Stethoscope Magazine by Stethoscope Magazine @UGA

STETHOSCOPE MAGAZINE FALL 2018

Franklin College of Arts and Sciences HEALTH

SCIENCE stethoscopemagazine.org NEWS MAGAZINE

SERVICE

STAFF FACULTY ADVISOR

WRITERS

Dr. Rob Nichols

Merritt Daniels Raleigh Duran

EDITORIAL BOARD

Emma Ellis

Katie Luquire - editor-in-chief

Yasmin Goreja

Grant Mercer - communications editor

Riya Kansara

Sherry Luo - design editor

Katie Luquire

Muhammad Siddiq - campus outreach

Ana Mehranian

Ushna Syed - photography editor

Eric Santana

Neil Jacob - treasurer

Faiz Saulat Muhammad Siddiq

COPY EDITORS

Ishan Vaish

Katie Luquire

Austin Wahle

Sherry Luo

Olivia Wallon

Muhammad Siddiq Ellie Pryor Mira Bookman Riya Kansara Cindy Nguyen PHOTOTOGRAPHERS PHOTOGRAPHERS Yasmin Goreja Sachi Shastri

Daniel Sutphin STETOTHOSCOPE MAGAZINE

A LETTER

FROM THE EDITOR

Welcome to Stethoscope Magazine, a

Next semester we hope to add more staff

publication for students interested in science and

members, expand our readership, and increase

health. To me, being editor-in-chief doesnâ&#x20AC;&#x2122;t just

coverage of current events.

mean that I make decisions and ensure that they

are seen through. Instead, I see my role as one in

transitioned to become an online publication,

which I serve to not only express my opinions but

added new members to our staff, and created an

also listen to the perspectives of others for the

email listserv to make access to our articles even

benefit of something that is bigger than myself.

easier. We have also produced new content that

Without question, the most rewarding aspect of

we are eager to share with you in the following

my role so far has been communicating with staff

pages.

members and other members of the editorial

board. Whether I am editing someoneâ&#x20AC;&#x2122;s article

opioid epidemic, our writers have tackled issues

or discussing ways to expand our readership, I

that are not only facing our society but need

am constantly inspired by these individuals who

solutions that we as future medical professionals

elect to spend countless hours writing, taking

are expected to help solve. With the rapid

photos, and editing a magazine that educates its

changes that are present in medicine today, it is

readers on critical issues. While the inception of

important to stay informed throughout your career

Stethoscope Magazine is recent, I know that its

in order to provide the best care possible. We

future is bright. I hope that we will continue to

hope that with this issue, pre-health students can

provide reliable and relevant information to those

better inform and prepare themselves for what lies

who need it most: future healthcare providers.

ahead.

Over this past semester, we have

From future trends for the flu shot to the

Katie Luquire STETOTHOSCOPE MAGAZINE

Table of Contents A Letter from the Editor......................................................................................................................................2 Fall 2018 Leara Scholarship Winner: Visual Art by Jenna Scott.......................................................................4 Fall 2018 Leara Scholarship Winner: Writing (“A Pharmaceutical Marketing Strategy: Gifts to Physicians or Burdens to Patients?”) by Lan Huynh...........................................................................................................5 “The Indoor Invader: Mold” by Ishan Vaish......................................................................................................7 Senior Spotlight: Faiz Saulat..............................................................................................................................8 “A Silent Epidemic” by Eric Santana.................................................................................................................9 “How to Navigate Finding a Research Lab” by Katie Luquire......................................................................11 “Resisting a Rest” by Austin Wahle.................................................................................................................15 “The American Epidemic” by Yasmin Goreja.................................................................................................17 “Enabling the Disabled: Innovations in Assistive Technology” by Muhammad Siddiq.............................19 “Decisions, Decisions” by Riya Kansara..........................................................................................................21 “Technology and the Patient-Care Experience” by Raleigh Duran..............................................................23 “The State of Georgia Healthcare” by Merritt Daniels..................................................................................25 “Stress vs. Flu Vaccine” by Olivia Wallon........................................................................................................27 “The Future of the Flu Shot” by Ana Mehranian............................................................................................29 “Addiction in Your Pocket: Is Smartphone Addiction Doing More Than Just Wasting Your Time?” by Faiz Saulat.........................................................................................................................................................31 “Popping (The Wrong) Pills: The Effects of Substandard and Falsified Drugs Worldwide” by Emma Ellis.....................................................................................................................................................................33 “Brain Food: School Lunches and Cognition” by Bemsi Wallang................................................................35

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Fall 2018 Leara Scholarship Winner: Visual Art by JENNA SCOTT

Jenna is an undergraduate student majoring in Biochemistry and Molecular Biology. She hopes to attend medical school and have a career in obstetrics and gynecology. Her goals also include opening a women’s clinic in Haiti, where this photo was taken. This is an original piece inspired by her summer interning at a medical relief organization in Titanyen, Haiti. When asked about her experience, she said “My eyes were opened to the health disparities in Haiti (specifically for women) as well as the ways in which American and Canadian health professionals can help.”

Source: https://www.cia.gov/ library/publications/the-worldfactbook/geos/ha.html

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A Pharmaceutical Marketing Strategy: Gifts to Physicians or Burdens to Patients? by LAN HUYNH In the business world, the term “marketing” is generally understood as the activity of advertising and selling products or services from a company directly to the consumer. In the Big Pharma world, however, the consumer is usually not the main marketing target of pharmaceutical companies. A study estimated that about 84% of pharmaceutical marketing is directed towards medical doctors, who have the power to prescribe and determine the sale of drugs.1 Most people wonder what magic drug companies use to be able to persuade these experts of the medical field. Unfortunately, physicians are just normal humans like anyone else. They are not immune to behavioral manipulation, and the Big Pharma knows it. Pharmaceutical sale representatives meet with doctors for an average of four times a month and offer them a variety of gifts.2 The gift, regardless of value, makes the recipient feel indebted to the giver. In this case, gifts from the pharmaceutical industry can make doctors feel like they need to return the favor by starting to prescribe the company’s products. This biased decision making can lead to an increase in financial burden on patients, compromise doctors’ professionalism, and weaken patients’ trust in their physicians. In recent years, the issue has gained more attention from a segment of the medical community who is against the pharmaceutical industry’s effort to influence physicians. A number of policies and guidelines were enacted to restrict or ban pharmaceutical representatives’ visits and set limits for gifts’ price. Although these solutions can be helpful as the first step to prevent bias in treatment decisions and lower overall cost for indigent patients, individual physicians must carry a great responsibility to make ethical decisions

about accepting gifts from pharmaceutical industry. In 2012, the pharmaceutical industry spent about $24 billion in marketing its branded products to health-care professionals.3 This number is eight times the amount spent on direct-to-consumer advertising. The gifts offered to medical doctors by pharmaceutical companies and sale representatives range from inexpensive items such as pens and notepads to expensive ones such as meals, trips, and drug samples.2 Furthermore, some types of gift can have unclear intent by targeting independent continuing medical education, peer-to-peer selling by physicians, resident programs, and sponsored studies.1 The practice of giving and accepting any kind of gifts between pharmaceutical companies and physicians has been raising ethical concerns over two decades. One of the main arguments focuses on the quality of treatments provided to the patient. Gifts may result in inappropriate changes in doctors’ prescribing habit, thus compromise the objectivity of treatments. An analytical study conducted in the District of Columbia found that prescribers who received gifts from the pharmaceutical industry generated more prescriptions per prescriber, and an average of two more prescriptions per patient, compared to non-gift recipients.4 This changing in physicians’ prescribing behavior is more likely a result of trust in biased and inaccurate information from the pharmaceutical sale representatives, who might or might not have a sufficient medical knowledge. Consequently, doctor’s practices can become neither evidencebased, nor clinically safe, nor cost-efficient, which is another main argument against the widespread acceptance of pharmaceutical gifts. According to the same study in STETOTHOSCOPE MAGAZINE

Washington, D.C.,4 physicians who received any gifts from pharmaceutical companies were two to three times more likely to prescribe branded drugs than those who did not receive gifts. These branded drugs are often much more expensive than available generic drugs but offer minimal, if any, benefit over generic formulations. High drug prices may diminish patients’ ability to afford the therapy, thus putting their health in serious danger. If a patient finds out that the drug he or she received was not chosen based on the medical condition solely but also was influenced by gifts from the drug company, he or she may lose trust in the physician, which can affect the patient compliance to the treatment.1 Therefore, receiving gifts from the industry can compromise physicians’ professionalism and their main duty, which is putting the patient’s best interest before personal benefits. Although the acceptance of gifts from the pharmaceutical industry has been criticized by a growing segment of the medical community, defenders of this practice view it as morally permissible and provide several counter-arguments to the critique. They argue that gifts from the industry may offer various benefits directly or indirectly to patients. According to the “pro-gifts” group, free drug samples are actually gifts for patients as they allow patients to start the therapy immediately and help them overcome financial obstacles.1 Moreover, physicians believe that to provide the best services to their patients, it is important for them to be informed and updated with newly approved medication or medical devices. This also means that financial support from pharmaceutical companies is ethically acceptable if it is directed toward professional continuing education activities

Fall 2018 Leara Scholarship Winner: Writing such as sale representatives meetings, medical professional society conferences physicians, and medical journals.1 Although such activities appear to be objective, the contents delivered by “paid experts” often serve the interest of their industry sponsors. Lastly, most physicians who accept gifts may argue that the relationship between them and the pharmaceutical industry is morally permissible as both parties enter the relationship freely and knowingly.1 Hence, this relationship should be able to be maintained and not interfered by third parties. In response to the widespread conflicts in the issue of gifts from the pharmaceutical industry, several organizational policies and guidelines have been developed for the past three decades. In 1990, the American Medical Association adopted an ethical opinion titled “Gift to Physicians from Industry” to acknowledge and provide physicians guidelines to avoid acceptance of inappropriate gifts. According to the guidelines, “any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value.”5 In 2002, the American Medical Student Association started a “PharmFree” campaign calling physicians and medical students to say no to gifts from the industry.1 Another document titled “Compliance Program Guidance for Pharmaceutical Manufacturer” was published in 2003 by the Office of Inspector General for the US Department of Health and Human Services. The document stated that gifts to physicians “have a high potential for fraud and abuse”6 and set forth essential elements that pharmaceutical manufacturer should consider before implementing an effective compliance program. In an effort to keep

the physician-pharmaceutical industry interaction transparent, several states have also required drug companies to disclose the annual payments and gifts they sent to physicians and hospitals as part of product marketing. Moreover, a number of academic hospitals started to enact their own policies to restrict or ban pharmaceutical representatives’ visits in hopes of reducing the Big Pharma’s influence.3 Although the problems resulting from pharmaceutical gifts have deep and complicated roots, all of the mentioned solutions are high-yield first steps to improve the quality and ethics of medical treatment as well as reduce the health care cost for the patient. The pharmaceutical companies’ marketing strategy by sending gifts to physicians still remains a matter of debate. This article has summarized both arguments for and against the doctor’s practice of receiving gifts from drug companies and provided current policies and guidelines as potential solutions for the controversy. It can be concluded that gifts such as free drug samples, in some circumstances, may be beneficial to patients; however, they can indeed influence physicians when it comes to making the best decisions for the patient. Industry-manipulated decisions from physicians can diminish their self-worth and lead to biased treatments as well as higher cost for patients. Although the Big Pharma seems to be the devil in this debate, it is the physician behavior that plays the largest part in allowing the problems to continue. Medical practitioners should serve as role models whose responsibility is providing their community with the best service and the safest interventions at the lowest cost. Any alteration in physicians’ prescribing habits based on interactions with pharmaceutical sale representatives STETOTHOSCOPE MAGAZINE

and against those core values should be considered unethical and inelegant medical practice. References 1. Marco CA, Moskop JC, Solomon RC, Geiderman JM, Larkin GL. Gifts to Physicians from the Pharmaceutical Industry: An Ethical Analysis. Annals of Emergency Medicine. 2006; 48(5): 513-521. 2. Iserson KV, Cerfolio RJ, Sade RM. Politely Refuse the Pen and Note Pad: Gifts From Industry to Physicians Harm Patients. The Annals of Thoracic Surgery. 2007; 84(4): 1077-1084. 3. Big Pharma gives your doctor gifts. Then your doctor gives you Big Pharma’s drugs. https://www.washingtonpost.com/ opinions/big-pharma-gives-your-doctorgifts-then-your-doctor-gives-you-bigpharmas-drugs/2017/06/13/5bc0b5505045-11e7-b064-828ba60fbb98_story. html?noredirect=on&utm_ term=.00ee9692bbc6. Updated June 13, 2017. Accessed October 20, 2018. 4. Wood SF, Podrasky J, Mcmonagle MA, et al. Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia. Plos One. 2017; 12(10). 5. American Medical Association Journal of Ethics. Virtual Mentor. 2014;16(4):261-264. 6. Office of Inspector General. Compliance Program Guidance for Pharmaceutical Manufacturers. https://oig.hhs.gov/fraud/ docs/

Lan Huynh is a student in the DoubleDawg program in Pharmaceutical and Biomedical Science. She He hopes to become a pharmacist with an emphasis in drug discovery after graduation.

The Indoor Invader: Mold by ISHAN VAISH When the students of Russell Hall all started getting sick, whispers of an alleged mold problem broke loose. Within a few days, their GroupMe was blowing up with do-it-yourself mold kits suggesting that Russell Hall was breeding a few of its own fungal pathogens. However, could mold have even been the problem in the first place? Mold growth is a common phenomenon that most people have probably experienced because mold spores are always floating around in the atmosphere waiting to find a warm, dark and wet surface they can inhabit. College dorms particularly provide conditions that enable mold to flourish. A lack of an exhaust in the bathroom, poor ventilation systems, and the heavy use of shared showers all play a part in allowing mold to seep through a college dormitory. Merely spilling a glass of water and not drying it up quick enough can be enough to instigate growth. It would seem, then, that something as common as mold would be completely innocuous, but even small mold growth can be dangerous. Mold is a known asthma trigger that induces sneezing, coughing and wheezing. In larger quantities, mold can cause skin rashes, sore throats and respiratory infections. Toxic black mold can even be deadly. Toxic black mold or Stachybotrys chartarumtakes the prize for being the most lethal mold found commonly in living quarters. If left untreated, it can cause internal bleeding within the lungs and in some cases even death. Toxic black mold generally festers in insulation and subflooring hidden from the eyes of a careless viewer like the student. Once it has been spotted,

the process of removing it is incredibly costly, and often a step taken too late to prevent casualty. To make matters worse, the past few years have been particularly bad for mold related infections in general. Invasive mold growth has steadily become more common, and scientists even predict the fall of 2018 to be one of the worst if not the worst year for mold problems. That being said, mold growth does not entail impending death. By keeping the windows open and drying up water spills, average mold growth can be efficiently inhibited. If someone is really anxious, they can purchase air filters that can trap mold spores before they even germinate. Mold testing kits can be bought from most hardware stores for under twenty dollars. In the case that someone does become infected because of mold growth, most primary care centers are equipped to identify mold related sickness quickly. After a few cocktails of antihistamines and decongestants, the average victim of mold will be feeling as good as new. As for Russell Hall, no one is really sure if the newly renovated building is housing some less than friendly fungal residents. Even if it turns out to be mold free, it is quite likely some of the older dorms and apartments on campus are home to mold. However, as long as the right steps are taken to prevent further growth, and administration is promptly notified, mold can be the least of a University of Georgiaâ&#x20AC;&#x2122;s studentâ&#x20AC;&#x2122;s problem this semester.

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SENIOR SPOTLIGHT

Faiz Saulat Faiz Saulat is a Biology major who has been with the magazine for one semester. Q: What has been your favorite part of being on the magazine staff? A: I enjoy the fact that we cater primarily to UGA students and that we are a very relatable publication. Q: What are your plans for after graduation? A: Work and save up enough money to travel for my semester off. After that, I start my M1 at MCG in Fall of 2019! Q: Give us a fun fact about you! A: I am a collector of classical Urdu poetry!

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A SILENT EPIDEMIC by ERIC SANTANA STETOTHOSCOPE MAGAZINE

In the last decade, there has been a steady increase in the number of deaths related to the misuse of an increasingly common class of drugs known as Opioids. Opioids are drugs that bind to the Âľ-opioid receptor of the brain and encompass a variety of substances such as fentanyl, heroin, and pain relievers such as Oxycodone and Hydrocodone. According to the National Institute on Drug Abuse the misuse of this drug has accounted for over 49,000 deaths due to overdose and other complications. To put this in perspective in 2002, the number of deaths was closer to 10,000. This steady increase may be attributed to a variety of factors such as societal conditions, perspective on drugs, and notably a larger interest along with misuse throughout younger generations 18-24 years old particularly in relation to pharmaceutical opioids. Opioids have a rich and deep history in their plague of addiction and it is not something that we can allow to fly below the radar. Opioids are known to have mind and body numbing effects, it is truly a way for the user to escape from reality and almost bypass the understanding and acknowledgement of their own existence. Many users take these forms of drugs in order to make themselves feel better, when in truth these drugs are often also the cause of depression, due to their addictive natures and false representation of the true nature of reality. Therefore, not only do they pose a threat physically, but also mentally often involving complications with depression and anxiety due to addiction. Opioids, specifically, pharmaceutical drugs such as oxycodone and hydrocodone are known as pain relievers. Moreover, when they are misused, they produce a large rush of feelings of relief and a numbing feeling that almost pushes users to forget any signs of physical and or mental discomfort. At first this may seem very appealing because it can serve as a potential way to relax. In some scenarios for people who are in serious pain, this can be very beneficial and truly alleviate pain that could not be tolerated in any other situation. However, the dangers of this medication when abused surely outweigh any of the benefits that it provides. As previously stated, when medications such as these are abused they create a heavy dependency which can be very dangerous seeing that it will lead to more and more consumption of these drugs. At higher doses these drugs begin to accelerate the heart rate and this alone can lead to death. Alternatively, at lower doses it generally provides a more drowsy feeling which can be beneficial. However, once one is addicted and begins consuming more and more it is clear the benefits fade. Additionally, as one continues increasing the dosage of these drugs the potential for overdose is highly likely and when mixed with other drugs such as alcohol it poses an even larger threat. It is estimated that 115 people die every day due to overdoses from opioids. One reason that the amount of overdoses and general presence of pharmaceutical opioids has increased is in part due to the structure and system created by the American pharmaceutical and medical industries. These industries are not all to blame, however, they have made the issue significantly worse. The issue that has occurred is that doctors today can, at times, prescribe medications much too freely, particularly pain relievers such as Oxycodone. This often can be in part due to pressure from pharmaceuticals to prescribe their drug. Often if someone breaks their arm or has a surgery, they receive high doses of medications such as these. This creates a very easy

way to stimulate an addiction or dependency, which leads to using the medication even after the pain has dissipated. One of the reasons this may occur easily is due to the fact that patients are not educated enough of the potential dangers of this medication. They are simply informed to take it to help the pain with that being the end of its instructions. By not truly divulging into the fact that this medication could cause heavy addiction as well as painful symptoms of withdrawal, the patients are kept in the dark and left at risk. Therefore, change needs to occur. Patients, first off, need to educate themselves on the dangers of medications such as these. Additionally, doctors need to be more thorough and conscious of the dangers these medications pose to their patients, particularly to those who are younger and perhaps more inexperienced with these sort of medications. Many critics blame addiction on a lack of character or a lack of will, but in reality I strongly believe that drugs such as these possess such an addictive nature that there sometimes is no way out for certain individuals once they begin misusing them. Therefore, the way to aid them is not to pressure and question their character, but instead provide real consistent help that will allow them to overcome this chemical addiction. Some resources that are available include rehabilitation centers, other medications that help combat addiction and aid recovery, counseling, and many other potential sources to truly combat the real problems one has. Today the world is full of examples of lives that have been taken too young or too early due to the presence of the abuse of opioids. One recent example in pop culture is hip hop artist Malcolm McCormick who died at the age of 26 on September 7th, 2018 due to the abuse of opioids and an apparent overdose. Malcolm is more commonly known by his stage name Mac Miller and for a large amount of time he had been struggling through a variety of substance abuse as well as mental issues, including depression. This is a prime example of the dangers of opioids. Essentially it acts as a very easy way to alleviate pain, however the dangers as I and this example have exhibited are deadly. Opioids take advantage of the fact that people may be undergoing difficulty such as depression or other personal issues by furthering its addictive properties in order to truly mentally and physically handicap the user. Mac Miller is just one example of the thousands that have been grasped by the iron grip of opioids, and there are many others that could be mentioned all emphasizing the same point. Opioids are a powerful chemical drug and it can take anyoneâ&#x20AC;&#x2122;s life and flip it upside down, therefore it should be taken seriously and only when absolutely necessary. The opioid epidemic is real and has taken the lives of far too many. The numbers and statistics do not lie and the fact is it is time for change. As consumers and patients, we need to educate ourselves of the dangers and the presence of this danger in our society in order to not only better the general understanding in our own lives, but also for those around us. Doctors need to begin to remind themselves of their Hippocratic oath by prioritizing the health and sanity of the patient thoroughly explaining the implications and ensure that they are aware of these dangers surrounding opioids. The reality of abuse regarding opioids has gone unnoticed far past itsâ&#x20AC;&#x2122; expiration date and can no longer be a silent epidemic. We must all think and deeply consider this essential question, are you ready to lose a loved one to the abuse of opioids?

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How to Navigate Finding a Research Lab by KATIE LUQUIRE Undergraduate research is one of the most rewarding experiences you can have in college. Through conducting a research project, you are able expand learning beyond the limits of the classroom and visualize concepts that you would otherwise only read about in a textbook. Undergraduate research has been a major part of my college career and has allowed me to form relationships with peers and my mentor, gain patient interaction, and develop skills in critical thinking. As a pre-health student, developing skills and learning to interact with people in a professional setting is critical for my future as a healthcare professional. I highly recommend

joining a research lab, not only for how it will look on your resume or the requirement it fulfills but for developing skills that you will undoubtedly use in your career. However, attempting to join a research lab can be an intimidating and confusing process. Here are some tips for navigating the process of joining your first research lab:

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FIGURE OUT WHAT KIND OF RESEARCH YOU WANT TO DO. According to the Carnegie Classifications of Institutions of Higher Learning, the University of Georgia is classified as a Doctoral University, which is the distinction for the highest degree of research activity in a university setting. Therefore, the university puts a lot of emphasis on research and as a result, there are many opportunities for undergraduate research. Research is conducted in all fields, from economics to molecular biology. There are also different methods of conducting research. For example, I do research in the Department of Kinesiology, so much of my research works with taking noninvasive measurements on human subjects. However, many science labs work at the molecular level. For example, the Complex Carbohydrate Research Center (CCRC) focuses on the carbohydrate science of plants, microbes and animals. Look at what opportunities are available to you and determine what you want to learn more about. The Integrated Life Sciences (ILS) website also has a list of research areas for science students if you are not sure what area you want to conduct research in. DO YOUR RESEARCH. There are many opportunities to find undergraduate research opportunities at UGA. CURO, the Center for Undergraduate Research Opportunities, is a great place to start. The program supports students by helping to select opportunities, choosing a mentor, and publishing their work. The CURO website even has a list of available research opportunities, complete with the principal investigatorâ&#x20AC;&#x2122;s contact information. Additionally, another way to find a mentor is to ask a favorite professor what research they have going on and if there are any opportunities for you. There are many professors on campus who highly support undergraduate research and would be happy to help you. STETOTHOSCOPE MAGAZINE

REACH OUT TO A FEW PROFESSORS. The best way to ask about joining a lab is to contact the professor of the lab, also known as the principal investigator (PI), directly. If you have a class with the professor, try to speak with them after class or during office hours. Otherwise, email is the best method to communicate with them. This can be challenging, and you may even need to contact the professor several times before they respond. Some professors wait for the student to initiate a conversation multiple times to gauge interest before responding. They will often want to meet with you in person in order to get to know you, which is a great opportunity for you to get a feel for their mentoring style as well. If you are able to, try to meet with the PIâ&#x20AC;&#x2122;s graduate students during your meeting with the PI. They oversee different projects and you will likely be interacting with them on a daily basis if you join the lab. However, just because you meet with

a PI and his graduate students does not mean you are tied down to that lab. It may be beneficial for you to visit a few labs before you make your final decision. WEIGH YOUR OPTIONS. A few essential points to consider when selecting a research lab include the type of research they do, the work environment, and level of commitment. Before going into any research experience it is important to know the type of research you will be conducting and what you will be evaluating. Additionally, you will be spending a fair amount of time in your research lab, so make sure you are in an environment in which you are able to thrive. Ask the professor if you are able to visit the lab during your in-person meeting and try to get a feel for how the lab is run. Also, other undergraduate students in the lab are a great resource for you through this process because they have probably been in the

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lab for a while and can tell you what their experiences have been like. Another factor in choosing a research lab is the time commitment. As a pre-health student, you take classes of rigor that often require significant amounts of studying. Therefore, know what amount of time you can spend on research and ask your potential mentor if that amount is sufficient. Some labs require more of a time commitment than others, so it is better to have that conversation with your mentor before you decide to join the lab than afterwards. CHOOSE YOUR LAB. Once you have made your decision, contact the professor and let them know that you would like to join the lab. Ideally, try to make this decision within a week or two of meeting the professor so they do not assume you are not interested. The first semester of

lab will likely be a training semester where you observe measurements taken in the lab so that you can collect quality data when you conduct your own research in the future. While research can be a great experience when it works out, keep in mind that if you are not happy with your work or if your work is not what you thought it would be, you are not locked into that lab. Even if you are doing the research for course credit you can finish that semester and if you want to, look for a new lab for the next semester. The process of finding a lab can be challenging and daunting. However, once you find a lab and conduct research that has meaning to you, it will all be worth it. Many research mentors support and even encourage undergraduate research so they are willing to help you achieve your goals. All it takes is enthusiasm for learning and a little bit of perseverance.

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Resisting a Rest by AUSTIN WAHLE

Holiday season is approaching… which means jingle bells, evergreen candles, and carols filling the cool night air. Unfortunately, one of the jolliest times of the years aligns with one of the most dreaded… one that is filled with late nights at the library, the smell of paper, and the fifth cup of joe in a day. This not-so most wonderful time of the year is, as you guessed, finals week. As nights at the library studying get later, hours in bed become fewer and farther between. In a statistics class my freshman year, we took a poll amongst ourselves for the number of hours of sleep obtained the previous night. The average came in at a whopping five hours, with extremes being as low as two and as high as

ten (I was one of these extremes, but I won’t bore you with those details). This poll was conducted during a typical semester schedule, and from experience, this number only plunges the closer you get to finals. Many people take their time staying up late to study in a classic “all nighter” fashion, but this can actually be worse for our minds and grades than just calling it a night and going to sleep. When a night of sleep is cut short, the tail end of the sleep cycle is cut off. The end of the sleep cycle is characterized mainly by REM sleep, which functions to rest our minds and to allow us to be mentally sharp the next day. This means that by staying up late to study, we deny our minds the chance to rest, recover, and sort information. Many a time can lead STETOTHOSCOPE MAGAZINE

to an impaired ability to remember the information that you stayed up to study in the first place. A recent study conducted by researchers at UCLA found that sleep deprivation affects the literal building blocks of the brain, the neurons that allow it to communicate with itself, and the rest of the body (Nir et al. 2017). Sleep deprivation impedes the ability of cells in the brain to process visual stimulus, meaning that vision and conscious thought are not linked as closely as they would be in a wellrested brain. If you have ever stayed up late for a test and then looked at the first question and been slow to process what it was asking, it could be because your brain itself does not have full capability of processing

the image. Combined with your lack of REM sleep from the

previous night and your impaired ability to remember the

we all feel better after a night of good sleep, whether our

information, you are playing a lose-lose game with this test.

bodies need five hours or ten. There seems to be nothing a

good night of sleep canâ&#x20AC;&#x2122;t improve, so as we approach this

In addition to the mental fatigue and drowsiness

Long-term, intimidating health consequences aside,

that follow a shortened night of sleep, there are also

finals season, be sure you are recharging your brain so that

long-term consequences of repeated sleep deprivation.

your holiday season can include less worrying about grades

Disruptions to a bodyâ&#x20AC;&#x2122;s normal sleep schedule can result

and more hot chocolate and carols.

in increased activity in the sympathetic nervous system, increased metabolic activity, and changes in circadian

References

rhythms (Medic, Willie & Hemels 2017). All of these factors

Medic, Willie & Hemels. Short- and long-term health

combined can create a body that is hyper-responsive to

stress, susceptible to mood disorders, cognitive deficits,

2017.

and performance deficits. Even more long-term effects of

Nir, Andrillon, Marmelshtein, Suthana, Cirelli, Tononi &

repeated sleep deprivation can include hypertension, heart

Fried. Selective neuronal lapses precede

disease, diabetes, obesity, and more (Medic, Willie, Hemels

human cognitive lapses following sleep deprivation.

2017).

Nature Medicine, 2017.

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consequences of sleep disruption. NCBI, 19 May

The American Epidemic by YASMIN GOREJA From pizza and french fries to burgers and hot dogs, the United States is widely known for their tasty foods. These food items may be a treat for one’s palate, however excessive consumption of these types of foods has caused a major rise in obesity rates among both adults and children over the last few decades. Obesity has become a major health issue and affects about 93 million adults in the United States, according to the Centers for Disease Control (CDC). One of the major contributing factors is the uprise of fast food chains and restaurants found throughout the country. With the increasing number of fast food chains throughout the United States, there has also been a drastic increase in the number of Americans who are overweight or obese. Chains such as McDonald’s, Burger King, and Wendy’s contain items such as burgers and fries high in calories and oversized portions. Serving sizes in the United States have also increased over the last twenty years. As a result, these larger portion sizes are now considered to be “normal” for Americans even though they are not accurate with what an average person’s calorie intake should be. For example, a medium Big Mac meal at McDonald’s contains around 1050 calories and 48g grams of fat. This is considered very high for a meal and approaches the number of calories a

person should be having in an entire day. People should be consuming about 1,500-2,500 calories in a day depending on a number of factors, but meals from fast food chains can easily add up to this amount. Not only are foods from these restaurants high in calories, but they also contain ingredients that are harmful to our bodies. They are high in sodium, fat, and sugars along with being overly processed. Overconsumption of these ingredients not only causes obesity but can cause other health problems such as heart disease, diabetes, and high blood pressure. Fast food chains are not the only contributor to America’s obesity epidemic. Many popular food companies produce snacks and beverages that are unhealthy for both children and adults. Although products such as Coke and Lays are tempting and delectable, they contain many ingredients that are harmful for one’s health. Products such as these are processed, genetically modified and contain unhealthy sugars such as high-fructose corn syrup. They can easily be found in any grocery store, gas station and vending machine, which is why many Americans opt for these convenient, processed snacks rather than fruits and vegetables. The American diet contributes greatly to the rising obesity rates in the country. While many of these foods are comforting and palatable, STETOTHOSCOPE MAGAZINE

moderation and dietary changes can be the key to decreasing obesity rates among Americans. Along with moderation, the more educated an individual is on what their food contains, the easier it will be for one to control their diet. One way to do this is to look at food labels before purchasing a product. Using information such as serving sizes and calories on a product can help one practice healthy dietary choices. Furthermore, many grocery stores and vending machines now carry alternative, healthier options. Instead of purchasing a bag of Lay’s chips which is filled with sodium, one can opt for Veggie chips instead. With more widespread education regarding healthy eating, Americans can begin working towards a healthier lifestyle. If more people take control of their diet, a vision of America without obesity as its epidemic could one day become reality.

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Enabling the Disabled:

Innovations in Assistive Technology by MUHAMMAD SIDDIQ According to US Census Data, about 1 in 5 Americans identify as having some form of disability . This number is fairly consistent in other parts of the world, such as the United Kingdom where over 13 million people are registered as disabled. While different definitions of disability in result in discrepancies between reports, experts agree that the number of disabled around the world is only increasing. New diseases, stress, increasing lifespan, drug use, and malnutrition all contribute to this increase. Technology companies are now pushing harder than ever to make services that people with impairments can use. Here are just a few of the awesome pieces of tech improving lives around the world: DOT For years companies have tried to make watches that are usable by the

visually impaired. These watches, often used by touching the hands of the clock, have always had their issues. Dot provides a simple solution, calling itself the worldâ&#x20AC;&#x2122;s first braille smartwatch. Developed in Korea, Dot not only tells users the time, but is also host to smart features. Dot allows users to read app notifications in braille, be notified of phone calls, monitor steps and other activities, and even practice reading braille. The watch is sleek, using aluminum to keep its weight down to 27 grams. Motorized dots on the watch face are raised and lowered to allow the user to read it just like they would read braille on paper. It boasts an impressive 10 day battery life, a touch sensor, gyroscope, vibration and bluetooth. Dot is a practical solution to a problem not many people consider these days. Dot can be ordered online starting at $399.

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GOOGLE MAPS ACCESSIBILITY ROUTES Technology has made navigation, once an irritating process, simple and available from the palm of your hand. Gone are the days of driving aimlessly looking for signs or clumsily using a huge paper map. Over the past few years Google Maps has dominated navigation, reporting over 150 million unique users per month as recent as April 2018 (Statista). Google is constantly improving their products, and one of their recent additions to Google Maps is catered directly to wheelchair users. Added in March of this year, the feature currently helps those with mobility needs

navigate public transportation. Currently,

the feature is available in London, New

was completely designed with accessibility

of voice control and head movement

York, Tokyo, Mexico City, Boston and

in mind. Even the packaging keeps those

tracking to give people full touch-free

Sydney, but more locations are on the way.

with limited mobility in mind. There are no

control over their smartphones. A simple

The feature is easy to use, simply requiring

twist ties, zip cords or rough edges that

“open sesame” unlocks the phone and

one to tap “wheelchair accessible” as the

can cause cuts. A special lever system on

from there a cursor follows the the user’s

route type.

both the shipping and retail packaging

head movements. This combination of

Along with these routes, Google

The Xbox Adaptive Controller

Open Sesame uses a combination

holds the boxes together. Once a tear strip

control methods allows the user to do

has been working hard to add more

is removed the box simply unfolds using a

anything from texting to browsing the web.

accessibility information to location pages.

single hinge. The box features a low center

Open Sesame can be used for as little as

Information regarding whether a place

of gravity that provides stability.

$19.99 a month. A full kit which includes an

has accessible bathrooms, and step free

android device, a mounting kit, and 2-year

entrance has been added to over 12

Controller can be used as a unified hub

licensing can be purchased for just over

million locations after surveying guides

for a number of devices that make gaming

$1000. Open Sesame has been nominated

from around the world. Street view images

accessible. Along two large programmable

for Best Accessibility Experience at

are also constantly being added and

buttons and a directional pad on the top,

the Google Play Awards and is easily

updated so that people can view areas

the adaptive controller features numerous

downloadable on the Google Play Store for

before they visit. Google has been working

inputs on the sides. These inputs can be

anyone to use.

for years to make a more accessible world

used to plug in numerous devices such as

not just for wheelchair owners, but also

foot switches, motion controllers, pedals,

LIFTWARE STEADY

people using crutches or pushing a stroller.

and various styles of joysticks. Numerous

It will be exciting to see how the project

mounts can be purchased to attach the

suffering from hand tremors have difficulty

expands and evolves in the future.

device to wheelchairs, beds, etc. Using

doing basic tasks such as eating. These

Once unboxed, the Adaptive

Around the world, people

these inputs and mounts individuals

tremors can be the result of medical

XBOX ADAPTIVE CONTROLLER

can create the perfect input device to

conditions such as Parkinson’s Disease

Video games have long been an

cater to their needs. The accessory list

or Multiple Sclerosis. In 2012, a group of

outlet for people to connect with friends,

for the device is expected to continue

scientists and engineers came together

experience rich storytelling and spend a

growing and at only $99, Microsoft has

to form Liftware, a company that creates

little time away from the busy routine of

engineered an affordable way to make

eating utensils for those with tremors.

life. Traditional video game controllers have

one of the world’s most popular forms of

proved to be difficult to use for people with

entertainment even more inclusive.

of sensors including an accelerometer

limited mobility in their hands. For years,

Liftware Steady uses a series

to detect hand motion. An on-board

devices that made gaming more accessible

OPEN SESAME

computer can distinguish intentional and

have been very limited, expensive and

unintentional movements. Motors in the

only available through organizations

world are unable to use their hands as a

handle of the utensil move the utensil

creating custom solutions. Earlier this

result of spinal cord injury, ALS, stroke, and

in the opposite direction of any tremor.

year, with the announcement of the Xbox

other diseases that restrict motor function.

Liftware Steady is compatible with multiple

Adaptive Controller, Microsoft decided

Limited use of the hands prevents many

attachments allowing it to be used as a

to take the matter into its own hands.

people from doing day to day tasks such

soup spoon, everyday spoon, fork or spork.

Microsoft CEO, Satya Nadella, spoke about

as using a cell phone. Open Sesame,

It contains a rechargeable battery which

how Microsoft believes that technology

developed by Sesame Enable, is the

lasts approximately 3 meals. The Liftware

should be inclusive of everyone around

world’s first touch free smartphone app.

Steady Starter Kit is available for $195

the world. Microsoft partnered with The

and comes with a travel pouch, handle,

AbleGamers Charity, The Cerebral Palsy

came to be when CEO Oded Ben Dov

spoon attachment and charger. Additional

Foundation, Craig Hospital, SpecialEffect,

appeared on TV showing off a game that

utensil attachments can be purchased for

and Warfighter Engaged to create a device

used head gestures as its control method.

$35 each. Tremors make a simple task

that is affordable, adaptable and easy

Giora Livne, who is quadriplegic, contacted

such as eating, that we often take for

to set up. Microsoft worked closely with

Oded the next day and asked if he could

granted, incredibly difficult. Liftware Steady

these organizations to consider those who

create a smartphone that can be used

has become the leading solution to this

could not reach all the buttons or hold

without hand movement. The two quickly

problem.

a traditional controller for an extensive

partnered up and began working on the

period of time.

project.

Millions of people around the

The idea for Open Sesame first

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I should go for a walk today. Better yet, I should go for a run! But, it’s so cold outside… maybe I’ll do it later. Should I still go out when I have four exams tomorrow? Maybe I’ll go for the deep, dark chocolate cheesecake instead of the blueberry muffin. It’s fairly easy to make your own decisions since everyone has their own. But, are you really the one making your own choices, or is it possible that other forces are influencing you behind the scenes? Neuroscientists at Beth Israel Deaconess Medical Center (BIDMC) have recently uncovered how the concept of free will and self-decision making play a role in bodily movements. Their research has led them to question: do our innate actions, let alone our innermost thoughts, truly result from conscious activity? The frontal lobe, which is the decision-making part of our brain, allows us to make rationalized conclusions rather than impulsive choices. The frontal lobe is associated with judgment, problem solving, and memorization, as well as how we think, act, and learn. With its multi-faceted approach towards directing our actions and behavior, many people assume that this unique cerebral feature plays the primary role in whether we decide to participate in adrenaline-influenced activities, such as sky diving or bungee jumping. Surprisingly, the frontal lobe may not be the only part of the brain involved in risktaking and decision-making. An MRI scan performed by the California Institute of Technology demonstrated how the parts of the brain located underneath and behind the frontal lobe may also influence how we think. If the “precise pattern” of how the brain functions can be predicted,

can this pattern also be manipulated to influence our decisions? By analyzing a group of students at Georgia State University, a group of researchers conducted several experiments, which involved linking outside influences and emotional states to physical actions and thought-out decisions. The first experiment involved determining whether a person’s neural state would influence their beliefs. Researchers described a scenario in which an advanced neuroimaging method was possible. This enabled scientists to either predict the decisions of the participant through the concept of neuro-imaging or attempt to attempt to influence the behavior of the person making the decision. Students were then asked: whether a hypothetical participant was truly making their own choices or were they possibly being manipulated by some unseen force into making those decisions? The study found that most students believed that the participant was making their evaluations without the influence of others, even when scientists were predicting the decisions of the subject. However, the presence of possible manipulation, where the scientists

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Decisions, Decisions by RIYA KANSARA

were said to possibly be influencing the participant’s behavior, caused students to lean towards the idea that the subject was not able to make their own decisions. This meant that when the “threat of manipulation” was present, students were more likely to state that the participant was not able to make their own choice. These researchers found that the majority of the students were more likely to assume that neural activity was linked to thought and action rather than thinking that their emotional or mental was encouraging decision making. This concept is known as neuro-prediction, which describes the notion of being aware of another’s mindset and actions before they themselves are through the use of neuroimaging. This concept is often paired with the idea of mind reading, in which an assumption is made where another person’s inner thoughts are known without the use of diagnostic technology such as neuroimaging. This demonstrates how before a decision is even made, an underlying sense of manipulation has the ability to possibly influence your brain and whether a decision you made was really yours.

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As the researchers later point out, it is difficult to pinpoint whether decisions we make are truly ours or whether the different regions of our brain work to influence how our decisions are made without the presence of neuro-prediction. Even with the prior knowledge of manipulation, brain activity cannot be manipulated when the “mental states have an effect on [their] actions”, meaning a decision cannot be influenced when the brain itself is not yet aware of said decision. So next time you decide to go to that restaurant you saw on TV or hold off on studying for an exam, think about whether you are truly following your heart, or rather, your head. Sources: https://doi.org/10.1016/j. cognition.2014.07.009 http://link.galegroup.com/ apps/doc/A558128700/

Technology and the Patient-Care Experience by RALEIGH DURAN

You walk into the doctorâ&#x20AC;&#x2122;s office, greeted by a receptionist that hardly takes her eyes off of the screen in front of her, or even worse, you sign in on the iPad screen directed towards you, sit down and wait for your name to be called. Eventually, you follow someone into a room and sit uncomfortably on the paper-covered bed while a nurse or other medical professional asks you questions, quickly typing your answers onto the computer. Without touching or interacting with you at all, she inquiries about your visit, your dietary habits and your stress levels, then moves on to the next patient. You wait patiently for the physician, who must additionally repeat the questions and input your answers into your electronic medical

record, a document of information about you, containing your medical history, a list of medications and any other pertinent information about you. The physician quickly examines you, then again sits down to order the correct lab work or imaging studies needed for your complaint. In a world that has become inundated with technology, it makes logical sense to incorporate these advances into the medical field. In many ways, technological advances in treatments and procedures have tremendously improved the world of medicine, from less invasive surgical techniques to x-ray imaging that transmits less radiation, and from the outside it appears that technology has revolutionized and optimized our healthcare system. STETOTHOSCOPE MAGAZINE

However, a closer investigation reveals that patients seem to be less satisfied with their physicians and medical care, given that the provider must sit down and detail their communication with you on the electronic medical records, keeping track of the patientâ&#x20AC;&#x2122;s complaints, physical exam and course of treatment. This is a relatively new reality in the world of medicine, and patients have begun to notice. No one likes to feel as though the person they are speaking with is disinterested in what they have to say, and this is exceptionally true when speaking with a medical provider. Not only are patients unhappy with this type of relationship, but physicians are

beginning to understand the problem as well. According to a recent study of internal medicine performed by JAMA, even the physicians are concerned with the amount of time that they must spend charting, consuming their time with the patient and detracting from true medical care and connection (Doyle, 2016). After countless hours in the libraries and laboratories throughout medical school, most doctors have brewed enough desire to actually interact with their patients and understand their symptoms and conditions, not sit at the computer while listening for key phrases to type into the chart. Additionally, they want to leave the patientâ&#x20AC;&#x2122;s room feeling positively about their interaction, not as though they were limited in their abilities or hindered by technology. In a review of the JAMA research by Medical Economics, studies found that doctors who must spend more time charting on their patients are less likely to make eye contact and maintain positive rapport

with their patients, (Medical Economics, 2016) an unfortunate reality for a healthcare system dominated by a need to keep track of patient interactions. Due to government regulations and impositions by insurance companies, physicians find themselves with the difficult task of balancing between their interactions with their need to document. In order for insurance companies to pay for necessary treatments, the patientâ&#x20AC;&#x2122;s medical record must indicate that these treatments are required, and the physician is left stuck explaining their decisions in the chart instead of informing the patient. Rather than instilling confidence in the patient or updating them of courses of treatment, the doctor must provide explanation after explanation, simply to provide the best care possible. Although technology has benefited the world of medicine, we must pay careful attention to what it is doing to our desires for human relationships and how it impacts our STETOTHOSCOPE MAGAZINE

trust with our medical providers. We are indebted to technology for many of its advantages, but must keep in mind that there may be a dark side as well. Patients want their complaints and concerns to be taken seriously and considered carefully, but when the physician is staring at the screen instead of the patient, the quality of care is dramatically decreased. This is particularly true for patients with chronic medical conditions who join their physician monthly, or even more frequently, for constant follow-up and close monitoring. There is a specific need for these patients to feel at ease and establish a comfortable relationship with their doctors, however this can be challenging on both sides when technology creates a staunch barrier. As with most indulgences, too much of a good thing can create an issue, and medical professionals across the country should evaluate this with a keen eye, making sure that patientcare is truly patient oriented.

The State of Georgia Healthcare by MERRITT DANIELS

Throughout history, there has been a consistent idea of the “American Dream,” which views the United States of America as a place where each person is given equal opportunities to lead the best life possible, regardless of where they live or the circumstances they were born into. This concept that freedom includes the opportunity for prosperity and success should ultimately lead to health equity; meaning that everyone has a fair and just opportunity to be healthier. However, in today’s world that is not always the reality. Health disparities emerge when some groups of people have more or less access to opportunities and resources over their lifetime. In order for the United States to achieve such health equity, there needs to be a significant reduction and ultimately an elimination of these health disparities. Minimization of such disparities will require improving these marginalized groups’ access to healthcare professionals and facilities. These health disparities are not a foreign issue. In fact, the state of Georgia is currently being negatively impacted by such differences in health conditions and resources. Health is influenced by a range of social and economic factors, one of which is access to healthcare. The Georgia County Health Rankings of 2018 identifies the ratio of population to primary care physicians as 1,520 to 1, as well as 1,980:1 for dentists and 830:1 for providers of mental health within our state. In fact, our own Athens-Clarke

county is directly impacted with a similar ratio of population to primary care physicians of 1,522 to 1, which is greater than the average for the over all state’s deficit. Therefore, the state’s and Athen’s population is not thoroughly represented with an adequate number of healthcare providers needed to reach the desired health equity associated with “the land of opportunity.” This shortage of physicians, dentists, mental health providers, and many other healthcare professionals in Georgia ultimately has lead to Georgians having limited accesses to the care they need, causing the health outcomes and health factors within our state to decline directly at the cost of the quality of life of the state’s residents. Aside from the deficit of physicians, there is also a maldistribution of those physicians and other healthcare providers throughout Georgia. According to the Georgia Department of Community Health, 130 of the 159 counties in Georgia are classified as medically underserved areas. From those statistics, one can derive that 81.76% of the state has areas that have too few primary care providers, high infant mortality, or high poverty levels. From those underserved areas, 124 of those counties have been identified as geographical areas with primary care health professional shortages (HPSAs); one of which is Athens-Clarke County. This lack of providers in rural and underserved areas is causing not only a maldistribution of physicians, but STETOTHOSCOPE MAGAZINE

ultimately a proportional relationship between where one lives and that person’s quality of life. University of Georgia (UGA) pre-health students have the opportunity to help alleviate this deficit and maldistribution of healthcare professionals within the state while completing their undergraduate degree, as well as, after their professional schooling. Through volunteer opportunities, like those are offered at Mercy Health Center, UGA students can contribute to increasing access of healthcare for Athens-Clarke County’s underserved populations. Dr. Jean Sumner, Dean of Mercer University School of Medicine, described it best when she said, “The opportunity to change health care in Georgia by becoming a physician or healthcare professional and serving in an area of need requires the best and brightest and those with courage, high intellect and a servant’s heart”. The future state of Georgia’s healthcare is dependent upon a passionate and capable next generation of physicians, dentists, nurses, therapists, and the other factions of healthcare professionals. Pre-health students can have a direct impact on improving the quality of life for Georgians statewide by contributing to the alteration of the current deficit and maldistribution of professionals in their designated fields.

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Stress vs. Flu Vaccine by OLIVIA WALLON

Flu season is like a groundhog day for America. Campuses and offices are littered with flyers and posters to get vaccinated. News articles claim that this flu season is the worst yet, and the public is repeatedly told the same tips to stay healthy: keep hands clean, get vaccinated, and avoid others with the flu. This “trifecta” to avoid the flu has been ingrained in the public’s mind for years, resulting in a feeling of invincibility to those who follow each step meticulously. But there is a flaw in this system. Recent studies have clued that an individual’s susceptibility to the flu is not based solely on physical factors, but stress levels too. Stress is the body’s response

to demand, both positive and negative. The body’s threat reaction initiates a “flight or fight” response that results in focus, energy, and alertness. The initial stress response originates in the brain. The amygdala sends a threat-like message to the hypothalamus, which directs the sympathetic nervous system to engage and protect. The triggering of the sympathetic system affects the pituitary gland, the heart, adrenal glands, and the digestive system. Heart rate increases, blood vessels constrict and dilate, digestive processes slow down, and cortisol is secreted. Some stress is beneficial to trigger motivation, but when persistent

negative stress is present, there seems to be a drop in physical health. A study conducted by Gregory Miller and colleagues analyzed the effects of stress levels on antibody production in students. Each student recorded their stress levels over a 13 day period. During this time, the students had their baseline antibody levels recorded and were administered a vaccine. The individuals’ antibody count was also measured one month after vaccination and four months after vaccination. The researchers then analyzed the self reported stress for each individual and calculated average daily stress and a cumulative stress index. Researchers then created three

groups; low-stress individuals, medium-stress individuals, and highstressed individuals. Initially, all 3 groups reported similar baseline antibody levels. But at both the one month and the four month check in, the high-stress group had considerably less antibodies compared to the other two groups. They also saw consistency in low antibody production with those who experienced high level stress between eight and ten days after vaccination, around a twelve to seventeen percent decrease. In a meta-analysis of 13 studies, Pedersen and colleagues explored the hypothesis that stress contributes to a high risk of contracting influenza and a lower antibody count. The studies consisted of comparing increased antibody levels of vaccinated caregivers verses vaccinated noncaregivers, and an individual’s self reported stressors and antibody production after vaccination. The 13 studies all had consistent results involving higher psychological stress and a lower than normal level of

antibodies after being exposed to the flu vaccine. The findings also hinted that stress’ effects on antibody production did not change based on age, sex, or race, but solely on an individual’s stress levels. These studies, along with a multitude of others, support the idea that stress is debilitating to the immune system because of the body prioritizing “fight or flight” over things like antibody production. Antibodies are crucial for the immune system. Their jobs are to latch onto and terminate antigens, which are potentially dangerous foreign pathogens. The immune system also uses antibodies as a form of memory, meaning that if the body successfully fights off a foreign pathogen with specific antibodies, these antibodies will be stored, creating a life long immunity to a specific antigen. This “memory” is what makes vaccines effective. In specific, the flu vaccine works by introducing small amounts of the flu virus into the body, stimulating antibody production. This

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predisposition to the flu virus allows a person to have less of a chance to contract the flu, especially during peak flu season. These studies hint the effects of stress on vaccines by showing that chronically stressed individuals had insufficient antibody production, resulting in an almost ineffective flu vaccine. As this flu season approaches, it is important to focus on not only physical health, but mental health too. Integrating practices like exercise, a balanced diet, and meditation are often suggested to help ease stress. Although finding time to relax may not be as easy as a prick in the arm or using hand sanitizer, it is vital to be mindful of stress levels, because no one wants the flu.

The Future of the Flu Shot by ANA MEHRANIAN

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It all starts with a scratchy throat, a few sniffles, and an unexpected sneeze or two. Before you know it, you can barely roll out of bed, breathing through your nose is not an option, and class started thirty minutes ago. Most of us are familiar with this feeling and its culprit: the flu. Caused by a virus with an incubation period as short as twentyfour hours, the onset of flu symptoms appear too quickly to curb, yet often linger longer than expected. On college campuses, the influenza virus circulates rapidly due to the high volume of students sharing living and study spaces, as well as restrooms and classrooms. According to the Centers for Disease Control and Prevention (CDC), college students infected with the influenza virus experience symptoms for an average of eight or more days. An extremely contagious respiratory illness, the flu is caused by influenza A, B, or C viruses. The virus itself is circular and covered in specialized glycoprotein “spikes” comprised of hemagglutinin and neuraminidase. These proteins allow the virus to enter and exit the host cell upon initiation and completion of the viral life cycle. Variants and combinations of these surface proteins (e.g. H1, H2, H3, N1, N2, N3, etc.) make each virus unique, altering the ability of each virus to spread and cause illness. The influenza virus diversifies through genetic shift and drift, patterns of genetic change and recombination made possible by the chemical makeup of the virus’s genetic code: ribonucleic acid. During RNA synthesis and replication, incorrect nucleotides are often inserted and misincorporated into the new RNA chain. These copying errors are the driving force of viral evolution, with rapid mutations having the potential to cause pandemics. In other words, the

flu is so successful because it makes mistakes. According to the World Health Association (WHO), there are 3-5 million cases of severe influenza every year, causing between 250,000 and 500,000 deaths annually. After the influenza virus enters your body, it travels to the cells lining your respiratory tract and begins replication. To do this, the virus must first gain entry to its chosen host cell. The surface protein hemagluttanin acts as a key, unlocking the door to the cell membrane. Once the virus is safely inside the cell, it bursts, releasing its genetic sequence into the host cell’s nucleus. The host cell is then transformed into a factory for virus production and export. As the body detects these invaders, it recruits immune cells, sending them to the areas containing the replicating viruses. At this point, the immune system has been kicked into gear and is actively attacking viral cells to halt their proliferation. How can we prevent all of this in the first place? The answer is in vaccination. Traditional seasonal flu shots are trivalent vaccines, meaning that they provide protect against three influenza viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The specific types and strains are chosen every year based on the viruses research indicates as the most common for that season. Why not create a vaccine that protects against all possible combinations? The antigenic differences between influenza types A and B as well as subtype and strain diversity has caused difficulty in creating effective and all-encompassing influenza vaccinations. Within each influenza season and strain, there is an (almost) unpredictable combination of both influenza A and B lineages. This creates a “mismatch” between the vaccinations and circulating strains. Dr. Ted Ross, a microbiologist

and the director of the Center for Vaccines and Immunology at the University of Georgia (UGA), is attempting to face these challenges as he and his colleagues work to create a universal or broadly reactive influenza vaccine. The approach taken by Ross and his team involve combining mutations of the surface protein hemagluttanin from every flu strain to ever exist into a single molecule with the potential to build the foundation of a new vaccine. The data technique used in the process is called computationally optimized broadly reactive antigen (COBRA). COBRA employs computer algorithms to analyze genome sequence information and select antigens with the characteristics to represents a wide variety of clades. These antigens are then used to produce a vaccine with a wide crossclade coverage and high potency. This immunological breadth is important to the unpredictable tendency of influenza to mutate and evolve. In a study conducted by Ross’ laboratory, a COBRA-derived vaccine was designed to protect against all possible variations of the H1N1 virus. Mice treated with the vaccine were successful in developing the necessary antibodies and were granted immunity. The results were published in the Journal of Virology in 2016, and as of last year, the vaccine has been planned for testing in clinical trials. In the words of Dr. Ross, “The development of a universal or broadly reactive influenza vaccine will be a paradigm changing event in vaccinology. A vaccine that can protect all people, from infants to the elderly, pregnant women, the immunocompromised for 5, 10 or more years will change our lives.” The future for a universal flu shot is bright, and it all started here at UGA.

Addiction in Your Pocket: Is Smartphone

Addiction Doing More Than Just Wasting Your Time? by FAIZ SAULAT STETOTHOSCOPE MAGAZINE

What’s the first thing you check in the morning? What do you carry in your pocket everywhere you go? What do you use for news, music, work, social media, etc? The average time young adults spend on a smartphone each day is 5 hours. Assuming 16 hours are set aside for school, work, and sleep, that is over half of our waking hours. Even worse, children 8 and under are spending over 2 hours per day on screens and children between 8-12 years old are spending double that time. Smartphone addiction is certainly not a new threat, however, the time we are spending each day is unprecedented. In 2008, the total number of hours adults spent each day on digital media was 2.7 hours - in 2017, it was 6. This further translates to lack of performance in the workplace as well. While smartphones are an essential part of modern-day career life, they also serve as severe distractions. Employees spend approximately 1 hour out of their work shift on their phones for non-work related purposes; for young adults, it’s over an hour. Even having your phone nearby, regardless of active usage, can harm performance and focus in the workplace. Educational environments are no exception. A study conducted by Notre Dame University found that undergraduate students were far less likely to achieve GPA’s of distinction if they were at risk of addiction to their smartphones. This comes as no surprise considering it is now common practice to be using one’s laptop or phone throughout class - if you’re a UGA student, scan the room during your next lecture. But while these numbers are indeed shocking, Americans have heard the same tune for years. We get it, we use our phones too much, we could get addicted, and it eats away at productivity, what could be worse? - A lot. The threat now is even greater than just wasting time. The negative side effects of this unparalleled increase in cell phone use are manifesting itself in damage to brain chemistry, mental health, sleep cycles, and other elements we are still unaware of. Our brain hosts a delicate reward system based on dopamine, a

neurochemical that is responsible for positively reinforcing certain beneficial behaviors. In other words, when we have sex, consume drugs, exercise, eat tasty foods, or even have positive social interactions, dopamine is the signal that tells us “that was good - let’s do it again.” But too much of anything isn’t good. Every notification or “like” we get is another dose of dopamine that creates newer and deeper neural connections. Over time we develop an addiction to our smartphones and constantly desire these shots of dopamine. Furthermore, this abuse of our own reward system could lead to loss of interest in other activities in which we are not near our phones. Loss of interest and too much time with your phone are also recipes for cycles of depression and anxiety. Researchers at the University of Georgia found that teens who spend more screen time were generally less happy than those engaged in activities unrelated to screen use. Furthermore, users are at risk of developing a psychological dependence on their devices. Just as drug users experience withdrawal symptoms, individuals addicted to their phones also can experience separation anxiety from not having it nearby. Essentially, too much attention to your phone could lead to a lose-lose situation whereby the use of your device is likely to cause depression, and separation from it is correlated with anxiety. The overuse of our smartphones not only affects us when we are awake but also influences our sleep. One study found that high mobile phone usage is directly correlated with sleep disturbance. This comes as no surprise considering our smartphones emit blue light. This light is what allows us to view our screens without glare during sunny days. In fact our brain process it as sunlight since they are so similar. When we check that last snap, like that last post, or scroll through our feed for a while before sleeping, we are preventing our brain from producing melatonin which cues our body to begin regular sleep cycles. More phone use equals less sleep which comes with a host of its own problems that need no further explanation. STETOTHOSCOPE MAGAZINE

Mental health damage, sleep disturbance, and neurochemical imbalances are just a few of the known side effects of overusing smartphones. Considering smartphone development and subsequent overuse is a recent phenomenon, there are even more predicted threats that are waiting to materialize in the future. New studies show that phones emit radio-frequency (RF) radiation, low levels of which can still put users at risk of forming cancers due to constant exposure. Furthermore, research has shown that smartphone overuse is now increasing likelihood of developing ADHD and other behavioral issues that could interfere with children’s performance in school. Similar to the aforementioned studies, even the mere presence of a student’s phone could interrupt their learning. However, not all hope is lost considering both consumers and tech manufacturers are becoming increasingly aware of the numerous ill effects of smartphone addiction. In fact, earlier this year, Samsung worked with Arianna Huffington, founder and CEO of Thrive Global, to release the Thrive app. This app allows Android users to track their usage, view a summary of how many minutes they spend on what apps and even lock some apps for certain amounts of time to maximize their productivity. Personally, my experience with Thrive showed me that I was spending an average of just over 5 hours per day on my phone, a large amount of which was not productive work. After closely monitoring my usage, I now spend about 2 hours for work and no more than an hour for entertainment. My ability to pay attention in lectures, meetings, and general conversation is now rarely consumed by the itch to check a notification. Apple has also followed suit this year in its development of iOS 12 allowing users to set app time limits and get activity reports of their usage. Smartphones are not the bane of our existence. They serve a vital purpose and have enhanced our productivity and lifestyles in many ways. However, it is important to stay in control of your device - not the other way around.

Popping (The Wrong) Pills: The Effects of Substandard and Falsified Drugs Worldwide by EMMA ELLIS

STETOTHOSCOPE MAGAZINE

Victoria Amponsah arrived at

purposeful deception, created as

The contagious nature of these

the hospital with a slew of symptoms.

a part of a $30 million fake drug

illnesses makes each country’s use of

According to USP, it was there that

business.

substandard drugs the business of

she learned of the child nestled in

another’s, as antibiotic resistance is

her stomach, soon to become the

of drugs can be devastating.

not able to be contained within the

center of her world. It was also there

Approximately 72,000 children

borders of a nation. Thus, members

that she discovered that she was one

die of pneumonia from fake or

of the countries who supervise the

of the 3.5 million Ghanaians who

substandard drugs, as well as 69,000

spread of substandard medication

had contracted malaria that year. A

individuals from malaria, according

will feel the same ramifications as

trip to the local pharmacist should

to recent data from the World Health

those who do not, making the call

have prepared her body for both,

Organization. Beyond death, falsified

to better regulate the drug market a

yet, hours later, she once again stood

drugs have also fed the opioid

global challenge.

in her hospital gown, now with an

crisis, with individuals unknowingly

empty jar of counterfeit medication

consuming, and then becoming

international consensus is needed

in her purse. A mere seven months

addicted to, opiods hidden within

regarding the best possible way to

later, Victoria again became

basic medications like cough syrup.

detect falsified medications at the

devastatingly ill, as she began to

Drug shortages exacerbate the

lowest cost to all parties involved.

uncontrollably shake, vomit, and

issue, as pharmacies and individual

Joel Breman of the National

bleed after taking what she thought

shoppers become more desperate

Institutes of Health argues that

to be a basic painkiller. Victoria once

to stock their shelves. Vulnerable

the success of the United States’

again found herself the victim of the

populations, in particular, gravitate

Food and Drug Administration

worldwide falsified and substandard

towards falsified or substandard

(FDA) in decreasing counterfeit

drug epidemic, this time nearly

drugs because of their discounted

drugs suggests that forming a

losing her daughter’s life as well as

prices. Drugs are additionally more

similar worldwide organization is

her own.

likely to be falsified when there is

necessary in creating and enforcing

a stigma attached to purchasing

international regulations. Smaller

Organization quantifies the frequency

the medication, forcing individuals

solutions, such as improving methods

of cases like Victoria’s, stating that

to obtain the drug from someone

of trash disposal to avoid the reuse

around 10% of all medical products

other than their doctor. Viagra and

of pill vials, are equally needed, as

in low and middle income countries

birth control, for example, are often

well as inexpensive devices that

are either substandard or falsified.

counterfeited.

can judge the legitimacy of pills in

Substandard medications refer

the field. Individuals like Victoria

to drugs that are in inadequate

especially problematic, as they help

Amponsah, who should not even

condition when consumed by a

perpetuate bacterial resistance.

be contracting malaria in light of

patient, even though they were

When bacteria is treated with a drug

today’s medical advancements, need

approved by the country in which

that lacks enough active ingredient,

the certainty that the medicine they

they were produced. These drugs

the bacteria will be exposed to

recieve will improve their condition.

may be past expiration, damaged

the antibiotic but not actually

during transport, or simply lacking

killed. When this occurs, all other

the appropriate amount of active

patients receiving treatment in the

ingredient. Falsified drugs, on the

same hospital are put at greater

other hand, are the product of

risk of contracting the disease.

The World Health

The effects of both types

Substandard drugs are

STETOTHOSCOPE MAGAZINE

Looking to the future, an

Brain Food: School Lunches and Cognition

by BEMSI WALLANG Childhood is a precious, critical time. The brain is constantly developing and adapting to its environment. Physical growth, increased socialization, and a gradual, but certain evolution into one’s identity are the hallmarks of childhood. None of this process could be made possible without nutrition. Nutrition nurtures the furthering of the growth of every being, and good nutrition makes room for intellectual aptitude to flourish. Even prenatal nutrition has profound impacts on the mental capabilities of children. Given that children spend a considerable fraction of their days and ultimately, their lives at school, it is imperative that while they are at school, they are supplied with meals that promote optimal learning, memory, and retention. The provision of school lunches became a national mandate in 1946 with the passing of the National School Lunch Act. From the Act grew the National School Lunch Program, which to this day provides children with low-cost and free lunch options on school days. Today, while students are guaranteed lunch at school, proper nutrition is not always a guarantee once they get home. There are millions of children in the United States that live in “food insecure” areas where their access to nutritious food is limited. Food insecure areas are often home to “food deserts,” a term encompassing urban areas lacking supermarkets within a one-mile radius and rural areas lacking supermarkets

within a ten-mile radius. Children that live in food deserts are often left without nutritious meals on school holidays and breaks, especially in the summer. To remedy the disparity, the USDA’s Summer Food Service Program provides children from low-income communities across the country with healthy meals that they would otherwise never receive. Shaw, Mississippi is a food desert where “one third of its population is considered food insecure” (Pekow, 2017). If it weren’t for the town’s “Delta Hands for Hope” initiative, an after-school and summer program that provides children with meals and academic support, Shaw’s children would go hungry. With threats of impending budget cuts under our current administration on advantageous programs such as these, the span of their effect could be drastically limited in the years to come. According to the Centers for Disease Control, “hunger due to insufficient food intake is associated with lower grades, higher rates of absenteeism, repeating a grade, and an inability to focus among students” (CDC, 2014). Proper nutrition is positively correlated with high performance, so the assurance of a healthy meal is of severe importance in the life of a child. Harding Senior High in St. Paul, Minnesota prioritizes just that. A 90:90:90 school where roughly 90% of its students are minorities, come from families of low socioeconomic status, and attend college or seek careers after graduation,

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Harding provides three nutritious meals for its students each day and this practice is believed to have a link to the academic success of its students (Brody, 2017). Harding’s program lies in the midst of a state where 10% of its households are food-insecure and 1/6th of its children are at risk for hunger. Undoubtedly, schools across Minnesota and the nation should consider implementing transformations in meal provision for the enrichment of the health of their students. Some progress is certainly being made, but we still have great lengths to surpass as a nation. In 2010, President Obama signed the “Healthy, Hunger-Free Kids Act” into effect which standardized an increase of fruits, vegetables, whole grains, and lean protein options in school lunches across the country. It also limited sodium levels in school lunches, a decision that is now being

repealed by the Secretary of Agriculture, Sonny Perdue (Brody, 2017). However, increasing sodium intake in school lunches could pose dangerous risks for students. Excess sodium intake is an increasingly problematic issue in the United States and is a main contributing factor in the onset of hypertension, stroke, heart disease, and obesity. Relaxing our standards only agitates our problems, and it’s common knowledge that childhood obesity is an overhauling epidemic in the United States. It’s an alarming reality that a third of America’s children are obese, which directly predisposes them to various chronic diseases, including diabetes, heart disease, and asthma (Campbellsville University, 2016). This reality is just as inescapable as it is alarming, and must be addressed with the health and wellbeing of our children in mind. Nutrition plays a crucial role in determining the mental trajectory of children as they progress into adulthood. Proper nutrition prolongs their lives and overall quality of life. School-aged children undergo a substantial amount of development in such a concentrated amount of time, so it’s crucial that they receive optimal nutrition through it. Efforts to equalize proper nutrition in schools must be prioritized by the school system and the federal government alike for improvements in disproportionate access to healthy meals to be made tangible.

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References Brody, J. E. (2017, June 05). Feeding Young Minds: The Importance of School Lunches. Retrieved November 30, 2018, from https://www.nytimes.

com/2017/06/05/well/ feeding-young-minds-the-importance-ofschool-lunches.html Centers for Disease Control. (2014, May). Health and Academic Achievement [Brochure]. The Impact of School Lunch on Student Performance. (2016, December 7). Retrieved November 30, 2018, from https://online.campbellsville. edu/education/healthy-body-healthy-mindthe-impact-of-school-lunch-on-studentperformance/ Pekow, S. (2017, July 10). What children in food deserts do during the summer. Retrieved November 30, 2018, from https://www. apmreports.org/story/2017/07/10/brain-food

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