IN THIS ISSUE Science & Technology 4
Tailoring Medicine for You with Precision Medicine Srijit Paul Northwestern University '20
6
Eric Kim James Guo
Machines for Mankind Troy Biermann
Managing Editor
Molluscum Contagiosum Virus Scott Dent
Executive Editor
Northwestern University '20
8
Editors-in-Chief
University of Michigan '19
Nathan Shlobin Tina Liu
Creative Directors
Health Care & Policy 12
Technology's Impact on the Future of Healthcare Elaine Sobel Northwestern University '20
Human Interest 15
Schizophrenia: A Comprehensive Understanding Casey Norlin
18
Antioxidants Katherine Casey
Northwestern University '18
Rutgers University '17
20
Narcan Jennifer Slota
22
In Vitro Gametogenesis Elizabeth Sager
Northwestern University '20
Northwestern University '20
2 • The Medical Decoder • Winter 2018
Mariam Ardehali Matthew Lam
PR Director
Evan Sitar
Outreach Director
Carson Wilmouth
Writing Staff
Troy Biermann Katherine Casey Scott Dent Casey Norlin
Writing Staff (cont.) Srijit Paul Elizabeth Sager Jennifer Slota Elaine Sobel
Editing Staff
Michael Abert Eugenie Bang Troy Biermann Angie Chen Shannon He Monica Juarez Rachel Seng
Design Team
Harcourt Allen Matthew Casler Esther Chung Alicja Jankowski Zhaklin Sevova
Sincerely, Eric Kim and James Guo Editors-in-Chief medicaldecoder@gmail.com Letter from the Editors • Volume 10 • 3
TAILORING MEDICINE FOR YOU WITH PRECISION MEDICINE by Srijit Paul
In his 2015 State of the Union address, President Barack Obama introduced the Precision Medicine Initiative. This new initiative was the government’s way of backing the rapidly growing field of precision medicine. However, this left many asking, “What is precision medicine?” As the name suggests, precision medicine is an
individualized approach to medicine. It deviates from traditional medical procedures and focuses on developing treatments specific to the affected individual and their lifestyle factors.1 Precision medicine is grounded in genetics. With the successful sequencing of the human genome, gene-based treatments became
4 • The Medical Decoder • Winter 2018
feasible in recent years. Today, precision medicine is quite widespread. Trastuzumab and pertuzumab are precise medications that can be used to treat patients with breast cancer with a specific mutation of the HER2 gene. Precision medicine has also given rise to the field of pharmacogenomics, which is the development of
drugs based on patient response. ever, giving consent is important precision medicine is common Many genes can influence an indi- for the progression of medicine. with any form of customization, vidual’s response to a drug--with These unpreceded shifts in pri- whether it be a car or a computpharmacogenomics, drugs can be vacy and patient data show the er—the cost of developing pretailored to patient response and influence that precision medicine cision medicine can be high. For create a more efficient treatment has on the entirety of the medical instance, the drug ivacaftor esregimen.2 field. sentially cures cystic fibrosis in These theories are being fur- However, like many promising patients with a certain mutation. ther applied in other areas of scientific theories, precision med- However, developing ivacaftor medicine. Autism is traditional- icine does struggle to fully meet took many years, even with raply diagnosed through signs and the public’s high expectations. id approval of the Food Drug Adqualitative observations. How- Huub Shellekens et al. points out ministration. Furthermore, ivaever, with the emergence of pre- that precision medicine is not caftor is incredibly expensive for cision medicine, more focus has quite as precise as one would ex- patients. The regimen itself costs gone into searching for the genet- pect. Current models of precision $300,000 a year--a staggering figic causes of autism so that treat- medicine are based on making ure. On top of that, the drug only ments can be specially tailored drugs for groups of people with helps around 5% of cystic fibrosis towards individual patients.3 Be- the same trait for a disease. This patients.6 From both a drug comyond this, the healthcare indus- method does not consider the pany and patient’s standpoint, try as whole is starting to feel many other genetic and physio- Ivacaftor and other precision the effects of the precision drugs do not seem financialmedicine movement. Healthly appealing in any way. “Many genes in an care providers and individual Precision medicine is a long individual can dictate doctors have been more and way away from the overly more encouraged to collect optimistic ideas of persontheir response patient data and create gealized pills based directly to a drug. With netic and trait databases that off a patient’s genetic code. can aid medical professionals pharmacogenomics, drugs Of course, each person is when developing personalunique in innumerable can be tailored to ized treatment plans. This ways, and universal treatpatient response and system of patient data also ments cannot possibly acdepends on patient consent. create a more efficient count for all these small Patients need to be willing differences. However, pretreatment regimen.” and well-informed to release cision medicine itself is the their treatment information, future of disease eradicaas well as personal data to build logical differences of the mem- tion. As time progresses, the dathese databases. Collecting data bers of a group of patients that tabases are sure to grow and prois a new experience for many pa- are treated with the same “per- vide medical professionals with tients as data collection has been sonalized” drug.5 This general- the tools necessary to treat each long contained within medical ized method seems to contradict patient individually. The goal of research. Precision medicine, on the central idea of precision med- medicine is to alleviate suffering, the other hand, requires a wider icine. While there is a higher lev- and that calls for newer, more effiinput of patient data that can only el of specialization in this type of cient treatment methods that adbe collected directly from clinical treatment, this deviates from the dress many of the medical issues care, which calls for reform of the expected individualized care that we face today. patient consent system.4 Being precision medicine is too often asked to share personal data with touted as. For references, please see Page unknown medical professionals Another issue that is often brought 26. can seem intrusive to some. How- up with the customized nature of
Science & Technology • Volume 10 • 5
MACHINES FOR MANKIND The present and future of robotics in medicine by Troy Biermann
Many people picture the future of hospitals and medical care filled with a variety of hi-tech machines and robots. They do not realize this future might be closer than it seems. Since the early 2000s, robotics within medicine has advanced from theory to a burgeoning and promising reality. The medical robotics industry is currently worth around $3.5 billion, with spending estimated to increase to approximately $6 billion by 2020.1 These robots help
streamline the medical process, whether by allowing safer and more efficient surgical techniques or by ensuring more accurate and effective treatment. Some of these devices require direct human input to be utilized while others act autonomously and gather data to provide some sort of output. Regardless, the rapid development of such technology has garnered large amounts of both excitement and skepticism. In particular, significant
6 • The Medical Decoder • Winter 2018
progress has been made in the advancement and utilization of robot-assisted surgery. Such devices provide robotic limbs that can act as an extension to those of a surgeon. These limbs, controlled via a remote console, allow a surgeon to perform minimally invasive procedures with extreme precision. Perhaps the most notable among these is the da Vinci Surgical System, initially developed in 2000 and operated with a set of four robotic
arms, which has served as both fed Watson data from the case this technology more expensive a standard for similar machines files of previous patients. Watson for patients. In addition, since and a method of popularizing was able to produce a list of 2004, there has been a significant medical robotics. Since its potential sources of the symptoms increase in the rate of injury inception, nearly four thousand ranked by likeliness of a certain and death reports from robotic units have been installed across disease, and its top suggestions surgery, from around 13 reports the world,2, a number that grows matched the diagnoses that the for every 100,000 procedures in as newer models are designed doctors had originally given. Most 2004 to around 50 reports per and produced. A study has impressively, Watson was able to 100,000 procedures in 2012, and shown that proper operation of do so within a matter of seconds as a large majority of these cases the da Vinci Surgical System can opposed to the days or even weeks involved device or instrument significantly reduce blood loss, that doctors deliberated over malfunction.7 Many also assert recovery time, and the chance the source of symptoms.5 Now, that effective diagnostic A.I. is not of surgical complication for Watson is used as a diagnostic widespread enough to be used prostatectomies, nephrectomies, tool in the Marburg hospital, outside of remote cases, and any hysterectomies, and other lower- with information fed to Watson similar substitutes, such as online body procedures.3 As these robots via extensive questionnaires symptom checkers, are not nearly continue to grow more versatile filled out by the patients. The as accurate as an actual human and user-friendly, many hope they doctors there anticipate that doctor.8 can be used for an even greater such technology could be used to Despite the potential setbacks variety of surgeries, that medical robotics especially for more “...proper operation of may have, it is undeniable intensive procedures that the benefits it can such as cardiac surgery. provide are noteworthy. the da Vinci Surgical An additional area Given recent rates System can significantly of of interest comes in technological the form of diagnostic progression, it is readily reduce blood loss, artificial intelligence. apparent that we are These machines recovery time, and the merely on the brink of account for factors what is possible for this chance of surgical that may not be field. In years to come, it commonly considered is likely that this sort of complication...” by practitioners during technology will become diagnosis in effort more advanced and fill to reduce the possibility of someday recognize entirely new larger roles within the healthcare misdiagnosis as a result of human or unknown diseases. system. Accordingly, it would be error, and their advancement However, many argue that it is wise to keep an open mind with has been rapid. For example, in a somewhat hasty to flaunt this regards to what the future has in study from 2012, Watson, IBM’s advanced technology as the be- store for these intelligent medical advanced artificial intelligence all and end-all for the future of machines. supercomputer, answered a healthcare. For one, the devices series of diagnostic questions required for robot-assisted from Doctor’s Dilemma, a surgery are often extremely competition for medical expensive. The da Vinci Surgical residents, with approximately System can cost a hospital 50% accuracy.4 Although this by upwards of $2 million,6 not to itself is not hugely notable, in mention the additional costs 2016, doctors from the University of training surgeons to use this Hospital of Marburg’s Centre for kind of technology, which in For references, please see Page 26. Undiagnosed and Rare Diseases turn make surgeries that utilize
Science & Technology • Volume 10 • 7
The Adaptive Brilliance of the Molluscum Contagiosum Virus by Scott Dent by Scott Dent
812• •The TheMedical MedicalDecoder Decoder• •Winter Winter2018 2017
In 2007, a large patch of North America was graced by the presence of an elusive and mysterious insect inhabitant: the Cicada Mania. Broods of cicadas remain active underground for 17 years before rising to the surface for five weeks to breed, lay eggs, and die.1 At age ten when I first witnessed the unconventional life cycle of the cicada, it just didn’t make sense to me. Why do they live their lives like that? What is the point of their existence? My father explained to me that, as odd as the cicada is, the same questions could be asked for any organism, and the answer will be the same for each. All living things on this planet, be it a dandelion or insect, are ultimately here to survive and reproduce. The way in which a species ‘lives its life’ is simply the result of millions of years of natural selection favoring the attributes of organisms that have been successful at, well, surviving and reproducing. For the cicada, its 17-yearlong subterranean campout is actually an adapted means of survival. In so doing, the insect-eating predators of North America have had neither access to eating the cicadas nor the impetus to adapt and become better hunters.2 As a result, cicadas have survived longer than any other insect in North America.3 When
considering the fact that cicadas are known to be “clumsy” and “defenseless” around predators, this evolutionary success is, undoubtedly, attributed to the obscure lifestyle that keeps the species safe. Though fascinating and unique in its own way, the cicada is not the only organism that has found evolutionary success through unorthodox adaptations. This logic helps explain the marveling success of the most abundant type of
a virus is a far less complex being than even a single-celled organism and is incapable of reproducing on its own. Without the organelles and enzymes needed to replicate its own DNA, a virus must highjack and make use of a host cell’s proliferation mechanics.6 How exactly this occurs depends on the type of virus, but essentially the virus does so by injecting its genetic code into the host cell. Once in the cell cytoplasm, the DNA strand is then transcribed into mRNA by an enzyme called RNA polymerase.7 The mRNA then acts as a blueprint which is read and translated into amino acids by the ribosome, an organelle which typically makes proteins for its host. These amino acids are assembled into virons. The process is repeated until the host cell can no longer hold all of its guests and bursts.7 One virus has adapted so well to its human host that it has been the most prevalent human-bound poxvirus in the world since the eradication of smallpox in the 1980’s.9 Known as Molluscum Contagiosum, this virus is infamous for its defense mechanisms and longevity. Within 5 weeks of infection, the Molluscum grows to a pearly white, dimpled lesion on the skin that is easily spread by scratching or even touching.10 Unfortunately, I have become
"Within five weeks of infection, the Mollusculum grows to a pearly white, dimpled lesion on the skin that is easily spread by scratching or even touching." organism on this planet: the virus.4 In fact, a virus is so inherently different from other organisms that most biologists don’t consider it to be an organism at all.5 This is because a virus operates in such a bizarre way that it simply does not fit the man-defined criteria for life. By definition, a ‘living’ entity is composed of at least one cell and has a means of selfreplication.6 Containing only a genetic sequence, glycoprotein receptors, and a protein capsule,
Science & Technology • Volume 10 • 9
very familiar with Molluscum as I contracted and fought against the adaptive brilliance of the virus for nearly a year. Though the infection is technically harmless to one’s physical health, it dragged me into a state of confusion, despair, and anxiety that I had never in my life experienced. After months of dermatologist appointments, prescribed medications and home remedies, the virus had only gotten worse. So how can Molluscum survive for several years on someone while the common cold (rhinovirus) is purged from our system within a matter of days? To answer this, let us look at the mechanism by which the Molluscum has evolved to protect itself. As mentioned earlier, viruses are adapted to manipulating and thriving off a specific type of host cell. The proteins sticking out of the Molluscum virus attach to receptors on the cell membrane of keratinocyte stem cells in the basal layer of our epidermis.9 By binding to and infecting only these cells, the virus has done itself two huge favors. First, all such cells lie above the basement layer of the epidermis. The importance of this is that the human immune system functions only within the boundary of the epidermis, so the Molluscum can grow comfortably on top of the skin without being detected by the natural defense system.
Secondly, by binding only to stem cell, and not mature, keratinocytes the virus can manipulate a host to its liking. According to Ruijin Hospital’s Xiaoying Chen, MD, the Molluscum virus does so by “modulat[ing] the normal stem cell differentiation programme, so that viral particles withstand lysosomal degradation and are eventually released to the surface of the epidermis as
infected cells break up.”9 In this process, the virus stimulates the epidermal growth factor proteins on the keratinocytes, which causes the cells to undergo mitosis and divide. Under normal conditions, an organelle called a lysosome is activated to destroy the cells that proliferate when they should not, but the virus inhibits this mechanism.11 As a result, the virus grows up and away from the immune system while protecting itself from the cell’s self-destruction system.
10 • The Medical Decoder • Winter 2018
Similar to how the cicada has found its niche in evading its predators underground, the Molluscum virus has achieved great success in hiding from its natural killers. Although no single medication has been found to be statistically better than another in the treatment of Molluscum, 9 many of the treatment options prescribed to Molluscum patients act as immune system activators. The first of these medications prescribed to me was Imiquimod, a topical ointment that promotes activity of the immune system by stimulating a protein called Toll-like Receptor 7 (TLR-7).12 The protein recognizes pathogen-associated molecular patterns (PAMPs) found in viral DNA and then stimulates the production of proteins called cytokines, which act as an immunological response to kill the foreign entities.13 Another medicinal approach to treat Molluscum seeks to disturb the proliferation of the virons. Implemented in prescription medications such as Cidofovir and found in natural home remedies such as tea tree oil, these antiviral proteins inhibit activity of the DNA polymerase used to make copies of the viral DNA in the host’s cytoplasm.9 Such treatments, unfortunately, do not kill off the virus, but they do keep the
lesions from expanding. The last category of treatment, known as physical therapy, takes a more direct approach by either removing or damaging the viral crops. These procedures include scraping away the virus with a curette, freezing the virus with liquid nitrogen, and electron beam therapy.9 I, personally do not recommend any of these physical therapy options. They were very painful and left scars on my skin that I may never see go away. Ultimately, however, it is imperative that you discuss your options with a dermatologist and strongly
consider their advice if you are ever to be infected by Molluscum. Every patient is different, and healthcare professionals are the only ones who are properly educated to provide the best course of treatment for an individual. In addition to medicinal treatments, I have found that a key factor in ridding your skin of Molluscum is having mental strength and a positive attitude. A bad case of Molluscum is frustrating, embarrassing and perplexing all at once. But clearing skin as soon as possible will require a great deal of patience and discipline. It is
up to the individual to develop the good habits and willpower necessary to eliminate the relentless, yet remarkable, virus. For references, please see Page 26.
Science & Technology • Volume 10• 11
TECHNOLOGY's FUTURE OF
12 • The Medical Decoder • Winter 2018
IMPACT ON THE HEALTHCARE by elaine sobel
The growth of technology continues to drive the evolution of medicine. With more and more technology readily available at both patients’ and doctors’ fingertips, emerging opportunities to impact the medical field abound. From mobile health devices and apps to artificial intelligence and digital medicine, novel forms of technologies are poised to change medicine even more as science and research advances. However, these developments necessitate vigilance and responsible action. These technologies must be safe and reliable, and should not be allowed to overshadow the humanity and sensitivity to nuance that currently only doctors, with their human touch, can provide. Mobile medical apps are currently available to patients, providing increased access to health and wellness information. It is
estimated that by 2018, half of the world’s more than 3.4 billion mobile phone and tablet users will have downloaded a health application.1 These apps, for example, exist for those seeking mental health advice for anxiety and depression2 or those trying to maintain a healthy weight and lifestyle.1 While having access to more medical information is likely beneficial, the full effects of apps like these, both positive and negative, have yet to be thoroughly investigated. For instance, more data does not guarantee better understanding; essential details could be obscured, or false associations could create undue anxiety and over-testing. In addition, the FDA does not strictly regulate mobile apps that do not provide specific treatment suggestions.1 With fewer safeguards in place, some of what is shared on these plat-
forms may be more vulnerable to communicating misleading information, or biased information by the influence of financial actors. Furthermore, even apps that may prove helpful may not reach all those within the population who need it, as disparities regarding the use of mobile technologies related to age, socioeconomic status, and literacy may hinder access.3 Mobile devices and apps also exist to directly benefit healthcare professionals. Some are designed to provide mobile access to medical information, including drug reference guides and medical calculators.4 Other apps involved in clinical decision-making can help clinicians determine which scans or tests to order, while other mobile device apps can monitor patient health through vital signs and ECG data.4 With the growth
Health Care & Policy • Volume 10 • 13
of “big data”, artificial intelligence, and increasingly complex data processing algorithms analyzing many data points (including biomarkers, millions of patients’ imaging results, published clinical research, and physician notes from electronic health records),5 future AI technology may have the power to threaten doctors’ role in patient care. Machine learning and data-driven clinical predictions have already been implemented within healthcare to provide risk scores for cholesterol patients or stratify intensive care unit patients by risk.6 AI-driven image recognition technology has even been shown to perform as well as or better than physicians on tasks such as recognizing metastasis in lymph nodes or classifying skin cancer.5 These technologies offer many possible benefits. By handling and analyzing vast quantities of information and sharing these results quickly with doctors, new technologies might help clinicians make more accurate and safe decisions for patients. However, these analyses can be limited by the quality of the initial data. Data source problems including patient self-selection, variable availability of outcome data, and the exclusion of holistic data such as social determinants of health, may bias machine-learning technology and compromise its predictive power.6 While still in its beginning stage, the role of artificial intelligence in medicine is a burgeoning realm of possibility. As technology continues to grow at such a fast pace, it is prudent and necessary
to consider the challenges of the progressively technologically-integrated world we are facing. AI cannot yet displace doctors, as current technology cannot engage in higher levels of interaction with patients. The human elements of doctoring—instilling trust, offering reassurance—may never be replicated by a machine. Furthermore, medicine is an ever-evolving field characterized by
Another element for concern as the digitization of healthcare progresses is the security of patient health information. As more and more health information is integrated into technologies, personal information is becoming more vulnerable to hackers. Without adequate safety measures to prevent the compromise of sensitive information, patients’ health and the protection of vital, private data could be put at risk. This concern is even more relevant with the discussion of medical devices that can directly administer care to patients, such as pacemakers or closed-loop insulin systems.7 These devices could be externally controlled by those who seek to cause harm.8 There is no doubt that technology plays an important role in finding innovative ways to gray areas in diagnoses and ethi- improve the health and lives of cal concerns. Applying algorithms patients. However, growth in techto providing care may never reach nology must be equally checked the level of understanding and by parallel growth in security and appreciation a human mind can regulatory measures. Before intehave for nuance, uncertainty, and grating information and technolunprecedented cases. ogy into our lives in such an imIt is also essential to consider portant way, it is imperative that the risks of becoming overly reli- we first understand its effects, ant on technology in healthcare. limitations, and pitfalls. Without To avoid placing doctors in help- a reasonable degree of vigilance, less situations, vigilance to main- society may fall prey to its effects tain back-up systems and down- at the expense of humans’ health time procedures must remain a and safety. focus. As well, greater reliance on technological tools could limit physician experience and knowledge on prior methodologies, impairing their ability to recognize misleading answers when they arise. Moving forward, a delicate balancing act between beneficial technological advancement and self-reliance must be struck. For references, please see Page 27.
"While still in its beginning state, the role of artificial intelligence in medicine is a burgeoning realm of possibility."
14 • The Medical Decoder • Winter 2018
Schizophrenia: A Comprehensive Understanding
By Casey Norlin Schizophrenia is a chronic mental disorder that affects 1-2% of the population. It is one of the most debilitating mental illnesses and currently has no cure. Once thought to be a solely genetic disease, schizophrenia and its causes are now best understood through a more comprehensive “biopsychosocial” model, wherein the development of the disease is instigated by genetic, environmental, emotional, and biological factors. From birth through puberty, schizophrenia exists in a “pre-
morbid” stage. During this period, a person experiences mild symptoms and impairments that, unless closely monitored, may be impossible to detect. However, once a person reaches puberty, the individual enters the prodromal stage and begins to express unusual psychotic behaviors. During the prodromal stage, a patient may experience fluctuations in behavior. Around ages 22-24, a schizophrenia patient experiences the full onset of the disease, and begins suffering from both
positive and negative symptoms. At the beginning of the deterioration caused by the disease, a patient may experience periods of remission, but eventually, the disease sets into a chronic and constant decline. The positive symptoms of schizophrenia include hallucinations and delusions, being unable to differentiate between reality and these hallucinations, and feeling singled out as if being controlled or followed. The negative symptoms are often dif-
Human Interest • Volume 10 • 15
ficult to distinguish from those of and even immunological abnor- nia.4 Overall, this study showed depression and include wanting malities – in line with the biopsy- that different microbial species to be alone, a lack of motivation, chosocial model – may help diag- and metabolic pathways predomfeeling as if something has been nose schizophrenia earlier. inate in control groups versus taken away, and difficulty in unIn recent years, the human schizophrenic groups.5 While the derstanding conversations and gut microbiome has been linked direction of the causal relationemotions. While there are medi- to brain development, cognition, ship between schizophrenia and cations to help patients cope with and behavior.2 Though the direc- changes in microbiome is still unthe symptoms of schizophrenia, tion of causality in this relation- clear, , testing the microbiomes of there is currently no cure for the ship has yet to be formalized, patients may be a useful diagnosdisease, and 40-60% of schizo- there appears to be a connection tic tool. phrenia patients attempt suicide. between the gut microbiome and Abnormalities in the basal As a result , much of the current the development of schizophre- ganglia of schizophrenia patients scientific research on schizophre- nia. A recent study from 2015 generates motor irregularities nia focuses on identifying which swabbed the throat microbiomes that can be used to predict the onmembers of at-risk groups are of a control group and of a group set of the disease. An increase in most likely to develop the disease, of schizophrenic patients, and dopamine in the basal ganglia cirso that they can begin receiv- found distinct differences be- cuit leads to hyperkinesia, the ining treatment earlier and possi- tween the groups. Most simply, voluntary movements associated bly prevent the onset of the dis- the control group had a wider di- with diseases such as schizophreease. Within high-risk nia and Huntington’s. groups, 25% to 35% While patients who will develop schizowill eventually develphrenia. Stressors in op schizophrenia may adolescence such as show motor developchanging body chemismental delays as chiltry, an increase in hordren, these delays and monal activity, and the irregularities may be loss of grey matter 1 all difficult to identify increase an at-risk paduring childhood. For tient’s chance of develexample, a child who oping schizophrenia. has difficulty learning Research has shown to walk will eventualthat treating high-risk ly learn to walk. Howpatients early on – with ever, when these irlow-dose anti-psychotregularities resurface ics, therapy, etc. – may during adolescence, help patients avoid the they can be used to ditriggers that initiate agnose which at-risk Figure 1: Differences in bacterials strains in the guts of the onset of the disease. patients are developschizophrenic and non-schizophrenic subjects Traditionally, schizoing the disease. phrenia was thought of as a pure- versity of bacterial species presDysfunction in the cerebelly genetic illness. While genes do ent. The schizophrenic group had lar-thalamic circuit may also play a part in the development of a higher abundance of lactic acid lead to motor abnormalities in schizophrenia, genetics is not a bacteria present, species of which schizophrenia patients. The cerperfect indicator for who will and modulate chronic inflamma- ebellar-thalamic circuit enables who will not develop the disease. tion.3 Chronic inflammation itself motor learning, without which Examining a combination of bio- is thought to be either another it can be difficult to maintain or logical, cognitive, genetic, motor, cause or symptom of schizophre- correct movement. A postural
16 • The Medical Decoder • Winter 2018
control task can be used to see if patients have difficulty maintaining their posture. Struggling with this task may indicate a deficit in a patient’s cerebellar-thalamic circuit, in turn indicating that the individual may be developing schizophrenia. A mismatch between speech and gesture is another motor-based indication of schizophrenia. The basal ganglia and cerebellar-thalamic circuits work in tandem to generate, maintain, and correct movement. Groups that are at-risk for schizophrenia can be tested for motor irregularities and difficulty maintaining or generating fine movement; which may indicate development of the disease. Cognitive changes are also
seen in patients with schizophrenia and can be used as a diagnostic and predictive tool. Deficits in memory, verbal comprehension, and perceptual organization are often seen with schizophrenia.
ation below the mean IQ score of individuals of similar age. While much uncertainty remains surrounding the causal relationships between schizophrenia and its symptoms, we can use diagnostic methods to attempt to prevent onset of the disease. Traditionally thought of as purely genetic and unavoidable, schizophrenia is now possibly preventable when a comprehensive collection of diagnostic tools are used to identify at-risk groups earlier and with more precision. Even though there is no cure for the disease, integrative diagnostic models may allow us to prevent the onset of schizophrenia. For references, please see Page 27.
"While genes do play a part in the development of schizophrenia, genetics is not a perfect indicator for who will and who will not develop the disease." In the premorbid stage, a patient will experience a minor IQ loss. When the disease has become fully chronic, a patient’s IQ may drop down to ~85, one standard devi-
25-35% of high-risk members develop schizophrenia
40-60% of schizophrenia patients attempt suicide Human Interest • Volume 10 • 17
ANTIOXIDANTS By Katie Casey Many food and supplement companies boast about the presence of antioxidants in their products. However, what do antioxidants actually do for our health? Antioxidants neutralize free radicals in the body, preventing them from causing damage. Free radicals, which are produced by normal metabolic processes of the body and external phenomena such as exposure to air pollution and X-rays (Lobo et al., 2010), are molecular species containing an unpaired electron in an atomic orbital (Lobo, Patil, Phatak & Chandra, 2010). The unpaired electron makes the species unstable and highly reactive, causing it to extract an electron from a more stable molecule, generating a new free radical. This chain reaction continues to create more free radicals, promoting more and more cellular damage (Thompson & Manore, 2016). Free-radicals have powerful oxidative properties. Atherosclerosis, the buildup of plaque in the arteries, is largely due to the oxidation of low-density lipoproteins, or LDLs. Release of free radicals from cells in the vessel wall cause the oxidation of LDLs, contributing to plaque formation and damage of endothelial cells (Lobo et al., 2010). Since cardiovascular disease is one of the leading causes of death in America, it is especially important to find ways to
prevent atherosclerosis. Another topic of great importance in health is cancer. Cancer develops when the typical orderly process of cell division is disrupted. Cells become abnormal, unhealthy cells survive when they should die, and unnecessary cell division causes tumors. When genes designed to control cell division and DNA repair are compromised by free radicals, cancer can develop (National Cancer Institute, n.d.). For example, reactive oxygen species, such as the hydroxyl radical, cause strand
Studies have shown a correlation between eating foods high in antioxidants, especially fruits and vegetables, with lower cancer risk. break base modification and DNA protein cross-links, and this alteration can cause a cell to become cancerous (Lobo et al., 2010). In fact, cancerous cells are found to have higher levels of reactive oxygen species than normal, healthy cells (Galadari, Rahman, Pallichankandy & Thayyullathil, 2017). In addition, free radical damage impacts the lipid membrane of cells. Free radicals cause lipid
18 • The Medical Decoder • Winter 2018
molecules to lose their water-repellent properties, destroying the integrity of the cell membrane. As a result, the cell loses its ability to regulate the movement of liquids and nutrients in and out of the cell (Thompson & Manore, 2016). The lipid peroxidation propagates, resulting in the formation of molecules like alkanes that serve as markers for illnesses such as neurodegenerative diseases and diabetes (Lobo et al., 2010). So what do we do to prevent free radical damage? The answer lies in antioxidants. Some antioxidants, such as uric acid and ubiquinol, are produced internally during normal metabolic processes, while others must be supplied through the consumption of vitamin E and vitamin C. These antioxidants can delay or prevent damage by interacting with free radicals and terminating the chain reaction of oxidation before vital molecules are destroyed. Antioxidants also work to prevent the formation of free radicals as well as recognize and remove oxidatively modified proteins from the cell (Lobo et al., 2010). Vitamin E is a fat soluble vitamin. About 90% of it is found in adipose tissue, while the rest is found in cell membranes. To protect the membrane from being oxidized by free radicals, vitamin E donates an electron to the free radical, stopping the chain reac-
tion of oxidative damage. Vitamin ever, antioxidant supplements the recommended amount of anE also protects LDLs, red blood have not shown the same posi- tioxidants is unnecessary and pocells, and lung cells from similar tive results. Utilizing antioxidant tentially harmful. The researchreactions. Much of the vitamin E supplements had no effect on ers concluded that simply eating we consume comes from vegeta- cancer risk in some studies and a diet high in antioxidants can ble oil and its derivatives, nuts, actually increased the risk in probably supply enough free-radseeds, cereals, and some vegeta- others (Thompson and Manore, ical-fighting nutrients for optimal bles. The recommended amount 2016). Research by Hercberg et cancer prevention. of vitamin E consumption per day al. (2004), found that low-dose Free radicals can be quite damis 15 milligrams for both men and supplementation of antioxidants aging to the lipid, DNA, and prowomen (Thompson and Manore, vitamin E and vitamin C, in ad- tein components of cells. This 2016). dition to beta-carotene, zinc, and damage can lead to serious health Another antioxidant vita- selenium lowered cancer inci- issues such as heart disease and min is vitamin C. Unlike vitamin dence in male participants, but cancer. Therefore, it is importE, vitamin C ant to consume is water solenough antioxiuble. Theredants to protect fore, it is the body against mostly found oxidative damin the extraage. Appropricellular fluate levels of anid, where it tioxidants can binds with be obtained by free radicals eating a wholeand presome, balanced vents them diet, and supfrom damplements should aging cell only be taken in Figure 1: Cartoon of antioxidant metabolite glutathione. membranes. the cases of malVitamin C nutrition and protects lung tissue from smok- not in women. The researchers miniscule baseline amounts of ing, ozone, and air pollution and commented that their study dif- the nutrients. Among the creative helps to regenerate vitamin E af- fered from others in that supple- ways people attempt to prevent ter vitamin E has been oxidized. mentation was at levels close to cancer, getting a sufficient dose The typical recommended allow- the recommended daily amount of antioxidants is a good place to ance of vitamin C is 75 mg per for each nutrient. However, wom- start. day for nonsmoking women and en have a higher baseline level 90 mg for nonsmoking men. Bell of certain antioxidants than men peppers, strawberries, and grape- have; therefore, it is easier for fruit are good sources of vitamin women to receive enough antioxiC (Thompson and Manore, 2016). dants through their diet, and supStudies have shown a correla- plementation is less effective. Antion between eating foods high tioxidant supplements are more in antioxidants, especially fruits beneficial to populations with and vegetables, and lower cancer a low baseline status of antioxirisk. Due to the ability of antiox- dants, often due to poor diet. It is idants to protect the body from likely that both free radicals and damage from free radicals, this antioxidants can be toxic at high should not be surprising. How- levels so supplementing beyond For references, please see Page 27.
Human Interest • Volume 10 • 19
Narcan Brings Development and Dispute to the World of Public Health in Schools
BY JENNY SLOTA
Every time opioids are used, a warning (or five) is surely given. On the side of every bottle of prescription painkillers, at every public school, and from every parent comes repeated instructions to be careful regarding the potential risks of dependency and misuse when it comes to opioids. Yet, the drug overdose and opioid death rates are on a continual, sharp rise in America. Upon finding that opioid overdoses in the country have nearly quadrupled in the last 20 years and are responsible for 91 deaths each day, the Centers for Disease Control and Prevention (CDC) are now declaring that America is facing an opioid epidemic, adding that young people are at the most risk.1 In an effort to combat this crisis, scientists and medical professionals have looked to naloxone, a drug described as an opioid antidote. In 2015, the FDA rushed to approve a very pragmatic form of this drug: a simple nasal spray. Known by its brand name Narcan, some scientists, educators, and
parents believe this drug-delivering device, through introduction into high schools around the country, could save a countless number of lives. Others, on the other hand, argue that when it comes to overdose deaths, making Narcan more easily available is not a solution but an enabler. Narcan can save a life with the push of a button. With its easy nasal delivery system and pocket-size portability, anyone can learn how to use it, anytime and anywhere. While not an entirely new invention, the urgent need for this simple device makes it one of the biggest breakthroughs in the fight against the nationwide epidemic. Adapt Pharma, developer of the current Narcan one-push nasal device model, explained that their priority was to “create a product that anyone could use, with no medical training,” due to the fact that overdoses commonly occur in public or non-emergency environments like homes and schools.7 Once the administrator places the small device in the na-
20 • The Medical Decoder • Winter 2018
sal cavity of the victim and pushes a button, the drug is released and should take only between 2 to 3 minutes to begin reversing the effects of an overdose.5 The drug works as an antagonist in the brain; it blocks the binding ability of opioids to their receptors in the brain by also binding to the sites on those receptors.6 Both high schools and middle schools all over the country have begun to taken advantage of Narcan. A school district in Westchester, New York has chosen to equip all of their schools with it, just as they always have EpiPens, inhalers, and fire extinguishers.2 The district’s medical director told the New York Times, “Rarely do we pull a defibrillator off the wall, but it’s there if we need it, and that’s how we approach this opportunity to have naloxone.”2 At least eight states have programs in place that require or encourage the drug in some capacity in schools. Some even provide free supplies to hundreds of schools in vulnerable areas8. In addition, there is a mas-
sive list of school districts around the country that have begun the process of obtaining the drug on their own, separate from state legislation.2 The largest force of resistance to bringing Narcan to schools comes from those who believe that having this opioid antidote on hand will actually lead to an increase in opioid use (and overdose and thus, death) among the teenagers who attend participating high schools. The thought that their school has immediate, on-site access to naloxone might suggest opioid immunity to students, and this mindset could be both dangerous and deadly. In Akron, Ohio, a 5-1 vote by the city’s Board of Education authorized all Akron high schools and middle schools to be stocked with Narcan.3 Debbie Walsh, in casting the only opposing vote, explained that she was worried about the “attitude of, ‘As long as there’s Narcan, we’re safe,'” and “sending the message to kids, ‘Don’t wor-
ry, take drugs. We’ve got Narcan to save you.'”3 Following this logic of a public safety device paradoxically encouraging a targeted unsafe behavior, one might ask if air bags shouldn’t exist because they might encourage reckless driving or if fire escapes on highrise buildings might wrongfully promote pyromania. While these ideas sound ridiculous, in the same sense, many say the crisis this country is facing is too serious to risk not having Narcan around. A New Jersey superintendent expresses his frustrations with those who think Narcan sends a bad message out to teenagers, explaining that this epidemic is not something that any school district can try to run away from. “There are drugs every-
have general over-the-counter accessibility which has become the recent case in the state of Michigan.9 Aside from the debate over the life-saving opportunity Narcan brings, the opioid epidemic in American faces increasing criticism regarding race and timing, in that this crisis only gained national attention and warranted such exceptional public health efforts once it began to affect white, suburban America. For references, please see Page 28.
where. We want to teach kids the right way to respond.” And maybe, he continued, “you’ll save a life.”2 Introducing supplies of Narcan to schools is a proactive measure to be taken in battling America’s opioid epidemic. The push continues beyond the walls of schools as drug overdose is now the leading cause of death for all Americans under 50.4 Many even want to see Narcan
Human Interest • Volume 10 • 21
22 • The Medical Decoder • Winter 2018
In just the past 40 years, traditionally accepted ideas of reproduction have been turned on their heads by breakthroughs in ART (Alternative Reproductive Technology) by the likes of methods such as in vitro fertilization (IVF). Despite initial hesitations regarding the ethics of artificially manipulating fertilization, ART has become a common and popular method of reproduction. Since the first successful in vitro fertilization in 1978, “test tube babies” now make up almost 2% of those born in the US each year. Alternative reproductive technologies have given millions of couples and individuals who were unable to conceive naturally the ability to have children. The domain of ART was recently introduced to in vitro gametogenesis, which endeavors to push these boundaries further in unprecedented ways. Not only would it help overcome many existing hindrances to reproduction, it--like other forms of ART that came before-challenges socially accepted ideas of parenthood. In vitro gametogenesis (IVG) is much like in vitro fertilization; in both, the process of fertilization is manipulated in a regulated laboratory environment. However, IVG does not require gametes from two donor parents as IVF does. In fact, neither
ovum nor sperm cells are required for IVG to carry out a successful fertilization. Instead of only traditional gametes, IVG allows for reproduction with any combination of somatic cells and gametes. First, epidermal cells obtained from either one or both parents are reprogrammed into manipulatable Induced Pluripotent Stem Cells (iPS). An iPS cell is a mature adult cell such as a skin or liver cell that becomes a stem cell after exposure to transforming
couples hindered by infertility to have children. Although this would certainly be a possibility through IVG technology, there are many other scenarios in which this technology could be implemented where there is currently no solution. Primarily, IVG could make reproduction possible for postmenopausal and premenarche women, multiplex parents, individuals, and same sex couples, each of which would have its own triumphs and concerns.6 The ability to derive ovum from somatic cells of postmenopausal women who wish to have children with a fertile partner would eliminate current age barriers of parenthood that restrict some families. On the other hand, the idea that premenarche girls could conceivably have children raises concern regarding IVG development. Although IVG would allow for reproduction to occur in situations that are both compromising for baby and parent, this potential risk could be assessed and restricted before its implementation. The idea that groups of more than two parents could be utilized with IVG technology also raises many concerns. It would eliminate many conventional ideas of parenthood, and many unconventional situations that society has no protocol for dealing with could emerge. In
“IVG allows for reproduction with any combination of somatic cells.” genes.2 These pluripotent cells have all the characteristics of embryonic stem cells and can then be manipulated to produce functional ovum or sperm. Although it is relatively easier to produce sperm cells through this method, ovum have also been successfully produced.5 These cells can then be used to fertilize already existing gametes, or a complimentary gamete derived similarly through this method. The gender of the cell donor has no impact on the gametes derived from this technique. At first glance, IVG seems to serve a similar purpose to current technologies that allow for
Human Interest • Volume 10 • 23
addition, allowing individuals without a partner to have children through a ‘solo IVG’ using solely their own genetic information introduces a unique set of problems. Although one-parent fertilization through IVG would not lead to exact clones of a parent, there are still many risks to selecting from such a small gene pool. The genetic information of one individual would be combined through a reshuffling of the alleles, which would have a greatly increased risk of homozygosity for many uncommon, genetic diseases. IVG technology raises additional concerns due to its ability to produce many usable gametes, which increases the chances of fertilization,1 but
could also allow for the selection of traits of future offspring. This raises ethical concerns, as by having so many gametes available, the ability to carefully pick and choose genetic traits
genetic patterns of future generations, which would have unpredictable results, possibly diminishing variety and reducing populations with genetic conditions that are only objectively ‘undesirable’ in our society, such as autism and achondroplasia. On the other hand, it could introduce the ability to select against lifethreatening disease and susceptibilities, leading to healthier children better prepared to live to the most dramatic extent longer lives unrestricted by would become a reality. People medical complications that are would be able to try and achieve commonplace today. perfection, as each possible Same-sex couples are a combination of alleles would be large group of individuals who present and able to be fertilized. could potentially utilize IVG This would open the doors to technology. Although they are the manipulation of human able to adopt children, female
"IVG could make reproduction possible for postmenopausal and premenarche women."
24• The Medical Decoder • Winter 2018
same-sex couples can often have half biological children through the use of a sperm donor, same-sex couples are currently unable to have children who are biologically related to both parents. IVG would provide same-sex couples with the ability to have biological children, which would be a large step from current technology. Some worry that this will reduce the number of current families of same-sex parents seeking to adopt children, implying that the adopted children are lesser and undesirable. However, the idea that family extends beyond biological boundaries is something that transcends sexual identity and is practiced universally. By making this technology available to the future LGBT community, the validity and kinship of current adoptive families would not be diminished at all. This opportunity would give future same-sex couples and transgender people the ability to have biological children in a way that is now an inconceivable dream for many. The desire for further biological relation to their children has often been expressed to reproduction specialists who attempt to use related donors or similar looking donors in order to achieve this effect. IVG would allow for these couples to experience this biological relation to their children and would also defy current societal norms. This
possibility challenges current anti-LGBTs who use the idea that same-sex couples cannot conceive biological children as a main argument against them. This may help people come to the realization that sexual reproduction and genetics reach far beyond socially constructed ideas of gender, giving more recognition to a group which is still largely discriminated against. IVG is nowhere near ready to be implemented in clinical trials due to the ethical concerns that it raises, particularly because of a lack of knowledge about the impact this technology would have on the lives of children born.3 This is because there are many factors that go into whether a birth is considered successful after ensuring preliminary conception
that researchers don’t fully understand. However, many believe that it will not be long until these methods are ready to be tested due to the fast paced advancements in ART. Although IVG is a long way from becoming a commonplace ART method, its development and future potential are groundbreaking. By challenging ideas of parenthood that have long been accepted, IVG is a technology that has the ability to implement positive change both medicinally and socially. l
For references, please see Page 28.
Human Interest • Volume 10 • 25
REFERENCES Cover
1. Greenhill, Richard, and Hugo Elias. Shadow Hand Bulb. 9 Jan. 2007. 2. Hodan, George. Doctor.
Tailoring Medicine for You with Precision Medicine
1. White House Precision Medicine Initiative. (n..). Retrieved July 6, 2017, from https://obamawhitehouse.archives.gov/node/333101 2. Ashley, Euan A. "Towards Precision Medicine." Nature Reviews Genetics 17, no. 9 (September 2016): 507-22. doi: 10. 1038/ nrg.2016.86 3. Geschwind, Daniel H, and Matthew W State. "Gene Hunting in Autism Spectrum Disorder: On the Path to Precision Medicine." The Lancet Neurology 14, no. 11 (November 1, 2015): 1109-20. doi: 10.1016/S1474-4422(15)00044-7. 4. Aronson, Samuel J., amd Heidi L. Rehm. "Building the Foundation for Genomics in Precision Medicine." nature 526, no. 7573 (October 15, 2015): 336-42. doi: 10.1038/nature15816 5. Schellekens, H., Aldosari, M., Talsma, H., & Mastrobattista, E. (2017). Making individualized drugs a reality. Nature Biotechnology, advance online publication. https://doi.org/10.1038/nbt.3888 6. Interlandi, Jeneen. “The Paradox of Precision Medicine.” Scientific American. Accessed July 6, 2017. doi:10.1038/ scientificamerican0416-24.
Machines for Mankind
1. Dhabale, S. (2016). Surgical Robotics Market by Component (Systems, Accessories, Services) and Surgery Type (Gynecology, Urology, Neurosurgery, Orthopedic, General) - Global Opportunity Analysis and Industry Forecast, 2014 – 2020. Allied Market Research. 2. Investor FAQ. (2016). Retrieved from http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-faq 3. Yu, J., Wang, Y., Li, Y., Li, X., Li, C. & Shen, J. (2014). The safety and effectiveness of Da Vinci surgical system compared with open surgery and laparoscopic surgery: a rapid assessment. Journal of Evidence-Based Medicine, 7:121–134. 4. Ferruci, D., Levas, A., Bagchi, S., Gondek, D., & Mueller, E. (2013). Watson: Beyond Jeopardy! Artificial Intelligence, 199: 93-105. 5. Marks, P. (2016). Dr House goes digital as IBM’s Watson diagnoses rare diseases. Retrieved from https://www.newscientist.com/ article/2109354-dr-house-goes-digital-as-ibms-watson-diagnoses-rare-diseases 6. Singer, E. (2015). The slow rise of the robot surgeon. Retrieved from https://www.technologyreview.com/s/418141/the-slow-riseof-the-robot-surgeon 7. Alemzadeh, H., Raman, J., Leveson, N., & Iyer, R. (2013). Safety Implications of Robotic Surgery: A Study of 13 Years of FDA Data on da Vinci Surgical Systems. Coordinated Science Laboratory, University of Illinois at Urbana-Champaign. 8. Semigran, H.L., Levine, D.M., Nundy, S., & Mehrotra, A. (2016) Comparison of Physician and Computer Diagnostic Accuracy. JAMA Intern Med, 176(12):1860-1861.
Molluscum Contagiosum Virus
1. 17 & 13 Year Cicadas, (Locusts), Cicada Broods & Maps. (n.d.). Retrieved July 07, 2017, from http://www.cicadamania.com/where. html#broodchart 2. Why Do Cicadas Spend So Much Time Underground? (2013, March 25). Retrieved July 13, 2017, from http://mentalfloss.com/ article/49609/why-do-cicadas-spend-so-much-time-underground 3. Cicada News, Facts, Lifecycle & Sounds from Cicada Mania. (n.d.). Retrieved July 05, 2017, from http://www.cicadamania.com/ 4. Eveleth, R. (2013, February 15). Guess What the Most Abundant Organism on Earth Is? Retrieved July 07, 2017, from http://www. smithsonianmag.com/smart-news/guess-what-the-most-abundant-organism-on-earth-is-19254662/ 5. Tracking Viruses Back in Time. (2010, September 06). Retrieved July 08, 2017, from http://www.astrobio.net/extreme-life/ tracking-viruses-back-in-time/ 6. 2004, 9. J. (2008, May 16). Are Viruses Living? Retrieved July 08, 2017, from http://www.virology.ws/2004/06/09/are-virusesliving/ 7. The Viral Life Cycle. (n.d.). Retrieved July 10, 2017, from https://courses.lumenlearning.com/microbiology/chapter/the-viral-lifecycle/ 8. The Viral Life Cycle. (n.d.). Retrieved July 08, 2017, from https://courses.lumenlearning.com/microbiology/chapter/the-viral-lifecycle/ 9. Chen, X., MD, Anstey, A. V., & Bugert, J. J. (2013, August 21). Molluscum contagiosum virus infection. Retrieved July 06, 2017, from http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70109-9/fulltext 10. Schaffer, M. J. (2016, September 01). Molluscum Contagiosum. Retrieved July 06, 2017, from http://jamanetwork.com/journals/ jamadermatology/fullarticle/2547245 11. Jordan, T. X., & Randall, G. (2012, February). Manipulation or capitulation: virus interactions with autophagy. Retrieved July 08, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264745/ 12. Ogbru, P. O. (n.d.). Imiquimod (Aldara, Zyclara): side effects and interactions. Retrieved July 10, 2017, from http://www. medicinenet.com/imiquimod-topical/article.htm
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REFERENCES 13. TLR7. (2017, July 12). Retrieved July 10, 2017, from https://en.wikipedia.org/wiki/TLR7
Technology's Impact on the Future of Healthcare
1. FDA Staff. (2015). Mobile Medical Applications. U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/MedicalDevices/DigitalHealth/MobileMedicalApplications/ucm255978.htm 2. Paul, Marla. (2017). New apps designed to reduce depression and anxiety as easily as checking your phone. Northwestern Now. Retrieved from https://news.northwestern.edu/stories/2017/01/apps-to-reduce-depression-anxiety/ 3. Ernsting, C. et al. (2017). Using Smartphones and Health Apps to Change and Manage Health Behaviors: a Population-Based Survey. Journal of Medical Internet Research. doi:10.2196/jmir.6838. 4. Ventola, C. Lee. (2014). Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. Pharmacy and Therapeutics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/ 5. Krittanawong, C. (2017). The rise of artificial intelligence and the uncertain future for physicians. European Journal of Internal Medicine. doi: 10.1016/j.ejim.2017.06.017. 6. Chen, Jonathan H., & Asch, Steven M. (2017). Machine Learning and Prediction in Medicine – Beyond the Peak of Inflated Expectations. New England Journal of Medicine, 376 (26), 2507-2510. 7. Hakami, Hooman. (2016). FDA Approves MiniMed 670G System – World’s First Hybrid Closed Loop System. Medtronic Diabetes, Between the Lines. Retrieved from https://www.medtronicdiabetes.com/blog/fda-approves-minimed-670g-system-worlds-firsthybrid-closed-loop-system/ 8. Knapton, Sarah. (2014). Terrorists could hack pacemakers like in Homeland, say security experts. The Telegraph. Retrieved from http://www.telegraph.co.uk/news/science/science-news/11212777/Terrorists-could-hack-pacemakers-like-in-Homeland-saysecurity-experts.html
Schizophrenia: A Comprehensive Understanding
1. Cannon, T. D., Chung, Y., He, G., Sun, D., Jacobson, A., Erp, T. G., . . . Heinssen, R. (2015). Progressive Reduction in Cortical Thickness as Psychosis Develops: A Multisite Longitudinal Neuroimaging Study of Youth at Elevated Clinical Risk. Biological Psychiatry,77(2), 147-157. doi:10.1016/j.biopsych.2014.05.023 2. Dinan, T. G., Borre, Y. E., & Cryan, J. F. (2014). Genomics of schizophrenia: time to consider 3. Castro-Nallar, E., Bendall, M., Perez-Losada, M., Sabuncyan, S., Severance, E., Dickerson, F. Crandall, K. (2015). Composition, taxonomy and functional diversity of the oropharynx microbiome in individuals with schizophrenia and controls. Peer J. doi:10.7717 4. Bloomfield, P. S., Selvaraj, S., Veronese, M., Rizzo, G., Bertoldo, A., Owen, D. R., . . . Howes, O. D. (2016). Microglial Activity in People at Ultra High Risk of Psychosis and in Schizophrenia: An [11C]PBR28 PET Brain Imaging Study. American Journal of Psychiatry,173(1), 44-52. doi:10.1176/appi. ajp.2015.14101358 5. Castro-Nallar, E., Bendall, M., Perez-Losada, M., Sabuncyan, S., Severance, E., Dickerson, F. Crandall, K. (2015). Composition, taxonomy and functional diversity of the oropharynx microbiome in individuals with schizophrenia and controls. Peer J. doi:10.7717 Other citations: Kotsiubinskii, A. (2002). A Biopsychosocial Model of Schizophrenia. International Journal of Mental Health,31(2), 51-60. doi:10.1080/00207411.2002.11449556 Müller, N., Weidinger, E., Leitner, B., & Schwarz, M. J. (2015). The role of inflammation in schizophrenia. Frontiers in Neuroscience,9(372). doi:10.3389/fnins.2015.00372 Schizophrenia. (2016, February). Retrieved July 08, 2017, from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml The Causes of Schizophrenia . (2010). Retrieved July 08, 2017, from http://www.schizophrenia.com/hypo.php# Understanding Schizophrenia Based on the Biopsychosocial Model. (n.d.). Retrieved July 08, 2017, from http://www.noeticmind.org/studies/biopsychosocial-model-for-schizophrenia.htm
Antioxidants
1. Lobo, V., Patil, A., Phatak, A., & Chandra N. (2010). Free Radicals, Antioxidants and Functional Foods: Impact on Human Health. Pharmacognosy Review. 4(8). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249911/ 2. Thompson, J. & Manore M. (2016). Nutrition for Life. United States: Pearson Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel A, Favier A, & Briançon S. (2004). The SU.VI.MAX Study: A 3. Galadari S., Rahman A., Pallichankandy S. & Thayyullathil F. (2017). Reactive Oxygen Species and Cancer Paradox: To Promote or to Suppress? Free Radical Biology and Medicine, 104. Retrieved from http://www.sciencedirect.com/science/article/pii/ S0891584917300035 4. Randomized, Placebo-Controlled Trial of the Health Effects of Antioxidant Vitamins and Minerals. Archives of Internal Medicine. 164(21) Retrieved from http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217683
References • Volume 10 • 27
REFERENCES Narcan
1. Centers for Disease Control and Prevention. (2016, December 16). Drug Overdose Death Data. Retrieved August 24, 2017, from https://www.cdc.gov/drugoverdose/data/statedeaths.html 2. Harris, Elizabeth A. (2017, March 29). In School Nurse’s Room: Tylenol, Bandages and an Antidote to Heroin. Retrieved August 21, 2017 from https://www.nytimes.com/2017/03/29/nyregion/in-naloxone-heroin-schools-room-overdose-antidote.html 3. Hawkins, Derek. (2017, July 13). After record overdoses in Ohio, Akron’s public schools will soon stock opioid antidote. Retrieved August 21, 2017 from https://www.washingtonpost.com/news/morning-mix/wp/2017/07/13/after-record-overdoses-in-ohioakrons-public-schools-will-soon-stock-opioid-antidote/?utm_term=.42fecae793e2 4. Katz, Josh. (2017, June 5). Drug Deaths in America Are Rising Faster Than Ever. Retrieved August 21, 2017 from https://www. nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?mcubz=1 5. Narcan® Nasal Spray 4mg. (2017). Frequently Asked Questions. Retrieved August 21, 2017, from https://www.narcan.com/faqs 6. The National Alliance of Advocates for Buprenorphine Treatment. What’s this agonist / antagonist stuff ? Retrieved August 23, 2017, from https://www.naabt.org/faq_answers.cfm?ID=5 7. Nelson, Kristi L. (2017, June 5). Opioid antidote becoming more easily available for general public. Retrieved August 24, 2017, from https://www.usatoday.com/story/news/health/2017/06/05/opioid-antidote-becoming-more-easily-available-generalpublic/361078001/ 8. Wheeler, Eliza, Jones, T. Stephen, Gilbert, Michael K., Davidson, Peter J. (2015, June 19). Opioid Overdose Prevention Programs Providing Naloxone to Laypersons — United States, 2014. Retrieved August 26, 2017, from https://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6423a2.htm 9. Wimbley, Randy (2017, May 25). Narcan will be available over-the-counter in Michigan. Retrieved August 21, 2017 from http:// www.fox2detroit.com/news/local-news/257064137-story
In Vitro Gametogenesis
1. Bourne, H., Douglas, T., & Savulescu, J. (2012). Procreative beneficence and in vitro gametogenesis. Monash Bioethics Review, 30(2), 29–48. 2. Kamp, T., & Murphy, W. (2013). What are iPS cells? Stem Cell & Regenerative Medicine Center University of Wisconsin-Madison. Retrieved September 19, 2017, from https://stemcells.wisc.edu/sites/default/files/What_Are_IPS_Cells_0.pdf 3. PESHEVA, E. (11, January 2017). The Promise and Peril of Emerging Reproductive Technologies. Retrieved from https://hms. harvard.edu/news/promise-and-peril 4. Number of test-tube babies born in US hits record percentage. (2014, February 16). Retrieved August 14, 2017, from http://www. reuters.com/article/health-testtube-babies-idUSL2N0LL0A520140217 5. Oxford University Press. (2015, December 18). In vitro gametogenes: Same-sex couples may be able to have children biologically related to both partners: How in vitro gametogenesis could create the possibility of same-sex couples having children biologically related to both partners. ScienceDaily. Retrieved July 26, 2017 from 6. Suter, S. M. (2016). In vitro gametogenesis: just another way to have a baby? Journal of Law and the Biosciences, 3(1), 87–119. http://doi.org/10.1093/jlb/lsv057 7. West, J., & Daley, G. Q. (2005). In vitro gametogenesis from embryonic stem cells. Current Opinion in Cell Biology. doi:DOI: 10.1016
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References • Volume 10 • 29