The Examiner: Rutgers Pre-Health Journal Issue 9

OCTOBER 2013 ISSUE No.

09

STAFF EDITOR-IN-CHIEF Vishal Patel

MANAGING EDITORS Shireen Hamza Yuli Noah

LAYOUT EDITORS Ivana Ganihong Khushbu Parikh

TREASURER Kaiwal Patel

Secretary

Dhaval Mehta

CONTACT US

ruexaminer@gmail.com eden.rutgers.edu/~examiner/

PR CHAIRS

Reshma Shiwdin Erum Farooqui Anshika Verma

EDITORS

Kristin Baresich Sahitya Cherukuri Sailaja Darisipudi Meghna Dev Nikhitha Kotha Sri Puli Hima Sathian Issac Song Evagelia Stavrakis Pujitha Talasila

JOURNALISTS

Tiwalade Adediji Kunal Bailoor Jasmeet Bawa Melanie Chen Meghna Dev Nithya Gandam Tvissha Goel Neha Kayastha Emily Moore Ronak Patel Emilie Transue Saima Usmani Chir Wei Stephanie Yuen

LETTER FROM THE EDITOR-IN-CHIEF Dear Readers,

Welcome to the ninth issue of The Examiner – Rutgers Pre-Health Journal! We are Rutgers University’s premier pre-health media publication that is run for and by undergraduate students with the mission of informing fellow pre-health students on current events in the healthcare field.

We hope the semester and 2013-2014 academic year is going well for everyone! This issue continues our goal of being a multidisciplinary journal that attempts to bridge the current gap between the traditional sciences and the humanities. We have tried to accomplish this by presenting diverse issues relating to healthcare policies, geopolitical issues, fun columns, complex societal issues, health economics, medical school admissions, etc. to demonstrate how these seemingly unrelated topics might affect the future of healthcare professionals.

We would like to thank and congratulate our executive staff, journalists, editors, RUSA allocations, and faculty as well as administrative advisors for contributing to this issue and ultimately to serve the needs of the Rutgers prehealth community.

We hope that you enjoy reading The Examiner, and we would sincerely appreciate your feedback on our Facebook page, Twitter, or at ruexaminer@gmail.com.

Thanks and regards,

Vishal Patel Editor-in-Chief

SO DOES THAT MEAN I SHOULD PARTY WITH MY FRIENDS? Saima Usmani

THE EXAMINER

4

Humans are social animals, and biologically crave interaction with other humans.1 It has long been said that these social interactions evolved along with neural, behavioral, and genetic mechanisms because they posed survival and reproductive benefits [3]. So, does that call for going to parties, meeting with friends, and becoming involved with organizations in communities to maintain optimal physical and mental health?

According to a recent study, social isolation may be in close contest with traditional risk factors when it comes to mortality.

Matthew Pantell and collaborators published a paper in the American Journal of Public Health that reviewed 16,849 adults from a survey and death index.2 After readjusting for sociodemographic variables (race, economic status, gender), the study assigned a Social Network Index (SNI) to each individual. The SNI number is calculated from marital status, rate of social contact, communal religious activity, and participation in various

clubs and organizations. The authors found, after analyzing these SNI numbers, that both men and women with lower SNI numbers were associated with significantly decreased survival curves.

There are many elements to consider before jumping to the conclusion that “you must be social or else you will die.” True, it is difficult to deny that less social activity is an indicator of poor health. Certainly, a socially isolated individual is likely to be more prone to depression, dietary misdemeanor, and stress-related illnesses such as heart disease and diabetes, to name a few. Dr. Martha McClintock, a psychology professor from the University of Chicago says, “The increase in morbidity with social isolation is equal to that of cigarette smoking” [4]. In regard to mental health, individuals who feel left out will tend to become more anxious and stressed and therefore, he or she may experience severe emotional and physiological mechanisms [5]. These considerations, if anything, make the findings of Pantell et.al. more viable.

However, there are still several variables unaccounted for. Firstly, social interaction may be a cause of stress and poor health choices for certain individuals. In these cases, the individual may be equally or more likely to exacerbate mortality factors than the socially isolated individual. For instance, the power of a nagging significant other or spouse should not be underestimated, and the health risks of certain forms of college partying cannot be ignored.

Another catch is if social isolation is a lifestyle choice that an individual makes and one has the determination and ability to take care of himself, then in that case his health may be better. The risks for hypertension and depression stemming from social interaction or unwilling social isolation would be lowered. The willful hermit is more likely to be healthier than the shunned outcast.

The third factor to consider is if the individual was led to social isolation because of a debilitating

illness or poor health. In this case, the individual’s mortality risk led to social isolation, an alternative to the proposal that social isolation causes poor health.

Despite these variables, the importance of assessing a patient’s level of social isolation should not be overlooked in the clinical field. Evidence from animal studies on rats indicated that social isolation slowed wound healing from a study published by the American Journal of PhysiologyRegulatory, Comparative and Integrative Physiology [4]. Furthermore, behavioral inhibition,

“The increase in morbidity with social

isolation is equal to that of cigarette smoking”

relating to social isolation does portray a threat to health and survival. In a study done by Dr. Sonia Cavigelli, it was shown that behaviorally inhibited rats died earlier due to finding the environments they were placed in more intimidating [4].

Overall, this highlights the significance of being more active in the community, especially in school or college because many young adults are trying to find their own niche and starting out early can certainly be beneficial. Rutgers provides a plethora of options, from over 400 clubs and organizations to fraternities and sororities, and living and learning communities all presented at the Involvement Fair. Every person can find his or her own niche. So, does this research indicate that partying with friends is a survival benefit? Maybe, maybe not, but it certainly makes for a good excuse.

References 1 Gray, Paula. Humans are social Animals. Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. AIPMM. May 7, 2010.

2 Pantell, Matthew, et al. Social Isolation: A Predictor of Mortality Comparable to Traditional Risk Factors. American Journal of Public Health. Jan 20, 2013.

3 http://psychology.uchicago.edu/people/faculty/ cacioppo/CHNB2011.pdf 4 http://www.apa.org/monitor/nov06/isolated.aspx 5 http://socialwellness.wordpress.com/why-social- isolationmakes-us-sick-%E2%80%93-a-theory/ Image retrieved from: http://media.emirates247.com/images/world%20new%20year/5.JPG

5

Easy on the Eyes: The Benefits of E-Readers for Students with Dyslexia Tvissha Goel As tablets continue to shrink in size and increase in user-friendliness, e-readers in particular seem to be growing in popularity and prevalence among college students. Not only are they now more convenient than ever and nearly weightless, but they also offer a potential benefit to those with dyslexia.

In a recent study, Matthew Schneps, Director of the Laboratory for Visual Learning, and his colleagues at the Harvard-Smithsonian Center for Astrophysics conducted an experiment involving 103 high school students with dyslexia and no history of any other neurological disorders.1 Text was given to the students in both print and digital forms while the students’ reading speeds were measured with stopwatches. The electronic versions were presented on iPods and had a 42pt font with only three or four words per line.

Multiple choice questions were then administered to the students to assess their comprehension.4 Most students performed better on the assessments after using the iPod rather than print form. E-readers may lessen the effort needed by dyslexic students to read texts, because of the larger font and fewer words per line made possible by these e-readers. This is a key advantage for students with this disorder since dyslexia has been associated with oculomotor—i.e., eye movement—deficits and a lack of visual attention. This was attributed to a low VA span score, or the inability of a reader to keep his or her attention on the reading content.4

At Rutgers in the 2010-2011 academic year, 122 students identified as dyslexic, compared with 78 in the previous year. One of the resources that the university provides for such students is Kurzweil 3000, an assistive software that presents text and reads the documents aloud for students.3 THE EXAMINER

6

Among other features designed to enhance learning, writing capabilities are also provided with this software, allowing the reader to add notes. However, studies have shown that assistive technologies have limits when it comes to math and science subjects. As researcher Klaus Miesenberger writes, “Mathematical and scientific formulas are not of a one-dimension nature like text. In addition, the spatial nature of formulas makes comprehension of their meaning from hearing them alone extremely difficult. … People read them in quite a different way than the way they read novels.”2 Considering this perspective, there is still work to be done in the domain of learning technology for scientific and technical content.

While the research does not specifically compare the advantages of e-readers with those of assistive technologies such as Kurzweil 3000, tablets and iPods may serve as an alternative or an addition to the current technologies used by students with dyslexia at Rutgers. Such texts that provide larger font may be a feasible option to help aid in reading comprehension.

EMILIE TRANSUE

THE STIGMA OF MENTAL ILLNESS

On a website sponsored by the Substance Abuse & Mental Health Services Administration (SAMHSA), Kevin Coyle writes “Losing control of your mind, of your very being is a scary thing.

It impacts and influences everything: how you act and what you believe. I never thought it would happen to me.”1 Even though he never thought it would happen to him, mental health issues are strikingly common. In one year, the National Institute of Mental Health estimates that one in four adults experiences mental illness and as do 20% of children aged 13-20. To put that into perspective, this totals 61.5 million adult Americans.2 Even with such a high incidence in the United States, Kevin recalls “Socially I felt very alone. I felt like I was hiding a big secret that I couldn’t let others know.”

The National Alliance on Mental Illness defines mental illness as “a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning.”2 Just as someone cannot “just get over” their cancer, a mental illness is not something to be brushed off lightly.

Serious mental illness costs America $193.2 billion in lost earnings per year. On the individualistic level, adults with serious mental illness die on average 25 years earlier than other Americans. In fact, among youths ages 15-24, depression and mood disorders are the third leading cause of death.2

Society plays a role behind these shocking statistics. The negative attitude towards mental illness and the lack of understanding of mental illness creates a stigma so powerful that only 38% of adults with diagnosable mental health problems receive the treatment they need. In children and youths, that number drops to 20%.3 A study published in Fall 2013 investigated this stigma and the attitudes toward mental illness. Participants were asked to agree or disagree (along a scale) with the following statements: “Treatment can help people with mental illness lead normal lives” and “People are generally caring and sympathetic

to people with mental illness.” Interestingly, 67% of adults strongly agreed that treatment is effective, but only about 23% of adults strongly agreed that people are caring and sympathetic to those with mental illnesses. The stigma was further highlighted by those currently receiving mental illness treatment: only 17% strongly agreed that people are caring and sympathetic to people with mental illness.4 As SAMSHA notes, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders.”1 The administration explains how the stigma further leads to a decline in selfesteem and pushes people to feel ashamed of their condition, causing them to hide their symptoms.

It is highly likely that you will know someone struggling with a mental illness at some point in your life. Instead of judging these individuals and adding to their distress, one should give them the support they require and direct them to appropriate resources. There are a number of organizations here at Rutgers that provide mental health services for students and faculty. Many students know about Counseling, Alcohol, and Other Drug Assistance Program and Psychiatric Services (CAPS). This foundation’s mission is to enable access for students to services that range from individual counseling to outreach initiatives to training programs.5 A less-known and recently founded organization that boosts awareness of eating disorders and advocates a positive body is Project Heal.6 No one should be made to feel too embarrassed or afraid to seek the help they need.

References 1 Coyle, K. A Deaf Recovery Story. SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center). Retrieved from http://promoteacceptance. samhsa.gov/publications/mystory/story_kevin.aspx 2 National Alliance on Mental Illness. (2013) Mental Illness Fact Sheet. Retrieved from http://www.nami. org/factsheets/mentalillness_factsheet.pdf 3 MentalHealth.gov. Myths and Facts. Retrieved from http://www.mentalhealth.gov/basics/myths-facts/ index.html 4 Kobau, R., Zack, M. (2013). Attitudes Toward Mental Illness in Adults by Mental Illness–Related Factors and Chronic Disease Status: 2007 and 2009 Behavioral Risk Factor Surveillance System.

American Journal of Public Health. Retrieved from http://ajph.aphapublications.org/doi/pdf/10.2105/ AJPH.2013.301321 5 CAPS. (2013). Rutgers Health Services New Brunswick. Retrieved from http://rhscaps.rutgers.edu/general-information6 Find an Organization. (2013). Rutgers Student Life New Brunswick. Retrieved from http://getinvolved.rutgers.edu/organizations/find-an-organization/?page=12 Image from http://segment.com/wp-content/uploads/2013/09/mental-illness-art-a3ce9bb6a9a7cdbc.jpg

7

Why is ODASIS Necessary?

Shireen Hamza

Shireen Hamza Rutgers is not the only public University to have a program in place to help historically underrepresented groups join medicine, medical research and other STEM fields.

Under the Rutgers Division of Life Sciences, the Office for Diversity and Academic Success in the Sciences (ODASIS) program. It states that its mission is to “increase the recruitment and academic success of underrepresented students, as well as educationally and economically disadvantaged students, who are interested in pursuing careers in the science, technology, engineering, and mathematics professions”.1 Similar programs are funded by private and public organizations as diverse as the National Science Foundation, the U.S. Department of Health and Human Services, and the Robert Wood Johnson foundation, among many others. However, many students at an institute as diverse as Rutgers may wonder if a program like ODASIS is still truly necessary.

Such broad support for similar programs would suggest a near consensus among healthcare professionals that diversity is a positive factor. The AAMC’s annual report

THE EXAMINER

8

on the “Diversity in Medical Education,” remarks that “the exposure to and experience with racial and ethnic diversity are key to understanding and improving patient care as well as reducing health disparities.”4 They

have good reason for their positive opinion on diversity. The report explains that “it is hoped that a wider expression of interest in general specialties would translate into care for the underserved,” and that “Black or African American and Hispanic or Latino matriculants have remained quite stable in their interest” for entering internal medicine and serving the underserved, although “American Indian or Alaska Native, Asian, and White matriculants since 2000 have become increasingly undecided about their interest in serving the underserved.”4 However, the report this year noted a significant drop in the number of Black males in medical education. This year, “Black or African American males are applying to, being accepted to, and matriculating into medical school in diminishing numbers, which speaks to the increasing need for medical schools to institute plans and initiatives aimed

at strengthening the pipeline.”4 ODASIS is a program that does just that.

The AAMC study discussed above shows that, in 2011, Hispanics/Latinos and Blacks or African Americans comprised 15.2% of all applicants, while American Indians or Alaska Natives (0.2%) and Native Hawaiians or Other Pacific Islanders (0.2%) comprised less than 1% of all applicants combined.4 Shockingly, though nearly 46% of all applicants in 2010 and 2011 were accepted to medical school overall, less than 41% of Black or African American applicants were accepted during the same period.4 The lowest percentage of applicants accepted in 2010 and 2011 included Native Hawaiians or Other Pacific Islanders, at 30.2% and 25.0%.4 Heather Alarcon, a senior member of the Association for American Medical Colleges (AAMC), says “race is one of the many factors that can provide insight into how a future physicians will make decisions and overcome adversity,” and thus medical schools have long supported affirmative action policies “based on the notion that the policy aids both students and patients.”2 Affirmative

action in general is embraced by many institutions of higher learning in America, but it remains contentious as an effective means to increase diversity in the workforce, making it to the supreme court most recently in 2008.2 Those arguing against affirmative action claim that it promotes negative stereotypes against black and hispanic applicants, and creates suspicion about the credentials of minority graduates.2 However, there is a clear need to support certain minorities who are consistently underrepresented. However, the figures above seem to show that affirmative action does not boost acceptance rates for minorities above the average.

They are still below average for these minority groups.

Programs like ODASIS provide supports to underrepresented minorities, like “supplemental academic instruction, continued guidance, and advising,” to which the arguments against affirmative action do not apply. Better equipped and more diverse applicants to the health professions can only bode well for students and patients.

9

Politics and Science of Fetal Pain Nithya Gandham

THE EXAMINER

10

The debate over abortion has been an ongoing one since the Roe v. Wade Supreme Court ruling.

In 1973 the Supreme Court struck down states’ laws banning abortion, relying heavily on the substantive due process principle, which explains that the federal courts should protect certain fundamental rights without any government interference.

Although abortion was legalized, it is only legal until the fetus is considered viable outside of the womb, which many states have determined to be at the 24th week.

When determining abortion laws, lawmakers referenced scientific research for data. This research indicated that not only were fetuses viable at 24 weeks but they could also sense pain. Fetal pain is defined as both a psychological and physiological experience. The Family Research Council further claims that although some pain sensors develop early on in pregnancy, fetal pain compared to that of newborns only occurs around 24 weeks after conception1. However, many previous studies featured in the Journal of the American Medical Association stated that pain perception in fetuses was highly unlikely to occur before the third trimester; there must be neural connections between pain receptors and the cortex in order to perceive pain2. Because the cortex is not fully

functionally developed until the 26th to 27th week after conception, it is unlikely the fetus feels pain before that point2.

However, some fetal-pain law advocates have argued that the cerebral cortex is not necessary to sense and perceive pain. Rather, the thalamus, developed at 20 weeks, plays a larger role in pain sensations than was previously believed2. They cite one study which observed five children with hydranencephaly, a disorder in which most of the cortex is missing and is instead replaced with fluid. The conclusion of this study found that these children still seemed to display emotion through smiling or crying despite their lack of cortex2. In addition, research done in 1996 by the Emory School of Medicine found evidence that unborn infants have pain receptors on their face as early as seven weeks and by 20 weeks these pain receptors cover their body in equal or greater density than adults3.

In response to this research, prolife advocates have lobbied for laws preventing abortion after the 20th week.

Abortion is fraught with complexities and is often mired in a heated debate between pro-life and pro-choice advocates who both claim irrefutable validity for their respective arguments. It can be even more difficult for the younger generation such as college students who are bombarded by oftentimes-conflicting perspectives across the board. Although Rutgers’ Health Centers do not provide abortion services they can direct you to other locations that do provide these services.

Rutgers University does have a CAPS program (Rutgers counseling, ADHP, and psychiatric services), which can help aid and educate the Rutgers community of their options or give them assistance if pursuing further treatment and help.

To learn more about services available at Rutgers, contact Rutgers Health Services: (848)-932-7402.

pre-med cornerYuli Noah

Many pre-med students (or maybe it’s just me) are so confident in their extensive knowledge of the human body, that they rather annoyingly begin to diagnose people after day 1 of organic chemistry, and occasionally even feel the need to explain the molecular basis of said problem. But that’s not to say that my methods aren’t scientific or methodical. I quite expertly ask about family history, and utilize the WongBaker FACES Pain Rating Scale, for my friends with particularly low pain thresholds, as well as the Verbal Descriptor Scale. And despite my friends not wanting my help, I like to put my two cents in anyway. The usual symptoms that are presented to me (or not) are as follows: Headache Stomachaches

Well isn’t it obvious? Headaches 9 out of 10 times are due to dehydration right? So just drink up the liquid of life. Of course, there is always that 1 in 10 person that may require some more serious treatment, i.e. Advil, and sometimes I’ll even have to bring out the big guns, Excedrin.

Now on to stomachaches, if a stomachache persists for more than a few days then it’s likely due to a parasite, otherwise you were just eating those wings too fast.

Now if only I was given the power of writing prescriptions, I could start a clinic in my very own living room. And all of this is possible without a stethoscope, needles, or even tongue depressors. I’ve been using my phone light to examine my patients’ mouths, ears, and noses.

And who needs a thermometer anyway? A hand to the forehead or back of the neck will tell you all you need to know.

So you’ve been warned. Think twice before you even think about complaining of your ailments because there will likely be a premed student right behind you (it’ll probably be me) ready to diagnose you with jaundice. *The information presented in this article is not meant to replace an official diagnosis by a certified physician. Please see your doctor if symptoms persist or worsen.

11

The Challenge of Integrating Pharmacists Into Primary Healthcare Teams

Pharmacists have yet to become substantially involved in primary healthcare teams, despite their expertise in drug interactions and safe usage of medicines. Certain interprofessional barriers between general practitioners (GPs), who diagnose patients and prescribe medication, and pharmacists, who advise both patients and physicians on drug effects, prevent pharmacists from being fully integrated into patient-directed health systems. Previous studies illuminate a number of these obstructions.

The main barrier is the common perception of pharmacists as people whose sole job is to pick medicines off a shelf, count pills, and hand vials over the counter to waiting patients. In his New Scientist article, “In the Pharmacist’s Image,” Professor Ian MacKillop writes, “To most members of the general public, the pharmacist remains a glorified shopkeeper who enters their consciousness only when they need a prescription filled or the weekend is coming up.”1 A study conducted in 2003 by two members of the School of Pharmacy at Queen’s University in Northern Ireland reaffirms Dr. MacKillop’s opinion. Dr. Carmel M. Hughes and Dr. Siobhan McCann surveyed 22 GPs and 31 pharmacists to explore the rift between these two professions. The pharmacist’s “shopkeeper” image emerged as the study’s prominent theme and accounted for most of the concerns GPs had with extending prescribing rights to pharmacists.

Another concern emerged, regarding pharmacies as businesses. One GP observed, “There is definitely a conflict between the NHS (National Health Service) primary healthcare team THE EXAMINER

12

Melanie Chen

effort that we all feel we are involved in and with pharmacists and their role as the shopkeeper and their role in looking for profits for themselves.”2 Many other GPs in the study also mentioned this conflict of interest in the pharmacist’s dual role as both a healthcare professional, serving the patient, and as a businessperson, trying to sell products.

Many of the surveyed pharmacists felt indignant, citing that this kind of bias restrains their influence in healthcare, and places pharmacists lower on the healthcare hierarchy than their skill level warrants.

One pharmacist echoed the thoughts of his fellow pharmacists with his response, “In my opinion, we have to be respected for what we do with medicines and it is likely that at the minute GPs do not fully understand what we do. I think they believe that we just put pills into a bag and dispense them. I don’t think they see our vital role in healthcare.”2 A common thread among pharmacists’ responses was that most GPs are unaware of the rigorous educational and clinical training all pharmacists go through, thereby contributing to the divide.

The inclusion of pharmacists within a health system could have widespread positive results, such as those documented at Fairview Health Services at Minneapolis, St. Paul. Pharmacists at Fairview play a very active role in healthcare.

They consult patients directly on how to take their medication and also work with other medical professionals, such as doctors and nurses, as part of multidisciplinary teams3. A study conducted by the University of Minnesota’s College of Pharmacy looked at Fairview’s pharmacist model over a

15-month period and found that drug-related morbidity and mortality was significantly lower at FHS, compared to other statewide clinics. Forty percent of diabetic patients within pharmacist-integrated health systems at Fairview, or “innovation clinics,” reached all their performance treatment goals in 2009, compared with the statewide average of 17.5% in noninnovation sites. In addition, over 4,000 individual drug therapy problems were reported to be resolved.

The Fairview study concluded that pharmacist-integrated healthcare teams helped to achieve quality performance through collaborative efforts between GPs and pharmacists4. If barriers arising from misconceptions and general unawareness between doctors and pharmacists could be mitigated, all members of the healthcare team – and most importantly, the patient – would benefit.

These misconceptions do not just exist in the professional medical world.

The Rutgers community of pre-medicine and pharmacy students should begin deconstructing these misguided frameworks within their own minds. By understanding the importance of the myriad fields of healthcare, and thus acknowledging the contribution that every healthcare professional makes to patient care, students will be on track to participate in multidisciplinary healthcare teams as future professionals.

“

I think it is likely that at the minute GPs do not fully understand what we do. I think they believe that we just put pills into a bag and dispense them

” 13

Ronak Patel

Can OVERTHINKING Affect Performance?

After a long night of studying, don’t overtax your memory systems by cramming in more material or attempting to do practice problems the hour before the exam. What you think is a last-minute effort to improve your test performance may actually be a brain-drain; you may end up losing the ability to remember material you have already learned. A recent study by researchers at UC Santa Barbara reveals that paying full attention and trying one’s hardest can actually impede performance.1 The study’s lead author, Dr. Taraz Lee, distinguishes between two kinds of memory: implicit, a form of long-term memory that does not require conscious awareness or deliberate retrieval of information, and explicit, another form of long-term memory that requires conscious, intentional recollection of previous information and learned experiences.1

Based on previous brain studies, it has been suggested that continually

THE EXAMINER

14

stimulating one’s explicit memory, through “distractions,” improved perceptual recognition memory without awareness, a form of implicit memory.1 Studies have shown that attempting to consciously control an automated skill may disrupt a person’s ability to execute it.2,3 Lee hypothesized that explicit memory processes mediated by a specific region of the prefrontal cortex (PFC) can interfere with the memory processes necessary for implicit recognition memory. Lee concluded that explicit memory processes mediated by the dorsolateral PFC can indirectly interfere with implicit recognition memory tasks. “If we ramped down activity in the dorsolateral prefrontal cortex, people remembered the images better,” reported Lee. Many of us have been victims of this paradoxical performance phenomenon. You may have spent hours upon hours studying for an exam only to draw a blank and not recognize a single item on the day of the test. The findings of this study suggest that the over-activity of one brain region may interfere with normal functioning of a complementary region.

These findings may seem counterintuitive, but have been shown to be important to overall performance, even outside the context of academics.

Many students participate in some type of sport or athletic activity. Athletic performance is often hindered by explicitly thinking about what the next move may be. According to this research, it makes more sense to trust one’s practice through implicit memory.

Lee hopes to continue his studies and dissect how high-pressure situations and overthinking can cause stress on critical brain regions and impede performance ability. The take-away here is clear: overthinking and worrying obsessively about something can be detrimental to your performance in school, sports or just about anything else. If you’re confident in your abilities and preparation, it’s best to just leave it at that.

Addiction: Pathology or Choice?

Meghna Dev

While society typically addresses addiction as a disease that over-powers an addict’s self-control, recent studies have shown that drug addicts may refuse drugs when given a better option, such as money. It is commonly believed that an addiction is caused by changes to the brain that cannot be overcome by willpower. But how much of a role do physical and chemical changes in humans play in addiction, in comparison to social factors?

A study published in April 2011 presented a choice to addicts: drugs or money. The study sought to determine whether receiving a drug is more appealing to addicts than receiving another reward, regardless of the time at which both rewards are offered. Prior to the procedure, cocaine addicts were asked to estimate the amount of grams of cocaine that would be worth $1000 to them. The individuals were then offered a choice between certain amounts of immediate money and specific amounts of cocaine, at a later time.

Depending on the choices made, the amounts of money and cocaine were either decreased or increased to gain a clearer understanding. 1

An important conclusion from the study showed that many cocaine addicts valued “immediate money over later cocaine, even if the immediate money amount was relatively low”. This finding complicates the traditional view of the basis of addiction; addicts may not necessarily seek drugs to the exclusion of all else. Instead, they may value the immediate reward most highly. How much self-control do individuals suffering from addiction truly have? 2 However, it is important to remember the other side of the argument: some addicts may consider immediate money as equivalent to immediate cocaine. They may be more interested in gaining a smaller amount of cocaine now rather than a larger amount later.

This still brings an interesting twist to the discussion concerning the amount of cocaine versus the length of time before it is received.

Alternative explanations of addiction are offered by other disciplines, like genetics.

One researcher, Tristan Darland, put a pad of cocaine on one side of a fish tank. The fish enjoyed feeling the cocaine and remained in the area even after the removal of the cocaine.

However, fish bred with an altered gene resisted the cocaine. Darland stated that “these fish don’t know anything about peer pressure. They either respond or they don’t respond to the drug.” Darland is not alone in claiming genetic factors play a large role in addiction. 3

The factors involved in addiction are continuously investigated. Some may argue that, if addiction causes one to lose self-control, why are some addicts able to voluntarily quit successfully? Others wonder if successful quitters are proof that addiction is not a disease.3 Are other health or social factors preventing certain addicts from quitting? There are many possibilities, but more analysis is needed to gain a clearer picture.

15

s e h s i W s ’ r o t c o D The

and performing examinations to figure out the The best treatment plan for patients, rather than annual survey of United being compensated for the procedures they States doctors published by Medscape/WebMD perform.2 One developmental pediatrician in 2013 showed that only 54% of doctors would claims that his brain work has allowed him to choose medicine as a career, if given a second help children avoid complicated and intrusive chance.1 This number was down 15% as compared tests and procedures, but he is compensated to the previous year. The Public Insight Network based on the number of tests and procedures he surveyed doctors and asked them what specifically orders. This system of compensation incentivizes would make their jobs better. The growing unnecessary testing rather than quality of care. frustrations of America’s doctors are largely Doctors need more time for patients. centered on the ineffective system of compensation.

Doctors

want to be

compensated

Are people in the healthcare industry any better off than the rest of for the time they Americans, when it comes to obtaining affordable healthcare insurance? Common spend “using assumptions about the benefits of being a medical professional are excellent their brains,” job security, concrete opportunities for advancement, generous monetary or studying compensation, and excellent health insurance. However, the last perk on that list patient histories might not be very true. Does the healthcare industry take care of its own members? .

Tiwalde Adediji

Healthcare for Physicians

THE EXAMINER

16

Doctors currently have to shop around for health insurance, or receive benefits from their employers, just like most Americans. In spite of this, of the fourteen companies in the United States that provide the best health benefits to their employees, none are in the healthcare sector 3. On October 1st, 2013, the political argument over the Affordable Care Act led the American government to bring in the fiscal year with a government shutdown (which has not occurred since the Clinton administration in 1996), rather than a new budget as planned. This issue has made concerns regarding the ability of Americans to afford hospital visits widely known. As of 2010, 49.9 million Americans were without health insurance.1 Even for the 256.2 million that are insured, health care costs in America are some of the highest in the world.2 Having health insurance, and even being a healthcare professional, does not necessarily protect anyone from exorbitant healthcare costs.

As of today, fewer and fewer people are working towards becoming medical professionals for numerous reasons, such as the hefty price tag of a medical education or the stressful and challenging lifestyle of those practicing medicine.

Although more research needs to be done about the current state of healthcare affordability for doctors as compared to other professions, it would be beneficial to lower healthcare costs for our medical professionals along with those in financial distress. Healthier doctors will lead to a healthier society as a whole.

Neha Kayastha They wish they could have more time to engage in meaningful conversations with patients about preventative measures that they should be taking and to explain their diagnoses and treatment plans.2 Unfortunately, many doctors hold back from holding such lengthy conversations because they would be “holding up the works.” Instead, they are busied with other requirements, like paperwork. Doctors wish less documentation was required, or that they had more time to make good use of required documentation.2 One orthopedic surgeon claimed that he spends approximately half of his clinic time typing up documentations which are “tangential at best to what [he] actually [does] for the patient.”

In addition, some doctors wish they had the time to review their performance based on quality to really understand how to improve. However, such self-evaluation is neither part of a physician’s daily documentation, nor is it compensated by the system.

The Other Golden Nectar Vishal Patel

Physicians also report great dissatisfaction with the current system of payment, and cite it as an obstacle to effective patient care.2 Based on another national survey, less than 20% of physicians feel that they can make clinical decisions based on what is best for patients but rather make them based on the dictations of insurance companies.3 Renowned doctor Atul Gawande stipulates that the only way for a physician to make money is to wage war with insurance.4 Whatever the dissatisfactions in the field may be, one physician says the best part of medicine is becoming increasingly marginalized. People enter the field seeking one thing: the one-on-one healing relationship that only exists between a doctor and patient. This core relationship still exists, though revolutionizing the healthcare system would yield great improvement in patient care and the satisfaction of physicians.

The nineteenth century was brimming with medical discoveries that pushed the boundaries of scientific knowledge and provided mankind with a stepping-stone into the modern medical age. The time period was dotted with innovations such as the first successful human blood transfusion, vaccination for cholera, X-Rays, and the stethoscope. However, one of these many life-saving breakthroughs was stumbled upon through a coincidental natural occurrence. It was 1889 and German physicians Joseph von Mering and Oscar Minkowski were studying the pancreas at the time. These two scientists were interested in the role of the organ in digestion. Naturally, they decided to remove the pancreas from a healthy dog in order to observe the effects on its health. Afterwards, they stood vigil for any noticeable physiological effect on the animal. Then, one day while in the laboratory, the would-be-innovators spotted a swarm of flies drinking from a pool of the dog’s urine. Curious as to the explanation of this phenomenon, they tested the urine and found high levels of sugar. This was a definite indication of diabetes. After further testing, Minkowski and Mering came to the conclusion that the pancreas secreted a key substance that controlled the metabolism of sugar. Although this compound (insulin!) would not be discovered until later, this accidental medical discovery provided the link between the pancreas and diabetes.

Joseph von Mering

17

Emily Moore

COMMUTEROPATHY

Over 17,000 undergraduate students here at Rutgers-New Brunswick commute to campus. If that statistic seems massive, it should, since it accounts for more than half of our entire undergraduate population. This number has only increased in recent years, as more people choose to commute in order to avoid the costs of dorming on campus.1 Commuters often resign themselves to this fact of high dorming costs and bookend each day with a long stretch of time seated. Sedentary styles of travel, such as driving a car or riding a train is called passive commuting (referred to as commuting in this article).3 On top of that, many pass the entire day sitting as well.

For a typical Rutgers commuter, for instance, sandwiched between the daily commute are hours of sitting in class, sitting in the library, or sitting in a lab. If this is the reality for over half of the undergraduates (and countless other students, faculty, and staff) on campus, it is necessary to analyze the toll that the twice-daily trek takes on the body.

Commuting worsens various aspects of human health. Researchers have determined that “commuting distance [is] negatively associated with physical inactivity and [cardiorespiratory fitness] and positively associated with [Body Mass Index], waist circumference, systolic and diastolic blood pressure, and continuous metabolic score…”3 More time spent commuting results in less time for exercise, and may explain the harmful impact commuting has on weight.3 Similarly, a recent study demonstrated “significant weight gain over 4 years” in people who drove to and from work.4

THE EXAMINER

Mental health suffers from commuting as well. Those who rely on trains may have to deal with unexpected delays and crowded conditions, while those who drive cars may have to face aggressive drivers and traffic congestion on the roads. Each of these factors, especially traffic, can contribute to high levels of stress. In fact, researchers assert that “daily commuting represents a salient source of chronic stress,” a mental condition whose physical ramifications may include “high blood pressure, self-reported tension, fatigue, and other negative mental or physical health effects.”3 Social isolation also presents challenges, according to a German study of long-distance commuters, for many of a social and personal nature. Rutgers commuters hoping to join extracurricular activities may find themselves in a similar dilemma, and may feel a resulting disconnection from campus life.

Given the reality of commuter health challenges, taking measures to mitigate these negative effects seems crucial.

Common suggestions for how to improve the commuting experience include carpooling, finding alternative modes of transportation, or even moving closer to work or school.5 But for many Rutgers students, most or all of these options are difficult to implement, and the health of the majority of the undergraduate population could be negatively affected as a result. Commuters must decide whether or not the money saved by living off-campus justifies the potential cost in health from commuting.

“daily commuting

represents a salient source of chronic stress”

18

Remembering Musings of Memory in Literature

“

Pathologies and medical issues have been discussed in literature, even before their official scientific discoveries. For example, in Fundamentals of Neurobiology, I learned of Fatal Familial Insomnia (FFI), a disorder caused by a mutation in an autosomal dominant gene. The disorder can cause an inability to sleep in entire families, which causes, as time goes on, a failure of memory and even motor skills.1 I realized that these symptoms are described in Gabriel García Márquez’s One Hundred Years of Solitude. In the novel, the entire town of Macondo suffers from insomnia. Slowly, they lose their memories, and, in a panic, they start to label everything. At moments, their memories are described to walk in front of them, or, to rephrase this clinically, they were described to be hallucinating from sleep deprivation. While Márquez wrote this novel in 1967, scientists did not discover and identify FFI until 1984, in a family in Italy.1 Though it seemed apparent to me that this disorder is almost exactly what was described by characters in the novel, there is currently no information published in the public sphere connecting these two occurrences.

This realization demonstrates fluidity between the arts and the sciences, which is a treat for those who resent the institutionally imposed divide.

Jonah Lehrer’s book, Proust Was a Neuroscientist, argues the claim that artists actually knew of these issues and pathologies before they were scientifically discovered. The book is problematic due to its pop-culture

Jasmeet Bawa

approach to science, and Lehrer has been under fire for bending quotes to propagate his argument.2 Regardless of the book’s critical reception, it is interesting to note that the title of Lehrer’s book refers to a scene in Marcel Proust’s In Search of Lost Time, and provides us with another instance of a scientific discovery having been discussed at an earlier date in literature. In the novel, Proust dips a madeleine into tea and, upon eating it, is flooded with memories. Neuroscientists would read, in this narrative: involuntary memories are triggered by an olfactory and/or gustatory sensory perception.

The rest of the novel is an exploration of these memories. Also, Proust observes in the novel that his memories are changing upon being recalled.

This discovery is familiar to many neuroscientists, and was officially explained in 2012. Proust wrote In Search of Lost Time much earlier, in the 1920s.

There is contention that Proust’s narrative describes a voluntary memory, rather than an involuntary memory, suggesting that after his initial reminder of the past, he begins to consciously retrieve and look through older memories.3 However, narratives like this can alert us to the way that the mystery of memory is not solely contained to neuroscience or to literature, but that similar accounts of its nature, and its impact on human nature and experience, can be found in both fields. Truly exploring and identifying actual connections between the two would require an interdisciplinary effort between art historians and neuroscientists.

Shingles: A Chir Wei Stephanie Yuen

MUNDANE MYSTERY

If you had the flu and rolled around with

abandon in a bed of poison ivy, the aftereffects

three adults, with the risk increasing significantly

above the age of 60.7 No one really knows

of your actions would give you a good idea of the

definitively why shingles reactivates.7 Stress and

Shingles is characterized by a bright red rash that

reactivation. Karen Lasserre of the University

appearance and the excruciating pain stemming

from symptoms of Shingles or Herpes Zoster Virus. starts out as a stripe on one side of the body and

can spread in patches to cover the rest of the body.

The rash will produce blisters, which will crust over as the disease retreats.1 Accompanying the rash are fever, chills, aches, and upset stomach, with the

possibility of vision impairment or complete loss of

vision. These symptoms should subside within 2-4

weeks.1 If you are one of the unlucky ones, however,

you may experience post-herpetic neuralgia, a

lasting pain that remains even after the rash has faded.5 The disease may be treated with antiviral medication such as acyclovir, but those serve only

the associated lowered immune system have been

posited as interrelated triggers for varicella zoster of Pierre and Marie Curie in Paris examined psychological questionnaire data gathered from 250 patients with VZV and 500 control patients

from the same age range (50+) with matches for

other traits.3 Questions on the study included those on family history, depression, physical trauma, drug

abuse, and other possible negative factors as well as

protective factors such as exposure to children. This study demonstrated shingles has, not causation, but

a correlation with high levels of depressive mood and unhappy recent events in life.3

The stress caused by psychosocial events,

to shorten the disease state, not cure it entirely.

according to the authors of the study, also are

causes the chickenpox that lays many a child in

seen in immunocompromised patients who due

Shingles is caused by a reactivation of the

Varicella Zoster Virus (VZV), the pathogen that

bed. Decades later, the virus awakens from its long

sleep to cause illness and misery in up to one in

THE EXAMINER

20

related to the lowered T-cell immunity that can lead

to reactivation of the VZV.3 This effect can best be

to radiation for cancer or conditions that lower immunity experience higher levels of anxiety due to

psychosocial events. For example, patients with AIDS can experience shingles as one of the many

opportunistic infections that sets in with hosts having a lower T-cell count and general lowered immunity.4 Patients who have only received the chickenpox vaccine may also be at risk for shingles.

The wide array of symptoms and the type of tissue affected suggests the virus lays dormant in the

peripheral nervous system. An experiment carried out by Gershon et al. of Columbia University

examined the ganglia of children with VZV and used guinea pigs to test whether skin infection of VZV lead to dormancy elsewhere.2 The results showed VZV present and expressing proteins

associated with latency in the cranial, dorsal and enteric ganglia, which are bundles of neurons found around the head, spinal cord, and intestines.2

There is now a vaccine called Zostavax for the prevention of shingles that has been found to

be effective in preventing shingles and reducing postherpetic neuralgia.5,6 It has been approved by

the U.S. Food and Drug Administration for those above 50, although the Center for Disease Control recommends it for those over the age of 60. 5 This means that one can request the vaccine from the

pharmacy or physician at age 50+, but the CDC only judges the risk of shingles to be great enough at 60 to give out their weighty recommendation for those 60 and above. The vaccine contains live,

attenuated VZV, which means they have been weakened enough so as not to cause the symptoms of shingles in the vaccinated patient, but can still illicit a primary response in the patient wherein the body learns to recognize the pathogen and makes the antibodies needed to target it.5 Just

because

someone may be under the age when it is most common to get shingles, it does not

mean that the shingles is not something of which you should be aware and remain knowledgeable

about.

Older relatives are at risk for the painful condition.

The young may also be at

risk for VZV if they become

immunocompromised.

Thus, because Shingles may

be undiscriminating in who it targets, it is best to be

cognizant of its pathology

Varicella Zoster Virus

and treatment no matter what age you are.

21

REFERENCES Cover image retrieved from http://www.snell.co.nz/images/iso14001a.pdf Staff page image retrieved from http://www.meaningfulmama.com/wp-content/ uploads/2012/11/salt-dough-fall-crafts-decorations-0261.jpg Pg 6: Easy on the Eyes: The Benefits of E-Readers for Students with Dyslexia 1 Mientka, M. (2013). Dyslexia ‘cured’ by e-readers? Scientists find handheld devices greatly improve speed, recognition of written word. Medical Daily. Retrieved from http://www. medicaldaily.com/dyslexia-cured-e-readers-scientists-find-handheld-devices-greatlyimprove-speed-recogniton-written.

2 Miesenberger, K. (2008). Computers helping people with special needs. Linz, Austria: Study Center for the Visually Impaired: University Linz, Institute Integriert Studieren.

3 Rutgers, the State University of New Jersey. “Kurzweil 3000.” Retrieved from https://ods. rutgers.edu/my-accommodations/assistive-technology/kurzweil.

4 Schneps, M.; Thomson, J.; Chen, C.; Sonnert, G.; Pomplun, M. (2013) E-readers are more effective than paper for some with dyslexia. PLoS ONE 8(9): e75634. doi:10.1371/journal. pone.0075634 Pg 8-9: Why is ODASIS Necessary?

1 “About Us.” (2013) Office for Diversity and Academic Success in the Sciences. Retrieved from: http://odasis.rutgers.edu/about-us 2 “How the affirmative action ruling affects medical schools.” 28th June, 2013. The Advisory Board Company. Retrieved from: http://www.advisory.com/Daily-Briefing/2013/06/28/ How-the-affirmative-action-ruling-affects-medical-schools 3 “Underrepresented in Medicine Definition.” (2013) Association of American Medical Colleges. Retrieved from: https://www.aamc.org/initiatives/urm/ 4 Castillo-Page, Laura. “Diversity in Medical Education: Facts & Figures 2012” (Fall 2012).

Association of American Medical Colleges, Diversity Policy and Programs. Retrieved from: https://members.aamc.org/eweb/upload/Diversity%20in%20Medical%20 Education_Facts%20and%20Figures%202012.pdf Image retrieved from http://school-stories.org/wp-content/uploads/2012/05/SEO-class-4.jpg Graph retrieved from https://members.aamc.org/eweb/upload/Diversity%20in%20Medical%20 Education_Facts%20and%20Figures%202012.pdf Pg 10-11: Politics and Science of Fetal Pain 1 Fragoso, Ashley Morrow. “Fetal Pain: Can Unborn Children feel pain in the Womb.” Family Research Council. n.d. 1-20. Web. 6 Oct. 2013. <http://downloads.frc.org/EF/EF10H06. pdf>.

2 Belluck, Pam. “Complex Science at Issue in Politics of Fetal Pain .” New York Times. 16 09 2013: n. page. Web. 6 Oct. 2013. <http://www.nytimes.com/2013/09/17/health/complexscience-at-issue-in-politics-of-fetal-pain.html?pagewanted=all&_r=1&>.

3 Wright , Jean A. Advances in the Understanding of Fetal Pain. Diss. Emory School of Medicine , Christian Medical Association, 2002. Web. <http://www.cmda.org/WCM/source/Fetal_ Pain_Jean_Wright_March96.pdf>.

4 Monahan, Jeanne. “THE SCIENCE OF FETAL PAIN.” Family Research Council . 07 2010: n. page. Web. 6 Oct. 2013. <http://downloads.frc.org/EF/EF10G26.pdf>.

5 Abortion Bans at 20 Weeks: A Dangerous Restriction for Women.” NARAL: Pro Choice America. 13 01 2013: n. page. Web. 6 Oct. 2013. <http://www.prochoiceamerica.org/ media/fact-sheets/abortion-bans-at-20-weeks.pdf>.

Image retrieved from http://interestingtalks.in/London/wp-content/uploads/2013/08/Fetus.jpg Pg 12-13: The Challenge of Integrating Pharmacists Into Primary Healthcare Teams 1 MacKillop, I. (1991, May 18). In the pharmacist’s image. Retrieved from http://www. newscientist.com/article/mg13017696.300--forum-in-the-pharmacists-image-ianmackillop-dispenses-a-literary-touch-in-the-pharmacy--.html 2 Hughes, C. M., & McCann, S. (2003). Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment.

British Journal of General Practice,53(493), 600-606. doi: PMC1314673 3 Pharmacy careers. (2013). Retrieved from http://www.fairview.org/careers/explorecareers/ pharmacy/index.htm 4 Isetts, B. J., Brummel, A. R., de Oliveira, D. R., & Moen, D. W. (2012). Managing drug-related morbidity and mortality in the patient-centered medical home.Medical Care, 50(11), 9971001. doi: 10.1097/MLR.0b013e31826ecf9a Image retrieved from http://images.flatworldknowledge.com/ballgob/ballgob-fig01_012.jpg Pg 14: Can Overthinking Affect Performance?

1 Lee, T. G., Blumenfeld, R. S., & D’Esposito, M. (2013). Disruption of Dorsolateral But Not Ventrolateral Prefrontal Cortex Improves Unconscious Perceptual Memories. The Journal of Neuroscience, 33(32), 13233-13237.

2 Robison, M. (2013, May 18). Why Do Top Athletes Suddenly Develop “the Yips”—a Tendency to Choke under Pressure? Scientific American. Retrieved September 28, 2013, from http://www.scientificamerican.com/article.cfm?id=why-top-athletes-suddenly-developyips-choke-under-pressure 3 Baumeister, R. F., & Showers, C. J. (1986). A review of paradoxical performance effects: Choking under pressure in sports and mental tests. European Journal Of Social Psychology, 16(4), 361-383.

Image retrieved from http://th09.deviantart.net/fs70/PRE/i/2010/214/1/5/Late_Night_Studying_by_shygal.jpg Pg 15: Addiction: Pathology or Choice?

1 Bickel, W. K. et. al. (September 2011). Single- and cross-commodity discounting among cocaine addicts: the commodity and its temporal location determine discounting rate. Psychopharmacology. 217. 177-187.

2 Jaffe, A. (2011, August 21). Money or Cocaine? It All Depends on Timing. All about Addiction. Retrieved from http://www.psychologytoday.com/blog/all-about-addiction/201108/ money-or-cocaine-it-all-depends-timing 3 Stossel, J. Is addiction just a matter of choice? ABC News. Retrieved from http://abcnews.

go.com/US/story?id=90688&page=2 Image retrieved from http://www.infiniteunknown.net/wp-content/uploads/2010/11/Statin.jpg Pg 16: The Doctor’s Wishes 1 Medscape (2013). Physician Compensation Report: 2013. Retrieved from http://www.medscape.com/features/slideshow/compensation/2013/public.

2 Ng, Melody (2013). Five things doctors want. Retrieved from https://www.publicinsightnetwork.org/2013/02/06/five-things-doctors-want/.

3 Chen, Pauline (2010). Fueling the Anger of Doctors. Retrieved from http://www.nytimes. com/2010/04/30/health/29chen.html?ref=health.

4 Gawande, Atul (2005). Medical Dispatch: Piecework. Retrieved from http://www.newyorker. com/archive/2005/04/04/050404fa_fact.

Pg 16: Healthcare for Physicians 1

By The Numbers: Health Insurance. http://www.cnn.com/2012/06/27/politics/btn-health-care/ index.html. Retrieved on October 2, 2013.

2 Health Costs: How The US Compares With Other Countries. http://www.pbs.org/newshour/ rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html.

Retrieved on October 2, 2013.

3 100 Best Companies To Work For. http://money.cnn.com/magazines/fortune/bestcompanies/ best_benefits/health_care.html. Retrieved on October 2, 2013.

Pg 17: The Other Golden Nectar 1 Krock, Lexi. “Accidental Discoveries.” PBS: Public Broadcasting Service. N.p., 1 Feb. 1927.

Web. 2 Oct. 2013. <http://www.pbs.org/wgbh/nova/body/accidental-discoveries.html>.

2 “Medical Advances Timeline.” Infoplease. N.p., n.d. Web. 2 Oct. 2013. <http://www.infoplease.com/ipa/A093266 Image retrieved from http://en.wikipedia.org/wiki/File:Josef_von_Mering_2.jpg Pg 18: Commuteropathy 1 Perillo, L. & Negrea, S. (2012, January 9). Rutgers Commuters Find Connections Through Campus Group. Rutgers Today. Retrieved from: http://news.rutgers.edu/issue.2012-01-03.4307075525/article.2012-01-09.0307396137#.UkgDyGTXgVk 2 Sims, T. (2011, October 7). Hitting the Road to Get to Work, and Back. The New York Times.

Retrieved from: http://www.nytimes.com/2011/10/08/sports/hitting-the-road-to-get-towork-and-back.html?scp=4&sq=tom%20sims&st=cse 3 Hoehner, C.M., Barlow, C.E., Allen, P., & Schootman, M. (2012, June). Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk. American Journal of Preventative Medicine, 42(6), 571-578. Retrieved from: http://www.sciencedirect.com.proxy.libraries. rutgers.edu/science/article/pii/S0749379712001675 4 Sugiyama, T., Ding, D., & Owen, N. (2013, February). Commuting by Car: Weight Gain Among Physically Active Adults. American Journal of Preventative Medicine, 44(2), 169173. Retrieved from: http://www.sciencedirect.com.proxy.libraries.rutgers.edu/science/ article/pii/S0749379712007763?np=y 5 Schaefer, A. (2005, September 21). Commuting Takes its Toll. ScientificAmerican. Retrieved from: http://www.scientificamerican.com/article.cfm?id=commuting-takes-its-toll Image retrieved from http://ocsa.rutgers.edu/content/logoblack.png Pg 19: Remembering Musings of Memory in Literature 1 Max, D. T. (2001, May 06). Case study: Fatal familial insomnia; location. New York Times 2 McQuarrie, F. (2013, March 23). [Web log message]. Retrieved from http://allaboutwork. org/2013/03/22/the-problems-of-jonah-lehrers-proust-was-a-neuroscientist/ 3 Troscianko, E. T. (2013). Cognitive realism and memory in Proust’s madeleine episode. Memory Studies.

Pg 20: Shingles: The Mundane Mystery 1 Centers for Disease Control and Prevention. (2011). Shingles (Herpes zoster): Signs & symptoms. Centers for Disease Control and Prevention. Retrieved from http://www.cdc. gov/shingles/about/symptoms.html.

2 Gershon, A., Chen, J., Davis, L., Krinsky, C., Cowles, R., Reichard, R., and Gershon, M. (2012).

Latency of varicella zoster virus in dorsal root, cranial, and enteric ganglia in vaccinated children. Transactions of the American Clinical and Climatological Association, 123:1735. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540599.

3 Lasserre, K., Blaizeau, F., Gorwood, P., Bloch, K., Chauvin, P., Liard, F., Blanchon, T., and Hanslik, T. (2012). Herpes zoster: Family history and psychological stress—Case– control study. Journal of Clinical Virology, 55(2):153-157. Retrieved from http://dx.doi. org/10.1016/j.jcv.2012.06.020.

4 Jansen, K., Haastert, B., Michalik, C., Guignard, A., Esser, S., Dupke, S., Plettenberg, A., SkaletzRorowski, A., Brockmeyer, N. (2013). Incidence and risk factors of herpes zoster among HIV-positive patients in the German competence network for HIV/AIDS (KompNet): a cohort study analysis. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3751196/ 5 Doan, H., Ung, B., Ramirez-Fort, M., Khan, F., Tyring, S. (2013). Zostavax : a subcutaneous vaccine for the prevention of herpes zoster. Expert Opinion on Biological Therapy,13(10):1467-1477. Retrieved from http://www.ncbi.nlm.nih.gov/ pubmed/23984934.

6 Kanbayashi, Y., Hosokawa, T. (2013). Vaccination against and treatment of acute herpes zoster for prevention of post-herpetic neuralgia. Current Pain and Headache Reports,17(10):371.

Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23996726.

7 Centers for Disease Control and Prevention. (2011). Shingles (Herpes zoster): Overview.

Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/shingles/ about/overview.html.

Image retrieved from http://mysteriousuniverse.org/wp-content/uploads/2013/06/creepy_ hospital.jpg Image retrieved from http://php.med.unsw.edu.au/embryology/images/9/9e/Varicella_zoster_ virus.jpg

the examiner