Harvesting freshwater from ocean vapor at a global scale

Rahman et al. Increasing freshwater supply to sustainably address global water security at scale. Scientific Reports, December 2022.

Water covers 70% of our planet, but the freshwater that we use for drinking, bathing, and irrigation is incredibly rare. Only 3% of the world’s water is freshwater, and 60% of that is frozen in glaciers, hence unavailable for use. Water scarcity is increasingly becoming a serious problem on every continent, with poorer countries most dramatically affected. A recent study proposed a new method of harvesting previously untapped sources of freshwater. There is an almost infinite supply of fresh water in the form of water vapor above the oceans, and scientists now want to design a new infrastructure to harvest it. The team evaluated 14 water-stressed locations across the globe and investigated the feasibility of a new structure that could capture water vapor from above the ocean and then condense it into freshwater. The proposed offshore structures are calculated to be standing 330 feet (100 meters) tall and 690 feet (210 meters) wide and would be placed several kilometers offshore to maximize their ability to collect water vapor. The structure would collect water vapor and send it through a pipe back to land, where it would condense into freshwater. In essence, evaporated moisture from the ocean is transported to land, cooled, condensed, and precipitated—very much like the natural water cycle. Interestingly, global warming causes more water evaporation and, consequently, more humidity is formed for capture. Thus, under a warmer climate, there will be more humidity available to meet humanity’s demand for water, making this approach feasible as the climate continues to change. This new method is substantially more environmentally friendly compared to other freshwater solutions such as desalination. Desalination plants produce brine, a salty chemical-filled mixture, as a waste product—one that can be toxic to wildlife. Water access solutions are urgently needed as about 2 billion people live in water-stressed regions—and that number may increase as climate change makes drought more common.

Gut-brain axis: Microbiome affects brain damage in neurodegenerative disorders

Seo et al. ApoE isoform– and microbiota-dependent progression of neurodegeneration in a mouse model of tauopathy. Science, January 2023.

It has been increasingly accepted that trillions of microbes living in our intestines, known as the “gut microbiome,” play a major role in many of our bodily functions. The two-way communication between the gut microbiome and brain can modify how these organs work through a complex network of microbe- and brain-derived chemical signals. Now, a new study suggests that the gut microbiome affects the behavior of immune cells in the brain that can damage brain tissue and exacerbate neurodegeneration. The researchers altered the gut microbiomes of mice predisposed to develop Alzheimer’s-like brain damage and cognitive impairment and found that depletion of all gut microbiome through antibiotics dramatically reduced brain damage and slowed down the disease course in mice. Further experiments revealed that three specific short-chain fatty acids produced by gut bacteria activated the immune cells in the bloodstream, which in turn triggered the immune cells in the brain and led to tissue damage. This study suggests that gut microbes from our intestines may affect the onset or progression of neurodegenerative disorders like Alzheimer’s disease. It also opened new therapeutic avenues to preventing and treating neurodegenerative diseases by simply modifying the gut microbiome with specific antibiotics, probiotics, or specialized diets.

The living fossils of galaxy formation discovered

Rhoads et al. Finding Peas in the Early Universe with JWST. The Astrophysical Journal Letters, January 2023.

Astronomers have discovered the most primitive galaxies ever found using NASA’s recently established James Webb Space Telescope (JWST). The images captured are thought to originate from 700 million years after the Big Bang. In other words, its light has taken roughly 13 billion years to reach Earth. Three galaxies observed are categorized as “green pea” galaxies due to their small sizes and greenish hues. They are composed of brightly glowing gas clouds, hence the distinct color, and typically very small—they have a diameter of only 5,000 light-years, compared to the Milky Way, which is about 85,000 light-years across. Although these “green pea” galaxies are small, their star-formation activity is unusually intense for their size; they produce massive, bright ultraviolet light. The spectrographic analysis of the images by JSWT also revealed chemical fingerprints, which reveals a lot about the age of the galaxies. Two of the galaxies have around 20%—and the third one only 2%—of the oxygen in the Milky Way. The discovery of such ancient and distant galaxies is a significant development in cosmology. It has been established that after the Big Bang, the universe cooled down for a billion years before starting to reheat—also known as cosmic reionization, which ultimately led to the formation of modern galaxies. But we don’t know what was the catalyst for reionization. This study and some others strongly suggest that strong ultraviolet light emitted from these primitive galaxies, which can rip electrons from atoms, produced the energy required to transition from the cosmic dark age to cosmic reionization. JWST has the capacity to image early galaxies with unprecedented detail, paving the way for further progress to explore how galaxies form and evolve.

Speaking of oneself all the time—in other words, doing things to attract attention to oneself and impress others—is a weakness in character. Of course, there are times when one needs to express himself or herself. For instance, prayer is a time when one stands before God and pours out their inner feelings to Him. The human being is a masterpiece of the Creator; each human carries lines and patterns that indicate to the Artist Who created them. The human, in the words of Bediuzzaman, is an index of all existence. When we can deeply scrutinize the human, we can testify to how wonderful a creation they are, how unique they are with their reason, spirit, heart, willpower, conscience, and consciousness. What is expected of the human is to recognize the source of all these qualities, be grateful to Him, glorify His Majesty, and address Him in full awareness of being a servant. It is required of a servant that he or she acknowledges their position vis-à-vis the Divine and that all in their possession in fact belong to their true Owner. Expressing oneself to God with such consciousness is only commendable.

What is not commendable is when a person comes forward at every opportunity to draw attention to themselves with their posture, behavior, thoughts, and even with their prayer and worship, so they can attain others’ admiration. What actually a person does when he or she shows off with their virtues and qualifications is that they forget their real source and claim ownership of them. They are, as it were, confiscating what in fact belongs to God, whether they are aware of it or not.

Those who presumptuously chase admiration and applause always make all kinds of turns and twists, so the conversation circles around them. When they speak or write, they imply their self-proclaimed qualities, if they cannot do it directly. They would produce art just so to show others how art should look; when they write something, everybody should read and praise it—they would not welcome negative criticism. If they happen to mention the All-Glorified name of the Almighty, they’d still seek some credit out of it. When they lecture from the pulpit about God, what they are really after is to show how talented they are to the congregation. This is why they raise their voice; this is why they pound the pulpit as they speak. Their lifestyle, cars, homes, every object they use is a tool for them to speak about themselves. While doing so, they manage to camouflage their ostentation—sometimes even with an artificial humility.

These people sick with showing off always wish for others to speak about him or her, too. Their own efforts are not enough; they keep other people by their side to cheer for them; they can even build institutions for this. Conferences or books that do not mention their name have no value in their eyes.

These poor people are also very jealous. They are extremely disturbed when others are praised. They may say how much they admire somebody to his or her face, but behind their back, they conspire to humiliate them. They highlight others’ weak spots, so their value can shine brighter. They dig the ground around them, so they can stand taller. All such behavior leads nowhere but to disaster.

Subduing the ego and exercising willpower

Our best qualities are all from God. We might have an exceptional career, vast knowledge, sprawling wealth, and countless skills; we can have all of these only if we use what God blesses us with and if God opens the pathways for us. Besides, whether we are making the best of these blessings in the most efficient way possible is not an easy question to answer.

All these skills and qualities should be utilized not to speak about oneself but to speak about the One who gave them to us. Our voice, words, looks, and pose should pour out meanings about the Almighty. When we speak, we should speak words of Divine knowledge and love. Those who listen should grow in enthusiasm for and connection with God. Each of our speeches should be like a prayer about His uniqueness.

Saving oneself from this sickness is dependent on “reducing oneself to zero”—in other words, making humility one’s character. This is possible with self-discipline maintained for a long time. Humility is not easy to adopt into one’s nature, but one has to force themselves into it. This sickness of self-admiration is related to our willpower; so is the effort to prevent it. Only by exercising discipline can we change our character in the long run.

A true believer should bury underground all manifestations of self-admiration—bury them deep and put rocks on them. This is what mystical traditions are about. People in Sufi lodges used to be taught how to bring their carnal soul under control. Practices like spiritual retreats, fasting, and journeying on this path are meant to free people from traits of egotism and arrogance, so they can adorn with beautiful character—to make them follow the proofs of Divine knowledge (marifatullah) and thus come to know God and love Him (muhabbatullah). These practices helped them acknowledge that everything is from Him and realize His grandiosity versus how small they are.

Megalomania

Sadly, people are not undergoing any such spiritual nurturing in our times. Egos are not purified, hearts are not cleansed. Carnal souls cannot be brought under control. Instead of taming them, many people make themselves the beast their carnal souls ride. This can be considered both at the individual and societal level. Such a sickness can easily spread among members of a nation or community which considers itself as a legendary group of heroes. Affiliation with a community, membership to a school of thought, an institution, a university, even to a profession can inflate people’s ego and make them see themselves as superior, sometimes without being aware of this situation. They always speak of their own legends and heroisms. This may reach a point where they become megalomaniac, but since everyone in the community is debilitated with the same sickness, none of them notices anything.

All these symptoms indicate the presence of a sickness in the soul. As our body gets sick, so can our soul. Sicknesses in the soul are more difficult to cure than in the body, demanding more time and effort. To heal them, people should consult both psychologists and spiritual teachers, who might be able to see with the light of faith and detect the weak points.

Every human is created with such gaps in their soul. These gaps can allow feelings like ostentation and pride to grow. These are testing items in the human condition. Yet, the sources of these feelings are in fact open to both goodness and evil. What we should do is to be cautious against inclinations towards the evil, to try to subdue what transpires as evil, and to work hard to channel all our potential to the good. Those who can reduce themselves to zero with the utmost of their willpower and purify their souls can master their existence in this life.

The relationship between nature’s physical and metaphysical dimensions have been under debate since time immemorial. The nature we see as the deterministic functioning of the laws of physics and chemistry—which we call “causes”—include such phenomena as the rain falling, the sun’s warmth, plants germinating in the bosom of the earth, and geological faults rupturing in the earth’s crust. How are these events represented in the spiritual realm? What do these events correspond to in the metaphysical dimension? These are not the subject of objective science, but many scholars with a conscience and a rich inner life speak about the connection between the events in the physical world and phenomena in the metaphysical world. Said Nursi, for instance, draws a connection between natural disasters or celestial calamities and human transgressions [1]. Are physical, geological, ecological, and biological factors, such as the decline of the ecosystem or the emergence of pandemics, a veil covering the real cause, that we cause suffering and inflict harm? Do our behavior trigger disasters? Are we “offending” nature?

Urbanization, modernism, and the ecosystem

Most ecologists and environmental organizations state that the earth’s ecosystem is gradually deteriorating. With more than half of the world’s population now living in cities—not to mention the increase in electronic devices, changing living conditions, and even changes in children’s perception of play—people’s opportunities for direct contact with nature are diminishing. The uncontrolled development of so-called modernity has negative effects on physical health, mental abilities, and peace of mind, as well as on the relationship between humans and nature. Signals of global biodiversity loss are evident all over the world.

In an ecosystem polluted by various elements such as pesticides and insecticides—which are supposedly produced to protect plants—as well as hormones, synthetic fertilizers, and industrial waste, birds that feed on poisoned insects have shorter lives. Other major topics of ecological discussion include the manifold impacts of pollution in water, soil, and air, sporadic but remarkably severe solar flares, and other atmospheric and meteorological phenomena, and the role of humankind in disrupting the balance of the life-sustaining ecosystem.

Are birdsongs distorted?

The decline in bird populations in North America is estimated at around three billion in the last 50 years. On websites, ornithologists list the species in swift decline. This decline means changes in the living environment of bird communities—and the disappearance of the familiar sounds of spring. Sounds in nature, especially birdsongs, are phenomena inherent to human nature and play an important role, like flowers and trees, in maintaining our connection with and reflection of nature. The widespread decline in bird flocks and the change of species in particular regions also imply the change of the sound patterns and acoustic properties of nature.

Vanishing species

Research on plants and animals that are extinct or facing extinction almost unanimously state that every aspect of life on earth is deteriorating. Take this detail from a significant research article published on November 2, 2021 [2]: Simon Butler and Catriona Morrison of the University of East Anglia, co-authors of the study that involved around thirty researchers and covered the whole of Europe and North America, determined that as the ecosystem deteriorates, bird populations decline on a global scale and melodic diversity gradually diminishes in nature’s vocal repertoire. Given the statistics of over 200,000 bird melodies studied, birds have not just declined in number, but in the variety and richness of notes they sing, too.

For a moment, imagine yourself at a concert, listening to a familiar song but without wind instruments in the orchestra; the melody would not sound as rich as it normally is. This is what is happening in the nature.

Birdsong and its effect on the soul

We perceive all the experiences we have in the bosom of nature with our sensory organs. We perceive the taste of apples, the smell of melons, the crispness of grapes, the riot of colors of flowers—all with our senses. However, sounds especially have a special place among these. There are studies on the effect of natural sounds on our moods and their ability to reduce pain and stress. The effects on the soul of the sounds of rain, wind, leaves, waves, and streams have been studied by measuring sound characteristics such as frequency, rhythm, intensity, and amplitude. To see the effect of birdsong on the human soul, just think of the many poems written about it, such as John Keats’ “Ode to a Nightingale.”

The breakthrough of voice recording technology

According to researchers, disruptive changes in bird and insect habitats suggest that, in the long term, both bird and soundscape diversity will continue to decline. Since the ability to record audio has only existed for around a century, archival recordings of bird melodies are at most a century old and are not clear enough for professionally extracting frequency patterns. To track how melodies have changed over time, it is necessary to examine songbirds’ past vocal repertoires.

Initiated to expand this research to a much wider area, a project collected regular late spring and early summer measurements and recordings made by volunteer ornithologists active at over 200,000 stations in Europe and North America. These were compiled into annual tables by bird species and number of individuals recorded. Annual bird count data from two websites [3] were combined with the recordings of over 1,000 species from Xeno Canto, an online database of bird songs to reconstruct historical vocal patterns. First, all downloaded sound files were standardized by truncating 25 seconds. Later, files of the individual members of the same species were added, and the contribution of each species was demarcated within the collective sounds. The acoustic properties of these sound patterns were then quantified using four indices designed to measure the energy, frequency, and temporal distribution of vibrations. These indices were used to measure the complexity and diversity of the songs collectively, like the variety of instruments in an orchestra. Dr. Butler summed up their findings as a widespread decline in the intensity of acoustic diversity and natural sound patterns resulting from changes in the composition of the different species that make up bird communities.

The “orchestra” of nature is rapidly losing both its players and its instruments. In general, there are about 10,000 species of birds, of which about 4,000 are songbirds. This number includes birds that do not sing or that have unpleasant voices, for they are a part of the acoustical range of a certain location. Depending on their breeding and feeding periods, the songs of some species may have a certain prevalence and prominence. For example, losing birds like the lark (Alauda arvensis) or the nightingale (Luscinia megarhynchos), of which rich and complex melodic lines enliven the concerts we are accustomed to in spring, will have an impact greater than losing birds like crows and gulls whose voices are not as pleasing to our ears.

This research elucidates that over the last 25 years in Europe and North America, there has been a steady decline in the density of acoustic diversity and sound patterns, along with a decline in the number of species and individuals. As a consequence of these losses, one of the fundamental ways humans interact with nature is in chronic decline. Hence, it has been revealed that the “music” we listen to in the spring, in the open air, and in the forest, has become poorer and weaker, almost like music performed by a debilitated orchestra. Is the decline and disappearance of birds and their melodies merely a biological and ecological consequence? Or is it a metaphysical and spiritual dimension of the ruthless cruelties being perpetuated in the world and a harbinger of the apocalyptic destruction of the earth’s ecosystem by humanity? Isn’t it worth reflecting more deeply on this issue?

Notes

• Bediüzzaman Said Nursî, Sözler [The Words], Istanbul: Sahdamar Yayinlari, 2010, s. 799; Emirdag Lâhikasi, Istanbul: Sahdamar Yayinlari, 2010, s. 29.
• C.A. Morrison, A.Z. Auninš ve S.J. Butler, “Bird population declines and species turnover are changing the acoustic properties of spring soundscapes”, Nature Communications, vol. 12, article number: 6217, 2021.
• North American Breeding Bird Survey (www.usgs.gov/centers/eesc/science/north-american-breeding-bird-survey) ve Pan-European Common Bird Monitoring Scheme (pecbms.info).

If there’s one thing I learned as a medical trainee who deals daily with death, it’s that humans want to be remembered. We want to survive the tides of the future. We want to survive death. All our lives are devoted to doing something, to leaving a mark on this earth. Too often, however, all we manage to leave is a scar.

As John Green once put it (in his novel, The Fault in Our Stars), we are like a bunch of dogs squirting on fire hydrants. We poison the groundwater with our toxic urine, marking everything as mine in a ridiculous attempt to survive our deaths.

Nowadays, this phenomenon has grown exponentially. Especially in the eyes of the younger generation, being famous is the equivalent of being alive, successful, and happy. And by constantly living on social media, eyes locked on these “superstars” and their viral videos, they convince themselves that this is what life is all about. But it is not. What truly matters is not how many people know you. It is what you are known for by those around you. Spread love and do good, and you won’t need to be a star to shine. Just like Maria.

And this is why I want to tell her story.

Maria was different. She walked lightly upon the earth. Maria knew the truth: We’re as likely to hurt the universe as we are to help it, and we’re not likely to do either. People will say it’s sad that she left a lesser scar, that fewer remember her, that she was loved deeply but not widely. But it’s not sad. It’s triumphant. It’s heroic. Isn’t that the real heroism?

April 14, 2020. Italy.

On this particular Tuesday, I was making the last round on my patients before my 16-hour shift ended. In medicine, we are used to working long and tiring shifts; however, with the novel Coronavirus pandemic in full swing, we had reached new heights. But we were all clenching our teeth and working hard to keep our healthcare system afloat. At the time, the situation was overwhelming in Italy. The sad truth was that, often, we had to make deliberate decisions on who we wanted to save and who we were going to let die because we couldn’t give them proper and timely treatment.

The heaviness of knowing that your decisions may cause the death of someone is agonizingly painful. It’s like an ocean crashing on you, letting you come afloat just to take a quick breath, before pulling you down again. It’s not easy to ignore the pleas of the families to save their loved ones. Truth to be told, it’s depressing, and I don’t think there are words that can properly express the sense of hopelessness that one goes through.

As Virginia Woolf once wrote:

English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache… The merest schoolgirl, when she falls in love, has Shakespeare to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry. And we’re such language-based creatures that to some extent we cannot know what we cannot name. And so we assume it isn’t real. We refer to it with catch-all terms, like crazy or chronic pain, terms that both ostracize and minimize. The term chronic pain captures nothing of the grinding, constant, ceaseless, inescapable hurt. And the term crazy arrives at us with none of the terror and worry you live with. Nor do either of those terms connote the courage people in such pains exemplify.

On the other hand, the pandemic has also restored my faith in humanity and brought to light some amazing stories. For example, the story of Maria. She was an 82-year-old woman who had been admitted to the hospital one week before, in the intensive care unit. On that Tuesday, I was checking on her to see if her condition was improving or not. She shared her room with two other patients. When I came around her bed, she had her eyes slightly open. Her heartbeat and systemic pressure were perfectly normal for a person of her age, even though she had great trouble breathing properly.

“Hey, Dr. Ahmet, how are you doing?” she said, managing a smile.

I smiled back. Typical of Maria: even though she was the one in a hospital bed, she always asked me if I was doing fine first.

“I’m good. Thanks. How about you?”

“I’m doing alright…” Her voice trailed off. “Actually… it’s a bit depressing, to tell you the truth. All these white walls and gloomy faces.”

“For the white walls, I could ask someone to move you to another room. Just tell me which color you prefer. And you are right. We should paint them.”

“Nah, the walls are not a big problem. It’s the gloomy faces that I would like to change…”

I tweaked the valve of the oxygen canister. “You are asking me to do something really difficult,” I said. I was completely exhausted, both physically and mentally. It had been almost a month since we began working non-stop, and at times it seemed all in vain.

“Why?” she sounded surprised, “Being happy is not supposed to be that difficult. You know, dear, I remember the old times, when we used to dance mindlessly and laugh together. I loved it. And dancing really washes away all stress.”

“But you didn’t have to deal with a pandemic,” I said, scribbling her physiological measurements on the clinical report.

Maria laughed. “Ahmet, we had to deal with a deadly war, don’t underestimate the oldsters. But you know what, it isn’t the situation you’re in that should determine your happiness. It’s you. Being positive is a choice.”

“Maria, you could be a motivational speaker.”

“I know. ”

When I was completing my round, I kept thinking about Maria’s words. It was true: happiness came from within. But sometimes it was so hard to find.

Maybe we were not even trying. For my part, I thought it would be careless to be happy among all the pain and affliction. However, Maria’s words made me think that with my depressed mood and dispirited face, I might be one of the causes of that suffering.

I would definitely not be able to fully eliminate it, but I could at least try to alleviate it. I had to. But how? It felt like wandering in a room full of darkness: you know there is a switch somewhere, but the true challenge is finding it.

The next day, I came into her room for the usual check-up routine.

“Don’t I look like a zombie?” she said as soon as I entered the ward, pointing at the tubes that ran from the ventilator to her smiling mouth.

“Not at all,” I answered, glancing briefly at her clinical report. “120/80 mmHg blood pressure, regular heart rate at 75 beats per minute, osmolarity of 295 mOsm/L. You are doing superbly. A few more weeks and you’ll be out of here.”

The smile on Maria’s face faded, washed away by something I couldn’t see. “A few more weeks?”

“Yup. And then you will be able to get back to your children and nieces.”

“Ahmet.” Her voice sounded strangely serious. Usually, Maria was the one who brought laughter to her ward. After all, she was the one who told us to always stay positive. “I have to ask you for a huge favor. ”

“Tell me; I’ll do my best to help you.”

“Look… I’ve been following the news recently…and I know how many hardships you are all enduring.”

“It’s nothing. Really. We do it because it’s what we want to do.”

I meant it.

“I know. I know,” said Maria, crisping her lips in an irritated line. “But I also know that there are too many cases and too few ventilators. You have to choose between who you will save and who you will let die.”

I didn’t answer. My throat felt like a tender patch of heat.

“Well…” continued Maria. “The favor I want to ask you is that you give my ventilator to someone else. Just let me see my children this evening and then I’ll be ready to go. And, oh, don’t tell them about this. Tell them that I couldn’t make it. This will be our little secret.” She winked at me, her big blue eyes glittering.

“But… in a few weeks, you will be out of here,” I protested, pursing my lips and exhaling slowly, to calm myself. “Why are you choosing to die?”

“Oh, my dear. Look… as Steve Jobs put it ‘death is the destination we all share. No one has ever escaped it and that is as it should be because death is the single best invention of life. It’s a life-changing agent; it clears out the old to make way for the new.’ I am old now.” And here she pointed at her wrinkles, smiling again. “And I want to give the gift of life to someone younger than me. I want to give them their second ticket to life, so that they can get to live pursuing their passions and with no regrets. Just as I did. This is my last wish. If you grant me this, I can leave this Earth in peace. And the only thing you have to tell the person who will take this bed is to not be scared of death because it will make you miss your life. You can’t beat the Reaper by living longer. You can only beat it by living well and fully. Do the things you want to do before the Reaper shows up. Because it will be too late then.”

And these were the last words I heard from her.

That evening, after her children went away, she unplugged the ventilator herself, and when I came into the room she was lying on the bed, with a peaceful smile on her face.

*Maria is a pseudonym used for privacy concerns.

Researchers at Georgetown University Medical Center discovered that when we look at a written word, a special part of our brain perceives it “like a picture, not a group of letters needing to be processed” [1].

The researchers studied 25 participants through fMRI (functional magnetic resonance imaging), focusing on a small area just behind the left ear called the “visual word form area.”

What’s particularly fascinating about this area is that a similar symmetrical segment in the right hemisphere of the brain, the “fusiform face area,” is the part of the brain tasked with recognizing human faces. Young children and illiterate adults use both this facial recognition and word imaging areas to recognize faces. Once they learn to read and write, the word imaging area performs word recognition only. As familiar faces are stored in our memory (facial recognition area), the words we learn are also entered one after another in this visual word dictionary.

Words we write, think, speak

The words studied in this research are written words, not spoken words, i.e., words produced by sound waves. What role, then, does hearing play in reading?

Neuroscientist Lorenzo Magrassi and his colleagues focused on neural activity in the language and speech processing/production center of the brain, known as Broca’s area [2], in 16 participants. One of the most interesting aspects of this experiment was that it could only be performed during “awake surgery”—i.e., when the participants were awake and their skull was partially open [3]. Since the brain itself does not feel pain, this form of research can be done with an open skull.

When people hear speech, it is transmitted from the ear to the brain as a sound signal or sound wave and triggers a neural activity and fluctuation in the brain via electromagnetic waves. This wave packet unit of sound is called the “sound envelope” or “sound sheath.” Hence, we can assume that each word has a sound envelope and a corresponding neural activity and electrical fluctuation in the brain.

Magrassi and his team discovered that the neural electromagnetic fluctuation matching of the sound envelope and neural electromagnetic fluctuations that occur when we read aloud or when we hear a word is the same when we read silently; neural activity in Broca’s area is the same as if the words were heard. Even before we speak, even before we intend and plan to speak, and although we only think about the word, the sound envelope of the word is already present in the brain. This discovery explains why we feel as if we hear the words inside us even when we are merely thinking about them. Accordingly, researchers started work on an interface software that would enable human-computer compatibility in transmitting thought words from the brain to the outside, even without speaking [4]. This will enable people with defective speech organs to convey what they think to their interlocutors helped by special software and hardware.

In sum, a word thought, whether read silently or pronounced, is first represented in the brain’s visual word form area and in Broca’s area as a sound envelope-neural activity. The word is given a certain form and, if we speak, it is reflected in the same areas of the listeners’ brains in a symmetrical process. These brain areas are created as “mirrors” where the word is reflected [5].

Since words also convey our feelings, when a word we choose is conveyed with its features, does it evoke similar feelings in the interlocutor? In another study on this matter [6], it was discovered that pitch changes in the pronunciation of words stimulate neurons in the brain—i.e., they mirror diverse reflections. By paying attention to the pitch of a speaker’s voice, it is possible to guess whether they are sincere or not. A person lying often averts their eyes because the feature of the word they pronounce does not match the word-imaging area in their brain.

It can be said in light of these studies that the human brain by default bears the ability to mirror the feature of words and that words are not any sound wave in the air. At this instant, let’s remember the following observation of Bediuzzaman Said Nursi:

Just as His art in the universe is in the form of a book, describing its perfect orderedness, so too His coloring and the inscription of His wisdom in human has opened the flower of speech. That is, His art is so meaningful, sensitive, and beautiful that it has caused the components of that animate machine to speak as though they were gramophones. It has given human such a dominical coloring in their ‘fairest of forms’ that the flower of speech and expression, which is immaterial, insubstantial and living, has opened in their material, corporeal and solid head. And it has equipped the power of speech and expression, which is situated in human’s head, with such exalted tools and abilities that it has caused it to develop and progress to a degree whereat they become the addressee of the Pre-Eternal Monarch. That is, the dominical coloring in human’s essential nature has opened the flower of divine address. Is it at all possible that anything other than the Single One of Unity could interfere in that art in creatures, which is so high as to be in the form of a book, and in that coloring in human whereby they attain the station of speech and address? [7]

Footnotes

• “After Learning New Words, Brain Sees Them as Pictures”, gumc.georgetown.edu/news-release/after-learning-new-words-brain-sees-them-as-pictures/
• “Broca’s area”, en.wikipedia.org/wiki/ Broca’s_area
• “Why you can ‘hear’ words inside your head”, www.bbc.com/future/article/20200929-what-your-thoughts-sound-like
• “The Long Search for a Computer That Speaks Your Mind”, www.wired.com/story/the-long-search-for-a-computer-that-speaks-your-mind/
• Bediuzzaman Said Nursi, Sözler [The Words], Istanbul: Sahdamar Yayinlari, 2010, s. 767.
• “How the human brain detects the ‘music’ of speech”, www.sciencedaily.com/releases/2017/08/170824141234.htm
• Bediuzzaman Said Nursi, Mektubat [The Letters], Istanbul: Sahdamar Yayinlari, 2010, s. 265.

At the 26th United Nations Climate Change Conference in Glasgow, Scotland, countries signed an agreement on a series of measures to address climate change. The agreement includes key decisions such as a commitment to phase out coal, regular reviews of emission reduction plans and more financial support for developing countries. Climate change, which can be defined as “changes in the average state and variability of the climate over decades or longer, regardless of cause,” is in fact the scream that resonates off the walls of the ecosystem. Unless addressed in tandem with population growth, migration, rapid and unplanned urbanization, surging scarcity in resources and food, extreme poverty, socioeconomic inequality, infectious diseases, and pandemics, climate change will cause erratic and insurmountable problems facing humanity and, as during the recent COVID-19 pandemic, it can upset established social behavior patterns.

The greatest danger knocking at our door

In 2021, the World Health Organization declared climate change “the greatest health threat facing humanity.” Climate change and increasing carbon dioxide emissions cause extreme heat, environmental destruction, and difficulties in the water and food supplies. Using fossil fuels, the main source of greenhouse gases, leads to air pollution and associated premature deaths. Increases in carbon monoxide, lead, nitrogen dioxide, sulphur dioxide, ozone, and respirable particulate matter smaller than 2.5 microns are the main drivers of air pollution. The vicious cycle between climate change and air pollution is associated with reproductive, respiratory, and cardiovascular diseases, as well as public health problems such as diabetes, cancer, premature aging, and psychiatric diseases. Climate change causes an increase in air pollution through extreme temperature and weather events (hurricanes, floods, droughts), natural (wildfire smoke, dust storms), and human and animal factors (air conditioning, litter). It also contributes to infectious diseases through expanded habitats for disease vectors such as mosquitoes and ticks, and to non-communicable diseases through increasing food shortages, malnutrition, and longer and more intense pollen seasons.

Temperatures and Drought

Although humankind is not fully aware of the impending catastrophe, the gravity of the situation is highlighted by reports on Europe experiencing its driest spell in 500 years, with more than half of the continent facing the threat of drought. Drought threatens not only Europe but the whole world, leading to water and food shortages as well as an increase in forest fires. It is noted that around 2.3 billion people live in areas at risk of drought, that drought has directly caused the deaths of 650,000 people in the last 50 years, and that millions of children are still affected by severe and prolonged drought. It is also estimated that as many as 3.5 billion people could face “unlivable” temperatures in the next 50 years because of human-induced climate change. As more people are impacted by drought, chronic poverty, war, or chaos, they will continue to migrate to “milder” locales.

Impact on marine ecosystems and ocean pollution

The quality of marine environments is also essential for protecting public health. Environmental pollution, contamination by chemicals, and pathogenic microbes hurt marine ecosystems; marine pollution also threatens marine animals and human health. Ocean pollution, exacerbated by global climate change, also negatively affects these ecosystems, with petroleum-based pollutants causing a decrease in photosynthesis in oxygen-producing organisms. Increased carbon dioxide absorption in the seas causes acidification, negatively affecting coral reefs, disrupting shellfish growth, dissolving calcium-containing microorganisms at the base of the marine food web, and increasing toxic effects from pollutants. Meanwhile, plastic pollution, which accumulates in large mid-ocean gyres and threatens marine mammals, fish, and seabirds, decomposes into chemical micro- and nano-plastic particles that enter the tissues of many marine organisms, including those consumed by humans. Industrial sewage increases the frequency and impact of harmful algal blooms, bacterial pollution, and anti-microbial resistance, while dangerous pathogens such as Vibrio species and other factors result in global declines in fish stocks.

Effects of air pollution

Climate change puts the three pillars of health—nutrition, shelter, and access to water—at risk. For instance, natural disasters destroy crops and people’s homes and contaminate safe water sources. This leads to malnutrition and water-borne diseases and contributes to 12.6 million preventable deaths in the world each year due to climate change. Since more than half of these deaths are caused by exposure to air pollution, it is clear that there is an association between climate change and air pollution and other environmental exposures. Longer wildfire seasons lead to more smoke exposure; climate change affects ozone and particulate matter formation by increasing the rate of chemical reactions in the atmosphere and increases the amount of pollen by extending the pollen season. The direct effect of each event is airway inflammation and lung damage due to the production of reactive oxidants. Ambient ozone and chronic accumulation of particulate matter in alveolar macrophages, impaired phagocytosis, oxidative stress, and poor mucociliary clearance jointly trigger airway inflammation. In addition to weakened antioxidant defenses, immunological and epigenetic (environmentally induced) changes play a role in the pathogenesis of lung diseases such as asthma and chronic bronchitis. Toxic effects in the respiratory tract and lungs eventually impact the cardiovascular system, causing autonomic disorders and increased inflammation. Ultimately, climate change-induced air pollution affects nearly every organ system (including the lungs, heart, kidneys, brain, and nervous system) through a complex interplay of increased oxidative stress, systemic inflammation, and immune dysregulation.

What can be done?

Climate change negatively affects several social determinants, such as equity, livelihoods, and access to health and social support services. Its impacts are felt disproportionately by the most vulnerable and disadvantaged, including women, children, ethnic minorities and impoverished communities, migrants or the elderly, and those with disabilities. Due to climate change, health services are in greater demand, while infrastructure is negatively affected. Faced with these challenges, experts recommend climate change adaptation and mitigation actions. Climate change adaptation means preparing society for actions and is known as the ‘secondary prevention.’ This is about improving people’s ability to cope with changes—such as increased cases of asthma and malaria or mental illness caused by forced migration—and giving them ease of access to health services. More importantly, it is also about tackling the causes and putting in place the “primary preventions.”

The earth is a trust on the shoulders of humanity. We humans should act as stewards of God on earth, to respect this trust and protect it meticulously. Measures like afforestation and preventing waste should be emphasized. Since the estimated (2.5 billion) tons of food waste ending up in landfills annually contribute to about 10% of greenhouse gas emissions, we must avoid waste and sort our garbage for recycling.

As a requirement of social responsibility, we should support efforts in finding solutions to problems like the global change. Since this social responsibility imposes on us the mission of “leaving our world and its entire eco-systems clean and problem-free for future generations,” we should contribute to the formation of a more livable world by prioritizing the protection of the environment. Climate change and the deterioration of the ecological balance remind us of this fundamental duty, and we must not hesitate to take responsibility for combating climate change for both individual and public health.

References

• Churruca-Muguruza C. The Changing Context of Humanitarian Action: Key Challenges and Issues. In: International Humanitarian Action, Springer, 2018, pp. 3–18.
• World Health Organization. COP26 special report on climate change and health: the health argument for climate change. Geneva: World Health Organization, 2021.
• Keswani A, Akselrod H, Anenberg SC. Health and clinical impacts of air pollution and linkages with climate change. NEJM Evid, 2022;1(7).
• Toreti A, et al. Drought in Europe August 2022, Publications Office of the European Union, Luxembourg, 2022, doi:10.2760/264241, JRC130493. https://edo.jrc.ec.europa.eu/documents/news/GDO-EDODroughtNews202208_Europe.pdf
• Xu C, Kohler TA, Lenton TM, Svenning JC, Scheffer M. Future of the human climate niche. Proc Natl Acad Sci USA. 2020;117(21):11350-11355.
• Landrigan PJ, et al. Human Health and Ocean Pollution. Ann Glob Health 2020;86(1):151.

Sincerity or purity of intention (ikhlas) and perfect goodness or excellence (ihsan) are the two bases and the most important sources of power for journeying and initiation. When the initiates’ heart beats with a feeling of sincerity and the consciousness of perfect goodness, they sometimes utter There is no deity but God, while having in mind several of the Divine Names, and therefore meaning “There is no Creator, no Provider, no Shaper… but God.” At other times they open a window in the heart for each Name of the Bestower of Life, and set out to observe what is beyond the door that has been opened by the consciousness of perfect goodness. On occasion also they travel

through reflection on the harmony of the qualities (color, scent, form, taste, sound, harmony) manifested on things, or on the horizon of Some faces that Day shall be shining and radiant, gazing toward their Lord (75:22-23), and they burn with the zeal of meeting with Him. With a deep, mysterious desire of observation, which is impossible for any mental faculty to make, they try to rise to the heaven of knowledge of God from the launch-pad of belief. Then their love develops into a passion, which is strengthened with zeal. They fly into the depths of eternality on the wings of attraction and, with the feeling of being attracted by Him, rise toward the high towers of the angels, being welcomed by spiritual beings, reaching points that few can reach, seeing amazing things that few can see. But aware that what they seek in no way has any form, they regard every scene that greets their eyes only as a picture, a tableau, and remain devoted to the truth beyond:

He is neither of bodily nor accidental existence, nor a substance, nor composed;
He does not eat, nor drink, nor is contained in time: He is high above all such features.
He is absolutely free from changing, transformation, and also from having colors or a form:
All of these we spell out so that we can clarify what God is not.

Whatever level they reach, they always feel humble in acknowledgment, We have been unable to know You as knowing You requires, O the One known, and stress that the Divine Being cannot be perceived. To whatever extent they fulfil the demands of devotion to God, they admit: We have been unable to worship You as worshipping You requires; and however deeply and sincerely they mention Him, they whisper their inability, saying: We have been unable to mention You as mentioning You requires, O the One mentioned.

These travelers regard respect for God’s commandments as the first and foremost means of approaching God, and piety and righteousness as the most blessed equipment for the journey. They train their souls and purify their spirits in devotion to the rules of Islam. They consider every effort for training and purification that is opposed to the rules of Shari‘a as falling away from the religion, and if anything out of the way occurs at their hands, they see it as a sign that they are going to perdition. In every stage of journeying and initiation, the travelers pay exceptional attention to the safety of the journey and see this safety in their devotion to the essentials of the religion and religious life, and know that their worth in God’s sight lies in piety and righteousness, and that only the pious, righteous ones can find God. “The final destination of the God-revering, pious will be Paradise, and their drink, the drink of Paradise.”

The author of Gulshan-i Tawhid expresses this truth beautifully as follows:

If you seek safety, know that piety and a righteous religious life are the safest stronghold against all fears and danger.

Self-training, or the training of the soul, has been accepted as an extremely important element of all religions. The self or the soul mentioned here is the human soul or self, which is also mentioned as the speaking self, and is dealt with in seven stages according to some Qur’anic allusions to it:

If the speaking self or soul lives only a life of ease in the swamp of carnal appetites, it is the Evil-commanding Soul; if it falters time and again while following the way of religion to attain piety and righteousness, but each time that it falters it criticizes itself and turns to its Lord, then it is the Self-condemning Soul. The soul which always resists evil in devotion to God and is favored with certain Divine gifts in proportion to its purity, is called the Soul Inspired or Receiving Inspiration. When it reach- es the point where it has a relation with its Lord in perfect devotion and sincerity and when its consciousness is at rest, it is the Soul at Rest. If it has reached the station where it abandons all its choices and is a representative of Divine will, it is the Soul Well-Pleased with God. When its greatest aim is acquiring God’s good pleasure and approval and when it is always acting to this end in consideration of, “I am pleased with You, so be pleased with me,” then it is the Soul Pleasing to God. Finally, the soul which has the capacity to be completely adorned with the full manifestations of Divine qualities and Prophetic willpower and resolution is called the Soul Perfected or the Soul Pure.

A believer with an evil-commanding soul is either unaware of the sins he or she commits or lives an uncontrolled life. Even if such believers perform the daily Prayers and sometimes do supererogatory acts of worship, they are neither conscious of what obedience to God entails nor aware of what committing sins signifies. Such persons need to be assisted, aroused to become aware of the balance between fear and expectation, and made to deepen their knowledge, love and awe of God. It is the beginning of the major or greater jihad (striving) that such believers heed advice, engrave their errors in the memory so that they frequently criticize themselves, and are determined to regularly fulfill their religious duties and resist sins. So long as they continue to strive, some changes will begin to occur in their feelings and thoughts. They begin to see that not even their best deeds are sufficient and criticize themselves even for the least of their evil deeds. This is the second step in the soul’s journey, which is called the Self-Condemning Soul.

Those who have reached the stage of self-condemnation intend to set out toward Him in their heart. However, they falter, making errors that stain their good deeds, and beautiful things follow ugly ones in their life. But whenever they stumble and fall, they pull themselves upright in remorse for the evils committed, cleanse themselves of sin by sincerely asking God for forgiveness and by trying to uproot their inclinations toward evil through prayer. Not content with these, they continuously reprove them- selves, and suffer pangs of conscience. A time comes when they express these pangs with sighs from the depth of the heart, and when they put these feelings into invocations and tears in seclusion. Those with a self-condemning soul advance along the intermediate corridor between carnal appetites and sins, and spiritual peace. They show great care in keeping their hearts upright in devotion to God and their thoughts travel between the outer and the inner worlds. They utter “There is no deity but God,” they turn toward Him and display their yearning for Him, saying “There is none to be desired save Him,” and continuously whisper “He is the Truly Desired One” and “the only One deserving worship.”

In the sight of the self-condemning travelers who have deepened in spiritual attainment and reflection, the smallest errors and omissions begin to seem to them the greatest and most perilous lapses. When they rise to this point, they can more easily distinguish dark from light and good from evil, and when they think of the ugly face of sins, they feel repugnance, and when they think of good deeds, they moan with remorse and regret for not having done them. However, they are always hopeful and determined. It is of the souls that have attained this point that God says: “Those who strive for Our sake—surely We will guide them to the ways to lead to Us. Assuredly, God is with those of perfect goodness who act consciously that We always see them (29:69).” God inspires in them all that is good and beautiful, and the things He approves of together with how they can attain them. The soul that has traveled so far in order to reach God and has come to the point of receiving this inspiration is the soul receiving inspiration.

Travelers who have attained this stage are preoccupied with Him and with consideration of Him. They breathe with observations everywhere of the matchless beauty of His making and look on everything as a beautiful scene of wonder, and they overflow with feelings of appreciation. While saying “There is no deity but He” with their voices, their hearts beat with the truth, “There is none deserving worship save He.” Without being able to find the words to express their wonder in Him and His works, they can only utter “He,” and begin to fuel the love and zeal in their hearts with every breath they inhale and exhale. While their spirit burns, their voices petition Him with the words,

O cup-bearer, in the fire of love I have burnt away,
so give me some water!

Since I fell in love with a beautiful one, I have burnt away, give me some water!

In addition to the world losing its attractions, even those aspects of the Hereafter that do not directly look to the Divine Being Himself, become of secondary importance to them. They seek welcome by Him in His Presence, they adorn their speech with yearning for Him and make their words more meaningful by arousing a yearning for Him in the hearts of others. They fill themselves with gifts that come from Him and try to distribute these, pouring the honey in their spirits into the hearts of those who yearn for Him. They frequently say, as Lamakani Huseyin Efendi¹³¹ said,

Clean the fountain of your heart when it is filled,
keep your eyes open when your heart becomes an eye for your heart.
Drive out denial, and put the pitcher of your heart against that fountain;
so that the pitcher may be filled with its exhilarating water.

When they get filled to the extent that they continuously overflow with the gifts coming from God, they pour them into the hearts of those around them, calling them as Muhammed Lutfi Efendi did:

O you who are seeking God’s gifts, come and join this circle (of dervishes)!
O you who are passionately pursuing God’s light, join this circle (of dervishes)!

Travelers who have attained this point eat, drink, and sleep little, and always feel wonder. Their interest in and occupation with worldly affairs is only because they live in the realm where cause and effect have a certain part. Fulfilling the responsibilities that are inherent in their rank and being thankful for the gifts of the Ultimate Truth, they sometimes breathe with the manifestations of the Divine Names and sometimes with those of the Acts. However, if they cannot strictly continue their spiritual journey under the guidance of the Prophetic way or if they do not take refuge in the guidance of those who represent the Book and the Sunna, they may, due to the depth of their devotion, go so far as to make utterances of pride that are incompatible with the rules of Shari‘a; also they may display affectations instead of maintaining humility and self-possession in their relationship with God.

The final point that a soul who receives inspiration can reach is the ultimate point of certainty based on knowledge and the beginning of certainty based on observation. Until travelers reach this point, their belief that everything is from God is only a theoretical assertion. When they reach this point, they confess with all their being that everything is from God. Every time they make this confession, they feel new breezes of contentment and begin to taste every commandment of God and everything pleasing to Him as if it were a dimension of their nature. This means that they are at the threshold of attaining the soul at rest.

Although we may not completely understand the meaning of gratitude when we’re young, it is one of the first things we are taught. As soon as we are able to speak, we are prompted to say please and thank you. What we do understand, at that point, is that these words have power. The word “please” will get us that cookie and “thank you” will make the giver smile and gush, possibly showing us, and our manners, off to anyone nearby.

As years pass, we start to understand the feeling that comes with gratitude. That bike you have been yearning for all year is sitting next to the Christmas tree: instant joy. Being led out to the driveway where your first car glistens in the sunlight with a big bow on its roof: elation and disbelief. These scenarios bring immediate gratitude to the receiver of the gift and that overwhelming feeling of joy is undeniable.

However, as we get older it is not material items we are most grateful for. It is the steady paycheck that pays the bills; a full refrigerator; the hugs from our children or the arrival of that new grandchild. It is the sight of our spouse walking through the front door after driving for hours through a dangerous snowstorm. Gratitude is easy to feel when life is good, but being grateful when life is full of struggles is a challenge. When you lose your job, or your home is in foreclosure, gratitude is the last thing you feel.

It is during the hard times in life that we need to find something, anything, to feel grateful for. I have always been a happy, appreciative person. The past few years have been difficult, but I tried my best, almost challenging myself to find something to be grateful for each day. However, this past August had me wondering if I would ever be grateful again. Gratitude, happiness, and every positive emotion seemed to vanish the day my husband of twenty-one years passed away. How could I feel grateful about anything ever again when I lost my best friend, my confidante, my partner in everything?

Two years ago, my husband, Jeff, went to the doctor with severe abdominal pain. After several tests, the diagnosis came back: bladder cancer. I had lost my mother to cancer twenty-three years earlier, and that was a word I hoped never to hear again. But we remained hopeful and were determined to beat it. We flew from Boise to Seattle, where he had a softball-size tumor, along with his bladder, removed. His recovery was amazing and a few months later he was able to return to work; two months later he was in remission. We were truly grateful, and we clung to that feeling with every breath.

When Jeff went back to work I began to do research for something I had been dealing with myself. A few years earlier, I started to develop a twitch under my eye. At first, I wasn’t alarmed since I had gotten them before, and they never lasted long. I did, however, become concerned when they began to last several minutes, even pulling up the side of my mouth. In my research, I learned of a rare neurological disorder called Hemifacial spasm (HFS). This is when a blood vessel compresses the facial nerve causing involuntary spasms. An appointment with a neurologist, along with an MRI, confirmed that I did have HFS. The most common treatment for this is Botox injections. However, they can include some unpleasant side effects and typically become ineffective over time. The only cure is surgery—extremely high-risk surgery. And since it is a rare disorder, trying to find a qualified, experienced neurosurgeon can be difficult. I decided to live with it for as long as I could, but aware that it was a progressive disorder.

Just when things had gotten back to normal, almost a year to the day of Jeff’s first diagnosis, his cancer returned. He began chemotherapy again and handled it amazingly well. He would get chemo Friday mornings and then go to work for eight, sometimes twelve, hours with no issues. Meanwhile, my condition worsened. My face began contorting to the point that the whole left side would spasm and lock into place, making it difficult to open my eye. This happened a few times a day to almost every hour. I could not read, write, or sleep. It also made it dangerous for me to drive. After finding a brilliant neurosurgeon and waiting until Jeff’s chemo was completed, I had surgery. To this day, I am spasm-free. For that, I am eternally grateful.

But the hits kept coming! Five weeks after my surgery, I ended up in the emergency room needing a blood transfusion due to severe anemia. I ended up needing laparoscopic surgery for a bleeding ulcer. A week after my surgery, Jeff was admitted to the VA Medical Center’s Intensive Care Unit for severe sepsis. Two weeks later was Christmas. Although we weren’t able to have our usual Christmas celebration, we were grateful to be alive and home together.

In February, we were notified that our rental home was being sold, and we had to move at the end of our lease, May 4^th. Luckily, a different property our landlords managed became available. In April, in the midst of packing, our eighteen-year-old cat became very ill and had to be put down. Ten days later, we lost our fifteen-year-old dog. Two weeks after that, the day before our move, Jeff’s doctor found blood clots in his arm. He was put on blood thinners and not allowed to lift anything for months.

We moved into the new house and for the first six weeks, it was great. Then Jeff began having pain again. Between June and July, he was in and out of the hospital numerous times. But in July we were feeling very hopeful. There had been some positive results from an immunotherapy drug, specifically for bladder cancer. He started on that in July and did very well. At the beginning of August, he had his second treatment. That night he was admitted into the hospital, where he stayed for eighteen days. At that point, there was nothing more they could do, and he was then released to come home, with hospice. He passed away seven days later.

Was it difficult to find something to be grateful for during all of this? Yes. But it wasn’t impossible. In truth, when I focused on being grateful for something it was like taking a deep breath of fresh air. When I went through my HFS, I met a wonderful group of people living with the same condition. It can be a very isolating experience but this group of people showed me I wasn’t alone. Also, through this group, I learned about the surgery and what to look for in a qualified surgeon. Without them, I would never have found that incredible neurosurgeon. For that I am grateful.

During Jeff’s battle with cancer, I was grateful for every minute we had together. I was thankful for every positive test result. I was extremely grateful for the incredible teams of medical professionals that gave us more time together than we would have had without them. I was grateful that we had to move to a different house. The house we moved to is thirty minutes closer to the three different hospitals we frequented.

Although I would give anything to have Jeff back, I am grateful he is no longer in pain—physically, mentally, and emotionally. One of the many awful things cancer does, especially in the later stages, is that it robs a person of their dignity. He went from being a strong, capable, hardworking man to someone who was too weak to get himself dressed, stand up, or use the bathroom without help. When I think of those things, along with the many other negative aspects of the disease, I am grateful he is no longer going through that kind of suffering.

When Jeff was first home with hospice, I was cleaning him up. I did not have much training from the nurses regarding his care. I really didn’t know what I was doing and I was afraid that I would hurt him. When I was done I stepped outside to catch my breath and wipe away tears I didn’t want Jeff to see. There, standing in our driveway, were eight of our friends who came to visit with hugs and words of comfort. That week there were fifty people who came to visit and let Jeff know how much they loved him. These same people brought food, helped with his care, forced me to try to eat and sleep. They made Jeff laugh and shared stories of times that meant so much to him. For that we both were grateful. But the thing I am most grateful for is the twenty-two years I had with Jeff. Good or bad times, there is no one else I would rather have had by my side in this life.

Sound is created by fluctuations in air pressure caused by a vibrating source that stimulates hearing in humans. We produce sound with the help of organs such as the vocal cords, lungs, and muscles. Humans speak using sounds at the limited frequencies they can perceive (20 Hz-20 kHz).

Music is defined as the artistic expression of emotions, thoughts, and symbols in one or many voices. Scientists have established music’s positive or negative effects on the human body in all conditions and environments and determined that our body reacts differently to various types of music and sound. The nature of this effect may vary depending on parameters such as the emotional state of the person, time, and place.

Music therapy is an independent specialty of modern medicine and has been used since antiquity. In Islamic civilization, Sufis mentioned the use of music in the treatment of mental and neurological disorders, and scholars like al-Farabi (d. 950) and Ibn Sina (d. 1037) defined the principles of music in treatment.

According to scientists, music can not only be used effectively in the treatment of diseases—it can also be deployed as a shield against psychological problems such as stress and intense anxiety by selecting the appropriate rhythm, sound, and musical genres. Recent years have witnessed several studies on the psychological and physiological effects of music on humans [1]. According to these studies, music affects the human brain at an anatomically measurable level; this explains how music can change a society’s understanding of culture and art [2].

By altering the levels of mood-affecting hormones such as serotonin, dopamine, adrenaline, testosterone, and serotonin, music can lower respiration, heart rate, and body temperature; stabilize blood pressure and cerebral blood flow; and lead to deep relaxation and enhanced quality of life [3]. It reduces anxiety and nausea and alleviates insomnia by diverting patients’ attention to other activities. Music also plays an important role in improving the quality of life of end-stage cancer patients [4]. The positive effects of music on pain and anxiety are prominent.

Which area of the brain perceives music?

It is crucial to be familiar with the relevant musical terminology to have a better understanding of this matter. Timbre is the characteristic that distinguishes the sound produced by the vibration of an object from the sound produced by a different object at the same height. Rhythm is the harmony of sound resulting from the repetition of stress, length, or sound features and stops in a verse or a note. Melody is a sequence of sounds created in line with a certain rule.

These sounds are processed in different regions of the brain that are separate but close to one another. Damage to these areas, through trauma or similar reasons, may complicate hearing or distinguishing the relevant sound. For instance, damage to the auditory cortex in the right temporal region may result in the inability to keep a regular tempo, while damage to the cerebellum and basal ganglia may result in impaired rhythm perception and inability to produce rhythm. While rhythm is detected in the motor area, timbre is sensed in the auditory area. The right hemisphere of the brain has better frequency resolution, which is crucial for processing precision. Meanwhile, the left hemisphere has better temporal resolution, which is imperative for speech analysis.

Timbres activate the right auditory cortex, whereas rehearsing music stimulates the dorsolateral and inferior frontal cortex. Melodies are typified abstractly in the brain while emotional melodies activate the fronto-occipital region of our brain. The superior temporal cortex detects the instrument and speed changes. Our secondary auditory cortex is activated when we visualize music; listening to a favorite piece of music activates a different sensory area [5].

In temporal lobe disorders, some may lose certain musical abilities such as playing and identifying melodies, singing, and following rhythm. For instance, Maurice Ravel, one of the greatest composers of the 20th century, could listen to pieces of music but could no longer compose after cerebral palsy affected the left hemisphere of the brain.

 Effects of noise on human physiology

Noise is the common name for meaningless and unpleasant sounds that have an adverse effect on people. While some may hear sounds as music, others may hear them as noise. The threshold of discomfort varies from person to person.

The effects of noise on human physiology are divided into short-term effects that disappear with the cessation of noise and long-term effects that can last for hours or even days. In most people, noise causes short-term effects such as stress, changes in heart rate, respiratory rate and blood circulation, muscle spasms, startles, and insomnia. These side effects are felt more acutely during sleep, with automatic reactions to sudden and loud noises. In addition, gastritis, ulcers, high cholesterol, hypertension, and migraine disorders are common long-term effects of noise. Even in cases where people think they are accustomed to noise, these side effects cannot be inhibited [6].

Exposure to intense and loud music, defined as music intoxication, increases the height of alpha waves in brain electrical activity. This situation varies from person to person, but as reported in some people even toxic doses can be considered normal. This explains why music is perceived and processed differently by different people, and while in the same person, character and music perception show parallelism.

Musicogenic epilepsy

Current technological developments have expanded our access to all kinds of music. Studies have shown some disorders can be triggered in line with the type and volume of music listened to. Epilepsy tops the list of these disorders. It is well known that exposure to sunlight or flashing or flickering lights in the 16-25 Hz range can trigger epileptic seizures. While some patients made to listen to music during a seizure benefited from the music and their seizures ceased, others’ seizures deteriorated [7]. The reason for this bidirectional effect of music on epileptic attacks is not yet fully understood.

Musicogenic epilepsy, where epileptic seizures are triggered by music, is a rare form of epilepsy, first defined in 1937. The French composer Berlioz, who contributed significantly to the composition of the modern orchestra, suffered from musicogenic seizures. Affecting one in a million people, these seizures are often triggered by listening to or playing music, or by its inspiration or conception. It has even been shown that some patients’ seizures can be triggered by the type of music, instrument, or composer they listen to. Church bells, the melody of La Marseillaise (the national anthem of France), some hymns, and even some songs sung in a low, muffled, or metallic voice have been shown to trigger such seizures [8]. Experts say the therapeutic efficacy of music can be demarcated by understanding the mechanism.

Musical pharmacology

Musical pharmacology is when, after a diagnosis, various kinds of music protocols are uploaded to digital tablet device and sent to the patient’s home. Analyzing the music pieces the patient prefers to listen to, the active parts are extracted and blended into balanced medical compounds. The most common areas where such medical compounds are used include psychosomatic disorders, pain, anxiety, depression, insomnia, and certain cardiac arrhythmias [9].

Studies examining the effects of music therapy during pregnancy suggest that nurses and midwives providing maternity care would be wise to take advantage of the positive effects of music. In pregnant women with pre-eclampsia, music can help keep fetal movement and heart rate at normal levels by lowering blood pressure [10].

Newborn babies, especially premature ones, benefit the most from music in terms of stress reduction, pain detection, and hearing improvement [11]. This notion is supported by the common practice of singing lullabies to calm crying babies or babies who have trouble falling asleep, or singing prayers, for instance the call to prayer (adhan) in Muslim cultures, often achieving the desired result.

A study in Japan has shown fetuses feel their mothers’ reaction to noise, and that noise increases the incidence of low-birth-weight babies. The human cochlea, an important component of hearing, completes its development by 24 weeks of gestation, and by 26 weeks, the fetus can respond to sound stimuli. By the 35th week of gestation, the fetus can distinguish between sounds with a frequency of 250-500 Hz and between the sounds, “baa” and “bee.” This shows that babies’ sense of hearing develops significantly before birth [12].

As seen, human interest in music and sound begins in the womb and continues over a lifetime. When we listen to a piece of music that suits our mood, we unconsciously follow the rhythm with our brain waves, heart rhythm, breathing and emotional state. Each person reacts differently to music and sound. This is due to the two-way effect of music. People like or dislike music based on the effects it has on the body. This is an individual response, based in part on our anatomical, physiological, and psychological functions.

During speech, Broca’s and Wernicke’s areas in the left hemisphere of the brain are mentally active. It is believed these areas may have another feature representing feelings and emotions. This feature perceives the emotional components of speech, including melody, intonation and gestures. Voices, words, gestures and facial expressions move humans indiscriminately. Likewise, reciting prayers with a beautiful voice and its impacts on the human nervous and endocrine physiology is a subject for further research.

We can liken the human organism to a unique work of art and an ensemble of tunable, delicate instruments [13]. Everyone should discover the music and rhythms in sync with the physiology of their own body, and not tune their body to random types of music and sounds. Hence, it would be wise to manage our body like a conscious conductor. It is essential to find the music that suits our nature.

References

• F. S. Ünal, “Müzigin ses olarak insana fizyolojik etkisi”, Kültür Evreni Dergisi, 6(22), 2014, s. 118–125, www.kulturevreni.com/22-118.pdf.
• S. A. Azizi, “Brain to music to brain!”, Neuroscience Letters,459, 2009, s. 1–2.
• N. Karamizrak, “Ses ve Müzigin Organlari Iyilestirici Etkisi”, Kosuyolu Heart Journal, 17(1), 2014, s. 54–57.
• H. Covington, “Therapeutic music for patients with psychiatric disorders”, Holist Nurs Pract, 15, 2001, s. 59–69.
• A. J. Blood ve R. J. Zatorre, “Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion”, Proc Natl Acad Sci US, 98(20), 2001, s. 11818–11823.
• MEB. Gürültünün Etkileri. Ankara: Millî Egitim Bakanligi, Aile ve Tüketici Hizmetleri, 2012, s. 1–25.
• A. T. Berg ve ark. “Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology”, 2005–2009; Epilepsia, 51, 2010, s. 676–685.
• S. E. Brien ve T. J. Murray, “Musicogenic epilepsy”, Can Med Assoc J, 13, 1984, s. 1255–1258.
• I. Ün, “Farmakoloji ile müzik arasinda olasi etkilesimlerin arastirilmasi”, Lokman Hekim Dergisi, 6(3), 2016, s. 159–164.
• E. Toker ve N. Kömürcü, “Effect of Turkish classical music on prenatal anxiety and satisfaction: A randomized controlled trial in pregnant women with pre-eclampsia”, Complementary Therapies in Medicine, 30, 2017, s. 1–9.
• J. Loewy ve ark. “Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy”, Am J Electroneurodiagnostic Technol, 46(4), 2006, s. 343–355.
• S. E. Trehub, “The developmental origins of musicality”, Nat Neurosci, 6(7), 2003, s. 669–673.
• D. Campbell, Mozart Etkisi, Istanbul: Kuraldisi Yayincilik, 2002, s. 156–343.

“Medical education is the process for training doctors, subordinate to the dominant economic and social structures in societies in which it takes place.” [1]

Over the last decades, we have witnessed increasing income inequality. The US is no exception. The discrepancy between upper-income and low-income households has been on the rise [2]. This, of course, manifests itself in medical education, making it accessible to only a fraction of society. Approximately 50% of medical students come from families whose incomes are in the top quintile, and 80% come from the top two quintiles. Yet, these doctors are expected to empathize with patients from lower socioeconomic status (SES) and understand the difficulties a patient must overcome before being able to step foot in a doctor’s office [3,4]. They must be able to recognize the obstacles a patient has overcome, whether that be losing money from missing work or spending hours on a bus to be seen for merely 10 minutes. Imagine going through all this trouble, only to be judged for having low medical literacy or not speaking a specific language, and then being sent home feeling your problem is unresolved. The fact that many experience this for a medication they may not be able to afford ensues further distrust in the medical establishment.

The structural issues mentioned above are present in every aspect of our healthcare system. In medicine, fee-for-service—being paid for each office visit, procedure, CT scan, etc.—is how doctors are paid. This draws a strong parallel to how medical school applicants are selected. How many hours did you volunteer, how many leadership positions did you hold, and how many test questions did you get right? Subjective measures of a student’s potential, resilience, and grit, such as if they had to support a family during the process or had to make tough decisions such as picking between MCAT test prep materials and groceries, hold little to no weight depending on the institution. Without considering such inequalities and offering bottom-up solutions to these issues, our healthcare system is likely to remain dominated by people who have difficulty empathizing with a socioeconomically diverse patient population.

Our healthcare system, however, isn’t broken—at least for some people. The structural issues work quite well for those who built the system to benefit from it. We have a very profitable “disease care system,” according to Escape Fire: The Fight to Rescue American Healthcare, a documentary that analyzes the American healthcare system and some of its underlying issues: “It doesn’t want you to die, and it doesn’t want you to get well. It just wants you to keep coming back” [5]. What incentive does a person from the top quintile have to change a system that has benefited them their entire lives? A UK study illustrated a direct association between medical student SES, academic ability, and specialty choice [6].

As noted in Escape Fire, specialized physicians are given more seats at the table than primary care physicians in health policy matters because they fund pharmaceutical and high-tech companies with the nature of how they practice medicine—reinforcing a “disease care system” [4]. Medical schools that do not prioritize socioeconomic diversity in their incoming classes will train a workforce that will likely remain complacent in a healthcare system that benefits a handful of people. It is important to note, however, that this complacency does not necessarily come from a place of ill intention—after all, we all promise to, “first, do no harm” [7]. Like the phrase, “ignorance is bliss,” when we are not exposed to something, it is less likely to be on our radar. We are less likely to even perceive issues if we are not affected by them. Integrating curriculums focused on emotional and social intelligence alongside efforts to increase diversity will no doubt spark conversation and dialogue surrounding these issues, leading to new and innovative solutions.

Thanks to various social media platforms, these apparent issues are being discussed among healthcare professionals more than ever. For instance, #medtok—the medical side of the social media app TikTok—has become a platform for such discussions. A user called @pathdoctormd asks, “When did u first realize ur friends in med school came from families that were way richer than yours?” and answers, “when a group of my friends in medical school were planning a trip to Europe during our one week of vacation for spring break”[8]. The comments include answers as well: “I only applied to the medical schools my family donated to” (@dmccooey4); “When I heard about their private jets … two different individuals had grandfathers who OWNED entire med schools. Legacies are a diff breed” (@neebsz); “My boy is in medical school and tells me similar stories. He lives on lentils and they thought he was a cool vegan … No, we are just poor” (@distractedpainter).

I had a similar experience after learning a classmate’s father had sponsored our whitecoat ceremony, and other parents sponsored rooms and various parts of the new medical school building. Even one of my classmates posted a TikTok explaining her medical school acceptance story, lacking support from advisors and applying to only six schools due to cost [9]. On October 16, 2021, @drglaucomflecken posted a video criticizing the greed of the Association of American Medical Colleges (AAMC) in the Electronic Residency Application Service (ERAS) process—again supporting how those from higher SES backgrounds may be more likely to match into more competitive specialties, getting more seats at the health policy table that will determine what the future of American healthcare will look like [10].

From the collective experiences shared in the previous paragraph, it is challenging to believe peers from higher SES can genuinely empathize with future patients—who will be strangers—when they already struggle to empathize with their medical school peers. Greater exposure to classmates from various SES is a crucial way to combat this. An unspoken power dynamic may even exist between higher SES and lower SES students, and lower SES students may not be comfortable sharing their backgrounds. Not only is increasing admissions in this population necessary but creating space for them and their stories is also non-negotiable if we’re to truly promote dialogue among peers.

Research shows “diversity among providers leads to better patient outcomes, greater attention to cultural issues in the treatment process, reductions in disparities in health outcomes and access, innovation in thought and practice, and increased satisfaction among patients” [11, 12]. Many argue that this gap is closing; however, in fact, it is actually widening for some groups. For example, low-SES are underrepresented in medicine [13, 14]. Pipeline programs and holistic criteria in the application process are missing the mark if medicine is not diversifying: “It seems impracticable that, Dr. Nakae posits, qualified potential trainees should spend thousands more dollars and hours to recuperate a few tenths of a point in their grade point averages before applying. Do the additional classes they take make them better doctors? Do they make a difference, or only deter and delay applicants?” [12].

There is a national call for more physicians, and studies have shown there is no evidence that higher MCAT scores or GPAs predict better doctors. They predict approximately 50% variance in performance in the first two years of medical school. This is one of the least considered elements of residency program applications, yet the most important factor in a medical school application [15, 16, 17].

In Escape Fire, Dr. Ornish says, “We change medical practice, we change medical education” [4]. I would add that we must also change the medical school application process, making it more accessible and affordable. This will, in turn, create a more accessible healthcare system. Consequently, a healthier society will decrease the financial burden on the state, thus making room for improving other aspects of people’s lives. Dialogue—making spaces to have discussions where these voices and concerns are heard—is the first step to developing simple yet innovative solutions to this complex issue.

I would humbly like to conclude by proposing some potential solutions:

1) Preventing the “Leaky Pipeline” phenomena, which is defined as an “early decline in interest in premedical studies among underrepresented minority undergraduate students.”

• Increasing high school programs in low-income areas to motivate students to prepare for college;
• Collaborating on grassroots efforts to fund students who are accepted into college;
• Organizing coaching and mentorship programs to continue to support and motivate students through the difficulties of college and medical school admissions. (One example of such an organization is The UpLIFT (Under-represented, Low Income and First-Time students) Project.) [18]

2) Increasing funding and support through government grants.

• Advocating for increased educational opportunities at the high school, college, and medical school levels by writing letters to Congresspeople and attending town halls in local communities.

3) Increasing transparency and accountability of medical schools and the AAMC.

• Requiring more detailed public disclosure of applicant and matriculant data in medical school and residency programs;
• Not only focusing on recruitment but also retention activities to improve access.

4) Increasing ease of access to support and resources within the medical education system.

• Funding free healthcare for students within institutions;
• Funding a variety of free mental health resources within institutions;
• Increasing spaces for discussion of topics around diversity.

5) Integrating emotional and social intelligence education in medical education curriculums.

• Allocating time within existing curriculums to train and practice emotional and social intelligence skills;
• Initiating conversations regarding cost in didactic lectures as well as clinical opportunities.

References

• Garcia JC. Características generales de la educación médica en la América Latina [General characteristics of medical education in Latin America]. Educ Med Salud. 1969;3(4):267-316.
• Horowitz, Juliana Menasce, Ruth Igielnik, and Rakesh Kochhar. “Trends in U.S. Income and Wealth Inequality.” Pew Research Center’s Social & Demographic Trends Project. Pew Research Center, August 17, 2020. https://www.pewresearch.org/social-trends/2020/01/09/trends-in-income-and-wealth-inequality/.
• Chun LY, Lee WW. “What do your parents do?”- A very informative question. Aamc.org. Accessed October 17, 2021. https://students-residents.aamc.org/medical-student-well-being/what-do-your-parents-do-very-informative-question
• Rafi AG. Secondary Medical School Applications Place an Unfair Financial Burden on Middle- and Lower-Income Applicants. Acad Med. 2017;92(6):728.
• Matthew, Heineman et al. 2013. Escape Fire: The Fight to Rescue American Healthcare. Santa Monica, Calif.: Lionsgate.
• Kumwenda B, Cleland J, Prescott G, Walker K, Johnston P. Relationship between sociodemographic factors and specialty destination of UK trainee doctors: a national cohort study. BMJ Open. 2019;9(3):e026961. Published 2019 Mar 27. doi:10.1136/bmjopen-2018-026961
• Edelstein, Ludwig. The Hippocratic Oath: Text, Translation and Interpretation. Baltimore: The Johns Hopkins Press, 1943.
• https://vm.tiktok.com/ZM8YhLsBS/
• it only takes one. https://vm.tiktok.com/ZM8Yh4ShM/
• https://vm.tiktok.com/ZM8jG1tA3/
• Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.
• Nakae S. The Backgrounds and Outcomes of Allopathic Medical School Applicants: Exploring Stratification and Inequality. Published online 2014. https://ecommons.luc.edu/cgi/viewcontent.cgi?article=2293&context=luc_diss
• Le HH. The socioeconomic diversity gap in medical education. Acad Med. 2017;92(8):1071.
• Morris DB, Gruppuso PA, McGee HA, Murillo AL, Grover A, Adashi EY. Diversity of the national medical student body – four decades of inequities. N Engl J Med. 2021;384(17):1661-1668.
• Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: A meta-analysis of the published research. Acad Med. 2007;82(1):100-106.
• Julian ER. Validity of the Medical College Admission Test for predicting medical school performance. Acad Med. 2005;80(10):910-917.
• Green M, Jones P, Thomas JX Jr. Selection criteria for residency: Results of a national program directors survey. Acad Med. 2009;84(3):362-367.
• https://uplift.guide/

Ceyda Sablak is a resident pediatrician at Tripler Army Medical Center