PULSE Autumn 2024

VOLUME 11, ISSUE 1. AUTUMN 2024

FROM THE EDITORS-IN-CHIEF Dear Readers, Welcome to 2025! We hope you all have had a splendid holiday season and are ready to get your gears turning this Winter Quarter. These past few months, our team –– full of returning and new faces –– was hard at work on our newest issue. Now, we’re proud to finally present to you the Autumn ‘24 Edition of PULSE magazine!

In this issue, our writers and editors tackle a wide breadth of topics in medical journalism. We first feature one of our very own UChicago Medicine faculty, Dr. Thomas Fisher. A few pieces chronicle the variety of roles doctors have played in shaping healthcare, ranging from accounts of a wartime physician who pioneered skin grafting in the early 20th century to “medical influencers” in our modern age. This issue also digs deep into social determinants of health, such as cultural relativity in healthcare and the importance of parenting on childrens’ behavioral development.

All that said, the sciences of medicine aren’t lost on us; PULSE wouldn’t be what it is without its penchant for scientific journalism. As many of us commence down the pre-medical journey at UChicago, we find a knack for reporting on novel treatments in pediatrics and psychiatry, as well as the neurological foundations of love.

Finally, we want to address the future of this magazine, as both of us are graduating in a few months. It is PULSE tradition for EICs to pass down the mantle when entering the new calendar year and begin the transition into a new board and era of the magazine. As such, this will be our last issue as Co-EICs. We first want to thank our board for supporting us in leading this initiative for over a year. Furthermore, we can’t thank enough all the writers, editors, and designers who have worked with us and carried out the bulk of journalistic work. Finally, we want to thank you, our reader, for enjoying the work that we put so much passion into, and encouraging us to keep improving this publication. Happy reading, and we wish every single one of you a strong start to the new year!

Sincerely, Fareen Dhuka and Ayman Lone Farewell.

Writers

Francisca Anazco MacKenzie Brogan Emnet Djibrila Amiti Goel Alexandra Hannett Franziska Kungys Mia Mahon Chioma Okegbuson Alexander von Kumberg Sienna Yamini Winni Zhao PULSE Spring 2024

Editors

Hunter Bershtein Fareen Dhuka Roxanna Fahid Sophia Falk Sophie Feng Chantel Johnson Michelle Mejia Shannon Meng Kim Mercado Alexis Truta

Editorial EIC Fareen Dhuka Ayman Lone

Layout EIC

MacKenzie Brogan

Senior Editors Sanaa Imami Michelle Lu

Production

MacKenzie Brogan Rina Iwata

Cover Design Kim Mercado

CONTENTS Faculty Spotlight: Dr. Thomas Fisher, Jr., MD, MPH ......................................... 4 Mending the Wounds of War: Sir Harold Gillies’ Facial Reconstruction Revolution ................................................................................................................ 6 Doctors in the Digital Age: The Rise of Medical Influencers ............................ 8 Reimagining U.S. Healthcare with a Culturally Competent Approach ......... 11 Growing Up Alone: The Hidden Consequences of Absent Working Parents and Child Development ....................................................................................... 14 From Diagnosis to Discovery: AI’s Impact on Pediatric Cancer Care .......... 16 UV Blood Irradiation: Hack or Hoax? ............................................................... 18 What’s on the Horizon for Alzheimer’s and Dementia? .................................. 20 The Chemistry of Love: How Neurotransmitters Shape Our Emotions ....... 22 Postural Orthostatic Tachycardia Syndrome in the Post-COVID Era .......... 24 From Chaos to Cure: The Evolution and Impact of COVID-19 Vaccines in Ending the Pandemic ........................................................................................... 25 References .............................................................................................................. 27 PULSE Applications ............................................................................................. 30 PMSA MCAT Resources ..................................................................................... 31

PULSE Table of Contents

Faculty Spotlight: Dr. Thomas Fisher, Jr., MD, MPH Written by: MacKenzie Brogan Edited by: Fareen Dhuka

Dr. Thomas Fisher is a board-certified emergency medicine physician and has served as an attending physician at the University of Chicago Medicine since 2011. His work with UChicago began as a medical student at the University of Chicago Pritzker School of Medicine from 1996 to 2001, where he also earned a Master of Health Care Policy and Management from the Harvard T.H. School of Public Health. He remained at UChicago Medicine for his emergency medicine residency from 2001 to 2004 where he was selected as Chief Resident.

Beyond clinical and administrative roles, Dr. Fisher has been actively involved in health policy.

He previously worked as a White House Fellow under the Obama administration from 2010 to 2011, advising on national healthcare policy initiatives. In addition, his healthcare entrepreneurial work earned him recognition as one of Crain’s Chicago Business 40 Under 40 in 2013, Chicago United’s Business Leader of Color in 2015, and the Aspen Institute’s Health Innovator Fellow in 2017. Also an accomplished writer, Dr. Fisher authored “The Emergency: A Year of Healing and Heartbreak in a Chicago ER,” which explores the intersections of medicine, policy, and social justice during the COVID-19 pandemic.

Recently, members of the PULSE Board had the opportunity to listen PULSE 4

to Dr. Fisher’s “Systems vs Humans in Healthcare” as part of the MacLean Center for Clinical Medical Ethics 43rd Annual Interdisciplinary Lecture Series. Dr. Fisher’s lecture centered on a powerful exploration of the role of caregivers within the systemic challenges in healthcare and the broader social factors affecting health outcomes. He began by emphasizing the critical role caregivers like nurses, doctors, and pharmacists play in society, noting that larger societal decisions are often large determining factors of their patients’ stories.

Listening to patients, he argued, provides crucial insights into the health systems and societal structures that shape their experiences.

To illustrate the deep-rooted challenges within emergency care, Dr. Fisher shared two patient stories which illustrated systemic failures: one of mental health issues and one of surgical subspecialty needs, highlighting the struggle to access scarce clinical resources hidden behind paywalls, if they exist at all. These stories underscored the broader issue of how healthcare systems can entrap both patients and caregivers, leading to moral injury and burnout among healthcare providers. While caregivers strive to deliver excellent care, they are often confronted with the distressing reality of systemic failures.

On an average day, ER caregivers are managing too many patients to dedicate sufficient time to fighting the system for one patient. Their shift often ends before they can see the patient through their admission or

treatment, and it’s easy to transfer the responsibility to the next shift. These caregivers are often too tired or burnt out to fight the system every day, for each patient. These systems conspire to leave patients trapped, and they trap caregivers alongside their patients.

Social determinant factors such as poverty and systemic inequities shape health outcomes beyond general healthcare access. Concentrated poverty and institutional injustices create a predictable cycle of disadvantage that perpetuates poor health outcomes. This cycle is deeply embedded in the history of segregation and discriminatory policies in Chicago, including redlining policies, NAFTA, and the War on Drugs which disproportionately affected and targeted minority communities.

Dr. Fisher urged attendees to reflect on their roles in addressing these systemic issues. Drawing on Dr. Martin Luther King, Jr.’s call to disobey unjust laws in Letter from a Birmingham Jail, he advocated for caregivers and citizens to oppose the unjust healthcare systems that work against the humans within them. Specifically, Dr. Fisher encouraged individuals to engage in moral leadership that challenges rather than conforms to unjust systems, the creation of new systems that prioritize shared humanity over profit, and the use of existing quality improvement tools to address inequities in healthcare delivery. He then left listeners with a reading of Audre Lorde’s poem “A Litany for Survival,” emphasizing the importance of speaking out against injustices and the fear that accompanies silence.

Following the lecture, Dr. Fisher was kind enough to answer some questions for us.

on a spectrum from the molecule to society, and all of the places that exist in between are important and good and valid.

Q: What made you decide to Q: What have you found most become a doctor and specialize in rewarding about being a doctor? emergency medicine?

What has been the most challenging?

A: I chose emergency medicine after starting medical school. This A: What I’ve found most rewarding was the only specialty that allowed is the flexibility to work on healthfor certain things that were import- care from different perspectives, as a ant to me. Before the ACA, emerclinician, with the government, and gency medicine was the only place in the nationwide health system. I’ve where everyone can be seen regard- also had the opportunity to work less of their ability to pay. I wanted in large systems and to work in and to pursue medicine out of desire to build small ones. All of this helps to serve the least among us without understand the things at play at the barriers. patient bedside and with the continuOther specialties have boundaries: al growth of knowledge. Throughout cardiologists only work with the my practice, medicine has evolved, heart, pediatricians only work with and I’ve evolved within medicine. kids, and some specialties might The biggest difficulty is patients being have to treat patients based on trapped in systems and being trapped their insurance or ability to pay. in them as well. This gets no less Emergency medicine also allows frequent despite growing knowledge, me to work with my hands and use skill, and experience. It’s something problem solving. When someone that everyone experiences, so there’s comes to you as a pulmonologist, some comfort in commiseration, but you already know that the problem there’s frustration there as well. is in the patient’s lungs as opposed to anxiety or something else. Emer- Q: What motivated you to pursue gency medicine allows for more an MPH, and how has that impactunfiltered problem solving. The ed your perspective/approach to emergency department is also an medicine? interface between the hospital and the community. It can be a laboA: In med school there are a lot ratory for understanding society. of career choices. I chose to purThe ER reflects what’s going on in sue community health more than America. research. I worked in a clinic in ​I went into medicine for a lot of the Woodlawn, and it broadened my same reasons: taking care of people, perspective on how healthcare fits touching society, using science both into society, from employment to the to understand and to cure in real environment. When I was in medical life with real people and pressing school, classes skewed towards the problems today. Medicine exists molecule, organ system. Public health

fits this into a larger society. I got a glimpse of this from working in the clinic, and public health school really gave me the tools to see and to understand this.

Q: If you could give any advice to an aspiring doctor, what would it be?

A: I have three. First, find a professional peer group that you can rely on for help, support, and mutual accountability, and go beyond just other doctors to find it.

Second, medical education teaches you to avoid risk. Buck that impulse.

Some risk is okay – sometimes you may have some weird opportunities, but you should pursue them and have faith in yourself.

Third, maintain balance while committing to excellence. Self care is important, but when you’re at work go hard. Be fully present at work, doing the best work that you can. Don’t let self care become an excuse to do lazy work. Experience life outside of work, and commit to building a three-dimensional life outside of work that you love and can love you back, because medicine won’t love you back.

Q: What was the most important or your favorite thing that you do/ have done outside of medicine?

A: I have a strong meditation game, and I can still run a seven-minute mile. Maintaining health is definitely important. But what’s most important is that I have a life full of love, full of family and friends who are like family. That’s what creates meaning in your life.

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Mending the Wounds of War: Sir Harold Gilies’ Facial Reconstruction Revolution Written by: Alexander von Kumberg Edited by: Fareen Dhuka and Michelle Lu Although an undesirable truth, it is evidently the case that wars fuel scientific innovation. Medicine is certainly not immune to this phenomenon; indeed, it may very well be the field which has developed most in times of conflict. In such dire circumstances, we often see the rise of brilliant physicians – such as Sir Harold Delf Gillies – who selflessly promoted human dignity regardless of the patient’s uniform and who fostered medical innovation. Gillies was born 1882, in Dunedin, New Zealand, a city defined by its Victorian and Edwardian architecture and large Scottish patrimony. As a schoolboy, Gillies attended Wanganui Collegiate School on the North Island. His first encounter with medicine may have been a childhood accident, in which he stumbled while sliding down his home’s banisters and was left with a stiff elbow. Nonetheless, he was a prestigious athlete – receiving golf blue thrice (1903, 1904, and 1905) as well as a rowing blue in 1904 (blue being a recognition of sporting excellence). A scholar and student of science, he left ‘the Britain of the Pacific’ for Gonville and Caius College, Cambridge to study medicine.

In 1910, Gillies continued his medical studies at St. Bartholomew’s Hospital – the primary teaching hospital of London - and began working as an PULSE 6

Ear Nose and Throat (ENT) doctor under the head of the newly created ENT Department, Douglas Harmer.

In August of 1914, Great Britain declared war on the German Empire following their refusal to remove troops from neutral Belgium. Aged 32, Gillies, in line with the trend amongst all young Britons, hurriedly joined the British Army, specifically the Royal Army Medical Corps. His first posting was in Boulogne, France and later Belgium where he worked with Franco-American dentist Auguste Charles Valadier. Valadier developed jaw repair systems, and it is clear that Gillies’ experience as an ENT, paired with his time with Valadier, prompted Gillies’

experiments with facial reconstruction and nascent skin grafts.

Skin grafting is a transplantation surgery in which surgeons use healthy skin tissue to promote healing and treat extensive trauma, burns, and some cancers on the skin. Modern skin grafts were developed in the mid to late 19th century by Swiss surgeon Jacques-Louis Reverdin who introduced the “pinch graft,” also called the “Reverdin graft,” but the technique was not prevalent and remained in its early forms until the 20th century. A contemporary pioneer of the technique was the oral surgeon, Hippolyte Morestin, whom Gillies enthusias-

tically shadowed in the early war period. In one particularly inspiring instance, Morestin used jaw skin to cover the excision wound of a facial tumor. It was this experience which invigorated Gillies’ zeal to pioneer facial injury reconstruction.

The very nature of the conflict, namely raining shrapnel, machine gun fire, soldiers peering over parapets and trench warfare, meant that wounded with facial injuries were abundant. Shrapnel in particular resulted in jagged wounds and often carried soil with it when penetrating the body, promoting infection and increasing mortality. Surviving often meant lifelong social and functional disabilities. Gillies was reacting to this historical circumstance with his medical experience as an ENT. A noteworthy example of Gillies’ innovation is his treatment of Willie Vicarage – a sailor who was wounded at the pivotal Battle of Jutland in 1916. A fire had caused the development of a scar tissue mask which prevented him from closing his mouth or eyes. The trouble with Willie’s case was that

it demanded a larger than normal skin Budd, an infantryman wounded by a graft, and thus necessitated skin from shell blast, recounts Gillies’ treatment Willie’s chest. The living skin tissue plan for a nose reconstruction; “It curled up at the edges under tension, was Gillies’ intention to take a strip which prompted Gillies and his team of skin from my forehead and after to sew it into a tube-like shape. This lifting it to twist it downwards over allowed for controlling the curling and the site of my nose to be, and at the decreasing the risk of infection. This same time to get some cartilage from tubed skin pedicle was then attached me elsewhere to from the bridge of to the face, and cut open, allowing for my nose.” Between 1916 and 1925, peeling and extension of the skin over Gillies performed over 11,000 surgerthe wide site of injury. Willie’s surgery ies on over 5,000 military personnel. is an example of the ingenious and nov- For his wartime endeavors, he was el operations that Gillies created and knighted. His interwar life was depromulgated. fined by extensive lecturing, teaching, In 1916, Gillies convinced Chief and the promotion of novel surgical Surgeon William Arbuthnot-Lane to techniques. With the outbreak of the establish a facial injury ward at Alder- Second World War, Gillies mobilized shot, the Cambridge Military Hospital. once again, organizing plastic surgery While the ward was extremely sucunits in Britain and training other cessful, the war brought with it endsurgeons. He suffered from sudden less supplies of patients. New hospital cerebral thrombosis while performing wings around France and England had surgery and died shortly afterwards in to be devoted to facial repairs. In 1917, 1960. he established the Queen’s Hospital at Certainly, Gillies’ novel methods Frognal House, which became his base of posttraumatic reconstruction were of operations. These developments were only made possible by his wartime exoverseen by Gillies while he simultaperiences. Indeed, for most of human neously developed many innovative history, surviving major war-related plastic surgery techniques. Captain facial injuries was a rarity – if sustained and survived, one was found to be immensely fortunate with the concern for reconstruction virtually nonexistent. Yet, medical innovations developed during the Great War by surgeons like Gillies meant that the wounded could survive the unsurvivable, and better, present patients with a chance to resume living with a degree of normalcy.

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Doctors in the Digital Age: The Rise of Medical Influencers Written by: Alexandra Hannett Edited by: Shannon Meng

In this day and age, countless professionals have taken to TikTok, Instagram, Youtube, and other social media platforms to advertise their companies, share their knowledge, and provide insight to what their daily lives are like. Doctors and healthcare professionals are no exception.

Despite the demanding nature of their work, these professionals continue to embrace their role as trusted advisors, prepared to engage with concerned online followers after long hospital shifts. From educating the public on essential health topics, to connecting with a network of fellow professionals, more and more healthcare providers are using the internet to extend their impact. For some, online engagement has become a secondary career, producing content at a volume comparable to a full-time job alongside their clinical commitments.

This article explores the benefits and potential pitfalls of broadcasting a career in medicine on the internet, PULSE 8

focusing on popular medical influencers like Doctor Mike and Dr. Miami as primary examples. The goal is to highlight the immense opportunities for healthcare professionals to educate, inspire, and connect with others through a digital presence while also addressing the professional, legal, and ethical challenges that come with it.

Ultimately, this complex endeavor requires careful consideration of both the pros and cons, as navigating a digital platform in medicine is a path filled with rewarding possibilities and significant responsibilities.

Two practicing doctors serve as examples of medical influencers who have amassed significant followings, yet remain distinct in the tones and intentions of their content. Firstly, Dr. Mikhail Varshavski, D.O., commonly known as “Doctor Mike,” is a board certified family medicine physician who began creating medical content on YouTube in April 2017. Since then, he has accumulated over 12 million

subscribers on YouTube and expanded his platform to all forms of social media, including TikTok, Instagram, and X. Doctor Mike’s content heavily consists of reaction videos where, as a credible physician, he comments on medical drama television shows, trending medical topics, and healthcare current events. Additionally, he produces informative content on topics that are widely relatable to the younger generation through podcasts with other medical professionals and videos such as “Why We’ve Become the ANXIOUS Generation & How we can fix it” and “Worst Health Mistakes Young People Make.” Known for his objective stance, Doctor Mike protects the privacy of his patients by not discussing them, and focuses on educating viewers through thoughtful, sit-down videos.

An interesting contrast to Doctor Mike’s content is that of Dr. Michael Salzhauer, MD, more commonly known as “Dr. Miami,” a plastic surgeon based in Bay Harbor Islands, FL. Dr. Miami first built his following by livestreaming plastic surgeries he was performing on Snapchat, providing viewers with an up-close and unfiltered look at his procedures. While he has been engaged with social media for some time, he has increased his following through his candid, relatable, and humorous approach to medical content creation. He offers a very transparent view into his lifestyle, even starring in a one-sea-

son reality show titled Dr. Miami, immediate environments. Additionalwhich featured many patients as they ly, hearing stories about the personal underwent consultations and surger- challenges of burnout, struggles with ies. Today, his primary audience is on work-life balance, and mental health TikTok, where he posts short, often issues can foster a sense of solidarity. playful and satirical videos, particiMany healthcare influencers share pating in trends, lip-syncing to pop- these stories openly, helping others in ular audio clips, and even poking fun the profession feel less isolated in their at his patients rather than focusing on struggles. For example, Doctor Mike’s original educational content. His con- videos often touch on challenges in tent is intentionally unserious, blend- medicine, such as dealing with anxiety, ing elements of humor and satire that the pressures of medical school, or his make his account feel more like a own experience in navigating his cacomedy channel than a medical one. reer. Similarly, various medical vloggers However, he frequently continues to detail their application processes, resipost content of surgical work he has dency journeys, or the highs and lows done on patients with their consent, of their daily lives in healthcare. This perhaps to market his capabilities to transparency provides not only guidpotential clients interested in plastic ance for those navigating similar paths, surgery. Overall, Dr. Miami’s tone is lighthearted and occasionally facetious or juvenile, presenting a stark contrast to the more traditional and educational approach of Doctor Mike.

Nonetheless, the ability to connect and relate to others online is an invaluable benefit for medical professionals, aspiring practitioners, and anyone interested in learning more about healthcare. One of the most significant advantages of engaging on social media as a healthcare professional is the chance to foster a vast, supportive, and global medical community. By sharing their experiences, doctors and other medical professionals help build a space where but also a sense of camaraderie across those in similar fields can feel unthe online healthcare community. derstood and validated. For young Moreover, even for those not workprofessionals just starting out, this ing in or aspiring to a career in mednetwork provides access to seasoned icine, following medical influencers experts who share genuine advice offers an engaging way to learn about and insights developed over years of health topics and gain insight into the practice. Such connections bridge the lives of healthcare professionals. At the knowledge gap between generations, very least, content from medical influoffering mentorship and support that encers provides entertainment and a may be otherwise inaccessible in their unique perspective for viewers. While

it’s unlikely that Dr. Miami’s humorous and satirical approach inspires viewers to pursue a career in plastic surgery, his engaging persona attracts audiences who enjoy his personality and style. This blend of entertainment and education, common among medical influencers, helps make medical information more relatable and digestible. Social media, after all, can serve as a powerful educational tool, allowing the public to access simplified explanations of complex medical concepts that might otherwise feel overwhelming. Doctor Mike, for instance, frequently uses his platform to break down complicated health issues and offer practical advice, making important health information accessible to a wide audience. Influencers like Doctor Mike also play a crucial role in debunking health myths, delivering accurate information, and positively impacting public health behaviors. In a digital world where medical misinformation is prevalent, these credible voices build trust with viewers and provide a reliable source of factual health information.

However, there are significant concerns that arise when professional medical care intersects with something as public as social media. One of the primary issues is the potential for ethical and legal breaches, especially regarding patient privacy laws like HIPAA, a federal law that protects patients’ private health information from being shared without their consent. When doctors share details about their work online– even with the best intentions–there is a risk revealing sensitive information or inadvertently violating privacy regulations, which could have serious legal consequences. For instance, Dr. Miami grew his platform by live-streamPULSE 9

ing plastic surgeries on Snapchat, offering an unfiltered view of procedures. Although these streams were shared with patient consent, they illustrate how easily privacy boundaries can blur on social media. In other cases, being on social media may result in a doctor inadvertently revealing identifiable patient information through photos, descriptions, or even casual anecdotes, risking a breach of confidentiality. Beyond legal ramifications, such as fines or lawsuits, violations of privacy policies can severely damage a healthcare provider’s professional reputation. Doctors on social media often face the difficult task of balancing transparency about their work with the obligation to protect patient confidentiality.

Beyond privacy, the logistics and ethics of providing medical advice over social media are complicated. It is difficult to tread the fine line between general education and personalized medical advice, which raises questions about doctor-patient boundaries. While Dr. Mike uses his platform to debunk health myths and provide practical tips, he must carefully avoid offering personalized

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advice to viewers he has never met. An online presence raises many questions for medical influencers: Is it ethical for a doctor to provide guidance to an unknown online audience? What are the potential consequences if such advice is misinterpreted or misapplied?

Unfortunately, these questions lack clear answers, as no formal governing body currently oversees the conduct of healthcare professionals who share content about their work online. This absence of regulatory guidance leaves healthcare influencers largely responsible for determining appropriate boundaries, adding another layer of complexity to the ethical standards of medical content on social media.

Unfortunately, as influencers, medical influencers may feel pressure to create content that maximizes likes and engagement, which could lead to prioritizing entertainment over education.

In striving for popularity, there is a risk of oversimplifying complex issues or posting content that appeals to viewers but lacks educational substance, like in the case of Dr. Miami, when he often participates in TikTok trends that amass millions of likes. Moreover, putting one’s opinions or personal content

on such a public platform can be a double-edged sword. While it may boost a doctor’s visibility or even attract more patients, it also opens the door to scrutiny that can harm their reputation or even discredit their professionalism.

In the end, the presence of healthcare professionals on social media offers both significant opportunities and notable challenges. On one hand, medical influencers have created a valuable bridge between the public and the world of healthcare, educating and inspiring while fostering a sense of community and transparency.

Doctor Mike, for instance, uses his platform to simplify complex health topics, helping to combat misinformation and build trust with his audience. Dr. Miami, with his humorous, unfiltered, and candid approach, provides a different kind of insight into the realities of plastic surgery, making the field more relatable to the general public. However, as these professionals navigate the demands of social media, they must also contend with ethical and legal risks that accompany this exposure. The line between education and entertainment can blur, and without clear regulatory guidance, healthcare influencers face difficult questions about the boundaries of their role online. Ultimately, as medical influencers continue to grow in popularity, they must tread carefully in balancing the benefits of public engagement with the responsibilities and standards expected within the healthcare field.

Reimagining U.S. Healthcare with a Culturally Competent Approach Written by: Francisca Anazco Edited by: Michelle Mejia

For over two millennia, newly initiated physicians have declared, “I will do no harm or injustice,” as one of the professional ethical standards outlined by the Hippocratic Oath [1].

In light of today’s rapidly diversifying environment, obstacles have emerged in providing equal, quality healthcare across cultures and languages.

According to the U.S. Census Bureau, Hispanic individuals comprised 19% of the U.S. population in 2019, with nearly 70% of them—about 42 million people—speaking Spanish at home [2]. However, despite being the largest ethnic minority in the nation, it has become well recognized that they receive less and lower-quality care than the white majority of Americans.

Multiple studies in the Journal of General Internal Medicine attest that language differences explain ethnic disparities in healthcare. For example, Cheng et al. utilized evidence-based healthcare services to discern discrepancies between white Americans and Hispanic/Latinos. Using this analytic approach, the study observed that white Americans are generally more likely to receive all recommended services for prevention and chronic disease management compared to Latinos. However, when grouping individuals by language—meaning white Americans and English-speak-

ing Latinos compared to Spanish-speaking Latinos, English-speaking Latinos were not significantly less likely to receive these services. It turns out that those with limited English proficiency were severely disadvantaged compared to their English-speaking counterparts [3]. At first glance, the apparent ethnic disparity seems to conceal a deeper language disparity among various communities in the U.S. Further analyses, however, revealed that Spanish-speaking patients who were also comfortable conversing in English received fewer services, even when they were able to communicate with their doctors in English [3]. Ongoing research in this area has begun to reveal a complex tangle of explanatory factors that result in unfair and adverse health outcomes—a reality for millions that the U.S. healthcare system has disavowed, despite physician’s ethical contract to the

Hippocratic Oath.

The discourse surrounding healthcare disparities among ethnic groups, primarily contrasting white Americans with immigrant, non-English speaking communities, gives room for an ethnocentric rhetoric that raises the question: should the healthcare system adapt to accommodate the growing non-English speaking population, or should these individuals learn English to access existing resources?

The U.S. was built on the tenets of equality, justice, and unity. Modern demographic changes don’t negate the fact that immigrants— voluntary or forced—built the foundations of this nation, transforming it into a cultural melting pot. There are many ethical, legal, and practical reasons to serve the PULSE 11

health needs of all groups, regardless Experts call for a multidimensional of the culture or language with which approach to deliver equitable care to they associate. minority communities. “With all the However, the reality is that while complexity of this issue, it’s not enough immigrants are expected to learn to tackle this just from the educational English, there is no well-coordinatangle, it’s not enough just to do policy, ed system to accomplish this goal it’s not enough to do research alone,” [4]. While assimilation to American says Pilar Ortega, MD, MGM, vice culture is expected, immigrant com- president of diversity, equity, and inclumunities are marginalized and segre- sion for the Accreditation Council for gated. The overall cultural separation Graduate Medical Education. in communes allows immigrants to A promising beginning to address continue speaking their native lanthis reality calls for initiatives to emguage, not creating a real necessity to power and grow the Hispanic represpeak English [4]. That is, until they sentation in the healthcare workforce. fall ill.

While Hispanics make up 20% of the Thus, while Title VI of the Civil U.S. population, only 6% of physicians Rights Act of 1964 mandates that identify as Hispanic, and only 2% of healthcare systems receiving federal non-Hispanic physicians are Spanassistance provide equal, language-ap- ish-speaking [6]. This stands in stark propriate care, disparities continue to contrast to the resounding 66% of persist [5]. So what’s the solution? non-Hispanic white physicians in the U.S. [7].

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A policy brief written for the UCLA Latino Policy and Politics Initiative in 2018 recommended “increasing medical school admissions for Latino students, recruiting Latino out-of-state physicians, expanding opportunities for Latino international medical graduates, and creating a state-funded, Spanish-language residency pilot program” [6]. Emphasizing the need for Spanish language skills, representation, and educational opportunities would improve discordance in patient-physician interactions and enhance the potential for culturally competent care.

A sizable body of research has shown that patient-physician interactions and practice patterns are influenced by the race, ethnicity, gender, and socioeconomic status of both parties [7]. Studies have shown that Hispanics are less likely to seek

medical care for a present illness and less likely to say that they have seen a professional in the past year [8].

Although the reasons why Hispanics resort less to healthcare services are complex, factors such as lack of insurance and cost of healthcare shed light on marked socioeconomic differences, but factors such as biases, lack of cultural relativism and understanding show a sense of mistrust between Latino and non-Latino physicians [6].

This can have devastating implications on healthcare outcomes: communication challenges and mistrust result in a decrease of adherence to medication and treatment, as well as lower rates of hospital admissions or interventions [9]. Language discordance, coupled with racial and ethnic discordance, introduced additional hurdles to providing equitable healthcare.

Another resource that supports patient-physician interactions is the use of trained medical interpreters.

Such is the case at CommunityHealth, a free clinic for low-income, uninsured adults located in Ukrainian Village, Chicago, IL, where most of the patient population is of Hispanic

heritage and primarily Spanish- and Polish- speaking. As one of the largest volunteer centers in the nation, CommunityHealth utilizes on-call and onsite volunteer interpreters trained by the organization to support physicians in facilitating effective communication between patient and physician.

Other studies suggest incorporating AI tools for interpreting alongside English-Spanish translators; however, these resources require physicians to be trained and competent in their use. Educational interventions such as Spanish medical courses or training on utilizing interpreter services positively impact patient outcomes and strengthen patient-physician relationships [5].

When discussing the need for Spanish language instruction in medical training, Richard Brower, MD, assistant vice president for academic affairs in El Paso, TX, emphasizes the importance of language concordance, where more than 80% of residents are Hispanic. “I think the clinical effects extend beyond translation or formal interpretation,” he says. “Most students don’t reach independence, but it’s about building on existing skills and the ability to establish rapport and trust… Even just introduc-

ing themselves, asking questions, picking up on humor or distress…

It’s a big plus” [6].

Language identity—often intersectional with cultural and ethnic characteristics, as well as immigrant status—plays a significant and influential role in patient-physician interactions across the nation. Since the U.S. population is expected to remain multilingual in the foreseeable future, a healthcare system transformation is needed to deliver culturally competent care efficiently and equitably. A multidimensional approach, drawing from policy and education initiatives, will be necessary to uphold the Hippocratic Oath’s professional standards and reduce harmful, nationwide health disparities.

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Growing Up Alone: The Hidden Consequences of Absent Working Parents and Child Development Written by: Winni Zhao Edited by: Roxanna Fahid The exasperated sighs from consumers in grocery store aisles as they confront the startling price tags of fresh deli bread and chicken breast are all too familiar. Stagnant wages and minimal government regulation—which allows large corporations more self-aware, confident, and asto drive up the prices of productions sertive in their choices as young children often look up to their parents for with little accountability—insuffivalidation. The presence of encouraging ciently compensate for the inflating parents and guardians boosts children’s prices of basic daily necessities. self-esteem which has a positive imThese consequences wreak havoc on household budgets, especially for pact beyond just childhood, carrying low-income families. More and more these traits throughout their lives. Such parental presence is an example of working parents are finding themselves taking on extra jobs to put food attachment theory. According to The on the table at the expense of quality Impact of Parental Absence on Early Childhood Development in the Contime with their children, taking a physical and psychological toll on the text of Thailand (Jampaklay 2013), a next generation of young Americans. study on children of migrant parents, The extra work responsibilities these such attachment allows brain stimuparents and guardians take on influ- lations that play a role in establishing emotional development. The emotionence children’s overall development, including emotional and psychosocial al “attachment” formed by the child provides them a sense of stability and health, academic life, and physical confidence to take risks during their growth. growth. Without this security, the child Emotional and Psychosocial consequently becomes more fearful of Development learning the environment around them, Parental presence is critical in childhood development, especial- hindering their emotional growth. They are more withdrawn and have difficulty ly in achieving early developmental forming healthy relationships as they milestones. For instance, a parent’s involvement with a hobby their child distrust others. These characteristics developed early on play a key factor in is interested in helps them become later challenges, including substance PULSE 14

abuse and temper problems.

Parental Stress: How Contagious is it?

The development of healthy parental attachment can be more difficult in the presence of stress.

The pressure of work environments is inevitable—and keeping up with multiple jobs only worsens it.

Stress spillover in home environments is common in this case, and raising toddlers could only add to the strain. These stressful environments negatively affect family dynamics: they worsen the quality of time spent together, interfere with parental judgment, and disable their awareness of their children’s whereabouts and emotional states.

Waters (2014) notes in her study Stress Contagion: Physiological Covariation Between Mothers and Infants that a child learns to handle stress and strong emotions through a parent-child relationship; without parent-child quality time, the process of managing and gaining awareness of their emotions becomes stunted. Over time, the

child picks up the strained attitude and develops emotional difficulties.

Emotional challenges, such as anxiety, often arise due to the inability to control new feelings—they are left to experience and process new emotions without a parent’s guiding hand.

Emotional management deficiencies can translate into the academic and social dimensions of school life. Pressure in an educational environment is common, but stress regulation requires emotional control that is often honed through parental guidance since early childhood.

Poor grades are the consequence of procrastination and difficulty concentrating due to a lack of such guidance. Additionally, in the study The Effects of Parental Absence on Children Development: Evidence from Left-Behind Children in China (Mao 2015), the author emphasizes that the separation from parents deprives these “left-behind children”—those whose parents left behind to seek financial stability—of care, protection, and education. In turn, these children become more vulnerable to psychological problems, including depression, loneliness, and anxiety. The inability to regulate emotions may lead to unhealthy coping mechanisms such as emotional outbursts or even bullying. These consequences prevent the children from developing socially Food for Thought Learning to manage emotions requires a good parent-child relationship and quality time—this also applies to eating responsibly. Paradoxically, taking on second or third jobs to put food on the table can lead to physical consequences for their child’s wellbeing. Quick meals become the simpler choice after draining their energy in high-stress environments,

but the adverse effects accumulate over growth, and carbohydrates are indistime. In a similar study on the left-be- pensable for vital organs such as the hind children in Health Seeking Behav- kidneys and brain along with meior Among Rural Left-Behind Children: tabolism. Additionally, minerals and Evidence from Shaanxi and Gansu vitamins are vital for bone growth, Provinces in China (Guan 2018), those regulation of the immune system, left by their parents showed lower and overall development. These are levels of physical health than their essential nutrients to stay healthy, peers, including poor vision and lower requiring attention and care from in average height and weight. Tempoparents to supervise the proper intake rary caregivers who fill in the roles of amounts. However, without parental parents lack proper experience and can attention, these habits can be permaneglect the children’s health, leading nently “ossified” when young, carryto malnutrition, missed vaccinations, ing poor habits into adulthood. In the and ignored signs of disease. These study Tracking Dietary Patterns over children are at risk for stunted growth, 20 Years from Childhood through low physical activity, and unhealthy Adolescence into Young Adulthood: food preferences. This phenomenon The Saskatchewan Pediatric Bone is like a double-edged sword: having a Mineral Accrual Study (Movassagh 2017), the author reveals that “western-like” diets high in refined grain, processed meats, and surgery foods showed a high likelihood of continuing into adulthood. Thus, when unhealthy dietary habits are established at a young age, they become challenging to break. Fast and easy meals are time efficient but are hardly sufficient for a balanced diet, creating risks for inadequate physical development and habits that create further health problems during adulthood.

With impacts ranging from emotional instability to insufficient nutrition, parental presence in a child’s life is as equally important as basic quality life is difficult without taking on physiological needs. Given how easily extra jobs, but these longer work hours early childhood experiences can into provide the children with food take fluence the development of personality, economic challenges play a notable a toll on their emotional and physical role in not only the current working health. parents but also in shaping future Macronutrient and micronutrient generations. The future of our youngintake is vital in child development.

Protein is crucial to meet growth needs est generations depends on our ability to address these underlying issues. and should be one of the top priorities, lipids are a source of essential fatty acids that support brain and heart

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From Diagnosis to Discovery: AI’s Impact on Pediatric Cancer Care Written by: Amiti Goel Edited by: Chantel Johnson

Advancements in artificial intelligence (AI) are advancing various industries by the development of new modeling systems in healthcare.

AI in medicine involves the use of algorithms, machine learning, and predictive models to enhance patient care, diagnosis, and treatment. As technology evolves, AI has the potential to revolutionize pediatric cancer treatment and expand applications in oncology practice in the near future.

Pediatric cancer, with its unique challenges—such as early detection, treatment side effects, and long-term prognosis—can particularly benefit from AI tools to support healthcare professionals with delivering earlier diagnoses and personalized care.

These challenges are amplified in pediatrics due to the not fully developed anatomy and physiology of children, which makes diagnosing and treating diseases inherently more complex than in adults. However, the recent developments in AI applications to healthcare has caused a raise in important questions that have yet to be answered. How do we ensure AI furthers, rather than replaces, the human touch in medicine? Could parents rely on AI models to be a significant aspect of their child’s care?

Let’s explore how AI is transforming pediatric oncology, while highlighting both the potential and the limitations PULSE 16

with an overall focus on the future of healthcare.

Early detection is critical in improving cancer outcomes for pediatric patients who have limited detection capabilities and larger potential for relapse in the future. AI-based diagnostics have already made significant breakthroughs. For example, Google Health’s breast cancer detection model reduced false negatives by 9.4% compared to radiologists, showing how AI can identify subtle patterns that might otherwise go unnoticed by medical professionals (McKinney et al., 2020).

Similar advances are being made in brain tumor diagnostics, with MIT’s AI system aiding in the analysis of glioblastomas which helps clinicians make quicker, more accurate decisions (Chang et al., 2019). In addition to imaging, AI tools analyze genetic markers to identify high-risk individuals even before birth. DeepGestalt, an AI platform profiled in Nature (Gurovich, Y., et al., 2019) , demonstrated remarkable accuracy in detecting rare genetic conditions, outperforming many specialists. Such predictive tools are invaluable

for early screening, potentially altering the course of a child’s treatment before symptoms develop. By integrating advanced technologies into pediatric oncology, healthcare professionals can provide earlier and more precise care for children at risk.

AI is also transforming how clinical trials are conducted in pediatric oncology, where pre-screening participants is complex and time-consuming. PathAI (2024), a platform specializing in AI-based pathology, has improved clinical trial enrollment times by 30% by quickly identifying eligible participants from patient records (PathAI, n.d.). The technology ensures that clinical trials reach full enrollment faster, bringing new treatments to children more efficiently. AI models also play a critical role in drug discovery because of the significant reduction in time it takes to develop new therapies.

DeepMind’s AlphaFold (Jumper, J., et al., 2021), for example, has transformed biology by predicting the

structures of proteins which accelerate the discovery of new drug targets.

With AI-powered simulations modeling drug interactions before clinical trials begin, the process of developing breakthrough therapies becomes both faster and more cost-effective. While AI can make processes like clinical trials and drug discovery faster and more precise, it’s important to consider how these advancements might influence the cost of healthcare. The initial investment in AI technology and infrastructure could drive up costs for consumers, even as the outcomes of treatment become more effective and potentially curative in the long term. Regardless, for pediatric oncology and beyond, these advances offer hope for new treatments to be available sooner with more options and better outcomes in the long run.

One of AI’s most impactful applications is the creation of personalized treatment plans. Each child’s response to cancer therapy varies, therefore doctors need tools that can tailor treatments to individual patients.

Platforms like Tempus and OncoKB are already being used to analyze vast oncology datasets and recommend personalized treatment plans based on a patient’s specific genetic profile and medical history. By harnessing patient-specific data, AI can suggest optimal drug combinations and dosing regimens to maximize efficacy while minimizing side effects. This particular approach of precision medicine ensures that treatment decisions are not only evidence-based, but also centered on maintaining the best possible quality of life for young patients and their families.

Another developing aspect of AI in medicine is offering new techniques to monitor children during

and after treatment. Wearable devices such as the Oura ring or Apple Watch, incorporating AI algorithms, allow doctors to remotely track vital signs in real time which alert them of any concerning trends without requiring in-person visits. For families managing complex treatment schedules, the technology provides reassurance in knowing that their child’s condition is being monitored continuously. In addition, AI-powered chatbots and virtual assistants are becoming essential tools in pediatric care. Sensely (Sensely, 2021), it is already in use in hospitals by helping patients and caregivers with appointment scheduling and answering routine medical questions. These AI tools ensure that families stay connected to their child’s medical conditions while facilitating smoother care coordination throughout their treatment journey.

Despite AI’s benefits on medicine, it does come with limitations. AI-driven oncology tools can perpetuate biases with racial and socioeconomic factors that can influence treatment recommendations. This highlights the need for diverse datasets and careful oversight to ensure equitable care for all patients. Additionally, while AI can streamline research and development, the high cost of developing and implementing these advanced technologies could still drive up healthcare costs in the short-term. Increase in healthcare costs because of the new AI models would cause these helpful innovations to be less accessible to certain patient demographics.

Although, it is important to consider that while these treatments may be more expensive, they could ultimately lead to better outcomes, reducing the need for costly interventions later on.

The arrangement for a child to receive a

higher-cost, effective treatment would be more beneficial in contrast to a less expensive treatment currently offered that does not propose the same chance of success. Moreover, trust between doctors and families is extremely vital, distinctly when parents are asked to rely on AI-driven recommendations for their child’s care.

But, it is important to understand that AI is being utilized to enhance, not replace, the expertise of healthcare professionals to ensure that treatment decisions align with the child’s specific needs and values to improve patient quality of care.

AI is revolutionizing pediatric oncology by enabling earlier diagnoses, creating personalized treatment plans, improving long-term prognosis, and accelerating drug development. These advancements bring hope for better outcomes that reduce treatment burdens and provide more effective therapies tailored to each child’s needs. Nevertheless, the integration of AI into pediatric oncology care must be thoughtful and balanced. By combining the best of human expertise with the power of AI models, healthcare providers can offer more precise, compassionate care to young patients and their families. As the advancement of innovations in healthcare evolves, it is still critical to have clinical judgment, empathy, and human insight remaining indispensable. AI will play a pivotal role in the future of medicine by guiding healthcare professionals, empowering patients, and enhancing everyone’s understanding of cancer and other common health complications in ways we are only beginning to understand.

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UV Blood Irradiation: Hack or Hoax?

Written by: Franziska Kungys Edited by: Sophie Feng Everyone’s heard that sun exposure can be good, but how good? Is it possible that Ultraviolet Blood Irradiation–a treatment in which small amounts of blood are drawn out, exposed to UV light, and reintroduced into the circulatory system– could be some kind of miracle treatment? It has a brief, but rich history. In about thirty years of popularity it was found to treat a variety of ailments, but some research suggests it might do the opposite.

The germicidal effects of UV light were first observed in 1877 by two scientists, Downes and Blunt, when they noticed that sunlight preventkilling bacteria, resulted in similar if ed the growth of microorganisms in not better results; the harmed bacteria their test tubes. About twenty years later, physicist Niels Finsen won a No- created a similar result to a modern vaccine when reintroduced into the bel prize for his research using conbloodstream by increasing the immune centrated beams of UV light to treat response to the remaining, unharmed Lupus Vulgaris, a cutaneous form of tuberculosis. This treatment became bacteria.

The first use of Knott’s device on a widespread for many skin conditions, human was in 1928 as a last resort on and eventually led American scientists Emmet Knott to hypothesize that a woman dying in the aftermath of a septic abortion and ailed by hemolytic its effectiveness was due to UV absorption by subcutaneous capillaries. streptococcus septicemia. It led to a Knott and his partner, Lester Edblom, quick and complete recovery. Knott’s created the first UV blood irradiation device was then used for a series of 75 cases of pneumonia, all resulting machine, patented in 1928. in lessening of symptoms and quickThe purpose of the device was to draw, expose a small amount of blood er recovery times. After these initial successes, the irradiation device was to concentrated UV light, and reinredesigned to increase irradiation troduce it into the patient’s circulaefficiency and uniformity and a couple tory system. The light exposure kills bacteria and deactivates toxins, effec- were distributed to doctors for further tively treating diseases. With further experimentation.

For a while, blood irradiation beexperimentation, Knott found that a came a relatively common treatment shorter exposure time, insufficient for PULSE 18

for a number of diseases, including • Infectious arthritis • Osteoarthritis • Mastoiditis • Furunculosis • Escherichia coli • Septicemia • Post-abortion sepsis • Puerperal sepsis • Peritonitis • Typhoid fever • Tuberculosis glands • Chronic blepharitis • Uveitis • Chronic paranasal sinusitis • Acne vulgaris • Secondary anemia Beyond the bactericidal and inflammation reduction abilities that allow for the treatment of the above conditions, UBI has been found to potentially have more general benefits worth further exploration. Among these are

improved circulation, increased red surrounding potential negative side blood cell count, and pain relief, likely effects. Most of the research that has an effect of reducing inflammation. been done on UBI has revealed results Another possible use of UBI is opposing the observed effectiveness of immunity building because a short the treatment; yet, it is worth noting exposure time, as Knott discovered, that most experiments were done at results in harmed but not dead bacte- high or extended UV exposures that ria. In his experiments, the resulting did not reflect the actual treatment. viral fragments created a vaccine-like Still, these studies have shown that exresponse, strengthening the immune tended, intense UV irradiation actually response to the virus. This merits reverses production of cytokine–an further research because successful essential messenger protein of the immunomodulation through this immune system–and blocks its release, method would, in theory, not create which seems to contradict observations viral resistance or super pathogens, of increased immunity. With the more unlike antibiotics. extreme and extended exposure, UV Despite the observed effectiveradiation also has the potential to affect ness, the treatment faded out after the membranes and submicroscopic the 1950s as pharmaceutical antibistructure of red blood cells. otics rose in popularity and is not These studies raise real concerns, commonly used in medicine today but further research needs to be done because it is not properly underwith more varied parameters to find if stood, and there are many questions there are in fact ranges and intensities

of exposure that can create positive results such as those first observed by Knott. The presence of modern UBI clinics in the United States and globally that still observe positive treatment results suggests there was and still is such a range, and its historical applications and diverse health benefits highlight that it is worth finding.

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What’s on the Horizon for Alzheimer’s and Dementia?

Written by: Emnet Djibrila Edited by: Alexis Truta While many individuals and families are personally affected by Alzheimer’s and dementia worldwide, public knowledge about these neurodegenerative diseases is generally low.

Despite the two conditions having different clinical definitions, people often use the terms interchangeably.

According to the Alzheimer’s Association, dementia is an umbrella term that describes the symptoms associated with a decline in memory, reasoning, and cognitive function. While dementia can be caused by Alzheimer’s disease, this only accounts for 60-80% of cases with the remainder in the brain, decreased energy producof cases being attributed to a variety tion in cells, damaged blood vessels in of conditions. the brain, and production of unstable Given that a majority of patients molecules called free radicals leading with dementia have Alzheimer’s, to oxidative stress in the brain. There there has been a significant push to are also genetic risk factors that conunderstand the determining factors of tribute to the development of Alzheithis condition, biochemical, genetic, mer’s disease. The apolipoprotein E or otherwise, in order to effectively (APOE) gene, specifically inheritance treat or prevent it. According to the of the APOE4 allele, is associated with Alzheimer’s Association, “an estimat- increased risk for disease development, ed 6.9 million Americans age 65 and as well as for an earlier age of onset. older are living with Alzheimer’s in Specific demographic factors can also 2024.” Causes for Alzheimer’s are still contribute to how likely one is to presnot entirely understood by scientists; ent with Alzheimer’s. Black Americans however, significant progress has been that are a part of the aging population made in understanding determinants are approximately twice as likely to for the disease. Most people are aware develop Alzheimer’s compared to their of the main risk factors for the disWhite counterparts. Aging Hispanic ease—genetics and aging. There are Americans are 1.5 times more likely to various age-related changes that are develop the disease compared to aging thought to contribute to Alzheimer’s White Americans. damage, including the shrinking of While scientists pursue research to certain brain regions, inflammation identify the risk factors of this disease PULSE 20

to develop more effective preventative measures, public health and patient advocacy organizations must strive to support the communities disproportionately affected by this disease. Many of the aforementioned demographic factors also intersect with social factors that impact how families care for patients affected by Alzheimer’s and dementia. Individuals with dementia require more and more care as their disease progresses. It is difficult to quantify exactly how much assistance a patient with progressing Alzheimer’s might need, but with a sharp decline in cognitive abilities that can make it increasingly difficult to dress, eat, and maintain personal hygiene, it becomes clear that a caregiver is necessary to maintain both the patient’s well-being, and their personal safety as well. Later-stage

dementia requires support with ment for dementia patients that will be mobility and personal care around beneficial for the patient and caretaker the clock. While dementia is blind to as well. socioeconomic status, those in lower The growing population of individincome groups may lack the resources uals and families affected by dementia to place the patient into a long-term has created an equally rapidly growing care facility, often being forced to find field of clinical research with the hopes a caretaker or take on the roles of a of finding treatments and preventative caregiver themselves while balanccare for the disease. Scientists have ing other obligations. Caregiving for made great progress in their investigaan aging individual with dementia tions of the causes of Alzheimer’s and can take an emotional, physical, and dementia, as well as in potential treatfinancial toll. A large population ments and preventative measures. Preof caregivers are women, with ⅓ of ventative care for Alzheimer’s was funccaregivers being daughters of the tionally equivalent to maintaining a affected individual. They also tend to good bill of health until the early 2000s, fall within a category called the “sand- with physicians and public health offiwich generation,” where they care for cials encouraging aging individuals to an aging parent in addition to one or maintain good health practices, avoid more children. The financial burden smoking, and continue exercising their of caring for someone with dementia brains, when researchers conducting can also create long-term expenses evidence-based trials have begun to that severely inconvenience families. study the positive effects of various The impact of dementia is not just vitamins and drug treatments on limited to the individual who suffers Alzheimer’s and dementia. One recent from the condition, which is why it is development is the FDA approval of so important to work towards finding two promising drug treatments, Lecaeffective avenues of care and treatnemab and Donanemab. This approval

means that these drugs have been determined to be safe and effective for their intended use. Lecanemab and Donanemab are now openly available in the US and were approved, in 2023 and 2024 respectively, for patients with early stage Alzheimer’s and dementia experiencing mild symptoms. These drugs are intravenous (IV) therapy treatments that have shown to clear amyloid plaques from the brain. This is extremely relevant research because a feature of Alzheimer’s disease that has long puzzled scientists is the irregular accumulation of beta-amyloid plaques and how these plaques specifically relate to the development of conditions like Alzheimer’s. Scientists have supposed a strong positive correlation between the accumulation of these plaques and the development of Alzheimer’s.

Ideally, in earlier-stage dementia patients, clearing this amyloid plaques would stop or slow the progression of the disease.These treatments are newly implemented, so there is not yet much longitudinal research on the long-term effects of these drugs; however, affected patients and their families have agreed to participate in this cutting-edge research that will hopefully, one day, minimize symptoms of Alzheimer’s and dementia in all patients regardless of the progression of their condition.

Ultimately, as the US population continues to grow and the aging population becomes larger, Alzheimer’s research becomes even more medically relevant than ever. With many medical innovations to treat dementia on the horizon, caretakers and medical professionals alike are increasingly confident that dementia’s impact on the aging population will eventually diminish.

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The Chemistry of Love: How Neurotransmitters Shape Our Emotions Written by: Chioma Okegbuson Edited by: Sophia Falk

When people fall in love, many chemicals are involved in producing physical and emotional responses like sweaty palms or a hint of blush on their cheeks. Dopamine, norepinephrine, serotonin, oxytocin, and cortisol are some of the most important neurotransmitters that play a role in such a strong feeling. Without them, love wouldn’t be possible. Neurotransmitters are vital for carrying out important messages from one neuron to the next, making it necessary to think about your loved one, feel love for PULSE 22

your significant other, and act the way you do around your crush.

Dopamine is often associated with pleasure and satisfaction, a core feeling that cannot go unpaired with love.

It controls memory, motivation, and especially, mood—the three M’s. In the beginning stages of love, dopamine activates the reward “circuit”, allowing love to be a pleasurable experience.

In 2005, Fisher experimented with dopamine’s association with love. She gathered college students ages 18 to 26 and showed pictures of their loved

ones for 30 seconds. When shown these pictures, two areas of the brain with dopamine abundance, also known as the “feel-good” neurotransmitter were activated: the caudate nucleus, which is linked with detected rewards/ expectations, and the right ventral tegmental area (VTA), which is a dopamine-abundant area associated with focussed attention and the three M’s. However, when shown pictures of regular friends, Fisher noticed from fMRI scans, that

parts of the brain not associated with dopamine were activated.

Norepinephrine, similar to adrenaline, heightens arousal and increases blood pressure. This neurotransmitter is the cause of one feeling their “heart racing,”. It brings people the feeling of exhilaration and excitement when seeing their “crush” or the burst of relief when they see their loved one.

Norepinephrine also plays a role in our stress response, which is why some people experience the nervousness and intensity that come with the beginning of a new relationship.

However, the stress people experience in their initial stage of romance is caused by cortisol secreted by HPA, an endocrine system organ. As cortisol levels rise, the neurotransmitter, serotonin, is depleted, leading to obsessive-compulsive behavior associated with infatuation. In an experiment run by Donatella Marazziti and Domenico Canale, they discovered that plasma cortisol levels were higher during the first 6 months of a romantic relationship than in their control group of singles and those in long-term relationships. Cortisol levels aren’t just high in newly forged relationships, but higher in women by merely thinking about their significant other. In contrast, people in long-term relationships have lower cortisol levels. This is because of the consistent social support and happiness that buffer that feeling of anxiety and reduce HPA axis activity.

Last but not least, the two main, and widely known neurotransmitters associated with love, are serotonin and oxytocin. Serotonin helps regulate mood and overall well-being, bringing couples a sense of happiness and contentment with their partners, which can stabilize the highs and lows

associated with being in a committed relationship. While dopamine and norepinephrine might heighten during the early stages of a relationship, serotonin levels tend to be lower, contributing to obsessive thoughts, like norepinephrine, about their partner. But over time, as serotonin levels increase, people begin to familiarize themselves with their partners, promoting a sense of calmness and contempt. Oxytocin, known as the “cuddle hormone” or “love hormone”, is released mainly when physical touch and affectionate interactions are involved. It promotes a sense of bonding, solidifying trust and security. When engaging in something as simple as holding hands or hugging, the body releases oxytocin, building a stronger connection while regulating the nervous system. This is because touch can trigger a pressure-sensitive

sensory nerve called Pacinian corpuscles, which sends signals to the vagus nerve that conducts signals to the hypothalamus, lowering their heart rate and blood pressure which can contribute to managing stress.

Love is beautiful, so thank the brain and the many neurotransmitters at work for helping you experience such an exciting emotion.

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Postural Orthostatic Tachycardia Syndrome in the Post-COVID Era were palpitations (68.75%), fatigue (62.5%), and dyspnea (37.5%)” with headaches and syncope/ presyncope being the next most common (Cantrell et al., 2024). It is important to note that symptoms Postural Tachycardia Syndrome vary for patients with POTS, and (POTS) is an autonomic disorder this same variation is seen in the characterized by lightheadedness, Post-COVID POTS group. In fact, a rapid heartbeat (specifically an Post-COVID POTS was observed increase by over 30 bpm when standto accurately reflect the POTS poping), and fainting. POTS “mainly afulation (Cantrell et al., 2024). Since fects women between the ages of 15 to the presentation of POTS and PostOne study found “that 2%–14% of 50 years of age” and can come and go COVID POTS can be variable, it coronavirus disease 2019 (COVID-19) for years (Postural tachycardia syncan be harder to obtain a diagnosis. drome (POTS), n.d.). There are many survivors develop POTS,” and even Post-COVID POTS is diagcauses for the development of POTS, more survivors showed long-term nosed as POTS, so the treatment POTS symptoms (Ormiston et al., and newfound research has related 2022). While these case numbers grow, and management processes of COVID-19 to a POTS diagnosis. so does the research on why COVID-19 both are the same. One of the most Post-COVID-19 POTS has becommon treatments is increasing come a topic of interest following the is linked to POTS. Autoimmunity is water and salt in a patient’s diet. In many accounts of patients experienc- one possible cause, as COVID may addition, “compressive garments cause the production of autoantiboding long-term POTS symptoms after ies that attack autonomic nerve fibers. significantly reduce venous pooling COVID. Research has shown that and improve POTS symptoms,” Another cause may be spike proteins, POTS can be triggered by viruses or and are key parts of a typical which can cause toxic action. This bacterial infections, and COVID-19 POTS treatment plan (Mallick et occurs when “a spike protein of the has been identified as a possible al., 2023). Medications are also COVID-19 virus attached to ACE2 trigger. Many people recovering from available to help reduce symptoms COVID-19 have symptoms similar to receptors enters the cell and causes caused by POTS. It is important multisystem damage, ” leading to POTS POTS, such as “brain fog, tachycarto be aware of the many treatdia (increased heart rate) and severe symptoms (Mallick et al., 2023). Lastment methods, as different POTS ly, COVID can cause hypovolemia, chronic fatigue,” which has led to symptoms require different treatleading to decreased cardiac output, these patients being tested for POTS ments. As scientists continue their and potentially POTS (Mallick et al., (Covid-19 and pots: Is there a link?, research, more treatment options 2023).

These are all just theories, and 2024). However, a POTS diagnomore research needs to be done to find for POTS will be found and an sis is often overlooked and difficult a definitive answer as to why POTS and understanding of the connections to obtain, as not many doctors are between COVID-19 and POTS will COVID have an apparent association. familiar with the disorder. POTS be obtained.

In order to better understand symptoms are often easily dismissed, Post-COVID POTS, it is important to which could be prevented with more understand the leading symptoms of research and educational outreach. the disorder. One study found that “The most common high-impact symptoms Written by: Mia Mahon Edited by: Sophia Falk

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From Chaos to Cure: The Evolution and Impact of COVID-19 Vaccines in Ending the Pandemic Written by: Sienna Yamini Edited by: Hunter Bershtein

For over three years, the world was in chaos. The spread of the virus was rampant, and businesses around the world shut down. However, on May 5th, 2023, the big announcement was made: the World Health Organization declared the end of COVID-19 Pandemic. A critical development leading to this declaration was the invention and use of vaccines worldwide. When the world stopped, innovation flourished, leading many different vaccines to be developed throughout the pandemic years. Vaccination was a key factor in reducing COVID-19 infection rates and the pandemic death toll (McLaughlin, 2022). However, with many vaccines in circulation, it is important to understand their differences, as not all vaccines are built the same. Each comes with its own unique biological mechanism, efficacy, and side effect profile. Though each vaccine has distinct characteristics, they all have one important commonality: bringing about the end of the pandemic.

The COVID-19 mRNA vaccines were the first FDA approved mRNA vaccines (CareFirst). mRNA vaccines carry viral mRNA, which causes the recipient to produce viral protein.

When the body’s immune system comes into contact with the viral

protein, it triggers an immune response in the form of antibodies that target the viral protein encoded by the mRNA from the vaccine. Since these antibodies are specific to the viral protein, they can recognize and mark the specific virus in the body for attack by the immune system. As such, when someone who is vaccinated with an mRNA vaccine is infected, they are already equipped with antibodies to recognize the virus, and they can more quickly evoke a strong virus-specific immune response.

This heightened immune response leads to more efficient clearance of the virus, hopefully, before it can spread (Carefirst). Both Pfizer-BioNTech and Moderna are examples of mRNA vaccines against COVID-19. These vaccines use mRNA to make copies of the spike protein on the outer membrane of the COVID-19 virus, which then triggers the body’s immune system to produce antibodies specific for these spike proteins. When someone contracts COVID-19, these antibodies bind the spike protein and mark the virus for clearance by the immune system, helping fight off infection. The Pfizer

and Moderna vaccines have a 95% efficacy for preventing COVID-19, a measure of how well the vaccines can protect people against the virus. Additionally, one study found that overall vaccinations in the U.S. (2020 to 2022) were able to stop around 18.5 million hospitalizations and 3.2 million deaths (Fitzpatrick et al., 2022). It’s clear the COVID-19 vaccines were extremely effective in reducing the severity of the disease (Center for Disease Control, 2024).

The Pfizer vaccine began development in January 2020, and clinical trials in March 2020. The first doses were released December 14th, 2020. The Moderna vaccine began development in January 2020 as well, and clinical trials started in February 2020. Shortly after the Pfizer vaccine, Moderna was released for use December 18th, 2020. While these are both mRNA vaccines, they have slight differences. For example, the Pfizer vaccine contains 30 mg of mRNA in a dose, while the Moderna PULSE 25

vaccine contains 100 mg of mRNA in a dose. Additionally, the Pfizer vaccine is commonly stored at -70˚C, while the Moderna vaccine is stored at -20˚C. However, these vaccines do have similar side effects, including pain at the injection site, fatigue, and muscle pain.

Another type of vaccine is the viral-vector vaccine, which uses a modified version of a different virus to send information about the virus in question (OIDP, 2024). For COVID-19, viral-vector vaccines take material from Covid-19 virus and put it in a different viral vector, which then sends the information to your cells. Your cells use this viral information to make copies of the COVID-19 spike protein, and display it, mimicking the actual virus. This prompts the body’s immune response and creates antibodies against the virus for future use. An outdated example of a viral-vector vaccine is the Johnson and Johnson vaccine, which is not available in the U.S. anymore due to side effects issues. The Johnson and Johnson vaccine began development in January 2020, and was released for use in February 2020. The efficacy of this vaccine was around 85% for severe cases, and side effects includ-

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ed fatigue, muscle and joint pain, and nausea. Another example of a recalled vaccine is the AstraZeneca viral-vector vaccine, which used modified chimpanzee adenovirus as its viral vector.

It began development in April 2020, and was released for use December 30, 2020. The side effects were mild, such as fever or fatigue. However, some rare side effects include blood clots (Vanaparthy et al., 2021) (Katella, 2024). As a general consensus, mRNA vaccines have been shown to be more effective at reducing the spread of the virus, especially due to their high efficacy.

Protein subunit vaccines use harmless parts of the virus that will most effectively trigger an immune response.

The body recognizes the harmless spike proteins the vaccine carries, and creates antibodies. They do not carry live viruses, and usually have less side effects. The Novavax vaccine contains a modified spike protein that cannot cause disease. When used, the vaccine triggers an immune response and antibodies are released. The Novavax vaccine is the only non-mRNA vaccine that was approved for use in the U.S., released in 2021. It had around 90% efficacy. Side effects include pain at the injection site, fatigue, and muscle pain (Katella, 2024). However, since this

vaccine was developed later and there is a high demand for mRNA vaccines, the Novavax vaccine is not as widely used.

Inactivated vaccines take a live virus and kill it. The inactivated virus in a vaccine can create an immune response. Live Attenuated Vaccines use a live but weaker form of a virus. They directly target the immune system and trigger immune responses without causing disease (Pfizer).

There is currently no live attenuated COVID-19 vaccine, but there was one in clinical stages in 2023 (IDSA).

A live attenuated COVID-19 vaccine would mean easier storage and administration, making it more widely available to certain communities. However, these vaccines require extensive testing before they could be released to the public. An example of an inactivated covid vaccine is the Sinovac vaccine (OIDP, 2024). It was released for emergency use in China in July 2020, and had a 50-83% efficacy. Side effects also include pain at the injection site and fatigue.

These are some of the major vaccines that were used during the pandemic and are still currently in use.

In terms of numbers, around 80% of Americans have been vaccinated at least once against COVID-19, and about 70% have had two doses (USAFacts, 2024) (CDC Covid Data). 60% of fully vaccinated people received the Pfizer vaccine, while 37.5% of vaccinations were from Moderna. Although the pandemic brought about chaos and death, it ultimately demonstrates the power of scientific innovation in fighting against such crises.

Each COVID-19 vaccine differs in its usage and efficacy, but we nonetheless must attribute our departure from the pandemic to their development.

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