MeduCollab: Issue 1

THE

M EDU C OLLAB

SEPT 2020 | Issue 1 www.meducator.org M C M A S T E R U N D E R G R A D U A T E H E A LT H S C I E N C E S Z I N E

TABLE of CONTENTS COVER ARTIST ANNISA SIU

02 Introduction

Sowmithree Ragothaman 03

Complex Chemistry Sowmithree Ragothaman

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Behind the Looking Glass Sowmithree Ragothaman

07 Toxic

David Zhao 09 Lifelines

David Zhao 11

Microscopic Monstrosity Aishwaria Maxwell

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13 Xenotransformation

Aishwaria Maxwell

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Stress in Undergraduate Programs Nehal Lubana

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Interview Spotlight: Dr. Eric Brown Hannah Silverman

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FOCO or FOMO? Alan Cheng

dear reader, Welcome to the inaugural issue of The MeduCollab! Over the past year, we were able to collaborate with an incredible team to explore the vast field of health sciences through both writing and visual mediums. Through this small, hearty zine we hope to showcase the many pieces our mentees have worked hard on throughout the academic year!

We are excited to feature two Opinion pieces, an Interview Spotlight, and six Artist Showcases in this issue! In his opinion piece, Nehal Lubana outlines common stressors affecting undergraduate undergraduate students and discusses the negative lifestyle changes that follow. Meanwhile, Alan Cheng examines the consequences of Homecoming and Fake Homecoming traditions frequenting Ontario universities. Hannah Silverman parts from social issues with her interview with Dr. Eric Brown, a Professor at McMaster University whose research explores novel strategies in combating the ever-growing antibiotic resistance.

From the Graphics and Illustration side, we have two Artist Showcases for each of our three illustrators. Sowmithreee Ragothaman beautifully depicts the workings of the blood brain barrier as well as how social determinants impact one’s health. David Zhao illustrates the imminent dangers of water toxicity and the emergence of soft robotics in medicine. Aishwaria Maxwell carefully captures a microscopic view of the coronavirus and the eerieness of xenotransplantation.

This issue was the product of the combined efforts between all of our talented mentors and mentees, who are all irreplaceable members of the MeduCollab family. We would like to thank our mentors, Aaron, Matthew, Kien, Ruby, Michelle, Sophie, Meera, and Adrian, who took the time out of their busy schedules to help foster the next generation of writers and artists. And of course, we would like to thank our mentees, Alan, Nehal, Hannah, David, Aishwaria, and Sowmithree, who gave MeduCollab a chance and inspired us with their passions for the health sciences. We wholeheartedly look forward to witnessing their continued growth and future creative pursuits.

Sincerely,

ANNISA SIU

Bachelor of Health Sciences (Honours) Class of 2021

DANIEL RAYNER Bachelor of Health Sciences (Honours) Class of 2022

Complex Chemistry

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SOWMITHREE RAGOTHAMAN Bachelor of Health Sciences (Honours) Class of 2021

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This piece was based on a recent article by Yoon et al. in The Journal of Neuroscience, titled “Blocking the Thrombin Receptor Promotes Repair of Demyelinated Lesions in the Adult Brain”. The study investigated the ability of an existing drug, vorapaxar, to reverse the myelin sheath degeneration present in diseases like multiple sclerosis and Alzheimer’s.

However, a key limitation of the study was that vorapaxar is not able to cross the blood-brain barrier (BBB) in humans. I found this detail interesting as it highlights the difficulties still faced by scientists in accessing the brain for therapeutic purposes, and titled the piece “Complex Chemistry” as a result. The piece depicts a bright red-and-white pill (representing vorapaxar) being unable to squeeze through the BBB junctions (shown in dark red and orange) to reach the neurons (bright blue). I used bright colours and gradients to create a sense of direction, and contrasted this with the increasingly dark purple background to symbolize neuron degeneration and death. I hope that this piece helps viewers understand the intricacy of the human brain, and inspires them to learn something more about the topic!

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Behind the Looking Glass SOWMITHREE RAGOTHAMAN Bachelor of Health Sciences (Honours) Class of 2021

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This piece was inspired by my work in Hamilton’s downtown core and a Hamilton Spectator article I read as part of my coursework, called “Worlds Apart”. The piece depicts a street-involved woman, with half of her face being shown and the other half disintegrating into factors that make up the “social determinants of health”, i.e. external factors that influence a person’s health, wellbeing, and living situation. I was really inspired by the intersectionality of the concept, and it taught me to think beyond someone’s appearance and the behaviours they may display outwardly. I titled the piece “Behind the Looking Glass” to invite the viewer to consider this, and used bright blue to highlight the woman’s eyes and silhouette as being a facade that covers the history, trauma and nuances of one person’s life. I also specifically chose to portray the subject smoking to challenge societal perceptions, as smoking is usually perceived to be the moral failure of an individual to make healthy lifestyle choices. I hope that this piece helps viewers realize that health is not “good” or “bad” in isolation, but is shaped by multiple systemic factors that are often beyond an individual’s control.

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Toxic DAVID ZHAO Bachelor of Health Sciences (Honours) Class of 2023

This illustration was inspired by the article Unsafe levels of toxic chemicals found in drinking water of 33 states in The Harvard Gazette. This article addressed the levels of toxic chemicals, specifically PFAS, found in drinking water in the US and how it impacts the health of people (i.e. reducing immune function).

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Green is often the colour associated with toxins or toxic substances so that was why I used it in my piece. The eye of the man submerged in toxic water is in the top right region following the rule of thirds and the bright contrasts of the eye and mouth in comparison to their surroundings grabs the audience’s attention. Some of the highlights are tinted in turquoise to have a more meaningful effect compared to a regular white highlight; in addition, the man is covered with a layer of blue or green at certain regions to illustrate that he is underwater.

Furthermore, the subtle gradient of the water is used to indicate the orientation of the man underwater. The use of green to fill his eye and mouth implies that he is poisoned internally as a result of ingesting toxic water.

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Lifelines DAVID ZHAO Bachelor of Health Sciences (Honours) Class of 2023

Art complements health sciences topics well as it is able to represent concepts and information in a visual, more concrete way, making them more easily understood and engaging.

This artwork is an illustration of a heart being pumped by various robotic devices and was inspired by the article ‘Soft robot’ designed to pump failing hearts, introducing the emergence of soft robotics in medicine. Naturally, the waiting lists for heart transplants are long, and many patients die before they are able to receive a transplant. Advancements in soft robotics have made it a favourable field to develop towards to restore cardiac functions temporarily and help the heart pump. Some of the current designs are extremely effective and I’m curious as to what other designs and technology will emerge in the near future.

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In addition to the reference article, sci-fi films are another source of inspiration for my artwork. In the films, there are sometimes large glass tubes of liquid that contain preserved organs or organisms floating in within. This was the basis of my artistic design. I decided to work with purple because I wanted to try something unconventional, different from the typical bright red heart that most people have in mind, and impact the mood of the illustration. Following the rule of thirds, the heart is arranged in the bottom right to quickly draw attention to the main aspect of the piece. Wire pumps attached to the heart flow upwards, disappearing in the top left corner, once again following the rule of thirds to naturally direct the eyes of the audience. The thinning out of wires as they approach the top left is used to effectively create the perspective of looking up from slightly under the heart and a sense of distance. The disappearance of the wires is due to the light and liquid masking over them causing them to fade from our visual field which generates a sense of mystery aligning with the sci-fi genre.

A robotic hand can also be seen reaching out from the bottom right corner to help pump the heart.

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I hope that my artwork is an impactful representation of the topic that will grab the attention of the audience and intrigue them enough to explore the topic on their own.

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Microscopic Monstrosity AISHWARIA MAXWELL Bachelor of Health Sciences (Honours) Class of 2023

Back in January, the Wuhan coronavirus seemed like a less threatening version of malaria. The distal proximity of the virus made it a subject of curiosity as opposed to the fear it came to invoke two months later. Coronavirus is an identified species of viruses that infects many animal populations, primarily birds.

It once held the spotlight in 2003, when the SARS epidemic hit the nation and has resurfaced to the public eye with the recent global pandemic.

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This piece is expository as it shows the virus on a microscopic scale. The illustration has a toneless finish, given the current management of the pandemic. Given the current knowledge of the virus, it is contagious and has very flu-like symptoms. However, the rate of infection can be hindered through quarantine measures and cautionary hygienic practices.

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Xenotransformation AISHWARIA MAXWELL Bachelor of Health Sciences (Honours) Class of 2023

Pigs bear a small semblance to humans physically. With a conicalshaped head, a stubby prominent nose, and grayish-pink skin, pigs seem almost unidentical to humans. Thankfully, not all scientists saw these mammals so superficially and examined the organ reservoir within the specimen to note some uncanny similarities with humans.

In 1993, Groth carried out the first clinical pig islet transplant and since then, pigs have become the unsung hero for many awaiting a transplant. Of course, only some organs mimicked the structure and abilities of human organs. And the arrival of the age of Genetic Engineering provoked a change in the standstill development of xenotransplantation.

This piece is expository in its intention to demonstrate a pig’s transformation to a human-like pig. The article inspiring this piece described a new CRISPR-based method that removed many of the original complications that came with genetically engineering a pig. The article describes the relative ease, quickness, and accuracy of using the CRISPR system that almost makes the process seem so quick. However, this piece is set with an ominous tone, given the ambiguous nature of genetic engineering in terms of its regulations and long-term effects.

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STRESS

in Undergraduate Programs NEHAL LUBANA Bachelor of Science (Honours) Class of 2023

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ABSTRACT Stress is an all encompassing term used to describe how the body reacts to harsh or harmful situations. Stress has been consistent throughout time, and has more recently come into the spotlight due to high stress and high speed lives, facilitated by modern society’s focus on money over self-care. This especially includes university students, making the transition to university from the relatively low-stress high school environment. A variety of factors can cause stress, and if all happen in the relatively same time period, it can lead to one dealing with their issues in a self-destructive manner, in the format of increased alcohol and drug consumption, and a decrease in exercise. These lifestyle impacts can impact the rest of one’s life, causing severe weight gain and potential organ damage. These changes are further facilitated by academic burnout, as a large workload accompanied by a difficult program can impact students negatively. Improvement to these stress-related choices can only happen if students are self-motivated to improve and have the resolve to not give up.

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Introduction Stress, when built up over time can cause a variety of damning health issues, including high blood pressure which can lead to heart attacks. Stress, anxiety, and other mental stressors can begin or continue in undergraduate programs of study, mainly due to the often heavy course load combined with financial barriers and familial pressure to succeed. This is outlined within this piece with a focus on three factors: consumption of drugs/ alcohol, lifestyle factors, and long hours or burnout. Stress must be addressed with a greater focus on addressing and identifying

its contributing factors. Stress, anxiety and other issues can lead to a student feeling overwhelmed and frustrated with their university experience, and should be minimized when possible. Individuals should not try to hide their issues, or cover them up with more selfabuse. Instead, as will be discussed later in the article, they should use initiatives or empower themselves to remove themselves from stressful situations.

Stress & Drug Consumption Among Canadian undergraduate students, 89.5% of respondents felt overwhelmed with school, with 13% having seriously considered suicide.1 Students often cope with stress in unhealthy or unproductive ways, frequently involving excessive consumption of cigarettes and alcohol. This is highlighted by Zhang and colleagues who found that in regions such as China, university students are at a high risk of both cigarette smoking and alcohol consumption, with 67.0% and 30.5% of total surveyed taking part, respectively.2

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Lifestyle-Related Stress Stress in university life also manages to promote unhealthy lifestyles, with undergraduates consuming more unhealthy foods and participating in less exercise if they reported experiencing high amounts of stress. Specifically, a McMaster-based survey showed that students with poor diets suffered from greater amounts of stress than those with better diets (p<0.001).1 Unhealthy diets and

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Additionally, these problems can also be facilitated by the university and city social culture, which could lead to students increasing their consumption of depressants and stimulants to deal with their stress. These activities can force longer hours of studying, and subsequent sleep deprivation, resulting in a need to catch up on missed work, and an alteration in melatonin levels.3,4 Studies from Southern Illinois University showed a negative correlation (r=-0.28) between alcohol consumption (number of drinks consumed and frequency), and cumulative GPA, which can lead to further complications, including alcohol poisoning and alcoholism.5 Excessive alcohol consumption plays with the neurotransmitters in your brain, causing chemical imbalances that promote the release of corticotropin releasing factor, which stimulates the release of stress chemicals and the suppression of excitatory neurotransmitters (e.g., dopamine).6 These neurological effects can lead to a relapse into more drinking to get into that happy state, which is further promoted by stress-related work and long studying hours. That becomes a circular relationship with each behaviour reinforced by the previous activity.

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1. Poole H, Khan A, Agnew M. Stressing in the fall: Effects of a fall break on undergraduate students. Can J High Educ.

2019;48(3):14164.

Available from: doi:10.7202/1057133ar.

2. Zhang C, Fan J. A study of the perception of health risks among college students in China. Int J Environ Res Public Health.

2013;10(6):2133-49.

Available from: doi:10.3390/ ijerph10062133.

3. Gustems-Carnicer J, Calderón C, Calderón-Garrido D. Stress, coping strategies and academic achievement in teacher education students. Eur J Teach Educ.

2019;42(3):375-90. Available from: doi:10.1080/026 19768.2019.1576629.

4. Kumar A, Rinwa P, Kaur G, Machawal L. Stress: Neurobiology, consequences and management. J Pharm Bioall Sci. 2013;5(2):91. Available from: doi:10.4103/09757406.111818.

5. Singleton RA, Wolfson AR. Alcohol consumption, sleep, and academic performance among college students.

J Stud Alcohol Drugs.

2009;70(3):355-63. Available from: doi:10.15288/ jsad.2009.70.355.

6. Banerjee N. Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian J Hum Genet.

2014;20(1):20. doi:10.4103/09716866.132750.

7. Kim SY, Sim S, Park B, Kong IG, Kim JH, Choi HG. Dietary habits are associated with school performance in adolescents.

Medicine (Baltimore).

2016;95(12):e3096. Available from: doi:10.1097/ md.0000000000003096.

8. Deliens T, Clarys P, Bourdeaudhuij ID, Deforche B. Determinants of eating behaviour in university students: A qualitative study

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reduced exercise can lead to obesity, which can further impact one’s stress and mental health. Short term, stress-driven consumption (defined as 55% kcal from fat) reduces cognitive function and impairs exercise activity, which could impair one’s studying habits.7 It is well established that social and academic stress are key contributors to negative changes to students’ eating habits.8 This is applicable to McMaster University, as many campus eateries (e.g. Tim Hortons, Pizza Pizza) serve foods considered “unhealthy” within the Canada Food Guide, with many containing high amounts of sodium, sugars, or saturated fats.9 Moreover, the majority of first year students have a meal plan, which limits their choices to many of these “unhealthy” restaurants.

The combination of these food-related factors can impair frontal, limbic, and hippocampal function in the brain —regions that are imperative to learning and retaining information.7 Under a high-fat diet, the hippocampus produces a neuroinflammatory response to an immune challenge (including stress), causing memory deficits.10 Proinflammatory cytokines in the hippocampus have also been shown to result in deterioration of long-term memory.10 These neurological changes can lead to impared studying and a negative effect on an individual’s grade point average (GPA), which, when lower than a 9 on McMaster’s 12-point scale, has been associated with greater stress.11 Ultimately, this results in a positive feedback loop with more stress leading to a lower GPA and so on and so forth.

Stress Management Canadian universities are putting in effort to put new mental health initiatives into focus, which includes the Student Wellness Centre (SWC) and available therapists at McMaster. As mental health continues to become a prevalent topic of discussion within mainstream media and a more open topic in social circles, universities are making the adjustment for the sake of their students, who want to talk about their issues, instead of hiding them, with the provision of therapy circles and therapist appointments available to the students via the SWC. These programs at all Canadian post-secondary institutions emphasize the need for education on mental health and stressors. Accompanied by these programs, students can be prescribed pharmacological drugs to manage stress, including benzodiazepines (to deal with anxiety) and serotonin 1A receptor agonists (which can

produce anxiolytic and antidepressant effects).4 These drugs are important as stress prevention can allow for the avoidance of lapses in immune function due to psychological stress.4 Moreover, these pharmacological interventions can help decrease the frequency of alcohol abuse and poor eating habits that are directly associated with stress. Overall, initiatives that target students’ stress are necessary to help ease their transition into university life, and universities are taking steps in the right direction to provide students with the help they need to stay successful.

using focus group discussions. BMC Public Health.

2014;14:53. Available from: doi:10.1186/1471-245814-53.

9. Government of Canada.

Food guide snapshot [Internet]. 2019. Available from: https://food-guide.canada. ca/en/food-guide-snapshot [cited 2020 Feb 27].

10. Spencer SJ, Korosi A, Layé S, Shukitt-Hale B, Barrientos RM. Food for thought: How nutrition impacts cognition and emotion. NPJ Sci Food.

2017;1(1). Available from: doi:10.1038/s41538-0170008-y.

11. Barker ET, Howard AL, Villemaire-Krajden R, Galambos NL. The rise and fall of depressive symptoms and academic stress in two samples of university students. J Res Adolesc. 2018;47(6):125266.

Available from: doi:10.1007/s10964-0180822-9.

Conclusion To conclude, those faced with issues with eating habits, stress related to their academic standing, and alcohol abuse need to take steps towards preventing themselves from being consumed by them, and having their academic progress halted as a result. Stress and their associated lifestyle changes can impact one’s life negatively, and as seen before, affect one’s GPA. With networking and applying for the coveted internships a student may need to advance in their desired field, applying, waiting, and/or getting rejected for those things can become stressful problems. Various initiatives are in place that can help with a student’s stressors, however, at the end of the day, students themselves need to take an active role in their own education and their mental health by taking advantage of the available initiatives. Additionally, this should be combined with good eating habits and a push to reduce the use of alcohol as a relaxation tool. In doing so, they will be able to stay focused and maintain their academic standing. Overall, stress needs to be addressed as a huge concern for students now and going into the future, so that the correct measures can be taken to improve their lives and reduce their stress.

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Interview Spotlight: Novel Strategies in Combating Antibiotic-Resistant Bacteria HANNAH SILVERMAN Bachelor of Health Sciences (Honours) Class of 2023

Dr. Eric Brown is a Distinguished Professor in the Department of Biochemistry and Biomedical Sciences at McMaster University and a member of the M.G. DeGroote Institute for Infectious Disease Research. A recipient of several awards in the field of molecular biology and biochemistry, Dr. Brownâ&#x20AC;&#x2122;s research is primarily focused on understanding the systems that drive drug resistance in superbugs.

He currently serves as the Director of the Biomedical Discovery and Commercialization Program as well as the Canada Research Chair in Chemical Biology.

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Can you tell us how you got started in the field of microbiology and infectious disease research?

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I was a postdoctoral fellow at Harvard Medical School in Boston, and I was studying enzymes that are involved in synthesizing cell walls in bacteria. Quite honestly, I had no idea that [I] was doing something that might be useful â&#x20AC;&#x201D;I was just really fascinated with how bacteria built their own cell walls. But that was a time in the early 90s where drug resistance was beginning to rear its head in the clinic, and I became aware then that the work I was doing may have some practical utility [by] way of discovering new antibiotics.

The problem of antibiotic resistance has been described as an ‘arms race’ between the scientists creating novel antibiotics and the superbugs who mutate to resist them. Since the majority of antibiotics today are just variations of the same classes discovered decades ago, how does your lab differ in its approach to antibiotic research and development?

The fundamental problem that surrounds drug resistance is that existing drugs are really just tweaks on existing chemical classes, and so there’s been a real lack of innovation in antibiotic discovery. The most recent discovery of a new chemical class of antibiotics was actually in the 80s, so [it’s] quite remarkable that there’s been so little innovation [since] that time. In my group, we’re trying to think about completely new ways of discovering antibiotics. Much of the effort that’s happened over the last 30 years or so has been rooted in fairly reductionist [and] industrial approaches to drug discovery, which in the modern era, involve genomics to discover what’s the right target, recombinant DNA technology to express and purify a target, large chemical libraries over that target, and then medicinal chemistry to make that compound better. What’s at issue there is a fundamental lack of understanding of the system as a whole, before these reductionist approaches are commenced. A lot of what we do [at my lab] is [to] try to understand the bug as a system, think about studying the whole organism in the context of drug discovery, and then letting the bugs tell us what will work best.

Antibiotic resistance has been recognized by the World Health Organization and many countries worldwide as a serious and urgent threat, making it now a research priority. Looking to the future, do you think that we will be able to continue to combat this problem effectively using antibiotics, given the rate at which bacteria are becoming multi-drug resistant?

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Yes. The solution to the drug resistance problem is, in part, new antibiotic drug discovery. There needs to be stewardship measures to reduce the use of antibiotics. We need to be really mindful about the way that we treat disease. But there is always going to be a need for antibiotics. If you think about straightforward surgeries and things that we take for granted, like hip replacements and cancer chemotherapy, all of these are interventions that just require antibiotics. It’s hard for me to imagine a world where antibiotics aren’t necessary, where we’re so careful about infection and we’re so good at stewardship that we no longer need antibiotics. I think they’re here to stay. Let’s hope they’re still useful for the future.

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You recently conducted some interesting research regarding the antibiotic properties and mechanisms of cannabigerol (CBG), a cannabinoid compound found in Cannabis Sativa. What do you think are the broad implications of your findings for future pharmaceutical research?

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Canada kind of jumped with both feet into the legalization of cannabis, and we thought that would give us a bit of a leg up in such studies. We were inspired that the plant makes all these cannabinoids: why is it doing this?

[We] don’t think it’s doing that for the sake of recreational cannabis. Our hypothesis was the plant was making these molecules for a reason, and that might be for their antibacterial, antifungal, and antipest properties.

There was certainly some evidence in the literature [indicating] that was true, but we went pretty deep to reveal that there are indeed some really strong antibacterial properties of these compounds. CBG is a non-psychoactive compound that we’re interested in because these molecules have known properties that make them amenable for usage as drugs. After all, THC and other compounds are sort of famous for [their] vile bioavailability through various routes of administration, [as they] cross the blood brain barrier. These compounds themselves have unique and special properties that might make them suitable as a starting point for drugs. We think that we’ve got a long way to go. I think with a molecule like CBG, there are some toxicity issues with that compound, especially its mechanism of action. It’s a membrane-active compound, and so I think there can be some issues of host toxicity there. But it’s a really interesting starting point for a new drug.

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One of your lab’s recent discoveries was finding a compound that reverses β-lactam resistance in methicillin-resistant Staphylococcus aureus (MRSA) infections. Could you elaborate on your findings, and the importance of this compound for combating MRSA infections?

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Yes, this [was] a really fun project in my lab. We’ve been working in MRSA cell wall synthesis for about 20 years, interested in a particular pathway.

We ran a screen for chemicals that would interfere with that aspect of cell wall synthesis. Knowing that there might be interacting pathways, it kind of gets back to my obsession with the system as a whole, and how cells are really complex in the way they respond. It turned out [that] we identified a compound that hit a pathway that was interacting [with], but quite separate from, our starting hypothesis —a gene product that was involved in helping cells respond to an assault on cell surface. It turns out that this target had a lot of really interesting effects for the bacterium. It made it difficult for the organism to make a biofilm, it slowed its growth, it halted its virulence in a worm model of infection, and it [reversed] drug resistance. This thing is a ‘Swiss Army knife’ of targets. All kinds of really interesting consequences to the inhibition of this target ensued when we found this compound. [However,] it has less than perfect physical and chemical properties in order to be a drug. In other words, we didn’t pull a [fully developed] drug out of our compound libraries here. It requires more chemistry to turn it into something that would be closer to a drug. It’s probably not work that we’ll do here, but certainly, I’m hoping that people will read our paper and be inspired by that compound and that target, and try to move that forward.

What are some of the major obstacles preventing effective antibiotic research from a scientific and societal standpoint, and how are you working to resolve them?

I touched on the science stuff earlier, in terms of these largely reductionist approaches with modern discovery.

I think that’s certainly a hurdle —understanding the system, [which is] something that we’re really interested in. There’s another really interesting and quite difficult hurdle, which is economic. All drugs are paid for on a ‘per prescription’ basis. In other words, they’re paid for in terms of volume of use. If you think about it, that’s exactly the wrong thing for an antibiotic. We really want to discourage high volumes of use of antibiotics, because we know that with use comes resistance.

Stewardship demands that we use as little of a drug as possible, [but] on the business side, that’s the worst possible thing for a pharmaceutical company —to come up with a drug that’s use will be restricted. If you think about it, a designer new antibiotic that’s really effective and could save a patient’s life in the ICU is one which will see very, very low volume of use.

It will be used as a last resort. So one of the biggest obstacles is having to [incentivise] pharmaceutical companies to discover and develop drugs like these. There are a lot of interesting proposals [brought] before legislators and thought leaders about how to incentivise this industry, and some of the most interesting ones involve decoupling volume from value. That would be a first —to pay for the value of a drug and not the volume of a drug. It’s a really interesting problem.

Do you foresee a change in policies surrounding antibiotic usage in hospitals, now that the world is becoming more aware of this threat?

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Yeah, certainly worldwide there are very different approaches to the provision of antibiotics. There are many countries in the developing world where antibiotics can be [purchased] over the counter very, very simply. It’s different here in Canada, of course, and I think we’re seeing a greater and greater emphasis on stewardship in this country. I think we’re going to see even more in the future. So [the question is] whether or not that will take the form of policy or it will become part of the culture of antibiotic use [and] prescription —more the latter, it’s difficult to come up with policies. Certainly when physicians are prescribing, they’re going to be aware of the best practices. There’s going to be greater and greater emphasis on what’s the first line, second line, third line antibiotic, when to be prescribed

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“If you’re an this one, [and] when to avoid prescribing any at all. I think there’s undergraduate right going to be a culture of stewardship now in the social and best practices that is going to improve.

But I’m not sure that there’ll sciences, think about be necessarily strict policies around health economics this. It’s difficult to be too prescriptive about what is the right course of action and think about necessarily in the clinic. policy that would All things considered, given the pace of anget around the tibiotic research now and current practices, difficulties in the do you think we’re on top of this fight? Do you think we’re going to be able to control superdiscovery and bugs? development I am concerned, particularly with the [fact that] of new we’ve seen a significant departure of pharmaceutiantibiotics.” cal effort in this area. The research intensity of phar-

maceutical companies really correlates to return on investment for shareholders. That’s a big concern —it really hampers our ability to deal with this. I think it is a very significant part of the lack of innovation over the last several decades in this research area. That concerns me a lot. What gives me a lot of hope is [that] there’s been no time, at least in my career, where there’s been a greater understanding of this problem. We’re seeing a lot of discussion among legislators [and] a lot of concern among governments and non-governmental organizations worldwide. If that can be translated into action, I think we’ll be in good shape, but it is a difficult problem to tackle. It’ll require multinational cooperation. That’s a realm of research that I don’t engage in and that’s really something for the social scientists to tackle. If you’re an undergraduate right now in the social sciences, think about health economics and think about policy that would get around the difficulties in the discovery and development of new antibiotics.

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What’s your favorite part of working in microbiology research?

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I think it’s such a great area, the model systems are really straightforward to work with. I witness the struggles of my colleagues to work with things like human stem cells and how difficult that is, and there’s just tremendous power in how simple it is to work with bacteria to do biochemistry on an organism.

A doubling time [of bacteria] in the laboratory of 20 minutes is really helpful.

Microbiology in general is amazing because it’s in us, it’s all around us. We kind of ignore it but there are more bacterial cells in and on the human than human cells. And increasingly, we’re recognizing how important that is and

what the role of microbial physiology is in human physiology. So, the microbes are a big part of human life. Of course, you [can] start thinking about the environment and the diversity of bacteria in the environment, from the deep oceans to the soil, and it’s just staggering to think of the microbial complexity. I think there [will be] a lot of research projects in microbes for many years to come.

What are some exciting projects happening at the M.G. Degroote Institute for Infectious Disease Research?

[The Research Institute] is a really fantastic place to work and [has] great colleagues to interact with in terms of the research area close to my heart, which is antimicrobial drug resistance. You’ve got fantastic work coming out of Gerry [Wright]’s lab in the area of natural products —he’s really interested in trying to [mimic] molecules that are made by nature to deal with drug resistance. Many of the existing antibiotics are products of bacterial metabolism, and in recent years, drug companies have [reused] these approaches. So [it’s] kind of a Back to the Future approach, but really exciting with the new technologies that are available now to deal with natural products. Laura Burrows is interested in really interesting topics that have to do with things like biofilm formation. Biofilms are a hugely important problem in bacteria being difficult to treat with antibiotics. They go into these quiescent and structured communities that are difficult to treat with antibiotics. People like Andrew McArthur are running computational, dry lab only research programs. [They] are really interested in the catalog of drug resistance chains that are out there, and it’s a staggering effort that they’ve done, for example, to build a database that’s used by people worldwide to try to understand the scale of drug resistance. Those are three examples [of what] I think are pretty cool things going on here.

Do you have any advice for undergraduate students considering a career in biomedical/infectious disease research?

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Infectious disease research is really interesting, to me anyway. I think it’s something that we take for granted, when we just expect these antibiotics to work and we expect to be able to take care of infections. We’re currently going through a huge scare worldwide with the novel coronavirus that I think reminds us that the microbes are really quite capable and quite clever. I think, for undergraduates, there are a lot of opportunities here at McMaster in particular. This university has a particular strength in this research area. I think that’s something to think about in terms of projects, in terms of students thinking about spending a summer in a lab or doing a thesis project, as it is possible for students to make really significant contributions, in part due to the ease of manipulation of these model systems.

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FOCO OR FOMO? The pressures and implications behind social drinking

ALAN CHENG Bachelor of Health Sciences (Honours) Class of 2023

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ABSTRACT Homecoming (HOCO) and Fake Homecoming (FOCO) celebrations in Ontario universities have increased in size and popularity, resulting in increased government spending and cases of alcohol abuse among students. Alcohol reduces the connectivity between parts of the brain, leading to a desensitization of emotional processing and threat detection â&#x20AC;&#x201D;a double-edged sword as facilitator for socializing and impairment to danger.

Early exposure to binge drinking at occasions like HOCO and FOCO also contribute to issues, such as alcoholism, during adulthood. Despite knowing the effects of alcohol, students still choose to drink irresponsibly which indicates social, development, and environmental factors which are overriding their morality. Solutions to alcohol abuse are complex due to the various factors that affect drinking, and it requires multi-level action from governments, universities, communities, families, and the students themselves. A stronger push towards celebrating HOCO for its original tradition of building school spirit and community must be considered and that ultimately comes down to the individual no matter what the conditions are.

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Introduction If you are reading this, chances are you are probably someone currently studying in university and you may or may not have had your fair share of experiences with alcohol, whether it be at parties or university-wide traditions such as Homecoming (HOCO) or the recently popularized Fake Homecoming (FOCO).

With over 2000 students at Dalewood Avenue and 130 police officers present during the 2019 FOCO, damage was bound

to happen in terms of neighbourhood noise and litter.1,2 However, the magnitude of FOCO pales in comparison to other university celebrations across the province. In Waterloo, around 33,000 students from both Wilfrid Laurier University and the University of Waterloo flock Ezra Avenue during March to celebrate St.Patrick’s Day —costing the public nearly $800,000 to control the party in 2019.3 Additionally, there were 80 calls for emergency medical services during the celebration, with 59 people sent to the emergency room for issues primarily involving overconsumption of alcohol, head injuries, lacerations, falls, and fractures.3 University traditions like FOCO often give students a reason to drink and many times go overboard, putting pressure on not only themselves but also the surrounding community.

Alcohol as a Vehicle In university traditions, there is almost an expectation to socialize and talk to new people by putting yourself out there. Alcohol serves as a facilitator for this due to its effects on the brain —it reduces one’s self-consciousness and in turn makes one more open to others— it is a social lubricant.4 As a depressant which slows down the central nervous system, alcohol consumption reduces levels of anxiety, decreases coordination, causes loss of vision, and impairs one’s judgement.4 One of the main areas that alcohol targets is the brain, particularly the cerebellum, amygdala, and orbitofrontal cortex (OFC).5

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The amygdala and OFC have been found to work together in processing and decoding emotional input, and alcohol’s effects on social behaviour are thought to be caused by changes in connectivity between these regions of the brain.6,7 Specifically, when heavy drinkers were given socio-emotional stimuli (angry, fearful, and happy faces) to process, alcohol significantly desensitized the amygdala to threat signals and reduced amygdala-OFC connectivity, resulting in dampened emotional response towards the stimuli.7 Therefore, when intoxicated, students may misperceive the threat of dangerous stimuli due to their dampened amygdala reactivity and/or reduced amygdala-OFC interactions, increasing the pressure on medical support

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1. Malik S. McMaster students celebrate a fake homecoming [Internet]. The Silhouette.

2019 Sep 26. Available from: https://www.thesil. ca/mcmaster-students-celebrate-a-fake-homecoming [cited 2020 Jan 18].

2. O’Reilly N. ‘Unsanctioned’ McMaster street party draws thousands of students [Internet]. The Hamilton Spectator.

2019 Sep 23. Available from: https://www.thespec.com/ news-story/9608989--unsanctioned-mcmaster-streetparty-draws-thousands-ofstudents/ [cited 2020 Jan 18].

3. Outhit J. Ezra street parties are ‘a rite of passage’ not easily ended, Waterloo task force warns [Internet].

TheRecord.com. 2019 Sep 6. Available from: https:// w w w. t h e r e c o r d . c o m / news-story/9584894-ezrastreet-parties-are-a-rite-ofpassage-not-easily-endedwaterloo-task-force-warns/ [cited 2020 Jan 18].

4. Alcohol.org. Effects of alcohol on the body and mind: short and long-term. Available from: https://www.alcohol. org/effects/ [cited 2020 Jan 18].

5. Oscar-Berman M, Marinkovic K. Alcoholism and the brain: An overview. Alcohol Res Health. 2003;27(2):12533. Available from: https:// pubs.niaaa.nih.gov/publications/arh27-2/125-133. htm [cited 2020 Jan 18].

6. Murray EA, Izquierdo A. Orbitofrontal cortex and amygdala contributions to affect and action in primates. Ann NY Acad Sci. 2007;1121:273-96. Available from: doi:10.1196/annals.1401.021.

7. Gorka SM, Fitzgerald DA, King AC, Phan KL. Alcohol attenuates amygdala-frontal connectivity during processing social signals in heavy social drinkers: A preliminary pharmaco-fmri study. Psychopharmacology. 2013;229(1):141-54.

Available from: doi:10.1007/ s00213-013-3090-0.

8. Sayette MA, Creswell KG, Dimoff JD, Fairbairn CE, Cohn JF, Heckman BW, et al. Alcohol and group formation: A multimodal investigation of the effects of alcohol on emotion and social bonding. Psychol Sci. 2012;23(8):869-78.

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services. Furthermore, researchers at the University of Pittsburgh found that alcohol not only increased the time that a group of three strangers talked to each other, but also increased the frequency of genuine smiles along with the synchronized occurence of these smiles.8 The benefits of alcohol in lightening mood and encouraging smiles makes its almost inevitable for it to not be a part of social events like HOCO/FOCO, suggesting an inherent issue in the process that must be addressed.

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Growing Pains To many, university is a time to experience newfound freedom and independence. When far from home and friends, students can struggle with finding their people and being “one with the crowd” with others.9 People are typically motivated to behave in ways that will show socially-desirable images of themselves. One’s concerns about acceptance, social image, and fitting in potentially serve as major determinants on drinking behaviour among students.10 Arnet’s theory of Emerging Adulthood describes the period from late teens to mid-twenties, where young adults take risks and test their limits to discover who they are in an unregulated environment with others experiencing the same thing.11 From a developmental psychology standpoint, consumption of alcohol in university may in fact be something almost expected —a rite of passage. While everyone responds to change differently and have diverse coping mechanisms, many changes in university may have both positive and negative influences in terms of a developmental perspective.12 In other words, one’s decision to drink, while negative at times, may indicate their desire to mature and grow up faster.

Additionally, personal experience with alcohol allows young adults to better reflect upon the consequences of alcohol use, prompting them to have better judgement in the future. This raises the question of whether students should be the ones blamed for the damage caused by FOCO when the act of drinking is something that is almost natural for them to do.

Future Consequences While some may consider the occasional episode of drinking at HOCO to be rather unharmful, it only takes one drink to set yourself up for alcohol-related issues in the future. Experiments on mice conducted by researchers at the University of Illinois revealed that teenage binge drinking may cause changes in particular gene expressions in the brain, which can potentially contribute to alcohol abuse in later adult life.13 High levels of alcohol consumption in mice was found to increase levels of miR-137, a short non-coding regulatory RNA molecule, completely changing the molecule’s regular function and impacting brain development.13 When the mice were later analyzed in adulthood, they were more likely than the rodents who did not initially drink to choose alcohol over water.13

Available from:doi:10.1177/0956797611435134.

9. Borsari B, Carey KB. Peer influences on college drinking: A review of the research. J Subst Abuse Treat. 2001;13(4):391-424. Available from: doi:10.1016/s08993289(01)00098-0.

10. University of Minnesota. Why Students Drink. Available from: https:// www.cehd.umn.edu/fsos/research/ alcohol/whydrink.asp [cited 2020 Jan 18].

11. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000;55(5):469-80. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/10842426 [cited 2020 Jan 18].

12. Schulenberg JE, Maggs JL. A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood.

J Stud Alcohol Suppl. 2002;(14):5470. Available from: doi:10.15288/ jsas.2002.s14.54.

13. Kyzar EJ, Bohnsack JP, Zhang H, Pandey SC. Microrna-137 drives epigenetic reprogramming in the adult amygdala and behavioral changes after adolescent alcohol exposure. eNeuro.

2019;6(6):ENEURO.0401-19.2019.

Available from: doi:10.1523/ENEURO.0401-19.2019.

14. Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse. 1997;9:10310. Available from: doi:10.1016/ s0899-3289(97)90009-2.

15. Rose RJ. A developmental behavior-genetic perspective on alcoholism risk. Alcohol Health Res World.

1998;22(2):131-43.

Available from: https://www.ncbi.nlm.nih.gov/ pubmed/15706788 [cited 2020 Jan 18].

16. Wilson A. Students promote Homecoming safety. Queen’s Gazette. 2019 Oct 17. Available from: https://www. queensu.ca/gazette/stories/students-promote-homecoming-safety [cited 2020 Jan 18].

17. National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2000: Young Drivers. Washington, DC: NHTSA; 2001. 5 p. Report No.: DOT HS–809–336.

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The Future Fortunately, many universities and colleges in Ontario have implemented measures to combat this issue. During their HOCO celebration in 2019,

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While most of the students in university are over the legal drinking age, results from the 1992 National Longitudinal Alcohol Epidemiologic Survey found that people found that the odds of lifetime alcohol dependence and abuse were reduced by 14% and 8%, respectively, for each increasing year of age at initiation.14 Therefore, it may be beneficial for programs to focus on limiting underage alcohol access and consumption first. However, the results from this study had no temporality to the relationship, raising the question if early age drinking causes alcoholism or if it just demonstrates an existing vulnerability to alcohol use disorders.14 It has been found that people who partake in early drinking and alcoholism share similar personality traits, such as strong tendencies to act impulsively and to seek out new experiences and sensations.15 While a nature vs. nurture issue is at play when considering the impact of FOCO on students, it is indisputable that the exposure of binge drinking at an early age does serve as a gateway for future heavy alcohol abuse.

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Queens University created a collection of short videos about safety.16 Featuring the tagline â&#x20AC;&#x153;Save our Pawsâ&#x20AC;?, the video addresses the issue of broken glass on the streets, but instead of focusing on cleaning it up, it reminds students to keep the safety of animals in mind, as small shards of glass can injure the paws of dogs walking in the streets.16 Although campaigns like this are somewhat effective, it is naive to rely solely on them to solve the issue. Higher powers such as legislation and university governing bodies need to take action to restrict the accessibility of alcohol to young adults. While each country has had its own successes with decreasing alcohol abuse, there is no correct method. There are multiple ways to target availability, such as raising the legal drinking age and implementing zero-tolerance laws. When the United States raised the legal drinking age to 21, an estimated 20,000 lives were saved between 1975 and 2000.17 Factors such as marketing, accessibility, and pricing will ultimately change the way a population drinks, but the control of alcohol is far more complicated than a couple of decisions.

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Conclusion Solving the problem of underage drinking and alcohol abuse in young adults is a multifaceted issue, including personal, social, and environmental factors. Strategies such as governmental interventions, school-wide policies, and peer support can alleviate the issue but they can only go so far. It comes down to the user itself, and students should return to the core reason for celebration â&#x20AC;&#x201D;at the end of the day, HOCO is for a football game, not a reason to get drunk.

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THE MEDUCOLLAB Volume 1, Issue 1 Published September 2020

address

The Meducator, BHSc (Honours) Program Michael G. DeGroote Centre for Learning and Discovery Room 3308 Faculty of Health Sciences 1280 Main Street West Hamilton, Ontario L8N 3Z5

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@the_meducator www.meducator.org facebook.com/Meducator issuu.com/themeducator

meducollab directors

Daniel Rayner (Editorial) Annisa Siu (Graphic Design & Illustration)

contributors (mentees) Writers: Alan Cheng Hannah Silverman Nehal Lubana

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mentors

Writers: Aaron Wen Matthew Lynn Sophie Zarb Adrian Wong Meera Chopra

layout designer Annisa Siu

special thanks to The Underground

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Artists: Aishwaria Maxwell Sowmithree Ragothaman David Zhao

Artists: Ruby Zheng Kien Nagales Michelle Chen

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