Examiner Fall 2023, Vol. 28

FALL 2023

The Cost of Being Fat: Fatphobia In Medicine as a Barrier to Health

Vividha Venkatrajan "You Are What You Eat": The Diet's Influence on Gut Microbial Composition

Sriya Sadangi

Humanitarian Crisis in Chiapas, Mexico

Cielo Tumbokon

Letter from the Editor

Fall 2023 Dear Reader,

Welcome to the Fall 2023 edition of The Examiner. Our journalists, managing and layout editors, and entire executive board team have worked incredibly hard this semester to provide you with a quality pre-health newsletter on the cutting edge of medical research and current events. From articles on fatphobia in medicine to research here at Rutgers integrating artificial intelligence with cardiology, we strive to provide you with articles that are relevant to the Rutgers community as well as to your daily lives.

This semester, our journalists- many of them new to the club- worked with our fantastic managing editors to learn about the research and writing processes that they’ll need on their path to become successful health professionals, turning mere pitches into robust articles in a matter of a few months. Highlights of our meetings included a peer review between managing editor groups, our new health awareness blog initiative, and, most importantly, an alumni panel consisting of gap year and medical students who gave us invaluable advice on the pre-health journey.

I am incredibly proud of the progress and work our members have put in to bring these articles to you, and I could not imagine my role as president this year without my executive board.

Endeavors like The Examiner are needed now more than ever in a climate where credible sources of medical news are becoming harder to find, and we can’t wait to return this spring to bring you another new issue.

Without further ado, please enjoy our Fall 2023 edition.

Sincerely,

Sarah Adams Editor-in-Chief

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TABLE OF CONTENTS The Link Between Diabetes and Dental Health

4

ChatGPT and the Future of Healthcare Models

5

The Cost of Being Fat: Fatphobia in Medicine as a Barrier to Health

6-7

How Much Do We Know About Insurance?

8

CAR-T Cell Revolution

9

The Impact of Space Travel on the Brain

10

Accelerated Approval For New Alzheimer’s Disease Treatment

11

From Plant to Pill

12

Is Math the Key to Curing Cancer?

13

Party On: New Naltrexone Study in Binge Drinking

14

The Mysteries Behind Deja Vu

15

“You are What You Eat”: The Diet’s Influence on Gut Microbial Composition

16-17

Artificial Intelligence Usage in the Field of Cardiology

18

The Stress of Medical Training: Impacts on a Cellular Level

19

Humanitarian Crisis in Chiapas, Mexico

20-21

Digital Progress Parallels Cognitive Decline

22

The Effects of Traffic Pollution on Cognition

23

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THE LINK BETWEEN DIABETES AND DENTAL HEALTH Heather O’Donnell There is a not-so-sweet relationship between diabetes and oral health issues. There are two types of diabetes: type 1 and type 2. Type 1 diabetes occurs when the pancreas cannot produce insulin, a hormone that controls the amount of glucose (sugar) in the blood. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced.1 There are many complications of diabetes that are well-known, including issues with the eyes, blood vessels, kidneys, heart, and nervous system. However, there are also many diabetes-related oral health issues that people may be unaware of. Compared to people who do not have diabetes, people with type 2 diabetes are three times more likely to develop dental problems. People with type 1 diabetes also face an increased risk of dental problems.2 The relationship between diabetes and dental health issues therefore must receive public attention.

People with diabetes are more susceptible to oral health issues due to their biological and physiological differences.

For instance, they have a more intense inflammatory response to over 500 types of bacteria that are found in the plaque, which build on the teeth as people eat and interact with starches and sugars in food. This interaction creates acids that attack the teeth and cause cavities. Furthermore, people with diabetes have higher blood sugar levels, which result in a greater amount of sugars and acids that will decay the teeth.1 High blood sugar also weakens white blood cells, which help the body fight infections that occur in the mouth. This, in turn, slows down the healing process and makes the body vulnerable to infections.3 The more sugar that is present and the longer it is present in the body, the higher the risk of tooth decay (caries) and other oral health problems.2 There are many specific oral health issues that people with diabetes experience. People with diabetes have a higher risk for gingivitis (early-stage gum disease) and periodontitis (advanced gum disease). Some signs of gum disease include swollen, bleeding, or receding gums, mouth pain, persistent bad teeth, and loose or missing teeth.

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Another issue is dry mouth, which occurs when a lack of saliva causes food debris, acid, sugar, and bacteria to not get washed away as easily. The effects of dry mouth include soreness, ulcers, infections, and tooth decay.4 In addition to dry mouth, people with diabetes experience thrush, a fungal infection that causes painful white patches in the mouth.5 In fact, a study conducted by the Rutgers School of Medicine demonstrates how diabetes increases the risk of dental health issues. Diabetes can lead to tooth decay by weakening the enamel and dentin, the hard substance that gives teeth a certain structure. Researchers created Type 1 diabetic conditions in 35 mice and used a hardness test to compare their teeth with those of 35 healthy controls over a period of 28 weeks. After 12 weeks, the diabetic mice developed softer enamel than the healthy mice. Even though both groups started out with comparable teeth, there were significant differences in microhardness (tooth strength) between them by week 28. This study shows that diabetes weakens teeth by disturbing a natural process called mineralization, which occurs when the enamel layers add minerals to the teeth as they wear away from being used normally. Minerals are important because they harden the tooth enamel, strengthen the jawbone, and protect the inner parts of the teeth. This study is part of a broader effort to explore the effects of diabetes on dental health, which will allow researchers to develop targeted treatments that reduce or prevent those negative effects.6 There are several ways people with diabetes can keep their teeth healthy and reduce their risk of oral health issues.

They can brush their teeth at least twice a day with fluoride toothpaste, floss at least once a day, and see the dentist twice a year for routine checkups. They can also control their blood glucose levels by managing their caloric intake, visit the dentist if their gums are red, swollen, or bleed easily, and quit smoking, which increases the risk of gum disease and can make diabetes symptoms worse.3 There is a need for greater awareness of the effects of diabetes on oral health.

CHATGPT AND THE FUTURE OF HEALTHCARE MODELS Medha Satti In January 2023, ChatGPT passed all three steps of the U.S. Medical Licensing Exam (USMLE) without any user input or special training. This has been a significant turning point for ChatGPT’s future in the medical field, as it shows the knowledge capabilities of machine learning-reinforced AI.¹ First launched in November 2022, ChatGPT is an pre-trained AI chatbot that utilizes machine learning and reinforcement training from human feedback to provide in-depth answers to questions in a variety of disciplines. As seen by a multitude of users, ChatGPT provides a thoroughly researched answer to medical questions regarding symptoms and conditions.

Currently, it can be used as an initial guide for patients to ask questions related to illnesses that can subsequently be brought up to healthcare professionals. ChatGPT not only has the potential to be an aid for patients, but also may be an incredibly useful tool as a digital assistant for medical providers.

The most applicable use of ChatGPT at its current ability is to increase efficiency in clinical documentation and preauthorization/appeal letters to insurance companies.

Studies have shown that physicians spend an average of 16.4 hours a week on authorization letters for procedures and imaging.² Additionally, transcribing notes following an encounter with a patient is a tedious and long-winded process, which generally falls to a medical student or resident.³ These processes can become more efficient with pre-written templates given to ChatGPT to train it in medical writing.4Physicians would only need to ask ChatGPT to write up a letter or summary referencing any scientific literature if needed. This would, in turn, provide healthcare professionals with more time to see patients and not focus on billing or notes.

ChatGPT can also save physicians’ time by providing quick, easily digestible summaries of research papers, which is especially helpful for doctors who do not practice in that specific field, but still want to keep up to date. A provider can ask ChatGPT to provide an in-depth summary of a long research paper with just important facts and figures. As described by Salvagno et al. , this gives physicians the opportunity to fill any gaps in their understanding of the 5 current research in a field without having to spend hours reading through all the literature.

ChatGPT is already being theorized to be a powerful tool for physicians. At NJMS, a study was conducted regarding the efficacy of ChatGPT for clinical decision assistance and improvement in patient wait times in the plastic surgery field. The researchers concluded that there is reason to believe that machine learning, even in its6 infancy, can confirm physicians’ diagnoses and help determine the most appropriate course of treatment.

However, it is still important to consider the skepticism of ChatGPT’s accuracy. Dr. Ateev Mehrotra, professor of healthcare policy at Harvard, recently conducted a study regarding ChatGPT’s diagnostic efficiency. He found that given patient histories and present symptoms, ChatGPT’s 7 accuracy fluctuates, but is consistently lower than physicians’ accuracies. Furthermore, AI has a welldocumented issue with gender and racial bias. A study by Obermeyer et al. , for example, showed that algorithms 8 used in a hospital recommended Black patients less medical care than their White counterparts. Further, Meta’s Galactica, a language model 9predecessor of ChatGPT, was shut down three days after its launch due to racial prejudice and factual falsehoods. As ChatGPT scours historical facts and information, there is concern that it can be harmful to historically oppressed groups, particularly in the context of access to health equality.

It is clear that ChatGPT must still undergo modifications before it can be trusted for medical advice. Yet, it is incredibly promising for the future of medicine. Long wait times and short patient encounters have been the topic of much discourse in the medical community. ChatGPT, even in its primitive form, has the capabilities to be an asset for physicians. At the center of ChatGPT’s use in medicine is its ability to save physicians’ time to actually interact with their patients.

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The Cost of Being Fat: Fatphobia in Medicine as a Barrier to Health Vividha Venkatrajan

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This bias manifests itself in medicine and creates barriers to health for overweight people. A study published in the American Journal of Public Health found that patients with higher BMIs receive fewer preventative screenings for various conditions.7 This fact is corroborated by Dr. Jennifer A. Lee, who found that “fat cis women are less likely to receive cervical cancer screenings, breast cancer screenings and colorectal cancer screenings than non-fat cis women.”6 The predisposed notions that healthcare providers hold also lead to discrimination and fat-shaming in medicine.

A trip to the doctor’s office is never fun, but it is certainly not supposed to be distressing or fearinducing. For people like Aubrey Gordon, however, going to the doctor can be a daunting task. Aubrey did not see a doctor for eight years because every time she did, she would receive lectures on weight loss and insults instead of medical treatment, regardless of the condition that brought her in. Every doctor took one look at her and decided that she was unhealthy and lazy, without even examining her because she was overweight.1 Every doctor blamed her symptoms on her weight, instead of digging deeper to make a diagnosis.1 This experience is not unique to her. Our society has deeply rooted stigmas framing fatness as a personal and moral failure.2 This comes from the common misconception that obesity is solely a result of poor diet and exercise, or that fatness is inherently unhealthy.

The reality is that, as research suggests, obesity is the result of a multitude of complex environmental and genetic factors that are often out of an individual’s control.3 Furthermore, poor diet and exercise do not always result in obesity, and the inverse is true.

According to data from the Canadian Health Measures Survey, the levels of physical activity and diet are not correlated with obesity.4 Despite these facts, fatphobia persists, and doctors are not immune to this bias. A 2012 study demonstrated that doctors have an explicit anti-fat bias, and often exhibit a “strong preference for thin people rather than fat people.”5 Another study found that healthcare providers also view fat patients as “failed citizens”, and feel that they are “less likely to be compliant with healthcare instructions.” 6

“Like Aubrey, many overweight patients’ concerns are ignored, and they are often belittled or insulted to the point that they stop seeking 8 healthcare."

It is clear that social and structural inequities play a significant role in determining the health outcomes of overweight people. Therefore, the solution to the “obesity crisis” and improving health outcomes for fat people lies in addressing these larger issues. Dr. Rina Bliss, a researcher, and professor in the Department of Sociology at Rutgers University, states that obesity “is something that we need to stop thinking about in terms of the individual and in terms of a person's lack of doing well enough… and really start to think who is being failed by the healthcare system.”9 She thus suggests a top-down approach that involves addressing structural inequities in order to improve access to healthcare for overweight people as well as “educating providers on when bias is happening structurally in a patient’s life, and to see when bias is happening in the space of care.”9 Health at Every Size (HAES) is one such public health approach to medicine that deemphasizes weight loss as a health goal and works to educate healthcare providers on fatphobic biases.10

People like Aubrey deserve to make a trip to the doctor’s office without the fear of being dismissed or disrespected. Such a comprehensive approach can make that possible, so that overweight people can safely access healthcare and live healthier lives.

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HOW MUCH DO WE KNOW ABOUT INSURANCE? Tyler Tran

The United States’ healthcare system policies towards health insurance are unquestionably contentious, consistently arising as a major political issue and running platform. As it stands, it is characterized as a mixed system with coverage options including public plans from Medicaid & Medicare and private options from the market or employer. Through legislation such as the Affordable Care Act, the US government attempts to encourage the highest amount of coverage possible, with the uninsured rate reaching an all time low of 8% in 2022.1 Yet, despite the fact that the vast majority of Americans are insured, a high number lack basic health insurance literacy— potentially leading to ineffective usage of healthcare resources and consumer confusion, which worsens health quality and exacerbates social disparities.

Throughout the 2010s, over half of Americans were consistently unable to understand basic health insurance terms.

Along with the inadequate knowledge of insurance policy, around 50% of Americans have low confidence in using insurance to access healthcare.2 This includes a lack of knowledge about basic and essential components, such as the meaning of out-of-pocket costs or deductible amounts. Lower health insurance literacy can result in the overestimation of treatment costs, which in turn leads to many forgoing or postponing care.3 Similarly, those unaware of preventative care coverage share the fear of financial burden, again potentially avoiding diagnosis and treatment of chronic illnesses early before they significantly worsen. On the other hand, many also underestimate their costs, leaving them with unexpected financial obligations. These issues especially affect racial minorities. For instance, research by the University of Connecticut revealed that only 9% of primarily Spanish speakers selected could accurately predict healthcare costs.4 Being unsure about costs and terminology results in consumers being unable to adequately compare and utilize insurance. Therefore, they may be overwhelmed when choosing a plan or hesitate to obtain healthcare service, ultimately leading to higher costs in treating the advanced stages of poor health.5 Health literacy, treatment, and finances are related and cyclic issues, as worse status in any one leads to worse outcomes in the others.

Despite higher levels of education, college students make up another unique population with health insurance illiteracy. While they may be better in defining terms, a large number of students still cannot accurately determine costs or apply terms to compare plan options.6 In fact, approximately half of the 455 participants in a public university questionnaire were confused regarding their own plan, and a quarter stopped or delayed care due to that confusion.6 With so much changing in this period of life—new employment, leaving the family insurance plan, making independent health decisions—health insurance literacy is essential.

At Rutgers full time students are required to have health insurance coverage, either through the Student Health Insurance Plan (SHIP) or their own personal one.7 The SHIP costs over $1,000 per term, not including dental or vision service. As such, it is critical to be aware of the services you are paying for, be it from Rutgers or your own plan. For instance, SHIP and many other plans cover a variety of preventative services, such as immunizations and screenings without charging copayment or coinsurance, even before the deductible is met. It is important to note that services often either require or are cheaper through an in-network (or “preferred”) provider, which can be found on UHCSR for Rutgers or on your health insurance’s website.

With proper health being a personal necessity, there must be an effort to accurately understand available services and their accompanying prices. Unjustified fear, the consequential avoidance, and insurance misuse can lead to ultimately higher costs for worse health outcomes. With the American healthcare model placing the onus on consumers to make proper choices, it is absolutely necessary for us to be properly aware of what those choices actually mean.

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CAR-T CELL REVOLUTION Ashwin Bhaskar

Blood-based cancers account for approximately 10 percent of all diagnosed cancers each year in the United States.

They occur when blood cells grow abnormally and excessively in the bone marrow, interfering with its function.1 There are currently treatments in place to treat these blood-based diseases such as chemotherapy, radiation therapy, and targeted therapy drugs. However, these therapies have drawbacks as they are not fully effective in distinguishing healthy cells from cancerous cells. Car-T Cell Therapy, a therapy which was introduced in the 1950s but was only recently utilized in a clinical setting, has the potential to address this issue in a safe and effective manner.2

Car-T Cell Therapy primarily works by targeting T cells, which are white blood cells which fight bacteria, viruses, and cancer.3 The drawbacks of T cells include difficulties destroying the cancerous B cells, eventually losing the ability to even target the cells. However, Car-T therapy modifies T cells in order to increase their recognition ability and aid in the process of eliminating the cancerous B cells.3 In order to initiate this therapy, a patient is required to go to his or her closest Car-T medical center where patients undergo apheresis, in which blood is processed through a machine tasked with isolating the T cells and then returned to the patient’s physician. The isolated T cells are then subject to modification as a chimeric antigen receptor (CAR) is placed on the cell's surface allowing for the T cells to better recognize the cancerous B cells. The Car-T cells are then frozen and returned to the patient’s primary physician who can then infuse the cells in the blood, similar to a blood transfusion.3

Currently, there are two prominent Car-T therapies utilized: Yescarta and Kymriah. Yescarta is a personalized single infusion Car-T therapy which is designed to target, bind, and kill cancerous B cells. Furthermore, it is the only Car-T therapy which promotes rapid T cell expansion and healthy B cell recovery.4 It is primarily prescribed to people suffering from Non-Hodgkin’s Lymphoma and follicular lymphoma.4 A disadvantage of Yescarta is that it could induce neurological deficits such as memory loss. The Kymriah therapy, unlike Yescarta, is primarily focused on reinforcing and protecting the existing T cells as opposed to rapid T cell proliferation.5 In addition, this therapy induces T cell differentiation, increasing the stability of existing T cells. Furthermore, this therapy is FDA approved for use in all children, as opposed to Yescarta, to treat relapsed or refractory B-cell acute lymphoblastic leukemia.5

Although these therapies have been effective in safely treating blood based cancers, there is still room for improvement. The primary issue is that this therapy can currently only be used to treat a limited number of blood based cancers. It is essential to expand the scope of this therapy in order to increase its effectiveness and impact.

Currently, research is being done by Dr. Christian Hinrichs at the Rutgers Cancer Institute of New Jersey with the aim of “developing new technologies to make T cells target common types of cancer such as stomach, lung, and breast cancer”.6 Eventually, the treatments developed through this research will be offered by the Cancer Institute through in-human clinical trials. If similar studies can be performed successfully, Car-T Cell therapy has the potential to have a worldwide impact.

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THE IMPACT OF SPACE TRAVEL ON Prachi Lad THE BRAIN As humans continue to advance in many areas of science and technology, our understanding of space travel grows. We are able to frequently send astronauts and robots to space.

As a result, the health effects of space travel on astronauts are being studied more deeply. The four day spaceship travel time has considerable impacts on the central nervous system (CNS) including the vestibular system, cerebrospinal fluid, and intracranial pressure. These impacts can have harmful effects that need to be recognized before space travel becomes more common in the future.

A study done by the Sheffield Institute for Translational Neuroscience in the UK reveals the direct impact of various space travel simulations on the human and rat brain. The study explains how “astronauts are exposed to hazards that include microgravity, cosmic radiation, hypercapnia, isolation, confinement and disrupted circadian rhythms”.¹ The combination of all these conditions disrupts of brain plasticity. In particular, there is a tremendous effect on the brain's vestibular system, which is our body’s balance control.

This is important, because when in space, our body has a difficult time understanding its orientation A main component of the vestibular system are the otoliths organs which are located in the semicircular canal of the ear and contain fluid that helps our body with orientation and balance. The otoliths are not able to distinguish the gravity pull that is endured when in space. The gravitational pull on them can eventually lead to an increase in intracranial pressure which can then cause negative effects on the brain and its blood flow. This concept was studied with mice placed in a simulation of spaceflight. For humans, however, the head down bed rest (HDBR) system was used, which is another type of space simulation. HDBR is proven to be more accurate than the mice simulation despite the mice simulation being easier to conduct. Furthermore, many other aspects of space travel and their effects on the CNS are being studied. For instance, space and cosmic radiation can increase the risk of brain tumors.¹

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Furthermore, many other aspects of space travel and their effects on the CNS are being studied. For instance, space and cosmic radiation can increase the risk of brain tumors.¹ As space flight continues today, astronauts are given medicine to mitigate some of these effects. However, this medicine is not fully effective and is not sustainable if we wish to normalize spaceflight. Promethazine is currently NASA’s motion sickness medication, used to combat the effects on the vestibular system despite many side effects.

NASA explains how these side effects include dizziness, drowsiness, and impaired motor and brain function. Other medications are currently being run in clinical trials to help astronauts with this issue.² Along with the brain, space can affect muscle as well. Driscoll Lab, at Rutgers University, is currently researching the effects of space travel on the muscle and on the brain. The lab sent 3600 worms into space to see the effects of muscle deterioration that occurs during space flight.

Since the worms are clear, they are able to see inside the body. According to their research, the neuronal morphology of the worms were also altered. There was a build up of neuronal waste in the surrounding tissue due to the high stress environment. This research is important as it mimics what happens in the human brain.³ Furthermore, understanding these effects in the future is necessary as space tourism is currently in its infancy. Space tourism is the ability for people to pay money to space stations in order to take a flight to space. As of right now, SpaceX, offers flights to space along with their partnership with NASA. Currently, a ten day trip costs around 55 million dollars.⁴ This is expected to become more common in the future.

ACCELERATED APPROVAL FOR NEW ALZHEIMER’S DISEASE TREATMENT Alexa Dakrat

Alzheimer’s disease is an irreversible neurological disorder

Overall, Leqembi shows promising results, offering the

affecting millions of people worldwide. The disease is

possibility of months of improved cognitive function for

characterized by profound cognitive decline, including

Alzheimer’s patients and their families struggling with the

memory loss and difficulties performing everyday tasks.

impact of this degenerative disease.

Early signs of Alzheimer’s include the inability to recall recent events, owing to synaptic dysfunction and abnormal

Leqembi’s potential benefits may be outweighed by adverse

protein accumulation in the brain.¹ Despite extensive

side effects, although incidence is relatively low. While

research efforts undertaken to discover a cure for

showing potential as a breakthrough Alzheimer’s treatment,

Alzheimer’s disease, the unknown etiology of the condition

the drug may cause brain swelling and bleeding, which can be

makes treatment exceptionally challenging. However, the

life-threatening,

development of Leqembi, a promising new drug, offers hope

treatment price points are substantial, and there are still

for the treatment of Alzheimer’s disease. Similar to many

uncertainties whether Leqembi will be covered by Medicare.

drugs undergoing trials, Leqembi’s potential benefits may be

Furthermore, the tests required to confirm amyloid buildup

outweighed by adverse side effects that occur in rare cases.

are often not covered by insurance. Patients undergoing

although

rare.

Additionally,

Leqembi

treatment with Leqembi are also required to undergo several Leqembi,

also

was

MRIs before fifth, seventh, and fourteenth infusions of

cognitive

Leqembi to monitor for side effects or any signs of brain

impairment and confirmed presence of amyloid beta

bleeding.³ Without insurance coverage, the cost of Leqembi

protein, which is suspected to contribute to Alzheimer’s.

could be unaffordable for many families. Strikingly, “Eisai, the

Abnormal protein buildup is a key indicator of Alzheimer’s.

company that developed Leqembi in partnership with fellow

According to the National Institute on Aging, “...abnormal

drugmaker Biogen, has said it will price the treatment at

levels of naturally occurring protein, Beta Amyloid 42,

$26,500 per year.”³ The significant costs may be a major

clump together to form plaques that collect between

barrier for many families accessing Alzheimer’s treatment.

neurons and disrupt cell function.”¹ The decrease in amyloid

For many families, the time commitments and pricing can be

beta plaques as a result of the drug expedited approval for

considerable barriers to treatment with Leqembi.

administered

referred to

to

patients

as

lecanemab-irmb,

displaying

mild

Leqembi, which offers patients the possibility of delayed memory decline due to the preservation of synaptic

Leqembi represents an optimistic new treatment option for

connections in the brain. In addition to targeting amyloid

Alzheimer’s disease. Shu-Chan Hsu, a Rutgers University

beta, Leqembi has also been found to target the Tau protein,

Associate Professor in the Department of Cell Biology &

which is responsible for maintaining the structure and

Neuroscience, states, “Leqembi is a monoclonal antibody

function of neurons in the brain. In Alzheimer's disease, Tau

effective in binding amyloid peptide polymers. It can slow

becomes abnormal and forms clumps called neurofibrillary

down the amyloid buildup progression. Its clinical benefit is

tangles that can lead to the death of brain cells. As studies

thought to be modest, carrying significant side effects.”

have shown, “Leqembi seems to decrease accumulation of

Overall, Leqembi has shown a decrease of protein buildup

tau protein, which forms tangles inside neurons of

such as amyloid beta plaques and the Tau protein, but there

Alzheimer’s patients, particularly in the memory centers of

are many price and time commitment factors to consider

the brain.”²

before undergoing treatment with Leqembi.

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FROM PLANT TO PILL Or Doni One of medicine’s greatest tools is drugs - substances that have a physiological effect when they enter the body. From treating disease to counteracting disorders and bolstering different body systems, drugs are ubiquitous in medicine.

Most physician and emergency department visits involve drug therapy, and nearly half of Americans take at least one prescription drug a month.¹ Given their value in healthcare, the development of drugs is a vital process in the advancement of medicine. Surprisingly, many drugs for humans are developed from specialized molecules found in plants.

As chemistry, biology, and botany have advanced, plant medicine has progressed from traditional home remedies to the extraction and modification of compounds from certain plants to create pharmaceuticals.² Various commonplace modern drugs for treating diseases from malaria to Alzheimer's are based on molecules found in plants.³ But how and why do plants create these compounds, and how do they impact humans?

Plants produce an array of useful molecules called secondary metabolites to repel predators and attract beneficial species, which enhances how competitive they are 4* in their environment. While most of a plant’s energy goes toward producing primary metabolites used for growth and development, they divert some energy towards the creation of these specialized secondary metabolites. While secondary metabolites are not the sole plant compound class utilized for medicinal purposes, they are widely used in drug discovery and embody the process well.

Some of the effects metabolites have on plants can translate into humans, making them potentially effective medical compounds. For instance, the plant Ocimum sanctum (holybasil) is a medicinally important ayurvedic herb commonly 7 used in India. Its secondary metabolites “have antioxidant, anticancer, anti-inflammatory, antimicrobial, antistress, immunomodulatory and radiation protective activities.”

Different parts of the plant are used for treating bronchitis, 8 malaria, stomach ulcers, eye diseases, nausea, and vomiting.

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Eugenol, one of its secondary metabolites, has “antimicrobial, anticancer, antioxidant, anti-inflammatory, and analgesic” properties, and different eugenol derivatives 9 are used in various medications. In another modernmedicine case, A. annua (sweet wormwood) was used in China to treat fever from the fourth century. In the 1970’s, the active agent- the compound having a physiological effect- called artemisinin, was isolated, and is today used in 10 various antimalarial drugs.

Finding the active agent in a plant is a difficult process, and does not by itself result in a final drug. Anthony Lockhart, medicinal chemistry PhD candidate at Rutgers, provides insight. He explains that one way medicines are developed is by observing a traditional plant medicine, making extracts of the plant, finding the active molecule by making more specific extracts for different compounds in the plant, and then testing the active molecule’s pharmaceutical performance. Another path for drug discovery is called “high throughput screening” (HTS), testing batches of chemicals from a “chemical library” for a desired effect. To turn a plant compound into a drug, Lockhart says that some natural products can go straight from plant to pill. However, other natural products have undesirable effects on humans, or can benefit from further modification. To alter plant compounds, “medicinal chemists go through a process of ‘structure activity relationship’ to identify and modify parts of the molecule to make it perform better as a drug.” Using computer models to test the interaction between the natural product and receptors, they “synthetically modify the natural product to better fit the computer docking model.” Once modified, they can join the ranks of drugs serving humanity.

Plant-based medical herbalism is often regarded as outdated and unscientific as it stems from centuries-old traditions.

However, scientific fields like medicinal chemistry are valid and valuable, utilizing plants to inform and empower medicine today.

Is Math the Key to Curing Cancer?

Erin Oxnam

The idea of healthcare is generally thought of as a “hands-on” activity, i.e., the interaction between a patient and provider. However, healthcare is a much broader practice, and it must pull from other fields of study in order for healthcare to be as beneficial as possible. These fields range from art to create accurate illustrations in medical textbooks to law in order to ensure that patients are treated safely and ethically. In fact, one of the most critical fields in healthcare is math, specifically biostatistics. Biostatistics is focused on applying statistical processes in order to analyze and make sense of biological phenomena.1 There are many applications in this field, one of the most well-known being its usefulness in studying and stopping pandemic outbreaks such as COVID-19.

However, the field of biostatistics is also currently helping take down another giant in the disease world: cancer.

Across the country, cancer research centers have established biostatistics divisions to aid in the research process. Research centers include Rutgers University, Stanford University, and the University of Michigan. The University of Michigan Center for Cancer Biostatistics displays the importance of such centers: it is key in all steps of the research process, from the designing of experiments, analyzing the results, and drawing conclusions in a manner that ensures reliability.2 There are a variety of statistical methods and applications used in cancer research. The Journal of Thoracic Disease in 2015 outlined how statistical tests such as the t-test and Wilcoxon Sum Rank tests help analyze factors such as tumor size, a patient’s weight, or number of lymph nodes. These tests can help determine a patient’s tumor stage, and such information will inform doctors of the best way to treat the patient. 3 Additionally, the results are within a specified confidence level, allowing researchers to know the reliability of their results Additionally, the National Cancer Institute describes how statistical software programs; namely SEER*Stat, Head-Bang, and SaTScan; can calculate accurate incidence, mortality, survival, prevalence, and spatial 4 statistics regarding cancer. These software programs utilize many statistical methods, such as the aforementioned t-test and a Wilcoxon Sum Rank test, but within a specialized computer program.

A specific example of biostatistics application in cancer research comes from a study co-authored by Rutgers University Director of Biostatistics Shared Resource at the Cancer Institute of New Jersey, Hao Liu. The study looked at exactly how effective tertiary lymphoid structures and tumor-infiltrating lymphocytes were in helping the body’s immune system fight gastric cancer. The study utilized a variety of statistical tests, including the ttest, to conclude that there was a positive association between the number of tertiary lymphoid structures in a patient and the immune system’s ability to fight gastric cancer, being a valuable indicator of a patient’s survival.5 As the healthcare field grows and more advancements are made, it is critical that biostatistics grows alongside it in order for such advancements to reach their full potential. Every year, more and more students begin an education in hopes of joining the healthcare field. With goals such as helping cure cancer, it is important that students know medical school is not their only option: someone can be just as valuable for the healthcare system if they study math or statistics. At the end of the day, it will take interdisciplinary collaboration to cure cancer, with math being one of the most important.

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Party On: New Naltrexone Study in Binge Drinking Kaitlyn Adkins Binge drinking is defined as drinking more than 3 drinks for women and 4 drinks for men at any given time, but these numbers are frequently exceeded at social events, 1 particularly in America. Though binge drinking has become normalized within American culture, it is considered a 1 major risk for alcohol related illnesses or injuries. Dr. Danielle Dick, the Director of the Rutgers Addiction Research Center, explains that this is particularly true on college campuses, with alcohol-related injuries being one of the biggest health harms to young adults. A new 2023 study analyzed the effects of taking a pill, naltrexone, before anticipated binge drinking in order to reduce binging.

Naltrexone was approved for use within the U.S. 30 years ago and is used to treat alcohol and opioid use disorders by blocking the effects of the substances and reducing cravings. 2 This medication reduces the “buzz” of drinking by blocking endorphins during intoxication; without that good feeling throughout the body, the brain and person as a whole are less likely to crave more of that substance. 3 Men in this study were not severely dependent on alcohol, but they did want to make efforts to reduce binging.1 This is relevant, as people do not need to be severely addicted to a substance in order to want to reduce their habits. It may also be difficult for some people who do have addictions to admit it, so not having that as a prerequisite for treatment allows a larger consumer pool to access preventative measures. Dr. Dick elaborates on this, detailing that those with alcohol addictions are often perceived as “weak,” without considering genetic components to addiction that make some people more susceptible than others. Effective harm reduction, such as this medication, are important steps in allowing people to partake in social events that may involve drinking without the negative consequences of feeling the urge to binge.

This particular study looked at 120 sexual and gender minority (SGM) men, including transgender and gay men, who were not severely dependent on alcohol. 4

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This population was chosen because they are more prone to HIV, and binge drinking is more common in those who are HIV-prone.4 This was a double blind study in which the men were instructed to take naltrexone when they either felt a 1 craving to drink or anticipated a heavy drinking period. The study lasted 12 weeks, but results show that the changes in drinking habits in the test group persisted up to 6 months 1 after they stopped taking the medication. Overall, naltrexone significantly reduced the number of binge drinking days compared to the placebo group; the trial group had fewer 4 weeks with binge drinking and fewer drinks per month. The effects were measured based on participant reporting and two biological markers: ethyl glucuronide (EtG), which detects if alcohol has been used in the past 1-3 days on average, and phosphatidylethanol (PEth), a phospholipid 4 which is formed only in the presence of alcohol. Though EtG and PEth levels were statistically similar in the two groups, PEth levels were technically lower in the test group.4 This suggests that the two groups likely drank and abstained the same number of days, but when they did drink, the test group consumed less alcohol than the placebo group.

Using this drug as-needed is the primary difference from its past uses. It is beneficial that the user can decide when they want to use the medication because it eliminates the hassle of taking a daily pill and limits potentially negative side effects. Having the option of occasionally taking this medication allows more autonomy and the same benefits, without the feeling of having a severe alcohol-related problem. Dr. Dick explains, however, that many people do not realize this option is out there, partly because the drugs are no longer under patent so drug companies cannot significantly profit from them. Hopefully, with new studies such as this one coming out, the reach of these medications will expand and more people will have access to these kinds of interventions. Dr. Dick’s final remarks on the study are that, “This was just one small study and focused on sexual and gender minority men, so we need to replicate it in other studies to make sure the effect holds, but if it does, it represents another important tool that could be used to reduce harm associated with risky alcohol use.”

Has this happened before? Most people have experienced the odd sensation of perceiving their present moment as if it has happened before — and they are experiencing the same thing again. This phenomenon is also known as deja vu, French for “already seen.”

While deja vu is a common phenomenon, with around 60% of people experiencing it at least once in their 1 lifetime, it is still a mysterious event. Thus, in order to study deja vu, researchers focus on the ‘dreamy state’ instead, which is an experimental surrogate for deja vu in epilepsy patients. By stimulating various areas of the brain, researchers are able to discern that the hippocampus and amygdala play a significant role in the deja vu experience, while the temporal neocortex plays a more secondary role. More specifically, the temporal neocortex encodes the perceived information that the hippocampus later stores, with the amygdala adding an emotional context. One theory suggests that inappropriate activation of these three structures is what leads to deja vu.

Another popular theory behind deja vu is that a person’s cognitive resources of memory and perception momentarily break down on each other due to distraction, inattention, or fatigue; this correlates with the observation that deja vu most frequently occurs after periods of emotional distress or mental fatigue. Deja vu may also occur due to a change in the speed of normal neurological transmission. In other words, a momentary delay of neuronal transmission from the sensory organ to higher-order processing centers in the brain causes misinterpretation of new information as old. The fatigued mental state that often accompanies deja va may underlie these neurological effects.

Alternatively, deja vu might occur when an appropriate sense of recognition of a small part of a scene is inappropriately extended to the whole scene. For example, the brain might take a familiar sign or landmark and extend that familiar feeling over the entire scene.

Interestingly, Freud proposed that deja vu is triggered when a particular scene has some similarity to a suppressed fantasy. He suggested that deja vu in this scenario is a defense mechanism used to better the present situation. Notably, all these theories are not necessarily competing, but rather, may all contribute to the sensation behind deja vu.

THE MYSTERIES BEHIND DEJA VU Laine Ansari When people experience this phenomenon, they often tend to disregard it as it is not necessarily a sign that something is wrong. While deja vu is commonly seen in healthy individuals, there are two types of deja vu: pathological and non-pathological deja vu. While nonpathological deja vu tends to be short in duration, pathological deja vu tends to be prolonged and cannot be terminated. Although deja vu in psychiatry is less established, it is thought to be a manifestation of many major psychiatric disorders. Further, researchers have found that the frequency and intensity of deja vu incidences are heightened in people with higher anxiety.

Of course, correlation does not equate to causation, and therefore there is a possibility that there might be an underlying reason causing both deja vu and high anxiety.

However, this association supports the earlier observation that deja vu is often associated with emotional distress and mental fatigue. Deja vu also does not increase with age, peaking around the ages of 20-24 years old, with the highest incidence of 81% among those with a graduate 1 degree. One interpretation of these findings is that undergraduate and graduate students experience higher levels of stress due to the many pressures they face, causing the most to experience more incidences of deja vu.

While deja vu remains to be a mysterious phenomenon, researchers have recently begun to approach this phenomenon with virtual reality technology. The study of deja vu has spanned decades, and eventually, with more research and new technology, it will be possible to understand this phenomenon.

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“You are What You Eat:” The Diet’s Influence on Gut Microbial Composition Sriya Sadangi

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W

hen what feels like the hundredth round of midterms rolls around, students are not exactly mindful of what they eat.

Although we may want to ignore the old

adage “you are what you eat,” it typically rings true — and when students are stressed for an exam, they tend to gravitate towards more junk and fatty foods. By having relatively unhealthy eating habits, college students are unknowingly contributing to their own increased risk for developing symptoms associated with type-2-diabetes.

With this condition, the body resists or is unable to make enough insulin, resulting in a reduced ability to metabolize glucose. As a result, patients affected by this chronic disease are typically overweight and may be at increased risk for other chronic diseases, including 1 stroke and hypertension. But how do the foods students eat contribute to ameliorating or worsening these symptoms? Studies have shown that diets rich in carbohydrates and fatty foods may lead to an increased abundance of certain gut microbial species, leading to the development of symptoms associated with chronic conditions like type-2-diabetes.

The human gastrointestinal tract houses a very diverse population of microbes, otherwise known as the gut microbiota, whose specific composition can influence the development of certain diseases.2 While there are multiple factors at play, numerous studies suggest that diet plays an important, if not the most significant, role in determining gut microbial composition. 2 Within an individual’s diet, “consumption of particular types of food produces predictable shifts in existing host bacterial genera.” 3 For instance, gut microbial profiles of obese patients typically reveal a lower intestinal Bacteroides: Firmicutes ratio, two bacterial species whose concentration modifications have been associated 3 with type-2-diabetes and metabolic syndrome. It appears that gut bacterial populations prefer certain types of foods over others, leading to a relatively increased or decreased abundance of such species.

Unfortunately, the diet that students are typically accustomed to is not exactly the healthiest; at the Harvard School of Public Health, researchers have found that “the typical Western diet, red meat, high-fat dairy products, refined grains, and desserts may increase your chances for [type-2-diabetes].”4 Research conducted on the influence of both Western diet (a diet higher in sugar and fat content and lower in fruit and vegetables) and lifestyle changes during the pandemic revealed that Western diets disrupt normal insulin homeostasis, causing insulin hypersecretion and an increase in reactive oxygen species, both of which have been heavily 5 implicated in type-2-diabetes.

To further elucidate the connection between different foods and their influences on the gut microbiota, new research aims to shift from foods that increase risk to foods that improve prognosis for patients with type-2diabetes. In the Department of Biochemistry and Microbiology at Rutgers University, Professor Liping Zhao recently published a paper detailing how dietary fiber can lead to an increase in beneficial gut microbes that ultimately help alleviate symptoms associated with type-2-diabetes.6 The Zhao lab found that dietary fiber intake reduced inflammation and improved bloodglucose regulation.6Currently, the lab is examining how a personalized gut microbiota can be an effective 6 treatment solution for patients with type-2-diabetes.

While current research objectives delve beyond investigating the role of the Western diet towards learning how foods such as whole grains and fruits may beneficially alter gut microbial composition, it is clear that further research is needed to determine a more suitable diet — if there truly is one — that may prevent future risk of developing type-2-diabetes.

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ARTIFICIAL INTELLIGENCE USAGE IN THE FIELD OF CARDIOLOGY Haris Atif

Imagine walking into the emergency room and an EKG not only being able to tell you what is currently happening, but being able to predict the chances of you having certain heart diseases. As much as this might sound like a farfetched idea, this is soon to be our reality as artificial intelligence has taken the ropes in the medical field, specifically in the field of cardiology. Engineers have been able to create a deep learning system, which is a subset of machine learning that allows for a more accurate and streamlined diagnosis and prediction of heart diseases. It has diverse functionalities including improving the detection of certain cardiac-related diseases that can typically be missed by a human as well as predicting systolic function and mortality. The usage of this artificial intelligence will therefore result in greater positive patient outcomes.

Of the many advantages of implementing the artificial intelligence system for EKG interpretation and prediction, one is the improved prediction and analysis compared to a human. When identifying a major abnormality in an 2 ECG, an AI-enhanced analysis showed significantly higher accuracy compared to conventional methods.

Furthermore, it allows for a greater accuracy in the prediction of many heart diseases. It was found in a study that an ECG integrated with an AI algorithm, was significantly more accurate in detecting left ventricular hypertrophy in patients compared to conventional methods of ECG and cardiologist interpretation.2 Given this evidence, this new technology can make a substantial difference in the overall community as it increases the accuracy of detection and early treatment of said heart diseases, therefore increasing the life expectancy of the average human.

However, there are important considerations with implementing and utilizing artificial intelligence in the field of cardiology. The main points are to ensure that the AI is able to accurately evaluate patients of all races, ethnicities, and socioeconomic statuses and ensure patient safety. Firstly, we must ensure that the AI is not susceptible to any bias that could lead to problematic and incorrect results. A research study included in the International Journal of Arrhythmia stated, “AI models may be susceptible to bias if not developed and tested on diverse populations; care must be taken to preserve individual privacy; assessment of performance in practice is required to avoid unnecessary anxiety and diagnostic testing.” 4 Secondly, we must ensure that patient safety is maintained throughout the process by implementing regulatory mechanisms. In order to do so, we must have a framework that regulates the usage and implementation of the AI. We must also be aware of the limitations of it when using it, as the main goal is to safely increase the quality of healthcare delivery.

As much as it may be hard to fathom such innovative technology, this is a heavily researched field and occurs right within the Rutgers University community. Dr. Partho P. Sengupta, Rutgers professor and chief of the Division of Cardiology at Rutgers Robert Wood Johnson Medical School discusses how AI can enhance ECG usage, improve 5 detection, as well as reducing overall healthcare costs. Rutgers University has announced a multi-year collaboration with a medical technology company called HeartSciences that will focus on developing an AI based ECG algorithm 5 that allows for the expansion of ECG usage and heart disease detection. Moreover, the expansion of the intersection of AI and the field of medicine is one that is fairly new, but has the capability to make a great contribution to the overall community. Who knows, maybe the next time you go for a wellness check, an AI will be able to predict any possibility of heart disease for you!

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The Stress of Medical Training: Impacts on a Cellular Level Caitlyn Colabraro The several years of residency that follow medical school are notorious for being an extremely stressful experience. However, the extent of the impacts that such levels of stress have on the body are less well known. Aside from dark under-eye circles and other visible symptoms of stress and sleep deprivation, recent studies have demonstrated that the most worrisome impacts of stress may not be outwardly displayed, as effects are being found at the cellular level. Within each of our bodies’ cells, there are 46 chromosomes. At the ends of each chromosome, there are long regions of repeated DNA sequences called telomeres that do not code for any of our genes, and their purpose is to protect the genetic material found at the ends of chromosomes from being degraded. Each round of cell division that our cells undergo leads to a shortening of telomeres in most types of cells, so it 1 is a natural process to see shorter telomere lengths in older cells as a marker of aging. However, once telomeres get too short, cells can no longer undergo cell division successfully without degrading areas of valuable genetic information.

Telomere length is known to be related to cell age, but a new field of research is showing a connection between stress and telomere shortening. In 2019, the first large longitudinal study was conducted on the effects of chronic stress on telomere length using the first year of a residency program for physicians, a well established intense and tiring experience, as a model for chronic stress. The sample included 250 residents from 55 hospitals across the United States and measured their self reported accounts of childhood memories, internship experiences, personality traits, as well as their telomere length before and after their first year of residency. The study revealed that the average attrition rate of telomeres over the first year of residency was six times the average rate 2 for non-residents. Studies that show these effects of residency training on the shortening of telomeres have served to emphasize the importance of strides to make medical training less 3 strenuous for future healthcare providers.

One potential contributing factor to these results is shown in the average hours worked per week among the subjects of the study. The average work week for the residents of the study was 64.5 hours long. Further, residents with the longest work hours displayed even more shortening than 3 those with less hours, which hints at a connection between sleep and telomere length as well. This logic can also be applied to other career fields where hours are similarly demanding and shifts may regularly switch from day shifts to overnight shifts within one work week, disrupting circadian rhythms. Hopefully, with more research to demonstrate the damage that can be done by overworking medical residents across the country, changes can be made to the structure by which our medical staff is trained in order to promote longevity and overall health.

Additional research on telomere length is currently being conducted by Rutgers New Jersey Medical School Professor Utz Herbig. Herbig is in the process of studying various factors that may affect telomere length and how these factors that shorten telomeres are also correlated with cancer 4 growth rate, aging, and wound healing. So far, the research has confirmed that telomere shortening is a mechanism for aging, but it also has the benefits of suppressing cancer growth in humans and allowing for faster wound healing. Although undoubtedly a complex topic that calls for more research, the impact of chronic stress on telomere length is significant and has been shown to disproportionately affect future healthcare providers. Addressing the factors that exacerbate these affects, such as excessive work hours and sleep disruption, is essential for protecting the well-being and longevity of our future healthcare providers.

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Humanitarian Crisis in Chiapas, Mexico Cielo Tumbokon 20

There are certain circumstances when one’s health and ability to nourish their body with nutritious, affordable meals is not an option. People who have minimal control over the food choices they make live in areas known as food deserts. These areas have higher rates of poverty, limited access to transportation, and fewer food retailers selling fresh produce.1 In these areas, there are fewer food retailers able to provide fresh produce and healthy choices for affordable prices. In other cases, when there is low initial wealth, it is hard for businesses to settle in the first place. Everyone should have access to healthy and affordable options because, without them, they are at higher rates of diabetes, obesity, and cardiovascular disease.2 A primary example is Chiapas, Mexico, where its residents drink more Coca-Cola than water.

This issue arose due to a nearby Coca-Cola bottling plant that is draining the nearby town's freshwater supply. Some residents have to walk two hours a day to their closest drinkable water source.3 In the town of San Cristobal de los Casas, the Coca-Cola plant dries the drinkable groundwater accessible by well. Locals are forced to ration their water, and many have no choice but to get their necessary water from soft drinks. In areas where soda costs less than water, the business has embedded itself into local culture and is considered a holy drink. It is widely believed that carbonated drinks have healing abilities.4 To counter public criticism and government intervention, CocaCola builds public trust, in this case, becoming ingrained in local religious practices. 5 This was done through aggressive marketing campaigns in local towns. Billboards advertised indigenous people and used religious references in their native language.

Coca-Cola’s ubiquity in Chiapas, Mexico allowed easy access to soft drinks and was the cause of residents’ addiction.

“In areas where soda costs less than water, the business has embedded itself into local culture and is considered a holy drink.”

Coca-Cola’s influence on the region can be exhibited through rising rates of diabetes and other heartrelated conditions. In Chiapas, the mortality rate increased from 30 percent from 2013 to 2016 and is 6 disease. the second-leading cause of death after heart Dr. Carol Byrd-Bredbenner, a professor of Nutritional Sciences at Rutgers University, claims that sugarsweetened beverages intake in children is a reflection of the observed parental consumption and learned 7 dietary preferences.

Breaking the cycle of dependency on Coca-Cola is more difficult when generations of Mexicans rely on the caloric-rich beverage as a source of energy. Ideally, Coca-Cola would have never exploited Chiapas’ land for its own profit, and its residents would have access to drinkable water and not have to resort to sugary beverages for essential hydration.

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DIGITAL PROGRESS PARALLELS COGNITIVE DECLINE Neha Badade More often than not, older generations tend to point out the several ways in which technology has dominated the lives of today’s youth. Books are not used as much, long distance communication is effortless, and valuable information is accessible in seconds. Technology has become an inseparable part of people’s social, working, and leisure life.

This change first began in the 2000s, and to this day, technological advancements are evolving. Yet another issue evolving parallel to this revolution is the way our brains function. Broadly speaking, younger generations now face cognitive, as well as social changes, as a byproduct of this advancement.

With the rise of online platforms such as Google Drive applications, Canvas, and Sakai, younger generations have assimilated to technology in a way that is slowly changing cognitive functions as well. What used to be a daily routine with printed pages and use of pencil sharpeners is now subject to personal choice. A large part of this change is due to the normalization of smartphones and social media within young adults. In a study done by the Pew Research Center, it was found that “95% of teens now (2018) say they had or have access to a smartphone, which represents a 22percentage-point increase from the 73% of teens who said 1 this in 2014-2015”. When young minds develop, neurons make fundamental connections for vision, hearing, and language. There are several credible studies highlighting positive outcomes of the internet, most notably the global access of knowledge and opportunities. However, the detrimental effects such as stress, sleep, and memory loss are equally as undeniable. According to ‘The Google Effect’, individuals that are in a habit of receiving information from the internet instantly tend to have a decreased long-term and working memory, which is why younger generations are less likely to remember phone numbers or directions when driving. 2 When it comes to sleep, the use of devices at night tricks the brain into believing that it is light enough outside to inhibit the release of melatonin, an important hormone that induces sleep.

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While there are observable differences in cognitive functions between generations, there are also morphological changes that have been studied when it comes to reliance on technology. In research studies conducted by the Cincinnati Medical Center, researchers correlated screen time with changes in the brain’s cortical thickness (CT) and sulcal depth (SD). The latter refers to the depth of the space between brain folds, which alongside cortical thickness can define several aspects of brain development. They found that a “higher screen time was associated with lower CT and lower SD for higher levels of digital media use in multiple brain areas… (and) under-development in other higherorder areas that support more complex skills”. 3 This is significant because lower CT and SD have been linked to language development, reading and social skills such as complex memory encoding, empathy, and understanding facial expressions. 3 While the continuous influence of technology, the internet, and social media seems to be set in stone for this generation, there are several ways in which the effects of this evolution can be adapted to yield largely better outcomes rather than worse. Dr. Mauricio Delgado, director of the Social Affective Neuroscience lab at Rutgers University, believes that it is up to the individual to decide whether technology and social media controls them, or if it can be the opposite. He suggests, “Just like any behavioral issue, like I drink too much soda, I shop too much, be aware of it and control it…

Have times when you are not connected to a screen and enjoy the environment and people around you”.4 While professional and educational settings make it hard to escape technology, personal use- often the accomplice towards addiction- can certainly be controlled. Delgado also suggests asking for professional help to form healthy behavioral patterns.

A lot of younger generations are forced into this world of digital advancement, and navigating it with balance is often more complicated than learning the works of it. So although there are two sides to any coin that represents global change, it is important to be well versed in staying on the positive side of personal growth.

THE EFFECTS OF TRAFFIC POLLUTION ON COGNITION Riya Patel The history behind cars is intriguing and mysterious. The origin of vehicles can be tracked down in history to the 15th century; however, Karl Benz, a German engineer in 1885, is credited for inventing the automobile that most closely represents cars today.8 Cars can run using many power methods like gasoline, diesel, or electricity. The cars that are the most harmful to the environment and humans are vehicles that operate using diesel and gasoline. The most commonly used cars tend to use gasoline while bigger vehicles like commercial trucks use diesel. Due to the emission of cars many are at risk of developing cognitive issues and should find methods to decrease that exposure.

Diesel and gasoline not only differ in how they operate but also what makes up the source itself. Harmful chemicals like paraffin and aromatics make up both diesel and gasoline, which are released into the air in high concentrations every time a vehicle is used. 1 It wouldn’t have been a problem with a few cars, but nowadays, there are millions of cars. These chemicals can lead to carcinogenic compounds building up in exhaust gases. Not only can the compounds affect cognition but also contribute to cardiovascular, gastrointestinal and respiratory diseases. Some examples of 3 diseases include fatal ventricular fibrillation and pulmonary congestion in the lungs. With the world increasingly relying on gas-run vehicles to get them where they need to be, people turn a blind eye to the adverse impacts on their health.

A study by the University of British Columbia, Vancouver Coastal, and Canada shows the effects of traffic emissions on brain function.4 The study was performed on 25 participants aged between 19 and 49; they were tested before and after their exposure to diesel exhaust and filtered air. The participants were blinded, which means they didn’t know if they were the control who were exposed to filtered air or experimental if they were exposed to diesel exhaust. Once the experiment was done, four MRIs were taken of the brains of each individual before and after each situation. The study focused on the default mode network part of the brain, which is in charge of passive tasks that don’t need special attention. For example, when someone pays close attention and is thinking then the DMN is less active, but when someone isn’t actively thinking then it is more active. 2 In this study, exposure to diesel exhaust showed an increase in DMN compared to exposure to filtered air.

Increased traffic pollution can also be linked to dementia in adults. Dementia is a condition in older adults that causes progressive memory loss and intellectual function. This condition affects the person’s ability to complete daily activities of living and communicate. A study performed by Western University in Canada found that particulate matter from traffic pollution increases the risk of a person developing dementia by 3%.5 This happens when particulate matter is inhaled and then enters the lungs which direct it to the bloodstream. The bloodstream goes to the brain where the particular matter can cause inflammation and neuron death, leading to problems with brain function. Symptoms that accompany neuron death include slurred speech, problems with memory, muscle cramps and weight loss.

Rutgers students are directly impacted by this problem since the method that is used the most for transportation is the bus. The buses require diesel which over time is harmful since those walking around the bus can inhale large amounts.

A lot of students that use the buses are undergraduate students between the ages of 18-21. The prefrontal cortex of the brain is in charge of decision-making and planning and doesn’t finish developing until the mid-20s.7 Interference with brain development at this stage can lead to issues in the future for the student. Not only are buses used a lot, but also cars, so in order to avoid this problem people should start walking more if it is a short distance. If the class is too far, “vehicles” like bikes or electric scooters can be used to make traveling easier. It is also recommended to not go on runs in places where there is a lot of traffic and to check the air quality before leaving.

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THE EXAMINER STAFF Editor-in-Chief External Vice President IVP/Secretary Treasurer Senior Managing Editor Managing Editors

Chief of Layout Layout Editors

PR/Events

Sarah Adams Sathya Gopinath Mehwish Imran Laasya Gaddipati Tulip Sengupta Kaitlyn Adkins Alexandra Dakrat Nidhi Gourabathuni Caitlyn Colabraro Vividha Venkatrajan Medha Satti Mehwish Imran Neha Badade Noorulain Ansari Cielo Tumbokon

WORKS CITED

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10.1016/j.archoralbio.2022.105434 Photo: Laårk Boshoff ChatGPT and the Future of Healthcare Models 1. Kung, T. H., Cheatham, M., Medenilla, A., Sillos, C., Leon, L. D., Elepaño, C., Madriaga, M., Aggabao, R., Diaz-Candido, G., Maningo, J., & Tseng, V. (2023, February 9). Performance of chatgpt on USMLE: Potential for AI-assisted medical education using large language models.

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STAT. Retrieved March 26, 2023, from https://www.statnews.com/2023/02/ 13/chatgptassisted-diagnosis/ 8. Obermeyer, Z., Powers, B., Vogeli, C., & Mullailathan, S. (2019, October 25). Dissecting racial bias in an algorithm used to manage the ... - science. SCIENCE. Retrieved March 26, 2023, from https://www.science.org/doi/10.1126/science.aax2342 9. Heaven, W. D. (2022, November 22). Why Meta's latest large language model survived only three days online. MIT Technology Review. Retrieved March 26, 2023, from https://www.technologyreview.com/2022/11/18/1063487/meta-large-language-model-ai-onlysurvived-three-days-gpt-3-science/ Photo: Adi Goldstein The Cost of Being Fat: Fatphobia in Medicine as a Barrier to Health 1. Gordon, A. (2018, June 26). Weight stigma kept me out of doctors' offices for almost a decade. SELF. Retrieved April 3, 2023, from https://www.self.com/story/weight-stigma-keptme-out-of-doctors-offices 2. DeJong, W. (1980). The stigma of obesity: The consequences of naive assumptions concerning the causes of physical deviance. Journal of Health and Social Behavior, 21(1), 75. https://doi.org/10.2307/2136696 3. Chaput, J. P., Ferraro, Z. M., Prud'homme, D., & Sharma, A. M. (2014). Widespread misconceptions about obesity. Canadian family physician Medecin de famille canadien, 60(11), 973–984.

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