Examiner Spring 2023, Vol. 27

FEATURED:

Did your doctor not tell you something about your antidepressant?

Forever chemicals: A hidden health hazard

Protecting those who protect

Erin Oxnam Heather O'Donnell Caitlyn Colabraro

SPRING 2023

Letter from the Editor

SPRING 2023

Dear reader,

It is my pleasure to unveil our Spring 2023 issue. In this issue, we cover some of the most relevant and forefront topics in medicine including racial biases in healthcare, developing cancer therapies, and healthy sleep schedules. Our goal has always been to inform our readers of these important issues and developments. We hope that being more aware of medical news will allow the community to understand healthcare in ways that best help them and the people around them.

This issue concludes our first year fully back in person. We have had many amazing moments as an organization this semester with fun icebreakers that get us out of our seats to intellectual discussion, such as our most recent event hosted by Dr. Haviland, Director of the Undergraduate Office of Life Sciences at Rutgers. Despite our busy schedules and lives, it is always inspiring to see all of us come together every Monday night to craft this journal piece by piece while having a slice of pizza.

Many seniors a part of this club, including myself, will be graduating and moving on to the next chapters of our lives this May. While it is bittersweet to leave The Examiner after four years of writing, laughing, and learning, I am thrilled to see what this organization does next. The incoming eBoard and journalists are truly special, and I have complete faith in their ability to continue to make an impact on the Rutgers community through every article. I hope that everyone who remains in the journal can experience even a fraction of the amount of joy that I have had being part of this organization.

On behalf of all of us here at The Examiner, enjoy reading.

THE INFLUENCE OF MEDIA ON CHILD DEVELOPMENT Alexa Dakrat

During their first three years of life, a toddler’s brain triples in volume as synaptic transmissions are constantly created in their developing brain. The minds of children require stimulating environments that promote creativity and allow them to hone their problem solving skills. In this digital age, children’s media has psychological implications that are both advantageous and damaging. Beneficial attributes of children’s media may consist of an early development of learning skills, while drawbacks include the lack of representation in different socioeconomic statuses and negative gender stereotyping for growing, vulnerable children.

Studies have shown that children are stimulated from watching television shows, leading to an increase in their learning abilities. A 30 year study from Routledge examining the television show, Sesame Street, highlights scenes that immerses children in such experiences, “...on topics ranging from nutrition, to space, to the way crayons are made.” Evidently, the situations that Sesame Street depicts teach children about their health, real world facts, and even prompt thinking about how everyday objects are created. Children's shows also often display scenarios portraying characters visiting libraries, museums, bookstores, and zoos. The imitation of real world settings allow children to learn about books, animals, and proper behavior in social environments. Other valuable lessons taught to children include cooperation, team building exercises, acceptance of classmates, and even touching on simple mathematical concepts. Television has proved serviceable towards the learning developments of children through introducing experiences, facts, and promoting positive behavior.

On the other hand, research also suggests that children’s media lacks proper inclusion of characters from different racial backgrounds, ages, disabilities, and economic statuses. Children are highly vulnerable and studies express the concern of children influencing their self worth based on the representation in media of their favorite characters. A study from the Center for Scholars & Storytellers in 2019 examined fictional characters in TV broadcasters for children including Cartoon Network, Disney Channel, and Nickelodeon. In examining 1654 children’s characters, researchers concluded that representational issues were present, leading to low self esteem in children.

Additionally, children who turn to female characters as role models may be disappointed to find that female characters often use magic to problem solve, “...while males are more likely to use science, technology, engineering, mathematics skills and physical power.” The stereotypes incorporated into characters’ abilities display detrimental messages to children who wish to have careers in STEM. Research additionally asserts that most economic classes shown in children’s media are often representative of the middle class. Many children watching may belong to families facing economic hardships feeling shame in their family’s difficulties. In order to combat the insecurities that may arise in children’s identities not being reflected on a big screen, digital media creators can incorporate more characters of diverse backgrounds.

Media is a powerful tool when utilized responsibly. Although many television shows can enhance the learning process for children, many may feel underrepresented by their favorite television shows, leading to low self esteem. Dr. Margaret Ingate, Associate Teaching Professor in the Psychology Department at Rutgers University affirms this, “Where parents do not have the ability or resources to monitor and control their children's media exposure and consumption, under-representation sends a pervasive message that some people, some groups of people, are more valued than others.” Certainly, broadcasting media must strive to include more diverse groups of people, free of stereotypes, to support the generation of growing children and subsequently increase their self esteem.

KETAMINE AS AN ANTIDEPRESSANT Vividha Venkatrajan

Ashley Clayton had struggled with severe depression and suicidality her whole life. She tried dozens of antidepressants, various kinds of talk therapy, and even electroconvulsive therapy, all to no avail. Desperate for help, she enrolled in a double-blind clinical trial for ketamine, a drug that in recent years has been used offlabel to treat severe depression, and started receiving infusions. After the first infusion, she said in an interview for the Brain Behavior Research Foundation, “I can’t even explain to you how dramatically different I

An excess of glutamate in the brain leads to excitotoxicity, or overexcitation of neurons, resulting in neurons dying. This is why inappropriate levels of glutamate can lead to disconnectivity in the brain and lower levels of neurogenesis, which play an essential role in depression. Ketamine regulates glutamatelevelstoincreaseneuronalconnectivityin areas like the hippocampus, and to increase the rate of neurogenesis, both of which are associated with a reductioninthesymptomsofdepression.

had finally worked.

For those struggling with treatment-resistant severe depression like Ashley, ketamine is proving to be an effective solution. Ketamine was used primarily as a dissociative anesthetic, but it is now being studied for its rapid antidepressant properties. According to a study published in the Journal of Clinical Psychiatry evaluating over 400 patients with treatment-resistant depression, 72% saw, an improvement in their mood, and 38% were symptom-free after 10 infusions of ketamine.2

felt when I woke up....it was a miracle”. 1 A treatment 3

Little is known about its exact mechanism of action, but ketamine is thought to reverse stress-induced changes in the brain via glutamate modulation. Chronic exposure to stress leads to the shrinking of the neuronal network, and a reduction in neurogenesis (the process by which the brain makes new neurons).4 This happens in part due to a malfunctioning of the glutamic pathways in the brain. Glutamate is the most abundant excitatory neurotransmitter in the brain and works to regulate the nervous system along with inhibitory neurotransmitters like GABA.5

This direct mechanism of action could explain why ketamine works so rapidly and why it works for treatment-resistant populations. It is well known that commonly prescribed antidepressants, like Selective Serotonin Reuptake Inhibitors, take a few monthstoworkwhichcanbeespeciallyproblematic for those that need help immediately. SSRIs take time to work because they increase neurogenesis indirectly via specific neuromodulators of glutamate

like serotonin 4However, as Dr. Tara Cominski, a neuroscientist and professor at Rutgers University, explains, if the root cause “of one patient’s depression symptoms is not really serotonin, then maybe that is why those drugs don’t work that way” for that patient. “The idea with ketamine is that you can tap into a different system”, she says. Patients with severe depression that do not respond to antidepressants benefit from ketamine due to its rapid and direct mechanism of action. There is still a great deal that is unknown about how exactly ketamine works and the effects of its long-term use. On the other hand, at the very least for those with severe and treatment-resistant depression, ketamine can be a life-saving solution.

DID YOUR DOCTOR NOT TELL YOU SOMETHING ABOUT YOUR ANTIDEPRESSANT?

Erin Oxnam

Medication for depression is intended to increase one’s overall quality of life. However, there is a lesser-known phenomenon when prescribing youth medication to aid in their depression that can harm their quality of life. When youth are being prescribed SSRIs (selective serotonin reuptake inhibitors) to fight depressive symptoms, they are often unaware of the full scope of side effects the SSRIs entail, notably sexual inhibition. SSRIs are often labeled as antidepressants; some examples are Prozac, Lexapro, and Zoloft. While it is essential for those on SSRIs to understand the risks of all known side effects, for youth, it can be particularly harmful to not know about sexual side effects as they are in the stage of life where they are just starting to understand and interpret their sexuality.

Many people who have been on SSRIs have reported feeling inhibited sexually as a result of their medication. Up to 80% of those on SSRIs experience side effects including, but not limited to, delayed ejaculation, absent or delayed orgasm, and sexual desire/arousal difficulties. In adolescents, a trial in 2004 indicated that 23% of youth on SSRIs would experience sexual inhibition as a result. However, the study acknowledges that the trial was too small to generalize to the general population.

Despite the large number of clinical trials assessing the side effects of SSRIs in adolescents, very few examine sexual inhibition as one of these side effects. This lack of data makes it hard for youth to be well-informed about what may potentially happen to them as a result of their SSRIs. However, a more significant reason why youth often remain uninformed about these side effects is that their doctors do not tell them. Doctors may find talking about sex awkward with their patients or they may fear that patients will not take SSRIs if they know about the sexual side effects, so they oftentimes do not discuss it.

Two Rutgers University students, whose identities are kept confidential, provided anecdotes of their experiences with SSRIs. Both were prescribed SSRIs before they turned eighteen, and state that their prescriber did have a conversation about potential side effects, one recalling “loss of appetite” and the other potentially worsening depression, but in both cases, their prescriber did not discuss sexual inhibition as a potential side effect.

Dr. Tierney Lorenz from the Kinsey Institute at Indiana University states concern over the fact that youth may not know about these side effects. Stating that youth are “just trying to figure out what healthy sexuality looks like for them” and that if they do experience sexual inhibition, they will not be sure if the lack of sexual desire comes from their medication, it is just the way they are, or if it is a reflection on how they feel about their partner, which can have damaging impacts on their relationships and self-understanding.

These issues are likely amplified for LGBTQ+ youth who are subjected to the societal expectation to be straight; these youth, confused about their sexuality due to side effects from their SSRIs are likely to experience “compulsory heterosexuality” , or will engage in heterosexual relationships due to societal pressures rather than their own desires. Queer youth who struggle with sexual inhibition due to SSRIs will have a harder time coming to terms with their own sexuality, and may even experience relationships they do not truly want to be in; these effects can have a damaging effect on their mental health.

It is becoming increasingly imperative that attention be paid to this issue as youth begin to be prescribed SSRIs more and more. Between the years 2015 and 2021, reports indicate that prescriptions for SSRIs for people aged five to twelve years old increased by 41%. Such an uptick in prescription rates for youth represents an increasingly large population that will enter young adulthood without the knowledge that the medication they are taking to assist in their mental health could be inhibiting their sexuality and, in turn, distorting their view of their sexuality. Doctors currently have no regulations on whether or not they choose to inform their patients about these side effects; without such regulations, the mental health and quality of life of youth on SSRIs are threatened.

DEPENDENCY WITH DEMENTIA: ELDER ABUSE IN HEALTHCARE FACILITIES

Elder abuse is one of the least-discussed public health issues of the modern century, despite its prominence. 15.7% of elders in communities have experienced abuse, but that number skyrockets to 64.2% amongst people living in nursing homes. These types of facilities are long-term care and nursing homes, which generally deal exclusively with senior citizens. Generally speaking, the types of elders more prone to abuse are those who are disabled to some degree, typically with mental or physical issues and cognitive impairments. In addition, being in the low income bracket puts them at a higher risk of being taken advantage of. There are also certain factors that are regularly seen in the abuser; including substance abuse, mental health issues, and financial dependency. Furthermore, younger family members often rely on these older relatives for money in some regard, whether that be directly getting paid for their caregiving or receiving a spot in a will. Unfortunately, elder abuse can have severe effects on the victim, often coinciding with premature mortality, depression, cognitive decline, and financial problems.

While there are many risk factors for elder abuse, cognitive impairments seem to be particularly salient. Studies have shown that 95.6% of cases where elders are abused in long-term care involve the patient having cognitive impairments. A variety of other studies even show that 15-30% of all adults with dementia are abused. Poor training and a lack of education for the staff are some of the biggest factors, with about 35% of cases involving staff that report not feeling fully trained. In particular, inability to identify and deal with abuse was one of the biggest issues. If staff were trained to recognize when a patient is being taken advantage of, they could stop it from happening and prevent the negative health effects associated with abuse. Signs of physical abuse can include bruises, sores, or abrasions of some sort, whereas tense relationships can signify some kind of emotional abuse. Additionally, sudden changes involving finances can be an indicator of financial abuse, a very common problem for older adults. Ultimately, learning to identify abuse would be exceptionally beneficial not just to the patient, but also to the staff, who could then maintain a good reputation.

At Rutgers, there have been efforts to further understand the nature of elder abuse through a variety of research projects. XiQui Dong, the director of the Rutgers Institute for Health, Health Care Policy and Aging Research, focuses on efforts to analyze prevention and risk factors for elder abuse. Dong states that groups who have been historically mistreated are experiencing abuse at a higher rate than others. This includes discrimination on the basis of race or ethnicity, sexual orientation, class, gender, disability, or any intersection of these issues. Additionally, Dong heavily encourages the medical community to strengthen their understanding of both risk factors and protective factors when it comes to mistreatment of older people.This would enable the development of screening techniques and improved prevention and treatment methods.

When speaking in regards to dementia, people with this diagnosis are particularly vulnerable because they are reliant on other people. The nature of their disease makes it difficult to be independent, putting them in a helpless position requiring support. Researchers have hypothesized that one of the biggest factors in dementia-specific elder abuse is that the victim is less likely to report it due to a fear of losing support. Another major factor in why victims with dementia go unreported is that many typical signs of abuse, like decreased communication, are also symptoms of dementia. There have been suggestions that people working in these facilities should be specially trained to handle adults with dementia and Alzheimer’s. Specialized training like this would be extremely beneficial in recognizing the signs of abuse as opposed to the real symptoms of their disease, and could help combat the elder abuse crisis, particularly in long-term care facilities. Dementia patients, as well as anyone in treatment facilities, deserve to be treated with respect and dignity.

Kaitlyn Adkins

Laine Ansari

Endometriosis, a painful chronic disease that affects 5-10% of females of reproductive age globally, is often misdiagnosed and recognized too late, leading to detrimental physical and psychological consequences. It occurs when endometrial tissue —typically found in the uterine lining—grows outside the uterus. Endometrial growths most often involve the ovaries, fallopian tubes, and the tissue lining of the pelvis.

The cause of endometriosis is still yet to be determined; currently, scientists are researching links between menstrual flow, genetic factors, auto-immune disorders, and hormones. Endometriosis has four stages based on the severity and location of the growths—stage I being minimal and stage IV being severe. The most common symptom is various types of pain, including but not limited to painful menstrual cramps, chronic lower back or pelvic pain, intestinal pain, painful bowel movements, etc. Other possible symptoms include bleeding between menstrual periods, infertility, or digestive issues. The symptoms listed are often ignored under the guise that it is normal to feel such pain, but it is essential to recognize that pain is not normal and should be addressed. Moreover, the full effect of endometriosis goes beyond the pelvis; it affects the metabolism in the liver, which can lead to systemic inflammation. Additionally, it can alter gene expression in the brain, causing pain sensations and mood disorders. This disease is debilitating in how it affects a person's daily life by making the most mundane tasks painful. Currently, there are no cures for endometriosis. Treatments aim to ease the symptoms and make them manageable.

Despite the prevalence of this disease, diagnosis time typically ranges from 4-11 years, with 65% of women initially misdiagnosed. So why, if it is so prevalent, is it often misdiagnosed? One main reason is that symptoms overlap with other common gynecological and non-gynecological disorders. Additionally, diagnostic challenges only increase when symptoms, such as painful menstrual cramps, have been normalized to the extent that they are accepted and ignored. Most women often have a difficult time articulating and expressing their symptoms of pain, as it is considered normal for one's menstrual cycle to be painful. When they finally share their symptoms of menstrual-related pain, they often report being dismissed, disbelieved, or even misdiagnosed. Diagnostic delays cause the impact of endometriosis to be much more severe than it would be otherwise. As young women, it is crucial to be conscious and aware of one's health. When endometriosis is left untreated, growths can become more invasive, eventually forming scar tissue and adhesions. This scar tissue can increase pelvic and back pain as well as negatively affect fertility. Therefore, it is paramount that one be conscious of their health. Female students around the age of 21 should consider seeing a gynecologist. Moreover, one must remember that doctors are also people that come from all different walks of life with various biases, so they should find one who validates their concerns.

Endometriosis is not a disease to be taken lightly, as it substantially affects a person's quality of life. While there are many diagnostic challenges present, there is hope for improvement. New Jersey recently passed legislation for endometriosis screening and awareness programs to help combat said diagnostic challenges. Aforementioned, it is vital to be upfront and acknowledge issues that are negatively affecting one's quality of life, as intense pain of any kind is not normal.

ACHIEVING 20/20 VISION: IS IT WITHIN REACH?

Cielo Tumbokon

Chances are you or someone you know is affected by an eye disorder. Students who rely on glasses or contacts in their everyday life know the struggle of forgetting their glasses or putting in their contacts. These students have to get through the day by squinting, whether it’s at the board, their laptop, or the paper in front of them. Vision impairment is among the top 10 disabilities in adults 18 years and older and even more prevalent among children. Why is there no permanent cure for vision deterioration since it is a ubiquitous issue?

Suffice it to say the most effective solution is prevention, but eating foods high in omega-3 and wearing sunglasses on sunny days only work to a certain extent. An individual may be genetically predisposed to an eye condition or disease through conditions such as diabetes or high blood pressure. There are long-lasting treatments available such as LASIK, for minor issues such as myopia (nearsightedness) and hyperopia (farsightedness). Even so, a patient will find their eyesight worsening as they get older. In this case, the treatment isn’t “wearing off” because LASIK causes permanent changes to the eye. Ultimately, LASIK does not always solve the problem of age-related macular degeneration (AMD). Rutgers’ Ocular Cell Transplantation Laboratory, co-directed by Dr. Marco Zarbin and Ms. Ilene Sugino, studies AMD and is currently developing technology and is focused on the development of transplantation technology for the treatment of various ocular conditions such as age-related macular degeneration and retinitis pigmentosa.

In extreme cases where LASIK is ineffective, optogenetics has been proven to restore vision in mice by increasing light sensitivity in surviving retinal neurons. The downside is that the treatment involves exposure to high-intensity light which may result in further retinal damage. Although the results provide a promising start, the success of this study is limited to mice whose retinas are 70 times smaller than a human’s. This novel approach to eyesight restoration is only at the clinical trial stage.

The dynamic nature of eyesight makes it difficult to construct an all-encompassing treatment. Many researchers are still fine-tuning methods in restoring eyesight while also trying to limit the risk of further damage. While the answer to a safe technique to permanently restore vision is in foresight, it is essential to limit strain on the eyes to decelerate degradation. Every 20-30 minutes, take a break from staring at your computer screen. On a sunny day, grab a hat on the way out. These small things compile to help preserve eyesight.

WHEN DAYQUIL BACKFIRES: UNDERSTANDING IMMUNE SYSTEM FUNCTION AND STRESS

Sriya Sadangi

Looking around a college campus, it’s clear that students are incredibly stressed Whether it’s the paper due in a few short hours at 11:59 PM or tomorrow’s back-to-back exams, students often find themselves faced with more and more tasks as the week trudges along However, the exact mechanism for how these immense amounts of stress take a toll on the body is yet to be discovered. For years now, scientists have shifted their focus to understanding how the immune system’s ability to fight infection is reduced when faced with stressful situations But why exactly does being stressed make us more prone to infection? While research has largely focused on the various possible connections between stress and the immune system, looking at the effects of stress on cognitive acuity are a new goal Studies indicate that the negative impacts of stress on our immune systems may be tied to the relative amounts of cortisol found in the body.

Cortisol is the body’s primary stress hormone and is involved with suppressing the digestive system and altering immune system responses. Research has also shown that during longer periods of stress, the body can produce “higherthan-normal levels” of cortisol, which can “hamper the body’s anti-inflammatory response and cause continual infections.” Thus, being stressed for a long period of time, whether or not we realize it, can ultimately lead to increased susceptibility to colds and infections In contrast, acute or short-term stressors have been associated with “potentially adaptive up regulation of some parameters of natural immunity and down regulation of some functions of specific immunity” While chronic or long-term stressors have typically been associated with a body-wide down regulation of immunity, it appears as though acute stressors have a less harmful impact on the immune system

Additionally, the types of stressors that students are exposed to may impact how their immune systems respond For example, Student A has two exams in the next 24 hours that they haven’t studied for. The acute stressor Student A has been exposed to would make their immune system more “effective in responding to new stressful events or [ ] pathogens” during this time period. On the other hand, consider Student B, who has to drive to class during rush hour every day for a daily quiz As opposed to Student A, Student B can’t avoid this stressor due to its chronic nature Research shows that as opposed to Student A, Student B may find themselves more prone to infections and have more difficulty with wound healing Currently, some psychologists hypothesize that the difference in the two types of stressors may be tied to the fact that acute stressors have the ability to activate the immune system, an “adaptive response preparing [the body] for injury or infection,” while chronic stressors lead to breakdown of the immune system because of increased “ wear and tear” on the body

While there have been significant strides in determining the impact of various types of stressors on the immune system and how individuals can effectively cope with the negative side effects, this broad view of looking at the impact of stress on the immune system is now becoming more focused In particular, a new perspective of research has shifted to examining the cognitive and emotional impacts of stress and reduced immune system activity. In the Department of Psychology at Rutgers University, Professor Alexander Kusnecov is currently examining the cognitive and emotional impacts of immune system activation Some of the questions he is exploring involve determining whether or not there is a correlation between levels of stress and immune activation as well as between levels of stress and our cognitive and emotional responses to different circumstances Understanding the answers to these questions may help illuminate further treatment options for the side effects of acute and chronic stressors. While this research is still ongoing, make sure to take breaks and unwind while studying for your upcoming exams to let your immune system activate in response to those acute stressors.

COLD PLASMA CANCER THERAPY:

IS IT THE ANSWER?

Ashwin Bhaskar

Approximately 3.5 million women overall have been diagnosed with breast cancer today, and this number is growing by approximately 277,000 annually. The expected yearly death total is about 42,000. Current treatments in place for breast cancer include medications such as Verzenio, chemotherapy, and surgical procedures such as lumpectomy where the cancer tissue is surgically removed. Many of these treatments have adverse side effects and in certain instances can kill normal cells in addition to cancerous cells. The Jerome Canady Research Institute in Maryland has attempted to rectify this issue by performing research on breast cancer in an attempt to find a more sustainable treatment. The institute's most recent findings involving cold plasma show the most promise and could be implemented in the near future to better the livelihood of breast cancer patients.

Researchers at the Canady Research Institute have created a device known as the Canady Hybrid Plasma Scalpel which is used to remove the cancerous tumor in an efficient manner. The tumor margins are then sprayed with the cold plasma using the scalpel. The plasma cells specifically target and induce apoptosis in the cancerous cells, eliminating them from the body. There are many benefits to utilizing cold plasma in cancer therapy as opposed to other methods. For example, it is more effective in its ability to elicit cell cycle arrest and apoptosis in cancerous cells. Furthermore, cold plasma completely eliminates various types of solid tumors including breast carcinoma and is a much more pleasant experience for the patient. Unlike chemotherapy and other procedures, only one treatment is required, and it takes just three to seven minutes. Furthermore, it attacks cancerous cells at a microscopic level, meaning that the healthy cells are not targeted, minimizing the corresponding side effects.

Before cold plasma treatment could proceed to the next step in FDA testing, the Canady Research Institute had to better understand the mechanisms behind the cold plasma treatment. In their first study, researchers isolated four breast cancer cell lines and treated them with cold plasma. The progress of apoptosis was monitored. From the results, researchers determined that the cold plasma causes degradation in the histone mRNA rather than the DNA itself. What this means is that during mitosis, the DNA will not continuously replicate itself during the S phase, arresting cell growth and eliminating the cancerous cells.

Currently, the first FDA approved clinical trial at Rush University Medical Center in 2020 was a success and more trials are scheduled to take place this year. If successful, the cold plasma treatment has the potential to become standardized across many countries, leading to a better treatment option available to patients suffering from breast cancer. In addition, it can help facilitate research done here at Rutgers that investigates effective breast cancer treatments. The Robert Wood Johnson Medical School has a breast cancer program led by Dr. Bruce Haffy, Dr. Nisha Ohri, and Dr. Malcolm Mattes, and it is dedicated to treating breast cancers through the use of radiation therapy. More specifically, this program utilizes external beam radiation therapy which involves daily sessions in order to accurately deliver radiation to the cancerous regions. However, as stated previously, radiation therapy has its risks. Similar to chemotherapy, it has the ability to kill healthy cells. If cold plasma therapy gets standardized, it has the potential to obtain a higher success rate and better ensure the safety of patients seeking treatment.

MICRO MEDICINE: NANOTECHNOLOGY AND THE SPINAL CORD Prachi Lad

Using nanotechnology is a relatively new technological advancement that has proven very beneficial in the medical field. Nanotechnology uses mechanisms on a nanoscale to help deliver drugs and materials to specific molecules of internal structures to allow for imaging. There are two predominant applications of nanotechnology in medicine: target specification and controlled drug release. Target specification allows the nanotechnology to target critical areas of interest in the body and insert or apply certain molecules. Controlled drug release involves inducing certain parts of the cell with stimuli to elicit a response. These methods of nanotechnology can be used in spinal cord repairs and injuries and are proving to be beneficial.

The nanoparticles themselves have a wide array of compositions. According to a study done in 2018 on nanotechnology and spinal cord injury, “A wide range of materials, including metals, metal oxides, silica polymers, and biological molecules, have been used to synthesize nanoparticles” and these molecules allow “for a combination of both diagnostic and therapeutic benefits.” This is significant to understand because it explains the large variety of molecules that can be used inside our body, which can be helpful for many different issues. Furthermore, these mechanisms, as explained by the study, are very useful in spinal cord injury. Osteoporosis is a condition in which an individual's bones become brittle. This disease can be especially damaging when it occurs in the spine vertebrae. In this same study, it is explained how nanotechnology works by using nanoparticles, specifically, those similar to bone marrow, to assist with bone structure. This would be considered as target specification as the particles are targeting the lack of bone marrow. It can also be helpful to “enhance gastrointestinal bioavailability of calcium supplements for preventing osteoporosis” which is beneficial for longterm support. Its beneficial immediate and long-term effects further indicate the extent to which nanotechnology can be used.

The spinal cord injury applications for nanotechnology are vast and can also be applied to the field of sports as well. Nanotechnology is recently being used to help with cervical spinal injuries from an accident in short-track speed skating. A nanoparticle, NHP66 (Nanohydroxyapatite/polyamide 66), is a bioactive cage for spinal injury for these athletes. A bone cage is a hollow instrument filled with material that promotes bone growth in a particular area. Thus, NHP66 provides “marvelous toughness, stress strength, and fusion with bone” which allows it to be a great material to use. NHP66 achieves this by being able to “closely contact intervertebral nerve and muscle tissue” thereby “reducing the friction against endplate.” This is important because NHP66 has similar properties to collagen and provides a suitable replacement that is equally strong as bone. The high specificity of nanotechnology is exhibited by NHP66. The ability of scientists to get to such a small level by helping bone marrow is remarkable.

At Rutgers University, nanotechnology is being used for spinal injury treatment as well. Adam Gormley’s lab at the Rutgers School of Engineering uses artificial intelligence to synthesize therapeutic proteins that assist in the degradation of scar tissue in spinal cord injuries. This is a significant achievement because nanotechnology has never been used to this extent before; it is usually seen with on-site damage, whereas Gormley’s team found a way to stabilize an unstable protein to help with post-injury damage. The lab specifically used polymer therapeutics, which is a subset branch of nanotechnology. The protein ChABC is a part of the scar regeneration process and is unstable in the human body, so the lab used synthetic copolymer, a form of a nanoparticle. Specifically, synthetic copolymers are able to wrap around enzymes such as ChABC and stabilize them in hostile micro environments. As seen in these studies, there are increasing scientific discoveries being made with this technology. Nanotechnology can prove to be very successful in the future and can continue to provide treatment for many different conditions, especially in the spinal cord area.

“The protective clothes firefighters wear were designed forty years ago, and people believed they were safe they did not know about the dangers of exposure to PFAS chemicals.”

Forever Chemicals

A Hidden Health Hazard

By Heather O’Donnell

Haveyoueverstoppedtothinkaboutthehidden health and environmental hazards lurking in everyday products, such as non-stick pans, clothing,fastfoodwrappers,andmicrowave

popcorn bags? Our society has been so focused on consumerism and industrialization that we have completely disregarded the harmful effects of our behaviors on our health and the environment

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are a group of human-made chemicals that are ideal to use in consumer and commercial products due to their ability to fight off stains, grease, water, oil, and fire¹ PFAS chemicals do not break down in the environment because they have strong chemical bonds between carbon and fluorine atoms As a result, they will remain in the environment forever, hence their other name: “forever chemicals” PFAS chemicals can be found in water, air, and soil, and build up rapidly in the bloodstream.

While PFAS pollution is a major public health issue that affects the entire population, novel research shows that it disproportionately affects volunteer firefighters In fact, researchers at the Rutgers School of Public Health and the Environmental and Occupational Health Sciences Institute found that volunteer firefighters, who make up over 65% of the fire service, have higher blood levels of PFAS chemicals compared to the general population In this study, the researchers asked 135 volunteer firefighters in New Jersey about their lifestyle, and compared their blood levels of nine PFAS chemicals against the blood levels recorded in the general population Blood tests revealed that volunteer firefighters have greater amounts of two PFAS chemicals: perfluorododecanoic acid (PFDoA) and perfluorodecanoic acid (PFDA). The Rutgers researchers ultimately discovered that volunteer firefighters have a higher risk of being exposed to PFAS because they encounter burning materials that release harmful particles. Moreover, they wear protective gear and fire suppression clothes that are made of PFAS chemicals, which can linger on their gear and skin. The protective clothes firefighters wear were designed forty years ago, and people believed they were safe they did not know about the dangers of exposure to PFAS chemicals This study could thus explain why volunteer firefighters have higher rates of heart attacks and cancer compared to the general population.⁶

PFAS chemical contamination endangers our health and therefore must receive more public attention.

Industrial sites release PFAS chemicals into the water or air, and PFAS chemicals leak from disposal sites into groundwater³ People can become exposed to PFAS chemicals by using products that have PFAS chemicals, or by consuming PFAS-contaminated water and food ⁴ PFAS chemicals are hazardous to human health because they stay in the human body for a long time They can cause low birth weight, weight gain in children and adults, increased cholesterol levels, infertility, high blood pressure during pregnancy, heart attacks, hormonal issues, and weakened immune response to vaccinations.

PFAS chemicals also increase the risk of testicular, kidney, liver, breast, and pancreatic cancer.⁵

PFAS chemicals are harmful to human health and the environment, and it is therefore important that you become proactive in reducing your exposure to PFAS chemicals. Some ways you can protect yourself and your loved ones from the dangers of PFAS chemicals are by checking local fish advisories before eating fish or seafood, avoiding using non-stick cookware and stain-resistance treatments, and utilizing a water filtration system ⁷ You can also check product labels for ingredients that include “perfluoro” or “fluoro,” exercise caution when handling packaging for foods that have grease-repellent coatings, and wear clothes and sports gear that do not contain PFAS chemicals.⁸ Since PFAS chemicals are invisible to the naked eye, it is time that we view them through a microscopic lens for the everlasting hazard they are We must take immediate action to protect ourselves from them, or else they will continue to sneakily wreak havoc on our health forever

Almost99%ofAmericanshavePFAS chemicalsintheirbloodwithouteven knowingit.²

THE COMPASSION CRISIS

Laasya Gaddipati

Leaving the doctor’s office feeling unseen, invalidated, and helpless might be a reality for more patients than one would expect. The healthcare field is experiencing a crisis in one of the most crucial aspects of patient care: compassion. A trait that some may consider to be one of the most reliable certainties of healthcare is being overlooked and neglected.

For many doctors and medical students, their desire to become a doctor stems from wanting to be a trusted presence in a patient’s life. And yet, a substantial amount of biomedical evidence and medical literature points to a significant lack of compassion and caring attitudes among interactions between patients and physicians. The word compassion refers to a desire to help someone that stems from feelings of empathy. The key difference between empathy and compassion is often forgotten. Empathy is our ability to understand and acknowledge someone else’s feelings, whereas compassion is taking it one step further and adding the zeal for action.

Stephen Trzeciak and Anthony Mazzarelli, authors of Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, are physician scientists at Cooper University. In their book, they accumulated evidence from various studies to exemplify why compassion is crucial for better outcomes for both providers and patients. One of the studies used found that 56% of physicians said that they do not have time to show compassion to patients, while nearly half of Americans believe that health care providers are not compassionate. On both sides, a lack of compassion hinders the overall experience in a time that is already difficult and strenuous. By not taking the time to connect with a patient and build a trustful relationship, health care professionals are causing patients to be less inclined to share sensitive information. Additionally, evidence suggests that showing compassion towards patients can considerably lower burn out rates for physicians. Trzeciak himself, after working 20 years in the ICU, realized that he was severely burnt out. To increase feelings of fulfillment in his life, he started taking the time to connect with his patients which immediately made a difference. He slowly built a resistance to burn out.

College and medical students endure the long and arduous journey of wanting to become a physician. This universally difficult, yet rewarding experience is the cause of burn out for many students. At Rutgers University, students who take the “Sociology of Medicine and Health Care” class are exposed to the nuances of patient-physician relationships which can greatly influence students’ mindsets on the implications of compassionate, open-minded interactions with patients, preparing them for the future.

Due to the demanding nature of the profession, physicians are extremely susceptible to feelings of dissociation and reduced professional efficacy in all stages of life. As students are working towards creating the best possible application for medical school, it is easy to forget the reason for wanting to become a doctor. Similarly, as physicians see patients at high rates and work to be as efficient and as accurate as possible, pausing to take the time to connect with a patient becomes an afterthought.

Being compassionate leads to feelings of self accomplishment and opens up the ability to make those personal, deeper relationships with patients. This bond facilitates a desire to take the time to alleviate a problem more holistically rather than checking off another box on a list of symptoms.

THE IMPACTS OF HEALTHCARE ACCESSIBILITY ON QUALITY OF TREATMENT

When you think about healthcare, it is seemingly safe to assume that everyone receives standardized treatment within the United States; however, that is not the case A vulnerable community is defined by its lack of access to primary care services, amongst many other factors. As the shortage of primary care physicians in the United States worsens, underserved communities are particularly under attack In fact, only 55% of the national need for primary care physicians is met. As a result of the limited capacity of existing healthcare resources, the quality of healthcare also severely decreases, as there is a surplus of patients that a physician must treat Therefore, physicians are not focused on key factors during patient care such as cultural competency and holistically listening to the patient, which negatively impacts the quality of care

Cultural competency in healthcare is defined as the ability to provide care to patients with diverse values, beliefs, and behaviors, including the tailoring of healthcare delivery to meet patients’ social, cultural, and linguistic needs Cultural and linguistic differences between healthcare providers and health service users can result in significant miscommunication, patient-physician mistrust, decreased satisfaction, and disempowerment In a research study, it was found that practitioners’ increased cultural competence has been linked to increased patient satisfaction, treatment adherence, and information seeking and sharing Cultural competency is a key barrier that underserved communities are faced with, resulting in the quality of care being compromised.

A second key barrier that affects underserved communities is that physicians are unable to holistically evaluate a patient before treating them This problem is directly linked to the shortage of primary care physicians, which prevents them from spending more time with each patient Often times, it is found that providers are too focused on maximizing the number of patients seen each day, which results in patients’ primary concerns being relayed and addressed in the shortest amount of time possible In a 2002 study of primary care encounters in six countries, it was found that an average visit length was around 10.7 minutes. A decrease in the amount of time during a patient-physician encounter is directly linked to physicians’ inability to fully address a patient concerns, compromising the quality of healthcare

In order to combat the issue of cultural competency with physician-patient encounters, our focus must be on educating medical students on cultural competency. Cultural competency training includes understanding “the central role of culture in all lives” namely through having an overall awareness of how people are treated as a result of “cultural differences”. Rutgers New Jersey Medical school has designed a cultural competency program to, “ prepare physicians, residents, and medical students to properly serve the increasingly diverse community" The Rutgers Center for Cultural Competency has many initiatives which act as training for their medical school faculty, as well as conferences highlighting cultural competency and health equity. To address the second key barrier that underserved communities face, a similar approach must be taken Patient-centered communication seeks first to understand what matters most to a patient, and then to incorporate these preferences into shared decisions on subsequent care. When effectively executed, this communication strategy strengthens the doctor-patient relationship and leads to improved outcomes of care Due to the shortage of primary care physicians, the quality of healthcare in underserved communities has been negatively affected Everyone deserves to have quality care from physicians trained in cultural competency who sincerely listen to patients before and during treatment.

Haris Atif

In 2019, 76 percent of Blacks, 76 percent of Asians, and 58 percent of Hispanics received unfair medical treatment due to racial bias Although there has been a recent increase in awareness of this discrimination pointed out by the minorities at risk, the continuing concern of internalized prejudice, both racial and otherwise, has been woven into fundamental policies and guidelines of healthcare administration from the inception of modern healthcare The lack of change is reflected by the prejudiced policies governing the foundations of healthcare to this day

Currently, healthcare standards reflect the presentation of illnesses and conditions in the white demographic; the diagnosis of non-white patients is consequently reduced in accuracy. This discrepancy is observed in different races through varying incidence and presentation of specific conditions, such as sickle cell anemia and dermatologic conditions. However, pre-screening becomes inaccurate due to these standards, meaning the illness grows when it could have been prevented Specifically, the American Heart Association (AHA) inexplicably increases the risk score for heart failure-related death for non-Black patients This unnecessarily adjusted standard creates the false impression that Black patients are at a lower risk of death from their condition when in reality, they are not. As a result, necessary treatment plans are not implemented in a timely fashion, so the disadvantaged patient consequently faces negative health effects or even premature death. This potentially fatal discrimination in pre-hospital screening is a nuanced representation of the larger issue present in medical treatments Without explanation, doctors around the world are trained to implement this minute, yet greatly impactful discriminatory practice when assessing their patients.

According to Scientific American, implicit, or cognitive, bias has been a driving factor of undetected racism in healthcare administration through the years. Since implicit bias is more discreet than outright racism, it has gone unnoticed and allowed the bias in healthcare administration to grow over the years Moreover, contributing factors such as poverty further impact access to pre-screening. These factors lead to inaccurate data and future misdiagnosis, and contribute to structural racism and unequal resource distribution Even at Robert Wood Johnson University Hospital, a world-renowned healthcare institution in New Brunswick, many are unable to afford the correct medical attention, which perpetuates the risk of misdiagnosis due to financial barriers In addressing this concern, Rutgers partnered with Robert Wood Johnson and received a $10 million grant to assist economically-burdened communities and ease their access to healthcare The funding is described as supporting healthcare insurance policies that are more suitable for heavily impoverished families in New Brunswick, as well as assisting emergent situations in which a financial barrier is the primary concern preventing successful treatment. This partnership concurrently served as an acknowledgement from these stakeholders in New Brunswick that poverty is a barrier to healthcare access in the region Nonetheless, this partnership has been a successful first step in mitigating the effects of poverty on misdiagnosis and perpetuating racial stereotypes in the medical field, though the issue continues to plague the community In general, population data is a popular source of reference when assessing patient care and proposing novel treatments. However, as this development is based on inaccurate data from previous minority patients, the inaccuracies in diagnosis and treatment continue to disadvantage new generations. In the case of the individual, doctors often chalk down the severity of minority patients’ conditions, causing issues in the future when new doctors refer to the patient’s medical records and find essentially inaccurate information In using this inaccurate information in the new diagnosis, doctors are unknowingly continuing the chain of misdiagnosis that often leads to severe health complications and even death for minorities on a generational level

RACIAL BIAS AND MISDIAGNOSIS

There are three million refugees living in the United States today, increasing by the day, whose health and well-being may be diminished by an inability to understand and use health information Health literacy is “the degree to which an individual can obtain, communicate, process and understand basic health information and health services to make appropriate decisions about their health” Low health literacy is linked to poor overall health outcomes, with higher rates of illness and increased hospitalizations Good health requires a coupled process of access to adequate health care and appropriate health knowledge and health literacy.

In a study conducted by Iris Feinberg and her colleagues at Georgia State University in 2020, they examined the relationship between English proficiency, health literacy, length of time in the US, and health status They looked at the differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health They recruited 136 refugees from the ages of 18 to 65 year to fill out a survey that analyzed their demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to receiving health care Their results show that there is a high correlation between health literacy and English proficiency, which were both moderately correlated to health status. In conclusion, poor English proficiency and health literacy, individually and together, facilitate poor health and present health-related barriers for refugees Systemic barriers in such a complicated American health care system, such as lack of appointments, limited hours of operation, referral system, and wait times at diagnostic tests, make it hard for even an average American to navigate Refugees are coming from war-torn or economically unstable countries with limited English and knowledge about healthcare, much less the American healthcare system/insurance

At Rutgers University, students continue to impact their community, including improving the health literacy among refugees One example of these efforts is the “Refugee Health Connection” club at Rutgers It was founded in September 2022 with 2 major goals: improving health literacy among refugees in the New Brunswick area and making health resources more readily available They hope to do this by conducting a needs assessment of refugee resettlement agencies, developing a robust, 7-8 session curriculum focusing on improving health literacy with didactic and activity components, executing the curriculum with teams of 2-3 Rutgers undergraduates alongside translation help, and finally conducting pre and post assessments of both refugees and undergrads to determine the effectiveness of the program To deal with the resource issues that refugees face, they hope to conduct research and collect data regarding locations providing free/low-cost health services in central Jersey, compiling and organizing the research into a directory Each page of the directory will provide information regarding a specific site They also plan on creating a variety of resources on different platforms ranging from websites to pamphlets for refugees

Refugees come to the United States to flee danger and distress in their home countries as a result, they usually arrive to the US with limited English, money, and social connections. They may face a variety of health related issues upon their arrival or may develop mental or physical health conditions during their stay They might be suffering infectious diseases like tuberculosis or intestinal parasites, chronic illnesses such as diabetes or hypertension, and mental health issues such as post-traumatic stress disorder or depression Systemic barriers like these make it hard for them to find help and highlight the importance of initiatives that seek to improve their health outcomes through increased health literacy

LIMIT FOR WAKEFULNESS Neha Badade

Your Sleep is an altered state of consciousness during which there are limited, and often involuntary, thought processes activated Many human beings plan their day around maintaining a proper sleep schedule, while others alter their sleep schedule around their day However, there is significant research done to prove the former to have better effects on a person’s life span and overall well being. It is well established that getting eight hours of sleep is the best amount. Yet, sleeping before midnight has equal, if not more, importance for fitness.text

Sleep is an altered state of consciousness during which there are limited, and often involuntary, thought processes activated. Many human beings plan their day around maintaining a proper sleep schedule, while others alter their sleep schedule around their day. However, there is significant research done to prove the former to have better effects on a person’s life span and overall well being It is well established that getting eight hours of sleep is the best amount Yet, sleeping before midnight has equal, if not more, importance for fitness.

The human body functions under a biochemical system that allows for internal systemic balance when it comes to the body’s sleep needs. The circadian rhythm controls the sleepwake cycle, which functions by signaling the brain to wake up in the presence of light by stopping the secretion of the sleep hormone melatonin Thisclockistunedtowards processes after midnight that primarily promote sleep instead of wakefulness.Thebody’ssleepdrive,or sleep-wake homeostasis, makes sure the body wants to fall asleep after goingtoolongwithoutresting.¹

andweightproblems Additionally,oneofthethreestagesofsleep,the non-rapid eye movement stage, represents deep sleep, and occurs in threestages.Sleepingpastmidnightreducesthebody’schancetoenter thisdeepsleepduetoanimbalanceofnightanddayexposure,which initiallyleadstoshort-termproblemssuchasdaytimesleepinessand impairedmemory,andeventuallyprolongedsleepapnea³

Dedicated to a career in sleep research, Dr Andrea Spaeth at Rutgers University has published several articles that support the argument that sufficient sleep leads to better health One of the articles discussed the correlation between good sleep and a lowered risk of diabetes ⁴ Spaeth discusses how there is a Ushaped relationship between sleep duration and risk of diabetes, which is why getting too little or too much sleep is harmful for insulin level control Insulin is a hormone that promotes the absorption of glucose from the blood, which is essential to prevent high glucose levels that leads to diabetes. Additionally, Dr Spaeth reports that “individuals who self-report habitually sleeping less than 7 hours or more than 8 hours are at increased risk” of type 2 diabetes Although this claim supports thesleepdurationdiscussionratherthan bedtime specifically, it is important to emphasizetherelevanceofbothinorder tohaveanoverallhealthylifestyle.

In a study done by Huma, a British health-tech company, researchers found that sleeping after midnight poses far greater health risks than sleeping before midnight Dr David Plans, who initiated the study, found that the ideal time for adults to sleep is between 10 pm and 11 pm at night. After collecting data for nearly six years, Plans concluded that there was “ a 25% higher risk of cardiovascular disease with a sleep onset at midnight or later, [and] a 12% greater risk for 11:00 to 11:59 pm.”² Although there is currently no known cause for this increased cardiovascular risk due to limited research, a possible reason behind this statistic is that deviations to the sleep-wake cycle and circadian rhythm reduce the likelihood of being exposed to daylight properly, hence resetting the body’s clock and causing more problems such as high blood pressure

It is certainly difficult to have a steady sleep schedule in today’s bustling world, especially when it comes to prioritizing tasks that yield rewards faster than those that can be put off. Sleep can easily be jeopardized to give precedence to daily activities, but it is with good reason that sleeping before midnight is often promoted. Along with its ability to reduce daytime fatigue and lack of concentration, sleeping on time allows for robust completion of the activities we often consume ourselves with, therefore allowing for several long-term benefits as well.

Whether it’s stepping out for a breath of fresh air in the middle of a hectic work day or regularly engaging in outdoor activities like jogging and hiking, time spent in nature has been shown to improve both physical and mental health outcomes Getting in touch with nature is an important way to disconnect from stressors, with research from the University of Chicago echoing that simply having exposure to green space boosts cognition, improves memory, and decreases overall stress levels

On top of the cognitive benefits of outdoor immersion, a study done at the University of Washington has also found emotional benefits and increases in overall mood, well being, and quality of social interactions

THE HEALING

Horticulture therapy works to improve the relationship between people and nature, specifically plants It involves the use of psychology, education, occupational therapy, and vocational rehabilitation techniques to improve the health and wellness of patients. Using the natural world around us, this mode of therapy employs gardening, plants, nature-oriented views, scent recognition, and use of gardening tools to help those who have suffered a neurological condition or mental disorder that has interrupted their daily functioning. Horticulture therapy can involve visiting a healing garden, cultivating plants, and meditating in nature.

In the case of physical illness, horticulture therapy is tremendously helpful to those who have suffered a stroke and are experiencing neurological and motor skill deficits. Gardening and seeding plants involve activities that improve balance, grip strength, and pinch force such as reaching, grasping, squatting, and stepping. As one study reports, those who suffered a stroke and received HT had improved upper limb function, hand force, were less likely to experience a fall, and had decreased rates of depression. Learning to use gardening tools, recognizing familiar scents, and working on fine motor skills through selection of and planting of seeds also resulted in improvements in fine motor skills and overall cognition, with a similar study done in Korea finding that communication, social cognition, and self care were all higher in those stroke patients who received HT treatment.

NATURE POWER OF 1 6 5

In those who regularly engaged in plant cultivation therapy and employed other HT techniques, researchers found a significant decrease in cortisol levels as well as overall self-reported stress and anxiety, along with improved fitness as opposed to the control group Not only did overall stress decrease, but those patients who received horticulture therapy rated themselves higher in emotional wellness, life satisfaction, and social participation, with gardening allowing patients to meet others with their condition and work together on projects Finally, scent and texture recognition of plants and spices was another aspect of HT that helped patients suffering memory problems improve their overall cognition and mood through reflection on the emotions triggered by plant immersion.

Not only is horticulture therapy effective, but it is also extremely cost friendly. For those who cannot afford expensive therapeutic treatments and medications, or who wish to take a more natural approach to medicine, HT is an affordable way to rehabilitate the mind and body, in a way that is easy for any institution or individual to implement Here at Rutgers, students have the opportunity to minor in horticulture therapy as an extension of the occupational or physical therapy major, in order to receive specific training in the techniques of the rising profession. Providing students with the handson experience of the restorative value of plants and people-plant interactions, students can learn the “unique qualities of plants that are conducive to therapy, and how to apply this knowledge in the professional practice.” No matter a person ' s age, race, or background horticulture therapy can be used to help individuals recover from their disabilities or conditions in a positive way

PROTECTING THOSE WHO PROTECT

Caitlyn Colabraro

Emergency medical technicians, paid and volunteer alike, have played a vital role in the healthcare system since their origins and can provide rapid, life-saving care if needed

Despite the importance of EMS and the value of utilizing volunteers within communities to serve as EMTs, many volunteer emergency squads including many in the Rutgers and central New Jersey area are unable to continue providing volunteer services and are being shut down in a widespread transition to paid services

Providing emergent medical care and rapidly transporting patients to hospitals are just two of the many demanding responsibilities involved with being an EMT. In the case of volunteers, these demands must be completed at the same standard but do not involve monetary compensation. For those who already have a full-time paid job, the time commitment it takes to be an EMT is intense and can prevent those who may be interested from acting as a volunteer, especially during daytime working hours when emergency services are typically most needed. The training and certification process is standardized and equal for all EMTs, paid or volunteer. Therefore, the level of training or certification will not change in a transition to paid emergency medical services, so it is not an issue of “upgrading” to paid EMS, but rather a lack of volunteers who are able to commit enough time to cover all of the emergency calls in their community without compensation

Though the level of care provided to patients should remain standard, there is an element of community that is lost when EMTs volunteer to care for the neighbors within their own communities. For both the patients and volunteers, this can be more comforting and rewarding for everyone involved when the person coming to aid in a medical emergency is a known neighbor

Unfortunately, due to the financial barriers and therefore the volunteer constraints that many communities are facing, several agencies within New Jersey alone have begun the transition to paid emergency medical services South Plainfield, Liberty Corner, and Shrewsbury Township are only a few examples of emergency squads that have recently had to discontinue their volunteer services. In the case of Shrewsbury Township, local officials have “struggled to arrange for service since the last squad it used folded a year ago,” which was the emergency squad of a neighboring town to begin with Due to such a small township population, there is a lack of potential volunteers to staff the necessary number of crews needed to cover the emergency calls at all hours of each week.

Although Liberty Corner has a more substantial population, many volunteers are needed to staff an all volunteer squad, and they are unable to meet the demand. If there are three EMTs on duty each day for twelve hours each week, assuming that multiple dispatches do not occur and that each volunteer would be able to attend their shift every week, an absolute minimum of forty-two volunteers would be needed to properly cover all hours of each week With no compensation and an intense, ongoing education process involved in maintaining an EMT license, it is becoming increasingly rare for communities to find a sufficient number of volunteers within their towns.

In order to become an EMT in the state of New Jersey, close to two hundred hours of training are required which involve lectures on medical concepts, emergency room and ambulance experience hours, and hands-on skill practice Each candidate passes a number of skill assessments as well as a standardized written test to assess both their conceptual and situational abilities. Training is in depth, but expensive, which creates another barrier for recruiting volunteer EMTs. In New Jersey, many community colleges offer the training course for EMT certification. Although Rutgers New Brunswick has an emergency squad, it is non-volunteer and the university does not offer an EMT education program As a state university that educates many students across the state, adding an EMT education program at Rutgers New Brunswick could allow many more students to access the necessary training more easily and affordably if they are able to contribute their financial aid resources towards the cost of the training. With immense potential benefits for all involved, implementing widespread EMT education is a goal worth pursuing to protect volunteer EMT agencies and to prevent further closures.

STAFF:

Editor-in-Chief

External Vice President

IVP/Secretary

Treasurer

Senior Managing Editor

Managing Editors

Rachel Shrivastava

Ajita Nair

Sarah Adams

Sathya Gopinath

Kamola Agzamova

Siddhi Shah

Amy Li

Nidhi Gourabathuni

Bianca Battaglia

Jay Kavia

Tulip Sengupta

Chief of Layout

Layout Editors

Tayana Roychowdhury

Mallika Ravi

Mehwish Imran

Kirsten Tiangco

Eman Shamshad

PR/Events

Cielo Tumbokon

WORKS CITED

Cover Photo: JC Gellidon

Letter from the Editor photo: tamas

Table of contents photo: tamas

The Influence of Media on Child Development

1 Fisch, S , Truglio, R (2000, December 1) G is for Growing: Thirty Years of Research on Children and Sesame Street Routledge https://books google com/books?id=8xqQAgAAQBAJ&printsec=frontcover&source=gbs book other versions r&cad=2#v=onepage&q&f=false

2 Ford-Jones, A , Nieman, P (2003, June) Impact of Media Use on Children and Youth Canadian Pediatric Society https://www ncbi nlm nih.gov/pmc/articles/PMC2792691/

3 Lemish, D , Russo Johnson, C (2019, April) The Landscape of Children’s Television in the US & Canada Scholars & Storytellers

https://static1 squarespace com/static/5c0da585da02bc56793a0b31/t/5cb8ce1b15fcc0e19f 3e16b9/1555615269351/The+Landscape+of+Children%27s+TV.pdf

4 Levinson, J (2020, March 5) Why Diversity in Children’s Media is So Important Psychology In Action

https://www psychologyinaction org/psychology-in-action-1/2020/3/5/why-diversity-in-c hildrens-media-is-so-important

Photo: Patricia Prudente

Ketamine as an Antidepressant

1 A recovery story: After every available option was exhausted, ketamine has enabled her life to resume Brain & Behavior Research Foundation (2019, October 29). Retrieved November 21, 2022, from https://www bbrfoundation org/blog/recovery-story-after-every-available-optionwas-exhausted-ketamine-has-enabled-her-life-resume

2 Oliver, P A , Snyder, A D , Feinn, R , Malov, S , McDiarmid, G., & Arias, A. J. (2022) Clinical effectiveness of intravenous racemic ketamine infusions in a large community sample of patients with treatment-resistant depression, suicidal ideation, and generalized anxiety symptoms The Journal of Clinical Psychiatry, 83(6) https://doi org/10.4088/jcp.21m14336

3 Matveychuk, D , Thomas, R K , Swainson, J , Khullar, A., MacKay, M. A., Baker, G. B , & Dursun, S M (2020) Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers Therapeutic advances in psychopharmacology, 10, 2045125320916657 https://doi org/10 1177/2045125320916657

4 Warner-Schmidt, J L , & Duman, R S (2006) Hippocampal neurogenesis: opposing effects of stress and antidepressant treatment Hippocampus, 16(3), 239–249 https://doi org/10 1002/hipo 20156

5 Redmond, J M , Gillinov, A M , Zehr, K J , Blue, M. E., Troncoso, J. C , Reitz, B A., Cameron, D E , Johnston, M V , & Baumgartner, W A. (1994). Glutamate excitotoxicity: A mechanism of neurologic injury associated with hypothermic circulatory arrest The Journal of Thoracic and Cardiovascular Surgery, 107(3), 776–787 https://doi org/10 1016/s00225223(94)70333-7

6 Onaolapo, A Y , & Onaolapo, O J (2021) Glutamate and depression: Reflecting a deepening knowledge of the gut and brain effects of a ubiquitous molecule World journal of psychiatry, 11(7), 297–315 https://doi org/10 5498/wjp v11 i7 297

7. Rawat, R., Tunc-Ozcan, E., McGuire, T.L. et al. Ketamine activates adult-born immature granule neurons to rapidly alleviate depression-like behaviors in mice Nat Commun 13, 2650 (2022) https://doi org/10 1038/s41467-022-30386-5

8 Penn, E , & Tracy, D K (2012) The drugs don't work? antidepressants and the current and future pharmacological management of depression Therapeutic advances in psychopharmacology, 2(5), 179–188 https://doi org/10 1177/2045125312445469

Photo: TERESA CRAWFORD/AP

Did Your Doctor Not Tell You Something About Your Antidepressant?

1 Rosen, R C , Lane, R M , & Menza, M (1999) Effects of SSRIs on sexual function: a critical review Journal of clinical psychopharmacology, 19(1), 67–85 https://doi org/10 1097/00004714-199902000-00013

2 Scharko, A M , & Reiner, W G (2004) SSRI-INDUCED SEXUAL DYSFUNCTION IN ADOLESCENTS Journal of the American Academy of Child & Adolescent Psychiatry, 43(9), 1067–1068 https://doi org/10 1097/01 chi 0000132832.05219.65

3 Levine, A E McGlinchey; Assessing Sexual Symptoms and Side Effects in Adolescents Pediatrics April 2015; 135 (4): e815–e817 10 1542/peds 2014-3003

4 Rapaport, L (2015, March 23) Antidepressants have sexual side effects in teens, too U S https://www reuters com/article/us-antidepressants-teens-side-effects/antidepressants-havesexual-side-effects-in-teens-too-idUSKBN0MJ24C20150323

5 Asayag, N (2021, June 16) Why Sexuality Is Important: The Benefits Of Coming To Terms With Yours DiveThru https://divethru com/why-sexuality-is-important-coming-to-terms-withyours/

6 Number of young children prescribed antidepressants has risen by 41% since 2015 (2022, February 8) The Pharmaceutical Journal https://pharmaceuticaljournal com/article/news/number-of-young-children-prescribed-antidepressants-has-risen-by-41since-2015

Photo: Anthony Tran

Dependency with Dementia: Elder Abuse in Healthcare Facilities

1 World Health Organization (2022, June 13) Abuse of Older People World Health Organization https://www who int/news-room/fact-sheets/detail/abuse-of-older-people

2 Dong, X , Chen, R , Simon, M (2014, April) Elder Abuse and Dementia: A Review of the Research and Health Policy Health Affairs https://www healthaffairs org/doi/10 1377/hlthaff 2013.1261

3 Mileski, M , Lee, K , Bourquard, C , Cavazos, B , Dusek, K., Kimbrough, K., Sweenet, L., McClay, R (2019, October 22) Preventing The Abuse Of Residents With Dementia Or Alzheimer’s Disease In The Long-Term Care Setting: A Systematic Review

https://www ncbi nlm nih gov/pmc/articles/PMC6816079/# ffn sectitle

4 Alzheimer’s Association (n d ) Abuse Alzheimer’s Association https://www alz org/helpsupport/caregiving/safety/abuse

5 Swenarton, N (2021, August 27) Recommendations for Understanding Incidence and Risk of Elder Mistreatment https://www rutgers edu/news/recommendations-understanding-incidence-andrisk-elder-mistreatment

Photo: Matt Bennett

The Painful Struggle of Endometriosis

1 Taylor, H S , Kotlyar, A M , & Flores, V A (2021). Endometriosis is a chronic systemic disease: clinical challenges and novel innovations Lancet (London, England), 397(10276), 839–852 https://doi org/10 1016/S0140-6736(21)00389-5

2 Mehedintu, C , Plotogea, M N , Ionescu, S , & Antonovici, M. (2014). Endometriosis still a challenge Journal of medicine and life, 7(3), 349–357

3 https://www njleg state nj us/bill-search/2022/A3737/bill-text?f=A4000&n=3737 I1

4 https://www womenshealth gov/a-z-topics/endometriosis

5 Zondervan, K T , Becker, C M , Koga, K , Missmer, S. A., Taylor, R N., & Viganò, P. (2018) Endometriosis Nature reviews Disease primers, 4(1), 9 https://doi org/10 1038/s41572-018-0008-5

6 Bullo S (2020) "I feel like I'm being stabbed by a thousand tiny men": The challenges of communicating endometriosis pain Health (London, England : 1997), 24(5), 476–492 https://doi org/10 1177/1363459318817943

Photo: Danah Pascual

Achieving 20/20 Vision: Is It Within Reach?

1 Fast facts of common eye disorders Centers for Disease Control and Prevention. (2020, June 9) Retrieved October 31, 2022, from https://www cdc gov/visionhealth/basics/ced/fastfacts.htm#: :text=Approximately%2012%20millio n%20people%2040,due%20to%20uncorrected%20refractive%20error

2 Tips to Prevent Vision Loss Centers for Disease Control and Prevention. (2021, August 10) Retrieved October 31, 2022, from https://www cdc gov/visionhealth/risk/tips.htm

3 A R S C (2022, August 18) LASIK Enhancements: LASIK Touch-Up Facts Refractive Surgery Council Retrieved October 31, 2022, from https://americanrefractivesurgerycouncil org/understanding-facts-lasik-enhancement/

4 Montazeri, L , El Zarif, N , Trenholm, S , & Sawan, M. (2019). Optogenetic Stimulation for Restoring Vision to Patients Suffering From Retinal Degenerative Diseases: Current Strategies and Future Directions IEEE transactions on biomedical circuits and systems, 13(6), 1792–1807 https://doi org/10 1109/TBCAS 2019 2951298

Photo: Nico Titto

When Dayquil Backfires: Understanding Immune System Function and Stress

1 Mayo Clinic Staff (2021, July 8) Chronic stress puts your health at risk Mayo Clinic

2 Web (2022, September 25) How does stress affect the immune system? UMMS Health Retrieved October 24, 2022, from https://health umms.org/2020/11/10/stress-immune-system/

3 Segerstrom, S C , & Miller, G E (2004, July) Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry Psychological bulletin

4 LaFee, S (2016, March 1) Moments of acute stress can cause molecular alterations in immune response UC Health - UC San Diego Retrieved October 24, 2022, from https://health ucsd edu/news/releases/pages/2016-03-01-acute-stress-and-immune-response aspx

5 American Psychological Association (2004) Stress affects immunity in ways related to stress type and duration, as shown by nearly 300 studies American Psychological Association Retrieved October 24, 2022, from https://www apa org/news/press/releases/2004/07/stress-immune

Photo: CDC

Cold Plasma Cancer Therapy: Is it the Answer?

1 Canady Helios™ Cold Plasma scalpel for breast cancer treatment Sheba Medical Center. (2022, August 16) Retrieved November 21, 2022, from https://www shebaonline org/canady-helios-coldplasma-scalpel-for-breast-cancer-treatment/

2 Breast cancer treatment at Fox Chase Flex Landing FCCC (2021, January 12) Retrieved November 21, 2022, from https://lp foxchase org/breast-cancer-treatment? msclkid=5bb9e88701e315f8eafe8bca8e942ea5&utm source=bing&utm medium=cpc&utm campai gn=Breast+Cancer-Reach-NonBrnd-IntentExact Bing&utm term=treatment+for+breast+cancer&utm content=Treatment#0

3 Canady Helios™ Cold Plasma Canady Life Sciences (n d ) Retrieved November 21, 2022, from https://canadylifesciences com/products-technology/canady-helios-cold-plasma/

4 The Granger-causal effects of Canady Helios cold plasma on the (n d ) Retrieved November 21, 2022, from https://canadylifesciences com/pdfs/JCRI%20Poster 2022%20ISSO XC pdf

5 Cheng, X , Murthy, S R K , Zhuang, T , Ly, L , Jones, O., Basadonna, G., Keidar, M., Kanaan, Y , & Canady, J (2021, September 3) Canady Helios cold plasma induces breast cancer cell death by oxidation of histone mrna MDPI Retrieved November 21, 2022, from https://www mdpi com/1422-0067/22/17/9578/htm

Photo: National Cancer Institute

Micro Medicine: Nanotechnology and the Spinal Cord

1 Research, G T (2020, July 10) Nanotechnology in Medicine: Technology Trends Medical Device Network https://www medicaldevice-network.com/comment/nanotechnology-medicinetechnology/

2 Viswanathan, V K , Rajaram Manoharan, S R , Subramanian, S., & Moon, A. (2019)

Nanotechnology in Spine Surgery: A Current Update and Critical Review of the Literature World Neurosurgery, 123, 142–155 https://doi org/10.1016/j.wneu.2018.11.035

3 Yang, X , Liu, F , Yin, Y , Zhang, P , Jia, Y , Zhang, Y., Yao, Y., & Tian, Y. (2022). Efficacy of NHP66 Bioactive Cage on Patients with Cervical Spine Injury in Short-Track Speed Skating Computational and Mathematical Methods in Medicine, 2022, 6088398–7 https://doi org/10 1155/2022/6088398

4 Rutgers Researchers Harness AI and Robotics to Treat Spinal Cord Injuries (2022, March 25) Rutgers University https://www rutgers edu/news/rutgers-researchers-harness-ai-androbotics-treat-spinal-cord-injuries

Photo: Michael Dziedzic

Forever Chemicals: A Hidden Health Hazard

1 PFAS Health Effects & Ways to Reduce Exposure (2022) Public Health Madison & Dane County Retrieved from https://publichealthmdc com/environmental-health/environmentalhazards/pfas/pfas-health-effects-ways-to-reduce-exposure

2 Grossman, A , & Dennings, K (2022) The Influence of Environmental Toxicity, Inequity and Capitalism on Reproductive Health Retrieved from https://www biologicaldiversity org/programs/population and sustainability/pdfs/environmental reproductive health report pdf

3 Sneed, A (2021) Forever Chemicals Are Widespread in U S Drinking Water Scientific American Retrieved from https://www scientificamerican com/article/forever-chemicals-arewidespread-in-u-s-drinking-water/

4 Per- and Polyfluorinated Substances (PFAS) Factsheet (2022) Centers for Disease Control and Prevention National Biomonitoring Program Retrieved from https://www cdc gov/biomonitoring/PFAS FactSheet.html

5 What are PFAS chemicals? (2020) Environmental Working Group Retrieved from https://www ewg org/what-are-pfas-chemicals

6 Graber, J M , Black, T M , Shah, N N , Caban-Martinez, A. J., Lu, S., Brancard, T., Yu, C H , Turyk, M E , Black, K , Steinberg, M B , Fan, Z , & Burgess, J. L. (2021). Prevalence and Predictors of Per- and Polyfluoroalkyl Substances (PFAS) Serum Levels among Members of a Suburban US Volunteer Fire Department International Journal of Environmental Research and Public Health, 18(7), 3730 https://doi org/10 3390/ijerph18073730

7 Zajac, L (2022) PFAS: Limiting Children’s Exposure to "Forever Chemicals " American Academy of Pediatrics Council on Environmental Health and Climate Change Retrieved from https://www healthychildren org/English/safety-prevention/all-around/Pages/LimitingChildrens-Exposure-to-Forever-Chemicals aspx

8 10 Things You Can Do About Toxic PFAS Chemicals (2022) Clean Water Action Retrieved from https://www cleanwateraction org/features/10-things-you-can-do-about-toxic-pfas-

chemicals

Photo: Kevin Sicher

The Compassion Crisis

1 Trzeciak S Mazzarelli A & Booker C (2019) Compassionomics : the revolutionary scientific evidence that caring makes a difference Studer Group

2 Sinclair, S , Beamer, K , Hack, T F , McClement, S., Raffin Bouchal, S., Chochinov, H. M., & Hagen, N A (2017) Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences Palliative medicine, 31(5), 437–447

3 D’Amico, L Empathy and compassion in the health-related literature: disciplinary and topic trends and gaps J of Compassionate Health Care 5, 6 (2018)

Photo: Giulia Bertelli

The Impacts of Healthcare Accessibility on Quality of Treatment

1. Bhatt, J., & Bathija, P. (2018). Ensuring Access to Quality Health Care in Vulnerable Communities Academic Medicine, 93(9), 1271–1275 https://doi org/10 1097/acm 0000000000002254

2 Improving Access to Care in Rural and Underserved Communities: State Workforce Strategies (2017) Ncsl org https://www ncsl org/research/health/improving-access-to-care-inrural-and-underserved-communities-state-workforce-strategies.aspx

3 VanderWielen, L M , Vanderbilt, A A , Crossman, S. H., Mayer, S. D., Enurah, A. S., Gordon, S S , & Bradner, M K (2015) Health disparities and underserved populations: a potential solution, medical school partnerships with free clinics to improve curriculum Medical Education Online, 20(1), 27535 https://doi org/10 3402/meo v20 27535

4 Jongen, C , McCalman, J , & Bainbridge, R (2018). Health workforce cultural competency interventions: A systematic scoping review BMC Health Services Research, 18(1), 1–15 https://doi org/10 1186/s12913-018-3001-5

5 “Rutgers New Jersey Medical School ” Njms rutgers edu, njms rutgers edu/culweb/about php https://njms rutgers edu/culweb/about php

6 Bokhour, B G , & Cutrona, S L (2018) Time to Listen More and Talk Less Journal of General Internal Medicine, 34(1), 1–2 https://doi org/10 1007/s11606-018-4711-4

Photo: john amachaab Racial Bias and Misdiagnosis

1 Epstein, Helene “Why the Color of Your Skin Can Affect the Quality of Your Diagnosis ” Society to Improve Diagnosis in Medicine, August 3, 2020 https://www improvediagnosis org/dxiq-column/why-the-color-of-your-skin-can-affect-thequality-of-your-diagnosis/

2 “Take Racism out of Medical Algorithms ” Scientific American. Scientific American, December 1, 2020

3 Arana-David, Annabelle “A Path toward Health Equity.” Rutgers University Foundation, March 28, 2022 https://support rutgers edu/news-stories/a-path-toward-health-equity/

4 Russell, Tonya “Racism in Care Leads to Health Disparities, Doctors and Other Experts Say as They Push for Change ” The Washington Post WP Company, July 11, 2020 https://www.washingtonpost.com/health/racism-in-care-leads-to-health-disparities-doctors-andother-experts-say-as-they-push-for-change/2020/07/10/a1a1e40a-bb9e-11ea-80b940ece9a701dc story html

Photo: Clay Banks

Refugee Health Disparities in the United States

1 Feinberg, I , O'Connor, M H , Owen-Smith, A , Ogrodnick, M. M., & Rothenberg, R (2020, November 9) The relationship between Refugee Health Status and language, literacy, and time spent in the United States HLRP: Health Literacy Research and Practice. Retrieved November 7, 2022, from https://journals healio com/doi/10 3928/24748307-20201109-01

2 Improving health literacy in refugee populations (2016, January 18). Mja https://www mja com au/system/files/issues/204 01/10.5694mja15.01112.pdf

3 Umar, T , & Thelapally, S (n d ) RHC intro [Slide show] https://docs google com/presentation/d/1SEPEVypDBrLocyBPtKaHV9G1HYWSyd39XdMlycnGQ nw/edit#slide=id gff0bab3979 0 0

Photo: Ahmed Akacha

Midnights: Setting a Healthy Limit for Wakefulness

1 Melore, C (2022, August 8) The brain is not meant to be awake after midnight, study concludes Study Finds https://studyfinds org/brains-not-meant-awake-midnight/

2 Bedtime linked with heart health European Society of Cardiology (n d ) https://www escardio org/The-ESC/Press-Office/Press-releases/Bedtime-linked-with-hearthealth

3 What time should I go to bed? Go to bed before midnight Sleep Centers of Middle Tennessee (2022, April 22)

4 Spaeth, A M (2015, May) Additional sleep duration associates with improved Blood Sugar Regulation Sleep Research Society https://www ncbi nlm nih gov/pmc/articles/PMC4402671/

Photo: Anne Nygård

The Healing Power of Nature

1 Han, A -R , Park, S -A , & Ahn, B -E (2018, March 28) Reduced stress and improved physical functional ability in elderly with mental health problems following a horticultural therapy program Complementary Therapies in Medicine Retrieved November 30, 2022, from https://www sciencedirect com/science/article/pii/S0965229918301407

2 Harris, K , & Trauth, J (2020) Horticulture therapy benefits: A report Research Gate

3 Kim, M -Y K (2010) Effects of horticultural occupational therapy on the physical and psychological rehabilitation of patients with hemiplegia after stroke Horticultural Science & Technology

4 Lee, A -Y , Park, S -A , Park, H -G , & Son, K -C (2018, January 1) Determining the effects of a horticultural therapy program for improving the upper limb function and balance ability of stroke patients hortsci Retrieved November 30, 2022, from https://journals ashs org/hortsci/view/journals/hortsci/53/1/article-p110.xml

5 Rutgers University (2022) Minor in horticultural therapy Rutgers University

6 Soderback, I (2009) Horticultural therapy: The 'healing garden'and gardening in rehabilitation measures at Danderyd Hospital Rehabilitation Clinic, Sweden Taylor & Francis

7 Tu, H -M (2022) Effect of horticultural therapy on mental health Wiley Online Library

8 Weir, K (2020) Nurtured by nature Monitor on Psychology Retrieved November 30, 2022, from https://www apa org/monitor/2020/04/nurtured-nature

Photo: pikisuperstar

Protecting Those Who Protect

1 Caruso, V (2022, April 21) South Plainfield's Evening EMS Services Turned Over to RWJ Mobile Health Services TAPinto Retrieved November 20, 2022, from https://www tapinto net/towns/south-plainfield/sections/government/articles/south-plainfield-sevening-ems-services-turned-over-to-rwj-mobile-health-services

2 Strunsky, S (2021, May 3) Small NJ town still without ambulance service 1 year after squad shut down EMS1 Retrieved November 20, 2022, from https://www.ems1.com/ambulanceservice/articles/small-nj-town-still-without-ambulance-service-1-year-after-squad-shut-downq8Y2tnMtktlM2b5K/

3 Tarrazi, A (2022, August 25) Liberty Corner First Aid Squad Halts Operation After 57 Years Patch Retrieved November 20, 2022, from https://patch.com/new-jersey/baskingridge/libertycorner-first-aid-squad-halts-operation-after-57-years

4 RWJBarnabas Health (n d ) Overview of EMT Initial Training Robert Wood Johnson University Hospital Retrieved November 20, 2022, from https://www.rwjbh.org/treatment-care/trainingcenter/emt-training-classes/emt-initial-training/overview-of-emt-initial-training/

Photo: Mikita Yo

Photo: Mpho Mojapelo

Staff photo: Vasily Koloda

Back cover photo: Toa Heftiba