CLiR No. 2 – Biotechnology

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NO. 2 3 EDITORIAL 4 RESEARCH IN MEDICAL ROBOTICS 15

VIRTUAL CLINICAL STUDIES

1 7 ANDRAGOGY AND MEDICINE NOW 1 9 BIOINFORMATICS IN THE

HEALTH FIELD

22 COVID-19 PROPELS A

DIGITAL TRIAL REVOLUTION

26 CLINICAL RESEARCH:

THE ERA OF DIGITAL TRANSFORMATION

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AUGUST 2 0 2 0

28 NEURONANOTECHNO-

LOGY: FROM MIND IMAGING TO BRAIN REPAIR

32 FROM PROMETHEUS TO

THE PRESENT DAY OXIDATIVE STRESS: A WINDOW ONTO THE ENTRAILS OF COVID-19

36 MIRA AROYO: THE GENES OF A ROCK STAR 38 LITERARY BIOETHICS AND THE CHANGING DOCTORS-PATIENTS RELATIONSHIP

41 FROM FELIS CATUS TO XENOPUS LAEVIS: STILL LIFES AND XENOBOTS

42 POEM 43 ARTIFICIAL CHEMIST:

THE SELF-DRIVING CAR OF CHEMICAL SYNTHESIS

48 BEYOND ANTHROPOCENTRIC ESTHETIC: “EVOLUTION” 52 MEXICAN SCIENCE

AGAINST COVID-19: SILVER BULLET

55 A NOTE ON GATTACA: BE THE BEST VERSION OF YOURSELF

57 CLIR TOON

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STA F F D I R ECTO RY

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• DIRECTION

• T RAN SL ATO RS

G ENERA L DIR ECTO R

Kimrey Anna Batts Gregory J. Dechant

Marco Cid

Ángel Ortuño Tania Carrera Luis Javier Plata Rosas Selene Flores

• GRAPHI C D ESI GN

EX EC U T IVE DIR ECTO R

Ivette Venegas

César A. Pérez Valencia

• E DITORIA L

• C O L L ABO RATO RS

EDITO R IN C HIEF

Yara Patiño-Estévez

• STYLE C ORRECTION Kimrey Anna Batts Gregory J. Dechant Carolina Villanueva López

Guillermo Caletti Federico Lerner Thor Nissen Jocelyn Robles Léon Van Wouwe Dante Alducin Trilce María Fernanda Ortega Ana Villaseñor-Todd Dolores Garnica Miguel Mesa

Clinical Research Insider w w w.cl i r i n s i d e r.co m

CLiR Insider. Year 1, No. 3, July - September 2020. CLiR Insider is a trademark of CRPS, Clinical Research Professional Services, LLC. All rights reserved. CLiR Insider is a bimonthly publication, published in Calle Volcán Popocatépetl No. 3351, Colli Urbano, Zapopan, Jalisco, C.P. 45070. Tel. 33 20 02 86 97. Website: clirinsider.com.

Editor in Chief Carolina Villanueva López. Reservation of Rights to the Exclusive Use: in process. ISSN: pending at the National Copyright Institute. Title and Content Lawsuit: pending. The content of the articles and advertising is the responsibility of their authors and sponsors. CLiR Insider is not responsible for the information in the advertising content. Prices shown in this publication are for information purposes only and are subject to change.

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ED ITORIAL NATURE AND ARTIFICE: LIFE-SAVING MACHINES “Nature constantly produces difference, even favoring the appearance of the strange and the anomalous, and experimenting all the time.”

-Brigitte Baptiste Medical robotics, biotechnology, nanotechnology, and new kinds of treatments are the subjects we explore in this new issue, which proposes to generate and communicate scientific knowledge from a multidisciplinary perspective, with an emphasis on clinical research and pharmacology.

From the beginning of history, human beings have created extensions of themselves. The pencil and the wheel, motors and computers: these are all extensions of the body or of the mind, designed to provide greater capacities for survival and evolution. Our development as a species depends on each generation progressing further than previous generations, and on doing more than has been done before. On aspect of this is speed. Another is size. Machines, robots, computer calculations, and artificial intelligence have succeeded in moving mountains, doing everything more quickly and covering distances once thought unattainable. Our capacity to observe the smallest aspects of reality, to build on a diminutive level, offers enormous possibilities.

Now and in the future, new technologies can help us to travel great distances or to penetrate minuscule dimensions. Robotics now offers possibilities of clinical development inconceivable not long ago, from surgery to installing nanobots into our own neurons.

This issue addresses issues such as robotics applied to medicine, the revolution taking place in virtual clinical research, bioinformatics in the health field, andragogy, neuro-nanotechnology, genetics, the relation between esthetics and artificial intelligence, living robots, literary bioethics, and the changing doctor-patient relation.

We continue asking questions and attempting to offer, if not definitive answers, at least a dialogue about how to generate synergies between human beings and machines, and between different socio-ecosystems, in order to save lives and improve quality of life, with everyone’s future in mind.

Yara Patiño -Estévez, EIC Writer, editor, science communicator, and art curator

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R ES E A RC H I N M E D I CA L RO BOT I C S Guillermo Caletti, Ph.D. Chief of Clinical Operations at Boehringer Ingelheim for Mexico and Central America.

What is a robot?

The word “robot” was used by the Czech novelist Karel Čapek in his 1920 play entitled R.U.R. (Rossum’s Universal Robot). “Robot” in Czech is a word for a worker or servant.

“The word robot which Josef Capek [K arel’s brother] coined for the play, based on the C zech word robota , ‘forced labor,’ has become a part of most modern languages .” – L ewis , Utopian Literature , pp. 38-9.

“A robot is a reprogrammable, multifunctional manipulator designed to move material, parts, tools, or specialized devices through variable programmed motions for the performance of a variety of tasks.”

– Robot Institute of America, 1979.

“Such a definition leaves out tools with a single task (e.g., a stapler), anything that cannot move (e.g., image analysis algorithms), and all nonprogrammable mechanisms (e.g., purely manual laparoscopic tools). As a result, robots are generally indicated for tasks requiring programmable motions, particularly where those motions are to be quick, strong, precise, accurate, untiring, and/or made via complex articulations.”

(Beasley, 2012)

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We also have the idea that a robot looks like a human being, but this kind of robot is better known as an android, a robot with a human appearance. Androids are among the few robots available to help humans with their daily activities.

Robotics: The field of robotics stands at the intersection of science, engineering, and the technology that produces machines, called robots, that can act as substitutes for (or replicate) human actions.

As technology progresses, so too does the scope of what may be considered robotics. In 2005, 90% of all robots could be found assembling cars in automotive factories. These robots consisted mainly of mechanical arms tasked with welding or screwing on certain parts of a car. Today, we have seen an evolved and expanded definition of robotics, which includes the development, creation, and use of “bots” that can explore the earth’s harshest environments, of robots that assist lawenforcement, and even of robots that assist in almost every facet of healthcare.

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being to come to harm, unless this would violate a law of a higher order. + Law 2: A robot must obey orders given to it by human beings, except where such orders would conflict with a law of a higher order. + Law 3: A robot must protect its own existence, as long as such protection does not conflict with a law of a higher order.

The “laws” described above are fiction and are to be taken as such, but they may be useful and should perhaps be taken into account when we begin to think about the artificial intelligence (AI) that is being

The L aws of Robotics In his book I, Robot, Isaac Asimov proposed three “Laws of Robotics ” and later added the “zeroth law” (Asimov, 1950). + Law 0: A robot may not injure humanity or, through inaction, allow humanity to come to harm. + Law 1: A robot may not injure a human being or, through inaction, allow a human Fuente: https://upload.wikimedia.org/wikipedia/en/d/ d5/I_robot.jpg

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developed as a tool to help human beings in their daily activities.

Bearing this in mind, we can devise countless useful activities where robots could help human beings, as described below (adapted from Mendes, 2014): •Dirty tasks. In the manufacturing sector, many factory jobs are messy or dirty.

Dirty tasks may include welding, grinding, molding, and casting. When robots are used to perform these tasks, they enable human workers to partake in more meaningful and creative pursuits.

•Repetitive tasks. Robots are reliable workers.

They do not feel emotions and therefore do not feel worthless when performing menial tasks. For most people, the repetitive tasks performed in much industrial work are considered very dull or boring. For example, a robot’s only task may be to pick up an object from a conveyor belt and place it in a box.

The robot can perform this task all day, every day, without getting “bored.” Other examples are packaging, lifting heavy objects, and installing parts in manufacturing.

•Dangerous tasks. In manufacturing, robots often perform tasks which are very dangerous for human beings. For example, using robots for tasks involving extreme temperatures reduces the risk of workplace accidents. Apart from these dangerous tasks in manufacturing, robots are also used to carry out important but perilous activities such as clearing out landmines, helping in rescue missions, or mopping up toxic leaks. Police robots are used to defuse and eliminate explosive devices. Sometimes, the police may have to detonate a device on site. Some robots are so tough that they can survive multiple blasts.

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•Impossible tasks. Working deep under water, exploring live volcanoes up close, or travelling to faraway planets are tasks that are simply impossible for humans to execute. Robots are often called upon to perform underwater salvage missions in order to find sunken ships or planes. In 1985, a team of researchers and a robot called Jason Junior were able to locate the wreck of the Titanic. Underwater robots operating a kilometer and a half under the ocean’s surface played a vital role in the fight to stop oil gushing into the Gulf of Mexico.

•Assistive and caregiving tasks. The world’s most sophisticated robots are now designed to support our surging population of elderly and disabled citizens. There is a range of household robots that can understand verbal instructions and help with any household chore. They can also assist disabled people with the use and control of artificial limbs. Finally, robots can help in the medical profession, assisting surgeons to perform operations.

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Why is Robotics Important?

Robots in M edicine

As we have seen above, robotics is an emerging field with applications in many facets of our lives. It is important for all members of society to have an understanding of the technology that surrounds us. Robotics, however, is important for more than that reason.

Robotics provides a unique combination of the pillars of STEM: science, technology, engineering, and math. When taught in schools, it allows students to explore a truly interdisciplinary field while studying an exciting cutting-edge subject. At the same time, the esthetics that go into the design and creation of robots allow students to experiment with their artistic sides, even as they work through technical principles.

This combination rewards participants on a plethora of different learning levels.

According to a recent report by Credence Research, the global medical robotics market was valued at US$7.24 billion in 2015 and is expected to grow to US$20 billion by 2023. A key driver for this growth is demand for using robots in minimally invasive surgeries, especially for neurologic, orthopedic, and laparoscopic procedures. As a result, wide ranges of robots are being developed to serve in a variety of roles within the medical environment. Robots specializing in human treatment include surgical robots and rehabilitation robots. The field of assistive and therapeutic robotic devices is also expanding rapidly.

These include robots that help patients rehabilitate from serious conditions such as strokes, empathic robots that assist in

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the care of older or physically/mentallychallenged individuals, and industrial robots that take on a variety of routine tasks, such as sterilizing rooms and delivering medical supplies and equipment, including medications (Crawford, 2016; Credence Research, 2016).

Medical robots have been reviewed in various papers since the 1990s. Many such reviews are domain-specific, focusing, for example, on surgical robots, urological robots, spine robots, and so on. We shall attempt to make a comprehensive review of those already available, according to therapeutic area, in order to provide an overview of these technologies and their uses in treating patients. • Neurological Brain surgery involves accessing a buried target surrounded by delicate tissue, a task that benefits from the ability of robots to make precise and accurate motions based on medical images. Thus, the first published account of the use of a robot in human surgery was in 1985. The robot was used for a brain biopsy using a computed tomography (CT) image and a stereotactic frame.

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In 1991, the Minerva robot (University of Lausanne, Switzerland) was designed to direct tools into the brain under real-time CT guidance.

Another robotic system, Pathfinder (Prosurgics, formerly Armstrong Healthcare Ltd.) allows the surgeon to specify a target and trajectory on a pre-operative medical image, while the robot guides the instrument into position with submillimeter accuracy. Reported uses of the system include guiding needles for biopsies and guiding drills to make burr holes. •Orthopedics The expected benefit of robot assistance in orthopedics is accurate and precise bone resection. Through good bone resection, robotic systems can improve the alignment of implant with bone and increase the contact area between implant and bone, both of which may improve functional outcomes and implant longevity. Orthopedic robots have so far targeted the hip and knee for replacements or resurfacing. Initial systems required the bones to be fixed in place, and all systems use bone screws or pins to localize the surgical site.

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•General Laparoscopíc Robot assistance for soft-tissue surgery was first done in 1988, using an industrial robot to actively remove soft tissue during transurethral resection of the prostate. As with neurosurgery, the researchers deemed use of an industrial robot in the operating room to be unsafe. The experience provided the impetus for a research system, Probot, with the same purpose.

In 1995, Computer Motion combined two tool-holding robot arms with Aesop to create the Zeus system (since discontinued). The Zeus’s tool arms were teleoperated, following motions the surgeon made with instrument controls (a.k.a. “master” arms or joysticks) at the surgeon console. Technically, the Zeus is not a robot, because it does not follow programmable motions, but rather a remote computer-assisted telemanipulator with interactive robotic arms. To improve precision in tool motion, the Zeus filters out hand tremor, and can also scale large hand motions by the surgeon down to short and precise motions by the tool.

Meanwhile, Intuitive Surgical Inc. was developing the da Vinci. Like the Zeus, the da Vinci is a teleoperated system, with the surgeon manipulating instrument controls at a console and the robot arms following those motions with motion scaling and tremor reduction. Like the Zeus, the da Vinci was initially designed with three arms and therefore able to hold two tools and an endoscope, mounted on a single bedside cart.

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•Steerable Catheters Vascular catheterization is used to diagnose and treat various cardiac and vasculature diseases, including direct pressure measurements, biopsy, ablation for atrial fibrillation, and angioplasty for obstructed blood vessels. The catheter is inserted into a blood vessel and the portion external to the patient is manipulated to move the catheter tip to the surgical site, while fluoroscopy provides image guidance. Owing to the supporting tissue, catheters typically require only three degrees of freedom: tip flexion, tip rotation, and insertion depth. The potential benefits of robot-steered catheters are shorter procedures, reduced forces exerted on the vasculature by the catheter tip, increased accuracy in catheter positioning, and teleoperation (which reduces the exposure of the physician to radiation).

•Radiosurgery Radiosurgery is a treatment (not a surgery), in which focused beams of ionizing radiation are directed at the patient, primarily to treat tumors. By directing the beam through the tumor at various orientations, high-dose radiation is delivered to the tumor while the surrounding tissue receives significantly less radiation. Prior to real time tissue tracking, radiosurgery was practically limited to treating the brain, using stereotactic frames mounted to the skull with bone screws. Now that real-time tissue tracking is feasible, systems are commercially available.

•Emergency Response Few medical robot systems are suitable for use outside of the operating room, despite significant research funding on medical devices for disaster response and battlefield medicine. Typical goals for such research include improved ex-

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traction of patients from dangerous environments, rapid diagnosis of injuries, and the semiautonomous delivery of lifesaving interventions. Current emergency response robots are little more than single-motor systems, but those systems can be controlled by health monitors to minimize the necessary attention by emergency responders. Such a feedback control makes it more likely that such systems will be autonomous, as for example automated external defibrillators. •Prosthetics and Exoskeletons Microprocessor-controlled prosthetics have been available since 1993, specifically the Intelligent Prosthesis knee (Chas. A. Blatchford & Sons, Ltd.). Several more microprocessor-controlled prosthetics exist today, predominantly for knee prosthetics, hand prosthetics, and exoskeletons. • Assistive and Rehabilitation Systems Assistive robotic systems are designed to allow people with disabilities more autonomy, covering a wide range of everyday tasks.

Current Research and Development in Medical Robotics Medical robotics is a young and relatively unexplored field, made possible by technical improvements over the past couple of decades. Currently available systems have been available for too short a time to allow long-term studies. Nor are the benefits potentially provided by medical robots fully understood. Medical robots have only passed through a few technological generations, and the technology continues to change and leap into new areas. Yet by looking at the current market and representative research systems,

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educated guesses can be made about the impacts of robots on near-future medicine. Moreover, many more medical robots are currently being researched, and such research will lead to the new capabilities of future commercial systems.

Swallowable capsules take patient trauma reduction to an extreme, but current systems are limited to diagnostic uses.

Core temperature measurement has been FDA-cleared since 1990, by CorTemp (HQ Inc., formerly HTI Technologies). More recently, capsule endoscopy systems, consisting of a forward-looking wide-angle camera taking regularly timed pictures, a battery, and lights, all contained in a capsule, utilize multiple sensors to measure pressure, pH level, gastric emptying time, and bowel emptying time. Sayaka (RF Co Ltd.) is a novel design, not yet FDA-cleared, which uses a lateral-facing camera that rotates inside the capsule to image the entire tract and is designed without a battery, relying instead on an externally applied magnetic field for inductive power supply. For the future, many enhancements have been proposed, including biopsy, real-time localization of the capsule, drug delivery, ultrasonic imaging, increasing motility by electrically inducing peristalsis, and utilizing an active locomotion system involving treads or legs.

In a more dramatic approach to in vivo robotics, micro/nanotechnology is a multibillion dollar area of research, including investigation for various medical robotic uses such as inexpensive directable drug delivery vehicles, radio-controlled biomolecules, tissue micromanipulation platforms, artificial mechanical white blood cells, and many other therapeutic approaches that may benefit

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from robots working at the cellular level.

Construction of functional systems is an ongoing area of research, particularly with respect to generating and powering motion. Many current prototypes are propelled and guided via magnetic fields, though some utilize external electrical energy sources. As far as we know, no clinical trials have been performed for any medical micro/nanorobot.

In surgical robotics, there has been a trend away from autonomous or even se-

miautonomous motions toward synergistic manipulation and virtual fixtures. Thus, the robot acts as a guidance tool, providing information (and possibly a physical nudge) to keep the surgeon on target.

Such use requires accurate localization of the tissues in the surgical site, even as the tissues are manipulated during surgery.

Improved imaging systems (e.g., Explorer, an intraoperative soft tissue tracker by Pathfinder Therapeutics, or robot compatibility with MRI or CT will provide that loca-

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lization. In particular, MRI-guided robots will benefit from intraoperative 3D images with excellent soft tissue contrast and accurate registration between the tool and the tissue, thus allowing precise virtual fixtures, such as “snap-to” and “stand-off” behaviors. Furthermore, such imaging will allow modeling and rapid prototyping of patient-specific templates/jigs/implants.

The physical designs for medical robots will continue to improve, reducing expense and size, while minimizing or compensating for non-idealities such as flexion, as in the case, for example, of the CRIGOS robot. With better physical designs, semiautonomous behavior will likely become more useful. “Macros” may become com-

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monplace, wherein the surgeon presses a button and the robot performs a preprogrammed motion, such as passing a suture needle between graspers, or the Sensei’s auto-retract feature. Robots will see more use for medical training purposes, bolstered by improved tissue-modeling capabilities, by the increasing objectivity in healthcare assessment, by advances in computer simulations, and as a result of increased data mining, arising naturally from improved data connectivity between devices and between institutions.

Some such systems are already available, such as the aforementioned da Vinci Skills Simulator, the Virtual I.V. Simulator by Laerdal, and the EndoscopyVR Surgical

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Simulator by CAE. For the same reasons, robotics will continue to make possible new medical procedures and treatments, such as new Single-Port Access procedures. Even as robots are developed for new medical areas, other tools may encroach on medical needs currently filled by robots. Medical robots must develop a firm basis in improved medical outcomes, or risk being displaced by pharmaceuticals, tissue engineering, gene therapy, and rapid innovation in manual tools (e.g., the SPIDER Surgical System by TransEnterix, and the EndoStitch by Covidien). To that end, improvements in medical robotics must address and solve real problems in healthcare, ultimately providing a clear improvement in quality of life when compared with the alternatives.

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References 1 .Beasley, Ryan A. Journal of Robotics. Vol 2012, Article ID 401613.

2 .Asimov, Isaac. I Robot. Gnome Press. December 2, 1950.

3 .Erika Mendes. https://prezi.com/uatrfrr1rrmc/differentpurposes-of-robots/ 4 .Crawford, Mark. ASME.org. Sep 14th, 2016. https://www. asme.org/topics-resources/content/top-6-roboticapplications-in-medicine 5 .https://www.credenceresearch.com/press/globalmedical-robotics-market

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VI RTUAL C L I NI CA L STUDI ES Federico Lerner

Operations Director at LatinaBA, a regional CRO; and President of CAIC, Argentine Congress of Clinical Research. Dr. Lerner was responsible for leading many different clinical research teams for the first time to conduct large global registry trials, he was a former Latin American chief of four major global CROs.

Although there is not yet any consensus about the term in the research sector, “virtual clinical studies” refer to tests in which patients do not have face-to-face visits with the personnel of a research center: visits are made virtually. These tests are different from those designated “decentralized,” which are also performed away from a center: in this case, the researchers seek out the patient, making contact at a distance. The “virtual” aspect of the studies is not necessarily complete: it is more frequent for them to be only partially so, with just some of the patient evaluations being performed virtually. The definition seems simple enough, but it implies a far-reaching change in our way of understanding clinical research, in the way medical attention is provided in the context of research, and in the way all of us who work in this area interrelate.

Virtual biomedical research began just a few years ago, and there are already some (rather few, to be honest) completely virtual clinical studies, in which all of the information has been gathered

without any in-person visits and the data obtained has been used to approve the product being researched. Obviously, the current COVID-19 pandemic is bringing this research method to the forefront, given the impossibility of going to the research center or the increased risk for the patient of possible infection as a result of a visit.

We know that very few patients participate in research protocols, out of the total number who are able to do so. While there are many reasons for this, if a large number of these patients are unwilling to participate, it is simply because the centers are far from where they live or the visit would cause a significant disruption of their daily routine. What can we do, then, to facilitate the participation of patients in a clinical study? One answer is technology, the very technology we are using today

to do our banking, to watch movies, to listen to music, or to do our shopping. In short, gathering the information required by research can be done automatically, through sensors embedding in clothing, smart phone applications, automated online assistants, or by bringing research closer to people’s daily routines (home delivery of the clinical study medication, arranging to take blood samples at a convenient address, chosen by the patient, etc.)

To be sure, not all medical research can be undertaken in a decentralized manner: there are some procedures which have to be carried out in controlled biomedical environments, as for example spinal taps.

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can normally be performed without the patient having to go to a specific place: in other words, we can go to the patient, or rather to wherever he or she wishes to have the procedure done.

In order for research to be carried our virtually, not only do we have to adapt to a new environment, but we also require the participation of many agents actively collaborating within the framework of this new paradigm. For example, if our laws do not permit digital signatures, then paper and ink will continue to be necessary to the process of obtaining informed consent. There are already companies that provide the filming of the process and the capture of the signature in a digital format, but we need the laws to go along with it. To put it another way, we need to build a digital ecosystem for virtual research. The development of virtual or decentralized clinical research will play a crucial role in helping us to adapt to the needs of patients, rather than requiring them to adapt to our needs.

Although some countries have passed legislation that regulates virtual medical practice (Mexico is one of them), this is not the case in most countries in Latin

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America. As a result, it becomes more difficult to carry out virtual procedures within a research protocol, since they are not adequately covered by our insurance.

I believe we have to widen the base of patients that have access to research studies. This would serve various purposes, offering patients treatment alternatives for their conditions, and in general providing better treatment, in addition to medication (more controls, better complementary studies, faster diagnoses, etc.), as well as generating more and better scientific information. All this would lead to more highly qualified work and better health policies, while at the same time generating increased knowledge and understanding.

In these times of the COVID-19 pandemic, we have been forced to decentralize many of our processes, but I hope that many of these changes will last into the future, so that we can learn from this opportunity and improve. Obviously, it is a situation none of us wished for, but we can take advantage of it and implement improvements as we move forward in our sector.

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AN DRAG OGY A N D M ED I C I N E NOW Thor Nissen Doctor, graduate in Clinical Pharmacology and MBA in Quality Management. He has managed to collaborate for the development of medicines in world leading pharmaceutical companies both in medical matters and in clinical research in new drugs, regulation, marketing and sales departments.

Humankind stands for its unique way of accumulating and generating knowledge and how this knowledge is transmitted through generations. As other animals do, humans learn by watching and by their own experience. But it is clear that teaching, an ever-evolving discipline, is a specialty on its own.

Pedagogy is generally the term to refer to the method and practice of teaching. Yet, back in 1833, the term andragogy was introduced by the German teacher Alexander Kapp to separately deal with adult education. Since then, several andragogists have contributed to this discipline, where Malcolm Knowles, more than a century after Alexander Kapp’s contribution, was acknowledged as the father of andragogy in the United States .

The Hippocratic Oath is perhaps the most widely known text upholding some

professional ethical standards oriented to the teaching, learning, and practice of medicine. It also binds the student to his teacher and the greater community of physicians, marking the early stages of medical training . So all physicians, as professionals, are adults trained by other adults. And, one way or another, they will further teach the science and practice of medicine to other adult colleagues or colleagues to be.

Adults are in a situation of freedom in their learning processes and they surely learn in a different way than children do. Andragogy is a term commonly used to address these differences, although it is not the only one. As with other disciplines, different orientations may be found. Some authors, especially European, make more emphasis on the social role. Others, like Malcolm Knowles representing the American approach, focus on individual development, and have a more practical orientation .

Among the principles of adult learning, self-direction could be the most distinctive one. It encompasses other principles like internal motivation, experience, usefulness, immediate applicability, and problemcentricity. According to Knowles, selfdirected learning describes a process in which the initiative is held by individuals on what, when, and how, they need to know including the way learning outcomes should be evaluated .

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So, andragogy concepts have been integrated into a broader scope of selfregulated learning (SRL) environments.

Online education is the area where SRL models are mostly considered. eLearning medical and non-medical programs are well embedded in adult learning theories . Of course, eLearning is not the ultimate solution. It is now more and more attractive and practical in some instances.

Especially in situations where mobility is cumbersome or time-consuming. And it may save costs too. But barriers exist. A literature review on known barriers and solutions of online programs in medical education identified such issues and possible counteracting measures. Four listed hurdles, four intuitive yet supported solutions, plus the coveted online content development and delivery.

Unfortunately, many college courses continue creating curricula based on pedagogical principles. Classroom interactions and assessments should be designed to harness student experiences and self-directedness as the primary pathway to learning . Every day more, medical education is being enriched by instrumental, humanistic, transformative, and social learning theories using motivational and reflective models . So medical students and teachers can benefit from SRL techniques better serving the purpose of excellence in the medical practice.

Dealing with kids or grownups, all in all, learning processes are, and will always be an unavoidable challenge and hopefully progressing discipline for all people involved.

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Castillo Silva, F. (2018). Andragogía, andragogos y sus aportaciones. Voces de la Educación, 3(6), 64-76.

Andragogy and Adult Learners. https://thelearner101. wordpres s .com/2019/03/1 1 /e ds-131- mo dule -1andragogy-and-adult-learners/ Greek Medicine - The Hippocratic Oath. https://www. nlm.nih.gov/hmd/greek/greek_oath.html Svein Loeng (2017) Alexander Kapp – the first known user of the andragogy concept, International Journal of Lifelong Education, 36:6, 629-643, DOI: 10.1080/02601370.2017.1363826 Bordeianu, Otilia & Morosan-Danila, Lucia. (2014). Steps toward Lifelong Learning and Knowledge.

Adult Learning Theories Archives. eLearning Industry https://elearningindustry.com/tags/adult-learningtheories 6 Reasons Why eLearning Development Costs Less Than Traditional Training - https://elearningindustry.com/ elearning-development-costs-less-than-traditionaltraining-6-reasons O’Doherty, D., Dromey, M., Lougheed, J. et al. Barriers and solutions to online learning in medical education –an integrative review. BMC Med Educ 18, 130 (2018). https:// doi.org/10.1186/s12909-018-1240-0 Conaway, Wendy & Zorn Arnold, Barbara. (2015). The Keys to Online Learning for Adults: The Six Principles of Andragogy. Distance Learning. 12. 37.

David C. M. Taylor & Hossam Hamdy (2013) Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83, Medical Teacher, 35:11, e1561-e1572, DOI: 10.3109/0142159X.2013.828153

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B I O I N FO R MAT I C S I N TH E H E A LT H F I E L D Jocelyn Robles

B.S. in Biotechnology is currently a specialist in initiation of studies and closure of studies at CidVID.

Over the last few years, we have constantly been linking words in the area of medicine with others from science and technology, as we hear more and more about fields such as “biotechnology,” “biomedicine,” and “bioinformatics.” What does all of this mean for us and for our health in general?

These new and diverse multidisciplinary groups have made possible solutions and techniques for diagnosis and treatments that were not available before, or have improved the ones that were already in use. Bioinformatics, for example, is a field

that combines biological data with health information, analyzing it so that it can be used in the medical field (Majhi et al., 2019).

A very good instance of this is the Human Genome Project (Venter et al., 2001). While this did not provide us with a complete human genome, it did mark the beginning of human genomics and generated many new possibilities for using bioinformatics (Ahn, 2011). Thanks to a “reference genome,” made available through this project, it is now possible to compare a patient’s

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genome to this reference and, through the use of various tools, help in the diagnosis of multiple genetic diseases (GonzagaJauregui et al., 2012). The sequencing technology has improved greatly in the last few years, although it is still far from perfect.

But the ability to sequence a patient’s DNA is not enough to make a successful diagnosis or to predict a future disease. All the information obtained from sequencing a genome (or part of the genome) needs to be analyzed. This ranges from aligning the patient’s genome with the reference genome to finding the segments that might be related to a disease. Once the whole genome has been reduced to a few sequences, a geneticist or the clinician examining the case can make a diagnosis based on this information (GonzagaJauregui et al., 2012). All this has been made possible through the collaboration between bioinformaticians, geneticists, biotechnologists, doctors, and specialists in many other fields.

While these developments have presented some new challenges and ethical dilemmas, they also represent countless possibilities for the diagnosis and prevention of diseases.

One of the biggest challenges of using sequencing for diagnosis is the amount of storage space needed for this data. This is why one of the key steps is to determine which mismatches between the reference genome and the patient’s genome are significant.

The National Health Service (NHS), the public health system in the United Kingdom, has recently introduced the work of clinical bioinformaticians to improve their methods of diagnosis, with these clinical bioinformaticians working hand

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in hand with geneticists and clinicians (Gallagher, 2018). In 2014, a successful study was performed by the NHS to determine the genetic cause of congenital cataracts, using DNA sequencing. Knowing this makes for more accurate treatment and will help with future diagnosis of this disease (Gillespie et al., 2014).

Another area where bioinformatics has proven to be of great help has been in finding a treatment for tuberculosis. One of the main problems for treating this disease resides in the fact that the bacteria that causes it, Mycobacterium tuberculosis, is able to resist antibacterial agents.

Science and technology have identified the fragments in the DNA that make the bacteria resistant, which helps physicians choose the best drug for treatment (Bah et al., 2018). This discovery still has a long way to go before it can be applied to the prevention or better treatment of tuberculosis, but it certainly marks a great start.

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It should be pointed out that many of the new technologies still have a long way to go before they will be perfected or even completely understood. But they are paving the way to better things, many of them considered impossible just a few years ago.

By combining different fields and areas, we have finally started to be able not only to treat, but also to prevent. We are all looking forward to seeing these technologies more fully in action.

Reference Majhi, V., Paul, S., & Jain, R. (2019). Bioinformatics for Healthcare Applications. 204–207. https://doi. org/10.1109/AICAI.2019.8701277 Venter, J. C., Adams, M. D., Myers, E. W., Li, P. W., Mural, R. J., Sutton, G. G., Smith, H. O., Yandell, M., Evans, C. A., Holt, R. A., Gocayne, J. D., Amanatides, P., Ballew, R. M., Huson, D. H., Wortman, J. R., Zhang, Q., Kodira, C. D., Zheng, X. H., Chen, L., … Zhu, X. (2001). The Sequence of the Human Genome. Science, 291(5507), 1304. https:// doi.org/10.1126/science.1058040 Ahn, S. (2011). Introduction to bioinformatics: sequencing technology. Asia Pacific Allergy, 1(2), 93–97. https://doi.org/10.5415/apallergy.2011.1.2.93 Gonzaga-Jauregui, C., Lupski, J. R., & Gibbs, R. A. (2012).

Human Genome Sequencing in Health and Disease.

Annual Review of Medicine, 63, 35–61. https://doi. org/10.1146/annurev-med-051010-162644 Gallagher, E. (2018, November 23). Day in the life: clinical bioinformatician - Genomics Education Programme. NHS. https://www.genomicseducation. hee.nhs.uk/blog/day-in-the-life-clinicalbioinformatician/ Gillespie, R. L., O’Sullivan, J., Ashworth, J., Bhaskar, S., Williams, S., Biswas, S., Kehdi, E., Ramsden, S. C., Clayton-Smith, J., Black, G. C., & Lloyd, I. C. (2014).

Personalized Diagnosis and Management of Congenital Cataract by Next-Generation Sequencing.

Ophthalmology, 121(11), 2124-2137.e2. https://doi. org/10.1016/j.ophtha.2014.06.006 Bah, S. Y., Morang’a, C. M., Kengne-Ouafo, J. A., Amenga–Etego, L., & Awandare, G. A. (2018). Highlights on the Application of Genomics and Bioinformatics in the Fight Against Infectious Diseases: Challenges and Opportunities in Africa. Frontiers in Genetics, 09. https:// doi.org/10.3389/fgene.2018.00575

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C OV I D -19 P RO P E LS A D I GI TA L T RI A L RE VOLU T I ON LĂŠon Van Wouwe

COVID-19 impacts all of us significantly.

Most notable are the lives lost, the struggling health care services, and the social distancing measures that affect our emotional wellbeing, along with the still unknown impact on the economy.

Clinical trials in trouble In the area of clinical research, trial enrollment has dropped massively. A Medidata analysis showed an average reduction in trial enrollment of around 65%, comparing March 2019 and March 2020 (B. Adams, 2020).

The pandemic also poses obstacles to ongoing study conduct: lockdowns and social distancing impact compliance with visit schedules and assessments.

In the worst case, trial facilities become inaccessible or unsafe, as hospitals are overloaded with COVID-19 patients.

Efficacy and safety endpoints may be compromised, as COVID-19 results in excess deaths and complications throughout the study period. This can be especially detrimental to oncology studies, where survival is often a primary endpoint. Supply chain difficulties and availability and access to investigational products pose further challenges (F. Melhem, 2020; GlobalData Healthcare, 2020).

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Challenges drive opportunities Clinical trials are essential to developing new treatments. Remote patient monitoring, home care, and telehealth have been gaining momentum for some time, but COVID-19 is forcing through a (r)evolution in clinical trial execution, from the area of recruitment to that of data submission.

COVID-19 research is hungry for immediate access to real-world data in order to gain insights. Digital health technologies that enable continuous real-time data collection meet this need. Across COVID-19 clinical trials, social-distancing measures force the widespread use of virtual connectivity and remote monitoring and management, so we are likely to see a real acceleration in the uptake of new technologies and processes (D. Piekarz, 2020).

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These technologies can significantly reduce the time, effort, and burden on investigators, clinical research centers, and participants.

The industry has been discussing these benefits for years, but with the traditional ecosystem at a standstill, COVID-19 fuels the adoption of digital and virtual technology.

D e EHR a EDC One area in which to expect progress is the movement of clinical trial data points from electronic health records (EHRs) directly into electronic data capture (EDC), at scale.

Data entry and the verification of data entered in EDC is still mostly 100% manual. Transcription has long been the only method to get data into the study eCRF (electronic case record form) or EDC system. Transcription works across all data sources, but has significant limitations, especially human fallibility, which brings the need for validation and monitoring of the transcribed data. This monitoring is an additional resource and an extra effort. The resulting process can

be one of the most problematic issues in clinical trials.

The reason we have transcription goes back to the beginning of the EDC industry. EDC was, and is, the method of digitizing subject data, so that this can become the clinical data reported to regulators, replacing paper. In the period of around 1998 to 2003, electronic hospital information systems were not yet generally available, but the ability to collect clinical data over the internet existed, and the industry needed a way to get valuable patient data into these new web-enabled EDC databases.

A new workstream developed around the manual transcription of source data into EDC, resulting in a “web-enabled paper process.� While EDC was successful at displacing paper, manual transcription created its own challenges, and still required source data validation (SDV).

Today, sophisticated EHR systems based on common data standards and interfaces have become available.

In theory, therefore, we can make the EHR-to-EDC data transfer a reality. This would give us 100% accurate data, while eliminating the need for transcription and associated SDV and fulfilling the original promise of EDC: better data management that transcends data entry errors and focuses on clinical issues with the data. Bear in mind that we are talking about clinical trial data points and about transferring them from EHRs directly into EDCs.

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In spite of the obvious benefits, remarkably little progress has been made in this area across the industry thus far (H. Levaux, 2018). But COVID-19 is propelling progress: I expect to see more studies where study

data points are transferred from EHR straight into eCRF, and welcome an exciting new digitally-enabled future for clinical trials!

About the author LĂŠon van Wouwe, MSc, is a versatile clinical research professional with over two decades of experience working in international drug development organizations, across a variety of therapeutic areas and development phases. Taking a holistic, ecosystem approach, LĂŠon brings a broad cross-functional perspective and advocates for innovative approaches that address the challenges faced in drug development, facilitating more effective collaboration, in order to accelerate the development of new treatment options for patients.

Reference 1. Adams B, Global clinical trials take a major hit from pandemic, with endocrine targeted tests worst hit, FierceBiotech, April 8, 2020, disponible en: www.fiercebiotech.com/biotech/worldwideclinical-trials-take-a-major-hit-from-pandemic-endocrine-targeted-tests-worst-hit 2. Melhem F, The Global Impact of COVID-19 on Clinical Trials and the Way Forward, Technology Networks, April 20, 2020, disponible en: www.technologynetworks.com/drug-discovery/blog/theglobal-impact-of-covid-19-on-clinical-trials-and-the-way-forward-333652 3. GlobalData Healthcare, The impact of the Covid-19 pandemic on clinical trials, Clinical Trials Arena, March 20, 2020, disponible en: www.clinicaltrialsarena.com/comment/covid-19-pandemicclinical-trials 4. Piekarz D, Will the Impact of COVID-19 on Clinical Trials Fast-Track Digital Health Technology?, HCP Live, April 21, 2020, disponible en: www.mdmag.com/medical-news/impact-covid-19-trialsfast-track-digital-tech 5. Levaux H, Will the Impact of COVID-19 on Clinical Trials Fast-Track Digital Health Technology?, Clinical Pipe, June 19, 2018, disponible en: www.clinicalpipe.com/blog/why-pharma-needs-an-ehrto-edc-connection

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C L I N ICA L RE SE A RC H : T H E E RA O F D I GI TA L T RA N SFO RM AT I O N Dante Alducin He has 12 years of experience in the field of clinical research specialized in oncology, currently he is dedicated to promoting studies registration on demand through social networks.

Mr. Schultz opens his refrigerator door to check how much milk he has. He sees that he needs to get more. A man of habit, he typically goes out for a daily walk, so he figures he can get some along the way. He also realizes, however, that it’s a bit later than usual and that the sky is starting to cloud over. Before leaving, he picks up his umbrella and hat. And he intends, upon returning home, to call his grandchildren, as he normally does every week.

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At a steady pace, he leaves the house and sets out on his march. Although in his late seventies, he is still mentally alert and in reasonably good physical shape.

But on this particular occasion, Mr. Schultz suddenly gets dizzy and his steps become clumsy. The world around him starts to become blurry and then suddenly goes pitch dark.

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Meanwhile, three thousand kilometers away, a signal is received in a health outfit with more specific information from the accelerometer in Mr. Schultz’s watch, which detects a sudden and unusual change in his blood pressure and cardiac rhythm. In an instant, all the data related to Mr. Schultz’s critical situation is processed and recorded. It is determined with certainty that Mr. Schultz has had a stroke and has passed out.

Immediate alerts are sent to the local ER and an ambulance is dispatched to Mr. Schultz’s location, according to the GPS in his watch. His neurologist immediately receives a notification via SMS, while his three sons are simultaneously contacted by phone. Mr. Schultz has been participating in a clinical trial related to strokes, so the affiliated clinical testing team involved is immediately notified.

As exemplified in the story above, information and the way it is collected have been revolutionized. What used to be medical blind spots have now become infinitesimal bits of critical information.

This new phenomenon is true of almost every aspect of investigational drugs, including their safety profiles and their pharmacokinetic and pharmacodynamic properties, to name just a couple.

Traditional clinical research activities and knowledge alone will no longer be enough. A synthesis between computer science, data analysis, wearable devices, real-time information, statistics, and new algorithms are now required, along with other skills sets, ranging from information technology management to bioengineering.

In the era of digital transformation, our jobs as well as our lives will be changed by this revolution. Thanks to all this, Mr. Shultz and many others like him will get a second chance to speak with their grandchildren and enjoy their regular afternoon walks.

This new phenomenon is what we call “digital transformation” and it is revolutionary in all aspects of every industry. Health and clinical research are no exception.

As part of a new race among enterprises, we are starting to see dramatic changes at the core of clinical research activity through digital transformation. These have major implications, requiring people to have the related skills necessary for bravely competing in this new world.

ART & LITERATURE ART & LITERATURE

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N EURO N A N OT EC H N O LO GY: FROM M I N D I M AGI N G TO B RAI N RE PA I R Trilce MarĂ­a Fernanda Ortega HernĂĄndez Biologist, neuroscientist, and researcher in neuroethology in non-human primates at the Instituto de NeuroetologĂ­a of the Universidad Veracruzana

Ever since the speculations of ancient philosophers and the first studies of the human nervous system, we have been fascinated by this mysterious black box that connects us to the surrounding world. The path to understanding how it functions has been arduous, and many scientists think that we are far from having discovered everything that this most astonishing of biological machines, with its countless cellular connections, is able to do. The human brain, however, is able to conceive and create tools to study and to heal itself.

One of these creations of the human mind is bionanotechnology, used in the fabrication of materials, composites, and machines with biocompatible structures no larger than 100 nanometers, to be used in medical diagnosis, therapy, and surgery, and offering more efficient and less invasive alternatives. Much of this technology has already been tested both in vitro and in vivo (on animals), but

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there is still much to learn and better understand about the processes of biological systems as complex as the human brain.

The brain does not only interconnect our entire body, but also connects us with the environment around us, drawing sensorial information from our surroundings, codifying it in an electronic language, and translating it on demand to enable us to interact with our environment and to survive within it. Marvelous as it is, however, our brain remains exposed to damage, deficiencies, and eventual death. Nanotechnology can be a tool for understanding how the brain functions, for treating pathologies and disorders in the brain, and possibly even for raising it to a higher cognitive level and taking it beyond the barriers of death.

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Neuronanotechnology can be very effective in the early diagnosis of neural pathologies and tumors and in research on brain functions in general. A good example is “quantum dots,� which have proven effective in diagnosing diseases that are difficult to detect owing to their small concentrations of pathogens. For example, early-stage bacterial meningitis can be detected by means of this nanocomposite that reacts with a solution of quantum dots with various epitopes, locating the pathogen before serious symptoms appear, and when the disease is still treatable (Guo and Wei, 2005).

Other devices that can improve neuropathological diagnoses and provide help in researching the nervous system are implants of nanotechnology, such a platinum nanowires that can pass through the bloodstream without interfering with the circulation of the blood. In one experiment, these nanowires, guided by the neurovascular system, were used to detect the activity of neurons adjacent to the blood vessels (LlinĂĄs et al, 2005). Interactions between neurons can be more fully explained thanks to these nanowires, which broaden the scope of neurobiological research and shed light on both the biological causes of mental disorders and the diagnoses of lesions. Nanorobots are electromechanical machines assembled on an atomic scale, with the ability to

detect and adapt to heat, rays, surfaces, sounds, and chemical substances, as well as to repair themselves and to self-replicate. Nanorobots can be used to locate and treat malignant brain tumors, through the use of focalization sequences and magnetic fields for the direction and concentration of particles.

Thanks to nanotechnology, neuroimaging for diagnosis will become more precise, sensitive, and localized. Positron emission tomography, which uses isotope labeling, could increase in scope, thanks to nanomaterials that provide better resolution. These same nanomaterials could even be built in nanorobots capable of eliminating cancerous tumors in the brain. The ultrasensitive properties of nanocomposites will allow for the mapping of neuronal networks and of the molecular processes that occur within the neurons to be improved. One such example is the laser luminescence technique used to detect gold nanorods (Wang et al., 2005).

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Nanotechnologies can also be applied to therapeutics, from pharmacological nanomaterials to nanorobots used to repair brain tissue. In the area of pharmaceuticals, the use of guided nanorobots for the administration of drugs is being studied. Certain nanomaterials, such as nanoparticles of metal and metallic oxide, nanocapsules, and others coated with biocomposites, increase the bioavailability and multifunctionality of the pharmaceuticals (Fonseca-Santos et al., 2015).

potential where neural circuits have been damaged owing to cerebrovascular lesions or neurodegenerative disorders (Saniotis et al., 2018).

The task of deciphering the biological underpinnings of the mind is one of the most complex and fascinating riddles that human beings have ever faced. Many

For example, Buckminsterfullerene, also as known as “Buckyballs,� are hollow spherical molecules with specific ligands in their structure that can be guided to specific locations in order to release the drug over time. The nanocapsules protect the biological agent during the entire journey to the target cell or tissue (Ellis-Behnke et al., 2007). Another property of these nanomaterials and nanocapsules is that they can easily pass through the bloodbrain barrier, some of them even being able to pass through the cell membrane and modify the functioning of enzymes or genes. Thanks to these nanocomposites, dosages can be reduced by anywhere from ten to fifty orders of magnitude.

Moreover, the therapy period is shortened and there are fewer side-effects, with increased efficiency of the drugs in the nervous system.

Another remarkable potential therapeutic application of neuronanotechnology is that of regenerating nerve tissue by means of nanofibers of self-assembling peptides, which may be able to repair axons and foster the propagation of the action potential. A study group in the United States is developing an endomyccorhizae-like interface as a neuronal nanoprosthesis made of interconnected nanofibers that form a hybrid network with neurons. These nanofibers are able to diffuse action

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scientists, researchers, and engineers agree that, although neuroscience is still in its early stages, nanotechnology is likely carry it into the future by leaps and bounds, as even the mind itself may be uploaded into computers to be studied, with the creation of a brain-computer interface. This is what is promised

by IBM’s Blue Brain project, which is being developed in collaboration with companies and institutes all over the world. The project consists of creating an artificial brain that will reconstruct

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and simulate, with biological details, first of all the brains of rodents and finally the human brain itself. These reconstructions and simulations are mapped from a brain in vivo by means of nanorobots recording data through the interface of a supercomputer. Although the project is still at the laboratory stage, it may well open a window toward understanding the structure and function of the brain at many levels, particularly cognitive and mental, as it seeks to decipher the neural code (Ganji and Nayana, 2015; Poonia, 2019).

We need to ask ourselves, however, whether all this new technology, as impressive and promising as it is, may not have long-term disadvantages or repercussions. There are always challenges and obstacles to understanding complex natural phenomena, especially along the frontier separating the biological realm from the artificial world. Nevertheless, some authors, such as Ray Kurzweil, enthusiastically predict that, within ten years, much of this technology will already be in use, including even interfaces between computers and the human brain.

Reference Ellis-Behnke, R.G., Teather, L.A., Schneider, G.E., & So, K.F. (2007). Using nanotechnology to design potential therapies for CNS regeneration. Current pharmaceutical design, 13(24), 2519-2528.

Fonseca-Santos, B., GremiĂŁo, M. P. D., & Chorilli, M. (2015).

Nanotechnology-based drug delivery systems for the treatment of Alzheimer’s disease. International Journal of nanomedicine, 10, 4981.

Ganji, S. & Nayana, K. (2015). Upgrading human brain to blue brain. Information Technology, 3, 4.

Guo P & Wei C. (2005).Quantum dots for robust and simple assays using single particles in nanodevices.

Nanomedicine.

Nanotechnology, Biology, and Medicine, 1(2): 122-4.

LlinĂĄs R.R., Walton K.D., Nakao M., Hunter, I., Anquetil P.A. (2005).Neurovascular central nervous recording/ stimulating system: Usingnanotechnology probes.

Journal of Nanoparticle Research. 7(2-3): 111 - 27.

Poonia, S.(2019) A Study on Blue Brain Modeling, Applications and its Challenges. International Journal of Research in Engineering, Science and Management, 2 (2). Saniotis, A., Henneberg, M., & Sawalma, A.R. (2018).

Integration of nanobots into neural circuits as a future therapy for treating neurodegenerative disorders.

Frontiers in neuroscience, 12, 153.

Wang, H., Huff, T.B., Zweifel, D.A., He, W., Low, P.S., Wei, A., et al. (2005). In vitro and in vivo two-photon luminescence imaging of single gold nanorods. Proc Natl Acad Sci U S A, 102(44): 15752-6

Comité técnico: PhD. Rosa del Carmen López-Sánchez, PhD. José A. Hernández-Hernández 3 2 ] [ 3 2 ]

FROM P ROM E T H E U S TO T H E P RE SENT DAY OX I DAT I V E ST RE SS: A W I ND OW O N TO T H E E N T RA I LS OF C OV I D-19 Dra. Ana Villaseñor-Todd PhD candidate (Technical committee: Rosa del Carmen LópezSánchez, PhD, and José A Hernández-Hernández, PhD) Mexican scientist noted for her research studies in minimal encephalopathy, oxidative stress, quality of life and social cognition. He complemented his graduate studies at Texas A&M University. Candidate to receive the degree of doctor of medicine by the UANL. Founder and CEO of AVE strategic consulting.

Having

stolen fire from the gods and given it to men , Prometheus received a hideous punishment: Z eus , the father of the gods , ordered that he be chained to a rock , and that an eagle should come every day to devour the hero’s liver, only for it to grow back overnight. Prometheus was condem ned to endless suffering.

In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) broke out in Wuhan, China. The serious respiratory disease that this virus causes in human beings (COVID-19) has been declared a pandemic by the World Health Organization (Zhang and Ma, 2020). Several months ago, the Mexican government declared a public health emergency as a result of the SARS CoV-2 epidemic. My heart took a leap when I learned the news. The Ministry of External Affairs made a call to the scientific community to join in the work of research and analysis required to confront the pandemic. The situation is developing rapidly: as many as 20% of COVID-19 cases have been described as serious illnesses, with fever and pneumonia, leading to acute respiratory distress syndrome (ARDS) (Moore and June, 2020). There are no clear clinical or paraclinical parameters yet to

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indicate the course of its evolution. I have spent ten years of my life in the fascinating world of hepatocytes, oxidative stress, quality of life, and the effects of all these things on social cognition, as well as how metabolic comorbidities are associated with diseases of the severity of COVID-19. I have formulated a hypothesis here that I hope will interconnect all these matters.

Chronic hepatitis is one of the leading causes of death all over the world. It can be caused by different mechanisms, including chronic viral infections, alcohol abuse, and metabolic alterations. It is known that, in the early stages, the liver can repair the damage caused to it, but that, if the ailment continues, the accumulation of molecules produces fibrosis, which eventually progresses towards cirrhosis and, finally, hepatocellular carcinoma (M. Masarone et al., 2018).

The metabolic alterations that produce a significant accumulation of fat in more than 5% of hepatocytes and which are not the result of the consumption of a “dangerous” amount of alcohol or of any other cause of hepatic disorders constitute a potentially pathological condition known as nonalcoholic fatty liver disease (NAFLD).

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Over the last two decades, NAFLD has become an increasingly widespread condition all over the world, taking the place of the hepatic damage traditionally caused by viral infections, the incidence of which has been reduced. This is due, perhaps, to an increase in the prevalence of obesity, diabetes, and dyslipidemias, among other causes, owing to the adoption of habits commonly gathered under the umbrella designation of a “Western lifestyle” (M. Masarone et al., 2018).

It has been estimated that the prevalence of NAFLD among the general population ranges anywhere from 17% to as high as 33%. Mexico is one of the countries whose population shows several risk factors for the disease, where its incidence could surpass 50% (R. Bernal-Reyes et al., 2019).

It is as high as 75% among persons with obesity and even higher among patients with type 2 diabetes mellitus (DM2). DM2 and hepatic damage both constitute risk factors for the development of cardiovascular diseases, and central obesity is an acknowledged risk factor for the development of NAFLD. Prevalence differs on the basis of gender, race, and ethnicity, with genetic and epigenetic factors playing a role in the pathogenesis of the disease. Resistance to insulin is the principal factor in the physiopathology of NAFLD, along with metabolic syndrome, a cluster of conditions which include central obesity, high blood pressure, glucose intolerance, and dyslipidemia (Zhang and Ma, 2020).

Lack of exercise, overweightness, and poor nutrition can all provoke an increase in reactive oxygen species (ROS), which lead to a state of chronic oxidative stress (Moore and June, 2020). In a model of multiple parallel impact ― the presence of a significant accumulation of fat in the

hepatocytes, resistance to insulin, liberation of inflammatory substances (cytokines) through the adipose tissue, an increase of free fatty acids coming from adipocytes and diet―, an imbalance in the liver is produced that leads to accelerated oxidation of fatty acids (mitochondrial beta-oxidation) and the production of reactive oxygen species.

ROS are a group of small reactive molecules that perform critical roles in the regulation of various cellular functions and biological processes. The principal evidence for the strict physio-pathological link between the mechanisms of oxidative stress, the presence of NAFLD, and its progression, are mitochondrial dysfunction, reticular stress, iron metabolism and brain-gut-axis disorders, fatty liver disease, and endothelial dysfunction (R. Bernal-Reyes et al., 2019).

In physiological conditions there is a state of equilibrium between the functional interaction of oxidant agents derived from the incomplete reduction of oxygen, the ROS, and the enzymatic antioxidant agents. Oxidative stress occurs when the redox balance is lost owing to a greater generation of oxidant agents than of antioxidant agents. Chronic oxidative stress is harmful to the cells, as it provokes oxidation of macromolecules and causes changes in cell-signaling pathways, altering their function and even causing cell death (C. Poblete-Aro et al., 2018).

The biochemical integrity of the brain is vital to the normal function of the central nervous system (S. Salim, 2017). Owing to its high consumption of oxygen and rich lipid content, the brain is also highly susceptible to oxidative stress. As a result, the damage caused to the brain by oxidative stress has a high potential for negatively impacting the normal functions of the central nervous system. Although oxidative stress has generally played a

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role in neurodegenerative disorders, such as Alzheimer’s, Huntington’s, and Parkinson’s diseases, it has also been related to other diagnoses in the field of mental health. We also find it in many neuropsychiatric disorders, such as depression, anxiety, and schizophrenia, as well as along the autism spectrum, where it significantly affects behavior and cognitive functions and has a negative impact on quality of life (Zhang and Ma, 2020). The biochemical integrity of the brain is vital to the normal functioning of the central nervous system (S. Salim, 2017).

Another tissue that is frequently damaged is the vascular endothelium. Oxidative stress induced by the excessive generation of reactive oxygen species has become a common mechanism in arterial sclerosis.

Although ROS are essential to vascular homeostasis, their uncontrolled production is a factor in strokes.

The evaluation of the redox state in the human organism is complex, owing to a large variety of biomarkers, both for oxidant and antioxidant agents. The most commonly employed strategies to evaluate oxidative stress are: 1) measuring the abundance and activity of antioxidant proteins; 2) quantifying products derived from oxidation; and 3) analyzing the oxidant/antioxidant balance (S. MuñizHernández, 2012).

Many of these biomarkers can be detected in blood samples (red blood cells, plasma, or urine). A correlation has been observed between the levels of oxidative stress biomarkers in the blood and central organs, such as the liver, skeletal muscle, heart, and kidneys. These findings suggest that the analysis of oxidative stress biomarkers obtained from blood samples may offer a broader vision of the organism’s redox state (M. Masarone et al., 2018).

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The field of metabolomics has become a powerful discipline for identifying new biomarkers in an non-invasive way and may guide us to earlier diagnoses and more effective treatments. Metabolomics is the scientific study of the chemical processes that involve metabolites.

Specifically, metabolomics is the “systematic study of the unique traces left by specific cellular processes as they occur”: in other words, the study of the profile of metabolites (small molecules) of a biological sample. The metabolome is the complete set of metabolites in a cell, tissue, organ, or organism that are the result of cellular processes. The metabolic profile provides an instant window onto the physiology of the cell. The endogenous molecules modified by the chemical interactions, with high levels of reactive oxy-

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gen and nitrogen species in the cellular microenvironment, can be considered biomarkers of oxidative stress and, together with any alteration of the metabolic composition, would constitute specific early predictors of many diseases.

It is necessary to look for early markers that allow doctors to react in a timely fashion to any such non-specific and rapidly evolving clinical picture. Advanced age, cardiac complications, disorders of the central nervous system, and pneumonia are elements enough to draw up a metabolic and nitro-oxidative profile to study the cellular process of the natural course of this disease.

Nitro-oxidative stress plays a role in the inflammation, cell damage, and process of tissue repair of the respiratory tract (Y. Kyogoku et al., 2019), and the modulation

of redox imbalance and its causes can be useful in diagnosing and evaluating the severity of COVID-19. Understanding oxidative stress and its biological processes as a common factor in chronic-degenerative diseases, which have such great impact on public health, requires us to implement structural public policies in the near future, with its new normal: evidence-based interventions that favor a positive antioxidant state for the general population.

We have the opportunity to create an historic link and to lay the groundwork for a new development in human wellbeing and quality of life. An innovative way of buffering the severe blow suffered by humanity as a result of the COVID-19 crisis.

In short, a way of redeeming Prometheus from his eternal torment.

References 1 . Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: A cross-sectional study. Int J Environ Res Public Health. 2020;17(7).

2 . Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science (80- ). 2020;368(6490):473–4.

3 . Masarone M, Rosato V, Dallio M, Gravina AG, Aglitti A, Loguercio C, et al. Role of oxidative stress in pathophysiology of nonalcoholic fatty liver disease.

Oxid Med Cell Longev. 2018;2018.

4 .Bernal-Reyes R, Castro-Narro G, Malé-Velázquez R,Carmona-Sánchez R, González-Huezo MS, GarcíaJuárez I, et al. The Mexican consensus on nonalcoholic fatty liver disease. Rev Gastroenterol Mex [Internet].

2019;84(1):69–99. Available from: https://doi.org/10.1016/j. rgmx.2018.11.007 5 .Poblete-Aro C, Russell-Guzmán J, Parra P, SotoMuñoz M, Villegas-González B, Cofré-Bola-Dos C, et al.

Efecto del ejercicio físico sobre marcadores de estrés oxidativo en pacientes con diabetes mellitus tipo 2.

Rev Med Chil. 2018;146(3):362–72.

6 . Salim S. Oxidative stress and the central nervous system. J Pharmacol Exp Ther. 2017;360(1):201–5.

7 . Muñiz-Hernández S. Alcoholism: Common and Oxidative Damage Biomarkers. J Clin Toxicol.

2012;S7(01).

8 . Kyogoku Y, Sugiura H, Ichikawa T, Numakura T, Koarai A, Yamada M, et al. Nitrosative stress in patients with asthma–chronic obstructive pulmonary disease overlap. J Allergy Clin Immunol [Internet].

2019;144(4):972-983.e14. Available from: https://doi. org/10.1016/j.jaci.2019.04.023

RESEARCH

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TH E G E NE S O F A RO C K STA R Por: Farahnoise y Dolores Garnica Essayist and journalist. She has worked as a promoter, manager and communicator. She is a columnist for ITESO’s Magis magazine and a regular contributor to Luvina, a magazine of the University of Guadalajara. His first book of essays, “Un gris, casi verde ”, by Editorial Paraíso Perdido, was presented in 2017.

2003. In the voice and synthesizers of Ladytron, there was Mira Aroyo. In a laboratory at the University of Oxford, behind a high-range fluorescence microscope, there was Mira Aroyo as well, a graduate student in genetic science. With her pale complexion, black hair, and uncanny voice, having abandoned her studies just a year short of completing the impressive postgraduate program, she is now one of the best-known icons of the musical genre known as electroclash.

Mira Aroyo was born in Sofia, Bulgaria in 1977. As a girl she like to play the guitar and the accordion, but she was also interested in science. Years later, her family moved to Israel and then to the United Kingdom, where Mira began to collect vintage synthesizers and to work as a DJ. It was there she came into contact with other musicians interested in breaking up the stereotypes of Britpop, which had been in fashion through the 1990s and the early years of the new century: Helen Marnie, Daniel Hunt, and Reuben Wu. Assembled under the name Ladytron, they sold millions of albums between 2001 and 2013. And in 2019 they released a new album bearing simply the name of the group as title.

Speaking of her parents’ reaction, Mira told an interviewer: “Naturally they were a bit scared and skeptical at first, but they knew it made me happy and that we were taking it seriously, so they ended up being supportive.”

For as it happened, while Ladytron was recording Light & Magic (perhaps their best album) in 2002, the secondary vocalist of the band, which produced a sophisticated, sometimes darkly-tinged combination of pop, rock, and electronic rhythms, was also working in the field of genetic science, under the supervision of two legends in biochemistry François-Xavier Barre and David J. Sherratt as part of a research project entitled “The Role of the C-terminus of FtsK in Xer Recombination,” about a product of

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protein truncation and its relation to DNA: “In simple terms it is about how bacteria know when to divide, which is something they do in order to replicate, and make sure they have the right kind of genes in each new cell,” commented Mira in an interview with Peter Quincy Ng in a Swedish online magazine.

“For a while I was balancing both, and then it became impossible . It’s not the

“I was a geneticist doing a PhD and realizing lab work wasn’t for me. We were doing Ladytron at the same time and I was enjoying it more. It was easier and more fun.” This was Mira Aroyo’s account of her abrupt abandonment of her postgraduate studies, just a year before completing them. As she explained in an interview with Thomas Matich:

you can dip in and out of

kind of thing that you do a little bit of freelance stuff, it totally consumes you; you work seven days a week

—people

work

70

hours a week with

their heads in the dirt. It’s not something

...

and the

field moves so quickly that even when

I

was working, to now, it’s just light

years ahead — it’s moved on so much .

It’s easy to read Scientific American or something, but it’s hard to stay in touch with exactly what’s going on .”

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L I TERARY BI OE T H I C S A ND T H E C HAN GI N G D OCTO R- PAT I E N T R ELAT I O N SH I P Luis Javier Plata Rosas Born in Mexico City. He emigrated to Ensenada, Baja California, to study a degree in Oceanology (UABC), a master’s degree in Physical Oceanography (CICESE) and a doctorate in Coastal Oceanography (UABC, again). He emigrated to Puerto Vallarta, where since then he has been wearing the Black Lions shirt of the University of Guadalajara, since he works at the University Center of the Coast of this worthy institution. He lives with his wife (also an oceanologist, also a doctor, also Leona UDG), two sons and five cats and runs a marathon per year.

“…the two of them skilled physicians.” The phrase from the Iliad explicitly expresses the link between the sons of Asclepius (and I don’t say this to embellish the text, since, in the case of Greek mythology, we are “really and truly” speaking of the offspring of the god of medicine) and the Achaean warriors. Although Podaleirios and Machaon were demigods, Homer omits to mention their divine lineage in favor of their activities as professional healers (and possibly colleagues, if the suspicions of certain historians concerning the poet are correct) in a context where medical skill is at a premium: the battlefield.

In their first appearance on the stage of Western literature, doctors play an honored role, with deserved praises heaped upon them. For the great majority of the casualties wounds caused by spears, arrows, or rocks to the head, chest, abdomen, hips, or extremities, including even snakebites―, recorded in hexameter verse with the detail and precision of a surgeon (the aforementioned suspicions are by no means idle), the timely intervention and trauma management of the two “leeches” (to use an archaic term) led to the survival of the patient and, as a result, a low mortality rate: 5%, compared to 77.5% for those unfortunates in the epic poem who did not receive medical attention. The only exception? Wounds to

OPINION

the head, which were invariably mortal.

Demigods they may have been, but they couldn’t perform miracles.

Homer was as detailed in his descriptions of battle wounds and the results of medical intervention as he was sparing of insights into the relations between physicians and their patients, among both Trojans and Greeks (or rather Achaeans). But we know at least that the healers were not described as insensitive to the pain of those they cared for: when Machaon learns that Menelaos has been wounded by an arrow, “the heart in breast was roused.” And as mentioned above, there is no lack of appreciation for

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the profession in Homer: “… for a doctor is worthy of many other men, whether for cutting out arrows or for applying soothing See C. Koutserimpas, K. Alpantaki, and G Samonis, “Trauma Management in Homer’s Iliad,” International Wound Journal, 14(4) (2017), pp. 682-684.

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drugs.” An unfavorable opinion of Machaon and his colleagues is foreign to the Homeric poems.

If there is any profession of which depictions abound in world literature, it is that of the medical doctor, and if we turn from classical epic to the Middle Ages, in Dante’s Divine Comedy there is a place for practitioners of medicine in Purgatory (Hippocrates, Galen, and Avicenna), in the Inferno (to which Dante, channeling God, condemns the alchemist Michael Scot, notwithstanding his merits as a mathematician and translator of Averroes), and in Paradise (Taddeo

Alderotti, the most famous physician of Dante’s time and possibly the poet’s teacher at the University of Bologna). Dante’s career and recurrent use of medical language bear witness to his interest in medicine, not surprising in someone who was a member of the Florentine guild of physicians and apothecaries. Unfortunately, neither Hell, nor much less Heaven, are places suited to displaying doctor-patients relationships, likely to be torturous in the underworld and perhaps sickly in purgatory.

Many and varied are the paths whereby to discuss, from the perspective of fiction, the changing views held by society of its healers. Nineteenth-century Russian writers are particularly useful to a discussion of medical ethics: Tolstoy and The Death of Ivan Ilyich, with its reflections by the main character on the value of life; Chekhov (a doctor himself, let us not forget) and “A Medical Case,” with the compassionate Dr. Korolev, who, when he says “we’ve come to take care of you,” is referring not only to the patient’s physical ailments; and Mikhail Bulgakov (a colleague of Chekhov’s in both the literary and medical professions) and his A Country Doctor’s Notebook, where the author of the much more famous novel Heart of a Dog (equally relevant from a bioethical perspective) examines an issue familiar and common to both Russians and Mexicans: paternalism and its (in) advisability, or the physician who decides for his or her patient what is best for him or her (or, at the opposite extreme, not necessarily or morally better, the physician whose leaves decisions entirely to the patient).

But what particularly interests us here is to examine our subject rather from a humanistic viewpoint than a scientific one (without excluding the latter more systematic

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A discussion of literature’s boundless capacity to present nuanced answers to concrete bioethical problems, and to explore issues of medical ethics in particular, exemplified in the most representative Russian authors of the nineteenth century, can be found in N. Nikolaevna-Sedova and M. VladimirovnaReymer, “From Literary Bioethics to Bioethical Literature,” Life Science Journal, 11(10s) (2014), pp. 538-543..

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approach, or even, insofar as bioethics permit, an experimental one). And we can attest that, in recreating the idea of the complex interaction between doctor and patient, of what it should and should not be, there is nothing like opera. In around fifty of the five hundred or so opera libretti produced over a period of almost two hundred years, a doctor and patient are members of the cast.

Although they sing, doctors do not always play the leading role, but range from itinerant quacks, more concerned with their own profits than with healing the patient (even if the ailment be love), like Dr. Dulcamara in Donizetti’s L’elisir d’amore (The Elixir of Love), to respected and empathetic professionals who accompany the dying in their final moments, like Dr. Grenvil in Verdi’s La Traviata. Thus far, all well, until, in the twentieth century, we come across the

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figure of the doctor as amoral scientist, for whom the patient is merely an object of study with whom to experiment (an omnipresent fear since the revolution made possible by modern science), like Wozzeck in Alban Berg’s opera of the same name. If we began this literary and musical tour with money and fame in mind, we do not expect to end it by simply replacing the wellbeing of the patient with the social status conferred by academic merit.

What is the future of relations between doctors and patients? To what extent will they be influenced by new technologies?

Will the internet, virtual reality, different applications, and artificial intelligence facilitate them, making them more relevant than ever, or will they diminish them and render them dispensable?

If there is anywhere we can reflect on these and other real questions, and imagine possible responses, that place is the realm of literary fiction.

Véase, por ejemplo: Soriano, J.B., 2018, On doctors and their operas: A critical (and lyrical) analysis of Medicine in Opera, CHEST, 154(2), 409-415.

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FROM FEL I S CAT U S TO X E N O P U S L AEVI S : ST I L L L I F E S A N D X E NO BOTS Ángel Ortuño (1969).

He has published just over a dozen books of verses in Mexico, Puerto Rico, and Spain. His poems have been translated into French, English and German.

His most recent book is entitled “ Gas lacrimógeno y otras cosas que no son poemas” (University of Guanajuato, 2018)

The earliest paintings that can be considered “still lifes” go back to the fifteenth century BCE, in Egypt, although they were actually funerary decorations and not still lifes in the modern sense of the term. The most famous of them comes from the socalled Tomb of Menna and depicts a group of inanimate objects as a sort of collection of vignettes from everyday life.

Canonically, any arrangement of inanimate objects is considered a “still life.” The notion of “arrangement” is central: that is, the composition, or the way the objects are depicted within the space delimited by the picture frame.

Occasionally, among these inanimate objects and as part of the evolution of the genre a living thing may also be depicted. But to be clear: in many still lifes, living things were depicted, yet they were not represented as such, but rather as hunting trophies or food. What was new, then, was the depiction of a living being while still alive.

Such is the case of The Spirit of the House: Still Life with Cat, by the German painter August Macke (1867-1914). An outstanding member of the avant-garde movement Der Blaue Reiter (The Blue Rider), Macke included a frolicsome little cat in his painting. The idea was supposedly not his own, but came from his mother, who saw the painting when it was presumably finished and commented that it “lacked life” (a slightly peculiar observation in the case of a still life). In order to remedy the situation, Macke decided to include not just one life but nine lives (as we say in English), or at least seven (as they say in German and Spanish). In this way, the still life was finally completed in 1910. The cat contributed the portion of life summed in

the metaphor of the title: the “spirit of the house.”

And as Macke’s mother would say, we can always affirm that “life” is lacking somewhere. Why not take it into account?

Not the seven or nine lives of the cat, perhaps, but… could there be life in a robot?

In a study performed at the University of Vermont, xenobots have been considered “a completely new form of life.” The name of the xenobot comes just as in the case of Macke’s painting from the inclusion of a living being: the African clawed frog, or Xenopus laevis. It is thanks to the stem cells of this spirited African frog that we now have what Joshua Bongard, a researcher at the University of Vermont, has called “novel living machines.” A beautiful way in which science and art continue to amaze us, acting on the frontiers of human knowledge, at the limits between zones still to be redefined, through a combination of research and imagination.

• Original title: Der Geist des Hauses: Stilleben mit Katze • Museum: Städtische Galerie im Lenbachhaus, Munich (Germany) • Technique: Oil (69 x 74 cm.)

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ART & LITERATURE ART & LITERATURE

Tania Carrera She is a poet and singer. He has published the poetry collections Espejos (Gato Negro Editorial, 2013) and Un dios lubricante (www.undioslubricante.com, 2015; Fondo Editorial of the State of Morelos, 2018)

The puppet walks, it looks happy; it seems as if the hand that manages it doesn’t exist. the show goes on, at least that’s what they say.

You were satisfied with your role; the ties gives you a morbid satisfaction you love them, they’re already part of you while you brag that yours are colorful, instead of gray or brown.

You get to feel that you deserve them, that the colors were awarded for mere justice. Yes, you deserve them just like the carrion of those who die that you devour with hypocrisy, all those things you call “class”.

Once the puppeteer leaves you carefully take the threads sewn on your back, precariously you move them, your face is again the one they told you to wear The man sees you, says nothing he laughs, louder [more and more] you don’t realize that you force yourself.

-You mutilate yourselfthey will throw you, my dear doll, they will throw you because they already have more, and they all swallowed the same lie of being a spectacle for the pigs.

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ARTIF I C I AL C HEM I ST: T H E SE LF-DRI VI N G CAR O F CHEMI CAL SY N THES IS Édgar Mondragón Al parecer, hay algo en común entre el cálculo de la ruta trazada por Waze o Uber a través de las calles de una ciudad y la síntesis de nuevas nanopartículas.

Ya sea en una celda solar o en la imagenología de tumores cancerígenos, la nanotecnología continúa ofreciendo respuestas a problemas con soluciones hasta hoy elusivas.

Los Quantum dots son un tipo de nanopartículas que recientemente han atraído la atención de diversos investigadores de la salud por su promesa de ayudar en el diagnóstico y tratamiento del cáncer. Éstas son nanopartículas que miden menos de 10 nanómetros. Como referencia, un cabello humano tiene un diámetro de alrededor de 10,000 nanómetros.

“El Químico Artificial es similar a un vehículo autónomo, pero un coche autónomo al menos tiene un número finito de rutas posibles entre las cuales puede escoger para alcanzar su destino preseleccionado. Con el Químico Artificial, se dan los parámetros deseables, los cuales son las propiedades que se quiere tenga el material final. El Químico Artificial tiene que resolver todo lo demás, como descifrar cuáles serán los precursores químicos y qué ruta de síntesis usará, a la vez que minimiza el consumo de estos precursores químicos”.

Los Quantum dots pueden ser sintetizados químicamente, sin embargo, esto implica un proceso caro y complicado, además de presentar frecuentemente efectos secundarios tóxicos.

Para evitar estas desventajas, un equipo de investigadores de la Universidad Estatal de Carolina del Norte y la Universidad de Buffalo ha desarrollado una tecnología llamada “Químico Artificial” que involucra inteligencia artificial (IA) y un sistema de automatización para realizar reacciones químicas sin intervención humana y así acelerar el proceso de R&D y manufactura de materiales basados en nanopartículas.

Entre sus ventajas, este sistema permite ingresarelresultadodeseadocomoparámetro de entrada y con base en ello iniciar el proceso de experimentación con reacciones químicas hasta llegar a la respuesta óptima.

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It seems there is something similar about the calculation of the route followed by your Uber or Waze through the streets of a city and the synthesis of new nanoparticles. And whether in a solar cell or in the imaging of cancerous brain tumors, nanotechnology continues to provide answers to problems whose solutions seemed elusive until just yesterday.

Quantum dots are a type of nanoparticle that have recently attracted the attention of medical researchers by their promise of helping in cancer diagnosis and treatment.

Quantum dots are nanoparticles that measure less than ten nanometers in diameter. To give an idea of how small that is, a human hair has a diameter of approximately 10,000 nanometers.

Quantum dots can be chemically synthesized, but this costly and complicated process frequently entails toxic side effects. In order to avoid these disadvantages, a team of researchers from North Carolina State University and the University at Buffalo have developed a technology called “Artificial Chemist,” which involves artificial intelligence (AI) and an automated system for performing chemical reactions without human intervention, thereby accelerating the research and development process and the manufacture of materials based on nanoparticles.

Among its many advantages, this system allows the desired result to be entered as an entry parameter. On that basis, the

experimentation process is initiated with chemical reactions that lead to the best result.

“The Artificial Chemist is similar to a selfdriving car, but a self-driving car at least has a finite number of routes to choose from in order to reach its pre-selected destination. With Artificial Chemist, you give it a set of desired parameters, which are the properties you want the final material to have. Artificial Chemist has to figure out everything else, such as what the chemical precursors will be and what the synthetic route will be, while minimizing the consumption of those chemical precursors.”

Chemical synthesis: as easy as hiring a ride with your app!

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The Robot That Knows How to Suture ( and How It Learned to Do It) “Originality is the child of imitation,” Octavio Paz has reminded us. But is there any potential for originality in artificial intelligence? It is too soon to know. What we can already see, however, is how robots are getting better and better at imitating us.

Researchers at the University of California, Berkeley, led by Dr. Ajay Tanwani, in collaboration with Intel, has developed a system call Motion2Vec, which is able to “learn” to suture by example, “watching” videos of surgeries performed by human doctors. The system uses a machine learning algorithm that “observes” the suturing process, following the movements

of the surgeon’s needle and then attempting to reproduce it with the utmost precision.

In order to achieve optimal functioning, the system needs to train itself with thousands of hours of surgery videos, which does not happen to be a problem nowadays.

“YouTube gets 500 hours of new material every minute. It’s an incredible repository.”

The technology is not yet ready to be used in the operating room, but it is expected to be used soon, as a sort of doctor’s assistant, freeing surgeon’s from the need to perform repetitive tasks and allowing them to concentrate on more complicated procedures.

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And after all, how will we know when it’s ready? A doctor friend of mine confessed to me that, after months of practice as a medical student, he really only learned the subtleties of stitching up patients in the emergency room.

Let’s give our robots a chance.

The Generosity of Light The Use of Ultraviolet Light in the Combat against SARS CoV-2

GADGETS

With the onset of the present pandemic, scientists have been looking for effective non-contact sterilization options to eliminate traces of the virus from different surfaces. An old acquaintance, ultraviolet light (discovered in 1878), particularly in its UVC spectrum (with a wavelength of 254 nanometers), has demonstrated its effectiveness in the inactivation of SARS CoV-2. Nevertheless, this wavelength represents a risk to humans when directly radiated, so that it can only be used in uninhabited places. So far, the solution to

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this problem has been robots designed to circulate in the areas to be sterilized with UVC lights, when there are no people around. In factories and hospitals, these automata carry lamps that irradiate the light wherever they pass, leaving the zones free of the virus.

Nevertheless, a team of researchers from the Irving Medical Center at Columbia University has now found that a compromise is possible between the use of a wavelength that is safe for humans and effectiveness in destroying the virus.

In a study entitled “Far-UVC light (222 nm) efficiently and safely inactivates airborne

GADGETS

human coronaviruses,” the researchers have demonstrated that it is possible to use a wavelength of 222 nanometers to inactivate 99.9% of the virus within a period of 25 minutes.

The importance of this finding is that it will now be possible safely to use ultraviolet light for this purpose in areas with humans present. It will become ever more common to see fixed lamps radiating UVC in public spaces.

It looks like our future is going to resemble one of those parties with “black light” lighting up fluorescent smiles.

ART & LITERATURE ART & LITERATURE

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B EYO N D A N T H ROP OC E NT RI C ESTH E T I C S: “ E VOLU T I ON” Miguel Mesa. Abril 2018 Interdisciplinary artist and Computer Systems engineer with specialization in composition and new media. His concerns intersect with social, cultural and natural phenomena and sometimes the same supports or artistic forms.

Sound is a determining material in his work. He has exhibited in Mexico and several countries abroad.

In the 1960s, when NASA was wondering how to explore extraterrestrial life, scientist James Lovelock suggested that, before gazing into space, we should first observe the planet Earth from the outside, in order to understand how it is possible to perceive life at a distance. Once we have done this, we can turn our eyes to space again.

Lovelock’s idea is fascinating. It is the subject explored in this essay: how to widen our view in order to broaden the panorama ―to see it de-anthropocentrically― and to observe from that vantage point what can be seen when we take ourselves, so to speak, out of the picture. In this way, we can reflect on the esthetic expressions of non-human beings: animal, plants, fungi, minerals, etc.

First of all, it is worthwhile making a few brief observations about the origin and significance of the term “esthetic.” Introduced in 1735 by Alexander Baumgarten, in his Philosophical Reflections on Poetry, it refers to the notion of aisthesis (sensation), that is, of knowledge through sense perception.

Baumgarten established that the notion of beauty is not a clear and distinct idea as in the case of mental ideas but rather a confused one. We may add that it is also in part unconscious.

The style is the man (“Le style est le homme même”), said Georges-Louis Leclerc, Comte de Buffon. But esthetics are everywhere, and not just in manmade things.

LUDIC

When connecting the notion of the “esthetic” with living beings, it is indispensable to consider the notion of evolutionary esthetics proposed by Darwin, and his idea that, of all the animals, birds appear to be the most esthetic.

According to Darwin, the colors and textures manifest in different beings ― whose appearance depends solely on their chemical or physical composition― were pre-esthetic manifestations. He also

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claimed that the first esthetic manifestation of a living being was created by so-called natural selection: the cross-generational transmission of physical characteristics that fit an organism to its environment. Thus, flowers have striking colors in order attract the insects that will pollinate them, certain trees grow taller in order to gain access to more light, and stags grow large antlers to prevail in confrontations with others of their species.

At some point, females began to decide which physical characteristics they preferred, including even those that did not render males more fit for survival, followed, later on, by not only physical but also ethological (behavioral) characteristics. It was then that the first “useless” esthetic decisions emerged, solely of a sexual character.

When Darwin suggested that it was the females that took this highly advanced evolutionary step, his hypothesis was met with fierce opposition. Hetero-patriarchal English society was unable to accept such a “barbarous” notion. To make a long story short, the study of evolutionary esthetics was restricted to the historical analysis of human esthetics: a cultural and anthropological approach, rather than a biological one.

To return to Darwin’s theory, it states that, by means of this transformation, the males came to understand the females’ preferences and began to develop an agreed-upon type of beauty, an esthetic correspondence: there is type of beauty in the male that has developed for the purpose of being appreciated by the corresponding sense of beauty in the female.

And so we are left with the sexual usefulness and the natural uselessness of beauty.

One of Darwin’s many merits was to have established this distinction. He did not

reduce the appreciation of beauty to a mere awareness of natural utility (as did many theorists in the field of evolution in his time), nor did he declare that beauty simply has no purpose. The key point in the case of Darwin is that esthetic utility is different than and removed from natural utility. Although they have no purpose in terms of natural selection, esthetic elements have a purpose in terms of sexual selection: “a purposeless purpose.”

The need to choose from among sexual and natural advantages entails, for both sexes, a willingness to balance and agree, in order not to risk extinction. As a result, the two esthetic levels converged, becoming the standard of the species: without neglecting their fitness for survival, beautiful males began to couple with females endowed with good taste. Thus, beauty and the sense of beauty evolved together, influencing offspring: a transgenerational coevolution.

Consider, for example, the incarnation of beauty: a tiger is beautiful in itself and the tigress appreciates that. Something similar happens among human beings, with tonal music or with language: they are integrated into us, penetrating mind and body. The importance of esthetics may seem banal

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esthetics are not metaphysics, but although they do not raise the spirit, or lead to life after death, esthetic traits are passed on to the next generation.

It is important to emphasize that esthetic appreciation is based on the internal and external sensations of each individual, as well as on group conventions, and it is given different expressions. One has only to observe phenomena such as cultural diversity or birdsong. What we all have in common are the physical properties of the planet, which affect our sensations. A soap bubble is spherical in shape owing to gravity and the surface tension of the liquid. Our

ART & LITERATURE

receptors and those of plants or animals adjust their “understanding” on the basis of abstractions we could describe as metaesthetic. Graphene takes the form of a twodimensional lattice, like the honeycombs built by bees. The molecules are arranged in a certain way and we perceive, process, and decodify them in keeping with our “understanding.”

Nevertheless, it is still impossible to affirm that a plant or an animal follows abstract creative processes that we make our own.

Bateson would say that we act as we do because we lack balance or grace in the psyche. But perhaps our consciousness

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took another evolutionary step, one of great economy in terms of sexual or natural selection: not having to wait many generations in order to be more fitted for survival. Our mind developed to take immediate decisions, and it would seem we have incorporated a sort of “environmental judge” in our thought processes, who evaluates the possibilities of survival before acting, thereby taking the solution onto a disembodied plane, without waiting for the slow process of a physical evolution.

This mental realization has allowed us to sustain our esthetics in immaterial form, in the imagination only (for example,

conceiving a song or a poem) and so to disincarnate the path of esthetics. Each one of the evolutionary steps denotes an “emergency” of progressively more complex properties. The next step might be when the intelligence is separated from the body, to become, in its “disembodied” state, a mere abstraction floating in electronic components: artificial intelligence.

And this is where a great question arises: What are and will be the esthetic expressions of artificial intelligence? In order to address this question, we must choose a path… but we shall follow it in the next issue of the magazine.

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M EX ICA N SC I E NC E AGA I N ST C OV I D -19: SI LV E R BU L L E T By: Dolores Garnica Essayist and journalist. She has worked as a promoter, manager and communicator. She is a columnist for ITESO’s Magis magazine and a regular contributor to Luvina, a magazine of the University of Guadalajara. His first book of essays, “Un gris, casi verde ”, by Editorial Paraíso Perdido, was presented in 2017.

Science at the service of the community.

In the city of Guadalajara, Mexico, a group of scientists works to help in a clinical trial.

The idea, most importantly, is to develop effective treatments against COVID-19, and maybe, a vaccine. They have already obtained the difficult Mexican certification to carry out the study. This is the first protocol against the coronavirus made by the private initiative in Mexico as CidVID explains in the press release.

We are sure that the science of COVID-19 will be one of the fundamental topics in scientific meetings and journals. Like the CLiR group in the coming months, and years.

The scientists are part of the biometric research company CidVID. Based in Mexico but with a global presence. Starting June this year, a team of scientists, doctors, and patient volunteers will make Silver Bullet a reality. As they named their study, a title with several readings, all positive.

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In technical terms, Silver Bullet, in other words, it is a “Multicenter Study to Evaluate the Efficacy, Safety, and Tolerability of a drug. In Mild Virus-positive Subjects (SARSCOV-2 ) with or without symptoms�. The name was taken from some capital letters of the study. Also, referring to a commitment to the common good to combat the COVID-19 pandemic, which already has millions of victims worldwide.

Against COVID-19:

science for the

CidVID is a Mexican company dedicated to the development and conduct of clinical studies in its different phases. For example, pharmaceuticals, nutraceuticals, medical devices, and any product that seeks to demonstrate efficacy and safety. The company works with the most important laboratories in the world. Conducting clinical research with the highest quality and under international standards and legislation. For more information and ways to support this initiative and Latin American science against COVID-19

common health

The first phase consists of communicating with patients diagnosed with COVID-19.

With mild or moderate symptoms, the possibility of participating in this study.

Its characteristics, and the value of contributing to solutions aimed at a common benefit. Also, the company opened a fund to support this initiative on the Fondify website.

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Disease knows no borders A fast-moving pandemic requires a global perspective and new ways of monitoring the patient journey and treatment outcomes, live, across geographies.

Clinerion’s real-world data services support patient data enquiries for COVID-19 cases and conditions associated with SARS-CoV-2 infections. This enables a search of patient characteristics, and an analysis of treatment patterns to provide insights on disease incidence and transmittance, treatment success rates and patient outcomes.

With our partners and hospital networks, we facilitate longitudinal epidemiological studies and enable patient outreach. www.clinerion.com

COVID-19 highlights our need for reliable, timely, patient medical data which can provide Real World Evidence and Health Economics and Outcomes Research insights to develop a quick response.

Clinerion’s reports present real-time statistics derived from the deidentified electronic health records of the millions of patients in the global network of partner hospitals – in 15 countries worldwide, and counting – on the Patient Network Explorer platform.

Disease knows no borders, nor timezones ...and neither do we.

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A N OTE ON GAT TACA : BE T H E B EST VERSI O N O F YOU RSE L F Selene Flores Selene Flores is a Sociologist with a specialization in Social Communication. She is currently a digital media editor and runs the film critic blog Aire Concreto.

Consider God’s handiwork; who can straighten what H e hath made crooked?

Ecclesiastes 7:13

This is the opening quote from Gattaca, a 1997 motion picture written and directed by Andrew Niccol and starring Ethan Hawke, Uma Thurman, and Jude Law. Although the movie (or the bible verse) may not be familiar to everyone, Gattaca conveys a profound and still relevant message, which continues to be openly discussed in bioethics and genetics, and even in our daily affairs.

Imagine a future, not so far from now, in which matters of race, sex, gender, and cultural preferences in general are no longer considered to be important to the development of the individual. Even class has ceased being an issue, while “faith” and “chance” have long disappeared from our vocabularies. In the jargon of the movie, we will be living in a world ruled by genoism.

Vincent, played by Ethan Hawke, is what might kindly be called a “child of God,” or, less kindly, an “in-valid,” a “degenerate.” He is a person conceived naturally, not in vitro or with scientific help of any kind. He and his fellows represent a new underclass, as part of a new division of labor that depends on life expectancy, susceptibility to both physical and mental diseases, and even inherited personality type.

RESEÑA

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Of course, as in any system that creates its own categories of the privileged and the doomed, there is a certain amount of corruption, which renders possible things we have been told are impossible by birth. In the universe of Gattaca, the black market works to match those who were not conceived with the help of doctors and geneticists with strong, healthy providers of all sorts of biological benefits, so that they can have a clear forecast about their lives. Whether it is about getting a better education, aspiring to advance through demanding professional careers, or simply climbing higher up on the social scale, the right amount of cash can purchase a personal dispenser of urine, blood, hair, and fingerprints: in short, an identity.

These ideas need not be placed in some hypothetical future to see the negative consequences they may produce. Controlled breeding, endogamy, and incest are just a few practices that go far back in human history: attempts to “straighten what [God] hath made crooked.” But now that we are scientifically so close to the possibility of choosing the most fortunate futures for our still unborn children, will we be able to make responsible decisions that won’t slide into subtler forms of discrimination?

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Wouldn’t it be wonderful to know that our sons and daughters won’t inherit our cancer-prone cells? Or just in terms of personal preferences, wouldn’t it be lovely to see a return of our grandmother’s green eyes, unfortunately caused by a recessive gene? But what if our decisions turn on the problems existing here in the present?

Would we prefer to have a son instead of a daughter, in a world where women are victims of violence every day, just for being women, or at the very least unlikely to receive equal pay?

Maybe the movie Gattaca fails to ring a bell with you, but I would wager that we have all heard the story of Vincent more than a few times. The lives of women that dress as men to get into college, of indigenous people abandoning their clothes and their culture in order to earn a place in society, of people with disabilities forced to make daily adjustments simply in order to fit in: all of them ―all of us, maybe― trying to exist in a world that was not made for the unfortunate, the unplanned, the different.

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