Differentiating Acute Otitis Media (AOM) from Otitis Media with Effusion (OME) Using Autofluorescence of NADPH in Neutrophils; Medical Deserts and the Inequitable Distribution of Medicine

Introduction
Diagnosis of disease by clinicians is one of the most important aspects of the profession but oftentimes it is difficult for clinicians to differentiate between various diseases due to the diagnosis methods available. My Capstone project group found that there are a large number of misdiagnoses occurring with patients who exhibit signs of ear infection. Specifically, when attempting to differentially diagnose two types of ear infections: Otitis Media with Effusion (OME), where fluid exists in the ear, and Acute Otitis Media (AOM), where the fluid in the ear is infected and requires antibiotic treatment; studies have found that these diagnoses are currently unreliable about 27% (Pichichero & Poole, 2001). The misdiagnosis of these diseases leads to a direct cost of $4 billion per year due to the unnecessary removal of adenoids or tonsils, over-prescriptions of antibiotics, and loss of hearing (Rosenfeld et al., 2016). For our technical project, my Capstone group is attempting to reduce the level of misdiagnosis occurring with these types of Otitis Media by developing a proof of concept to differentiate between the infected and uninfected fluid in the middle ear to differentially diagnose OME and AOM.
In addition to the problem of medical misdiagnosis, another large issue that is under-addressed in the United States is the inequitable distribution of medicine and medical supplies around the country. Medical deserts, which are medically underserved areas that have a lower quality of healthcare, remain a big factor in the unequal nature of the field of medicine. Medical deserts typically exist in low-income and rural communities and are often created along racial lines where there typically exists lower numbers and lower quality of healthcare professionals (Lucas-Gabrielli & Chevillard, 2018). Through the synthesis of literature such as peer-reviewed research journals and medical blogs, my STS Thesis topic explores examples of, reasons for, and future approaches to address the inequalities in the medical field.

Technical Project: Differentiating Acute Otitis Media (AOM) from Otitis Media with Effusion (OME) Using Autofluorescence of NADPH in Neutrophils
For our technical project, my Capstone group is addressing the high level of misdiagnosis occurring between Acute Otitis Media (AOM) and Otitis Media with Effusion (OME) by developing a proof of concept to differentiate between the infected and uninfected fluid in the middle ear. To develop the proof of concept, we are designing and integrating various electrical and optical components into our product design to use the autofluorescence properties of the middle ear infection to differentiate between AOM and OME. When an infection is present in the middle ear, an immune response occurs causing neutrophils, which release high concentrations of NADPH, to respond by accumulating in the location of the infection (Segal et al., 2012). The NADPH at the site of the infection is then excited by our product using its autofluorescence properties to be excited at a wavelength of ~360 nm and emit at a wavelength of ~450 nm (Croce & Bottiroli, 2014). Unlike other diagnosis methods, our product allows for diagnosis by determining the contents of the middle ear infection, rather than basing a diagnosis on visual observation.

STS Topic: Medical Deserts and the Inequitable Distribution of Medicine
Healthcare and medicine are included in a rapidly growing field in the United States along with the rest of the world. Through the continuous development of medicine, patient care quality and positive patient experiences may be generally increasing, but the increasing complexity of the field also causes increasing costs and decreasing accessibility (Mark & Hlatky, 2002). By reviewing scholarly literature and research discussing accessibility and inevitability in medicine, my STS research and Thesis paper aim to provide examples of failures in medical distribution techniques and demonstrate that our healthcare system must become more equitable. Through my research, I am able to discuss the inequitable nature of the medical field regarding medical deserts in the United States, the unequal distribution of medical supplies during the COVID-19 pandemic, and the impacts of racial inequalities on the unequal distribution of medicine over time.

Conclusion
Overall, medicine is a complex and ever-growing field, especially in the United States. By addressing issues such as misdiagnosis and equitability in medicine, the future of the field is looking up to becoming a more equal space. My technical project is a step to lower the rate of misdiagnosis as well as bringing to attention the extreme impacts of new and improved medical devices when they are used in an equitable manner. Additionally, my STS research topic is bringing to light some of the drastic inequalities that exist in the medical field through the discussion of medical deserts, the unequal distribution of medical supplies during times of emergency, as well as the racial inequalities experienced by many patients in medicine.

Acknowledgments
I would like to express my deepest gratitude to my Capstone advisor, Dr. William Guilford, for his continuous guidance and support throughout the development of our proof of concept Capstone project. I would also like to emphasize my appreciation for my Capstone partner, Abigail Boitnott, and my technical project team member, Esha Tulsian, for the endless patience and support throughout the entire technical project. Finally, I would like to thank Dr. Joshua Earle for supporting me throughout the development of my STS topic including my Thesis and Prospectus papers as well as thank Dr. Timothy Allen, Dr. Shannon Barker, Noah Perry, and Vignesh Valaboju for their guidance throughout my Capstone project and technical paper.