From this point on, The Pulse plans to feature advertisements which will in some way relate to the readership of the journal. The Pulse will be accepting advertising requests from all individuals and parties who feel their ad will correlate with the health-related theme of the journal. The Pulse would also like to extend an invitation to all clubs on campus, as we will be accepting announcements. All appropriate announcements will be published. However, The Pulse reserves the right to refuse any such announcement. The following guidelines are meant to govern the acceptance and display of advertisements and announcements in The Pulse. —All advertising shall comply with the laws and regulations of the United States of America. —The Pulse staff shall have sole discretion for determining the advertising that will be accepted and displayed. —Acceptance of an advertisement will, under no circumstances, be considered an endorsement of the product(s) advertised. —The Pulse reserves the right to reject any advertising. —No advertisement or announcement will be published on the condition that it appears in conjunction with a particular article/commentary.
Journal of the Brandeis
Pre-Health Society Spring 2011 From the Editors
Dear Readers, We are pleased to share the Spring 2011 issue of The Pulse with you. The Pulse is a student-written, student-edited collection of works which directly relate to the greater realm of health and its tie to students in our Brandeis community. Our goal is to produce articles by students, for students in an open forum which allows us to voice our opinions and share our ideas. This issue marks The Pulse’s rebirth on campus. After a brief hiatus from Brandeis newsstands, our passion for the potential of this publication, as well as the wonderful effort seen by students eager to share their health experiences and ideas, has made it possible for The Pulse to come to fruition.” Throughout this issue, you will note diverse topics such as neurological research, a veterinary experience completed on a farm, and contemplation of what it means to be “pre-med.” We greatly look forward to the future of this publication, and as we do so, we aim to increase its scope and to feature health-related ads. To anyone who would like to submit a piece, we encourage you to do so! This can be done via e-mail (see below), and we would be more than happy to answer any question with regards to writing or editing as well. We also encourage anyone who would like to become more involved with The Pulse to attend Pre-Health meetings. Thank you to everyone who assisted in putting together this issue, we could not have done it if not for your labor and love. Enjoy! Sincerely, Sarah Azarchi and Kapri Kreps
the
Pulse Table of Contents
Mares, Ultrasounds, and Foley Catheters............................................... 2 My Research Quest to Cure Diabetes........ 3 A Different Approach to Scientific Research............................................... 5 Summer of Scalpels and Cannolis............ 6 Healing the Community........................... 8 Cultural Psychology and Socio-Cultural Perspective on Illness............................ 9 Summer in the Operating Room................ 12 Pulseline................................................. 14 A Summer Studying Brain Computer Interfaces.............................. 16 The New Health Care Reform................... 17 Folding of the RNA Recognition Motifs of TDP-43.............................................. 19 Quiz: What kind of doctor are you?.......... 20 Health Studies of International Adoption............................................... 22 Neural Modeling for the Treatment of Chronic Pain......................................... 23 A Curious Case of Doubt......................... 27 Special Thanks to our Editors.................. 28
Contributor Guidelines The Pulse invites students to contribute articles on all aspects of healthcare. The Pulse especially encourages students to voice their own personal experiences and interests. It is our belief that impassioned and personal fulfilling pieces provide a strong basis for general interest. For full author guidelines, contact: Kapri Kreps (kkreps@brandeis.edu) or Sarah Azarchi (saraz@brandeis.edu) Please note that the views expressed within the body of this publication are not the opinion of The Pulse, its editorial staff, or the Pre-Health Society.
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Mares, Ultrasounds, and Foley Catheters My Time at a Veterinary Facility
As I pulled up to the Young Veterinary Research Services in the small town of Turlock, CA, I imagined my intern experience would be some variation on the quaint James Herriot adventures I had been so fond of listening to growing up; for a moment, this was true. It was late in the evening when I arrived. After placing my bag in the room that would be my home that summer, Dave, the owner and head veterinarian, took me on a tour. It was the most picturesque ranch one could imagine: a large outdoor arena lit by stadium lights at night, a brand new round pen for breaking the young horses in, two state-of-the-art barns, plenty of grassy paddocks bordering a sparkling pond complete with paddle boats, and a grassy field enclosed by large wooden grandstands for Dave’s new favorite pastime—jousting. Just as we completed the tour and a sense of drowsy comfort blanketed me, everything changed. We entered the mare barn; Dave pointed to a stall and told me to grab Olive. Fortunately for me, Olive was a sweet-tempered older mare, who did not appear the least bit aggravated by my hands fumbling nervously over the buckle on her halter. I led Olive (although I sensed she knew what was going on more than I did) to the room where Dave was standing. He motioned for me to get her set up in the stalks. As he washed his hands and donned long rubber gloves, he
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explained to me that Olive had developed a uterine infection some time ago. This left her with the tendency for her uterus to become inflamed and filled with fluid. I was amazed by his ability to carry on this conversation while evacuating Olive of feces, and admittedly I was slightly embarrassed that it phased me as much as it did. I remember fearing that Dave would notice and think me unfit for the internship. Dave continued to explain that we needed to flush Olive before she ovulated so that we would have a better shot at successfully inseminating her. The procedure was relatively simple, after I had cleaned and dried her perineal area and vestibule, Dave inserted a foley catheter into the body of her uterus. I was instructed to use a syringe to fill the air cuff of the catheter with 30 mL of air. Through a Y junction, we carefully allowed the flushing fluid to flow into the catheter and would stop every so often to drain the uterus; we continued this process until the fluid, which was originally transparent, ceased to drain with any color or froth. Had I known that this was one of the simplest procedures I would assist with that summer, I probably would have had serious doubts about my ability as an intern. If I had known that that night and many nights in the future I would be asked to wake up every two hours to assist with and later perform supervised ultra-
sounds to check for ovulation, I probably would have packed up and left, but, as they say, ignorance is bliss. The first night of performing ultrasounds was not too bad—I had to be awake every two hours on the hour, but all I did was bring Olive to and from her stall and prepare her for her ultrasound. The second night was far more challenging; Olive had been getting carefully planned ultrasounds at strategic times throughout the day to check if she had ovulated, but each had showed that she had yet to start. Because Dave intended to use frozen sperm, it was crucial that there was no more than a two-hour window between Olive’s ovulation and the insemination procedure, which meant another long night of ultrasounds lay ahead. Dave performed the first two ultrasounds; I had watched carefully for the past few days, and was now able to tell the tone of the cervix with relative confidence and measure the size of the follicles, tasks that I had originally thought to be difficult. However, when Dave asked me to perform the third ultrasound, I realized that it was not quite as easy as it looked. I was tired and intimidated, and Olive certainly was not pleased with all the interruptions. She made it clear with some pawing that she was unhappy about the situation, and I tried to assure her I was less thrilled than she was. Dave had made it seem so easy in the way that he cupped the ultrasound head in his hand and moved to the perfect position from which to see the follicles. I had never thought about the complex maze of organs I would encounter inside of Olive; all I could think about was the damage
I might do. With guidance from Dave, I fumbled around and eventually found a workable view of the follicles, though Olive made it clear that it was taking me long enough. When Dave wrote down the measurements of the follicles and told me I could clean Olive up and take her back to her stall, I was beyond relieved. Two hours later, Dave performed the next ultrasound and found that Olive was finally ovulating, at which point the rest of the ranch woke up to help with the artificial insemination procedure. There were many more long nights at the ranch, and they were accompanied by more ultrasound procedures. Initially, I dreaded these nights, but after a while I came to find a strange sense of serenity in them. The sky was dark, the ranch was calm and quiet, and the mares for the most part were well behaved and sweet-natured. When I became more adept with the equipment, I could tell that the mares much preferred my small arm to Dave’s. There was an overwhelming sense of content and achievement in those nights. Though they were some of the longest and hardest I have experienced, I am grateful every day that I had the opportunity to discover my passion for medicine.
Christina “Chrissy” Fisher ’14 is a first year student from northern California who grew up spending time outside and with animals. She intends on double majoring in Neuroscience and Biology.
My Research Quest to Cure Diabetes
Every day, children, teenagers, and adults are diagnosed with Type I Diabetes, for which treatment involves the administration of daily insulin injections and glucose monitoring, as well as a lifetime of proper diet and exercise. Living with Type I Diabetes is challenging not only for the individual with the disease, but also for friends and family members who have to
constantly be vigilant and accessible to provide help in times of emergency. In addition to the sacrifice of foods high in sugar and carbohydrates, patients with diabetes have to be aware of bodily injuries and illnesses that can affect their blood sugar levels. On a personal note, I have been living with Type I Diabetes for five years, and would re-
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ing to insulin dependence, otherwise known as Type I Diabetes. I looked at the expression of DSCAML1 in non-obese diabetic (NOD) and wild-type mice of three, six, and eight weeks of age to determine if there was a difference in visualization with increasing age of the mouse, which could suggest a difference in functionality of this molecule. During my ten-week scientific research internship, I not only refined my microscope imaging and immunohistochemistry techniques, but I also had the chance to learn new laboratory procedures, such as dissection of mice thymuses. At the end of my ten weeks, and after many different staining optimization experiments, I did not notice any obvious difference in the expression profile of DSCAML1 by flow cytometry or by microscopy, but the work was not any less meaningful. In the end, I was glad to have expanded my knowledge of immunology techniques, and to have had the opportunity to work on an independent project in one of the world’s leading diabetes research institutions. As I said my final goodbyes at the conclusion of the internship, I realized that I not only wanted to do more to help fight this disease, but also pursue an MD/PhD so that I can conduct clinical laboratory research of my own in the future Manchanda Lab! All my thanks go to Dr. Serwold and the Serwold lab members for helping me to develop my passion, and giving me a wonderful chance to fight for a cause so dear to me.
ally love to see an end to this disease. When I was first diagnosed, I was shocked, scared, and grief-stricken. I was referred to a team of doctors and nurses at Joslin Diabetes Center who helped me to monitor the progress of the illness. Now in my third year of college, I am leading a healthier lifestyle and am also a mentor for high school diabetic patients. Scientific research in Type I Diabetes can lead to alternative medications and treatments for inhabitants of third-world countries that do not have access to all of the health benefits that are available in the United States. Through my summer internship with Joslin Diabetes Center in Boston, Massachusetts, I was able to further my understanding of Type I Diabetes by conducting research. As a student intern in Dr. Tom Serwold’s Immunology Laboratory, my summer project involved looking at the expression profile of DSCAML1 in thymic epithelial cells. DSCAML1 helps to maintain neural spacing in the mouse retina and prevents clumping. These cell surface molecules could possibly form T cell and epithelial cell connections, and help prevent the release of autoimmune T cells. Autoimmune T cells are responsible for destroying the pancreatic cells that release insulin lead-
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Vani Manchanda ’12 is a Biology major and Chemistry minor student from Natick, MA. On campus, she is a part of Dr. Pontrello’s research team, enjoys Indian classical dancing, and is actively involved in tutoring as a member of English Language Learning.
A Different Approach to Scientific Research I have performed experiments before: calculated standard deviations, tried to perfect abstracts, hoped and prayed for decent percent yields, reasoned probable sources of error, and counted an inestimable number of colonies. However, I had not conducted a human-only experiment until recently—one that goes beyond the swiftness of what science appears to be and probes further into the mind, emotions, and motivations of the “subject.” My HSSP experiential learning practicum class, taught by scholar Professor Laurie Nsiah-Jefferson, is conducting epidemiological research via one-on-one interviews and focus groups on college-educated African-American women to assess their experiences with racial, ethnic, gender, and social inequalities and how those factors affect their health outcomes. Before I began my participation in this class, I had no idea that this class would reinvigorate my passion for science and my thirst to help others. Our research team, a group comprised of undergraduate and Master’s students from Brandeis University, the Heller School, and Suffolk University, is a cohort of dedicated women and men from an assortment of cultures, beliefs, and upbringing. We were so different but very much connected by a common goal to aid in eliminating healthcare disparities. Together, we are working on achieving a product that cannot be measured on a scale or with an expensive and very sensitive probe. Our product looks to cater to the emotional and mental health of the women interviewed and those alike by means of a retreat center. Early into the study, when the weather decided to grace us with warm breezes hinting at spring, I spent about an hour and a half inside a “safe-space” with my first “subject” for whom confidentiality purposes I will name Jenna. A few demographic questions later, Jenna became
more comfortable with the interviewing process. I found her willing to open up about her experiences. I carefully posed questions to engage her in a dialogue about her life: her struggles, accomplishments, and hopes for her future.
Jenna expressed her thoughts on being part of a minority racial group on campus, how she manages college life and working two jobs, and what her perfect weekend would be like: no responsibilities, no work, no homework, just plenty of sleep and parties. I learned about the strong women in her life – her sister, mother, and grandmother – all of whom she considers anchors in her network of friends and family. When I asked her about what she would like to see at a retreat center tailored for AfricanAmerican women like her, she sought a safe, meditative place where she could do things like get a massage, do some yoga, talk and reflect with other women, learn ways to show herself love, and feel empowered. By the end of the interview, we had begun to trace a story about her life and what she would like to see her future become. We were interrupted only by time, as she headed off to work. I remember originally planning to keep our interview very professional. I would keep our
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interview super professional. It was almost as though I was trying to recreate a science lab setting within my dorm lounge. I quickly discovered, however, that this was a very different type of research. It required me to use my bedside manner by creating a space in which Jenna felt welcome, and not like a dispensable model organism from which I was trying to extract data. Contrasting my experience in the lab to this safe space where science existed in both environments, I was able to view an aspect of healthcare I had not experimented with before: direct human interaction. Collecting these ethnographies has pieced together many of my passions: applied scientific methods, real world issues, and the desire to learn about and contribute to the people in our society. My experience with collecting data from interviews and focus groups reminded me of my passions and the reason why I am pursuing science with such earnestness. Too often, we become entangled (and disgruntled, to say the least) on our path to realizing goals of helping people achieve good health, advancing scientific
technology and theory, discovering and improving ways to create a better world, etc. Priorities can sometimes shift for the worst when we become increasingly ‘goal-hungry.’ Recalling the reasons why we were first entranced by science is a necessary tool in succeeding at it. Allowing our passions to guide us may seem daring at times, especially if our plans for the future seem set in stone. I believe, however, that had I not taken the chance to participate in this practicum, I would not have been reminded of how important it is to maintain the integrity of my desire to use science to better the lives of others. Jessica Christian ’13 is a sophomore from Brooklyn, New York majoring in Biology, Heath: Science, Society and Policy and Women and Gender Studies. In her spare time, she is a photographer and enjoys rock climbing and kayaking.
Summer of Scalpels and Cannolis
If you could live out your perfect day, what would it be? Down to the smallest intricacies: Where would you go? Who would you meet? How would you feel? This summer, I experienced my perfect day. It was perfect because it was entirely imperfect, as nonsensical as this may seem. That day, I fell in love. I fell hopelessly in love with medicine, with people, and with the notion that in this life, we are the writers of our own futures. It began promptly at 6 am in a hospital, and concluded in a bakery… Donning a gown, size 6 surgical gloves, and a grin, my face was inches from the operating table of the woman receiving a c-section. Suddenly, the OB/GYN declared, “Feel the baby in the uterus, Kapri” and pushed my hand inside. I will remember the next moment for the rest of my
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life: the feeling of an unborn life kicking at your hand is simply indescribable. My second week into the Overlook Hospital Internship Program, and I was already exhilarated by medicine. From the operating room, to the hospital’s psychiatry ward, to private practices, my days proved immensely diverse. One day I could be scrubbed in on a six-hour craniotomy, and the next, meeting with a transgendered woman and discussing societal pressures. Two hours later, I journeyed to the cardiac ward where I would shadow a physical therapist. Throughout morning rounds, we assisted numerous patients who required constant physical treatment. However, in one room we met an elderly woman who lived alone and had been found by her landlord lying on the floor of her apartment. She weighed just 90 pounds and her body was
covered in severe ulcers and sores; just standing in her room was heart-wrenching. I could not fathom that I had gone from watching life enter the world to near-death within the course of an hour. Two floors’ difference made for two opposing worlds. Even now, the juxtaposing images of the woman and the newborn appear vibrantly in my mind. Prior to this occurrence, I viewed medicine as an exciting, healing, and inspiring profession. While these may comprise a vast portion of the field, my experience brought me to the realization that when it comes to the core of what medicine truly is, it’s dealing with lives on a highly personal level: people’s lives which are precious, imperfect, and fleeting.
everyone has some sort of story. On this Friday night, after ringing up the customer for his cannoli, I stood at the sink in the back kitchen, washing plates and contemplating my day yet again. I had gone from sterilizing my hands in a hospital sink to washing dirty dishes. I had witnessed life and near-death, all in the same day. It was then that I promised myself once and for all that no matter what, my life would not be one of quiet existence. Each day, the realization I came to that evening strengthens with fervor. When it comes down to it, it is not recognition or materialistic success that I desire; it is those brief yet lifechanging moments that make a person question their surroundings, think deeply about one’s life’s work and purpose, and prioritize what is most important. I want every day to be like this day, perfect in being imperfect. In life, there are days you begin with the assumption that the outcome will be an enthralling one. However, there are also those with no clear-cut finale, no definitive conclusion. The best, though, are the ones which take you completely by surprise, the days that start in a simple, concrete fashion, and bloom into something else entirely. This summer, the juxtaposing worlds of a hospital and a family-run, Italian bakery converged, and on a particular day, ignited the flame of my eternal, internal journey. The dichotic merger of scalpels and cannolis proved enlightening, inspiring, and electrifying, and reconfirmed my goals for the future and my outlook on life.
“Sir, I highly recommend you try our cannoli. I’m not just telling you this because I work here, it really is the best cannoli I’ve ever tasted; I’m talking even better than one from Little Italy. I’m a cannoli connoisseur, trust me.” It was now 10:30 pm. My scrubs had been replaced by the signature maroon collared shirt of Bovella’s Kapri Kreps ’13 hails from employees. Although my weekdays were spent Scotch Plains, New Jersey. She in Overlook Hospital, my nights and Sunday afis a Health: Science, Society ternoons were devoted to Bovella’s Italian Pastry and Policy major. On campus, Shoppe, a quaint, welcoming, mouth-watering she both works and chats for the bakery about ten minutes from my house. HowAdmissions Office, volunteers ever, dubbing my time at Bovella’s as a “summer with Waltham Group, and is the job” would be a derailing understatement. Over VP of Academic Affairs of Delta the course of the summer, everyone there became Phi Epsilon. She hopes to conduct health-related my second family. Working at the bakery proved fieldwork abroad next year in Chile. to me that I love people and hearing their stories;
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Healing the Community
Between May and July of 2009, I interned at a facility in Minneapolis, MN called the Greater Minneapolis Crisis Nursery (GMCN). This unique establishment houses up to eighteen children between the ages of birth and six years of age for 72 hours in times of crisis in order to prevent abuse and neglect. The overarching mission of the nursery is to work with parents and the community to strengthen families, alleviate crisis, and ultimately prevent child abuse and neglect. At this facility, my role as an intern was twofold: I worked in chlidren’s services and as a childcare provider. While in children’s services, I worked under the director’s guidance on two separate projects. The first consisted of rewriting the nursery’s medical policy manual, which had not been updated since 2002. This consisted of reading through the document to make sure the policies were still relevant and current, researching policies of more recent health developments such as the H1N1 epidemic, and coordinating my findings with my supervisor as well as the nursery’s Children’s Services Manager. The second project that I focused on in children’s services was the creation of a handbook that outlined the symptoms of common developmental disabilities and the ways in which care givers should interact with the children affected by these disorders at developmentally appropriate levels. This handbook was originally created in response to the fact that an overwhelming number of children who stay at the nursery show symptoms and signs of various develop
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mental and behavioral disabilities. Moreover, many of the childcare providers and volunteers are not trained to identify these disabilities, and because of this, few knew how to appropriately interact with these children. This handbook was created as a tool to assist in the creation of programs, to identify ways to appropriately reprimand a child with behavioral problems, and to help providers give the best emotional and physical support to children in need. The second aspect of my internship allowed me to work as a childcare provider and interact closely with the children at the nursery. This aspect of my internship enabled me to learn a lot about working as a part of a team, providing care for disadvantaged children, and working with others who represent a variety of cultural and socioeconomic backgrounds. One of the most rewarding parts of this internship was the fact that I got to design my position from scratch, be my own manager, and create my own projects. By finding an organization that interested me, but did not have a set internship program, I had a certain amount of freedom that I would not have had in many other programs or at many other sites, and is something I highly suggest to others looking for internship opportunities. Overall, this was a great learning experience for me, and if anyone would like more information about my experience or the Greater Minneapolis Crisis Nursery, you can contact me at astein@brandeis.edu.
Ariel Stein ’11 is a senior majoring in Health: Science, Society and Policy with a minor in Anthropology, who originates from Minneapolis, MN. On campus, she enjoys playing ultimate Frisbee, presiding over the Pre-Health Soci ety, and studying for the MCAT. Next year she hopes to be doing clinical work in Ethiopia.
Cultural Psychology and Socio-Cultural Perspective on Illness Medical professionals must develop a better comprehension of the immigrant cultural experience in order to provide adequate care for their patients. In the book The Spirit Catches You and You Fall Down, Anne Fadiman explicitly illuminates the poignant clash of cultural beliefs and Western medical practice through the encounter between the Hmong family and the American medical community. The works of cultural and social psychologists have expressed similar things. The interplay between psychology and socio-cultural perspectives greatly influences how persons of non-western background define illness and disease, which in turn affect their behavior in relation to their utilization of the American health system and how they convey information to their American doctors. Assessing and integrating cultural differences is essential to successful health prevention and treatment efforts of our nation’s increasingly diverse population. Fadiman tells the story of a Hmong family’s struggle with their daughter’s epilepsy. The emotional, agonizing story took flight with Lia’s first epileptic seizure, which her parents, Foua and Nao Kao Lee, perceived to be a qaug dab peg. Qaug dab peg means “the spirit catches you and you fall down” (20) and it is generally translated as epilepsy. The Lee family is well aware that the situation with their threemonth-old daughter is due to a malevolent illness; however, they regarded it with reverence. Their ambivalence towards their daughter’s illness was largely a result of their preconceived notion and misunderstanding of epilepsy. The Hmong family’s fixed understanding stems from their cultural perception of epilepsy. According to Fadiman, “Hmong epileptics often become shamans.” Fadiman unequivocally showed that a person of non-western background’s refusal to
yield to authority figures like doctors can be partly due to one’s lack of confidence in Western medicine and one’s cultural understanding of how the world works due to their cultural background. In the case of Foua and Nao Kao Lee, they “had their doubts about the efficacy of Western medical techniques” (Fadiman 23). One of the reasons Foua and Nao Kao did not comply with western medicine was due to the Hmong cultural notion of illness and diseases.
Disease etiology varies for both medical professionals and their non-western patients. The differences in disease etiology can be understood through two principal etiologies: personalistic and naturalistic. “A personalistic medical system is one in which disease is explained as due to the active, purposeful intervention of an agent, who may be human (a witch or sorcerer), nonhuman (a ghost, an ancestor, an evil spirit), or supernatural (a deity or other very powerful being)” (Foster 775). “Naturalistic etiology systems logically require a very different type of curer, a ‘doctor,’ a specialist in symptomatic treatment who knows the appropriate treatment. Theories of natural causation entail viruses,
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bacteria, infection, aging, accidents, aggression and stress as etiological agents of illness” (Landrine 268). In the perspective of personalistic etiology, a sick person is the victim of aggression or punishment directed specifically against him for reasons that concern him alone. The personalistic system is evident in African settings. Across diverse setting in the West African country of Ghana, the proportion of people who claim to be the target of personal enemies ranges from 60 percent to 95 percent. Moreover, roughly half of the Ghanaian participants who reported personal enemies also reported that the identities of these suspected enemies remain hidden (Adams 541).
Many non-western people understand illness as an interpersonal process. Members of a diverse ethnic-cultural minority groups within the United States may present an ostensibly vague, contradictory history of their symptoms and health-related behavior. This, in turn, can lead Western American health professionals to construe them as “poor historians” and “difficult patients” or as mentally ill somaticizers
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(Landrine 268). Likewise, members of many ethnic-cultural minority groups may view treatment not as curing but as healing; as long-term, informal, highly personal and cooperative process in which healer, victim, and family atone for the wrongdoings and improve the habits and relationships that are construed to be the cause of illness (Landrine 268). Cultural perspectives help to reveal how accounts of health and illness in mainstream health science are not a simple reflection of objective reality, but instead are grounded in particular constructions of reality that also require explanation. For the non-western patients, illness is culturally shaped in the sense of how they perceive experience and cope with diseases. Their understanding is based on their explanations of sickness, explanations specific to the social positions they occupy and systems of meaning they employ. Due to the intrapersonal of the western notion of illness, people of cultural background might provide vague information to a physician. Attributing illness to various forms of misconduct is a path of “social control that reinforces and maintains behavioral norms” (Landrine 269). Biomedicine as a result banished the illness experience as a legitimate object of clinical concern. The systematic inattention to illness is in part responsible for patient noncompliance, patient and family dissatisfaction with professional health care, and inadequate clinical care (Kleinman 3). To help facilitate negotiation, “clinicians need to be persistent in order to show patients that their ideas are of genuine interest and importance for clinical management. [1] What do you think has caused your problem? [2] Why do you think it started when it did? [3] What do you think your sickness does to you? How does it work? [4] How severe is your sickness? Will
it have a short or long course? [5] What kind of treatment do you think you should receive?” (Kleinman 147). This methodology enables a physician to understand the broader context of the problem from the patient’s perspective. Dr. Lori Arviso Alvord, a Navajo female surgeon, is a testament to this method of negotiation. She asserts that a “good doctor asks a lot of question and looks searchingly into the patient’s eys, which communicates caring and interest” (Lori 46). It is important to incorporate personal meaning because assessment and interventions will be valued and believed to the extent that they take cognizance of a person’s own experience of his or her situation (Maclachlan 380). To understand by incorporating personal meaning is a physician’s attempt to try and find a middle ground. Maclachlan in his paper “Cultivating Pluralism in Health Psychology,” addresses the ways to proliferate pluralism in medical setting. According to Maclachlan, the clinical challenge of pluralism is that although there are different approaches to health and illness exist, they are rarely integrated. To facilitate the integration, a physician should use the Problem Portrait Technique (PPT). The steps on how PPT works with the challenges that pluralism presents include: 1) Write down the patient’s description of his problem; 2) Create a causal web for the elicited beliefs and allow patient to rate the strength of each of the beliefs; 3) Talk about the treatment that would be appropriate to the ontology of the different potential causes (Maclachlan 374). PPT is a medium in which clinician and patient attempt a more comprehensive assessment of a problem that might otherwise be the case. Through the PPT process patients “original presenting problem may be refined, redefined or embellished” (379). It would help a clinician to understand the broader context of a problem from the patient’s perspective. Cultural psychology and socio-cultural perspective greatly influences the behavior of persons of non-west-
ern background and their relation to the utilization of American health system. In addition to socio-cultural perspective, cultural definition and limited vocabularies also influence nonwestern help-seeking options. By integrating the patient’s perspective, physicians can more effectively attend and treat their patients. ——— References
Adams, Glenn. Salter SP. “Health Psychology in African Setting: A Cultural-psychological Analysis.” Health Psychology. 1997;12(3):539-551. Berkanovic, Emil. Reeder G. Leo. “Ethnic, Economic, and Social Psychological Factors in the Source of Medical Care.” Social Problems 1973 21: 246-259. Barimah, Kofi. Teijlingen, Edwin. “The use of Traditional Medicine by Ghanaians in Canada.” BMC Complementary and Alternative Medicine. 2008, 8:30. Foster, M. “Disease Etiologies in Non-Western Medical Systems.” American Anthropologist 78.4 (1976): 773-782. Maclachlan, Malcolm. “Cultivating Pluralism in Health Psychology.” J Health Psychology. 2000 5: 373-382. Landrine H, Klonoff EA. “Culture and health-related schemas: a review and proposal for interdisciplinary integration.” Health Psychology. 1992;11(4):267-76. Kleinman, et al. “Culture, Illness, and Care: Clinical Lessons From Anthropologic and Cross-Cultural Research.” Focus 2006 4: 140-149. Thoits, P. Angel R. “The impact of culture on the cognitive structure of illness.” Cult Med Psychiatry. 1987;11(4):465-94.
Emmanuel Obasuyi ’12 is a Neuroscience and Biology double major from the Bronx, NY. On campus he works at the Jeffrey Agar Laboratory and he plays soccer with friends. Off campus he is a student intern at the Children’s Hospital Boston at Waltham and a mentor at the Hyde Square Task Force at Northeastern University.
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Summer in the Operating Room I began my summer experience in the operating room of Overlook Hospital in Summit, New Jersey completely overwhelmed and nervous, but at the same time incredibly inspired and exhilarated. I had absolutely no idea what to expect; my job description had not been made clear when I applied, and all I knew was that I would be working in the operating room. During my first two weeks at the hospital, one of the nurses gave me a binder that contained a basic introduction to working in the operating room. She took me on tours of the operating room core (a hallway where all of the supplies are kept), the central supply room (where the instruments are sterilized and organized), and the pathology lab (where specimens are studied and analyzed). I spent almost a full day in the central supply room simply memorizing the countless surgical instruments, lacking any faith that one day I might remember them. I was also able to observe several surgeries a day, during which I was in complete awe, even if I could not distinguish the pancreas from the stomach.
the surgery field’s sterility is maintained. Initially, one of the greatest challenges was stopping myself from touching my skin or anything else that was not sterile, which caused a great deal of frustration. I had to constantly re-scrub and put on a new gown and gloves. Eventually, I got the hang of it, and I think the nurses were pretty relieved that they didn’t have to repeatedly supply me with new gowns and gloves. The next step of this eternal learning process was setting up the instrument table. During most surgeries, there is a large table that has the instruments to be used by the physician and nurses that the physician and nurses throughout the surgery. There is also a “mayo” stand: a small stand placed in the surgery field so that the physicians and nurses can have easier access to certain instruments. The nurses showed me different ways of setting up the tables. Initially overwhelmed, I slowly realized that it was mostly a matter of preference, and it made no difference if I placed the water basin on the left, right, or center of the table. After two weeks of observing and learning the basics, I was ready to actually commence working in the operating rooms. I was still not exactly sure what this would entail, but I was excited nonetheless. Each day, I was assigned to an operating room, along with two other nurses and at least one physician. Sometimes medical students or residents helped with the surgeries or observed as well. All of the nurses and doctors with whom I worked were extremely supportive, informative and fun. For the first few weeks that I scrubbed in, one of the nurses would scrub in with me. The nurse showed me After I was finally familiar with the rudi- how to glove and gown the physicians after mentary aspects of the operating room, I began he or she scrubbed, plug in different tubes and to scrub into surgeries. Scrubbing is, in a way, wires, put drapes over the patient, pass instruthe most trivial part of the surgery, but also the ments, and load sutures onto needle holders. If most vital. Thoroughly washing one’s hands a nurse was in a good mood and had confidence and putting on gloves and a gown ensures that in me, she would allow me to stand where she
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would normally stand, across from the physician. If the physician said “hemostat,” I would quickly hand that type of clamp to him or her in the correct manner. Just like there is a correct way to pass someone a scissor, there is a correct way to pass someone a surgical instrument in order allow the surgeon to operate more efficiently and to reduce the chance of injury from sharp instruments. Initially, I probably passed instruments pretty slowly, but most physicians were patient with me. Some of the surgeries with which I assisted and observed were cystectomies (removal of the bladder), tonsillectomies (removal of the tonsils), laparoscopic cholocystectomies (removal of the gall bladder using a minimally invasive technique), hysteroscopies (inspection of the uterus), amputations, gastric bypasses, and a carotid endarterectomy (removal of plaque in the carotid artery). I also learned how to set up the room prior to the surgeries and clean and organize the room after the surgeries. Eventually, I was able to scrub in for the surgeries and assist physicians without the help of a nurse. Each day in the operating room was a new experience in which I was truly amazed and inspired by the surgeries, medical advances, technology, and the operating room staff. One of my most distinct and memorable moments from this past summer was when I was walking down the operating room core, the hallway outside of the twelve operating rooms. As I passed each room, I quickly glanced through the windows, catching just a glance of the different surgeries. I remember feeling completely amazed and inspired by the collaboration, dedication, and perseverance of the doctors, nurses, and other operating room staff. Each individual in the room was focused and concerned with the well-being and recovery of each patient. My main goal for the summer was to observe what it was like to work in a hospital while speaking with physicians about their experiences and their journeys towards becoming surgeons. During a surgery, I would sometimes
simply ask, “What exactly are you doing right now?” This would usually open up a conversation, beginning with an explanation of the operation and leading to different topics of discussion, such as college, medical school, biking, traveling and television shows. I learned about different aspects of a medical career, such as patient care, business, healthcare, and insurance companies. During a toe amputation, the physician suggested that I pursue podiatry. When I told him that I don’t really like feet, he responded, “Me either, that’s what I take them off!” While some conversations were entertaining and humorous, others were more serious. I would often ask, “If you had to do it all over again, would you?” The responses varied, and it was very interesting and insightful to hear different opinions. Reassuringly, everyone I spoke to said that they loved their job. Others said that considering the countless laborious and sleepless nights and weekends, as well as considering the direction they see medicine heading in the future, they might not pursue becoming a physician if they had to decide now. However, most physicians said that they would definitely, without a doubt, do it all over again. Ultimately, I know that I will have to decide for myself whether I want to go to medical school and become a doctor. I was incredibly fortunate to work in an environment where I was able to see not only the technical side of medicine but also the very personal and human side, and what both sides entail. I gained a small glimpse into one aspect of the life of doctors, and I will integrate everything I learned into my studies at Brandeis and beyond. Rachel Miller ’13 hails from Livingston, New Jersey. She is a Health: Science, Society and Policy major who has a passion for science, tennis, Brandeis Intramural sports, Boston, and Vogue.
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Pulseline January
February
March
Research at the Stanford University School of Medicine shows that skin cells can be genetically modified to turn directly into brain cells. This breakthrough could revolutionize the treatment of brain disorders like Parkinson’s disease, Alzheimer’s, and dementia.
Scientists at the Johns Hopkins Kimmel Cancer Center develop the first personalized blood tests for cancer patients, based on data obtained from whole-genome sequencing. Using this information, treatment can be tailored to each individual’s genetic makeup, and the likelihood of various diseases can be predicted.
Researchers at Bionic Vision Australia unveil an advanced retinal implant or “bionic eye” to restore sight for patients suffering from degenerative vision loss. The device electrically stimulates the retina using signals transmitted wirelessly from a camera mounted on a pair of glasses.
July
August
September
The U.S. government’s Defense Advanced Research Projects Agency (DARPA)has developed a thought-controlled prosthetic arm for amputees that has the same weight and almost the same dexterity as a natural arm. It works by decoding signals from the patient’s brain while sending back information from sensors embedded in the arm.
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A protein called TRIM5a that destroys HIV, the viral cause of AIDS, in rhesus monkeys has been discovered by researchers at Loyola University. Treatments based on a modified version of this protein may also be effective against HIV in humans.
In an international effort led by scientists at the University of California— San Diego, autism disorders have been linked to a misfolded protein, neuroligin-3. The misfolding is caused by a genetic mutation, and may disrupt communication between neurons.
2010: A Year of Medicine
By: Nick Iftimia ’13
April
May
June
Using a robotic arm, doctors in England successfully perform the world’s first remote heart surgery, marking a big step in telemedicine.
Scientists at the J. Craig Venter Institute announce the creation of Synthia, the first ever “synthetic” organism, made by taking a species of bacteria and replacing its genome with DNA artificially produced from chemicals, using a sequence stored on a computer.
The newest generation of CT scanners can now image entire organs in 3-D in real time. Using the scanners, doctors at UT Southwestern Medical Center can cut the diagnosis time of a stroke or heart attack to minutes.
October
November
December
Biotech company Organovo has developed a printer that can produce human tissues such as blood vessels and nerve cells, layer by layer, using technology based on traditional inkjet printers. This joins previous developments in the field, such as printable skin for burn victims and heart tissue in which the cells started to beat as they were printed.
Groundbreaking research at the Laboratory of Molecular Biology in Cambridge, UK has shown that antibodies can fight viruses even after they have already infected cells. This finding paves the way for next-generation antiviral drugs that may cure, among other things, the common cold.
Penn State University scientists discover that kinesin-2, a motor protein, is crucial to nerve cells’ ability to repair and regenerate themselves. This could help to treat brain injuries and neurodegenerative diseases.
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A Summer Studying Brain Computer Interfaces Last year, I spent a summer studying brain computer interfaces at the University of Washington, Department of Neurological Surgery. I was recommended to the internship by a family friend, Chief Medical Examiner of Seattle, Dr. Richard Harruff. After observing several autopsies (courtesy of his office) and expressing my interests in neuroscience, neurosurgery, and intentions of medical school, he recommended me to the University of Washington Department of Neurological Surgery. The internship was not advertised and the chair of the department simply relied on word of mouth as evidence of an applicant’s desire. The Ojemann Laboratory at UW is headed by Dr. Jeff Ojemann, an epilepsy neurosurgeon. Three people work alongside him in the lab: Tim Blakely, a recent UW computer science graduate, physics professor Larry Sorenson, and Felix Darvas, an assistant neuroscience research professor. Their work focused on paralysis.
terfaces (BCIs), are devices that record neural activity at specific brain regions and convert that information to drive limb prostheses. Most current BCIs seek to use the slow P300 brainwave that arises from active expectation of a specific stimuli. However, few current BCI proposals utilize only brain signals and fewer still focus on the promise of the faster high gamma brainwaves, that appear to represent movement, movement-thought, and movement-imagery. Using cutting-edge technology and the integrative approach of electroencephalography (EEG) and electrocorticography (ECoG), the Ojemann laboratory analyzes these high-gamma brainwaves in order to significantly improve the speed and efficacy of neuroprosthetics that may one day restore limb function to paralyzed patients. The scope of experiments was actually quite large, as everyone worked on various pet projects that seemed to tie together. Blakely conducted tests to determine how well a subject could learn, with biofeedback, to control a cursor on a computer screen with his or her brainwaves. He investigated this with ECoG, which involves an electrode array overlaid on the surface of the brain and supplies much more reliable data, as opposed to EEG, which applies electrodes to the scalp. Darvas led 24-channel EEG studies that looked at high-gamma brainwave responses in order to investigate mirror Paralysis is one of the most devastating ef- motor neuron activity. His study consisted of fects of central nervous system injuries and dis- showing subjects two short videos: one of hand orders. Almost 1.3 million people have suffered movement and another of trees waving in the from a form of spinal cord injury, producing wind. Together, Blakely and Darvas noted their complete loss of muscle control often beyond data to have similarity to other studies: EEG the point of treatment. With an estimated 5.6 data was not simply of a lower magnitude than million people having some degree of paralysis that of ECoG, but that there was high-frequency in the United States, the need for scientific re- filtering, or dampening, that could possibly be search grows. attributed to the dura mater. This is where SoNeuroprosthetics, or brain-computer in- renson came in – he set up an 81x81x4 analog
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circuit simulation of a cortex with simple resistors, using alligator clips to short out parts and mimic the action of electrodes directly on the surface of the brain. He had at first planned to use the simulation to study the change in voltage that electrodes made in order to perfect a brain mapping program, however, later realized that it could also be used to determine whether the dura truly was a frequency-dependent deamplifier. It was my task to record the placement of various alligator clips on the cortex simulation as well as the change in voltage coursing through the resistors. While some might have viewed the work as tedious (especially considering the vast number of spreadsheets generated), I greatly enjoyed that such a simple experiment
could have such implications for neurophysics. In addition to gathering data, I observed two neurosurgeries: a frontal tumor resection and a trans-occipital tumor resection. Overall, it was a summer extremely well spent. Jean-Paul Wiengand ’11 is a senior Neuroscience major and Religious Studies minor from Bothell, Washington. He is the UDR for the Program in Religious Studies and the General Manager of WBRS. He is interested in neurosurgery, sleep research, and the neuroscience of religion.
The New Health Care Reform Shedding Light on the Patient Protection and Affordable Care Act
that you already had before signing up Congress passed a landmark health care for coverage. Because health insurance reform bill on March 23, 2010 to expand health companies in the U.S. want to make profits, care insurance and delivery. At the time that the law was passed, there was so much false they avoid paying for people who need health care the most. Insurance companies information being circulated about the bill that can also charge higher premiums, which very few people could make an accurate judgment are the amount you pay each month to stay of the changes taking place. For example, 4 out insured, in order to chase away their most of 10 Americans thought they would have to costly clients. change the health care they had, but really, most people will not have to change anything. Many o New System: Health insurance companies will not be able to refuse to cover people of us will not notice any difference because the with pre-existing conditions or raise their law is aimed at those having the hardest time premiums. This policy has started for finding affordable health coverage, namely children in September 2010 and will start low-income individuals and small businesses. for adults in 2014. For example, Patrick, a To give a clearer picture, let me outline some of single dad who lost his job, has a fourteenthe main differences between the current health year old daughter with scoliosis. With the care system and the new one. new bill, insurance firms cannot deny his Pre-Existing Conditions daughter coverage or raise premiums as o Current System: Health insurance companies they did before, saving him from falling into are allowed to deny coverage to people with massive debt. pre-existing conditions, medical conditions
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Insurance Coverage Requirement
o Current System: 50.7 million Americans are uninsured. Uninsured people do not pay premiums, so their hospital bills get spread out to everyone else. In 2009, to cover uninsured people, the average insured American paid an extra $410 in annual premiums while families paid an extra $1100. In addition, only 4 out of 10 adults under the poverty line have Medicaid, the health coverage for low-income people, because of its current income restrictions, leaving many uninsured. o New System: Every American citizen will be required to have health coverage in 2014; otherwise they must pay a yearly fine starting at $95. With more healthy people purchasing health insurance, the premiums will drop for everyone. Medicaid will expand to cover more than 16 million people and federal subsidies will also be available for low-income individuals to buy private insurance.
Minimum Health Benefits Online Health Exchanges
and
o Current System: Some insurance plans known as “limited benefit” health plans are very cheap, but offer very little coverage, so if you have a serious illness, you will most likely be in debt. Many insurance companies also do not disclose all their payment information before signing up and often have annual and lifetime limits on each person’s medical expenses. These limits can cause debt during a serious illness. o New System: All private health care plans in 2014 must include some minimum benefits including emergency services, hospitalization, maternity and newborn care, mental health care, prescription drugs, rehabilitative service, preventive service, and oral and vision care. There will be no “health czar” in the government that will dictate every single person’s coverage; this
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is just a minimum guideline. In 2014, the government will set up a “health insurance exchange” online where customers will have all the payment information available to them and can compare plans among different insurance companies to select the plan that is best for them. Small businesses can also select these plans to provide health insurance for their workers. All health insurance companies must ban annual and lifetime limits on an individual’s medical costs by 2014.
Health Care Cost-Effectiveness
o Current System: The U.S. spends more than $2 trillion on health care every year, more than any other developed country, yet America still ranks relatively low on life expectancy and infant mortality. Medicare, the health coverage for senior citizens, costs much more than an average insurance plan in certain places, and much of the money often goes to administrative costs rather than health care. In addition, many doctors administer multiple tests to increase their paychecks rather than effectively treat the patient, resulting in wasteful medical spending. o New System: Medicare providers will undergo payment cuts as an incentive to become more efficient. The government will also distribute money from high-spending Medicare providers to low-spending providers. Pharmaceutical companies will provide 50% discounts on prescription drugs for Medicare customers after they have paid a certain amount on drugs each year to help close the “donut hole” in senior citizens’ prescription drug costs. New plans will cover preventive services such as immunizations, blood tests, and screenings. With greater prevention, less people will have to be treated, reducing medical costs. There will also be federal funding for comparative effectiveness research to evaluate different methods for treatment and help doctors
decide which method is best. Doctors that use this research to select the most effective tests and cut down on unnecessary tests will be given rewards. Hospitals treating Medicare patients that are readmitted for heart attacks, heart failure, and pneumonia will be paid less as punishment for their poor treatment. In addition, hospitals that receive federal grants for treating uninsured patients, especially in inner cities, will no longer need these grants because everyone will be required to be insured. It is quite clear that the current health care system is inadequate in providing coverage and is hurting the people that need health care coverage the most. The government has a plan to expand health insurance in order to make health care delivery more efficient and costeffective. While there will be sacrifices along
the way, such as higher taxes for the wealthiest 2% and less tax deductions on medical expenses for the middle class, the overall outcome will be lower premiums and better health care coverage in the U.S. For more information, read The New Health Care System: Everything You Need to Know by David Nather or visit www.healthcare.gov Aditya Sanyal ’13 is a sophomore from South Brunswick, New Jersey majoring in Health: Science, Society, and Policy. He is interested in biology and public health, and is currently president of Positive Foundations, a club that raises awareness about global poverty.
Folding of the RNA Recognition Motifs of TDP-43 Understanding the Potential Role of Protein Conformational Changes in ALS
Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease, is the most prevalent adult motor neurodegenerative disease. Pathological alteration of TAR DNA-binding protein-43 (TDP43), a protein involved in various RNA-mediated processes, is observed in most cases of
sporadic ALS. C-terminal fragments of TDP-43 are observed in patient tissues and aggregate in the cellular cytoplasm, suggesting that conformational changes involving the second RNA Recognition Motif (RRM) domain, together with the disordered C-terminus, play a role in aggregation and potentially toxicity in ALS. To understand the potential role of RNA in mitigating the protein conformation of the RRM domains of TDP-43 in ALS, isolated RRM1 and RRM2 fragments were designed. Human TDP-43 fragments expressed in E. coli with Nterminal Polyhistidine (His6)-tags were created to include the following regions of TDP-43: 1) RRM1 (residues 102-181) and 2) RRM2 (residues 190-261). Gene constructs were cloned in pUC57 and transformed to pET3d for expression followed by His-tag affinity purification. In addition, Glutathione S-transferase (GST)tagged wild-type full length TDP-43 expressed
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in pGEX and purified with glutathione resin beads showed that the majority of the fulllength protein was located in inclusion bodies. This suggests that His-tag purification under denaturing conditions may be more successful. Urea denaturation experiments probed by CD spectroscopy were performed on the monomeric S134N variant of SOD1, a protein implicated in familial ALS, to provide a framework for future comparison with the folding of the RRM domains of TDP-43. A potential mechanism for aggregation and toxicity in familial and sporadic ALS may involve the conformational changes that expose aggregation-prone regions in various ALS-linked proteins.
Amanda Winn ’13 is a sophomore from Roslyn Heights, New York majoring in Neuroscience, Biology and Anthropology. At Brandeis, she enjoys giving rats TLC and studying their behavior in the Katz lab, spreading autism awareness through Spectrum, and copying for The Justice.
The Pulse Quiz: What kind of doctor are you?
Your exercise regime involves: a. Sprinting from Gzang to the science center and then back, because you spend 15 hours a day in the Science Complex. b. Benching your science textbooks. c. Running around as a Snitch for your intramural Quidditch team.
Fire in your chem lab!!!! What do you do? a. Calmly seal your flasks and shut the fume hood, and evacuate in an orderly manner. b. Stop, drop, and roll your way out of the lab. Even if you’re not on fire yet, you learned in physics that the greater your momentum, the smaller the chance of you catching on fire. c. Get out your laptop and blast a remix of Sean Kingston’s “Fire Burning” and Cascada’s “Evacuate the Lab Floor.”
You have finished inoculating a culture but have some leftover E. coli in your tube. What do you do with it? a. Carefully dispose of it in the designated bacterial waste disposal bins. b. Pour it down the sink. A little bacteria never hurt anyone! c. Drink half of it, and pocket the rest for your “personal” experiments at home. On a typical Thursday night, you can be found: a. Watching Grey’s Anatomy while taking avid notes on the advanced procedures and surgeries performed, and then crossreferencing them with the notes you took from Physiology class to make sure they are correct. b. Studying for your chemistry test by watching Bill Nye the Science Guy. c. Watching Jersey Shore – you can’t wait to see Snooki get punched again! In your free time, you like to:
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a. Free time? What is that? b. Email your TA flirty messages in hopes that he/she will favorably grade your lab report. c. Sleep, eat, sleep, watch TV, sleep…and when you’re really bored, attend class. At parties, you: a. Go around to everyone explaining the acidbase neutralization reaction of tequila and lemons (alcohol OH- + acidic lemons H+ --> H2O). b. Perform dramatic readings of the Citric Acid Cycle. c. Carry around an Erlenmeyer flask that you stole from lab and occasionally take shots from it. During finals week, you: a. Move into the library, sleeping bag and all. You even chain yourself to the chair so you won’t be tempted to take a bathroom break. b. Divide up your time wisely: 18 hours sleeping, 4 hours eating, 1.5 hours napping, and 30 minutes studying. c. No classes?! PARTY!!!!!
If you got mostly As, you are a Doctor of Medicine. Congratulations! You are destined to spend the next decade of your life in school while everyone else is actually having a life, but in 35 years when you’re rich, it will be worth it! (As long as you don’t get sued.)
It’s the night before your Orgo midterm. You: a. Hide out in the dungeon of the library behind the obsolete books so that they won’t kick you out at closing time, and you can stay and study all night long. b. Are not entirely sure what organic chemistry is, but you figure if you draw a bunch of benzene rings and arrows, they’ll just assume you know what you’re doing. c. It’s optional, right? You can sleep in… “or go.”
Results
If you got mostly Bs, you are not a doctor, but you could play one on TV! Start preparing your monologue ASAP. We suggest watching every season of Scrubs and memorizing the complicatedsounding words.
If you got mostly Cs, you are Dr. Seuss. You are most fitted for a career writing literary masterpieces consisting only of three-letter words.
Sarah Azarchi ’13 is a sophomore from Morganville, NJ double majoring in Biology and Health: Science, Society and Policy. On campus, she assists in the Petsko-Ringe lab, is a STAR peer counselor, and is an enthusiastic Chatter in the Admissions Office.
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Health Studies of International Adoption Currently, I am an intern with the Department of Otolaryngology and Communication Enhancement at Children’s Hospital Boston (CHB), an internship that has been supported by World of Work (WOW) Fellowship and Undergraduate Research Grant (URP), both financially awarded by Brandeis. During the summer, I had the opportunity to shadow physicians and clinicians in consultations with patients, and even sit in on surgeries. Towards the end of the summer, I became introduced to a clinical research project within the department. The research project, preliminarily entitled “Hearing Loss in Children with a History of Intercountry Adoption,” is mainly conducted at Children’s Hospital Boston at Waltham. Children’s Hospital Boston at Waltham is an outpatient satellite of CHB. CHB is one of the largest pediatric medical centers in the United States, offering a complete range of health care services for children from birth through 21 years of age. In addition to being the primary pediatric teaching hospital of Harvard Medical School, CHB is also home to the world’s largest research enterprise based at a pediatric medical center. Their success is greatly due to their mission, which focuses on care, research, teaching, and the community. This research project is a retrospective chart review
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of patients at Children’s Hospital Boston. The goal is to find a medical and/or social correlation between internationally adopted children and hearing loss. Past records have shown that protocols that are standard in the U.S., such as screening newborns for hearing loss and vaccinations for diseases that are no longer common, are not standard in countries that have a high rate of international adoption. These children are therefore more at risk for hearing loss, and in fact the rate of hearing loss in these countries is more than twice that in the United States. Despite this risk, many children who have been adopted are not screened for hearing loss, and the loss is only identified much later, which has a negative impact on language and social development. The study will assess medical and developmental predictors of hearing loss in internationally adopted children and discover the impact on medical treatment and developmental outcomes. The study will look at the impact of the frequently delayed diagnosis on the children to determine potential policy implications. This research is a collaborative project among varying departments at Children’s Hospital Boston, as the team includes clinicians and
physicians from departments of Otolaryngology, the Deaf and Hard of Hearing Program in Otolaryngology, Psychiatry, and Developmental Medicine. Research members include leaders in their field, such as the Director of the Deaf and Hard of Hearing Program and a Director of Clinical Research. Thus, this overlap of different offices has the potential to impact many other departments within the Children’s Hospital network. The research project expects to generate two papers, with my name included as an author, culminating with a conference presentation. The research began at the end of July 2010 and is anticipated to be finished by the summer of 2011. From thorough analysis of data, we will be able to find predictors of hearing loss, responsiveness to treatments, and developmental outcomes in these children. Learning about these predictors should provide data in part to alert the pediatric community to the importance of screening or hearing loss in children who are
adopted internationally, so that they may receive appropriate interventions during the critical phase of language development. Working on this project allows me to be a significant part of a major research project at a leading institution in pediatrics. As I have a great desire to become a physician myself, particularly a pediatrician, this gives me a unique opportunity to gain clinical research experience in a pediatric setting. TThis research is certainly worthwhile, as the internship pays me with experience by contining work that is important to me, while also providing me with the opportunity to work alongside other great leaders in their fields.
Angela Chau ’12 is a junior hailing from Chelmsford, MA majoring in Biology and minoring in Health: Science, Society and Policy. In her free time, she enjoys singing, playing the piano, and photography.
Neural Modeling for the Treatment of Chronic Pain It is easy to see medicine as a self-contained system, to forget that it is constantly influenced by progress in other seemingly unrelated fields. In the past few decades, computers have revolutionized many aspects of science. Information technology is not only advancing at an accelerating pace, but also is becoming more pervasive and expanding in scope. The life sciences are becoming increasingly information-based. For instance, since the completion of the international Human Genome Project in 2003, we now have a complete digital replica of our genetic selves (ORNL). This past summer, I got to experience first-hand how computers are impacting medicine as I worked in the Neurosurgery Department at the Lahey Clinic in Burlington,
Massachusetts. Neurosurgery in particular stands to benefit greatly from computer science. The nervous system is so bewildering, dynamic, and complex that in certain respects it is only through massive computer simulations that we can really even begin to understand it – hence the field of computational neuroscience. The brain itself is one of the most complex structures that we know of, with over a thousand times more connections than there are stars in our galaxy (Eckert 35, NASA). The spinal cord, although significantly simpler and more primitive in terms of evolution, is still a veritable jungle of neurons, dendrites, axons, hormones, peptides, and neurotransmitters, all working together trans-
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According to the National Institutes of Health, “back pain is the second most common neurological ailment in the United States” (NIH). Spinal cord stimulation consists of implanting electrodes in the epidural space to stimulate the dorsal region of the cord; these are powered via extension wires by an electrical pulse generator located in the lower back, abdominal, or gluteal region. The generator is controlled with an external device to meet the needs of the patient (PMA). Since we lack adequate information, determining the best electrode configuration is still, to a large extent, a process of trial and error. Having a software model of the cord allows us to calculate the most effective configuration and thus maximize patient outcome and minimize pain. Spinal cord stimulation works by implanting electrodes This computational approach has into the spinal cord in order to alleviate chronic pain. several advantages. For one thing, it This treatment is limited by our knowledge of the cord’s is more practical; it is easier to test neural circuitry and the effect of different electrode the effects of electrodes virtually than configurations. by implanting them in real patients. It mitting and modulating electrochemical signals also bypasses the ethical issues that arise when across space and time. The large-scale anatomy real patients are involved. In addition, it is more and physiology of the cord are well-established, concrete; it allows us to run virtual experiments but it is only recently that we have begun to un- and test specific hypotheses mathematically, derstand its wiring and function at the micro- obtaining precise and rigorous results. We can scopic level – in other words, what “makes it control many variables that we would not be tick.” A complete genetic map of the mouse spi- able to otherwise, and we can study the system’s nal cord was published in 2008 (PR Newswire), behavior in real time down to the level of indibut to date there has not been an effort to map vidual cells, over a high resolution time scale. the actual circuitry of the spinal cord as a whole. The simulation gives predictions that can be The research project I am involved in at La- tested in reality, and experiments provide data hey aims to construct the first neural model of that can be incorporated back into the model. the human spinal cord. Such a model could then Thus, the whole process is self-correcting, drivbe implemented into software. The ultimate ing the development of an increasingly accurate goal is to use the model as a tool to guide the model. placement of spinal cord stimulators, which are As more experimental data becomes availcurrently used in alleviating chronic pain due to able, and as computing power continues to spinal cord injury or related problems. increase and visualization techniques such as
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This screenshot of our software shows a simple neural circuit. Using this program, we are able to model how the spinal cord is connected and functions at the cellular level, as well as how it is affected by electrical fields. This allows us to develop more effective and sophisticated treatment options for chronic pain based on spinal cord stimulation.
3D graphics improve, more accurate, detailed models will emerge. Storing a neural map as a digital database makes it easier to access, edit, navigate, and manage this vast quantity of information, a crucial factor when dealing with this level of complexity. This format also allows for rapid sharing of scientific data, enabling a true collaborative effort. The obvious disadvantage is that any model is bound to be imperfect, an abstract simplification of what it is meant to represent. Simulations are only approximations of reality. Yet the model does not have to be perfect; it only has to achieve its purpose. Traditionally, there are two approaches to neural modeling: singleneuron and gross circuitry. In the single-neuron approach, single neurons are simulated with molecular precision, down to the scale of indi-
vidual ions. This makes it highly realistic, but also very computationally intensive. In addition, for many applications, this level of detail may be redundant. At the other extreme is the gross circuitry approach, which simulates the behavior of large neural networks by treating neurons as simple input/output nodes. While this is much more efficient, it may overlook relevant “biological” qualities. Our software combines aspects of both approaches in order to create a model that is both efficient and biologically realistic. Our current model contains almost 70,000 neurons and roughly 10,000 connections between neuron groups, all extensively supported by the relevant literature. The model is a scaleddown version of a typical spinal cord segment, which has on the order of 3 million neurons. We
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were able to estimate the number of neurons in each of the ten regions, known as “laminae,” for all 31 spinal cord segments. Much of the data on which the model is based comes directly from experimental research, and the rest from reasonable, consistent hypotheses that serve to fill in the current gaps in our knowledge, at least until more discoveries are made. The model does not make any assumptions about the higher-level behavior of the circuit, but only incorporates salient features of the basic neuron types and connectivity. Any higher-level functions should “emerge” by themselves. In particular, we are focusing on so-called wide-dynamic range and nociceptive-specific cells, which are thought to play a key role in the processing and modulation of pain information. One way to study the circuit’s pain response is to watch for specific motor reflexes such as the flexor-crossed extensor reflex, in which pain stimuli to a muscle cause the ipsilateral limb to flex as a protective response and the contralateral limb to stretch for postural support. We are already studying the output of the circuit’s motor neurons via a “virtual EMG” and, in the future, we will construct a virtual muscle that reacts to these signals. We will also add appropriate excitatory and inhibitory connections to and from the brain. Eventually, we intend to include the chemical/pharmaceutical aspects as well. Such research has many potential long-term applications. Electrical stimulation of the cord could be modeled for the treatment of demyelinating and degenerative diseases of the nervous system, restoring sensation for patients suffering sensory loss due to spinal cord injury, and inducing motor reflexes for the treatment of paralysis. Hypothetically, future models of the spinal cord’s neural circuitry could be used in the development of advanced neuroprosthetics, in which a damaged part of the biological circuitry is replaced by a virtual counterpart that mimics its sensory and motor functions. As a proof-of-principle, a cognitive prosthesis is now in development that would replace damaged re-
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gions of the hippocampus (Berger). One thing is certain: research at the cutting edge of neuroand computer science holds great promise for improving current neurosurgical techniques. ——— References
“Allen Institute for Brain Science Unveils World’s First Genome-wide Spinal Cord Atlas.” PR Newswire. MultiVu, 17 July 2008. <http://multivu. prnewswire.com/mnr/alleninstitute/33951/>. Berger, Ph.D., Theodore W. “Home of Research on the Development of Biomimetic Models of Hippocampus to Serve as Neural Prostheses for Lost Cognitive and Memory Function.” Neural Prosthesis. University of Southern California, 2009. <http:// www.neural-prosthesis.com/>. Eckert, Kathryn L., Vincent A. Loffredo, and Kathleen O’Connor. “Adolescent Physiology.” Behavioral Approaches to Chronic Disease in Adolescence: A Guide to Integrative Care. By William T. O’Donohue and Lauren Woodward Tolle. New York: Springer, 2009. 35. “Galaxy.” World Book at NASA. National Aeronautics and Space Administration (NASA), 29 Nov. 2007. <http://www.nasa.gov/worldbook/galaxy_worldbook.html>. “Human Genome Project Information.” Oak Ridge National Laboratory (ORNL). 29 July 2010. <http://www.ornl.gov/sci/techresources/Human_ Genome/home.shtml>. “Low Back Pain Fact Sheet.” National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health (NIH), 14 June 2010. <http://www.ninds.nih.gov/disorders/backpain/ detail_backpain.htm>. “Spinal Cord Stimulation.” Procedures. Pain Management Associates (PMA), 2010. <http://www.painmanagementfw.com/procedures.aspx>.
Nick Iftimia ’13 is a sophomore majoring in Biology and Neuroscience. He was born in Romania and likes drawing, volunteering in the Waltham area, and writing for The Justice in his free time.
A Curious Case of Doubt
Let’s face it. For many students here at Brandeis, the aspiration of becoming a doctor is fervent and nothing short of glamorous. Personally, it has been a lifelong dream of mine to obtain an MD and, perhaps one day, work as a pediatrician, oncologist, or orthopedic surgeon. However, much to my surprise, I find myself beginning to question this dream. Why did I want to be a doctor in the first place? More importantly, I’ve asked myself: have I limited my horizons because of a decision I made when I was ten years old? A few months ago, I feared I had prematurely dismissed alternate career options without considering my various likes and interests. So here I am, nineteen years of age, a freshman at a fantastic university, on a pre-medical track, and yet questioning my career choice and future. Now, don’t get me wrong; I love the sciences. It’s not that I’m considering majoring in the liberal arts; I’m just not certain if I want to become an MD. To be completely honest, ever since coming to Brandeis this past fall, I’ve become enamored with laboratory research. I began working at the Paradis Neurobiology Laboratory about two weeks after moving in and I have loved every single moment spent there. At first, I was merely excited to get a paying job in the science field, but then as I started performing actual hands-on dissections and more (of which I’d love to tell you all about, but then I’d have to kill you for confidentiality purposes), I began to see myself turning research into a viable career option. At first, I ignored my PhD vs. MD qualms, because I feared that, if I acknowledged them, I would be putting my future plans in jeopardy. Questioning something I thought I had all figured out was unthinkable. But, one night as I sat studying for a chemistry exam, an epiphany struck me. I remembered that I am just nineteen years old, fresh into my first year of college. Many people my age don’t even have any ink-
ling as to what they want to do with their lives. College is the time to explore and discover new passions. Why should I confine myself to a career I actually know little about and, furthermore, might not even enjoy down the road? Being a doctor in real life is not like being a doctor in Scrubs or Grey’s Anatomy. Television shows like these like have romanticized the idea of medicine. Realistically, medical interns are worked to death, and many doctors are unhappy even when they’ve “made it.” So, I wonder: will becoming a medical doctor bring me happiness? Even Blaise Pascal, a renowned mathematician and scientist, once said, “Everyone, without exception, is searching for happiness.” The truth is, if we don’t enjoy our careers, then no prestige or glamorous job can save us from an inevitable sense of regret. So then, I’ve made a discovery when it comes to considering a future in medicine, which may apply to others in a similar predicament. First of all, I urge you not to forget that this world needs physicians. To be a doctor is to invest in the health and welfare of others; to save a life is one of the greatest gifts one human being can give to another. If you feel that the path of a physician is your calling, then embrace it with open arms. However, I strongly believe in fully pursuing your interests before resigning yourself to a career path. You might just be surprised to find out what tickles your fancy. I certainly was.
Deborah Rothbard ’14 from Livingston, NJ is seriously considering a Neuroscience/Biology major. During the week, she can be found harvesting hippocampus cells in Paradis Neurobiology Lab, curled up with an engaging book, sipping a mocha latte, or heading to the gym with her friends.
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Special Thanks to our Editors:
Jeetayu Biswas ’13 is a Neuroscience and Biology double major from Mansfield, MA. On campus he can be found studying cytochromes in the Pochapsky Lab, playing intramural sports with friends, or volunteering for the American Red Cross Disaster Action Team.
Angela S. Chau ’12 is from Chelmsford, MA, and is majoring in Biology and minoring in Health: Science, Society and Policy. In her free time, she enjoys singing, playing the piano, and photography.
Claire Fishman ’14 is from New York City, and is most likely majoring in Psychology and minoring in Environmental Studies. On campus, she can be found singing with the University Chorus and playing flute in the Wind Ensemble.
Max D. Goldstein ’13 is a double major in Biology and Health: Science, Society and Policy from Needham, MA. He enjoys sports, playing guitar, and working out. Additionally, he is involved in Relay for Life and Brandeis Orientation.
Editors-in-Chief
Sarah Azarchi ’13 is a double major in Biology and Health: Science, Society and Policy from Morganville, NJ. She works with a post-doctoral student in the Petsko-Ringe lab and is intrigued by science-based research; this summer, she is interning at NYU Langone Medical Center researching neuro-degenerative diseases. She is a Chatter and Tour Guide-in-training for the Admissions Office, a peer counselor for S.T.A.R. (Students Talking About Relationships), and will be a Roosevelt Fellow in the fall. After taking a glide year to work as a health care volunteer, she hopes to go on to medical school and become a physician.
Kapri Kreps ’13 hails from Scotch Plains, New Jersey. She is a Health: Science, Society and Policy major. She both works and chats for the Admissions Office, volunteers with Waltham Group, and is the VP of Academic Affairs of Delta Phi Epsilon. This year, she studied language barriers and their impact on health care at the Joseph Smith Health Clinic in Waltham. She hopes to conduct health-related fieldwork abroad next year in Chile, and to participate in the Peace Corps after college, with the goal of eventually earning an MD/MPH.
We are so grateful to everyone who contributed their time and hard work to make this issue possible. We thank Leah Finkelman, Layout Editor, for her impeccable work and Ariana Boltax, Cover Design, for her impressive graphic designing.
28 • The Pulse
From this point on, The Pulse plans to feature advertisements which will in some way relate to the readership of the journal. The Pulse will be accepting advertising requests from all individuals and parties who feel their ad will correlate with the health-related theme of the journal. The Pulse would also like to extend an invitation to all clubs on campus, as we will be accepting announcements. All appropriate announcements will be published. However, The Pulse reserves the right to refuse any such announcement. The following guidelines are meant to govern the acceptance and display of advertisements and announcements in The Pulse. —All advertising shall comply with the laws and regulations of the United States of America. —The Pulse staff shall have sole discretion for determining the advertising that will be accepted and displayed. —Acceptance of an advertisement will, under no circumstances, be considered an endorsement of the product(s) advertised. —The Pulse reserves the right to reject any advertising. —No advertisement or announcement will be published on the condition that it appears in conjunction with a particular article/commentary.