OWLS VI - Miscellany of the Muses

Oxford & Wimbledon Leading Scholarship

Edition VI: Miscellany of the Muses January 2020

The Journal of the Academic Scholars of Oxford and Wimbledon High Schools

OWLS QUARTERLY, EDITION VI, JANUARY 2020 MISCELLANY OF THE MUSES In ancient Greek religion and mythology, the Muses (Ancient Greek: Μοῦσαι, Moũsai) are the inspirational goddesses of literature, science, and the arts. They are considered the source of the knowledge embodied in the poetry, lyric songs, and myths that were related orally for centuries in these ancient cultures. A Miscellany is a collection of writing on diverse subjects.

This edition of OWLS Quarterly is an offering to the Muses from the Year 12 Owls of WHS and OHS. Their work is a celebration of diverse and deep interests, from stem cells to the origin of idioms, and from writing on the differences between how men and women experience pain to the purpose of literary criticism – and, it seems, most things in-between!

Editors OWLS Quarterly Ms Rachael Pallas-Brown (OHS) and Dr John Parsons (WHS)

International Adoption.....................................................................................3 Exploring the importance of connection and meaning in the healing of complex trauma.....................................................................5 Can we live normally with only half a brain?...................................................7 What does the future hold for potential stem cell treatments?..........................9 Should medical cannabis be re-introduced into the British healthcare system? ..............................................................................11 To what extent are alternative medical therapies valid compared to mainstream medical practise......................................................................13 Ugliness in Coleridge’s ‘The Rime of the Ancient Mariner’..........................15 Humans & Influenza.......................................................................................17 HIV/AIDS: 101 are we making ourselves more vulnerable to a global pandemic?.....................................................................................21 The Rise and fall of the British Empire and the extent to which its legacy is still relevant today.........................................................................23

INTERNATIONAL ADOPTION Chloe D’Souza Eva (OHS) International adoption has faced many criticisms and is often misunderstood. Families can face backlash from others, as well as exploitation from adoption agencies.

Additionally, there is the danger of the adoptee not being an orphan in need of care, but instead a victim of human trafficking groups. In recent years, the dangers of international adoption have been revealed, ranging from the effects of children taken from their history and culture, to the influence of celebrities and the view of international adoption as a “trend”, in which babies are taken from their culture and established lives. However, among the online horror stories are the positive effects of international adoption. The uncovering of appalling conditions in orphanages found some children transformed with sensitive parenting, and advocates see international adoption as full of opportunities.

Certainly, it is a controversial issue, and as I researched the topic, I began to understand why.

Why do people choose international adoption?

The process of international adoption has some similarities to national adoption, but people’s reasons for choosing it vary. In a survey I sent out to my school year, the majority of people guessed that the most significant motivating factor is that “They feel they as parents and their country could offer the child a better quality of life”. This reflects what I found online, but it seems to change in every situation. Some, for example, see it as a religious calling; others have familial ties to a certain country. For example, if an individual was biracial, they may feel drawn to adopt a child in similar circumstances as they could relate to their experience and give the child a better quality of life through their understanding. Whilst these ideas are positive, there are also darker motivations involved. For example, it has been suggested that many choose international adoption because of celebrities doing the same; this has led to the term the “Angelina Jolie factor”, following her adoption in 2005 of a child from Ethiopia. This could be seen as positive - celebrities serving as inspiration could lead to more children adopted. However, it could also be argued that influence by celebrities is not a valid reason for international adoption, and that people judging the experience on biased news reports may find themselves unprepared for the realities of international adoption. Hopefully, with the complicated application process, people adopting for this reason will be discouraged.

The eye opening situation of Ethiopia.

Following adoptions by high profile celebrities, countries like Ethiopia came into the light and questions were raised about their ethical standards relating to adoption.

Debate came from both sides, eventually culminating in the case of Larry and Carri Williams, in which their daughter Hana Grace-Rose Williams, adopted from Ethiopia, died from hypothermia. Upon investigation it was found that the couple had left her outside in their garden where she died from hypothermia and starvation in May 2011. Her step-brother Immanuel, also adopted from Ethiopia, testified that he and Hana were beaten and abused, such as being locked in a closet. Carri Williams was sentenced to just under 37 years, whilst Larry was given almost 28. This case is considered by Ethiopia as a factor in preventing international adoptions; this was finalised in May 2018.

The UK, however, gives different reasons, highlighting trafficking and corruption as suspected problems. This case and the subsequent ban also raised the question of what happened to the children adopted prior to the ban - could it be possible that some children were unknowingly trafficked, with no knowledge of their searching families and previous life?

How can an ethical adoption be ensured?

In the survey, I also included some ethical questions- for example, I was interested in people’s opinions regarding the ages of those involved. In the UK, with national adoption, you must be at least 21, and can adopt a child of any age. 68% of people, given this fact, believed that the age to adopt internationally should also be 21, with 27% stating that the minimum age should be somewhere from 22 to 30. I found this intriguing many countries, such as China, give a minimum age of 30, which was chosen by only one person in the survey. Perhaps, at this age, people are assumed to be both more mature and financially stable. In addition, costs range significantly - in the UK, the average cost for an adoption is £10-12,000, whilst in America this is much higher at around $35,000 (or £27,000). Estimates from the survey ranged from £400 to £77,000, but excluding outliers, the mean was ~$12,000 or ~£9300; fairly accurate considering many added “I don’t know”. Research was highlighted as important when considering international adoption, with several people in the survey mentioning how “I would definitely research before making a decision”, and people saying that they “don’t know enough about it”, suggesting that they would need to do their own independent research were it a consideration. Such research would involve the requirements of adoption in different countries, as well as careful selection of different international agencies.

With the help of the internet, individual stories can be found, in which people have detailed their experience with various agencies. In addition, organisations like the IAC offer courses on inter-country adoption, so each person can do their best to ensure that they are doing their best to ensure their child is not one that has been taken from a family and trafficked into the system for the monetary gain of a corrupt organisation. In the survey, there was a trend in people acknowledging the

dangers of international adoption, with one stating that that it is important to “do enough research and work with organisations like Lumos that make sure that international adoption is ethical”. In addition, 80% of people considered child trafficking schemes related to international adoption as the most significant problem in the process. It was reassuring to see that so many people recognised both the potential dangers and the need for further research.

Individual cases I was fortunate to be able to talk to two people in my year with experience of international adoption.

Jasmine* told me about her sister who was adopted from Thailand at 18 months. When adopted, she could not speak, but understood some Thai. In the survey, on a scale of 100, with 0 being “not important”, and 50 being “neither important nor unimportant”, and 100 as “very important”, the average number given was 75. Many websites agreed that “recognition and understanding as well as respect for the racial and ethnic origin of the adoptee is vital.” Jasmine told me that her family also agreed that it was important to keep their adopted daughter connected to her culture. They plan to take her on a tour of her homeland when she is older, and currently send her to Dharma school, which teachers her Buddhist values, as Buddhism is the most practised religion in Thailand. When she came to the country, the family found that she was malnourished and had been subject to a lack of individual care; the situation of one carer to about twenty children was all that she had known for the first 18 months of her life, an unfortunately common situation in many countries, which can lead to attachment and behavioural problems. As a result, they found that she was initially very clingy and reluctant to be away from them.

However, they found that there were no other long term effects, and Jasmine told me her sister improved with time and has grown into a happy, settled six year old.

Olivia*, another girl I talked to, was adopted from Vietnam at 9 weeks old, and she too went with her family to see the country where she was born. However, though she enjoyed the experience, she does not feel a strong need to re-visit. Her sister, also adopted internationally, from China, was adopted when she was around 1 year old. Similarly to the other individual I talked to, she displayed Type C behaviour (as defined

by Ainsworth’s Strange Situation), such as extreme separation anxiety but saw no long term effects. In addition, I found it interesting that both Olivia and her sister were raised by a single mother, and also personally knew other single mothers who had adopted internationally. I found this encouraging as many reports online had spoken on the difficulties for single mothers trying to adopt internationally. The most glaring message from my research process was that international adoption is very difficult to speak about in general terms. Previously, I would have assumed that

both families would have had more difficulties than what they described. However, clearly each individual has a different experience and this should be taken into account; though there are patterns, it should be considered, when possible, on a case by case basis.

Conclusion The situation in Ethiopia, the case of Hana Williams and the trend in celebrities adopting internationally exposed many of the problems, and the truth about some adopted before the ban may never be known.

However, since then, things have been handled with more tough regulations to prevent unethical practices such as human trafficking. Because of these restrictions, and the time involved in the process, it should be more difficult for people to adopt based on the passing celebrity “trend”; in addition, the steep cost would likely discourage those unwilling to commit fully. I found that research was the most important factor, frequently highlighted in the survey responses. Talking with the girls in my year was also a valuable experience, showing the importance of considering international adoption on an individual basis- though the internet provides useful statistics and practical help, the responses from both the survey and individuals I spoke to gave me the most insight, leading me to conclude that a combination of research and sensitive parenting are essential for a successful international adoption.

Bibliography http://www.icacentre.org.uk/adopters/intercountryadoption/getting-started/ https://www.dailymail.co.uk/news/article-4124360/ Angelina-Jolie-s-adopted-Ethiopian-daughter-Zahara. html https://www.dailymail.co.uk/news/article-1375752/ Angelina-Jolie-factor-More-Americans-adoptingchildren-different-countries-different-races.html https://assets.publishing.service.gov.uk/government/ uploads/system/uploads/attachment_data/ file/708778/Adoptions_restricted_list_2018.pdf https://www.bbc.co.uk/news/world-africa-42635641 https://www.bbc.co.uk/news/world-uscanada-24035136 https://www.dailymail.co.uk/news/article-2479174/ Hana-Williams-adoptive-parents-Larry-Carri-Williamsmaximum-sentences.html *Name has been changed

EXPLORING THE IMPORTANCE OF CONNECTION AND MEANING IN THE HEALING OF COMPLEX TRAUMA Elsa Voak (OHS) What does terror do to a person?

‘Complex’ trauma is broadly defined as ‘a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts’ (Courtois) and includes, but is not limited to: child abuse, domestic abuse and multiple military deployments in dangerous locales.

Fundamentally, when trying to understand the multifaceted effects of complex trauma on an individual, we need to have a basic understanding of the concept of attachment. Bowlby (1988) saw attachment as the secure base from which a child moves out into the world; for most of us we carry a secure attachment - the emotional and physical synchrony we develop with our primary caregivers from the age of about 2-7 months (Schaffer and Emerson 1964) and then onwards throughout our development initiates a sense of pleasure and safety, which helps create the foundation for all future social behaviour.

Bessel van der Kolk (2015) states ‘Our attachment bonds are our greatest protection against threat’.

In situations of terror, people seek their first source of comfort and protection. Children are programmed to be loyal to their caretakers, even if they are abused by them : the terror inflicted on them increases the need for attachment which results in ‘disorganized attachment’; ‘fright without solution’. Vulnerable adults in situations of domestic abuse or traumatic military combat feel utterly abandoned and isolated, as no one

comes to their aid and protection during their repeated, intense, unbearable distress - the vital connection and meaning fostered through attachment has been broken.

Both children and adults thereafter commonly feel a sense of total alienation and isolation; indeed, many struggle with ‘alexithymia’ (Ancient Greek for not having words for feelings). They are compulsively and constantly pulled back into the past; their imagination and mental flexibility - the qualities that allow us to lead meaningful lives - fail. Van der Kolk comments ‘without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach’.

Survivors may go into denial - their bodies sensing the threat, but their conscious minds refusing to accept it.

Stress hormones send signals to the muscles to tense for ‘fight or flight’ or immobilize for ‘freeze’, and numerous unexplained medical symptoms such as autoimmune disorders and chronic pain arise. They may experience a sense of ‘dissociation’, where the world is full of triggers that create a life where the fragmented memory of the trauma is constantly present.

Often, they cannot tolerate knowing what they have experienced or feeling what they feel - not talking, staying silent, acting and dealing with feelings through rage against others and the self, shutting down, becoming excessively compliant or defiant.

Medications, drugs and alcohol may serve as a temporary sedative to these unbearable sensations and feelings; however, connection with others, belief in divine authority and sense of self all crumble. This state of ‘hyperarousal’ means that survivors are often not able to take in deeply what is going on around them: they cannot be fully alive in the present so they are trapped eternally in the past.

Joy, creativity, meaning, connection, recovery: Disempowerment and disconnection are the markers of psychological trauma. Recovery, therefore, includes a return to self-determinism, self-confidence, intensely supportive and loving relationships, and finally playfulness, creativity and meaning.

Complex traumas are, by their very name, complicated syndromes, requiring complex, comprehensive treatment and involving every aspect of human functioning from the biological to the social. In this piece I have decided to focus on solely the fundamentals of the later stages of recovery once a diagnosis by a professional has been initiated and the safety of the individual established. In addition, the second stage known as ‘remembrance and mourning’ (Herman 1992) which involves slowly reassembling an organised, detailed and verbal account of the trauma from the previously fragmented components of frozen imagery and sensation remembered, has commenced. The cutoff elements of the trauma are gradually integrated into the ongoing narrative of life.

As with any psychiatric condition, the connection between patient and therapist (the ‘therapeutic

alliance’) and the deep faith of the therapist in his/ her client’s recovery is crucial if recovery is to be successful. This is especially key in the case of traumatic syndromes where survivors feel chronically unsafe in their own bodies, often have no internal sense of security and where capacity to trust has been profoundly damaged. There is no room for mistakes: no individual is just a list of symptoms on a diagnostic questionnaire - rather, as Herman states, ‘the therapist becomes the patient’s ally, placing all the resources of her knowledge, skill and experience at the patient’s disposal’, which involves consistent validation of the survivor’s experience and solidarity with him/her. This requires that the therapist him/herself have access to regular, experienced supervision.

Attaining a grip on the terrifying outer world is very unlikely to be solely achieved solely by a pill-dispensing attitude, where only faulty biology and defective genes are to blame. Some patients on SSRIs (selective serotonin reuptake inhibitors) feel calmer, more in control and engage more readily with therapy, while others feel it blunts their emotions and interferes with motivation and curiosity - particularly vital in children to enable them to become well-functioning and contributing members of society. Van der Kolk approaches it as an ‘empirical question’: ‘Let’s see what works, and only the patient can be the judge of that’.

Self-regulation is dependent on a friendly relationship with the body. Survivor groups exist for each stage of the recovery process, ranging from a source of validation and emotional support beyond the therapist’s room to groups such as Paul Griffin’s New York City Possibility Project where the ugly reality of our culture’s tendency to repress our deepest feelings is overcome by theatre - the poignant realities of the human condition are confronted and expressed.

Mindfulness allows us to note our inner feelings such as annoyance, anxiety or pain without judgement, which helps survivors calm down their sympathetic nervous systems, convincing mind and body that they can finally let go by feeling safe at a visceral level. At a physical level, yoga and martial arts groups allow survivors to reconnect with their sensory world that they have felt such disconnection with and which is often subdued through compulsive or restricted eating and drinking and terror of social or intimate contact.

The final stage of recovery exists in the continuous establishing of meaning and, ultimately, commonality.

With a renewed sense of agency, the survivor is faced with the task of creating a life. Imagination and fantasy are now tools which have been liberated - the ‘specialness’ of the traumatised identity is set aside but never forgotten: the survivor is able to contemplate his/her story as one among many of especial tragedy in the wider context of the human condition. Those who forget the past are condemned to repeat it, and many survivors develop a ‘survivor mission’ or discover a vocation that deeply embodies the essence of what they stand for and will devote themselves to - a marker

of the rekindling of the indispensable bonds of attachment which motivate us to do whatever it takes and believe that anything is possible.

It is hard to accept a world where trauma in domestic and professional settings is so prevalent and urgent and its effects so devastating. In order to understand it, I believe we must breach our natural denial of its reality and confront it through the privileged positions we hold - through listening to the stories of survivors and in change through action.

As van der Kolk so powerfully puts it: ‘Trauma constantly confronts us with our fragility and with man’s inhumanity to man but also our extraordinary resilience. I have been able to do this work for so long because it drew me to explore our sources of joy, creativity, meaning and connection - all the things that make life worth living’.

Bibliography Lewis Herman, J. (1992), Trauma and Recovery: From domestic abuse to political terror, London: BasicBooks Van der Kolk, B. (2015) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Penguin Random House USA https://www.psychologytoday.com/gb/blog/ compassion-matters/201207/recognizing-complextrauma Images ‘They Dance Alone’ (Ben Singleton) ‘Dance of Life’ (Vicki Cowan)

CAN WE LIVE NORMALLY WITH ONLY HALF A BRAIN? Maya Patel (WHS) Following on from a lecture from Dr Guy Sutton on the brain, I researched further and found out about hemispherectomies, which is the procedure where half your brain (either the right side or the left) is removed from your body.

The procedure, hemispherectomy is done usually in children from birth to 10 years old. This is because these children usually have severe epilepsy or brain seizures that cannot be controlled by medication and are caused by one side of the brain that has been working very poorly. After the procedure has taken place, the risk of seizures decreases to very few or none at all. 86% of the 111 children that underwent the procedure from 1975 to 2001 either experience nondisabling seizures that no longer require medication or no seizures at all [1]. Two main syndromes are the cause for having the procedure done; which are Rasmussen’s Encephalitis and Aicardi’s syndrome.

Khloe Guy, three years old, had a hemispherectomy when she was two years old in April 2018, to stop her from seizing. Khloe was diagnosed with Aicardi syndrome at three months old, which means that the tissue that connects both halves of her brain wasn’t there, causing her to have seizures. For two years, Khloe lived with having up to 100 seizures every hour and using eight different anticonvulsant medication that had little impact. A solution to the uncontrollable seizures was hemispherectomy, which when Khloe had completed, meant that she no longer had any seizures.

[6] Hemispherectomy is a dangerous procedure but it means that children with syndromes like Aicardi or Rasmussen’s Encephalitis, can lead normal lives after the procedure. Rasmussen’s encephalitis is an autoimmune process that causes one half of the brain to become inflamed and deteriorate. A symptom of the syndrome is epilepsy and so in extreme cases, hemispherectomy is used to treat the seizures.

Anatomical Hemispherectomy is a procedure that takes out half of the brain that has not been well developed and is the reason seizures to occur. The brain is divided into two hemispheres by a deep groove separating the left and the right side of the brain. The corpus callosum is a thick block of nerves that allows each side to communicate with the other. During the procedure, a doctor will make an incision in your scalp and take out a piece of bone from the skull, which is later replaced. The doctor will then move aside the tough membrane that covers the brain called the dura and take out the half of the hemisphere from where your seizures occur from. The final part of the procedure will be the doctor removing the corpus callosum so that no signals can be sent across for a seizure to start [2]. In functional hemispherectomy, the doctor will only remove the parts

of the brain that is afflicted, however neurologist John Freeman from John Hopkins Hospital stated ‘leaving even a little bit of the brain behind can lead seizures to return’ [1] .

This type of procedure can lead to side effects such as scalp numbness, nausea, depression, fatigue, headaches and depending on which hemisphere of the brain that is removed, there can be trouble with speech and memory.

More serious side effects can occur during the procedure itself where the brain is exposed, and infection can occur along with bleeding [3]. However, while these are immediate side effects, the other hemisphere of the brain will take over many of the functions that the other hemisphere used to do, and so problems such as speech difficulty will return after some time. After the procedure, you can return to your normal life after 6-8 weeks, after controlled tests to make sure that the patient is okay [2].

Arron Purnell, at 17 years old, underwent functional hemispherectomy to help stop life-threatening seizures that had placed him in two medically induced comas.

He was diagnosed with Rasmussen’s Encephalitis that left him with up to 200 devastating seizures every day.

The procedure led for Purnell to a reduced vision, partial intellectual disability and an infection in his brain forcing him to remain in hospital for 12 months after his operation. The hemisphere of the brain that was left behind, naturally rewired so that Purnell could relearn to walk and regain use of his arm, both of which would have been coordinated by the left hemisphere of the brain that was taken out [4].

A research case took place at Great Ormond Street Hospital where 33 children from 3 months to 17 years underwent either functional or anatomical hemispherectomy. After the procedure, 52% of the children became seizure free, 9% of the children were only affected by rare seizures, 30% experienced a reduction in the number of seizures and 9% experienced relatively little change. From this procedure, 16 children no longer had to take anti-convulsant medication and the remaining children were taking a median of one medication, an inordinate difference to the amount of medication that they were taking previously. Another improvement for the patients that came from surgery was that 11 out of 12 children that had previously been reported as having behavioural issues, had improved drastically [5].

The brain is the most complex organ in our body that even the slightest injury can affect how it operates and the signals that it sends. Although it sounds inconceivable, a person can function normally with only half their brain because both hemispheres of the brain have the capability to control most of the body through the formation of new neural pathways. This however can only work if you have the complete function of one of the hemispheres, this meaning that it is not damaged, because as stated by John Freeman ‘You can’t take more than half ’ referring to the brain as it will lead to severe complications[1]. Therefore, living with half a brain is plausible, but if possible, should be avoidable.

Bibliography [1]https://www.scientificamerican.com/article/ strange-but-true-when-half-brain-better-than-whole/ Choi, Charles (24/05/2007) Strange but true: When half a brain is better than a whole, Scientific American [2]https://www.webmd.com/epilepsy/guide/ functional-hemispherectomy#1 Lava, Neil (19/07/17) What is functional Hemispherectomy? Web MD medical reference [3]http://www.chp.edu/our-services/brain/ neurosurgery/epilepsy-surgery/services/ hemispherectomy (2019) Functional Hemispherectomy in children, UPMC [4] http://hemifoundation.homestead.com/ aaronsstory.html Purnell, Aaron (2008) Aaron’s story, The hemispherectomy foundation [5] https://academic.oup.com/brain/ article/126/3/556/321214 A. M. Devlin J. H. Cross W. Harkness W. K. Chong B. Harding F. Vargha‐Khadem B. G. R. Neville (01/04/03) Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence, Oxford Academic [6]https://www.dailymail.co.uk/health/ article-6856589/Girl-2-100-seizures-HOUR-halfbrain-removed.html Kekatos, Mary (27/03/2019) Girl, 2, who has 100 seizures an hour, has half of her brain removed to treat rare disorder that doctor’s feared would leave her paralysed Daily Mail [7]https://www.hopkinsmedicine.org/health/ conditions-and-diseases/epilepsy/epilepsy-syndromesin-children (2019) Epilepsy syndromes in children John Hopkins Medicine

WHAT DOES THE FUTURE HOLD FOR POTENTIAL STEM CELL TREATMENTS? Leslie Lee (WHS) The continuous stream of new discoveries in the field of stem cell research foreshows the dormant strength stem cell holds. It has a potential in becoming a major role-player in a number of medical procedures including xenotransplantation, in a not so distant future. An escalating number of investments and various researches in this subject are making this happen even faster.

The stem cell treatment lies at the core of regenerative medicine- a branch of medicine centring on engineering, replacing or regenerating cells, tissues or organs of human, with an aim to restore or establish normal function. Ongoing studies in this subject are unravelling potential ground-breaking treatments in a number of areas which was unthinkable a few decades ago.

The two properties of stem cell characteristics are self-renewal and multi-differentiative potential. This implies that it has an ability to undergo a number of cell division cycles yet maintains its undifferentiated state, and to generate into various distinct specialised cell types.

There are 4 types of stem cells, which are: • Embryonic stem cells - from the embryo with 3 to 5 days of age.

• Adult stem cells - from adults’ bone marrow or fat.

• Induced pluripotent stem cells - adult cell genetically programmed into stem cells.

• Perinatal stem cells - from amniotic fluid and umbilical cord blood.

In order to maintain its self-renewal quality, stem cells undergo special type of divisions, symmetric and asymmetric cell division.

Symmetric division results in two identical stem cells, whilst asymmetric cell division gives rise to one stem cell and one progenitor cell. Progenitor cell lies at the centre between a stem cell and fully differentiated cell.

They are oligopotent or unipotent, only having the capacity to differentiate into a few or only one cell type, being limited in maintaining self-renewal property.

Stem cells are either totipotent, pluripotent or multipotent, indicating that they can self-renew by division to develop into unlimited, or at least multiple specialised cell types present in a specific tissue or organ.

Asymmetric division fulfils both roles of self-renewal and differentiation with a single division. However, it only produces one self-renewable stem cell per division, limiting its expansion in number. Symmetric stem cell divisions commonly take place during healing of injury and regeneration.

Some adult stem cells seem to divide asymmetrically under steady-state conditions, however, they have the ability to undergo symmetrical division to restore stem cell pools depleted by injury or disease. This capacity to shift between symmetrical and asymmetrical cell division depends on developmental and environmental stimuli, and such act of switching back and forth has been observed in the nervous and hematopoietic systems.

Whether the cell division is symmetrical or asymmetrical, the only two possible daughter cells are a stem cell with self-renewal ability and progenitor cell.

Although progenitor cell is far closer to a differentiated state, both stem cells and progenitor cells have a function of recovery of damaged tissues, the difference being the level of detail.

Because stem cells have its ability to differentiate to any cell type, it can easily replace a wider range of dead or damaged tissue, therefore acting as a mechanism for renewal. This opens the door to a number of treatments, where some are widely in use today.

One of the large-scale use in stem cell is a bone marrow transplant, which is widely used to treat Leukaemiasomatic stem cell therapy. Leukaemia is a cancer of white blood cells and to treat this, the procedure involves the replacement of abnormal leukocytes with new leukocytes. Chemotherapy is often used to kill the abnormal leukocytes; however, it is often the case when it does not prove to be enough. Bone marrow transplant from a matching donor allows the stem cell to differentiate into leukocytes. After killing all abnormal leukocytes by radiation and chemotherapy, the donor’s bone marrow is introduced to the bloodstream where they differentiate to healthy leukocytes. Alongside, a similar procedure is widely used to treat sickle cell anaemia, as well as many blood cancers and immune disorders, having to save a number of lives. More than 26,000 patients are treated with blood stem cells in Europe each year, empathizing the big role stem cell plays in the area of medicine.

Recent studies using stem cells are revealing a number of fascinating discoveries, where one of them includes a study which consisted of turning stem cells into insulin-producing cells, which could be a life-changing treatment for diabetics in the future.

In February of 2019, researchers in the UCSF (University of California San Francisco) transformed human stem cells into ones that produce insulin, a huge discovery in the study of type 1 diabetics. This research can be further expanded into medical procedures such as islet cell transplantation- possibly becoming an alternative to insulin injections.

During the research, the team artificially isolated the pancreatic stem cells from the remainder of the pancreas, then regenerated them into groups of insulinproducing cells. As a result, beta cells responded to blood glucose following the transplantation, starting to produce insulin in a similar way to the animal’s own islets within days.

“We can now generate insulin-producing cells that look and act a lot like the pancreatic beta cells you and I have in our bodies. This is a critical step towards our goal of creating cells that could be transplanted into patients with diabetes,” - Matthias Hebrok, PhD, Professor in Diabetes Research at UCSF and director of the UCSF Diabetes Centre.

Another research was conducted from Washington University School of Medicine in St. Louis, MO, on January 2019, on a similar subject.

The research team managed to produce beta cells that are more responsive to blood glucose level, where previously it was challenging in regulating the amount of insulin produced from beta cells. The researchers observed that after transplanting the new cells into mice which could not produce insulin, the cells began to secrete the hormone within a few days, as well as helping to control animals’ blood sugar level for several months. Being able to generate more than a billion beta cells in a single lab in just a few weeks shows easy mass production if the time comes.

Whether this will work well in us humans, is yet unanswered. It is absolutely crucial to develop a means of testing the cells safely in people, as well as clinical trials.

Stem cell research is not only on its way to help diabetics but also in curing HIV patients. Recently, a second person is known to be free from the HIV virus after receiving stem cell therapy.

March of 2019, a research team led by Ravindra Gupta replaced the white blood cells of the patient with HIV and immune-cell cancer, with the versions which are HIV-resistant, obtained from a donor with a Δ32 mutation in CCR5 gene through bone marrow transplant.

CCR5 gene is responsible for coding the receptor protein on the surface of the immune cell targeted to bind by HIV. It restricts the cellular entry of the virus by having the absence of protein coded by the CCR5 gene, therefore, making the immune cells resistant from infection by CCR5-dependent HIV strains. This is very similar to procedure Brown, the first person to be free from HIV, underwent, where it took place a decade ago. However, this time around, the mode of treatment was much less aggressive than Brown’s, as radiotherapy wasn’t involved but instead the patient was given a regimen consisting of chemotherapy alongside a drug that targets cancerous cells. The replication of this procedure suggests that stem cell therapy for making HIV remissive was not a one-off case, but a possible treatment for people with immune-cell cancer alongside HIV. However, for some strains of HIV, the virus enters the cells using CXCR4 alongside CD4, rather than CCR5. This type of HIV strains is associated with drug resistance or might arise if antiretroviral treatment starts later than normal in the course of infection. Also,

donor stem cell transplantation is expensive, as well as carrying high risk and requiring intensive effort and concentration.

This study might have proved such replication of procedure is possible, but this would only be viable on a small scale and only targets people with both immunecell cancer and HIV. The fascinating discovery we are waiting for will be aimed at a wider population with easier accessibility.

Research in stem cell carries high complications. There are many ethical issues surrounding stem cells especially with embryonic stem cell, and many restrictions are placed on funding and use. Frequently updated strict guidelines are crucial at this age where rapid advances in stem cell research are attracting more scientists into this field of regenerative medicine every year.

It is one of the fastest growing areas of science with predicted stem cell market size to worth $297 billion by 2022. From tissue engineering to potential treatment for Parkinson’s and Alzheimer’s’, stem cell holds high expectations in the medical world.

Bibliography https://www.nature.com/articles/d41586-019-00989-y https://www.ucsf.edu/news/2019/02/413186/ functional-insulin-producing-cells-grown-lab http://what-when-how.com/stem-cell/division-typessymmetrical-and-asymmetrical-stem-cell/ https://en.wikipedia.org/wiki/Progenitor_cell https://www.cell.com/stem-cell-reports/fulltext/ S2213-6711(18)30531-9 https://stemcells.nih.gov/info/basics/7.htm https://www.diabetes.co.uk/news/2019/feb/scientistsmake-breakthrough-by-turning-stem-cells-into-insulinproducing-cells-94739587.html https://learn.genetics.utah.edu/content/stemcells/ sctoday/

SHOULD MEDICAL CANNABIS BE RE-INTRODUCED INTO THE BRITISH HEALTHCARE SYSTEM? Sara Lyden (OHS) Medical cannabis today plays a controversial role in medicine and politics and there are strong arguments for and against the re-introduction of medical cannabis into the UK healthcare system. From ancient times, marijuana has been used in medicine, for its medicinal properties, however there are concerns about whether the advantages of medical marijuana outweigh the disadvantages of using this drug widely in healthcare.

Currently in the UK, the use of medical cannabis is not widespread, but cannabis oil is allowed to be prescribed (this is tightly regulated and must be approved by a panel) to relieve and treat severe chronic conditions.

This law was implemented following several cases where medical cannabis played a vital role in the treatment of epileptic patients, famously Alfie Dingley.

There are also drugs such as Sativex, a derivative of hemp used to treat and relieve symptoms of MS. The US government approves the use of Epidiolex, a drug used to tackle childhood-onset epilepsy, suggesting that medical cannabis could be used more widely in the future.

In recent years there has been little research surrounding marijuana in medicine because it is considered a schedule 1 drug, implying it has no accepted medical use and therefore making it illegal.

This classification stalled research so many of the potential uses of medical cannabis have not been properly investigated and therefore at the moment there are very few medical practices where hemp is used. Currently, it is thought that marijuana could help manage nausea, weight loss, contribute to Glaucoma, PTSD, and IBS treatment. Furthermore, it is known to help relieve the symptoms of chronic pain (like MS and fibromyalgia). It has also been suggested to be an effective muscle relaxant which helps reduce shaking for Parkinson’s patients. Medical cannabis has immense potential and with more research, it may help a new demographic of patient, in fact it is thought that cannabidiolic acid has some bactericidal properties, but this has not been investigated in any depth.

Despite medical cannabis having the potential to revolutionise treatments for many conditions, the large-scale re-introduction of hemp products would come with drawbacks, which could be considered characteristically similar to those of opioid drugs. Like most drugs, a potential problem that could arise from the widespread introduction of medical marijuana

would be an addiction to cannabis which could be harmful to a patient, and expensive to treat. This could lead to the misuse of marijuana because some patients may become dependent on the drug and seek to obtain it when it is no longer needed for medical reasons. Another way in which medical cannabis could be misused is by those attempting to obtain the drug for non-medical reasons, including for recreation. If cannabis was readily available in healthcare, a situation mirroring the current opioid abuse epidemic could arise as more people would be exposed to marijuana and the drug may also become more acceptable in society due to its prevalence in medicine. There is also a possibility that clinicians could dispense medical cannabis too freely and it may result in an overuse of cannabis. A reverse of this could be that doctors may be too hesitant to prescribe hemp products (due to controversy), and so patients miss out on potentially more effective treatments.

Disadvantages of medical cannabis may not only occur on a socioeconomic level, but also on a physiological basis. It is still unclear as to how beneficial cannabis is in medicine, due to lack of research in recent years.

Known side effects of cannabis include; induced psycho-activity, anxiety, short term memory and coordination loss and these have consequences on the patient’s well-being.

In spite of the potential issues that may arise from the use of medical cannabis, there are many positives surrounding hemp products. Currently, in the UK recreational cannabis is illegal and there is much criminal activity surrounding the drug. If cannabis products were legalised in medicine, it may result in a reduced black market for the drug as currently some obtain it to relive medical ailments. Medical cannabis is also deemed relatively safe to use, and it is agreed that it is safer than most opioid drugs.

Medical marijuana could help relieve many chronic symptoms in patients and improve the quality of life for many. Currently in the US, chronic pain effects 25 million people and if marijuana could relieve this for some, it would have a great impact on their lives.

Medical cannabis, with more research could be used to help relieve and cure some illnesses. Marijuana could also be used for palliative care in cancer patients, and it could potentially stop cancer from spreading, as well as alleviating nausea from chemotherapy. There is also hope for marijuana to be used to prevent Alzheimer’s, relieve arthritis, and help people with mental health related conditions such as anxiety or PTSD, to name but a few. It is clear that medical cannabis has the potential to revolutionise medicine, yet the specifics of the drug’s capability are still widely unknown.

In conclusion, there are many arguments supporting and opposing medical marijuana. It is important that cannabis can be used in healthcare as it has the potential to positively contribute to the treatment and care of many. With more research around the use of medical cannabis, it is possible that hemp-based drugs

are capable of more than what is already known. It is important that if medical cannabis was introduced into the British healthcare system that doctors are trained on when to appropriately prescribe patients with cannabis, and also how to spot symptoms of misuse, as if not detected, it could have serious consequences for the patient. It is therefore important to have safe and good licencing practices and to agree on how accessible these drugs should be to patients, for example, should they only be administered in hospitals? In order to try and safely control medical cannabis, the MHRA are developing a clear definition of what constitutes a cannabis- derived medical product so they can be more widely prescribed in the future with ensured safety.

Bibliography The Guardian News and Media Limited (date accessed 28/11/2018) Cannabis-based medicines get green light as UK eases rules: https://www.theguardian.com/ society/2018/jul/26/cannabis-based-medicines-getgreen-light-as-uk-eases-rules N. Volkow, R. Baler, W. Compton, S.Weiss (date accessed 26/04/2018) Adverse Health Effects of Marijuana Use: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4827335/ Healthline Media UK Ltd (date accessed 26/04/2018) Marijuana: Good or bad: https://www.medicalnewstoday.com/articles/320984. php T. Mikuriya (California medicine, January 1969) (date accessed 26/04/2018) Marijuana in medicine:

TO WHAT EXTENT ARE ALTERNATIVE MEDICAL THERAPIES VALID COMPARED TO MAINSTREAM MEDICAL PRACTICE? Libby Westwood (OHS) Some may say that the NHS is the jewel in the crown of the UK, since it provides healthcare free of charge and impressive employment opportunities (1.7 million people are employed in the NHS, making it the world’s fifth largest employer). A survey conducted by ITV in 2018 revealed that the NHS was the British institution that was apprised most highly in the eyes of Britons, 54% of adults that undertook the survey were proud of the National Health Service, for reasons including its democratic nature, the kindness of staff and how the NHS saves and improves people’s lives on a daily basis. However the NHS has come under criticism for not providing a holistic approach to treatments (ITV News, 2018). A recent survey by the department of health found more than two thirds of doctors believe alternative therapies should be available free on the NHS. One in five Britons pay an average of £450 million a year for treatments such as acupuncture, osteopathy, homeopathy, chiropractic and aromatherapy. The validity of these treatments is still relatively unknown however, over the last decade, scientific research has shown that such treatments can work effectively alongside mainstream medical practice. The Foundation of Integrated Medicine (an independent body which aims to combine orthodox and alternative therapies) has said that complementary medicine is now available in 10% of doctors’ surgeries or alternative hospitals, but not without a significant price (MailOnline, 2019).

Homeopathy is an alternative medical treatment that works in two ways, administering highly diluted versions of medicines or administering a substance that causes the symptoms of an illness, with the idea that it will help remove the symptoms. People suffering from asthma, ear infections, hay fever, arthritis and dermatitis will often approach homeopathy as a treatment (British Homeopathic Association, 2019).

However, a 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic treatment works in the same way as a placebo, therefore, it has no effect on the physical health but does have a psychological effect as it makes the patient think they have been cured, despite not actually having been cured at all. The report went so far as to say that homeopathy as a medical treatment

was scientifically implausible, as a result in 2017 NHS England advised GPs and other providers of homeopathic remedies to stop providing homeopathic courses of treatment (NHS, 2018).

Acupuncture is a form of complementary and alternative medicine which is popular within the NHS used alongside orthodox treatments. It was derived from ancient Chinese medicine and involves the insertion of very fine needles into certain sites of the body to stimulate sensory nerves under the skin and in muscles. By stimulating these sensory nerves, substances created by the body are produced, for example commonly, pain relieving endorphins can be released, the pain relief given by acupuncture can be used to supplement drugs which provide the same effect, but for people that are allergic to the painkillers given in hospital such as codeine, oxycodone, hydrocodone and morphine, acupuncture can be an attractive option.

Acupuncture is largely used to treat chronic tensiontype headaches, migraines, chronic pain, joint pain, dental pain and postoperative pain. The location of where the needles are inserted can be altered depending on the condition being treated (NHS, 2016).

Chiropractic is a non-conventional treatment in which bone, muscle and joint pain can be relieved.

Chiropractic is not offered widely across the NHS but, it is in certain areas. Chiropractic care is centred on spinal manipulation and is extremely popular amongst people suffering from back pain, in the US it was found that 74% of adults who had suffered from back pain in a point of their life had resorted to a chiropractor.

Musculoskeletal disorders have put great strain on the NHS, which already has had to endure cut after cut in funding since the election of David Cameron and the Conservative Party in 2010. Therefore it is difficult for the service to provide support for mild muscular pain that is not affecting quality of life, especially because it has not been scientifically proven to be effective and it is very expensive (NHS, 2017).

Aromatherapy is the form of alternative medicine which involves the use of essential oils to improve both health and wellbeing, it is a prevalent feature used in clinics which practice holistic medicine. It has limited availability on the NHS, similarly to many other alternative treatments, but is often used by cancer patients to treat symptoms of cancer and the side effects of cancer treatments such as radiotherapy and chemotherapy. Largely though, aromatherapy is believed to be more beneficial to one’s mental wellbeing than their overall physical health, it is said to also be very effective in relieving stress. Different essential oils provide different benefits, for example some have antiinflammatory properties that can be used in treating conditions like arthritis, some help fight infection and some can improve sleep patterns. The oils can be administered by either inhalation or rubbed into the skin (Cancer Research, 2018).

Colonic irrigation is a method of alternative medicine which is used to remove toxins from the colon, warm

water is passed into the colon and carries out loose faecal debris and waste to effectively flush the colon.

Colonic irrigation can increase the speed through which food is moved through the digestive system which subsequently leads to many benefits such as reduced numbers of headaches, less bloating and higher energy levels. Colonic irrigation is extremely useful when completed before a procedure such as a colonoscopy, whilst this is not used in the UK, it is popular in the US, in the UK bowel preparation involves a change in diet and a strong laxative powder, likely due to once again the expense (Mayo Clinic, 2018).

In conclusion, alternative medical therapies can be useful in providing a holistic attitude towards healthcare, which not only looks after physical health but also mental health. From the most common of alternative medicine therapies, acupuncture is the most valid method of treatment, this is shown by the fact it is the only alternative medicine treatment offered relatively widely across the NHS and in hospitals.

Whilst most alternative therapies can be effective in relieving pain, curing illnesses etc, there is no scientific proof of their effectiveness which means they could never be used alone, but alongside effective treatments under the NHS, there is no doubt that these alternative methods may help. Just because they cannot be used alone does not mean that they aren’t valid, they can be particularly useful if a patient is intolerant to an orthodox treatment.

Bibliography British Homeopathic Association, (2019). What is homeopathy? [Online] Available from:https:// www.britishhomeopathic.org/homeopathy/what-ishomeopathy/ [Accessed 13th April 2019] Cancer Research UK, (2018) Aromatherapy [Online] Available from: https://www.cancerresearchuk. org/about-cancer/cancer-in-general/treatment/ complementary-alternative-therapies/individualtherapies/aromatherapy [Accessed 13th April 2019] Kane, R et al, (1974), Manipulating the patient a comparison of the effectiveness of physician and chiropractor care, The Lancet, 303 (7870), 1333-1336, Available from doi:10.1016/S0140-6736(74)90695-3 [Accessed 13th April 2019] ITV News, (2018). Britons most proud of NHS, survey finds [Online] Available from:https://www.itv.com/ news/2018-06-07/britons-most-proud-of-nhs-surveyfinds/ [Accessed 13th April 2019] MailOnline, (2019), Naomi Coleman. Why you could alternative treatment on the NHS [Online] Available from:https://www.dailymail.co.uk/health/ article-55405/Why-alternative-treatment-NHS.html [Accessed 13th April 2019]

Mayo Clinic, (2018), Michael F. Picco, M.D.Consumer Health [Online] Available from: https://www. mayoclinic.org/healthy-lifestyle/consumer-health/ expert-answers/colon-cleansing/faq-20058435 [Accessed 13th April 2019] NHS, (2016). Acupuncture [Online] Available from: https://www.nhs.uk/conditions/acupuncture/ [Accessed 13th April 2019] NHS, (2017). Chiropractic [Online] Available from: https://www.nhs.uk/conditions/chiropractic/ [Accessed 13th April 2019] NHS, (2018). Homeopathy [Online] Available from: https://www.nhs.uk/conditions/homeopathy/ [Accessed 13th April 2019]

UGLINESS IN COLERIDGE’S ‘THE RIME OF THE ANCIENT MARINER’ Laura Fletcher (WHS) The Rime of the Ancient Mariner is one of Coleridge’s best-known works and was first published in 1798.

During Autumn of the previous year, Coleridge had been living in north Somerset and had spent some time in the company of William Wordsworth. A walking tour across the Quantock Hills gave them the inspiration to write their Lyrical Ballads that have been said to mark the beginning of the English Romantic movement in literature. The Rime of the Ancient Mariner is written in the English ballad tradition – mostly quatrains with an ABCB rhyme scheme alternating four-stress and three-stress lines. However, it is a real contrast to the other poems in the collection due to its occasional uses of ugly and monstrous imagery, which helps to illustrate Coleridge’s ideas concerning guilt, suffering, and penance.

In the initial description of the Mariner as having ‘thy long grey beard and thy glittering eye’ an intriguing, mystical appearance is conveyed, suggesting a legendary or wise character, with beards having the associations of Greco-Roman philosophers. However, later in the poem, on closer inspection, the wedding guest is repulsed by the Mariner, describing him as ‘long and lank and brown’, and his emaciated and discoloured state conjures images of deterioration and decrepitude.

But the wedding guest’s choice to listen to the Mariner’s story pays off as he rises the next day ‘a wiser man’.

Perhaps Coleridge had another seafarer in mind when he wrote the poem, as the description recalls Homer’s description of Odysseus his raft from the island of Ogygia is shipwrecked and he arrives in Scherie. He too has a somewhat deceptively ugly appearance as the women who see him flee: ‘But, streaked with brine, he terrified them so, that they fled in fear, at random, over the sand spits.’

More grotesque, however, is the figure of Death that the Mariner describes: ‘His bones were black with many a crack, All black and bare, I ween; Jet-black and bare, save where with rust Of mouldy damps and charnel crust They’re patch’d with purple and green.’

Coleridge uses the vivid imagery of the bare bones of the living skeleton, with the alliterative ‘charnel crust’ conveying the death and destruction associated with the figure. The use of a vivid bruise-like colour palette of purple and green furthers the sense of human illness and deterioration. Critic Seamus Perry notes how Coleridge’s ‘roughly pantheistic vision of the world completely suffused with God’s abundant goodness’ ‘there is a problem with this otherwise intoxicating

view: much of the world seems very short of lovely.

On the contrary, it is full of cruelty and arbitrary violence and acts of evil.’ The figure of Death seems to encapsulate these realities of cruelty and violence as he plays dice to win the lives of the crew, and this is reflected in his terrifying appearance.

Some of the ugliest imagery of the poem emerges as the Mariner loses hope when spirits pursue the ship and later as his crew dies around him. The sinister and repulsive sights reflect his descent into despair.

‘Yea, slimy things did crawl with legs Upon the slimy Sea.’ Coleridge’s repetition of ‘slimy’ conveys an unpleasant image and the detail of ‘with legs’ suggests that they have a disturbing blend of land and marine features, made even more unsettling by his inability to identify what kind of creatures they are.

The Mariner’s complete despondency at his situation is shown as he suggests that the world is devoid of all beauty after his crew die: ‘The many men so beautiful And they all dead did lie!

And a million million slimy things Liv’d on – and so did I.’ The hyperbolic description of ‘a million million slimy things’ conveys an overwhelming build-up of creatures in contrast to the beauty of his men. Dr Andrew Green suggests that ‘The sea and creatures from the deep may be seen as an externalisation of the Mariner’s guilt’ and in this way the increase of ‘slimy things’ during the poem might represent the Mariner’s increasing guilt and despair.

The figure of Death is contrasted with the arguably more terrifying Life-In-Death who comes to represent human suffering.

‘Her lips are red, her looks are free, Her locks are yellow as gold: Her skin is as white as leprosy, And she is far liker death than he; Her flesh makes the still air cold.’

Whilst ostensibly beautiful with the traditional ideals of feminine beauty of the time of red lips, golden locks and pale skins, she appears distorted and sinister.

There is a grotesque quality to her skin that is ‘as white as leprosy’ and her body that is described ‘flesh’, suggesting a bareness, and both emphasise her diseased state. The bright colours, rather than conveying health and vigour, seem gaudy and uncomfortably bright, suggesting a twisted and unnatural beauty.

The Romantic poet Percy Bysshe Shelley wrote in ‘A Defence of Poetry’ that ‘poetry is a mirror which makes beautiful that which is distorted.’ Coleridge demonstrates the transformative nature of poetry in his description of the water snakes. Although some of the ‘ugly’ images in the poem reflect the genuine danger of the Mariner’s situation, Coleridge argues through the water snakes that lead to the Mariner’s salvation, that appearances can be deceptive. Whilst the Mariner notes that ‘no tongue their beauty might declare’, he sees the

value in them nonetheless: ‘I watched their rich attire: Blue, glossy green, and velvet black, They coil’d and swam; and every track Was a flash of golden fire.’

Coleridge uses a lexical cluster of adjectives associated with richness and luxury (‘rich’, ‘glossy’, ‘velvet’), utilising the language of rich clothing to suggest their worth both visually and spiritually to the Mariner.

Whilst this is not the traditional imagery of the Romantic sublime, the snakes inspire a change in the Mariner and Perry argues that ‘Recognising a joy implicit within natural appearances appears to mark a saving transition from ‘spectral persecution’ to a progressive penance.’ The snakes have value both in their rich colours and their role in the Mariner’s spiritual development.

Coleridge makes beautiful what is distorted in the conclusion of The Rime of the Ancient Mariner as although the Mariner has experienced the ugliness and distorted nature of guilt and human suffering, embodied by the sea creatures and the figures of Death and Life-In-Death, he is partly healed of his guilt by recognising the beauty and richness of the sea snakes.

By exploring the changing state of the Mariner from despair to piety, Coleridge presents ugliness as being in the eye of the beholder and representative of the state of the individual.

Bibliography Coleridge, S., Wordsworth W. (1798). Lyrical Ballads Penguin Classics Perry, S. (2014). A introduction to The Rime of the Ancient Mariner <https://www.bl.uk/romantics-andvictorians/articles/an-introduction-to-the-rime-of-theancient-mariner> Green, A. (2016). A Study in Guilt – The Rime of the Ancient Mariner <https://www.englishandmedia.co.uk/e-magazine/ articles/20473> https://www.poetryfoundation.org/articles/69388/adefence-of-poetry

HUMANS & INFLUENZA: ARE WE MAKING OURSELVES MORE VULNERABLE TO A GLOBAL PANDEMIC? Charlotte Furness (OHS) In January of this year, the World Health Organisation (WHO) released its list of the ‘Ten Threats to Global Health in 2019’. On this list was ‘Global influenza pandemic’, however what made this threat different was that the others on the list are known ongoing problems, yet influenza was the only one with uncertainty, as even WHO admits they can’t be sure of “when it will hit and how severe it will be.” On this list were a range of threats, from Dengue to air pollution and climate change . Subsequent monitoring systems are in place to detect any potential pandemic-causing strain of influenza, however could it be possible that human causes are speeding up the process of heading towards a global outbreak?

Influenza is a virus, with several different strains. Most commonly known is seasonal influenza, which tends to occur in the coldest seasons in both the Northern and Southern Hemispheres. It is prevalent year-round along the equator . There are 3 strains of seasonal influenza: A, B, and C, yet influenza A and B pose a much greater threat of a large outbreak. Humans can also be infected by influenza that affects animals, known as ‘zoonotic influenza’ and while these currently don’t have the capacity to cause large scale outbreaks, if a mutation of the virus allowed it to spread effectively between humans, then the repercussions would be serious .

An influenza pandemic is when a new variation of the virus previously not seen among humans emerges. If many people aren’t immune to this new variation then the virus will transmit rapidly, potentially causing a rapid, large-scale outbreak of influenza .

An influenza pandemic could be deadly because the pandemic causing virus will be one that can easily infect people and that few people have immunity towards, causing the virus to spread rapidly. Flu pandemics on a global scale have been seen multiple times, but most notably in 1918. It’s estimated that around one third of the global population was infected with the virus, and up to 50 million people died as a result, which is more than double the death toll of the First World War, which was around 17 million. Each year, over half a million people are killed by seasonal influenza and 1 billion are affected by the virus . Recently, an increasing number of influenza positive viruses have been found over the past 20 years, as seen in Figure 1, meaning the likelihood of an outbreak is increasing as there are more variations of the virus which can mutate.

Figure 1 A growing population means that more people are vulnerable to influenza, as well as more people which the virus can infect, making it harder to contain outbreaks. The most vulnerable are the very old, the very young, and pregnant women . As Figure 2 and Figure 3 show, the population of the US has increased and the age structure has changed, with a large increase in the number of dependents, who are the most susceptible to influenza. A larger number of vulnerable people means more people to treat and more people to vaccinate. In lower income countries, the rate of population growth tends to be higher, leaving them more susceptible to outbreaks as their healthcare systems often lack resources needed to treat outbreaks of the virus.

Figure 2

Figure 3 A recent study has linked climate change and warmer winters to worse flu seasons. It indicates that milder winters are followed by heavier and earlier influenza seasons, as fewer people are infected with the virus during the warm winter, so more people are susceptible to it entering the next season . As climate change increases global temperatures, warmer winters will become more common, meaning the effects of future

influenza seasons could be more and more serious .

Figure 4 shows the percentage of influenza-like illness (ILI) visits to medical centres in the US, which is a way of recording influenza cases, and Figure 5 demonstrates the large number of record warmest temperatures from November 2017 to January 2018, coinciding with the large spike in visits for ILI over the same time period.

However, this theory has not been explored in enough depth for the findings to be absolutely conclusive.

Figure 4

and a similar rate in Europe, these numbers haven’t increased exponentially over time , meaning their impact is minimal. However, a Canadian study reported that people who partially vaccinate are actually a larger issue than the relatively few total vaccine refusers .

In Canada in 2014, there was an increase in 30% of vaccine-preventable disease cases from 2005 . Although many issues such as inaccessibility may also cause fewer people to get vaccinated, the fact still remains that not all those who are able to be vaccinated do, leading to a more susceptible population to outbreaks of disease and viruses like influenza. Even so, the impacts of vaccine hesitancy could be argued to be negligible, as Figure 5 shows that global vaccine dose distribution has increased by 27% since 2006 over 157 countries, from 350 million doses in 2006 to 450 million in 2009 . Nevertheless, only 20% of WHO Member States studied in one report reached the ‘hurdle’ rate of 159 doses per 1000 of the population, as seen in Figure 6.

Over two thirds didn’t distribute enough doses to cover 10% of the population and over a third didn’t distribute sufficient to cover 1% of their population, despite the global increase in vaccine dose distribution . In the UK, young children over 65s, pregnant women and people who work in situations that mean they could catch the virus, such as health workers, are given free vaccination . However, the relatively small vaccine cover means that a lot of the global population is still vulnerable to influenza outbreaks and herd immunity is not yet achieved.

Figure 5 Another, more recent reason for the growing influenza pandemic concern are people who don’t get vaccinations and those who are against vaccinations.

Vaccine hesitancy is another of the threats to global health that WHO announced this year . The US’s Centre for Disease Control and Prevention estimated that in the 2016-17 season, overall influenza vaccination for the US was 47%, below the national target of 70% . A vaccinated adult may still get the flu, as the vaccine only protects against the potential outbreak-causing strains, however it’s been proven to reduce deaths and hospital care duration for those who have been vaccinated. Vaccines helps prevent the circulation of the virus by stopping it from being spread to others as fewer people are exposed to the virus, creating what is known as ‘herd immunity’ . While complete vaccine refusal in the US is estimated at 2%,

Figure 5

Figure 6

While the human-related problems of a growing population, milder winters and vaccine hesitancy could increase the effects of a global influenza outbreak, the fact still remains that the pandemic will be caused as a result of a mutation of the virus into one that our immune systems aren’t effective against. People may get influenza several times through their lifetime due to its constant evolution, meaning seasonal vaccines are reviewed biannually to increase their effectiveness .The constant mutation into new variations, means continuous surveillance is needed to monitor the spread of the virus. In 1952, the Global Influenza Surveillance and Response System (GIRS) was created by WHO to monitor outbreaks in countries, watch for potential pandemic-inducing strains and to help advise the composition of vaccinations to ensure they are the most effective. With 114 countries participating, it is the largest influenza monitoring scheme to date. WHO has also set up the Pandemic Influenza Preparedness Framework, to help the 194 member countries of WHO should a pandemic ever occur . Furthermore, vaccine production capacity has increased, with Figure 7 representing the estimates of global seasonal and potential pandemic influenza vaccine production capacity in million doses per year.

Figure 7 While humans cannot stop the Influenza virus from mutating, it appears that through climate change, vaccine hesitancy and increasing vulnerable population size we are making ourselves more vulnerable to a global influenza pandemic by decreasing the effectiveness of the preventative methods that are in place. That being said, our capacity to monitor outbreaks as well as produce and distribute vaccines has increased, despite the arguable effect that vaccine hesitancy is having on coverage. Therefore, it remains to be seen just how prepared, or unprepared we truly are for an influenza pandemic until the day comes when we have to put it to the test.

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Centers for Disease Control and Prevention. Pandemic Basics. https://www.cdc.gov/flu/pandemic-resources/ basics/index.html Vanderslott, S. (2018). Anti-vaxxer effect on vaccination rates is exaggerated. The Conversation. https:// theconversation.com/anti-vaxxer-effect-on-vaccinationrates-is-exaggerated-92630 Busby, C., Jacobs, A., Muthukumaran, R. (2017).

In Need of a Booster: How to Improve Childhood Vaccination Coverage in Canada. C.D. Howe Institute. https://www.cdhowe.org/public-policy-research/needbooster-how-improve-childhood-vaccination-coveragecanada Dubé, D.E. (2017). Who’s really to blame for Canada’s falling vaccination rates? It’s not just anti-vaxxers, report says. Global News. https://globalnews.ca/ news/3409038/whos-really-to-blame-for-canadasfalling-vaccination-rates-its-not-only-anti-vaxxersreport-says/ World Health Organisation. (2014). Global Action Plan for Influenza Vaccines: Global Progress report: January 2006- September 2013. https://apps.who.int/iris/bitstream/handle/10665/112307/9789241507011_eng.pdf;jsessionid=7C5014B40E7A6F27182D00758B27E6F5?sequence=1 Palache, A. (2011). Seasonal influenza vaccine provision in 157 countries (2004-2009) and the potential influence of national public health policies. ScienceDirect. https://www.sciencedirect.com/science/article/pii/ S0264410X11016379?via%3Dihub NHS. Who should have the flu vaccine? https://www. nhs.uk/conditions/vaccinations/who-should-have-fluvaccine/

HIV/AIDS: 101 Emily Kress (WHS) One of the world’s most prevalent pandemics is HIV/ AIDS. In 2017, there were approximately 36.9 million people in the world who were living with HIV/AIDS. Of these 36.9 million people, over 1.8 million were children under the age of 15, and there were around 5000 new infections diagnosed a day. 25.7 million (70%) of these people live or have lived in sub-Saharan Africa and most of the children were infected during pregnancy or breastfeeding. Over 9 million of these people still lack sufficient medical resources to test, prevent, treat, and support HIV-positive people.

Human immunodeficiency virus (HIV) is a retrovirus that targets and alters the immune system which increases the risk and impact of other opportunistic infections and diseases. Without treatment, the infection causes the disease, acquired immune deficiency syndrome (AIDS). The life expectancy of a person with HIV/AIDS taking antiretroviral treatment (ART) is now close to that of a person without the infection.

A retrovirus is a type of virus where the genetic information is in the form of RNA. However, in a host cell, the viruses are able to synthesize DNA from their RNA using an enzyme called reverse transcriptase.

This section of viral DNA is then inserted into the host DNA. Following infection, HIV enters and circulates the body via the bloodstream. As HIV is a virus, it cannot replicate itself, so it uses its genetic material to instruct the host cell’s biochemical mechanisms to produce the components required to replicate new HIV. This occurs when the HIV reverse transcriptase found in the virus converts viral RNA into DNA which can be inserted into the cell’s DNA. During protein synthesis the HIV DNA in the nucleus creates messenger RNA which contains the instructions for making new viral proteins. This mRNA passes out of the nucleus via nuclear pores and uses the cell’s protein synthesis mechanisms to make new HIV particles. As the mRNA contains the instructions for making new viral proteins and viral RNA, new HIV particles are able to break away from the cell by exocytosis (the process by which there is an outward bulk transport of materials from the cytoplasm through the cell-surface membrane).

When HIV was first discovered is was highly stigmatized because of the minority groups it was primarily seen in which was gay males, heroin users and people of African or Haitian descent. On June 5th, 1981 an article was published which described cases of five white, gay males who had a rare lung infection pneumocystis carinii pneumonia. The same day a doctor in New York noticed a cluster of a rare and unusually aggressive cancer- Kaposi’s Sarcoma. Both of these conditions were seen with other unusual infections and are typically associated with people who have weakened immune systems. Within the next few days

reports around the U.S. saw many similar cases of PCP, KS and other opportunistic infections in gay men. At this point it was seen that people would only live up to 15 months after they were diagnosed with HIV/AIDS. When HIV was first discovered, it was rare that those infected would live longer than 10 years after they tested HIV-positive however, current treatments can reduce HIV to an undetectable level which allows most people living with HIV the opportunity to live a long and relatively normal life. Starting antiretroviral therapy (ART) in the early stages of the virus is important for this to be true. I a patient adheres strictly to their treatment plan, a person living with the virus is able to reduce their viral load so much that it cannot be detected in a blood test. After doing many studies, it was determined that those who have an undetectable viral load cannot transmit the virus to others.

If someone is infected with HIV, they may show early signs or symptoms such as fevers or early sweats.

However, around 80% of people will not show symptoms until around 4-6 weeks after they have been infected when they have acute retroviral syndrome which may cause fever, chills, muscle aches, weight loss or other flu-like symptoms. However, after any acute retroviral symptoms many people will not have any other symptoms for up to 10 years in which time, the virus can continue to replicate causing immune system and organ damage. Without treatment to slow the viral replication, HIV will seriously weaken the immune system leaving the patient vulnerable to many opportunistic infections. At this point, the patient has AIDS, or stage 3 HIV. During this stage the body is very susceptible to many infections which may have otherwise caused minimal to no problems.

As HIV is such a complex virus which has many effects on the body, people often use a personal combination of drugs to suppress the virus. A team of medics will adapt treatment for each individual to find the exact mix of drugs which will extend their life expectancy providing that the patient takes the pills on a regular schedule — this is usually a lifelong daily routine.

Many people have tried alternative or herbal remedies however, there is not yet sufficient evidence to confirm their efficacy. Some other studies show that mineral and vitamin supplements could provide benefits in overall health which may decrease the number of opportunistic infections contracted.

Even though HIV/AIDS is a very difficult disease which does not yet have a cure, scientists have recently ‘cured’ two patients with HIV/AIDS. The first person to be cured is Timothy Brown. He was living with HIV and received two HSCTs (hematopoietic stem cell transplants) in 2006 to treat leukaemia. His donor had double copies of a very rare genetic mutation which is only present in around 1% of Europeans. This mutation, CCR5-delta-32, results in a non-functional CCR5 co-receptors on T-cells. The HIV virus uses either CCR5(majority and preferred) or CXCR4 co-receptors on the cell surfaces of CD4 T-cells for

entry into the host cells. Therefore, when Brown’s body started to make new T-cells, they lacked a functional CCR5 co-receptor, so no new HIV particles were able to infect the new cells. Brown stopped ART after the first transplant and doctors were surprised when his viral load did not rebound. Doctors tested his blood, gut, brain, and many other tissues and found no evidence of replication competent HIV. He has now been living 12 years free of HIV. There have been other attempts like this of which, none of the donors had the same gene mutation so they have not been as successful and have all led to remission. However, the viral rebound had taken longer than expected; 3, 8 and 10 months in each case which suggested that the stem cell transplant itself helped to reduce the viral load and the gene mutation was just the ‘cherry on top’.

More recently, the “London patient” had a HSCT to treat Hodgkin lymphoma in May 2016. His donor also had a homozygous CCR5-delta-32 mutation.

Unfortunately, there was a complete lymphoma remission, as well as mild graft versus host disease (selfresolved) and deactivation of his pre-existing EpsteinBarr virus and cytomegalovirus. However, blood tests showed undetectable HIV and that the new CD4 T-cells lacked the CCR5 receptors. Doctors stopped ART 16 months later (Sept. 2017) and in March 2019, there was no HIV DNA found in peripheral CD4 cells.

These blood tests also showed less than one copy of HIV RNA per 1ml of blood, and in 24 million reset T-cells there was no ‘reactivatable’ HIV virus.

From these results, Dr. Ravindra K. Gupta said that this shows that the “Berlin patient” (Brown) was not an anomaly and that they add to the strength of the argument for gene therapy to delete CCR5 receptors from T-cells as a feasible approach to curing and preventing HIV. However, researchers still say that it is “premature to conclude that this patient [London patient] is cured”.

The transplant is a big risk and due to the nature of the procedure, it will not be an option for most people even if it becomes a functional cure.

Bibliography www.fromhopetocures.org/infographic/hiv/aids-thenand-now https://www.healthline.com/health/hiv-aids/ medications-list https://www.healthline.com/health/hiv-aids/ history#prep https://www.hiv.gov/hiv-basics/overview/history/hivand-aids-timeline https://www.hiv.gov/hiv-basics/overview/about-hivand-aids/what-are-hiv-and-aids www.unaids.org/en/resources/fact-sheet

THE RISE AND FALL OF THE BRITISH EMPIRE AND THE EXTENT TO WHICH ITS LEGACY IS STILL RELEVANT TODAY Rosie Leeson (OHS) The British Empire can be viewed as the symbol of an era in history when Britain’s international power and significance as a nation reached heights previously unknown. It followed a number of equally influential and important empires that had left a lasting impression upon the world, and would also survive to see the fall of other major powers, such as the collapse of the Ottoman Empire at the end of the First World War. The British Empire has been termed ‘the first genuinely global empire’ on which ‘the sun never sets,’ as it encompassed roughly ¼ of the world’s landmass and population. As a result, this made it the largest empire in history. However, similar to its predecessors, the British Empire also came to an end during the mid20th century, as nation after nation began to demand independence from British rule. And yet, despite its clear downfall, there remains the debate as to whether the British Empire still retains some significance in the 21st century. Technically it still exists in a very basic form, with 14 territories still under British rule in 2015.

Furthermore, the creation of the Commonwealth has meant that the former territories of the Empire are still connected within one association, with the current British monarch, Queen Elizabeth II, as its Head.

Traces of the old Empire have therefore been woven into modern politics, suggesting that its legacy still remains strong and relevant.

The exact origins of the British Empire remains unclear, however it is believed Britain first attempted to establish settlements overseas in the 16th century.

Unlike the orderly expansion of other major empires, the early settlements created within the British Empire were the work of different enterprises and companies, meaning the colonies were essentially ‘self-managing enterprises.’ However, this changed rapidly as the crown began to take control of colonies involved in trade and shipping. It was at this point, therefore, that Britain began to see the potential of these areas in terms of the raw materials they contained. By introducing policies such as the Navigation Act of 1651 they were able to enforce a closed economy between Britain and its colonies; all imports from the Empire had to pass through England, and all exports from the Empire had to be taken on English ships to the British market.

Throughout the following centuries, Britain’s Empire continued to grow, gaining some of its most valuable

additions such as Canada in 1763 and India in 1858.

As a result, Britain began to expand the range of ways it could make use of its colonies. For example, they were ideal for stationing military garrisons and bases, could be used as land to provide homes for their own population, and their resources could be used to create trading links with other nations. Later in the 20th century, their supply of men would prove invaluable for the Allies in their efforts to gather troops to fight during WW1. As a result, Dr Zoe Laidlaw has stated that ‘Britain’s empire overseas was characterized by its diversity.’

Nevertheless, many of the colonies became resentful of the power the British exercised in their country, and it was this resentment that created the first fractures in the Empire’s seemingly strong foundations. In 1839 it was proposed that some of Britain’s colonies should be offered the idea of ‘limited self-government’; in other words a cabinet of ministers chosen by the people would carry out executive powers in place of the officials chosen by the British Government.

This was put into place in Canada in 1847, and was extended to Australia, New Zealand, and what would become South Africa, at a later date. Eventually these colonies were granted the status of dominions in 1907 as they had such control over their internal affairs.

This marked an effective separation between Britain and these nations, exemplified in the aftermath of WW1 when the dominions joined the new League of Nations as independent states. Eventually in 1931 the Statute of Westminster declared these dominions to be independent countries within the British Empire, of equal status to Britain itself.

For other nations, the path to independence was not so simple. Nationalism was growing in many colonies following WW1, and yet Britain was unwilling to let its Empire fall apart. The result of this was seen most clearly in India, a country which had been described as the ‘jewel in the crown’ of the British Empire.

Their independence movement, led by Mahatma Gandhi, was gaining support across India, with Gandhi overseeing three nationwide movements in 1920 - 22, 1930 - 34 and 1942. Fearful of losing one of the Empire’s biggest assets, the British responded to any signs of resistance with violence. For example, one of the most shocking acts of the British was the Amritsar Massacre of April 1919, when soldiers fired into a crowd of peaceful protestors gathered in Punjab.

However, these acts of violence instead confirmed the popular opinion that Britain was unworthy to rule over India, thereby strengthening the nationalist beliefs of the people.

The turning point for the countries desiring independence came after the end of WW2. Britain was crippled by the war. It owed huge amounts of debt to other countries, and also faced the challenge of how to find the money to rebuild its own damaged towns and cities. It was therefore financially unable to maintain and support its huge empire any longer. Britain’s

position on an international stage also needed adjusting following WW2. Although its part in the war had earned much admiration from other nations, in reality it was the contribution of the USA and USSR that had enabled an Allied victory. These two nations had emerged as the rival global superpowers, completely overshadowing both Britain and its broken Empire.

As a result of all these factors, Britain began to grant independence to numerous colonies, beginning with India in 1947. This continued up until the very end of the 20th century, when in 1997, Britain’s last notable colony, Hong Kong, returned to Chinese rule.

There has been much debate as to the worthiness of the British Empire since its downfall. In the early 20th century, it was declared by Lord Curzon, viceroy of India, that ‘the British Empire is under Providence the greatest instrument for good that the world has ever seen.’ His evidence for this would have been based upon the fact that under British control, medical and educational institutions, new infrastructure and ideas about religion, politics, and science, were being spread across the country. However, this also resulted in the anglicisation of certain colonies, arguable examples being Canada, Australia and New Zealand. In the 21st century most people would now see this as a drawback to the Empire, understanding the importance and value of maintaining cultural diversity. However, the main reason for objections to the Empire is the way the British exploited the riches of the areas they conquered and harmed its indigenous groups, a major example being the slave trade of the mid-17th to early 19th century. This has led to the conclusion that in many cases they did more harm than good to their colonies.

This is noticeable even today, as certain countries previously under British rule, such as Sierra Leone, have struggled to develop their own infrastructure and political voice after years of being suppressed and manipulated by British colonists.

With this in mind, it might be difficult to understand why so many countries would choose to honour the British Empire and the connections it created across the world through joining organisations such as the Commonwealth. When independence was first granted to colonies following the end of WW2, countries were given the option to maintain a connection with Britain and its former dependencies by joining the ‘Commonwealth of Nations.’ Now, this organisation contains 53 nations, 32 of which are republics, 16 which have the Queen as their monarch and 5 which have their own monarch. Significantly, in recent years countries with no connection to the British Empire were permitted to join the group, two of the most recent being Mozambique and Rwanda. This point is one of a few which suggests that the Commonwealth has little connection to its imperial past. For example, it also has no army, no formal trade agreements, and is a group that is joined by choice. Perhaps the only obvious connection of the Commonwealth to the Empire is that the British Monarch remains its head. However, in the

Commonwealth Charter it states that the group is ‘a compelling force for good and ... an effective network for co-operation and for promoting development.’

Even if the British Empire had much to be ashamed of, one of its main prides was the way it helped to bring new developments to poorer countries, and the many connections that it was able to develop between countries.

From this knowledge it is clear that the Commonwealth is a united group of countries that honours their past connections as part of an imperial family. As a result, they have based some of their main values on the most admirable aspects of the British Empire, proving that, to a certain extent, its legacy remains relevant today.

However, the main purpose of the organisation today is really to ensure that in this internationally connected world, the individual experiences and knowledge of all nations can be listened to and acted upon. As a result, all countries can come together to create changes that will ensure a more united and prosperous future.

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