PPHR Magazine (Issue 2) by Princeton Public Health Review

P P H R

2017 PPHR

This publication is supported by funding from the Princeton University Global Health Program and Center for Health and Wellbeing.

The Princeton University Public Health High School Essay contest was conducted in partnership with the Program in Teacher Preparation at Princeton University.

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Editorsâ&#x20AC;&#x2122; note T

he realm of public health, which is dedicated to protecting and improving the health of communities as a whole, is affected by a wide variety of factors. On one hand, medical breakthroughs and scientific innovations improve our ability to diagnose and treat diseases. At the same time, however, sociopolitical factors also greatly influence the extent to which global health interventions help to improve population health. The increasing health disparities in our society due to the societal and political environments suggest that a lot more needs to be done despite scientific progress.

The Princeton Public Health Review has been dedicated to informing the Princeton community about public health events and research going on globally. Our goal has always been to shed light on the key health needs, disseminate information about developments in public health and science, and start a discussion within the Princeton community about these issues. This year, the Princeton Public Health Review expanded its reach beyond the Princeton community and engaged high school students to begin thinking and conversing about global health concerns ranging from mental health to climate range to infectious diseases and so on. This magazine features content created by our writers about global health concerns plaguing the world today. It also includes top submissions from the 1st Princeton University Public Health High School Essay Contest launched by PPHR in conjunction with the Program in Teacher Preparation at Princeton University. We hope that you, by picking up this issue, will engage in this conversation to bring to light the pertinent health needs and overcome the global health challenges present today. Aastha Chokshi & Karmen Rivera Editors-in-Chief

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Contents

articles from the writers of pphr

4 Combating Blood Shortage: In vitro Red Blood Cells 6 Emergence of Extensively Drug-Resistant Tuberculosis Holds Unsettling Consequences 7 Predictive Measures for Organ Transplant Rejections 8 The Food Paradox: An Augmenting Connection Between Obesity and Malnutrition in Developing Countries 10 Paperwork and Physicians: Medical Documentation in the Information Age 12 Development of Novel Flow Cytometry Technique to Study Yellow Fever Virus 14 Airstrikes Destoy All Hospital in East Aleppo: Dangerous Repercussions for Civillian Health 15 The War on Disease: The Creation of a Global Vaccine-Development Fund high school essay contest winners

16 Are Video Games Really... “Mindless”? 18 Untreated Mental Illness: The Causes and Effects featured artist sandra carpenter

20 Face Time for Children with Craniofacial Disorders

Staff Editors-in-Chief: Aastha Chokshi ‘17, Karmen Rivera ‘18 Managing Editors: Francisca Bermudez ‘18, Julia Song ‘18 Design Editor: Sarah Santucci ‘17 Treasurer: Minjia Tang ‘18 Cover Page Art: Sandra Carpenter ‘18 Article Art: Sandra Carpenter ‘18, Sarah Santucci ‘17 PPHR

cOMBATING B

LOOD IN VITR O RED SHORT BY SHA RON W BLOO ASHIO D CEL AGE: LS

DONATION DEPLETION

At any given time, or more exactly every 2 seconds, blood transfusions are needed for complicated surgeries, treatments, accident victims, sickle patients, pregnancy complications, severely anemic children, and more. While blood can be donated even concurrently with the use of medications like aspirin, and in the U.S. approximately 38% of the population is able to donate, less than 10% do, according to the Red Cross. Even donated blood does not last forever and there is a constant shortage problem that, unless donors increase, is projected to rise due to longer lifespans, the limited shelf life of blood, blood requirements, and the specificity of blood types. The scarcity of blood supplies often prevents necessary surgeries and treatments from reaching a loved one.

CELL LINE SUBSTITUTE The appeals of in vitro blood, or blood made in a laboratory setting, is that it is more reliable and safe than in vivo blood, which must undergo screenings prior to use.

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Recently, researchers K. Trakarnsanga, R. Griffiths, M. Wilson et al. developed the Bristol Erythroid Line Adult (BEL-A), the first human immortalized blood line that successfully undergoes erythrocyte reproduction. Prior to

BEL-A CELL

this, efforts to cultivate blood in vitro through means such as pluripotent stem cells, adult peripheral blood, and umbilical cord blood had encountered the problem of producing cells with nuclei, which is problematic because normally red blood cells do not contain nuclei as that would diminish their functionality.

DUPLICATING NATURE In this study, cells were immortalized by the integration of the Human Papilloma Virus (HPV) gene. This was done by using a Tet-inducible HPV16-E6/E7 expression system on adult bone marrow, which is the location of blood cell production. Immortalized cells are mutated in a way that they engage in constant cell cycles, though they do not overpopulate in the way that cancer cells do.Throughout the experiment, the researchers froze the cells periodically and the cells were shown to maintain function after thawing. Over 100 days, the cells were very stable, exhibiting no change in shape or quality. Centrifuging the samples demonstrated their ability to carry oxygen through the production of red pellets, which indicated the presence of the protein hemoglobin. The cultures were then exposed to the antibiotic doxycycline for six days to enucleate them and make them mature, with a 30% of the samples effectively

HPV gene

cell s wit are tra h an nsf ma ke t HPV ormed hem gen imm e to orta l

d forme s n a r re t e to cells a HPV gen tal an mor with m im e h t make

losing their nucleus and the rest filtered out for future use. The successful mature cells also lost the HPV gene after being treated with doxycycline. The researchers compared their samples to cells made from adult peripheral blood, and found the size and the shape of the immature and mature cells of the two samples to be similar, even during replication. The blood type of the sample corresponded to that of the donor whose bone marrow they used. As for the immature red blood cells or reticulocytes, they are often used in tests of bone marrow conditions. The reticulocytes produced in this experiment were found to have the same types of proteins as normally produced reticulocytes in adults. When reintroduced into the human body, the reticulocytes matured as expected and carried out red blood cell functions.

doxycycline

WORK IN PROGRESS Even in a continuously stirred system, the growth of the BEL-A line remained stagnant, which is a factor to be considered for large-scale production. Future investigations

Even though this is a huge turning point in medicine, an increase in

blood donations is still essential.

include successfully enucleating more of the samples and working on more efficient ways of separating the blood into mature and immature cells. Apart from that however, not only is BEL-A a viable adult cell line, but it also allows for meticulous testing to be done

on related diseases such as anemia, leukemia, sickle cell disease, parasites and more. It is exciting to think of the possibility of needing only a few donors of every blood type to sustain the different lines, and of the prospects of being able to donate blood to developing countries that do not have access to a safe supply. Yet, even though this is undoubtedly a huge turning point in medicine in progress, the regular use of artificial blood in clinical settings is still a far reality and an increase in blood donations is still essential. and its references can

This article and its references can be found on the PPHR website at pphrblog.wordpress.com

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Global

Emergence of Extensively Drug-Resistant Tuberculosis Holds Unsettling Consequences BY AVA TORJANI

recent study found that a rare form of multi-drug resistant tuberculosis (MDR TB), called extensively drug-resistant tuberculosis (XDR TB), has been spreading across regions of South Africa and currently has no effective treatment for or prevention against it. Although in much smaller numbers, cases of XDR TB have also been reported in countries including the U.S., Russia, and Brazil. Tuberculosis (TB) is an airborne disease characterized by coughing – occasionally with blood – fatigue, fever, and weight loss. Although it usually affects the lungs, it can also cause issues with the liver, kidney, and heart, which leads to detrimental outcomes including meningitis and heart failure. It is one of the top ten causes of death globally, and is the number one killer of HIV-positive patients. Typical treatment constitutes a six-month course of antimicrobial drugs with extensive supervision to ensure prescription adherence. The Bacille Calmette-Guérin (BCG) vaccine is used to prevent severe types of TB in children but is an ineffective prevention measure for adults. As of 2013, there have been 450,000 reported cases of active TB, showing an increase of 400% over the last fifteen years. While MDR TB is resistant to first-line drugs like isoniazid and rifampin, it can be effectively treated with second-line drugs, albeit with slightly worse side effects and a longer, twoyear treatment span. Unfortunately, XDR TB includes resistance to both first-line and at least one second-line drug, making it substantially more difficult to identify new, equally effective treatments. In fact, the current treatment for XDR TB has more side effects, is costlier, and can only be applied to 30-50% of those who get XDR TB. With a combination of treatment difficulty and the fact that 95% of cases occur in low- or middle- income countries, XDR TB has an alarming fatality rate of 50 to 80%. Causes for the emergence of this strain of TB include lack of proper adherence to medical prescription (dosage and time), re-development of the disease after having already taken medication for it, and proximity with someone who has it, given its airborne nature. If you are 6

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exposed to someone with XDR TB, it is recommended you get a TB skin test or a QuantiFERON®-TB Gold test at a medical center as soon as possible. However, testing highlights yet another concerning matter on this strain of TB: to distinguish between drug-susceptible and drug-resistant TB, extra tests need to be conducted that can take 6 to 16 weeks to get conclusive results. Dr. Michael Gardam, a doctor managing the TB clinic at Toronto’s Universal Health Network, effectively sums up all issues associated with XDR TB in the following statement: “We all know that tuberculosis is something that spreads between people, but it just hasn’t been as big a focus with XDR and MDR [multi-drug resistant] TB because there’ve been so many treatment failures that have caused [new] cases.” All in all, though primarily concentrated in South Africa, the infectious nature of XDR TB highlights the need for effective treatment of and prevention strategies against it.The Centers for Disease Control and Prevention (CDC) proposed several suggestions, including improving accessibility to TB drugs and healthcare providers, establishing more efficient diagnostic tests, and boosting preparedness for outbreaks. However, if no action is taken, XDR TB could soon become similar to the recent unexpected, contagious outbreaks of Ebola or H1N1 flu. Therefore, the emergence of this deadly strain of TB is a warning not only to those living in susceptible regions of South Africa, but globally, since drug resistance is a very common phenomenon. This article and its references can be found on the PPHR website at pphrblog.wordpress.com

Global

Predictive Measures for Organ Transplant Rejections

By YUSHA SUN

ust recently, the Ebola outbreak lead to over While organ transplant operations have been increasingly successful over the past few years, the ultimate concern is whether the transplants will be successful in the long term. Unfortunately often, organ transplants get rejected, as the bodyâ&#x20AC;&#x2122;s immune system may suddenly attack the donor organ and cause it to fail. In heart transplants, the rate of organ rejection and patient mortality are the highest, even though the transplants are monitored by regular biopsies. Specifically, some 40% of heart recipients experience some type of severe rejection within one year of their transplant. It is clearly important to develop methods to detect the possible transplant rejection sooner, especially for organs like the heart. The solution might come from developing predictive measures for other types of organ transplants. For example, patients with Type 1 diabetes sometimes undergo islet transplantation, which is the replacement of clusters of islet cells in the pancreas that control the blood sugar levels. High blood glucose levels are often indicators of tissue rejection; yet, this is only observed when rejection is imminent and at an advanced stage. Since almost 15% of islet transplant patients experience acute rejection, there clearly is a necessity for a better and earlier way to detect if an organ transplant might possibly be rejected, so that doctors can interfere before cell damage spreads dangerously and enhance patient survival rate. Recent studies have developed biomarkers to detect the possibility of islet transplant rejection, which shows promise in lowering the rate of acute rejection, and might plausibly be applicable to other organ transplants, such as the heart. Here we present one such study. Specifically, researchers at University of Pennsylvania published a study in late March in which they used exosomes to determine whether islet cells might be rejected by the body. Exosomes are small vesicles, or bodies, outside of the cell that are released by various tissues into the bloodstream or other bodily fluids. Because these exosomes represent their tissue of origin biologically, quantifying and characterizing their presence within the

bloodstream could serve as a biomarker for the new islet cells. First, by transplanting islets from the human pancreas into diabetic mice, the researchers confirmed that exosomes released by islet cells express a certain protein on their surface, the HLA antigen. They then showed that a drastic decrease in the number of HLA-carrying exosomes in the bloodstream is almost always observed prior to an increase in blood sugar levels in the mice, which indicates a high likelihood of rejection. Besides the change in the number of exosomes detected in the bloodstream, an analysis of specific RNA and protein compositions of exosomes revealed numerical differences between normal exosomes and possible rejections. To test their claim from their mouse models, the researchers attempted to detect islet-related exosomes in a clinical setting. In all the patients tested, exosomes from the donor islets could not be detected prior to transplant, as expected, while after the transplant, exosome levels became quantifiable. Notably, in one out of the five patients tested, a decrease in the number of cell exosomes was observed six months before the blood glucose levels rose, which thereafter led to rejection. The other four patients that did not show a drastic change in exosome level did not experience rejection, even after 5 years of follow-up. The researchers also managed to quantify and characterize exosomes from urine, showing the plausibility of utilizing this method in renal (kidney) transplantation, alongside pancreatic islet transplantation. Indeed, the application of exosome detection as a biomarker for islet and renal transplants provides a solid foundation on which organ rejection can be predicted. Because the specific RNA and protein compositions of exosomes can also be analyzed, the exosome tool might have many future applications in other organ transplant models, such as heart or lung transplants, and even in other fields, such as stem cells and cancer. Overall, exosomes have been proposed to be a powerful predictive tool in the clinical realm of islet transplantation, which, with more research and trials, can be applied in predicting whether a patient will likely reject their organ many months before current standard techniques could. This article and its references can be found on the PPHR website at pphrblog.wordpress.com PPHR

The Food Paradox:

An Augmenting Connection Between Obesity and Malnutrition in Developing Countries By Mimi Chung

A PARADOXICAL PAIRING Obesity, a growing problem in industrial and post-industrial countries, is in many areas intertwined with malnutrition. Though many industrial nations have seen a sharp increase in the number of people facing problems stemming from obesity, such as heart disease and diabetes, hunger and undernutrition still persist in wide swaths of the same nation. In China, 100 million citizens faced obesity in 2009, while 200 million suffered from undernutrition. Increasingly, developing countries face the double threat of the food paradox: confronting over and undernutrition at the same time.

these overweight individuals live in developing countries, indicating the increasing prevalence of these nations having both an obesity epidemic and persistent hunger. Nutritionists have coined the phrase “nutrition transition” to define the phenomenon—as the area becomes more wealthy, those with more access to resources will naturally increase in weight much faster than those without. However, this phrase suggests that eventually, the entire country will soon face a uniform struggle

sense logicallyr—with more money, people can buy more food and are thus at more risk for gaining too much weight. However, those in poverty can and do face the same nutritional issues as those with a higher income. Especially prevalent in more well-off nations is the existence of a high poverty, high obesity connection. As countries become more industrialized, high calorie and low nutrition foods becomes cheaper and easier to obtain, and food deserts, or areas with few options for healthy foods like fresh fruits and vegetables, grow more prevalent in large cities.

developing countries face the double threat of the food paradox: confronting over- and undernutrition at the same time.

COMMON ISSUES The World Food Programme estimates that some 795 million people around the globe still face severe problems with hunger and food insecurity, with a majority living in developing nations. Even as statistics for the number of undernourished people slowly decline, stunting in children suggests that much more needs to be done: for example, South Africa reports approximately 12% of their children as underweight, and 27% as still exhibiting signs of stunting. On the other hand, global trends reveal that obesity has continued to increase, even in nations still struggling with hunger—one in three people around the world are overweight, with an increase of 4.5% in children from 2000 to 2015. Surprisingly, 62% of 8

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with obesity. Real-life statistics paint a much more nuanced portrait of the future. MISCONCEPTIONS Though a stereotypical portrayal of obese people commonly connects higher weight with increased wealth and access to more food, overweight individuals can be found at both ends of the socioeconomic spectrum, often dictated by the relative wealth of their nation. For less industrialized or lower-income nations, obesity and wealth are more likely to be directly correlated. Problems stemming from being overweight concentrate on urban populations, where income tends to be much higher. This phenomenon makes the most

THE GLOBAL THREAT Thus, obesity cannot be tied directly to income or the wealth of a nation. Similarly, hunger issues persist even in the wealthiest areas. Almost 15.7 million facing chronic hunger live in developed nations while the Pew Research Institute study saw over 20% of Americans struggle to afford groceries in 2012. For all nations, infrastructure and social support nets contribute greatly to the inability to effectively combat this continuing and systematic issue. Strikingly, nutritional deficits and obesity are not mutually exclusive: numerous studies highlight the seeming contradiction of having too much to eat and yet receiving too few nutrients. Even though many overweight people are getting an overabundance of calories in their daily diet, they lack several essential micronutrients, creating yet another hunger

paradox of being both overweight and undernourished. For example, Vitamin D deficiencies in obese people in America range from 80% to 90%; 17% to 79% of obese people looking to undergo surgery have a severe lack of thiamine, a nutrient that works in regulatory systems. A COMPOUND PROBLEM Therefore, obesity and malnutrition cannot be extracted from each otherâ&#x20AC;&#x201D;many causes of obesity like fast food and junk food can be implicated in the high level of malnutrition in these populations. Implications

of this connection may be vast, especially in hospital settings. Because of the difficulties in sight identification of malnutrition in overweight individuals as well as a general lack of laboratory tests for malnutrition, clinicians may fail to take this issue into account when the patient is recovering from treatment. This problem is especially worrying for those undergoing surgery for weight loss, since their treatment team may miss an important factor essential for convalescence. While obesity and hunger may once have existed as separate entities for nations to tackle individually, the continued devel-

opment and socioeconomic changes within countries now requires multiple initiatives to tackle both forms of food issues. Simply addressing one is insufficient to solving the dual threat of food overabundance and underabundance.

This article and its references can be found on the PPHR website at pphrblog.wordpress.com

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Pape r and w Phys ork icia n s

Medical Documentation in the Information Age BY MIMI CHUNG

PAPERWORK AND PATIENT CARE

of documentation for every hour of patient care, while skilled nursing care only had thirty minutes. In other words, half of the work time was spent not on caring for the injured or sick, but instead was lost finishing reams of paperwork. Over a decade after these problems were

healthcare system. Documents can be edited simultaneously by multiple people, providing instant updates on a patient’s health without having to fax or email information. Copying relevant information and disseminating it becomes a trivial concern. Timestamps and alerts can increase accountability for physicians, since the EMR and EHR would provide legal evidence of misconduct or neglect.

As in many professions, the constant presence of paperwork is an annoyance, but in the medical field, it serves an important and obvious purpose – namely, to protect patients from malpractice and record medical history. Nurses and physicians must keep accurate note of clinical documentation, such as tests, patients’ conditions, and INFO OVERLOAD other essential inof the work time However, the implementation formation. Such on caring for the was spent of these records have provided a straightforward an ethical and legal minefield, process, however, injured or sick , since technology advances much has paradoxically faster than the court can resolve grown more combut instead was finishing problems. A key question is liaplicated and bloatbility issues involved with EMR reams of paperwork. ed in an attempt and EHR alert systems. EMR and to make medical EHR include alerts for doctors, records more which are popups warning them streamlined. of potential health consequencMedical docuidentifi ed, after years of technological innoes based on certain medications or surgery mentation has been a frustration for physivation, and after a large number of new regarrangements. Alerts can range from allergic cians for years. A 2002 survey by Powerhouse ulations, physicians still fi nd that paperwork reaction information to NPO assignments. Cooper, a consulting and research organizaimpedes their actual job. The most signifi cant This alert system provides a check for busy tion, found that documentation made up a sigcurrent challenge is the introduction and doctors, but worries about alert fatigue have nificant portion of a physician’s time in clinic, adoption of electronic medical records (EMR) brought this potential benefi t into question. often cutting deeply into patient care time. and electronic health records (EHR), a move Because a large number of the risks pinpointThe most striking results came from some of meant to simplify the process and increase ed by the system are fairly negligible, physithe most important specialties: the emergency transparency. This move has many potential cians can miss some of the more important care department reported an hour’s worth of paperwork for every hour spent with a pa- benefits, yet the actual implementation of the alerts, which could provoke substantial probtient. In other words, half of the work time program has been hindered by a slow accep- lems for physicians. Further, the sheer volume of information, was spent not on caring for the injured or tance in the medical field and a host of legal, ethical, and fi nancial questions. both provided to and provided by physicians sick, but instead was lost finishing reams of EMR and EHR can potentially solve exand nurses, has drawn criticism, especially from paperwork. Surgery and inpatient acute care tremely salient issues that still plague the those working against the clock to find spefared slightly better, with thirty-six minutes

HALF

THIS IS ANOT PULLOUT QUOTE. IT IS USED TO BREAK UP COLUMNS OF TEXT. LOST

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cific information. The ease of copy-paste both benefits physicians while hindering the ease of finding pertinent diagnoses. “Information overload,” a common phrase in today’s oversaturated Digital Age, hides information under all the other data within an electronic file – and if the nurse or doctor can’t find what they are looking for, they face consequences since the information was, technically, right there.

EMR DISSATISFACTION

DATA DISCLOSED Perhaps the most concerning is the question of privacy. Digitizing medical records increases the risk of privacy breaches, as cases of healthcare hacking has increased exponentially–about one in three Americans have had their records compromised, with criminal attacks on healthcare records increasing 125% since 2010. Medical identity theft is much more serious

About one in three Americans have had their records compromised, with criminal attacks on healthcare records increasing 125% since 2010.

Although 33% of doctors who have implemented EMR said that the system has improved quality CONCLUSION of care, according to a survey Though EMR and EHR have by the Physicians Foundation brought a significant benefit to in 2012, physicians have voiced certain specialities, much more frustrations with the system as research and development must well. One pointed out that EMR be done to provide the American Americans “simply do not work for certain people with the best care – and have had their specialties,” such as dermatoloallow doctors to focus on their gy, and requested that mandapatients, not their paperwork. tory adoption be postponed. . Another doctor claimed that the “benefits of an EMR are overstated” since it “do[es] not seem to have been designed with any significant physician input,” resulting in “poor” outcomes. More harshly, some physicians have said the system is “a scam” be- than financial identity theft: with someone’s cause increasing the amount of required note complete medical record, hackers can fabricate This article and its references can be found on taking has led to a decrease in time spent with an entire person, including ordering prescripthe PPHR website at pphrblog.wordpress.com patients. 34% of those who have not yet imple- tions and filing false tax returns. Hospitals and mented EMR have stated that the cost of intro- private physicians struggle to provide adequate ducing the system has been the most prevalent security for this data due to high costs and lack concern. of innovation.

About 1 in 3

records

COMPROMISED

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Development of Novel Flow Cytometry Technique to Study Yellow Fever Virus BY DEVORAH SAFFERN

UNDERSTANDING YELLOW FEVER Researchers in the Ploss lab of the Molecular Biology department at Princeton University have utilized a new technology to analyze the pathogenesis of the yellow fever virus (YFV), which can be applied to other viruses and lead to significant progress in understanding disease mechanisms. Published in Nature Communications on March 14, their study discusses the ways in which viruses interact with host cells, in an effort to discover more effective vaccines. Currently, there is a lack of scientific knowledge on how viruses interact with the host cells and cause illness or proper immune response, and their research begins to uncover these behaviors.

plicable.

YELLOW FEVER AS A MODEL DISEASE Yellow fever and other similar viruses affect many people â&#x20AC;&#x201C; there are approximately 30,000 deaths due to yellow fever per year, and 200,000 infected people. YFV is a positively-stranded, prototypic flavivirus, meaning it is similar to other disease-causing viruses, such as Dengue and Zika. Analysis of YFV however could reveal the inner mechanisms not only of viruses in the Flaviridae genus family, but also of other viruses that similarly interact with host cells. This includes the many positively-stranded infectious viruses like Hepatitis C, West Nile, and the common cold. YFV is therefore a prime virus to study, and results can be broadly ap-

behaviors can be analyzed at high resolution through these labeled antibodies. This process is limited, however, in that highly specific antibodies must be used to attach to proteins for the vast virus types that are prevalent. In addition, it is important to understand not only viral protein behavior during translation, but also other antibody behaviors in the host cells of the immune system. It is also difficult to track antibodies in vivo. The viral RNA might affect the immune system in a number of other ways, which calls for a more broad analysis of the virus in action. A new and advanced flow cytometry method called Prime RNA Flow, first presented in a Nature Communications paper

ANALYSIS OF VIRAL RNA The experiments consisted of tracking the positive and negative sense RNA in YFV viruses found in the immune systems of mice. Typically, researchers track viruses by targeting the viral proteins with fluorophore-labeled antibodies and analyzing the pathways of the proteins using flow cytometry. Cellular

published in 2014, enables improved tracking of viral RNA. The technology involves antibodies that can track multiple RNA strands at once, through amplifications. In this particular study, researchers used the technique to track YFV RNA replication in mice immune cells found in the blood stream. They built a new device that consists of two probes that analyze a specific set of base pairs on the RNA strand â&#x20AC;&#x201C; one probe to sense positive RNA strands, and one to sense negative. Positive and negative YFV-17D RNA strands, which are strains of YFV used in the yellow fever vaccine, were then injected into mice and tested with the Prime Flow technique. Fluorescence . signals as well as amplifiers were built into the probes to detect and track the RNA and obtain resolution on the single cellular level.

IN ORDER TO CONTROL OUTBREAKS AND PRODUCE EFFECTIVE VACCINES, WE NEED TO UNDERSTAND THE MECHANISMS OF THE VIRUS

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NEW DISCOVERIES In experimenting with these new tools, the researchers found that removal of STAT1 on the RNA segment, a transcription factor important in the antiviral process, increased YFV-17D replication. YFV-17D normally does not replicate in mice but does in human cells. That result shows that signals within STAT1 are what normally shield mice from infection by YFV-17D, as opposed to humans who are susceptible. The researchers also found that YFV-17D is able to replicate in human B cells, a type of white blood cell, and NK cells,

which are blood cells in mice in the immune system, facts unknown prior to this study. During infection, different cells in the blood and spleen are infected at various points through the course of the virus. These new understandings were possible using the RNA Prime Flow technique. Six tissue sections from three biological replicates (three animals) were examined for each experimental condition (non-infected or infected) and tissue (Liver and Spleen). The histopathological manifestations observed in the infected animal tissues were absent in all non-infected animals.

FUTURE OF YELLOW FEVER CONTROL More research will be necessary to further elucidate and demonstrate more specific viral mechanisms. Future work may include verifying the YFV replication process in immune cells of sick and vaccinated patients, analyzing more of the range of host immune cells involved, and studying other viral mutations, as well as their varying symptoms. Outbreaks are commonly found in tropical areas of South America and Africa and are transmitted through mosquitoes. They occur relatively frequently, and in order to control

outbreaks and produce effective vaccines, we need to understand the mechanisms of the virus. Analyzing these host cell interactions is significant progress toward understanding and targeting viruses of many diseases.

This article and its references can be found on the PPHR website at pphrblog.wordpress. com

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Airs

trik

Destroy All Hospitals in East Aleppo:

Dangerous Repercussions for Civilian Health BY AVA TORJANI DESTRUCTION OF SYRIAN HEALTH On Saturday, November 19th 2016, the last functioning hospital in east Aleppo was destroyed by airstrikes, leaving more than 250,000 civilians with no access to healthcare including surgery, trauma care, and consultations. The distressing news was confirmed by the World Health Organization (WHO) representative in Syria, Elizabeth Hoff, who stated that “All hospitals in eastern Aleppo are out of service.” This was one of more than 30 different attacks since early July 2016 including those that resulted in the destruction of two general hospitals providing trauma care in the warzone and the only children’s hospital within the region. Undoubtedly, dire health consequences lie ahead for all remaining residents. According to the non-governmental humanitarian-aid organization, Doctors Without Borders, the number of medical staff and supplies have significantly reduced with “no possibility of sending more supplies in,” leaving the city with no more than 2 weeks’ worth of medicine and food. One doctor vividly described the detrimental impact of the lack of healthcare workers. He discusses the story of a child who died after not receiving a surgery that could have easily been performed by any pediatric surgeon. moreover, given the combination of chronic stress and lack of vaccine supplies induced by many years of war, children are found to have weakened immune systems that have

led to multiple cases of otherwise preventable diseases such as measles, polio, and meningitis. furthermore, according to an emergency room nurse, Abu Al motassem, children have no access to food essential for healthy growth such as formula one milk or breast milk, causing them to become malnourished which consequently invokes a vicious cascade of diseases. INTERNATIONAL RESPONSE These disastrous repercussions have evoked great distress among external gov-

understaffed medical and rescue workers who are working extremely hard despite the harsh conditions. for now, healthcare has shifted from hospitals to basements where patients are sheltered from airstrikes, yet the environment is unsterile for safe and effective treatment. ONGOING CRISIS All in all, it is evident that the destruction of hospitals in east Aleppo has resulted in an increased risk of infectious diseases and ultimately, death. It is also clear that improvements in healthcare can only be achieved through the establishment of an effective and stable political solution. Although the frequent attempts of organizations, such as the U.N, for a temporary truce have repeatedly failed, it is important to remain persistent in trying to improve healthcare for the sake of preserving over a quarter million lives.

IMPROVEMENTS IN HEAlTHCARE CAN ONlY BE ACHIEVED THROUGH THE ESTABlISHMENT OF AN EFFECTIVE AND STABlE POlITICAl SOlUTION.

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ernments and health authorities, leading to a series of proposals to resolve this matter. Sadly, hardly any proposed solutions became a reality. After each airstrike, health and rescue workers have strived to restore the damaged hospitals—a task that has been made increasingly difficult due to a shortage of supplies. Meanwhile, the U.N representative of Syria, Staffan de mustara, personally confronted the government to request a ceasefire and a safe entry of humanitarian aid, only to be rejected because opposing rebel groups supported the solution. Consequently, civilians’ health is left in the hands of the remaining

This article and its references can be found on the PPHR website at pphrblog.wordpress.com

n o ar

: e eas

s i D

W e The Creation of a Global Th

Vaccine-Development Fund BY MOSES IM

EBOLA OUTBREAK Just recently, the Ebola outbreak lead to over 11,000 deaths. Yet, the pandemic also exposed the constant looming threats that affect global health due to the lack of necessary medicines and vaccines. Thus, as the world shook in fear, WHO (World Health Organization) and other supporting countries rushed in to control and stop the disease. Coincidentally, before the outbreak occurred there were at least seven different vaccines that passed animal testing with promising results. Out of those only one went through further clinical trials before being abandoned due to costs and difficulties in the licensing process. Here, bureaucracy took precedence over safety and health. Due to the pandemic, however, the governments and organizations pushed the research further. Eventually the right vaccine was licensed but it came thousands of lives too late.

pediatrics at the University of Pennsylvania, Adel Mahmoud, M.D., Ph.D, professor in the Molecular Biology Department and Woodrow Wilson School of International and Public Affairs at Princeton University, and Jeremy Farrar, M.D., Ph.D, director of the Wellcome Trust, in a published article called for a “global vaccine-development fund.” Their plan requires a $2 billion investment in vaccine research which will target “the valley of death.”Thus, the funds are meant to help vaccines and projects get past preliminary rounds of research and simplify the licensing process. Therefore, the ideology relies on paying large sums upfront and decreasing the costs later down the road. For context, the

the European Commission, the Bill and melinda Gates Foundation, the Wellcome Trust, World Economic forum, and the governments of Norway, Japan, Germany, and India. Organizations like Pfizer, Johnson & Johnson, Johns Hopkins Vaccine Initiative, and many more have joined as well. CEPI have decided to start by targeting lassa, Nipah and MERS as advised by their scientific advisory board. While CEPI may have been launched with a little less than $500 million, they hope to finish fundraising by the end of this year. Thus, CEPI has created a feeling of hopefulness for the creation of solutions to diseases. The world may soon be rest assured that another crisis like Ebola will not erupt.

BUREAUCRACY TOOK PRECEDENCE OVER SAFETY AND HEAlTH.

HISTORICAL INADEQUACIES This pattern of pharmaceutical profit and insufficient government funding is seen in many diseases considered under the term of the “the valley of death.” For example, Ebola, West Nile, and the SARS virus are all included on this deathly list of diseases. If this reluctance for action continues many people around the globe will become vulnerable to death. A NEW HOPE In July 2015 three prominent physicians, Stanley Plotkin, M.D., emeritus professor of

Ebola crisis alone costed the world about $8 billion. Overall, through their article, Plotkin, mahmoud, and farrar called the world to learn to adapt to “the lesson we [can] take from the Ebola crisis.” And it appears the world indeed learned. WORLD RESPONSE The science community responded positively to the article, and, just as the authors hoped, great discussion grew out of this call to action. As a direct result, under the leadership of Director Jeremy Farrar, the Coalition of Epidemic Preparedness Innovations (CEPI) was formed and launched on January 18, 2017. The global company is backed by

This article and its references can be found on the PPHR website at pphrblog.wordpress.com

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Disease

Are Vide oG ame s Re ally…

“Mi

ndle

ss”?

Hopewell Valley Central High School AMEYAVIKRAM PATHAK

INTRODUCTION We’ve all heard from, well, about everyone, that video games rot your brain. People often tell their kids to turn off their devices because they want their kids to have healthy eyes in this new era of technological advancements. Some can even argue that violence in certain video games such as Call of Duty, Battlefield, and Fallout, is causing many people to commit acts of violence, like Columbine. But, very few have come to think that maybe Pac-Man or Galaga actually can improve your senses and capabilities that no one has ever thought would do. These “mindless” video games that we assume are just entertainment today can actually help us tomorrow by improving our cognitive abilities, which will help everyone, even adults, complete everyday tasks more efficiently than before.

results came back, his score wasn’t just above average… it was almost near perfect. Bavelier, who was his adviser and older than Green, performed the test on herself, and she came back with an average score. They wanted to find out more about this, so they experimented on other people. Green asked his friends, and all of them also came back with the same results as him. Bavelier and Green were both astonished by this discovery, but they came to find out that there eventually was one big difference… Green and his friends used to play the so-called “mindless” video games for

details, huge sensitivity to contrast, better spatial senses, efficient multitasking, and even working better under pressure, which all help in our daily lives. Video games also enhance reflexes and reaction timings by almost 10 percent, which improve precision and efficiency.

WHAT ACTION-THEMED GAMES IMPROVE Non-gamers usually see people who play FPS games as repulsive, chubby, mean guys who have no jobs and are living in their parent’s basement. While some of these gamers are like that, the studies of Bavelier and Green disagree with that stereotype. “Players who immerse themselves in the fast-paced events of digital fantasy worlds derive significant cognitive benefits,” says Bavelier. FPS games are now being used in labs because these are the types of games that bring forth a better sense of attention. If you’ve actually played Call of Duty, you know that in the game, you have to look for your enemies and get the most amount of kills to win. You can use the map to find your enemies, and you can also use the map itself to find clues as to where your enemy was, is, and is going to be. Even in the zombies mode of the game, one must require strategy, because as

Gamers THIS IS Aprocess PULLOUT informaQUOTE. IT IS FASTER, USED TO BREAK UP COLUMNS tion helping them OF TEXT. complete everyday tasks more efficiently.

BACKGROUND

Two scientists, C. Shawn Green and Daphne Bavelier, were completing a study one day on neuroplasticity, or the ability for adults to create even more brain cells or reconstruct the thought process. Green, who was 18 at the time, tried the test on himself. When the PPHR

more than 10 hours per week. The thought that first person shooter games, or FPS games, were actually helpful for the mind isn’t a very new idea, yet other labs also established that playing FPS games are really good for you. These new skills that gamers make consist of a better ability to focus on certain

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“Players who immerse themselves in the fast-paced events of digital fantasy worlds derive significant cognitive

benefits.”

new rounds start, the zombies get faster and harder to kill. But it’s not just better focus that gamers get out of violent video games; gamers also process information faster. When playing COD, if an ally comes in front of you, you can see his gamer tag is blue, whilst the enemy’s is red. A gamer has to make a decision in a split second if the person in front of him is an ally or enemy, and if he is an enemy, the gamer has to decide which weapon to use; if he’s close range, use the melee knife, or if he is further, use the gun.

wrong. But, if you play for a steady interval, it can be very healthy for you.

CONCLUSION Yes, there are bad qualities in video games. But, there are bad qualities in literally everything. What we must do is look for where the benefits are in everything and use them to our advantage, like these video games. We should not abuse them by playing for however long we want, but use them to improve ourselves.

EXPERIMENTS ON NON-GAMERS To prove their work, scientists experimented on a group of individuals who have rarely or never played video games. First, the entire group gets a psychological evaluation.Then, they are split into two groups; one group plays action games, and the other plays social games. They are required to play one hour a day for five days a week with a set amount of weeks. When the two groups to the evaluation again, the amount of improvement for the group that played action games improved much more than the other group. The intervals of time that the group played the video games was one hour a day, so yes, playing video games all day every day is

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Disease

Unt reat ed M The enta l Illn Cau esse ses s: an

d Ef

Lawrence High School

fect s

BY MIlENA BIMPONG

INTRODUCTION

A GROWING CONCERN IN THE U.S.

People view taking time off from school or work because of the flu or a broken bone as perfectly acceptable, but taking time off because of stress from a mental illness such as anxiety or depression, unfortunately, is not. People usually believe that someone who takes time off from school or work because of a physical illness needs the time to recover quickly. However, when someone does the same for a mental illness, they are usually told that they are “lazy” or that the problem is “all inside their head.” Why is this the case? Physical health and mental health are equally important. However, people with mental illnesses are sadly stereotyped and looked down upon by society. The stigma of mental illnesses, along with several other factors, result in high percentages of untreated mental illnesses in both the United States and across the world. Although, there are several solutions that can improve this problem, and the analysis of the reasons why some people with mental illnesses do not seek treatment/lack access to treatment and the various effects of untreated mental illnesses can help to develop these solutions.

Untreated mental illnesses are a growing concern in the United States. In the United States, about 43.8 million adults have a mental illness – this is equal to 1 in 5 adults. And among these adults, 60% were left untreated in 2011, according to the 2012 National Survey on Drug Use and Health.Also, this source claimed that 40% of adults with severe mental illnesses such as schizophrenia or bipolar

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to the Children’s Mental Health Report by the Child Mind Institute, 80% of children with anxiety are not receiving treatment, along with 40% of children with diagnosable ADHD/ADD and 60% of children with diagnosable depression. Untreated mental illnesses have a severe impact on the nation’s economy. According to the National Alliance on Mental Illness (NAMI), untreated mental illnesses cost about $100 billion a year in lost productivity. Along with many other countries, the United States has a high population of both children and adults with untreated mental illnesses.

A GLOBAL PROBLEM

disorder did not receive treatment. Untreated mental illnesses do not only affect adults but children as well.Approximately 17 million children in the US have or have had a mental illness, but most are not treated. According

Untreated mental illnesses are also becoming increasingly common across the globe. Worldwide, about 450 million people have a mental illness – this is equal to 1 in 4 people. Most of these people, about 400 million, are not receiving the treatment that they need. According to the World Health Organization in 2002, 154 million people had depression and 25 million had schizophrenia. The World Health Organization later stated in 2009 that 50 million had epilepsy, and 24 million had Alzheimer’s and other forms of dementia. The number of people with untreated mental illnesses also depends on the

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Worldwide, about

450 million people have a mental illness, and 400 million are not recieving the treatment they need.

country’s economy. According to Clubhouse International, 76 to 85% of serious mental illness cases went untreated in developing countries. However, this source claims that only 35 to 50% of mental illness cases went untreated in developed countries. Mental illnesses remarkably impact the global economy, costing about $2.5 trillion per year. Untreated mental illnesses are a public health concern worldwide, and it is not limited to the United States.

EXPERIMENTS ON NON-GAMERS In order to discuss this public health concern, it is crucial to realize why some people with mental illnesses lack access to treatment, or why they do not seek treatment. One main reason that can decide whether someone with a mental illness has access to treatment is their socioeconomic status. Some cannot afford the medical costs, which is why they might avoid seeking treatment. The stigma of mental illness also prevents people from seeking treatment, as it is sometimes associated with shame and embarrassment. There are other reasons as well, such as people simply having busy schedules and not taking the time to acknowledge their mental health. However, it is very im-

portant to make mental health a top priority, because leaving a mental illness untreated can have extremely negative effects on the person. Some specific examples of these direct and indirect effects are the condition worsening over time, physical health issues, financial problems, lack of job stability, prison, being taken advantage of by others, and suicide. According to Clubhouse International, mental illnesses are the cause of about 90% of suicides. There are several solutions that would help to substantially decrease the number of people with mental illnesses who are left untreated. Firstly, it is important for low-income families to have access to health care.This will allow for people of all socioeconomic backgrounds to seek treatment from a psychiatrist. Also, it is important to change the view mental illnesses in society. Acceptance of mental illnesses will encourage people to seek help without feeling ashamed. Lastly, it is necessary to take the time to talk to someone about these issues before the situation becomes worse. Explaining your feelings to a family member or friend is comforting, and receiving professional help will eventually be the next step. Despite the increasing number of current untreated mental illnesses, noteworthy

developments in mental health treatment can give a positive outlook in the years to come.

CONCLUSION To end, there are multiple economic and social factors that cause the high number of untreated mental illnesses in the United States and worldwide. Many mental illnesses are left untreated due to the amount of money that it costs to seek medical help, and because of the way that society resentfully views people with mental illnesses. Although there have been many improvements throughout the years, there is still a lot of work for the years ahead. There is still hope for the future, even if it may take an incredibly long time.

This article and its references can be found on the PPHR website at pphrblog.wordpress.com

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Featured artist

Sandra Carpenter ‘18

andy is a Molecular Biology major. Her experiences in a genetics lab working on rare diseases, primarily craniosynostosis and related syndromes, incited her interest in portraying children with craniofacial anomalies. Moreover, she is passionate about disability, its marginalization in both society and portraiture, and the contentious future of eugenics in defining a new class of disability. She strives to reveal the miracle that is a healthy-functioning individual, compelling viewers to deliberate on the unfathomably complex processes that underlie their organism. Inspired by Susan Sontag’s 1978 essay “Illness as Metaphor,” Sandy hopes to dismantle prevailing stereotypes about disability to encourage true empathy, acceptance, and learning. This body of work was motivated by the patients and researchers at the Weatherall Institute of Molecular Medicine, and the artist expresses her gratitude for the sage counsel of her professors and advisors, particularly Eve Aschheim.

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