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August 16, 2018August 16, 2018

Week in BioE (August 16, 2018)

Microscopic Magnets Reduce Pain

A new approach uses “mechanoceuticals” to treat pain.

Drugs are commonly injected directly into an injury site to speed healing. For chronic pain, clinicians can inject drugs to reduce inflammation in painful joints, or can inject nerve blockers to block the nerve signals that cause pain. In a recent study, a group from UCLA developed a technique to deform a material surrounding nerve fibers to trigger a response in the fibers that would relieve pain. The combination of mechanics and treatment – i.e., ‘mechanoceuticals’ – is a clever way to trick fibers and reverse painful symptoms. Done without any injections and simply controlling magnetic fields outside the body, this approach can be reused as necessary.

The design of this mechanoceutical was completed by Dino Di Carlo, PhD, Professor of Bioengineering, and his team at UCLA’s Sameuli School of Engineering. By encasing tiny, magnetic nanoparticles within a biocompatible hydrogel, the group used magnetic force to stimulate nerve fibers and cause a corresponding decrease in pain signals. This promising development opens up a new approach to pain management, one which can be created with different biomaterials to suit different conditions, and delivered “on demand” without worrying about injections or, for that matter, any prescription drugs.

Understanding the Adolescent Brain

It’s no surprise that adults and adolescents often struggle to understand one another, but the work of neurologists and other researchers provides a possible physical reason for why that might be. Magnetic resonance elastrography (MRE) is a tool used in biomedical imaging to estimate the mechanical properties, or stiffness, of tissue throughout the body. Unexpectedly, a recent study suggests that brain stiffness correlates with cognitive ability, suggesting MRE may provide insight into patients’ behavior, psychology, and psychiatric state.

A new paper in Developmental Cognitive Neuroscience published the results of a study using MRE to track the relative “stiffness” vs. “softness” of adult and adolescent brains. The University of Delaware team, led by Biomedical Engineering Assistant Professor Curtis Johnson, PhD, and his doctoral student Grace McIlvain, sampled 40 living subjects (aged 12-14) and compared the properties to healthy adult brains.

The study found that children and adolescent brains are softer than those of adults, correlating to the overall malleability of childhood development. The team hopes to continue their studies with younger and older children, looking to demonstrate exactly when and how the change from softness to stiffness takes place, and how these properties correspond to individual qualities such as risk-taking or the onset of puberty. Eventually, establishing a larger database of measurements in the pediatric brain will help further studies into neurological and cognitive disorders in children, helping to understand conditions such as multiple sclerosis, autism, and cerebral palsy.

Can Nanoparticles Replace Stents?

Researchers and clinicians have made amazing advances in heart surgery. Stents, in particular, have become quite sophisticated: they are used to both prop open clogged arteries as well as deliver blood-thinning medication slowly over days to weeks in the area of the stent. However, the risk of blood clotting increases with stents and the blood vessels can constrict over time after the stent is placed in the vessel.

A recent NIH grant will support the design of a stent-free solution to unclog blood vessels. Led by Shaoqin Gong, PhD, Vilas Distinguished Professor of Biomedical Engineering at UW-Madison, the team used nanoparticles (or nanoclusters) to directly target the affected blood vessels and prevent regrowth of the cells post-surgery, eliminating the need for a stent to keep the pathways open. These nanoclusters are injected through an intravenous line, further reducing the risks introduced by the presence of the stent. As heart disease affects millions of people worldwide, this new material has far-reaching consequences. Their study is published in the September edition of Biomaterials.

NIST Grant Supports

The National Institute of Standards and Technology (NIST) awarded a $30 million grant to Johns Hopkins University, Binghamton University, and Morgan State University as part of their Professional Research Experience Program (PREP). Over five years, this award will support the collaboration of academics from all levels (faculty, postdoc, graduate, and undergraduate) across the three universities, enabling them to conduct research and attend NIST conferences.

The principal investigator for Binghamton U. is Professor and Chair of the Biomedical Engineering Department, Kaiming Ye, PhD. Dr. Ye is also the Director of the Center of Biomanufacturing for Regenerative Medicine (CBRM), which will participate in this collaborative new enterprise. Dr. Ye hopes that this grant will create opportunities for academics and researchers to network with each other as well as to more precisely define the standards for the fields of regenerative medicine and biomaterial manufacturing.

People and Places

The A. James Clark Scholars Program has been established in the School of Engineering and Applied Science at the University of Pennsylvania with an extraordinary $15 million gift from the A. James & Alice B. Clark Foundation. It is the largest one-time gift to undergraduate support in the University’s history. The Clark Scholars Program will provide financial aid and create a new academic program for undergraduate engineering students.

The gift honors the late A. James Clark, former CEO of Clark Enterprises and Clark Construction Group LLC, one of the country’s largest privately-held general building contractors. It is designed to prepare future engineering and business leaders, with an emphasis on low income families and first-generation college students. Clark never forgot that his business successes began with an engineering scholarship. This has guided the Clark family’s longstanding investments in engineering education and reflects its commitment to ensure college remains accessible and affordable to high-potential students with financial need.

Read the full story at Penn Today. Media contact Evan Lerner and Ali Sundermier.

We are proud to say that three incoming Clark Scholars from the Freshman Class of 2022 will be part of the Bioengineering Department here at Penn.

And finally, our congratulations to the new Dean of the School of Engineering at the University of Mississippi: David A. Puleo, PhD. Dr. Puleo earned his bachelor’s degree and doctorate in Biomedical Engineering from Rensselaer Polytechnic Institute. Most recently he served as Professor of Biomedical Engineering and Associate Dean for Research and Graduate Studies at the University of Kentucky’s College of Engineering. Building on his research in regenerative biomaterials, he also founded Regenera Materials, LLC in 2014. Over the course of his career so far, Dr. Puleo received multiple teaching awards and oversaw much departmental growth within his previous institution, and looks poised to do the same for “Ole Miss.”

August 9, 2018August 9, 2018

Week in BioE (August 9, 2018)

Converting Fat to Fight Obesity

White fat stories calories and provides the body with insulation.

There are two types of fat in the human body: brown and white. Brown fat, the “good” fat, is rich in mitochondria, which gives it its brown appearance. Whereas white fat stores calories and acts as an insulator, mitochondria-rich brown fat burns energy to produce heat throughout the body and maintains body temperature. White fat, conversely, uses its stored energy to insulate the body and keep its temperature level. While all fat serves a purpose in the body, an excess of white fat cells causes obesity, a condition affecting one in three adults in the U.S. and the root cause of many potential health problems. Finding ways to convert white fat to brown opens a possibility of treating this problem naturally.

A new study in Scientific Reports proposes a clever way to convert fat types. Professor of Biomedical Engineering Samuel Sia, PhD, of the Columbia University School of Engineering and Applied Science, led a team which developed a method of converting white fat into brown using a tissue-grafting technique. After extracting and converting the fat, it can then be transplanted back into the patient. White fat is hard-wired to convert to brown under certain conditions, such as exposure to cold temperatures, so the trick for Dr. Sia’s team was finding a way to make the conversion last for long periods. The studies conducted with mice suggested that using these methods, newly-converted fat stayed brown for a period of two months.

Dr. Sia’s team will proceed to conduct further tests, especially on the subjects’ metabolism and overall weight after undergoing the procedure, and they hope that eventual clinical trials will result in new methods to treat or even prevent obesity in humans.

Cremins Lab Student Appointed Blavatnik Fellow

Linda Zhou is currently pursuing her MD/PhD in Genomics and Computational Biology under the supervision of Dr. Jennifer Phillips-Cremins.

The Perelman School of Medicine named Linda Zhou, a student in BE’s Cremins Laboratory, a Blavatnik Fellow for the 2018-2019 academic year. The selection process for this award is highly competitive, and Linda’s selection speaks to the excellent quality of her scholarship and academic performance. The fellows will be honored in a special ceremony at the Museum of Natural History in New York City.

Linda received her B.S. in Biophysics and Biochemistry from Yale University and is currently pursuing her M.D./Ph.D. in the Genomics and Computational Biology Program at Penn. “I am honored to be named a Blavatnik Fellow and am extremely excited to continue my graduate studies investigating neurological disorders and the 3D genome,” she said. “This support will be integral to achieving my long term goal of driving scientific discovery that will help treat human disease.”

Linda’s research is overseen by Penn Bioengineering Assistant Professor Jennifer Phillips-Cremins, PhD. “Linda is an outstanding graduate student,” said Dr. Cremins. “It is a true delight to work with her. She is hard working, intelligent, kind, and has extraordinary leadership ability. Her unrelenting search for ground-state truth makes her a shining star.”

The Blavatnik Family Fellowship in Biomedical Research is a new award announced by the Perelman School of Medicine in May of this year. This generous gift from the Blavatnik Family Foundation awards $2 million to six recipients in the Biomedical Graduate Studies Program at Penn for each of the next four years.

Growing Lungs in a Lab

As the demand for lung transplants continues to rise, so does the need for safe and effective transplanted lungs. Bioengineered lungs grown or created in labs are one way of meeting this demand. The problem – as is ever the case with transplants – is the high rate of rejection. The results of success are always better when cells from the patient herself (or autologous cells) are used in the transplanted organ.

Recently Joan Nichols, PhD, Professor of Internal Medicine, and Microbiology and Immunology, at the University of Texas Medical Branch at Galveston, successfully bioengineered the first human lung. Her latest study published in Science Translational Medicine describes the next milestone for Dr. Nichols’ lab: successfully transplanting a bioengineered lung into a pig.

These advances are possible due to Dr. Nichols’ work with autologous cells, continuing the trend of “on demand” medicine (i.e. medicine tailor for a specific patient) which we track on this blog. Dr. Nichols’ particular method is to build the structure of a lung (using the harvested organs of dead pigs in this case), de-cellularize the tissue, and then repopulate it with autologous cells from the intended recipient. This way, the host body recognizes the cells as friendly and the likelihood of acceptance increases. While further study is needed before clinical trials can begin, Dr. Nichols and her team see the results as extremely promising and believe that we are on the way to bioengineered human lungs.

Nanoparticles Combat Dental Plaque

Combine a diet high in sugar with poor oral hygiene habits and dental cavities likely result. The sugar triggers the formation of an acidic biofilm (plaque) on the teeth, eroding the surface. Early childhood dental cavities affect one in every four children in the United States and hundreds of millions more globally. It’s a particularly severe problem in underprivileged populations.

In a study published in Nature Communications this week, researchers led by Hyun (Michel) Koo of the University of Pennsylvania School of Dental Medicine in collaboration with David Cormode of Penn’s Perelman School of Medicine and School of Engineering and Applied Science used FDA-approved nanoparticles to effectively disrupt biofilms and prevent tooth decay in both an experimental human-plaque-like biofilm and in an animal model that mimics early-childhood caries.

Dr. David Cormode is Assistant Professor of Radiology and Secondary Faculty in Bioengineering at Penn. His research includes Bioengineering Therapeutics, Devices and Drug Delivery and Biomaterials.

Read the full story at Penn Today. Media contact Katherine Unger Baillie.

Stopping the Flu from Catching On

The flu virus is notoriously contagious, but there may be a way to stop it before it starts. In order for the influenza virus to successfully transport itself into the cells of a human host, it needs a certain protein called hemagglutinin which mediates its entry. By interfering with this vital ingredient, researchers can effectively kill the virus.

A new study in the Proceedings of the National Academy of Sciences discusses a method of disrupting the process by which this protein causes the virus to infect its host cells. This discovery could lead to more effective flu vaccines that target the flu virus at its root, rather than current ones which have to keep up with the ongoing changes and mutations of the virus itself. Indeed, the need for different vaccines to address various “strains” of the flu is moot if a vaccine can stop the virus from infecting people in the first place.

This breakthrough results from grants provided by the NSF, the Welch Foundation, and the NIH to Rice University and Baylor College of Medicine. Lead researchers José Onuchic, PhD, Harry C. and Olga K. Wiess Chair of Physics and Professor of Chemistry and BioSciences at Rice University; Jianpeng Ma, PhD, Professor of Bioengineering at Rice University and Lodwick T. Bolin Professor of Biochemistry at Baylor College of Medicine; and Qinghua Wang, PhD, Assistant Professor of Biochemistry at Baylor College of Medicine. Their team will continue to study the important role proteins play in how the flu virus operates.

People and Places

This week, we congratulate a few new leadership appointments in bioengineering. First, the Georgia Institute of Technology appointed Penn BE alumnus Andréas García, PhD, the new Executive Director of the Parker H. Petit Institute for Bioengineering and Bioscience. In addition to his new role, Dr. García is also the George W. Woodruff School of Mechanical Engineering Regents Professor. He conducts research in biomolecular, cellular, and tissue engineering and collaborates with a number of research centers across Georgia Tech. Dr. García graduated with both his M.S.E. and Ph.D. from the University of Pennsylvania’s Department of Bioengineering.

Secondly, the University of Minnesota Institute for Engineering in Medicine (IEM) named the Distinguished McKnight University Professor John Bischof, PhD, their new director. This follows Dr. Bischof’s recent position as interim director for the IEM. Dr. Bischof earned his Ph.D. in Mechanical Engineering at the University of California at Berkeley, and is currently a faculty member in both the Mechanical Engineering and Biomedical Engineering Departments at the University of Minnesota. Dr. Bischof holds the Carl and Janet Kuhrmeyer Chair in Mechanical Engineering.

At an earlier, but no less impressive, point in his academic career, Tanishq Abraham became the youngest person to graduate with a degree in biomedical engineering. The fifteen year old recently graduated summa cum laude from the University of California, Davis. As part of his graduating research, Abraham – a first-generation Indian-American – designed a device to measure the heart rates of burn victims. Abraham has already been accepted by U.C. Davis for his Ph.D. and plans to continue on to his M.D.

Finally, the work continues to create affordable and well-fitted prosthetics, especially for remote, rural, and underfunded areas both in the U.S. and abroad. Unfortunately, recent studies published by the Centre for Biomedical Engineering at the India Institute of Technology Delhi (IIT) demonstrate the uphill nature of this battle; stating that India alone contains over half a million upper limb amputees. To address this explosive population, researchers and entrepreneurs are using new bioengineering technologies such as digital manufacturing, 3D scanning and printing, and more. The best innovations are those that save time, resources, and money, without sacrificing quality in the prosthetic or patient comfort. Penn Engineering’s Global Biomedical Service (GBS) program similarly responds to this need, as each year students follow an academically rigorous course with a two-week immersive trip to China, where they learn how to create and fit prosthetic limbs for local children in conjunction with Hong Kong Polytechnic University.

June 7, 2018June 6, 2018

APOC Ghana: Day 12

By Summer Kollie, Health & Societies ’19; Amber Figueroa, Biology ’21; and Bosede Ajiboye, Psychology ‘19

Ghana 2018 — (left to right) Penn students Amber Figueroa, Bosede Ajiboye, and Summer Kollie watch a nurse at KATH demonstrate how she teases Kangaroo Mother Care to new mothers.

Today, we made a visit to the premature infants and Kangaroo Mother Care (KMC) wing of Komfo Anokye Teaching Hospital (KATH). Our visit was very informative. The overall goal for premature babies was for mothers to engage in KMC. When talking to the doctor in the premature clinic, she mentioned that, on average, a baby would stay in the clinic, where there are incubators and CPAP machines, for about one week before being referred to the KMC ward. In some cases, babies who have more severe cases might stay for a month or longer. The goal of the premature clinic was to stabilize the baby. An infant was stable when they no longer needed supplied oxygen and IV fluids, they had no more difficulties in breathing, and they were able to take food, as in breastmilk, through their mouths. After the baby was stable, then they were moved to the maternal ward, where the mother could administer KMC.

Kangaroo Mother Care (KMC) is an efficient way to take care of premature infants without using an incubator. With skin-to-skin contact, the baby is placed on the mother’s chest between her breast. Then, two to three blankets are wrapped securely around the baby to keep them warm.

At the KMC ward, a nurse demonstrated on herself how a mother would tie her infant onto her chest. Th nursey emphasize for mothers to be able to perform the process of tying the blanket on their own. In this ward, KMC is administered 24/7. The only time a mother gets a break is if she needs to use the bathroom or to buy food. Fathers and other relatives only assist in this process for short periods when the mother needs a break or when the mother has more than one baby, as in twins or triplets, and cannot physically carry more than one on her chest.

June 6, 2018June 5, 2018

APOC Ghana 2018: Day 11

By Shihan Dong, Biotechnology MS ’19; Xuanjie (Lucas) Gong, Biotechnology MS ’19; and Princess Aghayere, Health & Societies ‘19

As usual, today we left for to visit the psychiatric ward of the Komfo Anokye Teaching Hospital (KATH), the biggest hospital in Kumasi and the second biggest in Ghana. However, when we arrived at the KATH it turned out that the clinic wasn’t ready for our visit, because there was a mix-up with the letter sent to inform them of our visit. So, we went back to School of Public Health to access to internet to let everyone research and work on their projects.

In the evening we returned to Christ Apostolic Church, a church for women who are poorly educated and mostly petty traders. Last Tuesday, we spoke to inform them about nutrition. This time, presentation was delivered by Ethan Zhao, Sheldon Amoo-Mitchual, Rebecca Zappala and Yasmina Al Ghadban, with KNUST medical students Kwabena Asoka Sarpong and Muti Agyekum as translators.

Since last time there was a woman asked us to talk about cervical cancer, we decided talk about that as well as about cancer in general this time. At first, Ethan introduced the cancer was the result of cellular instructions being modified, and that there are ways to either protect those instructions or increase the risk of modification. Next, Sheldon talked about the importance of nutrition in cancer prevention, as introduced in last week, as well as the importance of good habits like exercising regularly and not smoking. Then, Rebecca introduced prevent cervical cancer and how to help prevent it through things like HPV vaccines and diagnosing it at early stages through Pap smear test. Finally, Yasmina covered the breast cancer, another cancer prevalent among women. She introduced that everyone is at risk of it and some certain factors would increase the risk like family breast cancer history. She taught them the self-exam, and recommended that women over 40 get a mammogram annually. During the question section, the audience was really active to ask questions, so much so that the other group that was supposed to present on pregnancy, Amber Figueroa, Bosede Ajiboye, and Summer Kollie had to be rescheduled to present next week. The churchgoers were curious about things like how and how often they should wash genitals area, as well as how to take care of their pre-pubescent daughters. They also wanted to clarify some rumors they were told about the causes of cancer, such as if things like phone vibration, or putting a phone to the left ear could cause cancer.

After the presentation, we sang a simple church song in Twi, Asem papa bia mate ne s3 oye oye, which we had prepared before coming. The churchgoers were delighted and they joined in, creating beautiful harmonies as our voices combined.

June 5, 2018June 4, 2018

APOC Ghana 2018: Day 10

By Adam Yablonski, Health & Societies ‘21

Another early start to the day and another breakfast later, we were on our way to the KNUST Counseling Center. Our aim was to inquire further into another of the four fields our groups are interested in, today’s visit being geared towards mental health in Ghana (and more specifically, the mental health of university students at KNUST). Our plan for the afternoon was to return to the Kokoben Academy for our final set of lessons for the students there.

Upon arriving at KNUST however, we hit an unexpected roadblock (figuratively, that is). There was an unforeseen situation (the details of which remain undisclosed) that resulted in the unavailability of our contact in the facility. Luckily, we are no strangers to scheduling changes. We were able to call an audible, and simply ended up switching the order of our activities for the day – we drove instead first to Kokoben. Once again, the kids were eager to learn anything we would teach, but they seemed most interested in American culture. They inquired about our holidays, demographics, geography, food, and even our government. We ourselves were able to learn from them as well – both introspectively at our own culture as one of immigrants, but also simpler lessons, like the first ten numbers in Twi! Since today marked out final trip to the school, many of us bought candy beforehand to gift to the students. We had to exercise caution however, Ghanaian children are almost as voracious as their American counterparts and will not hesitate to swarm any candy-giving figure in proximity (no matter how tall you are, I found). Though fun, our trip was marked by melancholy; we had to say goodbye to the very real connections that we had formed in just a few short days. The service aspect of APOC will not end though, as we will be teaching at another school in the coming days.

After skipping lunch due to its lateness and our crunch for time, we returned to the University Counseling Center to discuss the state of mental health among the students there. They have low funding and just 10 staff members, and they see 900 new cases each year. We learned about what the Center does, which includes therapy, outreach, and training programs. Since poverty and hunger are unfortunately not rare problems among students at KNUST, the Center will also provide basic food items to students during exam times, and provide free health screenings of all kinds.

In speaking with a faculty member there, we uncovered some rather stark cultural differences that surround the issue of mental illness in this country. Firstly, there are no explicit diagnoses made at the Counseling Center, at least not as we would think of them. Instead, patients come in and simply speak with counselors there. The counselor will listen and perhaps will be able to diagnose something, be it GAD, MDD, or another condition. There is a disconnect though – because of Ghanaian society’s attitude towards mental illness, counselors are unlikely to even tell their patients of their condition, for fear that they will not return to counseling. As a result, emphasis is usually placed on what are perceived to be the causes of these conditions – the most commonly cited are relationship and family issues, financial issues, and academic stress (oftentimes, combinations will manifest). Counselors focus on these stressors with patients, rather than the disorders themselves. This stigmatization of mental illness is widespread, structural, and systemic, and will be a real challenge for our mental health group moving forward.

May 31, 2018May 30, 2018

APOC Ghana 2018: Days 7-9

By Summer Kollie, Health & Societies ’19; Amber Figueroa, Biology ’21; and Bosede Ajiboye, Psychology ‘19

Friday

We spent Friday morning learning more and experiencing Ghanaian history and culture. This was after we got the bad news that the scheduled programming to visit the urban high-risk maternal clinic was canceled. Even though we were disappointed because we wanted to learn more about high risk pregnancy in urban areas, we were luckily able to re-plan our day by going to the Center for National Culture Kumasi, a small museum containing objects significant to Ashanti history.

While there, we learned about the history of the kings and warriors of Ashanti culture. We learned about the golden stool and how it fell from the sky. We also visited the shops of several Ghanaian artisans and got the chance to patronize their work. We bought various jewelry, paintings, fabric, bowls, bandanas, and food.

We also had the chance to see a basket weaver weave an elaborate basket from scratch. It took him about 30 minutes to do so while we got an educational talk about the process while he was doing it.

On Friday night, we went to a bar and grill with music, where we ate dinner and danced with the other restaurant-goers.

Saturday

We spent Saturday morning at the market exploring and getting a taste of the rush of the market. We went to a big market, which had many sections and was bustling. The Ghanaian students helped us to navigate and barter with the sellers. We bought a lot of pretty fabric, like kente cloth. We also bought Ankara fabric, whichis used to make colorful wax-printed clothes that are common in Ghana, in preparation for the tailor, who will come in the following week to measure us and sew nice outfits for us.

On Saturday afternoon, we went home, slept, and later hand washed our laundry. We got a taste of what it was like to do laundry the way the locals do it, without washing machines. It took hard work and elbow grease, but it was fun.

Sunday

On Sunday morning, we moved into our new home which is more secluded. We went from having no air conditioning at the last location to having wonderful and cooling AC, along with private bathrooms. In this location, we are able to vibe with new people and get to know the neighborhood and culture more.

We spent Sunday afternoon resting after we enjoyed a delicious homemade lunch. On Sunday evening, we went out to a nice bar called Bar-Nas, where we enjoyed music and traditional Ghanaian dishes.

May 30, 2018May 29, 2018

APOC Ghana 2018: Day 6

By Sandy Tang, Bioengineering ’19; Eliza Culp, Fine Arts ’20; and Jessica Fan, Biotechnology MS ‘18

After a delicious breakfast, we headed out to Afrancho Health Center, a rural health center about an hour away that specializes in maternal ante-natal care. There we talked with the head nurse about their internal processes and the general work flow of the center, as well as general practices for maternal healthcare. She showed us several examples of blank paperwork used to register expecting mothers and their medical history, which was very helpful to our understanding of their process. From our conversation, we learned to identify and categorize pregnancies as high risk based on conditions such as anemia, hypertension and preeclampsia, hepatitis, teenage pregnancy, and timing of pregnancy.

The Afrancho Health Center sees all women once a month during pregnancy and weekly during the last month before delivery. Sonograms are done at each visit. Diagnostic tests are also run when the women initially come in to screen for risk factors and conditions. The center also provides educational materials on nutrition, safe delivery practices, and other important information. In addition to speaking with the head nurse, the center kindly arranged for us to speak to patients with their consent to gain a better understanding of each of the high-risk factors identified by the center. Afterwards, we got a glimpse of their delivery rooms, as well as the laboratory spaces where they are able to run several diagnostic tests for the center. They are able to provide these services, but they need more staff, an ambulance system, a reliable power source, bigger facilities, and lab machinery.

After lunch on the road, we arrived at the Kokoben Municipal Assembly school. We continued to assist with their classroom lessons, including English grammar, math, and physics, and we also introduced some new topics, such as Chinese and art. The kids were wonderful and very active participants. We look forward to working with them again on Monday.

We also look forward to re-visiting the health center in two weeks to follow up on some cases.

May 29, 2018May 29, 2018

APOC Ghana 2018: Day 5

By Yasmina Al Ghadban, Bioengineering ’20; and Rebecca Zappala, Bioengineering ‘21

This morning, after a breakfast of eggs, sausage, and toast, we headed to the Maternal and Child Welfare Center (at the Komfo Anokye teaching hospital) to visit the malnutrition ward. We learned about two types of severe acute malnutrition: marasmus, which is characterized by severe wasting due to starvation and a lack of both protein and energy nutrients; and kwashiorkor, which is characterized by swelling of the belly, cheeks, and limbs due to a lack of protein in the diet. We also learned about the process of treatment starting from diagnosis by measuring the mid-upper arm circumference (MUAC), as well as the weight. After the specific case of malnutrition has been diagnosed, healthcare providers look for underlying conditions, such as infection, anemia, HIV, or malaria, by running lab tests. For treatment, depending on the severity of the case and the age of the child, they administer F75 or F100, which are different kinds of ready-to-use therapeutic agents. After learning about the third case that we will be working on, we went to the nutrition center where families are sent for outpatient care and follow-up. This is also the first point of contact between the family and the healthcare system; if the case is severe, the patient is referred to the malnutrition ward that we first visited. At first, we had questions about how the follow-up process works. We discovered that mothers are supposed to come back weekly to collect more food and check the weight and MUAC of their children to track their progress. In cases in which mothers do not come back for their follow-up, they are called and sometimes even visited at their homes by nurses.

Although we had visited this same ward yesterday, it is still so hard to look at the children there. The clinic seems to be doing everything they can; however, it is difficult to ignore that there is a clear lack of resources, funds, and accessibility. For example, the malnutrition center had to move from being a 2-room clinic to a 1-room clinic due to a lack of funds. This resulted in having the waiting area, the food distribution, and the assessment of the child in the same confined space, which then limits the number of patients they can care for at once.

Later in the afternoon, after a drive through the market and a stop to get coconuts, we headed to Kokoben Municipal Assembly school (kindergarten through grade 9) for service. We were divided into pairs, which each taught a class about something the grade was currently working on or wanted to learn. The experiences ranged from singing with 5-year-olds and struggling to communicate in English, as most children only know Twi, to teaching about heart diseases and the circulatory system. There was a lot of shock at first since it was not easy to stand in front of 40 students and teach an unprepared lesson. Overall, the kids seemed very excited and fascinated by our presence. Although we were glad we were able to spend some time with them and share an (infinitely) small part of knowledge, we were shocked by their fascination and overwhelming joy to see us.

As on our fourth day in Ghana, we feel like we have learned so much — both about the healthcare system and the culture, and we look forward to continuing to learn and grow tomorrow.

May 28, 2018May 25, 2018

APOC Ghana 2018: Day 4

By Xuanjie (Lucas) Gong, Biotechnology MS ’19; Shihan Dong, Biotechnology MS ’19; and Princess Aghayere, Health & Societies ‘19

Today, we all went to the Maternal and Child Health Hospital in Rural Kumasi. The main purpose of the visit was to observe malnutrition cases in children and to interact with doctors and nurses who treat children suffering from malnutrition.

While visiting the clinic, the nutrition group asked the questions that we prepared yesterday. It turns out that the situations here match up with our research. Doctors and nurses use WHO standards to determine the nutrition status of the kids. Also, they use MUAC tape to determine the severe acute malnutrition. Children who have MUAC less than 11.5 cm will be sorted into a severe acute malnutrition group.

As for solutions or treatments, they do know about and have RUTF (Ready-to-Use Therapeutic Food). We also learned that they have therapeutic milk, F-75 and F-100, to treat malnourished children in different phases. They have F-75 to use at the starting phase of treatment. If F-75 helps to stabilize the children, they move onto F-100, and they use diluted F-100 for children under 6 months.

We had 2 cases that we mainly focused on. The first case was of a 3-year-old girl who suffered from Kwashiorkor, Marasmus, and Marasmic Kwashiorkor. All 3 diseases are signs of severe acute malnutrition. She had been there for 3 weeks for treatment, and her condition was not improving. The doctors attributed her declining condition to poverty and the mother’s psychiatric problems. The patient’s mother has already lost two children to the same condition. The doctors describe the girl’s status as unstable because she often vomits and isn’t gaining weight. The second patient is a child exposed to HIV as a result of her mother being positive for the disease. Because she is only 3 months old, blood cannot be drawn, and testing cannot be done to ensure her HIV status.

In the evening, we went to a church to give a presentation to local women with little to no education. We started by asking them what they eat everyday, and luckily we received a lot of responses. From their responses, we could clearly see that their diet lacked components of vegetables and fruits. Then, we delivered a brief speech containing basic nutrition knowledge, mainly based on the six essential nutrients. We explained the function of these nutrients and some local sources to obtain them. Surprisingly, one of the female audience members said that this was her first time hearing about vitamins and minerals.

During the question and answer segment of our presentation, some women asked about the different types of sources for minerals and vitamins. In particular, one woman asked about the foods that she could eat to help with her hypertension. To our surprise, another women asked whether her intake of fruits was excessive. This question made us think about people’s awareness of obesity and other diseases related to overeating. At the end of the presentation, the audience was happy about what we presented today and looked forward to learning more on our next visit.

May 27, 2018May 25, 2018

APOC Ghana 2018: Day 3

By Xuanjie (Lucas) Gong, Biotechnology MS ’19; Shihan Dong, Biotechnology MS ’19; and Princess Aghayere, Health & Societies ‘19

This morning, we had our official kickoff in the morning. It was a great meeting with Dr. Ellis, the Dean of School of Public Health. In the afternoon, professors from different schools delivered three lectures about the state of mental health, maternal and child nutrition, and health systems in Ghana.

Ghana 2018 The mental health lecture, given by Dr. Emma Adjaottor, was impressive and surprising. We are so lucky that we met one of the psychiatric physicians among a hundred across the country. The doctor frankly introduced mental health development in Ghana. Though they have lagged behind, they have made a lot of progress, with the number of psychiatrists in Ghana recently increasing from single digits to the double digits. Dr. Adjattor emphasized that the epidemiology of mental health in Ghana is nearly identical to the rest of the world, particularly in terms of incidence and prevalence, even though it is severely under-reported. The doctor explained that, although the epidemiology is the same, the terms used to describe these issues are often different, relying on more local ideas, such as spirits and witchcraft.

The maternal and child nutrition lecture, given by Dr. Samuel Newton, was even more astonishing. Kangaroo mother care (KMC), in which a prematurely born infant is given constant skin-to-skin contact with the mother, is undergoing study in Ghana, and it has shown promising outcomes. Even with limited studies, KMC has been found to greatly increase the likelihood of survival even when using “surrogates,” such as grandmothers and even fathers. The professor also introduced another study that found that the application of oxytocin during the third stage of labor in mothers at risk of postpartum hemorrhage (PPH) greatly decreased the likelihood of PPH.

Finally, Professor Ellis Owusu-Dabo gave an extensive lecture covering the health systems of Ghana, which are logically and hierarchically managed, with administrations at the national, local, district, sub-district, and community levels. We also learned about the insurance program in Ghana. For formally employed workers, national insurance participation is mandatory, as it is funded by a mandatory tax on their income, like in many socialist countries. However, insurance coverage is a more complicated matter in Ghana, in which a very large proportion of the population is not formally employed and instead earn its living through trading and cash-paying jobs. For these people, other than the free public health services provided by the government such as malaria, tuberculosis, and HIV care, they must pay out of pocket for many other services.

Tomorrow will be the very first clinic visit, where we can observe children suffering from severe acute malnutrition. So the three of us in the nutrition group, Princess, Shihan, and Xuanjie, gathered together after dinner to discuss what we would ask the doctors and nurses during the visit. We agreed that, at first, we should ask whether we can take pictures to record. As for nutrition, we will ask how healthcare workers there define malnutrition.

To our knowledge, malnutrition standards are normally based on BMI, which is a composition of weight, height, and age-related data. We want to know whether Ghanaian healthcare professions use the same standards here, as well as how the local standards differ from the established WHO standards. Furthermore, we will ask for access to their local data sets. In addition to the results of malnutrition, we also want to know what the major causes of malnutrition are. We assumed that the principal cause is poverty, and based on this assumption, we want to ask them whether there are any welfare systems or NGOs helping to resolve the problem. We hope to find out what the clinics’ initial steps are to resolve malnutrition. Our last question involves how macronutrients are measured.

Tomorrow evening, we will give an open presentation in a local church to female market workers. We first planned to deliver the presentation in a discussion form, but considering the language barrier and other factors, we decided to give a speech, but we will ask simple questions. We thought that the scope of our research was not appropriate for local life in Ghana because much of the research was done in the U.S.; thus, it was necessary to get the input of local people. By asking them questions about what they eat on a daily basis, we want to make our research as appropriate as possible. In relation to our presentation, we will briefly introduce what nutrition is and explain the 6 essential nutrients through definitions and explanation. For example, when introducing carbohydrates, we will refer to fufu or banku, which are local main dishes basically consisting of starch. Also, we came up with an educational idea for the future. If we have a projector, we could possibly show some dishes to let the audience choose which is more nutritious, to provide general idea of a nutritious diet.