Summer 2021 Publication

Youth Perspectives on

Global Health Issues

Eunoia

TELLING UNTOLD STORIES

SUMMER 2021 ISSUE

E

TABLE OF CONTENTS

4 Microplastic Contamination

EDITOR-IN-CHIEF

Alyssa Tang

LAYOUT DESIGN

Alyssa Tang

Eugenia Calvo Prieto

Eric Gu

Tanisa Goyal

COVER DESIGN

Tanisa Goyal

PROOFREADERS

Chinedum Aguwa


Tanisa Goyal

Baala Shakya

CONTRIBUTORS

Chinedum Aguwa

Mahsa Baghbanijavid


Isabelle Chiou

Audrey Czarnecki

Eric Gu

Adwaith Hariharan

Sara Maggio

Hannah Pescaru

William Suringa

Alyssa Tang

Katherine Yan

6 A New Look at Mask Culture

7 Majestic Mammals on the Road to Extinction

8 An Interview with an Expert: Dr. Yen

10 The COVID-19 Pandemic and the Disability

Paradox

12 COVID-19 Vaccines

13 Life On The Edge of Independence:

My Brother and Tuberous Sclerosis

18 Hidden Heroes

20 Tuberculosis in the Time of COVID-19

23 More Than a Habit: Stories From Inside the

BFRB Community

27 The Social, Environmental and Economic

Impact of the Fast Fashion Industry

29 The Island of Wonders

31 The Neuroscience Behind Body Dysmorphia

34 Beware the Delta Variant

35 The Story of an Immigrant Teenager During

the Pandemic

39 The Other Pandemic: A Dive Into the COVID-19

Pandemic and Adolescent Mental Health

41 Safe and Responsible AI for Healthcare

43 Map of Contributors from Around the Globe

2 | SUMMER 2021

Letter from

the Editor

Dear readers,

We approached summer of 2021 with

optimism, eager to put the pandemic in

our rearview mirror. However, as we

are in production for this issue, the

Delta variant is wreaking havoc on our

plans once again. Just as the virus is

ever changing, we too must be flexible

to cope with constant updates in

vaccination mandates and mask

policies.

In addition to scientific articles, you'll

find more creative pieces in this issue,

from personal narratives, patient

stories, to breathtaking photography.

Storytelling combined with technical

facts and statistics effectively convey

their message and help readers be more

understanding and compassionate. I

applaud our contributors for sharing

their stories.

I’m incredibly grateful to work with such

amazing ambassadors since the last

publication. This team of passionate students

from across different time zones have not only

collaborated in the layout designs and

proofreading of this issue, but also launched

several new initiatives. Please check out our

website for the latest additions!

Let us remain committed in our fight against

infectious diseases and invisible disorders as

well as the inequities in global health.

Sincerely,

Alyssa Tang

Founder and Editor-in-Chief

EUNOIA GLOBAL HEALTH | 3

MICROPLASTIC

CONTAMINATION

EUGENIA CALVO PRIETO

S

ince mass production of plastic began the natural environment. Smaller than 5

in the 1950s when the industrial mm in dimension, much of the hundreds

processes went mainstream, humankind

has produced over 8 billion metric tons of

plastic. In fact, half of the plastic was

of millions of tons of plastic waste in the

ocean is made up of microplastics. The

smaller the size of the plastic particles,

made after 2000. However, just 9% has the more likely they are to cross

been recycled, another 12% incinerated. biological barriers (such as cell

membranes) and cross tissue damage.

The rest amasses in landfill sites or ends

up in the natural environment, eventually

finding its way into rivers, streams and

oceans. Particularly, plastic is

accumulating in our oceans at an

alarming rate. Every year, around 8

million tons of plastic enter our oceans.

However, when these enter the oceans,

they can’t biodegrade. Therefore, they

break into smaller and smaller pieces,

resulting in microplastics. Microplastics

are comprised of tiny fibers from nylon

clothes and other synthetic items. They

can also come from fragments of larger

plastic items that have broken down in

4 | SUMMER 2021

Any wildlife in or around rivers, streams

or oceans is being exposed to the threats

of microplastic pollution. These plastics

can be ingested by organisms as small as

zooplankton. This can block the

gastrointestinal tracts of organisms, or

trick them into thinking that they don’t

need to eat, which could lead to

starvation. Many toxic chemicals can also

adhere to the surface of the plastic,

exposing organisms to high

concentrations of toxins. Overall, all of

this could reduce growth and reproductive

output for animals.

Small pieces of plastic, known as microplastics, are routinely mistaken

for food by seabirds and marine life. (Image Credit: Florida Sea Grant)

However, these tiny microplastics and the

chemicals that attach to them in the

water can contaminate the food chain,

including seafood products that are eaten

by us. Around 114 pieces of microplastic

settle on a dinner plate during the 20-

minute duration of a meal, adding up to

anywhere between 13,000 and 68,000

pieces per year. When you breathe in air,

you could also be breathing in the

microplastic particles as well. Since we

know that microplastics can be found in

oceans, lakes and other water sources,

drinking water could also contain toxic

plastics. In order to test this, a company

tested 259 bottles of water from

companies such as Aquafina, Nestle Pure

Life, Dasani, Evian and others. Out of all

the bottles tested, 93% contained some

sort of microplastic particles. The tests

found that for particles that were 100

microns (0.1 millimetres) or larger, there

was an average of 10.4 plastic particles

per litre of water. Additionally,

microplastics can come from our clothing;

fleece and synthetic clothing shed

microplastics into the water with each

washing. In fact, a fleece jacket can shed

about 2,000 pieces of plastic per

washing. Wastewater treatment plants

don’t have the ability to screen these tiny

pieces, meaning they end up in both the

discharged water and the sludge that is

composed.

Big chunks of plastic, like the ones floating

here, can be clearly seen. But tiny pieces are

scattered through the oceans too. (Image

Credit: Rich Carey/Shutterstock)

In total, the average human consumes an

estimated 70,000 microplastics each

year, but it’s still unclear what health

consequences this causes. Scientists

believe that microplastics likely can

cause toxicity through oxidative stress,

inflammatory lesions and increased

uptake or translocation. Several studies

have also demonstrated the potentiality

of metabolic disturbances, neurotoxicity

and increased cancer risk in humans

since plastic often contains carcinogenic

materials.

There are ways we can reduce our

microplastic consumption and its impact.

For example, you could reduce or stop

your bottled water intake. Drinking water

is one of the main sources of

microplastics in our bodies. If you only

drank from bottled water, you would be

consuming 130,000 microplastic particles

per year, compared with just 4,000

particles per year from tap water.

Therefore, transitioning to tap water will

reduce microplastic consumption by a

significant amount. To further reduce or

completely remove microplastics from

your drinking source, you can also look

into filtering your tap water.

Additionally, plastic bottle waste also

contributes to the creation of new

microplastic, which can have a

detrimental effect on the environment.

Therefore, reusable water bottles would

also help reduce these effects.

As said before, microplastics can also

contaminate the food chain, including the

seafood that we eat. Therefore, reducing

your shellfish consumption would help

avoid us from ingesting the microplastics

present in marine wildlife.

Another way to reduce microplastic

contamination is to buy clothing made

from natural materials. Synthetic fabrics

like nylon, spandex and polyester are

made out of plastic. Over time, these

pieces of clothing will shed fibres as they

are washed or rubbed against rough

surfaces like walls. To eliminate your

exposure to microfibres, avoid wearing

clothes made out of synthetic fabric and

instead opt for fabrics made of natural

materials, such as natural cotton.

A final way to reduce microplastic

contamination is to air-dry your clothes

rather than using a dryer. Synthetic

fabrics shed microfibres when they are

machine dried. Air drying your clothing

can reduce the number of microfibres

that your clothes shed.

In summary, microplastics are a major

environmental issue mainly because of

their distribution, uncontrolled

environmental occurrences, small sizes

and long lifetimes. However, there are

effective ways in which we can reduce

the contamination of them to lessen their

impacts.

References

[1] Brodde, K. (2017, November 7). Why is

h&m burning new clothes? Retrieved

April 09, 2021, from

https://wayback.archive-

it.org/9650/20200220111509/http://p3-

raw.greenpeace.org/international/en/new

s/Blogs/makingwaves/hm-burning-newclothes-fast-fashionincineration/blog/60640/.

[2] Brown, R. (2021, January 8). The

Environmental Crisis Caused by Textile

Waste. RoadRunner Recycling HQ.

https://www.roadrunnerwm.com/blog/te

xtile-waste-environmental-crisis.

[3] Global garment industry to grow 8.8

per cent CAGR from 2021–27. (2020,

August 14). Fashionating World.

https://www.fashionatingworld.com/new

1-2/global-garment-industry-to-grow-8-

8-per-cent-cagr-from-2021-

27#:%7E:text=An%20Allied%20Market%

20Research%20report,and%20its%20infl

uence%20over%20consumers.

[4] Kan, H. K. (2009, December 1).

Environment and Health in China:

Challenges and Opportunities. PubMed

Central(PMC).

https://www.ncbi.nlm.nih.gov/pmc/articl

es/PMC2799473/.

[5] Lohr, S. (2014, October 19). 5 truths

the fast fashion industry doesn't want

you to know. Retrieved April 09, 2021,

from arch 7). What are Microplastics?

And 6 tips on how to reduce them.

https://tappwater.co/us/what-are-microplastics-and-5-tips-to-reduce-them/.

[6] GetGreenNow. (2019, November 30).

8 Ways to Avoid Microplastics and Why

It’s Important. https://get-greennow.com/ways-to-avoid-microplastics/

Global Citizen. (2021, March 19). Global

Citizen Life.

[7] 5 Easy Ways You Can Avoid

Microplastics in Your Everyday Life.

https://www.globalcitizen.org/en/conten

t/microplastics-how-to-avoid-reduce/?

template=next.

ABOUT THE AUTHOR

Eugenia Calvo Prieto is a current sophomore

at Sha Tin College, Hong Kong. She is

passionate about the biomedical sciences and

the intersection between the social sciences

and medicine. She enjoys pursuing these

interests through scientific research and

initiatives. Being an ambassador for Eunoia,

she is able to raise awareness and educate

others on various global health issues through

writing, videos, podcasts and lessons. Outside

of Eunoia, she also likes to sight and explore

wildlife species and learn about the issues

surrounding animal conservation and ecology.


In the heart of South Africa, the Timbavati Nature Reserve, bordering

Kruger National Park, is home to a myriad of creatures namely the

Big Five of the safari world: the elephant, rhino, lion, Cape buffalo,

and leopard. The elephant specifically was a sight I will never forget.

The matriarchal herds were like nothing I had ever seen before with

strong personalities throughout.

TAKING ACTION

With elephant populations currently

declining due to illegal poaching and the

ivory trade, it is a pressing matter that

needs to be addressed. One does not have

to travel to South Africa to realize that these

creatures need our help whether it be via

organizations like the World Wildlife Fund

(WWF), education, or advocacy. These

amazing mammals are worth the fight!

Photography by Sara Maggio


INTERVIEW WITH AN EXPERT:

DR YEN

(Interview conducted by Eugenia Calvo Prieto)

What drew you towards the study of epidemiology/epidemiological science?

I am a virologist with training in veterinary medicine and epidemiology. As most

of the emerging infectious diseases are of animal origin, I was very interested to

understand the drivers that facilitate their emergence and spread.

Your research interests focus on the mechanisms of influenza transmission among and

between different reservoirs, potential virus-host interactions and pathogenicity. What

types of influenza viruses do you study and what are some interesting findings?

I study animal and human influenza viruses.

For animal influenza viruses, such as avian influenza and swine influenza, we are interested to

understand why some of these viruses can cross the species barrier and infect humans. For example,

H5N1 or H7N9 avian influenza viruses can cause severe infections in humans with high case fatality

rates. Close contact with infected poultry at the human-animal interfaces, such as live poultry markets,

is an important risk factor. Our study at the live poultry markets detected avian influenza viruses in

airborne particles and from contaminated surfaces, suggesting the risk of exposure to these viruses

via aerosols and fomites.

We studied the 2009 H1N1 human pandemic influenza virus that originated

from swine influenza viruses that lacked the sustained human-to-human

transmissibility; we identified viral factors that contributed to its efficient

transmissibility in humans. In addition, we use animal models to investigate

the size range of airborne particles that mediate human influenza

transmission. Since last year, our research has been extended to work with

the SARS-CoV-2 virus that causes COVID-19. We work closely with a

multidisciplinary team to study the relative significance of different modes of

influenza transmission.

You also examine the molecular determinants that can confer antiviral resistance, can you

explain what these determinants are?

8| SUMMER 2021

Antivirals target specific viral proteins, usually, an enzyme that has a critical function during the virus

replication cycle. The mutation that confers resistance to the antiviral compounds may emerge in the targeted

viral protein due to selection pressure. Since these targeted viral proteins are essential for viral replication,

some of the resistant mutations may lead to a functional loss of the protein and reduce viral

fitness. On the other hand, some mutations can confer resistance to antivirals without

causing too much fitness loss of the protein/viral fitness. These mutations have a higher

potential to spread in humans. Identify these mutations may help to improve the design of

current antivirals.

What are some ways we can prevent antimicrobial, specifically antiviral, resistance?

One of the strategies to reduce antiviral resistance is combination therapy, a strategy that is very effective for

treatment against HIV infections. It is because the likelihood for a virus to acquire multiple mutations to confer

resistance to different antivirals while maintaining its fitness is low.

There has been a sharp drop in flu cases during the past year most likely due to maskwearing

and social distancing. Could this be an effective way of preventing (and controlling)

flu outbreaks? What else could we do to prevent there from being many flu cases like in

past years?

The use of multiple non-pharmaceutical interventions has been effective in reducing the

transmission of SARS-CoV-2 and influenza. However, the socioeconomic cost of implementing

these interventions is significant. I can see this strategy being used again when we face a new

influenza pandemic but not against epidemics. Influenza vaccines, especially novel vaccines

that are currently under development with new vaccine technology, may be alternative tool.

Additionally, since there have been such a small number of cases, how could the virus have

evolved or changed differently in the past year?

Indeed, the global influenza activity has been very low in the past 16 months. In Hong Kong, we have almost no

detection (low numbers) of influenza patients through the surveillance system, but low influenza activity can still

be detected in some regions. This low-level circulation may reduce the evolution rate of the virus. At the same

time, population immunity for the influenza virus is waning due to the lack of exposure to the viruses. It is likely

that we will see a surge of influenza activity when most of the countries lift COVID-19 related control measures

and when international travel is resumed.

DR. YEN

ABOUT

Dr. Hui-Ling Yen received her Ph.D. in Epidemiological Science from The

University of Michigan, Ann Arbor followed by her postdoctoral training at St.

Jude Children’s Research Hospital, Memphis, TN. Her research interests focus on

understanding the mechanisms of influenza transmission among and between

different reservoirs, investigating potential virus-host interactions that affect viral

pathogenicity and transmission, and examining the molecular determinants that

confer antiviral resistance.

EUNOIA GLOBAL HEALTH |9

THE COVID-19 PANDEMIC

AND THE DISABILITY

PARADOX

KATHERINE YAN

A

ccording to the Office of National

Statistics, as reported by the BBC (2021),

six in ten people who died from COVID-

19 in the UK last year had disabilities.

At first glance, this statistic might be

distressing, but not especially surprising

— after all, it makes sense that

disabilities mean poorer health, and

lower chances of survival. It makes sense

that there’s a disproportionate amount of

people with disabilities getting infected

in the first place, as many of them either

live in group homes or are low-paid

essential workers, reliant on public

transportation (a problem unto itself).

The presence of Intellectual and

Developmental Disorders (IDDs) is the

highest predictor of coronavirus fatality,

outside of age,¹ which might make an

awful sort of sense… until you realize

that IDDs beat out heart failure, chronic

kidney diseases, and cancers —

including lung cancer, the only of the 15

conditions analysed in a study that

rivalled IDDs’ threefold increase in death

rates — as a risk factor.²

Of course, most IDDs come with many

underlying health conditions that play a

major role in death rates, but what is also

notable is that while patients with IDDs

have a higher rate of hospital admittance

and a higher rate of coronavirus mortality

following that admittance, there is no

corresponding increase in admission rates

into the Intensive Care Unit (ICU).¹

What does this all mean?

Patients with disabilities are dying, and

they aren’t receiving the higher levels of

care they need.

Michael Hickson, a quadriplegic, was

admitted into Austin Hospital in June

last year.³ ⁴ He was put on a ventilator

when his condition became serious, but,

when it further worsened, his wife,

Melissa Hickson, was told that he would

be moved out of the ICU and into hospice

care. He would not be intubated. He

would not be receiving hydration,

nutrition, or resuscitation. Essentially, he

was left in a comfortable place to die.

When Melissa called the hospital to ask

why her husband wouldn’t be receiving

(Image Credit: Pixabay)

further treatment, she wasn’t told any of

the more valid reasons that treatment

would be futile — his sepsis, pneumonia,

multiple organ failure, low chances of

survival. Instead, the attending physician,

in the recorded call, informed her that

they would not aggressively pursue

treatment because of “his quality of life

— he doesn’t have much of one.”

“What do you mean? Because he’s

paralyzed with a brain injury, he doesn’t

have quality of life?” she had asked.

“Correct.”

Nobody made decisions based on what

Michael Hickson, or his wife, or his five

children, thought of his “quality of life”

— that right was taken away. Michael

Hickson died on June 11.

The hospital denied that this decision

was based on his disability, but, given

what the doctor had said on the phone,

could that really have played no role?

This isn’t an isolated incident. Research

shows that doctors tend to rate the

10| SUMMER 2021

quality of life of someone with disabilities

much, much lower than the person

themself would rate it. This is the

Disability Paradox.

Sarah McSweeny was a woman from

Oregon with multiple disabilities, unable

to walk or talk. When she was admitted

into the hospital, she carried a legal

document that stated she wanted any and

all life-saving treatment.⁵ ⁶

She stayed at the hospital for the next

three weeks, during which she developed

severe pneumonia. The doctor agreed

that a ventilator was critical, and then

proceeded to insist on having McSweeny’s

care document rewritten with an order to

not resuscitate or intubate. An order to

deny her that very ventilator — at a time

when, as should be noted, there was no

shortage.

One of her caretakers was told that it

was a matter of risk versus quality of life.

“But she has quality of life.”

“Oh, can she walk? Can she talk?”

No, she couldn’t, but she loved country

music and makeup and having her hair

done. She couldn’t eat solid food, but she

loved going to malls and laughing and

making her friends laugh with her.

Sarah McSweeny died in that hospital,

but she had wanted to live.

The same stories pop up again and again:

denial of treatment, equipment,

assumptions on a patient’s quality of life.

Pressure for admitted disabled or elderly

patients to sign “Do Not Resuscitate”

orders they might not even understand.⁴

Lack of, or even cuts in funding for

coronavirus protection in group homes,

despite the most vulnerable patients

residing there.⁷ Early in the pandemic, in

the UK, many general practitioners even

assigned blanket DNRs to over five

hundred disabled and elderly care home

residents, without consulting them or

their families — and around a third were

still in place in December.⁸ ⁹

It’s easy to discriminate against people

with disabilities, thinking their lives or

the love their families hold for them as

lesser. It’s easy to tell the vulnerable to

stay shut in their homes so the rest of us

don’t have to, as if their freedom is worth

any less. It’s easy to be less that

stringent in precautionary measures when

those most likely to die for it are the

faceless, the “expendable”, in

wheelchairs or care homes. Easy.

Should it be?

References

[1] Gleason, J., Ross, W., Fossi, A.,

Blonsky, H., Tobias, J., & Stephens, M.

(2021, March 5). The Devastating Impact

of Covid-19 on Individuals with

Intellectual Disabilities in the United

States, Nejm Catalyst.

https://catalyst.nejm.org/doi/full/10.105

6/CAT.21.0051.

[2] Diament, M. (2020, November 16).

Mounting Evidence Points To Serious

COVID-19 Risk For Those With IDD,

Disability

Scoop.

https://www.disabilityscoop.com/2020/11

/16/mounting-evidence-points-toserious-covid-19-risk-for-those-withidd/29084/.

[3] Roberts, K. (2020, June 29). Austin

Hospital Withheld Treatment from

Disabled Man Who Contracted

Coronavirus, The Texan.

https://thetexan.news/austin-hospitalwithheld-treatment-from-disabled-manwho-contracted-coronavirus/.

[4] Shapiro, J. (2020, July 31). One

Man's COVID-19 Death Raises The Worst

Fears Of Many People With Disabilities,

NPR.

https://www.npr.org/2020/07/31/89688

2268/one-mans-covid-19-death-raisesthe-worst-fears-of-many-people-withdisabilities.

[5] Shapiro, J. (2020, December 14). As

Hospitals Fear Being Overwhelmed By

COVID-19, Do The Disabled Get The

Same Access?, NPR.

https://www.npr.org/2020/12/14/945056

176/as-hospitals-fear-beingoverwhelmed-by-covid-19-do-thedisabled-get-the-same-acc.

[6] Kinross, L. (2021, January 1). How

ableism influences who gets care during a

pandemic, Holland Bloorview.

https://hollandbloorview.ca/storiesnews-events/BLOOM-Blog/how-ableisminfluences-who-gets-care-duringpandemic.

[7] Shapiro, J. (2020, June 9). COVID-19

Infections And Deaths Are Higher Among

Those With Intellectual Disabilities, NPR.

https://www.npr.org/2020/06/09/87240

1607/covid-19-infections-and-deaths-arehigher-among-those-with-intellectualdisabilities.

[8] Booth, R. (2020, April 1). UK

healthcare regulator brands resuscitation

strategy unacceptable, The Guardian.

https://www.theguardian.com/world/202

0/apr/01/uk-healthcare-regulatorbrands-resuscitation-strategyunacceptable.

[9] Covid-19: Concern over 'do not

resuscitate' decisions during pandemic

(2021, March 18), BBC News.

https://www.bbc.com/news/health-

56435428.

[10] Covid: Disabled people account for

six in 10 deaths in England last year -

ONS (2021, February 11), BBC News.

https://www.bbc.com/news/uk-56033813

ABOUT THE AUTHOR

Katherine Yan is a high school student

in King George V School in Hong Kong

and is passionate about social

equality. Her hobbies include reading

and writing.


COVID

19

A p o e m b y

A u d r e y C z a r n e c k i

VACCINES

V a c c i n e s a r e h e r e ! V a c c i n e s a r e h e r e !

B e w a r e , C O V I D - 1 9 , t h i s i s y o u r f e a r !

W e ’ l l s l o w l y d e f e a t y o u !

W e ’ l l s u r e l y b r i n g d o w n y o u r c r e w !

{Image Credits: South China Morning Post}

12| SUMMER 2021

But not everyone’s getting the vaccine, oh dear.

And some are suffering from it, shed a tear!

What can we do?

There’s no telling what course we will pursue.

ABOUT THE AUTHOR

Audrey Czarnecki is a rising junior at

Thomas Jefferson High School for

Science and Technology in Alexandria,

Virginia. She wishes to pursue a

career in medical sciences and

research while also being an artist

and a writer. She has been serving on

her county library’s Teen Advisory

Board since eighth grade, and she has

been on her high school’s wrestling

team for the past two years.


LIFE ON THE EDGE OF

INDEPENDENCE: MY BROTHER

AND TUBEROUS SCLEROSIS

WILLIAM SURINGA

ounding the corner of Powhatan Street

Ronto Kirby Road,my mother sweeps her

head side to side checking for cars

approaching; my novice driving skills

frighten her. My older brother sits in the

back of the car, his head tilted up,

listening to Frank Sinatra with his phone

next to his ear. After completing my left

turn, I accelerate up and down the rolling

hills of Kirby. At the end of a

straightaway, I spot a red stop light and I

begin to press down on the brake pedal.

My mother turns her head to the back of

the car to check on my brother; he looks

out the window with his mouth open,

mumbling a few words of the Frank

Sinatra song. A few more turns in the

hills of Northern Virginia and we have

arrived at our destination: Safeway

grocery store.

I pull up into a space close to the store,

and put the car in park. My mother

instructs my brother to pick up his

things: a lunchbox, a mask, and a name

tag. We all exit the car, and walk up to

the sliding-door entrance. My mother

continues to give my brother instructions

and reminds him of all his tasks as a

courtesy clerk. Once my brother has been

escorted to the sign-in station, my

mother and I turn to our shopping duties.

Realizing that my brother is out of our

hands, we can breathe easier. My mother

and I stroll around the store and check

off a list of items we need. Because we

come to the store so often to drop off my

brother for work, we know exactly where

to find all of our items. We collect frozen

meals for dinner, some cheap cereals for

breakfast, and some snacks for my

brother.

Walking down the frozen aisle with my

mother, I pass the various brands of ice

cream: Breyer’s, Ben & Jerry’s, Haagen-

Dazs, Edy’s, and more. A teenager

dressed in black with his Safeway badge

pushes a cart around the corner of the

aisle: a courtesy clerk like my brother. He

greets me with an open-mouth smile as

he pushes his glasses up on his face. He

leans down into his cart, grabs a box of

frozen vegetables and opens the door to

the freezer. The freezer makes the usual

loud humming sound, amplified by the

open door. The worker sets some turned

down items from the cash register back

in their appropriate positions inside the

freezer. With his cart empty, he pulls his

arm out from the freezer, which claps

back into place with a loud slam. Just as

he finishes, my brother walks around the

corner.

As my brother approaches the other

courtesy clerk, they form a perfect

juxtaposition: a normal teenager

standing next to a flawed one. My

brother’s differences are quite clear next

to someone like him. My brother hunches

his back over while the other teenager

stands straight. My brother has his hair

jumbled while the other teenager has his

combed. My brother’s glasses are

smudged with fingerprints while the

other teenager’s glasses are clean. My

brother strolls around the Safeway until

he is told what to do while the other

teenager returns items independently. My

brother had to be driven to his job at age

eighteen while the other teenager drove

himself to the same job. They both grew

up in the same neighborhood, they both

went to the same elementary school, and

they both work the same job but are still

so different in their abilities. Why?

The story begins in 2004 in Tampa,

Florida. In a small doctor's office only a

few blocks away from Hillsborough Bay,

my brother was taken at the ripe old age

of two to see my grandfather at his

dermatology practice. The building of

gray concrete surrounded by mosscovered

trees would be a place I would

visit after I was born. My grandfather had

routinely examined my father when he

visited; because my father grew up in

14| SUMMER 2021

Florida, he occasionally had a piece of

skin that had to get checked out. My

parents simply brought my brother along

with them to their routine visit to my

grandparents. After taking a look at my

father, my grandfather had just enough

time to examine my brother before his

next appointment. A bumpy patch on my

brother's lower back, believed to be a

birthmark by my parents, would change

our family’s life.

The bumpy patch, also known as a

shagreen patch, indicated the presence of

Tuberous Sclerosis Complex (TSC) in my

brother, a genetic disease which causes

benign tumors to form in various vital

organs such as the brain, kidneys, heart,

lungs, eyes, and skin. Tuberous Sclerosis

Complex appears in two types: type 1 and

type 2. My brother has type 1,

corresponding to a mutation of the TSC1

gene located on the ninth chromosome.

The TSC1 gene instructs how to create a

protein called hamartin which helps

regulate cell growth and size. The protein

limits the proliferation of a protein called

the mechanistic target of rapamycin

(mTOR), which helps with cell growth

and repairs. When the mTOR protein is

let loose by a mutation of hamartin,

enlarged and abnormal cells form.¹ These

enlarged cells, typically found in the

brain in TSC brain lesions, cause mental

issues that separate my brother from

other teenagers his age. My grandfather

would explain to me at a young age that

my brother’s brain simply is wired

differently than other people. When my

grandfather first used this terminology, I

did not see the effects of the rewire.

Ever since his diagnosis, my brother has

travelled to Boston every year to visit a

specialist on TSC. I would usually stay at

home with a friend while my parents took

my brother. However, one year I travelled

to Boston to meet the specialist and

spend a few days exploring the city.

During my trip, my parents underwent

several tests along with my brother to

learn about how my brother may have

acquired the disease. TSC occurs when

the TSC1 mutation spontaneously forms

or when the mutation is inherited. Most

TSC cases originate from a spontaneous

TSC1 mutation, where a mutation

randomly occurs in a newborn child. TSC

is inherited when one parent of a child

has TSC, even if the parent was unaware

they had the disease. The children of TSC

patients often have completely different

symptoms than their parents; a parent

may never be diagnosed with TSC

because they have never shown

symptoms, but their child may have

severe symptoms of the disease.² The

testing on the Boston trip determined

that my brother had acquired the disease

spontaneously (Office of Communications

and Public Liaison National Institute of

Neurological Disorders and Stroke,

2020).

Alongside the annual Boston trips, my

brother requires scanning of his kidneys.

TSC patients often develop kidney

problems in two different types: cysts

and angiomyolipomas (an·jee·ow·mai·ow·

lai·pow·muh). Cysts, benign growths of

muscle cells and fatty tissue, can cause

kidney issues. In a few cases of TSC,

childhood cysts lead to bleeding, anemia,

and kidney failure. Angiomyolipomas are

a more common type of benign growth in

both kidneys and typically produce no

symptoms. In a few rare cases,

Angiomyolipomas grow large enough to

cause pain in TSC patients and even

result in kidney failure. Angiomyolipomas

occasionally bleed, which causes pain in

most patients. If this bleeding is severe

and the blood does not clot naturally,

patients experience dramatic losses in

blood pressure and require urgent medical

attention.³ While my family has not been

threatened with kidney complications,

my brother will require close kidney

observation for the rest of his life.

After one Boston trip, my brother

returned with a white cloth wrapped

around his head with wire attached to a

handheld monitor. My parents explained

to me that the cloth was used to monitor

my brother’s brain activity for seizures.

TSC patients, although mostly with TSC

type 2, experience seizures starting at a

young age. Three types of seizures plague

"The symptoms of TSC change

the lives of everyone around

them. Whether a brief flex of an

extremity or a kidney failure or

an outburst of emotion, TSC

patients often embarrass their

family members. For me, the

embarrassment progressed with

age."

TSC victims. Infantile spasms appear in

the earliest stages of life; babies ranging

from 4 to 8 months experience this type

of spasm. Infantile spasms occur when

babies are going to bed or are waking up.

Babies that experience these spasms may

jut their arms out uncontrollably or flex

muscles.⁴ Partial seizures are the most

noticeable type of seizure to the average

passerby. One might notice a partial

seizure when a TSC teenager or adult

jerks their head, repeatedly move their

arms, or lock their eyes upward. Absence

seizures also appear in TSC patients,

where they decrease their response to

other people. Sometimes my brother will

stare off into the distance with his mouth

open, which I believe may be an absence

seizure. Although ninety percent of TSC

patients have epilepsy, few antiepileptic

drugs benefit TSC patients.⁵

The symptoms of TSC change the lives of

everyone around them. Whether a brief

flex of an extremity or a kidney failure or

an outburst of emotion, TSC patients

often embarrass their family members.

For me, the embarrassment progressed

with age.

At a young age, I did not notice any

differences between my brother and the

kids around him. When I was in

Kindergarten, my grandparents would

take my brother and me to Whole Foods


in Lyon Village outside of Washington

D.C. to buy some cookies. I remember

telling my brother that “I could smell the

cookies already” even though we were a

few blocks away from the store. My

brother, likely having an absence spasm,

did not respond to my comment and

simply stood still. My friends sometimes

ignored me, so I figured that my brother

had just done the same. At the time, my

brother appeared the same as everyone

else around him. His handwriting was

horrible, and my handwriting was

horrible. My brother had no more than

five or six friends, and I had no more

than five or six friends. My brother rode

the bus to and from school, and I rode the

bus to and from school. My brother’s

artwork was simple and abstract, and my

artwork was simple and abstract.

Figure 1: My Childhood Artwork vs. My Brother’s

Childhood Artwork

Note. This is a comparison between my artwork (right) and

my brother’s artwork (left) that we both created at age 10.

However, as we aged, the differences

between my brother and I emerged. Most

differing features emerged slowly, but the

most obvious was performance in school.

I had stayed consistent through most of

my middle school and high school career,

performing well. My brother completed

his early education well, but his grades

and performance declined in middle

school and high school. My family began

to support him in school, helping him

complete homework and study for tests.

Our physical differences arrived next. My

brother developed spinal issues, as he

often hunches over when sitting at his

desk or in his room. By high school, my

brother and I were about the same height

even though he was taller most of his life.

Today, I stand about 3 inches taller than

my brother. Perhaps the most obvious are

simple everyday capabilities. I am in the

process of earning my drivers license,

while my brother has never driven a car.

My brother has to be monitored while he

does his homework, while I do my

homework on my own. My brother plans

to stay an extra year in high school while

I plan to go straight to college.

July 26, 2018, Dallas, Texas. My mother,

brother, and I exited a taxi and entered

the Hilton Anatole. The lobby contained

several banners, each reading “TSC

Global Conference.” in

blue, orange, and green

letters. We arrived

around 7:00 pm just

before sunset and most of

the conference's

activities were over. We

took an elevator up to

our hotel room and saw a

few parents watching

their children run around

in the hallway. At 8:00,

we took an elevator down

to the lobby floor and

walked over to a large

ballroom for dinner. The

TSC Alliance prepared a

large buffet for the

conference attendees and

assigned each attendee to

a table around the room

with random others. I put my plate down

last out of those seated at my table: all of

whom appeared to be adults with

research experience. I greeted them with

a smile, and they invited me to sit with

them. Then someone started the usual

icebreaker: what is your name and why

are you here? My tablemates discussed

their research responsibilities, most of

which I did not understand. When it was

my turn to introduce myself, I explained

that I am the sibling of a TSC patient,

here to learn more about the disease.

The woman next to me, probably in her

sixties, discussed herself. I expected more

research jargon, but instead she

explained that her son had had TSC for

almost 25 years. She described her son’s

childhood, his experience with bullying,

his struggles with college and career. She

talked about kidney scans, endless

appointments, and rising bills. These

challenges had clearly worn down on the

woman, who spoke in a quiet and

pessimistic voice. Everyone else at the

table looked down to reflect on their

challenges with the disease. The

researchers may have thought about the

TSC patients they had met in the past,

but I took an honest look at my brother.

I tried to imagine my brother a decade

older. I couldn’t do it. My family had

spent so much time on my brother and I

couldn’t think of him becoming an adult.

The woman at my table explained that

her son still lived with her. But I could

not think of my brother living with my

parents either: “he is capable of living on

his own, isn’t he?”

Since that woman turned my eyes on my

brother’s future, it has become

increasingly hazy. My brother can work

at Safeway, but my mother and I still

need to guide him. My brother can still go

to high school but my family still needs

to help him study. My brother lies right

on the edge of independence.

"Everyone else at the table

looked down to reflect on their

challenges with the disease.

The researchers may have

thought about the TSC patients

they had met in the past, but I

took an honest look at my

brother. I tried to imagine my

brother a decade older. I

couldn’t do it. "

16| SUMMER 2021

Figure 2: My My Teenage Artwork vs. My Brother’s Teenage Artwork

Note: I created the landscape on the left in freshman year of high school and the painting on the right was

created by my brother in sophomore year of high school.

References

ABOUT THE AUTHOR

[1] National Center for Biotechnology

Information. (2021). TSC1 TSC

complex subunit 1 [Homo sapiens

(human)] - Gene - NCBI. Nih.gov.

https://www.ncbi.nlm.nih.gov/gene?

Db=gene&Cmd=ShowDetailView&Ter

mToSearch=7248.

[2] MedlinePlus Genetics. (2011).

Tuberous sclerosis complex:

MedlinePlus Genetics.

Medlineplus.gov.

https://medlineplus.gov/genetics/cond

ition/tuberous-sclerosis-complex/.

[3] Overwater, I., Rietman, A., van

Eeghen, A., & de Wit, M. (2019).

Everolimus for the treatment of

refractory seizures associated with

tuberous sclerosis complex (TSC):

current perspectives. Therapeutics and

Clinical Risk Management, Volume

15,951–955.

https://doi.org/10.2147/tcrm.s145630.

[4] Office of Communications and Public

Liaison, National Institute of Neurological

Disorders and Stroke. (2017). Tuberous

Sclerosis Complex (TSC). Epilepsy

Foundation.

https://www.epilepsy.com/learn/epilepsy

-due-specific-causes/structural-causesepilepsy/specific-structuralepilepsies/tuberous-sclerosis-complextsc.

[5] Office of Communications and Public

Liaison National Institute of Neurological

Disorders and Stroke. (2020). Tuberous

Sclerosis Fact Sheet | National Institute

of Neurological Disorders and Stroke.

Nih.gov.

https://www.ninds.nih.gov/Disorders/Pat

ient-Caregiver-Education/Fact-

Sheets/Tuberous-Sclerosis-Fact-Sheet.

My name is William Suringa and I live

just out outside of Washington D.C. in

McLean, Virginia. I am a student at

Georgetown Preparatory School in

Bethesda, Maryland and I hope to study

sciences in college. I am the president of

the Georgetown Prep Hippocratic

Society and I spoke at the International

Youth Research Conference (IYRC) in

March 2021.


Hidden Heroes

P H O T O G R A P H Y B Y S A R A M A G G I O

Fort Myers, FL is well known

for a myriad of reasons:

namely its beaches, golf

courses, and large

population of elders;

however, even in a simple

butterfly garden, mother

nature can be seen at work.

Butterflies, bees, and moths

serve as key pollinators

which are essential in plant

reproduction.

18| SUMMER 2021

H I D D E N H E R O S

By using their bodies to

collect and carry pollen

from plant to plant,

pollinators help fruits,

vegetables, and flowers pass

on their lineages to new

seeds which eventually may

grow into exquisite plants

like the ones above.

About The Photographer:

Sara Maggio is an incoming junior at Prospect

High School in Mount Prospect, IL. She is a

straight-A student and multisport athlete, who

loves to be outdoors and explore. Whether it is

1 mile away or 1,000 miles away, she loves to

experience diverse places, cultures, and

environments and preserve those memories

and newfound knowledge via photography.


TUBERCULOSIS IN THE

TIME OF COVID-19

ADWAITH HARIHARAN

T

he coronavirus disease (COVID-19) is

not the only pandemic the world is

currently battling. Tuberculosis (TB) is a

silent pandemic, with approximately one

person dying every 21 seconds worldwide

[1]. Both COVID-19 and TB are resilient,

deadly, airborne diseases and are the

leading cause of death from infectious

diseases worldwide. Although the world is

diverting a significant amount of

resources to singularly fighting COVID-19

because it occupies the global center

stage, it is equally, if not more important,

that the recent progress in tuberculosis

prevention and care is not reversed due to

COVID-19. It is, therefore, imperative to

ensure that the prevention and care

approaches to TB are reviewed and

adapted appropriately to ensure the safe

delivery of high-quality TB services in a

continuous manner.

The synergy and commonalities between

COVID-19 and tuberculosis abound. The

initial clinical manifestations and spread

of COVID-19 and tuberculosis are very

similar, most significant being their

COVID-19 Vs TB (Image Credit: Virginia Department of Health)

20| SUMMER 2021

transmission. Both Mycobacterium

tuberculosis that causes TB and severe

acute respiratory syndrome coronavirus 2

(SARS-CoV-2) that causes COVID-19 are

transmitted from person to person

through secretions from the respiratory

tract [2-4]. They are both spread mainly

when a healthy person comes in contact

with the particles that contain the virus

(in the case of COVID-19) or the bacteria

(in TB) that are expelled when people

with the illness either cough, sneeze, or

talk. Even though the causative

organisms are different, the initial

clinical manifestations of both these

highly contagious diseases mainly involve

the respiratory tract, with similar

symptoms such as cough, fever, shortness

of breath, fatigue, and loss of appetite.

Although both tuberculosis and COVID-19

are transmitted through contact between

people, their modes of transmission are

distinct. TB bacilli remain suspended in

the air for several hours after a TB

patient coughs or sneezes, and those who

inhale them can become infected with

tuberculosis. TB is an opportunistic

infection. Based on the infected person’s

immune response, the TB-causing

bacteria can go into either an active or

latent state, ready to kick into action at a

later date when the immune system is

weakened and cannot fight back. The

spread of COVID-19 is mainly through

direct breathing of droplets discharged by

COVID-19 patients when they exhale,

speak, cough or sneeze. These droplets

may land on objects and surfaces, leading

to a COVID-19 infection when a person

touches these surfaces followed by

touching their eyes, nose, or mouth. TB

has a lengthier incubation period,

generally with a slow onset, while

COVID-19 has a shorter and immediate

incubation period, usually less than two

weeks.

There isn't enough evidence to

demonstrate that tuberculosis patients

aren't more likely to contract COVID-19

[5]. Individuals with pre-existing

tuberculosis, on the other hand, are far

more likely to develop serious

consequences if they contract COVID-19.

Given the weakened immune systems of

TB patients, they are at a substantially

higher risk of getting COVID-19 and may

further have poorer treatment outcomes

due to their compromised immune

systems, especially if their TB treatment

is suspended. Consequently, effective

preventative interventions and treatment

strategies are needed to reduce the risk

of COVID-19 severity in tuberculosis

patients. When a patient has a history of

previous respiratory disease, their

damaged lung function substantially

lowers their resistance to viruses.

Therefore, as recommended by health

officials, tuberculosis patients must take

protective measures while maintaining

their prescription tuberculosis drugs to

protect themselves from COVID-19.

Estimated Drug resistant TB Notification: % change by region in GF-supported

countries, 2020 vs 2019 (Image Credit: The 13th meeting of the South-East Asia

Regional Multidrug-resistant tuberculosis Advisory Committee)

Treating people who have both TB and

COVID-19 presents a unique set of

challenges. While the information on

joint management of both COVID-19

infection and TB remains limited, TB

treatment is not different in people with

or without COVID-19 infection. No

cautions on drug-drug interactions are

indicated at present since no medication

is currently recommended for COVID-19

[6]. To protect the patient's health,

decrease TB transmission, and avoid drug

resistance, TB treatment in COVID-19

patients should be continued

uninterrupted.

Estimated impact of the COVID-19 pandemic on

the global number of TB deaths in 2020, for

different combinations of decreases in case

detection and the duration of these decreases

(Image Credits: WHO 2020 Global TB Report)

The unprecedented negative impacts of

the COVID-19 pandemic are pervasive. It

is a social and an economic crisis just as

much as it is a health crisis, with its

severe, far-reaching repercussions felt

across the world and drawing attention

and resources from many other public

health services. The COVID-19 pandemic

has completely eclipsed and jeopardized

efforts to eliminate tuberculosis. The

COVID-19 pandemic's potential impact on

essential tuberculosis services is

pervasive. The efficiency of TB

prevention and treatment activities

around the world are being harmed by


policies enacted to limit the spread of the

current COVID-19 pandemic, including

lockdowns, reassignment of resources,

healthcare staff, and equipment. The

World Health Organization (WHO)

estimates that a 3-month lockdown

followed by a 10-to 12-month recovery

phase will result in a huge increase in TB

cases, with 6.3 million new cases and 1.4

million TB fatalities registered between

2020 and 2025. According to the

modeling studies, the COVID-19 pandemic

is expected to lead to a 25% reduction

globally in expected TB detection for a 3-

month time span, given the levels of TB

service disruption seen in several

countries. Consequently, we can expect a

13% increase in TB deaths, thus sending

us back to the levels of TB mortality seen

5 years ago [7]. This could possibly be a

conservative estimate because it excludes

other potential pandemic effects, such as

the transmission of TB, disruptions in

treatment, and worse prognosis in

patients with TB and COVID-19 infection.

As a result, an additional 1.4 million TB

deaths could be recorded between 2020

and 2025 [8]. All measures should

therefore be taken to ensure continuity of

care so that patients who require TB

treatment, both preventative and

curative, have access to services.

[2] Wu F, Zhao S, Yu B, Chen YM, Wang

W, Song ZG, et al. A new coronavirus

asso-ciated with human respiratory

disease in China. Nature.2020;579:265–

9. DOIExternal LinkPubMedExternal

Link.

[3] Hopewell PC. Factors influencing the

transmission and infectivity of

Mycobacterium tuberculosis: implication

for clinical and public health

management of tuberculosis. In: Sande

MA, Root RK, Hudson LD, editors.

Respiratory Infections. New York:

Churchill Livingstone Inc.; 1986. P. 191–

216.

[4] Meyerowitz EA, Richterman A,

Gandhi RT, Sax PE. Transmission of

SARS-CoV-2: a review of viral, host, and

environmental factors. Ann Intern Med.

2020;•••:M20-5008; Epub ahead of print.

DOIExternal LinkPubMedExternal Link.

[5] D. Visca, C.W.M. Ong, S. Tiberi, R.

Centis, et al. Tuberculosis and COVID-19

interaction: A review of biological,

clinical and public health effects.

Pulmonology. 2021 (Vol 27, Issue 2, Pages

151-165).

https://doi.org/10.1016/j.pulmoe.2020.12.

012.

(Image Credit: DW)

Khundi, M., Dodd, P., Ku, C., Kawalazira,

G., Choko, A., Divala, T., Corbett, E.,

MacPherson, P. (2021). Effects of

Coronavirus Disease Pandemic on

Tuberculosis Notifications, Malawi.

Emerging Infectious Diseases, 27(7), 1831-

1839.

https://doi.org/10.3201/eid2707.210557.

ABOUT THE AUTHOR

(Image Credit: eMedicineHealth)

References

[1] WHO. 2019. Global tuberculosis

report. World Health Organization,

Geneva,

Switzerland

https://www.who.int/tb/publications/glo

bal_report/en/.

[6] Mousquer, G. T., Peres, A., &

Fiegenbaum, M. (2021). Pathology of

TB/COVID-19 Co-Infection: The phantom

menace. Tuberculosis (Edinburgh,

Scotland), 126, 102020.

https://doi.org/10.1016/j.tube.2020.1020

20.

[7] Cilloni L, Fu H, Vesga JF, Dowdy D,

Pretorius C, Ahmedov S, Nair SA,

Mosneaga A, Masini E, Sahu S,

Arinaminpathy N. The potential impact

of the COVID-19 pandemic on the

tuberculosis epidemic a modelling

analysis. EClinicalMedicine.

2020 Oct 24;28:100603. doi:

10.1016/j.eclinm.2020.100603. PMID:

33134905; PMCID: PMC7584493.

[8] Soko, R., Burke, R. M., Feasey, H.,

Sibande, W., Nliwasa, M., Henrion, M.,

Adwaith Hariharan is a junior at

Biotechnology High School in New

Jersey. He is interested in the

intersection of technology, sciences,

and social entrepreneurship. This drive

has him giving back to his community

through research involving AI, Machine

Learning, and health analytics. As a

STEM DEI advocate, he strives to create

and lead STEM conferences, hackathons,

and science camps to empower

youth, underprivileged, and neurodivergent

students around the world.

22| SUMMER 2021

{PHOTO CREDITS: CC SEARCH}

HANNAH PESCARU


repetitive behaviors (BFRBs) are

Body-focused

in which an individual repeatedly fidgets with

behaviors

or her own body in ways that cause physical harm.

his

trichotillomania (hair-pulling),

BFRBs―including

(skin-picking), and onychophagia (nailbiting)―can

dermatillomania

be subclinical and relatively common, but

can also be more severe, being then considered

they

disorders.

BFRBs are still novel points of

Because

in the research world, causes and

discussion

are still unknown. Most people with BFRBs

cures

feel misunderstood by loved ones who

often

their conditions as ‘bad habits.’ Through the

label

of more educated communities

implementation

sharing of stories, the BFRB community can

and

to be more accepted and understood.

grow

24| SUMMER 2021

THE SOCIAL, ENVIRONMENTAL

AND ECONOMIC IMPACT OF

THE FAST FASHION INDUSTRY

Toxic chemicals from clothing (Image credit: Smart Water Magazine)

ISABELLE CHIOU

T

he mass production of textiles leads to

environmental issues that have farreaching

— and often disastrous —

implications for human health and the

health of wider ecosystems.

Fast fashion is cheap, trendy clothing

that rapidly switches in and out of style.

Instead of replenishing stock, companies

will replace items sold with new designs,

making previous ones outdated and

unfashionable. As customers buy more

items, existing items are carelessly

discarded — except, a week later, an

even newer design is introduced, and thus

a vicious cycle is born. The issue stems

from how firms create demand instead of

meeting consumer needs: all to maximise

profit.

The booming industry directly impacts

the health of millions of sweatshop

workers. Firstly, the workforce in these

sweatshops often constitutes child labor,

and more generally, modern slavery.

These individuals are forced to work up

to 16 hours a day in cramped, poorly lit

conditions, yet receive little to no reward

for their efforts — they are paid

extremely low wages.¹ For example, in

Bangladesh, sweatshop workers earn an

average of 33 USD per month, far below

the living wage of 60 USD a month.² In

addition, many of these workers are

subject to injuries due to the poorly

maintained environment in these

sweatshops. The most notable evidence is

the collapse of the Dhaka garment

factory in 2013 that took the lives of 1,134

people and left around 2,500 injured.³

The unprecedented environmental

changes caused by the fast fashion

industry affects the health of the general

public. 85% of the cheap and disposable

textiles end up in landfills, where they

can take nearly two hundred years to

decompose.⁴ ⁵ Unregulated factories pollute

nearby bodies of water in their

rampant use of clothing dye. Toxic

fluorescent chemicals can enter the

human body through the skin barrier,

putting passersby in medically critical

situations. When streams are compromised,

water and soil miles away are

polluted too. These pollutants begin to

appear in our food.

While there are obvious economic

benefits of a growing apparel industry

which employs thousands and collects

large amounts of profits, it arguably does

more harm than good.⁶ As the health of

sweatshop workers worsens, the

productivity and economic growth of the

country follows suit. As firms place

greater and greater reliance on fossil

fuels in the manufacturing process, large

quantities of resources will be needed to

reverse its effects. For instance, in 2008,

the Chinese government had to invest

$66 billion in US currency, 1.49% of its

GDP, on environmental conservation and

protection.⁷

There are many ways to reduce your

impact, such as questioning who made

your clothes and contacting companies to

voice your concerns. With more and more

individuals doing so, the increased

consumer awareness will lead to change.


Reduce the size of your purchases, buy

from companies with ethical practices,

and wear clothes for the entirety of their

lifespans. For companies, a positive first

move would involve increased

transparency. We need budget-friendly

ethical brands that engage in

environmental sustainability — before it

is too late.

References

[1] Zuo, M. (2018, July 20). Under 16 and

working 16 hours a day . . . Chinese

clothes factories import cheap child

labour from across China. South China

Morning

Post.

https://www.scmp.com/news/china/socie

ty/article/2048231/clothing-factorieseastern-china-import-child-labourmigrant.

[2] Sweatshops in Bangladesh. (2011,

January 28). War on Want.

https://waronwant.org/newsanalysis/sweatshops-bangladesh.

[3] Wikipedia contributors. (2021, April

14). 2013 Dhaka garment factory collapse.

Wikipedia.

https://en.wikipedia.org/wiki/2013_Dhak

a_garment_factory_collapse.

[4] Brown, R. (2021, January 8). The

Environmental Crisis Caused by Textile

Waste. RoadRunner Recycling HQ.

https://www.roadrunnerwm.com/blog/te

xtile-waste-environmental-crisis.

[5] Why should we Get Involved? (n.d.).

Redress. Retrieved April 15, 2021, from

https://www.redress.com.hk/getredresse

d/issue.

[6] Global garment industry to grow 8.8

per cent CAGR from 2021–27. (2020,

August 14). Fashionating World.

https://www.fashionatingworld.com.

/new1-2/global-garment-industry-to-

grow-8-8-per-cent-cagr-from-2021-

27#:%7E:text=An%20Allied%20Market%

20Research%20report,and%20its%20infl

uence%20over%20consumers.

[7] Kan, H. K. (2009, December 1).

Environment and Health in China:

Challenges and Opportunities. PubMed

Central

(PMC).

https://www.ncbi.nlm.nih.gov/pmc/articl

es/PMC2799473/.

[8] Brodde, K. (2017, November 7). Why

is h&m burning new clothes? Retrieved

April 09, 2021, from

https://wayback.archive-

it.org/9650/20200220111509/http://p3-

raw.greenpeace.org/international/en/new

s/Blogs/makingwaves/hm-burning-newclothes-fast-fashionincineration/blog/60640/.

[9] Lohr, S. (2014, October 19). 5 truths

the fast fashion industry doesn't want

you to know. Retrieved April 09, 2021,

from

https://www.huffingtonpost.com/shanno

n-whitehead/5-truths-the-fastfashion_b_5690575.html.

[10] Perry, P. (2018, January 7). The

environmental costs of fast fashion.

Retrieved April 09, 2021, from

https://www.independent.co.uk/lifestyle/fashion/environment-costs-fastfashion-pollution-waste-sustainabilitya8139386.html.

[11] Sax, S. (2018, March 12). Fashion's

crippling impact on the environment is

only getting worse. Retrieved April 09,

2021, from

https://www.vice.com/en/article/437egg/

why-fashion-is-the-worlds-mostpolluting-industry.

Image Credit: Rio Lecatompessy

Image Credit: Hakelbudel

ABOUT THE AUTHOR

Isabelle is a junior with a love for

biological sciences. She hopes to

show others how simple lifestyle

changes can benefit the

community. Isabelle does

taekwondo, and in her free time,

she enjoys playing tennis.

28| SUMMER 2021

Photography by Sara Maggio

Wonders

of Island The

Borneo, the third-largest island in the world, is divided between the countries of

Brunei, Malaysia, and Indonesia. According to Yale, approximately fifty percent

of Borneo’s lowland rainforests have been destroyed primarily by human

activity such as deforestation and the palm oil industry.

However, some places aim to preserve Borneo’s natural beauty while showing

it off to thrill-seeking nature lovers like myself. At Sukau Rainforest Lodge,


located on the bank of Kinabatangan River, visitors can see breathtaking views,

animals ranging from Proboscis monkeys to Pygmy elephants, and tribal

culture all while following green policies and leaving little ecological footprint.

This sustainable tourism allows a glimpse of raw nature that many have yet to

experience.

30| SUMMER 2021

THE NEUROSCIENCE BEHIND

BODY DYSMORPHIA

CHINEDUM AGUWA

Body dysmorphic disorder (or BDD) is a times later in life. The effects of

mental illness that is unknown to several developing BDD are alarming. For

people. Body dysmorphic disorder is

commonly observed as an obsessivecompulsive

disorder (similar to eating

disorders and OCD). It is defined as when

individuals “have persistent unwanted

thoughts about a perceived defect in their

physical appearance. Common obsessions

include concerns about parts of one’s

body being misshapen, abnormally sized,

instance, there is a large suicide attempt

rate in the BDD community (about 25% of

those with

BDD).³ In addition, there are risks of an

increase in depression, social anxiety,

drug and alcohol use, as well as other

reported symptoms from patients with

BDD. The many risks associated with this

disease warrants more research on this

or otherwise unattractive.”¹ These serious psychiatric illness.

“abnormalities” could be scars, body

weight, face shape, skin color, and so Symptoms

much more. These emotional reactions

There are many indicators of body

vary from one person to the next, but

dysmorphic disorder. One of them is

most people suffering from BDD refer to

ritualistic behavior which are persistent

these emotions as invasive to their

actions a patient performs to manage the

everyday lifestyle. This disorder impacts

anxiety of having the body part which the

approximately 2% of the world

patient dislikes. Some examples include

population,² but many health

skin picking (also called dermatillomania)

professionals believe it is frequently

and/or routine makeup processes.

misdiagnosed with depression and other

Additionally, another symptom of BDD

mental illnesses. This condition usually

includes the act of hiding the feature that

emerges in early adolescence and somethe

patient does not find “attractive”.

This can be by using makeup, specific

types of clothing, or covering the feature

with other body parts. According to

scientists Emily Jane Willingham,

“camouflaging [or hiding] appears to be

the single most common symptom among

Anxiety & Depression Association of America persons with BDD, occurring in 94% of

patients.”⁴ Another symptom includes

abnormal behavior around certain objects

like mirrors or other reflective surfaces.

A majority of people with BDD tend to

frequently check their appearance;

however, some BDD patients try to avoid

mirrors altogether. Lastly, some other

symptoms include frequently asking

others about appearance, comparison of

one’s appearance to others, and avoiding

public events with large groups of people.

Neurochemical causes

There has been limited evidence that

there are lower levels of serotonin in

individuals that are diagnosed with BDD.

Serotonin is a neurotransmitter that is a

“chemical produced by the brain that

helps to transmit nerve impulses across

the junctions between nerve cells.”⁴ Low

amounts of serotonin have been linked to

an increase in obsessive-compulsive

disorders like BDD and depression. Due to

a lack of research on body dysmorphic

disorders, it is not clear if serotonin is

the cause or the effect of BDD.

Psychological Causes

Like many anxiety and post-traumatic

stress disorder (or PTSD) many develop

this mental illness in early

childhood/adolescence. Some common


causes are traumatic events from the past

(from life changing surgery to emotional

and physical abuse), low self-esteem,

others that are critical of the person’s

appearance, and not fitting in the Eurocentric

beauty standard.

Callisto.ggsrv.com

Neurocognitive Function

There has been little research on the

neurocognitive functions of people

diagnosed with BDD. Concerning visual

memory, there have been studies that

conclude that people with BDD may have

visual memory deficiencies. In one study

of cognitive functioning, subjects were

asked to copy and recall a complicated

figure drawing. The BDD group recalled

more specific parts of the drawing

instead of the overall structure which

makes sense because BDD patients focus

on a specific part of their body. In

addition, there has been research about

organization and planning for people with

BDD, and a study by “K.R. Hanes found

that BDD subjects made more errors on a

search task, demonstrating deficits in

working memory, compared to healthy

controls. They also were slower on a task

measuring planning ability.”⁵ ⁶ A study

by Ulrike Buhlmann et al., found that

people with BDD were more likely than

healthy subjects to mistake neutral faces

as angry.⁷ This means that patients with

BDD have a harder time processing

emotions than healthier subjects. Lastly,

another study from Ulrike Buhlmann et

al. found that patients with BDD had

“more delayed responses to words such

as attractive and beauty compared to

more neutral words.”⁸

32| SUMMER 2021

Heritability

Heritability is by far one of the most

limited studies concerning BDD, but

researchers found that “8% of individuals

with BDD have a family member also

diagnosed with BDD, a statistic 4–8

Visual Processing

times the

prevalence in

the general

population.”⁹

Additionally,

there is a

connection

with OCD

that comes

from family

studies. In

one study by

Phillips et

al., “7% of

BDD patients had a first-degree relative

with OCD.”¹⁰ Therefore, OCD and BDD

may be correlated and BDD itself may be

heritable.

Researchers studied the ways patients

with BDD distinguished their own faces

compared to others’ faces. One study by

Jose A Yaryura-Tobias et al. showed that

BDD patients perceived distortions of

their own faces which were not really

there.¹¹ In another study by Ulrich

Stangier et al., BDD participants were

more accurate than healthy subjects in

detecting changes in beauty features of

others’ faces.¹² The studies showed that

people with BDD have a superior ability

to process details after it was found that

those with BDD were faster than healthy

controls at identifying others’ faces that

were upside down. These studies suggest

that BDD individuals have a greater

sensitivity to detecting details, which

may lead them to notice defects that are

unnoticeable to others.¹³

Treatment

Currently, there is no way to prevent

body dysmorphic disorder, but since the

mental illness begins in adolescence

years, it may be easier to detect the issue

and begin treatment early.¹⁴ Some

treatments include psychotherapy which

is individual counseling that focuses on

changing a person’s cognitive thinking

and behavior. There is also exposure and

response prevention which uses thoughts

and real-life situations to prove to the

patients that their view of themselves is

not accurate. Medication can also be used

as antidepressants. For example,

selective serotonin reuptake inhibitors

(SSRIs) may help treat body dysmorphic

disorder as it increases serotonin (a

hormone that controls overall well-being

and happiness) in the brain. Lastly, there

is group or family therapy which allows

family members to learn to understand

body dysmorphic disorder and recognize

the signs and symptoms of the BDD

patient.¹⁵

Conclusion

Overall, body dysmorphic disorder is an

illness with harmful effects if undetected

or left untreated. Due to limited

information known, it is very difficult to

receive help and diagnose people with

BDD. However, people should be aware of

BDD and empathize with people with this

illness and be cognizant of their

symptoms. More resources should be

funneled to researching BDD so help can

be provided for those who suffer from

BDD.

Chainwit, Wikimedia Commons

References

[1] "Obsession." International

Encyclopedia of the Social Sciences,

edited by William A. Darity, Jr., 2nd ed.,

vol. 6, Macmillan Reference USA, 2008,

pp. 17-18. Gale in Context: Global Issues,

link.gale.com/apps/doc/CX3045301797/

GIC?u=lom_inac&sid=bookmark-

GIC&xid=099f864a. Accessed 28 July

2021.

[2] Li, Wei, et al. "Body Dysmorphic

Disorder: Neurobiological Features and an

Updated Model." Www.ncbi.nlm.nih.gov,

2013,

www.ncbi.nlm.nih.gov/pmc/articles/PMC

4237698/#R27. Accessed 28 July 2021.

[3] Scott M. Granet, LCSW. "Impact of

BDD." iocdf.org, bdd.iocdf.org/expertopinions/impact-of-bdd/.

Accessed 28

July 2021. International OCD Foundation

[4] Willingham, Emily Jane, and Heidi

Splete. "Body Dysmorphic Disorder." The

Gale Encyclopedia of Medicine, edited by

Jacqueline L. Longe, 6th ed., vol. 2, Gale,

2020, pp. 763-67. Gale in Context:

Science,

link.gale.com/apps/doc/CX7986600285/

SCIC?u=lom_inac&sid=bookmark-

SCIC&xid=3017dcaf.

[5] Lai, Tsz Man, et al. "The

Neurobiology of Body Dysmorphic

Disorder." iocdf.org,

bdd.iocdf.org/professionals/neurobiologyof-bdd/.

International OCD Foundation

[6] Hanes, K. (1998). Neuropsychological

performance in body dysmorphic

disorder. Journal of the International

Neuropsychological Society, 4(2), 167-171.

[7] Buhlmann, U., Etcoff, N., & Wilhelm,

S. (2006). Emotional recognition bias for

contempt and anger in body dysmorphic

disorder. Journal of Psychiatric Research,

40(2), 105-111.

Biol Psychiatry. 2000 Aug 15; 48(4):287-

93

[10] Li, Wei, et al. "Body Dysmorphic

Disorder: Neurobiological Features and an

Updated Model." Www.ncbi.nlm.nih.gov,

2013,

www.ncbi.nlm.nih.gov/pmc/articles/PMC

4237698/#R27. Accessed 28 July

2021.

[11] Yaryura-Tobias, J., Neziroglu, F.,

Chang, R., Lee, S., Pinto, A., & Donohue,

L. (2002). Computerized perceptual

analysis of patients with body

dysmorphic disorder. CNS Spectrums,

7(6), 444-446.

[12] Stangier, U., Adam-Schwebe, S.,

Muller, T., & Wolter, M. (2008).

Discrimination of facial appearance

stimuli in body dysmorphic disorder.

Journal of abnormal psychology, 117(2),

435-443.

[13] Lai, Tsz Man, et al. "The

Neurobiology of Body Dysmorphic

Disorder." iocdf.org,

bdd.iocdf.org/professionals/neurobiologyof-bdd/.

Accessed 28 July 2021.

International OCD Foundation

[14] Mayo Clinic Staff. "Body dysmorphic

disorder."

Www.mayoclinic.org,

www.mayoclinic.org/diseasesconditions/body-dysmorphicdisorder/symptoms-causes/syc-

20353938. Accessed 28 July 2021.Mayo

Clinic

[15] "Body Dysmorphic Disorder."

My.clevelandclinic.org,

my.clevelandclinic.org/health/diseases/9

888-bodydysmorphic-disorder.

Accessed 28 July

2021. Cleveland Clinic

callisto.ggsrv.com/imgsrv/FastFetch/UBE

R1/ZI-0359-2015-OCT08S1-IDSI-14-1.

Accessed 29 July 2021.

Chainwit. Is this me mental disorder of

looking.jpg. Wikimedia Commons, 24

Dec.

2018,commons.wikimedia.org/wiki/File:Is

_this_me_mental_disorder_of_looking.j

pg. Accessed 28 July 2021.

(Image Credit: Society of Mental Health Studies)

ABOUT THE AUTHOR

[8] Buhlmann, U., McNally, R., Wilhelm,

S., & Florin, I. (2002). Selective

processing of emotional information in

body dysmorphic disorder. Journal of

Anxiety Disorders, 16(3), 289-298.

[9] Bienvenu OJ, Samuels JF, Riddle

MA,Hoehn-Saric R, Liang KY, Cullen BA,

Grados MA, Nestadt G

Image Citations

"Body Dysmorphic Disorder." Anxiety &

Depression Association of America,

adaa.org/understanding-anxiety/bodydysmorphic-disorder.

Accessed 28 July

2021. "Brain Imaging." Callisto.ggsrv.com

Chinedum Aguwa is a rising senior

living in Michigan, USA. She is

interested in neuroscience and wants

to inform marginalized communities

about important public health issues.

She also likes reading, sewing, and

doing yoga.


BEWARE THE

DELTA VARIANT

Art by Audrey Czarnecki

The COVID-19 Delta variant recently prompted the WHO to

suggest that vaccinated people should continue to wear masks.

This variant seems to spread easily and quickly, which does not

bode well for the current pandemic situation. This drawing depicts

the suggestion of the WHO. Even if we have been vaccinated,

there is still a chance that we could get sick from the virus. It is

better to be safe than sorry.

34| SUMMER 2021

The Story of an

Immigrant Teenager

During the Pandemic

Mahsa Baghbanijavid

{Photo Credits: lincolnri.org}


leaving my family and friends in August of 2019, the

After

of seeing their smiles, hugging them, and being next to

dream

was the only thing that prevented me from giving up in

them

moment of the hard year I was experiencing. As an

every

I was not able to find an easy path to get through

immigrant,

year. Making new friends, getting used to a new

that

finding my way in the hallways of a new school, and

language,

a new culture, were some of the many problems

accepting

I had to deal with. But I did not give up with the hope of

that

back home to the people who had always supported

getting

day I was going back home, I had butterflies flying in my

The

I could barely keep my tears from falling down on my

stomach.

With my AirPods on, I was listening to a song about going

cheek.

home to see loved ones, and I started crying even though the

back

was a happy one. When I finally sat down on my seat on the

song

I looked outside of the window. The sunset of New York was

plane,

end of all the hard things I had gone through, and as the big tall

the

became more blurry, all my sad memories were also

skyscrapers

blurry. I closed my eyes to skip the waiting time on the plane

getting

smiled because I knew I would wake up to the sunrise back

and

the rise of my happiness and joy. When the plane finally

home,

I ran towards the departure section down to baggage

landed,

I could see my whole family waving at me as I stepped on the

claim.

but when I finally got past the gate, I was not able to hug

escalator,

because of COVID. I could not cry on their shoulders and tell

them

how much I missed them during the past year, and how

them

they were to me. I had to keep a 6 feet distance from

important

while my soul was longing to hold them in my arms.

them

me emotionally and were beside my side during difficult times.

36| SUMMER 2021

I finally got home, I could see my grandmother waiting on the balcony.

When

waved her hands with a smile and I could see the tears in my mom’s eyes.

She

held her hands open to hug me, but I could not hug her. Instead, I told her

She

I need to take a shower before even being able to sit next to her. At that

that

I realized my dream that I had held onto had been crushed without

moment,

even realizing it. That summer, I was not able to see the smiles that I had

me

missing for a year, and I was not able to hold the hands that held me

been

falling into depression and anxiety. I had to stand 6 feet apart from

from

and only watch them being as lovely as they had always been

everyone,

being able to hug them.

without

I went back to the United States, I could feel an

When

in my heart that hurt my soul. I had not been able to

emptiness

all the dreams that I had, and I felt like a warrior who had

fulfill

for years in a war, with the hope of saving their home,

fought

realized that his home was ruined during the war when he

and

came back home. I did not know how to get over the

finally

of my longtime dream, and how to wait for another year.

loss

on May 14th my distant dream became vivid and

Finally,

again when the vaccine finally entered my

touchable

and I knew that I would soon be able to hug all

bloodstream,

people I have missed for two years and see their smiles

the

again.

waiting for the plane that will take me home, I don’t

Now,

what it will feel like to be in the skies again and touch

know

clouds, dreaming about the memories I will be able to

the

because my soul no longer needs to fight with loss

make

when my body is able to fight with COVID.


vaccine is finally able to

The

me home, not only

take

this time but also

physically

my emotions and soul.

with

Baghbanijavid is a

Mahsa

of the class of

member

at Lincoln High

2022

in Rhode Island.

School

is originally from Iran

She

she moved to the

and

States as a

United

two years ago.

sophomore

About the author

38| SUMMER 2021

ERIC GU

T

hroughout the COVID-19 epidemic,

many adolescents experienced mental

health hardships as a result of public

health safety precautions, including

school closures, social isolation, economic

hardships, and health-care access

disparities. In May 2020, just a few

months after the epidemic began, 29% of

parents said their child's mental health

had been negatively affected.¹

Furthermore, according to a research

study conducted by the National Institute

of Mental Health in October 2020, 31% of

parents believe their child's mental or

emotional health is worse now than it

was before the pandemic.¹ Irritability,

clinginess, and dread have all been

documented in children, as well as

sleeping problems and a lack of appetite.

Difficulties relating to access to good

mental health treatment may be rising as

mental health issues become more

widespread and visible in our youth.

Accessibility concerns in the healthcare

system may exacerbate existing mental

health issues among teenagers.

The number of teenagers with early

indicators of "learning anxiety, sensitive

propensity, somatic anxiety, and phobia

anxiety has increased dramatically,"

according to the same study. A risk-filled

perception of COVID-19 in this modern

era is detrimental to people's mental

health. Although adolescents are not the

primary risk group for COVID-19 virus

infection, they still experience significant

psychological distress and are at risk of

allostatic overload of various recent life

events and/or chronic stress. Such a

stressor is deemed to exceed or place

immense pressure on learned individual

coping skills.

The causes of psychological distress

leading to potential anxiety and other

mental health issues that adolescents

were exposed to are numerous. They may

be related to several different facets, for

example, large scale quarantining and

being confined within the home, facing

waves of negative news and other

potential triggers, fearing that they or

(Image Credit: Energepic from Picography)

their family and friends could be negative

impacted by the pandemic, a major or

significant lack of knowledge or awareness

surrounding disease prognosis or

risk factors, coming into account with

such fragility and brevity of life, becoming

sensitive to their physical discomfort,

and even fear of death. The

triggers of stress with observable mental

health impacts were also prevalent during

past pandemics, such as the SARS and

Ebola outbreaks, but none on the magnitude

as we are observing now given as

none of these pandemics had such drastic

tangible impacts on day to day life.²

More crucially, it is alarming to national

health authorities that while over 75% of

adolescents feel the need to seek help

with their emotional and/or mental wellbeing,

40% of these people did not

contact out for help. In the case of

women, this proportion jumps to 43%.³

The major mechanisms where people

would seek aid if needed are health

centers and specialty hospitals (50%),

EUNOIA GLOBAL HEALTH 39

followed by worship centers (26%) and

online services (23%).

When compared to adults, the pandemic

and lockdown have a stronger influence

on emotional and social development in

young children and adolescents. In one of

the earliest studies conducted during the

pandemic, it was discovered that younger

children(ages 3-6) were more prone than

older children to exhibit symptoms of

clinginess and fear of family members

becoming sick(ages 6-18). The older

children, on the other hand, were more

prone to inattention and were constantly

questioning about COVID-19. Regardless

of their age, all children displayed serious

psychological disorders such as increased

irritability, inattention, and clinging behavior.⁴

According to the results of the

parent-completed questionnaires, children

in today's world feel insecure, afraid,

and lonely. Disturbed sleep, nightmares,

poor eating, irritability, inattention, and

separation-related anxiety were also

reported by adolescents.

Pre-lockdown learning for children and

teenagers involved a significant amount

of one-on-one engagements and attention

with mentors and peer groups that was

simply not possible during the pandemic.

Over 91 percent of the world's student

population has been significantly

impacted by nationwide school and

institution closures. Children and

adolescents who are confined to their

homes experience uncertainty and

anxiety as a result of disruptions in their

education, physical activity, and

socialization opportunities. The absence

of a structured educational setting for an

extended period of time causes disruption

in routine, boredom, and a lack of

inventive ideas and engagement when

participating in various academic and

extracurricular activities. Not being able

to play outside, meet friends, or

participate in in-person school events has

had a negative impact on some children.

Because of the long-term change in their

routine, these children have grown more

clingy, attention-seeking, and reliant on

their parents. It's expected that children

may avoid returning to school once the

40| SUMMER 2021

lockdown is lifted, and that they may

have trouble reestablishing contact with

their mentors once the schools reopen. As

a result, the constraint of their movement

may have a long-term negative impact on

their psychological well-being.

The rates of attempted and completed

suicides among adolescents, particularly

teenagers, are increasing alarmingly,

according to hospital providers across the

United States. Since the pandemic began,

19 children have died from suicide in just

one Las Vegas school district.⁵ Clinicians

have highlighted the growing number of

pediatric patients in hospitals across the

country with suicide ideation as having

"worse mental states" than similar

patients prior to the pandemic.

These developments highlight the critical

significance of youth outreach, creative

intervention, and support during these

difficult times. “Mental health clinicians

must continue to push to ensure that

families and children receive the mental

health support they require to support

resilience, reduce family conflict and

child maltreatment, and reduce risktaking,

unsafe, and harmful behaviors,”

according to the previous study.⁵

COVID-19 has been linked to teenage

mental health problems, particularly the

dread of COVID-19 in a population with

adequate exposure to COVID-19, which

has been shown to cause anxiety and

depression. Adolescents who had

previously suffered trauma combined with

social isolation and loneliness were more

likely to develop these negative feelings

both during and after the enforced

seclusion ended. On the other hand,

several protective factors have been

discovered that can assist teenagers in

combating negative mental health effects

caused by COVID-19. Physicalpsychosocial

support, adequate

information about COVID-19 from

reputable sources, and a strong desire to

comply with physical distance have all

been proven to reduce the risk of

unfavorable mental health changes in

teenagers. A psychiatrist, pediatrician,

parents, or other parties who accompany

or care for teenagers might use this

methodology to improve awareness of

mental health changes and reduce the

negative consequences in the future. Further

research is needed to uncover other

factors that may be linked to mental

health problems in children and teens.

References

[1] Major depression. National Institute of

Mental Health. Updated February 2019.

Accessed online February 7, 2021.

https://www.nimh.nih.gov/health/statisti

cs/major-depression.shtml.

[2] Hertz MF, Barrios LC. Adolescent

mental health, COVID-19, and the value

of school-community partnerships. Inj

Prev. 2021;27(1):85-86.

doi:10.1136/injuryprev-2020-044050.

[3] Rogers AA, Ha T, Ockey S.

Adolescents’ perceived socio-emotional

impact of COVID-19 and implications for

mental health: results from a U.S.-based

mixed-methods study. J Adolesc Health.

2021;68(1):43-52.

doi:10.1016/j.jadohealth.2020.09.039

[4] Liang L, Ren H, Cao R, et al. The

effect of COVID-19 on youth mental

health. Psychiatr Q. 2020;91(3):841-852.

doi:10.1007/s11126-020-09744-3.

[5] Chatterjee R. Make space, listen,

offer hope: How to help a suicidal teen or

child. NPR. Published online February 2,

2021. Accessed online February 7, 2021.

https://www.npr.org/sections/healthshots/2021/02/02/962185779/makespace-listen-offer-hope-how-to-help-achild-at-risk-of-suicide.

ABOUT THE AUTHOR

Eric is an incoming high school senior

who is interested in studying medicine.

He is a passionate and determined

individual who believes in the importance

of highlighting key public health issues.

Eric enjoys playing basketball, writing,

and is an advocate for mental health.

SAFE AND RESPONSIBLE AI

FOR HEALTHCARE

ALYSSA TANG

F

eaturing Andrew Ng, Fei-Fei Li and

other renowned leaders in the field, the

AIMI Symposium focuses on the latest

research on the role of AI in diagnostic

and clinical implementation including the

societal impact of its use.

As one of the speakers at the virtual

symposium hosted by Stanford Center for

Artificial Intelligence in Medicine and

Imaging (AIMI) held on August 3, 2021,

Fries addressed the shortcomings as well

as advancements in machine learning and

artificial intelligence in areas of

medicine.

“There have been a lot of recent

publications on the proliferation of

COVID models but they haven’t made any

contribution to the value in healthcare,”

said Dr. Jason Fries, a research scientist

at Stanford Center for Biomedical

Informatics Research.

Fries attributes the aforementioned

problem to so-called “Frankenstein

datasets” citing “Hundreds of AI tools

have been built to catch COVID. None of

them helped,” published in the MIT

Technology Review. Such datasets of

scans and electronic health records were

often “spliced together from multiple

sources and can contain duplicates,”

according to the July 30, 2021 MIT

article. Researchers discovered that

algorithms trained on a combination of

scans of people lying down and standing

up were determining the risk of

contracting COVID based on their

position rather than the actual features of

the scan. This likely resulted from the

confounding factor that people lying

down had more serious conditions than

people standing up. Other models

incorrectly associated the scan label fonts

that hospitals with higher cases used

with greater risk for the disease. Fries

elaborated on the need for data-centric

AI to solve these issues presented by the

pioneer of machine learning, Professor

Andrew Ng. In his introductory remarks,

Ng emphasized the necessity of shifting

from model-centric to data-centric AI for

success in the medical space.

(Image Credit: IT Chronicles)

As the founder of DeepLearning.AI and

adjunct computer science professor, Ng

believes that “For many years, we’ve

known that healthcare and AI holds a lot

of promise. AI will - or at least

supposedly will - transform healthcare,”

Ng said. Despite the immense research

progress in AI and healthcare in the last

decade, significant work is needed to put

these algorithms into production in a

“safe and responsible way.”

“A lot of applications have a proof of

concept to production gap,” according to

Ng. Frequently, researchers publish

papers touting high diagnostic accuracy

on test sets, sometimes with comparable

or even better results than clinicians, yet

these promising algorithms are not

utilized in practical healthcare settings.

Ng said, “the gap is getting the

sufficiently high quality data to feed to

the neural network to get you the

performance you need to deploy these

systems.” The key is to invent the tools

and techniques to be more systematic

about entering the data. He also


addressed the importance of attention to

the entire life cycle of project scoping,

data collection, modeling, deploying,

monitoring and maintenance.

While Andrew Ng emphasized the

technical aspects of AI in medicine, Fei-

Fei Li, a recent appointee to the National

AI Research Resource task force,

discussed the ways ambient intelligence

can illuminate the dark space of

healthcare. Her work aims to reduce

medical errors which account for

250,000 deaths a year as the third

leading cause of death in the healthcare

system. As a co-director of Stanford

Institute for Human-Centered Artificial

Intelligence (HAI), Li hopes to transform

the physical spaces of healthcare with

sensing capabilities by “shin[ing] the

light figuratively” to identify fine-grained

healthcare activities to measure mobility

and categorize movements in a

“contactless” and “continuous way.”

Through direct observation with smart

sensors installed in a hospital unit, the

algorithm was able to classify patient

movements including “getting in bed,

getting out of bed, getting in a chair, and

getting out of a chair” with promising

quantitative results, according to Li. It

would be beneficial to extend the set of

clinical care activities classifiable. Other

AI models are being developed to “detect

any early indication of clinically

relevant events that we should be

watching” for daily living spaces for

seniors. Li explained these are

“emerging new exciting use case[s] and

research area[s] of AI for helping

patients and clinicians to illuminate a

dark space of healthcare.”

Li concluded with these inspirational

words: “Healthcare at the end of the

day is humans caring for humans. AI is

a tool and it’s up to us to use this tool

to enhance our humanity and to help

each other.”

(Image Credit: Mashable India)

ABOUT THE AUTHOR

(Image Credit: Stanford School of Medicine)

Alyssa is a high school junior who

engages in youth advocacy through

journalistic writing and social media

platforms. She is also interested in

developing AI and deep learning

products for use in medicine. She

cares deeply about disparities in

public health issues and hopes to

bring innovative solutions to global

challenges.

42| SUMMER 2021

C O N T R I B U T O R S F R O M

A R O U N D T H E G L O B E

1 2 U S S T A T E S | 7 C O U N T R I E S | 3 5 0 0 V I E W S * | 2 7 C O N T R I B U T O R S | 3 I S S U E S

*Total worldwide views for the first 2 issues

View the updated interactive version of the map at

www.eunoiaglobalhealth.com


Youth Perspectives on

Global Health Issues

Eunoia

E

Summer 2021 Publication

Create successful ePaper yourself

Delete template?

Save as template?