The University of Southampton

Month: March 2023

Prosthetics in developing countries

Posted on by

Following our lecture on prosthetics and orthotics, I became interested in the affordability of the new prosthetic technology in the UK and in developing countries. From the age of nine to sixteen I was a competitive swimmer, this lecture reminded me of a girl I swam with who had a below the knee amputation, she always struggled with her prosthetic limbs and swimming. This was mainly due to one factor; she could not afford the newest technology and the NHS would only cover certain costs. 

What is a prosthetic limb?

An artificial substitute for a missing part, such as an eye, limb, or tooth, used for functional or cosmetic reasons

medical dictionary

This prosthetic toe has been dated between 950 – 710 BC. It was composed of wood and leather

Prosthesis technology has been around since 950 BC, prosthetic limbs are used after a limb or body part can no longer be used due to incidents such as disease, trauma, or a medical condition present at birth. 

In recent years prosthetics are made from advanced plastic and carbon fibre. The leaps in our technology astounded me, but it left me thinking with increasing technology there must be an increase in price. After investigation I found that the NHS is improving significantly when it comes to accessibility and in November 2022 the new bionic arm became available through free healthcare this came as a shock as I previously had other ideas regarding the accessibility in the UK.

As I read around the subject further, I found that I was more interested in prosthetic limbs in developing countries especially after learning that the professor delivering our lectures on prosthetics is running an accessibility campaign. 

Approximately 40 million people have a need for a prosthetic leg in the developing world yet a mere 5% have prosthetic options. The newest technologies are expensive; I was astounded when I realised many people don’t have access to the most basic prosthetics! The citizens that have access may not even be able to afford the prosthetic limb available. I have come across an organisation called LIMBS they aim to develop new designs to allow people in developing countries to have access to prosthetics. They focus on rehabilitation processes amputees can go through which supports amputees mentally and physically. They call for social change to allow these countries to work through their emotional trauma whilst also providing high-quality, low-cost prosthetic limbs.

The LIMBS project is under the borgen project, which is a non-profit organisation. This provides a good source of information when researching prosthetics in developing countries and the real-life effects of their work.

Click on the picture to find out more.

What is Southampton university doing to help? 

Dr Alex Dickinson is currently leading a multidisciplinary team of health scientists and engineers to discover how we can use technology to help improve accessibility to prosthetic limbs in Cambodia. They are looking at the growing number of amputees and the countries inability to keep up with the high demand.  They have been researching into portable 3D Scanners and most importantly Dr Maggie Donavan-hall has been looking at what technologies will realistically meet their needs, culturally and socially. The key aspects I took away from reading about this research is the need to tailor prosthetics and orthotics to the country and the people, the prosthetics need to work well with what is already in place in that country. As well as this it made me think about how else portable and personalised prosthetics having would help communities. For example, it was explained that it would also help due to decreasing waiting times to see a clinician, the clinicians would be mobile meaning they can take these devices to the patients. This allows the patients to take less time off work. I think this is a big step as it means more members of the community can come forward to receive help as they won’t be scared about it affecting their jobs.

https://www.southampton.ac.uk/news/2019/01/a-step-change-in-prosthetics.page: Prosthetics in developing countries

Getting back on your feet- I Mean Literally

Posted on by

As comparison to now and a few decades ago, the field of bioengineering has come a long way, especially in the field of prostheses. Throughout our engineering lectures thus far, what particularly struck me was the week in which we had covered prostheses and limbs in our lectures. This was because they have such a huge number of applications in which can be used to help people return to living a normal life (at least as best as they can).

As someone who is passionate about the field of sports medicine, what triggered me to do further research into what prostheses were like in earlier ages- like the 90s in comparison to the ones now, specifically ones specialised for athletes.

  • The picture on the left is what prosthetics had looked like during the mid-90s. Earlier prosthetics were often made of wood, leather and metal that limited movement.
  • The image in the middle displays what prosthetics look like now. It shows that advances in material and design have enabled prosthetic limbs we use now to be more functional and comfortable. Making use of lightweight yet very durable materials like carbon fibre and thermoplastics.
  • The image on the right is what a specialized prosthetic for athletes looks like now, they make use of a device with a curved blade, which provides a good balance between flexibility and strength to withstand high- impact activities like sprinting and jumping.

From these design and material advances, more endeavors have been made to aid people in somewhat returning to a normal life (as well as attempts to make less expensive alternatives for those who can’t afford certain prosthetic’s), and furthermore provide less fortunate people an opportunity to at least recover from trauma.

A research study, taken by the University of Southampton, published in the journal of Global health. Talks about how they’re helping countries like Cambodia plan future prosthetics and orthotics.

It mentions: “thanks to a grant from Global challenges Research Fund, the University’s People Powered Prosthetic group and Exceed Worldwide, a Non-governmental Organisation (NGO) which trains specialist staff and provides P&O services- like supplying prosthetic limbs, braces, wheelchairs and community support- were able to access and, for the first time, analyse routinely collected data from existing electric patient records in an aggregated and anonymous way”

This indicates that by determining patterns in the cause of injury and disease from which amputations are required. Together with cross referencing data from the data from current patients, applications of prosthetics can be made specifically for these people, which can provide opportunities to return to work and sustain both themselves and their family.

CASE STUDY- AN ATHLETES POV

From another perspective- of someone with congenital (birth) defects- more specifically an athlete would be Richard Whitehead (a Paralympic gold medalist in London 2012, and silver medalist in Tokyo 2020). He was born with a congenital condition with which had left him with a ‘double through knee amputation’ meaning he was born without the bottom half of his legs.

Even with this condition, he went on to set a world record for athletes with double amputation (which took place at the 2010 Chicago marathon). Unfortunately, he was unable to compete in the marathon at London 2012 as there was no category for leg amputees, and was refused permission by the IPC to compete against upper limb amputees.

Because of this he turned to sprinting to compete at the 2012 Paralympics. Here was where he obtained gold in the 200m T42 Athletics event, setting a world record time of 24.38 seconds. And later on in 2013 was appointed the first ever patron of Sacroma UK, a bone and soft tissue cancer charity.

CONCLUSION

From just the past few decades (as mentioned before) technological advances, aiding both design and material advances have allowed us to consistently come up with new and innovative ways to get people back on their feet both figuratively and literally. And its yet to show and slowing down in its rate of improvement.

Overall, from cases such as Richard Whitehead, who had taken his condition as something that will not stop him from reaching his dream. As well as other cases like the people from the research study who were provided with a means to recover from traumatic events like natural disasters. It’s clear to see that prosthetics have become an integral part in the lives of these people. And taking these examples, as starting points for more research, more persistent endeavours can be made from which, more ingenious solutions can be introduced and applied to treatment for potential patients in the future.

Treating the Invisible Pain: Prosthetics and Phantom Limb Pain

Posted on by

I was initially intrigued by the concept of Phantom Limb Pain (PLP) because I was fascinated by how someone could experience pain in a body part they no longer possessed. The depiction of PLP in the sci-fi movies I watched when I was younger seemed to be a figment of the imagination; it appeared to be a mysterious occurrence, somewhat fantastical and an element of creative licence adding dramatic effect.

After further research, I discovered that this perplexing phenomenon is real, not make-believe! The basis of PLP although unclear, is suggested to be due to changes in an amputee’s brain organisation; more specifically, alterations in the somatosensory cortex responsible for processing sensory information such as sight and touch, thus affecting the perception of pain sensitivity.

For those who are unaware, PLP can occur within the first few days after amputation; and can persist without intervention. The symptoms vary from the perceived ability to voluntarily move the phantom limbs to intense pain and tingling sensations. PLP treatment is usually with pharmacotherapy, and prosthetic use is considered an adjuvant therapy.

So where do prosthetics come in?

A prosthesis is an artificial device that substitutes for part of the body that is absent due to amputation as a result of a disease or traumatic injury.

Weiss et al. (1999) investigated how increased use of the residual limb by a prosthetic could alleviate PLP by comparing the amount of PLP experienced by upper extremity amputees who wore either the Sauerbruch prosthesis or a cosmetic prosthesis. The Sauerbruch prosthesis allows for the performance of several activities by being connected to one of the muscles of the arm through a surgically created tunnel with cables that operate a rod inserted into the arm, allowing for the contraction and relaxation of the muscle connected to the prosthesis and therefore promotes substantial use of the residual limb. Contrastingly, a cosmetic prosthesis has little functional value and usually leads to the non-use of the affected limb in most individuals who use one. The study concluded that individuals using the Sauerbruch prosthesis have substantially less PLP due to direct motor control of and somatosensory feedback from the prosthetic hand originating in the muscle of the residual limb than those using a cosmetic prosthesis.

The original Sauerbruch arm
Cosmetic Prosthesis
Depiction of the functionality of the Sauerbruch Prosthesis

Modern myoelectric prostheses function like the Sauerbruch prosthesis, however, they utilise electrodes in the prosthesis to detect nerve and muscle activity along the residual limb musculature, which triggers motors in the prosthetic to control and produce the movement intended.

Basic Diagram of a myoelectric limb

Final Thoughts:

The understanding of PLP and prosthetics as an adjuvant treatment allowed me to consider further; whether cosmesis of prosthetics(making artificial limbs look lifelike, similar to the original missing limb) aids the alleviation of PLP, as the somatosensory cortex also processes visual information.

My learning extended to another study suggesting that the correction of body perception may modulate PLP. This hypothesis stems from the prosthetic ownership concept, whereby prosthetic use is experienced as part of the body rather than an attached device foreign to it. This added to my insight into the prosthetic treatment of PLP as the brain combines visual input and direct cortical-somatosensory electrical stimulation by the prosthetic, creating a multisensory illusion that an artificial limb actually belongs to the body, thereby reverting the somatosensory cortex to a healthy state.

Overall, PLP accounts for a significant reduction in the quality of life of amputees; thus, the development of prostheses with somatosensory feedback and a cosmesis effect is a promising therapeutic tool to reduce PLP.

Sustainability in Replacement Body parts

Posted on by

Replacement body parts are a central part of the medical world with anything from an organ to a finger able to be replaced in a human body. With the world population growing and the expectation for a certain quality of life rising, demand for replacements are at an all time high but the issue coupled with this demand is the environmental impact of designing, producing and implanting replacement body parts into patients. One of the biggest issues in the world today is the battle against climate change and not only how individuals can combat this issue but how bigger corporations like the NHS can contribute to the fight, and as a knock on effect, this alters the way in which replacement body parts can be manufactured.

Waste in the NHS

Biodegradable materials in medicine

I’ve always been a keen enthusiast of lowering carbon footprint and doing my part to contribute towards sustainability in the world and I’m also very keep on advancing medicine but the true inspiration for this literature came from my work experience at Bournemouth Hospital in the orthopaedics unit. Shadowing an anaesthesiologist allowed me to encounter many different angles of a working hospital but the most interesting area was the orthopaedics unit. I watched several knee replacement surgeries and the hundreds of pieces of sterile machinery and equipment used in the replacements but also the amount of waste produced. It made me question all the waste produced on the bigger scale and the negative environmental impact the manufacturing of the tools and prosthesis used in everyday surgeries and procedures.

Impact of sustainability on replacement body parts

A visit from MatOrtho in a module workshop highlighted how the pressure for the NHS to have net zero emissions by 2045 put immense pressure on them as manufacturers of replacement body parts to find more eco-friendly ways of producing what they already produce. With there already being so many limitations and restrictions to the way prosthesis can be produced, finding sustainable ways to carry on with their work is proving challenging but what I question is, at what point can you justify the production of carbon emissions in order to improve the quality of someones life through the creation of replacement body parts?

I was surprised to find the arguments of some claiming that the state of global health is a greater issue than the quality of life of those with a debilitating injury or loss of a limb but with the rise of sustainability activists like Greta Thunberg, the whole world needs to be thinking of ways to be more sustainable, not just the bigger corporations.

What does this mean for the future of replacement body parts?

3D printed heart using organoids and stem cells

Medicine is constantly advancing and nearly everyday there are discoveries or advances in the scientific world that lead to the improvement or saving of someones life so at what point do you limit that? As of 2022, there were 7000 patients on a waiting list for an organ transplant in the UK but this number is expected to decrease as organoids have opened up a whole new pathway in the world of organ transplants.

However this research could be restricted with the increasing regulations placed upon industries in order to preserve global health. But, if you were to break it right down to the foundations of transplants and prosthesis to the patients and family, if you were given the option to change your mothers, fathers, partners life by giving them the opportunity to undergo replacement surgery but the outcome may result in damaging the planet, would you go through with it? I know I would.

An Extra Brain Just in Case?

Posted on by

I was reading about how stem cells are used so much in research in recent years to grow and develop organs in the lab. In particular, the advancements being made in growing mini brains. How amazing would it be if we were one day able to develop a fully functioning brain from our own brain cells that could be transplanted into brain dead patients!

So how close have scientists got to creating a fully developed and functioning brain?

Many ongoing experiments have been able to take human tissue and develop it into cerebral organoids, better known as mini brains. But what is the science behind this? I read an article written by Tiare Dunlap from University of California, Los Angeles. The article explains that scientists take the human tissue and engineer it to become induced pluripotent cells. Induced pluripotent cells are cells that can differentiate into any cell type in the body. They can then take these cells and by changing the environment the cells are in they can make them become neural stem cells. These neural stem cells are capable of developing into most of the types of cells found within the brain. The article also explained how there is no set protocol that is used across labs resulting in huge differences between ongoing experiments. I suppose the differences obtained in the results of the experiments can be a good thing in such a new and developing area of science. However, it did make me question if discoveries could ever be backed up with more evidence if each experiment carried out is slightly different. Is it limiting the discoveries that could be made within this highly important research? (https://newsroom.ucla.edu/releases/making-mini-brain-organoids-brainier#:~:text=To%20produce%20mini%E2%80%93brain%20organoids,cell%20type%20in%20the%20body.)

I found this video which gives a good summary of the the ongoing research and some of the science behind it.

What can we do with mini brains?

This is an image of cerebral organoids that were grown in a lab. At the minute, the mini brains are being used to research neural development, creating models to research neurodevelopmental disorders and for testing drug administration and responses.

But the big question is how far can we go with these mini brains?

A large amount of ongoing research is aimed at developing mini brains that can be conscious. There has been a few experiments that have shown that it is possible for the organoids to develop properties of a conscious brain. This includes, in 2019, Muotri’s group published a paper showing the creation of human brain organoids that produced coordinated waves of activity, resembling those seen in premature babies.

At the present time, there is no evidence that cerebral oranoids can become fully conscious, but the theory behind it has sparked many ideas on how we can further develop and use cerebral organoids. The downloadable PDF written by Sara Reardon gives a great insight to some further research ideas that are starting to become a reality.

can_lab_grown_brains_become_conciousDownload

Further reading and research into my initial question; whether a fully functioning brain could be developed from our own cells, has shown that there is still a lot of research to be done if it is to become a reality. And although the reality of this happening is still far down the line it was extremely interesting to see how far science has come.

Henrietta Lacks: The Immortal Woman

Posted on by

If you’ve taken any lecture within the realm of cell biology – be it about cell division, transport, signalling, and so on – you’ve most likely encountered an experiment involving the use of HeLa cells. I certainly did, and after repeatedly seeing images of those strange, purple cells on my lecture slides, it made me wonder “What exactly is so special about HeLa cells that they are used in virtually every experiment to do with human cells?” This blog post is about these cells: what exactly makes them so remarkable, their polarising legacy, and the important bioethical discussions they raise about medical consent and racism.

An image of stained HeLa cells under a microscope.

What are HeLa Cells?

HeLa cells are an immortal cell line derived from the cervical cancer cells of Henrietta Lacks, a 31-year-old black woman and mother of five. They are the oldest and most used human cell line in scientific research and have contributed to countless scientific studies since their discovery in 1951.

Lacks was a patient at Johns Hopkins Hospital, Baltimore, Maryland in 1951, being treated for a very aggressive form of cervical cancer. Several months before her death, a sample of her tumour was given to George Gey, the head of tissue culture research at Hopkins at the time. Gey had been searching for an immortal human cell line to study cancer with for two decades and he had finally struck gold: Lacks’ cells multiplied faster than any cells he had ever seen, reproducing an entire generation every 24 hours. Unfortunately, it was this rapid and unlimited division that caused Lacks’ cancer to metastasise to virtually every organ in her body within months. She passed away on October 4, 1951.

The dicey bioethics of HeLa cells

It is quite difficult to put into words just how impactful Henrietta’s cells have been on medical research. They were used to develop the polio vaccine, study leukaemia, AIDS, and cancer, and more recently, help develop COVID-19 vaccines. Since their isolation, HeLa cells have been used in more than 70,000 scientific studies around the world as of 2022. There is a darker side to this story, however.

After her passing, Henrietta Lacks was buried in an unmarked across from her family’s tobacco farm in Virginia. For the next twenty-odd years, her family had no clue her cells had been shipped worldwide and were being used pioneering medical research. It wasn’t until 1975 that the Lacks family even were made aware about the widespread use of her cells in said research.

Henrietta’s cells were taken without her consent, which was legal at the time. Since then, policy changes have been made, and ethical guidelines for medical research have been put in place like the Declaration of Helsinki, which places emphasis on the informed consent of patients. In the USA, changes are being attempted to be made to the Common Rule, the set of ethical policies for research with human subjects, to make its consent rules more far-reaching.

Racism in science and Henrietta’s legacy

In my opinion, what Lacks’ story really highlights is the racism that has historically plagued science, particularly medical research and services in the United States. Hopkins, where she was treated, was one of the few American hospitals at the time that would admit black people. None of the multiple biotechnology companies whose research benefitted from her cells have financially compensated her family. In the 1840s, James Marion Sims, known as the “father of modern gynaecology”, infamously conducted experimental gynaecological surgery on enslaved black women without anaesthesia. There was also the Tuskegee Syphilis Study, when hundreds of black men in the 1930s were denied treatment for syphilis by researchers so the progression of their symptoms could be studied. I have linked further reading on both cases and more general scientific racism at the end of this blog.

While it is important to reflect on these past injustices, what the Lacks family would like to shift the focus is to is the legacy of Henrietta herself. In 2010, the Henrietta Lacks Foundation was established by Rebecca Skloot, the author of a book about Lacks, which awards grants to her descendants and other family members of people whose bodies were used without consent in research. In 2020, on her centennial year, the Lacks family started the #HELA100 initiative to celebrate her life and legacy.

Henrietta loved to dance and cook. She dressed stylishly and wore red nail polish. And most importantly, in the words of her grandson: “[Her cells] were taken in a bad way but they are doing good for the world.”

Henrietta Lacks (HeLa): The Mother of Modern Medicine by Kadir Nelson is a portrait of Lacks which has been on view in the Smithsonian Institute’s National Portrait Gallery in Washington D.C. since 2018.

My thoughts

I wanted to write about Henrietta Lacks for my blog post because as someone who wishes to work in biomedical research in the future, I will probably end up working with these cells myself and I think it is important to highlight the legacy of these cells: both the unjust way in which they were acquired, and what we and the scientific community at large can learn from these past injustices so we do not repeat them.

As a woman of colour myself, I have rather mixed feelings on HeLa cells. It is chilling thinking about the horrific treatment people of colour, and especially women of colour have faced in historical medical research. However, HeLa cells have done so much good for the world and do so for all ethnicities. As long as we acknowledge the story of Henrietta and continue to compensate her descendants, I think HeLa cells can continued to be used in research.

Much progress has been made on bioethics and informed consent in medical research and treatment since that extraction was made from Henrietta’s tumour all the way back in 1951. However, as biotechnology continues to advance and gene editing and the like becomes more commonplace, the door has opened to once again start having these important discussions on how to ethically apply these new technologies.

References

Johns Hopkins Medicine (2023) The Importance of HeLa Cells, Johns Hopkins Medicine. The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins Health System Corporation. Available at: https://www.hopkinsmedicine.org/henriettalacks/importance-of-hela-cells.html (Accessed: March 8, 2023).

Martinez, I. (2022) What are HeLa cells? A cancer biologist explains, The Conversation. The Conversation Trust. Available at: https://theconversation.com/what-are-hela-cells-a-cancer-biologist-explains-169913 (Accessed: March 8, 2023).

Nature (2020) Henrietta Lacks: Science must right a historical wrong, Nature. Springer Nature. Available at: https://www.nature.com/articles/d41586-020-02494-z (Accessed: March 8, 2023).

Skloot, R. (2000) Henrietta’s Dance, Johns Hopkins Magazine. Johns Hopkins University. Available at: https://pages.jh.edu/jhumag/0400web/01.html (Accessed: March 8, 2023).

More Reading

Racism in science

James Marion Sims’ experiments on enslaved women

The Tuskegee Syphilis Experiment

The Immortal Life of Henrietta Lacks by Rebecca Skloot is a great non-fiction book about Lacks and HeLa cells, and goes into great detail on the ethical issues of race and class in medical research. There is also a film adaptation of the same name that can be watched on HBO and HBO Max.

The future of prosthetics – mind control

Posted on by

Prosthetics have come a long way, from wooden toes in the Egyptian era, to now, where mind controlled prosthetics are enabling people to feel again. Prosthetics are artifical limbs, which replace those lost either from birth or from complications later in life, and they come in 4 different types. These are transradial (below the elbow), transhumeral (above the elbow), transtibial (below the knee) and transfemoral (above the knee). Prosthetics that begin below the joint are able to have a greater range of movement easier, but developments in research are finding ways for above the knee/ elbow prosthetics to have a better range of movement and capabilites.

A recent development in prosthetics are mind controlled prosthetics. These are more technically known as neuromusculoskeletal prosthesis. By connecting to the individuals skeleton, muscles and nerves, the prosthesis can be controlled by the individual much easier, and research has found, can enable them to feel the sensation of touch. This is a major development, impacting the individual greatly.

The neuromusculoskeletal prosthesis, and how it interacts with the arm. (Irving, 2020)

A small study, which focused on people with osseointegrated prosthetics, changed their prosthesis so that electrical connectors were embedded within their nerves and muscles, to understand its functionality as well as the impact it had on their lives. The individuals mental health and social life was followed, providing great insight into how these devices can really help someone.

This study of 3 individuals, all of which had socket fittings prior to their osseo integrated prosthesis, looked at their experinece of the attachment, control, sensory feedback, practice and use, phantom limb, self image and social relations. All of which are massivly important to the individual and all impact quality of life. It was found that the osseo integrated limb was more comfortable and easy to use, and they had better control of their prosthesis, due to embedded electrodes instead of surface ones, which would often interact with signals from their environment. It was found that the limb enabled sensory feedback but wasn’t described as natural. Although the participants did not seem to overly mind this lack of natural feeling. The prosthesis was found to increase the amount of activities the individuals could participate in, and they found an increase in self-esteem.

Overall, this development in technology has greatly improved the quality of life of the individuals within the study. In the future, the industry hopes to improve the sensory feedback of these mind controlled prosthesis, allowing for better sensation of touch. Hopefully, these prosthetics will continue to improve the quality of life for these individuals and be introduced to more people.

References

IRVING, M. 2020. Mind-controlled prosthetic arms “feel” like the real thing [Online]. New Atlas. Available: https://newatlas.com/medical/mind-controlled-prosthetic-arm/ [Accessed 09/03/2023].

MIDDLETON, A. & ORTIZ-CATALAN, M. 2020. Neuromusculoskeletal Arm Prostheses: Personal and Social Implications of Living With an Intimately Integrated Bionic Arm. Frontiers in Neurorobotics, 14.

ORTIZ-CATALAN, M., MASTINU, E., SASSU, P., ASZMANN, O. & BRÅNEMARK, R. 2020. Self-Contained Neuromusculoskeletal Arm Prostheses. New England Journal of Medicine, 382, 1732-1738.

PROSTHETICS, H. S. O. A. 2019. Prosthetics: What are They and How Do They Work? [Online]. Horton’s Orthotics and Prosthetics Available: https://www.hortonsoandp.com/prosthetics-what-are-they-and-how-do-they-work/ [Accessed 06/03/2023].

SURGICAL, P. 2017. History of Prosthetics [Online]. Premier Surgical Available: https://www.premierprosthetic.com/02/history-of-prosthetics/#:~:text=Ancient%20Greece%20and%20Rome%20through,Ages%20saw%20only%20limited%20progress. [Accessed 09/03/2023].

Reduce, Re-use, Recycle – Environmentally Friendly Prosthetics?

Posted on by

Following both prosthetic workshops and after hearing about the ZeroThirty initiative hoping to see the NHS carbon neutral by 2030, I began to wonder whether the conventional plastic used in prosthetic components could be sustainably sourced or even recycled. Being someone who is passionate about developing a greener future and currently conducting a research project in sustainable land management, this led me to wonder whether environmentally friendly prosthetic limbs already exist via the creation of new prosthetics re-using wasted materials or recycling those that no longer serve their owner purpose.

By prolonging the working lifespan of such a persistent material, could this reduce the unnecessary contribution of yet another source of plastic to the growing waste accumulation and help keep the NHS on track towards its target?

Recycled Plastic Prosthetics:

Prosthetic leg structure. https://www.physio-pedia.com/File:AKparts-of-a-prosthesis-268×300.jpg

While you wouldn’t expect false limbs to make up a large portion of landfills, the materials used to make prosthetic sockets and implant components, include high density molecular weight polyethylene (UHMWPE) and other thermoplastic polyethylene. UHMWPE has a very high strength to density ratio needed to withstand large amounts of stress while being relatively lightweight compared to titanium or ceramic materials that have also been used. One key feature of UHMWPE is its longer chain structure which is able to resist heavy loads more effectively resulting in being a high impact strength. However, thermoplastics do not biodegrade and will therefore persist in the environment.

UHMWPE components used in artificial joints. http://article.sapub.org/10.5923.j.ijbe.20110101.02.htm

This only becomes an issue when prosthetics are no longer required by a person, due to outgrowing replacements, gaining upgrades or eventual death. In 2019, researchers from De Montfort University (DMU), developed a recycled prosthetic limb by pulverizing plastic bottles and spinning them into polyester yarns that were moulded upon heating. Dr Kandan stated that, “Upcycling of recycled plastics and offering affordable prosthesis are two major global issues that we need to tackle.” Not only is this solution more cost-effective, but it is also more durable. The DMU team claimed that price per socket could be reduced from £5000 to only £10.

Evolution of recycled plastic prosthetic development. From discarded plastic bottle, to polyester yarns and finally moulded prosthetic limbs. https://www.weforum.org/agenda/2019/10/plastic-bottles-waste-prosthetic-limbs/

In 2015, the World Health Organisation estimated there were 40 million amputees in the developing world with only 5% having access to prosthetic care. Due to the staggering cost reduction, the largest beneficiaries of the recycled prosthetic limb are presumed to be amputees in developing counties, bringing a more financially accessible option to areas with limited resources and narrowing the inequality treatment gap. Although, there is little long-term evidence that this creation performs the same quality of function as modern prosthetics, so it is difficult to assess long-term benefits (or possible disadvantages) of using a prosthetic limb that is so different from all that came before it. Another issue is the weakened chemical structure of the plastics and questionable longevity once in use again. Are these unknown risks going to do more damage? Only time will tell 


Re-using prosthetics:

After further research into solutions to tackle the barriers of cost, supply and demand of prosthetics for amputees in developing countries, I discovered the Legs4Africa charity which does exactly that. Relying on public donations, recycled prosthetic legs are shipped worldwide to Africa. Since 2014, over 12,000 prosthetic legs have been collected, allowing amputees to return to work and regain a higher quality of life.

Pie chart showing the proportion of prosthetic leg donations from each country involved in Legs4Africa. UK has the highest number of donations of all participating countries. https://www.legs4africa.org/recycling/

The short video below demonstrates the incredible work Legs4Africa has achieved making a huge difference to the lives of so many.

Final thoughts:

Though both aspects explored in this blog are small contributions, they are headed in the right direction. Extending the life of prosthetics to fulfil pressures of demand and repurpose existing materials to limit consumption and waste generation could become revolutionary. There is a long way to go, and I believe that with a scrupulous trial of performance, recycled prosthetics could really take off. This topic is so important and I find it fascinating that large prosthetic manufacturers have not yet made the link between sustainable regeneration of plastics in prosthetics. What does this suggest about its reality?

The Mystery of Extreme Sleep Deprivation

Posted on by

We all know the effects of a late night, especially if we need to get up early in the morning. We’re more irritable, less focused and less alert. I previously thought that symptoms of extreme sleep deprivation of around 48 hours or more, might be similar. However, this is not the case. Interestingly, in extreme cases, your perception of reality can become very distorted and you may experience intense hallucinations. The first symptoms can be seen within 24-48 hours of no sleep.

What is Microsleep?

Sleep is essential for maintaining pathways in the brain that are important for forming memories and retaining information. I wanted to focus on one symptom that can been seen in both minor and extreme cases, known as microsleep. During microsleep, your brain is not processing external information and you have a reduced response to external stimuli such as noise. This happens for around 10 seconds and most people may not realise it happening. Have you ever been stuck at a red light and felt yourself drift off even though your eyes are still open?

Summer, J. (2023) Microsleep: Symptoms, causes, and safety risks, Sleep Foundation. Edited by A. Rehman. Available at: https://www.sleepfoundation.org/how-sleep-works/microsleep (Accessed: March 8, 2023).

Attached is a podcast with Professor Russell Foster talking about the effects of sleep deprivation and the relationship between sleep and mood disorders and abnormal cognitive behaviour. Here he discusses microsleep and the long-term effects of night shifts. This is a trustworthy source as he has scientific explanations for his conclusions but uses language that is easy to understand.

The Dangers Of Sleep Deprivation 2016 – Prof Russell Foster, Oxford UK

How can we further our understanding of extreme sleep deprivation?

Brain waves can be measured with the help of an electroencephalogram (EEG) and fMRI scans to show active areas of the brain whilst sleep deprived and compare this to the patient when well rested. The benefits of these methods are that the patient can remain awake so a real-time impression of the brain can be made. However, the patient must be made aware of the short and long-term risks associated with sleep deprivation and in order for the study to be controlled, the patient may need to be observed to ensure they are not asleep.

This was discovered in a 2018 study on sleep deprivation, where results were gathered from 760 participants, where first symptoms, around 24-48 hours in, included:

  • Distorted perception
  • Anxiety
  • Depersonalisation – an altered sense of self where you feel disconnected from your own thoughts and body.
  • Loss of time and sense of orientation

From 48 hours:

  • Hallucinations
  • Delusions
  • Disorientation
  • Depression
  • Euphoria
  • Anger/Hostility

From 72 hours:

  • Complex hallucinations – including visual, sensory and auditory disturbances.
  • Elaborated delusions
  • Aggressive attacks
  • Mood changes

This is because the brain still undergoes R.E.M (rapid eye movement) phase whilst awake so you experience a dream-like state whilst still awake. This has been observed in multiple experiments and is known as sleep deprivation psychosis.

Sutherby, R. (2022) Can sleep loss cause symptoms of schizophrenia?, Psych Central. Psych Central. Available at: https://psychcentral.com/health/sleep-deprivation-psychosis#what-causes-the-psychosis (Accessed: March 8, 2023).

Many ethical questions arise when trying to conduct experiments to understand sleep further. When mice have been tested in the past, they have all died as a result of sleep deprivation. So, extreme caution must be taken when testing humans. Older experiments can tell us what happens when we don’t just miss an hour per night, but go weeks without any sleep.

This YouTube video briefly highlights the different attempts made by scientists throughout history to further our understanding of sleep that had unfortunate effects. This video is animated and in laymen’s terms so is highly engaging and easy to understand.

Human Sleep Experiment That Went Horribly Wrong – The Infographics

Conclusion and Reflection

I chose this topic because it had a really interesting link between science and ethics. I find the topic of sleep fascinating, and what makes this topic even more interesting is that it is incredibly difficult to study. Nowadays, it is considered unethical to conduct experiments exceeding 48 hours of sleep deprivation. After watching the videos and listening to the podcasts, I found myself wondering if sleep deprivation is described as a physical or mental health illness.This means the topic of sleep is one big mystery and there is still so much we don’t know, or may never know.

A Better Solution for Human Cloning: The CRISPR/Cas9 Technology

Posted on by

Cloning is the technique of generating organisms that are exact genetic duplicates of one another. Scientists’ major goal is to discover the “ultimate code” that produces a “perfect” organism – a body free of diseases and anomalies. Cloning, in this opinion, is beneficial in reducing the spread of fatal inherited disorders. Dolly the sheep was the first organism to be successfully cloned.

Cloning Process of Dolly the Sheep

This case intrigued the psychologist in me, who wondered why some scientists are so eager to legalize this process when Dolly’s case was the 277th attempt. Thus, the unsuccessful 276th attempts have either failed to develop into a viable embryo or been aborted after they showed signs of abnormality. Such, high chances of failure with the accompanying issues of wastage of human embryonic material are not acceptable. However is it correct to think that cloning does not happen in the scientific community?

The Two types of Human Cloning

There are primarily two methods of cloning in which an embryo is formed other than by sperm fertilisation of an egg. Embryo splitting, also known as reproductive cloning, is a method of artificially stimulating the natural process of producing identical twins. This type of cloning was used in the production of Dolly. Somatic cell nuclear transfer or ‘therapeutic cloning’ is the only process capable of generating clones of living humans. It is a sort of non-reproductive cloning used to obtain stem cell lines for research. Stem cells are undifferentiated cells that can self-renew or develop into multiple cell types. Stem cells are classified into two types: multipotent stem cells (also known as “adult cell cells”) and pluripotent stem cells (also known as “embryonic stem cells”). The latter are derived from early embryos and have seen extensive study use.

The process of reproductive cloning is as follows: all genetic material carried by a single ovum (egg) is contained within a nucleus; if this nucleus is removed (ovum enucleation) and then replaced with the nucleus of a somatic cell (from the body of an embryo), an embryo genetically identical to the donor of the somatic cell nucleus can be created. The resultant embryo is subsequently implanted into a surrogate mother’s womb for gestation and delivery. The described approach has been applied in a process called ‘three-parenting IVF’. It enables women with mitochondrial disease to have a genetically related child free of the disease.

The mitochondrion has its own genome, the mtDNA, which encodes 13 proteins that are subunits of respiratory chain complexes. Mutations stop the mitochondria from converting food and oxygen into food, affecting negatively the heart, brain, and lungs. Dysfunctional mitochondria are implicated in several neurodegenerative diseases including Parkinson’s disease. Therefore, ‘three-parenting IVF’, or mitochondrial transfer in IVF could be considered an effective preventive strategy. However, it crosses ethical boundaries as it interferes with germ-line, not to forget the psychological and social implications.

Nevertheless, the CRISPR/Cas9 technology could be regarded as a better solution. It has grown in prominence due to its low cost and possible applicability in the treatment of genetic diseases. It is capable of strong gene editing. However, it may not affect all mtDNA, but it may change enough to lower the individual’s illness threshold, offering therapeutic benefits. This innovative technology could be utilised to treat diseased people as well as IVF embryos prior to implantation. It provides a reduction in mutation load, which lowers symptoms and disease burden. The CRISPR/ Cas9 editing of embryonic mtDNA may appeal as a more socially acceptable option to ‘three-parenting IVF’. Rather than merging the genetics of three people, it allows a couple to conceive without the need for donor genetic material.

The video shows the process of CRISPR/Cas9

The logic of human cloning and the logic of therapeutic cloning are identical; the spare embryo is created to expire. Nevertheless, a much better alternative could be the CRISPR / Cas9 gene editing technology, which attempts to cut off parts of defective DNA and subsequently reinstall it in the embryo. It can lead to reduced mtDNA disease, perhaps saving many affected people.

Reference list:

Brand, M.D. and Nicholls, D.G. (2011) Assessing mitochondrial dysfunction in cells, The Biochemical journal. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/21726199/.

Gurnham , D. (2016) The mysteries of human dignity and the Brave New World of human cloning …, Sage Journals . Available at: https://journals.sagepub.com/doi/abs/10.1177/0964663905051219.

How CRISPR let you edit DNA (2019) YouTube. YouTube. Available at: https://www.youtube.com/watch?v=6tw_JVz_IEc.

José , V.D. (2008) Cloning humans, cloning literature: Genetics and the imagination deficit, New genetics and society. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/17256208/.

O’MathĂșna, D.P. (2002) What to call human cloning – EMBO press, Viewpoint. Available at: https://www.embopress.org/doi/full/10.1093/embo-reports/kvf122.

Rulli , T. (2016) What is the value of three-parent IVF?, The Hastings Center report. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/27198755/.