The Process Behind Medical Innovations Revealed

by Claire Watry, Terra Linda HS

This week Dr. Art Wallace returns to the Marin Science Seminar to present “Making Medicine Safer with Drugs, Devices, Software & More”. Dr. Wallace is a cardiac anesthesiologist at the San Francisco Veterans Affairs Medical Center (SF VAMC) and the Chief of the Anesthesia Service. He is also a professor of Anesthesiology and Perioperative Care at the University of California, San Francisco. Dr. Wallace provides clinical anesthesia care to patients at the SF VAMC and has a laboratory that works on reducing perioperative risk. He has compiled an impressive list of innovative theories for perioperative cardiac patients. Dr. Wallace will explain the process of developing a new drug, device, or software and answer your burning questions: How is a drug or device developed? How is a new product tested? How is it determined whether the therapy is successful or not?  How do new technology and therapies change medical care? For a sneak peek preview of his presentation, check out part of my interview with Dr. Wallace below. 

What is the process of researching, developing, and implementing a new drug, device, or software?

a. The first step is to identify a problem and then identify the likely etiologic factors (what causes the problem). When we looked at patients having heart attacks around the time of surgery we first did an epidemiologic study to find out how often they died. We then put holter monitors (small portable ECG monitors) on the patients. We found that they had myocardial ischemia (not enough blood supply to the heart muscle).

b. The next step is to test likely therapies. We tested 20 different drugs to find ones that would prevent myocardial ischemia. We found four that worked.

c. The next step is to implement the programs. We implemented programs in our hospital to use those medications. Those programs decreased the mortality of patients about 35%.

d. The next step is to disseminate the program to other hospitals. We helped more than  1000 other hospitals implement the programs and they found similar reductions in mortality.

e. For devices the approaches are similar – 1) Identify a problem. 2) Find possible causes. 3) See if you can create a device to eliminate the problem. 4) Test the device to see  if it reduces or eliminates the problem.

How long does the process typically take?

The development of perioperative cardiac risk reduction takes many years and many billions of dollars. It depends when you start the clock. When did you identify the problem? When did you find a likely solution? When did you prove it works? When did you get others to use it? Science takes a long time. Once you find a therapy, it takes the average doctor 17 years to adopt it.

When asked about what serious health issues he believes can be alleviated by the development of new technology, Dr. Wallace answered that even with new technological advances, prevention is key because “many of the health care problems we face are related to behaviors”. Dr. Wallace cited using birth control and HIV prevention, not smoking, taking illegal drugs, becoming obese or drinking excessively, and exercising regularly as prime examples of how proper education and behavior alterations can dramatically reduce health problems. He maintained that “it is vastly easier and more effective to avoid having a problem than to attempt to fix it” and mentioned computerized reminders to eat reasonably, to avoid drugs, cigarettes, and excessive alcohol, and to exercise as an effective way to avoid having a problem.

Dr. Wallace stressed that even with advanced technology “developing some miracle drug or therapy for a disease is really, really hard. Avoiding getting the disease in the first place is vastly easier and cheaper. Literacy, flush toilets and sewers, washing your hands, chlorine and fluoride in drinking water, refrigerators, pasteurization, electricity, seat belts, and social security did vastly more for people than medicine.”

Learn more about the development of new medical therapies at “Making Medicine Safer with Drugs, Devices, Software & More” with Dr. Art Wallace M.D. Ph. D. on Wednesday, October 23^rd, 2013, 7:30 – 8:30 pm, Terra Linda High School, San Rafael, Room 207

http://www.marinscienceseminar.com/speakers/awallace.html

Claire Watry

Public Health Plays More Roles In Your Life Than You May Think

by Jessica Gerwin, Drake HS


When you hear the term public health, ideas that may come to mind might be about immunizations or food recalls. However, many of us don't realize how big of a role public health plays in our everyday lives.  From the faucets that we fill our drinking cups with to the seat belts that we wear in our cars, almost all aspects of our well being relate to Public Health in some way. On October 16th, 2013 Julie Pettijohn did an exemplary job of explaining the topic of public health and talked about what being in the field really involves. As an industrial hygienist, a typical work day for Julie is not just filling out paperwork in an office. Wearing a full outfit of protective gear, Julie often goes to a site to detect possible lead amounts in a work environment. Her job keeps us safe by enforcing the proper health requirements. The work and service of people like Julie in the public health field may often be taken for granted. Nevertheless, by attending the seminar many of us learned that being in the field is not just a job, it is establishing safe and healthy ways of life. I had the honor of asking Julie some questions about both herself and her field. Our interview is below.

1.) I’d like to learn a little about you. What made you decide to go into biology and then public health?

        I have been interested in science since junior high (now called middle school). I had a fantastic physical science teacher that really brought science to life for me. His teaching was unconventional, and his class time was spent mostly applying scientific principles through experiments instead of reading a text book. I was also a child of parents that went to community college while my sibling and I were kids. My parents met a fantastic professor that later became our good family friend. He was a Native American expert and professor of astronomy and geology. We would spend evenings at his home looking through his telescope and I often attended his college geology field trips along with my parents. While in college, I first majored in biological sciences and completed internships at the local community health center; I was thinking of going to medical school after graduation. I was fortunate to attend UC Santa Barbara, a university that is well known for aquatic biology coursework. I switched majors midway through college from biological sciences to aquatic biology and graduated with a degree in this major. This was done to pursue my due to my deep love of the ocean. My first 'real' job was with a state department, where I was a contractor working on public health issues related to fish contamination. My mentors at that position encouraged me to get a Master’s Degree in public health, where I could continue to learn about issues related to health, but also environmental issues, thus combining two of my interests (health and the environment).

2.)  I think that public health and public policy are difficult subjects for teenagers to relate to. Can you explain the role of public health in Marin County?

        I work at the state level, so I'm not as knowledgeable about public health issues in Marin County. However, the County Public Health Department provides a number of direct services to Marin residents and the one that I am most familiar with is Childhood Lead Poisoning Prevention. County public health nurses and environmental health specialists conduct home visits where children have elevated blood lead levels, putting them at lifelong risk for learning and behavioral problems. The purpose of these site visits is to determine possible sources of the lead in the child's environment, so that they can be reduced or eliminated.. See http://www.marinhhs.org/content/public-health-updates for some public health updates for Marin. My talk will include asking teens questions, and by the responses that I anticipate, I’m pretty sure that most of them know quite a bit about public health already, but may not automatically associate this knowledge with the field of public health.

3.)  Can you talk a little bit about the sampling equipment you are bringing? What are you sampling for? What personal protective equipment are you bringing?

        I'm bringing with me air monitoring equipment. I use the air monitoring equipment to measure lead in workplace air to assess if workers are being excessively exposed above legal limits and to make recommendations on lead safety. I'm also bringing lead check swabs which are used for immediately assessing the presence of lead surface contamination or the presence of lead in paint. I'll be demonstrating the use of these during the talk. I'll also be bringing wipe sampling equipment that can be used for quantitatively determining the amount of lead (or other metals) on surfaces in workplaces, homes, and other places of interest. As for personal protective equipment, I'll be bringing respiratory protection used for reducing the amount of a chemical of concern (like lead) that may breathed in by workers in workplace air. I'll also be showing tyvek coveralls which are worn in many industries to keep lead (also other contaminants) from contaminating your street clothes while working. I'll be bringing a hard hat, gloves, and a traffic safety vest too.

4.)  What are a few examples global climate change that are impacting Marin County?

        Extremes in weather, flooding, and water quality issues.

5). What do you consider to be the largest public health issue involving teens in Marin County?

        This is a great question. From my perspective, public health issues that affect Marin teens are wellness and injury prevention. What I mean by this is that teens should be thinking about personal physical fitness and nutrition. Many teens in our Country are unfortunately overweight putting them at risk for lifelong health issues, particularly as they age (heart disease, diabetes, etc.). In addition, teens are often new and inexperienced drivers, new to employment outside the home, may become sexually active for the first time and may have peer pressure to drink alcohol or take illegal substances. As a result, teens are at greater risk for accidents, particularly on the road, in the workplace, and may be exposed to sexually transmitted diseases, which if left untreated, can have serious health consequences. Besides this, a goal of my talk is to get teens to also think about global climate change and things that they can do to help.

6.)  What steps can our community take to better ourselves on these issues?

Get informed and get involved in the issues, and take care of your health to prevent or reduce future injury or illness.

7.)  Is there anything else that you’ll be talking about?

              The field of industrial hygiene, the program that I work for (Occupational Lead Poisoning Prevention Program of the California Department of Public Health), how lead impacts your health, where lead is found in various industries, and recent work by CDPH on making recommendations to reduce the allowable levels of lead in workplaces, which would be a major change in public health policy for lead workplaces. Also, I'll briefly cover some career opportunities in public health.

Julie is one of the many people that work in the STEM field (Science, Technology, Engineering, Math). If you are interested in learning more about these fields or just science in general, attending a Marin Science Seminar can be a great way to expose yourself to new topics and learn about a few different environments. Come check out our next seminar on October 23rd “Making Medicine Safer - Drugs, Devices, Software and More” presented by Dr. Wallace. The seminar will take place at Terra Linda High School in Room 207 so come check it out!

October is Nova’s “Innovation Month”. You can learn more about different seminars that are taking place by clicking on the link below.

http://www.marinscienceseminar.com/print/innovations-oct-2013.pdf

-Jessica Gerwin

The Making of an App Starts with a Passion

by Jessica Gerwin, Drake HS 

On September 25th, 2013, multimedia producer David Fox spoke to an audience of over 50 enthusiastic and curious individuals about his love for Rube Goldberg machines. Rube Goldberg, as defined in Webster’s New World Dictionary is a comically involved, complicated invention, laboriously contrived to perform a simple operation. It is easy to compare the concept of a Rube Goldberg machine to the popular 60’s board game, “Mouse Trap”.

Mouse Trap, a popular board game of the 60's was inspired by Rube Goldberg machines. The game involves setting up an array of objects in order to trap a plastic mouse.

Rube Goldberg himself is a famous cartoonist from San Francisco whose drawings focus on quirky combinations of gadgets that perform simple tasks in convoluted ways. The series of these “inventions” led Goldberg to become a founding member of the National Cartoonist Society and a Pulitzer Prize winner. Goldberg's unique style and sense of humor made him a beloved national figure who created a large cultural impact. Goldberg’s sense of humor is well emulated in the popular YouTube video called “The Page Turner” by Joseph Herscher. To take a further look into these machines, watch the video by clicking here.

Likewise, David wishes to emulate Goldberg’s intricate and whimsical style into his game. David introduced the app that he in conjunction with Electric Eggplant and Kalani games are in the process of creating. While the name of the app has changed from Casey’s Contraptions to another not yet known, the premise of the game remains the same. The mission of each level in the game is to set up an assortment of contraptions to carry out a simple task such as popping a balloon or filling a glass of orange juice.

However, the process that it takes to animate a scene like that is more intricate than the level that they are working on. The process of programming a level is a long and difficult one. Each level requires planning, drawing, programming, and graphics skills.

While programming can be very difficult, it is not an unattainable thing to do. Programming apps does take some specific knowledge and skills that can be learned if you want to. The earlier you learn about programming, the easier it becomes.  There are plenty online and offline resources that exist to help you learn about programming.

For instance, code.org is a website that refers you to free programs that teach you how to code. The site recommends websites such as Code Academy, Khan Academy and Code HS. All of which are great resources to help you get started. Many representatives of the site stress the importance of being able to code in the YouTube video here.

Creating apps are part of the “T” in STEM (Science, Technology, Engineering, Math) and is a creative way to entertain, teach, make money and more. The limitations for your own creativity is boundless.  The best way to start is to find something in which you are passionate about.  The STEM field is full of examples of many passions like David Fox's. 

To learn more about the STEM fields, check out our next seminar on October 16^th featuring Julie Pettijohn speaking on “Clean Air, Clean Water, Clean Work” about how Public Health research and policy keeps us healthy and improves our lives. The event will take place at Terra Linda High School at 7:30 pm. To download the Fall flyer, click here.

Sources Cited:

• "Rube Goldberg : Home of the Official Rube Goldberg Machine Contests." 
Rube Goldberg. N.p., n.d. Web. 16 Oct. 2013. <http://www.rubegoldberg.com/>.

• "Rube Goldberg." 
Wikipedia. Wikimedia Foundation, 15 Oct. 2013. Web. 16 Oct. 2013. <http://en.wikipedia.org/wiki/Rube_Goldberg>.

• Caplan, Lisa. "The App Store's IPad Game Of The Week: Casey's Contraptions."AppAdvice RSS. App Advice, 22 May 2011. Web. 16 Oct. 2013. <http://appadvice.com/appnn/2011/05/app-stores-ipad-game-week-caseys-contraptions>.

• "Code.org." Code. N.p., n.d. Web. 16 Oct. 2013. <http://code.org/>.

-Jessica Gerwin

Educational Video Games: No Longer a Contradiction

by Claire Watry, Terra Linda HS

The definition of a video game according to Merriam-Webster is: an electronic game played by means of images on a video screen and often emphasizing fast action. The definition does include the phrases “must contain violence,” “must be uneducational” or “guaranteed to turn children into zombies.” Video games are often stigmatized as a waste of time, and few realize that video games can actually be educational and help children’s learning rather than hindering it. With proper implementation, educational video games have the potential to transform traditional education and propel students into high-profile jobs in the tech-savvy world.

Video games are an innovative way to engage students in science. The Massachusetts Institute of Technology in partnership with the Smithsonian Institution experimented with alternative methods of teaching science and created the video game Vanished where students are presented with the scenario that in the future all historical records are destroyed, and are asked by the people of the future to investigate the causes of this catastrophe by researching and recording data about present-day Earth. The game incorporates problem-solving and analytical skills in an interactive way of exploring science in the hopes that science is seen as an “engaging process of mystery and discovery” rather than the sadly common perception that is a boring process full of memorization. Vanished gives the students a hands-on experience by requiring them to go out into their neighborhoods to research and record what they experience instead of  just memorizing vocabulary and looking up the answers on the internet. Although the trial run of Vanished is over, researchers hope to use the game as a model to create interactive educational tools for teaching science.

A leader in the use of education video games in the classroom is the Redwood-City-based GlassLab (Games, Learning, and Assessment Lab). The goal of the video games is to engage the students in an interactive manner and stimulate their interest in the fields of STEM (Science, Technology, Engineering, and Mathematics). For their first project, GlassLab took the commercially-successful SimsCity video game and modified it to be educational. The science-based video game titled SimCityEDU: Pollution Challenge! challenges middle-school students to run a successful town by considering the environmental impacts their actions have while maintaining employment levels and citizen happiness. For example, in the game a city will run out of electricity and the students must then solve the issue and return power to the city. The video game engages the students’ critical thinking and allows them to gain valuable insight into real world problems and potential solutions. The game follows lesson plans and assesses the students’ progress by tracking their progression through the various scenarios. Check out the video below to learn more about SimCityEDU: Pollution Challenge!.

For more information about GlassLab visit http://glasslabgames.org/.

Learn more about educational gaming at "The Making of an App—The First Official Rube Goldberg Invention Game" with David Fox, of Electric Eggplant, Marin County -Wednesday, September 25th, 2013, 7:30 - 8:30 pm, Terra Linda High School, San Rafael, Room 207.

Links:

http://www.theesa.com/games-improving-what-matters/education.asp

http://www.usatoday.com/story/news/nation/2013/03/04/video-games-education-simcity/1963239/

http://web.mit.edu/newsoffice/2011/vanished-smithsonian-0415.html

http://www.merriam-webster.com/dictionary/video%20game

Claire Watry

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What Makes a Cancer Cell

by Sandra Ning, Terra Linda HS

Cancer is most commonly treated through radiation, surgery, and chemotherapy.

(source)

    While it could be considered cliché to compare cancer cells to supervillains, the similarities are undeniable. Supervillains are cunning, deeply rooted within their far-reaching schemes, and fearsome to the extreme. Cancer cells are just as sly, difficult to remove from the human body and terrifying to the afflicted and their loved ones. It's not hard to visualize cancer cells as the shady criminal syndicate of the human body; their reach extends to the lungs, bones, tissue and bloodstream, and their tactics are ruthless. Make no mistake—cancer cells have long been antagonists to the scientists fighting for a cure and the patients fighting for their life.
    But when it comes down to the science of it, cancer cells differ from many classic villains in that they aren't innately evil. Rather, cancer cells and their dangerous properties originate from chance mutations during the division of normal cells. Mutations explain a lot of strange phenomena, from unexpected eye colors to increased resistance to diseases. These unexpected changes in gene sequences can be harmless, or even beneficial. However, they have an equal chance of damaging DNA, mutating it in such a way that the cell distorts into fast-splicing cancer cells.
     Usually, mitosis—the process in which a cell divides—takes precautions against such mutations. "Checkpoints" during a cell’s growth period scan for identity-changing DNA mishaps, ensuring things are running as expected. If something is wrong, the cell will stop growing; if the damage to the DNA can’t be repaired, the cell will kill itself in a process called apoptosis. Through such self-sacrificing vigilance, cells that are mutated beyond repair never get the chance to multiply into a runaway number of damaged cells. But sometimes cell mutations go undetected, due to the sheer number of cells within the human body, with its trillions of constantly dividing cells, each with their own double-helix sequences and enzyme and lysosomes. In such a rush, a handful of mutations can slip by even the strict quality standards cells hold to themselves. Many of these mutations go undetected because they're harmless to the identity of that cell—but some aren't so benign.

Normal and cancer cell division. Most damaged cells die through apoptosis.

(source)

     When a cell with damaged DNA successfully slips by and divides, it creates the first two in a series of cells that will rapidly divide and spread incorrect DNA, beginning the first rapidfire stages of cancer. The speed of growth and division of cancer cells is unmatched, and unyielding; a cancer cell's daunting ability to keep multiplying without ever dying, as normal cells do, is often referred to as 'immortality'. This trait is due to two substances within the cell in particular: telomere and telomerase.
      Telomere is a repeating DNA sequence that essentially acts as a cap for the chromosome it's on. The sequence acts as a buffer between valuable DNA sequences within the chromosome and the often messy process of dividing a cell. Without the telomere, the ends of the chromosome would lose important base pairs much like a rope fraying at the ends. The more a cell divides, the more telomere is lost in protecting the chromosome. Once all of the telomere is gone, the chromosome reaches “critical length” and no longer replicates. When this happens, the cell doesn’t divide and dies through apoptosis. The erosion of telomere thus measures the age of a cell, with long telomere sequences indicating young cells and short sequences indicating old ones.

The repeating TTGGGG sequence is telomere; the enzyme and RNA template belong to telomerase, which rebuilds worn-down telomere.

(source)

     To restore and keep the cycle of cells replicating in our body, telomerase is needed to extend the eroding telomeres. Telomerase is an enzyme made of proteins and RNA. As an enzyme, telomerase enables certain reactions that couldn’t happen without it—in this case, rebuilding and elongating telomeres to a longer sequence again. Telomerase is sparingly used in somatic, or body, cells, which comprise most of the human body. As a result, humans age without much interference from telomerase.
     While telomerase is rarely active in normal body cells, the enzyme becomes ten to twenty times more active in cancer cells. The abundance of telomerase gives cancer cells an endless supply of telomere, and with it, the ability to multiply indefinitely.
    In addition to 'immortality,' cancer cells have several additional unique properties that explain why finding a cure is proving so difficult. In addition to fast replication, cancer cells don’t undergo apoptosis easily; high levels of survivin, a protein, inhibits the usual method of cell death. Cancer cells need neither the physical space nor the same amount of nourishing chemicals, known as growth factors, that normal cells need. Instead, they pile freely on top of each other, and remain undeterred by a diet on growth factors. The clusters cancer cells often find themselves in form the lumps within the breasts and testes that doctors and outreach campaigns warn about. Despite their ability to clump, cancer cells have unfortunately high mobility, too. While normal cells anchor themselves onto neighboring cells, cancer cells can break away and travel through the body, infecting other organs. Their ability to invade and infect other areas is made possible through the ability to break through the lamina. The lamina is a noncellular shield that protects the tissues, organs and surfaces within the human body, deflecting normal cells with ease. Cancer cells don’t have the same limitation, and spread to different organs with relative ease.
     With its unique properties, cancer remains frustratingly difficult to cure. Treating cancer needs to somehow overcome the mobility and speed of replication cancer cells exhibit. Current treatments for cancer actually do better than that—the chemotherapy method of treatment uses the cancer cells’ speedy multiplication against it. Chemotherapy sends chemicals throughout the body that kill fast-replicating cells. Cancer cells are efficiently targeted and wiped out through this method, being some of the fasted replicating cells in the body.
     However, chemotherapy has serious faults in its accuracy; by targeting fast-replicating cells, chemotherapy hits hair and blood cells particularly hard. A broad swath of helpful cells get caught in the crossfire between chemotherapy and the cancer cells it's meant to target. As a treatment for cancer, chemotherapy can cause hair loss, amongst other more painful side-effects.

Chemotherapy affects the fast-growing hair cells as well, which is why cancer patients' hair often falls out.

(source)

     Other treatments are available, when cancer cells are concentrated in specific parts of the body. Radiation focuses on a single area, maybe one organ, to destroy cancer cells. When cancer cells are concentrated in a single area, forming a tumor, surgery can excise the infected part. Sometimes, a mixture of the three treatments are required to treat a patient.
     There is still no way to accurately target and eradicate cancer cells without collateral damage. For that reason, and for the growing number people with breast cancer, leukemia, and other forms of cancer, research for better treatment and ultimately a cure is incredibly important. Cancer is internal, deadly in its silent machinations and intimidating with its arsenal of lethal properties. It's up to the bright minds and generous hearts of every scientist, doctor, donor and activist to combat, quite literally, the enemy within.

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Interested in cancer cells and what scientists are doing to treat it? Come see Dr. Brad A. Stohr present "Why do Cancer Cells Grow Forever and Can we Stop Them?" Dr. Stohr will be presenting this Wednesday, April 17th, at the Marin Science Seminar. The Marin Science Seminar takes place during 7:30 to 8:30 p.m., in rm. 207 of Terra Linda High School. Come check out the Marin Science Seminar on our website and Facebook!

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Sources:

• Gregory, Michael J. The Biology Web, Clinton Community College.
• "What Is Cancer?" Cancer.org, The American Cancer Society.
• Zaidan, George. "How do cancer cells behave differently from healthy ones?" Getting Under Our Skin, TED-Ed.
• "Facts about telomeres and telomerase." Shay/Wright Laboratory, Southwestern University.

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Sandra Ning

Why do Cancer Cells Grow Forever and Can we Stop Them? Check out the teaser vid!

Check out this teaser video for Wednesday's science seminar about battling cancer cells with Bradley Stohr MD PhD of UCSF. Video by MSS intern Josh Leung.

Why do Cancer Cells Grow Forever and Can we Stop Them? from Marin Science Seminar on Vimeo.
April 17th, 2013
Unlike normal cells, cancer cells can keep proliferating forever. This "immortality" allows cancer to spread through the body, causing destruction and often death. In this seminar, Dr. Stohr will discuss how cancer cells become immortal and how we might be able to treat cancer by targeting their immortality.

Brad Stohr MD/PhD is an Assistant Professor in the Department of Pathology at UCSF. His laboratory studies telomeres and telomerase in human cancer. In addition, he serves as an attending physician on the autopsy service.