UChicago PULSE Issue 4.3: Spring 2018

PULSE VOLUME 3, ISSUE 3. SPRING 2018

MENTAL HEALTH IN THE AGE OF MILLENIALS

from the editor-in-chief Dear reader,

Welcome to the end of a school year, and the last issue of PULSE before we bound towards summer break! Spring quarter has been a whirlwind of a time (and a mess of a weather), so we hope that taking a break to read this issue can settle the storm and bring some calm to the chaos.

This quarter, we bring you some golden tidbits of undergraduate research, from the basic to the clinical to the emotions each experience can stir up. Our policy section takes a look at what goes on in our cities and schools, and our research and current event sections dive in deeper to examine our bodies and their inner workings, from brain to body to everything in between.

As spring continues to figure itself out, summer creeps closer and closer. Sunny days lie ahead, and we hope PULSE can join the cruise forward to our respective corners of the world this break.

Have a good summer, readers, and we hope you enjoy this issue!

With regards, Irena Feng

editors

writers

production

Swathi Balaji Daksh Chauhan Irena Hsu Jui Malwankar Ariel Pan Linus Park Abhijit Ramaprasad Fatima Sattar Scott Wu

Swathi Balaji Sharad Crosby Annagh Devitt Yassmin Elbanna Maria Hatzisavas Irena Hsu Nikki Kasal Helen Kessler Pranati Movva Sarah Nakasone Faith Whitehouse

Purujit Chatterjee (cover design) Irena Feng

GENERAL EDITORS Purujit Chatterjee Amber Keahey Edward Zhou

PULSE Magazine

other contributors Gold Standard Kaplan Test Prep The Princeton Review

CONTENTS EDUCATION MEDICAL SCHOOL LETTERS OF RECOMMENDATION KAPLAN MCAT PRACTICE PROBLEM MCAT GENERAL CHEMISTRY: ACIDS AND BASES UNDERGRADUATE RESEARCH 101

2 5 6 8

POLICY MENTAL HEALTH IN CITIES THE EFFECT OF CPS FOOD QUALITY ON STUDENTS' HEALTH ASTHMA INITIATIVES AIM TO LOWER PEDIATRIC RATES

12 15 18

RESEARCH THE BUZZING BRAIN MIND & BODY THE IMMUNE SYSTEM ON CANCER THE PATH TO AN ENTEROVIRUS-BASED

TYPE 1 DIABETES VACCINE

20 22 24 27

CURRENT EVENTS MENTAL HEALTH IN THE AGE OF MILLENIALS OUT OF SIGHT, OUT OF MIND

30 32

REFLECTION 423 MINUS 4

36

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MEDICAL SCHOOL LETTERS OF RECOMMENDATION Letters of recommendation for med school are typically submitted along with your AMCAS application. A good letter of recommendation highlights your academic or professional achievements. A great letter gives the admissions committee at your dream medical school deeper insight into the person you are and the doctor you may become.

how many letters will you need?

In most cases, schools request a minimum of three recommendations: two from science professors and one from a non-science professor or an extracurricular supervisor. Unless specifically instructed not to send additional letters , competitive applicants commonly send as many as six recommendations, including those from additional academic sources, clinical mentors, supervisors in extracurricular activities, and research sources. pre-medical committee letter Some schools request that you send your recommendations in the form of a pre-medical committee letter, which is either a letter written by the undergraduate pre- med committee specifically recommending you, or a letter that summarizes comments made by various committee members about you. If your school does not have a pre-medical committee (or you are a non-traditional applicant not officially with a university), you will typically need to submit a minimum of three letters of recommendation from individual sources instead.

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EDUCATION

GETTING A GREAT LETTER OF RECOMMENDATION Here’s a quick overview of how to choose the right people to write your medical school recommendations and ensure you get the right message across.

1. START EARLY

4. HELP THEM HELP YOU

2. IDENTIFY YOUR RECOMMENDERS

5. UNDERSTAND THE PROCESS

3. BE PROFESSIONAL

6. FOLLOW THE INSTRUCTIONS

Professors are busy! You will want to ask for letters well in advance of deadlines. If you are applying as an undergraduate in college, start asking for letters in the winter of your junior year.

Current professors and doctors with whom you work or volunteer are your best choices. But former professors and doctors with whom you've worked in the past are fine, too. (If you're applying to osteopathic schools, you must have a letter from a DO.) The best recommendations come from people who know and honestly like you as a person.

It’s natural to feel anxious about approaching prospective recommenders, especially if some time has passed since you've worked with them. But professors and doctors are used to receiving this kind of request, and most will be happy (even flattered) to write a recommendation on your behalf. Courtesy goes a long way in these interactions. A sincere thank-you note at the end of the process, not matter what the outcome, is essential.

Fantastic letters come from recommenders who can write about your specific traits and talents.

Provide them with a copy of your CV or résumé, a personal statement, and any other materials that will remind them about what you've achieved. Also let them know which medical programs you're applying to and why.

If you apply directly from undergrad, you likely have access to pre-health or pre-med advising, and your letters will be handled by that office. They will copy and send your recommendations to your list of schools. If you are a returning adult student, you may have to take care of all the requests and letters yourself.

Read directions carefully. If an admissions committee asks for a recommendation from a premedical sciences professor, sending a recommendation from a psychology or sociology professor instead will count against you, even if you suspect that the recommendation will be stronger.

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MED SCHOOL RECOMMENDATION LETTER ADVICE FOR NON-SCIENCE MAJORS Not a science major? Below are some common letter suggestions for humanities, social science, and other non-medically related disciplines. humanities or social science majors • • • • •

1 recommendation from a biology professor 1 recommendation from a chemistry or physics professor 1 recommendation from a humanities professor 1 recommendation from a humanities professor of an advanced-level course in your major 2 recommendations from from other sources, such as supervisors from lab/clinical work or extracurricular activities

want to get an edge over the crowd?

Our admissions experts know what it takes it get into med school. Get the customized strategy and guidance you need to help achieve your goals.

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non-medically related science majors computer science, engineering, math, etc.

• • • •

1 recommendation from a professor of a medically-related science class, ideally biology 1 recommendation from a professor of an advanced-level class in your major area 1 recommendation from a humanities professor (may be an intro-level humanities course) 3 recommendations from other sources, such as supervisors from lab/clinical work or extracurricular activities

EDUCATION

Kaplan MCAT PRACTICE PROBLEM QUESTION In the search for a vaccine against the human immunodeficiency virus (HIV), researchers were faced with a major problem: Certain HIV envelope proteins that are heavily glycosylated interfere with their detection by the immune system. The organelle within the host cell that is primarily responsible for glycosylation of proteins is also responsible for:

A. storage of glycogen.

B. aerobic respiration.

C. production of secretory vesicles.

D. protein synthesis.

THINK YOU’RE READY FOR TEST DAY? Find out with this fun and FREE way to tackle practice MCAT questions from Kaplan Test Prep. Register to receive one sample question a day for the next three months. You’ll get: • A new MCAT-style question each day to test your knowledge and skills • Complete explanations and expert strategies with every question • Compete against your friends to see who’s really ready for test day To get started go to: https://www.kaptest.com/mcat/mcat-practice/free-mcat-practice-question-a-day

C. Glycosylation occurs in the Golgi apparatus via a series of glycosylation pathways.

Golgi complexes are also responsible for the production of secretory vesicles, choice (C). Choice (A) is incorrect because storage of glycogen occurs in storage vacuoles.

Aerobic respiration occurs in the mitochondrion, so choice (B) is out. Protein synthesis, choice (D), occurs in the cytoplasm and may be associated with the endoplasmic reticulum.

ANSWER spring 2018 || 5

MCAT GENERAL CHEMISTRY:

ACIDS AND BASES Acid-base chemistry is guaranteed to be on the MCAT, especially questions involving calculations or interpretations of Ka, Kb, pH, pOH, pKa, and pKb values. Fortunately, such questions will not always require you to use a particular formula. Instead, you can often save yourself considerable time by reasoning through these questions to arrive at the correct answer. arrhenius vs. lewis vs. bronsted-lowry acids and bases • • •

An Arrhenius acid ionizes in water to produce H+ ions.

An Arrhenius base ionizes in water to produce OH- ions.

H+ will not exist by itself, but combine with water to form H3O+

• • •

A Lewis acid accepts an electron pair.

A Lewis base donates an electron pair.

Lewis acid-base reactions often produce coordinate covalent bonds

• • •

A Bronsted-Lowry acid donates a proton (H+) leaving a conjugate base.

A Bronsted-Lowry base accepts a proton (H+) forming a conjugate acid.

Bronsted-Lowry acids and bases can be described as strong or weak.

relationships between conjugate acid-base pairs The acid, HA, and the base produced when it ionizes, A-, are called a conjugate acid-base pair.

• Strong acids have weak conjugate bases.

• Strong bases have weak conjugate acids. pKa = -log( Ka )

pKb = -log( Kb )

pKa + pKb = 14

↓ pKa... ↑ acid strength ↓ pKb... ↑ base strength Remember, logs are exponents! So, if you have Ka = 1.6 x 10-5, the pKa is approximately 5.

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EDUCATION

determining acid and base strength • •

Strong acids dissociate completely in solution, so [H+] = [acid] Ka = acid-dissociation constant Ka = [H+][A-] / [HA]

pH = -log10[H+]

↑ Ka... ↑ acid strength

Ka > 1 ... strong acid ... reaction favors products Ka < 1 ... weak acid ... reaction favors reactants • •

Strong bases dissociate completely in solution, so [OH-] = [base] Kb = base-dissociation constant Kb = [HB+][OH-] / [B]

pOH = -log10[OH-]

↑ Kb... ↑ base strength

Kb > 1 ... strong base ... reaction favors products Kb < 1 ... weak base ... reaction favors reactants

common strong acids

common weak acids

common strong bases

common weak bases

Perchloric, HClO4

Hydrocyanic, HCN

Any hydroxide of Ammonia the group 1A metals

Chloric, HClO3

Hypochlorous, HClO

Nitric, HNO3

Nitrous, HNO2

Hydrochloric, HCl

Hydrofluoric, HF

Sulfuric, H2SO4

Sulfurous, H2SO3

Hydrobromic, HBr

Hydrogen sulfide, H2S

Hydroiodic, HI

Phosphoric, H3PO4

Hydronium ion, H3O+

Benzoic, Acetic, and other carboxylic acids

Any organic amine

Gold Standard MCAT Prep -- 20 Full-length tests * 7+ books * 9000 Q&As

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UNDERGRADUATE RESEARCH 101 HIGHLIGHTS FROM PMSA'S STUDENT RESEARCH AND CLINICAL EXPERIENCE PANEL, MARCH 2018 By

SWATHI BALAJI SCOTT WU (Editor)

In March of 2018, I moderated a Student Research and Clinical Experience Panel on behalf of the Pre-Medical Students Association to clear misconceptions about student research. Getting involved in undergraduate science or clinical research may seem like a daunting experience. However, as exemplified by our panelists, opportunities for such involvement are actually quite accessible and rewarding. Our student panelists reported success with cold-emailing professors, stating further that they work in their labs at flexible times, in a broad range of fields, and on diverse topics. During the panel, our panelists shed light on many different topics relating to undergraduate research, such as identifying research questions and managing time wisely, and shared their own experiences with basic science and clinical research!

PANELISTS

Yolanda Yu 2nd Year Biology Major

Adam Rizk 2nd Year Biology Major

Lianne Blodgett 3rd Year Biology and Chemistry Major

Pedro del Cioppo Vasques 3rd Year Neuroscience and Biology Major

Hospitalist Project and Manicassamy Lab – Clinical Research and Microbiology/Basic Science Research [focused on clinical research experience during the Panel]

Hospitalist Project – Clinical Research

Ben Glick Lab – Cell Biology/ Basic Science Research

Thinakaran Lab – Alzheimer’s/ Basic Science Research

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EDUCATION

Swathi: How did you get involved in research?

What do you enjoy most about your work?

Yolanda: I joined the Hospitalist Project spring quarter of my first year. The Hospitalist Project assesses the quality of care at the hospital by collecting data through phone call interviews and in-patient interviews. I happened to see a flyer and was very interested in assessing patient care, so I just emailed them my resume and cover letter, and they were very quick to respond and contacted me for an interview!

Adam: I joined the Hospitalist Project through the Metcalf Fellowship Program. The best thing is just being really comfortable in the hospital setting, just talking to patients and being very informative and making sure they are comfortable.

Lianne: Second year, I was starting to think that grad school might someday be of interest to me, and I wanted to get a feel for what research was actually like. At the same time that I was having these thoughts, I was taking the first quarter of the Fundamentals of Biology sequence, Cell and Molecular Biology, taught by Professor Ben Glick. I loved his lectures on the Golgi and the experiments he talked us through, so I sent him an email. I told him that I didn’t have research experience, but that I was a quick learner, and he responded really positively, encouraging me to come in and talk to him. Now, I’ve been working in his lab for about a year. The lab mainly studies the secretory pathway. One of my favorite things about this research is that the moment I started with Professor Glick, he gave me my own project – a project to look into an interesting protein complex.

To this end, I spend most of my time transforming fluorescent proteins into yeast and imaging them.

Pedro: I joined my lab spring quarter of first year.

I emailed some professors, and Professor Thinakaran was the one who got back to me. What I like about it is the independence you get in a lab. First you go through training, but after that, you have your own project. Right now, I am characterizing a mouse model, so a lot of immunostaining, Western blots, and behavior analysis.

Swathi: What are some things that you did not like or hoped had gone better about your experiences?

Adam: For clinical research, projects are restricted and take more time, due to the ethics of working with human subjects. You have to go through an IRB, which means more administrative work is involved.

Lianne: It takes a while to get into the research. It took me two quarters to make any kind of progress and to actually feel like I was getting things done.

There’s a lot of frustration and self-doubt at the beginning and I definitely questioned my goals and future directions. My best advice for starting research is to ask a lot of questions. Ask as many questions as you can right off the bat, and write down the answers.

Pedro: I’d say research can be very frustrating. This summer, I did a Metcalf and whatever I did never worked for spinal cord staining. A one-time careless mistake like vortexing something that shouldn’t be vortexed could affect the experiment. Frustration won’t be avoidable, but that’s not necessarily evil. Even if you’ve done the procedure 30,000 times, you have to stay focused.

Swathi: How do you balance classes with lab work and clinical activities? Is working in a lab over summer more productive?

Yolanda: For labs, I think doing projects over the summer is productive since you stay in a lab the entire day. But for Hospitalist, you know how many hours you will work and have a schedule with your employer. I work eight hours on Saturday, and some of my tasks include screening patients, interviewing patients, identifying when patients cannot consent or participate in interviews, whether a proxy is needed for patient, and conducting in-patient interviews.

Adam: I am given a great deal of control over my weekly schedule as a research assistant in the Hospitalist Project. During the academic year, I have been able to avoid any conflicts between my academic and clinical research responsibilities due to the project's flexibility with my schedule. I typically work about 8 hours every week with 4 hours on the weekend and 4 hours on a weekday. My role is to

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obtain consents from patients and conduct interviews with them. Obviously, every patient's participation in the research project is completely voluntary. On some days, I can enter the hospital, grab an iPad, and quickly obtain several consents for interviews.

However, there are other days when I approach several patients who do not feel like participating or would like me to come back later. These types of days can feel less efficient, but I have no control over this aspect of clinical research. Overall, my research coordinators expect research assistants to obtain at least 1 interview every hour, and this is definitely reasonable given the large number of patients screened into the project each day. It is a very similar experience over the summer.

Lianne: When I started out, I did not go into lab very often. I definitely worked less than ten hours a week. I actually think time management gets easier over time, because as you get more comfortable with experimental techniques, you need less guidance.

Now I know how to work in lab around my classes: if I know I have a reaction that lasts two hours, I’ll start it before physics lecture and come back afterwards.

It can be a challenge to decide whether to prioritize classes or research, and sometimes it’s important to take a step back from lab. I didn’t stay on campus this past summer and instead did a 10-week REU funded by the National Science Foundation at a marine science research center, working with oysters. If you want to make progress on a research project, summer is a good time to get into it, but I also encourage you to go out and explore during the summer like I did.

Pedro: Cells take a lot of work. I am aware of what needs to get done each week, and I rearrange my schedule to make sure it gets done. My first year, I went to do research in Brazil and did embryonic stem cell research. If you are a second or third year, go ahead and explore. If you are a fourth year, it depends on what you want. You can still explore different fields, or can get more depth in your own research. If you are doing a thesis, that’s also a consideration.

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Swathi: Basic science vs. public health vs. clinical vs. community-based research: Which one(s) did you choose to pursue and why?

Lianne: I do basic science research. I think this is really important because a lot of discoveries come out of basic science research and trying to figure out the mechanisms behind how cells work. There’s a lot of beauty in trying to explain complex cell machinery through pointed research questions and simple experiments. There’s also a sense of awe when you sit in front of the microscope and finally look at the strain you’ve spent a month trying to make.

Pedro: First year, I took the AP5 sequence, where research was thrown at me. Basic science involves puzzle solving.

Yolanda: I worked in a lab before I started clinical research and wanted to get actual patient interaction as a pre-med student. The Hospitalist Project allows you to interact face-to-face with patients.

Adam: I enjoy clinical research because of the direct interactions with patients in person and over the phone, learning how to talk to patients in a clear and concise manner. My involvement with the Hospitalist Project helps me cultivate stronger communication skills in the clinical environment, which will be very useful for a career in medicine.

Swathi: How often do you get to interact with your PIs? Adam: Definitely a lot less with clinical research.

Your PIs are doctors and they are actually seeing patients. We interact mostly with research coordinators hired by the doctors, some of whom are in grad school.

Pedro: My PI is always in his office room rather than in the wet lab and he’s very approachable.

EDUCATION

Lianne: I try to schedule a formal meeting with my PI once a week, which occurs more like once every two or three weeks. I donâ&#x20AC;&#x2122;t do it enough, but I think itâ&#x20AC;&#x2122;s really helpful to meet with your PI, since PIs are incredible repositories of knowledge. Lab culture is so important, and finding a PI who is approachable and accessible is key for a good lab environment.

Swathi: The culture of a lab can vary based on whether a PI has an MD, an MD/PhD, or a PhD. How do you take that into account when choosing a lab to work in, and how does it affect your lab work?

Lianne: The kinds of research questions that a lab might be interested in varies a lot from department to department. There are different clusters of professors in the Bio Department, and you become pretty familiar with the six or seven professors in your field of interest. For example, lots of people in the cell biology and genetics world know each other and ask research questions with similar approaches. When you try to find a lab, read about and identify their research questions, and decide whether you are interested in their questions and whether the techniques the PIs use in their lab appeal to you. The bio department here offers a suite of upper-level classes which are very different from one another. Choose classes that align with your research interests.

of the PI is much more important in basic science research because you are learning new material and techniques and adjusting your experiments along the way. In comparison, the work I do in clinical research entails gathering data from human participants and the focus is more about my own approach to patients and how I interact with them. I really enjoy doing both because they give me two different perspectives, where one deals with mechanisms underlying biological functions while the other deals with patient outcomes and provides an opportunity for really meaningful interactions.

acknowledgements I would like to thank all four panelists for their detailed responses, time, and enthusiasm to participate in the panel.

Pedro: Look at the methods that the PIs use. Basic methods can be applied with nearly any kind of basic science research, such as PCR. It also depends on what you want to do and your own field of interest.

Yolanda: From my experiences in both clinical and basic science research, I would say one difference I've noticed is the interaction with the PI. It is very rare (at least with the Hospitalist Project) to interact with the PI, who is usually an MD, whereas in a basic science lab, there is definitely a lot more mentoring and guidance from the PI. I would say the presence

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MENTAL HEALTH IN CITIES By

ANNAGH DEVITT FATIMA SATTAR (Editor)

May 1, 2018 marked the first time in 27 years that the South Side of Chicago had a trauma center. With 64 patients in just its first week, the opening of the Level One adult trauma center at the University of Chicago Medical Center was clearly greatly needed for the South Side community.

Before its existence, the nearest trauma center was Christ Advocate, which was nearly ten minutes away – the difference of life and death for a trauma victim.

While the center is a marked improvement for the community, it only plays a surface level role in combating the community’s myriad of health challenges. The trauma center treats the victims of the cycle of violence, but it alone cannot cure the systemic issues that is causing it – primarily racial and economic inequality and mental illness.

The lack of the trauma center for many years in the South Side community was seen as a sign

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of institutionalized racism. The original University trauma center was closed down in 1988 since the center frequently lost money, as do most trauma centers across the country, to the high rates of uninsured patients. The decision to close the original center felt to many like the hospital was choosing financial wellbeing over lives, particularly those of young black Chicagoans. As a mother who lost her child – who was shot just blocks away from the University of Chicago Medical Center – in the ambulance ride to Northwestern Hospital said, “The hospital doesn’t want the bill for poor people.” The trauma center was just one aspect of inequality that contributed to health disparities on the South Side.

If it seems strange that the University of Chicago Medical Center is the only major hospital on the South Side – it should. Of Chicago’s 10 major hospitals, only three are in high violence areas,

and five are not even within the city limits. A similar trend is found in other aspects of healthcare.

Among well-studied cases are food deserts, or neighborhoods that do not have access to fresh and nutritious food. Food deserts disproportionately affect black and low-income communities.

Nearly 50% of households that earn less than $25,000 annually are in a food desert. In Chicago, that amounts to nearly 500,000 people. Communities with limited access to supermarkets have higher risks for diet-related diseases like diabetes, hypertension, and heart disease. But perhaps more devastating are pharmacy deserts. Seemingly antithetical to city life, pharmacy deserts are neighborhoods that do not have a pharmacy within a one-mile radius. While this poses a great threat to patients with regular medications, it will also amplify the already devastating effects of the opioid crisis. Pharmacies stock

POLICY

A map of Chicago hospitals with trauma centers represented as red squares (University of Chicago Medical Center is the white square) and blue dots as shooting victims from 2017-2018.

drugs like naloxone and buprenorphine, which can help to prevent opioid overdoses and assist with addiction recovery. With an almost 30% opioid related death rate (per 100,000 as of 2016), mainly affecting the West and South sides – where all Chicago’s pharmacy deserts are located – new closings could mean the difference between life and death.

In between these two extremes is Cook County Jail, currently the largest mental health care provider not only in Chicago, but in America. Tom Dart, the Cook County sheriff, estimated that about 2,000 of the 7,000 inmates suffered from some form of mental illness. Due to the consistent lack of a budget in Illinois as well as the systematic closing of mental health clinics in Chicago, patients have nowhere left to turn. In fact, most of the crimes the mentally ill are convicted of are “crimes of survival” such as stealing for food, breaking and entering for shelter,

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and drug offenses as a means of self-medication. Tracy Aldridge is one such example of the chronic inmate. Since 1994 she has been arrested over 100 times and been in prison a combined 8 years. Her total cost of incarceration: over $700,000.

Aldridge is hardly an outlier; the incarceration of the mentally ill without providing treatment to prevent future incidents has led the cost of healthcare in prisons to rise nearly $400 million since 2009.

In Chicago, so called “Million Dollar Blocks” are communities that spend more than a million dollars from 2005 to 2009 to keep inmates incarcerated. West Englewood is one such community, dishing out nearly $200 million.

Cook County Jail under Tom Dart has started rise to their role as a mental health facility as a means to lower these costs and to get inmates like Tracy the help they need. They hired guards trained to identify mental health illnesses, as well as many more medical professionals. Earlier detection as well as an increase of resources has allowed the jail to properly identify inmates with mental illness and get them the help they need. Yet, this does not go far enough. On the journey to jail, the inmates had to go through multiple systems – all of which failed them. In order to be in the jail, they must have been arrested by the police. At this stage, the police could have sent them to family or a home if they have one, to a shelter or mental facility, or to arrest them. Not identifying the mentally ill is the system’s first failure. After being arrested, one has

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to appear before a judge for a trial and then a sentencing. The judge, if one is convicted, must then decide whether to send them to prison – which may only worsen one’s condition – or to a mental health clinic. The harsh sentences only cost taxpayers money and lengthen the amount of time those with mental illness must endure before treatment.

Mental illness is a pandemic in Chicago, one that cannot be cured by one simple solution – a panacea is needed. As mental health both affects and is in some ways caused by multiple failings of society and government, many things needed to be dramatically changed.

However, these changes do not need millions for spending or even a total upheaval of the institutions already present; instead a simple redistribution of resources could address many of the issues seen today. Cook County, for example, took the funding it had and used it towards addressing mental health.

No new clinic was established, and it was able to use the resources at its disposal but in a more effective manner. The University Trauma Center also used its resources more effectively. It was already on the South Side – no new hospital needed to be built, and the University Hospital only needed to focus its resources on what the community needed. As chief of neurosurgery, Dr. David Frim said, “Opening a Level 1 Trauma Center is an extraordinary opportunity for University of Chicago to help better the lives of patients on the South Side. As we track and study the care of trauma patients, we will improve the care of individuals affected by violence and trauma.”

Rubin, Gretchen. “‘It Takes a Village’ to Operate a Trauma Center.” The University of Chicago Medicine. October 6, 2017. Trauma. uchospitals.edu Bliss, Laura. “Mapping Chicago’s ‘Million Dollar Blocks.’” CityLab. July 34, 2015. Citylab.com “Better Planning and Evaluation Needed to Understand and Control Rising Inmate Health Care Costs.” U.S. Government Accountability Office. June 29, 2017. gao.gov Keilman, John. “Black victims of heroin, opioid crisis ‘whitewashed’ out of picture, report finds.” Chicago Tribune. December 26, 2017. chicagotribune.com “Epidemiology report: Increase in overdose death involving opioids - Chicago, 2015-2016.”

Healthy Chicago, Chicago Department of Public Health. October 2017. cityofchicago.org.

Ese Olumhense and Nausheen Husain, “‘Pharmacy deserts’ a growing health concern in Chicago, experts, residents say.” Chicago Tribune.

January 22, 2018. Chicagotribune.com Moore, Natalie. “After Push From Activists, Chicago’s South Side Gets An Adult Trauma Center.” Produced by WBEZ. NPR Weekend Edition Saturday. April 28, 2018. Podcast. npr. org Terry, Don. “A Death Sparks a Demand for Care.” The New York Times. October 2, 2010. nytimes.com.

Scheneker, Lisa. “U. of C. trauma center gains final state approval, set to open May 1.” Chicago Tribune. April 9, 2018. chicagotribune.com O’Shea, Bridget. “Psychiatric Patients With No Place to Go but Jail.” The New York Times.

February 18, 2012. nytimes.com Schencker, Lisa. “New Cook County clinic aims to keep mentally ill out of jail.” Chicago Tribune.

November 1, 2016. chicagotribune.com Ford, Matt. “America’s Largest Mental Hospital Is a Jail.” The Atlantic. June 8, 2015. theatlantic. com.

Lisa Schencker and Ese Olumhense. “University of Chicago’s new trauma center opens, with cautious optimism.” Chicago Tribune. April 30, 2018. chicagotribune.com Swanson, Lorraine. “UChicago Trauma Center Could Relieve Patient Volume In Christ ER.” Oak Lawn Patch. May 8, 2018. patch.com Dart, Tom. “How we shaft the mentally ill.”

Chicago Tribune. July 29, 2018. chicagotribune. com.

POLICY

THE EFFECT OF CPS FOOD QUALITY ON STUDENTS' HEALTH By

SHARAD CROSBY SWATHI BALAJI (Editor)

Introduction

As a teacher for Health4Kids (H4K), an undergraduate initiative at the University of Chicago to teach kids in the South Side about science and health, I have the pleasure of introducing weekly basic science material to elementary students in Chicago Public Schools (CPS) institutions. Much of the curriculum I have taught to many classes encompasses the basics of nutrition. In these lessons, my colleagues and I have covered general topics that help elementary students understand what they’re eating and how to build a healthy plate. In multiple sessions, we often talk about the 5 basic food groups, the food pyramid, complex and simple carbohydrates, and the food web. In supplementation to the lecture, my fellow teachers constantly take questions and comments from students to evaluate their understanding of the concepts. Most students I have taught understood nutrition quite easily. In fact, some of the students knew everything there was to say about general healthy eating habits.

After completing a session one April afternoon, an employee of William H. Ray Elementary school approached my co-teacher and me and said, “The cafeteria food in schools aren’t like they used to be,” stating in a boasting tone, “we used to have good cooked meals always cooked from scratch that I enjoyed. Nowadays we’ve been finding more food in garbage cans and kids bringing their own lunch.” The unnamed employee continued to update us on how kids’ opinions of school lunch have worsened.

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My colleague and I were generally shocked at this information, not because we didn’t agree, but because we were worried that students may not be receiving all the nutrients they need to grow and learn. According to the Chicago Public Schools’ Meal Program, CPS schools must provide all students breakfast and lunch every day.[2] Given this authority, the education system is in charge of supplying the majority of students’ daily nutrition. Registered dietitians from both Aramark and CPS have promised to provide the healthiest menus that are the most financially appropriate. Some of these promises include serving lunches for students in grades K-5 that have 550-650 calories, do not exceed 10 grams of saturated fat, and contain less than 640 milligrams of sodium.

In the year 2010, the passing of the Healthy Hunger-Free Kids Act was the beginning of many new initiatives to improve critical nutrition and the hunger safety-net for children. This act attempts to stop the serving of French fries, greasy pizza, cheesy nachos, and sauced up chicken wings in cafeterias all across the United States. To improve the accountability of schools nationwide, this act set a standard for all meals served, ultimately changing cafeteria as we know. However, if kids do not like the menus prepared for them and don’t eat school-provided meals, then these alterations mean nothing.

There are no requirements for kids to eat school lunches, leaving them with the option to bring homemade meals prepared by their caregiver or themselves. According to nutritional studies, the following activities have been proven successful to improve children’s food choices[1]: • Student involvement and family inclusion • Community cooperation • Healthy menu choices • Affordable food pricing • School food policies • Health and nutrition curriculum • Healthy environments • Modeling healthy attitudes and behaviors The school system is able to provide at least half of the arrangements on this list, and, since some CPS schools are located in verified impoverished areas, it is unlikely that all caregivers and communities of CPS students can consistently provide the remaining half.

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Therefore, if children won’t eat their daily meals in the cafeteria where their diets can be monitored, then we must assume that skipping school lunch is bad for students’ health.

I wanted to evaluate the validity of this testimony, so I decided to seek the opinions of the students I teach. Out of the 130 kids that I personally questioned, the majority of the responses reflected that most kids do not enjoy the lunch that the school provides and that they bring homemade meals – many of them saying, “No, school lunch is nasty!”

I took this analysis one step further and decided to send a survey back home that caregivers and students could answer, which I hoped would shed light on how school meals are perceived.

Methodology:

I asked two 4th grade classes from Edmond Burke Elementary and William H. Ray Elementary School first about if they’re familiar with the 5 basic components to every meal. I then asked how many times a week each child receives a homemade meal every day, and whether or not the student and the caregiver prefer the school meals versus homemade meals or think one meal is healthier than the other.

Neither school meals nor homemade meals are guaranteed to include all 5 food groups in each meal.

This means that asking if school meals are healthier than homemade meal on average is relative to what may be on the menu or at home that day. Consequently, I also asked students to comment what they prefer and what they think their caregivers prefer for them to eat. Additionally, I asked for the preferences of the caregivers and asked them to comment on their children’s opinions.

Results and Discussion:

In a survey of 4 questions testing for meal preferences during school hours, I received primary opinions from both students and caregivers. When both participants were asked to name the 5 food groups, 30% of all the students and caregivers that returned a completed survey received a perfect score of 10 out of 10, while the remaining 70% of the results received an average score of 6 out of 10.

When asked how often the student brings his own

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lunch to school, most of the surveys only replied sometimes (about 60%), and even fewer replied more than once a week. However, 40% of the legal guardians that answered said their children bring lunches to school every day, while only 30 percent of students gave the same reply.

From the remaining 2 questions, 90% of students prefer homemade meals over school lunches, but 10% of those same students said their caregivers prefer that they eat school lunches. When adults were asked the same question, 20% of the caregivers reported they prefer school lunches over homemade meals.

However, those same caregivers shared that their kids prefer homemade meals over school lunches. The 20% of caregivers that prefer school lunches explained that they primarily prefer school meals to homemade because they’re cheaper. But, only 50% of the caregivers that prefer for their students to eat school lunches believe that school lunches are healthier. All students that responded to the survey said they believed homemade lunches to be healthier than school lunches.

These results demonstrate that most kids and guardians think it would be optimal for their children to bring homemade meals to school. However, it seems if school meals were healthier, more caregivers would rather have their kids eat at school. There were also some caregivers who elaborated that sometimes school lunches can be healthier than home meals, and it comes down to the matter of ingredients.

Conclusion:

While most students and caregivers believe that meals made in their homes are healthier than the meals served in schools, not all of the families could perfectly answer what dictates a healthy meal, so my results must be explained with some more qualitative data. Also, I noticed that there are more caregivers who believe school meals are healthier than students who believe so, leading me to believe that some caregivers count on USDA protocols, such as the Healthy Hunger Free Kids Act of 2010, to provide cafeterias with the means to serve children healthier food than what the caregivers could give their children at home.

The only problem is the menu selection.

Even though the Chicago Public School’s Meal Programs report that all new foods added to the menu are tested by students and caregivers beforehand, I cannot assume that means all caregivers are aware of what their students are eating at school. The survey results show that there are some disagreements with meal preferences, but the majority of the results have identical preferences. These congruous opinions may exist because caregivers’ opinions on school lunches might be influenced by their children’s preferences. With this logic, if students’ appreciation of school lunches were improved, then caregivers may begin to think more highly of cafeteria food quality as well. This would require Aramark and CPS dietary specialists to redevelop CPS menus citywide and to make them more tasteful and more likeable to their consumers. In the end, once both students and legal guardians are on the same page of what healthy food is, students should become better at making healthier food choices.

[1] Birch, Leann, et al. “Influences on the Development of Children's Eating Behaviours: From Infancy to Adolescence.” Advances in Pediatrics., U.S. National Library of Medicine, 2007, www.ncbi.nlm.nih.gov/pmc/articles/ PMC2678872/.

[2] Chicago Public Schools, and Healthy Schools Campaign. “Chicago Public Schools’ School Meal Program - Frequently Asked Questions.” Healthy Schools Campaign, 2015.

[3] Murphy, Kate. “Why Students Hate School Lunches.” The New York Times, The New York Times, 26 Sept. 2015, www.nytimes.com/2015/09/27/ sunday-review/why-students-hateschool-lunches.html.

[4] United States Department of Agriculture: Food and Nutrition Services.

“School Meals: Healthy Hunger-Free Kids Act.” Food and Nutrition Service, 5 Oct. 2017, www.fns.usda.gov/school-meals/healthy-hunger-freekids-act.

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ASTHMA INITIATIVES AIM TO LOWER PEDIATRIC RATES IN UNDERSERVED NEIGHBORHOODS IN THE SOUTH SIDE By

PRANATI MOVVA SWATHI BALAJI (Editor)

Asthma is a chronic, multifactorial disease of the lungs and airways that affects 1 in 12 adults and 1 in 10 children nationally.

[1] The prevalence of pediatric asthma in particular is on the rise.

According to the Illinois Department of Public Health, 13.6% of children in Illinois currently have asthma, with an even higher occurrence of asthma in disproportionately affected, underserved neighborhoods in the South Side of Chicago.[2] A main concern, especially within the Chicago Public School System, is that students with asthma are not only uninformed of how to manage their condition, but are also undiagnosed and unaware that they have asthmatic symptoms, since they lack the proper resources and

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education to understand the scope and severity of asthma.

Because of the pressing health concern of asthma, many organizations have taken the initiative to educate and raise awareness about asthma in Chicago’s diverse communities. The Respiratory Health Association (RHA) is one such organization which offers community-based interventions to assist people living with lung disease through advocacy and education. The Respiratory Health Association offers two educational programs, Fight Asthma Now and Asthma Management, which effectively reach children living with asthma and their adult caregivers to provide them with increased knowledge about asthma care.

Fight Asthma Now (FAN), which

is specifically geared towards educating youth, was developed with input from pediatricians, respiratory therapists, and parents of children with asthma, based on the guidelines from the National Asthma Education and Prevention Program.[3] The RHA’s Senior Program Coordinator Amanda Weiler reported, “To date, more than 15,000 students have been reached with FAN and more than 33,000 adult caregivers have been educated through RHA’s Asthma Management throughout Chicagoland. Respiratory Health Association targets schools with populations of at least 70% low-income students and those in which Hispanic and African-American students represent the largest

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proportion of enrolled students.”

The RHA is able to reach large numbers of people living with asthma through the health education programming it provides in such schools. Because the prevalence of asthma is greater in areas of high economic hardship, the services that RHA offers to families from underserved populations are crucial to equip students and their parents with proper asthma management skills.

Mobile Care Chicago is another organization that proactively addresses childhood asthma by providing free healthcare and preventative care to low-income children and families. This organization has an Asthma Van Program, where asthma vans with medical professionals including physicians and nurse practitioners specializing in asthma care go to underserved areas to give consistent medical support to children with asthma. This Asthma Van Program has helped reduce community healthcare expenses, the number of hospitalizations, and school absenteeism among children with asthma. According to mobilecarechicago.org, “only 4% of Asthma Van kids missed over five days of school last year, and only 3% had to visit a hospital or ER.”[4] The Asthma Van fully acts a medical clinic on wheels that overcomes cost barriers to give quality asthma care to children in need, regardless of whether they have insurance.

As an undergraduate, I am currently involved in an asthma intervention program to address the asthma epidemic in the South Side of Chicago, specifically within the Chicago Public School

system. I am working with a team of three other undergraduate students – Swathi Balaji, Sweta Narayan, and Yolanda Yu – to pilot a school-based asthma intervention program to identify students with asthma, provide avenues for students to manage their condition and receive long-term care, and maintain air quality via indoor air quality kits and regular school inspections to minimize the presence of environmental asthma triggers. Our program will partner with the Respiratory Health Association and Mobile Care Chicago to educate students and improve asthma management in the long run.

Yolanda Yu, one of our team members, commented on the importance of our program, stating, “Because children spend a large part of their time at school, we believe that a school-based intervention will be the most effective approach. We want to evaluate the impact our pilot program will have and make adjustments, and [will eventually] expand to other Chicago public schools in the future.”

The intervention led by my team will first address the asthma epidemic in Washington Park, as it is an area in Chicago with low child opportunity and a high poverty rate inhibiting economic growth, both of which have been linked to high incidences of asthma. We hope to initiate our program at Burke Elementary, where there is a high percentage of students with asthma.

“Asthma is absolutely a serious problem for many students at Burke,” Burke Elementary Principal Jessica Biggs stated. “I do

not know an exact percentage of students who have documented cases of asthma, [as] the lack of documentation is a problem; however, anecdotally, it would seem that well over 50% of students experience symptoms of asthma.”

We hope that with this asthma initiative, we will be able to better identify students with asthmatic symptoms and give them the proper resources for long term care and management.

The initiative focuses on the child through the lens of the school, but it also focuses on creating partnerships between the school community, the child’s family, and local health clinics.

By educating parents and school faculty about asthma management, this school-based initiative will create a cohesive team of people to help students manage their asthma at home and in school.

Health is influenced by more than just direct healthcare, and from an administrative perspective, creating a well-informed team of people who have the child’s best interest in mind when tackling the asthma concern is of the utmost importance in combating childhood asthma in Chicago.

[1] “Asthma in the US.” Centers for Disease Control and Prevention. May 03, 2011. Accessed May 18, 2018. https://www.cdc.gov/vitalsigns/ asthma/index.html.

[2] “Asthma.” Chicago Allergy and Asthma.

2018. Accessed May 18, 2018. https:// chicagoallergyandasthma.com/services/ chicago-allergy-asthma.

[3] “Programs and Initiatives.” RHA. 2018.

Accessed May 18, 2018. https://lungchicago. org/what-we-offer/our-programs-initiatives/ fight-asthma-now/.

[4] “Mobile Care Chicago Mission.” Mobile Care Chicago. Accessed May 18, 2018. https:// mobilecarechicago.org/about-us-2/mission/.

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THE BUZZING BRAIN

Honeybees making collective decisions obey the same psychophysical laws as the human brain.

By

FAITH WHITEHOUSE IRENA HSU (Editor)

Every spring, European honeybees emerge and, after having produced a new queen, the former queen leaves the hive alongside thousands of scout bees to search for a new nesting-site. Some of the swarm stays behind to guard the queen while the rest explore their environment, returning to the nest after locating a potential nesting-site. While individual bees may only visit one nesting-site, they can instinctively assess the quality of the site they visit. Once rejoining the swarm, the individual scout bee performs a waggle dance that conveys the quality of the site that they had visited; the higher the quality, the longer and more vigorously the bee dances.

Through the waggle dance, the scout may recruit others to its nesting-site. If a scout committed to a site comes across another scout waggle dancing for another location, that first scout may deliver a “stop-signal” to the other through headbutting and the emission of a high-pitched beep. When a bee receives enough stop-signals, it reverts to an uncommitted state. After a sufficient number of honeybees are committed to the same nesting-site option and reach a quorum, the colony can make a decision.

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While on the surface, honeybees and the human brain may not seem comparable, a recent study led by Dr. Andreagiovanni Reina at the University of Sheffield suggests that collective decision-making by superorganisms – complex systems of individuals that collectively behave as an organic whole – follow some of the same basic psychophysical laws as the human brain. Honeybees, which are relatively easy to observe, could thus potentially be used as a model system for understanding psychophysics and the human brain better.

Psychophysics studies the relationship between a subject’s experience or perception and stimulus intensity. This relationship is represented through a set of psychophysical laws that have been demonstrated to hold through a variety of sensory domains, such as sound, loudness, weight, and brightness. Interestingly, many studies have shown that these laws are obeyed by organisms at many levels, including unicellular organisms such as slime molds. These similarities suggest that psychophysical laws arise from fundamental mechanisms underlying decision making and information processing.

Reina et al., however, are the first to have shown psychophysical laws being obeyed on the superorganismal level. They observed European honeybees choosing between nesting-sites of varying quality, focusing on the time it took for the colony to make a decision, and applied the laws to their observations. In particular, they focused on Weber’s, Hick-Hyman’s, and Pieron’s Laws, which all relate decision conditions to decision time and accuracy.

Weber’s Law states that “the minimum difference between two stimuli (also known as just noticeable difference) that an organism can correctly discriminate is a constant fraction of the base stimulus strength.” Thus, the more distinct in quality two options are, the easier it is to make a decision.

For example, when holding a pound of books, adding another pound to the books is easily felt; however, in the case of holding 20 pounds and adding an additional pound, that extra pound will not be felt as much.

Hick-Hyman’s Law states that “the reaction time to a stimulus increases linearly with the amount of information that needs to be processed.” In the case of the bee colony, colonies took longer to

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commit to a site when the number of potential sites increased.

Pieron’s Law states that “mean response time decreases as a power function of stimulus intensity.”

Essentially, this means quicker decisions can be made between two high-quality options than between two low-quality options.

Reina et al.’s study offers several interesting avenues for investigation. The researchers discovered that, just as individual neurons do not obey psychophysical laws while the brain as a whole does, individual bees do not obey the laws while the colony as a whole does. For example, Reina et al. noted while analyzing Hick-Hyman’s Law that, while making a decision, honeybees may only consider a limited number of options. This is similar to working memory in human brains, which refers to limits on humans’ capacity for short-term memory storage and processing of information.

Reina et al. also suggested a way to combine Hick-Hyman’s Law and Pieron’s law, both of which focus different aspects of reaction time as a function of the decision problem, into a single generic function which could later be empirically tested for confirmation. Thus, the similarities in how the brain and superorganisms respond to stimuli could motivate further research in cognitive science and psychology on collective behavior.

As Dr. Andreagiovanni Reina notes, “finding similarities between the behaviour of honeybee colonies and brain neurons is useful because the behaviour of bees selecting a nest is simpler than studying neurons in a brain that makes decisions.” Ultimately, further research on superorganismal systems could help us better understand the psychological mechanisms in which complex decisions arise from single nerves firing electrochemical signals.

Cowan, Nelson. “The Magical Mystery Four: How Is Working Memory Capacity Limited, and Why?” Current Directions in Psychological Science 19, no. 1 (February 1, 2010): 51–57. https://doi.org/10.1177/0963721409359277.

“Honeybees May Unlock Secrets of How the Human Brain Works - Neuroscience News.” Accessed April 14, 2018. http:// neurosciencenews.com/honeybee-humanbrain-8696/.

Maanen, Leendert van, Raoul P. P. P. Grasman, Birte U. Forstmann, and Eric-Jan Wagenmakers. “Piéron’s Law and Optimal Behavior in Perceptual Decision-Making.”

Frontiers in Neuroscience 5 (January 2, 2012). https://doi.org/10.3389/fnins.2011.00143.

Ma, Wei Ji, Masud Husain, and Paul M Bays.

“Changing Concepts of Working Memory.”

Nature Neuroscience 17, no. 3 (March 2014): 347–56. https://doi.org/10.1038/nn.3655.

“Psychophysical Laws and the Superorganism | Scientific Reports.” Accessed April 14, 2018. https://www.nature.com/articles/s41598-01822616-y#Sec3.

Perry, Philip. “A Superorganism and the Human Brain Operate in Much the Same Way.” Big Think, April 5, 2018. http://bigthink.com/ philip-perry/bee-colonies-make-decisions-thesame-way-the-human-brain-does.

Seeley, Thomas D., and P. Kirk Visscher. “Quorum Sensing during Nest-Site Selection by Honeybee Swarms.” Behavioral Ecology and Sociobiology 56, no. 6 (October 1, 2004): 594–601. https://doi.org/10.1007/s00265-0040814-5.

“The Place of Human Psychophysics in Modern Neuroscience - ScienceDirect.” Accessed May 2, 2018. https://www.sciencedirect.com/ science/article/pii/S0306452214004369.

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MIND & BODY

A DEPENDENT RELATIONSHIP

By

MARIA HATZISAVAS JUI MALWANKAR (Editor)

The random headache that pops up during finals week, the nausea you feel despite not being sick, even the reason you can’t sleep at night despite your best efforts. Psychosomatic symptoms are physical pains or discomforts that are either caused or worsened by the mind. Blurring the line that separates the mind from the body, this phenomenon has caused discussions and studies throughout the medical world. Although rarely acknowledged statistically, these symptoms are universally common and often caused by stress, while being worsened by the stress of experiencing the symptoms. This is often times a consequence of one’s self-diagnosing via the internet. Provided that psychosomatic symptoms are created in the mind, treatments are targeted to better the mind in hopes of reducing the severity and frequency of the psychosomatic symptoms.

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Correlation to Stress

Studies that examine the relationship between psychosomatic symptoms and stress range throughout age groups and cultures. The main commonality across all studies is that the test subjects are exposed to a certain level of stress. Therefore, school-age children are an appropriate focus due to the social and academic stresses they face. In a 2010 study set in China and published by Archives of Disease in Childhood, a medical journal, children were asked to report their stressors and how often they feel common psychosomatic symptoms. The study found that one-third of the children under

stress reported experiencing psychosomatic symptoms at least once a week – specifically, headaches and abdominal pains. This association is commonly found throughout numerous studies, such as the previously mentioned 2010 study, a 1981 study published in the Journal of Psychosomatic Research, and a 2004 study published in School Psychology International. All studies concluded that the students who reported higher stress levels also reported frequently suffering from psychosomatic symptoms such as those mentioned in the 2010 study. This consistent association found between stress levels and frequency of symptoms throughout the studies reinforces the idea

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that there is a relationship between the two factors.

Treatment

Although the discomfort from psychosomatic symptoms is caused by the mind, it is still physical and demands to be treated. To treat an illness of the mind, treatment must be for the mind. Many treatments in place revolve around therapy and remedying patients’ anxieties and stress in order to reduce their susceptibility to psychosomatic symptoms. Other treatments revolve around bettering one’s physical health through exercise and lifestyle changes, which are also suggestions to treat general anxiety and stress. Simply put, psychosomatic symptoms indicate a larger, less physical or immediately visible issue, and it is this issue (of anxiety and mental illness) that must ultimately be treated if we are to reduce the severity of psychosomatic symptoms themselves. Referencing the 2010, 1981, and 2004 studies, there is indeed an association between stress and the prevalence of psychosomatic symptoms. By treating the stress, the frequency of suffering from psychosomatic

symptoms should decrease, consequenting in remedies focused on the mind rather than the body.

turn into a migraine, the nausea into vomit, and a sleepless night into a sleepless week.

Technology

Ultimately, it is vital to take care of our minds in order to maintain a healthy body. Reducing stress and controlling our reactions to it could ultimately reduce the severity of psychosomatic symptoms, which cause unnecessary inconveniences. When our mental burdens become physical, we must acknowledge and treat the mental factors to successfully cure the physical issues. Additionally, in order to save ourselves from further stress, we must leave the diagnosing to the doctors before we truly do make ourselves sick.

When something is wrong, no matter how innocent the symptoms, we are quick to Google and self-diagnose ourselves, ultimately worsening our perception of the original symptoms and creating new ones that correspond with the illness that we researched. Technological advancements have fueled our desire to find, and in this case, create answers. If something is wrong and a satisfactory answer is not found, online communities such as Yahoo! Answers exist where one user fuels the stress of the other, providing anecdotal evidence of a larger, sometimes even deadly, issue at hand. We live in a world where it and its beyond can be quickly accessed through some swift movements of our fingertips. It is how you found this article, and how this article was written. While technological advancements have done wonders in the medical field, other advancements have arguably worsened the quality of our mental health – causing the headache to

Hasketh, Therese, Yan Zhen, Li Lu, Zhou Xu Dong, Ye Xu Jun, and Zhu Wei Xing. "Stress and Psychosomatic Symptoms in Chinese School Children: Cross-sectional Survey." Archives of Disease in Childhood 95, no. 2 (February 4, 2010). http://adc.bmj.com/content/95/2/136. info.

Murberg, Terje A., and Edvin Bru. "School-Related Stress and Psychosomatic Symptoms among Norwegian Adolescents." School Psychology International 25, no. 3 (2004): 317-32. doi:10.1177/0143034304046904.

Wright, Maijaliisa Rauste-Von, and Johan Von Wright. "A Longitudinal Study of Psychosomatic Symptoms in Healthy 11–18 Year Old Girls and Boys." Journal of Psychosomatic Research 25, no. 6 (April 30, 1981): 525-34. doi:10.1016/00223999(81)90106-9.

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THE IMMUNE SYSTEM ON CANCER

HOW THE HUMAN BODY REACTS TO A DEPRECATING DISEASE

By

YASSMIN ELBANNA LINUS PARK (Editor)

Treating cancer is a notorious challenge for doctors, one that only increases the more we learn about its unpredictable quirks.

To better understand cancer, we have to be bold and address the toughest of questions with regards to treatment. However, before we can even ask ourselves how we can do that, we first need to understand why our bodies are unable to resolve this deprecating disease, similar to how they normally react to illness such as the flu or infections.

Different mistakes in DNA can cause a variety of types of cancer.

One of the most media-attached ones are BRCA1 or BRCA2 genes due to their close relation with links to breast cancer. Scientists, to this day, don’t know why errors in these genes cause cancer in only specific organs and not others, despite the fact that errors occur all throughout the body. The biggest challenge today is devising approaches to prevent or treat cancer that determine tissue specificity of some of the cancer genes.

The more we learn about cancer’s activity and behavior, the better we can individualize treatments;

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however, before we can even begin to address treatments, we must first understand our own bodies and deconstruct certain myths that overshadow the conversation on cancer.

When we hear people talking about cancer, whether it’s on the news about a celebrity or at a family gathering, the first thing people ask is, “So, what’s next?”

Whether it’s Angelina Jolie’s infamous mastectomy or the impronunciable names of chemotherapy drugs, we always jump to external treatments – radiation, chemotherapy, and surgery.

Something that never seems to be addressed is the immune system.

The immune system protects the body against illness and infection caused by bacteria, viruses, fungi, or parasites. It is a combination of reactions and responses that are built over time, but also innate.

There are two main components of the immune system: acquired immunity and natural immunity.

Innate immunity doesn’t only refer to neutrophils, a type of white blood cell; it also refers to perfunctory actions such as urine flow or hair growth. Our acquired

immunity is a form of protection that our body learns after exposure to certain diseases. Lymphocytes, another type of white blood cell, are a major component of this system. Two subcomponents of these cells are B and T cells. B cells react against invading bacteria by producing antibodies, while T cells either stimulate B cells to make antibodies or kill the body’s own cells that have been invaded.

Our immune system is extremely thorough, and although we all get the common cold or the flu, we are constantly fighting off a variety of other illnesses – until you bring cancer into the picture.

A large aspect of the immune system’s success draws from its ability to distinguish self from non-self. When a natural killer cell recognizes a cancer cell, it sees it as a self cell that has become abnormal. However, the key is to be able to recognize it and have it respond to normal regulatory signals.

Cancer can weaken this seemingly impenetrable system by spreading into the bone marrow. The bone marrow makes white blood cells that help fight infection. Through its invasion, cancer can stop the

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bone marrow from making more blood cells that would detect it.

This is most common in leukaemia or lymphoma, but can also happen with other cancers.

During the first few days of development of cancer, our immune system identifies cancer cells not as abnormal cells that need to be eradicated, but instead as cells that need to be protected.

A study led by David Klatzmann identified how the immune system reacts to cancer. In the past, we believed that “immunosurveillance” of cancer implied that the immune system will recognize cancer cells as abnormal and that they are only able to develop when they escape this supposed surveillance. However, Klatzmann et al. found that tumor cells are treated the same way as any other normal cell in the body up until they are well-advanced. Using animal models, the study showed that when cancer cells first appear, they trigger an immediate response by regulatory T cells. They are then recognized as normal cells, which induces the regulatory T cells to block the action of effector T cells, effectively preventing them from

attacking the cancer cells and deactivating the immune system’s response.

Some cells in the immune system are able to recognize cancer cells and kill them. A study conducted by Houghton et al. found that most antigens expressed by human cancer cells and recognized by host T cells are non-mutated self antigens.

These self antigens are generally ineffective at triggering immune responses against cancer cells, which provides an explanation as to why it is difficult to try to immunize against cancer. This study went on to describe how tumors can avoid recognition by our immune system and how enhancing the interaction between a self antigen and the Major Histocompatibility complex (MHC) molecule found on a cancer cell may lead to immunity.

The greatest challenge in doing so is understanding whether or not cancer cells with mutated self peptides are able to stimulate host T cells. Therefore, the problem for host T cells involves the search for mutations in a cancer cell, similar to searching for a needle in a

haystack. Activated T cells might be able to survey cancer cells that are expressing extremely rare self peptides bound to MHC-I or -II molecules, and stimulate their destruction. However, this proves to be difficult for more common forms of cancer.

Host T cells are able to ignore cancer cells expressing weak self antigens. There are three mechanisms that a tumor uses to escape from T cell immunity, which are still studied today: (1) an insufficient number of host T cells against the self antigen are present for the mutated antigen; (2) immune tolerance of T cells occurs through a permanent state of inactivation, T cell deletion, or suppression by the cancer; or (3) T cells ignore the self peptide due to a lack of affinity to the MHC molecules present on the surface.

Treating cancer conflicts further with the immune system’s natural response. A shared theme among treatments such as chemotherapy, radiotherapy, and high doses of steroids is that they cause a sharp decrease in the number of white cells made in the bone marrow.

In a sense, they do exactly what

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cancer does to our bodies. Generally, when a doctor prescribes these plans, it is under the impression that the benefits outweigh the risks. There is never a case where a doctor can brush off a malignancy and state that the body will fight it off as it does with other common viruses. Instead, they assign drugs that overcome natural protection mechanisms under the assumption that it will be able to attack the cancer and hopefully reduce area of spread.

Overcoming the challenges that are present in immunity against self and mutated self antigens is a major concern in efforts to treat cancer using immunization.

This is especially dangerous as inducing immunity may lead to autoimmune damage to essential

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normal tissues. However, these forms of treatments have been found to be successful in shrinking tumors without extreme toxicity.

This form of treatment attempts to adapt the self/non-self paradigm that is normally used to describe immunity against microbial pathogens. However, it doesnâ&#x20AC;&#x2122;t sufficiently address adaptive immunity to cancer. There are still many questions left to be answered on how the immune system reacts to cancer and how we can utilize it. How frequently are these mutations recognized? How can the immune system evolve to recognize not only pathogens, but also cancer cells? In finding these answers, we can better understand cancer immunity and, eventually, autoimmunity as well.

Guillaume Darrasse-Jeze, Anne-Sophie Bergot, Aurelie Durgeau, Fabienne Billiard, Benoit L. Salomon, Jose L. Cohen, Bertrand Bellier, Katrina Podsypanina and David Klatzmann.

Tumor emergence is sensed by self-specific CD44hi memory Tregs that create a dominant tolerogenic environment for tumors in mice.

Journal of Clinical Investigation, August 3, 2009.

Houghton, A. N., & Guevara-PatiĂąo, J. A. (2004).

Immune recognition of self in immunity against cancer. Journal of Clinical Investigation, 114(4), 468â&#x20AC;&#x201C;471. http://doi.org/10.1172/ JCI200422685.

The immune system and cancer. (2017, December 18). Retrieved from http:// www.cancerresearchuk.org/about-cancer/ what-is-cancer/body-systems-and-cancer/ the-immune-system-and-cancer.

8 new challenges between us and beating cancer. (n.d.). Retrieved from http://scienceblog. cancerresearchuk.org/2017/06/22/8-newchallenges-between-us-and-beating-cancer/.

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THE PATH TO AN ENTEROVIRUSBASED TYPE 1 DIABETES VACCINE By

NIKKI KASAL DAKSH CHAUHAN (Editor)

Diabetes mellitus presents in all patients as a chronic condition that impacts the body’s ability to regulate insulin and effectively utilize glucose as an energy source. This disease may be further subdivided into type 1 and type 2 diabetes. The key difference is that the former, also known as insulin-dependent diabetes, is an autoimmune condition that often presents itself in childhood and is characterized by the pancreas’ inability to create insulin. This happens because the immune system mistakenly identifies insulin-producing beta cells as foreign objects, targeting these cells for destruction. On the other hand, type 2 diabetes, which is much more common, is identified either by the body’s resistance to insulin or by the overall lower insulin levels.

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Although the first recognizable reports of type 1 diabetes appeared in medical literature around the end of the nineteenth century, this subset of the disease was not characterized by name until 1951.

In the first use of these terms, British diabetes specialist John Lister describes those with type 1 diabetes as having “normal blood pressure and usually an acute onset to the disease” in comparison to the “insidious onset” and “hypertension” observed in older patients.

The autoimmune aspect of type 1 diabetes to date remains a key challenge in treating this condition. Recently, research has turned to the analysis of trends in type 1 diabetes incidence over the past several decades to understand deeper-rooted causes of its prevalence. It is no secret that the morbidity of type 1 diabetes has exploded in recent times. While one or two children under 15 in 100,000 developed this disease in the early 1900s, this number has risen today to more than 20 in 100,000 (and almost 60 in 100,000 in parts of Finland). In addition, this rise is largely recent, with a global incidence jump of 40% between 1998-2010.

This trend would be difficult to explain as a product of genetic flux, given that DNA takes much longer than twenty years to mutate to the point at which it can cause this kind of extreme growth.

Therefore, scientists instead are turning to emerging environmental factors as the culprit for this rise. A viral trigger of the disease

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arose as a prominent candidate of this research.

Enteroviruses are agents often found in contaminated drinking water that settle in the pancreas, causing the inflamed regions of viral replication in the body to produce autoimmune T cells that attack healthy beta cells. However, experiments performed with these viruses in the University of Nebraska and the University of Tampere in Finland yielded perplexing results. Though infecting type 1 diabetes-prone mice with a specific enterovirus increased diabetes incidence in older mice, infecting them in the early stages of life actually decreased the number of mice that acquired diabetes as adults.

A fluke? Not quite. This phenomenon falls in line with a scientific theory that has been in play for almost three decades.

Coined by British epidemiologist David P. Strachan, the “hygiene hypothesis” postulates that early exposure to bacteria and viruses actually protects children from allergic and autoimmune illnesses later on. Consequently, the rapid improvements in living standards and stress on a clean lifestyle eliminated this protective exposure in childhood and may be responsible for the soaring rates of these conditions. As enteroviruses were originally prevalent in sewage and untreated wastewater, rapidly decreasing contact with such a medium affected delivery of the protective viruses to developing children. This provides a tempting explanation for the rapid and

recent increase in the incidence of type 1 diabetes.

Though this theory is still disputed, it may provide a reasonable explanation for the findings produced by the University of Nebraska and University of Tampere. In fact, a subsequent study led by immunologist Matthias Herrath of the La Jolla Institute for Allergy and Immunology in California confirmed that early exposure to numerous enteroviruses prior to an autoimmune attack may stimulate the production of regulatory T cells that persist in adulthood. These cells subsequently protect the body from type 1 diabetes by suppressing the production of autoimmune T cells.

These findings have generated a wave of new research into the possibility of using enteroviruses to develop a vaccine against type 1 diabetes. In 2017, researchers from the University of Tampere and the Karolinska Institute in Sweden published findings on an enterovirus-based vaccine that managed to prevent artificially-induced type 1 diabetes in animal models.

“These exciting results showing that the vaccine completely protects against virus-induced diabetes indicate the potential that such a vaccine has for elucidating the role of enteroviruses in human Type 1 diabetes,” says Prof. Malin Flodström-Tullberg of the Karolinska Institute.

Currently, the vaccine is under development at the University of Tampere with the goal of engineering it to target a greater variety of

RESEARCH

enteroviruses. In addition, pharmaceutical companies Vactech Ltd. and Provention Bio are working to move it towards clinical studies in humans within the next few years.

Though research on the vaccine is still in its early stages, these preliminary findings are monumental. Test strips, needles, insulin, and doctor’s visits add up: currently, type 1 diabetes patients around the world spend an average of anywhere from 8% (USA) to 80% (Brazil) of their monthly income on managing their condition. Janine LePere, the mother of a 12-year-old son with type 1 diabetes, remembers a night when it took her child seven attempts to check his blood sugar. “If you don't get blood on strip right way, you have to start over with new strip,” LePere says. “It cost $8 to check blood sugar that night. There's nothing I can do about it.”

On a sobering note, it is important to remember that a vaccine will not eliminate type 1 diabetes in the population, as unalterable genetic factors play a large role in its incidence. For this reason, pharmaceuticals companies and researchers should not turn away their focus from the development of treatments for the disease.

Nevertheless, the possibility of such a vaccine would prove to be life-changing for type 1 diabetes patients for the improved quality of life they would enjoy.

Drescher, Kristen M., and Steven Tracy.

“Vanquishing Diabetes.” Nature News, Nature Publishing Group, 16 Jan. 2018, www.nature. com/scientificamerican/journal/v318/n2/full/ scientificamerican0218-54.html.

“Enterovirus Vaccine Prevents VirusInduced Diabetes in a T1D Experimental Model.” ScienceDaily, ScienceDaily, 20 Nov. 2017, www.sciencedaily.com/ releases/2017/11/171120101308.htm.

“Kindercare Pediatrics.” Kindercare Pediatrics, 5 Oct. 2014, kindercarepediatrics.ca/generaladvice/enterovirus-d68-parents-need-know/.

Kirkby, Russel, and E.A.M. Gale. “Historical Aspects of Type 1 Diabetes.” Management - Diapedia, The Living Textbook of Diabetes, www.diapedia.org/type1-diabetes-mellitus/2104085134/ historical-aspects-of-type-1-diabetes.

McRae, Mike. “ScienceAlert.” ScienceAlert, 24 July 2017, www.sciencealert.com/this-vaccinecould-prevent-many-cases-of-type-1-diabetes.

Niiler, Eric. “Is There Connection between Type 1 Diabetes and Cleanliness? Finland Serves as a Model.” The Washington Post, WP Company, 20 Jan. 2014, www.washingtonpost.com/national/ health-science/is-there-connection-betweentype-1-diabetes-and-cleanliness-finlandserves-as-a-model/2014/01/17/93d2fd28-0fe811e3-85b6-d27422650fd5_story.html.

Ramsey, Lydia. “Diabetics Can Spend $1,000 a Month Taking Care of Themselves - and It's Not Just Because of Insulin.” Business Insider, Business Insider, 19 Sept. 2016, www. businessinsider.com/costs-to-manage-type-1diabetes-2016-9.

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MENTAL HEALTH IN THE AGE OF MILLENIALS By

IRENA HSU JUI MALWANKAR (Editor)

There is no question that America’s current college students are facing a mental health crisis unlike anything previous generations have seen. According to a national survey conducted by the American College Health Association in 2014, 30% of college students reported feeling “so depressed that it was difficult to function” at some time over the previous year. In fact, not only are college students affected, but this crisis has even reached youths as young as eight years of age. According to statistics provided by the National Institute of Mental Health, approximately 1 in 5 individuals aged between 13 to 18 (21.4%) experience a severe mental episode at some point during their life and for children aged 8 to 15, the estimate is 13%. While the public is increasingly recognizing and responding to the quiet but tragic spread of this epidemic, it is a reality that should command everyone’s attention considering its monumental ramifications to the future of our society.

It goes without saying that the roots of mental health and mental illness are complex and encompass various factors ranging from social to biological. In fact, while the number of facilities offering help with depression and anxiety has increased, many other mental illnesses still remain heavily stigmatized and unresearched. As such, it is impossible and simply unfair to try and explain the crisis by reducing its stem to a single cause. However, the goal of this article is to, very generally, explore some explanations which could account for the growing trends we observe today. An article published in the journal Pediatrics in November of 2016 found that the prevalence of teens who reported experiencing a period of unusually low moods lasting for at least two weeks in the previous 12 months jumped from 8.7% in 2005

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to 11.5% in 2014 – a 37% increase. As the statistics continue to rise, the task of understanding the causes and effects of mental illnesses is the first step towards solving the crisis.

In specific regards to college-aged students, three general qualities seem to play a significant role in the growth of the epidemic. These factors range from trends and issues in society as whole, to the differences between the ideology and expectations among generations, and all the way to the unique environment that college students are surrounded by.

Altogether, a mixing and matching of the aforementioned points provides the breeding ground for the propagation of mental health issues.

To address the first point, current society is irrevocably intertwined with the advent of technology.

With the emergence of social media and technology that makes digital connections much more attainable, the fundamental way in which people relate to one another has also changed. In a seemingly contradictory fashion, teens can talk to others within seconds with platforms such as Twitter, Facebook, and Snapchat, yet at the same time are increasingly withdrawing into their screens rather than engaging in real, physical communication. In a study done in 2002, 1,501 youths were asked about the relationships they had formed online. Two percent of the teens in question admitted to having a romantic relationship with someone exclusively through the internet, though they had never met in person before. While 2002 was more than a decade ago, the data reveals just how long the internet has been shaping the relationships that younger generations are forming. Beyond the obvious problems technology can usher in, like powerful forms of cyberbullying, another possible

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issue is that the hyper-connected world gives people ever more access to an endless array of choices and information that can be overwhelming and confusing. Psychological research on choices shows that in many cases, more choices lead to more anxiety.

Additionally, the constant barrage of information and exposure to unrealistic standards creates a mismatch between the real world and the world that people are tuning into. The greater this gap between what is real and what is virtual, the more anxiety that is induced, threatening to derail any sort of healthy mindset.

As for generational considerations, one of the greatest points of comparison between modern times and years past is the increasing failure of the education system. From decreasing SAT scores to an increase in the remedial instruction provided by institutions of higher education, there is evidence to suggest that America’s education system is flawed. In addition to failing at the level of academic achievement, many also argue that the structure of today’s schooling, namely the intense focus on assessments and a universal school curriculum, creates a massively unhealthy environment for socializing. Fifty years ago, a high school diploma was enough to ensure that someone could go down various career paths; now, however, the expectation is that most job applicants have at least a bachelor’s degree. While the stakes are increasing for the level of education one needs in order to obtain the same standard of living as people of older generations, the end goal remains fixed.

Though often deemed as “lazy” by baby boomers, millennials – as shown in multiple studies – actually work much more than previous generations and hold their careers to be of greater importance. The pressures placed on today’s youth, whether from parents

or self-imposed, are a major source of stress and can often lead to deteriorating mental conditions.

Finally, on college campus themselves, young adults face a whole new set of issues as competition becomes fiercer and the resources to deal with mental health remains limited. Disturbingly, cases from universities throughout the country show that schools often default to punitive measures for students with mental health issues rather than helping them seek the aid they need. After a freshman at University of California at Santa Barbara told her friends that she was cutting herself, she received a notice from her school’s housing that she had taken part in “actions which disrupt the normal functioning and operation of the residence hall” and “actions which pose a significant risk of harm to self or to the community.”

She was given three days to plead her case, but the school never inquired after the medical attention she might need. Under a high-stress environment where students’ minds are still developing, not having access to critical resources can not only instigate an onslaught of mental health issues, but even make situations drastically worse.

Fortunately, as grave as the current situation surrounding mental health is, public awareness is growing and changes are happening right on college campuses as well. Two Skidmore students petitioned their school to hire more counselors and create a 24-hour hotline for students to call if they have urgent mental health concerns other than thoughts of suicide. The University of Iowa also followed the example by hiring eight new counselors for their students’ increased demands. These victories are worth every bit of celebrating, but the work ahead will still be an uphill battle.

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OUT OF SIGHT, OUT OF MIND

LONELINESS AND DEPRESSION IN OLDER GENERATIONS

By

HELEN KESSLER ABHIJIT RAMAPRASAD (Editor)

Mention the mental health of the elderly population, and most people’s immediate association is with some form of dementia. Alzheimer's and other such diseases dominate the public consciousness, and many people have personal connections to such cases through relatives or friends. Although Alzheimer’s is the most publicly recognized mental disorder, there are many other less discussed disorders that can impact an individual’s mental and physical state. Depression and overall loneliness are two interconnected factors that have a large influence over health in older populations.

Unsurprising to many, over 20% of adults aged 60 and over suffer from a neurological disorder; however, despite being the most recognized disorder, dementia only counts for 5%. Depression, on the other hand, is the leading mental disorder, and has been clinically diagnosed in over 7% of older adults. Additionally, nearly half of the world’s older population report depression and anxiety symptoms, and around a

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quarter of deaths from self-harm are among people aged 60 or over.

A study evaluating depressive symptoms across age groups also revealed that the frequency of depressive disorders appears to increase with age.

Despite being such a prevalent health problem, depression is under-identified by healthcare professionals and by older people themselves. Many older individuals do not seek the help they need in part due to the stigma associated with mental illness, as well as the fact that many individuals have trouble recognizing when a period of loneliness has transformed into full-on depression. Adding to the difficulty of diagnosing is the fact that elderly people may present a smaller number of symptoms or just one dominating symptom. They may show more aggressiveness, cognitive difficulties, or apathy; interestingly, the less common symptoms include depressed mood, which contributes to the under-diagnosing of the disorder. A core symptom of depression in the Diagnostic and Statistical Manual of Mental Disor-

ders is cognitive impairment; it is therefore not surprising that many older adults manifesting depression exhibit cognitive decline and are misdiagnosed as having a form of dementia.

There is one clear difference across age groups: recovery.

Depression is reported to have a poor rate of recovery among the elderly, although it is unclear why. One reason may be loneliness and lack of support by family and friends. Loneliness has been identified as one of the three main factors leading to depression, and it is a common cause of suicide and suicide attempts. A study revealed that loneliness was related to poor psychological adjustment and dissatisfaction with familial and social relationships. This can be connected to the rise of older adults living in nursing homes or adult-living cohorts, which isolate them from family and the outside world. Although both of these institutions claim that living with others of the same age is beneficial to older adults, this is not always the case. As people age, the likelihood of experiencing age-related

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Rantzen, Dame Esther. "Summertime Has Lost Its Magic for Me." Express.co.uk. August 12, 2017.

Accessed May 12, 2018. https://www.express.co.uk/ life-style/life/840196/Loneliness-summer-oldpeople-alone-Silver-Line-helpline.

loss increases, and these losses have many negative effects, including impeding future acquisition or maintenance of similar relationships. These losses, combined with other forms of social disengagement, lead to isolation and loneliness. Those in the oldest age group are most likely to report high rates of loneliness, which reflects an increased likelihood to experience such losses.

Similarly, isolation, either due to living alone or by self-seclusion, is another contributing factor to loneliness and depression in older adults. Loss of important relationships, whether it be with friends,

spouses, or other family members, often leads to social isolation.

Those without close relationships often become ignored and depressed; these feelings can manifest in negative self-perceptions, self-harm, and lack of motivation to change or care for themselves.

Although these symptoms may be triggered by age-related losses, as discussed earlier, older adults still benefit greatly from having friends of the same age. An essential aspect of the study of loneliness is the perceived internal locus of control over social interaction; for example, elderly people may enjoy time with their family less if

the visiting family is the one who dictates the schedule and activities.

Elderly people also report enjoying time with friends of the same age group more, since their interaction is more mutually decided.

For individuals living in nursing homes or in old-age cohorts, the continual loss of friends and neighbors over time can also affect an individualâ&#x20AC;&#x2122;s perception of loneliness, since those they know appear to be constantly dying.

Because of this, even individuals who report being social may also report experiencing increased feelings of loneliness as they age.

Despite the increased feelings

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of loneliness, sociability seems to immunize older adults against depression. Although sociable elders may feel lonely, they exhibit fewer depressive symptoms and often have an easier time of managing what symptoms they do have. Interestingly, depression is associated with mortality only when feelings of loneliness are present, so social adults usually wind up living longer than their isolated counterparts and maintaining better cognitive functions.

There are many consequences of depression and loneliness in older adults. These include poor quality of life, decline in cognition, and an increased risk for physical disorders. Isolation also has a large impact on mobility, which influences not only social but also

physical activity; decreases in light exercise or even walking have many negative impacts on health in elderly populations, and lead to increased risks for heart disease, stroke, diabetes, and non-suicidal mortality. Depression increases the overall perception of poor health as well as the utilization of healthcare services and costs, leading to more frequent and longer stays in hospitals. In a sort of chicken-andegg paradox, mental and physical health are closely related, as the impairment of one has a dramatic influence on the decline of the other. This is especially true with older adults, whose disabilities, like loss of mobility, can lead to poor mental health, and vice versa.

Despite the wide prevalence of depression and loneliness in

older adults, these issues are rarely addressed. Not only is depression underdiagnosed, many of the elderly suffering from depression are reluctant to seek help, both due to their inability to recognize the symptoms and due to the stigma surrounding the condition. At the moment, only 12% of the worldâ&#x20AC;&#x2122;s population is 60 and older, but by 2050, that number could surge to 29%. Due to the global increase in lifespan, humans are living longer, leading to a rise in the population of older adults. With the increase of older adults, it is important to target not just maintaining quality of physical health, but of mental health as well. As individuals grow older, they face numerous physical, psychological, and social changes that challenge their sense

Caldwell, Elizabeth. "Aging Well: Emerging Issues for Older Arkansans." UAMS Journal. October 28, 2014.

Accessed May 12, 2018. http://journal.uams.edu/article/ emerging-issues-for-older-arkansans/.

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of self and ability to live happily.

At the same time, old age can be an opportunity to discover things outside of the work and family obligations that dominate life from early adulthood to middle age. In the coming years, it will be important to find ways to support older generations through difficult times and give them opportunities to make new friends, find new hobbies, and discover new places.

This includes spreading awareness of elderly-onset depression and loneliness, and finding ways to better integrate older generations into the overall structure of society. Doing this will not only promote physical and mental health in the older generations of today but in those of the future as well.

"Mental Health of Older Adults." World Health Organization. December 12, 2017.

Accessed May 12, 2018. http://www.who.int/ mediacentre/factsheets/fs381/en/.

Parkar, Shubhangi R. "Elderly Mental Health: Needs." National Center for Biotechnology Information. 2015. Accessed May 12, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4381326/.

Singh, Archana, and Nishi Misra. "Loneliness, Depression and Sociability in Old Age." National Center for Biotechnology Information. 2009. Accessed May 12, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3016701/.

Skoog, Ingmar. (2011). Psychiatric Disorders in the Elderly. The Canadian Journal of Psychiatry, 56(7), pp.387-397. Accessed 12 May 2018. http://journals.sagepub.com/doi/pdf/10.1177/0 70674371105600702/.

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423 MINUS 4 STRADDLING THE LINE BETWEEN RESEARCH AND ACTIVISM

By SARAH NAKASONE ARIEL PAN (Editor)

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REFLECTION

In the beginning, no one could have guessed that I was going to end up in a job that both allowed and encouraged me to spit acronyms like “PrEP,” “AIDS,” and “YBMSM.” In fact, no one really expected me to get any job at all. I was 18 and unsteady in the way newborn animals are, limbs flailing at the introduction to the new, wide world. I still had the tendency to call my mother in tears after calculus exams and had yet to quite figure out the trick to making sure I didn't get locked out of my room while showering (resulting in multiple, awkward, towel-clad evenings waiting in the hallway of my dorm).

The interview with the National Opinion Research Center (NORC) was a courtesy move, a motion to my knowledge of people who were indispensable to the company more than anything. Marc Hernandez, my interviewer, certainly didn’t expect the girl who came stumbling into his office in an old debate suit and scuffed-up heels to amount to anything.

“I don't hire first or second years,” were his first words to me after pleasantries had been brushed aside.

Except he did. I was hired before I had taken my first final exam. Hired as a graduate research assistant on a multi-million dollar project to help the Administration for Children and Families. Hired because my background was in education and Department of Defense planning and that was just the next logical step.

So, in the beginning, I wasn’t supposed to be a research assistant on anything remotely related to HIV. And by the end of my time at NORC, I wasn’t supposed to be a research assistant at all.

– ·•· – No one seems surprised when I mention that I can remember the first time I heard about PrEP, a oncedaily pill to prevent HIV transmission. I’ve spent the better part of the last two years of my life chasing activists, organizers, health care professionals, and the occasional drag queen across three continents in an attempt to understand the people and communities that would alternately embrace and reject PrEP (sometimes in the same breath). People figure that my first introduction to the anti-HIV drug must have been kismet, must have had that same momentous air that falling in love for the first time does.

The truth isn’t quite as romantic. The only reason I remember hearing about PrEP is because I stuck the ads the New York Department of Public Health had just developed in an engineering report my senior year of high school. (My logic, I’m sure, was that a picture may be worth a thousand words, but it’s worth infinitely more if it gets you over the required page count.)

When I interviewed for a new position at NORC at the end of my first year of college, I wasn’t thinking about PrEP's potential to end the HIV pandemic or about the racial and gender disparities that affect access, or even about the stigma, still swirling, that

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One of these maps, featuring black gay and bisexual men in South Chicago.

Schneider, J. A., Zhou, A. N., & Laumann, E. O. “A New HIV Prevention Network Approach: Sociometric Peer Change Agent Selection.” Social Science & Medicine 125, (2015). 192–202. http:// doi.org/10.1016/j.socscimed.2013.12.034

dissuaded people from asking their doctors about it.

I was thinking, mostly, that color coding 712 articles for a literature review on TTA was the most boring thing I had done in my life, and I needed a change of pace.

So, when Stuart Michaels, a senior research scientist at NORC whose work focused on HIV in Chicago, signed the transfer paperwork to let me be the research assistant on the PrEP Chicago study, I wasn't thinking about the potential to do important work. I was just hoping it would be a little more interesting.

– ·•· – PrEP Chicago is the brainchild of John Schneider, the director of the Chicago Center for HIV Elimination. In brief, the project leverages social networks and opinion leader theory to accelerate drug dissemination to end the HIV epidemic.

Which is, I suppose, a good way of phrasing it for the NIH and not so much for your family around the Thanksgiving dinner table.

Think about it this way: imagine you could draw a map of your Facebook account – put yourself right in the center and then put little dots around you to represent your friends. Start drawing lines between everyone that knows each other. Then add more dots, those people you don't know but exist at the periphery of your world. Draw some more lines. Repeat.

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Eventually you're going to end up with some unholy mess that looks like a spiderweb from a very drunk arachnid.

It stands to reason that if you can create these networks, then maybe you can also figure out who are the best-connected people, the people who straddle two or more social groups. Intuitively, we know these friends. The ones who always know the gossip first; the ones who have friends in so many corners of campus/the office/the neighborhood that they might as well be the local news source.

Imagine if we could use that network. Imagine if we could target those well-connected people and teach them about HIV prevention, so that they could spread that news throughout their community.

That's exactly what I fell into with this project.

Six degrees of separation to end HIV in Chicago.

– ·•· – I can’t think of a boring moment the first year I worked on that study. I managed a database of over 700 people, alternately tracking, reminding, cajoling, and pestering the people in the study to get them to show up to appointments. I fielded questions about

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the study, complaints about the pizza we served, and hushed comments about where to get STI test results.

I researched whether it was possible to get a new birth certificate with almost no other identification papers (possible, feasible) and how to get approval from the Cook County Jail to get someone off house arrest for a study (impossible, unfeasible no matter who you are).

I became the voice on the other end of the phone for far too many people who needed a place to share good news and bad, their secrets and frustrations.

I know more about the new jobs and breakups and family drama of a small group of men on the South Side than I probably have any right to know. And I have more terms of endearment from these people (honey, sweetheart, dear, darling, cupcake) than a Hallmark store.

Maybe that was the problem. Maybe the busyness and the stories and the absurdity of my job served to mask the cracks I was already starting to feel.

The amount of times I watched someone write “homeless” when asked to give their address.

The study sessions where every single HIV test came back HIV positive.

The panicked denial of the first person who tests HIV positive when I'm in the room because “he doesn't act like that,” because “he's careful,” because “he's a good person” that runs on repeat in my head for days.

Maybe if I had been given a few more boring moments, I would have understood earlier how tiny cracks can bury themselves deep and then start to grow.

– ·•· – It’s October, over a year since I’ve been with the study, when the first major crack appears. It’s one of those moments when you almost knew then and certainly know now with the clarity of hindsight that this, this tiny bit of space and time, marks the beginning of the end.

Mondays – October or not – are team meetings which is usually the excuse for me to offer three statistics on recruiting for the study within the first two minutes and then daydream or read the news and just generally check out for the next 28. But this week, Hildie, my boss, shakes me out of my solitaire game with a simple command.

“Sarah, I need you to withdraw 1728 from the study.”

Everyone in the study has a four digit number, and this one isn’t familiar to me in the way that the people I would want to withdraw from the study are.

This one hasn’t harassed me or threatened violence or stolen tech equipment from us, so on the list of people I’d be comfortable booting out of the research project and never talking to again, he doesn’t even make the top twenty.

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But I am nothing if not determined to get back to my online solitaire game, so I fish out his record from our electronic system and start checking the boxes to withdraw him.

“What’s the rationale for withdrawal, Hildie?” I’m fully expecting that he moved to Atlanta or decided to pursue a career in Vegas or just got tired of me calling him about making appointments.

“His partner called us yesterday. He’s dead. He died.”

Everyone else makes gentle clucking sounds, and I spend the rest of the meeting staring at the ace of spades, unable to move beyond Hildie’s last statement.

– ·•· – Maybe I could have dealt with one death.

But it wasn’t just one death. It was one death and the way that Hildie said “sad” and not “avoidable.”

The way, in the unspoken silence after Hildie tells me to withdraw 1728, that we all sit there and think that no one we enroll in the study is over 35, and 20 or 30-somethings aren’t supposed to just up and die.

You don’t write “natural causes” for the cause of death when the birthdate is that recent.

It’s one death and the way that my best guess for the cause of that death is AIDS. Because even in 2017, I’m used to talking to guys in the study who have friends hospitalized with AIDS – friends who get diagnosed with the disease after it has already

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destroyed their immune system and put them in a hospital bed in the intensive care unit. Friends so deeply in denial about their status that they won’t take medications to treat it.

It’s one death and the way that we never talk about it again. I withdraw 1728 and the study goes on with just one fewer person and one more blockade to making our recruiting goal.

And then, by mid-December, it’s one death plus three more.

– ·•· – It’s December and so many cracks have appeared in this job that I don’t have a way to hold myself together anymore. I’ve curled up on the floor of my room after work and am crying as quietly as I can so as not to disturb my housemates.

Deaths two and three were a muted sort of sorrow.

We use Facebook to schedule most of the people for the study and in between copy-and-pasting the same scheduling reminder message to 47 people and trying to suss out a participant’s account with only a nickname to go on, two accounts break the pattern.

Their Facebook walls are covered in grief – messages of love and longing and wishes that things could have turned out just a little differently, just delayed themselves for a few months more because there wasn’t enough time to say goodbye, because no one was ready, because it wasn’t fair and why now, why you, why this.

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The accounts are fully public, the same way people leave pictures and stuffed animals at car crash sites, but it still feels like an invasion of privacy to email the research team saying that we’re going to have to withdraw another person.

Death four, though, is an open wound that I unknowingly tear into further. It’s a phone call when I’m expecting a participant in our study, and I unknowingly get his mother.

I ask for the participant, and I get a voice that is a mixture of grief and anger and exasperation that in the middle of her mourning, she has to talk to me.

“He’s dead.” And then the phone call ends.

And I know that the body can’t even be two weeks cold because I talked to this participant just a few days ago.

And I know that on Monday, when we discuss this case at our team meeting, it will just be another line on the agenda. Another cost of doing HIV research with black, gay men in Chicago. Another “that’s unfortunate” that we will never discuss again.

That night, before I write the email to inform my team that the 423 people with whom we began the study will be whittled down to 423 minus four, I write my resignation letter.

– ·•· – Here’s what I know.

At NORC, I worked with some amazing researchers; people who believed with all of their heart that

the work we were doing would lead to the end of the HIV epidemic. I believe them and I believe in them.

I also worked with people who, to deal with the enormity of the problem in front of us, held the pain at a distance. Who believed that to do good research, you had to reduce the problem to just the numbers, just the facts. A death was sad, but for us it was a data problem. We could not stop to view it as a social injustice – we could not take the time to mourn the larger social factors that still spelled death for so many in our research study.

I need to believe that they are wrong.

And I am not sure where to draw the line between being impartial and being furious. Between working within the system for systemic change and knowing that the research we do may be less important in that moment than the activism in the streets calling for healthcare reform, racial justice, and social change.

Between letting the pain you feel drive you and letting it eat away at you.

Some days, I wish I were still at NORC where we could all refuse to believe that a balance between these forces needs to be made, that we could just exist in one sphere alone. But all of us who want to do medicine, and especially those of us who want to do medical research, will have to figure out where our balance lies.

I’ll let you know as soon as I figure it out for myself.

spring 2018 || 41

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