Beyond the Algorithm Preserving Patient-centered, Holistic Approach in Artificial Intelligence-Driven Healthcare - Pg.7-8
Augmenting Clinical Rotations: An AI-Assisted, Low-Touch System for Clinical Interview Skill Building - Pg. 36-37
Medical Devices and Darker Skin Tones - Pg. 33-34
The Evolving Role of Ultrasound in Emergency Medicine: A Conversation with Sidney James, DO, FACEP - Pg. 11-13
THE FUTURE D.O.
STUDENT OSTEOPATHIC MEDICAL ASSOCIATION
Volume 3, Issue 1 May 2025
The Machine and The Doctor - Pg. 26
TECHNOLOGY AND MEDICINE: TWO SIDES TO ONE COIN
Editorial Board '24-'25..........................................2-5 Greetings from Editor-In-Chief..............................6-7 In Erratum......................................................... 8 Artwork: Fatima Bawaney..................................... 9 Editors' Perspectives............................................ 9-14 Artwork: Tatyana Opalko.......................................15 Abstracts: Case Reports........................................ 15-20 Abstracts: Original Research................................. 21-24 Poem: The Doctor and The Machine........................ 25 Abstracts: Literature Reviews................................ 25-30 Student Perspectives............................................31-37 Poem: The Pulse of Progress................................. 38 Announcements..................................................39 Message from Research Director............................ 40
About the Cover Artist:
Artwork Statement:
Savanna Lee is a first year osteopathic medical student at the California Health Sciences University COM. She has always had a passion for art and medicine, stating that she had known since she was 11 that she wanted to be a doctor. Savanna has always loved to draw, has been a part of many art competitions, and worked in digital marketing as her first job. Though she has less time for it now, she still takes any opportunity to utilize art to express herself, especially now, through the lens of medicine. She will continue using art in the future as she hopes to be a pediatrician and make kids smile through art and healing. Email: lee2589@chsu.edu
CONTENTS
To me, technology in medicine is crucial to the future of healthcare. My little brother was born without a properly formed hip joint, and to me his experiences have always influenced my views of medicine. If properly used, technology can be a great boon to the next generation and an incredible tool for healthcare providers to use. With the rise of AI and increasing fear around technology, I choose to think that it can be used to give the future a brighter outcome. Therefore, I decided to draw a child with a futuristic prosthetic, as an example of what advances in technology can do for medicine, without losing our humanity.
Editor-In-Chief Ivy Nguyen Editorial Board Ahana Chakraborty Alexandra Steck Aishwarya Rajendran Amardeep Kaur Dana Simon Ismihan Uddin Shuangtao Ma Varsha Reddy Venu Peddibhotla Winnie Chijioke Research Director Mahi Basra On The Cover Helping Hand Digital artwork by Savanna Lee The Future DO is a magazine for the advancement and education of the osteopathic medical student. It is published biannually by the Student Osteopathic Medical Association (SOMA). Funding for The Future DO is provided by the SOMA. Views expressed in The Future DO publications are solely those of the authors and do not necessarily reflect the opinions of the editorial board, The Future DO, or SOMA unless specified.
EDITORIAL BOARD
Aishwarya earned her bachelor’s degree from the University of Florida and her Master’s in Medical Sciences from Boston University. Her passion for working with underserved communities is deeply rooted in her experience as a first-generation immigrant. Before medical school, she worked in clinical research, dedicating her efforts to improving healthcare access and addressing health disparities in medically underserved communities in Virginia. Aishwarya is currently interested in Internal Medicine and plans to subspecialize in Endocrinology. She aims to empower her future patients through education, compassion, and personalized care to enhance their quality of life. In her free time, Aishwarya enjoys cooking, dancing, and spending time with her 7-year-old Pitbull, Kamal.
MEET THE EDITORIAL BOARD
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Ivy is a third-year medical student at TOUROCOM-NY, originally from Vietnam, and moved to the U.S. during middle school. She is currently completing rotations at Staten Island University Hospital and has a strong interest in primary care specialties. As the editor-in-chief, she aims to create a platform for osteopathic medical students to showcase their research, scholarly activities, and creative work to improve healthcare culture, advocate for patients, and enhance medical training. Through the magazine, she is committed to empowering students to have a voice in shaping the future of medicine. Outside of school and work, Ivy enjoys spending time with friends and family, cooking, dancing, doing art, and playing with her cat Krispy (and her roommate's cat, Mona).
Aishwarya Rajendran, OMS II WCU COM Editor
Ahana Chakraborty, OMS II CHSU COM Editor Magazine Design
IVY NGUYEN, OMS-III TOURO COM, harlem Editor-In-Chief
Ahana's journey through medicine is driven by a love of research and advocacy. Growing up in San Diego, CA, she was inspired by the city’s rich biomedical landscape and developed a curiosity for the science behind medicine, while her passion for advocacy stems from her family's experiences navigating healthcare disparities. As President of CHSU SOMA and the Pediatric Interest Group, Ahana creates spaces for peers to engage in discussions on healthcare and empowers them to pursue advocacy. She aspires to become a pediatric gastroenterologist or neurologist, continuing to champion vulnerable populations. In her free time, she enjoys baking, creating art, running, and all things spooky.
THE FUTURE DO • VOL 2 • ISSUE 2
Varsha Reddy, OMS IV MSUCOM Editor
Alexandra Steck, OMS III Touro COM, Harlem Editor
Alexandra is deeply committed to advancing women’s health through research. She has a strong background in oncology research from institutions such as Memorial Sloan Kettering and Sidney Kimmel Cancer Center, with work focusing on ovarian and prostate cancer, liquid biopsy diagnostics, and health equity. She has co-authored multiple peer-reviewed publications and presented at national conferences. Alexandra aspires to become a gynecologic oncologist, aiming to integrate patient care with translational research to improve outcomes for women diagnosed with cancer. Originally from Upstate New York, she enjoys spending weekends Upstate with her dogs, Reagan and Nori, and experimenting with new recipes from The New York Times Cooking collection.
Shuangtao (Shaun) Ma, OMS III NYIT COM Editor
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Varsha grew up in Michigan and has been interested in medicine from a young age. Before her medical school journey at MSUCOM, she graduated from Michigan State University with a degree in Neuroscience and worked as an ophthalmic technician/scribe and EMT. Her passions include community service and improving access to health care, which are embodied in her involvement in volunteer work and research. She enjoys spending her free time exploring new coffee shops and restaurants, dancing, and swimming.
Shaun is an enthusiastic cardiovascular researcher. He continues his research project funded by the American Heart Association while in medical school. He and his team found that ingredients in chili peppers can lower blood pressure, peppermint can help control weight in a high-fat diet, cinnamon is good for the kidneys, and wasabi and mustard oil can slow heart aging. He enjoys spending time with his family, cooking, hiking, and skiing.
Amardeep is a first-generation Punjabi American medical student who grew up in Yuba City, California. With a passion for providing compassionate care, she was inspired to pursue medicine to serve communities in need. Currently, Amardeep is interested in pursuing a career in either internal medicine or anesthesiology. Outside of her studies, Amardeep enjoys spending time with her nieces, watching TV, traveling, and capturing moments through photography. Her dedication to both her personal and professional pursuits reflects her commitment to making a meaningful impact in the lives of others.
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Winifred Chijioke, a second-year medical student at Touro College of Osteopathic Medicine, is passionate about advancing healthcare equity and advocating for women of color. Growing up as a Nigerian immigrant in rural Indiana, she developed a deep commitment to helping underserved communities and improving maternal health as an aspiring OB/GYN. Her leadership roles include serving as President of the American Medical Women’s Association, National Liaison Officer for her school's SOMA chapter, and Medical Students for Choice Leader. She is a Primary Care Leadership Program Scholar and a Johnson & Johnson Alliance in Medicine Scholar, as well as a certified Medical Laboratory Scientist. In her free time, Winifred enjoys exercise, cooking, baking, mentorship, and volunteering.
Venu enjoys working with undeserved populations and has a passion for treating cardiac disease. He hopes to become a Cardiologist serving the areas of rural Virginia.
Amardeep Kaur OMS II Touro COM, California Editor
Winifred Chijioke OMS II Touro COM, Middletown Editor
Venu Peddibhotla OMS IV Virginia COM Editor
THE FUTURE DO • VOL 3 • ISSUE 1
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Dana Simon OMS III MSU COM Editor
Dana's interest in medicine began during a trip to Cambodia in high school, where she quickly recognized her passion for working with under-served communities. She received her undergraduate degree from Michigan State University where she was able to build upon her medical experiences through research and community service. Since entering medical school, she has participated in two global health trips and hopes to be involved in international medicine as a physician as well. In her free time, she loves to play soccer, explore new restaurants, and hang out with friends.
Ismihan Uddin OMS II MWU Chicago COM Editor
I am a proud Bosnian woman with a deep passion for global healthcare. Growing up with a keen awareness of the disparities in medical access, I’ve always felt a strong desire to help bridge that gap. My goal as a physician is to provide quality care to underserved populations and advocate for those in need, both locally and globally. Whether through clinical practice, humanitarian work, or public health initiatives, I am committed to making a meaningful impact on health equity. My aspirations include working in international health settings, contributing to global health policy, and inspiring future generations of physicians to think beyond borders in their pursuit of healing.
It is undeniable that technology has permeated every aspect of medicine, driving advancements in diagnostics and treatment plans while improving workflow efficiency. However, while traditional medicine has long centered on the physician-patient relationship, championing compassion and personal trust, modern medicine now operates under the tremendous pressure of institutional regulation and monetization, heavily relying on technology to analyze the costs and benefits of healthcare based on the available resources. With the integration of artificial intelligence (AI), technology is not only designed to maximize sensitivity and specificity but also possesses complex algorithms and decision-making capabilities, influencing physicians’ approaches to care. Yet, how AI reaches its conclusions, why it makes particular recommendations, and whether it excludes certain groups of people in its analysis remains largely unknown, posing ethical questions about transparency and accountability that may potentially affect patient autonomy as well as exacerbating existing biases and health disparities. Will this “black box problem” challenge the physician’s oath to “do no harm”? What steps can we take to uphold ethical standards and ensure the quality of holistic care? To begin our discussion, let’s explore how AI is currently employed in the medical field. In their article, Kufel et al. discusses in detail the different AI subsets and algorithms, with machine learning (ML) and deep learning (DL) being the most widely used methods in medicine 1. ML algorithms can learn from input-output paired data (supervised learning), data with unlabeled output (unsupervised learning), or through trials and errors (reinforcement learning), identifying patterns and making predictions and decisions accordingly. In comparison, DL algorithms utilize artificial neural networks with multiple hidden layers, known as deep neural networks, to learn from much larger datasets. These artificial neural networks resemble the human brain, consisting of multiple perceptrons that process information and transmit signals similarly to how neurons function. The deeper the network and the more layers involved, the more complex patterns the system can learn 1. Neural networks are particularly useful for image recognition, natural language processing, and speech recognition. They are currently applied in various sectors of healthcare. For example, DL can be used to detect scaphoid fractures using only plain wrist radiographs, diagnose COVID-19 from chest X-ray (CXR) images, assess endomyocardial biopsy data in patients with myocardial injury, and identify aortic stenosis using audio files 2,3,4,5. An increasing number of AI applications in medicine have been approved by the U.S. Food and Drug Administration (FDA), including Ultromics, which detects heart failure with over 90% accuracy; Apple Watch IRNF 2.0 Software, which identifies cardiac rhythm abnormalities such as atrial fibrillation; and Aidoc, which enables quick and accurate analysis of X-ray and CT scans 1. While neural network layers enable an unprecedented level of diagnostic accuracy, they also raise concerns about how these conclusions are reached. To illustrate, think about when you have a foggy moment of knowing something but are unable to recall how and where you learned it. Similarly, the “black box problem” in deep learning AI happens when the system provides an answer without a clear explanation of the internal mechanisms behind it. It is not known for sure which factors, data subsets, or populations of patients are considered in the analysis process. One study described this phenomenon as the “new medical paternalism,” in which patients are not given adequate information to make informed decisions about their care 6. Using AI irresponsibly can push patients back into this paternalistic model of the physician-patient relationship, undermining patient autonomy and increasing the risk of malpractice. This lack of explainability in AI, combined with poor communication from physicians, may further erode the patient’s trust and worsen their suspicion 7. In addition, biased AI algorithms trained with unrepresentative datasets can lead to inaccurate diagnoses, or worse, discriminatory profiling, exacerbating health disparities 8. For example, data biased toward an overdiagnosis of schizophrenia in African Americans could have harmful consequences if applied to certain sub-Saharan African populations 9. The purpose of this article is not to portray AI and technology in a negative light but rather to highlight the ethical concerns and potential risks that arise from their inappropriate or irresponsible use. Strict regulations, including pre-market review, post-market surveillance, quality control, and transparency regarding data usage and collection, should be mandatory before an AI-powered platform is implemented. An AI-patient model is risky and should never replace the organic physician-patient relationship. Instead, an AI-physician-patient model is encouraged, where AI serves as a tool to assist physicians while physicians, with their expertise, remain responsible for effective communication, ensuring patients receive the necessary information to make informed decisions 6. AI may surpass us in accuracy and predictive capabilities; however, it can never replace our human judgment, emotional intelligence, and clinical experience. The “black box problem” will continue to exist in this digital age, but it is ultimately up to us to use our knowledge and communication skills to uphold ethical standards, “do no harm,” and preserve our tradition of patient-centered, holistic care. After all, with eyes to connect, ears to listen, and hearts to feel, we humans are always beyond the algorithm.
Beyond the Algorithm: Preserving Patient-centered, Holistic Approach in Artificial Intelligence-Driven Healthcare
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EDITOR-IN-CHIEF
Message from EIC It has been my honor to serve you as Editor-in-Chief for the past two editorial issues. My journey with National SOMA began as the SOMA National Liaison Officer at TouroCOM Harlem, followed by a year as a TFDO editor before stepping into the EIC role. There have been many ups and downs along the way, but I can honestly say I have enjoyed every second of this journey. I want to extend my sincere appreciation to my predecessor, Kathryn Lynch, our research director, Mahi Basra, and the entire editorial board for your dedication and hard work. Please join me in welcoming the amazing Alexandra Steck and Ahana Chakraborty as the new Editors-in-Chief for 2025-2026. I look forward to seeing you all continue to make an impact—keep your head up, make your voice heard, and continue to advocate. Thank you, and I hope to see you around in the next chapter!
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[A Case of Complicated Acute Retinal Necrosis] This note aims to correct an error in the authorship. The email address of the primary author was unintentionally listed incorrectly in the above-stated article of the following issue: The Future D.O. 2024; 2(2): 20. The correct author information is as follows: Chenxi Shi1, Deep Parikih, MD1 1Kansas City University College of Osteopathic Medicine Chenxi.shi@kansascity.edu The other elements, including the article itself, remain correct and unchanged.
[Expression and Function of SARM1 in Peripheral Blood Mononuclear Cells in Type 1 Diabetes] Gabrielle Groves1, Lila Dabill2, Ivana Shen2, Jennifer Brazill2, Aaron Diantonio2, Yo Sasaki2, Erica L Scheller, PhD, DDS2 1Kansas City University 2Washington University School of Medicine, St. Louis, MO After careful review and consideration, it has been decided that the above-stated abstract is being retracted. This decision was made due to the need for further development and refinement of the research. Therefore, the content is being retracted at this time. Reasonable efforts should be made to remove any references to this abstract.Published in: The Future D.O. 2024; 2(2): 26.
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IN ERRATUM
[Longitudinal Extensive Transverse Myelitis: A rare Initial Manifestation of Sarcoidosis] This note aims to correct an error in the authorship. The title of an author was unintentionally excluded in the above-stated article of the following issue: The Future D.O. 2024; 2(2): 15. The correct author information is as follows: Nikoloz Gvetadze1, Kevin Tse, MD1, Camila Bejarano, MD1, Ethan Rosenblastt, MD1 1TOURO COLLEGE OF OSTEOPATHIC MEDICINE, MIDDLETOWN, NY ngvetadz@student.touro.edu The other elements, including the article itself, remain correct and unchanged.
NOTICE OF RETRACTION
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The Code of Care Artist: Fatima Bawaney, OMS III fb486@mynsu.nova.edu Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine - Tampa Bay Regional Campus Platform used: Procreate
ARTWORK
This piece is a creative exploration of the future of AI in medicine. I enjoyed exploring the evolving relationship between physicians and AI. As technology continues to advance, it's important to consider the potential role of AI in enhancing healthcare and reshaping future medical practices.
EDITORS' PERSPECTIVE ARTICLES
The Evolving Role of Ultrasound in Emergency Medicine: A Conversation with Sidney James, DO, FACEP
Dr. James (CHSU) explains expectations of abdominal ultrasound
"Medicine is a science of uncertainty and an art of probability." - Sir William Osler The rise of technology in medicine has transformed how we diagnose and treat patients, enhancing efficiency, accuracy, and accessibility. From artificial intelligence (AI) in diagnostics to wearable health monitors, innovation continues to reshape the medical landscape[1]. One such advancement is point-of-care ultrasound (POCUS), which has revolutionized diagnostic speed and accuracy in emergency medicine. To explore its impact, I interviewed Dr. Sidney James, DO, FACEP, Medical Director of the Simulation Center and Assistant Professor at California Health Sciences University College of Osteopathic Medicine. Early exposures to POCUS As a third-year medical student at Touro University, Dr. James first encountered POCUS during clerkships at Kern Medical Center and UCSF Fresno. A defining moment occurred during a general surgery rotation when he observed a FAST (Focused Assessment with Sonography for Trauma) exam in the ER. Once the patient was stabilized, the trauma team let Dr. James try the process himself, which he fondly states really “hit home with [him].” When asked how POCUS has evolved compared to other imaging modalities, Dr. James states that the technology has significantly gained traction over the last two decades. He discussed his experiences with cardiac POCUS as an example. “The first view I learned was the subxiphoid view, looking for cardiac activity, contractility, and pericardial effusions,” he explains. “Today, if someone comes in with chest pain and has a borderline EKG finding, I can quickly expand my cardiac ultrasound and look for regional wall motion abnormalities. I can look at things on a deeper level.” Advantages and Challenges of POCUS POCUS offers significant advantages in emergency settings, providing “real-time, dynamic information.” Dr. James states, “In trauma cases, if a patient has shortness of breath and concern for pneumothorax, I can look right away and see if there’s any evidence, long before the chest X-ray even arrives.” He describes ultrasound as a gateway to other imaging modalities, allowing physicians to make more informed decisions about further testing. However, Dr. James believes the effectiveness of POCUS depends on the clinician’s skill. Before using POCUS for imaging, a clinician must identify their clinical question and the diagnosis they aim to rule in or out. “There is a significant time investment, and it takes a lot of practice to overcome different scanning obstacles,” he emphasizes. The Role of AI in Diagnostic Medicine Ultrasound technology is evolving rapidly. AI-assisted diagnostic tools are being integrated into ultrasound machines, helping physicians analyze scans more efficiently[2]. However, Dr. James cautions against over-reliance on AI. “AI can only do what we tell it to do—there could be false positives and false negatives,” he notes, stating that more research is needed to analyze AI’s sensitivity and accuracy in image interpretation. This caution extends to all imaging modalities. AI can be used to quickly interpret radiology findings in real-time[3]. While this efficiency can be helpful in time-sensitive scenarios, AI analysis should be a supplemental tool rather than a replacement for clinical judgment. Dr. James believes, “It takes the human element to decide, ‘Is this real?’” Real-World Impact of POCUS in Emergency Medicine Dr. James uses POCUS on every shift, though not necessarily for every patient. He shared a recent case where ultrasound significantly altered treatment. “A patient came in with chest pain. The initial EKG was non-diagnostic with mild ST changes, and cardiology wasn’t overly impressed. [Using POCUS], I noticed regional wall hypokinesis—a clear sign of cardiac dysfunction.” That changed everything. The patient was immediately sent to the cath lab, where a blockage was found and a stent was placed. POCUS provides life-saving insights as well as reassurance to patients facing uncertainty. Another case involved a six-week pregnant patient experiencing mild vaginal bleeding. Given her history of miscarriage, she was extremely anxious. “Within a few minutes, I was able to image an intrauterine pregnancy and reassure her, which immediately made her feel better.” This highlights the humanistic aspect of incorporating POCUS into holistic healthcare management. Emerging Technologies and Medical Education Looking ahead, Dr. James sees ultrasound becoming even more integrated into healthcare, extending beyond emergency medicine into fields like internal medicine. He strongly recommends early exposure to ultrasound for medical students. “Handheld ultrasound devices are becoming more affordable, and most manufacturers offer educational platforms.” He points to resources like POCUS 101, Core Ultrasound, and the Sonosite educational section as great tools for building a solid POCUS foundation. Technology continues to reshape emergency medicine, with ultrasound playing a central role in rapid diagnostics and patient care. Though Dr. James doesn’t know “where [he’d] be without POCUS,” he emphasizes that at the end of the day, there is no better tool than sound clinical reasoning. Like Dr. James, may we all strive to unravel “the science of uncertainty” with new diagnostic innovations that improve “the art of probability.” References 1. Alowais, Shuroug A., et al. “Revolutionizing Healthcare: The Role of Artificial Intelligence in Clinical Practice - BMC Medical Education.” BioMed Central, BioMed Central, 22 Sept. 2023, bmcmededuc.biomedcentral.com/articles/ 10.1186/s12909-023-04698-z. 2. Kim, Seungjun, et al. “Artificial Intelligence (AI) Applications for Point of Care Ultrasound (Pocus) in Low-Resource Settings: A Scoping Review.” Diagnostics (Basel, Switzerland), U.S. National Library of Medicine, 1 Aug. 2024, pmc.ncbi.nlm.nih.gov/articles/PMC11312308/. 3. Najjar, Reabal. “Redefining Radiology: A Review of Artificial Intelligence Integration in Medical Imaging.” Diagnostics (Basel, Switzerland), U.S. National Library of Medicine, 25 Aug. 2023, pmc.ncbi.nlm.nih.gov/articles/PMC10487271/.
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AHANA CHAKRABORTY CALIFORNIA HEALTH SCIENCES UNIVERSITY
OMS-I students at CHSU performing POCUS in their clinical skills lab.
Dr. James helps students troubleshoot POCUS exam
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EDITOR'S PERSPECTIVE
CHSU SOMA President Dylan Ellis practices his ultrasound skills
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SOMA Fall 2025 Research Symposium
The National SOMA Research Committee holds two research symposiums annually, one in the spring and one in the fall. Our goal is to create a platform for osteopathic medical students to engage in scholarly activity. At this time, the Fall 2025 National SOMA Research Symposium date is still TBD, so keep an eye out for the Call for Abstracts announcement in either the SOMA Weekly newsletter or by following @national_soma on Instagram. If accepted, students will be invited to prepare a poster and oral presentation. This is a great opportunity for students to showcase and articulate their research. All students and faculty are welcome to attend the symposium to support their colleagues as well as learn about a variety of research topics. Winners will receive national recognition and a monetary prize. If you have any questions or concerns, please email the SOMA Research Symposium Committee at: somaresearchsymposium@ studentdo.com. For more information about the symposiums and for information on previous winners, please visit our research website: www.studentdoresearch.org.
Medicine has always been tethered to innovation. From the invention of the stethoscope to the sequencing of the human genome, technology has never been a passive bystander. It has been a catalyst, a disruptor, a partner. And today, that partnership feels more intimate than ever before. Artificial intelligence, digital health tools, wearable tech, and social media platforms are not simply shaping the practice of medicine, they are reshaping its soul. This revolution is dazzling. We can monitor atrial fibrillation from a wristwatch, detect diabetic retinopathy through a smartphone camera, and simulate complex surgeries with virtual reality. AI algorithms can now comb through mountains of imaging data in seconds, flagging potential malignancies with precision. For patients in rural areas or mobility deserts, telehealth platforms mean access to specialists who would otherwise remain out of reach. In many ways, we are witnessing a democratization of medicine, where information, access, and care are no longer limited by geography or even by traditional infrastructure. But there is another side to this coin. A side that raises ethical questions about bias, equity, and the very nature of trust. As we feed AI systems patient data, we must ask: whose data is it? And whose stories are being told, or left out? When algorithms trained on homogenous datasets are applied universally, the result is not equitable care, but dangerous oversights. We already know that certain pulse oximeters perform less accurately on darker skin tones. What happens when AI, trained on similarly limited datasets, makes life-altering recommendations? The promise of efficiency should not overshadow the imperative for justice. We must also reckon with the emotional consequences of digitization. Electronic health records, designed to streamline care, have instead become a source of clinician burnout. Physicians now spend more time clicking through screens than connecting with their patients. The human touch, long considered the heart of healing, is in danger of becoming collateral damage in our quest for optimization. And yet, the path forward is not to resist technology, it is to engage it responsibly. We need transparency in algorithm development, with interdisciplinary oversight from ethicists, clinicians, patients, and technologists alike. The question is not whether we can build predictive models, but whether we should, and for what purposes. Tech must serve the patient, not replace the provider’s judgment or the patient's voice. Digital platforms, especially social media, present another paradox. On one hand, they can amplify public health campaigns, destigmatize mental illness, and provide a sense of community for those navigating illness. On the other hand, they can propagate misinformation at viral speed. The challenge here is not only technological, but moral. Medical professionals must step into these spaces, not with condescension, but with clarity, compassion, and cultural competence. Health literacy in the digital age means more than reading comprehension. It means teaching people how to evaluate sources, how to discern between influencer advice and evidence-based recommendations. It means making sure our messages are accessible to all, not just in language, but in format, tone, and relevance. It also means holding tech companies accountable. Regulation must keep pace with innovation, ensuring that digital health tools undergo rigorous testing and that data privacy is protected, especially for vulnerable populations. Consent cannot be buried in the fine print. Patients deserve to understand how their data will be used, and to have a say in that usage. We are standing at a precipice. One where medicine can become more precise, personalized, and proactive, or more fractured, inequitable, and alienating. Technology is the tool, not the savior. The scalpel still needs a steady hand. The diagnosis still needs discernment. And the patient still needs a human being who listens. In this digital renaissance, the physician’s role is not diminished, it is redefined. We are no longer just diagnosticians or prescribers. We are interpreters of data, defenders of equity, and guardians of empathy. So yes, medicine and technology are two sides to one coin. But we, as consumers, participants, pioneers, physicians, both future and current, decide which side lands face-up. Because at the end of the day, medicine is not about machines. It is about meaning. And our responsibility is to ensure that in an age of rapid change, we must remember: the heart of medicine was never just the tools we used, but the humanity we brought to them.
Winifred Chijioke Touro College Of osteopathic Medicine, Middletown campus
Two Sides to One Coin: Medicine’s Digital Renaissance
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Know a student researcher who deserves recognition? Encourage them to apply!
SOMA Research Spotlight Award
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Let's bring academia in Osteopathic Medicine to the forefront! The SOMA Research Spotlight Award is a great way to highlight and bring attention to your current and past works. Students are chosen monthly for Spotlight recognition. Apply now and let's celebrate your accomplishments together!
https://forms.gle/Zxd83h57PTuSjVm97
Medicine is not excluded from the unprecedented times that our country has found itself in, with threats of polarizing legislation and artificial intelligence touching the lives of patients and healthcare workers all across the country. I was inspired by how our hands caress and hold fascia and bone when we apply osteopathic techniques to treat somatic dysfunction. It’s an organic and raw process, compared to the robotic all-too-logical algorithm of a cold metallic hand invading the course edges of human vertebrae. Unfortunately for tech corporations, language models cannot hold a patient’s hand when difficult news must be delivered, nor can they cry or empathize from a place of sincerity.
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Cybernetic Osteopath Artist: Tatyana Opalko, OMS II opalko2657@chsu.edu California Health Sciences University College of Osteopathic Medicine Platform used: Acrylic on canvas
CASE REPORTS
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A Case of Postpartum Depression Successfully Managed with Zuranolone
C. Difficile Infection Complicated by a Pleural Effusion: A Case Report
INTRODUCTION: Clostridium difficile can be found in the intestines of healthy individuals without signs of disease. It may cause diarrhea after antibiotic use due to the eradication of the normal gut flora. Most cases resolve with proper treatment, but extra-intestinal complications may rarely arise. This case report examines a hospitalized patient with C. difficile infection (CDI) who subsequently developed a pleural effusion. CASE PRESENTATION: A 40-year-old male with a history of cellulitis treated with multiple antibiotics presented with abdominal pain and non-bloody diarrhea for two months. After taking an anti-diarrheal drug, he became febrile and presented to the hospital. FINDINGS: On physical exam, his abdomen was diffusely tender to deep palpation, with hyperactive bowel sounds. A stool sample tested positive for the C. difficile toxin and antigen. After admission, the patient began experiencing dyspnea. An abdominal CT scan revealed a large right pleural effusion. An ultrasound-guided thoracentesis confirmed exudative pleural effusion. TREATMENT/INTERVENTION: The patient’s dyspnea resolved after the thoracentesis. He was started on IV fluids and vancomycin 125 mg orally every 6 hours for a total of 10 days as this was his first CDI. CONCLUSION: Pleural effusions can rarely develop after a CDI, requiring appropriate antibiotic management or drainage via thoracentesis, depending on the size of the effusion and the presence of associated symptoms such as dyspnea or hypoxia. Awareness of these rare extra-intestinal manifestations and their appropriate management are critical to reduce morbidity and mortality rates.
THE FUTURE DO • VOL 1 • ISSUE 2
INTRODUCTION: Postpartum depression (PPD) is a serious psychiatric condition impacting 10-15% of mothers, with onset during pregnancy or within the first year postpartum. Conventional interventions, such as antidepressants or psychotherapy, are associated with adverse effects and delayed efficacy, limiting patient compliance and adherence. Recently, zuranolone received FDA approval as the first oral medication indicated for PPD. Zuranolone is an oral, synthetic steroid that acts as a positive allosteric modulator of GABAA receptors, promoting mood regulation. As a rapid-acting treatment, this medication offers promising clinical prognosis for patients with PPD. CASE PRESENTATION: A 35-year-old G3P3003 Caucasian female with a medical history of hyperemesis gravidarum, postpartum preeclampsia and postpartum depression, presented with severe depressive symptoms 9.5 weeks after delivery of her third child. FINDINGS: Patient was diagnosed with PPD, based on her reported symptomatology and clinical presentation, leading to a recommendation to initiate zuranolone. TREATMENT/INTERVENTION:fThe patient was first prescribed clonazepam and Auvelity, a combination of bupropion and dextromethorphan, which were ineffective. She then initiated a two-week oral course of 50 mg zuranolone nightly. By day 10, she reported substantial clinical improvement with resolution of suicidal ideation and restoration of functional capacity. Upon completing the course, she achieved near-complete remission of depressive symptoms. CONCLUSION: This case demonstrates the rapid efficacy of zuranolone in managing severe PPD, underscoring its potential as a transformative therapeutic modality. Future research initiatives should explore optimal patient selection criteria, long-term benefits, and comparative efficacy of zuranolone relative to conventional treatments.
PAIGE CONRAD1 RANJEETA BRAHMANAND1, SUDEEP YADAV MD2, KATRINA MARIE ROSIAK GENER DO2, ALEJANDRO BIGLIONE MD2 1NOVA SOUTHEASTERN UNIVERSITY KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE 2DEPARTMENT OF MEDICINE, WELLINGTON REGIONAL MEDICAL CENTER pc1038@mynsu.nova.edu
FAIGE JEIDEL1; ERICA GLANTS2 1NOVA SOUTHEASTERN UNIVERSITY- DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE, FORT LAUDERDALE, FL 2NOVA SOUTHEASTERN UNIVERSITY- DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE, CLEARWATER, FL Fj304@mynsu.nova.edu
Unusual Presentation of Acute Biliary and Pancreatic Inflammation Managed with Percutaneous Cholecystostomy
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INTRODUCTION: Percutaneous cholecystostomy tube (PCT) placement involves placing a drain inside the gallbladder with the aid of CT and fluoroscopy. This procedure is recommended for gallbladder drainage in cases of cholecystitis when the patient is unsuitable for surgery. This case highlights PCT as less invasive for managing biliary and pancreatic inflammation in patients. CASE PRESENTATION: A 62-year-old male with no significant past medical history came to the ED for a 9/10 radiating abdominal pain associated with nausea and fever. Multiple hepatic hypodensities were identified in addition to calculi in the right kidney. The patient was admitted for sepsis monitoring and further evaluation. FINDINGS: Leukocytosis indicated persistent infection. Thrombocytopenia (Plt 79) and AKI (BUN/Cr 39/2.6) suggested sepsis-related complications. ALT and AST levels of 343 and 428 reflected hepatocellular injury. Magnetic resonance cholangiopancreatography suggested acute cholecystitis and cholangitis. CT revealed 1.2 cm CBD dilation with distal gas locule concerning cholangitis, with gallbladder dilation and right kidney staghorn calculi. TREATMENT/INTERVENTION: Given the patient's septic physiology and surgical risk, a PCT was performed with ultrasound. A 22-gauge needle was used to access the gallbladder transhepatically. A pigtail catheter was advanced to ensure bile drainage. Imaging confirmed decompression and the patient received antibiotics with supportive care. CONCLUSION: PCT was chosen due to the patient’s acute sepsis, thrombocytopenia, and renal dysfunction, which increased the risk of complications. This case underscores the role of PCT in managing biliary infections when cholecystectomy is contraindicated. Further studies comparing outcomes of PCT versus early surgery may optimize treatment strategies.
Sahil Patel BS1, Jeffrey Joppen BS1 Nisha Patel BS1, Achal Patel MD2 1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine 2Nassau University Medical Center sp1887@mynsu.nova.edu
INTRODUCTION: A pseudoaneurysm (PA) is a vascular abnormality following arterial wall injury, while an arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. Both can result from catheterization, trauma, inflammation, or infection. CASE PRESENTATION: A 72-year-old male presented to the Emergency Department (ED) with pulsatile bleeding from a stab wound to his leg. The wound was primarily closed, a pressure dressing was applied, and the patient was discharged home. FINDINGS: Four weeks later, the patient returned to the ED with two weeks of progressive swelling, erythema, and a pulsatile mass at the wound site. CT angiography with runoff revealed a PA and AVF involving the posterior tibial artery and vein. TREATMENT/INTERVENTION: The patient underwent surgical hematoma evacuation and ligation of posterior tibial artery and vein. Endovascular repair is preferred when feasible, but ligation was performed. The decision was guided by proximal and distal vessel control, intraoperative testing for retrograde flow from collateral vessels, and confirmation of adequate distal perfusion. Following ligation, retrograde flow was confirmed, and distal pulses remained palpable. CONCLUSION: Early intervention with direct arterial repair and flow preservation has significantly reduced the rate of amputations. Many minor arterial injuries to extremities are often missed due to a lack of standardized screening. Early surgical exploration or arteriography may reduce complications.
Traumatic Peripheral Arterial Pseudoaneurysm with Arteriovenous Fistula Following a Stab Injury: A Case Report
Henry Knox MS1, Paul Creger DO2, Stephen McCloy DO2, Faez Ayoob MD2 1Edward Via College of Osteopathic Medicine – Carolinas Campus, Spartanburg, SC 2Spartanburg Medical Center, Department of General Surgery, Spartanburg, SC hknox@vcom.edu
Chamonix Michaud1, Prasanna Karur2, Rivka Benyaminov MD2, Eduardo Constantino MD2 1Nova Southeastern University College of Osteopathic Medicine 2Stony Brook Eastern Long Island Hospital cm3766@mynsu.nova.edu
INTRODUCTION: Cystic lymphangioma (CL) is a rare, benign lymphatic malformation that leads to fluid accumulation and cyst formation in areas rich in lymphatic tissues, such as neck, axilla, or mediastinum. While it is well-documented in pediatric populations, its occurrence in adults, particularly in the extremities, is exceedingly rare. This case presents an elderly patient with CL, initially misdiagnosed as a lipoma, highlighting the diagnostic challenges of rare conditions in atypical locations. CASE PRESENTATION: An 83-year-old female presented with a growing mass in her distal right thigh, initially thought to be a lipoma. The mass had been enlarging for a year, causing discomfort during ambulation. She used a walker for mobility but had no significant medical history or family history related to the condition. FINDINGS: Physical examination revealed a soft, mobile, and non-tender mass measuring 12 x 8 cm. MRI showed a cystic lesion with characteristics suggesting a non-lipomatous tumor, prompting further surgical investigation. TREATMENT/INTERVENTION: Surgical excision was performed, revealing a cystic mass arising from the vastus medialis muscle. During the procedure, the capsule of the lesion ruptured, releasing clear fluid, further suggesting the diagnosis of a cystic lymphangioma. Postoperatively, the patient showed significant improvement in mobility. CONCLUSION: This case highlights the rarity of cystic lymphangiomas (CL) in elderly patients and unusual locations, emphasizing the possibility of spontaneous development in adults without identifiable precipitating factors.Early imaging, timely surgical excision, and a comprehensive diagnostic approach are critical for accurate diagnosis and effective management. Further research is needed to refine management strategies for adults with CL.
INTRODUCTION: Both Social Phobia and and the first episode of psychosis (FEP) can present similarly, which can make it challenging to distinguish between the two in a patient that meets prototypical demographic and social factors. FEP typically occurs in adolescence or early adulthood, and it is more common in males who are unskilled or uneducated, and living with their parents. CASE PRESENTATION: 21-year-old Dominican male, domiciled in his parents home following discontinuation of community college, presented with suspected catatonia after self-isolating in his room for several weeks prior to admission. The patient required forceful entry into his room by emergency services. Heremained mute and confined to his bed until day 3 of his hospital admission. FINDINGS: On admission, the patient received a Bush-Francis score of 7, and after two days of unsuccessful Ativan challenge the likelihood of catatonia was considered low. His Social and Leisure Interest Measure (SLIM) score was 19, which suggested social phobia as the cause for his self-isolative behavior. Psychotherapy throughout his stay supported this diagnosis. He denied auditory or visual hallucinations, making psychosis unlikely. TREATMENT/INTERVENTION: The patient declined Selective Serotonin Reuptake Inhibitor (SSRI) therapy throughout his admission but participated in the therapeutic milieu, focusing on his discharge goals related to his career and living situation. CONCLUSION: This case highlights a unique presentation of social phobia that initially was suspicious for catatonia in the presence of a first psychotic episode. Evidence suggests that early recognition of FEP is associated with greater functional outcomes for patients, thus FEP must remain high on the differential especially in a young male patient's first hospitalization. In the future, clinicians should be aware of the potential overlap in psychotic episodes and the presentation of severe social phobia.
Spontaneous Cystic Lymphangioma in an Elderly Patient: A Rare Case of Misdiagnosis and Surgical Intervention
Melissa Santaya1, Karime Kafruni2, Dr. Adrian Legaspi MD2 1Nova Southeastern University. Kiran C. Patel College of Osteopathic Medicine 2Palmetto General Hospital ms5349@mynsu.nova.edu
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Severe Social Phobia Misdiagnosed as Psychosis: A Case Report
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Surya Tumbapura1, Lindsay McFarland1, Bita Behaeddin MD2, Carlos Carmona Mazo MD2, Michael Jerger DO2 1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine 2HCA Westside Regional Medical Center st1236@mynsu.nova.edu
Managing Recurrent In-stent Re-stenosis in a Patient with Extensive Coronary Stenting: A Case Report
Meghan Ta, Stephanie Escruceria, Hiba Ahmad, Calista Persson, Taylor Mazzei MD Nova Southeastern University KPCOM mt1902@mynsu.nova.edu
Intervention of VV ECMO in the resuscitation of a patient with severe ARDS as a result of drowning in a pool
INTRODUCTION: Acute Respiratory Distress Syndrome (ARDS) is defined as the acute onset of hypoxemia and bilateral pulmonary infiltrates not due to cardiac failure. Venovenous extracorporeal membrane oxygenation (VV ECMO) is a treatment modality indicated in cases of severe, reversible respiratory failure. This case emphasizes the intervention of VV ECMO in a patient with severe ARDS. CASE PRESENTATION: A 76 year old male with a history of seizures on levetiracetam (Keppra) presented to the emergency department (ED) after drowning in a pool due to an unwitnessed seizure. He was found minimally responsive with severe hypoxia and required intubation in the ED. FINDINGS: Imaging showed diffuse patchy opacities bilaterally from drowning pulmonary edema. Initial arterial blood gas (ABG) values were remarkable for a pH of 7.21, pO2 under 46.5 mmHg, pCO2 of 52.8 mmHg, and a pO2/FiO2 ratio of 46.5 mmHg indicating severe ARDS. TREATMENT/INTERVENTION: Mechanical ventilation with alternative ventilation strategies were attempted. Due to the extent of lung injury, VV ECMO was initiated after all other treatment options were exhausted. There was immediate improvement in oxygenation indicated by the ABG values returning to baseline. He remained on VV ECMO for two days and was later discharged home after displaying clinical improvement. CONCLUSION: The high mortality rates and poor functional outcomes in patients with severe ARDS exemplifies the need for more research on effective treatment options. This case demonstrates VV ECMO’s role as a potential modality for improving functional outcomes and increasing native lung recovery in ARDS.
INTRODUCTION: Percutaneous coronary intervention (PCI) with stenting is a cornerstone in managing acute coronary syndrome (ACS). However, in-stent restenosis increases with extensive prior stent placements. Optimal management of in-stent restenosis remains an ongoing challenge. CASE PRESENTATION: A 76-year-old male with a history of hypertension, myocardial infarction, heart failure with reduced ejection fraction, and over 30 stents presented with shortness of breath and sharp substernal chest pain (7/10 in intensity) radiating to his back. He had no history of smoking or alcohol use. FINDINGS: Physical examination was unremarkable, with no lower extremity edema or heart murmurs. ECG showed T-wave inversions and flattening. BNP was mildly elevated at 181 pg/mL, troponin levels were within normal limits, and chest X-ray was unremarkable. TREATMENT/INTERVENTION: The patient underwent PCI, with a drug-eluting stent (DES) placed in the restenotic lesion, given its superior long-term outcomes. Despite intervention, his chest pain persisted until day 5 of hospitalization. Troponin levels trended downward, and after passing a 6-minute walk test, he was discharged. CONCLUSION: While there is no established limit on the number of DES that can be deployed, this case raises the question of when the cumulative burden of stents begins to outweigh the benefits. Managing recurrent in-stent restenosis in patients with extensive coronary stenting remains a clinical dilemma, warranting further investigation to optimize long-term outcomes.
Skin-Deep Delusions: Pimozide in the Treatment of Delusions of Parasitosis in Psychiatric Dermatology
INTRODUCTION: Atypical fibroxanthoma (AFX) is a rare cutaneous malignancy with a generally favorable prognosis. However, in immunosuppressed individuals, AFX may progress to pleomorphic dermal sarcoma (PDS), a more aggressive tumor with a higher risk of recurrence and metastasis. This case underscores the importance of vigilant monitoring and aggressive management. CASE PRESENTATION: A 70-year-old male liver transplant recipient on chronic immunosuppressive therapy presented with a slowly enlarging, asymptomatic 1.5 cm postauricular mass. His medical history included end-stage liver disease requiring transplantation, with no personal or family history of cutaneous malignancies. FINDINGS: Physical examination revealed a well-circumscribed, firm, erythematous mass. Histopathologic evaluation confirmed AFX. Immunohistochemistry demonstrated positivity for CD10 and vimentin, with negativity for cytokeratins and S100, supporting the diagnosis. Wide local excision with 20 mm margins and split-thickness skin grafting was performed and achieved negative margins. TREATMENT/INTERVENTION: Despite initial clear margins, the patient developed a recurrent lesion at the same site seven months postoperatively. Fine needle aspiration and repeat histopathology confirmed progression to PDS. The patient underwent repeat wide excision followed by adjuvant electron beam radiation therapy. He remains under close surveillance for recurrence or metastasis. CONCLUSION: This case underscores the potential for malignant transformation of AFX in immunosuppressed patients. Given the aggressive nature of PDS, a proactive therapeutic strategy—including long-term surveillance and timely intervention—is essential. Future studies should focus on optimizing management strategies to prevent malignant progression in high-risk individuals.
Julienne Zhou1, Matthew Nugent2, Raquel M. Wescott2, Andrew R. Tomlinson MD2 1Touro University Nevada College of Osteopathic Medicine, Henderson, NV 2University of Nevada Reno School of Medicine, Reno, NV jzhou5@student.touro.edu
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Malignant Progression from Atypical Fibroxanthoma to Pleomorphic Dermal Sarcoma in an Immunosuppressed Patient: A Case Report
EMMA WOLDENBERG1 , FAIGE JEIDEL1, BRENT SCHILLINGER MD1 1 NOVA SOUTHEASTERN UNIVERSITY- DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE, FORT LAUDERDALE, FL ew867@mynsu.nova.edu
INTRODUCTION: Delusions of parasitosis (DOP) is characterized by the false belief of parasitic infestation. It is often associated with increased dopamine level in the synapse, which explains its higher prevalence among individuals with psychiatric disorders or substance use. This case examines a patient with DOP exacerbated by substance misuse, highlighting pimozide as an effective treatment option in resource-limited settings. CASE PRESENTATION: A 40-year-old unhoused woman with a history of intravenous heroin use, cocaine use, and smoking presented with painful skin lesions and delusions of parasites emerging from them. Despite no psychiatric history, she exhibited significant skin picking. FINDINGS: Physical exam revealed excoriated lesions on both arms with signs of infection. A detailed history, comprehensive physical exam, and psychiatric evaluation ruled out parasitic infestation, confirming a diagnosis of DOP. TREATMENT/INTERVENTION: The patient was treated with 2 mg oral pimozide daily for 30 days, along with hydroxyzine and triamcinolone cream. Pimozide, a first-generation antipsychotic antagonizing dopamine D2 receptor, was chosen due to its effectiveness in DOP and its affordability. Additionally, pimozide carries less of a risk of metabolic syndrome than other atypical antipsychotics do. Follow-up visits showed significant improvement in both delusions and skin lesions. CONCLUSION: Pimozide was effective in treating this patient’s DOP, consistent with existing literature. Substance-induced DOP may be linked to dopaminergic dysregulation, which pimozide helps regulate through its antagonistic effects on D2. This case emphasizes the importance of integrating psychiatric care with substance use treatment, particularly in marginalized populations. Future research should explore neurobiological mechanisms and more targeted therapies for substance-induced DOP.
ORIGINAL RESEARCH
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INTRODUCTION: Blood-contacting medical devices, such as artificial lungs and extracorporeal membrane oxygenation (ECMO) circuits, face significant challenges related to thrombosis, which arises from the activation of the coagulation cascade upon contact with foreign surfaces. A polyethylene glycol-conjugated corn trypsin inhibitor (PEG-CTI) coating selectively inhibits the intrinsic pathway of coagulation, while allowing the extrinsic pathway to activate from any potential trauma. METHODS: The PEG-CTI coating was applied using a sequential modification process and characterized through contact angle measurements and X-ray photoelectron spectroscopy (XPS) to evaluate stability over time and physiological conditions. A blood flow study using sheep blood assessed clot formation via confocal microscopy, measuring cell adhesion (DiI fluorescence) and fibrinogen deposition (FITC fluorescence). Statistical analyses compared coated and uncoated surfaces. RESULTS: The PEG-CTI coating significantly reduced hydrophobic recovery, maintaining lower contact angles (40–50°) compared to uncoated poly(dimethylsiloxane). XPS analysis confirmed successful CTI conjugation, with minor molecular rearrangement after three months. Blood flow studies demonstrated a 65% reduction in cell adhesion and a 46% decrease in fibrinogen deposition on PEG-CTI surfaces compared to uncoated PDMS (p < 0.05). Compared to PEG-only coatings, PEG-CTI further reduced cell adhesion by 41% and fibrinogen deposition by 33%, emphasizing the importance of Factor XII inhibition. CONCLUSION: The PEG-CTI coating effectively mitigates thrombogenicity by combining nonfouling surface properties with targeted inhibition of the intrinsic coagulation pathway. Its stability under fluid flow and extended storage suggests potential applications in artificial lungs and ECMO circuits, reducing reliance on systemic anticoagulation. Further in vivo studies are necessary to validate its long-term performance in clinical settings.
Relaxation-Optimized Heteronuclear Experiments for Extending the Size Limit of RNA Nuclear Magnetic Resonance
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Jake A. DeMeulemeester MS1, Alex J. Thompson PhD2, Joseph A. Potkay PhD2 1Michigan State University College of Osteopathic Medicine 2 VA Ann Arbor Healthcare System, demeulem@msu.edu
Aarsh Shah1 Heer Patel1,3, Arjun Kanjarpane1, Jan Marchant1, Michael F. Summers PhD1,2 1University of maryland baltimore county 2howard hughes medical institute 3Nova Southeastern University Kiran Patel College of Osteopathic Medicine hp631@mynsu.nova.edu
Surface Modification of Poly(dimethylsiloxane) Blood Flow Chambers with a Poly(ethylene glycol) Conjugate and Factor XII Inhibitor
INTRODUCTION: Nuclear Magnetic Resonance (NMR) spectroscopy has been a crucial tool for RNA structure determination. However, the size of RNA molecules that can be studied is limited by relaxation effects. Traditional heteronuclear NMR experiments struggle with signal loss as RNA size increases. This study aims to apply relaxation-optimized heteronuclear NMR techniques to extend the size limits for RNA structural studies. METHODS: We employed relaxation-optimized heteronuclear NMR experiments, including TROSY and HSQC, to analyze RNA samples ranging from 50 to 250 nucleotides. Data collection was performed on an 800 MHz NMR spectrometer, and relaxation times were measured to assess signal intensity improvements. The efficiency of these methods was compared to conventional heteronuclear NMR techniques. RESULTS: Relaxation-optimized heteronuclear NMR experiments significantly improved signal intensity and spectral resolution for RNA molecules greater than 150 nucleotides. This method allowed detection of previously undetectable peaks for RNA molecules up to 250 nucleotides. Statistical analysis confirmed the method’s effectiveness in extending the size limits of RNA NMR studies (p < 0.05). CONCLUSION: Our findings demonstrate that relaxation-optimized heteronuclear NMR experiments enable the study of larger RNA molecules by improving signal clarity. This advancement has significant implications for RNA structural biology, allowing for the analysis of previously inaccessible RNA structures. Future work will explore using this approach to develop drug targets for viruses and optimizing this approach for RNA molecules exceeding 250 nucleotides.
ORIGINAL RESEARCH/QI
Kishan Patel1, William Jacobs PhD2 1NOVA Southeastern University Kiran C Patel College of Osteopathic Medicine 2Department of Microbiology and Immunology - Albert Einstein School of Medicine kp2172@mynsu.nova.edu
megha Pingili1, shashidhar kusuma md facs2 1NOVA Southeastern University Kiran C Patel College of Osteopathic Medicine 2suria cosmetic surgery mp3028@mynsu.nova.edu
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INTRODUCTION: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health issue, with 1.5 million deaths annually. Mycobacteriophages, viruses that infect mycobacteria, serve as valuable genetic tools. Shuttle phasmids, which replicate as plasmids in Escherichia coli (E. coli) and as phages in mycobacteria, facilitate genetic manipulation. This study aimed to generate shuttle phasmids using novel mycobacteriophages for genetic studies in Mycobacterium smegmatis, a TB model organism. METHODS: Soil samples were screened for mycobacteriophages, which were purified and analyzed via restriction mapping. Partial digestion with Sau3AI facilitated ligation with a double-cos plasmid vector. Gel electrophoresis confirmed ligation success. Shuttle phasmids were propagated in E. coli, extracted, and electroporated into M. smegmatis. Plaque assays assessed transduction efficiency. RESULTS: Three novel phages were isolated and confirmed as unique by restriction analysis. Partial digestion with Sau3AI enabled successful ligation with double-cos plasmid vectors, which was confirmed by electrophoresis. After transformation into E. coli, plasmid DNA was extracted and electroporated into M. smegmatis. Electroporation into M. smegmatis yielded successful infections, demonstrating shuttle phasmid viability. DISCUSSION: Shuttle phasmids offer a robust tool for studying M. tuberculosis pathogenesis, enabling precise gene knockouts and transposon insertions. These constructs facilitate the study of essential and nonessential genes involved in virulence, resistance, and metabolism. Shuttle phasmids enable high-throughput screening for drug susceptibility and genetic function. Future work will focus on refining transduction efficiency.
Generation of Shuttle Phasmids Using Novel Phages For MTb Genome Manipulation
INTRODUCTION: Fitzpatrick skin types III-VI present challenges for traditional lasers (CO2, ER:YAG) due to risks of post-inflammatory hyperpigmentation (PIH) and thermal damage in melanin-rich skin. While fractional resurfacing shows promise for types III-IV,data on types V-VI remain limited. The UltraClear™ laser introduces cold fractional ablation, combining controlled thermal and mechanical injury to minimize risks while maintaining efficacy. This study reviews the UltraClear™ laser protocol as a safe and effective treatment for darker pigmented skin. METHODS: Twelve patients with skin types III-VI underwent cold fractional resurfacing using the 2910nm UltraClear™ laser. Preoperative and postoperative photos were taken 6 weeks apart and evaluated by a physician, supplemented by patient surveys on pain (1-10) and perceived efficacy (level of satisfaction). RESULTS: Patients demonstrated some to full improvement on physician evaluation with no complications after six weeks. Pain levels increased as high as a 6 with deeper penetration. Overall patient satisfaction was high. Discussion: The UltraClear™ laser effectively combines mechanical and thermal injury, offering advantages over traditional lasers. It safely treats darker pigmented skin with no PIH or thermal damage, demonstrating high efficacy and satisfaction. This study is limited by the patient sample size and future research should explore larger samples and long-term outcomes to optimize treatment.
Acclaro Medical UltraClearTM Laser Protocol on Skin Types III-VI: A Review
EMILY T YAN1, JACOB STROUD2, jacob anthony2, kyle walker md3, chung hyun goh phd2 1california health sciences university of osteopathic medicine 2 mechanical engineering department, UT tyler 3 department of orthopedic surgery, UC davis yan2851@chsu.edu
The SOMA Research Committee regularly provides opportunities for osteopathic medical students to engage in meaningful discussions and workshops. The monthly Journal Club serves as a forum for students, both SOMA members and non-members, to analyze and delve into current clinical research across various medical specialties, with a focus on topics such as asthma, diabetes, and surgical procedures. In addition, the committee hosts Research Workshops which offer education on a range of subjects including IRB approvals, writing abstracts, or case reports to aid students in gaining research experience and developing valuable skills to succeed in their careers. Join us at our next Journal Club and Research Workshop! Look for an announcement in either SOMA Weekly* or by following @national_soma on Instagram. *SOMA Weekly is a weekly email circular for all SOMA-related news and events. You must be registered as a SOMA member to receive the newsletter. Register to join SOMA at studentdo.com!
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Introduction: Total hip arthroplasty (THA) involves replacing pathologic hip joints with prosthetic implants to restore functionality and alleviate pain. Current implants use a "press-fit" application; however, in more complicated cases of suboptimal bone quality or sizing, additional fixation with screws is necessary. This study combines finite element analysis (FEA) and deep learning (DL) to customize a screw configuration for fixation between bony pelvis and acetabular cup. The objective of this study is to determine if these methods can accurately predict stress-strain distribution across the implant construct. Methods: FEA was conducted using a 3D computerized model in Ansys to simulate acetabular cup stress, strain, and deformation and produce an optimized design for screw fixation in THA. A non-linear regression algorithm was applied on MATLAB for neural network training and predictive simulation. Results: The DL-FEA model achieved a mean squared error of 0.11%, confirming strong agreement with traditional FEA. The deformation distribution map also closely matched the original FEA data in terms of location and pattern. Conclusion: The resultant DL-FEA surrogate model showed promise in its efficiency compared to the FEA-only method, as well as offered insights into optimal screw configuration and placement based on deformation under different loading conditions. Future work will focus on expanding the dataset and refining the DL algorithm to further improve its accuracy and reliability. This study represents a significant step toward developing a computational protocol for acetabular cup fixation, with potential applications in reducing revision rates and enhancing patient outcomes in THA.
Optimized Design For Screw Fixation In Total Hip Arthroplasty Using A Deep Learning-Finite Element Analysis Approach
LITERATURE REVIEW
“I’m no machine” Say Doctors all. Yet some patients say It was a machine I saw. Up and down Across the hall The Doctor and The Machine Are one and all. The Doctor learns For all their life. All to become A healer in strife. The Machine is made By a human hand. It does the impossible With a single command. Yet many times is there As Doctors are we A love and hate For The Machines we see. Some bring life To patients in wait. Others are The metaphor we hate. Yet, in medicine and care Is it not right to say Human or Not Healing must stay? So whether you’re The Doctor Or The Machine Today Always remember To patients we say: I am The Doctor This is The Machine. We both will care for you Is the promise in between.
POETRY
The Doctor and The Machine
Jordyn Yokoyama AT Still University College of Osteopathic Medicine
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Vera Wang1, Andre Aabedi1, Gregory Pecchia DO1 1Western University of Health Sciences, College of Osteopathic Medicine of the Pacific andre.aabedi@westernu.edu
Nontraditional Therapeutic Approaches for Lumbar Spine Injuries: A Scoping Review
Introduction: Artificial intelligence (AI)-assisted scribing has evolved to generate structured and accurate clinical notes. AI has demonstrated high accuracy not only in documenting the patient history but also in diagnosing dermatological conditions, suggesting the potential integration of both during clinical encounters. It is especially useful in enhancing teledermatology, where it facilitates accurate and timely documentation crucial for remote consultations. Methods: We conducted a review on PubMed using keywords "digital scribe," "artificial intelligence scribe," and "artificial intelligence scribe dermatology." This yielded 74 articles from 1984 to 2025. Articles prior to 2015 were excluded, and four articles remained after narrowing to articles related to dermatology. Results: AI technologies have demonstrated high accuracy in diagnosing dermatological conditions, especially melanomas and nevi, with an average accuracy, sensitivity, and specificity of 90%, 87%, and 91%, respectively. A pilot study using Dragon Ambient eXperience in a dermatology clinic demonstrated a reduction in time spent in electronic medical records from 90.1 minutes to 70.3 minutes, with a potential saving of $13,000 per year compared to an in-person scribe. Many AI scribes integrate with existing EHRs, making them translatable to clinical settings. Conclusion: AI-assisted scribing offers significant potential in dermatology by improving diagnostic accuracy, reducing documentation time, and supporting teledermatology. However, challenges remain, including ensuring accuracy, addressing medicolegal and privacy concerns, and integrating visual libraries like VisualDx for diagnosis and patient education. Future research should focus on assessing AI scribing’s impact in larger multi-center studies.
Introduction: Lumbar spinal cord injury is a serious condition resulting from trauma or disease affecting the spinal cord, leading to various life-altering complications. While traditional therapies remain the standard of care, non-traditional approaches may offer additional benefits. This review investigates alternative and adjunctive therapies for lumbar spine injuries. Methods: A scoping review was conducted using PubMed, CINAHL, Ovid Medline, and Embase to find peer reviewed, English-language articles published between 2000 and 2024. Studies that contained patients with a history of congenital spinal anomalies, patients with thoracic or cervical spine injuries without lumbar involvement, or used traditional therapies were excluded. Initial search identified 125 articles, with a total of 8 articles meeting inclusion criteria. Results: Aerobic exercise and underwater treadmilling showed improvements in cardiovascular endurance that contributed to better ambulation and exercise duration. Electroacupuncture and electrical stimulation decreased post residual bladder volume with the latter having a 93.3% success rate. Scalp acupuncture and “K-ing” strategy helped with lower extremity mobility and muscle strength as it increased strength from 2/5 to 4/5. Conclusion: Aerobic exercise, acupuncture, electrical stimulation, and “K-ing” strategy can be used as alternative or adjunctive therapies for improving mobility, gait, and systemic complications arising from lumbar spine injuries. Acupuncture can be used to improve bladder function, mobility, muscle strength, and gait. However, the limited number of studies on this subject highlights the need for further research to explore additional cost-effective and accessible options such as hydrotherapy and yoga.
Manisha Antony, Ashley Abraham MS, Zachary Harris DO Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine aa3754@mynsu.nova.edu
Artificial Intelligence-Assisted Scribing in Dermatology
LITERATURE REVIEWS
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Prevalence of Antinuclear Antibodies in Patients with Coronary Artery Disease: A Scoping Review
INTRODUCTION: Coronary artery disease (CAD) is characterized by atherosclerosis and vascular inflammation. Autoimmune diseases have a well-established association with CAD, which is accredited to the role immune modulators play in atherogenesis. Antinuclear antibodies (ANA) serve as a biomarker for many autoimmune conditions. This study evaluates whether ANA titers are associated with CAD independent of autoimmune disease. METHODS: A scoping review was conducted using CINAHL, Embase, ProQuest, OVID Medline, and PubMed to identify English-language, peer-reviewed articles from 2000 to 2024. Search terms included “Coronary artery disease” OR “Coronary disease” OR “Coronary aneurysm” AND “Antibodies, Antinuclear.” The search identified 442 articles, with 13 articles meeting inclusion criteria. RESULTS: Among 329 CAD patients with positive ANA titers (>1:40), the most prevalent titer was 1:160 (0.31, n=103). Confounding rheumatological factors were evaluated, and anti-cardiolipin (aCL) IgG and IgM were the second most common antibodies (0.39, n=130; 0.37, n=123, respectively). A strong positive association between ANA titers and the number of stenotic coronary vessels was seen in the coronary artery ectasia (CAE) population. CONCLUSION: Findings suggest ANA titers could be an independent risk factor for CAD in patients without established autoimmune disease. As autoantibodies cause endothelial dysfunction, ANA may play a role in CAD pathophysiology. This investigation suggests that patients with positive ANA titers may benefit from preliminary cardiovascular screening. Future studies should focus on isolating ANA from other risk factors and exploring its predictive value in diverse populations.
AI-Enhanced Urology: Integrating Smart Technology for Optimized Bladder Health Management
INTRODUCTION: Artificial intelligence (AI) is transforming medical fields, including urology, by improving diagnostics, treatment planning, and patient management. One key advancement is the integration of AI with catheter technology to enhance bladder health monitoring. This review explores how AI-driven innovations, particularly through smart catheters, are improving patient care. METHODS: A literature review using the keywords "urology," "artificial intelligence," and "bladder health" was conducted to examine the applications of AI in urology, focusing on diagnostics, personalized treatments, and catheter technology. The search returned approximately 20 relevant articles. Key studies on AI-driven bladder health monitoring, automated catheter management, and smart biosensors were analyzed. RESULTS: AI has improved bladder disease detection by using machine learning to analyze imaging, patient history, and urodynamic data. Smart catheters with biosensors enable real-time bladder function monitoring, predicting complications like urinary retention and infections. AI-guided automated catheter management helps optimize drainage timing, especially for patients with neurogenic bladder dysfunction. However, challenges such as data privacy concerns, regulatory hurdles, and high costs limit widespread adoption. Future efforts should focus on federated learning, streamlining with transparent, explainable AI models, and promoting cost-effective development through open-source tools shared by academic partners. CONCLUSION: AI-driven catheter technology has the potential to revolutionize bladder health management by improving diagnostic accuracy, enabling proactive interventions, and personalizing treatment plans. While current advancements show promise, further clinical trials and cost-effective strategies are needed for broader implementation. The integration of AI with telemedicine could also enhance remote bladder health monitoring and improve access to care.
Paige Bird1, Ava Digirolamo1, Sam my Sino MD2 1Midwestern University Chicago College of Osteopathic Medicine 2Northwestern Feinberg School of Medicine paige.bird@midwestern.edu
Manisha Antony¹, Christina Thymalil¹, Stephanie Nagy¹, Kayvan Amini², Marc M Kesselman DO³ ¹Dr Kiran C Patel College of Osteopathic Medicine, Nova Southeastern University ²Division of Cardiology, Dr Kiran C Patel College of Osteopathic Medicine, Nova Southeastern University ³Division of Rheumatology Dr Kiran C Patel College of Osteopathic Medicine, Nova Southeastern University ma2337@mynsu.nova.edu
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Effects of Aryl Hydrocarbon Receptor Activation by FMT on Neurodegenerative Disease Progression: A Scoping Review
INTRODUCTION: The safety of aspartame, a popular low-calorie artificial sweetener, has recently been debated for human consumption due to concerns about its breakdown products - aspartic acid, phenylalanine, and methanol – being linked to carcinogenic, metabolic, and potential neurotoxic effects in animal models. Due to the limited research on neurotoxicity, this scoping review analyzed the existing literature on aspartame’s possible neurocognitive impacts. METHODS: Existing literature on neurocognitive effects of aspartame were gathered and analyzed. Three databases, EMBASE, OViD MEDLINE, and Web of Science, were accessed, yielding 170 peer-reviewed, full-text studies. After consideration of exclusion criteria, 29 articles were selected for inclusion. RESULTS: Multiple experimental studies demonstrated that aspartame may have potential neurotoxic effects, showing histopathological changes, such as increased oxidative stress markers and neuronal loss, in the brain of animal models. Several studies also reported impairments in memory and learning, behavioral dysfunction, and mood disturbances, including symptoms of depression and anxiety, after aspartame consumption. Notably, many of these studies investigated aspartame’s impact not only at the Food and Drug Administration (FDA)-approved level, but below it as well. Two studies also indicated that populations with preexisting neurocognitive deficits or metabolic conditions, such as individuals with Parkinsonism or diabetes mellitus, may have an increased vulnerability to neurocognitive harm when consuming aspartame. CONCLUSION: The negative neurocognitive effects consistently reported in these animal and human studies demonstrate the necessity for further research into aspartame’s possible impacts on health and safety at current FDA-approved levels, with additional consideration for certain populations at higher risk for neurocognitive injury.
Aspartame and Its Potential Neurocognitive Effects in Human
INTRODUCTION: Fecal microbiota transplantation (FMT) has shown potential benefits in treating neurodegenerative diseases by modulating neuroinflammation via the gut-brain axis. Short-Chain Fatty Acid (SCFA) metabolites of tryptophan are thought to have neuroprotective effects and have been shown to modulate gut Aryl Hydrocarbon Receptor’s (AhR), suggesting a potentiality to alter disease processes. The exact mechanism by which the introduction of specific microbes can modulate the pathophysiology of neurodegenerative diseases is not well understood. METHODS: Five databases (EMBASE, Ovid MEDLINE, CINAHL, Cochrane, and Web of Science) were searched using the keywords ‘Fecal Microbiota Transplantation,’ ‘Alzheimer,’ ‘Parkinson,’ ‘Aromatic Hydrocarbon Receptor,’ ‘Dysbiosis,’ and ‘Tryptophan metabolism.’ The search was restricted to articles published in English after January 1st, 2012, focusing on Parkinson’s Disease (PD), atypical PD, and Alzheimer’s Disease (AD) in animal or adult human models. RESULTS: Thirteen studies were included, all showing an increase in performance on behavioral tests in both animal and human models after therapeutic FMT. Four studies demonstrated an increase in SCFAs following FMT, with one showing an increase in SCFAs in a pathological model. An increase in microbiota diversity following FMT was shown in all models. CONCLUSION: This review identified a potential link between the presence of tryptophan metabolites introduced through FMT and a decrease in neuroinflammatory states that results in improved neurologic function in PD, AD, and atypical PD models. Further studies are needed to elucidate the interplay between the AhR and SCFAs of the tryptophan metabolism in modulating inflammation.
Chamonix Michaud, Melissa Halprin, Brian Ellsworth, Surya Tumbapura, Parker Smith, Lindsay McFarland, Trent Nayve, Kole Winebrenner, Alison Todd, Maria Karla Sentamant, Joshua Costin PhD Nova Southeastern University Dr. Kiran College of Osteopathic Medicine, Florida cm3766@mynsu.nova.edu
Maiah Fogel MS, Alena Khalil MA, Sheikh Khaled, Elizette Rodriguez, Keaton Payne, Jesse Blount, Madison Petschke, Roshan Ara Nizamuddin, Faige Jeidel, Vivienne Riven, Stephanie Petrosky DCN MHA RDN Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL mf2112@mynsu.nova.edu
Irina Ter-Ovanesyan, Michelle Tashjian, Stephanie Escruceria, Richard Fernandez, Bryant Estadella, Harvey N. Mayrovitz PhD Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine it236@mynsu.nova.edu
INTRODUCTION: Technological advancements have transformed cardiovascular disease (CVD) diagnosis, treatment, and management, improving patient outcomes. Innovations such as artificial intelligence (AI)-driven diagnostics, wearable biosensors, telemedicine, and robotic-assisted interventions enhance cardiovascular care. AI-powered imaging and electrocardiogram (ECG) interpretation enable early disease detection, while wearable devices monitor arrhythmia and heart failure, reducing hospitalizations. However, challenges remain, including disparities in access, ethical concerns, data privacy risks, and regulatory hurdles. A systematic review of recent literature assessed the impact of cardiovascular technologies on patient outcomes, accessibility, and healthcare efficiency. METHODS: A focused search of PubMed, Embase, and IEEE Xplore (2015–2024) using terms like “AI diagnostics,” “remote monitoring,” and “cardiovascular digital health” identified 12 articles. Of these, 7 peer-reviewed trials and real-world studies met inclusion criteria, emphasizing clinical outcomes, integration, and user adoption. RESULTS: AI-driven imaging improves early detection of atrial fibrillation with 79% sensitivity and 83% specificity, coronary artery disease, and heart failure. Wearable devices support real-time monitoring, reducing hospital visits by 12–15%. Robotic-assisted procedures and 3D printing enhance surgical precision by 27%. However, accessibility is limited in underserved regions. AI biases may contribute to disparities. Cybersecurity risks demand stronger data protection, while regulatory and ethical concerns require oversight. CONCLUSION: AI imaging, wearables, and robotic procedures enhance early detection, reduce hospitalizations, and improve precision in cardiovascular care. However, access gaps, algorithmic bias, and cybersecurity risks remain barriers. Advancing equity, transparency, and regulation through cross-sector collaboration is vital for safe, effective integration.
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Technology and Cardiovascular Diseases: Two Seamlessly Intertwined Aspects of a Unified Field
Exploring Lymphatic Function in Skin Inflammatory Disorders: A Scoping Review
Ogechukwu Samuel Obi¹, Pawel Lajczak², Uchenna Diane Nweze3, Joerg Leheste PhD MSc1 ¹New York Institute of Technology College of Osteopathic Medicine, New York 2Medical University of Silesia Poland 3University of Massachusetts Global Aliso Viejo California oobi@nyit.edu
INTRODUCTION: The lymphatic system is essential in maintaining skin health through immunological actions. While research highlights its role in skin health and inflammation, comprehensive reviews are lacking. This review aims to describe the interplay between lymphatic function and skin health, as well as the role of lymphatic dysfunction in inflammatory skin disorders. METHODS: Web of Science, EMBASE, and OVID MEDLINE databases were searched using the PRISMA-ScR guidelines. Studies meeting the following criteria were included: peer-reviewed human or animal studies published in English from 2014 to 2024 on inflammatory skin disorders, including skin cancer, autoimmune diseases, and infections. A total of 1232 citations were identified, with 37 studies meeting eligibility criteria after assessment and critical appraisal. RESULTS: Findings demonstrate that a robust skin lymphatic system helps reduce the inflammatory state by decreasing lymphedema, thereby preventing lymphatic stasis. Lymphatic stasis increases risk of infection through accumulation of waste products and creating an ideal environment for pathogens to thrive. Cytokines are shown to prevent skin aging by decreasing lymphatic vessel endothelial cell apoptosis, as well as upkeeping lymphatic pumping and cell migration. In addition, extracellular vesicle interaction with VCAM-1 lymphatic endothelial cells, VEGF-C signaling, and specific genes, such as CYDL, increase lymphangiogenesis, leading to melanoma progression. CONCLUSION: The review shows that lymphatics are crucial in maintaining healthy skin and play important roles in mitigating skin inflammatory, infectious, and cancer-related processes, as well as delaying skin aging. Furthermore, skin cytokines and growth factors show promise as therapies for skin inflammatory diseases.
The Role of Multimodal Wearable Technology in Predicting and Preventing Postoperative Complications: A Review
Kenil D Mehta1, Rohan Wadhwa1, Rishi Kothari MD2 1Rocky Vista University – Montana College of Osteopathic Medicine, Billings, MT 2Department of Anesthesiology & Perioperative Medicine, Thomas Jefferson University, Philadelphia, PA rohan.wadhwa@mt.rvu.edu
INTRODUCTION: The Asian American population (AA) consists of diverse subgroups varying in financial, geographic, and educational backgrounds. While risk factors for myocardial infarction (MI), classified by the World Health Organization’s (WHO) social determinants of health, including socioeconomic status (SES), cultural and psychological influences, have been studied among AA, most research has overgeneralized them as a single, homogeneous group due to acculturation. This review examines the gaps in understanding how these risk factors vary across AA subgroups in MI. METHODS: Literature was collected using EMBASE, Web of Science, Medline, PubMed, and Cochrane Collection. Quantitative, quantitative studies, and primary studies discussing MI incidence were included. The study followed PRISMA 2020 guidelines and utilized Boolean operative terms regarding risk factors and MI. RESULTS: Filipinos have higher risk of MI compared to Chinese populations (2.6% vs 0.9%; OR 2.79) due to smoking, sedentary lifestyle, and risk factors such as hypertension. Although Asian Indians have increased rates of cardiovascular factors, they have lower risk of MI. Asian Americans over 65 years old, via survey data, had lower mental health and improved physical health. In Filipino, Chinese and Asian Indian subgroups, there is an inverse association between income and risks for MI. CONCLUSION: This study details the importance of SES, mental health, and cultural influences related to MI among AA. Limitations of this study include reliance on survey-based methods, self-reported data, and exclusion of uninsured AA populations. Overall, more research is needed to address and explore approaches to reduce these disparities.
INTRODUCTION: Postoperative complications, including infections, arrhythmias, and venous thromboembolisms (VTE), contribute to morbidity and rising healthcare costs. Multimodal wearable technology refers to sensor-integrated devices capable of capturing and analyzing data from multiple physiological modalities, thereby enabling continuous and non-invasive health monitoring. This review evaluates the efficacy of wearable technology in predicting and preventing complications, its integration into care management, and the associated challenges. METHODS: A systematic search of PubMed, Scopus, and Web of Science (2015–2025) identified 11 relevant studies, which were included in this review. Inclusion criteria required the use of wearable technology that monitored at least two physiological parameters in postoperative patients. Search terms included "postoperative complications," "multimodal wearables," "continuous monitoring," "machine learning," and "telehealth." Data extracted from each study included study design, type of surgery, sensor and device specifications, predictive modeling techniques, and associated clinical outcomes. RESULTS: Multimodal wearable devices were effective in detecting early postoperative complications, with sensitivity rates above 85% for infections, arrhythmias, and hypoxia. Several studies applied machine learning models that utilized clinical and physiological data to identify patterns and predict the likelihood of adverse events, which contributed to improved diagnostic accuracy. When combined with telehealth platforms, they enabled timely clinical interventions. Overall, their use was associated with a 30% reduction in hospital readmissions and a 20% decrease in VTE incidence. CONCLUSION: Wearable devices show promise in revolutionizing postoperative care through continuous monitoring, predictive analytics, and personalized recovery. Overcoming barriers in data accuracy, interoperability, and access is crucial for widespread adoption. Future innovations in machine learning and overcoming access disparity for wearable technology can further optimize patient outcomes.
An Exploration of the Role of Socioeconomic, Psychological, and Cultural Risk Factors in the Asian American Population for Myocardial Infarction: A Systematic Review
Alan Wang, Hasin Sharma, Madeline Manuel, Jayson Forbes PhD Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine aw2222@mynsu.nova.edu
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PERSPECTIVE ARTICLES
Disclaimer: Views expressed in The Future DO publications are solely those of the authors and do not necessarily REPRESENT the opinions of the editorial board, The Future DO, or SOMA.
"The systemic issue of racism throughout healthcare continues to negatively impact the health outcomes of ethnic minorities. "
Medical Devices and Darker Skin Tones
Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta Burrell College of Osteopathic Medicine - New Mexico
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Racial and ethnic minorities continue to suffer from health inequities in the United States due to structural and systemic racism. Research demonstrates that many medical devices and algorithms are primarily developed and tested on populations with lighter skin tones, yielding health data with limited generalizability. For example, pulse oximetry measurements exhibit skin color bias, where findings indicate an overestimation of oxygen saturation in individuals with darker skin tones, leading to potentially undetected hypoxemia. This underscores the critical need for inclusivity in the development and testing of medical devices to ensure accurate and representative health data that drives holistic and equitable care for all patients, regardless of skin tone. The pulse oximeter measures the oxygen saturation of an individual’s blood by detecting the amount of light that passes through the finger without being absorbed by tissue and blood. With this type of design, cosmetic factors such as nail polish and artificial fingernails can disrupt pulse oximeter accuracy. Studies have shown that the average SpO2 readings for Black, Hispanic/Latino, and Asian patients were higher compared to White patients. When adjusting for confounders, these individuals received less supplemental oxygen. The COVID-19 pandemic highlighted the impact of inaccurate readings on darker skin tones. A study conducted by the University of Michigan Hospital at the height of the pandemic revealed that Black patients with pulse oximeter readings of 92-96% on pulse oximeters had arterial blood gas oxygen saturation levels of 88% or below compared to 3.7% of white patients. These findings are concerning, as the American Lung Association recommends oxygen supplementation when patients' oxygen levels drop to 89%. As pulse oximetry readings often dictate the level of triage and inclusion of supplemental oxygen, skewed readings can delay medical interventions and treatment resulting in increased mortality. Retrospective studies during the pandemic show that Black and Hispanic/Latino patients eligible to receive COVID-19 therapy interventions were unrecognized due to overestimated oxygen levels. However, this issue extends beyond critical care. Pulse oximetry is a common non-invasive measurement of arterial oxygen saturation during procedures requiring anesthesia. The Journal of Anesthesiology reported that Black and Hispanic/Latino patients experienced a greater incidence of intraoperative occult hypoxemia increasing the risk of postoperative end-organ dysfunction and prolonged hospital recovery. The systemic issue of racism throughout healthcare continues to negatively impact the health outcomes of ethnic minorities. It is important to recognize these discrepancies and take caution when trying to resolve them. Attempts in the past that led to the changing of algorithms further intensified disparities such as the estimated glomerular filtration rate (eGFR) race coefficient. In January 2025, the Food and Drug Administration (FDA) proposed an update to recommendations aimed at improving pulse oximetry performance and accuracy for all skin tones. The new draft recommendations will be used to aid manufacturers in improving study designs and clinical data to enhance pulse oximeter performance across a range of skin pigments. Medical technology must serve all patients equitably, yet longstanding biases in device design continue to create disparities in clinical care. Inaccuracies in pulse oximetry, for example, have significant ethical and medical consequences by overestimating oxygen saturation in patients with darker skin tones. Since Medicare and hospital protocols rely on precise oxygen saturation thresholds to determine treatment eligibility, these misreadings can result in delayed interventions. Physicians can learn from these disparities by developing a deeper awareness of how medical devices function across diverse patient populations. Recognizing the limitations of pulse oximetry is an essential first step, but learning how to adjust clinical practices to prevent misdiagnosis and undertreatment is equally critical. Additional diagnostic tools, such as arterial blood gas tests, can provide a more accurate assessment of oxygen levels in patients with darker skin tones. Physicians can also engage in ongoing education and research to stay informed about how medical technology impacts different demographics. Encouraging device manufacturers to test and refine their products on diverse populations is another way physicians can advocate for equitable care. By questioning standard practices, incorporating alternative assessment methods, and actively addressing medical biases, physicians can help bridge gaps in care and ensure all patients receive accurate diagnoses and timely treatment.
Kaitlynn Esemaya (OMS III), Alexis Thompson (OMS III), Annique McLune (OMS III), and Anamaria Ancheta (OMS II) are dedicated students attending Burrell College of Osteopathic Medicine with goals of becoming physicians who are skilled and compassionate. These students are passionate about serving underrepresented and underserved communities while deepening their understanding of national and international medical affairs. As writers and editors of the Medical Ethics Newsletter, they are committed to shedding light on critical issues within the medical field. Kaitlynn Esemaya founded the newsletter in 2022 to address past and present medical injustices faced by minority groups. The newsletter aims to educate students, faculty, and healthcare professionals about these ethical concerns, encouraging reflection and discussion on how to create a more just and equitable healthcare system. Each edition of the Medical Ethics Newsletter covers a different topic that explores historical and contemporary ethical dilemmas in medicine. Included in the newsletter are thought-provoking reflection questions, resource recommendations such as videos and books, and other educational tools to help readers deepen their understanding of these complex issues. The newsletter is crucial in preparing future medical professionals to advocate for fairness and inclusivity in healthcare by fostering critical thinking and ethical awareness. Through their dedication to this initiative, Kaitlynn, Alexis, Annique, and Anamaria are not only expanding their knowledge but also giving them the unique ability to inspire their peers to engage in meaningful conversations about ethics, justice, equity, and the responsibilities of medical professionals.
PERSPECTIVES
About The Authors:
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d: Views expressed in The Future DO publications are solely those of the authors and do not necessarily REPRESENT the opinions of the editorial board, The Future DO, or SOMA.
Hannah Oteng-Quarshie & Sibongile Makatini California Health Sciences University College of Osteopathic Medicine
The rapid emergence of artificial intelligence (AI) in the last few years has sparked conversations amongst medical professionals about the effects of evolving technologies on the quality of care. While a promising addition to healthcare, we question: will technology prove to further alienate marginalized communities that currently suffer at the hands of state policies and the minutiae of the healthcare system at large in the United States? We hope to explore these technological advancements and provide a catalyst for fellow future physicians to engage in meaningful discussions about the potential drawbacks of this technology. As osteopathic medical students, our training is centered around providing whole-person care, with careful consideration of the various social determinants of health that impact our patients. Based in the Central Valley of California, our perspective is rooted in our experiences working with this severely underserved population. The San Joaquin Valley contributes over half of California's agricultural output, largely due to the efforts of more than 340,000 farm workers residing in the region.1 Despite this significant contribution to California’s economy, 45% of family incomes in the Central Valley are below 200% of the federal poverty line, compared to 30% statewide.2 As a result, a significant number of patients use Medi-Cal, California’s Medicaid program, but dwell in a vast rural area lacking medical providers and reliable public transportation. It is clear that availability of telehealth has revolutionized and expanded healthcare access for patients from the comfort of their homes. Yet barriers remain, especially with regards to the demographics that suffer most from the lack of equity in healthcare access, despite how obvious the benefits of this technology and medical intersection seem to be. These advances in medical technology spark a cautious curiosity in us. While telehealth has expanded our patients’ access to direct conversations with their providers, many health systems center care around electronic medical records that are linked to patient portals. This creates a barrier for patients with low incomes, less education, and the elderly who may lack the technological skills and finances to utilize devices with Internet capability.3 For these patients, when they have critical diagnoses that require timely and consistent care, they cannot message providers for medication refills, advice regarding concerning symptoms, or even remain up-to-date on new results simply due to lack of access to technology — creating challenges that can prevent patients from being able to take charge of their own care. Because AI is dependent on training input provided by developmental engineers,4 this may raise concern for the introduction of biases, including those based on race, gender identities, disabilities and others, that may be perpetuated and as a result impact marginalized communities, hindering effective patient encounters and potentially inviting discrimination within clinic settings. With growing interest in the use of socially assistive robots (SARs) for patient encounters, we wonder: will this further isolate communities with poorer health outcomes who need the most help? SARs have the potential to improve health outcomes by providing social interactions at a lower cost to health centers but there is insufficient data to prove the benefits of replacing the bond of human connection. Will patients feel disincentivized in their own healing if their care is replaced by the presence of AI-powered robots? Finally, the detrimental impact of AI on the environment stirs concern for the health of our patient population and the future of the region’s agricultural landscape that employs so many. The increasing demand for data centers AI depends on is concerning due to its substantial energy consumption, which adds pollutants to our air and increases water demands to cool servers. In a 2021 study by Google and the University of California, Berkeley, it was estimated that the training process alone for OpenAI’s GPT-3 model consumed 1,287 megawatt hours of electricity, which generated about 552 tons of carbon dioxide.5 As Californians have continued to suffer with raging wildfires due to worsening impacts on the environment every year, the Central Valley’s poor air quality surpasses state and national standards for ozone and particulate matter that predisposes patients to lung diseases such as Valley Fever and asthma.6 Will AI exacerbate our carbon footprint, endanger the health of our patients amidst a climate crisis, and potentially impact access to clean water in our patients' daily lives? Through the lens of local agricultural workers, we must also consider how increasing temperatures may limit harvests, decrease profits and create unemployment. With all this in mind, is this inevitable intersection going to prove more foe than friend? Will this technology fail to make life-saving diagnoses? Can AI be the answer to lessening the significant administrative burden that modern-day physicians face? When thinking about the future, who will be making decisions and what priorities do we consider regarding advancements of medicine and technology? We hope we’ve stimulated curiosity to dive deeper and explore this emerging and ever-present topic.
When Technology and Healthcare Embrace Who Gets Left Out?
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Hannah Oteng-Quarshie and Sibongile Makatini are osteopathic medical students based in California’s Central Valley. Hannah was raised in the Inland Empire of Southern California and obtained her B.S. in Biochemistry from the University of California, Riverside. Sibongile was raised in New Jersey, Hawaii, & California and obtained her B.S. in Biological Sciences at the University of California, Santa Barbara. They are both passionate about health equity and aim to use their privilege as medical students to advocate for marginalized patients and do what they can to give back to their communities.
"It is clear that availability of telehealth has revolutionized and expanded healthcare access for patients from the comfort of their homes. Yet barriers remain, especially with regards to the demographics that suffer most from the lack of equity in healthcare access..."
Disclosure: The author is co-founder of Auggie Health Inc, which is referenced in this article. This relationship may represent a potential conflict of interest. The content of this perspective piece is intended to offer insight based on the author’s experience and does not constitute an endorsement by The Future DO or SOMA
Augmenting Clinical Rotations: An AI-Assisted, Low-Touch System for Clinical Interview Skill Building
Technology continues to shape the future of medicine, including how medical students learn and practice their clinical skills. During my interview trail, a Program Director noted, “The unintuitive and cumbersome EMRs that we deal with today are the result of physicians taking a backseat in healthcare engineering for far too long. This needs to change.” First- and second-year medical students often benefit from SOAP format Objective Structured Clinical Examinations (OSCEs), which provide a structured foundation for history-taking and physical exams. However, as we enter our third and fourth years, the intensity of clinical rotations often leaves limited time and resources for focused skill refinement. Opportunities: A Bridge Between Training and Practice In January 2024, I began working privately on a project in my spare time to address this gap, and this effort ultimately culminated in the incorporation of a company in January 2025. As a co-founder, I have had the privilege of contributing to a tool designed to support third- and fourth-year medical students. We've created a voice & gesture-based iPhone app for clinical interviews, with a web-based counterpart for storing clinical pearls and populating the knowledge base. Together they enhance clinical skill development, ensure patient privacy, and seamlessly integrate into diverse clinical settings for real-time data capture and feedback Addressing Challenges: Ethical and Practical Considerations Integrating AI into clinical training raises ethical questions, particularly regarding patient privacy. Auggie addresses this concern by generalizing personal identifiers unless they are clinically relevant. For instance, it logs patients as “40-something male” rather than recording exact ages. This ensures anonymity while maintaining the utility of the data for clinical skill-building. Furthermore, the entire conversation remains confined to the room, with only medically relevant keywords—filtered through a “medical dictionary”—extracted for AI analysis. This robust design aims to uphold the integrity of Protected Health Information (PHI) and adheres strictly to HIPAA standards, ensuring both privacy and compliance. Another key challenge is avoiding over-reliance on technology. The system is designed as a facilitator, not a decision-maker, providing suggestions without dictating the approach. The operator (medical student in this case) calls all the shots during the clinical interview. By staying within the S&O of the SOAP domain, it enhances skill refinement without interfering with the deeper analysis required for the A&P portion. This enables students to remain actively engaged in the diagnostic process, fostering independence and critical reasoning. Future Applications: Standardizing Training Across Institutions Auggie’s modular design could adapt to other educational settings and integrate into medical training curricula in other countries. By providing consistent, high-quality feedback, it could help standardize training and level the playing field for students from diverse educational backgrounds. Furthermore, its alignment with osteopathic principles ensures that it promotes comprehensive, patient-centered care. By emphasizing the importance of considering all aspects of a patient’s history and physical findings, the system reinforces the holistic approach central to osteopathic medicine. The system’s potential extends beyond individual clinical rotations. It could be adapted for disaster relief efforts and medical missions, extending its impact beyond traditional educational settings. Conclusion The clinical years are crucial for skill-building but often lack resources for refinement. Auggie fills this gap by supporting the Subjective and Objective domains of the SOAP framework, allowing students to refine their reasoning while preceptors focus on collaborative discussions. Innovations like this empower future physicians to deliver better care, ensuring technology remains a tool to augment, not replace, the human connection in medicine.
Pulkit Singhal , CO-FOUNDER of auggie health California health sciences college of Osteopathic Medicine
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Figure 1 - Copyright © 2025 Auggie Health Inc. All rights reserved.
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Pulkit Singhal is a fourth-year medical student at California Health Sciences University in Clovis, California. With a background as a tech entrepreneur and former Chief Technology Officer of a successful startup, Pulkit brings a unique perspective to the intersection of technology and medicine. After immigrating to the United States at age 12, he pursued a degree in engineering at NYU Tandon School of Engineering, followed by a 14-year career in the tech industry. In 2018, inspired by his volunteer experiences in the NICU and Seva Hospice, Pulkit pivoted to medicine, driven by a desire to make a more direct impact on patient care. Pulkit’s clinical interests include medicine, medical education, and the integration of AI into healthcare. His innovative project, Auggie, an AI-assisted, voice and gesture-based system for clinical interview facilitation, reflects his commitment to enhancing medical training and addressing educational disparities. By leveraging his expertise in technology, Pulkit aims to empower students and physicians with tools that prioritize patient-centered care while refining clinical reasoning skills. Pulkit is also an avid educator, having served as a tutor throughout medical school and beyond. He enjoys mentoring peers and fostering collaborative learning environments. Residing in Modesto, California, with his wife and three children, Pulkit is committed to serving the Central Valley and contributing to advancements in healthcare education. When he’s not studying or working on his projects, Pulkit enjoys running a free tennis clinic, mentoring youth, and exploring ways to bridge the gap between technology and medicine.
About The Author:
The Pulse of Progress
In medicine’s hands, the circuits hum, A silent force, both sharp and numb. Through coded veins, the data flows, A lifeline where the healing grows. AI whispers in measured tones, Deciphering patterns in flesh and bones. A robot’s touch, precise and sure, Yet can it grasp what hearts endure? Wearables pulse with every stride, A watchful eye we hold inside. With clicks and swipes, we seek to learn, But can cold screens return our trust? Telehealth spans the miles with grace, A bridge between the wounds we face. Yet distance lingers, vast and wide— Can pixels sense the tears we hide? The future glows with endless light, Yet shadows form where lines aren’t right. Ethics calls for guiding hands, To shape the tech, where justice stands. So let machines refine the art, But never steal the healer’s heart. For medicine lives in touch and tone— Two sides to one coin, yet one alone.
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Julienne Zhou and Andre Ho Touro University Nevada College of Osteopathic Medicine
ANNOUNCEMENTS
Top image, NBD (left to right): Mahi Basra, Matt Boss, Ava diGirolamo, Caitlyn Simtion, Tyson Hillock, Raj Watson, Julia Beck, Nick Cristofari, Raelynn Dorscheid, Momo Cote, Jennier Wilson, Phuong Vo Middle image, BoT (left to right): Julia Moore, Kailey, Jacobsen, Nate Gentry, Monzer Alatrach, Josh Connor, Amy Chiou, Cassie Holub, Nick Cristofari, Grace Hwang, Sneha Pollam, Chethana Gallage Dona, Maria Rollinger. Bottom image (left to right): Dylan Bogle, NBD. Palmer Ford, BoT
The Future DO (TFDO) publishes student abstract submissions and perspective articles bi-annually. We welcome students to submit their research abstracts and articles for consideration to be featured in our next issue. Students are not required to be SOMA members to submit an abstract. In addition, TFDO will be accepting student artwork for print either on the cover or within the body of the magazine! Stay tuned for email announcements from the SOMA Weekly or check out our research website at www.studentdoresearch.org for updates and announcements. We look forward to receiving your submissions!
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We Are Not Replaceable: Why AI Will Never be the Heartbeat of Medicine
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MAHI BASRA (OMS-IV) Dr. Kiran C. Patel College of Osteopathic Medicine at Nova Southeastern University - tampa campus
As we have continued on through medical school, the conversation about artificial intelligence (AI) in healthcare has become impossible to ignore. Whether it's powering diagnostic tools, generating treatment recommendations or drafting patient notes, the field is evolving faster than ever. As medical students, we are constantly asked how we plan to “keep up”. A question for thought: What are we at risk of losing if we forget who we are in the process? Let me be clear – AI is remarkable and I find myself using ChatGPT throughout my day to simplify mundane tasks. AI is reshaping healthcare systems, improving efficiencies and streamlining diagnostics that we could not have imagined in healthcare even a decade ago. But as we continue onwards into residency, we can’t help but hear these whispers – Will AI replace doctors? ChatGPT passed USMLE, will our roles be obsolete? Is radiology going to be the first field gone? To this, I strongly urge no. We are not code and we are not replaceable because we are the soul of this profession. Medicine is more than problem solving, pattern recognition and data interpretation. Obviously, there are things that algorithms can be trained to do – and in most cases, they do it very well. However, as we progress through our training and become more “jaded”, we tend to forget that medicine is also sitting in support with someone whose life just changed in a single sentence. Medicine is notificing a way that a patient's story may not match the scan or line up with the diagnostics. Medicine is noticing how a subtle hesitation while taking a history may hint at something deeper. These are the human moments that machines are not built for. As medical students, we are quite literally in the trenches. We shadow, listen, absorb and are being actively shaped by the science and the stories. These stories matter. The journey of us becoming a physician isn’t just about how well we do on COMLEX and USMLE or about how much knowledge we accumulate through research. It is about learning how to navigate ambiguity and how to connect on a deeper level with patients. AI isn’t stressed about breaking bad news to a family in the best way possible. ChatGPT is not losing sleep over a missed diagnosis. It doesn’t sit in silence after delivering a poor prognosis. That weight and privilege is uniquely ours. As we continue in medical training, we need to stay at the center of the conversation – not just as users of AI but continuing to provide ethical, equitable care. The future of medicine isn’t just human or just AI – it's us as humans with machines. However, this only works if we bring our full selves to the table, bringing our lived experiences, empathy and critical thinking. As you continue in your journey, I urge you to remember your “why”. This often gets lost in the long hours of rotations you aren’t interested in, piling up Anki and boring research papers. I, myself, have been victim to the mindset of “I’m tired and bored, let me ask ChatGPT for a quick differential before rounds”. It's easy to forget that every moment of our struggle is shaping the kind of physician only you can become — one with unique experiences, instincts, compassion and a voice that no algorithm can replace.
1 MESSAGE FROM RESEARCH DIRECTOR
"It has been a pleasure being Research Director through this year. It has been a journey of many late nights, missed deadlines and connections that I wouldn’t trade for the world. Ivy, Alexandra and Ahana have been instrumental in the creation of The Future DO and have been incredible to work with. I wish all of you the very best in your medical and personal lives."
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"Discovery consists of seeing what everybody has seen and thinking what nobody has thought" - Albert Szent-Györgyi, PhD
VOLUME 3 • ISSUE NO. 1