2nd Annual New Jersey Women in Health Symposium Research Abstracts

  • WOMEN’S HEALTH INSTITUTE INNOVATIVE RESEARCH AWARD

Title: Artificial intelligence for evaluation of the endometrial tissue ultrasound data: a precursor for endometriosis diagnosis

Authors: Adrian Balica, Ilker Hacihaliloglu

Introduction: Endometriosis is a common gynecological condition affecting 10-15% of women in their reproductive years 30 to 50% of women with endometriosis are infertile  or suffer of pelvic pain(2). Ultrasound is the first line imaging in gynecology and increasingly    a modality used for endometriosis diagnosis. However, high noise and variability during data collection generates challenges and opportunities for developing computational methods. The recent advancement made in artificial intelligence/deep learning  has a vast potential for processing ultrasound data for improving the diagnostic accuracy of ultrasound [3]. The aim of this abstract  provide a review of methods developed, based on artificial intelligence, for processing ultrasound data related to endometrial tissue and in a larger  context of endometriosis  evaluation.

Methods: A Google Scholar search engine was used to identify published information using the following  combination keywords: endometriosis , endometrium, ultrasound, convolutional neural network, deep learning, machine learning, classification segmentation. There were no other restrictions added to the search.

Results: There is no published research identified in our search   regarding endometriosis and AI ultrasound. We have identified 6 papers [4-9] related  to artificial intelligence use for processing endometrium/endometrial tissue  ultrasound data. Data published suggests positive results related to: segmentation of endometrium ,automated thickness measurement and motion frequency of endometrium , automated and constant guidance of endometrial region, detecting the landmark of uterus and endometrium.  While the disease diagnosis was not investigated,fertility and endometrial malignancy are  mentioned as potential applications. The earliest article dates from 2000 with the rest of the articles were published between 2017 to 2019.

Conclusion: Based on the analyzed data it is evident that artificial intelligence-based algorithms has enter the area of processing ultrasound data for gynecologic and endometrial tissue evaluation. The above results could establish the foundation for endometriosis AI ultrasound imaging diagnosis. Success of the deep learning methods depends on the availability of large scale labeled data. Compared to other imaging modalities the data size of endometriosis ultrasound is limited. This represent one of the confining factors  for further application of artificial intelligence in endometriosis ultrasound processing. Recent increase in the number of publications  can establish a scientific base for new research  pathway.

1.Title: Menopause: Women’s perceptions and experiences across cultures

Author: Ria Melani-Lubis

Introduction: Menopause is marked by fluctuations in reproductive hormones due to declining ovarian function. Reported symptomatology of menopause varies in different areas of the world. This study aims to examine the prevalence of menopausal symptoms and perceptions about menopause among women across cultures. For instance, some menopausal symptoms in addition to hormonal fluctuations may be the result of modernizing lifestyle changes and/or genetic inheritance. Sociocultural research into the attitudes and beliefs impacting women’s experiences around menopause in conjunction with biological studies can contribute to a better understanding of this life cycle transition and better assist women and health care providers in managing menopause symptoms. This review analyzed women’s perception, attitude, symptoms, and experiences of menopause in different cultures in the past and present

Methods: Systematic review of the socio-cultural literature was performed using PubMed, Medline, PsycINFO, and Google scholar to retrieve English language studies that included information on the menopause, symptoms, cultures, perceptions, and experience keywords from the 1800s to 2020 fit the inclusion criteria. In this review, we excluded studies that were not based on primary qualitative data.

Results: Of the fifteen sources used, thirteen defined the diversity of menopause symptoms across cultures, five discussed the history of menopause in different cultures, and two articles considered the age at menarche genetically influencing menopause age. The data sought confirmed that there are marked differences across cultures in women’s experience of menopause. Biological, psychological, social, and/or cultural factors may be related to either positive or negative perceptions. In North America and Europe, menopausal women appear to report more symptoms than women living in Asian cultures. Asian women generally reported low rates of a variety of physical and psychological symptoms related to menopause. The former group of women has likely been educated to consider menopause as a deficiency disease that may cause uncomfortable symptoms around the time menstruation ends as well as cause an overall physical decline in women and elevate their propensity for various diseases in later life.

Conclusion: Western societies often place a high value on age and youthful appearance. Women from these countries reported higher rates of various physical and psychological symptoms related to menopause than women in Asian countries. During menopause, changes in physical appearance equated with loss of attractiveness, a belief that may cause people to take a negative attitude with regard to the menopause adjustment. Asian culture’s positive attitudes in regard to menopause appear to normalize menopausal symptoms as part of the natural aging process. While substantial research has been conducted to document the biological changes associated with menopause, further research into aspects of menopause and women’s perceptions is recommended.

2. Title: Oxytocin: Beneficial Effects for both men and women

Author: Tara Mason

Introduction: Oxytocin is a neuropeptide produced in the hypothalamus that appears to play an important role in lactation, early-life nurturing, maternal health, physical and mental health, overall well-being, and parent-infant social bonding. This paper synthesizes the long-standing effects of oxytocin levels on parent-infant interactions in order to suggest that more information on oxytocin should be provided to women (and men) and the ways that individuals can enhance their oxytocin production.  This study examined the benefits of oxytocin levels in both men and women.

Methods: An electronic literature search of Elsevier and ScienceDirect databases was conducted with search terms including oxytocin levels, lactation, maternal wellness, infant well-being, parent-infant contact, development, bonding, and attachment from 2005-2020 fit the inclusion criteria. Studies that did not focus on the effects of oxytocin, well-being, parent-infant interactions, and lactation were excluded from this review.

Results: There were a total of nineteen (19) studies found. Five studies (5) were selected and included in the final integrative reviews (references). These studies were chosen because they closely examined the benefits of oxytocin in maternal/fetal relationships and reported on how oxytocin supports a positive effect in a multitude of psychological disorders. These studies have shown an innumerable amount of positive effects between oxytocin levels and maternal-infant /paternal-infant contact. Both mothers and fathers have shown synchrony in motivational-emotional limbic structures in their brains. The increase for maternal oxytocin levels was linked heavily with more affectionate behaviors. For paternal oxytocin levels, it was linked heavily with stimulatory contact behaviors. During skin-to-skin contact, both parents have shown enhanced positive mood and reduced pain. It was found that oxytocin induces a stable sense of well-being, improved trust and calming behaviors and reduced fear, anxiety, depression.

Conclusion: This review suggests that oxytocin continuously plays a significant role in the development of early parent-infant contact and interaction. Oxytocin is crucial in facilitating attachments in early social interactions. This hormone is beneficial in decreasing the negative effects of conditions, such as anxiety and depression. In addition to more research in this area, it appears that more education should be offered on oxytocin’s beneficial role and ways individuals can enhance production.

3. Title: Gender-Affirming Facial Surgery Procedures: An Overview

Author: Archana Raghunath

Introduction: Gender dysphoria refers to the significant discomfort felt when an individual has an incongruence between their sex assigned at birth and their gender identity1. Along with social transition and hormonal therapy, gender-affirming surgeries are commonly used in the medical treatment of gender dysphoria1. The goal of facial feminization and masculinization surgeries is to transform the features of the face to reflect the individual’s gender identity1. Prior academic work has shown a positive correlation between transgender individuals who undergo these gender-affirming facial surgery procedures and an improvement in their psychosocial health after this surgery2. This study was done to provide an overview of facial feminization and masculinization procedures for transgender and gender non-binary individuals.

Methods: A literature review was conducted using scholarly articles within the last 15 years to retrieve information about gender-affirming facial surgery procedures. The most commonly used research sources were Google Scholar, ClinicalKey, The Journal of Craniofacial Surgery, and NCBI/PubMed.

Results: Facial feminization procedures commonly include rhytidectomy, brow lift, cheek implantation, reduction mandibuloplasty, frontal cranioplasty, and lip augmentation3. Facial masculinization procedures commonly include rhinoplasty, forehead augmentation, thyroid cartilage augmentation, and chin recontouring3. The hairline, forehead, nose, upper lip, jaw, and thyroid cartilage are notable features to address for patients considering facial feminization or masculinization surgeries3. Female hairlines are situated lower than male hairlines3. Male foreheads differ from female foreheads, as they protrude farther in front of the eyes and have prominent glabellar bossing3. Male noses are typically larger, more protruding, and wider at the base when compared to female noses3. Facial feminization procedures on the upper lip aim to reduce the vertical upper lip length, increase tooth show, and increase lip fulness3. The male jaw is typically larger and broader than the female jaw, with sharper gonial angles and a flatter mandibular plane3. Individuals seeking facial feminization surgeries may choose to reduce the jaw size and undergo osseous genioplasty3. For trans women, reduction of the thyroid cartilage is typically done through a direct approach or submental incision3. For trans men, masculinization of the thyroid cartilage is often performed using a submental approach with harvested and shaped rib cartilage3.

Conclusion: It is necessary for transgender individuals to understand the various aspects of these gender-affirming facial procedures, as they are an option for them. Facial feminization and masculinization surgeries offer great potential to improve the lives of transgender and non-binary individuals.

4. TitleThe Social History of Marijuana Use in South Asia

Author: Zaina Chaundry

Introduction: Cannabis use in certain regions of the world, such as South Asia or China, can be attributed to a variety of factors such as religious, cultural and even therapeutic practices. In the discussions on whether or not cannabis ought to be legalized, for either medicinal or recreational use, the socio-cultural origins of cannabis use was reviewed. The aim of this study was to explore the socio-cultural contexts of cannabis use in South Asia by analyzing the different forms of consumption/use over time.

Method: An analysis of a historical document was the primary source of information for this review. The historical resource used for this study was the Report of the Indian Hemp 1893-1894, which holds the title of being the first report ever written in such detail on the subject of marijuana. The research for the Report of the Indian Hemp 1893-1894 was conducted by both the British and ‘natives’ from the British colony in the Indian subcontinent. A significant number of secondary sources (journal articles, book chapters) – historical, sociological, and anthropological – were also analyzed around the primary historical source.

Results:  When examining the government reports, it was evident that South Asia had a unique mechanism of integration and societal rootedness when it came to cannabis. From the literature reviewed, it was evident that cannabis was widely and deeply integrated into cultures and religions in South Asia. Sufis, Sikhs, and Hindus all used the drug as an aid  to engage in devotional activities. Cultural and religious integration is perhaps what attributes to the drug being more socially acceptable. However, when looking at native plants, Cannabis Indica was found to be the cannabis species of South Asian origin. Indica strains tend to contain higher levels of CBD (cannabidiol) in comparison to THC (delta-tetrahydrocannabinol). CBD is generally found to be “non-intoxicating” in comparison to THC and is often opted for due to its medicinal uses such as pain management, anxiety reduction, inflammation reduction, etc. This can explain why cannabis was widely used as a source of medication and a surgical anesthetic in the region for years. Additionally, it is found that certain characteristics of THC contribute to higher potency of that drug. These include the position of double bonds in the ring, the numerical position of the alkyl groups, which alkyl groups are on the pyran ring, and the amyl group (today more commonly known as the pentyl group). Different forms of the drug evidently have different potency, and with that, have different levels of effect on individuals. For example, cannabis which is smoked in South Asia is generally referred to as ganja (consisting mainly of the flowering tops on a cannabis plant) and is smoked on a chillum (a smoking pipe made of clay).

Conclusion: Studying the points of origins of cannabis and the type of cannabis utilized in South Asia may enhance our understanding of not only how cannabis use is perceived differently in certain regions, but also provides direction in regard to its use. However, further research on historical analyses and the types of cannabis used are warranted.

5. Title: Pregnancy: Hurdles that Disabled Women Face.

Author: Stephanie Zito

Introduction: Women with disabilities experience two intersectionalities, in which they are more likely to be marginalized from society. Although women with disabilities are far more prevalent than we believe, with data suggesting 1 in 4 women have a disability. Only 2% of women with a chronic physical disability are pregnant in a given year. Regarding women with disabilities who are trying to become pregnant, their initial reaction is oftentimes fear, such as how they will be judged and cared for by the healthcare team. These problems arise from prenatal care issues to labor and delivery ones, which extend through to the postpartum period. This study evaluated the existing literature pertaining to the various difficulties that disabled women face before, during, and post-pregnancy.

Methods: A comprehensive literature review was conducted to identify various hurdles that disabled women face during pregnancy. In order to find relevant articles, various search engines were used such as Rutgers Libraries, EBSCO, and PubMed. The specific keywords that were used include: disabled, physical disabilities, mental disorder, women, and pregnant/pregnancy. The research was split into 2 categories, physical and mental disabilities. Each article was individually reviewed and sorted according to the different types of complications expected or experienced. These categories include advance planning, clinical knowledge, socioeconomic levels, and stigma surrounding disabled women getting pregnant.

Results: Being disabled effects about 36 million women in the United States of America alone, with disability seen more often in women without economic stability. The first category focuses on the barriers that women with physical disabilities faced. Findings concluded that during pre, during, and post-pregnancy, many providers were not necessarily equipped to respond to the mother’s pregnancy and disability together. Currently, healthcare providers do not have the research and extensive training to fully aid in disabled women’s pregnancies. Women with disabilities are more likely to have complications depending on their preexisting medical conditions, putting them at a higher risk. The second category focuses on difficulties women with mental disabilities face during pregnancy. Women with mental disabilities are often overlooked as many appear to be physically able. The data suggest that mental health affects both the mother and the child. Further, mothers with worsening mental health throughout the pregnancy displayed worse birth outcomes and maternal experiences. Common to all disabilities, another barrier that was faced was the stigma associated with a woman with a disability getting pregnant.

Conclusion: Throughout the review, findings were limited to online resources. Women with physical and mental disabilities oftentimes had unmet needs and barriers during pregnancy that adversely affected the mother and the child. These findings suggested that an increase in knowledge and practice of maternal care for women of physical and mental disabilities among healthcare professionals should be considered. There is also a need to normalize pregnancy among women with disabilities as many are able to have a healthy pregnancy with proper care and support. For the future, further research must be conducted to address this group of women’s needs in order to support progressive change in improving the care of women with disabilities throughout pregnancy.

6. Title: Influence of Media on HIV & HIV Disparities within the LGBTQ+ community.

Author: Samantha Tumblety

Introduction: In the U.S., there are approximately 1.2 million people who are positive for HIV. However,  the literature suggests that approximately 14% of HIV+ individuals are not aware of their status. Studies also note that HIV disproportionately affects those who belong to the LGBTQ+ population. HIV health care is often more challenging for these individuals due to the multiple “psychosocial and structural barriers” they are confronted with. (Batchelor, Fair, Greifinger, 2013). As well, the LGBTQ+ population also is at greater risk of homelessness, stigma, substance abuse, etc. Social media is a powerful tool that has the ability to control many aspects of cultural perceptions. Therefore, it is critical to understand how the media can influence perception of HIV status and assist those who are HIV positive. This study reviewed how the media can influence patient behavior for those who test positive for Human Immunodeficiency Virus (HIV) and to determine how HIV disproportionately impacts the LGBTQ+ population

Methods:  Google Scholar, Taylor & Francis Online, and National Center for Biotechnology Information were databases that were used to investigate this topic. Research was conducted on the role different types of media play in affecting HIV patient’s behavior in regards to prevention, treatment, and transmission. Research was carried out on the overlap of the HIV population within the LGBTQ+ population, specifically the number of individuals taking pre-exposure prophylaxis (PrEP) and how accessible it is to find information on this medication.

Results: Different types of media like print media, broadcast, counselling methods, and social media are used to teach people about the measures they can take to prevent HIV and/or HIV transmission. The “Social Vaccine” is deemed the best way to educate people on HIV/AIDS.  A large part of the “Social Vaccine” idea is to promote safe sexual behavior. Knowledge is a critical factor in influencing human behavior. Data suggested that of the HIV positive population in the U.S., 1 in 7  did not know they had it (hiv.gov). While there is a plethora of media/information available to the public, there is still a large percentage of people who do not take preventative measures to lessen their risk of contracting HIV. In 2013 gay/bisexual men made up 2% of the U.S. population, but were 55% of known persons living with HIV.. The total number of people using PrEP in the U.S. was over 77,000. In 2016, 93% of all PrEP users were men, which suggests that this population is more at risk than the female population. (https://aidsvu.org/prep/).

Conclusion: Media is a tool that can be used to assist in preventing HIV infection. However it must be accessible to those groups who are at highest risk. Issues of inequality and inequity need to be addressed in order for those in the HIV and LGBTQ+ population to have more access to health care, which goes hand in hand with greater knowledge of prevention and prophylaxis. Solving access issues, and addressing institutional stigma  also are priorities (Batchelor, Fair, Greifinger, 2013). Though mass media has shown notable effects in outreach, no long term effects on prevention and prophylaxis have been noted yet. Possible media campaigns should be longer in terms of time they are available and increasing  the number of TV based campaigns were seen to be most successful. 

7. Title: Smoking and Drinking During Pregnancy: Need for Intervention Programs.

Author: Khushali Patel

Introduction: Women can face many difficulties during pregnancies, however, there are many other problems that can arise if a pregnant woman consumes alcohol and smokes during the prenatal period. The consequences of participating in such behaviors while pregnant are taught to children as early as middle school and enforced year after year until high school graduation and even after in various different venues. However, still, more than 1 in 9 pregnant women in the United States of America drink alcohol while pregnant, and about 4 percent binge drink, according to survey estimates from the Centers for Disease Control and Prevention. Therefore, it is evident that this topic it is still very important for medical professionals to heavily reinforce to pregnant women. This study evaluated and analyzed the literature pertaining to the detrimental effects that drinking, and smoking can have on maternal and fetal health.

Methods:  An inclusive literature review was conducted to identify the various risks that occur to the women and the fetus if the mother drinks and smokes during the pregnancy. In order to find the relevant and necessary articles, many different search engines were used such as CDC.gov, Parents.org, and the U.S. National Library of Medicine National Institute of Health.  The types of searches that were conducted included; smoking, drinking, pregnancies, Fetal Alcohol Syndrome (FAS), Sudden Infant Death Syndrome (SIDS), and many related keywords. Each article, academic journal, news article, and factsheet was carefully reviewed to fully understand the outcomes of the impacts that drinking, smoking can cause on the fetus and the pregnant woman.

Results:  According to reports published by the CDC in 2018, in 2016one in fourteenwomen who gave birth in the United States of America (7.2%) reported smoking during their pregnancies. Additionally, in a CDC report from 2015-2017 one in nine pregnant women reports to alcohol use in the past 30 days, and among those, about one third reports to binge drinking. Smoking and drinking while pregnant increases the risk for adverse health problems for developing babies, such as, preterm birth, low birth weight, birth defects, FADS, SIDS, and even death. The available data suggest that despite being exposed to so many precautions as to avoid drinking and smoking while pregnant, women who engage in these behaviors are usually those without a spouse/partner, have limited formal education and health literacy, have an unplanned pregnancy, and have suffered from previous addictions.

Conclusion: Although information and statistics on the numbers of women who smoke or drink during their pregnancy us available, there are scant data as to why women indulge in these destructive behaviors when they know they are putting themselves and their babies in a compromised situation. For the future, it is crucial that the women who are pregnant in high risks groups be assisted on helping to prevent smoking/alcohol consumption. Although, healthcare officials are consistently reported on the negatives of smoking and drinking while pregnant it is crucial that this message be conveyed, and help be givean to those women who are still taking part in these behaviors.

8. Title: A One Health Undergraduate Student Club: Anticipating the Hurdles and Providing a Structure.

Authors: Eliana Schach, Mugdha Parulekar

Introduction: Although there was a need for a One Health Club, there were significant challenges in setting it up. We began by scouting members. With two people overseeing the commencement, we had to make sure to effectively spread the information about the club to a wide audience. It was especially important to find members with diverse interests, who would be active in the club. With COVID-19, all of our advertising had to be done virtually, as well as the interest meetings. In addition to adjusting advertising methods, club projects and goals had to be altered to being virtual for the coming fall semester. It was important that projects and initiatives were offered that fit various interests.

Methods: The One Health Initiative can appeal to many students of different interests, however pre-medical, pre-veterinary, public health and environmental health students were targeted . In order to gain the attention of students, ongoing projects were discussed in addition to the opportunity to run for positions to be on the executive board of this club. The rules to run for executive board positions were outlined to the new members. Any member planning to run had to provide a personal statement describing why they fit the position. The voting ballot was created once all statements were received. In order to engage all members, projects were converted to a virtual format, and future projects can be organized through online means.

Results:  Through joint efforts 50 members were recruited. About 40% of the club ran for executive, and a total of six members will hold positions within it. The club has now an established executive board and plans to form committees as needed for larger projects. All members were offered and soon became engaged with the upcoming projects as well as their own. The main project is to create a Children’s Book about the One Health concepts and how it relates to the environment. We are coordinating meetings to work on this book and discussing the tasks online. Other projects include a scholarship writing competition for high school students in order to encourage thinking about One Health and an advocacy arm that will utilize social media. In the future there will be in person lectures and activities to expand it across the local community.

Conclusion: From overcoming the hurdles until its establishment, the One Health Club started at Rutgers University, has gathered several members from different disciplines, who are motivated to move the club forward. This club is extremely applicable to health related professions, and members can transfer skills learned from research and the initiative to their careers. In the future, we plan to extend our projects to local academic institutions and medical students at Rutgers University and Robert Wood Johnson Medical School.  This will allow the initiative to gain more recognition within our community. Key factors for the club to stay active and efficiently expand is to keep members engaged, as well as continue to educate ourselves about the importance of the One Health Initiative. It seems that the club has a lot of potential to make a positive impact on the Rutgers and local community, as well future professionals coming from this chapter of the One Health Club.

9. Title: Clinical Differences between Aging Men and Women.

Author: Aishwarya Kumar

Introduction: This abstract aims to examine the medical differences that are seen within aging men and women. Hormonal mechanisms, structural changes, and physiological developments that result in divergent clinical consequences between elderly females and males are explored. It is important to understand these differences in order to provide effective healthcare to a growing elderly population.

Methods: A literature search was performed using Rutgers University Library Resources and search engines such as Google Scholar and PubMed. Findings, stratified by organ system, included information regarding the endocrine, cardiovascular, skeletal, nervous, renal, and immune system. Literature was narrowed down by date and most articles chosen for inclusion were published after 2010. Differences were found between aged men and women for all systems investigated.

Results: The aging changes associated with the endocrine, cardiovascular, skeletal, and nervous system corresponded to prevalent clinical diseases, namely menopause/andropause, cardiovascular disease (CVD), osteoporosis, and Alzheimer’s disease (AD) while the renal and immune system had no specific disease correlates. Findings showed that women exhibited higher rates of osteoporosis and Alzheimer’s while men exhibited higher rates of CVD, renal decline, and immune function decline. However, despite a higher prevalence of disease being seen in one gender, it is important not to neglect the other, evidenced by issues of underdiagnosis highlighted in some articles.

Conclusion: Many of the findings indicated that differences between aged men and women were attenuated after women reached menopausal status. This could suggest the similarity of the aged male and female systems after the age-associated decline of sex steroids.

10. Title: Impact of Continuous Cannabis Use.

Author:  Sameen Siddiqui

Introduction: The use of cannabis for both recreational and medical purposes has been a controversial topic in the US for decades. Many individuals hold the belief that cannabis leads to increased violence, mental deterioration and other dangerous behavior. On the contrary, many medical professionals and scientists claim that there are many positive impacts of marijuana use in certain cases. Scientists are currently conducting preclinical and clinical trials using marijuana and its extracts as treatments for symptoms of illnesses such as HIV/AIDS and MS as well as a treatment for inflammation, pain and seizures. Another interesting current area of study is marijuana as a treatment for mental disorders. Proof that marijuana does not cause more, or any, harm with continued use will help facilitate the motion for more individuals to begin using it as treatment for illnesses or painful symptoms. This study analyzed the social and physiological impacts of continuous cannabis use in individuals compared to isolated instances of cannabis use in individuals.

Methods: Reports from 1944 to the early 2000s detailing the impacts of marijuana on individuals were analyzed. In 1939, New York Mayor Fiorello LaGuardia commissioned the report, The Marihuana Problem in the City of New York: Sociological, Medical, Psychological and Pharmacological Studies which was completed after 5 years of research. The First Report of the National Commision on Marijauna (1972) commissioned by President Nixon was also looked into as it led to policies that criminalized the drug in America. Modern medical journals highlighting possible treatment uses of marijuana were also analyzed.

Results: The 1944 LaGuardia report was analyzed and showed that marijuana was less dangerous in that it’s use did not induce violence, sex crimes, insanity or lead to addiction. The results also found that non-users of marijuana exhibited more extroversion upon taking marijuana for the study whilst regular cannabis users did not want to be the “center of the scene” upon taking marijuana which concludes that these users exhibit poor adjustment and insecurity. In general, small doses of marijuana make individuals more easy-going and enhances the subjects confidence in verbal capacity as well as increased confidence and self satisfaction. Non-users seemed to experience more adverse effects in terms of their difficulty completing simple tasks. Regular users did not struggle as much during the cognitive tasks. Rote memory was not impacted. With regards to long term use, the committee ruled that marijuana did not result in mental deterioration. The 1972 report as done by the Commission on Marihuana found found that while the public opinion was that marijuana users tended to be dangerous, they noted the marijuana users they studied were more timid and passive. The conclusion of this commission was that cannabis did not cause a widespread danger to society, regardless of how often it was used. Scientists are currently conducting preclinical and clinical trials using marijuana and its extracts as treatments for symptoms of illnesses such as HIV/AIDS and MS as well as a treatment for inflammation, pain and seizures. Another interesting current area of study is marijuana as a treatment for mental disorders.

Conclusion:  As the findings suggest, there is no immediate or long term harm on an individual’s psyche or body with cannabis use. First time users struggled more with cognitive tasks while regular users were not as affected by the drug. Further research on the impacts of medical cannabis use specifically on pregnant women is still warranted.

11. Title: Impact on First-Year Medical Students of Peer-Teaching Transgender Medicine Session.

Author: Cynthia Zheng

Introduction: Based on recent data, approximately 0.6% of adults, or 1.4 million individuals, in America identify as transgender (trans)1.Despite increased research about and visibility of the community, trans individuals still face various health disparities, including higher rates of HIV infection and suicide2 and lower rates of health care coverage and access2,3. One of the main challenges in accessing healthcare is “erasure” by providers, either negative responses or lack of knowledge and perceived importance2,4,5. Although there have been increasing calls by professional organizations to increase education on the subject6-8, 52% of accredited medical schools report no LGBTQ+ training.9 Trans healthcare is often the least understood by students with most reporting less than 2 hours dedicated to trans medicine10,11. As such, there is an opportunity to expand and supplement the curricula. This study aims to examine the impact of a novel trans medicine session on first-year medical students.

Methods: All first-year students who were currently taking Endorcrine/Reproduction were offered to participate an optional peer-teaching, small group session on trans medicine. Students individually answered a pre-session survey on attitudes, beliefs, and prior experiences and pre-test on physiology and hormone therapy. After a group discussion of the answers and a patient case discussion, students completed a post-test and post-session survey. Survey data was collected on a 5 or 7 point Likert Scale or 100-point Self-Efficacy Scale. The trans-specific subscore of the pretest was compared to the post-test. Student’s paired t-test was used to compare changes in pre- and post-session responses.

Results: 33 first-year students participated in the study. There was a 42.9% (p=<0.001) increase in average post-test score compared to average pre-test score. Similarly, there were 18.8-35.9% increases in self-rated comfort levels addressing trans-related concepts in post-surveys compared to pre-surveys (p=<0.001). All students agreed to some extent that the session helped them better understand physiology and caring for trans individuals, will help them be better clinicians, and that the session should be formally incorporated into the curriculum. At least 85% of students either “agreed” or “strongly agreed” to each of the statements.

Conclusion: This study reinforced the need to provide more education in the area of transgender medicine. And further, that peer-teaching is an effective educational tool.

12. Title: Mental Health in Aging Transgender Individuals: A Literature Review.

      Author: Evan Perkiss

Introduction: Mental health in the transgender community is a significant issue (1, 2). The rate of suicidal ideation in transgender individuals is five times higher than that of the general population (3). Additionally, an estimated 32%-41% of transgender individuals attempt suicide at least once in their lifetime (3, 4), compared to less than 9% of the general population and an estimated 10-20% of lesbian; gay; and bisexual individuals (4). Similarly, 40%-52% of transgender individuals experience symptoms of depression and anxiety, and these symptoms are linked to experiences of stigma and gender-related discrimination (3). Furthermore, the prevalence of clinical depression in transgender individuals is estimated to be greater than 50%, compared to an estimated 30% in the general population (4). White Hughto and Reisner (2016) reported a connection between discrimination and poor mental health in transgender individuals, including anxiety, depression, and substance abuse (5). In contrast, social support, a connection to a community, and effective coping mechanisms function as protective factors (1).  Despite the numerous studies on mental health in the transgender community, most of the work has included transgender individuals of all ages. In contrast, this literature review focuses exclusively on identifying causal and protective factors for mental illness in aging transgender individuals.

Methods: This literature review examines six studies on mental health in older transgender individuals. Ten articles were reviewed, and six met the inclusion criteria, which were that the articles were written between 2010 and 2020, exclusively took place in the United States, and discussed aging transgender individuals as a separate group. Articles that focused on the LGBTQ+ community as a whole without breaking out the transgender community were excluded to avoid skewing the data. Other exclusion criteria included case studies. All six articles were found via the PubMed and Google Scholar search engines by typing in “mental health in aging transgender individuals.”

Results: All six articles examined focused primarily on depression. One of the articles reported that 43% of their participants had depression symptoms (6), another study from 2016 mentioned that 55.7% of the participants had depressive distress in the past week (5), and a third study reported that 47.9% of the participants had symptoms of clinical depression (7). Two of the articles also mentioned suicide, with one reporting a lifetime prevalence of 52.4% for participants age 40-59 (8). Finally, Fredriksen-Goldsen et al. (2013) also reported that 56% of participants recognized that they were stressed (6), another article mentioned that 26%-62% of trans women had a lifetime history of substance abuse (8), and an article that discussed stigma reported that some of the participants had anxiety (9). Two of the articles listed possible reactions to coming out as causal factors (6, 7), two other articles included discrimination (5, 9), and two articles listed negative feelings about gender identity and having to hide gender identity (7, 10). Other causal factors included internalized stigma and victimization (6), gender-related abuse (8), and stress (7). Three of the articles listed social support as a protective factor (5, 6, 9). Other protective factors included the positive emotions associated with transitioning (7), activism (9), military service benefits such as access to VA services (10), age (8), and a sense of inclusion in a community (6).

Conclusion: Mental health in older transgender individuals is an understudied, albeit significant, public health problem. The limitation of this review is that so few studies have examined this population. Future studies should research older transgender individuals and compare their mental health to that of this entire community as well as to younger transgender individuals.

13. Title: Evolution of access to healthcare for the middle-aged woman.

      Author: Megha Shah


Introduction: A brief review of available literature indicates that there is limited research documenting the evolution of access to healthcare in relations to the socioeconomic climate. In his study of ethics in medicine, Hippocrates once stated, “whatever houses I may visit, I will come for the benefit of the sick.”1,2 Through this, Hippocrates not only advocated for patient-centered care, but also paved the way for the western model of house calls.  As time has progressed, the healthcare arena has morphed from house calls, to office visits, to now telehealth, where the physician is essentially (virtually) back in the patient’s home. However, even today, access to healthcare remains limited due to socioeconomic factors beyond the arena. At multiple points in history, there have been times where healthcare economics has hindered the progress of access to care and wherein innovation and resilience of a few people have pushed the scales for change.  From the development of home-monitoring devices to the ‘stat’ adoption of telehealth during the COVID-19 pandemic, it has taken both socioeconomic strain and the integration of biomedical engineering to push the political climate enough to make a change.3,4

Methods:For this paper we performed a Mesh search on Pubmed.

  • (“Health Services Accessibility”[Mesh]) AND “Anthropology, Medical”[Mesh]- 57 results
    • (“Telemedicine”[Mesh])
      • Filters: Free full text, Full text, in the last 1 year, humans, English, Female, MEDLINE, Middle Aged +Aged: 45+ year -168 Results
    • (“Telemedicine”[Mesh]) AND “Health Care Quality, Access, and Evaluation”[Mesh]
      • Filters: Free Full text, Full text and within 5 yrs, English, Dental, Nursing and MEDLINE Journals – 3,101 Results
      • Filters: Free full text, Full text, in the last 1 year, humans, English, Female, MEDLINE, Middle Aged +Aged: 45+ year– 146 Results

Results: As such, there is a need to examine and understand our access to healthcare during this age of information and digital diaspora.5 Advances in technology have traditionally always been geared towards advancing the delivery of healthcare, but there is now evidence to suggest that access to care can be improved, including in the rural populations as well as in young adults and menopausal women.4,6,7  Studies have shown that, in high poverty areas, access to care remains an untapped source for advancing medicine.8 In the primary care setting, increasing access to care could be pivotal for addressing issues such as non-adherence, chronic disease management, and integrative services.9,10 

Conclusion: By understanding the evolution of access to healthcare up to this point, we can not only identify potential barriers for care but also learn from the evidence to act in a proactive manner for the sake of our present and future community.

14. Title: Commencing a One Health Undergraduate Club.

      Authors: Mugdha Parulekar, Eliana Schach


Introduction: One Health is a public health approach that acknowledges the interrelatedness of human health, animal health, and environmental health. The One Health Initiative is an organization of interdisciplinary professionals who work together at the local, regional, and global levels to achieve optimal health outcomes via this principle. Most recently, the Sars-Cov2 virus began a pandemic due to a failure to acknowledge the risk that occurs when several species exist in a shared environment. The next generation of professionals in the healthcare, veterinary, and environmental fields should be educated on One Health ideas in order to create a safer and healthier society. Because of this need, we have established the One Health Club at Rutgers University New Brunswick.

Methods: The purpose of this undergraduate club is twofold. First, we wanted to educate the student population about One Health. Second, we wanted to bring together students of different professions to promote collaboration on interdisciplinary projects. Keeping these goals in mind, we drafted a Constitution outlining how the club will be run. The main activities of the club will be 1) inviting guest speakers who incorporate One Health into their profession 2) advocating for causes related to One Health, such as environmental justice, and 3) organizing One Health-related research projects that members can take part in.

In order to reach out to a diverse pool of students, we advertised through several academic channels. Pre-medical students were recruited through the Health Professions Office. Pre-veterinary and environmental studies students were recruited through the School of Environmental and Biological Sciences Honors Program. We also reached out to several Living-Learning Communities.

Results: We currently have 50 club members who intend to go into medicine, public health, veterinary practice, academics, and more. As a result, the projects proposed have been diverse, including topics from antibiotic use in animals to the health disparities arising from CoVID-19. About 40% of the club has run for a leadership position.

Conclusion: We have seen a large interest in One Health amongst a diverse body of students. The One Health Initiative seems to be resonating with students who care about the environment but are pursuing fields outside of environmental health. The students we have attracted are passionate about the topic and are eager to take leadership roles within the club as well as propose their own ideas for research and educational initiatives. The advantage of interdisciplinarity has already been demonstrated as many club members are connecting with others beyond their major and creating new projects related to public health, economics, and healthcare disparities. We are optimistic that this club will achieve its purpose of promoting One Health and increasing collaboration between disciplines.

During times like these, shows how it can expand even once it can resume in person. In the future, we plan to extend our projects to local academic institutions and students at Rutgers University and Robert Wood Johnson Medical School.  This will allow the initiative to gain more recognition within our community. As the club will begin virtually, it is essential to be as productive as possible to start. Key factors for the club to stay active and efficiently expand is to keep members engaged, as well as continue to educate ourselves about the importance of the One Health Initiative. It seems that the club will have a lot of potential to make a positive impact on the Rutgers and local community, as well future professionals coming from this chapter of the One Health Club.

15. Title: One Health: Educating Future Health Care Providers Through an Interest Group.

      Author: Halle Fitzgerald


Introduction: One Health (Planetary Health) has been recognized as an approach to wellness that does not silo human health concerns exclusively to humans. Rather, the health of other animals and our shared environment impact overall health. Traditional medicine has minimized the study of other animals in the training of future physicians. Today there are 5 medical schools that address One Health through student groups or teaching. At Rutgers, we are exploring a diverse way of approaching One Health through the inclusion of other learners and we seek to improve the education of medical students by creating an interest group where students can host educational lectures for other students to attend from physicians, veterinarians, epidemiologists, etc. and eventually creating a non-credit elective via the group. The group will be established after assessing interest among the student body by means of an IRB approved survey ascertaining the student body’s cognizance of one health and interest in furthering their education of it through the group. This review assessed the number of schools Incorporating One health and also explains the RU approach of creating an across campus One Health special interest group with medical students, undergraduates, and specialists across other disciplines to improve overall health based on the results of a preliminary survey.

Methods: NJ is one of 4 states that commenced and have an ongoing One Health Regional Consortium (with MD, Del and Penn). One of the initiatives that has been stressed is education. At the last regional consortium meeting, the NJ leaders of this initiative invited medical and undergrad learners to gain insight into this initiative and to commence a template for starting a special interest group. Additionally, with faculty, staff and student input, a IRB  protocol was approved and has already begun to conduct a survey of the medical student body. The survey asks about pet and vector exposure among medical students, asks students to answer what they already know regarding one health, and how interested they would be in establishing a student interest group and incorporating one health teachings in to their learning via lectures from various specialists of One Health in a multi-disciplinary fashion.

Results:  The survey has been sent out, so far there have been 40 responses and the survey will be sent out periodically as we hope to receive around 750 responses which will then be brought to the deans of the medical school to help establish the Interest group. Through education, this initiative is introducing the One Health concept to new learners and other health care professionals without changing the medical school curriculum.

Conclusion: One health and its approach to the interdependency of health of humans to other animals and the environment is an important concept to teach the future health care team and guide current practice.

16. Title: Maternal Obesity and Its Effect On Stillbirths.

      Author: Serah Sannoh


Introduction: Obesity is an ongoing global epidemic that affects approximately 300 million women worldwide. Among this affected population are women in their childbearing ages, who are likely to experience maternal obesity. The increase in maternal obesity is a matter that contributes to many preventable adverse obstetric and perinatal outcomes, one being stillbirth1. In the United States, approximately 1 in 160 births are stillbirths and each year 24,000 babies are stillborn2. Studies have shown that pregnancies with maternal obesity are at increased risk of stillbirth, although the specific reason for this remains unclear. The goal of this abstract is to analyze the findings of multiple scientific studies on the correlation between maternal obesity and the event of a stillbirth.

Methods: Multiple studies were evaluated regarding the relationship between maternal obesity and stillbirth by first identifying how each article defined obesity and stillbirth. In some studies, stillbirth was defined as a fetal death that occurs at ≥28 weeks of gestation, while other studies referred to it as a fetal death varying from ≥16 to 28 weeks of gestation. All studies defined obesity as a BMI ≥30 kg/m2. The studies were mostly cohort studies, in addition to a few case-control studies. Statistical analysis including calculations of risks ratios, odds ratios, and chi-squared tests were done to determine the correlation between stillbirths and obesity in pregnancy.

Results: Obese pregnant women have a higher chance of having a stillbirth compared to normal-weight pregnant women. One study found that compared to normal-weight pregnant women, the odds of a stillbirth in obese pregnant women were 2.07 higher3. It was identified that the increase in the maternal BMI lead to an increase in diabetes and hypertensive disorder4, which are risk factors for stillbirth. In addition to this, studies found that high BMI in pregnant women correlates to stillbirths accompanied by placental disease, antepartum infections, and fetal genetic or structural abnormalities5. Additional studies showed that obese women with umbilical cord abnormalities were at a higher risk of stillbirth5 and those with fetoplacental dysfunction, which could impair placental blood flow to the fetus, are at increased risk of stillbirth.

Conclusion: The findings from multiple studies suggest that there is a linear association between increase in BMI and risk of stillbirth6, the highest risk seen in obese pregnant women. Although there is an association between maternal obesity and the increased chance of a stillbirth, more studies need to be done to determine if the comorbidities that arise from maternal obesity contribute to the increased stillbirths. It should be noted that the definition of stillbirth differs among the studies, and there is a need for a universal definition of stillbirth in order for future studies to be consistent with each other.

Due to the fact that the majority of these studies were done in developed countries, the results from the studies are likely not generalizable worldwide. The United States has an increasing prevalence of obesity, with nearly 1 in 3 women being obese3. The results from these studies can lead to more research to be done on this topic and can promote healthier maternal lifestyles to prevent stillbirths in future pregnancies.

17. Title: Domestic Violence Risk during the Covid-19 Pandemic.

     Author: Lauren Freidenrich


Introduction: Domestic violence, often defined as intimate partner violence, has increasing prevalence in the United states. According to data from the CDC, 1 in 5 women in the United States experience some form of domestic violence, with 41% of those females sustaining severe physical injury (CDC 2018). Furthermore, in samples of women who have survived domestic violence, many suffer long term consequences such as PTSD, which is seen with a prevalence of 40% in survivors, with some symptoms seen in as high as 70% of survivors (Riggs, Caulfield, and Street 2000). Additionally, the Covid-19 pandemic has exacerbated many risk factors associated with domestic violence, therefore fostering an environment which allows for the continuation of such abuse, and the provocation of new cases. This study aims to evaluate and analyze existing literature relating to the Covid-19 pandemic and the subsequent effects on the prevalence of domestic and intimate partner violence.

Methods: In order to gain a full understanding of domestic violence and the effects of the Covid-19 pandemic, a thorough review of literature was conducted. Searches regarding domestic violence included general information, risk factors, and statistics. In addition, it was necessary to understand a broad range of impacts brought about by the pandemic. While there are few empirical studies linking domestic violence and the Covid-19 pandemic directly, many drew broader connections, or provided information to predict a relationship. Helpful journals and search engines were the National Library of Medicine, the National Institute of Health, the Center for Disease Control, and several academic journals.

Results: In the United States, the National Domestic Violence Hotline has received an increase in call volume, with many individuals citing Covid-19 as a reason for their abuse. One pointed empirical study found a statistically significant increase in domestic violence in both Los Angeles and Indianapolis throughout the social distance period (Mohler et al. 2020). The same problem is occurring globally throughout the pandemic. According to data provided by the UN, domestic violence helplines have had a 25-40% increase in calls during the pandemic in countries such as Singapore, Australia and France. Similarly, in the UK, the national domestic abuse helpline has received a 97% increase in calls (UN 2020). It has been hypothesized that the increase in domestic violence could largely be due to increased time spent with family, psychological conditions, financial strain, and stress (Kim Usher et al. 2020). Other theorists believe the social distancing and lockdown periods, while necessary, have been a large proponent of the increase due to the link between isolation and domestic violence (Lanier and Maume 2009). This phenomenon was seen during the shelter in place following Hurricane Harvey and other natural disasters (Serrata and Alvarado 2019). Other potential contributing factors include substance abuse, and job loss, both of which have been seen in higher quantities during the Covid-19 pandemic, and both of which increase domestic abuse rates (Ornell et al. 2020).

Conclusion:  From these results, it appears prudent that in addition to addressing the infection risks associated with Covid-19, and any other pandemic, health and government agencies must have programs in place that may include 1) provision of an easily accessible hotline for assistance 2) designated safe zones for victims to leave the abusive situation and 3) continuity of essential services such as those that protect children. As well, continued research in the form of victim interviews, survey data, and analyses are necessary to provide better prevention, intervention, and support for individuals experiencing domestic violence. 

18. Title: Counseling Transgender Youth to Assist Them in Making Family Building Decisions.       

      Author: Eliana Schach


Introduction: Transgender youth have to make difficult decisions about hormonal medication, affirmation surgery and social adjustment at a young age. However, one aspect that is not often talked about is their family building. As they begin to receive gender affirming hormones such as testosterone or estrogen, this has the potential to increase their risk of future infertility. The options for fertility preservation that these young adolescents should be counseled about include preserving their eggs or sperm. Although this is an important decision for a teen to make, especially since most are not thinking of parenthood, there is scant data on how to handle this situation.

Methods: Multiple sources were used to review this topic. A comprehensive search was conducted of peer-reviewed scholarly journals based off the terms of transgender fertility, family planning, and fertility decision making. The databases that were searched included NCBI PubMed, Journal of Adolescent Health, Journal of Pediatrics and LGBT Health. The reference sections of the articles found were used to influence further searches relevant to the review. Qualitative analyses were found with personalized responses, which helped better understand the trans individuals viewpoints. A case illustration was also described, further evaluating the complexity of the discussion. Several studies were commented on or performed as well within few of the articles regarding fertility. This search revealed six peer reviewed articles published between 2016-2019.

Results: The available literature suggests that there are many factors that they have to take into consideration when counseling youth, including the receptivity of the trans individual. Involving parents is critical since there is a financial cost of preserving eggs or sperm (1,2). Further, deciding to proceed with the transition can be already stressful for the teen. Data suggest that some youth seek help and advice through fertility counselors, doctors and psychologists (6).  However, one important aspect of this decision is the capacity of the youth to make this decision, which should be evaluated by a trained psychologist or a social services individual. Several trans youth are facing mental health challenges from gender dysphoria (3). Hormone therapy could potentially alleviate this distress, but it comes at the cost of infertility. At young ages, some trans individuals, at the moment, may be unsure about their future parenthood plans or do not want children. As in a few studies (4,5), there was a pattern of low rates of fertility treatments as there not only personal reasons, but other barriers like finances or developmental age. This could raise ethical implications when involving patient autonomy. Fertility preservation involves a lot of effort from the patient and the medical staff, as patients may have conflicting feelings about the situation. Once evaluated and informed, only then should the trans youth be prompted to decide their next steps transitioning, provided with support from their medical staff.

Conclusion: From studies that have been done, the data suggests that there is a need to enhance pediatric infertility counseling to support the transgender adolescents when making this decision when considering multiple factors. There is a need to provide all the options available and clarify with them the impacts of their next steps (6). Even though this decision is put on them to make, they may feel pressure from their family or question their gender identity. There seems to be a lack of clarity shown from the participant answers in studies done (1). This could lead to certain regrets in the future. A direct protocol should be initiated when providing fertility advice to the trans youth, as all need to be properly educated. Transgender youth are in unique situations and require specific needs. The medical staff and fertility specialists should evaluate the cases as a team on an individual basis per patient as they come from different backgrounds. More research should be performed to optimize the best approach to maximize all the tools available to assist the trans youth decisions. The future goal is to provide enough support and counseling in order that the transgender youth can make the best informed decision that suits their wants as the expectations to make these decisions at a young age can be difficult. And, each year, this issue should be brought up during an annual clinical encounter as the teen progresses in age and maturity.

19. Title: Addressing Perinatal Mood and Anxiety Disorders: Novel Role of Women Helping Women.

Authors: Kristin Blackledge, Jane Jacob


Introduction: Perinatal mood and anxiety disorders are estimated to affect up to 30% of women worldwide. Investigation of new modalities to prevent and address these disorders is warranted given limited accessibility of current management options and the stigma associated with identifying as having a mental health issue. Peer-to-peer education has shown to be both accessible and effective in reducing stigma towards mental health disorders. This study assessed whether mothers sharing their experiences with perinatal mood and anxiety disorders can positively impact other women’s knowledge and attitudes about these maternal conditions. This was done through the use of an educational book, written and illustrated by participating mothers. 

Methods: This was a one-group pretest/posttest survey that assessed participants’ knowledge and attitudes regarding perinatal mood and anxiety disorders immediately before and after reading INSPIRE: Stories of Motherhood. The book was based on women’s stories and their artwork about their experience with PMADs and then put into final book format by a healthcare team. Data collection occurred during daytime hours over a six-month period in 2019. Participants were recruited at Rutgers Robert Wood Johnson Medical School Obstetrics and Gynecology ambulatory care office in New Brunswick, NJ. Our voluntary study population included English-speaking females over age 18. We excluded non-English speakers, men, preagnant women, and those under age 18. Surveys were conducted in an outpatient setting during routine clinical visits. Participants included women with white, Asian, Black/African American, and Hispanic/Latino racial/ethnic backgrounds. Mothers were asked to share their experiences with perinatal mood and anxiety disorders, which were then compiled in an anthology titled INSPIRE: Stories of Motherhood. Women participating in this study were then asked to read these stories while waiting for their appointments.  No minimum/maximum duration of exposure was imposed. The primary outcomes were whether reading about other women’s experiences changed knowledge and attitudes about perinatal mood and anxiety disorders. Measures included individual Likert scale items and composite “stigma scores.”

Results: 325 adult women were approached and 251 agreed to participate (response rate 77%). 181 of the participants completed all of the items in the pre- and posttest surveys. Results suggested increased knowledge and more positive attitudes after the intervention. The mean difference in stigma score on the 5pt Likert scale was 1.5 (95%CI .9 to 2.1, p<.0001), and on the 3pt Likert scale was 0.9 (95%CI .3 to 1.5, p=.0028).

Conclusion: The study suggests that engaging with other women’s experiences with PMADs may be a useful educational tool. In this study, the book INSPIRE: Stories of Motherhood, written and illustrated by women who experienced perinatal mood and anxiety disorders,increased participants’ knowledge and resulted in more positive attitudes about these disorders.

20. Title: Pets and Pregnancy: Recognizing Risks.

     Author: Sujay Deshpande


Introduction:  Since early human-kind, pets have been a great source of pleasure and companionship. However, one of the risks of having a pet, especially while pregnant, is the danger of contracting a vector-borne illness from them, as noted by the emergence in 2015-16 of Zika Virus. The Zika virus became a major public health crisis for South America in 2015, specifically in Brazil with reports of numerous cases and deaths. Although Zika was never at the scale of the 2020 Covid-19 pandemic, an argument can be made that Zika was worse due to the deadly consequences Zika had on unborn fetuses. Zika virus infection during pregnancy caused life-long neurological disorders in affected fetuses. Zika virus infection also can result in stillbirths, preterm births and fetal loss. The presence of Zika virus reminded the world the vulnerability of pregnant women to illness and the impact on an unborn fetus. However, aside for the Zika virus, there are many other vector borne illnesses that pets can affect pregnant women with.The purpose of this review was to study the dangers that pets may have in spreading vector-borne illness to pregnant women and whether pregnant women with pets in their home factor in this issue.

Methods: CDC and WHO guidelines were reviewed to determine the dangers and precautions.

Another method used for this study was the use of Google Trends. Basic words such as “vector disease”, “zika”, and “malaria”  and pregnancy were included in the search.

Results: From this search, there were 2 observations noted. One observation was a massive spike in searches of different diseases during March 2020, or the start of the COVID-19 pandemic in the United States and worldwide. Not only were searches high for vector disease but searches for zika, malaria, lyme disease, and west-nile virus peaked at this time. This means that not only were people concerned about COVID, but people were also searching various different diseases at the time. The second observation noted was that there was never any activity that showed how certain pets can impact pregnancy. From the trends, it showed that people did not look up information on vector-borne illness from pets, but rather looked up other information about pregnancy that may have been more relevant or urgent at the time.

Conclusion: From this study, it appears that the dangers of pets on spreading vector-borne illness are not issues that pregnant women actively consider or look into during the time of their pregnancy. Because pets are so adored and cherished by humans, the dangers that they may pose to exposing humans to disease, specifically pregnant women, may not be considered. Overall, more awareness needs to be spread about the potentials of vector borne illness and how pets can pose dangerous to pregnant women in spreading vector disease harmful to the pregnancy

21. Title: Should Women Be Denied Reproductive Assistance Based on Age?

      Author: Zainab A. Chaudhary


Introduction: With the increase in women’s autonomy for career choices and educational aspirations, many women are opting to have children later. The past three decades have seen an increase in the amount of birth rates for women aged 35-55 (1). External factors such as more years in formal education and career contribute to women’s decisions to delay pregnancies (2). It is also a fact that fertility and fecundity decrease as women get older (3). The conundrum of increased maternal age coupled with decreased fertility and fecundity has caused many women to turn to Assisted Reproductive Technology (ART), to assist them in the process of getting pregnant. ART, according to the American Medical Association, is treatments or procedures that involve human oocytes or embryos, including in vitro fertilization, gamete intrafallopian transfer, ovarian stimulation or therapeutic donor insemination (4). With these recent advancements in ART, the question then becomes, should women be denied reproductive assistance based on age?

Methods: The question itself was formulated to understand both sides of the ethical argument for or against IVF in advanced maternal age women. The research articles were found using the PubMed database. The keywords that were used in the search included the terms “assisted reproductive technology,” “ART,” “IVF,” and “advanced maternal age.” Of the articles found, articles with irrelevant focus from the research question were excluded. Articles that discussed pregnancy outcomes, childhood outcomes, as well as risk analyses were included.  Additionally, articles that discussed the ethics and made arguments that supported a particular side were included. The chosen articles were then summarized and organized so that they can be properly used for analysis.

Results: The data suggest that there are many arguments for restricting reproductive assistance based on ag. One of them is the medical problems associated with pregnancy in advanced maternal age (AMA) patients. Women are at increased risk for gestational diabetes, placenta praevia, pre-eclampsia, miscarriage, pregnancy-induced hypertension, and Caesarean sections as age increases (2). Additionally, perinatal mortality, perinatal and neonatal death, and intrauterine fetal death also increase as age increases (2). The risk of premature birth rises after the age of 40 (6). Aging also has a negative impact on ART outcomes and AMA decreases the chance of live birth rates achieved using ART, especially after age 40 (5). Therefore, ART may improve chances of pregnancy in older women, but does not remove pregnancy risks. Another point made against reproductive assistance for AMA patients would is that older mothers could lead to earlier parent loss, which can have traumatic effects on the child (6). According to couples who were first-time parents when the mother was 40 years old or older, the main perceived disadvantage was the difficult in conception and smaller families than they desired (7). This leads to the idea that enabling women to get pregnant later will prevent them from having as many children as they wanted. It is also argued that cost-effectiveness could be a reason to not fund ART, particularly IVF, in countries with publicly funded healthcare systems, particularly for older women (6). Because there is a lower chance of IVF working in older women, it is argued governments with universal healthcare should not fund them. The arguments against restricting reproductive assistance based on age decidedly come back to patient autonomy. Increasing maternal age is associated with specific adverse pregnancy outcomes, but the age increases acts as a continuum of risk and not a threshold after which adverse outcomes increase massively. This is important because if age is not looked at as a threshold, then it cannot really be used to restrict reproductive choices past a certain age. (9). Gestation has risked for all women, so gradual incremental differences should not be enough to refuse IVF for AMA patients (6). The decision to get pregnant is ultimately up to the woman, and it should be up to her to decide what risk she is willing to take to have a pregnancy after thorough and clinical counseling (6). One of the points made to restrict ART based on age is the traumatic loss of a parent. However, younger women who seek fertility treatments may do so due to disease, therefore, loss of a parent could also be a problem for children who had younger parents. (6). However, the risk of a younger women having a fatal event is lower than the aging woman.  As well, advanced maternal age was not associated with poorer child outcomes in early and middle childhood. There was no evidence of psychosocial advantage/disadvantage for children in any maternal age group. Older mothers were better educated, had higher family incomes and took fewer risks (less smoking, increased breastfeeding) (7). The final point is that women are viewed in a negative context and restricted for having children at a later age, while older men who father children are not judged and perhaps even celebrated (10).

Conclusion: The topic of reproductive rights in general has been met with many ethical debates, including restricting ART for women based on age. While there are a variety of arguments that can be made for or against the topic, the bottom line comes to patient autonomy. Women are free to decide what risk they are willing to take to have a child. If men are able to have children at a later age, then women should not be restricted simply based on age. If pregnancy is deemed too risky by a clinician for an older mother, insurance companies should provide coverage for surrogacy options. Ultimately, the means by which a patient is willing to have a child is up to the woman and restricting ART based on age is a form of restricting patient autonomy.

22. Title: Assisted Reproductive Technology; Proposing Legislation to Eliminate Socio-Economic Hurdles.

Author: Waad Sayed


Introduction: Wealth vs poverty has been the center of many conflicts for generations. Many necessities, including basic food and shelter are often not obtainable for many individuals.  However, in addition to having obtainable nourishment and housing, health care is another necessity that must be accessible to all, regardless of ability to pay for it. Many people with limited finances may not be able to obtain the care they need due to no or extremely basic health insurance. And this access issue must be a priority for society, as good health is not only desirable for the individual and their family, but also for society in general. And, there’s another aspect of providing health care access to all regardless of their finances. That is, should having a baby with the assistance of the health care advances be available to all or limited to those who can afford this intervention?

Methods: explain where your resources came from. Gathering research from the CDC, and other researches I was able to see trends in the data and how they relate to the many hurdles that pose to those who are unfortunate enough to not be able to afford assisted reproductive technology. The research is from different studies and experiments.

Results: The data suggest that only individuals with financial means and excellent health insurance have access to assisted reproductive technology (ART) at this time. According to the CDC, 1.8% of babies in the United States are conceived with ART (1). That is 3,075 women out of 1 million women are helped to achieve their family building goals through ART. These women were mostly under the age of 40 as those over 40 do not tend to get desired results (2). The average cost of each ART intervention is $12,400; oftentimes patients must come in for multiple tries before they are successful while others unfortunately do not find success at all (3). Although approximately 12% of the population is not able to conceive naturally, only 2% are able to go through with ART as an option (3). The socioeconomic status of the patient plays a major role in who gets treatment and who does not. Minorities across the country have little to no access to this type of technology

Conclusion: Clearly, ART is a great addition to the science of reproduction. However, it is discriminatory in which individuals this science helps. Legislation must be promoted that provides equal access to ART regardless of the financial status of the individual.

23. Title: Getting to Know the Person behind Our Patient.

Author: Samantha Elfanagely; edited by Vanessa Ortiz


Introduction: Often in clinical medicine we do not see the patient as a person, but rather a diagnosis. This is especially true of leaders, who in their mature years become patients who seem to lose their rich history of accomplishments when they become patients. This project aimed to interview a woman who we might see as a patient in her own home rather than in a medical setting.

Methods: A visit to the home of Dr. Maria Teresa Moevs was arranged with our preceptor.

Results: While visiting the ever elegant and graceful 93 year-old Dr. Maria Teresa Moevs, the atmosphere within her property felt warm. Along a winding road sat her residence, an isolated blue farm home in a sea of green, surrounded by luscious lawns and trees which seemed to touch the sky and where a red barn rested not too far along the drive way. She had no choice in buying this home, “once my kids saw the brook [nearby], they were in love with the home,” she reminisced, “they loved the water.”  Thinking back to my own childhood and the moments where my siblings and I begged our parents to buy our current home since it had a pool, I couldn’t help but feel immensely connected to Dr. Moevs. Like my parents, she immigrated to the US, and made an entire life for herself seemingly without hesitation or doubt in her capabilities to do so. Like many of us, she cherished her family, so much so she was motivated to buy a home because of the way her children romanticized it. However, Maria Teresa was unique for the way she fostered an appreciation for academia everywhere she went, not only for her children, but all those who surrounded her.

Dr. Moevs too had ties to Douglass College, my alma matter, which served as her former teaching grounds, where she was a pioneer woman in her field. There she created the Italian House, a living-learning community for women studying at Rutgers University.  She spent so many years of her own life encouraging others to pursue their dreams, my peers and I wondered as we sat along her wrap around porch debriefing from the interview for a bit, what encouraged her to think this way? What about her experience in Italy, while World War I was going on, set her apart from her female counterparts? Why was she an archeologist despite the culture within university at the time which so vehemently discouraged female academic excellence?

“I was exposed to university at a young age, and no one told me not to, so I did,” she accounted so effortlessly. Despite her simple answer, her memoirs never failed to mention her appreciation of being born into a family which valued education. She stressed how education is an opportunity, a privilege, that not all are granted. Yet still there is something very exceptional about Maria Teresa, which I can only think to attribute to her archeologist background. She seems to love and enjoy everything she’s ever owned, perhaps this is why education is so meaningful to her. As an archeologist, she lived by learning from everything around her in life, and then promptly shared this knowledge with others. It is her nature to not only explore via education but to pass on this acquired knowledge. This became immediately evident as we walked through her home, which quite felt like my own, primarily full of love, but by way of art and furniture with pieces that each possessed an identity of their own. Dispersed within the room I noted all items which either emphatically represented her Italian heritage or stood as reminders of her beloved husband and children. Everything within her home, especially as a former archeologist, possesses a sentimental purpose beyond functionality. By elaborating on the history behind the items within her home, Maria Teresa offered us invaluable insight into her life.

Conclusion: There’s something to be said about being allotted time to get to know a patient and asking them 0 questions about their medical history. Understanding who someone is without the context of what may make them vulnerable to you allows you to foster a true relationship with them. Often times our geriatric patients come to us unguarded, and we take them as frail, failing to remember there before us stands an entire life full of experiences, emotions, and fulfilled relationships. Truthfully, if I had met Maria Teresa in a hospital setting, there is no way I would’ve gotten to know her as intimately as I did in her home. I may have not seen her as complete as I did when she had a true chance to show me who she was and the life she lived through the items she collected all her life. Maria Teresa stands as a reminder of the life that lives behind every one of our patients. May we never forget the lives within the people who comes to us as patients.

24. Title: Global Health Experience with Maternal Healthcare in Finland.

Author: Alexandra Schmidt


Introduction: Finland is often looked at as an example of success in the realm of women’s health. Reported maternal mortality rates in Finland are as low as 3 deaths per 100,000 live births.1 Concurrent rates in the United States are more than 6 times as high, at 19 per 100,000.2 As a candidate for the Distinction in Global Health at Rutgers Robert Wood Johnson Medical School, I traveled to Tampere, Finland to audit maternal health clinics (“neuvolat”) to gain insight into the country’s maternal healthcare system and compare it to that of the United States.  

Methods: Observational data was collected at Hervanta Neuvola and Muotiala Neuovola in Tampere, Finland, and the Labor and Delivery Ward of Tampere University Hospital. Further discussion was informed by reports published by Finland’s National Institute of Health and Welfare, the United States’ Centers for Disease Control, and the World Health Organization.

Results: The Finnish system exists as a network of community-based, primarily nurse-run clinics. Pregnant women are paired with one nurse for the duration of pregnancy, and time allotted for appointments with this nurse average almost an hour per visit. Finland’s emphasis on nurse-directed primary care is complemented by the routine presence of a midwife during parturition instead of a physician. After giving birth, women are visited at home by the same nurse to be evaluated physically and emotionally. Another notable difference between the countries is a decreased prevalence of surgical deliveries in Finland as compared to the USA (16.7% vs 32.0% in 2017).3,4 However, C-sections in Finland have been on the rise and continue to increase, though they do not approach rates in the U.S. Other important maternal risk factors such as obesity and gestational diabetes have also been trending upwards in Finland in recent years, similar to trends we see in the United States.3,5,6

Conclusion: Finland provides an example of a country the USA may want to emulate in its goal to decrease maternal mortality. In spite of increasing maternal risk factors and rising C-section rates, the Finnish MMR remains consistently low. It appears that the Finnish system provides extended time for patients and health care providers to establish a relationship and emphasizes the benefits of a well-rounded, psychosocial approach to perinatal care. Further research should be conducted to see if a similar structure of care is feasible and would be as successful if implemented in areas of high maternal mortality within the USA.

25. Title: Mothers, Children, and the Microbiome.

       Authors: Nicole Fosko, BE; Gloria Bachmann, MD; Allison Cabinian, MD; Nancy Phillips, MD; Maria Rocktashel,    MSN


Introduction: The microbiome is a vast ecosystem of bacteria and other microorganisms within every human being; it supports life and healthy bodily functioning. However, the microbiome is poorly understood by the general population in terms of its roles, the consequences of medical and lifestyle choices, and the diseases and conditions attributed to a microbiome in dysbiosis. The team sought to demystify the microbiome through a Q&A style publication for patient education, particularly targeting women in the perinatal period.

Methods: A comprehensive literature review was conducted using the databases available via the Rutgers Libraries, utilizing articles related to the microbiome, antibiotics, and other relevant topics. Articles were included for analysis if they were written in English, underwent peer-review, and had full-text availability. A total of over 45 unique articles have been found that met these criteria. Once the data and information were compiled, the team engaged in several synthesis and editorial iterations over an eight-month period, ultimately producing a completed work that will be accessible to the general public. The team is currently producing an additional chapter that focuses on the COVID-19 pandemic.

Results: The team succeeded in relaying the significance of the microbiome throughout the course of a human’s life, with particular detail regarding the microbiomes of women who desire to become pregnant, are currently pregnant, or have recently given birth. The publication defined the term, components, and roles of the microbiome before discussing medical and lifestyle factors that alter its functioning. Mode of delivery, breastfeeding, diet, exercise, environment, medical treatments, and medications were explored in detail. Special attention was given to the discussion of antibiotics as well as bacteriotherapy as entities that greatly affect the microbiome.

Although a completed draft of this publication was achieved before the COVID-19 pandemic occurred, the team recognizes a need for discussion regarding the SARS-CoV-2 virus and its relationship to the microbiome. An additional chapter delving into COVID-19 is currently in the editorial process for addition to the final publication.

Conclusion: After extensive research, a Q&A style publication was produced in an effort to better inform patients and the general public about the existence of the microbiome and how their environmental, lifestyle, and medical choices affect it. The publication is specifically geared towards women in the perinatal period, providing dialogue on specific microbiome changes around pregnancy. The format allows for achievement of a conversational approach, ease of navigation among topics, and de-stigmatization. Additionally, the language and tone of the publication allow for accessibility and inclusivity. The publication will likely take on a new significance in light of COVID-19 and the heightened awareness of environmental microbes and pathogens. 

Future directions include addition of COVID-19 material before final edits and publication. The publication will also be translated into several additional languages in order to cater to a larger population. To understand the impact and success of the publication regarding its educational mission, future qualitative research can be undertaken to analyze and improve its impact.

26. Title: Alcohol Dependence: Exploring the Issue Among an Interdisciplinary Panel of Female Leaders.

      Co-Authors: Halle Fitzgerald, Evan Perkiss, Eliana Schach


Introduction: “The National Institute on Drug Abuse estimates that costs of healthcare related to alcohol use disorders in the United States is approximately $25 billion yearly and the overall costs in the United States are upwards of $224 billion”1. The cost of its ramifications is well described in the literature, but what about the psychosocial impact? A literature review was conducted, and an expert panel was assembled to bring light to these issues, specifically on how they may impact women. We look to examine the prevalence and cognizance of alcohol dependence in the workplace amongst those afflicted and those who may be affected as a result. We also look at what tends to happen when it is discovered, how to best approach a colleague, and how it is managed afterwards.  According to a national probability sample of 2805 employed adults using a random digit dialing telephone survey, “workplace alcohol use and impairment directly affect an estimated 15% of the U.S. workforce. Specifically, an estimated 1.83% (2.3 million workers) drink before work, 7.06% (8.9 million workers) drink during the workday, 1.68% (2.1 million workers) work under the influence of alcohol, and 9.23% (11.6 million workers) work with a hangover”2. Despite a general impression that alcohol dependence is of concern only to men, the problem has a great impact on women too. In a “multilevel analyses of data from 1,301 workers, it was found that, even when controlling for a variety of other demographic and unit-level factors, there is a significant association between the proportion of males in a work unit identified as being heavy or “at-risk” drinkers and the probability of gender harassment toward unit females.”3.   The paper will review the major finding of the panel, but more importantly stress that this issue should be addressed by multidisciplinary teams.

Methods: An interdisciplinary panel of five distinguished guests was formed. The interdisciplinary panel, chaired by Gloria Bachmann MD, had panelist Rebecca Mark, Ph.D., Kamana Misra, Ph.D., Sharon J. Parish, MD, Mary Rorro, MD, and Jeana Wirtenberg, Ph.D. The members were asked discussion questions related to alcoholism in the workplace.

Results:The importance of having a multidisciplinary team was immediately appreciated, as the panel approached the issue from many different viewpoints. Rebecca Mark, PhD, is currently the director of the Institute for Women’s Leadership at Rutgers and was the Chair of the English Department at Tulane University. Kamana Misra, PhD, is the President of the Association for Women in Science NJ chapter. Sharon J Parish, MD, is an Internal Medicine physician, who now directs medical consult services at Cornell and has psychiatry and behavioral health training. Mary Rorro, MD, is a  psychiatrist at the NJ Department of Veteran Affairs and has developed songs to help veterans at her practice. Jeana Wirtenberg, PhD, is  the Associate Director of the Rutgers Institute for Corporate Social Innovation (RICSI) and was the HR director at the Public Service Enterprise Group (PSEG). However, despite these varied backgrounds, all agreed that aside from the deleterious effects alcoholism has on the work environment for women and men alike,  the prevalence of alcohol dependence in women is actually rising faster than in men. In the past 20 years, there has been an increase in alcoholism among women. The experts also provided insight into how alcoholism has historically and currently been addressed in the workplace/college atmosphere and commented on its normalization.  Overall, the panel agreed that the direct and indirect effects of alcohol are a woman’s health issue and should be actively addressed.

Conclusion: Most of the panelists agreed that alcoholism is not addressed enough in the workplace and that internal programs and external resources should be expanded further. Employees should be educated about the effects of alcohol on their body. Even one drink per day can increase the risk of breast cancer. Light drinkers have a 1.04-fold increased breast cancer risk, moderate drinkers have a 1.23-fold increased risk, and heavy drinkers have a 1.6-fold increased risk.4 Women also should be educated on how to handle the social pressure of handling alcohol in situations involving the workplace. However, in anticipating next steps, “it appears from the evidence that brief interventions, interventions contained within health and life‐style checks, psychosocial skills training and peer referral may have potential to produce beneficial results”5. Thus, moving forward, we must address alcohol dependence, specifically the increasing rate for women, at conferences with open discussion to encourage stronger treatment options and strategies towards managing alcoholism in professional settings. Further educational programs for the workplace and college campuses should be created as education is an effective method for prevention and acknowledging existing problems. As the pressure on professional women is rising, especially during COVID-19, there is a need for better resources targeting women’s health.

27. Title: Addressing Pain: A Need to Consider All Organ Systems.

      Author: Nicole Fosko


Introduction:  Many times when a patient comes in to a specialist’s office, their major complaint is only evaluated through a focused lens. This is an example of needing a broad clinical approach.

Methods: The information from this case was obtained through a series of phone interviews with the patient. Afterwards, details were confirmed via chart review, utilizing medical records from the various aspects of the healthcare team. The results are presented as a Case Summary.

Results: In early 2017, a 52 y.o. gravida 4 para 2 woman with long-term history of ovarian cysts and endometriosis, recent diagnosis of diverticulitis, as well as two laparoscopic procedures in the remote past, presents to the emergency room with abdominal pain, cramping, and diarrhea of one month duration. Patient describes her pain as a “7-8 in intensity, [feeling] like labor contractions,” diffuse but most concentrated in the right lower quadrant. Patient is still menstruating regularly, but bHCG is negative. Vital signs are stable, and transabdominal and transvaginal pelvic ultrasound are performed. Ultrasound reveals a septated right ovarian cyst with normal adnexal duplex scan. The patient is treated for the pain, and the ultimate clinical impression for the incident is “pelvic cramping.” The patient reports that she “has just always had gynecologic issues,” and although she has never felt anything like this, she accepts the current diagnosis.

The patient follows up with her OBGYN three weeks later, whom she has been seeing since the age of 18. During the visit, the patient complains of continued right-sided pain, and a pelvic exam and ultrasound are performed. At the time of the visit, the clinician suspects possible cystocoele from ultrasound. Ultrasound is further analyzed later that week, with more specific findings of “bulky and heterogeneous [myometrium], possible adenomyosis.” Patient is advised to monitor symptoms and work on pelvic floor strengthening, and she also receives a GI referral. Follow up ultrasound 4 months later reveals resolution of ovarian cysts but still suspected adenomyosis. However, the patient still experiences right-sided abdominal pain.

Over the course of the following year, the patient visits a chiropractor for lower back pain, which is reported as right-sided sciatica. The patient has led an active lifestyle for over 20 years and has experienced various musculoskeletal issues as a result of strenuous exercise. Over the course of several visits, the patient reports pain ranging from 1 – 5/10, until one visit (in February 2018) in which the patient reports to the chiropractor that she is experiencing 9-10/10 “severe pain with an unknown cause.” The patient is recommended to visit the ER immediately but waits several days, ultimately going in due to unresolved, severe pain. In the ER, the patient reports contractions in the lower back radiating to the front of the body which interfered with walking. The contractions are distinct from the “labor-like” contractions experienced at her previous ER visit. Kidney stones are suspected, but after a workup, “acute myofascial strain of [the] lumbar region is discerned.”

The patient follows up with her family physician, who recommends physical therapy. The physician does not believe that this pain is related to ovarian cyst history or diverticulitis, but the patient is distressed by the unknown and unresolved origin of her right-sided pain episodes. Through several PT visits, the physical therapist explores the patient’s back and hip pain, and ultimately the PT reports that she believes the patient’s sequelae are a result of iliopsoas muscle strain. This diagnosis is also confirmed by a massage therapist, reporting an “antepulsed [right ilium] with significant tension on the iliolumbar ligaments.” The patient is given home exercises, follows up with the PT and her massage therapist, and utilizes acupuncture to address the iliopsoas muscle strain, and the patient’s symptoms gradually improve over the next two years. Three years after the initial ER presentation for cramping abdominal pain, now 2020, the patient reports improvement of symptoms at her gynecological annual visit. She emphasizes that she is better able to understand and address flare ups now that she knows the pain is muscular in origin.

Conclusions: An incorrect or missed diagnosis can be detrimental to a patient’s health and wellbeing; patients know their own bodies best and know when something is wrong, regardless of an attributed diagnosis. It is the duty of the healthcare provider to fully consider all diagnoses in order to best serve the patient. Along these lines, every individual deserves to live a life free from pain, regardless of willingness to accept pain as a part of their daily life.

For this case in particular, the presentation of iliopsoas muscle strain can mimic the individual presentations of diverticulitis or ovarian cysts, which at first appeared to be likely sources of the patient’s pain. These typical sources of pain should be considered and therapeutically targeted in all patients. However, when these diagnostic and management strategies do not adequately relieve the pain, alternative management strategies should be considered before surgical interventions or more invasive methods are prescribed. The whole healthcare team must communicate and deliberate in treating the patient.

Acknowledgements: The author would like to thank the patient from the case above (who has been deidentified) for her time and for sharing her story

28. Title: Product development intern at a pharmaceutical company: lessons learned.

      Author: Elizabeth Aikens

____________________________________________________________________________

Introduction: To understand the options in STEM professions, this paper will review the intern experience over the summer at a major biopharmaceutical. The experience also was important to understand product safety within the clinical supply group at a major pharmaceutical.

Methods: A virtual internship was offered by Bristol Meyers Squibb (BMS) to students interested in STEM related fields.  I was selected to participate in one of them at BMS. Bristol Meyers Squibb is a global biopharmaceutical who notes in their company literature that their focus is ‘on helping to address the unmet medical needs of patients with serious diseases.’ The internship was 8 weeks and due to the pandemic was a virtual one.

Results: The safety within the production of drug products and the compliance of ergonomics and process safety for employees within the clinical supply operation group was studied. The major take away from the entire experience was that over the last 20 years, the global hazard communication guidelines have been created and continuously updated to be sure that workplace safety is the primary necessity of the company and work group. It was interesting to see how common elements were turned into household name products that people use on a daily basis. The company also makes sure that people are using their medications correctly and that these interventions, during production and use, do not add to global health issues. They also encourage patients to report any side effects or product quality complaints.

Conclusion: An internship in a pharmaceutical company is invaluable for anyone considering a career in STEM. From this experience the objective measures that go into product development and safety became clearly apparent and the many options in STEM, through meeting many different team members, became obvious.

29. Title: Female gender associated with prolonged longevity as compared to male gender.

      Author: Mike Adarkwah

____________________________________________________________________________

Introduction: An intriguing aspect of the human race is the consistency in females outliving males. Because we have more control as a society to manipulate non-biological factors such as culture and socio-economic differences between genders, we can utilize the female gender to predict ways to enhance longevity. This scholarly review weighs the different mechanisms affecting gender and longevity of life and how we could utilize the female gender as a model to intervene and expand our knowledge on the biological aspects affecting longevity of life.

Methods: A Google Scholar search was done to identify relevant articles on this topic.

Results: In analyzing several differences reported in the literature between males and females, several key processes were identified that can be utilized to help gain scientific understanding on the discrepancies in longevity. There are data that expand our understanding of regulatory mechanisms governing biological factors such as gender differences in telomere length, estrogen, and production of Reactive Oxidative Species. These infer many explanations as to why females in general, outlive males. Some of the additional findings also include workplace injuries and women targeted killing that are non-biological threats to longevity of life to women. This is in comparison to the shortening of telomere length, increased production rate of Reactive Oxidative Species, and lower estrogen levels that tend to place males at a survival disadvantage in comparison to females.

Conclusion: A potential area for further research should focus on key hormones such as estrogen that are dominant in females as opposed to males and this step can possibly serve as the framework of endless scientific breakthroughs in discovering key processes that may influence longevity.

30. Title: Pet Visitation for Chronic or Terminally Ill Hospitalized Patients

      Author: Taylor Corsi

Introduction: The human health benefits gained from interaction with animals have been well-documented, ranging from physiological improvements such as lowered blood pressure1 to mental health improvements such as reduced risk of violence and decreased anxiety in chronic psychiatric inpatient populations2,3. The positive impact of animal visitation on human health could be of use in chronic or terminally ill populations hospitalized long term. 

Methods: Current literature regarding inpatient animal visitation was surveyed.

Results: Randomized control trials have assessed the psychosocial and physiological impact of animal therapy for patients in critical care with chronic conditions; animal-assisted therapy improved cardiopulmonary measures, anxiety, and neurohormone levels in patients hospitalized with heart failure4. Animal healing has also been used beyond critical care settings5; pet visitation has been reported to relieve stress, normalize the hospital environment, and improve the morale of pediatric patients and their parents6. Furthermore, benefits reported from animal visitation have been positively correlated with the relationship between the visiting animal and patients6

Care centers have piloted family pet visitation policies with consideration for unique health risks related to animal contact in a nosocomial setting and have reported high patient, staff, and family satisfaction7

Conclusion: Given that the potential magnitude of benefit from inpatient animal visitation may correlate with the patient-animal relationship, we suggest that allowing visitation from a patient’s pet may produce even greater positive health outcomes than generalized pet visitation. Populations who may benefit most from family pet visitation are those who are chronically or terminally ill and facing long term hospitalization, as purported emotional and physical healing potential of animal visitation may be effective in combating the mental health comorbidities facing these populations. Interventions addressing depression, hopelessness and social support have been described as important aspects of palliative care for terminally ill cancer patients8, for whom family pet visitation may be a potential personalized intervention addressing such concerns.   

Developing guidelines for which patients may qualify for pet visitation and animal health screening will be an important future step towards allowing family pet visitation in hospitals and can improve the experience for patients, families, and the healthcare team.