UGAPREMED A MAGAZINE FOR STUDENTS INTERESTED IN SCIENCE AND HEALTH GRADY COLLEGE OF JOURNALISM
E-MEDICINE: BRE AKI NG T HE CODE r o b o ts
web m d
e- cigar ettes
2 TECHNOLOGY AND MEDICINE
FIND US ON SOCIAL MEDIA www.premedmag.org
@ premedmag @ UGAPreMedMag
@ premedmag @ UGAPreMedMag
staff Faculty Advisors Dr. Leara Rhodes
Executive Editors Annika Carter Selin Odman Sona Rao Galit Deshe Heather Huynh Jesse Hu Lily Wang Hanna Friedlander Writers Emma Burke Grant Mercer Hamzah Ali Hallie Smith Leah Ginn Nikhil Gangasani Megan Murphy Rohit Munagala Sarah Caesar
Designers Galit Deshe Melody Modarressi Wayland Yeung Jonathan Cheaves
ANNIKA CARTER Editor-In-Chief
SELIN ODMAN Content Editor
SONA RAO Online Editor
HEATHER HUYNH Operations Editor
JESSE HU Treasurer
GALIT DESHE Design Editor
HANNA FRIEDLANDER Photography Editor
LILY WANG Photography Editor
Photographers Graham Cain Hanna Friedlander Lily Wang Nivedha Balaji Copy Editors Annika Jonker Christina Najjar Monisha Narayanan
4 TECHNOLOGY AND MEDICINE
a message FROM OUR EDITOR
When I was a child — up until middle school, in fact — I did not have a cell phone. My family owned one desktop computer and one TV. My mother watched my brother and I like a hawk to make sure we weren’t spending too much time (or any time at all, really) using these devices. When I was young, without an iPad or cartoons, I had to entertain myself by building Legos or playing make-believe outside. Now, I have my own personal laptop, a television, an Xbox and an amazing computer that I can hold in the palm of my hand — yes, I’m talking about my smart phone. The immense progress that consumer technology has gained in the past ten years makes me feel old! When I see a two-year-old playing on his own iPhone, I feel like a stereotypical grandparent — “Back in my day we didn’t have cell phones…” Technology has become a necessity. It has revolutionized the way that we learn, the way that we think and the way that we interact with others. The innovation in consumer technology is, no doubt, immense; however, immersed in our cell
phones and computers, many of us have failed to realize the life-changing advances technology has made in the medical field. 100 years ago in 1916, just following World War One, the first successful blood transfusion was completed and the fight for contraceptives for women began. Medicine was still highly experimental and unordered. Surgery consisted of a doctor who had no greater idea of what he was doing than you or I would. In the past century, we have developed vaccines that can stop viruses before we ever feel their symptoms, drugs that are capable of making us feel better in just thirty minutes, machines that can look into our tissues and brains and robots that perform careful surgeries in place of the skilled hands of a doctor. Technology has increased consumer knowledge of medical topics, streamlined doctor-patient interactions and increased the flow of scientific information relating to our health. The list goes on. With this issue, I hope to expose the technological advances that have made the miracles of modern medicine possible. Enjoy.
con ten ts 24 SELEX: Evolving Medicine Wayland Yeung explains a new approach to drug discovery.
36 Maybe you Shouldn’t Go to Med School Many people want to go to medical school because of the perfect lives doctors on TV hold or because of the promise of large salaries, but medical school is not easy. In this interview with Dr. Joseph Lee, Doc Thought’s Nirmal Gosalia explores who should maybe rethink their decision to go to medical school. 6 TECHNOLOGY AND MEDICINE
26 Me, Myselfie and I Social media might seem like fun and games, but it might actually be wreaking havoc on its users’ subconscious. Explore how social media can affect your mental health and wellbeing.
38 Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World With the fear Zika virus has been instilling around the globe, guest writers and PreMed Magazine alumni Linh Dinh and Michelle Vu describe the efforts to quickly and effectively create a vaccine to stop the epidemic.
12 RoboDoc – The Future of Medicine? Robotic surgery has made a breakthrough in society, decreasing incision size and recovery time, but should patients be so enamored with the technology? Is it really any better than traditional surgery?
28 The Neuro Revolution: The Next Major Breakthrough of Humanity With the increase in neuroscience technology and understanding of the brain, is society destined for a fourth revolution? After the agricultural revolution, industrial revolution, and information revolution, the neuro revolution might be right around the corner.
41 When Breath Becomes Air Nikhil Gangasani reviews Dr. Paul Kalanithi’s book When Breath Becomes Air, about Dr. Kalanithi’s struggle with a stage IV lung cancer diagnosis.
16 The Internet Told Me Iâ€™m Dying We have all, at some point, turned to Google for medical advice. Leah Ginn explores the accuracy -- or lack thereof -- of the information we stumble upon on the Internet.
30 Your Brain on Multitasking Multitasking is a skill that is lauded in our fast-paced, timeobsessed society, but it comes at a cost. We have all heard over and over the dangers of texting while driving, but other modes of multitasking, including being online during lecture, can decrease our efficiency and retention of information.
CRISPR: The Future is Now
The hip new "MRI"
CRISPR-Cas is a new research technique developed based off of a bacterial viral defense mechanism. Rohit Munagala explores the possible applications of human use of CRISPR -- including viral eradication and genetic manipulation.
An infographic describing diffuser tensor imaging, a new method of imaging the brain and it's many functional connections.
32 A New Face to an Old Enemy Electronic Cigarettes are taking the nation by storm, but are they really healthier than conventional cigarettes? Hamzah Ali discusses the possible effects electronic cigarettes may have on our health.
Telemedicine: The Future of Healthcare
Has Technology Changed Medicine?
Writer Sona Rao explored telemedicine -- a future outlook of healthcare allowing patients to receive care without ever leaving home
Technology has affected almost every aspect of modern-day life. Writer Hallie Smith explored how technologyâ€™s influence has invaded the medical field -from pacemakers to cancer treatments -- and how society has evolved or averted these advances.
35 On The Record Quotes on technology and medicine"
46 By the Numbers A breakdown of medical technology in numbers.
COVER ILLUSTRATION BY GALIT DESHE
THE LEARA SCHOLARSHIP WANNA WIN $500? PreMed Magazine will now be offering a scholarship in each issue. Each scholarship will require a submission from you, our readers. This submission can be a piece of writing, or artwork. In each issue, our scholarship will have a different topic for these submissions.
This month's topic is:
What makes you, you?
To enter, please send an email to email@example.com by January 31st with the following information: - Your Name - Your Email Address - Your Phone Number - Your Local Address - Your Expected Graduation Date - Your Major - Your Current GPA Please attach to this email a file containing your submission. Preferred files are Microsoft Word documents, .jpgs, or PDFs. Remember, this scholarship is open to ALL majors, not just pre-health students! The recipient of this scholarship will be announced in our December 4th issue. He or she will be rewarded with $500 to be spent on furthering his or her education both on and off campus.
8 TECHNOLOGY AND MEDICINE
OUR FIRST WINNER FALL 2016 LEARA SCHOLARSHIP WINNER
CHRISTIAN LAURENT TURN THE PAGE TO READ HIS ENTRY
10 TECHNOLOGY AND MEDICINE
WHAT IS MEDICINE? FALL 2016 LEARA SCHOLARSHIP WINNER BY CHRISTIAN LAURENT | PHOTOS SUBMITTED BY CHRISTIAN LAURENT
Medicine is about patience. This picture was taken in Terrier Rouge, Haiti during Spring Break 2016. Although, it seems as if it were all smiles, this was one of the most frustrating, but eye-opening days of the week during my time in Haiti.
long. He luckily spoke Spanish, so we dove into a deep conversation about how grateful he was for all that had helped him. And with the biggest smile on his face, he asked to keep the metal rod in remembrance of everyoneâ€™s work on him.
Unfortunately, medicine is severely limited in Haiti. Everything has to be used to its maximum potential before it can be discarded. This little piece of tissue in my hand is a reminder of why being patient can go a long way.
Although I found my job of cleaning medical tools to be miniscule, I found that patience was key in solving any problem. Hopefully, I can take what I learned from this experience and apply my definition of medicine to all aspects in my life.
Unlike the United States, many of the medical tools have to be reused in this clinic in Haiti because of the limited resources. Earlier that day, two surgeons that I had the pleasure of meeting (actually in the other picture I attached), had just removed a metal rod in a man that had been inserted there about two years ago. Since the rod had been placed in there for so long, bone and tissue grew in and around it. My job was to remove all the tissue and bone in order to sterilize it and one day for the metal rod to be used again. This little piece of tissue was so cemented to the rod that even the surgeon could not get it off. More than 45 minutes later, I luckily removed it successfully and although this metal rod qualified as being retired now, I had the chance to meet the man who had this rod in his leg for so
robo 12 TECHNOLOGY AND MEDICINE
Sixteen years ago, the Food and Drug Administration (FDA) approved the nation’s first robotic surgical system. Named after a Renaissance master, the da Vinci system promised a revolutionary breakthrough just as its name implied -- a revolutionary breakthrough reflective of the marriage between art and science. Then-FDA Commissioner Jane Henney predicted that the da Vinci would be the “first step in the development of new robotic technology that will change the practice of surgery.” Commissioner Henney’s prophecy has come true, as more than half of today’s prostate, gynecological and gallbladder operations are now performed robotically. In robotic surgery, the surgeon makes a small incision, often no longer than a half inch, and inserts a laparoscope -- a tiny, lighted 3D camera -into the opening. After clipping surgical instruments onto the three pencil-thin robotic arms hovering over the patient, the surgeon takes his or her spot, not standing by the patient’s side, but rather seated at a computer console. Resembling a high-tech video game, the console is equipped with foot pedals and hand controllers designed to mimic the surgeon’s hand, wrist and
finger movements. The controls allow an extensive range of motion and greater precision while the instruments perform complex procedures that would have been far more difficult and invasive using traditional methods. The 3D laparoscope gives a high resolution view of the surgical field, illuminating and magnifying every nuance of the body. The robotic system does not replace the surgeon’s skills, but enhances them. Should the surgeon’s hands tire and tremble during an hours-long operation, the computer automatically smooths out the motion, giving each movement a virtual stillness. If the surgical area is in a tight space, like the back of the throat, the high-definition magnified image allows the surgeon to better see his or her way around the surrounding tissue. Robotic surgery provides numerous benefits over traditional open operations, including faster recovery time (with smaller cuts, healing time shrinks from the usual four to six weeks to a measly one to two weeks); smaller scars, a definite cosmetic benefit when operations must be performed on more visible areas of the body and decreased costs for both patient and hospital due to lesser blood loss and a shorter stay.
BY GRANT MERCER | ILLUSTRATIONS BY MELODY MODARRESSI
oDOC THE FUTURE OF MEDICINE?
However, like all medical procedures, there are downsides to robotic surgical technology. To begin with, the time to perform a robotic surgery is usually longer than traditional methods, increasing the time the patient stays under anesthesia with its potential risks. Additional physician training is also required to utilize a robotic system. While most traditional surgical techniques require a yearlong fellowship to master, certification on the da Vinci varies widely by hospital. At some facilities, certification can be obtained in as little as three surgical sessions while other hospitals require up to 100 procedures before declaring a surgeon certified. This non-standardized training could lead to unequal skills among surgeons, leaving patients struggling to decipher their surgeon’s true expertise on a robotic system. Additionally, mid-operation tech glitches are always a possibility. Should the broadband signal be lost, the screen suddenly fade to black or the instruments simply fail to operate as promised, the surgeon must be capable of performing the operation by traditional methods. Space is also an issue -- robotic surgical systems can be quite large, taking up a great deal of room in an operating room already crowded with a gurney, anesthesia equipment and medical personnel.
14 TECHNOLOGY AND MEDICINE
In the early 2000’s, hospitals, eager to be recognized as technology leaders, began touting their da Vinci capability on billboards, in magazines and on their websites. One billboard emblazoned with a surgeon’s face boasted that robotic-assisted surgery had made him famous. Another hospital’s billboard promised that the da Vinci system transformed lives. One more featured a man happily fly-fishing as he exclaimed, “When I was diagnosed with prostate cancer, I chose da Vinci. So should you!” This direct-to-consumer marketing push has driven the number of robotic surgeries from 1,000 operations in 2001 to over half a million annually in the U.S., with patients often demanding the roboticassisted surgery. Today, over 25% of all American hospitals offer a da Vinci system, according to the American Hospital Association. Fortune magazine noted that up to one third of all surgeries will likely be performed by a robot within the next five years. Hospitals justify the $2 million cost of a robotic system as a means to bring more patients through their glass doors instead of those of their competitors’, according to a Wall Street Journal
survey. Dr. Eric Genden, a surgeon at New York’s Mount Sinai Hospital, observed that, “Patients will go to someone who has the robot because it’s been marketed so much,” also noting that, “This is a beautiful illustration of how American medicine and the patients tend to become enamored of technology without ever really asking the question, ‘What are we getting for the technology?”
“This is a beautiful illustration of how American medicine and the patients tend to become enamored of technology without ever really asking the question” A July 2016 study published in the British medical journal, The Lancet, described the results of a 250-surgery trial, comparing robot-assisted surgery to a traditional version. The researchers concluded that the outcomes of both surgery types had similar outcomes, with the overall skill of the surgeon being the main determining factor of success. The research team wrote that they would, “encourage patients to choose an experienced surgeon they trust, rather than a specific surgical approach.” Nearly two decades after the introduction and
now widespread adoption of robotic surgery, it is interesting that the first comprehensive study comparing these two types of surgeries finds little discernible outcomes. The da Vinci system has enjoyed a virtual monopoly on robotic surgical systems. While the system is now on its fourth iteration, Dr. Vince Loudone of Memorial Sloan Kettering Medical Center noted that, “There are no other true competitors in the field at this time. Even though we are 16 years into this technology, we haven’t seen the innovative breakthroughs that would come from having other players in the field.” In the world of medicine, novelty should not be automatically equated with progress. Robot-assisted surgical systems should be considered an enhancement of the surgeon’s skills, not a replacement of human performance. Robotic surgery may someday evolve to being the gold standard of all surgical procedures, but there is still work to be done. As of now, an experienced surgeon is where you’ll want to turn in times of need.
THE INTERNET TOLD ME
16 TECHNOLOGY AND MEDICINE
It always happens the same way: I experience a few different symptoms, Google them, select an enticing WebMD article and diagnose myself with a terminal illness - all within a mere five minutes. If I allowed the internet to be the authoritative voice regarding my health care the numerous times that this has happened, I would be in thousands of dollars of debt due to multiple tests done in search of a cancer that isnâ€™t there. Though technology has advanced medicine to unprecedented heights within the last decade alone, it also is responsible for millions of inaccurate self-diagnoses and the spread of incorrect healthcare information. The errors made by these health websites may be detrimental for someone who is truly in need of sound medical advice...and that is a big problem for a society thatâ€™s only growing more technologically dependent.
DYING BY LEAH GINN | PHOTO BY GALIT DESHE
In 2012, the online Journal of Pediatrics published a study entitled, “Safe Infant Sleep Recommendations on the Internet: Let’s Google It.” The study, conducted by Dr. Rachel Moon and colleagues, aimed to test the accuracy of medical information found online regarding sleep safety for infants. While the American Academy of Pediatrics (AAP) has published guidelines for reducing the risks of sleep-related infant deaths, such as Sudden Infant Death Syndrome (SIDS) and suffocation, the guidelines are written for clinical professionals, and most individuals seek health care information from websites that contain less medical jargon. The team Googled 13 phrases related to infant sleep safety and compared the medical advice written in the first 1300 search results to the AAP recommendations. Their
were only 8.5% accurate in their information! Also surprisingly, educational websites (like ebooks, peer-reviewed articles, and links ending in .edu) only had 50.2% accurate medical information. These numbers are quite scary for those of us that use the internet regularly to find healthcare information; the statistics prove just how difficult it may be to find reliable and non-contradictory advice regarding our health. Though you may feel like you’ve been lied to for years about all of the knowledge you’ve obtained via a Google search, there is still hope for finding accurate information in the future. Always investigate the websites that you refer to, and remember that .org and .gov sites will be the best place to look. It’s also important that the
43.5% of the 1300 websites contained information in line with the AAP’s recommendations
28.1% of the websites contained entirely inaccurate information
28.4% of the websites were not medically relevant at all findings were (somewhat) surprising: This means that over half of the medical information we find online is either inaccurate or irrelevant. They also studied the types of websites yielded by the search, and discovered that government and national organization websites (ending in .org) provided the most accurate health information, with 80.9% and 72.5% accuracy respectively. Of the 1300 websites reviewed, 246 of them were retail product review sites, which
18 TECHNOLOGY AND MEDICINE
sites update their content, as we all know that medical information in particular is subject to quick change as research and technology progresses. Most importantly, remember that when WebMD tells you that you only have a few months to live, this is likely not the case; by seeking the advice of a trustworthy physician, paying attention to your body and practicing healthy lifestyle choices, you may live for several more decades.
CRISPR THE FUTURE IS NOW BY ROHIT MUNAGALA |
20 TECHNOLOGY AND MEDICINE
ILLUSTRATION BY GALIT DESHE
P I C T U R E A W OR L D WH ERE Y O U C O UL D DE S IG N YO U R O W N C H IL D R E N. A world where you had the power to manipulate your own genome to produce the best version of yourself in your progeny. Regardless of any lingering ethical qualms about gene manipulation, this “science fiction” could be a reality sooner than anticipated because of the accidental discovery of the CRISPR-Cas9 microbial gene editing system. The culmination of chance observations by scientists Yoshizumi Ishino, Francis Mojica and Ruud Jansen, CRISPR is involved in bacterial immune response to invading viruses and pathogens. Ongoing research aims to reengineer the CRISPR bacterial immune system to target and modify specific DNA sequences. Mutations introduced from CRISPR-Cas9 potentially equips us with the tools to not only control our own genes, but also to the transform our biological environment. WHAT EXACTLY IS CRISPR-CAS? Simply put, clustered regularly interspaced short palindromic repeats, otherwise known as CRISPR, form base sequence repetitions in prokaryotes and serve as a DNA archive for their battles against viruses. Whenever a bacterium survives an attack from a foreign agent, it saves a piece of the viral DNA within their genome forming spacer DNA. Spacer DNA from encounters with pathogens form bridges between the repetitions of CRISPR and provide a pseudo-acquired immunity for the bacteria against future attack, similar in theory to vaccinations. When the pathogen invades the bacteria again,
bacteria transcribe the saved piece of virus DNA from the spacer DNA into an RNA copy known as guide RNA. The guide RNA is loaded into Cas9 (CRISPR Associated Protein 9), a DNA endonuclease enzyme that serves as genomic scissors by cleaving DNA at specific sites to add or remove genes. Guide RNA helps Cas9 by binding to sequences of target DNA, complementary to its own RNA bases, essentially binding to the virus DNA from which it was transcribed. In this way Cas9 is able to locate and cleave out foreign bacteriophage and plasmid DNA, thus protecting the bacteria against viral degradation. Scientists began to study CRISPR-Cas9 because of its precision, using it as a tool of genetic engineering. Researchers benefit from the fact that the CRISPR-Cas9 system works on live cells, can switch genes on or off, and functions with a similar mechanism on virtually every type of cell (plants, animals, and microorganisms). Initial tests with CRISPR were able to edit artificial point mutations designed in labs, before moving on to tackling virus-based disease. A huge success came under Dr. Kamel Khalili of Temple University who used the CRISPR system to cleave HIV retrovirus DNA from live mice. Khalili incorporated the HIV genes into nearly every type of cell in the mice’s body and then injected a precise CRISPRCas system to snip off the HIV DNA via two injections to the mice’s tail. CRISPRCas was successful in eradicating the foreign DNA in more than 50% of the different mice cells. Khalili has also been successful in cutting out HIV DNA from cells taken from HIV patients and his results lead to speculation that the advancement of this technology can make fighting HIV as simple as obtaining a shot from your local clinic. WWW.PREMEDMAG.ORG
FUTURE PROJECTS Manipulating genomes is not a new concept; we see the products of genetic engineering in the mass production of insulin, genetically modified crops, and even in glow in the dark zebra fish available for public purchase. However, gene editing has been very expensive and time consuming. CRISPR on the other hand provides a specific, cheap and easy alternative. In theory, the genomic influence granted by CRISPR allows for a high degree of control in manipulating human genomes. With expansion of the CRISPR system, we obtain the ability to not only screen for certain diseases, but proceed a step forward in correcting those mutations in the embryo. Considering over 3000 genetic diseases are caused by a single incorrect base pair, CRISPR could easily rectify small scale mutations. The interesting part about adjusting the embryo genome with the CRISPR system are the implications it has on the human gene pool. Over generations of using CRISPR to eradicate certain mutations in the genome will stimulate a level of microevolution. The reproduction of modified humans will gradually change the gene pool, thus eliminating certain disease. Similar to how we can control the human gene pool, gradual application of CRISPR to other organisms allows for adjustments in traits that we find useful or irritating. For example, CRISPR is being used to modify yeast as a biofuel and mutate mosquitos so they cannot transmit malaria. The precision of CRISPR as a genetic tool allows humankind to manipulate its surroundings for the betterment of the species and its potential is only limited by our creativity.
22 TECHNOLOGY AND MEDICINE
ETHICAL ARGUMENTS AND SUBSEQUENT IMPLICATIONS The CRISPR-Cas9 system is being proclaimed as the next big thing in biomedicine and its growth as a technology will shape mankindâ€™s outlook towards many biologic factors. CRISPRâ€™s simplicity, elegance and precision are contributing factors to the approval its first clinical trials in the US and China to combat some terminal lung cancers. Despite all the success and potential the CRISPR-Cas9 system possesses, there are ethical controversies surrounding the genetic modification of embryos, also known as designer babies. While some argue that modifying humans to defy illness and develop superfluous cosmetic traits is unnatural, there will be few who venture into editing their genome to eliminate a prominent genetic disease running in the family, opening a door of opportunities for genetics. As the practice becomes safer and more accepted, the ethical tide may sway with advocates claiming that not using genetic engineering is unethical because it submits children to undue illness and pain when cures exist. Only time and future discoveries will tell how this plays out. There is a low chance that we will see a genetically perfected human with perfect health, flawless skin and toned muscle build casually walking down the street in our lifetime, but whether you are skeptical or intrigued by the development of CRISPR-Cas9, it will be an interesting area to monitor in the coming decades.
DIFFUSION TENSOR IMAGING A SIMPLE, NON-INVASIVE WAY TO VISUALIZE WHITE MATTER
DTI tracks the movement of water molecules within axons.
Water molecules are forced to move in one direction down the axons because of the myelin sheath.
By tracking the movement of water, researchers can create a 3D image of the white matter in the brain.
THROUGH WHITE MATTER VISUALIZATION CLINICIANS CAN: •
Track the extent of traumatic brain injuries
Track the neural effects of damaging treatments like radiation therapy
Plan more detailed brain tumor removal surgeries
Identify neural infections and developmental disorders
The Next Generation of Drug Discovery Wayland Yeung
hat if there was a system that could discover and produce novel drugs in a matter of days? Such an ability would greatly augment our ability to respond to crises such as sudden outbreaks. Introducing SELEX (Systematic Evolution of Ligands by EXponential enrichment), a process developed independently by Larry Gold and Jack Szostak in 1990 that allows the discovery of high affinity binders for virtually any molecular target. This is accomplished by in vitro evolution where binders are systematically found within a library of random molecules. Successive iterations can yield binders of increasing specificity and affinity for the target. Libraries for SELEX are composed of aptamers, nucleic acid polymers that can adopt secondary structure and act like proteins. Here at the University of Georgia, research on this subject is being done in the lab of Dr. Ryan Hili. The lab has developed a modified version of SELEX that allows the evolution of aptamers with functional groups. An outline and explanation of this process is shown to the right.
library of biotinylated ssDNA
library of dsDNA R
Notable Aptamers Pegaptanib anti-2G12 anti-HepG2 anti-IL6 anti-EGFR Fun Fact
24 TECHNOLOGY AND MEDICINE
treatment for macular degeneration, currently the only FDA-approved aptamer a 2’-deoxy-2’-fluoro modified RNA aptamer developed by NeXstar Pharm. experimental vaccine for HIV a glycan modified DNA aptamer developed by the lab of Isaac Krauss experimental treatment for liver cancer a DNA aptamer utilizing six base pairing developed by the lab of Steven Benner experimental anti-inflammatory a Larry Gold-inspired modified aptamer developed by the SomaLogic Inc. experimental treatment for cancer an amino acid-mimic modified DNA aptamer developed by the lab of Ryan Hili
SELEX is pronounced “selects” Larry Gold, inventor of SELEX, dislikes it when people pronounce it “see-lects”
bt regenerated library of dsDNA
population of binders
with modified aptamers
exposure of library to target
R RR R
R RR R
library of modiďŹ ed aptamers R
R RR R
1. SELEX starts with a library of biotinylated ssDNA template strands consisting of random sequences flanked by two constant primers regions. 2. The template strands are exposed to a premade pool of modified pentamers with a variety of sequencedefined functional groups and the two matching primer sequences. The modified pentamers bind to matching sequences on the random regions of the template while the primers bind their respective ends. Nicks are sealed with DNA ligase. 3. The dsDNA library is denatured and the biotinylated template strand is removed by streptavidin separation. The remaining modified ssDNA strands (with R
Explanation groups) can adopt secondary structure to form the aptamer library. 4. The aptamer library is exposed to a predetermined his-tagged protein target. By random chance, small fraction of the library will bind to the target. 5. The his-tagged protein can be extracted using magnetic beads. Aptamers that bound to the protein will be extracted alongside it. 6. Because aptamers are nucleic acids, they can be amplified by PCR with a biotinyled primer and a nonbiotinylated primer. Following streptavidin separation a new ssDNA library is formed allowing additional iterations of the cycle.
ME, MYSELFIE, AND I BY ANNIKA CARTER | PHOTO BY GRAHAM CAIN
In fourth and fifth grade, my friends started getting cell phones (remember when the SideKick and Razr were the best?). Shortly thereafter, they started making MySpace accounts. Excited to join in on the social media craze, I created an account on my 13th birthday without my mother’s knowledge -- she definitely would have disapproved. I tried the whole social media thing -- posting statuses, taking selfies with friends, “checking in” at my favorite restaurant -- but I never got hooked. As a closet introvert, I have never been one to worry about what others think of me or to broadcast my life to the world.
26 TECHNOLOGY AND MEDICINE
I would much rather keep to myself and my small circle of close friends. Sure, I still have that Facebook account, and I even have an Instagram (created by my freshman year roommate here at UGA), but the number of posts I make on each are pitifully low. I haven’t posted on my Facebook in years (save for the occasional profile or cover photo change) and, for the longest time, my Instagram didn’t surpass nine photos. Now, three years later, my Insta sits at a whopping 33 photos. I did not fall victim to the social media craze, but most young people have not been so lucky.
For many, social media accounts provide a way to stay connected with the outside world while simultaneously remaining removed from it. Facebook, Instagram and Twitter all provide a platform on which someone can create a version of themselves that they are proud of -- perhaps a version of themselves very different from their actual self. And behind that computer screen, they are safe, protected by the 152 likes on their new profile picture. This new socialization brings its own pressures -- pressures to look good, better than that other girl and to be funny and interesting, so that you get more followers than that one guy. Over the years, as the number of watchers, followers, brands, advertisers and sponsors increased, these pressures only grew, creating the perfect cocktail for low self-esteem and self-worth.
of themselves. These users are particularly susceptible to the power of the “like.” But liking is a good thing, right? Well, not so much. Many use social media to get attention and, when they don’t get that attention, it can be hurtful. This attention is often equated as self approval or self worth. Michelle Linker, a daily Instagram user, told The Guardian, “I feel anxiety over how many likes I get after I post a picture. If I get two likes, I feel like, what’s wrong with me?” Some users even delete photos that do not get enough likes. The emotional pitfalls of social media
The evidence of social media’s harmful side effects is not all circumstantial. In 2013, French researchers from the Institut Pluridisciplinaire Hubert Curien published an article describing the effects social media has on its users’ emotions. They found that individuals who spend more time on social media sites tend to have higher levels of depression. This makes sense. Think about it -- when you scroll through Instagram, you look at pictures of your friends and celebrities, thinking, “I wish I had her makeup,” or, “Why can’t I be in the Caribbean right now like he is?” While on social media, even though you might not mean to, you are constantly comparing yourself to others. Many of us social media users fail to take into account that most of what we see is posed, staged and carefully orchestrated to give the illusion of perfection. Social media is not real life. Celebrity stylists spend hours upon hours making their clients look perfect for that one (of one thousand) photo that makes the cut to be posted online. Even our friends and families tend to only post photos themselves at their best. Even we do.
have not been secret these past years. Essena O’Neil, an Australian teenager, quit Instagram after accumulating over 500,000 followers on the platform with her posed, model-like photos. After quitting, she said Instagram is, “contrived perfection made to get attention.” Before quitting the platform altogether, O’Neil exposed the lie behind her beautiful photos, changing the captions to things like: “NOT REAL LIFE - I didn’t pay for the dress, took countless photos trying to look hot for Instagram, the formal made me feel incredibly alone.”
Many view their social media accounts as extensions of their personal identity. This means that every word and pixel is a piece
“most of what we see is posed, staged, and carefully orchestrated to give the illusion of perfection”
Should everyone follow O’Neil’s lead and quit social media? No. Many men and women will continue to use social media and there is nothing wrong with that. Social media is fun -- it is fun to share our lives with friends at home and overseas and exciting to scroll through our feed and see what our favorite celebrities or cats (I’m talking about you, Lil Bub) have been up to. We need remember to occasionally unplug and take a step back. Remember what makes you you, outside of that amazing picture floating around on the internet. We need to remember that we are more than a profile, more than a status. Remember what makes you great in the real world. Because seriously, you are great.
28 TECHNOLOGY AND MEDICINE
Ever since a traumatic skydiving incident that led to numerous scans and operations, Zack Lynch has been fascinated by the inner workings of the intricately complex and mysterious three-pound structure we call the brain. In his book, The Neuro Revolution: How Brain Science Is Changing Our World, Lynch, very much an optimist, mentions the current advances in the field of neuroscience and unfailingly convinces the reader of the promising future it holds. His main argument rests on the field’s capability to impact even the most distantlyrelated areas such as law and finance. In an effort to learn more about these future advances, he sought out some of the most world-renowned neuroscientists and brain researchers to learn how neuroscience can drastically alter our everyday lives.
The Neuro Revolution, a term Lynch coined to describe the fourth major revolution in human history after the agricultural, industrial and information revolutions, is exciting, mind-boggling and, sadly, quite daunting as well. A myriad of arenas in our society today will avail themselves of the new advances that will come about as a result of this new scientific revolution. In the legal system, for instance, brain-based lie detectors will enable us to identify criminals more easily by utilizing a technique known as “brain fingerprinting.” Brain fingerprinting uses an electroencephalograph (EEG) to measure the brain’s electrical activity and its changes in response to rare and common stimuli, which is then presented on a computer screen. In the marketing sector, a similar technique utilizing fMRI technology can gauge people’s emotional
THE NEURO REVOLUTION: THE NEXT MAJOR BREAKTHROUGH OF HUMANITY BY SARAH CAESAR | PHOTO ILLUSTRATION BY GALIT DESHE
states while shopping to understand which products are most attractive to consumers. These breakthroughs could vastly improve society but, like many other successful innovations, they certainly have their drawbacks. For instance, the use of neurolegal techniques like brain fingerprinting and fMRI might work well in open, democratic societies where CIA- and FBIlike agencies can use them to track down guilty terrorists and criminals and free the innocent. However, in autocratic and dictatorial regimes, governments might misuse these same techniques to suppress opponents, leading to more political turmoil and unrest. A whole other arena, known as neurowarfare, also shows us the possible dark side
of this new revolution. Neurowarfare consists of the neurological methods that can be used to punish people in horrific, unimaginably gruesome ways or even perpetuate war between different countries of the world. A sector of neurowarfare consists of so-called psychotronic weapons which would be capable of altering or erasing memories. While a lot of the aforementioned methods emulate things seen in science fiction movies, the reality of possibly utilizing these in the future makes one feel simultaneously exhilarated and uneasy. Considering both the benefits and drawbacks, societies should make careful decisions whether and under what circumstances to utilize these innovative techniques.
YOUR BRAIN ON MULTITASKING BY EMMA BURKE | PHOTO BY LILY WANG
Cramming in time for the latest bingeworthy Netflix series, catching up on social media drama and spending time with friends can seem impossible after a long day of classes and homework (especially if you want to get a full night’s sleep). To squeeze more than 24 hours of life out of one day, many of us resort to multitasking. Logically, doing two things at once sounds like an efficient way to accomplish tasks while leaving yourself with enough time to complete the newest BuzzFeed quiz that will predict your career based on your favorite waffle flavor. As harmless as it may seem, multitasking has a negative effect on our ability to learn and recall information. Recent studies have shown that attempting to do multiple things at once leads to decreased performance in one or more of the tasks. Wood and his team found that students who spend time on Facebook™ or MSN during class tended to do worse on a memory test over lecture material than those who did not. The average scores on the test for those using MSN and Facebook during the lecture were 48% and 50%, respectively. However, texting and sending emails during the lecture did not have a significant impact on memory. The mean score for students texting during the class was 57% and those taking paper and pencil notes was 60%. Researchers attributed the difference in the results to the number of tasks being done at one time. Using MSN or Facebook™ was considered to be multitasking, participants became more off task using 30 TECHNOLOGY AND MEDICINE
these sites than those using email or text messaging, since these tasks did not utilize as many cognitive resources as MSN and Facebook™. It was also found that students who did not use technology during the lecture did better on the memory test than those who did use technology in the classroom (Wood, 2011). In another study, it was seen that 96% of participants completed a task faster and more accurately when focused on one test rather than multitasking. However, the data collected by Lin and his research team also showed that age impacts a person’s ability to multitask more effectively. Participants who were ages 13-20 were finished a test more accurately while multitasking than their older counterparts. Males and females of the same age did not have statistically significant differences in accuracy or time (Lin, 2015). Despite numerous studies highlighting the downside to multitasking, it is a skill praised in modern-day society. When the human brain is multitasking, it comes at a cost. This Divide and Conquer of mental processes in the brain could lead to an increase in the time it takes to complete a goal or decreased accuracy. A study done by Al-Hashimi and his partners showed that participants with more activity in the superior parietal lobule (SPL) while multitasking had a smaller deficit in performance than those with less activity in this region. This region of the brain is a subset of the parietal lobe and plays a role in attention
(Rajimehr and Tootell, 2008). Based on fMRI imaging, they hypothesize that that more activity in the SPL allows subjects to better alternate between tasks. Inability to switch between goals results in a cognitive bottleneck, decreasing efficiency and accuracy (Al-Hashimi et al., 2008). Not only does multitasking result in inefficient cognition, it also can negatively impact the developing brain. A study analyzing media multitasking (MMT) of people ages 13-24 found that those who engage in more MMT on a daily basis have a more difficult time completing a task while distracted. It was also observed that subjects who engage in more MMT have more activity in the right prefrontal cortex while completing an activity (Moisala et al., 2016). It is not yet known how this will impact the brain
post-development, but these results might lead one to speculate that younger generations will have more difficulty focusing in a busy environment. In todayâ€™s fast-paced society, multitasking is being molded into a necessity. Access to information 24/7 via social media has placed an increased value on the younger generationâ€™s ability to complete multiple activities at once, which might come at a price to their developing brains. Even those whose brains are fully developed are not safe from the dangers of multitasking. Trying to meet more than one goal at a time does not increase efficiency, rather, it does just the opposite. So the next time you are in a time crunch, remember to take a break, slow down and focus on one task at a time.
32 TECHNOLOGY AND MEDICINE
A NEW FACE TO AN OLD ENEMY BY HAMZAH ALI | PHOTO BY GALIT DESHE
The world confronts an old enemy today, but it has a new face disguised by false premises. This enemy targets and misleads societyâ€™s youth. Electronic cigarettes are the new forefront of the tobacco industry, outgrowing popularity for conventional cigarettes. Are e-cigarettes leading to a new revival of an old habit or are they actually helping people to quit smoking?
Smoking conventional cigarettes has been strongly and causally associated with several adverse health consequences. The new alternative to conventional cigarettes, electronic cigarettes or e-cigarettes, is marketed as the “safe” new product that all current smokers should switch over to. Many people are under the impression that e-cigarettes are safe or that they are effective in helping people with smoking cessation. Studies by the Food and Drug Administration (FDA) show that e-cigarettes contain many toxins that are harmful in the long run. The safety of e-cigarettes has been questioned by many health professionals. The (FDA) has conducted several studies and the results show that e-cigarettes lead to many negative outcomes. Consumers have the misconception that, since there is no tobacco in e-cigarettes, the chances of developing cancer are very low or nonexistent. However, tobacco is not the main ingredient in cigarettes that causes cancer. Cigarettes contain a vast number of chemicals that are proven to be harmful, and e-cigarettes contain some of these same chemicals. Since 2009, the FDA has proclaimed that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.” For example, in e-cigarette cartridges marketed as tobaccofree, the FDA detected a toxic compound found in antifreeze that has been shown to cause cancer in humans. Studies conducted on e-cigarette liquids show that formaldehyde, another carcinogenic chemical, is released when heated. Exposure to gaseous formaldehyde over many years leads to the proliferation of cancer cells. High levels of nicotine in e-cigarette liquids are used to garner the same effect nicotine in conventional cigarettes provides the consumer. While many people benefit from the positive effects of nicotine, there are many negative effects from exposure to nicotine on adolescents and expectant mothers and their children. Exposure to nicotine
34 TECHNOLOGY AND MEDICINE
during pregnancy harms the developing fetus, causing lifelong consequences for the development of the brain and functioning of the lungs in newborns. It also affects maternal and fetal health during pregnancy and can result in premature delivery and low birth weight. The negative effects of nicotine are not limited to young children or pregnant women. Nicotine has a drastic impact on adolescent brain development. The development of the human brain has a much longer time scale than was previously understood. Early medical research showed that the human brain stopped development around adolescence. From recent discoveries, it is now understood that cognitive development continues through the early 20`s. Nicotine use during adolescence and early adulthood has been correlated with lasting intellectual and behavioral impairments, including effects on working memory and attention span. Although e-cigarettes are fairly new to society and safety studies have only been conducted in the past decade, the results seem to have confirmed hidden dangers. As future leaders of society, it is our responsibility to avoid being deceived by the new face of the old enemy and to help terminate the continual cycle of false, new alternatives.
ON THE RECORD PHOTO BY LILY WANG | DESIGN BY JONATHAN CHEAVES
If I could time travel into the future, my first port of call would be the point where medical technology is at its best because, like most people on this planet, I have this aversion to dying. NEAL ASHER
I fear the day that technology will surpass our human interaction. The world will have a generation of idiots. ALBERT EINSTEIN
In the 20th century, we had a century where at the beginning of the century, most of the world was agricultural and industry was very primitive. At the end of that century, we had men in orbit, we had been to the moon, we had people with cell phones, colour televisions, the Internet and amazing medical technology of all kinds. DAVID GERROLD
Any sufficiently advanced technology is equivalent to magic. ARTHUR C. CLARKE
Technology is a useful servant, but a dangerous master. CHRISTIAN LOUIS LANGE
If we can reduce the cost and improve the quality of medical technology through advances in nanotechnology, we can more widely address the medical conditions that are prevalent and reduce the level of human suffering. RALPH MERKLE
This is the whole point of technology. It creates an appetite for immortality on the one hand. It threatens universal extinction on the other. Technology is lust removed from nature. DON DELILLO
Technology is nothing. What’s important is that you have faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them.
One machine can do the work of fifty ordinary men. No machine can do the work of one extraordinary man. ELBERT HUBBARD
MAYBE YOU SHOULDN'T GO TO MED SCHOOL Are you cut out for medical school? Many of us dream of becoming physicians, but only a few of us will achieve the dream. For some of us, the stress is too much. For others, it’s the costs. For others still, it may be an incorrect fantasy about what being a doctor is like, thanks to dramatized shows like Grey’s Anatomy.
In this interview with Nirmal Gosalia Dr. Joseph Lee describes his unique journey towards medicine and explains the important factors to explore when considering a career as a physician.
36 TECHNOLOGY AND MEDICINE
CAN YOU TELL US A LITTLE BIT ABOUT YOUR JOURNEY TOWARD BECOMING A PHYSICIAN? My name is Joseph Lee and I was born and raised in Chicago to two Korean immigrants. I was born on the North side and went to Chicago public schools. I knew that I wanted to work with children, but I didn’t know what capacity. After four years at Northwestern, I joined a program called Teach for America. I became a 7th and 8th grade teacher in the south shore neighborhood of Chicago. I really enjoyed my experience as a teacher, but I felt very limited. I had thirty students that I had to take care of, but I felt that there were many more kids out there that I could advocate for. I thought that medicine would be the way to do that. I went to medical college for four years and now I am a pediatric resident. IT IS CLEAR THAT YOU PUSH YOURSELF TO THINK ABOUT “WHY MEDICINE?” YOU DEFINITELY HAD THE TIME TO REFLECT ABOUT THAT QUESTION DURING MEDICAL SCHOOL, BUT DO YOU HAVE ANY REASONS WHY YOU WOULD DISCOURAGE A STUDENT FROM ATTENDING MEDICAL SCHOOL? I’ve had this conversation with quite a few undergrads and I think it’s a great question. First of all, I think that medicine is the most amazing career that anyone can have. It is such a blessing to be a physician in the United States, but I don’t think that it’s for everyone. So who are the people who maybe should think twice about going into medicine? Sometimes when I talk to pre-meds, they have an idealistic view of medicine, maybe based on what they see on TV, that they will be saving lives every second of every day and that [being a doctor] is a very glamorous lifestyle. I would ask those students to second guess [their decision to attend medical school] because a lot of what we do is very difficult. A lot of what [doctors] do is very repetitive and can be mundane. There’s just a lot of things that go into being a physician, such as paperwork and the calls you make outside the hospital. Those are kind of aspects that people who haven’t thought much
about medicine are really taken aback by. You do sacrifice much of your 20’s to train. You don’t have the same flexibility as a resident that most people in other careers have. We work most weeks six days a week, if not seven, and our hours are usually longer that a nine-to-five. Vacations are rare in a residency, and not when we plan. You find that you turn 30 and you’re still in training. You miss out on some of the opportunities that some of your peers have, such as purchasing a house, or a car, maybe starting your family, or having children, because of how strenuous your training is. If someone isn’t willing to make that sacrifice [medical school] is a very difficult route. Another reason that I would have someone think twice about medicine is the burden of monetary loans that you need to take on to go to medical school. The average loan of a [medical] student can range between $200-$250,000. That’s a lot of money. I think when I first saw those numbers when I graduated, it was a little difficult. If you go into a career such as primary care, it is not easy to pay those off within one or two years. Another reason I would discourage a student from going to medical school would be if they have any other interests or possible career options that they are considering. The reason I say that is once you enter medical school and residency training, there aren’t a lot of plan B’s. So if someone is 50% medicine, 50% any other career, they should really consider that other career first. You really want to make sure you’re going into the field that is right for you because once you enter medical school, with the exception of a few people, it is basically
"You do sacrifice much of your 20's to train." a lifetime commitment. You really want to be sure you are ready for that. I would be lying if I said that it has all been very easy and I’ve never wanted to take more time off or wanted to have more of a Monday through Friday 9-5 life. But I would say those thoughts are very rare and I have many more thoughts of feeling blessed to be in medicine and enjoy my career.
To see the full interview or others like it, visit www.DocThoughtsMed.com.
AHH TO ZIKA!
LINH DINH, BSFCS IN HUMAN DEVELOPMENT AND FAMILY SCIENCE, UGA CLASS OF 2016 MICHELLE VU,PHARMD/MPH CANDIDATE CLASS OF 2018 MERCER UNIVERSITY
Would you think of a zombie outbreak to be a fascinating Halloween happenstance? Well let’s just say there’s no competition between the Walking Dead and the Zika outbreak. Zika is here and it is spreading, fast! Scientists are scrambling to respond and understand the virus. Scientific studies have reported that the Zika virus (ZIKV) is a mosquito-borne virus transmitted through monkeys, with humans being the virus’s occasional hosts. The major outbreak is threatening the lives of many throughout Africa, Southeast Asia and the Pacific islands. The good news? We know the source of this public health emergency and we’ve prepared methods of approach towards a solution such as Zika virus inactivation and genome-based vaccine developments and accessible resources such as the ZikaVR database to help catalyze vaccine discovery. The bad news? In early 2016, World Health Organization (WHO) declared Zika to be a worldwide emergency epidemic threat…Uh Oh! Even more horrifying are the effects it has on mothers and babies: a new study looked at the brains of 45 Brazilian babies whose moms were
38 TECHNOLOGY AND MEDICINE
infected with Zika while pregnant (Belluck, 2016). Zika can cause babies -- especially those born in Latin America and the Caribbean -- to be born with abnormally small heads. The study also reveals that Zika damages parts of the brain that control movement, speech and emotion. Unfortunately, Zika has now reached Miami, a major tourist attraction and metropolis, and the CDC now recommends against traveling to Miami-Dade County as well as other target areas (CDC, 2016). Even men are not safe: asymptomatic men can pass on the virus to their sexual partners and the fetus (CDC, 2016). As of yet, there is no vaccine, but scientists are working aggressively in hopes of developing one. Symptoms of the infection are essentially similar to that of a common cold, often leading to severe fevers and headaches, rash, malaise and chills (Gupta et al., 2016). What worries healthcare professionals and individuals alike are the asymptomatic factors which could lead to potential fatalities. The pressure is on to find out how to stop this epidemic...stat. The race to create
HH the first Zika vaccine has begun! With such a short countdown clock, waiting 3 or more years to develop a vaccine would be detrimental. But thanks to the silicon and genomic boom of the early 21st century, scientists are developing interdisciplinary, high-tech approaches that make traditional vaccine development look inefficient and antiquated. Traditional vaccine development research is akin to grafting a new tree from a source tree: vaccine components are taken from the original virus and inactivated, conjugated or broken down. This way has worked for centuries, ever since Pasteur created the rabies vaccine. The National Institutes of Healthâ€™s National Institute of Allergy and Infectious Diseases (NIH/ NIAID) Stage I clinical trial vaccine candidate was created using a traditional approach, Zika virus inactivation. However, using a traditional approach can take years to develop a viable candidate (Gupta et al., 2016). Also, some viruses can not be cultivated in large quantities and handled to make these vaccines.
The sequencing of the first organism genome has paved way to a new path of vaccine discovery: genome-based vaccine development or â€œreverse vaccinologyâ€?. Using a viral genome and computer processing system that can screen large amounts of candidates, researchers can predict suitable protein structures, those that induce human immune-response and can be surface-exposed, to develop into vaccines (Moriel et al., 2008). In this way, researchers are using the blueprint of the source, selecting the structures of interest, and building a new model with only the desired features. Several vaccines under development, such as for malaria and anthrax, have been synthesized using genomebased methods. However, the most outstanding challenges include difficulty identifying nonprotein virulent structure (e.g. polysaccharides) and incomplete information on viral genomes. Nevertheless, researchers have innovated methods to applying reverse vaccinology to Zika vaccine development.
A study published in Nature by Gupta et al. provides a database to help catalyze drug discovery. Generally, to synthesize an antiviral, researchers have to know the virus: its M.O. (rNA virus, DNA virus, or something new) and how its genetics relate to its viral activity. That’s why Gupta and colleagues integrated the genomics “multi-omics platform,” creating a map terrain of the genes, proteins, and potential-therapies of Zika. Drug designers can now ask questions such as, “How is Zika similar to other viruses?” and “What drug therapies could be effective against Zika?” and use the database to discover their answers. Another powerful feature of this platform is the ability to compare different viral strains and sequences (Dengue, Yellow Fever, etc.) to Zika, a field called comparative genomics. If you are interested in bestowing a deeper understanding of Zika, more information is available on the user-friendly engine called ZikaVR.
All aspects considered, ZIKV demands an international collaborative effort with interdisciplinary approaches in order to reduce and prevent the risk of further transmission in concerned regions and non-affected countries. Future developments and approaches include testing efficient vaccine candidates in the advent of next generation sequencing (NGS) platform that is able to decipher specific diseases (i.e. single nucleotide variants (SNVs)), mutations, epigenetic events and so on). Furthermore, the NGS data analysis tools will provide healthcare advocates with better insight of existing known variations relevant to distinct diseases, potentially providing a comprehensive basis for personalized medicine. We, as a growing technologically advanced world, can rest a little easier knowing that researchers are indeed guiding themselves toward the development of effective therapeutic solutions and vaccines.
GENES AND PROTEINS Figure: Structure of the ZikaVR web platform, which connects libraries of interdisciplinary fields to advance efficient vaccine development
ZIKA BROWSER 3-D STRUCTURES
• PHYLOGENETIC ANALYSIS • CODON USAGE • CODON CONTEXT • CpG ISLANDS • GLYCOSYLATION SITES
• Zblast • ALIGN VIEW • BLOCKCON • GENOPLOTTER • Str3D • PHYSICOPROP
ZIKA VIRUS RESOURCE
• FAQS • TEAM • CONTACT • EXTERNAL LINKS • WORLDWIDE NEWS • JOURNAL ARTICLES
DIAGNOSTICS AND POTENTIAL THERAPEUTICS VACCINE EPITOPES (B-CELL, T-CELL, MHC BINDERS)
40 TECHNOLOGY AND MEDICINE
• siRNAs • miRNAS • sgRNAs
MOLECULAR DIAGNOSTICS PRIMERS
PUTATIVE DRUGS (REPURPOSING AND TARGETS)
BY NIKHIL GANGASANI BOOK COVER FROM PAULKALANITHI.COM
Title: When Breath Becomes Air Author: Dr. Paul Kalanithi Price: $15.00 Hardcover, $12.99 Kindle
Imagine you are close to crossing the finish line of a grueling seven year residency in neurosurgery. You have worked hard to put your medical career on a trajectory for great success. You are finally getting ready to start a family. All of a sudden, everything changes. Your diagnosis: stage IV lung cancer.
Dr. Kalanithi splits When Breath Becomes Air into two parts: the first, his life leading up to his cancer diagnosis; the second, his life with terminal illness. As Kalanithi grows before the reader’s eyes in the first part of the book, his potential to make a monumental impact on the world becomes readily apparent -- by his thirties, Dr Kalanithi is a resident in neurosurgery at Stanford with top awards for his research in neuromodulation. Sadly, this trajectory turns to tragedy as the hero of the story, a thirty six year old, fit physician with no history of smoking, receives a diagnosis of metastatic lung cancer. Guiding the reader through his grief with utmost honesty, Dr. Kalanithi supplements his visceral judgment with great wisdom and insightful existential commentary. On the purpose of the physician: “...the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” Dr. Kalanithi lost his life battling cancer, but his wisdom, wit and spirit live on in When Breath Becomes Air. Just as Dr. Kalanithi’s life came to an end all too soon, so too does this beautifully crafted masterpiece.
TELEMEDICINE THE FUTURE OF HEALTHCARE BY SONA RAO| PHOTO FROM FIERCEHEALTHCARE.COM
What if it was possible to receive medical recommendations or diagnoses from a doctor without stepping out the door? Telemedicine is a prime example of how technology has enabled the field of medicine to reach new heights and has redefined the level of potential that health professionals and organizations have to increase the quality and effectiveness of care in the United States. Telemedicine is the exchange of medical information and services through electronic communication. With the widespread digitization of everyday tasks, organizational operations, and interpersonal communication, the healthcare industry is presented with a massive opportunity to transform the way patients receive care by improving the access of care, quality of care and relationships between patients and providers through telemedicine. Telemedicine can reach a wide population because technology is ubiquitous. Telemedicine traditionally occurs via videoconferencing but can also take form as emails, text, phone or tablet applications, websites or larger telemedicine equipment that include ancillary features such as heart rate monitors and ear inspection devices.
42 TECHNOLOGY AND MEDICINE
Each type of communication is designed to exchange data in many forms from numerical data like weight to to images of skin conditions. Because telemedicine is so flexible, it is a viable solution for many different types of health services. Psychiatry is the most popular use of telemedicine because there is very limited palpation involved in psychiatric care, so the doctor and patient can easily have discussions via phone or video call. Dermatology and Wound Care are the next two most common fields for telemedicine use because cameras can capture wounds and skin conditions from many angles. There are many more areas in which telemedicine is effective, such as oncology, ophthalmology and diabetes care. Telemedicine is particularly useful in nursing homes, where patients are typically immobile and are at risk of injury while commuting to care centers, especially in rural areas where the commute is longer. Variety and accessibility are not the only advantages of telemedicine. The benefits of using telemedicine as a means of patient care are plenty. While some may argue that speaking with a
doctor virtually would not foster the patient-doctor relationship as well as face-to-face appointments, the National Institutes of Health states that the frequency of meetings would increase with the use of telemedicine, thereby improving the communication and level of trust established in the relationship. In the long run, telemedicine reduces operating costs for hospitals and other health centers because doctors can cut travel between locations to visit their patients. Telemedicine increases patient adherence to medical recommendations because doctors will easily be able to hold their patients accountable for taking their medications and developing healthy habits. Mobile health also increases access to health resources through information sharing; providers can announce opportunities like support group gatherings and education events verbally or through email. While telemedicine can provide many benefits to the healthcare community and patients, it also comes with challenges. The highly-regulated environment of the industry makes implementing new technology difficult. The extensive training required for nurse practitioners and providers to learn the system can delay operations. This
potential delay is the reason why many providers are hesitant to adopt a new system. Additionally, senior patients may have difficulty videoconferencing if they are experiencing hearing or vision loss. The higher the quality of the videoconferencing system, the lower the rate of patient dissatisfaction and technical difficulties. High quality videoconferencing telemedicine systems can be expensive to adopt, especially those with augmented examination tools. However other forms of telemedicine, such as email, are not expensive. Government subsidies are for adopting telemedicine are becoming more common, so health centers will have more access to the resources necessary to implement telemedicine.
Overall, telemedicine is advancing the way medical practices are carried out, and while it may take time to implement, a medium for open two-way communication will benefit both patients and doctors. The role of the provider is changing because now more than ever, technology allows information on personal health to be more interoperable and accessible and fosters a better relationship between stakeholders in the healthcare environment.
HAS MEDICINE CHANGED BECAUSE OF TECHNOLOGY?
BY HALLIE SMITH | PHOTO FROM FLICKR.COM
Technological advances have not only improved the processes used in the industrial sector of society, but have also drastically altered the way we live our day-to-day lives. One hundred years ago, no one would have thought about heating dinner in a microwave or hopping on an airplane to fly half-way around the globe. In modern society, incessantly ringing cell phones are commonplace; many with numerous apps capable of changing the temperature of your home, tracking your heart rate or suggesting healthy bedtimes and calorie intakes. This influx of technology generated an inverse correlation between efficiency and employment levels. While the economy has turned from one based on agriculture to one dependent on industry, social classes have shifted and labor-saving machines have taken over jobs. Since machines
44 TECHNOLOGY AND MEDICINE
have increased the efficiency and decreased the cost of production, more people are earning less money, causing a boom of population within the lower class. Family organization is no longer important. Technology does allow us to know what our friends and family are doing, but more emphasis is put on the outside world rather than the intimate relationships that families provide. Children become less interactive with their parents and the husband and wife connection grows weaker as each member of the family bonds to technology. Religious foundations are shaky. Technology has given people an outlook based on rational and scientific premises. With everadvancing abilities to connect DNA samples, or determine the age of artifacts found at an archaeological dig, faith and trust are no longer necessary. People are more dependent on the
knowledge they have acquired to make decisions than their religious beliefs. As all of these technological changes have influenced American society, technology has also had a strong impact on the medical field. No one ever thought that a pacemaker could control an irregular heartbeat. Nobody knew that insulin could treat diabetes. No vaccines were known to prevent diseases. All of these treatments have been discovered within the last 100 years. No wonder our population’s average age is growing older and older by the minute. With such progressive medical practices, society has been able to push on through the many storms of life and, most of the time, prevent them before they even spark. Each human being can now be investigated and defined at an individual level. Instead of testing an entire population for a specific condition such as breast cancer, technology is giving us the ability to individualize the methods for screening and treating illnesses. Doctors are able to focus on preserving health rather than preventing illness. This idea is shown through their ability to run an entire genome of a fetus to search for abnormal conditions expected after birth. On the other end of life’s spectrum, DNA testing can help in determining the cause of death. Every molecule of one’s body
can be understood and analyzed to better care for that individual all throughout his or her life. Yet, there are hindrances to the gastronomical improvements in medical technology. The greatest impetus for the medical field is the controls that the government has placed on local hospitals and doctors’ offices’ practices. The gridlock between the government and medical community does not allow for improvement of common practice; therefore, medical care given today is “one size fits all.” This approach cannot be expected to provide an accurate determination of illness in real life. Additionally, the pharmaceutical industry is not inclined to produce medicines for a defined section of the population as this may not produce the largest profits. On top of that, regulatory agencies are unwilling to take risks. With all of these hurdles to jump, prevention of disease has been put on the back burner. As medical technology has improved, governmental practices have not. It is important for policies to shift as technology does so that medical care does not fall behind. The past 100 years have held great improvements for medical technology and practices. May the next 100 years be just as progressive.
number of robotic surgeries performed in the U.S. in 2012
number of times radiation from a CT Scan as compared to an X-Ray
percent of healthcare providers who say patients often bring information from the internet to discuss.
BY TH NUMB
A BREAKDOWN OF MEDICAL TECHNOLOGY IN NUMBERS.
average incision size from a robotic surgeon
46 TECHNOLOGY AND MEDICINE
number of medical device companies in the U.S.
year the first robotic surgery was performed
net worth of the medical technology industry
percent of helthcare providers concerned that patients are often unable to find reputable health content online
percent of healthcare providers who believe technology has impacted the quality of interction with patients
percent of healthcare providers who believe technologyÂ´s impact has been negative
115020 - MCG UGA Pre Med Ad Winter copy [VERSION 5].pdf
They chose to serve. At the state of Georgia's public medical school, our students define us. They are academically excellent and personally altruistic. They consistently rank at or above average on objective measures such as the Medical College Admission Test and United States Medical Licensing Exam. They consistently secure spots in the nationâ€™s top residency programs. They volunteer to tutor and mentor local grade-school students. They help ensure our urban neighbors get seasonal fresh fruits and vegetables. They work in clinics for the underserved. They even inspire the next generation by sharing what its really like to be a doctor with high school and college students from underrepresented-in-medicine populations across our vast state. They are great students who become great doctors.
Come change the world with them. augusta.edu/mcg