Category Archives: January 2021

Routine Examination: Maintaining Good Mental Health During a Global Pandemic

As a 6th year student, I’ve benefitted quite a bit from listening to students before me when they talked about successful time management. This article is meant to be more than just an article on time management, though; it’s also an article about resilience, and coping strategies, and how all of it affects our work. And maybe how, when everything else fails, having a little bit of a routine can help.

In Man’s Search for Meaning, Victor Frankl wrote that “people have enough to live by, but nothing to live for; they have the means, but no meaning” [1]. We are taught as scientists that it is the science itself that should drive us, that if we are passionate enough about science, if we’re curious enough, we’ll succeed.  Anyone who fails must not have had enough passion, we’re told.

I don’t believe that’s true.

During this pandemic, it’s so easy for academia to continue with a mantra akin to “passion will drive science forward.” To me, it seems much more about resilience, defined in the social sciences as a measure of the ability to cope with stress [2]. People who are resilient recognize the limits of their control, have an action-oriented approach, are patient and flexible, and have goals (perhaps life goals?), among other things [2, 3]. While some of our reaction to stress can be attributed to genetics, there are certain skills that can be cultivated to increase our resilience [4]. One example is increasing the amount of active coping, such as exercise, looking for social support, mindfulness, or reframing stressors more positively [4-6].

I realize that this can sound strange to us as biomedical scientists rather than social scientists, but there is a body of literature (some of which is cited here), suggesting that resilience can protect employees from work-related stress, and that it could explain why some people thrive in environments where others burn out [7]. Right now, we’re in an environment where many of us will burn out—if not from the stress of graduate school, then from the added stress of a pandemic. It is critical, then, that we foster resilience in populations of graduate students who have been shown to experience higher levels of depression and anxiety than the larger population (I’ve written about this here).

The link between resilience and having a schedule/maintaining a routine may not be immediately obvious. It turns out that many of the predictors of resilience (goals, social support, personal reflection included in mindfulness study, etc.), as well as having a meaning in life, are also predictors of happiness [8]. Maintaining routine also gives us a sense of stability. Research on Post-Traumatic Stress Disorder (PTSD) has shown that avoidance coping strategies, including reducing routine activities to avoid triggering places, was a significant predictor for functional impairment [9]. Much research is devoted to the effects of family routines and daily routines on child development, but much less is discussed regarding the effects of these things on adult individuals [10]. I think, however, that some level of routine is good for all of us, even if that routine consists mainly of going to work and coming home again. Routines help us build healthy habits.

Perhaps that’s why so many of us have struggled during this pandemic. Academic science is by nature a flippy-floppy, unstructured business, and when COVID-19 took away the last piece of structure—going into the lab every day—many of us were left wondering what to do with all that new free time. The shutdown really gave me a chance to codify what works for me as a daily routine and what doesn’t. Give some of these a try!

Find a space to work that isn’t in your bedroom
Not all of us have the luxury of a personal home office, but it’s best to keep work things out of your sleep space. Associating your bedroom with work, especially stressful work, can blur the lines of work-life balance. Just because we’re working from home, that doesn’t mean we need to compromise our boundaries!

Make time to exercise
Personally, if I don’t exercise first thing in the morning, it doesn’t happen. Without exercise equipment at home, bodyweight exercises or outdoor cardio are going to be your best friend. Medicine in Motion has a nice workout library that’s worth checking out (as an added bonus, Tufts has its own chapter!).

Do your normal morning routine—even if you’re not going out
Shower, brush your teeth, get dressed, eat breakfast. Make it feel like you’re getting ready to work! It’s so tempting to stay in pajamas with a blanket and take Zoom calls from bed, but even if your camera is off and your labmates can’t see you, you won’t feel prepared to work and your brain won’t engage in it. Pretend that you’re going into the lab and bring your A-game to the zoom-room.

Normalize your sleep schedule
Wake up and go to bed at the same time each day. Keeping a consistent sleep schedule is referred to as “sleep hygiene.” Sleep hygiene is critical for maintaining your body’s circadian rhythm, which tells you when to wake up and when to wind down for the day. If you constantly switch what time you’re waking up or going to bed, your body won’t know when to help you wake up on any given day. This goes hand-in-hand with working outside your bedroom and breaking any association you may have between work and sleep. It’s actually best to do this every day, even when there isn’t a global pandemic (and yes, even on weekends!).

Find a little meaning (outside of work)
If you have a pet, it could be as simple as feeding your pet every morning and making sure they are getting the exercise and playtime they need. It might be caring for houseplants, or checking in with your parents or a close friend to make sure they are doing okay. Or perhaps living out your dreams of cooking eggplant in every possible style, just to say you’ve done it. Or crocheting baby hats for preemies in the NICU. Find something that, when you do a little bit each day, makes you feel like you accomplished something that impacts the world around you.

Expand your support network
Humans thrive on social interaction (even the most introverted of us enjoy the occasional chat). Reach out to some old friends, join a support group. Check in on people. If you’re looking to connect with people, CoronaBuddies is still available! It can be helpful to use the human inclination to follow a schedule here: set a weekly time to zoom with a friend, so that no matter how busy or isolated you otherwise feel, you’ve got that weekly visit waiting in the wings.

Cut yourself some slack…
Know that it’s totally okay if you aren’t as productive as you were before the pandemic. None of us are, especially with density restrictions and having to work around each other in a way that we didn’t have to before. Give yourself a mental health day and binge some of your favorite TV shows, talk to a friend, or cook some good food. Know that 100% effort at work may not give you 100% of the results you may have gotten pre-pandemic.

…But don’t let your guard down
This is a marathon, not a sprint. It’s so tempting to take your mask off—it’s hot, it’s itchy, it’s uncomfortable, it’s hard to breathe—but we’re still in the thick of the pandemic. The vaccine is coming, but until enough people have been vaccinated, it’s not over. Keep on keeping on with mask wearing, social distancing, and hand sanitizing.

And finally, know where to find help
Reach out to the Student Wellness Advisor, Sharon “Snaggs” Gendron, if you feel you could benefit from additional support. She can refer students struggling with mental health to clinicians who can help. Other places to find help are the Talk One2One Student Assistance Program, BetterHelp, iHope, and the University Chaplaincy.

In the event of a crisis, the National Suicide Prevention Lifeline is available 24/7 at 1 (800) 273-8255.

References:
[1] Frankl, Victor. Man’s Search for Meaning. Beacon Press, Boston, 1946.

[2] Conner and Davison. (2003) Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety 18:76-82.

[3] Friborg et al. (2006) A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment? International Journal of Methods in Psychiatric Research 12(2): 65-76.

[4] Southwick et al. (2005) The psychobiology of depression and resilience to stress: Implications for prevention and treatment. Annual Review of Clinical Psychology 1:255-91.

[5] Callaghan. (2004) Exercise: A neglected intervention in mental health care? Journal of Psychiatric and Mental Health Nursing 11: 476-483.

[6] Galante et al. (2018) A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomized controlled trial. Lancet Public Health 3:372-81.

[7] Grant and Kinman. (2012) Enhancing wellbeing in social work students: building resilience in the next generation. Social Work Education 31(5):605-621.

[8] Bailey and Fernando. (2012) Routine and project-based leisure, happiness, and meaning in life. Journal of Leisure Research 44(2):139-154.

[9] Pat-Horenczyk et al. (2006) Maintaining routine despite ongoing exposure to terrorism: a healthy strategy for adolescents? Journal of Adolescent Health 39:199-205.

[10] Schultz-Krohn. (2004) The meaning of family routines in a homeless shelter. American Journal of Occupational Therapy 58:531-542.

The greatest show on earth

“We are going to die, and that makes us the lucky ones. Most people are never going to die because they are never going to be born. The potential people who could have been here in my place but who will in fact never see the light of day outnumber the sand grains of Sahara. Certainly, those unborn ghosts include greater poets than Keats, scientists greater than Newton. We know this because the set of possible people allowed by our DNA so massively exceeds the set of actual people. In the teeth of these stupefying odds it is you and I, in our ordinariness, that are here. We privileged few, who won the lottery of birth against all odds, how dare we whine at our inevitable return to that prior state from which the vast majority have never stirred?”

-Richard Dawkins, Unweaving the Rainbow: Science, Delusion and the Appetite for Wonder

This powerful passage signs off a wonderfully unique song by the Finnish symphonic metal band Nightwish from their album Endless Forms Most Beautiful. Drawing on works from Charles Darwin and evolutionary biologist Richard Dawkins (who’s book The Greatest Show on Earth inspired the song name), this 24-minute magnum opus explores the major events of life’s evolutionary history to present day. The song is broken up into four larger parts that tell the tale of Earth’s unique history. This has quickly become one of my favorite songs. Let’s now take a closer look at how Nightwish set out to marry heavy metal with evolutionary biology concepts (link to a live version with guest appearance by Dawkins will appear at the end of this article).

Part 1: Four Point Six

The song opens with a repetitive and fluid piano melody accompanied by orchestral components that signify whatever “existed” before the Big Bang . At 1:33 the Big Bang arrives, and the music shifts to convey the resulting chaos and energy of a nascent universe being born. At 1:55 we are introduced to the main melodic theme that we will revisit throughout the song. Several more explosions are heard (2:40) which I imagine as our solar system coming together from the ensuing bombardment. The first lyrics are sung as a haunting ephemeral wailing.

 Archaean horizon, The first sunrise
On a pristine Gaea
Opus perfectum, somewhere there, us sleeping

Geologic time is broken into distinct eons, and the Archaean signified the earliest emergence of life. In Greek mythology, this life arose from Gaea the Greek goddess of the Earth. Life has now been established (opus perfectum- “perfect work”) and eventually mankind will appear from this starting template billions of years later. We are reminded that all the elemental building blocks are present in this early Earth, “waiting” to be reorganized into the human species. Next is another Dawkin’s excerpt:

“After sleeping through a hundred million centuries
We have finally opened our eyes on a sumptuous planet
Sparkling with color, bountiful with life
Within decades we must close our eyes again
Isn’t it a noble, an enlightened way of spending our brief
Time in the sun, to work at understanding the universe
And how we have come to wake up in it?”

The song then erupts into fanfare (5:46), life is here and begins its unending 3-billion-year journey.

Part 2: Life

The cosmic law of gravity
Pulled the newborns around a fire,
A careless cold infinity
in every vast direction
Lonely farer in the Goldilocks zone
She has a tale to tell
From the stellar nursery into a carbon feast
Enter LUCA

Here is the birth of our solar system with Earth becoming one of the nascent planets circling our Sun. Outside the solar system, there is a vast and cold emptiness for light years in all directions. Earth is the lucky one in the Goldilocks zone (not too hot, nor too cold, but just right). The early Earth contains all the building blocks leading to the eventual evolution of our Last Universal Common Ancestor from which all current life sprang.

The tapestry of chemistry
There’s a writing in the garden
Leading us to the mother of all

In my mind tapestries evoke “weaving” which makes me think of the endless strands of double helical DNA connecting all forms of life through history. Life is commonly referred to as a garden and this can be interpreted as reading the fossil record showing us snapshots of the interconnectedness of all life in the past.

We are one,
We are a universe
Forebears of what will be Scions of the Devonian sea.
Aeons pass, writing the tale of us all
A day-to-day new opening
for the greatest show on Earth

Naturally what follows is that all life is connected as one. The band highlights the Devonian era which was a time period of massive radiation of fish (this era is termed The Age of Fishes) as well as land colonization of plants. We are all scions, descendants of a notable family (family tree of life), from this time period. Looking back even earlier to the Cambrian explosion, the earliest known chordate, Pikaia, is the ancestor to all vertebrates.  We now roll credits for the mention of the song’s title. Since life is always changing and evolving, each day is different. Thus, the story of life has a day-to-day new opening.

Ion channels
welcoming the outside world to the stuff of stars
Bedding the tree of a biological holy,
Enter life

There is a reference here to Carl Sagan who coined the term “starstuff” referring to all of life being made up of elements formed from the dying explosions of exhausted stars. Another beautiful connectedness of all life, arising not only from a common ancestor, but incorporating all matter born in the belly of long-gone stars. The focus on ion channels here is striking when you think about what they are trying to convey. Elements from dead stars were eventually combined into living forms that evolved proteins capable of generating action potentials in our neurons which allowed ourselves to become aware of the universe. Essentially through ion channels, the universe is able to learn about itself.

We are here to care for the garden
The wonder of birth of every formmost beautiful
Every form most beautiful

Chronologically humans have not appeared yet in the history of life, nor the song. I am unsure of the “we” that is referred to here, but it could be the general responsibility of all life due to our connectedness. Of course all lifeforms are beautiful, an homage to the final sentences of Darwin’s Origin of Species.

Part 3: The Toolmaker

Humankind has arrived. Animal grunts and other savannah creatures can be heard during our early days of trying to survive amongst animals that could easily kill us. The song explodes into another heavy riff signifying our eventual dominance over all life on Earth (11:53).

After a billion years
The show is still here
Not a single one of your fathers died young
The handy travelers out of Africa
Little Lucy of the Afar

This stanza makes us remember that we are all here because each one of our ancestors going back billions of years successfully reproduced itself to the next generation. An unyielding unbroken chain avoided life’s dead ends of extinct genera and species. We know that early humans migrated out of Africa and the earliest known mother of humankind was an Australopithecine named Lucy found in eastern Africa.

Gave birth to fantasy
To idolatry
To self-destructive weaponry
Enter the god of gaps
Deep within the past
Atavistic dread of the hunted

As the human brain developed it gave rise to religion and mythology to fill in gaps of missing knowledge, attributing that which was not known to deities. We also strive for continual and never-ending progress, as atavism is the fear of returning to a more primitive ancestral state (how could any of us live without the Internet?!)

Enter Ionia
The cradle of thought
The architecture of understanding
The human lust to feel so exceptional
To rule the Earth

Man has settled into civilizations and frees up time to think and discover how the world works. We elevate our status as greater than all other life forms, set to inherit the Earth.

Hunger for shiny rocks
For giant mushroom clouds
The will to do just as you’d be done by

Here is the self-explanatory human lust for gold and money, but also dominance over other humans through creation of super weapons. Weapons that have the capability of destroying ourselves.

Enter history
The grand finale
Enter ratkind

A warning of what may come. A reference to another Dawkin’s work, The Ancestor’s Tale. Here Dawkins imagines a post-apocalyptic world where rats survive and feast on the remains of human corpses and our agriculture/food products. As the population of rats explodes, they resort to cannibalism. Natural selection, always running in the background, allows rats to diverge and radiate out into different carnivorous and herbivorous species. Eventually through enough geologic time, intelligence arises in one species to that of humans. They then study human fossils and ponder how we had driven ourselves extinct.

Man, he took his time in the sun
Had a dream to understand
A single grain of sand
He gave birth to poetry
But one day’ll cease to be
Greet the last light of the library

I especially appreciate this passage as all scientists can relate to devoting our life’s work to a very small esoteric topic. Each of us has or could have their own “grain of sand” that they seek to fully understand. This is a unique attribute of human beings, but this facet of life may not always exist forever, ending with the destruction of the human race.

There is a notable section highlighting the evolution of humans through that of our music (starting at 13:55). Early tribal drumming and chanting can be heard. This is followed by throat singing and a famous Bach snippet. A rocket blast sets off the Modern Age and a banjo depicting country music. Then the unmistakable main riff from Enter Sandman by Metallica can be heard followed by a short measure of techno or electronic music.

Finally, the climax of the song. A desperate loud exclamation, “We were here!” emphasizes the desire that all humans have the need to be remembered, to leave their mark. I see this section as a warning as well. This proclamation ends with an explosion and crumbling rock. If continued on its current path, human society will be been destroyed. “We were here!” is an audible fossil to record how the human race once evolved to dominate the planet but like countless species before it, has gone extinct.

Part 4: The Understanding

Another gentle piano melody appears and allows us to reflect and take in the previous 17 minutes. We did just play out the entire history of life on Earth after all.

The song ends with the passage from The Greatest Show on Earth that began this article, and then the closing excerpt from Origin of Species.

There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one. And that whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved.

I hope you enjoy the song as much as I do. It has quickly become one of my favorite songs, combining my love of biology, the works of Dawkins and Darwin, and metal music. Check out a live version with guest appearance by Richard Dawkins below: https://www.youtube.com/watch?v=qrMwxe2ya5E&ab_channel=Nightwish

The Next Frontier for Diagnostic Imaging

The advent of Magnetic Resonance Imaging (MRI) revolutionized the way medical practitioners diagnose and track diseases throughout the body. MRI utilizes magnetic properties of ions in the body along with computer-generated radio waves to create detailed images of the body’s organs and tissues4. This allows for the detection of cancers, traumatic brain injury, strokes, aneurysms,  spinal cord disorders, and other  ailments, without exposing patients to radiation or necessitating the use of intravenous dyes as required in other forms of diagnostic imaging. While many advances in MRI technology have been made to implement artificial intelligence for image reconstruction, increasing magnetic field strengths, optimizing receiver coil arrays, and enhancing imaging gradients, there remains an ongoing need to prioritize expanding access of these technologies on a global scale.

One area of advancement in MRI research that has received recent attention is the use of lower field-strength (0.2 Tesla) MRI systems2,3. These systems were once thought to provide suboptimal imaging quality as they utilize a substantially lower magnetic field strength compared to modern MRI systems. Integration of artificial intelligence for low-field MRI systems provides the capability for its images to compete with the resolution of that of a high-field MRI2. There are several advantages to low-field MRI that directly impact healthcare facilities and the patients they serve. Importantly, low-field MRI does not require a cooling system nor a large energy source in order to function properly1,2,3,5. This allows for a reduction in the ongoing costs associated with MRI systems in addition to a reduction in the high maintenance fees (~$10 thousand per month) and acquisition costs (~$1million/T) that are required of high-field MRI systems1,3,5. For under-resourced healthcare centers, these fees can be the determining factor for whether or not a patient receives a lifesaving diagnostic scan.

The utility of low-field MRI systems extends beyond cost savings, however. Due to the smaller magnetic field, noise produced by these systems is reduced which favors its use among pediatric populations1,3,5. In 2020, the FDA approved the use of the first portable point-of care low-field MRI (Below is a video of Dr.Kevin Sheth, a critical care neurologist at Yale School of Medicine discussing the advent of a the world’s first portable low-field MRI). Its small footprint and open design allows for family members to remain at the bedside with patients as they receive their scan1,2,3,5. The small footprint of these systems also makes its use in preclinical research settings more accessible. The open design of these systems is an additional benefit for patients with claustrophobia as well as obese patients that have difficulty in high-field MRI systems. Widescale clinical use of low-field MRI would expand access for patients that have metal implants such as pacemakers or shunts, who otherwise would not receive such diagnostic imaging2. Given the ability of a portable low-field MRI system to provide cost savings to healthcare facilities, expand access to patients in need, and further diagnostic capabilities for practitioners, low-field MRI systems are posed to pioneer a new era of medical diagnostic imaging.

Incorporating artificial intelligence into low-field MRI diagnostic imaging stratifies the detection of disease by combining the observer-based image interpretation currently in practice with an artificial intelligence generated semi-quantitative approach (please see observer-based and semi-quantitiative decision making diagram below). In doing so, as larger datasets of diagnostic images are collected, artificial intelligence algorithms become more reliable in detecting disease pathology. Such measures may be used to not only detect disease but to better inform clinicians of potential treatment responses and health outcomes of their patients.

  1. Cooley CZ, McDaniel PC, Stockmann JP, Srinivas SA, Cauley SF, Śliwiak M, Sappo CR, Vaughn CF, Guerin B, Rosen MS, Lev MH, Wald LL. A portable scanner for magnetic resonance imaging of the brain. Nat Biomed Eng. 2020 Nov 23. doi: 10.1038/s41551-020-00641-5. Epub ahead of print. PMID: 33230306.
  2. Ghadimi M, Sapra A. Magnetic Resonance Imaging Contraindications. [Updated 2020 May 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551669/
  3. Grist, T. M. (2019). The Next Chapter in MRI: Back to the Future? Radiology, 293(2), 394-395. doi:10.1148/radiol.2019192011
  4. J.P. Hornak, The Basics of MRI, Interactive Learning Software, Henrietta, NY, 2020, http://www.cis.rit.edu/htbooks/mri/.
  5. Sarracanie, M., & Salameh, N. (2020). Low-Field MRI: How Low Can We Go? A Fresh View on an Old Debate. Frontiers in Physics, 8. doi:10.3389/fphy.2020.00172
  6. Sheth KN, Mazurek MH, Yuen MM, et al. Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurol. Published online September 08, 2020. doi:10.1001/jamaneurol.2020.3263