Controlling a prosthetic solely with your mind???

Back in 2008, scientists from the University of Pittsburgh published in Nature some amazing results – a monkey could feed itself with a prosthetic arm entirely under the control of the monkey’s motor cortex!  The scientists implanted a grid about the size of a large freckle just under the skull. It sat on the motor cortex, in an area known to control hand and arm movements. The grid held 100 tiny electrodes, each connecting to a single neuron, its wires running out of the brain and to a computer.  The computer was programmed to analyze the collective firing of these 100 motor neurons, translate that sum into an electronic command and send it instantaneously to the arm, which was mounted flush with the left shoulder.  Check out the video below that shows the monkey in action! If the video doesn't work below, here's the link.  The researchers believe that the monkey adopted the prosthetic similarly to a real arm because it was more natural and intuitive than a normal prosthetic.

You can imagine how these findings could potentially impact the lives of patients with spinal cord injuries in the future and allow them to control a prosthetic naturally and intuitively.

However, one major kink in the study published in Nature was that the monkey received no sensory input from the prosthetic, making biofeedback impossible.  In a more recent study published in 2011 by researchers from Duke University (also in Nature), scientists implanted electrodes in both the motor cortex and sensory cortex of monkeys.  Using a computer program, the monkeys were able to detect different textures and control a virtual arm to “select” a desired texture.  This research builds on the 2008 Nature study and shows progress toward the ultimate development of prosthesis controlled by the motor cortex that can also detect subtle differences in texture using sensory input.   

Link to the 2008 Nature article:  http://www.nature.com/nature/journal/v453/n7198/abs/nature06996.html

Link to the 2011 Nature article:  http://www.nature.com/nature/journal/v479/n7372/full/nature10489.html

Is Laughter the Best Medicine...really?

Is Laughter the Best Medicine...Really?

Most of us have heard the saying, “laughter is the best medicine.” Laughter makes us feel good, makes us relaxed and comfortable. It helps us with bonding and its role in relationships is outwardly.

But many people believe that laughter has a very significant role in our health; that laughter is not just important psychologically but physiologically. Supposedly it has been linked to the reduction of pain and tolerating pain and discomfort. Popular belief is that laughter has been linked to help with creativity and even problem solving.

The popular belief is that humor and laughter have a very significant role in our health. A “study” has been noted by Psychology Today that shows evidences of how “laughter helps our blood vessels function better.”

According to the article: Laughter causes the inner lining of blood vessels (the endothelium) to expand and thus increase the blood flow...as the article put it, “[Laughter] is good for your heart and brain.”

But is this true? Does laughing really induce all these positive physiological effects on our bodies? Is laughing really as significant to our health as the popular science claims it to be?

The answer is..well, we don't know.

A study has shown that the role of laughter in our bodies' physiology is very inconclusive, (Martin, 2002).

The study collected empirical evidence of the beneficial effects of laughter on the following categories: immunity, pain tolerance, blood pressure, longevity and illness symptoms (Martin, 2002). However, with more through and methodological research there can be more clear results.

But wait! There's more! A twist.

Another study shows that laughter has adverse affects instead of beneficial ones!

Children with a common asthma were examined to determine whether mirthful emotions such as laughter and excitement triggered the symptoms of their asthma. With a p value of = 0.01 it was determined that mirthful emotions actually triggered symptoms of asthma (Liangas, 2003).

So in this case, laughter is most definitely not the best medicine...as it makes the children symptomatic and much worse than before.

Laughter's role as a benefit to our health is not well determined however, it's adverse role in asthma is. Perhaps with more rigorous and through research we can determine it's precise role to our physiology and health.

Image:

http://fida-sunshine.blogspot.com/2012/06/laugh-best-medicine.html

References:

1) http://www.psychologytoday.com/articles/200504/laughter-the-best-medicine

2) Martin R. Is Laughter the Best Medicine? Humor, Laughter, and Physical Health. 2002. Curr Dir Psychol Sci.11 no. 6216-220 doi: 10.1111/1467-8721.00204

3) Liangas G, Morton RJ, Henry LR. Mirth-triggered asthma: Is laughter really the best medicine? 2003. Pedi Pulmon2:(36) 107-112. doi 10.1002/ppul.10313

 

Dying is not a Crime: Modern Assisted Euthanasia

"Dying is not a crime." - Dr. Jack Kevorkian. 

I recently learned that human euthanasia is legal in some areas of the world. I wanted to find out more about what is permitted and what isn't. I began this article believing it would be a short review. As it turns out the concept of human euthanasia is extremely complex and varies greatly in motivation, support, and practice. What follows is what I found.

Passive Euthanasia vs Active Euthanasia vs Murder

The phrase "assisted suicide" is associated most famously with two doctors. Dr. Philip Nitschke is an Australian physician who legally practiced assisted euthanasia in Northern Australia in the early 1990s. When it was later criminalized, he created EXIT International, a nonprofit organization advocating the right to death, regardless of illness or health.

Dr. Jack Kevorkian is an American physician who performed many assisted suicides before it was widely criminalized in the early 1990s. He advocated for the rights of terminally ill patients to be given the means to end their own lives. He was convicted in Michigan of second degree murder when, instead of allowing the patient to administer their own lethal injection, he administered it to a patient himself.

These are both instances of "active euthanasia," ending a patient's life with a deliberate administration of a lethal dosage or substance. 

Passive euthanasia is a far more common and accepted practice. Passive euthanasia is the removal of life supporting medical devices in order to end a patient's life. The most famous patient recently was Terri Shaivo. Terri remained in a permanent vegetative state after a 1990 cardiac arrest. In 1998, Terri's husband applied to have her feeding tube removed. Her parents blocked him in court for seven years. In 2005, after courts repeatedly upheld her husband's application, her feeding tube was removed and Terri passed away. 

Active Assisted Suicide

In the United States active assisted suicide is permissible in three states: Oregon (1994), Washington (2008), and Montana. In these states it is only legal under the circumstance of terminal illness. Internationally, Luxembourg permits self administered suicide for terminally ill patients. Other countries have more open laws. Assisted suicide regardless of illness is permissible in Belgium, the Netherlands, and Switzerland.

In the US states that permit assisted suicide the following minimum criteria must be met: patient is 18 years old and a resident of the state, death is expected within six months, the patient has voluntarily submitted a written request to end their life, and the lethal dosage of medication is self administered. It requires the written consent of multiple physicians and there are repeated reaffirmations and waiting periods allowing the patient to change their mind. 

Advocacy Groups

Three of the euthanasia advocacy groups that exist today:

• Dr. Nitscke's EXIT International advocates across the world, but mostly in Australia for the right of any person to end their life on their own. 
• Dignitas is a Swiss organization that provides the legal and medical backing to any person choosing to end their own life, including psychiatric evaluation, medical evaluation, and legal counsel. Dignitas supports suicide for any person. 
• Dignity in Dying is a UK organization that supports the right of terminally ill patients to end their own lives. Assisted suicide remains illegal in Australia and the UK. 

United States Assisted Suicide Law Timeline

Oregon State Ballot Measure 16: Allows Terminally Ill Adults To Obtain Prescription for Lethal Drugs (Death With Dignity Act)
Nov. 8, 1994
"An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner.”

March 26th 1999, Dr. Jack Kevorkian is convicted of Second Degree Murder in Michigan. 

Washington State Ballot Initiative 1000: Death With Dignity Act 

Nov. 4, 2008

"An adult who is competent, is a resident of Washington state, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication that the patient may self-administer to end his or her life in a humane and dignified manner...

Montana State: Assisted suicide upheld in court, but no legal statute permitting or criminalizing the act.

The Ethics

There seem to be two versions of active assisted suicide in the world. There are those who advocate for the right of any person, regardless or motivation, to end their own life. Then there are those, like Dr. Kevorkian, who advocate for what is often called "death with dignity," allowing a terminally ill patient to end their life prematurely. 

Ethically this is a very complex situation. Dr. Kevorkian's patients gave consent to their suicide and were only given the means to do so. They were often bedridden and while held the mental capacity and emotional desire to end their lives, the physically were unable to. It was not until he administered death to a patient who was not physically able to themselves, was he convicted of murder. 

A 2011 Gallup Poll found 48% of Americans morally opposed assisted suicide while 45% called it "right".

In the US there is also the concept of the right to refuse treatment. No matter how life threatening  any competent individual has the right to refuse necessary treatment. Is that not committing suicide? And is that any worse that choosing to end your life with the use of medical treatment?

How about the plain right to end your life? Is it ethical for a clinician to assist a healthy individual in ending their life? Do individuals have that right? 

EXIT International (2012) About Us. exitinternational.net Accessed Oct 9, 2012. http://www.exitinternational.net/page/AboutUs

Lydia Saad (2011) Doctor-Assisted Suicide Is Moral Issue Dividing Americans Most. Gallup Politics. gallup.com.
http://www.gallup.com/poll/147842/doctor-assisted-suicide-moral-issue-dividing-americans.aspx

Kate Pickert (2009). A Brief History of: Assisted Suicide. Time. Retreived from http://www.time.com/time/nation/article/0,8599,1882684,00.html

2016: The end of Endosulfan

 As an undergraduate I did a lot of research on immunotoxicology. I looked at the effects of the insecticide Endosulfan-a on certain macrophage cells and their inflammatory response. The usage of Endosulfan in agriculture is coming to an end in the United States in the year 2016. http://www.epa.gov/pesticides/reregistration/endosulfan/endosulfan-agreement.html

Endosulfan is an organochlorine insecticide used in agriculture.  It is typically manufactured as a mixture of endosulfan-a and endosulfan-b.  Although it has been banned from use in more than fifty countries, it is still manufactured, and it is still used in the United States, India, Brazil, and Australia.  

 Acute exposures in humans and animals have been shown to cause neurological toxicity.  Studies suggest that subacute and/or chronic exposures can cause endocrine disruption, altered immune function, altered development, altered liver metabolism, and other toxicities [1-3]. 

 A recent study [4] showed that endosulfan exposure in mouse macrophages caused deregulation of production of nitric oxide (NO). Dysregulation of inflammatory cytokines and NO may play a role in the pathogenesis of some human diseases.  Because the a and b isoforms of endosulfan have differential biological activity, I examined the effects of endosulfan-a on a macrophage cell line (RAW 264.7) in culture.

 NF-KB is a protein complex that controls the transcription of DNA. NF-κB is found in almost all animal cell types and is involved in cellular responses to stimuli such as stress,cytokines, free radicals, ultraviolet irradiation,  oxidized low density lipoproteins, and bacterial or viral antigens. Incorrect regulation of NF-κB has been linked to cancer, inflammatory and autoimmune diseases, septic shock, viral infection, and improper immune development [5].  NF-kappaB triggers nitric oxide synthase II transcription when it translocates from the cytoplasm to the nucleus when inhibition factors are degraded, where it interacts with kappaB elements in the NOS2 5' flanking region.  [5].

Endosulfan is a very dangerous insecticide, especially for the agriculture workers who are in contact with the crops every day. Phasing out the insecticide in the United States was decided by the EPA, and phasing it out world wide was also proposed in 2011. http://www.epa.gov/pesticides/reregistration/endosulfan/endosulfan-agreement.html

1.  De Hond E, Schoeters G. Int J Androl. 2009 29:264.

2.  Teather K, Jardine C, Gormley K. Environ Toxicol. 2005 20: 110.

3. ATSDR. 2000. Toxicological profile for Endosulfan. Atlanta, GA: U.S. DHHS, PHS.

4. Benitez Kruidenier, S. Endosulfan-α Does Not Enhance LPS-Stimulated Cytokine Production

in RAW 264.7 Cells. 2010.[Abstract].

5. Davis RL et al. Effects of mechanistically distinct NF-kappaB inhibitors on glial inducible nitric-oxide synthase expression. Nitric Oxide. 2005 12(4):200-9.