CNA - Safely Moving Residents - Lifting and Transferring (0.5)

  https://www.youtube.com/watch?embeds_referring_euri=https%3A%2F%2Fwww.snfclinic.com%2F&source_ve_path=Mjg2NjQsMTY0NTA0LDE2NDUwNg&feature=emb_share&v=2gQ_vKJE7yU

CNAs are on their feet all day, lifting and transferring heavy equipment and patients. It's easy to take for granted the danger of improper posture and mechanics in potential injuries. The CNA must be well educated on body mechanics, mechanical lifts, and teamwork to protect themselves and prevent injury to make their job easier and safer.

Good lifting and transferring habits are the best way to protect oneself from a serious back, shoulder, or neck injury. Following your facility's policies will help you protect your back and ensure you work smarter, not harder.

Here are some general lifting and transferring tips to help keep you and your residents safe, which is the most important consideration:

    Plan the move out well and make sure the area is cleared.
    Find out how the resident prefers to be moved, and always make sure to tell them what you are planning to do
    Your weight adds force to pushing, so it's always easier than pulling.
    When you lift or move an object or resident, always face it/them directly.
    The feet should be shoulder-width apart, providing a wide base of support when you lift or move.
    Determine the correct equipment or supplies needed for the move/lift and make sure to have it ready and use it as needed.
    To minimize the effect of a lifted weight on your body, hold the person or object close to you, not at arm's length.
    Use teamwork by asking your teammates for help and talking with them about what you do as you plan and while doing it.
    Moving people or things all at once is much harder than using repeated, small movements. For example, move a person in sections by moving the upper trunk first and then the legs.

·    One of the leading causes of injury during lifting or moving is twisting. Move your torso as one unit and never twist when lifting, transferring or reaching. Pivot your whole body toward the move by picking your feet up.

·         Always maintain correct posture:

o   Less stress is put on your back when bending your knees slightly while lifting. It will put stress on your legs.

o   Knees bent and back straight is the correct posture!

o   If you must bend from the waist, engage your core and tighten your stomach muscles while bending and lifting to help support your back.

Working smarter, not harder, can also include the use of assistive devices to aid us in moving and lifting residents and objects:

    Use the resident's bed as an assistive device. Raise and lower the height as needed to make the position safe for you, the resident, and your teammates. Utilizing rails temporarily for a resident's "handhold" can also help residents assist in their movement.
    Transfers can also be a time when a resident's skin can inadvertently be sheared or torn. Using a slide board can help reduce friction and allows the resident to move from the bed to another surface more easily
    A heavy canvas gait belt placed around a resident's waist is a good tool to assist in moving residents that provides a solid grip for the staff and avoids injury to resident's limbs
    Draw or lift sheets make it easier to move patients in bed. They may interfere with skin-protecting mattresses and shouldn't be left under the resident. Turn the resident to one side to place a draw/lift sheet. Roll half of the sheet up and place it against the resident, smoothing the side closest to the bed. Roll the resident over the roll, back to the other side, and smooth out the sheet. If the resident cannot manage or lift their own head or neck, be sure that the sheet extends high enough to support the head fully while still supporting the hips.
    Residents with upper-body mobility and strength may benefit from a trapeze above their bed, allowing them to lift and assist you in their movement.
    Mechanical lifts and hoists are also very valuable in lifting a heavy resident or one who has fallen to the floor to avoid injuries. Make sure you have completed all training on the appropriate and safe use of the devices in your facility before using them. Use your teammates to assist with these transfers.

Many transfers in our environment involve transferring from the bed to a chair or wheelchair.  Here are safety tips for this type of transfer

    As always, think through the lift and plan the job before beginning to execute it.
    Make sure the bed is in a low and locked position so it will not move.
    If transferring to a chair, place it slightly to the side of the bed.
    If transferring to a wheelchair, remove the footrests, fold up the foot pedals, and ensure the brakes on both wheels are locked.
    Put non-slip footwear on the resident.
    Move the resident to the edge of the bed in stages by first moving the upper trunk and then the legs one at a time and place the resident's legs over the side of the bed.
    Raise the resident to a sitting position on the side of the bed by placing your arms around them and circling their back.
    At this point, a gait belt is recommended.  Place it around the resident's waist.
    Assist the resident in moving forward until their feet are flat on the floor. This can be done by sliding or "walking" them forward. Grasping both legs under the knees, swinging them gently back and forth, and moving the buttocks forward is called "walking."
    Using a wide stance for good support, place your feet on both sides of the resident's feet.
    Do not have the resident put their arms around your neck. This is likely to injure you. Instead, ask the resident to slightly lean forward and place their arms around your shoulders if they can do so.
    Keep your back straight, bend at the hip and knee and allow the resident to reach for the far chair arm.
    Avoid injuring the resident by NOT holding them under the arms. Instead, place your arms around their waist, or grasp the gait belt at the sides of the back with both hands.
    Stabilize the resident's knees by holding your knees against theirs.
    Straighten your hips and knees while pulling the resident up as you both stand, keeping the resident close to your body and your hips and knees slightly bent.
    When the resident is high enough to clear the armrest or chair surface, keep their knees blocked with your own and turn them toward the chair seat by taking small steps together. Once turned, squat by bending your hips and knees to lower the resident to the seat.
    If transferred to a wheelchair, replace the footrests and adjust the pedals, so the resident's hips and knees are at a 90-degree angle. If transferred to a chair, make sure the resident can maintain their feet flat on the floor to avoid sliding.
    Follow the same principles to return the resident to their bed.

Safely repositioning resident in a chair:

    If the resident is in a wheelchair, ensure the brakes are engaged.
    Have the resident fold their arms across their chest.
    Stand behind the chair and wrap your arms around the resident while bending your knees. Fold your arms just under the resident in front, hugging their torso securely.
    Lift the resident's torso up and back in the chair while straightening your legs.

Utilize these safety methods when pulling a resident up in bed:

    Always get help. This seems an easy maneuver but is one that often injures the staff or resident.
    Remove the resident's pillow and place it between their head and the headboard. Place a draw sheet or lift pad under the resident.
    Raise the bed to a height comfortable for you and your teammate
    On either side of the bed, both you and your teammate should bend your knees and push with your feet while grasping the draw or lift sheet firmly, close to the resident's body
    If the resident can, ask them to hold their head up, chin to chest. If they are unable, ensure that the lift sheet supports their head.
    Have the resident assist by pushing backward by bending their knees while you and your teammate lean in the direction you want to move the resident's body.
    Simultaneously on the count of three, have the resident push with their heels while you and your teammate lift the draw or lift the sheet and pull the resident up.

In addition, turning the resident from side to side when in bed should also not be taken for granted as a simple movement.

    Raise the bed to waist height and while standing at one side, place your arms under the resident's shoulders or hips and grasp the draw or lift sheet.
    Moving trunk first and then legs, pull the resident to the edge of the bed and cross the resident's closest leg over the other leg.
    Lean in toward the resident, place your hands on their shoulder and hip, and push the resident's torso away from you.
    Place the top leg in front of the bottom leg.
    Make sure the resident is supported along their hips, back, and shoulders with pillows or bolsters. The resident may also benefit from a pillow between their legs to support the top leg but be sure to adjust for comfort.

Often we have to assist in transferring residents in and out of a car for appointments or discharge.  Here are safety tips to assist you:

    Make sure the front seat of the car is back as far as possible, and the wheelchair is positioned at a 90-degree angle to the seat.
    Using a wide stance for good support, place your feet on both sides of the resident's feet.
    Do not have the resident put their arms around your neck. This is likely to injure you. Instead, ask the resident to slightly lean forward and place their arms around your shoulders if they can do so.
    Keep your back straight, bend at the hip and knee in a squat and grasp the person's upper back. Do not pull under the arms.
    Move your feet to turn, being sure not to twist. Straighten your legs and hips slightly while lifting the resident's torso into the car and placing their buttocks on the seat.
    Before lifting the resident's legs in, ensure their buttocks are back as far as possible toward the driver's side to avoid sliding out.

You may find a resident on the floor.  Perhaps they just slipped to the floor, or perhaps they fell.  Here are some key safety tips for assisting a resident on the floor:

    Make sure to follow all facility policies for falls before assisting the resident up, such as a witnessed lowering to the floor vs. a resident found on the floor with a potential fall-related injury.
    If the resident is not seriously injured, they may be able to assist in getting up, but you should ALWAYS enlist a teammate to help you.
    Enlist as many people as necessary to execute the lift safely. This may be 4 to 6 people or require a mechanical lift.
    Once the resident is cleared for movement, roll them onto a lift sheet or blanket
    With two or more people on each side, get a secure hold on the blanket and have everyone kneel beside the resident. On the count of three, everyone should stand up, lifting the resident to the bed or stretcher.
    Be sure to complete any documentation required by facility policies related to the resident's fall.

Avoiding staff injuries is always the best choice, and the best way to avoid injury is to make sure to:

    Fully understand the task at hand. What or who are we lifting, what is its weight, do I need help to do this, should I use a mechanical lift for this? Can the resident help at all? Is there a potential they are injured?
    Take care of yourself by not getting in a hurry, attempting something you shouldn't because "it's easier to do by myself than wait on someone to help me," or "it takes too long to get the lift on the other unit," etc.  Your employer wants you to be as safe and healthy as you do, and following these safety tips will help you stay that way.

What is a significant number of PVC?

What is a high number of PVCs?

According to one study, experiencing more than 12 PVCs daily increases your risk of sudden cardiac death.Jul 29, 2022

Premature Ventricular Complex (PVC) • LITFL • ECG Library ...

PVHow many PVC are significant?

Premature Ventricular Complex (PVC) • LITFL • ECG Library ...

PVCs are said to be “frequent” if there are more than 5 PVCs per minute on the routine ECG, or more than 10-30 per hour during ambulatory monitoring.

Cs are said to be “frequent” if there are more than 5 PVCs per minute on the routine ECG, or more than 10-30 per hour during ambulatory monitoring.Jun 2, 2021

Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of the heart's two lower pumping chambers (ventricles). These extra beats disrupt the regular heart rhythm, sometimes causing a sensation of a fluttering or a skipped beat in the chest.

Premature ventricular contractions are a common type of irregular heartbeat (arrhythmia). PVCs are also called:

1. Premature ventricular complexes
2. Ventricular premature beats
3. Ventricular extrasystoles

Occasional premature ventricular contractions in people without heart disease usually aren't a concern and likely don't need treatment. You might need treatment if the premature ventricular contractions are very frequent or bothersome, or if you have an underlying heart condition.

Symptoms

Premature ventricular contractions often cause few or no symptoms. But the extra beats can cause unusual sensations in the chest, such as:

1. Fluttering
2. Pounding or jumping
3. Skipped beats or missed beats
4. Increased awareness of the heartbeat

When to see a doctor

If you feel fluttering, pounding or a sensation of skipped heartbeats in your chest, talk to your health care provider. A health care provider can determine if the sensations are due to a heart condition or other health concern. Similar signs and symptoms can be caused by many other conditions such as anxiety, low red blood cell count (anemia), overactive thyroid (hyperthyroidism) and infections.

To understand the cause of premature ventricular contractions (PVCs), it might help to learn more about how the heart typically beats.

The heart is made of four chambers — two upper chambers (atria) and two lower chambers (ventricles).

The heart's rhythm is controlled by a natural pacemaker (the sinus node) in the right upper chamber (atrium). The sinus node sends electrical signals that typically start each heartbeat. These electrical signals move across the atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the signals arrive at a cluster of cells called the AV node, where they slow down. This slight delay allows the ventricles to fill with blood. When the electrical signals reach the ventricles, the chambers contract and pump blood to the lungs or to the rest of the body.

In a typical heart, this heart signaling process usually goes smoothly, resulting in a resting heart rate of 60 to 100 beats a minute.

PVCs are irregular contractions that start in the ventricles instead of the atria. The contractions usually beat sooner than the next expected heartbeat.

The cause of premature ventricular contractions isn't always clear. Certain things including heart diseases or changes in the body can make cells in the lower heart chambers electrically unstable. Heart disease or scarring may cause the heart's signals to be misrouted.

💜Premature ventricular contractions may be caused by:

1. Certain medications, including decongestants and antihistamines
2. Alcohol or drug misuse
3. Stimulants such as caffeine or tobacco
4. Increased levels of adrenaline in the body due to exercise or anxiety
5. Injury to the heart muscle due to disease

Risk factors

Certain lifestyle choices and health conditions may make a person more likely to develop premature ventricular contractions (PVCs).

💗Risk factors for PVCs include:

1. Caffeine
2. Tobacco
3. Alcohol
4. Stimulants such as cocaine or methamphetamines
5. Exercise — if you have certain types of PVCs
6. Anxiety
7. Heart attack

Heart disease, including congenital heart disease, coronary artery disease, heart failure and a weakened heart muscle (cardiomyopathy)

Complications

💗Having frequent premature ventricular contractions (PVCs) or certain patterns of them might increase the risk of developing irregular heart rhythms (arrhythmias) or weakening of the heart muscle (cardiomyopathy).

Rarely, when accompanied by heart disease, frequent premature contractions can lead to chaotic, dangerous heart rhythms and possibly sudden cardiac death.

How to write the name for H2SO4 (Sulfuric acid)

https://www.medicalnewstoday.com/articles/322627 

Maintaining healthy relationships with age

 Positive relationships can be as important to your health and well-being as nutrition and physical activity. Even though relationships with others may evolve, maintaining a strong social network as you age can contribute to a longer, healthier life.

A social network is simply a group of people close to you. This network — made up of friends, family, co-workers, neighbors and others — is how you give and receive instrumental and emotional support.

Instrumental support is the tangible help you give or receive through acts, such as providing transportation for a neighbor to an appointment or offering child care for friends or family. Emotional support is intended to lift someone's spirits, relieve sadness, give encouragement or offer advice.

Giving relationships direction

Think of your networks and relationships as a convoy traveling down the road of life with you. Some of your relationships are in it for the long haul. Others use the on- or offramps, and some take different roads entirely. Relationships in your convoy change over time, but all provide support and contribute to your well-being along the journey.

As people age, the road can feel lonely. Caring for children or aging parents can make it challenging to maintain friendships. This is normal, and means you must be more intentional about establishing and maintaining relationships, which isn't easy.

Devoting time to relationships

If you're looking to expand your social network, try a few of these ideas:

Take note of current connections.

Do an inventory of who is already in your social network. Are there people you have already met you could reconnect with?

Make the effort to reach out.

In today's connected world, getting in touch with someone is as simple as a phone call, text message or video visit. If you prefer a method involving less technology, send a handwritten card or letter.

Go where people are.

Attend events, church or community activities. Look for classes or groups with people who have interests similar to yours.

Reap the benefits of volunteering.

Join or volunteer for a club or cause that interests you. Volunteering not only improves your physical and mental health, and provides a sense of purpose, but it's also a great way to build new relationships.

Extend and accept invitations.

Don't worry if your social skills feel a bit rusty. An invitation to meet for coffee or go for a walk around the neighborhood may brighten someone else's day as much as it does yours.

Be available.

Relationships take time and effort. Whether connecting with a friend you've known for a long time or someone you just met, be present in the moment, and give your full attention to the person and situation.

In addition to helping provide the necessary support, establishing and maintaining positive relationships also is good for your health. They can boost your happiness, reduce stress, improve confidence and help you cope with traumatic events.

Adults with a strong social network have a reduced risk of depression, lower blood pressure and tend to maintain a healthier body mass index, or BMI. Building new friendships and investing time in maintaining relationships can help you on the highway of life and the path to better health.

Bonnie Betts, Psy.D., is a licensed psychologist in Psychiatry & Psychology in Waseca,https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/maintaining-healthy-relationships-is-important-as-we-age

Living with bipolar disorder

 Your friend recently bought a new car on a whim and announced he was leaving on a cross-country trip without planning a destination or duration. Now you discover he's uninterested in any activity and doesn't want to leave home. The spontaneous actions followed by inactivity could be a sign of a mental health condition called bipolar disorder.

Previously known as manic depression, bipolar disorder causes extreme mood swings of emotional highs and lows called episodes. The highs create a mania or hypomania state with euphoria and energy. A hypomania state is a less extreme mood shift than mania. The lows cause depression, sadness and hopelessness.

Types of bipolar disorder

The type of bipolar disorder is diagnosed based on the occurrence of mania, hypomania and depressive episodes.

People with bipolar I disorder have had at least one manic episode preceded, or followed by hypomanic or major depressive episodes.

Bipolar II disorder is a separate diagnosis and is not a milder form of bipolar I disorder. People with bipolar II disorder have had at least one major depressive episode and at least one hypomanic episode but have not had a manic episode.

For every high, there is a low

Everyone has periods of elevated mood, typically lasting for several hours. For someone with bipolar disorder, that elevated mood can last up to four days. Typical early warning signs include increased activity level and decreased need for sleep, along with an extended elevated mood.

During this time, the person may demonstrate risky behaviors, poor decision-making and an inability to think clearly. Their level of impulsivity is high, particularly with drug or alcohol use.

The body's physical response is raised, causing speech to have a quicker cadence or more force, and movement and actions to be more pronounced.

Usually, a person will spend more time in a depressive state with slowed actions, speech and responses. The person may lose interest in activities, need more sleep and experience intense sadness and hopelessness.

This is different from major depressive disorder, in which people do not experience the highs of bipolar disorder.

Risk factors for bipolar disorder

Certain factors increase the risk of developing the condition or may trigger the first episode of bipolar disorder, including:

Drug or alcohol misuse or abuse

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Stressful life events paired with latent genes for bipolar disorder

Living with bipolar disorder

Getting treatment early can help prevent bipolar disorder from worsening. Knowledge is power. Learn the symptoms of the disorder to manage them better.

As part of psychotherapy, psychoeducation provides the tools needed to anticipate and control changing moods. It can increase your feelings of empowerment and hope by understanding how treatable the condition is.

These strategies can lessen disruptions in your life due to bipolar disorder:

Avoid drugs and alcohol.

Using alcohol or nonprescription drugs changes the chemicals in the brain. This can worsen symptoms and make them more likely to return.

Watch for early warning signs.

Addressing symptoms early can prevent episodes from getting worse. Over time, you may have identified a pattern to your bipolar episodes and what triggers them.

Involve friends and family.

Share the warning signs and triggers you have identified with family, close friends and your health care team so they can better support you. Develop a specific plan and share how you would like them to cue you into your symptoms when you show signs of mania. They often can identify the behaviors and actions that signal a mania episode first and help you prevent your symptoms from reaching the highest level.

Engage in a purpose.

Explore ways to create a sense of purpose by evaluating your values and beliefs. Identify what is important to you and set goals matching those ideals.

Manage stress and recharge.

The brain and body react similarly to positive or negative stress, which can trigger an episode. Consider keeping a daily journal or record of your feelings, mood and any activities that affect your stress level. Find a creative outlet or physical activity to channel your energy. Yoga or meditation can be helpful relaxation techniques.

Keep a sleep schedule.

Sleep disturbance is a core symptom of bipolar disorder. Maintaining a consistent, scheduled sleep pattern with the same sleep-wake schedule daily is vital. Getting seven to nine hours of sleep per night is important. A work schedule that requires changing shift times can predispose a person with bipolar disorder to episodes.

Take your medications exactly as directed.

You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects, or your symptoms may worsen or return. For some people, it can be tempting to stop medication during a manic episode because the symptoms produce a good feeling. This can lead to negative consequences, including taking longer to stabilize when back on medication.

Bipolar disorder is a lifelong condition, but it is treatable. Learn to manage your mood swings and other symptoms with the help of those who love and care for you. Call your health care team if you feel you're falling into an episode of depression or mania.

Janice Schreier is a child and adolescent clinical therapist in Psychiatry & Psychology in La Crosse, Wisconsin.

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/living-with-bipolar-disorder

Overwhelmed by anxiety?

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/overwhelmed-by-anxiety Stress and feeling anxious are common and normal. Your body naturally produces these reactions to situations that could lead you to harm's way.

Stress is a normal psychological and physical reaction to the demands of life. It's normal to feel anxious from time to time, especially during times of stress. This can be helpful, as it can help you remain focused and make better decisions.

However, people with anxiety disorders have frequent, sustained and excessive worry that they can't control. They also may feel fear, terror and panic in everyday situations.

There are many types of anxiety. Here are explanations of each, including symptoms and common treatments:

Generalized anxiety disorder

This type of anxiety involves persistent and excessive worry. If you have generalized anxiety disorder, you may have an uneasy feeling about most everything. This worry feels difficult to control and interferes with your daily life. You may overthink plans and solutions to worst-case scenarios. Or you may anticipate disaster and be overly concerned about money, health, family, work and other life events.

Generalized anxiety disorder can lead to worrying more than what seems warranted about situations or expect the worst even then there's no apparent reason to do so. You may feel an inability to relax or enjoy quiet time. You may feel tense all the time and have body aches.

You avoid stressful situations and may have difficulty concentrating. You may find it hard to tolerate uncertainty and may feel a sense of dread or impending doom. This disorder can cause you to struggle with intrusive thoughts about the worst that could happen.

Generalized anxiety disorder can cause you to not sleep well, or feel jumpy or restless. You may have an upset stomach or heart palpitations, shakiness, sweating, a dry mouth, difficulty breathing or a lump in your throat. You could feel dizzy; have cold chills, hot flashes, or numbness and tingling; or may have persistent irritability.

Ongoing generalized anxiety disorder may manifest physically through chronic neck and back pain, headache, irritable bowel syndrome, or stomach and abdominal pain.

There is evidence that biological factors, stressful life experiences, lack of personal security and lack of positive role-modeling of anxious behaviors can lead to generalized anxiety disorder.

Generalized anxiety disorder is treatable, but it takes persistence. A person can find significant relief with psychotherapy, relaxation and mindfulness techniques, or medication. Support groups also help.

Practicing helpful ways of thinking and stress coping skills can lessen the amount of worry. Seek healthy connections with others and a lower-stress lifestyle to find greater freedom from your anxiety. Set healthy boundaries in your life. Use humor and practice to manage your negative anxious tendencies. Exercise can help by relieving the built-up stress and tension.

One of the most important principles of overcoming anxiety is facing your fears. Therapy can help develop a plan, and little by little, you'll grow in self-confidence to manage and cope with anxiety.

Social anxiety

If you struggle with social anxiety, everyday interactions cause significant anxiety, self-consciousness and embarrassment. It is related to the fear of being scrutinized or judged negatively by others. It is intense and affects your work or social life.

You may worry about blushing, trembling, or fear you may look foolish or unintelligent to other people. You may have generalized anxiety disorder symptoms that are mainly associated with social situations. You may fear meeting new people, talking to others at work or school, or speaking in public. Some people with social anxiety fear using a public restroom, being seen eating or drinking in public, or having to perform in front of others.

You may experience feelings of panic or panic attacks, and feel self-conscious or awkward in front of others. You may have difficulty speaking and may avoid situations you feel may trigger anxiety.

Your body may feel rigid and tense while your voice may be soft during social interactions. You may have difficulty making eye contact with others and be sensitive to criticism. You may feel a low self-worth and have a lot of negative self-talk.

Sometimes people with social anxiety may not seek treatment because they feel this uncomfortable way of being is just a part of their personality. However, without treatment for this disorder, these people cannot achieve their potential at school, work or in their personal life.

Social anxiety is treated using the same methods as generalized anxiety disorder.

Panic disorder

A panic attack causes a sudden intense fear or discomfort that peaks within minutes. Other symptoms may include a rapid heart rate, sweating, shakiness, shortness of breath and hot flashes. A person may feel lightheaded, have a sense of impending doom, chills, nausea, abdominal or chest pain, headaches, and numbness or tingling.

Many people feel something is physically wrong when they have a panic attack and that they may be having a heart attack or stroke.

Expected panic attacks occur when there is an obvious cue or trigger, such as with generalized anxiety disorder or a specific phobia. Panic disorder is when a person has frequent, unexpected panic attacks. These panic attacks seem to come out of the blue without a trigger or apparent explanation. If you have panic disorder, you may not be able to stand the thought of experiencing the physical discomfort that has happened when you have panicked before and may always be on guard for another one potentially happening.

Treatment for panic disorder is similar to that of generalized anxiety disorder and social anxiety. Persistence and practice of healthy thinking and coping tools will help develop a better level of confidence in your ability to cope with stress, as well as with the strong feelings of anxiety or panic.

Phobias

Phobias are an overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance. Fear and phobia are different. Fear is a temporary emotion; whereas, a phobia is longstanding. Phobias can create fear that is so strong it becomes debilitating. When this occurs, a phobic fear has become an anxiety disorder.

Your sense of danger or fear is designed to protect you from danger. It can trigger your flight-or-fight instinct so you're ready to take action to protect yourself. A phobia overestimates the threat of a particular situation and triggers intense anxiety leading you to avoid that situation in the future. Avoidance worsens the phobia because it reinforces the brain's exaggerated association between the situation and its threat level.

There are various phobias, including a phobia of animals, insects or spiders; a phobia of natural phenomena like storms or water; and a phobia of blood or injury, blood tests or needles.

Social anxiety can lead to a phobia. Often this comes with agoraphobia, which is a phobia of any place or situation that you fear you can't escape or get help easily. You might avoid travel on public transportation, being in a crowded area or being alone in public. It's rooted in the fear of having intense anxiety or a panic attack in certain places rather than a fear of the place itself.

Health care professionals do not clearly understand why people develop phobias. Often, they begin in childhood — similar to panic disorders.

If you struggle with a phobia, you may notice a racing heart rate, difficulty breathing, trembling, sweating, nausea, dry mouth, and chest pain or tightness. You may feel an overwhelming anxiety or fear. You know your fear is irrational, but you feel powerless to overcome it. You may fear losing control and feel an intense need to escape.

According to research, cognitive therapy and exposure therapy tend to be the best treatment for phobias. Social skills training, mindfulness and medication may help, as well.

Obsessive-compulsive disorder

Obsessive-compulsive disorder, also known as OCD, is a pattern of unwanted thoughts and fears, or obsessions, that lead a person to do repetitive behaviors, or compulsions. The typical onset of OCD is before age 20.

OCD often develops related to a theme. For example, being fearful of germs — an obsession — leads to excessive hand-washing — a compulsion — to reduce the thoughts and fears. If you don't have control over your thoughts, you wash your hands more. This becomes a vicious circle that worsens, and it can become a debilitating lifestyle if not addressed.

Other types of OCD may be needing to have things in perfect symmetrical order; having taboo or other unwanted thoughts; having aggressive thoughts toward yourself or others; and fear of causing harm or danger to self or others by not turning off the stove or not locking the door, so you check and recheck.

Compulsions are the direct result of the obsessive thoughts that lead to repetitive behaviors. These are done in the hope of reducing the anxiety and preventing something bad from happening. Sometimes, actions bring temporary relief but no pleasure. Common compulsions include counting, checking, washing or cleaning; strict routines; orderliness; and a need for reassurance. Symptoms may come and go over time and seem to worsen when a person is under stress.

While adults may recognize their irrational fears and behavior, children may not. Usually, medication and psychotherapy are recommended and can help alleviate many OCD symptoms.

Post-traumatic stress disorder

If you suffer from post-traumatic stress disorder, you have significant anxiety and uncontrolled thoughts triggered by a terrifying or life-threatening event. This could be a terrible accident, a tornado, domestic violence, war, the sudden death of a loved one, critical illness, a near-death experience, kidnapping, terrorist attacks, an assault or a direct threat to your life, or witnessing someone else being attacked.

Some people work through these experiences and learn to cope and adjust with time. Occasionally, people find themselves reliving it, and this affects their ability to function. You may struggle with post-traumatic stress disorder if you get stuck in a state of fear and your symptoms don't improve or worsen.

Symptoms may include avoidance, intrusive memories, changes in emotional reactions, negative changes in thinking and mood, flashbacks, jumpiness and emotional detachment. You may struggle with an overwhelming sense of guilt or shame, sleep disturbances, difficulty concentrating, always being on guard for danger, irritability, angry outbursts, aggressive behavior, and self-destructive behavior. You may feel negative about yourself, have a lack of interest in activities you used to enjoy or have difficulty maintaining your relationships. You could experience memory problems, feelings of hopelessness about the future, and feeling emotionally numb or unable to experience positive emotions.

Having post-traumatic stress disorder increases your risk for depression, anxiety, eating disorders and substance use disorders. It is important to seek treatment if you struggle with intrusive memories, avoid thinking or talking about the trauma, have negative changes to your thinking and mood, and have changes in your physical and emotional reactions to life and others. Treatment may include psychotherapy, exposure therapy called EMDR, medication and other therapies.

For more information, watch this video for ways to combat stress and anxiety:

Panic attack and disorder Q & A

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/what-is-a-panic-attack A panic attack is an episode of intense fear with an abrupt onset, lasting from several minutes to up to an hour. It has many mental and physical symptoms such as chest pain, shortness of breath, nausea, dizziness, chest pain and a sense of pending doom. These symptoms may cause significant worry in people as they may mimic signs of medical problems such as heart issues. However, panic attacks can occur when there isn't a real danger or apparent cause.

Panic attacks aren't life-threatening, but they can be frightening for the person experiencing the attack and their loved ones. These attacks can affect your quality of life, especially if you have multiple or unexpected panic attacks.

What are the signs of a panic attack?

A panic attack usually begins suddenly and without warning. Typically, symptoms peak in minutes, and you may feel tired and worn out after it subsides. Panic attacks can cause chest pain and breathing problems that lead some people to seek medical care.

To be diagnosed as a panic attack, the episode must have at least four of these symptoms simultaneously:

Chest pain or discomfort

Chills or heat sensations

Derealization (feelings of unreality) or depersonalization (being detached from oneself)

Fast beating, fluttering or pounding heart

Fear of dying

Fear of losing control or "going crazy"

Feeling dizzy, unsteady, light-headed or faint

Feelings of choking

Nausea or abdominal distress

Numbness or tingling sensations

Sensations of shortness of breath or smothering

Sweating

Trembling or shaking

Panic attack symptoms may also resemble other psychiatric conditions, such as:

Agoraphobia — marked fear or avoidance of two or more places or situations

Caffeine or nicotine dependence — high doses of either substance may result in increased anxiety

Obsessive-compulsive disorder — obsessions often leading to ruminations or brooding

Phobias — fear of specific objects or situations

Post-traumatic stress disorder — involves emotions from previous events affecting a current situation

Separation anxiety disorder — fear of separation from attachment figures

Social anxiety disorder — fear of social situations

Do I need to go to the emergency room if I have a panic attack?

In most cases, a single panic attack episode does not require emergency medical care. However, it's important to discuss your symptoms with your health care team. They will evaluate you for medical disorders that may contribute to your symptoms, such as cardiac arrhythmia, respiratory diseases, pulmonary emboli, thyroid disorders, adrenal tumors or medication side effects.

What's the difference between a panic attack and panic disorder?

A person with ongoing, unexpected panic attacks who spends time worrying about another panic attack may have a panic disorder. People with panic disorders may be afraid of experiencing more panic attacks and live in a constant state of fear that affects the quality of their lives. Often, they change their behaviors and habits so much that it interferes with daily activities. This could result in the person missing social events, school or work.

People with panic disorder have panic attacks with mental and physical symptoms. The attacks happen without warning and can last several minutes to an hour.

Such people also may:

Worry about having panic attacks in the future.

Avoid situations that might cause them to have a panic attack.

Seek medical care at a clinic or Emergency Department when experiencing a panic attack.

Is there a test for panic disorder?

No. There is no test, but your health care team can determine if you have panic disorder or another condition based on your symptoms. You may have a complete physical exam, blood test or psychological evaluation to discuss your symptoms, fears, stress and family history.

Can panic attacks be treated?

Yes, treatment can reduce the intensity and frequency of panic attacks and panic disorder.

Treatment may include:

Cognitive behavioral therapy

Usually, this is the first treatment offered for panic attacks and panic disorder. During cognitive behavioral therapy, you talk with a psychologist or counselor about your experiences and learn how to react to situations differently. This teaches you how to cope better with your feelings and overcome fears of situations you may have avoided because of panic attacks. In some cases, it is possible to participate in cognitive behavioral therapy virtually, such as meeting with a therapist online or through a video call, rather than in person.

Medications

Medications can help reduce symptoms associated with panic attacks and depression. There are many options, and if one medication doesn't work for you, your health care team may switch you to a different medication. All medications have a risk of side effects, so talk with your health care team about the best choice for your situation.

You don't need to suffer alone or avoid aspects of life because of panic attacks. Talk with your health care team about your symptoms and about treatment options that can make a difference.

Brian Hesler, M.D., is a psychiatrist in Psychiatry & Psychology in Albert Lea, Minnesota.

Could you be depressed?

 Although we all experience grief and sadness, depression can be much more than that. An estimated 10% percent of the U.S. population suffers from some type of depression, so know that you aren't alone.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. There are ways to cope and manage if you feel that depression is taking over your life.

Signs of depression

Although depression may occur only once during your life, people typically have multiple episodes.

During these episodes, symptoms occur most of the day, nearly every day and may include:

Constant negative thoughts

Feeling of hopelessness, emptiness, sadness or tearfulness

Feeling tired or having less energy

Low mood

Overly self-critical or low self-regard

Thoughts of self-harm or suicide

Withdrawing from friends, relatives or work

Loss of interest or pleasure in most or all normal activities

Sleep disturbances, including insomnia or sleeping too much

Difficulty thinking, concentrating, making decisions or remembering things

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Prevention

There's no sure way to prevent depression but these strategies may help:

Eat nutritious foods with plenty of fruits and vegetables

Exercise every day for at least 20–30 minutes

Get 7–8 hours of sleep each night

Keep thoughts balanced and positive

Take a Vitamin D daily supplement

Take steps to control stress

Reach out to family and friends, especially during times of crisis

Treatment

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

If you are thinking about self-harm or suicide, seek professional help immediately.

There are resources available for you, such as calling or texting 988 for the 988 Suicide and Crisis Lifeline or calling 911.

Depression is nothing to be ashamed of and is treatable. Talk with your health care provider or a mental health professional if you are concerned you may be depressed. The nonprofit organization Mental Health America also offers a free, confidential online depression screening.

For more information about depression and tips to help you feel more like yourself, watch this video:https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/could-you-be-depressed

How mindfulness meditation improves mental health

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/mindfulness-meditation-improve-your-quality-of-life 

Quick and simple usually aren't terms used to describe medical treatments. Yet mindfulness meditation is a fast, easy way to reduce stress wherever you are.

It's often recommended as part of a comprehensive treatment for physical and mental health conditions. It's considered a type of mind-body complementary medicine. You can incorporate mindfulness meditation into your routine to improve your overall health.

Mindfulness meditation basics

Mindfulness meditation is the practice of purposefully being aware of and focusing your attention on the present moment. Mindfulness allows you to be in tune with your experience — right now in this moment — and to explore with curiosity whatever sensations, thoughts and emotions are present without expectations or judgment.

During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This focus can result in enhanced physical and emotional well-being.

Benefits of mindfulness meditation

Mindfulness meditation engages the brain. Think of it as a form of brain exercise. Just as physical exercise keeps your body healthy, mindfulness meditation keeps your brain fit. Research has shown that just five to 15 minutes of daily meditation is all you need to begin experiencing benefits.

After decades of research into the practice, these benefits have been found to include an increase in:

Cognitive flexibility

Diabetes control

Emotion regulation

Empathy

Focus and attention

Immune system response

Memory

Positive emotions

Positive relationships

Relaxation

Self-compassion

Self-esteem

The practice also affects many negative physical and mental symptoms, including decreases in:

Addictive behaviors

Anger and hostility

Anxiety

Burnout

Depression

Emotional reactivity

Insomnia

High blood pressure

Need for pain medications

Physical pain

Post-traumatic stress disorder symptoms

Stress

How to use mindfulness meditation

Many people may think of mindfulness meditation as "sitting on a pillow, being still, with eyes closed." This may work for some, but there are many ways to practice mindfulness meditation.

Practicing mindfulness involves using breathing methods, guided imagery, and other strategies to relax the body and mind and help reduce stress.

To try focused breathing meditation:

Sit down, take a deep breath and close your eyes.

Focus on your breath as it moves in and out of your body.

Sitting and breathing slowly for even just a minute can help.

Here are a few other structured mindfulness exercises to try:

Body scan meditation

Lie on your back with your legs extended and arms at your sides, palms facing up. Focus your attention slowly and deliberately on each part of your body, in order, from toe to head or head to toe. Be aware of any sensations, emotions or thoughts associated with each part of your body.

Sitting meditation

Sit comfortably with your back straight, feet flat on the floor and hands in your lap. Breathing through your nose, focus on your breath moving in and out of your body. If physical sensations or thoughts interrupt your meditation, note the experience and then return your focus to your breathing.

Walking meditation

Find a quiet place 10 to 20 feet long and walk slowly. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance. When you reach the end of your path, turn and continue walking, maintaining awareness of your sensations.

If you prefer guided imagery meditation, try one of these audio guides:

Ten breath practice introduction

Ten breath practice

What is mindfulness, and tips for the journey

Body scan

Mindful standing yoga practice

Mindfulness meditation on the breath

Mindfulness meditation on the body

Mindfulness meditation on sounds, thoughts and emotion

The 3-minute mindful breathing for the daily journey

Mindfulness is a supportive strategy to help manage many health issues. It pairs well with other medical treatments and counseling. It's a simple strategy that doesn't require a prescription or special equipment and can be practiced anywhere. Talk with your health care team about incorporating mindfulness meditation into your life, and see if it makes a difference in your health and general sense of well-being.

Joel Bobby is a licensed independent clinical social worker in Psychiatry & Psychology in Austin, Minnesota.

11 tips for coping with an anxiety disorder

 https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/11-tips-for-coping-with-an-anxiety-disorder

5, 4, 3, 2, 1: Countdown to make anxiety blast off

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-4-3-2-1-countdown-to-make-anxiety-blast-off 5, 4, 3, 2, 1: Countdown to make anxiety blast off

TOPICS IN THIS POST

Anxiety

 

Behavioral Health

 

Balance Your Mental And Emotional Health

 

Back To School

Stress bomb illustration

Everyone feels anxious now and then. But there are things you can do to minimize those feelings. Mayo Clinic Health System staff suggests trying the exercise below the next time your mind is stuck on the worry setting.

Sit quietly. Look around you and notice:

5 things you can see: Your hands, the sky, a plant on your colleague’s desk

4 things you can physically feel: Your feet on the ground, a ball, your friend’s hand

3 things you can hear: The wind blowing, children’s laughter, your breath

2 things you can smell: Fresh-cut grass, coffee, soap

1 thing you can taste: A mint, gum, the fresh air

This exercise helps you shift your focus to your surroundings in the present moment and away from what is causing you to feel anxious. It can help interrupt unhealthy thought patterns.

For tips on boosting your brain’s happiness, watch this fun video from Mayo Clinic’s Complementary and Integrative Medicine program:

Housing help brings stability to patients’ lives

 Housing help brings stability to patients’ lives

With medical-legal partnerships, we’re helping prevent evictions. Patients with safe places to call home can more easily focus on their basic health needs.

Medical-legal partnerships help families facing a housing crisis in order to prevent evictions and homelessness.

It can be overwhelming to care for twins. What’s even harder? Twins with special needs.

Ms. Smith (who asked to use her last name only to protect her privacy) is a Kaiser Permanente member and single parent of twins born with health and developmental issues. She struggled to care for her sons and pay for housing.

Unable to work outside the home, Smith got by with the support of relatives. When the pandemic hit, she was able to keep her Sacramento, California, apartment with help from the city’s COVID-19 relief emergency rental assistance program.

As pandemic-era funding ran out, Smith’s rental assistance stopped. She found herself in a cycle of paying back rent and late fees. Eventually, Smith received a final eviction notice.

“I had 3 days to pay a quarter of the rent and needed to go down to the courthouse to file. But I didn’t have finances to pay or gas to even get there,” said Smith.

Legal aid is pivotal to avoiding eviction

Smith’s medical social worker referred her to Legal Services of Northern California for assistance.

Legal Services of Northern California is one of a number of legal aid organizations that Kaiser Permanente partners with to provide legal services to patients in need. Members of our care teams are trained in spotting legal issues that could potentially impact a patient’s health. This especially includes housing-related legal concerns, such as evictions. When an issue is identified, the patients get a referral and can receive legal help at no cost.

“Our medical-legal partnerships are crucial in ensuring that patients who are most in need of housing stability can access legal resources,” said Stephanie Ledesma, vice president of community health for Kaiser Permanente.

In Smith’s case, Legal Services of Northern California contacted the courthouse on her behalf and filed the necessary paperwork to avoid her immediate eviction. The firm settled an agreement with her landlord’s lawyer that helped Smith stay in her home and granted her time to catch up on rent.

Kaiser Permanente has similar medical-legal partnerships in Baltimore; Portland, Oregon; Sacramento; Vallejo, California; and on Oahu, Hawaii. We plan to launch additional partnerships in Denver and Los Angeles later in 2023.

Our aim with the partnerships is to support our patients’ total health. Without a safe place to call home, it’s nearly impossible to focus on basic health and medical needs. We rolled out our medical-legal partnership initiative in 2021, in collaboration with the National Center for Medical-Legal Partnership and HealthBegins.

“By improving access to community legal aid, we are preventing homelessness. And we are eliminating the physical and mental health consequences that eviction can have on health,” said Ledesma.

Supporting social needs

In addition to fighting evictions, the medical-legal partnership team coordinates to support patients with a variety of other social needs.

Once Smith was able to fight her eviction, Legal Services of Northern California walked her through the steps to reapply for rental assistance under the city’s new regulations. Her medical social worker then turned her attention to helping Smith apply for in-home supportive services for her sons. Her sons now receive speech and language therapy at home.

“I’m so grateful to have a stable home and medical care for my kids,” said Smith. “I’m very appreciative of the legal help for me when it comes to housing. Regardless of anyone’s income, there are resources out there for people."

Get the help you need

We’re here to support you however we can. If you or someone you know needs help with essentials like food or housing, or needs assistance paying bills, start your search at kp.org/communityresources or call 1-800-260-7445 (TTY 711), Monday through Friday between 8 a.m. and 5 p.m. local time.

Eviction, equity, and health

Nearly 6 out of 100 renting households were threatened with eviction at least once during 2018, according to the Eviction Lab. In a typical year between 2000 and 2018, landlords filed 3.6 million eviction cases.

Eviction filings are now on the rise again as pandemic-era rental assistance funds and restrictions on evictions sunset. Black tenants — especially Black women — face a greater threat of eviction due to decades of inequalities in the housing system. Black women are more than twice as likely to have evictions filed against them as white people.

High blood pressure, depression, anxiety, and poor health are some of the negative effects associated with evictions.

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Hospital patients who are homeless connected to housing

 Hospital patients who are homeless connected to housing

A Kaiser Permanente program connects patients experiencing homelessness to permanent housing and help for life’s problems.

Rosa Williams relaxes in her new 1-bedroom apartment in Sacramento, California, which she rented with help from Kaiser Permanente’s Project Home.

Becoming homeless and living in her car while trying to manage stage 3 kidney disease and diabetes was not something that Rosa Williams of Sacramento, California, thought could ever happen to her.

“I never thought I would be in that position,” the 60-year-old Williams said, her voice breaking as she recounted her move from Las Vegas to Sacramento, which she thought would be seamless and easy. “And the way people treated me? I get really emotional just thinking about it.”

Today, thanks to a new $2 million Kaiser Permanente program in the Sacramento area called Project Home, Williams has settled into a cozy 1-bedroom apartment in a senior living community.

Under the program, Kaiser Permanente care teams identify people in its Sacramento County emergency departments who are experiencing homelessness. They are screened and referred to the nonprofit Sacramento Covered, which operates Project Home specifically for Kaiser Permanente to address housing, social services, and medical care coordination.

“I went from living with my son to a hotel, and then I ran out of money and got very sick,” said Williams. “Just imagine me living in a car and being really sick with all my medications. It was horrible.”

Flexible funding for housing and services 

A social worker in the Kaiser Permanente South Sacramento Medical Center Emergency Department where Williams was seen referred her to Project Home. Flexible funding that Kaiser Permanente provides through the program helps people pay for credit checks, application fees, back rent, security deposits, and first and last month’s rent to obtain housing — barriers that could otherwise prevent them from finding a stable home.

“Luis from Project Home came to the parking lot where I was living in my car, evaluated me, and the next day put me in a hotel room,” said Williams. “Then he helped me get the place I am in now. I want people to know how much this program helps. They did such a great job.”

Project Home in 3 West Coast cities

The partnership with Sacramento Covered is part of a larger, $5.7 million Kaiser Permanente effort in Sacramento, Los Angeles, and the Salem, Oregon, area to offer housing services to people experiencing homelessness who are frequent patients in its emergency departments.

Since it started in 2022, the program has enrolled 97 people and placed 46 in housing across all 3 cities, according to Vanessa Davis, Housing for Health program lead at Kaiser Permanente.

“Kaiser Permanente believes that housing is health and a secure and stable place to live is key to a person’s ability to thrive,” said Davis. “We are getting medically vulnerable people connected to vital housing and social supports.”

Individual housing needs

Project Home Sacramento Project Manager Chris Baker said the assistance caters to the individual’s specific needs.

“We always try to make sure we set up people in a living situation that makes sense for them,” said Baker. “Some of it will be permanent, supportive housing with a case manager and some will be independent living, usually with Section 8 rental vouchers.”

Having medical care teams at Kaiser Permanente collaborate with housing and social service providers is critical for patients with complex and intertwined medical and social needs, added Davis.

“The care team knows a patient’s health needs and where they are staying, and that improves outreach and the ability to identify suitable housing options,” she said.

Brandon Pace, chief operating officer of Kaiser Permanente South Sacramento Medical Center, said the goal is to use a “housing first” approach to get people in a home right away, then refer them to social services, mental health, or substance abuse services.

“Part of our mission is to improve the health of the communities we serve,” said Pace. “We feel an obligation to help, so people don’t need emergency room services as often. And if we don’t also address their housing needs, their medical conditions will deteriorate.”

For Rosa Williams, the help she received from her case managers at Project Home made all the difference in the world.

“They made me believe in people again.”

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Grant encourages long-running therapist internship program

 Grant encourages long-running therapist internship program

Instituto Familiar de la Raza’s Clinical Internship Program prepares mental health professionals to best serve San Francisco’s Latino population.

Left to right, Julio Gonzales, Gloria Romero, and Alexandra Capulong at IFR in San Francisco’s Mission District.

While many speak about building the pipeline of future therapists to meet California’s growing need for mental health services, Instituto Familiar de la Raza (IFR) is walking the talk.

The nonprofit based in San Francisco’s Mission District has been providing mental health and social services to San Francisco County residents for 46 years — and since 1985 has maintained an internship for master’s and PhD candidates who learn from its clinical advisors at the same time they provide Spanish bilingual or monolingual mental health care to children, adults, seniors, couples, families, and the LBGTQ community.

Currently serving around 6,000 San Franciscans a year, the organization employs 120 bilingual, bicultural staff members. 

Alexandra Capulong, PsyD, is a mental health specialist at IFR’s La Clínica’s de la Raza who first came to the organization as an intern in 2020 — at the worst of the pandemic.

“From the moment I walked through the doors, I felt a strong sense of community and connection,” she said. “I had applied to Instituto because of the population they serve and because I wanted to be able to give back to my community, particularly to assist monolingual Spanish speakers. I came back after I finished my final internship and graduated because of this sense of community and unity.”

Coming to intern; staying for good

IFR recently received a $75,000 grant from a Kaiser Permanente fund at the East Bay Community Foundation to help increase the clinical trainees’ stipends, provide resources for more clinician supervision, and support culturally based trainings in various modalities and venues.

“We’re pleased to provide financial support for Instituto to increase the number of therapists trained to meet the needs of our diverse communities,” said Yvette Radford, Kaiser Permanente Northern California vice president for External and Community Affairs.

“Any type of assistance really goes a long way,” said Julio Gonzales, La Clínica’s program director. “This grant is hugely appreciated for going toward helping us to maintain this important program.”

The interns come from institutions including San Francisco State University, U.C. Berkeley, and The Wright Institute for 2 semesters of classes and supervised on-the-job training. Competition is steep to intern at IFR.

While many go on to work for counties, the San Francisco Department of Public Health (SFDPH), and Kaiser Permanente, others have stayed at IFR for their entire careers in order to live the promise of an organization focusing on culturally sensitive health care.

One previous executive director began at IFR as a 19-year-old intern and retired after 38 years at the organization.

“We nourish and learn from our relationships with each other and our clients in order to be able to provide the accurate assistance,” said Gonzales, a former intern. “We have the cultural piece that not many other sites offer.”

Meeting a dire need

According to the Healthforce Center at U.C. San Francisco, if current trends continue, California will have 41% fewer psychiatrists than needed and 11% fewer psychologists, licensed marriage and family therapists, professional clinical counselors, and clinical social workers than needed by as soon as 2028.

With 8 to 11 behavioral health interns a year, IFR has trained and supported hundreds over its history — with many more planned for the future.

The 2020 pandemic drove home the importance of the organization, according to its executive director, Gloria Romero.

She said that the SFDPH looked to IFR’s institutional knowledge during the pandemic, since it served San Franciscans during another, earlier public health crisis — the AIDS epidemic.

“During the COVID-19 pandemic, we saw a rise in need among our existing clients, as well as new families and community members we hadn’t served before,” Romero said. “The need was just so great: grief, stress, depression, and isolation. As a result, we diversified some of our offerings, moved some to online, and even pivoted to provide some basic support, including food and diapers.”

For Capulong, serving that need is not just a job — and IFR is not just an employer.

“I have learned and continue to learn about even my own culture and the culture of other Hispanic individuals, as well as the Latine, Chicane, and Indigenous communities,” Capulong said. “I have had the chance to experience rituals and traditions that my family has not practiced, and it has been such a wonderful experience.”

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Mental Health Training Program recruiting now

 Mental Health Training Program recruiting now

Kaiser Permanente encourages employees and the public to apply for a training program culminating in a rewarding career in behavioral health.

To help strengthen and diversify the mental health care workforce and meet a growing demand for mental health care, Kaiser Permanente Northern California is currently recruiting for its Mental Health Training Program (MHTP).

The program provides comprehensive clinical training in adult and child behavioral health, chemical dependency treatment, and multiple specialty training tracks in evidence-based care to more than 250 doctoral and master’s level trainees in 21 Northern California medical centers. The program encourages applicants from a broad range of backgrounds and experiences.

Helen Chan, PsyD, has been in the Mental Health Training Program for 3 years: as a practicum student, predoctoral intern, and now as a post-doctoral trainee. She decided to become a licensed clinical psychologist to help those struggling with autism, like her 14-year-old son.

“I really want to work with other families dealing with autism to help them mitigate some of the challenges,” she said.

Woman's face

Helen Chan, PsyD

Kaiser Permanente Northern California Community Health is supporting the Mental Health Training Program as part of an ongoing commitment to expand the mental health workforce and increase diversity and representation.

MHTP trainees are taught clinical skills that support cutting-edge treatment protocols and follow evidence-based guidelines. They receive supervised training needed to graduate and become licensed clinical psychologists and therapists, which are in high demand throughout the United States.

They also provide mental health education, mentoring, and resources to local schools and community organizations.

Recruiting for trainees

The program is currently recruiting doctoral practicum, internship, and postdoctoral trainees, as well as pre master’s and post master’s trainees on a rolling basis. (Learn about each program.)

“Kaiser Permanente is committed to growing the mental health workforce, and programs like this one help us provide the experience and training needed in a supportive environment,” said Jennifer Thom, PhD, assistant regional director of the MHTP.

Asher Trahan, PsyD, is currently completing his postdoctoral residency training in clinical psychology in the program.

A veteran of the U.S. Airforce, part of his training includes providing individual therapy to those dealing with depression or other mental health diagnoses at Kaiser Permanente Vallejo.

“This is a great team to be a part of,” he said. “They look out for each other, and care for each other.”

Learn more about what the MHTP offers as well as how to apply.

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Metastasizing cancer is no match for coordinated care

 Metastasizing cancer is no match for coordinated care

Kaiser Permanente member Jessica Wade’s clinicians saw her through her cancer diagnosis, treatment, and on to follow-up care.

In 2013, Kaiser Permanente member Jessica Wade met with her dermatologist to discuss a couple of moles that seemed odd to her. As it turned out, both were melanoma. “I had surgery, they got clear margins, my PET scan was clear, and so life went on,” said Wade. 

Then, last year, Wade tested positive for COVID-19 and underwent a CT scan to check for pneumonia. Though her lungs were clear for pneumonia, the scan came back showing a worrying nodule. Concerned it could be related to her previous diagnoses of melanoma, Wade was referred to Brian Rezvani, MD, a thoracic surgeon at Kaiser Permanente South Sacramento.

“It was impressive to me that something from 9 years ago was still relevant in my medical record for them to consider,” said Wade. “I honestly had no idea that melanoma in my lung was even possible. Dr. Rezvani explained everything to me and gave me some options to consider. I really appreciated being a part of the decision-making for my care.”

Treatments to fight metastasized cancer

After surgery, it was confirmed that Wade’s melanoma had metastasized to her lungs and she was referred to Frank Hsieh, MD, an oncologist at the Kaiser Permanente Roseville Medical Center, a nationally certified Comprehensive Community Cancer Program, along with the Sacramento and South Sacramento medical centers.

“Melanoma is a very serious skin cancer. It has a tendency to spread to other parts of the body even years after the initial diagnosis,” explained Dr. Hsieh. “Unfortunately, it came back in her lungs.”

Wade’s care involved using the latest immunotherapy treatments, which not only resulted in a better outcome, but reduced nausea, allowed Wade to stay active, and even enabled her to keep her hair during treatment.

“Before the era of immunotherapy, the prognosis for melanoma — once it has spread — was poor,” said Dr. Hsieh.

Wade’s prognosis looks very positive, but due to her high risk she continues to be closely followed by Bianca Lemos, MD, her dermatologist at Kaiser Permanente Sacramento. Thanks to her entire Kaiser Permanente care team, Wade has been able to get back to long distance running and recently completed a 50k trail run in under 7.5 hours.

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Lung cancer surprises a population

 Lung cancer surprises a population

Non-smoking Asian American women have significantly high lung cancer rates.

Lung cancer is a devastating disease that takes the lives of hundreds of thousands of individuals each year. While smoking is the primary cause of lung cancer, anyone can develop the disease, including non-smokers. Certain populations such as Asian Americans face a significantly high risk of developing lung cancer.

The Association of Community Cancer Centers reports that Southeast Asians are 18% more likely to develop lung cancer than white Americans. Among Asian subgroups, Vietnamese individuals have the highest rate of lung cancer, while Chinese individuals have the highest rates of lung cancer death.

Asian women appear to be at particularly high risk for lung cancer compared to women from other ethnicities. Research published in the Journal of the National Cancer Institute shows that non-smoking Asian American women have generally much higher rates of lung cancer compared to non-smoking, non-Hispanic white women.

Barbara: A cancer survivor

Lung cancer survivor Barbara Kitagawa

Kaiser Permanente member Barbara Kitagawa, 70, of El Cerrito is one of the non-smokers who received a stage two lung cancer diagnosis. It was right before Thanksgiving 2012.

“It began with a dull, persistent pain in the lower right side below my lung,” said Kitagawa, who is of Japanese descent. “My primary care physician referred me to pulmonologist Peter Le.”

Dr. Le said that there was a shadow on Kitagawa’s CAT scan of her right lung, prompting a bronchoscopy in which a thin tube was used to look at the airways. Despite the case being inconclusive, Dr. Le said, “Something wasn’t right, so I pushed for a biopsy, which then showed lung cancer. Immediate surgery was then performed by our top-notch thoracic surgery department.”

Kitagawa was surprised — and yet not. She had had 2 female non-smoking family members of Chinese descent diagnosed with lung cancer. Both first presented with asthma. One died within a week of diagnosis.

In Kitagawa’s case, surgery followed by chemotherapy ending in April 2013 headed off the cancer. (Her original pain was from one end of the lung hitting a nerve.) A decade later, she credits Dr. Le for his tenacity in the face of every test coming back negative.

Being on the offensive

“This case illustrates the importance of being on the offensive end of looking after one’s health,” Dr. Le said. “If you have a family history or you are in a demographic skewed to a specific form of cancer, speak with your physician. And if you are using tobacco products, Kaiser Permanente has a robust tobacco cessation program.”

Lung cancer starts when abnormal cells grow out of control in the lungs and form tumors. Lung cancer can develop anywhere in the lungs, affect any part of the respiratory system, and can even spread to other organs. It can also start and progress without causing any noticeable symptoms, especially in the early stages. However, when caught early, lung cancer can be treatable — and even cured. 

Common symptoms of lung cancer may include coughing, wheezing, fatigue, chest pain, coughing up blood, and unintentional weight loss. Early stage lung cancer may present with no symptoms at all.

Kitagawa said she feels it’s urgent to get this message out to Asian American women. “In our culture, women are sometimes not as vocal in expressing their needs, including medical. Additionally, if English is a second language, it’s important that a woman’s information not be lost in translation to care providers.”

Learn about lung cancer screening and how it can save lives. If you’re a smoker, Kaiser Permanente offers quit-smoking tools to help you personalize a plan to kick your smoking habit.

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Mental Health Scholars Academy graduates first class

The program supporting and growing future behavioral health professionals has just launched its first group of newly degreed therapists dedicated to helping others.

 Leiza Santos knew she was taking on a lot by enrolling in Kaiser Permanente’s Mental Health Scholars Academy (MHSA) during the pandemic while working her administrative job at the organization.

A mother of 2 young children, Santos would need all of her energy and multi-tasking abilities to finish the 3-year program that supports the training of new mental health professionals committed to working for Kaiser Permanente in California. But with a bachelor’s degree already in psychology, she was well-positioned to become a therapist, which she calls “a passion.”

Half-way through her program, Santos added to her family. “With the support from my school and Kaiser Permanente, I was able to continue without disrupting my graduation timeline,” she said of juggling a newborn.

Santos credits many for her accomplishment, including the program for its 75% tuition assistance, enthusiastic co-workers, and managers flexible with her work schedule.

“I would encourage anyone who qualifies to apply and pursue this amazing path to further a career in mental health,” Santos said. “I would have never thought of challenging myself this much at this point in my life, but it was well worth it and I’m excited for the journey ahead.”

Building the pipeline

The statewide program launched in 2019 to create a career pipeline for new mental health professionals and increase diversity and representation in the mental health workforce. Santos and classmates including Janelle Hernandez are the Northern California MHSA’s first graduates.

Both earned their master’s degrees in counseling psychology-concentration in marriage and family therapy from the University of San Francisco.

“As soon as I found out information about the MHSA program, I jumped on the opportunity to pursue my dream to become a therapist,” said Hernandez, a Kaiser Permanente recreational therapist for 6 years who is motivated to help the Latinx population.

“The program brings additional diversity into California’s mental health workforce with over 75% of participants identifying as people of color and many bilingual,” said Lauren Sevey, MHSA’s lead consultant.

Over the past 3 years, each graduate has clocked between 300 and 500 hours of clinical training at practicums within the Northern California Region. The next step is for the post master’s requirement of 3,000 supervised hours for licensure — yet another hurdle that is being smoothed with help from Kaiser Permanente.

Streamlining the process

“We are partnering with Talent Acquisition to streamline the process of connecting MHSA graduates with open associate positions and developing new supports to help them with resume and interview preparation, as well as navigating the Kaiser Permanente behavioral health hiring process,” added Dan Gizzo, PhD, a clinical psychologist and the program’s director.

MHSA participants Lisa Goettsch graduated in February with her master’s degree in marriage and family therapy from Alliant International University. She worked a decade as a registered dental assistant at Kaiser Permanente, where she supported a maxillofacial pain physician in providing care to patients suffering from chronic facial pain.

“Through this work, I found those coping with chronic pain may also be working through anxiety and other mental health challenges,” she said. “I became eager to learn at a higher level how to best support those with their mental health.”

With her education completed, Goettsch can see her new career in sight. Of the MHSA, she said, “Every person in my cohort is so glad they decided to participate in the program.”

Are you a Kaiser Permanente employee in California interested in applying to the MHSA? Applications open on September 7. Learn more.

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Fighting alongside you, for you

 Fighting alongside you, for you

Cancer affects almost all of us at some point in our lives. Half of men and one-third of women will get cancer during their lifetimes.1 Others may support a loved one fighting the disease. The hopeful news is that about 44% of cancers are preventable.2

Kaiser Permanente is committed to being a leader in cancer prevention and screenings. For example, human papillomavirus (HPV)–related cancers, such as cervical cancer, account for several common cancer types worldwide. Kaiser Permanente has cervical cancer screening and HPV vaccination rates that are in the top 5% nationwide.3  We also have 2 of the top 6 highest-performing commercial plans in the nation for breast cancer screening.4 Our members are 20% less likely to die early from cancer compared to nonmembers in the same communities.5

From detection to recovery, Kaiser Permanente doctors, nurses, and specialists work together to give you high-quality care. No matter where you are on your care journey, we’ll be there to support all that is you.

Join a community ready to fight cancer and thrive during a free virtual event

Fighting Cancer with Kaiser Permanente is a yearly, no-cost virtual event. It’s a chance to learn about our total health approach to preventing and treating cancer. We hope everyone affected by cancer will unite for this event. Register today and continue fighting.

Trauma surgeon, nonprofit break cycle of gun violence

 

https://mykp.kp.org/en/news/ncal/trauma-surgeon-nonprofit-break-cycle-of-gun-violence.html

Trauma surgeon, nonprofit break cycle of gun violence

A Kaiser Permanente Northern California grant aids intervention when violence brings people to the hospital.

When 27-year-old Dion Cavin arrives at the hospital bedside of a person who has been shot, stabbed, or seriously wounded, he knows he’s got a small window to connect with the victim and break the cycle of community violence.

“I go within a day of surgery, and if the victim is unable to speak, I might be talking to a parent, a wife, or a grandmother,” said Cavin, an intervention specialist with the Sacramento Violence Intervention Program, which has received community health grants from Kaiser Permanente since 2010. “I try to make them feel comfortable so they can be vulnerable. I ask them, ‘Where’s your head space at right now?’”

Cavin said his mission in talking to victims of violence who are treated at the Kaiser Permanente South Sacramento Medical Center and one other area hospital is not to lecture or warn that next time they might not survive. Rather, he offers free wraparound counseling, social, and medical services that program leaders say are key in breaking the cycle of violence on the streets.

“The truth is, a lot of our clients are just in the wrong place at the wrong time, and a lot of our victims are cases of mistaken identity,” said Cavin. “That said, most people are grateful for the help we offer and want to make a life change right then and there.”

Dr. Maya Leggett, a trauma surgeon at Kaiser Permanente South Sacramento Medical Center, started the intervention program in 2010.

The intervention program offers a variety of services for 6 to 12 months, including rides to doctor’s appointments, help navigating health care, psychological counseling, referrals to parenting groups, and help applying for state money for victims of violent crime.

The organization served 150 victims last year, nearly double the previous year’s number due to rising crime rates.

Kaiser Permanente has supported the Sacramento Violence Intervention Program, part of WellSpace Health, for 13 years with about $11 million in grants.

“We know timing is critical right after someone becomes a victim of violence,” said Susan Little, program manager. “That’s when they are open to new information and before they start having recurring thoughts that could include retaliation.”

Program nearly eliminates reinjury

The work over the last 13 years has resulted in a less than 1% re-injury rate, said Maya Leggett, MD, a Kaiser Permanente South Sacramento Medical Center trauma surgeon who started the program at the medical center and who operates on gunshot victims and victims of all kinds of violence.

“Lowering the rate of re-injury was the idea of the program from the get-go,” said Dr. Leggett. “If you’ve been hospitalized after being shot or stabbed a first time, and it happens again, your rate of death goes up to 30%. I want these people not just to survive, but to live and to have the tools for success that they might not have had before.”

Over the past 5 years, Kaiser Permanente has made grants of over $2.4 million to organizations working to end retaliatory and cyclical gun violence in Northern California, including to Advance Peace, California Partnership for Safe Communities, Youth ALIVE!, Hope and Heal Fund, and Movement 4Life.

“Gun violence is ubiquitous in the United States, but it’s preventable,” said Yvette Radford, Kaiser Permanente Northern California vice president for External and Community Affairs. “The organizations we support use evidence-based models to decrease trauma and death plaguing too many of our communities.”

The trauma-informed care approach of the program that Dr. Leggett helped start, in which hospital clinicians approach victims of violence without personal bias in order to provide better, more empathetic care, has not only helped the victims, but has had an unintended yet positive effect on the medical providers themselves.

“Learning to understand the humanitarian component of caring for these victims has really changed how people in the trauma department see the patients who come in,” said Dr. Leggett. “We’ve all gained better understanding of and empathy for the victims of violence who we see here.”

 

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 So what is a coronavirus you can go to Wikipedia. And you can look at these viruses. These are, This is an electron micrograph of a number of coronaviruses. There are about 80 or 90 nanometers in diameter, so they're a tenth micron. They're about a hundred the width of a speck of dust.
so you can't see them. They are so like that they float in air China knew that they reported that to us in March of 2,020, and unfortunately. I'll just say people in our leadership did not take that seriously, and didn't understand the importance of masking
these little spikes here on the outer edge. This is how they attach to our to ourselves person deep in our lung. And now in the nasal cavities, coronaviruses
we're discovered in 1960, Ish.
and one of the first ones Oc. 43 was discovered.
and then to some genetic sequencing and some pathological data clinical data, it's
surmise that O. C. 43 was actually what we thought was a Russian influenza, a Russian blue pandemic in 1,890. If we go back and look at the symptoms. It seems more like it could have been a Coronavirus.
and in addition to that.
it it could genetically, over a period of about 70 years migrate into a cold virus. So coronaviruses are always on the move. There are 4 of these that are known in humans to circulate and cause common colds about one out of 5, one out of 6 common calls.
and then we have Sars. Cov. One, which is in 2,003. That was significant. If that had been as contagious as Sars Cov. 2, I think the world would have been a different place.
There's Mars, which is Middle Eastern respiratory syndrome which, in fact, camels
and among camel workers in the Middle East 50 will show antibodies, tumors. So it's still out there and still circulating. And then, of course, COVID-19.
If you ask, where do coronaviruses live? If you would ask, where does influenza live? Influenza lives in birds, mostly in birds, and why, while file, it also is able to.
In fact, pigs
and pigs are a particularly dangerous mixing vessel for influenza, because they can be infected by bird by avian influenza, and they, of course, have a million influenza. So that's likely where we get some really bad recombination. But beta coronaviruses tends to live in bats and rodents.
And so, if you have never been told this, if you are going through a garage, if you're going through the storage area, you start to find rodent down the inside boxes. Get a mask on immediately.
because it's really getting to risk.
So the start, this is a little nerve model of a Sars. Cov. 2 viral particle e, there are different proteins, ease and envelope protein. It sits on the outside of the membrane Ms, a membrane. Protein and S is the spike protein. The spike protein is what attaches to our cells, and this is where genetically all of the action is.
and it is where we are going to do our genetic, genomic, pairwise alignment, analysis. and look for a putative ancestor. But the word put it, it, means to be asserted, but not with a penalty.
So this is a diagram of the Coronavirus genome. If you're new to viruses, and and I'm going to assume that you guys don't know a whole ton about viruses, but viruses can be Rna. They can be DNA.
This letter here has 30,000 letters of Rna. And over this genome. By the way, HIV. Human immuno virus deficiency, syndrome.
as well as simian immunovirus, deficiency, syndrome, also 30,000 letters also containing most of these proteins, but they do different things. So viruses. If you look at their genetic chassis, they have a lot of similarities, and if you go into microbiology. You'll study all of this. We have an excellent microbiology program at Foot Hill College.
The programs that are the sorry, the programs, the genes that are called orphs are like zip files, open reading brain, and they unzip into multiple proteins. We come here to this bread section. And this is by protein.
So we're gonna look at Sars and Mers at the Covid genome.
And this is just letting you see over 30,000 letters span. Where do these genes live. So the open reading frame, one and open reading frame to an open reading frame begins with the methigning amino acid. It begins with atg, and the sequence. Reading will run with
The Rna brought the case
until you hit a stop code on, and then you stop, go and stop translation.
The protein that we're looking at here. The spike protein can be broken down into a couple of areas, the ones that you guys maybe may read about in the future Rvd is receptor binding domain that attaches to a cell. So this is really important.
Viruses don't know what animal
that they're attached to. They're just attaching to a protein. So Rvd attaches to a protein. And among other important areas here, if we look at a spike protein I'm trying to look for.
Oh, gosh! I think it's right here around. It's right here. So I apologize. It says, S. One subunit, and then there's an arrow in a in a bar, and then S. 2 subunit. These 2 subunits in this protein and the spike protein have to split. It's a process called cleavage, and they have to split so that Mrna can be injected inside of us.
and that Rna then is attached to our
sorry. My brain just stopped. There is a a unit within a cell that does all the transcription and at that point of injection you have to cleavage here. Cleavage takes a long time. unless there's an enzyme that can do that for us. And that's what we're gonna look at today where that enzyme came from.
So this is a slide that shows what happens when they when a virus comes. And if we're looking at a membrane, if we're looking at the 2 different pieces of our and below protein and our spike protein. The spike protein attaches here to an ace 2
and this is a Angio tense and conversion. Enzyme. This is present in our kidneys and in our lungs. It allows our body to quickly create an enzyme that allows our blood pressure to go up and constrict for fighter flight. So it's a very fast conversion.
and these cells exist everywhere. But this is what the Sars Covid, by protein, was able to
attached to. Initially. There's something called Tmp, which is a transmembrane of protease, and this is super important, because these 2 have to attach at the same time, and then cleavage occurs.
So a virus attaching to us is kind of a complicated process. It's a docking procedure you have to do, and then a hatch has to open, but there's a cleavid step before that.
and this slide here shows the fusion event here. It's a virus coming in, and the spike protein dots first with ace 2,
and then you have the subunit to which cleves from the subunit one. When that happens, then you get injection membrane fusion. So there's an initial docking event. Then there's proteolytic activation. That is the cleavage between S. One s. 2,
a subunit, one subunit 2. And that's where the magic is, and then the membrane fusion is boom. The rna is injected to us, and then we are infected.
So what's really important? Here is the spike protein is activated and cleaved at the S. One s. 2 level.
user avatar
Justin Tu
00:15:35
I have a quick question. You mentioned earlier. That cleavage is usually a
user avatar
Robert Cormia
00:15:41
long passes. How fast, how much faster is it with the
I want to say, it's a thousand times more efficient. Yeah. So I don't want to say faster because efficiency and speed are not quite the same thing. I don't. I do not have microbiology training right here, but my background. If I didn't share with you. I taught bioinformatics at Foothills College, 20 years ago I got a certificate at Uc. Santa Cruz
extension, and that allowed me to actually develop a program and teach a course in it.
If there's a question in the chat, I can't see it, but Adrian, perhaps can read it so you can look at.
user avatar
Adrienne Nguyen
00:16:32
Oh, sorry we did a lab in Bio to track this. It's so much faster with an enzyme present.
user avatar
Robert Cormia
00:16:49
And so I'm glad someone has seen that. So you can look at the structure of these spike proteins. And this is called Ncb. I, pdd, Pv. Stands for protein Data bank and 6 v. Atx is an accession number.
An accession number is a primary key in the database. It's like the license plate on your car. and so it attaches to a file. And this file happens to be a structure file for Covid.
and you can go here, and Cbi is free and freely available. So if you look at here, you can almost read this. This is out of our Csv.
but this is our csv.org slash structure. Slash 6 Dxx. All you need to do to find this is probably Google, our Csb, which is a data bank of genetic structure information. And then the accession number, which is 6. Vxx.
No, I'm not gonna touch on this a lot because this gets into chemistry biochemistry that you guys may do in D, you go on. You may do what's called the 5 Si angle, but the fi Si angle is like a second Level genetic code, where amino acids next to each other have different rotations and scare of hindrance. Derek. Hindrance is the bulkiness of what you are doing, colliding with a partner.
and so these.
a sequence of amino acids and their rotations and their confirmation that they eventually end up their shape right? And they charge is what allows them to fold and attach to things, and do what enzymes do and do what proteins do. So all the flexibility and all the shape is determined by the by side angle.
which is why you, an amino acid substitution can make a protein more effective at a certain place, or it can make it ineffective.
And again, this is. If you look at by side angles, you look at a rotation around the nitrogen atom and the carbon atom, and then a carbon nitrogen bond.
So the spike protein is key to vaccine development. That's why the sequencing of protein structure is so very important. If we didn't have that ability we couldn't quickly, rapidly, scramble and take a sequence and develop a vaccine for it.
The Mrna vaccines that we'll see, and a lot of people early on. We're concerned because they thought, how could we trust the vaccine that was developed in a year? Well, the quick answer to that was, it took 25 years to become that overnight sensation. And so there is 25 years, a long, painful development, 5 generations of scientific leadership.
all of them taking like a relay race, taking the baton a little further, but not closing in on it, and we were just gosh! Our lucky that in the year 2,000 that we had 2 companies, moderna
and Pfizer that we're able to scramble on this.
So the spite protein, this is a trimer. And so the there are 3 identical proteins that come together, and when you go to a protein databank you can see where the amino acids change, and you can see the Rvd is the receptor binding domain
we're gonna compare here. And this is you know, I read a number of papers early on sars cov 2, and that our atg. 1, 3. That's how you spell it. The car capital, R. Little, a, T, T. 1, 3
half. The signs I read was out of China, and all of it was outstanding.
And so early on, a lot of scientific prowess emerged from China to understand what's going on here, because obviously this was a pandemic. So this was a virus that had a lot of firepower in terms of being able to be contagious and and do some damage at the same time.
So there's a comparison, and Sars Cov. 2 and a bat virus in particular places. And so what you do is you look at these residues and compare them for similarity. And if they're not an identical residue, you compare them for their shape. So they're not. They don't need to be the same amino acid as long as they're from the same family, and when they fit in the same by side angle.
So all of this molecular modeling is done in the computer. It's very, very extensive. It requires just a lot of time.
So early on thanks to just a good journalism. New York Times. Ran an article and shows the spike, protein and amino acid compensation.
When I first read this article and saw a Pdv. 6 Vxx. I thought, well, heck! I can take these letters 1,270 odd letters, or brown there, and paste them into and Cbi. Blast and blast the protein sequence, and see where this came from.
They looked at this, and then they ran the article about the B 1, 1, 7 variance. So I think that this was some time around spring, mid spring, maybe Mayish, maybe about 3 years ago, when this article in in 2,021. I apologize 2 years ago, and came out and looked at
how the virus shape initially emerged, and then how mutations change the shape and the foldability of it. So one of the things and we'll look at this with the B 111 variant
was the point of mutations, and so scientists can very quickly from a sequence, and they look at the genetic sequence and translate to proteins. And so what they found in the B 1, 1 7 lineage is that there were 2 deletions. These 2 little dots mean that 2 amino acids disappeared. So that means that 6 nucleotides we're no longer there and did not cause a frame shift.
And then you have 1, 2, 3, 4, 5, 6 other key mutations and spots.
And so these are hotspots in the spike protein, where genetic changes that results in a different amino acid raise, then it can for much greater activity, much greater virulence.
And that's what this virus obviously wants to do.
Now I want to point out. And this is, I don't wanna get into the conspiracy re reg regime. But when you are, when you have these viruses and you're working in a lab. not just the Lab and Wuhan Institute of Virology, but all across the globe, and including the Us. Is at scientists by
biologists are able to move these things around. And so it is not implausible that the spike protein of one virus could be attached to pieces of another, or that
key features of one virus could be inserted.
And it's a matter of just changing the genetic code.
So, looking at this in more detail, there are 2 deletions. This is one at 69 and 70. So 870. There is a deletion, and why? 144, 145, also a deletion. And so those amino acids are no longer there.
and then, if we look at positions 501570. So this is long. A 1,270 is string amino acid string at these positions
amino acid, and there are 21 amino acids. When you go on to biology you'll probably have to memorize this I did in biochemistry. I can't remember most of them but and shifts to why, a shifts to the at position 6 81 P. Shifts to H.
7, 1 6 T. Shifts to I. And then at 9 82 s. Becomes A, and then 1, 1, 1 8 d. Becomes age. So there are couple of things going on here that aren't one is that are not immediately obvious. Not only does this confer greater or for virulent.
but if you guys know sports, you're familiar with what an all-star team is, and then all start. Team is when you have the best athletes at a particular position, and I want you to think of that metaphor and apply it to the sequence of amino acids and realize that these are an all star team. And once you get a good team member at one of these positions. It's awfully hard to replace that one because they're working well with their other team members.
I would make a basketball matter for right, but not everyone has the same basketball favorite that's involved in.
So what I did was New York Times again. This was super simple and great the way they did it. They published this sequence, and they wrote deletion here, deletion here and then I highlighted in red letters where there was a change of amino acid. So I literally went back to the first sequence of letters.
and then I copied this in. It's a little painstaking because you cannot make a mistake with a character, and then blast this in is you can. You can make a lot of big errors. But I was able to get all of these letters in. And so this is where I got the Wuhan sequence.
and then the B 1 1 7 variant. I then spent a lot of time plentying down other variants. it's not as simple as going to Google.
So what I want to show you is there about a dozen positions where amino acids have occurred. And some of these when we got to Delta K. 4, 1, 7, and E. 40,
4, 84 K. And 501, why.
They clustered together, and these 3 would appear in a lot of variance. This is your all-star team. There's a word for these 3 things, and this is just my my brain getting old and stressed.
there's a work for how amino acid mutations function together as a team, and then it becomes difficult to replace any one of them, because you're essentially replacing the entire team.
If these are what happens, you can have a virus more effective infected. You can also have a mean escape. so infection is attachment to us. An immune escape is avoiding the attachment of our antibodies to it, either through a vaccination or a natural infection
user avatar
Justin Tu
00:27:08
so early on one more question. So go back at the other side again. You mentioned Sorry. Not that one the one we were talking about the st stabilizing mutations and the infectivity genomes. I think it was. Go forward one more side
user avatar
Robert Cormia
00:27:26
here
user avatar
Justin Tu
00:27:28
one more by you.
Okay, so I think you said it briefly. But these stabilizing mutations that basically means these, all star members are not going away. They're gonna stay there through all of the.
It's always covid to mutations.
user avatar
Robert Cormia
00:27:46
Probably remember that there is probably so. We. We had a massive change between Delta and Omega.
and the exact origin of all, Macron is not understood, but there are assertions that are reasonable, that
what happened
with all Macron is that you had an infected patient who was amino compromised, and that could be any one of a number of things. So it's just choose cancer. And so they don't have a strong immune system. They're infected with Covid, and they're in a hospital for, and their studies done up to 100 days before they either lived or died, and Most of them would pass away.
but or a significant fraction of them. But during that 100 days their blood was sampled every 10 days.
and genetic analysis was done of the virus inside of this body, and it was found that giving a virus free run of an amino compromise patient means that
your immune system is gonna just stand up and try to knock down any new virus. But if your immune system isn't strong, then the virus is sort of gonna have their way with you, and they're going to explore a lot of different confirmational spaces with mutations and over time probably develop something that can be really, really different and really novel, because they're not fighting against a very strong partner.
This is. This is one of the theories of Omicron. And so when Omar Kron came out. And you'll see, Justin later that you can tear into these sequences and actually look point by point where these mutations occurred. And if you have a molecular modeling tool. I never took the molecular modeling tools that far within Cbi, because 20 years ago they were a little painful to make a point mutation. But today I think you may have access to free
modeling tools where you can make point mutations and see how this affects the shape.
I don't know if that answers your question.
that was more info than I was expecting. But I'm I'm going to do the best to sort of read into where all of this is right. And so this is all Delta. Once I'm a chron here. Omicron, I remember quite well, was Thanksgiving right of 2,000, 22,020, right going into 2, no, 2,021 going into 22.
I remember quite well, because, we were all you know, going into winter quarter, and at the end of Fall quarter, and yours truly stood up and asked, you know
we're looking at a doubling rate. This this virus is doubling every 2 days.
and You know it was a tsunami that came over the top of us. We were vaccinated right, but it sure got a lot of people sick
what I might, and still does. What I want to show you is a couple of things these proteins have. They're known as a trimer, a protom, or a proteom, or b protom, or C hemoglobin in your body are also Those are diners. Those are 2 subunits that come together there for proteins, and you get 2, one protein sub protein and 2 of another.
And so these sub proteins come together and they build these shapes. And here, in these low colors.
user avatar
Unknown Speaker
00:31:13
you can see.
user avatar
Robert Cormia
00:31:14
So within the 1,270 amino acids, this cleavid site. Here
is where where the fear and
this is where the fear and Cleveland site is inserted. When I I I want to be super careful in my language. Here.
This is where, when you compare 2 sequences of. and the Wuhan a two-one.
That was the the buyer. That was the sequence that China, released in the first week of January, that the fewer and Cleveland site appears here right there between S. One s. 2, and that's what confers its ability to be much more infected.
So here we have. S. One I'm going to show you 2 different slides. This is what this is more firepower than you'll probably have access to in a free modeling tool. But scientists, microbiologists and biologists
are able to take and model. Say, this is S. One Rvd. On the left hand side. This is the spike protein of the Coronavirus that is attaching to us, and on the right hand side. This is our ace, 2
cell on our body. So this would be deep inside our lungs. And this is why so many people got sick and died. Is that an infection deep inside your lungs is a big deal versus one in your nasal cavity is going to be more like a cold right? And so that's why this symptoms change so significantly.
Omega is so much more effective than Delta that it just displaced it. Delta couldn't compete with it.
So this
piece here when we have when we have a change in a mutation is detected, or we have a new variant. The first thing we do is, we ask, does it have better attachment, capability? And they actually scientists look at the energetics, the interaction between an amino acid and the shape of our protein. So our proteins don't change because of what we're born with, and they're what we have for our lifetime.
But this virus is gonna change, and it can be more able to attach to a particular type of cell. Or we can model an entirely different type of cell, say, in our nasal cavity.
And so literally, we look at these point mutations.
the. And again, the the Pdf that I sent out to you guys should contain presenter notes, and if I did my job well or half well, there should be references to where these came from.
The second thing, a microbial. This will be a viral. Just, we'll look at the change in a mutation pattern in the new variant and our immune system.
So this is called infectivity, and this is a mean escape. So you have 2 ways that you're gonna overrun, that mutations are going to be successful. One is to be more effective, and the other is to avoid the immune system.
And so scientists, again, can look at the docking
of this. All right, we're gonna have some fun.
So question number one in your assignment. And you know, you guys have 5 or 6 questions. If you don't get the questions perfect it it it doesn't matter so much. One of the
the pattern of questions that I'm asking you is what is a Geno general next portal one is one is Ncbi, one is our Csv. But then Cbi is the National Center for Biotechnology information. It's part of the National Institute of Health National Library and Medicine.
This was the class that I taught going on almost 20 years ago. I taught it, I think, in all 4 I was teaching it when Sars Cov one came out.
and so you can go to. And Cdi, what I'm gonna do is I'm gonna go. I should have to this up earlier. So hang on, guys. As I mentioned earlier. I have a little hiccup with my computer. Adrian is my co-host and so
pay me if I have
problem, what I'm gonna do. I'm gonna type in. I'd like you to open up
3 tabs.
Okay, one at a time and in your tab in your browser. What I would like you to do is to type in for Google. I'd like you to type in N. Cbi.
The reason that I don't pass out the URL is it's just really really complicated and hang on. I'm having a thought. Nothing is happening.
Adrian, are we looking at a slide that says Google and Cbi for the page? It says, yeah, and Cbi National Center for biotechnology information.
We there's not a lot of Urls and clicking to do. But I'll tell you. I thought dozens and dozens and dozens of sessions, and it's super easy to get lost. And so I don't want to get too far ahead of you. Maybe what we can do, Adrian, if I were clever
with the A big if is, I'm going to pay this in chat.
Oh, there's is there anyone in the waiting room right now, said Waiting room participants. Maybe that's just my chat. So I just paste it inside chat, for everyone
is to go to Ncbi. Okay? And so, Adrian, you can see that there.
Yeah. So how you you did a lab in Bio to track this. So that's that's great. How did you do a pairwise alignment in your class?
If not so, there's an answer in chat.
We use potato start. Okay? So this is all. This is all done with the computer. And this is the the fun part about what we're doing is that you can
anywhere in the world that you can have access to this portal. And so what I want you to think about is way back in the day. because I taught Internet technology, 1990,
5 ish. there was a new portal call Yahoo right? And so Yahoo was a directory. It was a catalog search, and you had entries for news and sports and health and medicine and friends and then search right in movies, and you name it in commerce. And it was there.
And Cbi is a genomics portal.
And it has basically 2 things there. 3 things. It has tools. it has data. and it has literature.
So the tools is what I use to teach tools that you could download. And you could then analyze genetic information.
And I'm going to slow down here. The genomic information
is comprises, probably. Oh, I'm gonna just throw this out and say half a dozen different categories. So category one would be viruses. Category 2 would be bacteria category. 3 would be mammals and us.
And then you're going to have
protein data.
You're going to have DNA data. Those can intersect these other categories.
You can also have structure data which is the shape of a data safe of a protein, or you can have snaps. so sniffs are single nucleotide polymorphisms if you haven't heard the term. but you've heard of 23 and me 23, and me as a company.
It'll they send you a spit, kit, and you just spit in it and It'll look at your genome, and it'll categorize
thousands of snips. And a snip is a place along our genome where every 6, 5, 6, 700 spaces in our genome, there is a point of variance. And so we are 99.9% the same. I wouldn't go 99.9, but it's 99, plus.
But every 6 or 700 spots there's this place where, a single nucleotide for us, that's DNA is going to be different.
And so it's usually one or 2 different things. It could be A or T, it could be G or C. I want you to think of it as simply chocolate or vanilla, and that that space you are either in in the Pr in the majority category or the minority category and majority minority doesn't mean anything. It just means. What is the dominant sniff, and what is the what is the balance of it? So if it'd be 60, 40, it could be 80, 20, it would be 70 30. But at that position there are 2 choices.
and then you run down the genome and other 1,000 spaces, and then there's another snip, and another snip, and another snip.
and so a pattern of snips is called the haplotype for any of you who play music and know what a chord is on a say guitar. So you have multiple notes that come together. I might either think of a half what type is multiple notes that come together, and so sniffs is why we are not identical. Right? Bacteria can be identical.
But in certain clones of other species can be identical. For very good reasons we are not identical. and these haplo types are what have blended when we have meiosis, which is our reproductive process. Right?
So
the snip database and and Cbi is particularly important, because over time we put in more variant data. And so then, 23 and me uses this, and they use snip data and use the literature data
to let you know if your genome matches data that's been in a particular study.
So spoiler, alert, we all have things that are going to end up costing us trouble. When you get older I'll just say as European being white European, there is a one third chance that you will develop cardiovascular disease.
hypertension, cholesterol. What is it called colesthemia? So high cholesterol and some other heart disease? It's like bang right? Or you may have certain in inbred allergies to things, or you may be prone to a particular type of cancer by not having the strongest immune response to a particular whatever.
So we all have something, we have multiple, something, because for good reason, we don't.
Or you hope that you
because at a certain point life catches up with you. And so all these resources pup. That is where you can go and download literature. This called pubnet Central, which is everything is free.
There's a book. So that's part of that of men. Central, everything is free. Blast is what we're going to do. We're going to do a local alignment search technique and be stands for basic. There's for you to hide data. There's protein data that's genes. Pub, can. So I just give you tons of information for your quit. First question, what is N. Cbi? It's a gen on this portal where you have tools, you have genomic data. And you have literature.
Okay?
So let's go and give me just a second here, because I haven't done this in a little while.
Close this. And then I'm gonna go back to.
I'm gonna ask Adrian, we're looking at the
I just switch to databases. Correct? Right? So this is your database information. And again, since you guys, you know, the phrase must be present to when you can go ask 5 pad points on this activity. And you can say I went to Genbank right, or I went to
of that central. I went to Dv. Snp. And lo and behold, I started to find all this information. You can always please me by saying, I always wondered what 23 and me was, so I ordered a kit.
It's fun, I mean, it's it's you can actually find out that your lineage is exactly what your parents told you it was. I found out that my paternal.
genetic flank is indeed a hundred percent branch.
So nucleotide databases. These get into the leads into some of the information. As I said, you have bacteria, you have
viruses, you have ways of doing vectors and for microbiologists. This is where you get some of your primers. I will go into what a primer is
because you're gonna do that in biology.
Some of the information that's also coded by whether it's new or old. one of my
hugeest frustrations in life is that
all the search capability that you have with Google does not exist in the genomics databases. They are literal literal string. That which means, if you misspell a character.
it ain't gonna find what you want. It's not gonna find it, it can't do it. And so when you go to Ncbi and search, and you're looking for, say, any of these sequences. It is painful. I find the sequences through literature, and then I get an accession number, and then I use the accession number, which is a primary key, and database is like a license plate. I use that to down information.
Alright. So this is where Adrian says Mr. Cormia, can we just do something fun.
Let's do it all right. So, guys, we are going to go to.
I'm gonna ask, are you looking at a screen that says Ncbi. Library of medicine and here.
But to get to this to get to this string, I'm gonna put this into chat. I don't know.
The fastest way to get here is just to type in. So I'll type in Google. And I'll type in Ncbi, and this will get you to this page. Google and Cbi blast.
And last is a central page where you're going to look at the various tools. So this is one of your 2, 5, 2 of your 5 questions, what is blast? It's where you do a search with a string of letters to see. Is there any other string of letters in the world
in these databases that matches ours. I didn't mention this, but half the genomics data in the world exist at Ncbi. The other half is private, so people will take, you know, tons of resources, and come up with their own sequence of a particular animal, a particular gene, and then they'll put it in a private database.
So, Adrian, we're looking at the page that says newly type last.
user avatar
Adrienne Nguyen
00:46:04
this is this is searching for against letters for nucleotide. Protein blast is searching for letters that are amino acids.
user avatar
Robert Cormia
00:46:12
Blast X is a translated. It'll take your nucleotide letters turn them into a protein inserts against a protein database.
and the last
T. Plus 10 is where you take your protein sequence and you translate it into potential nucleotides and search against a nucleotide database. I'm not going to go into what translated glass are.
20 years ago it took me a month to of a hard study to where I thought I could explain it to a class. But translation allows you to move between these 2 worlds of nucleotides and proteins and either discover proteins or discovered genes.
What I'm gonna have you do now is I'm gonna have you click on protein blast.
And then, Adrian, you're gonna tell us. Tell me if we're looking at a screen that says
yes, your screen may not look quite identical to my
that will say, Ni National National Library of Medicine, and the Blue Tab is highlighted last. P.
This is where I'm gonna I'm gonna pause and wait. And I need all of you guys to be in the same place. You have to be in the same place, otherwise you're left behind.
I don't want to.
If you're watching this on replay, just go to blast pleat last P. And I did send out a step by step. I did done on Friday. I hope it actually works.
But I want you to see this box here that says, align 2 or more sequences. When you come to this page, your box isn't checked right. My box was checked because I did an alignment on Friday.
and the cookie for this page left it in the checked position. Alright. So when you come here.
it's say, enter it. Session number.
and I want you to click on this one with this box. And then Adrian and Company, I'm gonna ask
you guys have 2 boxes here.
so I'm just gonna be good. I'm gonna look at and just call out, people, are you able to get 2 boxes?
Let's see here, Liz, are you able to get 2 boxes on your protein glass page?
user avatar
Elizabeth McGee
00:48:36
All right. Great, thank you, Holly. You probably done this before. Have you done a blast holly
user avatar
Robert Cormia
00:48:45
just in Justin? You have 2 boxes counter in
I got 2 boxes
and excellent, and then you to.
We've got a whole bunch of people from that a diversity.
This is the biggest group I've ever taken in, but it's not too big to manage, almost too big, but not too big to manage. All right, and in the chat everyone says so. No May or holly. No, no worries at all. You can communicate to Adrian.
Alright. So we have 2 boxes. So what we're gonna do. You are a guy, you guys are 5 min from being a spike protein. you. I'll just say that you've gone down the road that very few people have gone down
all right. What I want to do now is I'm gonna do a new share. And it's super important.
You need to have the Covid biomatic spike protein sequences file open.
You can scrape these letters out of the message that I sent out.
But it's probably easier to copy them from this file. So I'm gonna do one more time, and then I paste in here
a file.
And I'm gonna put the Covid by bioinformatics sequences. Okay? And then I'm going to hit return.
and so, if you joined us a little late, we may not have seen this file, but it is now in the it's now in the that all right.
And I'm getting something in the chat that says Stacy says, great. Okay? So Adrian, we're looking at a page that says, Covid bioinformatics, protein, spike sequences
perfect. All right, you guys, this is the carrot, right? And so this is the header.
once upon a time, actually, I can't remember what the name of this is, but this carrot, followed by sequence of letters that are text readable, but are not amino acids.
It is stripped out of the paste, and so you don't need to remove this. But for this exercise I want you to just copy your letters all right. You gotta copy your letters perfectly here.
and I don't need to say that in a denigrative way
I want you to highlight starting with I, T. 1, 3, and I'm going to highlight all the way down
through the last letter I'm going to control. C. I'm going to copy that
all right. And then I'm gonna go back to
my blast P. Page. And then, Adrian, I'm gonna ask, are you guys looking at my blast? P.
user avatar
Adrienne Nguyen
00:51:40
Yes, all right, great.
user avatar
Robert Cormia
00:51:43
4 or 3 min from 3 or 4 min away, so you'll notice that I copied and pasted my that virus up top.
Try to keep track of what you're doing here. Because if you lose track of what you're pasting, you're going to get a different result. I'm gonna go back to my
last, my sequence page. And I want you to look down to Wuhan. 81 sars. Cov. 2. Okay.
And then we're going to highlight all of this and come down to the letter T.
And so you notice we start with them. Which is Mac, I mean, that's a start. That's your start.
protein.
right? And at the atg, as your start code on.
I'm going to come back to
you. Want to come back to?
Here's my paste.
all right. So rat R, a. T. G. 1, 3, not a rat. It's about our it. G. 1, 3 is up top, Wuhan. 81 is on the bottom. Now, if you can remember this, it's it's helpful.
I'm gonna come down. And Adrian, did you see what I just did? I copied? I'd I'd already done this, but I brought in, and I wrote that rat. G, 1, 3 versus Wuhan, a 2, one. And I put that in my job title
right? All right. Can you quickly, guys just let Adrian know in chat.
Excuse me if you guys have 2 sequences, and because once I do my next activity. you really can't go back. hey?
And are you guys all pasted in 2 sequences.
All right. Now, you can show results in a new window. I typically don't do this because I've got on there already. Got a dozen times open. So when I click last, we're going to take these 2 sequences of letters. They're going to be sent to Virginia.
where their Server Farm is for Ncbi, and they're going to do pairwise. Alignment of these 2. You can do a single blast of one if you uncheck this box and you can search as a bunch of letters that can take over a minute to return, because there's
hundreds of thousands of people that are hitting these servers all at once. Right? So we're gonna do this all right. You guys ready 2 sequences.
I've got my mouse over blast. I've got a line 2, and I'm gonna do 3, 2, one
last. Okay?
Right? And then this will. This result will come back really fast, because it's just a pairwise alignment of 2 sequences. And what it's gonna do is look for similarities and do differences.
And so, Adrian, you're looking at our page now that says.
yes, okay. Once you guys to note here it says our Id. That's your request. Id. What the pros do is that they'll save this request. Id, so that they can come back to it. If your blast took you minutes to search a database, you don't want to do that over and over and over and over, so you can return to a save search.
Alright, we're gonna come down. And I want you guys to look at these tabs. Be really careful here, because if you click the wrong tab and then the back button. You may have to re
search, realign your sequences alright. So, Adrian. Descriptions, graphics, summary alignments, and dot plot. Alright, I want you guys to click on alignments.
Alright. And guess what?
30 of you have just become
bioinformatics searchers.
Okay. yeah. So
what the pros do I? I've already created a second tab and a third tab for my protein blast.
What we're gonna do at least 3 blasts. I want you to do at least 3 blast to get your 5 points, if you do more than that, and if you describe more than that, and if you really impress me with how much
effort and interest you put into this. I will say you can get more than 5 points.
and then 8 point. That's the credit is not unheard of. Alright. I'm going to highlight this. And
we're gonna look at this. I apologize before I go even further. We're going to look at
your identity, your positives and your gaps. So your identity set. there are 1,240 exact matches out of 1,273. That's 97%.
Okay.
there are 1, 252
of 1,273 that are positive. The difference between an identity and a positive is you send your partner into the grocery store and ask them to pick up an item right? And then you give them the brand. If they come back with the exact item. That's an identity. If they don't get the exact item. But they still get you catch up or they still get. You may names, or they still get you milk, or whatever you're looking for.
That's a positive so positive means you're in the same family. But it wasn't the same identical amino acid. You may have the same 5 Si angle or close enough. Right?
That's a 98% match. You now have gaps. And so when we have gaps, we're going to talk about indels in indels and insertion and deletion depending on your direction of time.
So in everything that we're going to do today? So query one on top is our atg. 1, 3.
Subject, one on the bottom is Wuhan, 81 H. Wuhan Wu Wuhan. 81. I'm sorry.
all right. What I want you to see is as we're going to go 60 letters at a time. There's a space here, but that space means is that you didn't have an identical match, and you didn't have a positive
if you don't have an identical match. But you have a plus. So if you look down here, you don't have an identical match, but you have a plus that's a positive. So you didn't get the same amino acid. But you got one in the same family.
The families are basic acidic polar non-polar, and the fifth is special. You don't have to memorize that for today. But this is a mutation space. This is a mutation space. All of those are identical.
If you look at position 61 to 120, they are identical, 121 to 180. They're identical.
You've got a mutation here. So again, you can go into a modeling program, and you can figure out what that difference means, and I want to quote a gentleman. He was my instructor.
He was, He was a charming man, and he was very humble. as a scientist and the biologists and computers.
he said, I'm not an expert, but I'll teach you some things, and he said it takes a difference to make a difference, and what that means is that if you have a different
insertion, if you have a different identity, then you can get different properties out of that. G,
so you make it.
you know, in case of a virus better infection, I mean escape. It takes a difference to make a difference. If you guys put that in and put a star by, it must be present to when
you'll get a point.
Okay, I can't remember his name. He's a charming
alright. So we come down here and you're looking. Okay.
Yeah, there appears to be quite a little bit of difference going on here. I wonder what that is. All right.
This is a bat virus on top. This is a human virus on the bottom ourselves are not different. Or excuse me, our cells are not the same. We are different animals, right? And so it could be that.
And I'm going to be extremely careful with what I say here. It could be that if it was this fat virus by protein that it infected a human, then these were the adjustments that were made during the first 6, 8 weeks before we actually saw the virus. If you do your literature, search in your homework.
This virus is likely circulating in early November, unbeknownst to people.
Certainly in December, unbeknownst to people, the stats are somewhere around 5, 6, 700 people cases putative cases.
What I want you to come down here. because this is where you're going to get some credit. You see these dashes. So, Adrian, we've got 4 dashes on top.
and we've got 4 letters down here. Right?
Yeah, I want, yeah. So now I'm gonna explain what last is doing. Last is saying letter for letter. I'm gonna compare these 2 sequences. And so we get to 6 6 one. And it's like, everything's great. We're identical. Everything's great. We're identical oops.
I see. On the other side of this ravine. Everything is identical, everything is identical. Right? So the middle band is is what your what your comparison is.
But you have a gap.
So, as I said, I'm time when I do this, I do, old on top.
new on the bottom. So we know that this bat virus on top. It's 2,013. That was its presence in the database was 2,013, and when it's Friday's were found in the dust on this cave
the Florida is Kate. This would be a deletion if it were newer.
because this is the younger virus. This is called an insertion. So if you are missing amino acids, as I've shown in that one. We'll look at it with the B 111. That's a deletion.
This is an insertion. And this spot, what? This is your s. One s. 2 cleavage site. And this is a poly basic p, r, a.
I want to say, prolene.
Okay, I mean.
I don't know. Pr, a. I'm sorry.
but this is a poly basic site. And so poly basic site allows the fear and enzyme. So the you're an enzyme exists in us. The virus says, if I expose the pure and enzyme to this poly basic sequence of letters, I'm going to trick you into cleaning me, and you're going to split these 2 pieces apart.
So this is the fear. And F. U. R. I, n, and it's capital F.
You're in Cleveland's site. Cleavage is C. L. E. A. V. A. T- to split right?
So this is
a deletion. If you were going forwards in time. But it's an insertion here. So what this means, guys, is that our at G. 1 3 did not contain. If you're in Cleveland site.
But Wuhan at you.
Wuhan, H. One which is extremely similar to our it. G. 1, 3 does contain the fewer and Cleveland site.
And so now you guys have seen what most mortals have not
is this is evidence, but
many people. And I'm sort of in that camp. This is the this, the telltale symptom of potential mischief.
Right? If you're looking for what's called gain of function work is, if you take a bad virus and ask, how do I make it more effective, I would put a cleavid site in it. No Cleveland sites can move. If you have these 2 viruses inside, inside a person
at the inside a mammal or any animal, the pure cleavit site can move from one virus to the other, so it is not necessarily evidence of human insertion. But this is definitely. If you compare 2 sequences.
it says how they're different.
Now, when you go to the rest of the genome. The rest of these amino acids, I think, from here on, in right, from here on in
these are identical. I don't think that there's a single difference.
And so you get to 1,269 for our atg. 1, 3. You get to 1,273 for the Wuhan, and this is the insertion of 4 amino acids.
Alright. So that was a long, long description and analysis, right?
Of 2
amino acids and the pairwise sequence alignment.
Okay.
alright. How do you guys, are you guys ready to do our next one? We're gonna do 3. Okay, you can do all 5. But we're gonna do 3. Adriene, are we ready to do another set?
user avatar
Adrienne Nguyen
01:05:06
Yes, alright.
user avatar
Robert Cormia
01:05:08
When I say, Are you guys ready? You'll learn. Yeah, always reply. I was born ready.
Okay, so here we go. Are we looking at? Take the blast survey today? And
on my screen
I change screens.
Oops, Adrian, or are you still there? Perfect? I'm sorry. So you'll notice that I didn't click align 2 or more sequences, did I?
user avatar
Adrienne Nguyen
01:05:41
So now I have my 2 boxes right?
user avatar
Robert Cormia
01:05:44
Alright. What I want you guys to do now is, I want you to go back to your sequences.
Yeah. And I want you to take
with them and compare 2 different ones. We're going to go to the consensus sequence. So consensus says.
after a bunch of time, scientists agree that this sequence is what we're going to call our standard sequence. Things change. But this is going to be our sequence, right?
And so I highlighted. I'm gonna copy. I moved down to
spike protein, right? This is a consensus sequence. It's different by one amino acid from all on one.
So we're going to take the consensus sequence. And then I'm going to go back to
my last P. All I did to get to blast P. Was I typed into N. Cb, I blast P.
Or if I started ahead of time I would open up 3 or 4 tabs, and I would to them on into the last P. Right? Okay. So now I'm going to go back to.
I'm gonna go back to my amino acids and I'm scrolling down. So, Adrian, you can see B 1, 1 7 alpha variant.
user avatar
Adrienne Nguyen
01:07:02
So I'm going to highlight all of the alpha variant.
user avatar
Robert Cormia
01:07:07
And then I'm going to come back here and I'm gonna go back to New share. And I'm gonna come back here.
And what are we looking at? So you can see that it says
I've got my sequence on top sequence on my bottom. And so now, what I'm gonna type in is this one is a little different. So I'm gonna pay paste in part of what I had here before.
But this is alpha variant.
So get out of there. And what we're gonna do is we're going to compare the consensus sequence against the Alpha variant. You could compare Wuhan one against Alpha Variant. That's perfectly fine.
You're only different by one amino acid. What you want to have. What you want to do is after we do 3. Is you want to have the courage to do a few more on your own, and you realize, gosh! If I can copy and paste and keep track of my tabs.
I can do this
user avatar
Adrienne Nguyen
01:08:02
alright. So, Adrian, we're ready. We're ready set and ready to blast again.
user avatar
Robert Cormia
01:08:09
Here we go, all right, blast away!
And so again this is pretty fast we come back. If the reason it's fast is the pairwise alignment doesn't take a whole lot of
computational power.
And I scroll down. And here's descriptions, graphics, summary. And I'm going to click on alignments.
And our alignments say.
now, remember, these are going to be very, very close, because consensus sequences. This is now Coronavirus. This is COVID-19. Right on top is a consensus sequence.
the Alpha variant.
and I cannot remember now when the also varying came out.
But the the New York Times did that analysis of it. And what I want to show you guys is
again, you're looking at 1,264, 1,273, 99% positive. That's what you expect.
a 99% identity. Your positives obviously are going to be one more than that, and then gaps are 3. So gaps mean you've got indels. You've got either a deletion or an insertion.
I want you to look in our first row. Everything is identical in our second row. What we see is the consensus sequence has H. And B in those positions, and that's 69, and 70, and you have 2 dashes.
So, Adrian, the the one on the bottom is my newer sequence, right? The one on the top is my older sequence. That's a deletion.
Okay, I come down here and you'd be hard pressed unless you've got a really good eye.
There is a mutation spot. Right?
Here's a mutation spot.
and there are total of 7 of these, right?
And I'm looking around and to see where most of these are, and I'm coming up with, here's one right here. It takes a good eye to see these.
But this is how you track mutations.
All right. How did you guys do on that.
So the big in terms of the big things that I want you to see is the first is our at G. 1, 3 versus Wuhan, which I think is not coincidental.
And then the second is, when we look at the Alpha variant versus consensus. All right.
Okay, we're gonna do one more. So I'm going to go to my tab right? And I shifted my tab. And so I'm going to show you exactly how I do this I type in blast.
T. Alright, I type in.
and then I go to
and Cpi. So this is how I get to blast. P.
If I forget. All I have to do is type in the last, all uppercase, and then P. Lowercase. Not that it matters when I get here, Adrian, what's the first thing I have to remember to do
the line 2 or more sequences right?
You don't want to stand there that page and go what the heck is wrong. Why don't I have to?
You have to align 2 or more sequences. All right.
Okay, we are now going to go back, and we're gonna go to our that to our
sequences, and I'd like you to take Spike protein again. We're going to do Sars Kobe, too. So we're going to take that one again.
And then I'm gonna put this one on top. So I'm going back to new share.
And I put that on top. So I'm sars, Cov 2 consensus.
Or you may see Covid consensus.
And then I'm gonna go back to
fine
letters, and I'm gonna go to Omaha.
Now, if you guys are feeling like you want to be. sequence a.
user avatar
Unknown Speaker
01:12:15
since you can do all 5 and impress me.
user avatar
Robert Cormia
01:12:18
and I can be impressed.
And now I'm back to
and back to my blast bait. So, Adrian, we're looking at blast again, right? And I'm going to type in. So
my job title here, as far as Cov. 2 versus on the ground. So if you can do 3 pair wise alignments, you're you're golden, and and if you can describe what you saw for those you're you're 5 plus already.
I can't remember what I told you. I'd give you an extra point, for. Oh, it takes a difference to make a difference. There we go
right, because that's not in the other instructions. Okay, Adrian, we're ready for our last blast.
user avatar
Adrienne Nguyen
01:13:04
Yes, we are.
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Robert Cormia
01:13:08
And sorry is Kobe, too. Now
try not to close your other tabs. Try not to forget what your other tabs are.
Try to go left to right. Sorry! That's a bias against left handed people.
But if you go left to right in your tabs and time, you can keep track of this. Most people I know have a scratch pad, and they're writing down what they're doing on each tab, because if they have a feeble memory like mine, I'll never remember, and then you'll get lost, especially if you forgot your job. Id.
All right, we're going to click on alignments. And now what we're looking at, what I want you guys to see and appreciate is we're looking at the consensus sequence. So what is consensus? You know? February, March 2,020.
And what is Omicron? Omar Kron was a horse of a different color. Right? So a lot of things changed. And the reason is is, we don't know.
But one of the suspicions is inside a patient. you know. Compromised is that the virus is given time to explore new structural patterns
and long, the whole one of which was to move up into being able to infect nasal cavity. which, if you think about the difference between a deep lung infection and a common call boom!
Oh, Macron, is this, and practices measles? So it's got an are not of 1516. This is in that. This is me.
Okay.
so what do we see, we've got mutations up here. And now what do we have?
We've got a deletion down here. So this deletion was probably inherited from what this deletion was probably inherited from B. 101 7.
But this deletion right here. I believe this new
right? So this is a deletion.
And then what do we have? Okay, what do we have down here on 1, 7, 6. Do you see the Epe?
All right. This is an insertion because you're older on top. You're younger on the bottom. So this is an insertion in time. Okay? And
scientists took P. You'll say you think, well, what's so special about Epe. Those 3 amino acids next to each other in a coronavirus, as it turns out, are not that common except guess where they were found?
So scientists go into a database. They blast this sequence of letters near this position. And what do you think they found? A cold virus?
So this omicron here in other theory could be. You have Coronavirus circulating with a cold virus. And the same time it's like, boy, and that's in your bad luck, right? You're infected with
a you're infected with Coronavirus, and you're infected with a cold virus. Well, another
another possible idea, for on the Chron is that boom
these viruses are just copying
in all of your cells right? And so genetic materials all mixed up, and the Epe jumps from the cold virus into the for excuse me, jumps from the cold virus into another Coronavirus, and then on the crime. Right?
So if you, if you were to go with that, what would you look for, you'd look for another sign that these other differences. which go much deeper into the genetic chassis of the spine protein they go is that they could be part of a cold virus.
So scientists couldn't have a lot of fun
doing this research. And what I want you guys to understand here is that you don't need a license to be a bioinformatics person.
You don't need a special membership. You don't need a special computer, and you don't need access to too many special databases, because that's what Ncbi is. That's your tax dollars at work.
So all 30 of you from today going on forward can be a bioinformatics researcher of site of types, right? You can think, call it citizen science. But you're just
scouring databases and looking for patterns and coming up with hypotheses and all this stuff, and you can do it on all on your own. Okay.
what I'd like to suggest. It's 1017. I'd like you guys to take a
one or 2 min break. And I'm going to queue up
a video. I'm gonna take my headphone off because I'm not smart enough to know how to play the audio of this video while I'm also
talking
right? And so I want to have the audio from my tablet go into the microphone. So go get a cup of coffee, or whatever you need to do. Take a break, and when you come back I'm going to put the S notorious link in here.
and
and Adrian, I'll get it to the
I'm not quite getting it. So, Mrna vaccines. I did put it into our our
instructions.
and I'm pretty sure that this is right. But let me make sure it's right before I actually put it in chat. Here we go.
Okay? And then, Adrian, I'm gonna ask a favor that you also queue of this video. And if I stumble on my side, you can take over as co-host.
user avatar
Adrienne Nguyen
01:19:13
But I I'm going to try to pull this off. I've done this a number of times. It's never
user avatar
Robert Cormia
01:19:19
any other.
And then what I'm gonna do is, I'm gonna get it for quickly, and we'll come back in in a minute.
I'm gonna have a tangerine.
Are they still on the top side? Yeah.
yeah.
alright
for it.
All right. Is everyone back? We're gonna do this adren, are we ready?
user avatar
Adrienne Nguyen
01:20:38
Yes. so
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Robert Cormia
01:20:42
I don't know how this is gonna work. You can just put in chat if you can hear it. But once I start the video.
I'm gonna go and
in trouble. So I'm going to do this in 2 steps. I'm going to go full screen. And then I'm going to launch the video.
user avatar
Unknown Speaker
01:21:07
There are many kinds of vaccines and many ways to manufacture them
user avatar
Robert Cormia
01:21:12
vaccines take an average of 10 years from research in the lab to administering them in a doctor's office. This timeline must be shortened if we want to be prepared for pandemics or novel diseases as they emerge.
Why do traditional vaccines take so long? Well, it's the process for developing and testing them
all pathogens that cause infectious diseases, like viruses of an associated Antigen.
This Antigen activates our immune system. To fight that virus scientists must identify the right antigen, find a way to produce mass quantities of it and then integrate it into a vaccine. It's a long process.
Antigens are usually proteins, and human cells are constantly making proteins as building blocks to maintain our bodies. So scientists asked the question, What if we could program our own cells to make these antigens and trigger the same immune response as traditional vaccines. This is the goal of Mrna vaccines.
Mrna, or messenger Rna is the code that tells ourselves which protein to make.
and, thanks to recent advances in DNA, sequencing scientists can quickly identify the code. To make the Antigen protein is specific to the disease. We want to find and build the Mrna in the lab at
the Mrna vaccine delivers this code, not a form of the pathogen or antigen to tell our cells to produce the Antigen. Once the Antigen is present in our bodies, it initiates an immune response, just as a traditional vaccine word.
The good news is that Mrna are much simpler to produce in the lab than proteins to create the synthesized Mrna. Scientists insert the sequence corresponding to the Mrna into a plasmid, a small DNA molecule within a cell that can replicate itself. This plasmid is put into a reactor where an enzymatic reaction treats the synthesis of the Mrna.
The synthesized Mrna is then purified and encapsulated in a lipid nanoparticle. The lipid coating enables the Mrna to reach our cells where protein production takes place, triggering the immune response.
This process could be used to produce many different Mrna, but just changing the sequence inserted in the DNA plasmid.
Scientists have great confidence in the potential of Mrna vaccines, not just for the prevention of infectious diseases, but also in the treatment of cancer, and perhaps even allergies.
To summarize Mrna vaccines will offer many benefits over traditional vaccine manufacturing speed. They don't require the slow process of producing antigens by cell culture or bacterial fermentation in a lab. They simply signal our bodies to produce the antigen ourselves.
Savings. The same production set up can be used for multiple vaccines, reducing costs significantly unlike traditional vaccines which require dedicated facilities for each kind of vaccine.
Mrna vaccines are not common today, but have tremendous potential and could alter how we think about vaccine development in the future to learn more about the different vaccine development and manufacturing processes. Visit sororious.com forward slash vaccines.
Okay, we did it.
Now, I have to get my computer back. It's not all right. Okay.
so let's go ahead, then a second. Here, Adrian, I'm goofed.
Okay, so are we looking back at? a page that says, blast look, alignment search. Okay, great. So you guys have this handout. If for any reason
you can't find it, just email, me and I'm happy to attach it. It's also in your canvas messages. These are the different types of last programs.
And the translated last again, back in the day, I was comfortable enough to explain this, but without a whiteboard I wouldn't even try. It's actually the on the complicated side.
the open reading frame. This is just some of your biology. If you're interested in in how we get the orphs.
and then the blast, step by step, right? What you guys have done, you can go to a database called unipr if you want, and you can also look up some of these files. The Unipro is a protein.
it's a genomics portal. It's in the Uk. It's a collaboration with another bioinformatics with another university, I think.
and they have tons of protein information much more detailed. and Cbi has covid resources. And this is the Cartorus video that you guys just saw if you want to play it again.
This is just a diagram of what happens with the injection. Remember, you're being injected with a sequence of letters. You're not being injected with the pathogen, your body. The ribosome will replicate that the cell says, I don't recognize you, tears it into pieces.
expresses it, on the outside membrane of the cell, and then that's where your immune system, picks it up and says, Okay, it goes into our database. That's why that seems give you
a faster response, because you've seen it before. So it's The virus doesn't have as much time to build up that viral mode and make you terribly sickly for you mean system, Hicks, and that's the plan. And also you have a more targeted response.
So bringing this to a conclusion way back in, I think, 2,021. When I started doing this activity.
we were looking at a time where we didn't have enough vaccine to get around the world. We're in a better strategy. We're in a better situation. Now.
staying ahead of that, making sure that we can get boosters. And again, I'll sort of nudge you guys if you haven't gotten your on the ground variant, which would have been as early as last September.
please go out and get that I'm already vaccinated. On the second. I have a boost on that, because I'm over. So I was able to get that. Our strategy is now probably every 6 months. If you want to stay up with this.
and so that'll be an Mr. An injection every 6 months. I wouldn't let it go a year, because I think your vaccine strength Will Will Lane.
The surveillance is antibody testing. Originally I thought we should be doing that in people, but then we realized that we can do that through sewage and through water treatment we can see if there's If there's that, if there's virus out there, it's important as, and with any new infection to figure out. Let's sequence it.
and then let's get on top of building in an Mrna vaccine. If we have to do this, this isn't just for Covid, this is not our last pandemic. I don't think I told you guys this story, but my maternal grandmother, my
my mother's grandmother, died in 1919 in the third way. what was called then Spanish influenza. Don't ask why it was Spain. Spain was the only country that reported on it. It's it's a crazy story because of the only country in World War one that was reporting news.
So
it's basically the influenza epidemic of 1918 which started in 1,917. The first wave, and my maternal grandmother died in 1,919,
so I never stop hearing about that. This is not our last pandemic. If you you don't have to look much further than Africa to realize that we've got some stuff out there, Ebola that would make Covid seem like nothing, and we, in my opinion, should be doing more aggressive work with vaccine development and getting ring inoculation. All of that. But the good news is we're in much better shape than we were 20 years ago.
We've also got great therapeutics. If you get sick. An older person in your also get sick.
Please get them packs a little bit. Get them in antiviral. That'll keep that viral load down so that their immune system can come back faster, and the last I'll just end common sense health measures. That's why I make you guys wear a mask and lab in lecture. Not so much, but I know that we have good that good ventilation.
I would just advise you that when you go into a building space and then closed area. Count the number of people you're in a building or an enclosed area with more than 100 people. I'd immediately try to figure out what the ventilation in that building is, and if it's not good, I would really think twice about being in there.
That's just me. There's some other follow up articles that you can download in what the waves of what we thought 2 years ago, what the waves of this pandemic might look like, and instead of Macron just came and said, We're just here, and we're just here all the time. I can tell you this, that the number of reported incidents among students, because I thought that I have to get a positive report.
Really, I'd say it's half of what it was 3 months ago. So I'm encouraged. But I'll simply say, don't let your card down.
Okay. So in summary genomics is pivotal to fighting Coronavirus, we went from the sequence, allows us to figure out what mutations are going on. The sequence allows us to develop an Mrna vaccine. We don't know where Coronavirus came from. There is still a lot of research going on. Some of it is obviously politically charged, because, You don't certainly want to to be digging up.
digging up evidence that could point to to opportunities messed. I'll just leave it at that. But you have seen, certainly that there's a putative ancestor. I think that our Atg, 103 is obviously an ancestor in my mind, is a putative ancestor to the Wuhan sequence, and what happened between 2,013, and where it is right now remains a mystery. My opinion.
How can bioinformatics and form therapeutics? Well, if you, if your spike protein is changing, you might have to change the shape of some of your.
and I'm not in therapeutics, and many of the, if you guys remember.
then President Donald Trump was infected in November of 2,020,
and he got a model from the antibody. They're no longer as effective because we've had other sequences that come out, but that could have saved his life.
How do we develop so? Surveillance tools just by being on top of it in China did an extraordinary job staying on top of surveillance for years and years and years, and just doing nasal swaps and just figuring out where people were sick.
And and that was important in and really keeping that down.
So where is the next covid likely to strike? We don't know.
but certainly being on top of having a a solid world health or plan right, having countries that are allies and not adversaries would help, certainly, and then working, in my opinion, working collaboratively
to move as quickly as we can to respond with vaccines and treatments.
All right. So that's where we are. And then, Adrian, do you have the question list?
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Adrienne Nguyen
01:32:50
We're right at 1030. So I didn't do too badly.
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Robert Cormia
01:32:55
So right at 1030 we've covered what is N Cbi? It's a bioinformatics portal. What kind of data is there all kinds of genomics data. So sequence data proteins,
obviously amino acids, nucleotides snip data, which is your variant variance data.
you have tools that you can use. You have organisms, everything, from viruses to bacteria, to insects, to plants, to mammals, or it's all there.
And I think this is so, I'm sort of getting further and further away from my area of I don't want to even say expertise familiarity.
But I'm hopeful that over time that we're going to be able to get sequence data from.
we have humans that have been frozen. And I right for thousands and thousands of years, and to be able to recover that DNA and understand what pathogens that they have to fight.
There is literature, data. And Ncbi, it's really important.
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Unknown Speaker
01:33:58
how does genomics data inform Mrna development? We have to have a target string.
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Robert Cormia
01:34:04
And every time, like with the on the Chron, I think we've waited way too long to get an overcome back scene out. We could have done it earlier.
Now you have a by Valent next, so you have the consensus sequence in that vaccine, which is the you you guys have have seen the consensus sequence. So it's one amino acid different than move on.
And then you have the
the over.
It is amazing. But the Mrna vaccines they didn't come out of nowhere. There was a 25 to 30 year development. People spent their careers painstakingly.
making advantage advances to get to where we were able to do this. We had an injectable vaccine inside a human, and I believe that person she was at Kaiser in Santa Clara within a hundred days.
so Moderna really came forward with it. The Us. Government worked hard.
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Unknown Speaker
01:34:57
What other questions are there.
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Robert Cormia
01:35:01
and I cover most of them.
Oh, important! How will you use? Everyone forgets this.
How will you use genomics data?
You could use it to tell the story right to to inform people about what you've learned. Tell me what you learned and how you might use it, that I was.
Please let me. Okay.
So how are we doing? What questions do you guys have? I have absolutely nowhere to go this morning. I'm not driving.
So if you have any questions in bioinformatics
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Unknown Speaker
01:35:35
and try to do my best with Covid. I'm not a microbiologist for all of this.
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Robert Cormia
01:35:40
Let's see, Holly. she was there earlier. I don't know if it is still there. Only did you learn anything today? You can put that in chat.
She took biology 40 or something
for the O 102 group you'll be. There's a bioinformatics assignment.
that you can upload to. I'm encouraging you to get that done by Sunday. There's an except until that goes past that date.
And for the 304 group I've set the assignment date as one week from today, and it will close on the following Sunday.
So you've got some time. Do at least a page of work for 5 points.
and if you do twice as much you'll probably get 50% more.
Liz, did you learn something new today? In Bella?
user avatar
Elizabeth McGee
01:36:54
I learned a lot new today.
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Robert Cormia
01:37:02
I always ask you, you know your trading time, your training time for experience.
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Elizabeth McGee
01:37:08
Yeah, it was interesting.
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Robert Cormia
01:37:10
There's the what I like about this topic is, it's approachable. You guys are, you know, you're smart. You're smart cookies to be in in 38, doing as well as you are, so if you can copy and paste it, just exploring a portal.
you can have tons of fun at N. Cbi. If you ever need to do a literature search of a human malady, go to Omem, the online Mendelian inheritance of man. As I said it at a certain point in our lives we will all be struck down with an inherited disease. That's how we're designed
and it's a great place to look things up.
if you've never. if you've ever had a curiosity about your own genetic makeup, get a 23 and me test their loads of fun.
All right, I'm gonna go ahead. Are there any questions on the assignment? If there are none, I'm going to stop recording?
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Justin Tu
01:38:09
I have something I don't. It's only a question, but more like
So bioinformatics they've been using that for.
I don't know how to put. I guess generations to study how viruses have been changing over the decades.
user avatar
Robert Cormia
01:38:27
So genetic information sequencing goes back to.
We had a code on lookup table in the late sixties.
and so probably 50 years of being able to use sequencing techniques. We didn't have sequencing machines like we like we have now.
And so companies like celera. What was cel around? I can't remember who their CEO was.
but we sequence the first human in 2,000. Who was that?
I don't remember his name.
He's a famous scientist. He, arrogant, is now but extremely brilliant. He grew up in San Mateo.
He actually went to
but he held it started to sell or see developed sequencing machines. So I would say, we've been using sequence data fast and hard for at least a couple of decades.
and where it's very, very important, is.
among other things, a test that I did a couple of years ago was looking at the Allele for dementia. As you get older, you know you'll be curious. Do I have an allele? For there, you know you'll have 2 different alleles.
and one can be fast and slow in terms of processing a protein. and that can be, you know, related. It's not strongly correlated. right? But it will give you some idea of your future.
I believe that it will it it. Our genetics helps us with
targeted
treatments in terms of medication. A lot of medicines will have an adverse effect depending on one genotype. So if you're of a particular Gina type, if there are 2 genotypes in your one where you have an adverse response, then your pharmacist probably doesn't want to, you know. Have that in your hand
versus another therapeutic that could be very effective against another population, and you just have to keep them separated. So that's another place where it is certainly targeting your cancer. If you have any form of cancer. So just in one area that it genomics is exceedingly important
when I studied this 20 years ago is in child leukemia. And so in childhood leukemia, you you do what's called tumor typing. And so you pull the tumor out right away and figure out from the sequence what type of tumor is, and then you go into a database and ask what therapeutics really work when we tried treating this leukemia
and patience so for a medication.
I I don't think that genomics will ever be used to discriminate against people. Because I will say this very strongly, we all have multiple ways that will undo us as we get older. And so, if you want to look for points of defects they're simply built in.
It's that's what inherent it is it about. So there's no point in discriminating. And there's a lot of point and trying to figure out if I've inherited a certain haplo type, a certain tendency, what can I do in my life that I change my diet right?
That is always important. no particular exercise, or the things that I should avoid.
But to, you know, to say that there is a gene for cancer. There are multiple genes that will allow you to be more susceptible to cancer, less able to fight it.
and we know those those are. Say, break a one break to 2 jeans, but that doesn't. That's not a best sentence. You know. Genetics is just one piece of it. You have something called your transcript on.
and that's where you influence your life and your genetics to your life habit.
This is where, I'll say, did you know that studying hard and doing math leads to longevity.
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Justin Tu
01:42:19
If Nope.
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Robert Cormia
01:42:21
you know what I know, I asked these things. No one's ever heard of that.
We'll see if it works all right. Is this a good place to leave it?
Yes, thank you very much.