Examiner Fall 2022, Vol. 26

FEATURED: A Doctor's First Patient: Should It Be Virtual?

Caitlyn Colabraro The Importance of CPR Training Anjali Patel How Reliable Is Your Favorite Medical Drama?

Cielo Tumbokon

Letter from the Editor

FALL 2022 Dear reader,

We are pleased to share our Fall 2022 Issue of The Examiner: Pre-Health Journal. This is our nineteenth publication discussing scientific breakthroughs and healthcare news relevant to the Rutgers community.

The spread of credible, reliable information regarding medicine is more critical now than ever, as we surpass more than two years of living amidst the COVID-19 pandemic. The innovations and research of talented individuals continue to give us hope for a safe and healthy world.

Our club has now returned to primarily in-person weekly meetings, where journalists can interact faceto-face with managing editors and other members who help keep the organization running. At each meeting, we dedicate a substantial amount of time for feedback from the managing editor groups in order for journalists to be fully satisfied with their resulting articles at the end of the semester. In addition to this feedback, the entire club gets to participate in our weekly activities, which this semester has included a halloween-themed debate and a second draft peer review. We also ran our first ever blood drive with the New York Blood Center alongside Mu Beta Psi, in which over 20 donations were made by members within and outside the club.

I could not have asked for a more wonderful group of journalists, layout editors, and executive board to begin my time as President and Editor-in-Chief of The Examiner. We hope to continue to serve as a resource to the Rutgers community on the latest news on the search for equitable, dependable healthcare. Enjoy reading!

Sincerely,

Rachel Shrivastava Editor-in-Chief

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TABLE OF CONTENTS ​Headaches 101: An Introduction to Migraines Stand Up to Sitting A Doctor's First Patient: Should It be Virtual?

The COVID-19 Intensification of Health Disparities in America Keeping Our Kidneys in Check: Estimated Glomerular Filtration Rate The Phantom Fix Battling Abdominal Adhesions at Rutgers The Living Drug Challenges and Advancements in Bypassing the Blood-Brain Barrier The Importance of CPR Training Preparedness for a Future Pandemic Rising Temperatures and Declining Health Alzheimer's Disease: Is the Cure Closer than We Think?

Breakthrough Treatment Cures Woman with HIV​ Climate Change: Defrosting Vector-Borne Diseases Microplastics: Hidden Danger or Harmless Byproduct?

How Reliable is Your Favorite Medical Drama?

Medicine's Commitment to People The Lasting Burden of Post-COVID Chronic Disease Music as a Drug Immunodeficiency and the Human Body: A Push for Rare Disease Research

4 5 6-7 8 9 10 11 12 13 14-15 16 17 18 19 20 21 22-23 24 25 26 27

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HEADACHES 101: AN INTRODUCTION TO MIGRAINES By: Kaitlin Adkins Imagine you’re fast asleep. Suddenly, you’re awoken by a powerful, throbbing headache. Unable to fall back asleep, you lay there thinking, not again—this being one of several headaches this week. This is the reality for many who suffer from migraines. Characterized by severe headaches, migraines are theorized to be caused on the neurological level by the strength of stimuli-generated responses by certain neurons.1 The pain then manifests either through inflammation of the membranes that line the skull and vertebral canals, referred to as meninges, or by an increased sensitivity in the nerves that send pain signals to the face called trigeminal nerves.1 The lifestyle of college students is comprised of a variety of activities that put them at increased risk of developing migraine headaches.2 Factors such as stress, fatigue, anxiety, and sitting in straining positions can all contribute to the onset of migraines.2 Other triggers include caffeine consumption, alcohol use, and inconsistent day-to-day schedules.

According to one study, as many as 16.1% of students suffer from migraines.3 In addition, the pain can increase a student’s already existing stress, resulting in an ongoing cycle of migranes.4 In recent years, a number of other migraine triggers have also been added to the lives of college students. In particular, the transition to online classes and increased quantity of online work and readings all add to computer-related triggers.

Studies have shown that the thalamic neurons, which are heavily involved in migraine pain, are most sensitive to blue light. 5Though many experts recommend taking breaks from screens every twenty to thirty minutes, that is not something that college students can always realistically accomplish because of the amount of time that needs to be spent on 6 computers daily.

Negative consequences of migraines seen in the college-aged demographic include a decreased level of performance in school, as well as more time missed from school.7 This can be devastating for students, considering how intensive many of their courses are. In addition, many classes only allow a certain number of absences and typically only have a few assignments that comprise their overall grade. Women who get migraines tend to also have a poorer quality of sleep, based on how long they sleep and other factors like snoring and shortness of breath.8 Getting less sleep, as most college students know, can make staying awake during lectures and focusing on assignments difficult. Joanna Kempner, a sociology professor at Rutgers who specializes in migraine studies, explained some of the effects of migraines in an article she published entitled Towards a Socially-Just Neuroethics of Inequalities in Pain Treatment. She explains that it is very difficult to measure pain, even utilizing the pain scale, which severely limits the credibility of patients. The inability to measure migraine pain and its effects serves as a barrier to receiving care, and may cause people to downplay their feelings. Dr. Kempner also reports that healthcare providers don’t treat everyone reporting pain related to migraines equally, creating disparities in individual’s ability to get treated.9 Migraines are a condition that plague a variety of people, however they often go undiscussed. College students in particular are exposed to a number of triggers in their daily lives, which can lead to debilitating levels of pain. If migraines in college students were discussed more frequently, then institutions such as Rutgers would be able to better support their students and be more accommodating to these individuals.

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STANDING UP TO SITTING Allyson Fu

Sitting seems unavoidable. Between eighty-minute lectures, weekly study sessions at the library, and hours spent doing homework, you have probably spent more time than you wanted sitting in a chair and hunched over a desk. Especially with the increase of virtual meetings and classes necessitated by COVID-19, it is likely that you fall into the national average of sitting for

around ten hours each day—whether you want to or not.1 Although this sedentary time seems like a normal part of our lifestyles, it is actually connected to intermediate and long-term health consequences from physical pains to chronic diseases. However, as academics and work continue to dictate our need to spend time at desks, there are several small adjustments to your sitting habits, including using a standing desk and taking breaks at given intervals, that can improve your health. And they all revolve around one tenant: stop sitting.

Remaining sedentary for extended periods of time is unhealthy for most people, especially as it causes—and increases their risk of developing—detrimental health conditions. Prolonged sitting is often associated with physical pains and has been linked to a higher risk of developing musculoskeletal disorders.2 In one randomized controlled trial, employees at a company were split into two groups—a control group and an “intervention group” which received sit-stand desks—and observed over three-months.3 Comparing participants in both groups, the intervention group reported “improved subjective health,” such as less neck and shoulder pains and improved mood, which lead to increased reports of productivity. 3 Several studies have examined further consequences of spending too much time sitting, linking it to heart diseases and obesity.4 To observe cognitive and cardiometabolic conditions in teenagers, one study designed school days with 65% of its time spent sitting, where students sat continuously for over twenty minutes, and days with 50% less time spent sitting, where students did not sit continuously for longer than twenty minutes.5 As a result of the reduced sitting day, the trial reported improvement in students’ cognitive function as well as lowered total cholesterol and HDL cholesterol levels and positive effects on apOb/apoA-1 ratios—a marker for cardiovascular risk.6 One way to combat harmful effects from sitting is using a standing desk. Whether you invest in a standing desk or find a desk space that lets you keep your work at a comfortable position while you stand, you can become a more “active” sitter and expend more energy. Energy expenditure increases with more physical activity: more energy is expended in standing than sitting, and even more energy is used to walk.7One study measured energy expenditure in working adults and found that alternating between sitting and standing increased energy expenditure—indicating increased physical activity—by around 7.8% per hour compared to sitting continuously.7 Furthermore, standing continuously increased energy expenditure by 11.5% per hour compared to sitting— all without any difference in the subjects’ mood or productivity.7 Evidently, research indicates that time spent at a desk is best mitigated by movement and that simply switching between sitting and standing every half hour makes a difference.

Of course, standing desks are only one factor that encourages an active lifestyle. Ideally, you want to mindfully monitor your fitness levels and spend time exercising—whether that is by walking during your commute or working out at the gym in between classes. However, to address the time we have to spend sitting, moving at thirty-minute intervals, incorporating seating exercises, and keeping an ergonomically-correct seated position all contribute to better cognitive and physical impacts on your body.8 Everyone has to sit during the day. Given how difficult it is to avoid, it is impossible (and unnecessary) to completely cut out sitting from anybody’s routine. And while standing is not the only step towards leading a healthier lifestyle, it is one of the easiest.

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A DOCTOR'S FIRST PATIENT: SHOULD IT BE VIRTUAL? Caitlyn Colabraro 6

Instead of being greeted with words or gestures, a doctor’s experience with their “first patient” and often their first procedure done on a human body typically begins with nothing but a scalpel slice and a cadaver. With the rapid advancements made in educational technologies, though, this experience has the potential to take place completely virtually. Although a physical cadaver dissection is one of the more notable moments in a medical student’s educational experience, as technology continues to become more advanced and more educational experiences are taking place virtually, dilemmas begin to arise when newer technology threatens to replace long-standing physical learning methods. In the healthcare field especially, where an in-depth education is an important part of becoming a trusted professional, the methods used for learning are important to ensure that future generations of physicians are knowledgeable and trusted. In particular, modern virtual anatomical models now have the potential to replace or greatly reduce the amount of time spent doing physical cadaver dissections in medical school. However, many medical schools have chosen to maintain the physical cadaver dissection curriculum, as the value of using a physical cadaver appears to outweigh the benefits of virtual models.

For the schools that have chosen to transition out of physical cadaver dissection, the virtual programs that are replacing it contain an intricate mix of virtual aspects. Using a combination of virtual reality, images from real ultrasounds and CT scans, and other digital replicas of organs, the virtual dissection program has a vast amount of information.1 Some medical schools are hesitant to turn away from physical cadavers, though, as there are various benefits that simply cannot be accurately replicated virtually. Aside from the fact that medical students usually value and look forward to the opportunity to use a real cadaver, there are certain tactile sensations that cannot be experienced without a physical dissection.2 Details such as body depth and the textures of organs and tissues are difficult to accurately observe when viewing a model through a two dimensional screen. Each cadaver is also a unique experience that comes with a natural slight variation in anatomy, and the cadaver dissection is even sometimes considered a doctor’s first interaction with a patient.1 Despite the obvious benefits of sticking to the cadaver dissection, there are other issues that often make virtual dissection appear as the more convenient option. Unlike physical cadavers that are physically cut open and manipulated, virtual cadavers have the ability to be reused as many times as needed, allowing students to go back for unlimited practice and undo any mistakes.2 Medical students from John Hopkins University have also testified that the experience of a physical dissection can sometimes be “desensitizing” in the sense that they are working with a real human body but do not get practice with patient interaction during the dissection.2 Practically, it is important to mention that cadaver shortages are not uncommon. The process of obtaining, preserving, storing, and burying cadavers is also a long and expensive process for medical schools, which begs the question of whether or not this money could be better spent in other areas of the medical school curriculum.3 Here at Rutgers, virtual anatomical models have been used since as early as 2018 in the School of Health Professions.4 Administrators of the program feel that these models help students to “visualize and better understand anatomy and lay the foundation for stronger skills in clinical medicine.”4 When the program was implemented, though, the virtual aspect was not implemented as a replacement for physical dissection. Instead, the program uses virtual models as supplemental material in addition to the cadaver labs.

Although there are several reasons that argue in favor of virtual models for convenience, there is still a certain appreciation from medical professionals towards the experience of cadaver dissection, as it can be considered a “rite of passage.”1 It seems that a mix of cadaver dissection and use of virtual models as a supplement, as done at the Rutgers School of Health Professions, may be the direction that most medical schools will work toward in the future. Students will still be able to physically feel structures in the body and use dissection tools to explore the body, while also having the opportunity to supplement this dissection with virtual references or practice resources. Most importantly, the goal should be to ensure a strong foundational understanding of human anatomy for future healthcare professionals.

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THE COVID-19 INTENSIFICATION OF HEALTH DISPARITIES IN AMERICA Prachi Lad

Disadvantaged communities across the country struggle with access to essential resources. Specifically, the disparities in health care access have proven to be life-threatening to these communities across the country during the COVID-19 pandemic. These individuals are at a higher risk of contracting the virus and cannot combat this risk due to less availability of health clinics where they live.

Throughout the pandemic, the vaccine distribution disparity amongst minorities became evident. During the pandemic, an increase in hospitalization has been seen for individuals in disadvantaged communities without access to healthcare resources. The CDC reports that African Americans have contracted COVID-19 at rates roughly 2.6 times higher than the average for Caucasian Americans and have 4.7 times higher hospitalization rates, which is consistent with an increased mortality rate.1 These rates are higher for African Americans due to increased exposure to COVID-19 in their living or working environments. To promote better vaccine distribution, vaccine facilities should offer accessible testing to those who do not have a primary care physician. Alongside lack of primary care, disadvantaged communities are less likely to have a health care plan, contributing to poorer health.

Along with vaccine distribution, the geographic location of disadvantaged communities contributes to medicine inequity.

African American and Hispanic communities tend to reside in areas that have been subject to a history of less investment.

As a result, the jobs available in these areas are industry businesses. Individuals who work in these jobs are subject to long hours in crowded spaces. Along with this, families in disadvantaged communities live off low incomes, thereby making every hour of work crucial for them. These conditions result in fewer resources, time, and effort allocated toward vaccinations.

This location distinction coupled with social determinants has led to vaccine disparities during the pandemic. Due to this disparity, the quality of health of these individuals has decreased. To measure these health conditions, a study done by Dr. Min Li, a quantitative sociologist, analyzed COVID trends in different neighborhoods in New York. The results showed that individuals who tested positive for COVID-19 and had higher morbidity rates lived in disadvantaged neighborhoods, such as the Bronx, Staten Island, and Queens. African American and Hispanic individuals, from those regions, tended to have poorer health conditions.2 The results exhibit that an increased risk of COVID-19 corresponds to geographic locations.

To increase accessibility to vaccines, Rutgers University’s Global Health Institute established the Equitable Recovery Program in 2021. This program focuses on creating pop-up clinics in neighborhoods with lower vaccination rates. These neighborhoods include the South and West wards of Newark and Esperanza of New Brunswick. These towns were predicted to have the most social disadvantage coupled with higher chances of infection. It is more difficult for members of these towns to receive vaccinations due to the inflexible work hours of many industrial jobs, language barriers, and no means of technology to find appointments/locations.3 The leader of the program, Arpita Jindani, explains how the program strives “to reach hard to reach populations” by setting up locations at “the heart of the neighborhoods.” Furthermore, Jindani explains how they are seeing an increase in the number of people who come to the clinics as of 2022, many of whom have already received their first dose of the vaccine. As seen by the Equitable Recovery Program, the disadvantaged population has been recognized and efforts are being made to assist with their vaccinations. These efforts will provide relief to those who are at higher risk for the virus, in hopes of permanently decreasing these risks.

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KEEPING OUR KIDNEYS IN CHECK: ESTIMATED GLOMERULAR FILTRATION RATE

Tulip Sengupta

Nowadays, when one buys something, the purchase almost always comes with a warranty to ensure that the item continues to work and that its quality does not falter. Similarly, in medicine, there are many metrics to check the quality of our organs and cells, and make sure that they work for our lifetime. One metric of particular interest is the estimated glomerular filtration rate (eGFR) which focuses on the kidney, an instrumental organ in the body that filters toxins in the blood and removes waste. Kidney function is crucial for one’s health in terms of preventing diseases such as chronic kidney disease and kidney stones.

The estimated glomerular filtration rate (eGFR) is used as a metric for the filtration quality of one’s kidneys.1 The eGFR is used to detect kidney disease, as the measurement is based on one’s serum creatinine levels and factors such as sex, race, and age. Creatinine is a waste product produced by the body which kidneys tend to filter out. The amount of creatinine in one’s body is a clear indicator of kidney function; therefore, serum creatinine tests are used 2 for the eGFR. As one’s kidney function deteriorates, their eGFR number decreases.

The eGFR formula was created in 1976 by Donald W. Cockcroft and M. Henry Gault and was based on male patients, with the intention of diagnosing chronic kidney disease (CKD). In the late 1990s, researchers incorporated a correction formula in the eGFR formula, which was based on race. The primary stipulation of the correction factor is that Black people have supposedly been observed to have higher creatinine levels than white people, so a 1.2 multiplier is used to calculate the eGFR for Black people.3 By increasing the eGFR, the multiplier causes one’s kidneys to appear to be higher-functioning and more efficient than they may be.

The use of a racial modifier in the eGFR formula is extremely controversial and debated in the medical community.

The racial modifier makes it so that two individuals with the same exact health status, sex, and age will have substantially different eGFRs, merely due to a difference in their race. This staggering difference can lead to an under-diagnosis of CKD in African Americans, which can have negative repercussions. As per a study in 2020, “when race wasn’t considered in eGFR, 743 out of 2,225 Black people with kidney disease (33.4 percent) would be reclassified to a more severe disease category.”4 This statistic exemplifies the potentially deadly nature of the racial modifier.

In 2021, Rutgers doctoral students published the research study, “Evaluation and enhancement of standard equations for renal function estimation in individuals with components of metabolic disease,” which studied various eGFR formulas, including the one devised by Cockroft and Gault. 5 The study found that more methods are needed to calculate eGFR, as all the methods studied had significant error. Now that Rutgers faculty have showcased the need for an updated formula for assessing kidney filtration ability, Rutgers students may be able to devise the formula themselves and employ it in their future careers.

Given that many concerns have arisen regarding the racial modifier in the eGFR formula, many organizations are attempting to take action and make reparations. Namely, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) have come together for the Joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases. In 2021, the task force released a report which proposed a new eGFR formula that disregards racial modifiers.6 The report also suggests considering cystatin C values when calculating the eGFR. They note that the outdated eGFR formula merely perpetuates health disparities, rather than working to rectify them. The new formula utilizes a blood test to calculate GFR and a urine test to calculate albumin to creatinine ratio, and completely neglects race in the calculations. The task force is working to spread awareness regarding the new tactic by sharing it with medical students and other healthcare professionals.

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Phantom limb syndrome, a peculiar phenomenon, is a condition in which patients experience sensations in a limb that has been amputated. With these sensations, however, can also come pain. In fact, 80% of amputees report feeling pain in their amputated limb — a pain that is incessant, unabating, and seemingly irremediable.1 This pain can come in many forms, such as sensations of cramping, aching, or burning. Phantom limb pain can be debilitating, and can severely impede a person’s everyday life. Therefore, the development of a new device by Ripple LLC, a neurotechnology company, has the potential to revolutionize the treatment of phantom limbs.2 Phantom limbs are caused by a reorganization in the somatosensory cortex, the area of the brain responsible for processing somatosensory information.3 The somatosensory cortex contains a map of the body, a sensory homunculus,

that represents each body part. But when a limb is amputated, the neural representation of that limb still remains in Bianca Battaglia

the brain. Over time, these neural connections in the area of the somatosensory cortex devoted to the missing limb undergo a rewiring, and the peripheral nerves in the residual portion of the amputated limb continue to transmit signals to these now cross-wired neurons. This discrepancy in the sensory feedback system, in which there is persistent and heightened neural activity in the corresponding area of the brain after amputation, leads to painful sensations in the phantom limb.4,5

Ripple’s device—which utilizes a peripheral nerve stimulation system to electrically stimulate the nerves in the stump of the amputated limb—aims to innovatively treat phantom limb pain while simultaneously acting as a prosthetic limb.

Specifically, this device will be used to treat people with amputations below-the-knee. In this peripheral nerve stimulation system, sensors on the prosthesis communicate with a sensor processor placed on the person’s leg and transmit information about its movement, force, and directionality. The sensor processor, in turn, interprets the sensory information and subsequently transmits signals to a nerve stimulator implanted in the patient’s leg. Then, the stimulator sends the message to the nerve cuff, a gadget that wraps around the nerve endings and stimulates the corresponding nerves in the leg to mimic the normal sensation. The cooperative communication between the sensor processor, stimulator, and nerve cuff creates a sensory feedback system that will provide controlled and consistent electrical stimulation, based on the prosthesis movements, and that will function to reduce the phantom limb pain. Dr. Jessica Schjott, an Assistant Teaching Professor in the Division of Life Sciences at Rutgers University, has high hopes for this novel technology. “This device may be able to provide the missing sensory feedback to the somatosensory cortex in the brain of someone with a missing limb,” she explains. 6 Current treatments for phantom limb pain include opioids or mirror therapy, among others. Opioids are not an ideal solution, as they are only effective in approximately 50% of patients and have adverse side effects, such as increasing the likelihood of addiction.7 And although mirror therapy has shown to reduce phantom limb pain in some patients, the results of this treatment method are largely mixed. Ripple’s next-generation technology thus poses an optimal new solution to the treatment of phantom limbs, while also providing the bonus of a functional artificial limb.2 In fact, this neural stimulation system is expected to provide better control of and increased sensitivity to the prosthesis, making it feel as if it were actually the missing limb. As such, a device like this would prove to be especially useful in the future, since researchers estimate that with a steady increase in the rate of dysvascular disease and diabetes, the number of people receiving amputations could rise to 3.6 million by 2050.

THE PHANTOM FIX Bianca Battaglia 10

If a surgical procedure had a 93% complication rate, would you get it done? Chances are, you wouldn’t take the risk.

Surprisingly, abdominal surgeries, one of the most commonly performed surgical procedures, result in complications at this frequency. Around 9/10 people who get abdominal surgeries, including C-sections, intestinal surgeries, etc. develop a complication known as abdominal adhesions. Though many cases are minor and don’t result in significant harm to the patient, there is an unmet need to develop a preventative technology to stop this complication.1 So what are abdominal adhesions? Abdominal adhesions are bands of scar-like tissue that form inside your abdomen, typically following surgery. The bands form between two or more organs or between organs and the abdominal wall.

Normally, the surfaces of organs and your abdominal wall do not stick together when you move. However, abdominal adhesions may cause these surfaces to become adherent, or stick together. Abdominal adhesions can kink, twist, pull, or compress the intestines and other organs in the abdomen, causing symptoms and complications, such as intestinal 2 obstruction or blockage.

Gnaneswar Chundi

Adhesions usually develop after surgery to the abdomen in particular because of the presence of multiple layers of organs and lining. This multi-layered anatomy is not present elsewhere in the body. Though abdominal adhesions develop in over 9 out of 10 patients, currently available adhesion prevention products are minimally effective. These products generally form only a physical barrier against adhesions and have undesirable properties, such as brittleness and the inability to function in the presence of blood.2 Rutgers scientists have recently taken steps to combat this problem. Researchers in the Rutgers Biomedical Engineering Department have developed and patented a device that can better prevent abdominal adhesions. They have developed novel biodegradable and non-toxic polyelectrolyte complex (PEC) films with anti-adhesive and antiinflammatory properties. These PEC-based films are strong and flexible and can be inserted postoperatively as a physical barrier between tissues and organs at the wound site. In vivo testing demonstrates that the PEC films prevent the formation of adhesions following surgery. Impressively, these films were also shown to be 5 times more effective than currently existing treatments in a comparative study.3 Explained simply, this device acts to prevent abdominal adhesions by inhibiting the attachment of fibroblasts, a type of cell that synthesizes collagen fibers. The device also inhibits the secretion of tumor necrosis factor alpha, an inflammatory cytokine that increases in concentration around the site of surgery. Furthermore, once the device has performed its function of preventing abdominal adhesions, which usually form within the first 2 weeks after surgery, it biodegrades harmlessly, eliminating the need for a procedure to remove the device. While other currently available products primarily use the mechanism of acting as a simple physical barrier between tissue layers, this device acts at a cellular level as well, amplifying its effectiveness.4 Dr. Noshir Langrana, the Principal Investigator for this project, explained that this solution was inspired by a negative experience one of his relatives had with abdominal adhesions following surgery. A biomedical engineer at heart, Langrana’s first thought after hearing the news was to research the current state of preventative measures for abdominal adhesions. He was “shocked to find that 0 viable options existed for such a prevalent problem,” prompting him to apply for grants to begin a new project at his lab. As of March 2022, the project is undergoing in vivo testing in mouse and rabbit models. Langrana believes that, should this project pan out by succeeding in this phase of testing, “the complication rate for abdominal surgeries could drop from 93% to 9%,” odds you may be more comfortable with.5 2

BATTLING ABDOMINAL ADHESIONS AT RUTGERS 5

Gnaneswar Chundi

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THE LIVING DRUG Mehwish Imran

The Centers for Disease Control and Prevention (CDC) has determined cancer to be the second leading cause of death in the United States.1 Undoubtedly, it makes sense as the disease has no cures and progressively becomes worse, leading to death if left untreated or the body fails to respond to treatments. However, a new “miracle” treatment is in clinical trials that show an increased survival rate in patients after being diagnosed with B-cell non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is cancer that begins in white blood cells called lymphocytes, which help protect us from infections and other diseases. The lymphocytes grow abnormally and attack the lymphatic system, causing the growth of tumors throughout the body. The development of tumors occurs when your lymphocytes don’t die and keep replicating, leading them to amass within the lymph nodes causing them to swell up. These lymph nodes can be noticed in your neck, armpits, or groin. Unfortunately, cancer can spread to other parts of your lymphatic system like lymphatic vessels, tonsils, adenoids, 2 spleen, thymus, and bone marrow.

Although the exact cause of non-Hodgkin lymphoma is unknown, certain factors can increase the risk of the disease. Certain infections such as HIV and Epstein-Barr both affect the immune system. Immunosuppressants, chemicals like weed killers and pesticides, and age increase the risk of development.3 Fortunately, there are currently approved treatments for nonHodgkin lymphoma. These include chemotherapy, immunotherapy, targeted drug therapy, radiation therapy, stem cell therapy, and surgery.4 However, even with all the treatment options, the disease can become resistant in some patients and lower the average survival rate to only six months.5 Fortunately, after the approval of Chimeric Antigen Receptor T-cell (CAR T-cell) therapy in 2017, patients with resistant non-Hodgkin lymphoma have an opportunity to live a cancer-free life. Only 38 states have access to CAR T-cell therapy. In New Jersey, the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital are the only institutes in the state with CAR T-cell therapy.

So, what is CAR T-cell therapy, and what is its impact? The patient’s T-cells, which help fight cancer, are collected in the treatment. Then, the T-cells are re-engineered to make unique molecules called chimeric antigen receptors (CAR). The special receptors allow T-cells to recognize malignant cells. The CAR T-cells are infused into the body to fight cancerous cells.6 This treatment is impressively effective. After twenty-eight days of treatment, approximately 82% of the patients showed a positive response, and half of them were in remission for six months.7 Dr. Dennis L. Cooper states that CAR T-cell therapy patients report “feeling good within a short amount of time as compared with stem cell transplant—sometimes within three to four weeks.”5 These promising results are only from the clinical trials. As more research is conducted on CAR T-cell therapy, the results will improve and potentially result in long-term remission.

Everything has its advantages and disadvantages. There are toxicities associated with infused CAR T-cell therapy, such as cytokine release syndrome (CRS). The severity of CRS can vary from mild to life-threatening complications, including fever, nausea, hypotension, organ impairment, etc. Although this may sound terrifying, CRS can be treated depending on its severity. A milder form of CRS is managed by supportive care, and a severe form is treated with corticosteroids.8 Toxicities shouldn’t scare you away from CAR T-cell therapy because all medications have dozens of side effects. Talk with your oncologist to choose the best treatment for your non-Hodgkin lymphoma. If you decide to enter a clinical trial for CAR T-cell therapy, you may understand why many patients call it a “living drug.”

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CHALLENGES AND ADVANCEMENTS IN BYPASSING THE BLOOD BRAIN BARRIER Rudra Joshi

Ever had a headache, a cut on your skin, or nausea? With modern technology and over-the-counter medications, treating your body with any ailments can be done easily. However, while modern medicines have created effective drug delivery systems to target specific tissues or illnesses, current drug delivery systems struggle to access one particular part of the body: the brain.

Such challenges to access the brain are often due to the blood brain barrier, which serves to protect the brain from potentially dangerous microorganisms, such as bacteria and fungi, from entering, growing, or inflicting any neurological damage to the brain. 1,2 The blood brain barrier’s ability to selectively allow certain solutes to permeate through the membranes and enter the central nervous system comes from its cellular composition. One of the primary classes of cells in the blood brain barrier responsible for maintaining the blood brain barrier’s function is the central nervous system's endothelial cells.3 In most cases, small molecules can easily diffuse through the cells or travel through a concentration gradient in order to travel across a semipermeable membrane. However, the central nervous system’s endothelial cells very selectively choose which solutes are able to pass through a membrane by creating specific transporter proteins: efflux transporters and nutrient transporters.3 Nutrient transporter proteins aid the movement of substrates across a membrane against the concentration gradient, allowing the blood brain barrier to control the number of ions and other macromolecules that are able to pass into the central nervous system while efflux transporter proteins prevent small molecules from easily diffusing through the membrane.

Through these concerted protein interactions, the blood brain barrier effectively prevents lethal solutes, such as bacteria and infections, from entering the brain.

While the blood brain barrier serves a vital role in protecting our brains from potentially toxic products in our body, it also becomes a hindrance in our efforts to deliver specific drugs to the brain to treat potentially lethal neurological illnesses such as Alzheimer’s disease and glioblastomas. Indeed, there are current therapies used in the clinical setting to bypass the blood brain barrier. One such potential therapy is hyperosmotic disruption, where a patient receives doses of chemical agents such as arabinose and mannitol, which effectively increases the permeability of the blood brain barrier and allows for macromolecules or chemotherapy treatments to enter a patient’s central nervous system. 4 However, prior studies have demonstrated that such treatments pose several risks for complications among patients who receive such treatment. As a result of the hyperosmotic disruption, other potentially chemical agents formed in the body, such as albumin, which are toxic to the brain, are able to permeate through the blood brain barrier and inflict potential neurological damage.4 It remains clear that while the current therapies to bypass the blood brain barrier allow clinicians to effectively deliver drugs into the central nervous system, such therapies pose several health risks to the patient in the long run. As a result, the biomedical communities are currently searching for other potential ways to treat a patient’s neurological condition without breaking the blood brain barrier and compromising the patient’s overall health. Since many of the neurological conditions physicians see involve some deficit in the neural conditions in the brain, several biomedical engineers are creating devices that could allow them to control certain neurons in regions of the brain. For instance, at the Rutgers Biomedical Engineering Department, Dr. Jay Sy’s lab is currently working on creating a device that can be implanted through the skull into the brain and effectively firing certain neurons in specific regions of the brain. Rather than breaking the blood brain barrier in order to deliver a specific drug, Dr. Sy’s lab intends to create a device that can have direct access to the brain that can connect to the neurons, like a circuit, and activate neurons associated with a particular psychiatric disorder. Connected to a computer interface, the device can effectively provide direct information regarding the patient’s neuronal activity and determine whether to excite or deactivate specific neurons. With this automated activation, this device can effectively provide deep brain stimulations that can improve a patient’s neurological activity in the long run.

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THE IMPORTANCE OF CPR TRAINING 3

Anjali Patel

In the United States, the most common cause of death is heart disease, which often leads to cardiac arrest.

Unfortunately, over 350,000 cardiac arrests occur outside of the hospital each year, with around 90% of these patients dying.1 There is an emergency life saving procedure—cardiopulmonary resuscitation (CPR)—that can double or triple the chances of survival if performed immediately after a cardiac arrest.1 A bystander can quickly begin to perform CPR if they witness someone collapse and their heart has stopped, greatly improving the patient's chance of survival. Learning how to perform CPR is relatively easy, and therefore increased public knowledge would help to reduce the death rate for cardiac arrest.

A study conducted in collaboration with CARES Surveillance Group and the HeartRescue Project aimed to understand the factors that underlie regional variation in out of hospital cardiac arrest survival. Only around 34.4% of patients received bystander CPR when they suffered an out of hospital cardiac arrest, and only 9.6% of 2 patients survived to discharge. There are also significant disparities in patients that do receive cardiac arrest.

Odds of receiving bystander CPR were 51% lower if the patient was in a low-income black neighborhood than a high-income white neighborhood.2 Therefore, improving rates of bystander CPR in communities that have lower rates will improve overall survival outcomes and reduce existing racial disparities in out-of-hospital cardiac arrest survival.

It is important to emphasize that CPR not only saves lives, but also helps with neurological recovery for patients post-survival. A study conducted in Korea shows that the largest improvements in good neurological recovery were seen in counties with the highest density of CPR training. 3 They worked on implementing a public education and advocacy campaign to increase the number of individuals trained in CPR and narrowed the differences in bystander CPR rate between highest and lowest density CPR-trained counties, helping to improve neurological outcomes.3 Unfortunately, there is a lot of hesitation surrounding CPR use. Bystanders may be reluctant to perform CPR due 4 to fears of inadequacy and worry about causing additional injuries. Many people are also afraid of performing CPR on women due to the need to remove the woman’s shirt. 4 These negative perceptions can be improved with improving CPR knowledge and helping the general public gain confidence in their skills.

There are many resources available for people to learn CPR and improve their skills. Many local first aid squads have classes, oftentimes free of charge. The American Red Cross also has classes available at a slight charge.

Thirty-nine states also have mandatory CPR training in high schools as a graduation requirement.5 At Rutgers University, there is an organization called MedicZero that strives to enable bystanders with the confidence to recognize emergencies and initiate care.6 They provide first-aid education, like hands-only CPR, stroke recognition, bleeding control, and opiate-overdose reversal to students, providers, and community members.6 So far, they have trained over 600 bystanders through CPR training events in schools, churches, parkes, and other public locations. 6 Programs like these help to empower the community and improve rates of CPR intervention and cardiac arrest survival for patients.

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Coronavirus disease (COVID-19) has rampaged its way through the world, disrupting generations of humanity. It is imperative that we prepare ourselves for future pandemics, especially after witnessing the devastating consequences that a lack of preparedness can result in. Key areas that require improvement include the production and manufacturing of PPE, vaccines, and essential sanitary products required during a pandemic; the re-evaluation of public health education in order to effectively inform the public on changing circumstances and expectations; and investment in infrastructure that facilitates the rapid mobilization of public health and relief resources.

The COVID-19 pandemic has revealed that the supply chain of healthcare is strikingly deficient. The Mason County Public Utility District explains that, “we have seen a raw material shortage, global semiconductor chip shortage, transportation logistics issues, unexpected shutdowns at factories and other areas of project pipelines due to COVID19 such as outbreaks and labor issues”. 1 The delay in initiating rapid production and dissemination of masks, tests, and other materials greatly contributed to the large number of people who have been affected by the virus globally. This combined with the fact that the coronavirus disease removed workers from factories resulted in a downward spiral and thus, major supply chain failure. Now, new steps are being taken to combat these issues. The US government accountability office explained that, “additional DPA and other actions are expected through 2025, using $10 billion in the American Rescue Plan Act for medical supply investments in order to strengthen the domestic medical industrial base”. 2 The US is now investing in its health, spending billions of dollars revamping the healthcare supply chain, and this must continue for the betterment of the people.

It is imperative that we have enough people to continue educating the public. Measures being taken include “increasing efforts to communicate clearly, taking into consideration the cultural perspectives of responses to epidemics/pandemics, increasing scientifically accurate information and for technology companies to react more responsibly in relation to health communication and education”. 4 A major issue with the ongoing COVID-19 pandemic is the spread of misinformation as well as vaccine hesitancy. Rutgers professor Mark Robson says, “There needs to be a national policy on who gets vaccinated and why everyone should get vaccinated”. 5 A united front, with a consensus between the government policy, scientists, and doctors, will allow for a straight-forward, reliable message to be heard from the public.

The importance of taking swift action during a crisis cannot be overstated. With this, a committee created by the World Health Organization (WHO) explored the reasons for the delay in responding to the pandemic. It took almost 11 weeks to describe the COVID-19 outbreak as a pandemic, which was “weeks after the coronavirus had begun causing explosive outbreaks on numerous continents”. 6 It is blatant that the world did not act swiftly: the WHO is holding itself accountable for not acting decisively. The Council on Foreign Relations claims that “The sooner health authorities know about a novel event, the more quickly they can mount an effective response”. 7 If countries are able to detect a virus early through a new, integrated system of patient info, they will be better equipped to eradicate it in a timely manner, which will minimize the amount of lives it affects.

Aspects including the healthcare supply chain, public health education, and swiftness of action need to be reevaluated in order to ensure that a future pandemic does not devastate the world as severely as the COVID-19 pandemic has.

The pandemic has also revealed an astonishing gap in public health education. An article from the Columbia University Department of Education explains, “With 22 percent of government public health workers planning to retire by 2023, workforce losses are expected to worsen”. 3 As one can see, there will be a glaring shortage of educated professionals to reliably inform the general public on healthcare matters.

PREPAREDNESS FOR FUTURE Jay Kavia PANDEMIC 16

RISING TEMPERATURES AND DECLINING HEALTH Nila Uthirasamy With every year that passes, we run the risk of no longer having an inhabitable planet. The data shows, that the top ten warmest years in history have occurred after the year 2005. 1 In fact, heat waves happen, “three times more often than… in the 1960s” and the heatwave season is lasting longer than before. 1 As the Earth continues to get warmer, populations will face severe fires, droughts, and storms. 2 However, it is important to realize that climate change’s impacts are not limited to just the weather. Changes in the climate are directly and indirectly impacting human health. While scientists and professionals in the field state that climate impacts could be limited if the global temperature rises no more than 1.5 degrees Celsius (C), we are currently projected to reach an increase of 2.7 C by the end of the century. 2 Research has shown that these rises in temperatures have lasting consequences affecting various facets of human health. One particular aspect of importance is the rise in water-related illnesses. This is a key issue because one in three people around the world already lack access to safe drinking water. 3 Climate change exacerbates this problem by increasing rain and storms which lead to runoff and flooding that contaminate water used for drinking and agriculture.4 Furthermore, the change in water temperatures introduces new water pathogens to areas that were previously pathogen-free. 4 As a result of these consequences, individuals are more likely to experience “gastrointestinal illness like diarrhea, effects on the body's nervous and respiratory systems, or liver and kidney damage.”4 Air pollution is also a major concern as ground-level ozone, which makes up smog, is predicted to increase. This pollution effects an individual in many ways such as increasing hospital admissions due to asthma and premature deaths.5 The increase in temperatures across the world is causing more particulate matter and ozone pollution, 5 which has an associated health cost of $6.5 billion.

However, it is not just one’s physical health at risk. Disasters have been shown to increase mental health problems. 6 In fact, after Hurricane Katrina, individuals affected by the disaster had high anxiety and posttraumatic stress disorder.6 As climate change worsens and extreme weather events become more likely, more individuals’ mental health will be affected regardless of whether they have a history of mental illness. This is particularly concerning since these individuals are also more vulnerable to heat, which has been correlated with an increase in suicides and hospitalizations. 6 However, climate change does not impact everyone equally. The Associate Director of the Rutgers Climate Change Institute, Dr. Kaplan, notes how there are “factors that exacerbate these [climate change] impacts that influence individual vulnerability such as age, disability status, and inequalities associated with race, immigration status, gender, and ethnicity that contribute to disproportionate vulnerabilities among marginalized populations.” 6 Therefore, it is important to find ways to mitigate climate change and advocate for better policies to protect those who are most vulnerable while working to save our planet. The first important step is to educate yourself and others on what climate change is and how its consequences can change people’s lives. Our university embodies this goal of spreading awareness through the Rutgers Climate Change Institute which is “a University-wide effort to address one of the most important issues of our time through research, education, and outreach.” 7 Scientific data shows how climate change has far-reaching consequences which impact our health and livelihood. Though we as humans are responsible for rising temperatures and the uncertain fate of our planet, we also have the power to rally together and be the voice for those disproportionately facing the consequences of climate change.

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ALZHEIMER’S DISEASE: IS THE CURE CLOSER THAN WE THINK? Mallika Ravi

For nearly six million Americans, the crippling effects of Alzheimer’s disease (AD) extend far beyond their own personal pain. The lack of treatment options and the toll that AD takes on their loved ones only compounds their grief, hopelessness, and sense of loss. The number of people experiencing this loss is growing, as the Center for Disease Control estimates the number of people affected by AD to triple by 2060.¹ These staggering figures have contributed to a sense of urgency on the part of researchers to gain a better understanding of this disease and how to cure it.

Alzheimer’s disease is the most common form of dementia, which is a broad term for severe neurodegeneration (loss of brain cells). As of now, there are a few known symptoms of dementia: cognitive impairment, disorientation, and loss of daily function. Most Alzheimer’s cases are late onset; those affected will not start displaying symptoms until they’re aged 65 or older. While researchers have yet to find a genetic cause, it is believed that Alzheimer’s has a complex combination of causes involving multifactor genetic and environmental interactions.² The next question facing researchers is how to treat this disease. Enter the controversial, yet all-too-powerful stem cells. The development and introduction of stem cells into clinical research is an important step in the discovery of a cure for Alzheimer’s. This is because stem cells possess the capacity to regenerate any cell type within the human body, known as ‘pluripotency’. In the case of dementia, stem cells could potentially repopulate the brain with neuronal cells that have been degraded and reverse the loss of function symptoms.

There are several types of stem cells, but researchers must pick the right ones for the specific types of treatments.

There are embryonic stem cells (ESCs), which are derived from a human embryo and are pluripotent. Multipotent stem cells, stem cells which can differentiate into cells only in the same germ layer, include mesenchymal stem cells (MSCs) and brain-derived neural stem cells (NSCs).

The controversial aspect of ESCs lies in the fact they must be obtained from human embryos. However, in the past decade, scientists have developed an alternative to ESCs: induced pluripotent stem cells (iPSCs). These are stem cells with similar differentiation capacities as embryonic stem cells; however, they are not obtained from human embryos. Instead, they can be found in adult somatic (body) cells and mature in vitro (in a dish). iPSCs have been used to model a variety of neurodegenerative diseases, and these models can shape the treatments that people receive. For example, the fibroblasts of people who have familial Alzheimer’s disease (FAD), an early-onset genetic form of Alzheimer’s, have been used to discern which mutations they have in common.3 After being extracted from the fibroblasts, these stem cells were differentiated into neurons and studied. It was found that these FAD-derived neurons had higher amyloid beta-42 secretion, a type of plaque which forms on the brain. This model allows researchers to create a molecular basis for FAD and tailor treatments accordingly.

Peng Jiang, a researcher utilizing stem cells to investigate brain diseases at Rutgers’ Cell Biology and Neuroscience department, explained the aspects of AD that make it a challenging disease to study: “The unique part of Alzheimer's Disease is that we do not quite understand the mechanism of why the neurons are dying, and there many other types of cells that die as well. This cell death takes decades, so researchers are still trying to understand what’s going on during those three to four decades.” 4 He added that the general technical difficulty of stem cell therapy is how to deliver stem cells to a human brain without the body’s immune system rejecting this cell transplantation. Human iPSCs may circumvent this though, because researchers are also concerned about the implantation of stem cells potentially causing brain tumors.

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The ever-evolving technology for stem cell research should be a cause for optimism for researchers and patients alike, as each innovation brings society closer and closer to curing this disease.

Following an experimental stem cell transplant procedure, a woman has gone over 4 years without detectable levels of HIV (human immunodeficiency virus) in her system.1 Deemed the “New York patient,” she is the fourth person, and first woman, to potentially be cured of HIV, marking a significant milestone in progress towards finding a cure for HIV/AIDS. HIV is a retrovirus that targets and alters the immune system, increasing the risk and impact of infections and illnesses such as cancer. Without treatment, the virus can progress to an advanced and life-threatening stage called AIDS. Currently there is no effective cure, but infected individuals can control HIV symptoms with proper medical care. Approximately 1.2 million people in the U.S. have HIV, and roughly 13% of this group are unaware of this and need testing.2 While antiviral drugs can control HIV, this alarming number highlights the need for a cure for HIV and the importance of breakthroughs such as the New York patient.

Gnaneswar Chundi

The New York patient was diagnosed with HIV in 2013 and leukemia in 2017, and received treatment at New YorkPresbyterian Weill Cornell Medical Center in New York City.3 She was one of 25 HIV-positive participants that underwent a cord blood stem cell transplant aimed to treat cancer and other underlying conditions. The woman underwent a haplo-cord transplant, which consists of a combination of two transplants: first a transplant of, “umbilical cord blood that contained the HIV-resistant genetic mutation”, followed by a transplant of adult stem cells carrying a specific mutation.4 The objective is to treat both the cancer (or other underlying health condition) as well as the HIV by essentially destroying and replacing the patient's immune system. Since this procedure is associated with serious potential side effects, it is only being used on patients that are already suffering from other fatal conditions like cancer. Scientists hope to eventually expand the pool of people who receive similar treatment to several dozen annually.

While this treatment marks a major breakthrough in HIV/AIDS treatment and stem cell research, there are a few concerns that need to be addressed before it can be further distributed. To begin with, given the high risks associated with this procedure there are some concerns surrounding the ethics of it. Specifically, experts have stressed that it is unethical to attempt to cure HIV via a stem cell transplant in anyone that does not already have a fatal disorder such as cancer.5 As a result, this effective but potentially lethal procedure is not feasible for the majority of people currently living with HIV. This is because other treatment options with less risks are available; however, these are only effective in controlling virus levels in the body whereas the stem cell treatment method serves as a cure. Thus, further research on HIV is needed in order to come up with treatment strategies that are safe and can cure HIV in a wider range of patients. At Rutgers University, Dr. Eddy Arnold is currently conducting research to understand molecular mechanisms of drug resistance and apply structure-based drug design for the treatment of serious human diseases such as HIV. Most notably, Dr. Arnold’s lab focuses on investigating the structure and function of reverse transcriptase (RT), an essential component of the AIDS virus and the target of most widely used anti-AIDS drugs.6 Recently, Dr. Arnold participated in a structure-based drug design effort that resulted in the discovery and development of non-nucleoside inhibitors with high potency against all known drugresistant variants of HIV-1 RT. This work offers great promise for future drug-based treatment for HIV infection.

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BREAKTHROUGH TREATMENT CURES WOMAN WITH HIV

Eman Shamshad 19

CLIMATE CHANGE: DEFROSTING VECTOR-BORNE DISEASES Reem Esseghir

Climate change is defined by the United Nations as “longterm shifts in temperatures and weather patterns.”1 Certain shifts may be the result of natural changes such as progression through solar cycles, but increased industrialization in the past two centuries has contributed to the alarmingly rapid acceleration of climate change.

Greenhouse gas emissions associated with transportation and industry generate a “blanket” around the Earth, trapping heat from the sun and increasing global temperatures. This global warming contributes to not just higher temperatures, but more acidic oceans, reduced food production, poorer air quality, and even the evolving nature of vector-borne infectious diseases. Changes in the prevalence of vector-borne diseases present a unique challenge to the international community, as future trends are difficult to predict and susceptible to the volatile nature of global climate shifts.

A vector-borne infectious disease is one “that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas”, with a vector being said insect that acts as a vehicle for disease transmission. These diseases include malaria, Lyme disease, and West Nile Virus.2 In general, such vectors thrive in warmer and wetter climates, increasing their opportunities for breeding and feeding. Increased precipitation and rising sea levels thus create conditions that allow them to thrive. Furthermore, as temperatures continue to rise, mosquitoes and other vectors will migrate to higher latitudes and altitudes, increasing their abundance in regions that are not normally exposed to such diseases.3New vector-borne diseases may also emerge as vectors adapt to and thrive in harsher climates created by the changing climate, giving rise to a host of new illnesses for the medical community to address.

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However, climate change may also have an inverse effect on vector-borne diseases. One of the leading agents of climate change is deforestation, in that it increases the concentration of carbon dioxide in the atmosphere. With the deforestation of acres of trees also comes the destruction of habitats that many disease vectors, bacteria, and parasites thrive within. Thus, it is expected for the prevalence of some of these agents, such as Borrelia burgdorferi, a spirochete transmitted by ticks, to decline.4 Ticks rely on the deer population as their hosts, which is expected to decrease in numbers as a result of deforestation.

Thus, the trends in relation to vector-borne disease are not clearly defined or known, underscoring the importance of action against climate change and better public health preparedness. It is also crucial to note that the trends discussed are not applicable to all vectors or vector-borne diseases. According to research being conducted at the Rutgers Center for Vector Biology, there is great variability in the patterns of transmission and intensity depending on the region. Specific insect populations react differently to temperature changes, and thus global temperature changes cannot be general indicators of vector-borne pathogen trends. Instead, one must consider insect genetics and population specifics as well.5 Hence, as research continues, it is important that we consider changing environmental conditions holistically and with respect to regional differences.

Shruthi Nandakumar

The modern world has become dependent on plastic for every need, whether it be single use packaging for foods, storage containers for a myriad of products, and electronics. 1 It is almost certain that every single person is in near constant contact with plastic. Current plastic materials break down into smaller particles creating microplastics which pollute our environment. Even the act of manufacturing plastics releases more of these substances into the air, which leads to inhalation of microplastics. When these minute particles get into soil and water supply, microplastics find their way into plants, or the 2 animals that eat those plants, and eventually are ingested. With the prevalence of plastic everywhere, the question arises as to whether plastics pose health risks.

It is known that most plastic, which comes from fossil fuels, contains toxic materials such as bisphenol A, phthalates, styrene, and vinyl chloride.4,5 Bisphenol A(BPA) is a widely used material in plastics and resins, as well as receipts. Phthalates are chemicals that are used in plastics in order to make the material softer and more flexible. They can have a variety of uses, from clothing, in order to make clothes durable, to construction, used in roofing and insulation.4,13 Styrene is also a chemical used in plastic production, specifically latex and packaging. These products have a wide range of applications — from tools used in healthcare to packaging for food, styrene is found virtually everywhere. Vinyl chloride is a material used to make PVC, a reliable plastic that can be found anywhere.14 Studies have shown high levels of BPA remain in the blood, even after fasting for a day. Microplastics have even been detected in 80% of those tested in a study.¹⁰ Currently, it is known that BPA and phthalates are an endocrine disruptor, which means that they can negatively affect the endocrine system. This can lead to developmental disorders, cancer, and other reproductive and hormonal disruptions as well as larger health problems like ADHD, Parkinson’s, and Alzheimer’s.15 BPA, in particular, has also been linked to abnormalities in the development of children, as well as diabetes.7, 10 Exposure can lead to irritation and gastrointestinal issues in the short term. Extended periods of exposure to styrene affects the central nervous system leading to symptoms from headaches and fatigue to depression and hearing loss.⁶ Vinyl chloride in PVC is a known carcinogen linked to liver cancer. With the pervasiveness of plastic use, it is certain that these health risks have an impact on our lives.

It is unrealistic to completely stop using plastic, as it is cheap to manufacture and purchase, and is the easier option.

However, it is certainly possible to reduce the use of plastics, specifically those with harmful chemicals. For example, plant based, biodegradable materials have become more popular. Shifting towards a safer, harmful chemical-free alternative can be extremely beneficial in terms of health.

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HOW RELIABLE IS YOUR FAVORITE MEDICAL DRAMA? Cielo Tumbokon

“The Pan-scan showed his spine, chest, and belly were clear, however his head CT showed diffuse bilateral parenchymal bleeding”. In short, there is a well spread bleed in the patient’s brain. This quote from an episode of a popular medical drama, Chicago MD, will leave both the patient as well as the majority of the audience perplexed. While these are real medical terms, physicians and patients on television are seen time and again showing improper conduct in a hospital setting. Unrealistic scenes that are added in for dramatic flair could potentially alter an audience’s perception of physicians and hospitals in general. These misguided preconceptions are to the detriment of the viewer.

In Grey’s Anatomy, Richard Webber, the chief of surgery, went against a patient’s signed “do not resuscitate” (DNR) order and began cardiopulmonary resuscitation (CPR) to revive him.1 CPR is administered when a patient’s breathing or heart rate has stopped in order to provide oxygen still present in the bloodstream to the brain. A DNR is a binding legal document written by the physician and signed by the patient that states that in the event of cardiopulmonary arrest, the patient does not wish to undergo CPR. There are multiple reasons why one would choose to sign a DNR including their quality of life would suffer due to permanent damage to the brain or other organs or death is to be expected soon. This is commonly the case when it is seen as causing more harm to revive the patient. It concerns mainly elderly people and persons with a terminal illness where a natural peaceful death is preferred.2 Scenes like this could mislead the audience into believing a physician is commonly unethical and inconsiderate.3 In reality, every patient has a right to bodily autonomy and their requests must be respected by the practicing physician unless exercising the right interferes with their nonmaleficence oath. A study polling 170 subjects shows that 40.79% of respondents watched medical TV shows primarily because of medical scenarios.3 It is important to understand the implications of spreading false information to viewers, mostly because those who constantly watch medical TV shows are more inclined to jump in and help.2 To the dismay of the rescuer, a TV show’s portrayal of immediate CPR survival rates are double that in real life.4 Television is a major source of information and underestimating what it takes to save a life may leave the prospective rescuer ill-prepared.

To those that are not deterred by spurting arteries and devastating deaths, medical dramas might spark a viewer’s interest in the medical field. But should they devote years of their lives based on a show that doesn’t accurately depict life as a healthcare provider? Of 126 Rutgers students polled, 25.39% of Rutgers students admit to using medical dramas as their primary means of obtaining information about the experience working in a hospital setting. Other methods include in-person experience (i.e. shadowing a physician/volunteering/job) (26.19%), through friends or family (14.29%), online from actual doctors (18.25%), clubs and organizations (9.52%) and other modes (6.35%). Having a reliable source is key when planning a career path is the most effective way to assess whether the medical field is right for you. While providing insight into the life of a M.D., plot lines littered with inaccuracies alter expectations about what being a doctor is really about.

Many pre-medicine college students turn to medical dramas as a way of obtaining crucial information they may need in the future while also finding enjoyment through leisure. Primary sources such as surgeons and physician podcasts, YouTube videos, etc., are a better way of obtaining accurate knowledge about the healthcare industry. The next time you settle down to binge your favorite medical drama, ask yourself if you should be taking the word of a doctor that has never had a bad hair day.

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MEDICINE'S COMMITMENT TO PEOPLE Nidhi Gourabathuni

It is important that medical schools work to improve diversity and inclusion education to improve the health care provided by the next generation of physicians, as they diagnose and treat patients of various demographics and backgrounds.

Healthcare providers must continue to renew our commitment to the community. By understanding the importance of crosscultural education, diversity within medical schools, and differences in quality of medical school education as a result of diverse backgrounds, we can better combat these issues and become better providers.

According to several studies, it is vital that we recognize “the importance of cross-cultural communication… as a means of eliminating racial/ethnic disparities in health care.”1 Otherwise, this will lead to “poor communication between providers and minority patients, minority patient mistrust, and stereotyping of minority patients by providers.”1 This lack of communication can only lead to insufficient care and care that doesn’t acknowledge the patient as a human being. Patients of different races can also exhibit a range of different symptoms of varying intensities for specific illnesses, and providers must be aware of how they present in different patients. However, “approximately one in five residents indicated that they possessed low skills in this area.”2 Melanoma is a common condition whose survival rate is based on the stage at which it is first diagnosed. In these cases, “in comparison with the general population, persons with skin of color continue to have more advanced stages at the time of diagnosis, lower survival rates, and generally poorer outcomes.”1 This is usually due to a lack of knowledge of the disease-related symptoms across a range of races and ethnicities.

There are many factors that affect the way that medical education has changed and is continuing to change. These can include generational issues, high debt, loss of economic diversity, inadequate ethnic/racial diversity, and delivering justifiable rather than “indicated” care that greater benefits the patients’ needs and current state. 3 The lack of diversity in educators greatly affects future medical care in a country as diverse as the United States. It affects one’s commitment to the various perspectives and skills needed to create healthcare that benefits a greater number of people.4 Patients respond better to healthcare professionals when they see themselves

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represented in the industry, and medical schools must be prepared by creating opportunities for a diverse background of students to learn and affect diverse communities.

Researchers at West Virginia University conducted a study that discusses how the training in a rural environment affects the quality of education. The study shows that rural areas have 5 sustained a continued shortage of primary care physicians.

There was no statistical difference in training among rural, community, and academic settings within this family medicine clerkship. This is important because it provides statistical evidence that reveals the adequate quality of education given in a rural environment. However, there are certain limitations to the study. For example, the experiment was conducted at a single medical school.5 Another study also discussing that significance of rural medical education stated that “fourteen of the 17 studies support positive effects of partially rural medical education on the production of rural doctors” and that “those who attended rural campuses are more likely to practice in non-metropolitan areas than those who attend the city campus of the same university.” 6 The place of education for physicians many times reflects where and what they choose to practice.

It is beneficial for us to learn about how our neighboring medical schools are working to educate and train the next generation of providers. At Rutgers Robert Wood Johnson Medical School, students focused on integrated care delivery and used the expertise and opportunities available to focus on health equity issues. When implementing this form of learning, Senior associate dean for education and academic affairs at Rutgers RWJMS Dr. Carol A. Terregino states that “the launch of the value-added roles for the first-year students has led to increased community organization engagement and a tangible way for students to understand health care structure and process, population health and the social determinants of health.”7 It is necessary to understand the significance of diversity and how medicine can change between communities. Medical schools need to be training and educating their students not only about various conditions and how to treat them, but how to mitigate racial, regional, and ethnic diversity within the healthcare field.

THE LASTING BURDEN OF POSTCOVID CHRONIC DISEASE Medha Satti

As we near a potential light at the end of a very dark tunnel, the feeling of normalcy is met with excited anticipation. Can we really put the COVID-19 pandemic behind us? Research suggests that maybe we shouldn’t be so quick to doff our masks. The long term effects are likely to last for a long time to come. Early statistics from 2020 show that of all patients hospitalized for COVID complications in New York and China, almost 30% developed some form of kidney disease.

Nephropathy, more commonly known as renal disease, is the deterioration of kidney function. 1 Nephropathy may be directly linked to pre-existing conditions such as hypertension or diabetes. In the cases presented in the early statistics, the majority of patients had abnormal levels of protein in their urine and blood work.2 The trend appears to be that if a patient with diabetes or hypertension contracts COVID, there is a significantly higher chance they will develop renal dysfunction, but there have been anomalies of patients without pre-existing comorbidities that have developed nephropathy.

As shown in a study done by Bouquegneau et al. (2021), there could be a multitude of reasons for why COVID-19 may exacerbate kidney-related dysfunction: a lack of oxygenation brought on by respiratory problems that leads to kidney malfunction, SARS-CoV-2 targeting kidney cells, COVID-19 causing blood clots that block kidney vessels, and the body’s immune response to COVID-19 that damages kidney tissue.3 While this research provides more insight into secondary problems, the issue of how to treat nephropathy remains.

Although doctors are confident in the ability to tackle treatment for acute renal disease (which is most likely because patients who develop this disease do not have comorbidities), chronic nephropathy is more difficult to treat.1 With a lack of equipment and beds for secondary-infection hospitalization, chronic illnesses like nephropathy are creating a serious burden for healthcare providers. For the patients themselves, lower-class families are associated with higher hypertension and diabetes rates, which means there is a higher chance of developing a chronic condition.4 Therefore, the emotional and financial burden of sustained treatment for long-term nephropathy prove to be a significant upcoming problem for lower- and middle-class families who cannot afford expensive, but necessary medication and dialysis.5 According to Pockros et. al (2021), the cost of dialysis can range from $40,000 to $90,000 annually in the U.S. Although Medicare and Medicaid help cover this cost, families may still be expected to pay up to 20% of the treatment cost. 6 It goes without saying that the far-reaching effects of COVID-19 will be present for years, if not generations, to come.

Amongst these impacts, the pandemic may have left our world more prone to developing chronic diseases like nephropathy. Rutgers and associated NJMS (Center for Proteomic Research) are conducting a large-scale clinical trial to 7 identify the immune system’s response to COVID and its subsequent effect on the kidneys. In turn, continued expensive treatment for chronic diseases threaten to widen the pre-existing socioeconomic divide.

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MUSIC AS A DRUG Esha Paghdal

Music has trickled its way into becoming omnipresent in human life. Our interactions with sound provide joy, enjoyment, and emotional fulfillment, but has it ever occurred to you that this enjoyment could be compared to one that is offered by drugs?

For humans, music is an intense pleasure stimulus similar to food, psychoactive drugs, and money. The pleasurable emotions induced by these stimuli are a result of the dopamine release pathway inside the brain. When a subject listens to music that gives them “chills”, this sensation is considered an indicator of a peak emotional response to music and an increase in dopamine activity. 1 Dopamine is a neurotransmitter in the brain that is released when expecting a reward and is significant in the “regulation of pleasant experiences and motivation to behave in certain ways.”2 With music specifically, the most intense emotional moments are associated with dopamine release in the right nucleus accumbens (NAcc) in the ventral striatum of the brain, which is a region that has been implicated in the euphoria associated with psychostimulants such as cocaine. 1 Music is also similar to psychostimulant drugs in the sense that the anticipation and prediction of the reward changes the dopamine response in a similar manner. As the reward of either music or drugs becomes better predicted and associated with a specific context, the dopamine response shifts to the dorsal striatum region from the ventral striatum region. Furthermore, in the same way that psychostimulant drugs induce a state of euphoria, or a “high”, music may also have the same effects due to the similarities found in the dopamine pathway. A recent study done by McGill University selectively blocked opioids in the brain.3 The researchers then measured the participants’ responses to their favorite music or song and found that they no longer elicited the same feelings of pleasure that they normally associated with the music.3 This was one of the first demonstrations of the connection between the pathway that opioids take to give the feeling of a “high” and the brain’s natural opioids that are responsible for the same effect via music.

All of this prompts the following question: if drugs and music are so similar, is it possible that one may become addicted to music in a similar manner that many become dependent on drugs? In general, the answer is no, but music often tends to distract one from important tasks or unwanted feelings that one may encounter, so overindulging can lead to negative consequences. Particularly in relation to addiction behavior, some studies have found that 43% of 143 people receiving treatment for substance use disorder connected a specific type of music to a greater desire for substances.4 This, however, does not necessarily mean that listening to music only has negative effects in relation to substance addiction and abuse.

In fact, it has also been shown that music therapy can aid with drug addiction. Music has been studied in multiple therapeutic settings to manage anxiety and stress with positive effects.5 In one particular study, it was found that participants who received music therapy demonstrated greater improvement to drug dosage than those who did not receive group music therapy.5 Another Rutgers University School of Nursing study assessed the ESAS score—a symptom scale measuring pain, shortness of breath, level of energy, drowsiness, nausea, etc.—of palliative patients before and after virtual music therapy sessions and found a significant decrease in the scores.6 This pointed to the necessity of using music therapy as a possible solution that could improve one’s mental and physical wellbeing.6 Given the many mental and physical causes of drug addiction, this study goes to show that music therapy could possibly even prevent the onset of substance abuse and addiction before it occurs by focusing on the source of the problem. Thus, as a whole, music has been found to have a multitude of similarities to drugs and the way that they affect the human body. These similarities beg the question of whether or not music could truly be considered a drug, and the answer is still up for debate to this day.

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IMMUNODEFICIENCY AND THE HUMAN BODY: A PUSH FOR RARE DISEASE Heather O'Donnell RESEARCH Imagine being a parent of a child who will die before the age of 25 and will never grow up to attend college, pursue a career, get married, and have a family. Imagine watching your child slowly lose the ability to read, write, talk, walk, and play. Imagine watching your child face a higher risk of infections and cancers, especially leukemia and lymphoma.

This is the reality for families of children living with ataxia-telangiectasia (A-T), a rare and fatal neurodegenerative disease that affects about 1 in 40,000 people worldwide.1 A-T affects the immune system and the nervous system. Ataxia refers to poor muscle control and coordination, and telangiectasia refers to widened blood vessels near the skin and eyes. A-T is caused by mutations in both copies of the ATM (Ataxia-Telangiectasia Mutated) gene, which codes for a protein that normally helps prevent cancer by controlling cell growth and division and by correcting mistakes that occur when the DNA (deoxyribonucleic acid) makes a copy of itself. Mutations in the ATM gene make the ATM protein unable to repair DNA damage and control cell growth and division.2 Some treatments that can improve A-T symptoms include injections and vitamins to improve immune function, as well as physical, occupational, and speech therapy to improve muscle control.3 However, there has not been a lot of research done on pharmaceutical therapies since A-T is a rare disease.3 Rutgers professors Ronald Hart, Karl Herrup, and Jiali Li in the Department of Cell Biology and Neuroscience, and Alexander Kusnecov, associate professor in behavioral and systems neuroscience in the Department of Psychology, sought to develop A-T pharmaceutical therapies by studying the genetic and environmental factors that contribute to A-T. Upon examination of cells in tissue culture and in brain samples from humans and mice with changes in the ATM gene, they observed that a lack of ATM increased the amount of a protein called EZH2, which normally assists with cell development by telling cells to turn off certain genes. An excessive amount of the EZH2 protein causes cells to turn off genes encoding for proteins that prevent tumor development and support normal brain development and function. Rutgers researchers found that this process led to the neuromuscular issues that are characteristic of A-T. To stop the brain from making too much of the EZH2 protein, Rutgers researchers decreased the amount of the EZH2 protein that built up in mice genetically engineered with A-T, and then produced a sufficient amount of the protein in the brain. Rutgers researchers observed that mutant mice that had A-T and increased EZH2 levels experienced improvements in movement, coordination, and muscle control, and were also more adventurous and open to new places. To validate their results, Rutgers researchers are working with the A-T Clinical Center at Johns Hopkins University, where they are collecting blood samples from children with the disease and their parents who carry the genes.

Examination of the blood samples will help scientists create human neurons like those in A-T patients and explore how ATM mutations lead to nerve cell disease.4 These research findings have implications for the development of therapeutic drugs that can improve coordination and neuromuscular control for A-T patients, and also for the discovery of the EZH2 protein’s role in common neurodegenerative diseases, such as Alzheimer’s and Parkinson’s.4 As the medical field continues to evolve, a better understanding of how neurodegenerative diseases occur can lead to more effective treatment and prevention strategies that will improve the health and well-being of people living with neurodegenerative diseases.

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Photo: Alina Grubnyak The Importance of CPR Training 1. American Heart Association. (n.d.). CPR Facts and stats. cpr.heart.org. Retrieved March 18, 2022, from https://cpr.heart.org/en/resources/cpr-facts-and-stats 2. Girotra, S., van Diepen, S., Nallamothu, B. K., Carrel, M., Vellano, K., Anderson, M. L., McNally, B., Abella, B. S., Sasson, C., & Chan, P. S. (2016). Regional variation in out-of-hospital cardiac arrest survival in the United States. Circulation, 133(22), 2159–2168. https://doi.org/10.1161/circulationaha.115.018175 3. Sasson, C., & Haukoos, J. (2019). Improving CPR in communities: Understanding the importance of CPR training density. Resuscitation, 139, 351–352. https://doi.org/10.1016/j.resuscitation.2019.03.008 4. Crist, C. (2019, October 2). Bystanders may hesitate to perform CPR for fear of causing harm.

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Differential effects of temperature and mosquito genetics determine transmissibility of arboviruses

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Photo: Clay Banks The Lasting Burden of Post-COVID Chronic Disease 1. Diabetic nephropathy (kidney disease). Johns Hopkins Medicine. (n.d.). Retrieved March 19, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/ diabetes/diabetic-nephropathy-kidney-disease 2. Coronavirus: Kidney damage caused by covid-19. Johns Hopkins Medicine. (n.d.). Retrieved March 19, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/ coronavirus/coronavirus-kidney-damage-caused-by-covid19 3. Bouquegneau, A., Erpicum, P., Grosch, S., Habran, L., Hougrand, O., Huart, J., & Krzesinski.

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