Examiner Spring 2022, Vol. 25

FEATURED:

Cancer in Developing Nations: A New Burden Kritika Singh On Multitasking: What You Lose by Doing More Allyson Fu Face Your Fears (With Virtual Reality Therapy) Nidhi Gourabathuni

SPRING 2022

Letter from the Editor SPRING 2022 Dear reader, Here, The Examiner Pre-Health Journal of Rutgers University proudly presents its Spring 2022 issue! To this day, the club continues to write intriguing articles about topics in science, research, and healthcare, whilst working towards relating them back to the general Rutgers community. I am so grateful to all of our journalists, as well as the rest of the executive board, for their hard work in the creation of this issue.

At The Examiner, we strive to provide students with a creative outlet to write about topics that interest them. We try our best to equip journalists with the writing tools necessary to succeed through writers’ workshops and qualified managing editors who help to guide them throughout the writing process.

During our meetings, we also hold journal discussions, debates, and invite guest speakers to foster curiosity and intellectual growth in each of our journalists. For instance, this semester, we held a debate regarding the arguments for and against physician assisted suicide. We also had each of our journalists present their topic in small groups for peer feedback.

I have been a part of The Examiner for the entirety of my college career, and I am so grateful to have had the opportunity to serve as the President and Editor-In-Chief in my final year of college. I have full faith that next-year’s executive board will continue to uphold the high standards of The Examiner’s publications and further grow our organization.

From all of the journalists, the rest of the executive board and I, we hope you enjoy this issue as much as we enjoyed putting it all together!

Sincerely,

Shruthi Thiyagarajan Editor-In-Chief

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TABLE OF CONTENTS ​Addiction and Alcoholism The True Tragedy of Miracle Weight Loss Advertising Cancer in Developing Nations: A New Burden Targeting Amyloid-beta, a Protein Responsible for Alzheimer’s Aduhelm: A Cure for Alzheimer’s or an Impending Disaster?

The New Pandemic: Social Media Addiction “Doctor” TikTok A Better Understanding of Associative Memory A New Form of Therapy: Sleeping The Reality of Giving Birth in New Jersey A Mother’s Cry On Multitasking: What You Lose by Doing More The Gut-Brain Axis: Effects of Microbes on the Brain Melatonin and Vancomycin: Can This Combination Stop Kidney Failure in Its Tracks?​ Diversity in Medicine Bilinguals: What Makes them Different?

Meditation and the Ability to Improve Brain Symmetry Leisure Sickness: Fact or Factitious?

Uniting AI with Medicine to Fight Pediatric Cancer Just One More: Addiction in its Many Forms Lyme Disease, Post-Treatment Lyme Disease Syndrome, & Curbing the Rising Cases Cytokine Control: A Gateway to Improving Cardiovascular Care in a Global Pandemic Face Your Fears (With Virtual Reality Therapy) Extra Bone Harms Amputees? A Patient-First Research Approach at Rutgers BME The Threat of Climate Change on Pregnancy and Infant Development The Three-Body Problem: The Relationship Between our Bodies, Bacteria, and Phages The Race to Rehabilitation: The Psychosocial Aspects of Sports Medicine

4 5 6-7 8 9 10 11 12 13 14 15 16-17 18 19 20 21 22 23 24 25 26-27 28 29 30 31 32 33

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ADDICTION AND ALCOHOLISM Esha Paghdal

Alcohol use disorder or alcoholism is a widely prevalent problem in today’s world. It is defined as a medical condition characterized by an inability to control or stop one’s own alcohol usage, despite having adverse effects on overall health. Its causes are not always well defined, but certain risk factors tend to influence its prevalence. A combination of these risk factors has a variety of effects.

In order to delve into this, we must touch upon the two different theories regarding the inheritance of alcohol use disorder: the 1 gene dilemma and the environment dilemma. The gene dilemma focuses on the effect of particular genes on the probability of developing an alcohol use disorder, while the environment dilemma focuses on the effect of different aspects on one’s 1 environment on the onset of alcohol addiction. The commonly accepted theory is a combination of the two that claims that environmental effects interact with genetic factors to influence drinking behavior.

Clearly, this assumes that many times the path to alcoholism starts within one’s childhood. Dramatic developmental changes occur within this period of time, including physiological, psychological, and social changes such as brain development, an 2 evolving sense of self, and the development of relationships with friends​​. When drinking occurs too early (ages 12-14), it disrupts their growth in all these aspects​​.2 During this earlier stage of life, it is mainly the environment that determines the level of alcohol usage​​.³ Such factors include the influence of parents and peers, which are essential when determining levels of alcohol use. For instance, parents who drink 4 more and view drinking more favorably are more likely to have children who drink. Another environmental factor includes the media consumed by adolescents, which tends to heavily affect their tendency to excessively drink. In today’s world, alcohol is promoted through all sorts of media including television, social media, billboards, and the internet, and it was found that 3rd, 4 6th, and 9th graders who found alcohol ads desirable were more likely to view drinking positively. Additionally, stressful events in early life, especially maltreatment or neglect by parents, are significant indicators of excessive alcohol intake in the future.

Overall, people who begin drinking early in life are more likely to become heavy drinkers in adolescence and experience 5 alcohol addiction in adulthood.

Once these adolescents transition to adults is when the switch from environmental to more genetic causes occurs. This is when genes start to affect the onset of alcohol use disorder. Scientists estimate that genetics influence approximately 40-60% of a 6 6 person’s risk to develop alcoholism. Many genes like Per1 and Per2 are associated with increased alcohol intake in mice.

6 People, especially teenagers, with these specific variations are found to follow this trend of excessive alcohol intake. According to a Rutgers University-led study, heavy drinking can even trigger changes in one's genes, like in Per2, causing a greater craving 8 for alcohol. In reality, these are very few of the genes that influence alcoholism. Due to the complexity of the disorder, many genes are involved in its level of onset.

These genetic factors in combination with the environmental factors explain a great deal of the cause for alcohol use disorder.

However, many of the genetic and environmental factors can be intertwined, affecting the onset of the other and leading to alcohol use disorder. This disorder is incredibly complex and there must be significant further research to find its causes in humans in order to discover a way to aid people with the disorder or detect risk factors.

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THE TRUE TRAGEDY OF MIRACLE WEIGHT LOSS ADVERTISING Reem Esseghir

The advent of social media has added a unique layer to the issue of the spread of misinformation, particularly in regard to health. Health misinformation can be defined as any health-related claim not based on scientific evidence, whether it be 1 anecdotal, misleading, or entirely false. It has remained rampant online in the form of health product advertisements, which actively promote unhealthy practices and promise dramatic results without scientific evidence. Social media sites, such as Instagram and Facebook, continue to allow companies selling dangerous and ineffective health products to advertise on their platforms via celebrity promotion or individual pages. Advertisements for merchandise such as weight-loss products pose a significant threat to the physical and mental health of social media users, and platforms need to take greater responsibility in limiting this proliferation of false health information. ​Various types of dangerous health product advertisements can be found across social media, such as diet pills, detoxification teas, and appetite-suppressant lollipops. Common claims for such products include that they “support metabolism and digestion,” “reduce bloat for a flatter appearing tummy,” and “boost energy.” These claims are placed directly on the advertisement, either in an image or a corresponding caption. The images associated with them often include a “before and after” that displays the supposed slimming or weight loss capabilities of the product. However, disclaimers for whether the products being advertised are medically safe or scientifically proven to have that effect are not directly on the advertisement, rather the brand’s main website. An example of a disclaimer offered there is, “The statements on the Site have not been evaluated by the Food and Drug Administration, and the products offered on the Site are not intended to diagnose, treat, cure, or 2 prevent any disease”. The disclaimers show the true essence of the product: that they have not been proven safe or effective by federal standards. ​The unique nature of social media sites is that they have the capability to target advertisements towards specific groups that are 3 likely to consume. In this case, the advertisements target a younger demographic, particularly young women aged 12-18 years old. At this age, they experience lower self-esteem and are more susceptible to developing eating disorders and body dysmorphia, which are exacerbated by exposure to advertisements promoting a certain body image ideal. 4 Psychologically, their heightened vulnerability to believing such harmful advertisements is a result of who is promoting them, high-profile celebrities.

Cognitive psychology studies have shown that celebrity endorsements generate positive reactions and trust from their audience, especially if that celebrity has earned credibility, the credibility here being having the ideal body these products seek to promote 5 and achieve. ​In the past two years, Instagram and Facebook have taken steps towards limiting the exposure of these advertisements to minors. If a person is under the age of 18, they no longer see misleading health advertisements. They have also made it easier to 6 report advertisements to be investigated by the companies. The issue with these new regulations is that it is entirely up to the user to actively work against these major diet companies. It should not be the responsibility of the consumer to report the advertisements, but rather the social media platform should not allow them to be posted in the first place. Further, minors can easily register as older than 18 years old and still be exposed to such harmful advertisements. ​The continued proliferation of these advertisements with limited regulation places users, specifically those prone to developing eating disorders, at risk. Eating disorders pose a direct threat on the physical and mental health of patients, and the Selby Lab here at Rutgers specializes in the treatment and research of various psychological disorders and behaviors, including eating disorders. In “The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease”, Dr. Edward Selby and his co-authors propose various treatment methods of eating disorders, including limitation of eating disorder-promoting content online.7 This further demonstrates the need for better regulation of health-related content and misinformation on social media sites, specifically those of which promote disordered eating and body dysmorphia.

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CANCER IN DEVELOPING NATIONS: A NEW BURDEN Kritika Singh

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American historian and sociologist Steve Shapin once wrote in Cancer World that “the rise in cancer mortality, in its way, is good news".1 Although this statement sounds perplexing, it makes an important point about the prevalence of cancer in developed areas of the world. Cancer is a significant issue in high-income countries because people are able to remain protected against infectious disease and other illnesses, allowing them to live long enough to develop cancer. 1 In a similar vein, in recent years, developing nations have become more equipped with increased access to healthcare and improved standards of living, allowing the population to age more. In 2015, there were 66 million people over 80 years old in developing countries, and by 2030, this is predicted to increase to 2 121 million people. However, this also comes with a disadvantage: people are now growing old enough to develop cancer. 1 According to the World Health Organization, 70% of deaths due to cancer occur in low and middle income countries. 3 Worse yet, for every ten new cancer patients in sub-Saharan Africa, nine die. 4 Why is cancer mortality significantly higher in these areas compared to higher income nations? Numerous factors come into play. First, there is a significant lack of primary care, such as vaccinations for prevention and screenings for early detection. In fact, 80% of cancer patients in developing nations already have 5 incurable disease when first diagnosed with cancer.

Furthermore, cervical cancer, for instance, can be easily prevented through regular screenings and a vaccine against sexually transmitted human papillomavirus, the cause of the disease. However, this cancer is particularly common among women in SubSaharan and West Africa due to the lack of access to these vaccines. Similarly, liver cancer is prevalent in West and Southeast Africa even though the disease can be prevented by getting vaccinated against hepatitis B. 4 A second key factor that leads to such significant health disparities is cost. According to the National Cancer Institute, cancer patients may have to pay outof-pocket up to $12,000 annually just for one drug.6 As of 2012, 11 out of 12 FDA-approved cancer drugs cost over $100,000 per year. 6 As a result, for several low and middle-income nations, many treatments and novel drugs remain inaccessible. The lack of government funding in many nations leaves two options for cancer patients: never receiving treatment because it is not found in the list of governmentreimbursed products or being put on a

waitlist that can last for months, if not years.7 The healthcare expenses due to cancer treatment are already staggering, but there are also additional indirect costs that add greater burden to underserved populations. This includes transportation to clinics and pharmacies, lodging due to patients having to stay long at treatment sites, a lower income due to patients having to take off from work while undergoing treatment, as well as costs due to wigs and cosmetic items.8 The Global Health Institute at Rutgers University has partnered with Botswana in an effort to combat the challenges cancer patients face in developing nations.9 Institute director Dr. Richard Marlink explains why he thinks this issue needs greater attention. He describes the devastating nature of having cancer in a low-income nation, as it puts the patient and the “generations going forward in the family into debt and wipes out whatever economic status” one has.

Considering this, Rutgers’ partnership with Botswana aims to create a national program for cancer care and prevention and to support more research, teaching programs, as well as increasing health care capacity. 9 Hopefully, with more of these programs, there will be increased resources, funding, and infrastructure to support patients suffering from cancer in low-income areas and to close the gap in the disparities that exist between developed and developing nations.

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In recent years, Alzheimer’s disease has come to the forefront of scientific research given how little is known about the 1 neurodegenerative disease despite over 1 in 9 Americans over age 65 being affected. Although definite causes and cures have not been identified, scientists have uncovered the effects of the disease on the brain and potential risk factors. Alzheimer’s specifically destroys neurons in the entorhinal cortex and hippocampus, both parts of the brain dealing with memory, but the disease is also known to affect speech and judgment.2 Beta-amyloid is a small protein known to build up senile plaques and accumulate around blood vessels in the brain of people with Alzheimer’s along with tau tangles, bundles of tau proteins that result from excessive phosphorylation. Where the beta-amyloid peptide originated from was a mystery until a recent discovery

by Dr. John Mamo and his team.

Dr. John Mamo, professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia showed that lipoproteins, fat-carrying proteins in blood, deposit beta-amyloid in the brain through leaks in the 3 brain’s capillaries. This discovery can prompt the development of drugs that target the lipoprotein amyloid, or can encourage physicians to enforce diets low in cholesterol which might prevent or slow the progression of Alzheimer’s.

Mouse models are the primary method used to test hypotheses related to Alzheimer’s. Dr. Mamo’s research team genetically 4 engineered mice in a test group so that their livers would produce human beta-amyloid. Dr. Mamo’s team subjected genetically engineered mice and control mice to memory tests. The mice in the test group performed extremely poorly compared to the mice in the control group. Researchers discovered that when the amyloid-beta combined with fats and were carried to the brain, they tampered with the function of the brain’s capillaries, leading to their rupture and leaking, resulting in brain inflammation. The inflammation occurred in both the test and the control group, but the inflammation occurred in the test group at a much younger age than that of the control group and was associated with neurodegeneration.

While amyloid-beta deposition is the major factor contributing to Alzheimer’s, there are other substances that can bind to amyloid-beta and increase the risk of the disease. Dr. Hyung Jin Ahn, professor at New Jersey Medical School, describes his research about the effects of fibrinogen, a primary protein component of blood clots, binding to amyloid-beta on the development of Alzheimer’s: “Fibrinogen is a soluble protein which circulates in the blood... We found that amyloid-beta and fibrinogen strongly bind to each other, creating abnormal fibrin clots, which are resistant to degradation. They can [cause] occlusion in small vessels and cause inflammation on the blood vessels that may lead to rupture. That is our basic idea of how amyloid-beta and fibrinogen make for Alzheimer’s pathology.”

Current research reveals a significant amount about the nature of amyloid-beta buildup in the brain’s vessels, but there is still work to be done before a safe and effective cure is created. While several drugs have been developed, none of them have been completely successful at curing the disease, only managing its symptoms.5 The process to curing Alzheimer’s may take several years, but recent discovery could be the starting point for Alzheimer’s to go from an untreatable sentence to a preventable and curable disease.

TARGETING AMYLOID-BETA, A PROTEIN RESPONSIBLE FOR Sneha Kandalgaonkar ALZHEIMER'S 8

The COVID-19 pandemic has exemplified the Food and Drug Administration’s (FDA) integral role in maintaining public health in the United States. Established through the 1906 Pure Food and Drugs Act, the FDA regulates drugs, medical devices, food, and biological products. In June 2021, Biogen’s Aduhelm, the first Alzheimer’s drug of its kind, was also authorized through accelerated approval. The authorization of Aduhelm has sparked controversy, prompting many to doubt the FDA approval process and claim that the approval pathway itself lacks transparency.

Aduhelm, also known as aducanumab, is the first FDA-approved drug targeted at Alzheimer’s disease. The drug is an amyloid beta-directed antibody that attacks and reduces amyloid-beta plaques in the brain, which cause Alzheimer’s disease.1 The drug was approved through the FDA’s accelerated approval pathway, a process that is only applicable “for a drug for a serious or life-threatening illness that provides a meaningful therapeutic advantage over existing treatments”.2 During its trials prior to approval, Aduhelm failed to meet objective goals, prompting many to scrutinize the FDA’s approval and contemplate the ethics of the FDA. However, the drug demonstrated strong potential to treat Alzheimer’s by its ability to consistently reduce amyloidbeta plaques.

One of the stipulations of the pathway is that drug manufacturers are required to conduct periodic random trials to ensure that the drug is clinically effective; if the drug fails the trials, the FDA reserves the right to revoke their approval. In late 2020, pharmaceutical company Bristol Myers Squibb withdrew the small cell lung cancer drug Opdivo, also known as nivolumab, after it failed its confirmatory trials. This illustrates the complex nature of drug approval and how the FDA is constantly monitoring drugs to regulate them.3 It is hoped that Aduhelm will confirm its effectiveness when used soon in clinical settings.

Accelerated approval is only provided to drugs if they “fill an unmet medical need ‘based on a surrogate endpoint,’” which insinuates that drugs with advanced approval are deemed to have benefits that are substantial and revolutionary in medicine, outweighing possible disadvantages.4 While some prefer to see a drug’s long-term effects on patients, for many conditions that warrant accelerated approval, time is valuable — some patients may benefit from slight immediate improvements, in lieu of waiting years for a more thoroughly tested option.

In order to ensure the safety of all Americans, it is crucial that there is trust in the FDA and that its decisions are not undermined. Many have argued that the FDA should require pharmaceutical companies to conduct confirmatory trials as a part of the accelerated approval pathway, rather than after receiving the approval.

Dr. Mark Robson is a Rutgers Board of Governors Distinguished Service Professor and Distinguished Professor of Plant Biology.

In regards to the FDA and its decision to approve Aduhelm amidst growing pressure to find a treatment for Alzheimer’s, he notes: The FDA is a government agency with a head appointed by the party in the White House, so it is a very political agency, just like the CDC and the Surgeon General. What bothered many people was that…the FDA should be independent, and instead, in this case, they worked very closely and now they are using the fact that this is such a devastating disease as the basis for this 5 close collaboration.

Though public health is the intersection of policy and medicine, science must still be the driving force of all decisions in institutions like the FDA, and transparency is crucial to maintaining public trust. For now, the world is waiting to evaluate the effectiveness of Aduhelm; if successful, it will revolutionize therapy for one of mankind’s most tragic diseases.

ADUHELM: A CURE FOR ALZHEIMER'S OR AN IMPENDING DISASTER Tulip Sengupta 9

THE NEW PANDEMIC: SOCIAL MEDIA ADDICTION Emam Shamshad

How many times have you checked your phone today? What about in the last ten minutes? If you’re like most people, the answer is probably more than a few.

Over time, technology such as the internet and social media has become an integral part of modern society. Social media has impacted millions of lives across the world, completely transforming how people communicate, connect, and share information. While social media can and does have positive effects, whether it be communicating with others or simply being entertaining, persistent use of these platforms can also have a negative impact. Although this issue can be resolved by limiting social media use, the COVID-19 pandemic has made it very difficult to do so by significantly increasing our dependency on the online world. This recent rise in social media use has sparked concerns about whether or not this dependency has spiraled into something as serious as social media addiction.

So, how can a seemingly harmless hobby turn into an “addiction”? This phenomenon is explained by the dopamine seeking-reward loop, a self-perpetuating cycle that is fueled by dopamine in the brain’s reward system. The reward system refers to a set of structures that are activated whenever we experience something rewarding, such as a positive experience or an addictive drug. 1 After exposure to a rewarding stimulus, the brain responds by increasing the release of dopamine, a neurotransmitter that plays an important role for numerous core functions such as movement control, memory, attention, mood, cognition, and sleep. In the dopamine seeking-reward loop, dopamine is associated with the “seeking” behavior. It motivates people to take actions to meet their needs and desires, as it works to control the 2 movements a person makes as well as their emotional response.

Structures involved in the reward system are found within the brain's four major dopamine pathways, which each have their own associated cognitive and motor processes. The most important dopamine reward pathway is the mesolimbic pathway. When this pathway is activated by a rewarding stimulus, dopamine neurons produced by the ventral tegmental area are activated and projected to the nucleus accumbens. This results in an increased amount of dopamine in the nucleus accumbens, an area associated with motivation and reward, which then triggers feedback for predicting rewards.

The impact of social media use on the brain serves as a prime example of the dopamine seeking-reward loop. Social media is designed to trigger constant dopamine release, making it very easy to become addicted to it. Studies have shown that the constant stream of retweets, likes, and shares from social media platforms have affected the brain’s reward area to trigger the same kind of chemical reaction as other drugs, such as cocaine.3 Similar to using an addictive drug, every like or notification that we receive acts as a rewarding stimulus that activates this dopamine seeking-reward loop and provides us with a brief moment of pleasure. With each stimulation, the brain gradually rewires in such a way that one’s experience of physiological effects decreases for the same amount of time spent on the social platform. The dopamine receptors become overused and worn down from constant use, making it more difficult for people to feel pleasure from everyday activities.

At Rutgers University, behavioral neuroscientist Dr. Joan Morrell has been conducting research on how addictions form and impact the brain. Morrell notes that social media addiction is often due to other underlying issues, stating that “It’s something people turn to, but it’s not the problem itself. For those where it has become an addiction, it could be an escape from such underlying issues as depression, anxiety or other mental health disorders. If things are going on in your life that don’t allow you to meet your goals or are interfering with your ability to sleep, eat well and study, you need to reach out for appropriate help".4 With the transition to virtual learning, it is important to remain conscious of the harmful effects of social media addiction and prioritize your emotional wellbeing by taking frequent breaks and setting clear boundaries for yourself in regards to social media use.

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"DOCTOR" TIK TOK Apurva Navin

We live in a modern world where most of our interactions take place on social media applications. Society uses social media and the internet as their primary source for news and looking up any medical conditions and symptoms they might have. It is an instinct to pick up the phone and scroll through Instagram or Tiktok. Medical journals are open to healthcare professionals, but some may not be available to the general public, who is then confined to reading about their symptoms through Google and social media apps. Social media apps have both advantages and disadvantages for learning new information, and the application of that new knowledge can be detrimental if it is given from a mere ‘influencer’ and not a professional in the field.

According to the DSM-5, the diagnostic manual for mental disorders used by health professionals, symptoms of ADHD include inattention, impulsivity, and hyperactivity, and the criteria for the diagnosis differs between adults and children.

1 Adults with ADHD often experience frustration, depression, anxiety, and difficulty in controlling emotions. These symptoms can often overlap with children having common behavioral issues while growing up or a college student not being able to focus during a lecture because they have an average amount of anxiety, making it difficult to diagnose ADHD. Some symptoms specific to college students with ADHD symptoms include difficulties with college adjustment, self-esteem, and academic issues. The definition of ADHD poses challenges in the medical community because the validity and accuracy of the1 diagnosis lack standardization and can be easily biased. The diagnosis of ADHD through TikTok has emerged as a problem among the medical community for the past year and a half. The prevalence of this neurobehavioral disorder in the United States is estimated at 5-11%, representing almost 6.4 million children 1 nationwide. The TikTok algorithm works in an intricate way where similar videos will pop up on the feed the more someone watches a particular type of video. Consequently, if a viewer watches an influencer talking about their ADHD symptoms often enough, most of the videos on their feed will be related to that.

Tiktok has about 1 billion users and one of these users, a 23-year-old woman named Matilda, found out she really had ADHD through TikTok's algorithm, and although it helped her figure out her diagnosis, the algorithm isn’t guided by a set of strict clinical ethics and its diagnostic techniques are built around viewing time and not DSM-5 criteria. 2 "Learning" you have ADHD on TikTok is such a common phenomenon that there is no hard data, but only symptoms from personal experiences. On the other hand, conclusions from a 2020 study show that institutions should appoint clinicians with strong social media experience to leadership roles to help spread awareness about mental health issues and medical conditions, instead of individuals who do not precisely have a medical degree and are communicating to 3 the public with informal education. Observing the other side of the spectrum, a well-known doctor named Doctor Schmidt uses his TikTok platform to spread educational content about gastrointestinal terminology and any GI issues.

He is often consulted for medical advice on several social media platforms. Although his content is delivered in a humorous way, he is able to break down and explain any misconceptions about any medical issue, specifically about COVID-19 recently. As people watch more content by reputable healthcare professionals, TikTok’s algorithm promotes those videos and helps mitigate disinformation about medical disorders.

The diagnosis of ADHD during childhood, adolescence, and even adulthood has mixed consequences psychologically, no matter what age they are, but when that diagnosis is made by a healthcare professional, it is more comforting to know that medical knowledge was taken into account when making that decision, and not from a TikTok video.

Although barriers exist between those who may not have access to help from healthcare professionals, some of these professionals are posting videos on TikTok and Instagram on specific health content in meme-like forms that include humor. Fortunately, Rutgers University has an Office of Disability Services that has options for healthcare and counseling services that helps students get the proper medication and counseling they need to get through their college courses. ADHD is a significant diagnosis, and universities like Rutgers want to make sure diagnosed students are getting the education they deserve despite the challenges that come with the disorder.

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A BETTER UNDERSTANDING OF ASSOCIATIVE MEMORY Bianca Battaglia

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Our sensations—the means through which we experience the world around us—are often stored in our brain in the form of associative memories, which are a type of declarative 1,2 memory that helps us remember the connections between different things. There are numerous neural and chemical processes involved in the formation of associative memories, though much is still unknown. While previous research indicates that dopamine is involved in reward-based learning, the mechanisms underlying how dopamine influences the entorhinalhippocampal memory circuit—which is responsible for declarative memory-formation—are still relatively unclear. However, recent research published by Nature aimed to address this open question by investigating a new line of inquiry: fan cells, which are cells located within the lateral entorhinal cortex (LEC) of the temporal lobe.

The study focused on measuring the stimulation of olfactory receptors, which are responsible for our sense of smell, and how that in turn led to associative memory formation in mice. At the onset of the experiment, the mice were trained and habituated for procedural learning of when to lick and withhold their licking. Following this procedural learning period, the mice were trained on an odor-cued go or no-go reward association task in which they had to lick or 3 withhold from licking using trial and error, depending on which odor was presented to them.

The mice then experienced multiple rounds of trials, in which new odors were gradually introduced. During the experiment, the researchers used optogenetic testing and electrophysiology cell recordings to control and measure how the mice associated certain odors with rewards. Associative learning and memory were measured by behavioral analysis of the mice, in which the researchers observed their licking behaviors in response to the odor stimuli. 3 The results of the study demonstrated that when the mice learned new cue-reward associations, they separated these novel associations into groups based on whether or not they included rewards. However, when their fan cells were inhibited, the mice’s ability to learn the new odor associations was impaired. Therefore, the researchers ultimately determined that fan cells convert sensory information into task-relevant information before it is sent to the hippocampus.3 Furthermore, the researchers discovered that during the associative tasks, dopamine transmits a reward expectation signal to the fan cells in the LEC. When the dopamine in the LEC was inhibited, however, the fan cells’ associative encoding was interrupted, and learning was impaired. Given these results, the experimenters were able to conclude that fan cells, facilitated by dopamine, are vital in order to acquire new associative 3 memories. Overall, this associative memory research is significant because it provides us with a more comprehensive understanding of the neurobiological and cognitive mechanisms underlying memory formation. Moreover, this research can potentially be applied to developing treatments for neurodegenerative diseases that impair a person’s ability to create associative memories, such as Alzheimer’s Disease. 4,5 One of the most complex organs in the body, the brain is constantly the focus of new and innovative research being conducted all around the world. In fact, similar research is being conducted right here at Rutgers University. The Baker Laboratory for Cognitive Neuroimaging and Stimulation—run by Dr. Travis E. Baker, an Assistant Professor at the Rutgers Center for Molecular and Behavioral Neuroscience—is one of the many neuroscience laboratories that, like this associative memory study, aims to further investigate the processes behind memory and cognitive control. Through their research, which utilizes multimodal neuroimaging techniques to observe, test, and modulate functioning in brain areas such as the midbrain dopamine system and parahippocampal cortex, the Baker Laboratory hopes to improve the 6 psychiatric care of patients whose cognition is disrupted.

A NEW FORM OF THERAPY: SLEEPING Mallika Ravi

Dreams have long been a topic of scientific and cultural fascination because of the mystery of how they work. Little is known as to what specific mechanisms our brains use in order to create these dreams or why their frequency and content seem arbitrary. Neuroscientists have concluded that dreams are a mechanism by which our brains consolidate, recode, and reorganize memories. The prospect of our brains being able to help us process emotional and traumatic memories is a powerful act of protection. New research from UC Berkeley suggests that dreaming during the REM stage of sleep is a form of “overnight therapy.” This model offers numerous insights into our individual emotional and mental health, as well as general human behavior.

While investigating multifaceted, restorative effects on the brain’s emotional health, it is important to consider the myriad of changes that the brain undergoes during the REM stage of sleep when dreaming occurs. Sleep-dependent emotional regulation allows us to reprocess recent emotional experiences. For example, in a study of the retention of positive/neutral emotional memories, researchers found that in “the sleep-deprived group, a severe encoding impairment was evident for neutral and especially positive emotional memories, exhibiting a significant 59% retention deficit, relative to the control condition".³ It is harder to remember positive emotional memories when a person does not consistently enter REM sleep. This can cause great mental toll, especially for those who struggle with sleep abnormalities and other mental disorders. For those recovering from emotional conflict and trauma, dreaming during sleep allows a pathway by which their brains can begin to process these events. The protective nature of the brain is already well established in the neuroscience field, however, the role of dreams in this function is only beginning to be understood. Researchers further postulated a “sleep to remember and sleep to forget” hypothesis. This model suggests that the reactivity of emotional memory dissipates over time, indicating that the brain helps us move on from traumatic events. The tagged memory remains, so important or major moments in our lives can remain in our memory. Sleep deprivation and its harmful effects are mostly understood through the negative physical effects it has on the body, but the affective mental toll it can take is not fully understood.

Without sufficient REM sleep (and thus, dreams), our reaction to and anticipation of emotional events can be severely altered.

A study, examining the role of REM sleep on emotional resilience, was conducted at Rutgers in 2017. Shira Lipkin, a researcher with Rutgers’ Center for Molecular and Behavioral Neuroscience stated that “If you have less REM, then you have less of an opportunity to reduce your overall levels of norepinephrine, which will make you more reactive the next day to a given stimulus".¹ It’s clear that the importance of REM sleep and dreaming cannot be overstated. In addition to building emotional resilience, dreaming allows us to process emotionally charged or even traumatic events. Similar to the treatment plan of a therapist, dreams slowly help balance and restore our resilience. The difference is, our brains do this for us for free, every night.

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Women in the United States today are 3 times more likely to die from pregnancy and childbirth than their mothers were 40 years ago.¹ It’s an incredibly sobering statistic that sums up the state of maternal health for women in America. Maternal health, which is defined as the health of a woman during pregnancy, childbirth, and up to one year postpartum, has been declining for the past 40 years, especially for Black women. In New Jersey, maternal health outcomes are on par with developing nations, consistently placing in the bottom for metrics like quality of care, access to care, and maternal mortality rate. Women in New Jersey, especially low income women of color, are facing worse maternal health outcomes than ever before.

Large disparities exist across socioeconomic, racial, and education groups. In New Jersey, low income women, women of color, women who did not attend higher-education, and women from rural areas are the most likely to experience life-threatening injuries or death related to pregnancy. Black women are the group with the worst maternal health outcomes, being 5x more likely to die during or after childbirth than any other group in the state.² This disparity exists across all economic and social lines, regardless of education levels or socioeconomic status. Black women report receiving a low quality of care and having their medical needs downplayed or ignored. This is a result of the medical discrimination and implicit bias that is wellestablished and present throughout healthcare.

Although New Jersey as a whole is highly-ranked among all states in terms of quality of healthcare, it has the 3rd highest rate of maternal deaths in the nation. The nationwide average of maternal deaths is 20 per 100,000 births, while New Jersey’s is almost double that at 37 per 100,000 births.³ This risk is especially elevated for mothers in New Brunswick, where the rate of post-admission infection and obstetric hemorrhage is double that of other hospitals throughout the state.⁴ New Brunswick is at an inherently higher risk of adverse maternal outcomes, with a documented population of 65% people of color with more than 35% of the population living in poverty.⁵ These statistics do not include the estimated 50% of the New Brunswick population who are undocumented, and therefore do not receive prenatal care or social services intended to help serve mothers.

The reasons for the increase in maternal mortality rate are complex, and almost all of them preventable. The percentage of women living with chronic disease that complicate pregnancy such as diabetes and cardiovascular conditions has risen, with nearly 25% of pregnant women admitted to hospitals in New Brunswick having either condition.⁴ Chronic illness increases the risk of complications before, during, and after childbirth. In addition, the cost of prenatal care has increased, causing 38% of pregnant women to skip prenatal care because of the cost.¹ As a result, many preventable and treatable pregnancy related conditions such as preeclampsia and placental abnormalities are not detected and treated before birth.

Although maternal mortality rates have been declining for years, outcomes for women across New Jersey are starting to look up. Many expectant mothers have been proactive in advocating for themselves by looking into alternative forms of care, such as midwives, doulas, and birthing centers. And as a new focus has been placed on maternal health in recent years, the state and Rutgers University are making efforts towards reducing maternal deaths. The Nurture New Jersey and “Stop, Look, and Listen” campaigns, respectively led by Tammy Murphy and Rutgers University’s Robert Wood Johnson Medical School, are fighting to end maternal mortality.³ These campaigns include raising awareness, increasing funding for prenatal care, expanding Medicaid insurance, and starting a commission investigating maternal deaths. The “Stop, Look, and Listen” campaign also features a free publication that highlights maternal health statistics and how to help the cause. These campaigns have already made strides in reducing the maternal mortality rate in just the last few years they have been implemented.

THE REALITY OF GIVING BIRTH IN NEW JERSEY Rachel Kays

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Cold is the night, and dark, the atmosphere. As lightning cracked and tested the strength of their wooden huts, a large group of villagers gathered outside of one hut. In the midst of the fierce storm, two embodiments of innocence and strength were brought into the world: a baby and a new mother.

In days gone by, for 40 days after the mother gave birth, she would be given hot oil massages, fed with special healing foods, and given proven herbal remedies to strengthen her immune system. These practices were common in Ancient India, Ancient Greece and Ancient Rome. These civilizations all knew the importance of post-birth care for the mother, but does modern day America?

The maternal mortality rate in the US has more than doubled from 7.2 deaths, to 17.4 deaths per 100,000 women in the last 40 years. This means that 2-3 women die because of pregnancy related problems per day in the US.¹ Even though America is a leader in scientific innovations, its women are dying at a higher rate than any other nation in the developed world.³ A biopsychosocial model must be adopted to properly grasp America’s struggle with maternal mortality. To begin with,a large number of American mothers use Medicare, which leads to lower revenue for hospitals. A hospital may continue to lose revenue until the board decides to cut the OBGYN wing from their hospital. This, combined with the decreasing number of OB residents, results in labor and delivery units to be located very far apart in certain areas.¹ Secondly, these high mortality rates mask underlying racial issues and prejudice. Women of color are 3-4 times more likely to die immediately after labor than white women. Finally, perhaps the most impactful factor: America’s unnecessarily high Csection rate.3 1 in 3 women give birth by cesarean section, making the procedure the most popular in the country.¹ While the csection is safer than vaginal birth in certain situations, the overuse of the procedure has led to many preventable deaths. So why then is the cesarean section only becoming more and more popular?

Medical culture has shifted, and doctors seem to prioritize speed over safety. Many c-sections are carried out because, “the fetus just seems large,” seldom offering any benefits for the mother or baby.² Small procedures to turn a breech baby to a head-first position are dismissed for a c-section and labors are induced without any reasoning. The overuse of electronic fetal monitoring, an epidural shot without a dose of synthetic oxytocin, and lying down in bed as opposed to being upright have all shown to be causes of c-sections. All widely ignored by medical professionals. Natural births are unpredictable and take much longer, meaning that a doctor who has weekend plans or wants 8-hours of sleep will perform a c-section. This time advantage translates into a monetary advantage. Not only do hospitals have more time for more procedures, but average “hospital payments are much greater for cesarean than vaginal birth,” offering hospitals more profit.² According to a survey called Listening to Mothers, these incentives are enough to make hospitals and medical professionals unwilling to offer the informed choice of a vaginal birth. However, these issues are rooted in the generations-old problem with American healthcare; the US has only 12 midwives and ob-gyns per 1,000 births. This overwhelming disparity causes doctors to take the steps they are taking, leading to America’s higher maternal mortality rate.⁵ At the end of the day, America does not have the necessary data and resources needed to take care of new mothers; the American medical system has focused more on infant safety than on the mother’s health. In the last decade, at least 20 hospitals nationwide have established multidisciplinary fetal care centers, but only one hospital has a similar program for highrisk moms-to-be1. However, the problems resulting in America’s high maternal mortality rate are all things that can be addressed. As Professor Pamela Valera, a Public Health researcher at Rutgers University said, “a system is a byproduct of the community,”and our communities “have fundamental structural barriers to healthcare”. Breaking these barriers and providing all people with equal, fair, and attentive healthcare is the ultimate goal. While statistics are an important part of the story, there is no way to quantify the gravity of America’s maternal mortality crisis. Mothers deserve to be a priority. Women deserve better.

A MOTHER'S CRY Sathya Gopinath

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ON MULTITASKING: WHAT YOU LOSE BY DOING MORE Allyson Fu

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It’s 10pm, and you just got home from your last club meeting. You have two midterms this week, a fivepage paper due tomorrow, and a new season of your favorite Netflix show waiting to be watched. With so much to do and so little time, how much harm can come from doing it all at once?

Actually, a lot.

Multitasking is trying to do two or more tasks at the same time. On a neurological level, the human brain is not functionally designed for the selective attention required for effective multitasking. Functional neuroimaging studies distinguish specific neural systems that dictate how we multitask: the frontoparietal control network, dorsal attention network, and ventral attention network. As you start a task, the frontoparietal control network is most important because it identifies the goal of your task.

Then, the dorsal attention network interprets that goal and distributes attention to focus on whatever sensory information, inner thoughts, etc. are relevant to accomplishing it. During this time, the ventral attention network functions more automatically and continuously reorienting attention towards relevant incoming stimuli. While each of these networks can work alongside each other given a single task, their collective interaction discourages the brain from handling two or more tasks simultaneously. The frontoparietal control and dorsal attention networks struggle when given goals for multiple tasks, and the ventral attention network is easily influenced by distracting information that competes with the relevant streams of information that the other parts of the brain are processing. Such cognitive inability to process objectives and information associated with too many disparate tasks at once leads to a behavioral method of compensation: switch cost.¹ By continuing to multitask, you sacrifice performance accuracy (efficiency) by switching between tasks. Such “switch costs” negatively affect both the behavior at hand as well as parts of the brain that deal with this repeated change in attention. For example, multitasking while doing work during class is negatively associated with current college GPA: of a surveyed population of 361 college students, those who reported social media usage during class were correlated with lower GPAs to a statistically significant.² In another study that looked at these switch costs on the road, driving performance of young adults worsened as a result of multitasking, and there was little difference between such performance deficits between the younger group and the older one that was tested, indicating that neither group was more proficient than the other.³

In general, errors and poor performance—exemplified by the studies through decreased retention of academic material as well as slower reaction times, inaccurate key pressing, and messier driving demonstrations—that come from multitasking largely arise from having to switch between tasks. Resulting from architectural and functional limitations of the brain, these switch costs are inevitable and even lead to long-term impacts that have been identified in adults.

Comparing younger and older adults, fMRI and behavioral analyses revealed similar habits of neural disengagement (indicating attention reallocation) between the two groups. However, the older group failed to completely reestablish their disengaged neural connections after switching between their key neural networks, attesting to long-term effects of continuing to switch between brain networks (as required by multitasking). In addition to deteriorating responsiveness and memory retention in the short term, multitasking contributes to continued memory disruption and failure to refocus attention for those who perpetuate it.⁴ So while you are dealing with those midterms, that paper, and your watch-later list on Netflix, it is hard to not do everything at once. However, considering the programming of your brain, statistics proving the detriments of switching costs, and long-term neurological effects of dividing attention, it is definitely better to focus on one task at a time.

Perhaps the best way to handle a busy schedule is to divide your time—not your attention.

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Ever had to make a decision based on your gut feeling? Turns out, the connection between our gut and our feelings is quite important. The gut microbiome plays a key role in our neurological well-being. For some, it could be a matter of having debilitating brain disorders like dementia and other cognitively impairing diseases. Researchers have investigated the effect of an unbalanced gut microbiome on neurological disorders like Alzheimer's, Huntington's, Parkinson's, and multiple sclerosis, as well as overall mental health. Findings suggest significant differences in the gut microbiome patients with these disorders as opposed to those who do not.¹ The gut microbiome, consisting of various bacteria and viruses, is an important part of staying healthy. The gut microbiome allows us to absorb vital nutrients from food. The brain and gut closely communicate, as the brain sends signals when stressed, and the gut sends signals that alter the brain through proteins.² This system is known as the gut-brain axis.³ Through the gutbrain axis, proteins and other materials are sent to communicate with neurons. These proteins and materials affect mental diseases like Alzheimer’s and are often involved in triggering these diseases. The pathway of most proteins created in the gut is through the vagus nerve or the bloodstream, which both lead to the brain. For example, when a certain strain of bacteria is added, it can result in creating a protein that causes other proteins to misfold, as in the case of Parkinson’s disease, where a specific strain of E. coli results in the misfolded a-synuclein protein. healthy bacteria vs unhealthy bacteria. Another link between the gut and the brain is the immune system. Microbes in the gut produce inflammatory toxins, for example, in response to a pathogen invading the body. Too much of the toxin can travel through the blood and into the brain, causing illnesses like depression and dementia.⁴ It is evident that the gut-brain axis has ties to many mental disorders.

When the gut microbiome is imbalanced, proteins and other materials transmitted to the brain are altered in a harmful way, producing unwanted side effects. For example, a protein playing a key role in Alzheimer’s is the tau protein, found in the axons of nerve cells. It is vital in forming microtubules, which are structures used to transport nutrients throughout nerve cells. In a person with Alzheimer’s brain, these tau proteins are misfolded into tangles, causing malfunctioning microtubules, and because the nerve cells cannot get nutrients, it leads to cell death and in turn, cognitive impairment.⁵ In a study of the relationship between gut microbiota and Alzheimer’s disease in mice, the transfer of healthy microbiota into the mice affected with Alzheimer’s disease helped correct malformed proteins, specifically amyloid and tau proteins as well as 6 helped correct cognitive impairment. It can be concluded that achieving a healthy gut microbiome can have a positive impact on patients with Alzheimer’s disease.

Research suggests a connection between substances produced or digested by gut bacteria that play a key role in neurological disorders. One example is a study on the effect of caloric restriction on microbiota changes affecting Alzheimer’s in mice by Martin J. Blaser, Professor of Medicine and Pathology & Laboratory Medicine at Rutgers University. Results suggest dietary changes can alter the gut microbiome favorably by controlling the influence of certain microbes that play a key role in 7 Alzheimer’s. Probiotic supplements have also been proven to have positive effects on the central nervous system, specifically 8,9 the bacteria strains Bifidobacterium and Lactobacillus. The overall positive response to probiotic use is confirmed in recent studies, but on an individual basis, it is advised to consult a doctor for one’s personal needs.10 It is certain that research relating to the gut microbiome has given many a hopeful outlook on the future of treating Alzheimer’s and other related disorders, and will continue to yield many promising developments.

THE GUT-BRAIN AXIS: EFFECTS OF MICROBES ON THE BRAIN Shruthi Nandakumar 18

The COVID-19 pandemic has exemplified the Food and Drug Administration’s (FDA) integral role in maintaining public health in the United States. Established through the 1906 Pure Food and Drugs Act, the FDA regulates drugs, medical devices, food, and biological products. In June 2021, Biogen’s Aduhelm, the first Alzheimer’s drug of its kind, was also authorized through accelerated approval. The authorization of Aduhelm has sparked controversy, prompting many to doubt the FDA approval process and claim that the approval pathway itself lacks transparency.

Aduhelm, also known as aducanumab, is the first FDA-approved drug targeted at Alzheimer’s disease. The drug is an amyloid beta-directed antibody that attacks and reduces amyloid-beta plaques in the brain, which cause Alzheimer’s disease.¹ The drug was approved through the FDA’s accelerated approval pathway, a process that is only applicable “for a drug for a serious or life-threatening illness that provides a meaningful therapeutic advantage over existing treatments”.² During its trials prior to approval, Aduhelm failed to meet objective goals, prompting many to scrutinize the FDA’s approval and contemplate the ethics of the FDA. However, the drug demonstrated strong potential to treat Alzheimer’s by its ability to consistently reduce amyloidbeta plaques.

One of the stipulations of the pathway is that drug manufacturers are required to conduct periodic random trials to ensure that the drug is clinically effective; if the drug fails the trials, the FDA reserves the right to revoke their approval. In late 2020, pharmaceutical company Bristol Myers Squibb withdrew the small cell lung cancer drug Opdivo, also known as nivolumab, after it failed its confirmatory trials. This illustrates the complex nature of drug approval and how the FDA is constantly monitoring drugs to regulate them.³ It is hoped that Aduhelm will confirm its effectiveness when used soon in clinical settings.

Accelerated approval is only provided to drugs if they “fill an unmet medical need ‘based on a surrogate endpoint,’” which insinuates that drugs with advanced approval are deemed to have benefits that are substantial and revolutionary in medicine, outweighing possible disadvantages.⁴ While some prefer to see a drug’s long-term effects on patients, for many conditions that warrant accelerated approval, time is valuable — some patients may benefit from slight immediate improvements, in lieu of waiting years for a more thoroughly tested option.

In order to ensure the safety of all Americans, it is crucial that there is trust in the FDA and that its decisions are not undermined. Many have argued that the FDA should require pharmaceutical companies to conduct confirmatory trials as a part of the accelerated approval pathway, rather than after receiving the approval.

Dr. Mark Robson is a Rutgers Board of Governors Distinguished Service Professor and Distinguished Professor of Plant Biology.

In regards to the FDA and its decision to approve Aduhelm amidst growing pressure to find a treatment for Alzheimer’s, he notes: The FDA is a government agency with a head appointed by the party in the White House, so it is a very political agency, just like the CDC and the Surgeon General. What bothered many people was that…the FDA should be independent, and instead, in this case, they worked very closely and now they are using the fact that this is such a devastating disease as the basis for this close collaboration.⁵ Though public health is the intersection of policy and medicine, science must still be the driving force of all decisions in institutions like the FDA, and transparency is crucial to maintaining public trust. For now, the world is waiting to evaluate the effectiveness of Aduhelm; if successful, it will revolutionize therapy for one of mankind’s most tragic diseases.

MELATONIN AND VANCOMYCIN: CAN THIS COMBINATION STOP KIDNEY FAILURE IN ITS TRACKS?​ Sharia Ajmal

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DIVERSITY IN MEDICINE Jay Kavia

Healthcare is impacted heavily by diversity and race, as there is a disparity in the overall health and quality of care available among different racial groups.. As such, diversity is an ever important subject that those in health professions must discuss in order to provide equitable and higher quality care to all.

There is a stark contrast in patient care between different racial and ethnic groups. Patients of color must often wait longer periods for assessment or treatment than their White counterparts.¹ Furthermore, healthcare providers may change their treatment plans depending on a patient's racial characteristics, despite the fact that race often has no effect on the success rate of said treatment. According to the American Bar Association, healthcare providers are less likely to deliver appropriate treatment to people of color even when other circumstances, such as socioeconomic status and overall health, are controlled for.² This implicit bias displayed by healthcare providers can be clearly shown by a study from the National Academy of Sciences: Black patients were found to be significantly less likely than White patients to receive analgesics in the emergency room, even if their pain levels were similar.³ As one can see, the implicit bias of healthcare providers has devastating effects on patient care, as those who may need a certain assessment or treatment plan do not receive it due to being part of a certain race or background.

Individuals of certain races are disproportionately affected by certain health conditions as well. For example, about 21.5 percent of Hispanic adults have been diagnosed with diabetes compared with 13 percent of White adults.⁴ It is thus important that those in healthcare understand these differences, and work towards combating them. Another example comes from the University of Michigan Health System, in which they found that societal factors, rather than genetics, contribute to a 2.5 times higher prostate cancer mortality rate for Black men, compared to White men.5 Thus, although it is important to note that genetics may play a role in health in certain cases, societal constructs of certain races can also contribute to varied health levels across different races.

An expert in this field and Professor of Sociology here at Rutgers, Dr. Catherine Bliss, provides her insight on this topic.

Specifically, she states, “In the last 15 years, we have seen the rise of pharmaceutical companies targeting specific racial groups. There have also been drugs that are specifically labeled to be made for specific racial groups. On this note, these same companies came out a few years later and said that their drug works for those of any race, when their initial marketing did not share this sentiment.” Immoral practices by pharmaceutical companies, on the basis of making a profit, have its foundations set in racial stereotypes, while also providing a basis for which healthcare providers can be implicitly racist by prescribing a patient a specific drug due to it being “made for a certain race”.

With the emergence of diversity and race in global discussion, it is important to understand its role in healthcare.

Diversity has always had a major impact on medicine, and it is becoming increasingly important to discuss this fact openly. Implicit bias and societal factors regarding race has led to a drastic difference in health levels and quality of care among those of different backgrounds. Now is a time for an urgent focus on the impact of race and ethnicity on health disparities, in order to provide more equitable, high-quality healthcare for everyone. Thus, for the betterment of this country, those in all parts of the healthcare system, as in healthcare providers, legislators, and also patients, must acknowledge these differences based on race and ethnicity, and find solutions in order to address these issues.

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BILINGUALS: WHAT MAKES THEM DIFFERENT? Kaitlyn Adkins Healthcare is impacted heavily by diversity and race, as there is a disparity in the overall health and quality of care available among different racial groups.. As such, diversity is an ever important subject that those in health professions must discuss in order to provide equitable and higher quality care to all.

There is a stark contrast in patient care between different racial and ethnic groups. Patients of color must often wait longer periods for assessment or treatment than their White counterparts.¹ Furthermore, healthcare providers may change their treatment plans depending on a patient's racial characteristics, despite the fact that race often has no effect on the success rate of said treatment. According to the American Bar Association, healthcare providers are less likely to deliver appropriate treatment to people of color even when other circumstances, such as socioeconomic status and overall health, are controlled for.² This implicit bias displayed by healthcare providers can be clearly shown by a study from the National Academy of Sciences: Black patients were found to be significantly less likely than White patients to receive analgesics in the emergency room, even if their pain levels were similar.³ As one can see, the implicit bias of healthcare providers has devastating effects on patient care, as those who may need a certain assessment or treatment plan do not receive it due to being of a certain race or background.

Individuals of certain races are disproportionately affected by certain health conditions as well. For example, about 21.5 percent of Hispanic adults have been diagnosed with diabetes compared with 13 percent of White adults.⁴ It is thus important that those in healthcare understand these differences, and work towards combating them. Another example comes from the University of Michigan Health System, in which they found that societal factors, rather than genetics, contribute to a 2.5 times higher prostate cancer mortality rate for Black men, compared to White men.⁵ Thus, although it is important to note that genetics may play a role in health in certain cases, societal constructs of certain races can also contribute to varied health levels across different races.

An expert in this field and Professor of Sociology here at Rutgers, Dr. Catherine Bliss, provides her insight on this topic. Specifically, she states, “In the last 15 years, we have seen the rise of pharmaceutical companies targeting specific racial groups. There have also been drugs that are specifically labeled to be made for specific racial groups. On this note, these same companies came out a few years later and said that their drug works for those of any race, when their initial marketing did not share this sentiment.” Immoral practices by pharmaceutical companies, on the basis of making a profit, have its foundations set in racial stereotypes, while also providing a basis for which healthcare providers can be implicitly racist by prescribing a patient a specific drug due to it being “made for a certain race”.

With the emergence of diversity and race in global discussion, it is important to understand its role in healthcare. Diversity has always had a major impact on medicine, and it is becoming increasingly important to discuss this fact openly. Implicit bias and societal factors regarding race has led to a drastic difference in health levels and quality of care among those of different backgrounds. Now is a time for an urgent focus on the impact of race and ethnicity on health disparities, in order to provide more equitable, high-quality healthcare for everyone. Thus, for the betterment of this country, those in all parts of the healthcare system, as in healthcare providers, legislators, and also patients, must acknowledge these differences based on race and ethnicity, and find solutions in order to address these issues.

21

MEDITATION AND THE ABILITY TO IMPROVE BRAIN SYMMETRY

Caitlyn Colabraro

Meditation, a historical practice that has been used for thousands of years, is becoming an increasingly mainstream practice known to help manage stress. Additional benefits of meditation, for both ill and healthy people, that have been studied for years, include reducing high blood pressure, improving psychological states of cancer patients, reducing symptoms associated with menopause, enhancing smokers’ ability to quit, and reducing depressive symptoms in those dealing with psychological trauma.¹ Most commonly, meditation is being used for everyday stress management. However, recent studies show that there is a connection between meditation and reduction in brain asymmetry, as well as between meditation and increased cortical folding in certain areas of the brain.

It was once thought that people were either “left or right brained.” Although more recent research has moved away from this idea, researchers still acknowledge that there are different skills handled by each hemisphere of the brain. In the left hemisphere of the brain, skills related to language are handled.² While in the right hemisphere, visual and spatial skills are mainly handled.² Analytical and logical thinking is more associated with the left hemisphere, whereas more creative thinking is associated with the right hemisphere.² Since meditation has been known to activate areas of the brain that are not normally active, researchers have spent time observing the changes made to the brain in those who meditate regularly. A study by Kurth et al detected “a decreased rightward asymmetry in the precuneus in meditators compared with controls.”³ The precuneus is an area of the brain involved with a variety of functions such as episodic memory and mental imagery. As a result of the decreased asymmetry in the precuneus, these functions are completed differently and more efficiently. Additionally, the amount of cortical folding (known as gyrification) has been observed between meditators and non-meditators.⁴ Cortical folding refers to the amount of folds found in the cerebral cortex, the outermost layer of the brain. It was found that there are significant differences in the amount of cortical folding between meditators and non-meditators. Those who meditate were found to have more cortical folding in specific areas of the brain linked to voluntary movements and visual processing.⁴ More cortical folding allows for a greater surface area while still allowing the brain to be contained in a smaller volume and has been associated with higher brain function in mammals.⁴ Although connections have been made between meditation and physical changes to the brain, there are many more opportunities for further research regarding the connections between meditation, brain symmetry, and cortical folding. In a 2016 study conducted by Rutgers professors Alderman and Shors, it was found that a combination of meditation and exercise helped to alleviate symptoms of depression.⁵ Observing the physical changes is an exciting new avenue for research where not much has been done yet, but hopefully more steps will be taken in this direction in the near future. As college students, the ability to improve brain function and efficiency through the reduction of brain asymmetry is something that is definitely worth the time and commitment of long-term meditation, and the emotional and psychological improvements that can result make the practice even more worthwhile.

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LEISURE SICKNESS: FACT OR FACTITIOUS? Cielo Tombukon Have you ever had the feeling you were missing an assignment even though you’ve triple checked your to-do list? Or felt guilty when you’re having fun because you should be studying? A person with leisure sickness has experienced all these thoughts, but to an extent that it starts to affect their physical health.

Someone who has never called in sick a day in their life may find themselves suffering from a constant migraine each weekend that miraculously goes away when Monday comes. This description is a prime example of one who suffers from leisure sickness. A Dutch study concluded that amongst 1,128 men and 765 women, 3.2% of men and 3.2% of women recognized leisure sickness symptoms in themselves.¹ These symptoms include headache/migraine, fatigue, muscular pains, and nausea.¹ Based on the study, those who are at high risk tend to have a high workload coupled with an inability to adapt to a nonworking environment, a high need for achievement, and a high sense of responsibility to their duties. In other words, those most likely to develop leisure sickness are workaholics.

Leisure sickness is not yet a verified condition recognized amongst scientists. It has been categorized as a psychological phenomenon rather than a diagnosable medical condition.

As not to confuse correlation and causation, it is important to identify the relationship between stress and this illness. Dr. Jessica Hamilton, Assistant Professor in the Rutgers Department of Psychology, explains, “Both acute and chronic stress, including stress related to work or academics, can take a toll on both physical and mental health. When our body is responding to a challenge (whether it is a physical or mental one), it releases stress hormones, which can create a host of both short and long-term problems that include a weakened immune system (increasing risk of infection), inflammation, tension, digestive problems, and poor mental health.”³ A hindered immune system caused by stress (resulting from the guilt of not working, for example) may be more susceptible to disease, especially in areas that people are at a high risk of contracting disease.5 Symptoms attributed to leisure sickness may therefore actually be caused by the onslaught of pathogens rather than psychological phenomena.

Even though the validity of this disease has yet to be confirmed through further research, it still has real life implications. Methods used to treat leisure sickness can be applied to mediate stressors in general. Simply getting outside and exposing yourself to nature can aid in improving mental status.⁴ Also, a consistent sleep schedule and getting an adequate amount of sleep (8-10 hours a night) and incorporating other relaxation techniques into everyday life (ie. yoga, cycling, meditation, breathing exercises) can alleviate stress.² The key to combating leisure sickness is to treat the stressors, not just the symptoms.

Whenever guilty feelings resurface during a well-deserved break from work, remember that it’s important to have a healthy work life balance.

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Cancer has been an unsolvable riddle for years with no single cure. However, there have been advancements in treatments that have helped destroy or at least mitigate the effects. One form of an aggressive cancer is diffuse intrinsic pontine glioma (DIPG), a brain tumor that affects the pons and makes up 75-80% of pediatric brainstem tumors. The biggest problem when 1,2 battling DIPG is that it isn’t contained and is located a vital part of the brain that make surgical excisions impossible. Right now, there is no current solution to eradicate DIPG, causing it to be the leading cause of brain tumor death among children ages 2-11 years old.³ However, advancements in technology have been paving the way as artificial intelligence (AI) shines a light on a possible alternative to battle DIPG. AI in health has been utilized in the identification of early brain lesions but recent developments have been focused on treatments as well. Currently, researchers seek to improve the statistical models AI runs to figure out the best treatment options for those with DIPG, advancements that can hopefully be extended and utilized in other areas of the medical field.

The gene mutation most commonly associated with DIPG is ACVR1.⁴ ACVR1 is involved in myelination (where myelin cells form around axons to allow for more efficient electrical signal transmission), hence the significant effects when the gene is mutated.5 Like most cancers, radiation therapy is the first method of attack. Shrinking the tumor buys more time but is still a very short-lived solution. Other medications like dexamethasone help reduce the tumor and manage symptoms. However, recently a collaboration between cancer specialists and computer scientists resulted in AI computing the best possible treatments for specific patients. The company BenevolentAI used AI to develop a biomedical knowledge graph that illustrated relationships linking diseases, current biological mechanisms, and drugs utilized to combat said diseases. By utilizing this graph, the AI can propose drugs that are able to cross the blood-brain barrier and allow attacks against the ACVR1 mutation. 6 Although not every child with DIPG has the ACVR1 mutation, artificial intelligence can use similar techniques to propose treatments for other mutations.

Interest in AI in the field of medicine has caused increased studies that hope to use AI to combat other diseases. At Rutgers, there have been many lectures that have delved into the subject, such as the recent "Emerging Technologies using AI in Life Sciences & Medicine'' talk by Dr. Paul Weber. The event aimed to teach more about the increasing use of AI and machine learning in the world of healthcare while also hoping to inspire students to create possible solutions of their own.7 In another interview, Dr. Zeeshan Ahmed believed that new advancements in technology, especially in AI and machine learning, have allowed for faster processing of data that would allow for a better understanding of human biology. The lab developed the app PAS that allows for quicker searches within the medical database, be it diseases, drugs, etc. 8 By intertwining technology and health, more advancements have been made while also inspiring the newer generations to adapt and innovate in this updated landscape.

The use of AI technology to battle medical anomalies used to be unimaginable decades ago. However, the impressive advancements have made it an invaluable tool in the medical world. Even today, it can be used to help combat cancers that used to be a death sentence, giving the helpless a fighting chance. Many schools, including Rutgers, are striving to meet new heights as they hope to inspire more people to find a way to further unite AI, computer science, and medicine.

UNITING AI WITH MEDICINE TO FIGHT PEDIATRIC CANCER 24

Marial Malabag

In August 2021, China made a firm stance against gaming by almost completely cutting off exposure entirely. By restricting activities in minors to 8-9 PM on Fridays, weekends, and public holidays the government hopes to “‘prevent the addiction to online games, and protect the healthy growth of minors'".¹ The idea that you can get addicted to video games is not a new one, and has been recognized recently as a bona fide issue according to many specialists. Though the DSM-5 currently does not list internet/gaming addictions as mental disorders, it does list it as a future consideration; the ICD11, a psychiatric manual published by the World Health Organization, does officially include gaming disorders as an official diagnosis. However, it is difficult to make substantive decisions towards curbing the issue with the limited attention the issue is currently receiving. In collaboration with Dr. Vivien Wen Li Anthony, a faculty member at the Rutgers School of Social Work, this article aims to better understand what a gaming addiction is, how it compares to traditional addictions like substance abuse disorders, and what kinds of interventions are effective against it.

What many people do not know is that problematic gaming behaviors are clinically and physiologically similar to substance abuse disorders. According to Dr. Anthony, many of the classical signs of addiction used to define substance abuse disorders like loss of control, preoccupation, tolerance, craving etc. are found in those with problematic gaming behaviors. Withdrawal is one of the more obvious signs, and though there are no physical withdrawal symptoms as there are with substance abuse disorders, 2 psychological withdrawal symptoms such as irritability, sleeping problems, depression and more are very common. In one particular study, researchers presented visual cues (images of a game) to Chinese speaking, male subjects who were self-labeled as “addicted” to the game World of Warcraft. While these subjects were undergoing fMRI the researchers noticed activation of a variety of similar brain areas to substance abuse, including the orbitofrontal cortex, nucleus accumbens, anterior cingulate gyrus, and the caudate nucleus among others.³ These observations were in-line with the subjects reporting a “craving” sensation to play the game.

If problematic gaming behaviors present similarly to greater perceived threats like substance abuse, logically the next step should be to assume that there are appropriate interventions for them as there are with substance abuse disorders. There seem to be a wide variety of interventions that are actively being studied, especially for adolescents: these include medication (for attention and impulsivity, but also for anxiety), cognitive behavioral therapy, mindfulness-based therapy and family therapy among others. However, a review of these methods (many of which are within Asia) do not meet the criteria for evidence-based treatments.⁴ For this reason, Dr. Wen Li believes that the ban is beneficial, as without reliable treatments, limiting gaming activity will assuredly result in a decrease of problematic gaming behavior as at-risk populations receive less exposure to develop such disorders.

While we’re stuck limited by our ability to study this phenomenon, what are some other solutions we can employ? Primarily, teaching consumers how to engage in responsible gaming activity is a must as with any potentially addictive product. Future legislation would do well to mandate further accountability from gaming companies to prevent addiction going forward. Dr. Wen Li recommends a strategy adopted by gambling companies that allow users to set their own time limits or inform users that they are playing for “too long,” a strategy that is already being employed by companies like Nintendo and XBox.² Early education to help parents and children identify and prevent problematic gaming is another must, especially since many parents are unfamiliar with what gaming is and how it engages their children.² With gaming becoming increasingly mainstream, it is important to acknowledge that it has its benefits and its flaws, and understanding them individually is necessary to prevent the unintended consequences that come with it.

JUST ONE MORE: ADDICTION IN ITS MANY FORMS Ayaan Memon

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LYME DISEASE, POST-TREATMENT LYME DISEASE SYNDROME, & CURBING THE RISING CASES Kayla Vuoso In North America, there’s a “backyard epidemic,” and many people do not know about its prevalence and severity until diagnosed. According to the Centers for Disease Control and Prevention, Lyme Disease (LD), a vector-borne disease transmitted by black-legged ticks, affects roughly 30,000 people each year, but this number is likely underreported. The actual statistic is estimated to be upwards of 440,000 cases a year.¹ If infected, oral antibiotics may cure Lyme Disease within two to four weeks.² However, some people may continue to experience symptoms outside that time, resulting in a diagnostic phenomenon known as Post-Treatment Lyme Disease Syndrome (PTLDS).

PTLDS is a medical discovery that evaluates the quality of life after completing the treatment recommended for LD. PTLDS is an autoimmune response that results in symptoms lasting longer than the infection itself.² Textbook LD symptoms may include fever, chills, headache, fatigue, muscle, and joint aches, swollen lymph nodes, and an erythema migrans rash.² Within six months post-treatment, PTLDS may develop in patients as persistent nonspecific symptoms, including musculoskeletal pain, fatigue, dysesthesias, and neurocognitive deterioration.² When patients experience misdiagnosis or do not get prompt treatment for PTLDS, the delay in care increases risk factors for the severity of the illness, such as neurological symptom development.³ Given that PTLDS records sparse yearly cases, there is a charged debate of its existence within the world of chronic disease medicine.

Due to a lack of worldwide acceptance of PTLDS, critical questions remain about defining, diagnosing, and treating the condition.

Researchers suggest that the lack of global acceptance of any medical condition leads to “poor patient health, discomfort, additional expensive diagnostic testing, lack of health care effectiveness, and deterioration of the doctor-patient relationship.”⁴ Reoccurring LD education and the associated PTLDS is necessary to reduce disease burden and transmission for further acceptance and treatment options. Dr. Alvaro Toledo, an Assistant Professor for the Department of Entomology at Rutgers University, and a researcher at the Center for Vector Biology investigating the impact of hypercholesterolemia in the pathogenesis of LD emphasizes: “Despite the significant advances in diagnosing and treating Lyme Disease, some questions, such as the basis for Post-Treatment Lyme Disease Syndrome, remain unsolved. Further research is needed to better understand the pathogenesis of Lyme Disease, which ultimately will improve patient health outcomes.”

However, Dr. Toledo advises that preventative measures are still the best way to reduce the prevalence of LD. As of 2018, New Jersey implemented LD curriculum guidelines for public schools to prevent LD transmission and openly provided the curriculum 5 to endemic areas. Even a short in-class program that includes “awareness and knowledge about the disease, benefits of preventive behavior, and confidence in [the] ability to perform preventive behaviors can improve knowledge, attitude, and selfreported precautionary behavior among at-risk children." 6 A study evaluating the program found that intervention students improved their overall knowledge score more than control students, allowing them to yield self-efficacy answers such as doing tick checks and identifying ticks on themselves.6 While New Jersey has adopted a public school curriculum for LD prevention, these interventions need administration nationwide to alleviate the rising number of LD cases each year. Furthermore, continued research to understand LD will help recognize its effects on people, leading to widespread acceptance of PTLDS. Both tick bite prevention education and clinical research are crucial to reducing yearly LD diagnosis and the associated PTLDS. By ensuring that civilians become knowledgeable in preventative LD measures, we can create a unified effort between scientists in reducing the rise in LD and PTLDS diagnosis.

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CYTOKINE CONTROL: A GATEWAY TO IMPROVING CARDIOVASCULAR CARE IN A GLOBAL PANDEMIC Rudra Joshi

Over the past century, cardiovascular diseases have become the leading cause of death in the United States. In the effort to effectively prevent and treat cardiovascular conditions, the United States has continuously made immense progress through new interventional cardiology innovations, personal devices to track our daily activities, and robust diets. However, the COVID19 virus has recently posed a new threat to our progress in treating cardiovascular conditions. COVID-19, while a respiratory illness, can damage cardiovascular tissue and cause complications while the patient is recovering from COVID-19 and even after the patient recovers from the condition.⁴ In a study of 191 patients from Wuhan, China who had acquired COVID-19, 17% of the survivors presented with some form of heart injury or increased risk of heart injury. Studies later performed on larger cohorts of COVID-19 patients in the United States have displayed a 36% myocardial injury rate post-recovery.¹ While myocardial injury could have been caused by other complications that developed as a result of COVID-19, including respiratory failures and pulmonary embolism, recent studies have explored ways that the COVID-19 virus can trigger certain biochemical responses that could actually damage myocardial cells post-recovery.² When any virus infects a human body, the virus triggers an immune response where chemicals, known as cytokines, are released into the bloodstream to signal immune cells to retaliate against the virus. COVID-19, specifically, elicits the production of too many inflammatory cytokines in the human body, causing the uncontrolled activity of the immune system. Thus, a cytokine storm release occurs. Ultimately, the immune system can attack other cells in the human body and inflict myocardial damage, causing permanent cardiovascular system collapse.² However, such cases of cytokine storm release syndrome is not unique to COVID-19: Other viral infections, including Ebola, have elicited these cytokine storm responses in the past, leading to complications, including myocardial damage as well. Similar to COVID-19 patients with cardiovascular diseases or developing conditions, individuals with underlying conditions who have acquired particular infections present cases of cytokine storms, increasing their chances of cardiovascular complications and conditions in the long run.

As variants of the COVID-19 pandemic continue to develop, the biomedical community is currently working on ways to prevent cytokine storms in patients with particular infectious diseases. For instance, at the Rutgers Biomedical Engineering Department, Dr. Martin Yarmush’s lab is currently examining the biochemical processes of cytokine storms and developing therapeutic strategies to control these cytokine storms for patients with particular infectious diseases. Delivering specific drugs to block the chemical pathways associated with a cytokine storm, doctors could significantly decrease the patients’ mortality risks and the patient’s chances of cardiovascular complications post-recovery.³ With infectious diseases becoming an inevitable part of our daily life, these therapeutic advancements will not only become essential in the effort to avert cardiovascular complications, but to also promise a better outcome for all patients with any lethal variant of infectious diseases in the future.

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FACE YOUR FEARS: VIRTUAL REALITY THERAPY Nidhi Gourabathuni

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The world of abnormal and irrational fears may be one that doesn’t appear to disrupt the daily lives of individuals. However, phobias regularly continue to prevent otherwise healthy individuals from performing tasks and connecting with others. If unregulated and untreated, these phobias can progress and become incredibly serious and diminish an individual’s quality of life. Specific phobias include agoraphobia, spiders, heights, social phobia, and patient anxiety. Today, exposure therapy, Virtual Reality, and phone applications make it easier for individuals to process fears and gain confidence in real situations.

Automated Virtual Reality therapy is a form of cognitive therapy that is designed to help people overcome anxious avoidance and build confidence in common social interactions such as those that exist within cafes, shops, and the doctors.¹ It involves a virtual coach that is used to guide the person through the treatment. It creates similar emotion and cognitive responses as well to imitate real world scenarios as much as possible. Researcher Jessica Bond and colleagues conducted trials with more than 50 people experiencing psychosis to contribute to the therapy process.¹ This form of therapy also exists within the walls of children's hospitals, where clinical trials illustrate how virtual reality can help to reduce pain and signs of anxiety with children who have to undergo intravenous catheter placement. As “stress... causes veins to constrict,” keeping a child’s mind at ease is important.¹ Within this trial “patients in one group used VR… while those in another group received standard of care, which includes simple distraction techniques and the use of a numbing cream. The patients who used VR reported significantly lower levels of pain and anxiety.”² The realm of technology continues to make it easier for patients to receive treatment and support. Developed by the researchers at the University of Basel, virtual reality apps such as “Phobys”

are available on any individuals phone to download.

This app was used to reduce fear of spiders, recognizing that “approximately 5% of the general population experiences a debilitating level of discomfort in height situations."¹ It included a trial of 47 participants who voluntarily spent time training with the app and built a tolerance to better handle real situations. The app uses 360 degrees images of real locations, which are captured using a drone.³ This form of therapy at home allows treatments to become more easily accessible and tailored to specific phobias and needs, creating confident individuals and positive results.

Fear-related anxieties and phobias present themselves in many different ways. At Rutgers University, Dorothy W. Cantor, a psychologist and Rutgers Alumni along with several colleagues polled 800 people between March and April 2021 regarding anxiety related to the ongoing pandemic and its effects. The survey found “their concerns and hesitancy relate to resuming prepandemic activities, such as dining out, traveling and attending in-person events.”¹ In addition, almost 75% of these participants had not previously experienced symptoms of social anxiety and phobias. 5 While these issues may not appear debilitating, having anxiety plays a big role in the normalcy and quality of an individual's life. The Rutgers Graduate School of Applied and Professional Psychology continues to assist and treat problems such as PTSD, Phobias, and Panic Disorders, to name a few.¹ The field of research and medicine holds many possibilities to tackle issues in a more personable manner, with different forms of therapy and preventing phobias from taking over someone’s life. Creating virtual forms of therapy and accessible apps continues to break barriers in healthcare and offers multiple treatment plan options for individuals to receive an equal level of treatment and care to process and face their fears.

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EXTRA BONE HARMS AMPUTEES? A PATIENT-FIRST RESEARCH APPROACH Gnaneswar Chundi

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When you think of an amputee, what comes to mind? A simple search on Google Images for the word “amputee” brings up pictures of people with missing limbs, prosthetic devices, and Paralympians racing down the track. What these images have in common is that they largely focus on restoring the limb function that an amputee has lost. Likewise, most research that has been done to help amputees focuses on restoring their limbs. The alternative—removing bone from amputees— seems counterintuitive. Surprisingly, new research at Rutgers aims to do just that: helping amputees by—ironically—stopping the growth of new bone.

Paradoxically, the growth of new bone at sites of amputation is a serious problem for amputees, called “heterotopic ossification.” Heterotopic Ossification (HO) is the formation of bone in places where it is normally not found, such as in muscle and soft tissues, and is commonly seen in combat-related amputations, traumatic injuries, and blast injuries. While HO has several causes, traumatic HO is most common and on the rise due to modern warfare tactics.¹ HO causes pain, reduces range of motion, and even makes it harder to fit prosthetic devices at amputation sites.² Current treatments include administering anti-inflammatory drugs and low-dose radiation; however, these don’t always work, resulting in periodic surgeries to remove the new bone every time it grows back, a process which is painful and results in extended recovery times.¹ Therefore, a need exists for a novel treatment strategy to mitigate HO. A research lab right here at Rutgers aims to meet this unmet need by taking conventional tissue engineering practices intended to induce bone growth, and “reverse engineering” them to create a scaffold that can instead stifle abnormal bone growth.³ The scaffold begins with the selection of biomaterials that biodegrade at a desired rate. As they degrade, the biomaterials are designed to release acidic byproducts that can prevent and dissolve bone mineralization, effectively stunting the growth of new bone. These biomaterials then get assembled with 3D-printing into a scaffold with small pores that allow for controlled release of those acidic byproducts. After this step, the scaffold ends up as a ceramic, bone-like material that can be implanted near the site of amputation where it will act to prevent bone growth.³ Dr. Kristen Labazzo, the principal investigator, conducts her research at the Biomedical Engineering Building. According to Dr. Labazzo, as of October 2021 the scaffold is being designed and tested in vitro. In an interview, Labazzo recollected how she happened upon the idea that inspired this project. “I begin many of my projects by going to the patient first and then generating a solution, instead of finding a solution for a problem that doesn’t exist,” she explained. This time, while visiting the JFK Prosthetics Laboratory in Edison, NJ, she noticed that patients were complaining of stiffness and pain at the site of amputation while donning and using their prosthetic. While most current research regarding amputees focuses on prosthetics, the doctor from JFK told Labazzo that the patients were dealing with HO, something Labazzo learned was a relatively common problem as well. “I asked if they had tried using a biomaterials approach to treat HO and he said no. That’s how it hit me. We could use some of the tissue engineering and biomaterials methods I teach my students about and ‘reverse’ them to treat this problem.”

Ultimately, Labazzo’s unconventional yet effective approach to finding research ideas led to research that may yield an unconventional yet effective treatment for HO. The next time you are trying to solve a problem, try going to its source. You may find an unorthodox solution that works nonetheless—such as helping amputees by stopping bone from growing back.

THE THREAT OF CLIMATE CHANGE ON PREGNANCY AND INFANT Anjali Patel DEVELOPMENT Air pollution poses a major threat to the healthiness of people around the world, and is the largest environmental contributor to early death.¹ Air pollution is the contamination of the environment by chemical, physical or biological causes, altering the natural atmosphere.

Globally, air pollution is linked to over seven million deaths per year.² In the United States (US), more than 135 million people are regularly breathing in air with dangerous ozone pollution, with communities of color being three times as likely to live in more polluted areas.³ The public health implications for air pollution are far reaching, but, more specifically, it has been linked with severe complications during pregnancy and infant development, like increased rates of low birth weight and premature births.⁴ Low birth weight occurs when a baby is born at less than five pounds and eight ounces.

Premature births, which could also be a cause for low birth weight, are births occurring more than three weeks before the estimated due date for the infant. Unfortunately, air pollution has been linked with an increased number of babies being born prematurely or with a low birth weight. A systematic review conducted in the US analyzed over 32 million births and found a statistically significant association between fine particles, ozone, and heat exposure with adverse obstetrical outcomes of preterm birth, low birth weight, and stillbirth. The review also indicated communities of color are more at risk. Black mothers are more likely to have preterm births or babies with low birth weight, due to the fact that 5,6 Black people face a higher risk from particle pollution. Dr. Emily Barrett is an associate professor of Biostatistics and Epidemiology at Rutgers University New Brunswick. Her research analyzes how exposure to environmental chemicals during pregnancy relates to reproductive development, neurodevelopment, and growth in childhood. She states, “We’re increasingly seeing the combined impacts of social stressors and air pollution on health outcomes like low birthweight may be even worse.”

These unfavorable birth outcomes have long lasting implications, and are linked with long term developmental and health problems. For example, babies with low birth weights often have trouble eating, gaining weight, or fighting off infections. It also causes a host of other health issues, including difficulties breathing, bleeding in the brain, and jaundice.

Babies born prematurely or with low birth weights are also more susceptible to developing conditions later in life, like diabetes, heart disease, high blood pressure, intellectual and 7 developmental disabilities, metabolic syndrome, and obesity.

It is clear air pollution has a harmful effect on fetuses. Current efforts in place to reduce air pollution include passing regulations and various public health efforts to ensure indoor spaces are free of contaminants. However, air pollution must be drastically reduced worldwide to mitigate the effect of pollution on pregnancies and prevent adverse obstetrical outcomes.

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THE THREE-BODY PROBLEM: THE RELATIONSHIP BETWEEN OUR BODIES, BACTERIA, AND PHAGES Medha Satti For decades, we have witnessed the exponential rise in antibiotic resistance. However, as antibiotics are the only commercially available drug against bacterial infections, there have been great efforts in identifying potential alternatives to antibiotics. One such alternative is bacteriophage therapy. Over the past few years, these bacteria-killing viruses have gained popularity in being indisputably efficient. While phages are able to efficiently eradicate bacteria, what can be said of their impact on the human immune system?

In order to understand these interactions, it is essential to recognize why phages are administered in the first place. At first, phages had been considered optimal as they were initially thought to be undetectable and irrelevant to the immune system. Yet, it is now understood that being exposed to large enough doses of phages can trigger the immune system to produce anti-phage antibodies.

In a study conducted on the human immune system’s response to phages, it was found that “the innate immune system… could be a mechanism for removing phages that are circulating in the human body.”¹ There are many implications of the immune system eradicating the administered phages; notably, because the immune system is fighting against phages, it reduces its ability to work with these phages to eradicate bacteria. In contrast to the immune system being the primary aggressor, phages have been also found to be able to penetrate human cells. For instance, in an experiment conducted by Zhang et al., the lytic phage species, vB_SauM_JS25 (which kills methicillin- resistant S. aureus inside bovine epithelial cells) can also penetrate into the nucleus of bovine immune cells.² This may indicate a potential minor parasitic relationship between immune cells and phages, where the phages penetrate the immune cells and the immune cells attempt to eradicate foreign phages. Despite this parasitic relationship, the penetration of the bacterial membrane by the phages can also increase the immune system’s defensive response to the pathogen. This is because the phages will coat the bacterial cell which alerts the immune system even more. Therefore, not only does the phage lyse the bacteria, the immune system is able to help eradicate the bacteria.³ The phage reduces the cytotoxic effect of the pathogen, as well.

To say the least, the relationship between phages, bacteria, and the immune system is complicated: it is both antagonistic and mutualistic. It is well-known that phages have a profound impact on bacterial pathogens. They are even supportive of the human immune response. To a lesser degree, however, phages have been found to be harmful to granulocytes and monocytes.

Even so, the immune system has also been seen as harmful to phage efficacy against bacterial cells. With this perpetually shifting parasitic relationship, it is difficult to say what needs to be changed about the current use of phage therapy. Most specialists are focusing on the precise dosage of phages in a cocktail that will be an effective antimicrobial treatment, but not enough to alert the immune system. At Rutgers, Dr. Severinov is currently studying how CRISPR can be used in phages. Genes which allow phages to act malevolently toward human cells can be altered to lessen this impact in humans. Genetic modification of the administered phages could be the key to ameliorating the parasitic relationship between the immune system and phages. Ultimately, the current three-way relationship between phages, bacteria, and human cells provides interesting insight into not only cell-virus antagonism, but also how viruses like phages could be used to treat multidrug-resistant bacterial pathogens.

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Nikita Nair

THE RACE TO REHABILITATION: THE PSYCHOSOCIAL ASPECTS OF SPORTS MEDICINE

Injuries are an inherent aspect of participating in physical activity or athletics. Upon receiving an injury, the common stereotype indicates that players must immediately return to play as soon as possible due to their competitive nature and commitment to the sport. However, this stereotype can oftentimes result in further complications. One of the many rehabilitative measures that is often overlooked is the psychological impact of a sports injury. From an intensified fear of re-injury to a lack of self confidence upon return to the sport, these heightened feelings can deteriorate a student athlete’s mental health. Athletes who rush rehabilitation and do not allocate the proper time and resources to the recovery process can incur further injuries. The external pressures that surround student athletes can lead to the presence of psychosocial mental health issues resulting in intensified fear of re-injury upon return to play, a lack of self confidence or identity, or emotional distress.

Along with the praise of being a student athlete follows the demand of balancing academic success with athletic performance and maintenance of interpersonal relationships. The pressure to pass certain classes and uphold certain GPA requirements adds on to the already stressful commitment of being a student athlete.¹ As an athlete, one’s commitment to the sport creates internalized pressures and fears if these standards are not met. Furthermore, athletes can suffer from physical and emotional exhaustion as a result of overtraining, thus contributing to the onset of mental health illnesses. A study conducted by the European College of Sports Science described a clinical diagnosis known as Overtraining Syndrome (OTS), which is the bodily response to excessive physical activity without sufficient rest breaks; this results in a decline of multiple body systems and muscle fatigue.² Overtraining not only takes a physical toll on an athlete, but also leads to mental exhaustion and emotional distress. Moreover, being an athlete takes away time from maintaining and forming interpersonal relationships with family and friends. Essentially, all of these factors can deteriorate the mental health of a student athlete.

The culmination of stress and the intense pressure to return back to the sport typically causes athletes to return prematurely, affecting not only their mental capacity but also increasing the risk of reinjury. Anxiety, anger, and treatment adherence problems were among the most common responses after injury in a questionnaire posed to student athletes and 47% of the respondents believe they experienced psychological trauma firsthand.³ When players are faced with an injury, athletes may often feel a combination of emotions including anger, resentment, fear and disappointment. In extreme cases, athletes who are faced with permanent injuries may feel a loss of identity, purpose, or self-confidence. It is imperative for athletes to seek counseling, rehabilitative services, and support from family members and friends in these circumstances.

At Rutgers University, the birthplace of college football and a major member of the Big 10 League and other D1 NCAA sports, there is an emphasis on athletic achievement that trickles down to the student athletes, placing immense pressures on them. Here at Rutgers University, there are several different counseling services available including Counseling, Alcohol and Other Drug Assistance Program & Psychiatric Services (CAPS) and Health Outreach, Promotion, and Education (HOPE).⁴ These services allow student athletes to get in touch with healthcare professionals to discuss any post injury stress, psychological issues, and the overall return to play strategy.

The external pressures that surround student athletes, from academic standards to physical stressors, and even maintaining meaningful relationships can affect the psychosocial aspects of student athletes. Since injuries are an inevitable aspect of physical activity, we must continue to holistically and properly rehabilitate student athletes, with an emphasis on mental health.

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2. Children's Hospital Los Angeles. (2021, August 25). A game changer: Virtual reality reduces pain and anxiety in children. ScienceDaily. Retrieved November 22, 2021 from www.sciencedaily.com/releases/2021/08/210825143034.htm 3. University of Basel. (2021, February 10). Virtual reality helping to treat fear of heights.

ScienceDaily. Retrieved November 22, 2021 from www.sciencedaily.com/releases/2021/02/210210133317.htm 4. Schumann, M. (2021, September 14). Rutgers alumni, graduate student suggest new term for anxiety about returning to the "New Normal". Rutgers University. Retrieved November 23, 2021, from https://www.rutgers.edu/news/rutgers-alumni-graduate-student-suggest-new-term-anxietyabout-returning-new-normal-0.

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Photo: James Yarema Extra Bone Harms Amputees? A Patient-First Research Approach at Rutgers BME 1.Heterotopic ossification. Craig Hospital. (2015, January). Retrieved December 3, 2021, from https://craighospital.org/resources/heterotopic-ossification.

2. Shehab, D., Elgazzar, A. H., & Collier, B. D. (2012, March 1). Heterotopic ossification. Journal of Nuclear Medicine. Retrieved December 3, 2021, from https://jnm.snmjournals.org/content/43/3/346.long.

3. Labazzo, K. (n.d.). Research Interests. Research – Kristen Labazzo. Retrieved December 3, 2021, from https://sites.rutgers.edu/kristen-labazzo/research/.

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Photo: CDC The Race to Rehabilitation: The Psychosocial Aspects of Sports Medicine 1. Lopes Dos Santos, M., Uftring, M., Stahl, C. A., Lockie, R. G., Alvar, B., Mann, J. B., & Dawes, J. J. (2020). Stress in Academic and Athletic Performance in Collegiate Athletes: A Narrative Review of Sources and Monitoring Strategies. Frontiers in sports and active living, 2, 42. https://doi.org/10.3389/fspor.2020.00042 2. Kreher, J. B., & Schwartz, J. B. (2012). Overtraining syndrome: a practical guide. Sports health, 4(2), 128–138. https://doi.org/10.1177/1941738111434406 3. Clement, D., Granquist, M. D., & Arvinen-Barrow, M. M. (2013). Psychosocial aspects of athletic injuries as perceived by athletic trainers. Journal of athletic training, 48(4), 512–521. https://doi.org/10.4085/1062-6050-48.3.21 4. Medical & Counseling Services. http://health.rutgers.edu/medical-counseling-services/.

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