1800. U of Chicago, 2005. Print. Elia, Nada. “Gay Rights with a Side of Apartheid.” Settler Colonial Studies: 49-68. Print. Massad, Joseph Andoni. “Re-Orienting Desire: The Gay International and the Arab World.” Desiring Arabs. Chicago: U of Chicago, 2007. Print. Rastegar, M. “Emotional Attachments and Secular Imaginings: Western LGBTQ Activism on Iran.” GLQ: A Journal of Lesbian and Gay Studies (2012): 1-29. Print. “Transcript of Edward Said on Orientalism.” Web. 17 Dec. 2015.

Conclusion The development of sexuality is the Middle East is closely related to Orientalism. Throughout history, culture has been used as a political tool to depict Western identities as superior to non-Western identities. First, the emergence of Victorian attitude created a distinct European identity based around morality and sexual restraint. It created a narrative that assumed European cultural tradition as progressive and civilized while portraying the sexually fluid Arab-Islamic culture as barbaric. Similarly, the recent rise in the Gay International and Brand Israel depicts gayness as a sociopolitical identity and equates gay rights with progression and rationality. By producing these narratives, both the Gay International and Brand Israel glorify Western cultural hegemony as liberal, progressive, civilized, and rational, while portraying the oriental narratives of the Middle East as regressive and barbaric. While the historical developments of sexuality in the 19th century and in the latter half of the 20th century are antithetic, the results are the same. Culture is used as a method of legitimizing the West while criticizing non-Western culture as uncivilized and regressive. However, it is important to note that while Western ideals might produce positive results in those nations, the application of such ideals in Middle Eastern society almost always results in greater repression of queer individuals, as demonstrated by the censorship

humanities and social sciences

hurj spring 2016: issue 22

A Brave New Feminist World:

The Effect of Parthenogenesis Cloning On Society’s Patriarchy Nisita Dutta, Class of 2019 Chemical and BIomolecular Engineering

Introduction How does scientific progress affect everyday life? Man has discovered gravity, gone to the moon, found treatments for cancer, and determined the genetic makeup for the entire human genome. Each of these breakthroughs has had significant social implications as well. Public discourse and opinion has changed, sometimes contributing not only to our knowledge, but to our humanity as well. By looking at the progress made between the 1970s and today, a relationship can be seen between human parthenogenesis cloning, a female-only form of reproduction, and the patriarchy that has dominated American society. As new technologies evolve, our gender norms and patriarchal social constructs are changing. New technologies in human genetic engineering and cloning have created a cloud of uncertainty around the patriarchy’s social dominance because they allow women to procreate without men. This has never been considered possible, historically giving men a sense of “superiority” over women. This superiority can be seen through the history of other reproductive technologies, in particular in vitro fertilization, liberal and conservative public opinions, and various fiction stories written between the 1970s and the present.

Background of Parthenogenesis Cloning and Patriarchy Parthenogenesis cloning is a technology that consists of removing the nucleus of one egg and inserting the nucleus of a somatic cell into it. The egg is then stimulated to undergo division, after which it can be implanted manually into a womb. If performed with female somatic cells, this technology would only produce female babies, making males entirely unnecessary in the reproduction process. Since 1975, this technology has been rapidly advancing in the field of mammalian reproduction, with its emergence influencing the way we view the existing patriarchy. Regardless of time or location, a patriarchy has prevailed through various cultures, religions, philosophies and economies. Traditional male domination and stereotypically aggressive masculinity are notions that have been expressed in the works of the world’s most influential philosophers and scientists. Many theories have evolved suggesting the limitations

and responsibilities of the female body in reproduction contribute to the biological basis of patriarchy. Countless sociologists and authors view reproduction as a main cause of inequality between genders. Frida Simonstein, a 21st century American author and editor, asserts that some feminists “suggested that equality would prove chimerical until children could be produced external to women’s bodies.” Simonstein goes on to highlight the cyber-feminist view which “present[s] technology as moving towards release from the constraints of the body.” According to Anita L. Allen, a current University of Pennsylvania law and philosophy professor, “Aristotle deemed women’s role in human reproduction to be that of a passive vessel of soil into which men plant the seed whence springs human life. The vital, active force, the seed, comes from man.” Thousands of examples of patriarchy are found across the world, dating back to ancient Mesopotamian literature of rapist kings in 150 BCE. Historically, this philosophical justification of patriarchy is what has given men social power. However, the power men received from the philosophical origin of patriarchy has since evolved into a general preference for men in society. Joan Offerman-Zuckerberg, a 20th century American clinical psychoanalytic, writes that preference for men is unquestionable when looking at “the requests of middle-class Americans for boys to adopt, and in the abortions of female fetuses in China.” These examples show although we may be centuries past the senseless reasoning behind justifying patriarchy, its consequences still haunt women today. Despite our sexist past, we are now dawning on a new age; an age where alternative reproductive technologies are becoming widely accepted and used. Now, due to various artificial insemination procedures, women no longer have to have sex in order to have a child. Going one step further, we see that parthenogenesis cloning, which is a solely female way of reproducing, could mean great improvement for the female society by signifying the end of the dominance of philosophies that portray women as inferior in regards to reproduction.

Influence of In Vitro Fertilization Different forms of assisted reproductive technologies (ART) started emerging as early as the 1790s, from the first successful case of human artificial insemination to Louise Brown, the first baby born through in vitro fertilization (IVF), in 1978. Up until Brown’s birth, ART procedures faced heavy social resistance and scrutiny. Simonstein notes, “despite much initial resistance by the medical community and by society, IVF has now firmly

hurj spring 2016: issue 22 established its place in the clinical management of infertility.” Although initially reluctant, mainstream communities eventually came to see the good IVF could do for infertile and homosexual couples. IVF even had a profound impact on our societal views of gender. Deeply ingrained gender roles influence parenting roles. Different forms of pregnancy and reproduction, however, allow us to break away from pre-determined gender biases, giving women more control over their bodies and decisions in bearing children. In addition, Andrea Bonnickson, a 20th century biotechnology policy research professor at Washington State University, says that IVF is a women’s political argument, and its applications should include feminist inquiries. Bonnickson writes, “in vitro fertilization, in particular, has made it possible for women to control their infertility.” This form of reproductive technology is already expanding possibilities for women and inspiring feminist discourse. Introducing human parthenogenesis cloning as a new player in reproductive technologies, we can assess its potential effects on ideas of patriarchy and femininity. Marie Aline Seabra Ferreira, an author and professor at the Portuguese University of Aveiro, tells us, “these new techniques, amongst which I will stress human cloning, have opened up the prospect of a revolutionary change in the way we consider sex roles and gendered conceptions of individuality.” Future progress of human cloning may have an even greater influence in subsiding patriarchy and giving women more autonomous rights than previous technologies, such as IVF, have had.

Public Opinion Public opinion on the use of parthenogenesis cloning, especially in regards to gender norms, tends to be extreme, favoring either a liberal or conservative viewpoint.

Conservative Opinion Greta Rensenbrink, a 21st century researcher on modern US social and cultural history, talks about the conservative opinion in the time that parthenogenesis cloning was being discussed. She explains these new technologies seemed especially threatening because women were taking control of reproduction. This line of reason is seen in various conservative dialogues. She clarifies the conservative opinion: By the early 1970s the impact of the women’s movement had become apparent in the increasingly worried predictions about how reproductive technologies might be implemented. Psychiatrist and ethicist Roderic Gorney argued that parthenogenesis posed a threat to American society. “Think what it could mean,” he expostulated, if women could have children on their own “and be certain that the offspring would all be girls!” Disdain for men could be passed down from mother to daughter, an attitude that “could lead to establishment of matriarchy, with eventual demand for separate statehood . . .If parthenogenesis was realized, women might

humanities and social sciences become the privileged sex or perhaps even a separate species embracing genocidal attitudes toward men.” Other conservative views include that of the Vatican in 1987: Donum Vitae stated, “Attempts or hypothesis for obtaining a human being without any connection with sexuality through ‘twin fission,’ cloning, or parthenogenesis are to be considered contrary to the moral law, since they are in opposition to the dignity of human procreation and of the conjugal union (173).” Nearly all religions are known to favor men in some sense, and although other reasons have been cited to oppose human cloning, the fact that institutionally patriarchal communities tend to oppose this technology most vehemently gives insight to how it is perceived to be affecting men and women in our society.

Liberal Opinion From a liberal standpoint, authors were beginning to acknowledge the fact that parthenogenesis could be a means by which women gain a separate kind of social standing – one that could reveal new possibilities in their perception and power. By looking at additional liberal opinions, it is obvious that people are starting to realize the social implications parthenogenesis cloning has on women. Allen says, “women may take competitive pride in being less dependent on men than vice versa to achieve their reproductive goals” This allows for women to gain reproductive control sans men. Davion discusses how cloning could improve women’s lives economically as well: Richard and Eric Posner speculate that the availability of cloning could lead some women to lose the desire to get married at all: “. . . Girls would no longer be likely to invest in complementary education; they would invest in whatever education would maximize their lifetime earnings independently of a husband’s career. The result would be an even more rapid entry of women into areas of the workforce traditionally dominated by men than we are observing today. Human cloning might thus portend an accelerating breakdown of traditional roles of men and women and facilitate the emergence of a class of wealthy and powerful women - both disturbing prospects to men and women who hold traditional views of sex roles.” (quoted in Nussbaum and Sunstein 1998, 47). Parthenogenesis cloning could give women the economic and social freedom they have been striving for throughout the centuries. From a social aspect, Ferreira claims the notion of women being “child-carers” would gradually disappear, creating “similar career opportunities” for women, as they would not be limited by their anatomy. As shown, notable authors hold various opinions on the effects of parthenogenesis cloning on female anatomy, the deterioration of existing gender norms, and, consequently, women’s role in society.

humanities and social sciences According to Rensenbrink, “producing only daughters, parthenogenesis offered a scientifically grounded argument for the possibility for a totally separate women’s world.” This idea was a very prominent one, inspiring historical movements, trends, and fiction novels.

Historical Social Trends A women’s separatist movement was a surprising trend during the 1970s. Lesbians in particular strived toward an all-female society. Around this time, parthenogenesis cloning was making breakthrough discoveries in mammals, and discussing its potential applications to human reproduction. Rensenbrink explains, “separatist communities developed in urban areas, especially San Francisco and New York, and increasingly on rural land communes across the United States. This social separatist movement can be linked to the evolution of female-only reproductive technologies. Rensenbrink also writes, “parthenogenetic discourse was very much shaped by these shifts within separatist communities, politics, and theory. Evoking unlimited possibilities in the early years, parthenogenesis became increasingly significant as an answer to the problem of reproduction for all-female communities.” This movement truly highlights how gender and patriarchy were affected by cloning as a new reproductive technology; these communities neither wanted nor needed men. It shows that some groups of women did not consider men important in society, but rather easily discardable, increasing the power of women and diminishing that of men.

Fiction A good indicator of a society’s status is the fiction works written during a time period. Feminist science fiction writers such as Ursula Le Guin have come up with altered worlds where gender does not exist and people are a combination of both sexes in her novel Left Hand of Darkness, published in 1969. When analyzing women’s literary utopias, we see that “a remarkable number of them propose either an androgynous utopia, as in Marge Piercy’s Woman on the Edge of Time, or an idealized, pastoral world in which men are conspicuously absent – a feminist, separatist utopia – such as we find in Sally Miller Gearhart’s The Wanderground, or Katherine Forrest’s Daughters of a Coral Dawn.” These books all propose a society where men do not exist – a vision made possible by parthenogenesis cloning. A noteworthy observation is the time in which these fiction novels were published. Woman on the Edge of Time was written in 1976, The Wandergroud in 1978, and Daughters of a Coral Dawn in 1984. These novels were influenced by society as well as influencing it at about the same time mammalian cloning was taking place. Jan Relf, a 20th century British author, tells of

hurj spring 2016: issue 22 her study of women utopias in fiction: Perhaps it is this powerful suggestion that men are utterly dispensable that causes critics like Widmer to respond with such virulence to “femtopia,” which he describes as a “minor literature of ressentiment,” as “mawkish,” “trivial,” “smug” and “reactive” (75, 63, 68, 65). Not only do the fictional women utopias show a matriarchal society, Relf also discusses conservative public opinion in reaction this genre. The conservative backlash to female utopias serves as an indication of the growing progressive ideals towards women’s equality. Conclusion For many years, women have struggled for equality. Much of the patriarchal prejudice has been justified by human anatomy and reproduction. Altering the way reproduction occurs also alters the traditional roles of male and female, consequently changing how people view gender. In America particularly, comparing Aristotle’s point of view to the social views today shows huge improvement in the treatment of women. Even still, women are legally allowed to be paid less for equal work and face harassment daily. New reproductive technologies, especially parthenogenesis cloning, provide hope for advancement in women’s rights. There have been significant social changes in public opinion, historical social trends, and fiction in America while parthenogenesis cloning was emerging, but the change is far from complete. If this technology is ever used on humans, the fear of females gaining too much power will take a significant lead in social debate. Despite the controversy, it is exciting to think the implications of human parthenogenesis cloning could include the liberation women have been working toward for centuries. References 1. Allen, Anita L. “The Poetry of Genetics: On the Pitfalls of Popularizing Science.” Hypatia 24, no. 4 (2009): 247-257. Accessed October 10, 2015. 2. Davion, Victoria. “Coming Down to Earth on Cloning: An Ecofeminist Analysis of Homophobia in the Current Debate.” Hypatia 21, no. 4 (2006): 58-76. Accessed October 10, 2015. 3. Ferreira, Marie Aline Seabra. “The Sexual Politics of Human Cloning: Mothering and Its Vicissitudes.” Journal of the Motherhood Initiative for Research and Community Involvement 4, no. 1 (2002). 4. Offerman-Zuckerberg, Joan. Gender In Transition: A New Frontier. New York: Plenum Medical Book Co., 1989. 5. Relf, Jan. “Women in Retreat: the Politics of Separatism in Women’s Literary Utopias.” Utopian Studies 2, no. 1/2 (1991): 131-146. Accessed October 10, 2015. 6. Rensenbrink, Greta. “Parthenogenesis and Lesbian Separatism: Regenerating Women’s 7. Community through Virgin Birth in the United States in the 1970s and 1980s.” Journal of the History of Sexuality 19, no. 2 (2010): 288316. Accessed October 10, 2015. 8. Scientific and Medical Aspects of Human Reproductive Cloning. Washington, D.C.: National Academy Press, 2002. Simonstein, Frida. Reprogen-Ethics and the Future of Gender. Dordrecht: Springer, 2009. 9. Westphal, Sylvia Pagán. “Take a thousand eggs—.” New Scientist 173, no. 2328 (February 2, 2002): 4-5. Applied Science & Technology Full Text (H.W. Wilson), EBSCOhost (accessed October 3, 2015).

hurj spring 2016: issue 22

humanities and social sciences

Evaluating Parental Involvement in the Provision of Clinical Contraception Raihan Kabir, Class of 2018 Molecular and Cellular Biology With over 600,000 pregnancies every year to young women ages fifteen through nineteen, teen pregnancy is undoubtedly one of the most troubling public health issues in the nation (Kost, 2014). The U.S. Department of Health and Human Services reports that parenthood during adolescence has negative repercussions on not only the social and economic well-being of a mother and her child, the latter facing “poorer educational, behavioral, and health outcomes,” but also on the expenditure of associated federal services that are funded by taxpayers, for whom teen childbearing costs “between $9.4 and $28 billion each year” (Office of Adolescent Health, 2015). Although public input may be justified in shaping these services, there remains substantial controversy surrounding the provisions that respond to teen pregnancy, specifically concerning abortion services. One approach to family planning that circumvents this heated debate over abortion is the anticipatory prevention of teen pregnancies by way of clinical contraception. As disparities in reproductive medical services continue to send a considerable population of youth through physical, social, and emotional turbulence, it becomes increasingly imperative to consider whether teens are effectively provided access to birth control. Adolescence is widely recognized as a period of physical and psychological growth that extends through the completion of cognitive development in adulthood, but because it’s a gray area, each state has its own protocol for determining access to clinical contraception for individuals under the age of majority. Usually, the parents of a child are granted legal responsibility to decide his or her medical care. The National District Attorneys’ Association (NDAA) reports that “twenty-one states and the the District of Columbia allow minors to consent to contraceptives,” but “twenty-five states permit minors to consent to contraceptives in certain circumstances” such as having a spouse, a previous or current pregnancy, or parental involvement, and the remaining “four states have not enacted a statute regarding this issue”

(NDAA, 2013). Whereas the use of birth control by those above the age of majority is usually permitted without third-party engagement, the mandate to involve parents in the case of a minor, whether by notification or consent, is warranted in part by claims that “parent-adolescent sexual communication… can positively affect safer sex behavior among youth” (Widman, 2015). Through her extensive meta-analysis published in the Journal of the American Medical Association (JAMA) Pediatrics, Dr. Laura Widman, an assistant professor of psychology at the North Carolina State University, synthesizes evidence from more than three decades of research on over 25,000 adolescents. She links a significant positive correlation between such communication and safer sexual behavior among youth. Dr. Widman considers parent-adolescent communication “a protective factor” and suggests that “a focus on communication remains justified” (Widman, 2015). Further rationale in support of parental involvement in adolescent’s access to contraceptives is that parents have the legal authority to make most medical decisions, and that their participation in minors’ family planning fosters positive outcomes in health and wellbeing. Whereas nearly half of all states enforce statutes explicitly permitting minors to consent to contraceptive services, there exists substantial support for the claim that minors should have the capacity to consent to birth control without parental involvement. Youth rights advocates argue that the mandate of either parental notification or consent may deter minors from seeking contraceptive services, and as such, it undermines the effectiveness of family planning and the efforts to reduce teen pregnancies. According to a survey of over five hundred nationally representative teens (ages 13 through 17) conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy, nearly 70% of youth agree that “the primary reason why teens don’t use birth control or protection is because they are afraid that their parents will find out.” Although opponents of expanding access may refute the scope of this claim by citing from this same survey that 68% of adults would help ensure the

humanities and social sciences use of birth control if they were informed of any sexual activity, teens are nonetheless apprehensive when faced with bringing up such a sensitive topic to the extent that they forego protection and surrender to the possibility of an unplanned pregnancy (National Campaign, 2015). Proponents of minors’ independent access to contraceptives further justify adolescents’ legal authority to consent to prescription birth control by highlighting legal cases in which doing so upholds the best interests of the individual’s wellbeing beyond the limitations of potentially conflicting parental viewpoints. Where one in four adults (18 and older) of over 1,000 surveyed would, in response to finding out that their teen was having sex, either “try to convince them to stop having sex [or] be angry and express disappointment,” a household that might fail to preserve the health of a minor in lieu of personal beliefs is far from uncommon (National Campaign, 2015). Dr. Widman recognizes the possibility of such a fault and states it best in her analysis: …while it is possible that parental communication about sex can be protective for youth, open sexual communication often does not take place… [and] instead, embarrassment, inaccurate knowledge, or low self-efficacy may prevent some parents from engaging their children in honest and supportive conversations about sexual behavior (Widman, 2015). Additional arguments in support of minors’ rights to consent to contraception with neither parental notification nor consent usually extends from this notion that mandating their involvement may deter from safe practices and lead to negative outcomes in public health. Whereas “all fifty states, the District of Columbia, and Guam permit minors consent to STI [sexually transmitted infection] services” such as testing and treatment, there exists a major divide between states’ policies on their right to access prescription contraception (NDAA, 2013). Despite the overall “long-term declines in teenage birth and abortion rates” (Kost, 2014), these rates are still among the highest of all developed countries (Office of Adolescent Health, 2015). Dr. Kathryn Kost, principal research scientist at The Guttmacher Institute, a highly accredited nonprofit research organization focusing on reproductive health policy, reports that this decline is driven by changes in contraceptive practices, namely the increase in use of birth control among young adults ages 18 to 19 (Kost, 2014). Perhaps, then, it is the inconsistency within youth reproductive rights that bars the nation from effectively reducing the rate of teen pregnancies. By evaluating the outcomes of adolescent health as a result of mandated parental involvement in contraceptive services, it becomes evident that the American justice system should federally extend to minors the authority to consent to birth control. While laws determining parental involvement in con-

hurj spring 2016: issue 22 traceptive access assume that an individual’s need for reproductive healthcare starts at the state-defined age of majority, sexual inclinations are triggered at the onset of puberty. Minors are usually rendered dependent by the law, but certain privileges such as the abilities to work, drive, and enlist, are all gradually granted to the individual as they reach adulthood. Academia usually characterizes this period of growth—adolescence—as a subset of chemical and biological processes that result in a transformational conglomerate of physical, intellectual, and emotional development (Kolbert, 2015). Elizabeth Kolbert, veteran staff writer at The New Yorker and Pulitzer Prize winner for general nonfiction, discusses many risks that teenagers inherently face and relates their social tendencies to scientific findings on adolescent neurodevelopment. She also writes on the inconsistency of laws between state lines, specifically mentioning the ages permitting minors to work, drive, drink, smoke, and enlist, which may successfully convey a sliver of frustration that sexually active adolescents face in seeking clinical contraception. However, differentiating between these other privileges and sex is that the maturity to engage in the latter is determined by human biology and thus involves a substantial population of teenagers. Whereas over 600,000 pregnancies were to young women ages 15 through 19, only 11,000 were among minors ages 14 and younger (Kost, 2014)—a statistic that should partially delineate an “account of the teenage brain” (Kolbert, 2015). Given that many adolescents over the age of fifteen are vulnerable to the health risks of sexual activities, requiring them to first either notify or obtain consent from a third party may hinder the delivery of care. Perhaps as a result of parental consent laws, further inconsistencies exist between the methods of contraception made available to minors in comparison to those for adults. The Kinsey Institute for Research in Sex, Gender, and Reproduction reports that the condom ranks third in popularity for choice of contraception, with the most popular being the birth control pill. While barrier contraceptives are usually made available at clinics and stores without a legal age requirement, more effective protection calls for medical attention and thus parental involvement. Hormonal methods of contraception such as oral birth control pills, injectables, and patches fail sig-

hurj spring 2016: issue 22

humanities and social sciences

nificantly less than do barriers, and long-acting reversible contraceptives such as implants or intrauterine devices (IUD) are found to be most effective (CDC, 2015). Whereas the Center for Disease Control and Prevention (CDC) asserts that “the effectiveness of birth control methods is critically important for reducing the risk of unintended pregnancy,” sexually active minors are limited from independently and confidentially accessing and utilizing prescription birth control by policies mandating parental involvement (CDC, 2015). Emergency contraception may be available for use after either unprotected sexual intercourse or a contraceptive failure, but these are strongly emphasized as not being “a regular method of birth control” (CDC, 2015). Granting adolescents the authority to consent to clinical contraception would thus favor greater access and utilization of more effective contraception and help reduce unintended pregnancies among teens. Before granting any individual such authority to consent to such services in lieu of a legal guardian, however, validation of their capacity to make reasonable decisions is warranted. Just as Kolbert questions whether “teenagers are under-informed or over impulsive” and calls for a “clearer account of the teenage brain” in making policies (Kolbert, 2015), Dr. Pierre-André Michaud and Dr. Robert W. Blum of the Switzerland University of Lausanne and the Johns Hopkins Bloomberg School of Public Health, respectively, in collaboration with 18 other members of a “multi-cultural, multi-disciplinary expert panel,” provide the first “policy guidance on how to assess the capacity of minor adolescents for autonomous decision-making without third party authorization” in their article published in the Journal of Adolescent Health. Michaud et al. ultimately suggest that “it is the healthcare provider’s duty to empower the adolescent” by assessing their thoughts on all options and their understanding of the situation, evaluating their reasons and unique condition, and “after this careful, step-by-step deliberation… [making] sure that the adolescent is able to express a choice” (Michaud, 2015). By differentiating between adolescents’ rights to contraceptive services and those provided to individuals above the age of majority, sexually active teens are, however, discouraged from these major tenets. Such trust and consideration of the adolescent, while bound by the authoritative guidance of a physician, is fundamentally in opposition to mandated parental involvement. However, this outlined dogma of teens’ capacity to make decisions is also dependent on the approach of the healthcare provider. Physicians conduct a scrupulous evaluation before prescribing birth control to patients of all ages. Although they play a significant regulative role in the process, pa-

rental involvement laws call for the authority of a third party in addition to professional medical recommendation. Dr. Kost reports that the pregnancy rate among women ages 15 through 44 is 54 unintended pregnancies per 1,000 women (Kost, 2014). However, narrowing this age range to adolescents up through 19 years of age significantly increases this rate to 127 pregnancies per 1,000 adolescents (Kost, 2014). Probability suggests that young patients are thus commonly asked to discuss sexual activity and contraception with their primary care physicians, who have developed insight on both patient trends and typical birth control practices, which Dr. Michaud outlines as necessary for any such healthcare provider (Michaud, 2015). Clinical contraception is prescribed by licensed medical practitioners at both clinics and private healthcare providers, including most Planned Parenthood health centers; regardless of the institution, however, the healthcare professional may be legally obligated to either notify or obtain consent from a minor’s parents if birth control is requested, depending on state law. Vermont is one of “four states [that] have not enacted a statute regarding” parental involvement in clinical contraceptive services and abdicates such judgment to the physician (NDAA, 2013). Dr. Catherine Rude, an associate professor of pediatrics at the University of Vermont College of Medicine and a pediatrician specializing in both developmental-behavioral pediatrics and health supervision, cares for children from birth through their teens. Moreover, she has a comprehensive understanding of contraceptive services and family planning as they relate to adolescents. Dr. Rude reveals in an interview that she usually ensures that all of her teen patients are made aware of birth control (Rude, 2015). Her practice oversees the provision of both birth control pills and the injectable birth control shot, Depo-Provera, but she speaks highly of the services provided by Planned Parenthood, for when discretion is necessary, and long-lasting reversible contraception such as IUDs, which continue to gain significant support (Rude, 2015). Although she encourages the involvement of parents, even for young adults 18 years of age and older, to “keep communication open” if not to “[make] sure there are no side effects at hope,” and normally “would ask what [the patients] think would or is going to happen if their parents were informed,” she is keen on having all patients clearly communicate their situations, as special cases exist that warrant her moving forward without parental involvement (Rude, 2015). Where the authoritative recommendation of a physician is usually comprehensive, following Dr. Michaud’s outline, parental involvement generally falls short of providing benefits that warrant its mandate.

The pregnancy rate among women ages 15 through 44 is 54 unintended pregancies per 1000 women.

humanities and social sciences Comparison of adolescent health between states that differ on their ruling of parental involvement in prescription contraceptives ultimately reveals favorable outcomes when minors are granted the authority to consent to birth control. According to the Department of Health and Human Services, a decline of unintended pregnancies is, in addition to changes in contraceptive practices, driven by increased sex education (Office of Adolescent Health, 2015). Running the assumption that two states with similar teachings of safe sex limits the majority of confounding variables that may influence the general adolescent in their sexual behaviors, Maryland and its neighboring state West Virginia are found to be two comparable states with different policies on parental involvement in minors’ access to clinical contraception; the former affords adolescents the same capacity to consent to birth control as individuals above the age of majority, while the latter requires the minor to either be married or notify parents (NDAA, 2013). The Guttmacher Institute, however, reports in their fact sheet “State Policies in Brief: Sex and HIV Education” that these states both mandate sex and HIV education, and require both contraception and abstinence to be covered in the curriculum, unlike other states that stress abstinence, negative outcomes on teen sex, and/or family communication (Guttmacher, 2015). Perhaps caused by their respective parental involvement laws, teenage birth rates in Maryland are among the lowest in the country at 19.4 births per 1,000 adolescents ages 15 through 19, whereas that in West Virginia are among the highest at 40.1 births per 1,000 (Office of Adolescent Health, 2015). Such outcomes and analysis of adolescent health as a result of parental involvement ultimately paint a negative image of these laws. Evidence consistently demonstrates that minors may be put at a disadvantage when required to involve their parents in receiving prescription birth control. Not only do trends in public health fail to support the continued mandate of parental notice, but analysts of these quantitative estimates explicitly state that “in states with parental notification or consent requirements for minors, the pregnancy and abortion rates may be too low because minors have traveled to other states,” which itself indicates a shortcoming in the provision of basic medical care in states like West Virginia (Kost, 2014). Although the involvement of parents in any such decision is encouraged for most, minors in states without such laws have historically informed them voluntarily. There exists a significant divide in the nation on the issue of the authority to consent to more effective reproductive healthcare, as well as a rate of unplanned pregnancies beyond any other developed nation. Evidence suggests that it is in the best interests of promoting positive outcomes in public health that adolescents be recognized as equals to sexually active individu-

hurj spring 2016: issue 22 als above the age of majority in being granted federal authority to consent to clinical contraception.

References 1. Michaud, P.A. “Assessing an Adolescent’s Capacity for Autonomous Decision-Making in Clinical Care.” Journal of Adolescent Health, 15 Aug. 2015. Web. 18 Dec. 2015. 2. “Contraception.” Centers for Disease Control and Prevention, 22 Apr. 2015. Web. 18 Dec. 2015. 3. “Frequently Asked Sexuality Questions to The Kinsey Institute.” The Kinsey Institute, 2015. Web. 18 Dec. 2015. 4. “Hide the Birth Control.” Digital image. The National Campaign to Prevent Teen and Unplanned Pregnancy, Apr. 2015. Web. 18 Dec. 2015. 5. Kolbert, E. “Why Teenagers Are the Worst.” The New Yorker, 31 Aug. 2015. Web. 18 Dec. 2015. 6. Kost, K., Henshaw, S. “U.S. Teenage Pregnancies, Births and Abortions, 2010: National and State Trends by Age, Race and Ethnicity.” The Guttmacher Institute, May 2014. Web. 18 Dec. 2015. 7. “Minor Consent to Medical Treatment Laws.” National District Attorneys Association, Jan. 2013. Web. 18 Dec. 2015. 8. Rude, C. S. “When Adolescents Seek Contraception.” Personal interview. 23 Dec. 2015. 9. “State Policies in Brief: Sex and HIV Education.” The Guttmacher Institute, 1 Dec. 2015. Web. 18 Dec. 2015. 10. “Teen Pregnancy and Childbearing.” Office of Adolescent Health. U.S. Department of Health and Human Services, 18 Dec. 2015. Web. 18 Dec. 2015. 11. Widman, L. “Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis.” JAMA Pediatrics, 2 Nov. 2015. Web. 18 Dec. 2015.

hurj spring 2016: issue 22

humanities and social sciences

Re-Programming Education:

An Investigation of Computer Science Education Currently Available to Underprivileged Students in Baltimore, Maryland Yash Jain, Class of 2019 Molecular and Cellular Biology

Introduction Growing socioeconomic disparity is a serious issue that plagues the United States. However, current efforts to bridge this gap have been severely insufficient. Some cities, such as Baltimore, have a very pronounced contrast between the wealthy and the poor. Based on data provided by the 2013 U.S. Census Bureau, sixty-one percent of children in Baltimore fall under the low-income bracket, while forty-five percent do nationally (Malter 2015). One of the reasons for this is thought to be the high unemployment rate (Sum et al. 2010). Good jobs – those that can help one escape the poverty trap – are hard to come by, especially in such a competitive economy (Plumer 2012). The poverty trap is a continuous loop in which individuals and families are stuck generation and generation due to a lack of resources, in effect preventing them from gaining sufficient capital to escape poverty and join the middle class. Ironically, however, there are more available jobs than can be filled in certain fields; in computer science, there are currently over 100,000 such positions. The National Public Radio (Westervelt 2014), corroborated by a White House Fact Sheet (The White House 2014), estimates that by 2020, there will be a surplus of over one million jobs in the field. To alleviate this problem, countries around the world, including England and New Zealand, have mandated that students take computer programming classes in school. They realized that including computer science in school curricula is not only important for the general knowledge and holistic development of their students, but also for the nation’s economy (Bell et al. 2014). Through the investigation of current efforts to educate children and teenagers in computer science and interviews with experts in the field, this research report aims to identify the most effective methods in kindling interest in computer science in Baltimore youth. The Surplus of Jobs in the Computer Science Industry If there are surplus jobs, why is no one taking them? The answer to this seemingly simple question is quite multilayered and complex. Many factors influence societal perceptions towards computer science, including gender imbalance, false preconceptions, and geographic localization. However, at its very core, I argue that the educational system in U.S. schools is not adapting to equip students with the necessary skills in disciplines such as computer science needed and desired in to-

day’s competitive economy and technologically-advanced world. Adoption of Computer Science in School Curricula It is estimated that only five to ten percent of public schools in the U.S. offer any computer programming classes, and the percentage in low-income areas is even lower (Westervelt 2014). The U.S. Department of Education found that schools in low-income areas are receiving inadequate funding and are thus unable to provide resources and classes in specialized areas such as computer science (Heuer 2011). Public schools that do offer these classes often lack proper computer science teachers, the requisite space in schedules, and tend have dull programs (Kosner 2013). Administrators also generally to lack basic knowledge about the subject, preventing them from making the appropriate decisions regarding these programs (Kosner 2013). Many countries around the world have already started to recognize the need to incorporate computer science in school curricula. In a report titled “Adoption of Computer Science in NZ schools,” Bell et al. argue that a primary reason why students are uninterested in pursuing computer science careers is because they lack proper exposure (Bell et al. 2014). This lack of exposure often prevents students from developing a potential passion and from understanding what such a career entails (Ben et al. 2014). While the U.S. government has urged schools to focus on STEM programs and has supported third-party organizations, it has made no real effort to support such causes through its own programs or legislation (The White House 2015). President Obama, however, does acknowledge the importance of STEM education in today’s school systems. In his 2013 State of the Union Address, he spoke about the importance of young, underprivileged individuals acquiring the skills and knowledge to qualify them for jobs and join the middle class, thereby escaping the poverty trap (The White House, 2013).

Current Efforts It is clear that education in computer science needs to be promoted in the U.S. In order to identify how to most effectively foster children in the subject, current efforts made by companies and organizations need to be investigated. CodeHS is one of the largest companies that aims to spread the knowledge of computer science to students by offering high-quality, purchased program materials and passionate tutors (CodeHS, 2015). The compa-

humanities and social sciences ny was co-founded by Stanford computer science graduate, Zach Galant. CodeHS strongly believes that online tutorials by themselves are not enough to teach computer programming; students must have “the full experience of being in a classroom.” Similarly, Codecademy is an initiative designed to provide free computer science courseware to users. It was co-founded by current CEO Zach Sims, a selflearned computer programmer. Uplift is a small organization based in Washington D.C. that “guides K-12 students through innovative educational experiences…teaching them to solve everyday problems as they advance toward making real world impact” (Uplift 2013). Founder and executive director Leshell Hatley has been teaching computer programming for over twelve years. This organization works with primarily underprivileged children, much like those in Baltimore. Examining the basic philosophies of each of these initiatives naturally leads one to question: Which has the most effective method of teaching?

An Optimal Exposure Timeline Many argue it is important to teach computer programming to children starting at a young age, as early as kindergarten (Yongpradit, 2014). Sixty-four percent of parents believe that education in computer science is just as important as taking courses like math, science, history, and English while twenty-one percent believe it is more important (Kamenetz, 2015; Google, 2015). This change in attitude is a key driving force behind educational reform; a growing demand in education in computer science could be a strong motivator for appropriate changes in school curricula. However, changes in the curriculum need to be done carefully. Galant expresses this concern: “just because you can play the piano at three, doesn’t mean you should…several people who have been doing something since they were three now hate it.” His apprehensions are justified; educators and others, such as New York City Mayor Bill DeBlasio, insist on mandating education in computer science “in all grades for all students” (Kamenetz, 2015). Curricula changes need to be carefully examined and properly evaluated by educators without haste. Experts in the field recognize this idea. Sims asserts that “it’s never too early,” but it is all about kindling a student’s interest properly. Galant corroborates: “If my kids were going to school, I’d want them exposed to it the whole time. I’d want them to try it. That may be a unit in second grade where they talk about what computers and apps are, and that you can program – and that’s it.” Hatley agrees with Galant in saying that the content and methodology varies depending on the age group. She argues that computer science is fundamentally problem solving, which is something that

hurj spring 2016: issue 22 can be taught to children of any age (Hatley, 2015). It is important to focus on key skills including problem solving, critical thinking, logical reasoning, basic computational thinking, and creative thinking that are imperative for computer programming (Voskoglou 2012).

Optimal Teaching Practices The most significant problem with Codecademy, CodeHS and other online computer science course providers is that they require students to have access to a computer and a Wi-Fi connection at all times, which may not be possible for many underprivileged students. Therefore, purely extracurricular online-based programs are likely impractical solutions. However, unlike Codecademy, CodeHS tries to take a step further by establishing partnerships with schools to integrate coding within their curriculum (Galant, 2015). This helps to alleviate problems for students who lack computers and reliable internet access. However, online systems such as CodeHS and Codecademy have multiple barriers to entry (e.g. cost of program, teachers, and adaption of curriculum) that often cannot be overcome that detriment their ease of implementation, especially in low-income school districts. Another major criticism to online tutorials is the lack of interaction personal engagement and interaction. Hatley asserts that it is unfair to “force our kids to sit down in front of a computer and watch something like a zombie…[because] they can’t ask questions… [and] they have to go at the pace of their instructor who has no idea who that kid is.” Uplift is built on the idea that interaction is necessary and uses a traditional classroom method to teach coding. However, since it is classroom-based, it has expanded much more slowly, currently catering to a population of approximately eighty students, Thus, its reach is limited and dependent on the quantity and quality of teachers. To mitigate these problems, one method suggested by Galant is to train teachers who have already developed relationships with students in the classroom. CodeHS has programs specifically aimed at teachers, which trains them in computer science and provides them with a curriculum to use for teaching (Galant, 2015). However, Hatley is highly skeptical of such programs, asserting that a teacher cannot learn computer programming within a year to the point where he/she can effectively teach children; a teacher has a number of responsibilities and many competing priorities, such as preparing students for standardized tests (Hatley, 2015). Another option is to hire teachers who have proficiency in computer programming. However, Galant argues that this is very difficult to do because of the challenges in recruiting computer programmers as teachers and developing new curricula (Galant, 2015). Sims asserts that “getting students interested is often as simple as just demonstrating the power of computer science to them” (Sims, 2015). He stresses on an important point: our perception of computer program-

hurj spring 2016: issue 22

humanities and social sciences

ming is an important part of students’ interest. It is nec- try could enlist for one-year programs, they could be essary to present the field in a manner that is not intim- placed alongside the teachers already in the classroom. idating; Hatley states, “Kids are intrigued by anything In fact, any computer science student in Baltimore, from and everything…[so] to say that a kid is disinterested in universities including the Johns Hopkins University, Unicomputer science is ridiculous if you haven’t even intro- versity of Maryland (Baltimore), and Loyola University duced it to [him/her] in a way that [he/she] can even (Maryland), could work as ‘experts’ in local schools or understand.” extracurricular programs. Together, they can optimize According to a Google study titled “Women Who the learning experience. Choose Computer Science – What Really Matters,” Overall, more opportunities to expose students to comwomen unfamiliar with computer science use words puter science will be beneficial and, with the help of othwith negative connotations, such as “boring,” “difficult,” er organizations working towards a similar goal, help to “nerdy,” “complicated,” “confusing,” “dull,” and tedious” alleviate poverty by allowing children and teenagers to to describe the subject (Google 2014). Those familiar eventually find good jobs. Nurturing interest will evenwith it used words with positive connotations, such as tually change popular societal perceptions towards the “fun,” “interesting,” “exciting,” “innovative,” and “cre- subject, and will instigate a ubiquitous rise in interest ative.” (Google 2014). Thus, exposin computer science. Greater intering and teaching children computer est in computer science will help to programming should bring about a decrease the surplus of open posiExposing and teaching tions and help the industry progress positive change in their perception. This change in perception translates children computer pro- more rapidly. The ultimate impact to interest that can then be kindled of such endeavors would be providfurther to eventually lead children gramming should bring ing low-income students with the to pursue the field. about a positive change opportunity to break through the poverty trap and achieve successful in their perception. careers. Conclusion Organizations working to teach underprivileged children computer References science are not employing the methods that would al- Bell T, Newton H, Duncan C, Jarman S. 2014. Adoption of ComputScience in NZ schools. Auckland, New Zealand: Cardiac Society low them to optimize their efforts, as was found through er of Australia and New Zealand. http://www.citrenz.ac.nz/conferanalysis of three primary initiatives. Online platforms are ences/2014/pdf/2014ITx_31_CSANZ_Bell_Adoption of CS.pdf unfeasible for underprivileged students due to a lack of Effects of poverty on society: Why we should all care. 2013 May. Povaccess to computers and Wi-Fi. Furthermore, CodeHS’s erties. http://www.poverties.org/effects-of-poverty.html SHEET: New Commitments to Support Computer Science Edumodel of training teachers seems inadequate. Lastly, FACT cation. 2014 Dec 8. The White House. Uplift, is unable to expand at the required rate and offer Galant, Zach. Personal interview. 3 Nov. 2015. Hatley, Leshelle. Personal interview. 23 Nov. 2015. its program to the greater audience. The most appropriate method of teaching is one that Heuer R, Stullich S. 2011. Comparability of State and Local ExpendiAmong Schools Within Districts: A Report From the Study of is long-term and gradual. New efforts should begin by tures School-Level Expenditures. U.S. Department of Education. teaching children at about five years of age, focusing Kamenetz A. 2015 Sep 18. Coding class, then Naptime: Computer scionly on skills such as problem solving, critical thinking, ence for the kindergarten set. National Public Radio. logical reasoning, basic computational thinking and Kosner A. 2013 Feb 14. Can Obama Convince High Schools To Teach To Code? Forbes. creative thinking. Starting at seven or eight, children Kids Malter J. 2015 Apr 29. Baltimore’s economy in black and white. CNN. should be gradually exposed to the ideas of computer Plumer B. 2012 Aug 3. Chart: Good jobs are getting harder and harder science. Proper training in computer science, however, to find. Washington Post. does not need to begin until age twelve or thirteen. This Rashid H. 2013 Aug 2. New STEM center at Aberdeen Proving Ground to students. entire process needs to be conducted in an enjoyable open Remarks by the President in the State of the Union Address. 2013 Feb and stimulating environment where students’ interest 12. The White House. in computer science is free to develop, rather than one Searching for Computer Science: Access and Barriers in U.S. K-12 Education. 2015. that fosters a distaste for the subject. Zach. Personal interview. 15 Nov. 2015. Organizations should work directly with schools to Sims, Sum A, Khatiwada I, Palma S. 2010. Labor Underutilization Problems maximize their reach and expose as many students of U.S. Workers Across Household Income Groups at the End of the as possible. If this is impracticable, then organizations Great Recession: A Truly Great Depression Among the Nation’s Low should function as afterschool programs (rather than Income Workers Amidst Full Employment Among the Most Affluent. Massachusetts. online) at these schools, open to all students. Programs Boston, Voskoglou M, Buckley S. 2012 Sep. Problem Solving and Computers in during school are necessary to slowly build widespread a Learning Environment. arXiv.org. interest. Teach for America places qualified individuals Westervelt E. 2014 Feb 17. A push to boost computer science learning, in particular schools for two-year rotations (Teach for even at an early age. National Public Radio. Who Choose Computer Science— What Really Matters. GooAmerica, 2015). If a similar model were applied, where Women gle. 2014. computer science graduates and employees in indus- Yongpradit P. 2014 Nov 14. Should we teach computer science in elementary school? International Society for Technology in Education.

science and engineering

hurj spring 2016: issue 22

Examining the Common Links along Neurodegenerative Diseases Ansh Bhammar Class of 2019, Neuroscience

Abstract In the past, many neurodegenerative diseases were grouped together and examined holistically. In recent decades, however, researchers have switched to investigating these diseases in isolation to understand each of their distinguishing features. Although recent approaches are fruitful in extracting specific and distinctive details, this paper will focus on reverting to a broader perspective on studying neurodegenerative diseases. Modern understanding of the brain provides a greater scope to investigate the broader perspective than when scientists had first explored neurodegeneration. Examining the commonalities in affected patients allows scientists to recognize and understand potential links among these disorders. While detail is essential in investigating abnormal conditions, it is also crucial to retain the overarching perspective that connects them. Thus, this paper will explore major neurodegenerative diseases and show key points of unity among the diseases. The paper will then highlight common anatomical/physiological and psychological changes as well as shared symptoms and risk factors. Finally, the paper will conclude with the implications that arise from such similarities.

Introduction Neurodegenerative diseases describe conditions that primarily affect neurons in the human brain. Neurons are in the G-0 phase of the cell life-cycle, which means that these cells do not typically divide like other somatic (bodily) cells. This poses a problem for neurological conditions, since the brain cannot “heal” itself in a traditional manner. If damage is caused to many neurons over an extended period of time, there is little the brain can do on its own to combat disease or injury. As a result, damage to large amounts of neurons cannot heal like somatic cells and such damage tends to worsen over time. Moreover, because neurons have a wide range of responsibilities, degeneration can disrupt an individual’s psychological abilities. Major neurodegenerative diseases that will be examined in this paper include Alzheimer’s Disease (AD), Parkinson’s Disease (PD), Huntington’s Disease (HD), and Amyotrophic Lateral Sclerosis (ALS).

Similarities in Anatomical and Physiological Changes One of the overarching anatomical/physiological effect of neurodegenerative diseases is an affected patient’s inability to maintain brain homeostasis, which is a sta-

ble state of the brain. This homeostasis is disrupted in numerous ways through these diseases. Dysfunctional homeostatic mechanisms, specifically autophagy and apoptosis, retain vital roles in the progression of neurodegenerative diseases. Autophagy is the natural destruction of old cellular components that allows for the creation of new cells. The process helps maintain homeostasis through the use of lysosomes, which are organelles that contain digestive enzymes. In neurodegenerative diseases, autophagy goes awry by genetic mutations that occur more frequently as the brain ages (Nixon 2013). In these diseases, there are genetic mutations that result in an accumulation of unwanted substances, including potentially toxic mutant and oxidized proteins, protein aggregates, and damaged organelles (Nixon 2006). The accumulation, in turn, results in lysosome dysfunction, which can then impair specific autophagic pathways. Impairment can later lead to neuronal cell death and eventually the progressive degeneration of certain areas in the cerebral cortex. Each major neurodegenerative disease is associated with an accumulation of different unwanted substances (typically disease-specific misfolded proteins): filamentous tau and β-amyloid in AD (Masliah et al.), α-synuclein (Masliah et al.) as well as iron and aluminum (Hirsh et al.) in PD, superoxide dismutase-1 in ALS (Kikuchi et al.), and mutant huntingtin as well as ferritin in HD (Wang et al.). Each of thse substances will not be explored in depth, because the purpose of this paper is not to examine the differences but rather the commonalities of such diseases. Moreover, the role of these substances is still debated, since scientists are unsure if these are the primary accumulations associated with each disease. Although these substances are different, all of the major neurodegenerative diseases discussed in the paper involve the impairment of autophagic pathways through such accumulations. Apoptosis, which is often paired with autophagy, is commonly defined as self-induced, or programmed, cell death. Apoptosis, like autophagy, is a process that naturally occurs in the brain (Miura). However, in these neurodegenerative diseases, apoptosis is triggered by signals in the organelles of affected neurons, resulting in the death of many neurons over time (Ghavami et al.). This eventually leads to the progressive degeneration of major brain areas similar to those affected by impaired autophagic pathways. So what induces apoptosis? Scientists point to oxidative stress as an explanatory factor. As humans age, there is an increase in the amount of reactive oxygen species produced (Ghavami et al.). This increase is known as oxidative stress,

hurj 2014: issue 18 22 hurjspring spring 2016: issue which then causes damage to nucleic acids, especially RNA, in neurons. This notion has been confirmed in patients with these neurodegenerative diseases, as data highlights, that there is a significantly larger increase in neuronal RNA damage than in unaffected aging adults (Nunomura et al.). The effects of reactive oxygen then lead us to another imperative question: what causes this oxidative stress? Mitochondria are among the main sources of oxidative stress because they use oxygen for energy purposes (Bhat et al.). Free radicals, which are highly reactive molecules, arise from the electron transport system (ETS) of the mitochondria because of mitochondrial inefficiency and dysfunction that increases with age (Hameed and Hsiung). These free radicals can damage cellular lipids, proteins, and nucleic acids (DNA and RNA) by inhibiting their functions because free radicals are highly reactive (Bhat et al.). In healthy bodies, a “redox homeostasis” is maintained among free radicals by protecting organisms from the effects of oxidative stress; there is a balance between pro-oxidants and antioxidants. In these neurodegenerative diseases, however, mitochondrial dysfunction impairs the ability of the mechanisms that deal with free radicals, and the mechanisms thereby cannot maintain the homeostasis necessary for the brain (Bhat et al.). This causes an imbalance between pro-oxidants and antioxidants in favor of the former (Mariani et al.). Thus, excessive free radicals in neurons causes severe oxidative stress that, as seen earlier, may result in neurodegeneration. Many of the mechanisms described above relate to neuronal cell death, which occurs in the late stages of each neurodegenerative disease. However, scientists have found defective axonal transport (AT), which leads to the loss of synaptic activity, to be prevalent in the initial stages of these diseases (Roy et al.; Morfini et al.). Therefore, scientists believe that defective AT and loss of synaptic activity contribute to the onset and progression of neurodegenerative diseases (Morfini et al.). Using animal models, scientists concluded that behavior and motor abnormalities were significant and detectable well before obvious signs of neuronal cell loss, demonstrating that neuronal dysfunction occurs before overt neuronal death (Morfini et al.). Researchers found that these synaptic dysfunctions and axon abnormalities occur as a result of slow axonal transport, because of the inhibition of fast axonal transport (FAT), which can be caused by mutations in genes coding for microtubule-based molecular motor subunits (Roy et al.; Morfini et al.). Defective AT and loss of synaptic activity have varying effects in each disease, but both play an important role in the early onset of the neurodegenerative conditions. Other mechanisms that occur in the early stages of these diseases are immunological and prior to largescale neuronal loss. Scientists have found common immunological pathways and mechanisms in these disorders that eventually result in neurotoxicity and neuronal cell death. The immune system plays an integral

science and engineering science and engineering role in these diseases by initiating neuroinflammatory responses that can contribute to neural injury. Microglia, astrocytes, and other immune molecules mediate these inflammatory responses in the brain (Doty et al.; Cappellano et al.). The neuroinflammatory responses can be either beneficial or detrimental, and their role in neurodegenerative diseases are still subject to scientific debate. These responses allow the body to clear harmful agents and repair injuries in the brain, but can be detrimental if they become deregulated (Capellano et al.). Although scientists are unsure of the role that neuroinflammatory responses play in these conditions, these responses are prevalent in all major neurodegenerative diseases.

Shared Psychological Changes One of the most common psychological changes in these neurodegenerative diseases is cognitive impairment. Higher-cognitive functions, which include learning, memory, and reasoning are often affected in each of these disorders. AD, PD, ALS, and HD can all lead to dementia or dementia-like symptoms, including severe impairment in memory, learning, judgment, orientation, and executive functioning (Chang; ALSA; Paulsen; Mayo Clinic). What is it about these diseases that lets them induce dementia and their symptoms? Neurodegeneration interferes with neurons’ ability to communicate with one another, through slow axonal transport, oxidative stress, mitochondrial dysfunction, as well as impairment of the autophagic and apoptotic pathways. Most higher-cognitive functions explicitly depend on the connections between neurons in the brain. However, when neurons can no longer communicate effectively, regions responsible for their corresponding functions cannot produce that specific behavior or desired response. Due to the progressive nature of neurodegenerative diseases, cognitive impairments tend to worsen without improvement and are often permanent.

Shared Symptoms and Risk Factors One of the most common shared symptoms of neurodegenerative diseases is a loss of motor control, which is likely due to neurodegeneration in motor neurons and motor areas of the brain. This loss of movement occurs to different degrees in each disease. However, near the late stages of each disease, patients are severely impaired in their motor skills and are often put in wheelchairs. Furthermore, as discussed previously, losses in cognitive functions characterizes these neurodegenerative diseases. Moreover, many patients’ social abilities decline, as they can no longer interact with others in the way they were originally capable of. Many of these symptoms are shared because neurodegeneration affects numerous brain circuits as the disease progresses. Thus, specific circuits responsible for certain behaviors are affected in all of these diseases at different stages. In addition to overlapping symptoms, these neurodegenerative disorders also share many risk factors. Aging

science and engineering is one of the most significant factor of such diseases. As an individual ages, by-products of metabolism and cell damage accumulate, allowing the onset of disease to appear (Hung et al.). As a result of accumulation, along with increased mitochondrial dysfunction (which also increases with age), there is a rise in the amount of oxidative stress in these patients (Hameed and Hsiung). Moreover, as one ages, increase in telomere erosion and DNA damage as well as decrease in tissue regeneration all contribute to neurodegeneration (Hung et al.; Sahin and Depinho). Whatever the risk factors may be, they are affecting a significant portion of the world’s population. In the United States alone, the National Institutes of Health provides a conservative estimate of more than five million people who have AD and at least half a million who have PD. The number of patients diagnosed with these diseases are continually increasing. World Health Organization predicts that, as many developed countries’ populations get older, neurodegenerative diseases will overtake cancer to become the second leading cause of death after cardiovascular diseases by 2040 (World Health Organization; Gammon). Thus, research for treatments and cures for neurodegenerative diseases needs to take the forefront of our medical concerns. Implications and Conclusion Since neurodegenerative diseases are so intertwined with each other, there is potential for the emergence of common treatments. However, current treatments focus on each disease in isolation. Specific and targeted therapies are considered by many to be the optimal route for treatment. Although it is generally agreed upon that cures must be specific and targeted for them to work properly, treatments in themselves do not necessarily have to be. Since these diseases are incredibly similar in their biological causes, symptoms, and risk factors, common treatments would be the most effective way to address these conditions. There will be special focuses on AD and PD because of their higher incidence rates. Overall, there is an extremely large amount of intersection among AD, PD, ALS, and HD. Although this paper is limited to these four major neurodegenerative diseases, it is likely that other conditions share these similarities. By examining these diseases holistically, scientists can understand the links that exist between them, allowing them to use treatments and therapies that address the shared symptoms and biological mechanisms. Until a cure is found for each specific disease, this approach is optimal. Retaining a broad perspective while exploring the details is not only crucial when examining these specific diseases, but also when examining any other diseases. Other conditions and illnesses can be linked in a similar manner to treat one disease with the therapies of the other. Therefore, we must focus on exploring these commonalities to optimize allocation of resources and R&D efforts (instead of splitting them up per specific disease) to maximize the benefit of such research to have a larger and more encompassing impact on patients.

hurj spring 2016: issue 22 References Bhat, A., Dar, K., Anees, S., Zargar, M., Masood, A., Sofi, M., & Ganie, S. (2015). Oxidative stress, mitochondrial dysfunction and neurodegenerative diseases; a mechanistic insight. Biomedicine & Pharmacotherapy, 74, 101-110. Cappellano, G., Carecchio, M., Fleetwood, T., Magistrelli, L., Cantello, R., Dianzani, U., & Comi, C. (2013). Immunity and inflammation in neurodegenerative diseases. American Journal of Neurodegenerative Disease, 2(2), 89-107. Doty, K., Guillot-Sestier, M., & Town, T. (2015). The role of the immune system in neurodegenerative disorders: Adaptive or maladaptive? Brain Research, 1617, 155-173. Gammon, K. (2014). Neurodegenerative disease: Brain windfall. Nature, 515, 299-300. doi:10.1038/nj7526-299a Ghavami, S., Shojaei, S., Yeganeh, B., Ande, S., Jangamreddy, J., Mehrpour, M., . . . Łos, M. (2014). Autophagy and apoptosis dysfunction in neurodegenerative disorders. Progress in Neurobiology, 24-49. doi:10.1016/j.pneurobio.2013.10.004 Hameed, S., & Hsiung, G. (2011). The role of mitochondria in aging, neurodegenerative disease, and future therapeutic options. British Columbia Medical Journal, 53(4), 188-192. Hirsch, E., Brandel, J., Galle, P., Javoy-Agid, F., & Agid, Y. (1991). Iron and Aluminum Increase in the Substantia Nigra of Patients with Parkinson’s Disease: An X-Ray Microanalysis. Journal of Neurochemistry J Neurochem, 56(2), 446-451. Hung, C., Chen, Y., Hsieh, W., Chiou, S., & Kao, C. (2010). Ageing and neurodegenerative diseases. Ageing Research Reviews, 9, S36-S46. Kikuchi, H., Almer, G., Yamashita, S., Guegan, C., Nagai, M., Xu, Z., . . . Przedborski, S. (2006). Spinal cord endoplasmic reticulum stress associated with a microsomal accumulation of mutant superoxide dismutase-1 in an ALS model. Proceedings of the National Academy of Sciences, 103(15), 6025-6030. Mariani, E., Polidori, M., Cherubini, A., & Mecocci, P. (2005). Oxidative stress in brain aging, neurodegenerative and vascular diseases: An overview. Journal of Chromatography B, 827(1), 65-75. Masliah, E., Rockenstein, E., Veinbergs, I., Sagara, Y., Mallory, M., Hashimoto, M., & Mucke, L. (2001). β-Amyloid peptides enhance α-synuclein accumulation and neuronal deficits in a transgenic mouse model linking Alzheimer’s disease and Parkinson’s disease. PNAS: Proceedings of the National Academy of Sciences, 98(21), 1224512250. Mayo Clinic. (2014, November 20). Dementia Causes. Retrieved December 1, 2015. Miura, M. (2010). Apoptotic and Non-apoptotic Caspase Functions in Neural Development. Neurochemical Research, 36(7), 1253-1260. doi:10.1007/s11064-010-0341-x Morfini, G., Burns, M., Binder, L., Kanaan, N., LaPointe, N., Bosco, D., . . . Brady, S. (2009). Axonal Transport Defects in Neurodegenerative Diseases. The Journal of Neuroscience, 29(41), 12776-12786. doi:10.1523/JNEUROSCI.3463-09.2009 National Institutes of Environmental Health Sciences. (n.d.). Neurodegenerative Diseases. Retrieved November 27, 2015. Nixon, R. (2013). The role of autophagy in neurodegenerative disease. Nature Medicine, 19, 983-997. Nixon, R. (2006). Autophagy in neurodegenerative disease: Friend, foe or turncoat? Trends in Neurosciences, 23(9), 528-535. Nunomura, A., Moreira, P., Castellani, R., Lee, H., Zhu, X., Smith, M., & Perry, G. (2012). Oxidative Damage to RNA in Aging and Neurodegenerative Disorders. Neurotoxicity Research, 22(3), 231-248. Paulsen, J. (2011). Cognitive Impairment In Huntington Disease: Diagnosis And Treatment. Current Neurology and Neuroscience Reports, 11(5), 474-483. Roy, S., Zhang, B., Lee, V., & Trojanowski, J. (2005). Axonal transport defects: A common theme in neurodegenerative diseases. Acta Neuropathologica, 109(1), 5-13. Sahin, E., & Depinho, R. (2010). Linking functional decline of telomeres, mitochondria and stem cells during ageing. Nature, 464(7288), 520528. Wang, C., Tydlacka, S., Orr, A., Yang, S., Graham, R., Hayden, M., . . . Li, X. (2008). Accumulation of N-terminal mutant huntingtin in mouse and monkey models implicated as a pathogenic mechanism in Huntington’s disease. Human Molecular Genetics, 17(17), 2738-2751. World Health Organization. (2004). Neurology Atlas. Retrieved November 26, 2015.

hurj spring 2016: issue 22

science and engineering

Microdeletion at 15q11.2 Causes Impaired Structural Development in Cortical Neurons Derived From Induced Pluripotent Stem Cells Michael Chickering, Ha Nam Nguyen, & Hongjun Song Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD

Abstract Microdeletion at the 15q11.2 chromosome region between Breakpoint 1 and Breakpoint 2 contributes to increased risk of neurological disorders such as autism and schizophrenia, but the epidemiological mechanisms of this mutation remain unknown. In order to model schizophrenia in vitro, cortical neurons were differentiated from induced pluripotent stem cells derived from schizophrenic patients with this gene mutation. To quantify the structural development of these neurons, cells were stained using immunocytochemistry, imaged under a fluorescent microscope, and ran through a data analysis software. This study indicates that cortical neurons with the 15q11.2 (BP1 – BP2) microdeletion have lowered synaptic protein expression, impaired adherens junction formation, and shortened dendrite length than wild-type samples. These findings reveal several observable phenotypes of the 15q11.2 microdeletion, which may lead to development of new drug targets or further investigation of the cellular mechanisms behind schizophrenia.

Introduction Deletion of 15q11.2 between Breakpoint 1 (BP1) and Breakpoint 2 (BP2) has been identified as one of the three most frequent copy number variants (CNVs) associated with two to four fold increased risk of schizophrenia and contributes to many other neurological disorders [1, 2] (Fig. 1). This CNV contains four genes

(CYFIP1, NIPA1/2, and GCP5) and is greater than 500 kb long, so it is extremely difficult to model in mice using traditional gene targeting techniques. Also, it is virtually impossible to fully analyze human neurons at the cellular level when they are inside a living patient. With induced pluripotent stem cells (iPSCs), patient-specific human cortical neurons can be grown in vitro, allowing scientists to investigate the 15q11.2 mutation closer than ever before. Skin cells from patients with the gene mutation can be reprogrammed into iPSCs, and then differentiated into cortical neurons with specialized neural differentiation protocol. These neurons’ developmental characteristics can be closely inspected, providing a new platform for disease research at a cellular level. This method is novel in that it does not require gene therapy or invasive surgery. In theory, neurons should retain all the cellular characteristics they would express in the donor’s brain. This study uses this disease modeling process to characterize the 15q11.2 microdeletion in cortical neurons in vitro. Cell lines from both schizophrenic donors with 15q11.2 microdeletion and healthy individuals are cultured into cortical neurons and analyzed with immunohistochemistry and fluorescence microscopy. Images are processed with a computer software to quantify relative expression of N-Cadherin and SYN1, as well as measure dendrite length.

Figure 1. The 15q11.2 chromosome region has four breakpoints that genetic mutations are normally involved in. The BP1-BP2 region consists of four genes: NIPA1, NIPA2, CYFIP1, and GCP5.

science and engineering Methods Generation of iPSCs To begin modeling the 15q11.2 mutation, fibroblasts were taken from both healthy individuals and patients with the genetic microdeletion at Johns Hopkins Hospital. The fibroblasts were delivered to the lab, where they went through the reprogramming process of being infected with a Sendai virus containing the four genes (Oct4, Sox2, c-Myc, and Klf4) that did not integrate into the host genome. After six days, the cells were transferred to mouse embryonic fibroblast feeder cells and maintained for three weeks. Once stem cell colonies appeared, the cells were picked and transferred to their own plate.

Differentiation of iPSCs into Cortical Neurons Once iPSCs were generated, they were subjected to the differentiation process (Fig. 2). At first, the stem cells in embryoid bodies (EBs) were treated with A83-01 and Dorsomorphine that have been shown to pattern stem cells into forebrain neuronal lineage. Four days later, EBs were plated down and grew into neuronal rosettes. N2 Supplement was added to promote growth of neuronal progenitor cells (NPCs). At eighteen days, rosettes were picked and dissociated. Single NPCs were treated with growth factors BDNF and GDNF, and supplemented with B27 and cAMP. Differentiated neurons were characterized at various stages of differentiation.

hurj spring 2016: issue 22 protein (RFP). This sample was stained for DAPI and NCAD (N-Cadherin). N-Cadherin is important to cell adhesion, because it forms adherens junctions to bind cells together [5]. Cell samples were also stained for CTIP2, a cortical neuron marker.

Image Analysis Images were loaded onto Adobe Photoshop and ImageJ to count the number of cells expressing SYN1, and quantify dendrite length and the number of crossings.

Results SYN1 Expression is Lower in Deleted Lines Judging from the images and quantification of SYN1 puncta, there were more synaptic vesicles containing SYN1 in the control lines than in the deleted lines (Fig. 3). This is a clear phenotype of the 15q11.2 (BP1-BP2) microdeletion and suggests that abnormally low SYN1 levels may be a pathological mechanism of schizophrenia. Abnormal synapse caused by this gene mutation could lead to the observable symptoms of schizophrenia.

Immunohistochemistry. To visualize the level of synaptic protein expression in the cortical neural cell lines, the cell samples were stained with antibodies to mark SYN1 and MAP2. Synapsin I (SYN1) is a phosphoprotein involved in synapse, and is in the synaptic vesicles of the central and peripheral nervous systems [3]. Microtubule-associated protein 2 (MAP2) is involved in microtubule assembly and is meant to show the structure of neuronal dendrites [4]. A combination of wild-type (C12) and deleted (Y13) lines were cultured, where C12 expressed green fluorescent protein (GFP) and Y13 expressed red fluorescent

Figure 3. (A) Cell samples from a control line (C1-2) and deleted line (Y2-1) were immunostained for SYN1 and MAP2. (B) SYN1 puncta per 100 micrometers is measured for each cell line (n = 3). Error bars represent SD.

Figure 2. (A) Timeline of differentiation scheme showing the different stages of differentiation and the small molecules and growth factors added. Media were switched at 4 and 18 days. (B) After four days after differentiation, embryoid bodies (EBâ&#x20AC;&#x2122;S) form in suspension; after 14 days, neuronal rosettes form expressing forebrain progenitor markers FOXG1 and NESTIN; after 28 days, neurons express more mature markers CTIP2 and MAP2; and after 60 days of differentiation, neurons express SYN1 and SV2. Scale bar = 100 m.

hurj spring 2016: issue 22 N-Cadherin is Less Concentrated Near Deleted Cell Lines The samples containing a combination of healthy and deleted lines were immunostained for DAPI and NCAD (Fig. 4). The merged images show that N-Cadherin is more concentrated near healthy cell lines (green) and less concentrated near mutated cell lines (red). However, N-Cadherin is also more concentrated near the bend in the curve of cells, which could confound a correlation between the gene deletion and N-Cadherin levels. Nevertheless, these results suggest N-Cadherin, a protein heavily involved in cell adhesion, could play a part in the pathology of diseases affected by the 15q11.2 (BP1-BP2) deletion.

Figure 4. Combined samples were stained for the deleted (Y13, red) and control (C12, green) cell lines as well as DAPI and NCAD, then imaged with fluorescence microscopy. Scale bar = 20 m

Deleted Lines Have Shorter and Less Complex Dendrites Once the images of stained neurons had been traced on ImageJ, the tracings were measured and averaged for each cell line (Fig. 5). Also, the number of crossings at various distances from the cell body was computed in order to determine the complexity of dendrites from each sample. It is clear that deleted lines have significantly shorter and less complex dendrites than control lines. Interestingly, dendrites of duplicated lines (U1-1) had similar length and complexity to control lines. Thus, genes in the 15q11.2 (BP1-BP2) region must regulate length and complexity of dendrites.

science and engineering Discussion Three phenotypes of the 15q11.2 (BP1 â&#x20AC;&#x201C; BP2) microdeletion were discovered through investigating neurodevelopmental characteristics of cortical neurons grown from patient-specific iPSCs. Deleted lines had less SYN1 expression, were situated near less N-Cadherin, and had shorter and less complex dendrites than controlled and duplicated lines. These three abnormal characteristics likely work in conjunction to contribute to the pathology of schizophrenia affected by the 15q11.2 (BP1-BP2) microdeletion. For future experiments, more data need to be gathered concerning cell lines with the gene duplication. Although the dendritic length data suggests that duplicated lines are less problematic than deleted lines, there could still be other phenotypes of duplicated lines that were not investigated in this experiment. Also, the presence of N-Cadherin could be influenced by many factors other than the genome of nearby cells. Synaptic vesicles, cell adhesion, and dendrite morphology play huge roles in the development of human neurons. If cells do not send signals correctly, are weakly attached to each other, and cannot reach where they should, a neurological disorder could develop. The 15q11.2 (BP1-BP2) mutation affects the functioning of the human nervous system by controlling these three factors. Future experiments should also investigate each of the three phenotypes in more detail to further understand how they contribute to the onset of various diseases. It is possible that the characteristics affected by these abnormalities influence one another. Perhaps shorter dendrites cause lower N-Cadherin levels, or vice versa. Future experiments are needed to analyze phenotypes both individually and comparatively to be conclusive. IPSCs provide researchers with a novel platform of disease modeling that could be used to expand upon the results of this study. A decade ago, it was impossible to study cellular mechanisms of most diseases in human cells. With patient-derived iPSCs, scientists can study neurological diseases affected by the 15q11.2 (BP1-BP2) microdeletion in the three phenotypes. Furthermore, drug developers can screen specific drugs on these cells and try to rescue the phenotypes. This kind of experimental freedom has never been seen before in biotechnology and it highlights the true value of iPSCs in research.

References

Figure 6. (A) Cortical neurons from control (CS3-3), deleted (Y2-2), and duplicated (U1-1) lines were immunostained and imaged. CTIP2 is shown in red at the nuclei of mature cortical neurons while MAP2 is shown in green over the dendrites. Scale bar = 50 m. (B) Data from tracings was used to compute dendritic length of cell lines (n = 3). Error bar represents SD. (C) Data from tracings was used to compute each dendriteâ&#x20AC;&#x2122;s number of crossings at specific distances.

1. Consortium, I. S., Rare chromosomal deletions and duplications increase risk of schizophrenia. Nature, 2008. 455: p. 237-41. 2. Stefansson, H., et al., Large recurrent microdeletions associated with schizophrenia. Nature, 2008. 455: p. 232-36. 3. De Camilli, P., et al., Synapsin I (protein I), a nerve terminal-specific phosphoprotein. J. Cell Biol, 1983. 96: p. 1337-1354. 4. Kalcheva, N., et al., Genomic structure of human microtubule-associated protein 2 (MAP-2) and characterization of additional MAP-2 isoforms. Proc Natl Acad Sci USA, 1995. 92: p. 10894-10898. 5. Angst, B., et al., The cadherin superfamily: diversity in form and function. J Cell Sci, 2001. 114: p. 629-641.

science and engineering

hurj spring 2016: issue 22

Over-Prescription of ADHD Medication for Adolescents Challenges Best Practices for Diagnosis and Treatment Gabriella Miller Class of 2016, Natural Sciences In the 1990s, Attention-Deficit/Hyperactivity Disorder (ADHD) was officially categorized as a mental illness rather than a constellation of symptoms (CDC, n.p.). This conclusion was supported by fMRI and EEG brain imaging studies, which demonstrate that behavioral abnormalities experienced by ADHD patients, including hyperactivity and inattentiveness, result from deficient function, blood flow, and metabolism of the brain’s frontal lobe (Michiana PBC, min. 13). Jen Alexander*, a twenty-four-year-old marketing manager, has been living with ADHD for most of her life. Jen vividly recalls the frustrations that preceded her ADHD diagnosis: it became “clear that it was taking [me] a longer time to do things than some other kids” (Alexander, min. 1). By the time Jen reaches high school, her symptoms start to take a toll on her academic performance: “I would be sitting in class and things would go in one ear and out the other […] I’d might as well not go” (Alexander, min 10; min 20). Since she started taking medication for her ADHD, Jen has become “more focused, efficient, and organized,” and an overall “better human” (Alexander, min. 12; min. 18). Increased by 1% since two decades ago, 11% of children today in the United States have received an ADHD diagnosis. Notably, approximately five million young people (US Census Bureau, n.p.) - more than two-thirds of children and adolescents who have received an ADHD diagnosis - currently take prescription medication for their condition (CDC, n.p.). The number of young people taking ADHD medications raises questions about potential driving forces of increased diagnosis and drug prescriptions. In recent years, ADHD has become over-diagnosed in the United States. Looking to the fu-

ture, appropriate ADHD diagnostics will improve mental health care for many young people in the United States. Many medical professionals believe that ADHD, although a serious mental disorder, is grossly over-diagnosed in the United States. Dr. Stephen P. Hinshaw, a developmental psychologist and Co-Chair of Scientific Research Committee of the Child Mind Institute in New York, presents a comparison of diagnostic and medication practices in supplementary materials of the 2011 article “International Variation in Treatment Procedures for ADHD: Social Context and Recent Trends” in the journal Psychiatric Services. This analysis reveals significantly higher diagnosis and prescription rates of ADHD in the United States compared to Canada (Hinshaw, S1-3). Hinshaw concludes that “the prevalence of ADHD varies across nations, but most of the variation […] can be attributed to disparate diagnostic practices and algorithms” (463). In other words, high diagnosis rates may be a product of flaws in the written diagnostic guidelines used by physicians in the United States. In the Wall Street Journal article “Are ADHD Medications Over-Prescribed?”, Dr. Sanford Newmark, the “head of the pediatric integrative neurodevelopmental program” at University of California – San Francisco, notes that physicians in the United States “diagnose [ADHD] too fast,” sometimes diagnosing and prescribing medication for a child within a fifteen-minute appointment window (Koplewicz & Newmark, n.p.). Newmark asserts that over-diagnosis of ADHD is a result of physicians not taking the proper measures to confirm their diagnosis. Newmark and Hinshaw agree that diagnostic procedures, both in theory and practice, contribute to an over-diagnosis of ADHD

hurj 2014: issue 18 22 hurjspring spring 2016: issue

science and engineering science and engineering

among young people in the United States. professional organizations to diagnose and treat ADHD. However, other medical professionals believe that phy- Seixas et al. conclude that the criteria used in the Unitsicians in the United States appropriately diagnose ed States are methodologically inferior to other criteria ADHD. Countering Dr. Newmark’s comments in the Wall evaluated (753-765). Street Journal article “Are ADHD Medications Over-Pre- Physicians are given substantial liberty to use sub-stanscribed?”, Dr. Harold Koplewicz, a preeminent psychia- dard guidelines to make diagnosis in a short period of trist and President of the Child Mind Institute in New York, time, without consulting a colleague, and rely on the attributes rising rates of ADHD diagnosis to increasing diagnostic skills of laypeople, like teachers and parents, public health outreach to teachers and parents. He to corroborate diagnosis. As such, the United States states that the outreach has been “leading many more guidelines allow for significant subjectivity in diagnosis. children to get early attention and treatment” for ADHD Although, as Koplewicz notes, an ever increasing voland other “childhood psychiatric disorders” (Koplewicz ume of children is being screened for ADHD, children & Newmark, n.p.). Further supporting Koplewicz’s as- in the United States are being evaluated on the basis of sertion, Drs. Jagadeesh Reddy, Ahmed Elmaadawi, and weak best practices. This would, in theory, make it more Vicente Gonzaga, three independent child and adoles- challenging for physicians to differentiate between true cent psychiatrists from the United States, participated ADHD cases and cases that appear to be ADHD. This in a 2014 episode of the television show Ask An Expert could, in turn, lead to a large population of misdiag– ADD/ADHD and touted improved recognition of diagnosed individuals. nostic markers as the principal mechanism to prevent Simple statistics demonstrate that when compared widespread over-diagnosis (Michito other developed countries like ana PBC, min. 6). According to KoCanada, United States’ best pracplewicz and the panelists, physicians tice guidelines can have serious in the United States have actually implications on the rates of ADHD made strides to improve their ability diagnosis. Overall, according SeixPhysicians are given to correctly diagnose young people. as et al., the Canadian best practice Koplewicz argues that an increase substantial liberty to use guidelines for the diagnosis and in diagnosis “is the result of more treatment of ADHD (CADDRA) reparents and teachers recognizing sub-standard guidelines ceived the highest score for meththe signs that certain children have to make diagnosis in a odology (763). Unlike best pracserious problems concentrating, tices measures employed in the short period of time. settling down, and controlling their United States, CADDRA encourimpulses” (Koplewicz & Newmark, ages confirmation of diagnosis by n.p.). Koplewicz assumes, howevanother physician or psychologist er, that if more youths are seeking and requires rigorous in-office neumedical attention for ADHD-like rological and psychological testing symptoms, physicians will be able to before determining diagnosis (Seixappropriately discern which adolescents have true cas- as et al, 758). CADDRA also requires consensus bees of ADHD and which present ADHD-like characteris- tween multiple professionals and encourage uniformity tics, such as “learning disabilities, anxiety, sleep apnea, of evaluations, decreasing opportunity for misdiagnochild abuse, or being gifted” (Koplewicz & Newmark, sis. Furthermore, the rate of ADHD diagnosis in Canada n.p.) within a short amount of time; as Dr. Newmark is nearly equal to that of the projected worldwide prevstates “many children are diagnosed after a visit of 15 alence, supporting the efficacy of CADDRA at diagnosor 20 minutes” (n.p.). In order to make these distinc- ing ADHD in youths. The National Institutes of Health tions, the best practice guidelines (the written informa- projects that 5.29% of children and adolescents worldtion physicians use as a guide for complicated or vague wide have ADHD (n.p.) and ADHD diagnosis in Canada diagnostic procedures) must have strong methodology is at 5.0% (Children’s Mental Health Ontario, n.p.). This – they must be easy for doctors to use and produce uni- affirms that Canadian providers accurately diagnose form outcomes. If best practice guidelines are not crys- pediatric ADHD by implementing Canadian diagnostic tal clear, improved awareness by parents and teachers procedures. may not have made diagnoses more accurate. Conversely, if the worldwide projected prevalence is Best practice guidelines used for ADHD diagnosis in the compared with the prevalence of ADHD in the United United States are actually quite vague, making it hard- States, a nation with lax diagnostic best practice for er for physicians to correctly diagnose ADHD. Miguel ADHD, 11% of children and adolescents are diagnosed Seixas, a researcher for the United Kingdom’s National with ADHD, doubling that of the worldwide estimate Health Service, published “Systematic review of national (CDC, n.p.). This analysis provides quantitative evidence and international guidelines on attention-deficit hyper- for Hinshaw et al.’s conclusion that international variaactivity disorder” with his colleagues in the journal Psy- tion in ADHD prevalence “can be attributed to dispachopharmacology. In this article, Seixas et al. analyze rate diagnostic practices and algorithms” (463). Supedifferent clinical best practice guidelines developed by rior guidelines in Canada likely prevent misdiagnosis. In

science and engineering contrary, the sub-standard guidelines used in the United States are not only insufficient, but may also lead to misdiagnoses in both theory and practice. However, does over-diagnosis present an opportunity for over-prescription of ADHD medication, and could this phenomenon cause any harm? Many children and adolescents who are diagnosed incorrectly with ADHD are now being improperly prescribed with medication. Although Koplewicz states that “what we don’t need is hysteria that we are handing out […] drugs to kids like candy,” approximately 8.1 million young people in the United States have received ADHD diagnosis, and upwards of 5 million are taking medications to treat ADHD (US Census Bureau, n.p.) (CDC, n.p.) (Fig. 1). Based on the premise that the true prevalence of ADHD in the United States is actually 5% rather than 11%, and that approximately two-thirds of young people diagnosed with ADHD in the United States receive medication, millions of children and adolescents in the United States are taking ADHD medication for conditions that they do not have. Although Koplewicz asks everyone to keep calm, over-diagnosis is undoubtedly a driving force of over-prescribed ADHD medication, and the phenomenon is occurring at an alarmingly high rate. There seems to be little doubt in the medical community that there are medications effective at treating ADHD. However, medication itself may not be as innocuous as previously thought, and may cause harm in some cases. Physician panelists on the Ask an Expert panel and Koplewicz make convincing claims to defend medication rates in the United States. Although it is certainly plausible that “[a]s many as 80% of children respond well to one of these medications,” (Koplewicz & Newmark, n.p.) both the panelists’ and Koplewicz’s rosy depictions of pharmacological efficacy minimizes the potentially dangerous side effects of the drugs. Jake Anthony*, who is twenty-one-year-old and a thirdyear college student, was diagnosed with ADHD when he was thirteen. He experienced fairly extreme side effects from the prescribed medication for the first five years after his diagnosis. Due to appetite suppression, Jake “lost fifteen pounds in the first couple of months,” had trouble sleeping, and became “extremely dehydrated” (Anthony, min. 3; min 12). He even visited the emergency department on multiple occasions for chest pains and respiratory issues attributed to his ADHD medication (Anthony, min. 15). Newmark has also noted patients’ diverse physical and emotional side effects, such as “decreased appetite, irritability, nausea and insomnia […] (n.p.). “One mother […] took her child off of ADHD medication because [...] it was as if the medication was a dam holding back her happiness” (n.p.). Such side effects should alert physicians to pause before “reaching reflexively for a prescription pad every time a child is diagnosed with ADHD” (Newmark, n.p.). It is challenging to weigh the benefits of medication against the potential side effects a child may experience. However, as the Center for Disease Control and Prevention states that although side effects are always mild, there is a serious flaw in medical care for youth in the United

hurj spring 2016: issue 22 States (CDC, n.p.). Over-prescription and inappropriate prescription of ADHD medication represent a failure of the medical community to care for the nation’s youth. Over-prescription is a problem that has serious effects on the health of millions of children in the United States. Acknowledging over-prescription and attenuating its causes would increase ADHD research and potentially improve ADHD diagnosis and treatment methods in the future.

hurj spring 2016: issue 22

science and engineering

Pre-Scribes: A Potential Model for Undergraduate Volunteer Scribes Laurence Hou, Nabeel Saif Public Health, Class of 2016; Molecular and Cellular Biology, Class of 2017

Objective To assess the utility, feasibility, and potential benefits of using an undergraduate volunteer, or “Pre-Scribe”, to scribe for healthcare providers. This program would operate within select clinics to reduce providers’ data entry workloads, utilize otherwise untapped pre-medical volunteer hours, and provide clinical experience to undergraduate students interested in medical careers.

Background The rise of electronic health records (EHRs) across healthcare organizations has not only altered the nature of patient-provider interactions, but it has also increased the amount of computer documentation required in daily provider workflows. At teaching hospitals, health care providers are tasked to enter patient data into EHR systems in addition to clinical, teaching, and administrative duties. EHR systems have a myriad of benefits, such as ease of access to data, imaging, and tracking ordering services; however, providers perceive the task of EHR documentation to be an unproductive use of their time, potentially increasing the incidence and prevalence of work-related burnout.1 The use of scribes is one solution to alleviate the volume of patient data entry required of healthcare providers. A recent study regarding the use of scribes in an emergency department resulted an increased satisfaction among patients and physicians, as well as increased volume of patients by 7.5%.2 This project set out to assess the utility and feasibility as well as the potential educational healthcare delivery and work-flow benefit of incorporating pre-medical scribe volunteers in a subspecialty outpatient workflow model.

Methods Phase 1: Needs Assessment Findings • CRNP for the pilot subspecialty clinic was shadowed for two clinical sessions to assess the clinic’s needs and potential areas to improve workflow. • Pilot subspecialty clinic currently manages patients with complex medical conditions involving high level care coordination. • Pilot subspecialty clinic current workflow: both new and returning patients always met the CRNP after a scheduled visit with Physician A months later. During the visit, CRNP utilized a paper template to record relevant patient data. In the last ten minutes of the visit, the CRNP switched to the computer to enter diagnoses,

prescriptions, and create a patient summary. • The entirety of the handwritten patient notes would need to be transcribed onto the EPIC EHR system on the provider’s time outside of clinical hours. • Pilot subspecialty clinic current workflow: visits typically lasted at least 45-minutes. • Pilot subspecialty clinic was challenged with an increase in time needed to document various aspects of care coordination in EHR system, resulting a delay for providers to fully complete medical notes and patients’ dissatisfaction. • All departments used varying templates and documenting procedures.

Phase 2: Pre-Scribe Pilot Preparation • HIPAA Compliance Certified • Completed Background Check and Health Screenings • Completed “EPIC Nurse Ambulatory Care I and II” Training Modules

Phase 3: Pre-scribe Pilot Design • Initially, the Pre-scribe recorded only the ‘Review of Systems’ section of the patient’s visit based on the patient’s self-report on neurologic, gastrointestinal, cardiovascular, pulmonary, etc. symptoms into the EPIC EHR. • After five weeks and 43 total work hours, the Prescribe was able to proficiently document the majority of the visits in real time as the provider was conducting the visit. Sections scribed included the following: Visit Information, History, Medical History, Family History, Substances and Sexuality, Pre-Designated Progress Notes Templates, and Problem List (excluded submit orders for prescriptions, diagnoses, summary of the patient’s visit, and various parts that only providers were allowed to enter). The patient note was subsequently reviewed, edited and finalized by the provider within approximately ten minutes after the patient encounter.

Results Educational Benefit The student was more educationally enriched Pre-Scribing than conventional “shadowing”. As a scribe, the student engaged in patient care by processing the data and asking points of clarification for documentation, which are experiences that cannot be obtained through observation. Additionally, the student felt rewarding as a helpful service to the provider. Working as

science and engineering a Pre-Scribe also gave the student a unique opportunity to observe the complexity of delivering longitudinal and coordinated care that is invaluable for students interested in healthcare professions. Health Care Delivery Enhancement: Incorporation of the Pre-Scribe resulted in a significant reduction in time to finalize clinical visit documentation during the post-visit period and reduction in the number of outstanding clinical notes requiring “Sign Off” within the milestone gives weeks by an estimated 90%. As the provider’s time was freed up due to time savings and increased turnaround for documentation, prioritization of patient care was enhanced. Additionally, the ability to close notes sooner rather than later resulted a more accurate and comprehensive note, consequently contributing to improved billings for the clinic and increased provider satisfaction.

Discussion The State of EHRs in Out-Patient Clinics • The implementation of time-efficient EHR workflow models may not have considered variables of subspecialty clinics that involve complex and ill patients, who are in need of atypical conventional visits in primary care. • EHR and the need for providers to enter aspects of the visit into the computer during the visit complicate the interaction and forging of the bonding necessary in a doctor-patient relationship. The need for face-to-face time is more critical in subspecialty clinics with patient

hurj spring 2016: issue 22 populations experiencing complex medical conditions. Given the sensitive and intense nature of the pilot medical subspecialty, the provider’s undivided attention and eye-contact are absolutely essential to high quality patient-centered care.3 • This model of EHR incorporation into clinic workflow has been better tested in primary care and emergency department settings. Current Culture and Impressions of EHR by the Sub-specialty Provider in Tertiary Center • Provider resistance was based on concerns regarding additional administrative burden placed on the provider to enter large volumes of patient history, orders, care coordination, and referral into EHR. • Providers display variable comforts in using potential time-saving EHR entry pathways, such as ‘SmartPhrases’, ‘SmartTexts’, etc. that also allow for clinical uniformity and efficiency. • Providers were willing to embrace the incorporation and ideas of younger and more technologically comfortable pre-health students.

The Benefits of Undergraduate Scribes • Clinicians may gain increased work satisfaction and direct face-to-face interactions with patients from decreased time spent inputting data into EHR. • Patients can benefit from this increased face-to-face interaction as well, as it may enhance patient-provider rapport, making the patient more likely to comply with provider directives.3

hurj spring 2016: issue 22 • The financial costs of this scribe model are minimal since it is operated by volunteers.

The Future of Undergraduate Volunteer Scribes • The use of undergraduate scribes may be more suited to an academic medical setting, where providers do not see patients every day and have time to develop mentoring relationships with their students. • To maintain a sustainable program model, a steady flow of reliable pre-medical volunteers with appropriate training and institutional support are critical. • Ongoing feedback by the scribes, providers, and patients (with consent) on their experiences with the program are needed, so evidences are compiled to support the usage of volunteer scribes. • To maintain compliance with HIPAA and patient privacy, members from each study group should be de-identified and pooled for analysis. • Future analysis should include financial impact of the use of scribes as measured by Relative Value Units (RVU) difference as this can be a strong indicator of improved patient care. Other useful measures include time per note to completion with and without the scribe, and time per patient encounter.

Conclusion As the American healthcare system becomes more complex and resources become increasingly scarce, it is imperative to explore new and innovative ways to find cost-effective methods of care delivery and medical education.

References 1. Sigsbee B, Bernat JL. Physician burnout: A neurologic crisis. Neurology. 2014;83(24):2302–6. doi:10.1212/WNL.0000000000001077. 2. Bastani A, Shaqiri B, Palomba K, Bananno D, Anderson W. An ED scribe program is able to improve throughput time and patient satisfaction. Am J Emerg Med. 2014;32(5):399–402. doi:10.1016/j. ajem.2013.03.040. 3. Mast MS. On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns. 2007;67(3):315–8. doi:10.1016/j.pec.2007.03.005.

science and engineering

Performance Wheelchairs for Basketball: History, Developments, and Future Direction

Rohil Malpani Class of 2016 Biomedical Engineering

hurj spring 2016: issue 22

A wheelchair

is defined as a movable chair with wheels that a person can control manually or electronically. There are two main classifications of wheelchairs based on the method of propulsion: manual (either by the person using the wheelchair or by a third party) or power (propelled by means of a motor). Patients with transient or permanent disabilities related to the use of their legs for walking purposes benefit from using a wheelchair. A licensed healthcare practitioner evaluates the patient’s locomotive abilities before prescribing a wheelchair. Many different conditions necessitate the use of a wheelchair. For example, amputation of the lower limbs would require use of wheelchairs for effective locomotion. Some conditions, like having broken bones, require the use of a wheelchair until the user’s legs have healed enough to walk again. Other conditions like paralysis, because of spinal cord injuries, require the use of wheelchairs permanently. “Wheelchair sports are an important tool in the rehabilitation of people with severe chronic disabilities and have been a driving force for innovation in technology and practice.” [7] Wheelchair sports allow the user to get used to using a wheelchair and strengthen the muscles of the trunk and upper extremities that are important for propelling a wheelchair. Basketball in particular is one of the most popular wheelchair sports and this provides motivation for this study. In patients with spinal cord injuries, physical activity provided in the form of sports helps decrease depression, and the increased social interaction along with the therapeutic effects of activity helps to increase the average life span in such patients. [11] Wheelchair basketball, characterized by high intensity intermittent training (HIIT) activities like sprinting, rapid direction changes, and shooting of the ball, is helpful to enhance dexterity and aerobic capacity of the players and reduce fat content (measured by skinfold tests). [11] A study by Ergun et al. found that there was a significant difference in skill test results like the 20-meter sprint test and the figure eight test with higher performance seen by participants trained in wheelchair sports. [11] A study by Moreno et al. also found that physical training involving wheelchair sports has a positive effect on “respiratory muscle strength and thoracic mobility” (measured by means of thorax cyrtometry and Maximal Respiratory Pressure Measurement) in patients with spinal cord injuries, especially quadriplegics. [24]

History Development of the Sport and the Specialization of the Basketball Wheelchair Wheelchair basketball was formally established as a sport under the National Wheelchair Basketball Association in 1948 in the United States of America. [25] The large number of disabled veterans that returned home after the Second World War was an impetus for the organization and playing of the sport. [25] It was introduced on the global stage with inclusion in the 1960 Paralympic Games in Rome, Italy. The first World Wheelchair Basketball Championship was held in 1975, and since then, the sport has gone from strength to strength earning substantial public

science and engineering attention since the 1990s with several competitions at the school, collegiate, national, and international levels [25]. Some early modifications in the 1980s were smaller diameter push-rims, lowered seat height and outward pointed wheels [6]. Nowadays, wheelchairs are tailored to each specific sport, and performance has seen big jumps with changes in material and design of wheelchairs. Because rapidly developing equipment plays a huge role in wheelchair sports, the improvements in performance by wheelchair athletes over the second half of the 20th century far exceed the improvements by traditional able-bodied athletes in the same time period when measured using different metrics of athletic performance. [16] In the words of wheelchair athlete Jeff Winnebraker, all of these modifications were analogous to “taking the wheelchair from a wheelbarrow to….an airplane.” [16]

Analysis of the Current State of the Art A. Design Principles and Current Design Current approaches and principles guiding design of sports wheelchairs in general (according to Cooper et al.) are: a) integrating the user into the wheelchair to make one efficient unit, b) minimizing weight while maximizing stiffness, c) minimizing rolling and stationary resistance and d) changing design according to dynamic needs of the sport. For basketball in particular, the current state of art requires six wheels. [7] This includes four swivel casters: two in the back and two in the front along with two drive wheels. [7] The push rims affixed to the drive wheels have a slightly smaller diameter than the drive wheel itself and is the point of transfer of momentum between the player and the chair. [34] Sometimes, only one front caster is present which not only increases the space available to the player in the frame but also decreases the rolling resistance due to the caster. [10] The presence of the center of gravity over the drive wheels leads to efficient turning which is important because basketball is a game requiring very quick starts and stops. [10] This necessitates wheelchairs are optimized for quick response times and not necessarily for high speed. Up to a ten-degree outward tilt of the wheel (camber) is added to further widen the base of the wheelchair and add stability. [7] By tucking feet under the wheelchair, the seat height can be lowered too. [7] The seat is often narrower than that found on everyday wheelchairs, and straps lie across the lap, allowing the player to become integrated into the wheelchair and function as a unit. [21, 7] A shroud is present in the front of the chair anterior where the feet rest in order to prevent head-on collisions from directly impacting the player’s body. [34] Between the drive wheels and the underside of the seat, the hub of the wheelchair is present. [34] The hub includes the wheel bearings and quick release mechanisms to detach the wheels to allow for easier transport because folding frames are no longer in use. [7,34] According to Cooper et al. we even have specialized wheelchairs for different positions like centers and guards due to differences in roles in the team. Just like in the NBA, there’s a difference in average heights of players in these roles. [7] For example, forwards and centers often have a higher seat height to allow for ease of shooting while guards have a lowered seat to lower their center of

science and engineering gravity and maximize maneuverability. [7] A labeled diagram of the modern basketball wheelchair can be found in Figure 2 of the Appendix section at the end of the paper. [20] Basketball wheelchairs are optimized for maneuverability. Ed Owen, a wheelchair basketball coach, said that “maneuvering the wheelchair is the most basic skill” in the sport of wheelchair basketball. [26]

B. Effects of different parameters on overall Wheelchair Performance 1. Wheel stiffness and tire orientation Wheels used in basketball wheelchairs differ in “number, thickness, material and orientation of the spokes” which in turn all affect the dynamics performance of the wheelchair. [19] Radial stiffness has so far been the metric studied to get an idea of wheel stiffness; however, considering that the relatively high angles of camber impose a lateral load as well, lateral stiffness might be a good parameter to quantify wheel stiffness. [19] As discussed before, pneumatic tires are used over solid rubber tires. Within pneumatic tires, a new movement is popularizing the use of tubeless variants which are more resistant to punctures when compared to the variants in clincher tires which have a lower inflation pressure. [19] Tubeless tires have lower oxygen uptake and better linear sprint performance when compared to clincher tires. [19] 2. Ergonomics and Seating Most of the studies have been limited to a daily life focus which does not necessarily transfer to the court for wheelchair basketball. [21] Seat positioning in the vertical domain (seat height) and the horizontal domain (fore-aft position) have a direct role to play in resistance, maneuverability and in-game factors like arm reach. [21] It has been shown that higher seat height increases oxygen uptake and has a reduced mechanical efficiency (ME), even though it increases reach. [30, 21] It has also been shown that when seat height is decreased tremendously, oxygen uptake increases, resulting in the hypothesis that an optimal seat height exists. [21] Higher seat height increases the trunk range of motion, so it may be of therapeutic effect for an associated illness. [21] Lower seat height also decreases push frequency and increases push height, so positions that require extended times of high velocity tend to benefit from lower seat positions. [30] 3. Effects of Wheelchair Camber Players themselves are conflicted on whether camber helps straight line performance or not although they all agree it increases maneuverability. [30] Increasing camber and thus having a wide wheel base is thought to improve lateral stability, turning speed and lead to larger protection of the player’s body from collisions. [21] Something to note from a study by Lim et al. is the fact that higher camber was associated with a lower efficiency, even though the results were not significant. [18] Isolating the effects due to change in camber is also difficult since it automatically affects seat positioning and resting posture (elbow angle, shoulder width etc.) of the athlete due to modifications that now have to be made for stroke trajectory. [21] Increase in physiological demands has been reported with higher camber when attempts have been made to stan-

hurj spring 2016: issue 22 dardize body parameters. [21] 4. Hand-rim Size and Positioning Smaller hand-rim had an advantage in terms of initiating movement and increasing velocity for a short amount of time, but the larger handrim chair had an advantage in attaining maximum velocity once a certain amount of velocity had already been attained. [18] Reducing the hand-rim diameter is equivalent to reducing the gear ratio available to the user. [21] Larger diameter hand-rims increase the linear velocity of the hand and require the application of a smaller torque to translate into the same linear speed [21]. 5. Efficiency of Propulsion and Different Strategies According to a study by Lenton et al., wheelchair propulsion by synchronous and asynchronous methods were studied in detail at two different arm frequencies and different linear velocities. [17] The results found were that efficiency indices decreased with an increase in velocity. [17] Asynchronous propulsion techniques generally resulted in a lower measure of efficiency metrics like ME. [17] Synchronous propulsion also resulted in a lower heart rate at peak velocity than did asynchronous propulsion. [17] 6. Wheel Size Players believed that smaller diameter wheels were attributed to greater initial acceleration and might enable higher maneuverability at the cost of other metrics like long-term high velocity performance. [30] Due to the higher magnitude of force required to accelerate a chair with larger wheels, players with significant impairment were recommended to use wheelchairs with smaller diameters. [30] These observations primarily refer to the diameter of the main drive wheels. In a study by Mason et al., they showed that increasing diameter from 0.59m to 0.63m increased time taken for a 20-meter sprint. [20] Sprinting performance was affected with higher performance from larger wheel diameter set. (r=0.63). [20]

C. Injury Prevention and Safety Some features have been introduced in order to prevent injuries: front and rear casters (to prevent tipping over) and a lowered center of gravity in basketball wheelchairs (to further stabilize it along with a wider base due to camber). [7] Since basketball is a contact sport, there is a chance of having body parts caught between colliding parts, but a wider handrim along with a shroud at the front seek to prevent that problem. [16] Shoulder injuries are most common since the shoulder is the joint that bears most of the brunt of locomotion and braking. [9] Lack of safety equipment specially designed for the sport, a higher risk of injury coupled, and a lower general level of satisfaction plague wheelchair athletes. [5] Serious permanent shoulder lesions can result from shoulder injuries which are taken as commonplace in this sport. [23] Blisters affect almost 75% of all participants and form ~25% of all injuries even though the athletes were using gloves. [23] Surprisingly, incidents of fractures in lower extremities are relatively low given that osteoporosis is inadvertently present in the lower limbs of participants. [23] A study by Jackson et al. claims that 70% of athletes examined had electro-diagnostic confirmation of Carpal Tunnel Syndrome which merits discontinuing their athletic pursuits in the sport. [13] The most serious

hurj spring 2016: issue 22 injuries normally are concussions suffered due to intense collisions and possible tipping over despite the casters being present. [23]

III. Suggested recommendations A. Overview of Possible improvements and Evaluation of Strength of Studies A lot of the studies examined that dealt with wheelchair patients had similar issues: problems in isolating certain factors responsible for changing wheelchair dynamics and ergonomics, difficulty in constructing a control group for many studies since being in a wheelchair actually changes physiological factors in the body not present in able-bodied individuals and challenges with sample size due to difficulty in recruiting sufficient number of volunteers. Most of the volunteers are already athletes with years of experience making it difficult to establish a baseline and lack of standardization of metrics to measure quantities like efficiency with different regions of the world adopting their own standards. On the whole however, there is a lot of research on the subject and after barring these issues, the studies are insightful and unique. One particular area of improvement that is apparent deals with the measurement of different metrics to determine the optimal conditions for various wheelchair components and settings. The problem with the studies done so far are that they use drills and test scenarios not necessarily found in basketball just for representative purposes. These include tests like the figure eight test for dexterity and the 50-meter sprint test for speed. However, basketball is a very modular game with many rapidly changing actions and reactions which make these simple tests invalid in actual performance. For example, a 50-meter sprint test is more suited for wheelchair racing than it is for wheelchair basketball. In wheelchair dynamics, in which customization is essential for optimized performance for a particular role, it is imperative that the tests that determine the customization be as close to the real world game as much as possible. A solution to this problem would be to use drills from training in the actual test. Training drills in the sport are consistent across the world, and these can be taken advantage of to result in more accurate optimizations of the wheelchair for the game. The hypothesis is that drills like free throw accuracy, a fast break, lay-up practice and evasive maneuvers to get around defensive players will result in more accurate representations of wheelchair basketball in the real world and a higher standard of research in the field.

References 1.Ardigo, L. P., Goosey-Tolfrey, V. L., & Minetti, A. E. (2005). Biomechanics and energetics of basketball wheelchairs evolution. International journal of sports medicine, 26(5), 388-396. 2.Berger, R. J. (2004). Pushing forward: Disability, basketball, and me.Qualitative inquiry, 10(5), 794-810. 3.Brown A, Banks K (2015). Wheelchairs & Assistive Devices. In Maitin I.B., Cruz E (Eds), CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. Retrieved November 22, 2015 from http://accessmedicine. mhmedical.com/content.aspx?bookid=1180&Sectionid=70383529. 4. Brubaker CE, McLaurin CA, Gibson JD. Effect of seat position on wheelchair performance. Proceedings of the International Conference on Rehabilitation Engineering. Ottawa Canadian Medical and Biological Eng. 5. Campbell, E., & Jones, G. (2002). Sources of stress experienced by elite male wheelchair basketball players. Adapted Physical Activity Quarterly.

science and engineering 6. Cooper, R. A. (1990). Wheelchair racing sports science: a review. 7. Cooper, R. A., & De Luigi, A. J. (2014). Adaptive Sports Technology and Biomechanics: Wheelchairs. PM&R, 6(8), S31-S39. 8. Coutts, K. D. (1991). Dynamic characteristics of a sport wheelchair. 9. Curtis, K. A., & Black, K. (1999). Shoulder pain in female wheelchair basketball players. Journal of Orthopaedic & Sports Physical Therapy, 29(4). 10. de Groot, S., Gervais, P., et al. (2003). Evaluation of a new basketball wheelchair design. Technology and Disability, 15, 7-18. 11. Ergun, N., Duzgun, I., Aslan, E., & Fizyoterapi, R. (2008). Effect of the number of years of experience on physical fitness, sports skills and quality of life in wheelchair basketball players. Fizyoterapi Rehabilitasyon. 12. Harbalis, T., Hatzigeorgiadis, A., & Theodorakis, Y. (2008). Self-Talk in Wheelchair Basketball: The Effects of an Intervention Program on Dribbling and Passing Performance. International Journal of Special Education. 13. Jackson, D. L., Hynninen, B. C., Caborn, D. N., & McLean, J. (1996). Electrodiagnostic study of carpal tunnel syndrome in wheelchair basketball players. Clinical Journal of Sport Medicine, 6(1), 27-31. 14. L. Lei, T. M. Guan, L. J. Shan, “Structure Design and FE Analysis of a Newly Basketball Wheelchair”, Advanced Materials Research. 15. Laferrier, J. Z., Rice, et al. (2012). Technology to improve sports performance in wheelchair sports. Sports Technology, 5(1-2), 4-19. 16. LaMere, T. J., & Labanowich, S. (1984). The History of Sport Wheelchairs: Part I: The Development of the Basketball Wheelchair. 17. Lenton, J. P., Fowler, N., Van der Woude, L., & Goosey-Tolfrey, V. L. (2008). Efficiency of wheelchair propulsion and effects of strategy. 18. Lim, B. O., Shin, et al. (2008, March). The effects of wheelchair camber and handrim size in wheelchair basketball movement. 19. Mason, B. S., Lemstra, M., van der Woude, L. H., Vegter, R., & Goosey-Tolfrey, V. L. (2015). Influence of wheel configuration on wheelchair basketball performance: Wheel stiffness, tyre type and tyre orientation.Medical engineering & physics, 37(4), 392-399. 20. Mason, B. S., Porcellato, L., van der Woude, L. H., & Goosey-Tolfrey, V. L. (2010). A qualitative examination of wheelchair configuration for optimal mobility performance in wheelchair sports: a pilot study. Journal of rehabilitation medicine, 42(2), 141-149. 21. Mason, B. S., van der Woude, L. H., & Goosey-Tolfrey, V. L. (2013). The ergonomics of wheelchair configuration for optimal performance in the wheelchair court sports. Sports medicine, 43(1), 23-38. 22. Mason, B., van der Woude, L., Lenton, J. P., & Goosey-Tolfrey, V. (2012). The effect of wheel size on mobility performance in wheelchair athletes. International journal of sports medicine, 33(10), 807-812. 23. McCormack, D. A. R., Reid, D. C., Steadward, R. D., & Syrotuik, D. G. (1991). Injury Profiles in Wheelchair Athletes: Results of a Retrospective Survey. Clinical Journal of Sport Medicine, 1(1), 35-40. 24. Moreno, M. A., Zamunér, A. R., Paris, J. V., Teodori, R. M., & Barros, R. M. (2012). Effects of wheelchair sports on respiratory muscle strength and thoracic mobility of individuals with spinal cord injury. American Journal of Physical Medicine & Rehabilitation, 91(6), 470-477. 25. National Wheelchair Basketball Association. (2004). History of Wheelchair Basketball. 26. Owen, E. (1982). Playing and coaching wheelchair basketball. Urbana: University of Illinois Press. 27. Skordilis, E. K., et al. “Comparison of Sport Achievement Orientation of Male Wheelchair Basketball Athletes with Congenital and Acquired Disabilities 1.” Perceptual and motor skills 103.3 (2006): 726-732. 28. Sporner, M. L., Grindle, et al. (2009). Quantification of activity during wheelchair basketball and rugby at the National Veterans Wheelchair Games: A pilot study.Prosthetics and orthotics international, 33(3), 210-217. 29. Van der Woude, L. H., de Groot, S., & Janssen, T. W. (2006). Manual wheelchairs: Research and innovation in rehabilitation, sports, daily life and health. Medical engineering & physics, 28(9), 905-915. 30. Wang, Y. T., Chen, S. H. I. H. U. I., Limroongreungrat, Weerawat, & Change, L. S. (2005). Contributions of selected fundamental factors to wheelchair basketball performance. 31. Woodard, Mike, comp. “National Wheelchair Basketball Association Official Rules 2015-2016.” 32. Yanci, J., Granados, et al. (2015). Sprint, agility, strength and endurance capacity in wheelchair basketball players. Biology of Sport. 33. Yildirim, N. U., Comert, E., & Ozengin, N. (2009). Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control. Journal of back and musculoskeletal rehabilitation. 34. Yilla, A. B. (2004). Anatomy of the sports wheelchair. Athletic Therapy Today, 9(3), 33-35. 35. Yilla A.B., La Bar RH, Dangelmaier BS. Setting up a wheelchair for basketball. Sport ‘n Spokes 1998; 24: 63–65.