9 Finding Research at Rutgers 10 Medical School Explained 13 Lessons for Undergraduates 18 Healthcare Payment Alternatives
1 ISSUE 8 II May 2013
STAFF EDITOR–IN–CHIEF
SECRETARY
EDITORS
Shashank Pandya
Vishal Patel
Kristin Baresich
MANAGING EDITORS
TREASURER
Shireen Hamza
Kaiwal Patel
Suhal Shah
EVENTS
Nirali Dave
LAYOUT EDITORS
Chirag Bansal
Meghna Dev
Yuliana Noah
PUBLIC RELATIONS
Nikhitha Kotha
Ivana Ganihong
Erum Farooqui
Justin Marson
WEBMASTER
Reshma Shiwdin
Harvinder Singh
Anshika Verma
Ruchika Bhargav Christina Chang Sailaja Darisipudi
Amit Patel Sri Puli Hima Sathian Isaac Song
Letter from the Editor-in-Chief
Pujitha Talasila Dear Readers, Welcome to the eighth issue of The Examiner – Rutgers Pre-Health Journal! We are Rutgers University’s premier pre-health media publication that is ran for and by undergraduate students with the mission of informing fellow pre-health students regarding the current happenings in the healthcare field. The Examiner has come a long way since we revived this organization in the Fall 2012 semester. We are continually striving to improve the quality of our journal and our organization by not only diversifying the range of topics that are presented in every issue in addition to having an engaging layout but also by organizing informative events. As always, this issue exemplifies The Examiner’s tenet of being a multidisciplinary journal that bridges the current gap between the variety of pre-health sciences and the humanities by presenting diverse issues relating to healthcare policies, geopolitical issues, complex societal issues, health economics, medical school admissions, fun columns, etc. It is our hope that we can demonstrate how these seemingly unrelated topics might affect the future of our fellow pre-health students in the healthcare field. I would like to thank and congratulate our executive board members, journalists, editors, RUSA allocations, and faculty as well as administrative advisors for contributing to this issue and ultimately to serve the needs of the Rutgers pre-health community. The entire Examiner executive board, journalists, and editors all hope that you, the readers, will enjoy reading this latest issue of The Examiner, and we would sincerely appreciate your feedback on our Facebook page, Twitter, or at ruexaminer@gmail.com. For more information on how to get involved with us as a journalist, editor, or an executive board member, please contact ruexaminer@gmail.com. Thanks and regards,
Shashank Pandya Editor-in-Chief
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How Not to Be the Next KONY 2012 Pre-health students are required to be service oriented and have an undying thirst to help people. What better way to prove this to medical schools than volunteering at your local hospital? But this seems far too vanilla and typical. No, to spice up your resume, you will need a recipe that proves you are the Overlord of Altruism. What better way to do this than to go abroad to help the underprivileged and to change the world with your bare hands? The dangerous subtext here is, “Look at me, medical school! I’m an American, educated University student! I took one course on Third World Women and am now more qualified to understand what underprivileged South African women need than those South African women themselves!” This line of thinking is exactly where the social justice agenda needs re-evaluation because it leads to misguided and ineffective attempts to “save” people rather than working with them as equals to improve their lives. These erroneous assumptions are commonly and habitually perpetuated by the media and are detrimental to the mission of aiding those in less fortunate circumstances. For the ignorant, well-intentioned prehealth student with a savior complex, here is a brief primer outlining the harms of certain attitudes towards social work. This is to keep you from making a misguided and embarrassing viral video campaign about an African warlord. You know which one. 1. Othering the “other:” Isn’t globalization so awesome? Those developing countries will start to be advanced, like us. Euro-centricity is embedded in our Western culture and dialogue. We relate every place and culture to the Global North (aka: us). When we label a country as underdeveloped or developing, we assume that a Western society is the standard that every other country is related to or “developing” towards. The irony here is that the global inequalities rampant in the world are more often than not rooted in colonialism. Regardless of our ethnicities, people living in America tend to create this duality called the West (the center of the universe) and the Rest (“the other”). Just because people in other countries do not live like people in the Global North, that does not mean that they are doing things the wrong way. 2. Victimizing the “other”: “Those brown men over there are savages, they raped a young girl. Glad that doesn’t happen here.”
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SRUTIKA SABU The recent New Delhi rape case was reported internationally. Though it showed that more effort is needed to stop gender violence across the globe, the discourse in America around the brutal rape was shocking: what happened in India does not happen here. American media often victimizes Indian (or Arab or African) women, as if they need to be saved from Indian (or Arab or African) men. It monolithically categorizes citizens of another country without representing them as a diverse group of human beings with behaviors and political opinions as diverse as the citizens of America. When Westerners think of African children, we too-often think of victims who we need to save. While we do have global humanitarian responsibilities, we must understand that we are not saving people – we are helping our equals and gaining much in the process. 3. Ignoring the Agency of the “other:” “What do you mean there’s a local NGO for this already?” One of the by-products of victimizing residents of an underprivileged area is to disregard their agency. When a disaster occurs in “third world” countries, the West feels obliged to tell the governments of affected countries how to handle the situation, as if the country’s own government and NGOs would not be the main force in solving the problem. Some UNICEF trailers show how UNICEF provided a village with a solar pump and made portable drinking water accessible. While this is wonderful for the village, it does not portray how local NGOs actively contacted UNICEF to obtain water pumps and aided in their installation. UNICEF did not just come out of the blue like an illusionist who got transported to Oz with all its inhabitants wondering if he was the “chosen one.” It was a collaborative effort: a mutual exchange in which UNICEF had the resources and the local NGO had the know-how and outreach to distribute those resources to those in need. The Cliff Notes summary: 1) Think outside the Euro-centric box. 2) Do not victimize/vilify the people you are helping. 3) Remember that humanitarian efforts are a collaborative effort. With these things in mind, go change the world, you altruistic soul.
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MEGHNA DEV
Birth control pills are a common form of contraception and much research is being done about the link between birth control and breast cancer. There are concerns that the levels of estrogen and the duration required for these pills may significantly increase the risk of breast cancer, but studies show conflicting results. A study in the Journal of the American Medical Association shows that women with a strong family history of breast cancer are eleven times more likely to develop the condition when taking the pill1. However, the study’s conclusion may no longer be relevant, since the study recruited "women who took birth control pills prior to 1975, when [birth control] contained much higher levels of hormones estrogen and progestin than today's lower-dose pill"1. Other studies show that taking birth control pills may reduce the risk of ovarian cancer. Valerie Beral, a professor at Oxford, and researchers from the Collaborative Group on Epidemiological Studies of Ovarian Cancer analyzed data from
the latter half of the 20th century and found a link between a woman's risk of ovarian cancer and birth control pills2. They stated after going through data from over "45 studies of over 23,257 women with ovarian cancer and 87,303 without the disease," that there was a correlation between a lower risk of ovarian cancer and a longer length of time on the pill. 2 They found that "of the women with ovarian cancer, 31% had taken the pill at some point in their lives, compared to 37% of the women who did not have ovarian cancer”.2 They reported that “taking the pill for 15 years or more cut a woman's risk of
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ovarian cancer by 58%; 10-14 years of pill use cut risk by 44%; and 5-9 years of use cut risk by 36%. But even women who used the pill for only 14 years saw a benefit: their risk was cut by 22%".2 The researchers also stated that the pill still had a beneficial effect on women, even 30 years after they stopped taking it.2 This study was thorough, and the large amount of data analyzed shows that its results are statistically http://scrubs.scrubsgiant.com/wp-content/u significant. Researchers took into account "the role of age, ethnicity, education, reproductive history, family cancer history, use of hormone replacement therapy, body mass index, and consumption of tobacco or alcohol, in addition to other factors"2. Though the researchers examined the effect of estrogen dosage on the risk of developing ovarian cancer, more research needs to be done in order to determine the effects of estrogen dosage commonly used in birth control pills today. When deciding to use birth control, an individual’s family history is a key factor, and must be discussed with a doctor before taking pills. Research cautions people with a "family history of breast cancer related to mutations in the BRCA genes" to be cautious. 1 Those that are carriers of, or suffer from, any genetic abnormalities related to breast cancer must also be careful. 1 History of specific alterations of these genes must be discussed, as some may be more pernicious than others.1 In addition, age, weight, and a woman's reproductive history may also play a role in the risk and safety of these pills. 2 As always, consult with a doctor or specialist and make sure to analyze the risk that other forms of contraception may specifically have for you. References: 1 The birth control pill and breast cancer risk. (2012, June 23). Retrieved from http://www.webmd.com/ breast-cancer/guide/pill-breast-cancer-risk 2 American Cancer Society (2008, January 28). Retrieved from http://www.cancer.org/cancer/news/news/ birth-control-pill-use-cuts-ovarian-cancer-risk
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The Cost of a Long Night: Long Hospital Shifts and Poor Healthcare CHIR WEI STEPHANIE YUEN The medical professional is not a skilled automaton but rather a human being with limitations that include the need to get a decent night’s sleep to function properly as a physician, nurse, physician’s assistant, etc. Think about the last time you pulled an all-nighter while trying to furiously review the notes you should have gone over weeks ago. On the day of the exam, your mind was probably not as sharp as it should have been to ace that exam. A similar dilemma faces the doctor who has to perform at a high capacity on few hours of sleep in order to help the patients that come under his or her care. One study examined 500 “unscheduled returns to the emergency room” (i.e. patients who came back to the hospital for medical purposes 72 hours or less after a prior discharge). 4 The findings showed that the factor which contributed significantly to an increase in the unscheduled returns was medical error which covered everything from a wrong diagnosis to incorrect information given to the patient.4 These errors in judgment and knowledge may be partly attributed to physician exhaustion from a long shift. Another study in 2004 showed that cardiovascular interns were 39.5% more likely to commit a medical error when working on a traditional schedule with extended work shifts (being “on call”) every third day while working 80 hours a week.3 This was compared to interns who worked fewer hours every week with the long 24-hour shifts eliminated.3 Yet another study in 2012 found that one third of nurses who worked 12-hours shifts were fatigued during their work hours.2 That fraction of nurses experienced inter-shift
fatigue or tiredness at the beginning of their shift, indicating insufficient rest after their last shift.2 There does not appear to be any difference between the sleep levels of the nurses who work long daytime shifts and long nighttime shifts. Lapses in attention were “traitlike” in this population of overworked nurses with 53% experiencing moderate lapses and 8% experiencing frequent lapses.2 Those attention lapses, while understandable, are potentially detrimental to both patients and nurses. If basic medical errors can be avoided by shortening the grueling 12-hours shifts, the quality of care may improve greatly. It would also be a gift to the physicians and nurses themselves who might improve their own health through a better sleep cycle and lower stress. This is not an easy task for cultural reasons. It seems to be a tradition for doctors and nurses to work for long, grueling hours. Many nurses would prefer the longer shifts which would allow them to work fulltime while going to work only 3-4 days a week.1 However, the tradeoff for this is the constant wear of those long shifts and the worsened quality of care. The previously cited study notes that marital and family strife are noted effects of physicians working long shifts because they are not present to help maintain a home by doing chores or helping their children with homework.4 When the revolutionary John Hopkins residency program was established over a century ago, the residents led a monastic life and were discouraged from starting families. Perhaps it is time to alter the culture to make it less demanding on the medical professionals for the benefit of both the patients and healthcare providers.
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SONIA LEE When it comes to Western medicine, we think of things such as anatomical models, bottles of pills in a pharmacy, and/or procedures like surgery or chemotherapy. Traditional Chinese medicine (TCM), which originated in China, is very different from what we are used to in the USA. Instead of pills, it focuses on the use of herbs and acupuncture to restore natural balance to the human body.1 One of the fundamental ideas in TCM is the flow of qi (chi) throughout the body. Qi is essential to the proper functioning of the human body. A problem such as a prolapse, for instance, is explained as a disruption in the ability of qi to stabilize that organ4. Acupuncture can be used to correct the imbalance of qi. Qi is also thought to play a role in the body's immune system, homeostatic control, and energy levels.4 Health issues ranging from poor mental clarity, osteoporosis, deafness, loss of appetite, poor circulation, bloating, and excessive fatigue can all be attributed to qi deficiency.4 TCM practitioners evaluate the tongue color and pulse of their patients in order to determine the quality of qi within their body.4 TCM views the body holistically -- in other words, it looks at the body as a whole. This is in contrast to Western medicine, which tends to study topics at the cellular level. One example of this is the way that TCM practitioners view blood in comparison to the way that Western doctors view blood. In Western medicine, blood consists of red blood cells, white blood cells, platelets, and plasma – characteristics of each of these separate components contributes to the overall function of blood. The blood is known to be responsible for oxygen and glucose transport, for immune system support, and for the distribution of hormones. However, in TCM, blood is generated from a combination of food essence and a type of qi called "jing.” 5 This is why food is of particular importance in TCM. Food can be viewed as medicine in its own right and having a healthy diet is essential to the proper production of qi and blood.5 The function of blood is to nourish organs and tissues, maintain healthy body movement and sensation, and allow for clear mental activity.5 Therefore, sufficient blood flow is needed for a healthy physical appearance (such as a glow in the skin, strong muscles, and strong bones). A famous Chinese medicine textbook from the Han dynasty reads, "having received sufficient blood, the liver can support healthy eyesight....the feet can walk....the palm can grasp hold of things.” 5 (TCM believes that there is a link between various parts of the body, thus the line about the liver's contribution toward eyesight). Issues such as memory and insomnia are also attributed to poor blood flow. In China, TCM and Western medicine coexist in harmony. Every city has a hospital that focuses on the practice of TCM, all of which still prescribe a significant number of Western drugs (and vice versa for hospitals that focus on Western medicine). Even in rich, sophisticated provinces such as Jiangsu province, 10 million patients per year request to be
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treated with TCM.2 TCM has, in turn, become a subject of increasing interest in the international community. Its main drawback is the lack of controlled trials to provide definite evidence of its effectiveness. Part of the problem is that in China, double blind placebo trials are apparently considered to be unethical (since it is erroneously believed that such trials withhold actual treatments from patients). However, due to the increasing demand, there are several ongoing trials in China. 2 Western countries have also been evaluating Chinese herbs in order to identify the active agents. This was successful with qinghaosu, which has been used to treat fever in China for over 2000 years.2 It was found to also have antimalarial activity in 1971. 2 After clinical trials were conducted, qinghaosu has risen to become a first line drug against malaria in many parts of Asia. 2 Acupuncture has also been evaluated with success internationally. Acupuncture involves inserting fine needles into certain points of the body in order to restore balance. Different points affect different areas of the body. In the West, acupuncture is particularly associated with pain relief.2 However, controlled trials have proven that acupuncture is effective for a variety of conditions, including allergic rhinitis, hypertension, nausea, arthritis, stroke, and treatment following chemotherapy.3 Just as the West has been increasingly influenced by ideas from TCM, China is opening up more to the West. With more studies underway to demonstrate the clinical effectiveness of TCM, perhaps one day the two practices will become increasingly integrated and transform the way medicine is practiced in the years to come. References: 1 Traditional Chinese Medicine: An Introduction. National Institutes of Health. June 2010. http:// nccam.nih.gov/health/whatiscam/chinesemed.htm 2 Hezketh T, Zhu W. Health in China. Traditional Chinese medicine: one country, two systems. BMJ. July 12th, 1997. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127090/pdf/9240055.pdf 3 Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. World Health Organization. 2003. http://apps.who.int/medicinedocs/en/d/Js4926e/5.html 4 What is Qi? June 20, 2006. http://www.yinyanghouse.com/theory/chinese/what_is_qi#jing 5 Blood from a TCM Perspective. 2006. http://www.shen-nong.com/eng/principles/blood.html
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NEHA KAYASTHA
If you have ever tried acupuncture, yoga, meditation, massages, or even the Atkins diet, you are part of the growing United States population turning to some form of Traditional, Complementary, and Alternative Medicine (TCAM). Most types of TCAM originated in the Eastern hemisphere, and the most popular practices come from China and India. TCAM eventually made its way to the Western hemisphere and began to grow tremendously. In the year 2007, 42% of the U.S. population reported regularly using TCAM1. This is notable, considering that the density of modern medicine physicians per 100,000 people in the US is 548.9, whereas countries that rely on TCAM typically have much lower physician densities, ranging from 1.9 to 164.2 per 100,000 people. 1 If America has so many physicians, why are Americans increasingly turning to TCAM? With the proliferation of life-saving hormones, drugs, and antibiotics in the 19th and 20th centuries, conventional medicine became the predominant form of healthcare in America. Infectious diseases and acute illnesses no longer
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posed a considerable threat, so modern medicine began to focus on chronic and degenerative illnesses: conditions that are significantly more complex and costly to treat. These advances, in conjunction with public health interventions, considerably increased people’s life expectancy. Consequently, the aging population saw an increase in chronic conditions, like diabetes, arthritis, back pain, hypertension, cancer, and heart disease. The combination of increasing rates of chronic illnesses and healthcare costs caused the emergence of medical pluralism – the need for multiple medical systems. The higher occurrence of chronic conditions and the high cost of modern medical treatments drove increased interest in TCAM2. Comprehensive surveys and studies show that those with some of the most debilitating and costly conditions like cancer, chronic pain, musculoskeletal problems, and HIV are most likely to use TCAM2,3. Others who use TCAM usually cite their emphasis on natural healing as their reason for turning to these traditional therapies4. While more and more money is being poured into research to advance modern medicine, and the rising cost of healthcare becomes an even bigger concern, tracking the use of TCAM methods in America becomes increasingly beneficial and relevant. Will advances in modern medicine overshadow the perceived need for TCAM, or will this trend of increased use of TCAM continue? References: 1 Payyappallimana, Unnikrishnan. Role of Traditional Medicine in Primary Health Care: An Overview of Perspectives and Challenges. Retrieved from http://kamome.lib.ynu.ac.jp/dspace/ bitstream/10131/6917/3/Payyappallimana.pdf. 2 White House Commission on Complementary and Alternative Medicine Policy. Chapter 2: Overview of CAM in the United States: Recent History, Current Status, And Prospects for the Future. Retrieved from http://www.whccamp.hhs.gov/fr2.html. 3 National Institutes of Health. (December 2008). The Use of Complementary and Alternative Medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/ camsurvey_fs1.htm. 4 World Health Organization. Some Traditional Herbal Medicines. Retrieved from http:// monographs.iarc.fr/ENG/Monographs/vol82/mono82-6A.pdf.
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Caribbean Medical Schools: An Alternative Option JASMAIR JASWAL
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The medical school application process can be a daunting task. Students strive to meet deadlines, gather recommendations, maintain a high GPA, score high on the MCAT, fill out applications, and spend hundreds of dollars to mail them out. While hearing back from these schools with acceptance letters is an amazing feat, statistics show that the national percentage of applicants accepted to medical schools is not a high number. Moreover, this percentage went down from 50.4% in 2003 to 45.6% in 2008, and the number continues to be around that range. 4
For the students who do not gain acceptance into any U.S. medical school, they may occasionally consider a few alternative options thereafter. Often, they will seek out a master's program or a post-baccalaureate program for continued education, take time off from school to work for a year before reapplying, consider alternatives to medical school, or might apply to medical schools in the Caribbean. Caribbean medical schools can be great alternatives for students who do not want to wait another year to apply for the next cycle. They accept students on a rolling basis and usually have between two to three cycles within a year that students can apply to compared to the single cycle that U.S. medical schools retain. This gives students the chance to stay on track and continue medical school following graduation. However, it is useful to note the various pros and cons related to Caribbean medical schools before a legitimate decision is made. On average, Caribbean medical schools are less expensive and less competitive to get into. The tuition for Caribbean medical school ranges from $15,000 to $17,000 while the tuition for medical schools in the U.S. ranges from $30,000 to $50,000.5Although the tuition for the Caribbean medical schools is considerably less, other factors must be accounted for such as traveling expenses, living expenses, and other miscellaneous costs that may be attributed to studying abroad. Caribbean medical schools are less
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competitive because their acceptance rates are higher and requirements are also lower when it comes to GPA and MCAT scores.3 For example, accepted applicants of Wake Forest University in North Carolina had a "mean GPA of 3.8 and a mean MCAT of 32," while those accepted into St. George’s University in the Caribbean had an "average GPA of 3.4 and a mean MCAT of 27" within that year's cycle. 1 The curriculum between the medical schools in the U.S. and the Caribbean is similar, if not the same. This includes two years of basic science courses followed by another two years of clinical rotations.1 Clinical rotations are held in the U.S., which means students return to the U.S. for their 3rd and 4th year of medical school training.1 Eventually, one receives an M.D. degree just like any other within the U.S. and if the school attended is accredited within the U.S., he/she can come back to the U.S. and practice medicine. As there are pros to Caribbean medical schools, there certainly are cons. Out of the several medical schools that reside on the Caribbean Islands, only a limited amount are accredited for students to come back and practice medicine within the U.S. Specifically, St. George’s University, Ross U., AUC, AUA, and SABA are the only ones accredited and well-noted for their ties within the U.S.2 Ultimately, this means that obtaining residency within the U.S. after attending a Caribbean medical school may be more difficult than if one were to have graduated from a U.S. medical school. For instance, in a 2011 match, statistics depict that 94.1% of U.S. medical school graduates were matched for a residency program while only 50% of Caribbean medical school graduates were matched.1 Additional paperwork is also required for one to apply to U.S. residencies.2 Hence, it is important to consider and evaluate the cons that may pose a challenge in the path to becoming a doctor. Before any decisions are made, it is useful to note down the credentials of each school and the opportunities they offer in terms of education, research facilities, and accreditation. Overall, acceptance into any medical school is news worth sharing; it is a step forward in one’s career as a health professional and a new chapter in his/her journey to becoming a doctor. References: 1 Veritas P.,Pros and Cons of Applying to ForeignMedical Schools, http://www.usnews.com/ education/blogs/medical-school-admissions-doctor/2011/08/01/pros-and-cons-ofapplying-to-foreign-medical-schools (August 2011). 2 Student Doc,Caribbean Medical School Accreditation, http://www.studentdoc.com/accreditedmedical-school.html(2013). 3 Student Doc,Caribbean Medical Schools, http://www.studentdoc.com/caribbean-medicalschools.html (2013). 4 Johns Hopkins University (n.d.).JHU Pre-Professional Advising. Retrieved from http:// web.jhu.edu/prepro/health/admissions_stats.html 5 Medical School Insider (n.d.).Caribbean Medical Schools. Retrieved from http://www.medicalschool-insider.com/caribbean-medical-schools.html
How to Have Your Cake and Eat It Too TIWALADE ADEDIJI
So, you want to be a doctor? Perhaps you are aiming to become a fancy surgeon while dabbling in a little research? But you also want to have three children. You would like to slice brains open in the morning, drop one kid off at soccer practice, and pick the other two up from dance class? You are on call tonight, but you also want to get the tuna casserole out of the oven before you have to go to the hospital? When you return home at dawn, you want to pack school lunches and head to the shower to wash off 12+ hours of blood, sweat, and tears? You want to have it all, but everyone has laughed and told you it is impossible, so you ask: can I be a doctor and still have a normal, fulfilling family life? The opportunity to battle a brain aneurysm in the morning and make it to your child’s swim meet by noon is afforded to very few professions in medicine. The more accurate answer would be that with excellent planning and determination, being a good doctor and a good parent is an achievable feat. The main factor here is balancing.1,2,3 Balancing is a skill that involves the ability to accommodate a range of activities in a finite amount of time. With strategic long-term planning and devotion to both professional and domestic goals, it is certainly possible to balance medicine and family. One thing to take into consideration is the time frame of your career. If you know how many children you would like to have, think about where you are in your career and how much space between children will allow you to still work diligently. Some people prefer to have another child after previous children are relatively old enough to care for themselves. Other medical practitioners prefer to have all their children in quick succession to knock out the early raising years (which are the hardest and most time-consuming) in one fell swoop.1 Another factor to consider is the kind of support system you have around you. Family members, friends, and certified daycares can go a long way towards helping you balance life at home and at work.2 It can be reassuring to know that someone you trust can watch over your family for a few hours when you get an emergency call from work. With regards to long term planning, some individuals choose residencies based on the amount of time they would be able to spend at home while pursuing that specialty. Specialties such as radiology, ophthalmology, and dermatology usually do not involve emergency calls in the middle of the night and generally have more flexible hours than internal medicine, surgery, pediatrics, and other branches of medicine. Some also choose to go into academic medicine which has significantly less working hours and allows more time to raise a family. Even though these career paths may show more attractive work hours, their residencies still have requirements of up to 80 hours a week. 2 This encourages some people to begin families after completing their residencies or even right out of medical school in order to avoid the “residency time crunch.” However, surveys of female physicians show that a number of doctors prefer to have their children within the first 2 years of residency. 3 The general consensus also shows that the internship year is the hardest year to raise a child.3 Learning the ins and outs of managing the profession along with family life is a task that requires time, dedication, and strategic planning. It is possible to cut open hearts and still attend piano recitals, provided that you understand the importance of balancing and use this skill to organize all aspects of your life.
“IS IT TOO LATE TO DO RESEARCH THIS SUMMER?” SHIREEN HAMZA Might I intrude on your crisis for a moment? No, it is NOT too late! Although not all research environments are willing to train undergraduates who can only commit to helping out over the summer, many studies seek and truly appreciate the extra help! If you are looking to spend even five hours a week getting hands-on experience with research over the summer, it is worth your while to look through the ongoing research projects at Rutgers. On the Aresty website (aresty.rutgers.edu), you can find the Rutgers “Undergraduate Research System (URS),” a database that lists every past and current research project (in every discipline from Film to Neuroscience) being conducted at Rutgers and even some clinical trials that are being conducted at UMDNJ. Read through the projects carefully, and send out emails to the professors in charge of a variety of studies that interest you. Explain, carefully, why their study in particular appeals to you, and why you are willing to consistently devote your time to helping the study over the summer. Do not be discouraged if some professors do not respond, or if they are not looking for volunteers. If you have not considered doing research during your time as an undergraduate at Rutgers, you are depriving yourself of a life-changing experience. Many students decide to shape their careers and majors based on the research they did at the undergraduate level. Look into the Aresty Research Assistant program - which provides undergraduate students with a stipend over the year as they do part-time research. Though the deadline to apply this year has passed, there is always next year! And you can always contact professors to volunteer at their laboratory/help with their research. From monitoring leukemia development in transgenic zebrafish to exploring the formation of memories to using visual imagery as a primary tool of historical analysis, the research opportunities at Rutgers are endless and stimulating.
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A TASTE OF MEDICAL SCHOOL
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You just found out that you've been accepted to your favorite medical school. Congratulations! But now you have all types of doubts running through your head on what to expect as a medical student!?! Although everyone's medical school experience is going to be different, there are definitely some basic components that are inherent to the life of a medical student. Below is a generic breakdown of what is ahead of you during each of the four years of medical school: Years 1 and 2: The first two years are classroom-based, with patient contact beginning in the second year. Be prepared for long hours of studying (i.e., lots of memorization). Your social life is likely going to suffer and the coursework is going to be much harder and more detailed than your undergraduate courses.5 Typically, students take about twenty-four credits of upper-level science courses per semester with labs.7 Due to the sheer volume of information that students have to learn during these years, many students analogize this experience to “drinking from a fire hose” or “eating five pancakes a day, every day.” However, the good news is that the first two years are perhaps the most gruesome years of medical school. Many medical students will tell you that, “The first two years are something that you just have to get through...things get much better from the third year6.” Year 1: The start of medical school consists of basic science courses that teach you how the body normally functions. Some of the courses include Gross Anatomy (ready for those cadavers and the smells of formaldehyde?), Physiology, Histology, Biochemistry, Embryology, and Neuroanatomy. In addition, medical students will be introduced to medical ethics courses (OSCEs).2 Year 2: Whereas Year 1 focuses on how the body should work, Year 2 teaches you what happens when the body does not work as it should and what to do about that abnormality. This is when students really start thinking like doctors! Emphasis is placed on disease and treatment. Courses include Pathology, Pharmacology, Microbiology, and Immunology. Students also get hands-on, clinical exposure as they learn to take medical histories and perform physical exams on patients.2 At the end of the second year, students take the USMLE Step 1 – an eighthour standardized exam that covers everything from the first two years of medical school. This exam is very important for a
YEAR 1 Basic Sciences Medical Ethics
YEAR 2
Clinical Exposure
DHAGASH MEHTA medical student as the score plays a big role in determining his/ her medical specialty and residency match6. Grades/Ranks: Many schools only award “Pass/Fail” grades. While this decreases competition and reduces stress, students are unable to use their grades to stand out during the residency application process. For these students, the residency directors place more emphasis on their board scores. Other schools award “Honors/High Pass/Pass/Low Pass/Fail grades,” similar to the “A/B/C/D/F” grading system. This latter grading system may increase competition, but allows students to use their GPA for residency application. Many schools also rank students. 7 The structure of the first two years of medical school varies from one school to another: Traditional Structure: Most of the schools that follow this structure use a semester format, teaching several courses at the same time. On the other hand, some schools only teach one subject at a time. For example, Physiology may be taught all day, every day for an eight-week block before moving onto the next subject.2 Integrated Structure: In this structure, all of the Anatomy, Physiology, Pharmacology, etc. about one organ system is taught at one time before going to the next organ system. So, the material is learned more by topic (systems-based approach) rather than by course.2 Many schools that employ this new approach report higher pass rates and USMLE Step 1 scores. 1 Years 3 and 4: This is when the real medicine begins. A lot of students look forward to their third year of medical school as this is when they gain more independence and start attaining more practical experience in the medical field.6 During these years, students begin clinical rotations in hospitals/clinics and become part of a medical team. There, they will have to look up to the interns, residents, and attending physicians for advice and instructions. Your grades will be based on “shelf exams” and subjective evaluation by your team (i.e., residents and attending physician).2 Year 3: Students begin rotating through each of the chief specialties of medicine, such as Internal Medicine, Pediatrics, OB/GYN, Psychiatry, etc.2
YEAR 3
YEAR 4
Rotations
Specialized and elective clinical rotations USMLE Step 2
THE EXAMINER II Page 10
Year 4: The final year consists of more specialized clinical rotations with a higher level of responsibility, in addition to elective rotations. Students chose their specialty, apply to residencies, and travel for interviews. Students are typically given two months off – which can be used for interviews, traveling abroad for rotations/medical missions, studying for USMLE Step 2, research, or even vacation. Due to the excessive downtime, many students find this year to be the easiest, least stressful, and perhaps “the best year of their lives.” In March, students find out their residencies and where they'll spend the next 3-7 years of their lives on Match Day.6 The “match” is determined by a computer matching game. Basically, after finishing the interviews, each student ranks his/her residencies in his/her order of preference. Each residency too ranks its applicants in its order of preference. The computer then matches students and residency programs with their highest possible choice. A student is expected to commit to the position he is
matched into. In case a student does not match into any of the programs, he/she is notified a few days before the match day so that he/she can participate in Scramble – a program that gets unmatched medical students into unfilled residency positions. 3 Towards the end of the 4th year, students take the USMLE Step 2 Exam – a nine-hour long standardized exam that assesses a student's clinical knowledge. The last part of USMLE (Step 3) is taken in the first year of residency. 7 The journey to becoming a doctor (Medical school + Residency) requires one to put in a lot of blood, sweat, and tears. Accordingly, it is highly recommended that before making this long commitment, students assess their reasons for becoming a doctor and be truly motivated and passionate. But, most medical students will tell you that with hard work and determination, it is very doable. After all, what is more satisfying than saving lives?
SHOULD DOCTORS EVER TURN A BLIND EYE TO TORTURE? JASMEET BAWA “Last month, on March 15, I was sick in the prison hospital and refused to be fed. [A squad from Extreme Reaction Force] forcibly inserted an IV into my hand. I spent 26 hours in this state, tied to the bed. During this time I was not permitted to go to the toilet. They inserted a catheter, which was painful, degrading and unnecessary. I was not even permitted to pray. […] During one force-feeding the nurse pushed the tube about 18 inches into my stomach, hurting me more than usual, because she was doing things so hastily. I called the interpreter to ask the doctor if the procedure was being done correctly or not. It was so painful that I begged them to stop feeding me. The nurse refused to stop feeding me. As they were finishing, some of the “food” spilled on my clothes. I asked them to change my clothes, but the guard refused to allow me to hold on to this last shred of my dignity.” - Samir Naji al Hasan Moqbel, a detainee at Guantánamo since 2002. 1 Guantánamo Bay, according to Sicko, Michael Moore’s documentary concerning American healthcare, is a prison for terrorist masterminds from the War on Terror. The audience learns from a clip of Representative Duncan Hunter that Guantanamo detainees are "are well-fed” and “given access to top-notch medical facilities.”1 How true are these claims? Of the 799 Guantanamo detainees, 92% have never been involved with Al-Qaeda and 86% were captured by bounty hunters.2 As of April 1st, 166 men continue to be indefinitely detained with no evidence against them. According to U.S. government officials like Duncan Hunter, many of the detainees have “top-notch medical facilities,” yet we learn through the testimonies of detainees that they were “treated like animals.” There have long been reports of sexual assault committed by female interrogators. Solitary confinement that lasts for as long as three months induces psychological trauma. There have also been multiple reports of severe light and temperature exposure: all conditions that have affected the physical well-being of detainees.5 Thirty-nine of these men are protesting their unfair conditions through a hunger strike. Eleven of those men are being strapped down to a chair and force-fed through their noses.3 The most disturbing actions have come from medical practitioners blatantly disregarding the Hippocratic Oath. No doctor has reported suspected torture in their medical evaluations of detainees. Psychologists have even been involved in the
process of developing torture methods and directly in administering torture.4 In August 2002, the United States Department of Defense stated that military personal were required to break patient confidentiality and provide non-medical personnel with any pertinent information. 5 Guantánamo Bay and the War on Terror are contentious topics of their own right, but what questions are raised as to the role of ethics in medicine? Do doctors have an allegiance to the country they are from, or do they have a responsibility to work towards human rights no matter what flag they fly? Dr. Robert Jay Lifton, a psychiatrist studying psychological causes and effects of war and political violence says that for military doctors, there is a “moral conflict” between helping individuals and appeasing the military’s chain of command.6 Vincent Iacopino, the senior medical adviser for Physicians for Human Rights, states that despite any conflict military doctors experience, “the physicians involved [have] an ethical duty not to do any harm.”7 Dr. Iacopino’s views align with the tenets of most international medical associations. Torture is prohibited, as is being in the presence of it. The American Medical Association goes so far as to direct doctors to, “whenever possible, strive to change situations in which torture is practiced or the potential for torture is great.” 8 This opens up a controversial debate: would the presence of medical professionals be considered ethical and necessary if it reduces harm to those being tortured?
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ASK SUHAL If I've gone through personal family/health issues that have impacted my grades, is there a way to address that in my application process? ~ Anshika V. It is always difficult to deal with personal, family, and health problems, and no doubt, they can certainly affect your grades and performance in school. However, medical schools are quite understanding of these situations, and there are ways to incorporate this into your application process. The first way would be through your personal statement if that time in your life was one of the most significant moments that truly made you want to go into medicine. You need to be able to explain how you grew and/or what you learned from that experience. If this is not something that made you grow as a person but mostly had a negative impact in that period of your life, then there will be a chance for you to explain it in your application. Most secondary applications have a separate area that asks you to explain or include anything else they should know about that may have impacted your candidacy such as explaining any bad grades. However, be aware that you should only write about this situation as something that truly affected you and not use it as an excuse. Using it as an excuse will hurt your application. They want to see that you are a strong person who had a fall in life but were able to get right back up and continue pursuing your goals.
Pursuing D.O. Over M.D.: An Interview SAIMA USMANI Z. Ali is currently a third-year student at NYCOM, The NYIT College of Osteopathic Medicine, studying to earn his D.O. degree.
Saima: What is a D.O. degree? Z. Ali: It stands for Doctor of Osteopathy, but it is functionally the same as a M.D., except that a D.O. knows a bit more about bones and osteopathy. S: What is the difference between a D.O. and a M.D.? Z: Some foreign countries do not recognize a D.O. degree. Only the United States and several European countries do; India doesn’t, I know that. S: So do you take the same courses as an M.D. student? Z: Yes, we have the same curriculum. However, in addition to that, we have a mandatory osteopathy course each semester—there’s a practical and oral for it too. S: Does that mean D.O.’s have a different residency program? Z: No, not at all. The process for finding residencies and fellowships is the same as it is for M.D.’s. S: Do you think that you have to be interested in bones to pursue a D.O. degree? Z: No, a D.O. can specialize in anything. The majority of practicing D.O.’s don’t do osteopathic manipulation. But, I do know how to massage really well now. S: How do you manage your workload? Z: (Long laughter). Oh, it’s very hard. (Laughter). S: How do you relieve the stress caused by your workload? Z: Working out. Playing basketball. Wearing boxing gloves and boxing Does a science major hold a higher advantage versus in my room. a non-science major? ~ Anshika V. S: How do you balance your social life with academics? Z: It’s very easy. You do them both together. Social life is pretty No, this is a myth. In fact, the changes to the 2015 important for me. I usually study the last few days before an exam. MCAT prove my point that medical schools want to see S: Uh-oh. That’s a politically incorrect answer. well-rounded students with the addition of the Z: Well, it’s depressing to study all the time. Most of my colleagues humanities section covering sociology and psychology. only study and do nothing else. I think that’s crazy. My methods have Many students I know are double-majoring or doing a been working for now. minor in a non-science field because they truly enjoy the S: Do you know what you want to do in the future? subject. In addition, this shows medical schools that you Z: Not yet, no. have knowledge in other fields besides just science. S: Why D.O.? Look at it this way, you are going to learn science in Z: Because my father wanted me to. And…it was also my interest. medical school, but you will not have the chance to S: What made you choose the D.O. route over the M.D. one? study music theory in depth once you are there. Plus, a Z: Well, NYIT was closer to home, and I got accepted into their 7-year hobby or two in music, language, or the arts can only BA/DO program. For students in the program, there was a reasonably help you relieve all the stress that medical schools will minimum MCAT score requirement—although, it’s changed since then. inevitably bring. Aside from that, building a good doctor S: Is D.O. cheaper? -patient relationship entails relating with your patients. I Z: No. It’s just as expensive. highly doubt that every single one of your patients is S: Do you have any advice to give to undergraduates interested in going to be interested in the new pursuing medicine? advances of gene therapy, unless of Z: Yes, if you don’t have passion in the If you have a question that you would course it pertains to their own medical field, don’t do it. Only do it if like answered, please email me at health. Regardless of your major, you’re interested in it, not just because your ruexaminer.managing@gmail.com. As you are still required to take parents want you to. per your request, you can have your biology, chemistry, organic S: So…do you still want me to include the name featured in the next issue or chemistry, and physics. Even then, part where you said you’re becoming a if you still want to do a sciencedoctor because of your father? remain anonymous. major, just consider adding another Z: Yes. That’s what makes my advice more major or minor in something nonvalid. (Laughter). science. (Z. Ali, personal communication, March 30, 2013) THE EXAMINER II Page 12
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A FIGHT FOR THE FRONT SEAT
SUHAL SHAH
This article is dedicated to all my readers, my examiner family past and present, the friends I have made, the students I have tutored, the faculty who has cared, and the professors who have inspired me. I thank you for all the support and encouragement that you have given me through all the good and bad times in the past four years. There comes a time in life when you look back and reflect upon how much you have grown. These are one of those times. As a chapter in my life comes to a close, I want to share with you my last bit of advice as my final piece for The Examiner. Perhaps, the underclassmen may find some useful information, and my fellow seniors will join me in appreciating this journey that many of us took together and learned these lessons that we have picked up along the way. Lesson #1: Help one another. As pre-med students, we have this mindset to be the best. However, you will soon learn that there is always going to be someone out there who is better than you. Instead, you are competing against yourself. I quickly learned this in a very unlikely place: organic chemistry lecture. My friend and I would get to lecture 40 minutes before in order to snag a front seat. Many times, we were beat to it. I quickly realized that this fight for the front seat was so much more than just that. I remember a student refusing to share her notes with another simply because this was the cut-throat attitude that most of us had. Since that incident, I realized that instead of fighting each other for the “front seat,” we need to help one another. If I created a useful study guide, it would not stay hidden in my drawer, I would email it to the people that I knew, hoping that they would find it helpful. Lesson #2: Know thy resources! Rutgers is full of resources that many people do not know about or learn about until it is too late. For instance, did you know that Career Services can help you build resumes, find internships or healthcare related jobs, provide mock interviews, and critique personal statements? They hold workshops on all of these things, yet when I ask an underclassman if they have heard of these services, they do not know about it. Have you tried utilizing the Rutgers Learning Centers? They provide free tutoring to get you to work independently in your classes. Have you checked out HPO? They are the ones that will send out emails about healthcare related opportunities, club meetings, and deadlines. In addition, they will support your application for whatever health professional school you want to apply to, so I suggest getting on their listserv and meeting with an advisor. Lesson #3: Ask questions. Do not expect any Rutgers department or advising center to remind you to meet with them like back in high school. This is what I initially thought when I came to Rutgers. I quickly realized that to get answers, I need to talk, ask questions, and find my own way around. While this
may seem like a nuisance to most, this is one of the best ways to learn to become independent and responsible for your future. Other than just depending on advisors and professors, there are many peer-mentoring programs where you can be paired with an upperclassman. Two of which I know are AMSA’s Peer Mentoring Program and HPO’s Peer Mentoring Program. I personally really enjoyed being a peer mentor, and I would hope that all the mentees will give back as upperclassmen as well. Lesson #4: Read, read, read! Rutgers University has so many student organizations and departments that have publications and send out emails about opportunities. For instance, The Examiner holds a wealth of information in every issue for anyone who is pre-health. I know many of you simply delete all those emails sent by various departments and advising office, but why do that? It takes less than five minutes to read them, and they may even contain information on clinical experiences, research opportunities, or informative workshops! Although my inbox is flooded with such emails, I am thankful for all the HPO, Career Services, and other student-run organization emails. Lesson #5: Learn from every experience. The worst thing you can do is participate in an organization, a research lab, a clinical experience just for the sake of putting it on your resume. You should only do these things because you are truly interested in the subject and want to learn something from it. Volunteering at St. Peter’s University Hospital taught me that no job is too small to hold importance. Shadowing internists, a pediatrician, and an ophthalmologist showed me all the patience, compassion, and eagerness to learn and grow are needed to go into medicine. Being part of the Examiner taught me teamwork and leadership. Whatever I have done, I have done because I intended to learn something from that experience. Lesson #6: Give back. While I have mentioned this last one several times, I cannot emphasize it enough. My way of giving back started with The Examiner. I have been sharing advice of the things I have learned about through my column for the past two years. I became a tutor at the Rutgers Learning Center so that I have the chance to help students realize that they can make it through classes like organic chemistry and physics by providing them with study tips that I picked up along the way. Finally, I became a peer mentor to help underclassmen find their way around Rutgers as seniors did in the past for me. To all the underclassmen and my fellow seniors, I wish you the best of luck on your journey as we part ways and continue to discover ourselves. As Ralph Walsh Emerson once wrote, “Two roads diverged….and I took the one less traveled by.” Everyone has their own road and college is all about maturing, discovering yourself, making lifelong friends, and, most importantly, paving your own, unique path.
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PEACE AND QUIET ...AND HEALTH??
EMILY MOORE Inhaling toxic fumes is unhealthy. Drinking contaminated water is unhealthy. But is living near a heavily-trafficked road unhealthy? While most people recognize and avoid potential sources of air and water pollution, many ignore a third environmental danger: noise pollution. 1 Noise pollution consists of the sounds present in our surroundings that disturb human life, like traffic, industrial equipment, loud music, and more.1,2 Between noisy dorm-mates, seemingly endless campus construction, and more time spent on crammed buses than most of us like to think about, Rutgers students know just how loud life can be. But excess noise is more than simply annoying: it actually harms our health. Hearing damage, speech difficulties, and stress are just a few downsides of noise exposure.1 For college students in particular, it is important to be aware of many of these impacts. Noise pollution, especially when caused by traffic, has been linked to sleep disturbance. Researchers have identified an inverse relationship between the amount of noise to which people are exposed to and the quality of their sleep. 3 Sounds may cause frequent awakening, reducing time spent in the crucial REM and slow wave stages of sleep.3 Noise-polluted-sleep has also been associated with increased heart rate and blood pressure in addition to a worsened mood and lower reaction time the next day.3 Studies suggest that “there may be some adaptation to sleep disturbance by noise” in people accustomed to it; however, complete physiological adjustment seems impossible.3 Therefore, those of us who think we are safe from the consequences of sleeping in noisy places may not be sleeping so soundly after all. Noise pollution also poses a possible threat to academic success due to its impacts on psychological health. Memory may suffer due to noise exposure, which has widespread implications in terms of both retaining and obtaining information. 3 Other findings support the notion that cognitive performance decreases as a result of noise or even by the expectation of noise. 3 Studies conducted on young students indicate “that chronic exposure to noise affects cognitive functions involving central processing and language comprehension.”3 When people feel they have control over what they hear, they carry out a task more successfully.3 This is a major cause for concern, given that we cannot turn off or avoid most sources of noise pollution. The potential psychological issues extend beyond academics. Too much “noise may reduce helping behavior, increase aggression, and reduce the processing of social skills.”3As more research about the detriments of noise pollution emerges, the negative effects of noise pollution on our health are shown to be both significant and widespread. Noise pollution affects countless communities across the globe. In Western Europe, where it has been estimated that “at least 1 million years of healthy living are lost each year due to noise pollution,” transportation-related noise is closely regulated. This is less true in the United States. 4 Our government shut down the Office of Noise Abatement and Control over thirty years ago, meaning that noise is no longer under any federal regulation. 4 However, developing nations face the toughest challenge of all. The rapid growth and urbanization taking place across the world has elevated noise pollution in many countries to dangerous levels, due to overcrowding and traffic. 5 Quieting our planet must therefore become a global public health priority. Just as we cannot mute the traffic outside of our windows or lower the roar of trains, subways and airplanes, we cannot tune out the risks of noise pollution. References: 1 U.S. Environmental Protection Agency (2012, July 16). Noise Pollution. Retrieved from http://www.epa.gov/air/noise.html 2 Orazem, B.J. Sources of Noise Pollution. Retrieved from http://www.macalester.edu/academics/psychology/whathap/ubnrp/audition/site/ noisesources.html 3 Stansfeld, S.A. & Matheson, M.P. (2003).Noise pollution: non-auditory effects on health. Retrieved from http://bmb.oxfordjournals.org/ content/68/1/243.full.pdf+html 4 Baughman, Brent (2011, May 14). Noise Pollution Hard On Heart As Well As Ears. Retrieved from http:// www.npr.org/2011/05/14/136288954/noise-pollution-hard-on-heart-as-well-as-ears 5 Norhona, G. Noise Pollution- A Growing Health Problem. Retrieved fromhttp://publichealthglobal.org/index.php? option=com_content&view=article&id=266:noise-pollution-a-growing-health-problem&catid=49:articles&Itemid=144
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The Unrest in Syria st
As of April 1 2013, it has been two years and fifteen days since the Syrian Civil War began. The Civil War began on March 15, 2011, after protests against President Bashar alAssad’s human rights violations and oppressive regime. The people of Syria have been hoping for a revolution promoting democracy, similar to those in neighboring countries such as Egypt and Tunisia. The Civil War began with the unrest in the southern town of Deraa, where Assad had fourteen schoolboys arrested and tortured for writing propaganda on walls and ordered his army to march through Deraa to open fire on the streets and the funerals of the victims.7 Upon hearing about the unrest in Deraa, the rest of the people of Syria contributed to the rebellion through mass protesting. One such rally is shown in the photo to the left, taken on March 19, 2011 in Damascus, Syria, where tens of thousands of people assembled.2 Within two months, the war was well on its way with more than 1,000 casualties (most of them civilians).7 Since then, Syria has split into pro-Assad government officials and armed forces, and resistance groups like the Free Syrian Army.3 March 2013 was reported to be the deadliest month of the Syrian War. In the past month alone, over 6,000 deaths were documented, including 298 children, 291 women, 1,486 rebels, and 1,464 government soldiers.1 Since the start of the war, there have been approximately 70,000 deaths, and 4,000,000 refugees
FIONA KIM 3
are now in need of aid. One tactic of Assad’s forces has been to attack the rebels’ infrastructure. This includes cutting off humanitarian aid, closing off borders, attacking health care centers, killing patients, and torturing physicians. The UN food agency has reported 20 attacks on food delivery trucks since the start of the Civil War.4 Doctors without Borders and the Human Rights Watch have reported that “patients have been taken away and killed, while doctors, nurses and emergency room workers have been arrested, tortured and even killed for doing their jobs”. 6 As a result, there are only about thirty-five doctors working openly, where there used to be 2,000. A reported “120 doctors, 65 medical aid workers, and 50 nurses [have been] killed, and 469 doctors jailed.”9The rest are working underground or have fled Syria to escape prosecution under Assad’s regime. 9 The humanitarian crisis has no easy solution and the death tolls are only increasing. Reading about this from the safety of a dorm room makes it difficult to envision the hardships of people in Syria. However, these dire situations force us to reflect upon the rights and privileges available to us– from the opportunity to safely and ethically practice medicine to civic equality. Our privilege necessitates action: please consider donating to Doctors without Borders or any of the non-profits providing medical and humanitarian relief to refugees of the Syrian Civil War.
Tanning Beds: Our Beloved Carcinogens
EMILIE TRANSUE
Now that the sun is finally coming out and the beach season is just around the corner, we will be spending more time pursuing that flawless looking skin. It is about time to head back to the tanning beds for our glowing prebeach tan. Ironically, a glowing tan is really the body’s way of displaying its skin damage. Our skin’s inherent reaction to damaging UV rays is to produce more melanin—a pigment which darkens the skin. Of course, we are bound to encounter some harmful UV rays when we participate in outdoor activities, but indoor tanning presents a dangerous side of tanning. In 2009, indoor tanning beds with their tanning UV rays were officially defined as “carcinogenic to humans.”2 MerriamWebster Dictionary defines a carcinogen as “a substance or agent causing cancer.” What kind of effects are we talking about? We are talking about skin cancers, various types of carcinomas, and eye cancers. The link between indoor tanning and melanoma—the deadliest type of skin cancer—has been widely studied. One 2010 study found that indoor tanning increases an individual’s likelihood to develop melanoma by 2-4 times depending on the type of equipment used.1 Tanning can also cause premature aging, immune suppression, eye damage, and sometimes allergic reactions.1 There are unwanted, adverse effects to tanning, but let us return to the idea of voluntarily disposing ourselves to skin cancer. Melanoma is the second most common cancer for women ages 20-29 years old.2 One out of eight people die
from melanoma, and we pay money for this access.2 Women pay for this cancer-causing service more frequently than men. For those 18 and under, it is estimated that 13% of all high school students use indoor tanning, and it is especially prevalent in Caucasian females.4 Slightly older individuals (18-29 years old) tan more frequently than any other adult age group, with 20-27% tanning regularly.5 College students, like us, tan even more often.5 An estimated 33-47% of us participate in this activity, an activity deemed carcinogenic by our own health system. 5 The US government has tried to limit the use of indoor tanning bed and products. The FDA sets strict guidelines and regulates all sunlamps, beds, and booths associated with UV tanning instruments.2 Obamacare added a 10% tax onto the price of indoor tanning, both to raise money and to discourage the harmful practice.6 Salon owners, however, are not seeing the expected change in customer visits.6 Some states, like Vermont and California, have a total ban on indoor tanning for individuals under the age of 18.7 Here in New Jersey, the ban applies to those under 14, but minors ages 14-17 may participate with parental/guardian permission.7 Other states like Pennsylvania have no restrictions whatsoever. 7 The Center for Disease Control recommendations on how to stay safe indicates the following: “Avoid indoor tanning.”3 If this is not convincing enough, ask yourself, is the reward of being socially acceptable skin worth the risk of developing skin cancer?
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Harder, Better, Faster, Stronger: Alternatives to Standard CPR JOE DZIERZAWIEC Cardiopulmonary resuscitation or CPR, is one of the most widely taught and mainstream medical practices—yet it is exceedingly ineffective. If a person enters cardiac arrest and is administered CPR outside a hospital setting, he or she has between a 2% to 30% chance of survival, depending on various temporal or preexisting conditions.2 Despite these sobering statistics, CPR is still a standard procedure for the simple reason that nothing better has been discovered. However, as more biomedical research is done in basic lifesaving procedures, alternatives to traditional CPR are being developed that could increase chances of survival and improve the protocols for dire cardiac situations. Standard chest-compression CPR has been in practice since the 1960s, and remains relatively unchanged as the standard of resuscitation today.1 It involves alternating forceful compressions to the victim’s chest with mouth/ mechanical ventilation through the victim’s mouth.2 Chest compressions performed in a repetitive, cyclic motion are meant to force the continued arterial flow of blood throughout the victim’s body when the heart has stopped pumping. 1 Air ventilation into the victim’s mouth is meant to artificially supply oxygenation to the blood, keeping brain or other tissue from dying or becoming permanently damaged when the victim’s lungs are not operating.1 Though the reasoning behind CPR is sound, there are many valid problems with the mechanical aspect of the procedure. Broken ribs or irreparable thoracic damage are often side-effects of quality chest compressions1,3 The force that must be applied to the chest is also rather large, and even professional caregivers often do not put enough strength into compressions to propel adequate blood flow.3
In light of the drawbacks of standard CPR, modern research has been conducted in qualitatively examining the effectiveness of each component of basic life support, and various changes to the system have been suggested. For example, research has shown that chest compressions alone, without ventilation, may be sufficient in maintaining the current survival rate.2 Other studies suggest that the most important part of CPR is neither compressions nor ventilation, but quick defibrillation, or attachment of an automated shock delivery device to the victim to electrically jab the heart into resuming a normal rhythm.1,2 Dr. Leslie Geddes has even concluded from his research that abdominal-only CPR, or compressions to the stomach, may result in a better survival rate than standard CPR. 3 He argues that abdominal CPR is easier to perform, does not damage the victim’s chest, and forces more blood through the heart’s coronary artery, which in turn helps the heart pump the blood to the rest of the body.3 Another trendy argument is for the expanded use of cold temperatures in emergency situations, particularly at hospitals. Advocates of “therapeutic hypothermia” point to studies showing that extremely cold temperatures slow the decay of cells during resuscitation activities and preserve the body almost perfectly until it is brought back to standard body temperature.1 Though the future seems bright for this branch of emergency care, it is not feasible to throw surprising, new procedures into the CPR protocol without significant trial. Basic life support should be thoroughly researched, and should not appear shocking to bystanders or professionals. That being said, CPR is a great example of modern research updating an old and rather clunky procedure—a medical trend that will hopefully have a lasting impact.
Overcoming the Outbreak: The Norovirus in the US ROHMA KHAN
The rapidly spreading variant of the norovirus is a recent, steadily rising health concern in the United States. First identified in Australia, this particular virus has been known to cause upset stomachs, vomiting, and diarrhea; these symptoms have led the infection to be more commonly known as the ‘stomach flu.’ 1 The United Kingdom was among the first to be heavily affected by the virus, with parts of France and New Zealand also seeing an increase in the norovirus activity. 2 Aside from its prevalence in other countries, an even more concerning fact is that the norovirus has been deemed to be the new leading cause of gastrointestinal disorders in American children, infecting over 21 million in the United States alone.2 Dr. Daniel Payne, an epidemiologist in the Division of Viral Diseases at the Centers for Disease Control and Prevention, informed the general public about the risks associated with young children (typically those who are age five and under) contracting the infection; the sudden onset of diarrhea and intense vomiting can cause severe dehydration, often necessitating a hospital visit. 1 Of those infected, it is estimated that nearly 1 in every 14 children will visit an emergency room, and 1 in 6 will receive outpatient care for norovirus infections.1 Roughly half of all medical visits regarding the norovirus were in children ages eighteen months to six years, as infants and toddlers are more likely to be hospitalized than older children.1 In total, investigators found that norovirus infections lead to nearly 1 million medical visits in young kids each year.3 According to the CDC, the norovirus has surpassed the rotavirus as the most common cause of gastroenteritis in US
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children.3 Researchers at the CDC attributed this shift from the rotavirus to the norovirus with the widespread and effective vaccination against the rotavirus.3 Similarly, they are now working on developing a vaccine for the norovirus, which will be significantly useful to young children, who are easily susceptible to contracting a norovirus infection.1 If a vaccination is successfully developed, it could significantly reduce the amount of illnesses associated with the norovirus. In addition, millions of dollars can be saved in health care costs, which are being used to treat dehydrated and hospitalized children.4 In previous instances of the norovirus affecting young children, effective care by doctors and hospitals cost up to $273 million a year.4 Both the number of patients and overall economic burden can be considerably reduced with the creation and distribution of a successful vaccine. The norovirus itself is extremely contagious and is spread primarily through contact with ill people as well as contaminated food and water.3 Health experts suggest that the most efficient way to reduce the risk of the norovirus infection is through good hygiene, proper hand washing, and safe food handling.2 There is no known treatment for a norovirus infection, though health officials generally recommend bed rest and drinking plenty of fluids to avoid dehydration. 4 Most children can usually recover from symptoms within 24 to 48 hours. The virus is notably difficult to contain in terms of preventing the norovirus from escalating within populations. However, if we each practice and maintain adequate sanitation precautions, we can reduce the risk of contracting this virus.
Polio—Last Vestiges Battling polio is not a foreign concept to Ramesh Ferris. When India was hit hardest by this crippling disease, Ramesh Ferris was one of many victims left paralyzed by it during his childhood. His biological parents were not able to provide sufficient care for him and placed him in an international orphanage. Tragically, there were and still are millions like him that were and are crippled from polio. Fortunately, with strong political will and international coordination, India has finally declared itself polio-free.1After significant global effort, the incidence of polio has significantly decreased over the last sixty years, but polio has still not been eradicated. Currently, there are three countries in the world that have not been declared polio free: Afghanistan, Pakistan, and Nigeria. Polio, a highly infectious and contagious disease caused by the poliovirus, invades the nervous system and can cause total paralysis within a matter of hours.2 The initial symptoms of polio include headache, fever, fatigue, vomiting, stiffness of the neck, and pain in the limbs.3 The polio virus is usually spread through fecal-oral contamination, so it is easily spread in areas with inadequate sanitation.2 Failure to eradicate polio in these last three regions could result in approximately 200,000 new instances of polio each year.4 The polio vaccine was first introduced in 1955. It was considered a success because it substantially reduced the number of polio cases. However, as some countries were first being declared polio free, certain other countries, namely Afghanistan and Pakistan, were still struggling to vaccinate their population. Constant political conflict within these countries had created unstable governments and poor healthcare infrastructure. Instability, low availability of the vaccination, and low awareness of the positive benefits of the vaccine have led to
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decreased participation in vaccinations in these countries.5 Many strategies have been employed to fight the poliovirus. One plan utilized non-traditional means of reaching children in unstable areas of the country by speaking with community leaders, and even seeking the aid and support of the Taliban. Blanket vaccinations of all children that cross the border were set up. Vaccination teams were formed at sites where children were likely to gather, and permanent vaccination teams were established in order to regularly vaccinate children and monitor the spread of the virus.5 Despite the aid of international donors and health groups, the eradication of polio in regions continually plagued by poor infrastructure, deteriorating security systems, and natural disasters, still remains a challenge. In order to tackle these challenges, The Global Polio Eradication Initiative made an emergency polio action plan to fight the disease efficiently and effectively. The main goal of this emergency plan is to target the high-risk areas, increase government oversight, increase vaccinations to all children, and increase accountability.5 As more people begin to understand polio and receive vaccinations, the numbers of incidents will inevitably decrease. After Ramesh Ferris left the international orphanage, a Canadian family later adopted him. As an adult, he decided he wanted to educate the public to take action against the deadly disease that paralyzed him for life. “We have invested so much time and money into this fight, we can’t let hostility and misconceptions veer [us] off our journey,” he said.1 Hopefully, with the implementation of innovative and unconventional techniques and continued global support, more people will have access to polio treatment, and the world will be declared polio-free.
http://www.unicef.org.il/pictures/uni103541.jpg
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The Shift in Healthcare from Traditional Fee-for-Service Systems KUNAL BAILOOR Rising healthcare costs are not anything new, especially in the United States, which spends the most per capita on healthcare of all the 194 nations in the World Health Organization.5 Part of the problem is America's changing demographics and aging baby boomer generation, but perhaps an even more significant reason lies with how insurance companies reimburse providers for provided services. 5 Under the current system, insurance companies reimburse doctors for every test, pill, and treatment, regardless of the existence and efficacy of cheaper alternatives. Doctors are now presented with a perverse incentive: the more tests and medicines they prescribe, the more they get paid, regardless of the alternatives. Patients are often over-tested and medication is prescribed in lieu of preventative lifestyle changes. Many feel that healthcare reform, though partially accomplished in the Affordable Care Act, needs to be extended to reform the insurance compensation system. Several alternatives to the fee-for-service system exist, and the future physicians and policymakers among our readers may encounter them by the time they start their careers. One popular alternative to the fee-for-service system is the bundled payment system, wherein a set payment is made to the healthcare provider for the bundle of services and medications required for a particular illness.3 It addresses the major fiscal concerns of the current system – doctors, rather than overmedicating and over-testing, now have an incentive to use the cheapest medications and the minimum number of tests necessary. The plan also includes a provision which states that if the provider can create a bundle of services that cost less than the allocated bundle, they can keep the remainder, amplifying the incentive for cost minimization.3 Bundling has already been implemented in some areas: United Healthcare, for example, offers bundles for oncology care.2 Bundles are not without problems, however. In particular, there are frequent debates on what services to include in a bundle, the duration of the bundle,
Is Herpes Hurting our Brains? Although the common cold sore may seem like a nuisance, the virus causing the sore has more severe effects, possibly including cognitive decline. Researchers at the University of Pittsburgh found that individuals affected by the herpes simplex virus were more likely to develop cognitive and memory deficits.4 A study conducted at Columbia University also assessed attention and memory abilities.5 The Mini-Mental State Examination, a questionnaire commonly used to screen for dementia, was administered to 1625 Manhattan residents of about 69 years of age.5 Blood samples were also tested for low grade infections such as herpes simplex virus 1 and 2, Chlamydia, and helicobacter pylori.5 After compiling the data, the researchers created an infectious burden index.5 Participants with higher levels of the virus infection were 25% more likely to score poorly on the MMSE.5 According to Dr. Mira Katan, the lead researcher of the study, "the link was greater among women, those with lower levels
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and which patients qualify. Perhaps the largest problem to resolve with the bundled payment system is to find the ideal bundle size: too small – patient care is compromised and too large – there are not sufficient incentives to minimize costs.3 Another alternative is found in alternative care organizations, which is a sort of middle ground: physicians are still paid a fee for the provided services but coordinate to lower costs.3 Essentially, the total cost of care for all the physicians in the organization is compared to a set benchmark, and if the cost comes in below the benchmark, all the members of the ACO (accountable care organizations) share in the savings.3 The ACO model has received wider implementation than the bundled payment system. The Affordable Care Act implemented the Medicare Shared Savings Program, which creates ACOs responsible in caring for groups of 5,000 Medicare beneficiaries.3,4 In addition, private hospitals, like the Beth Israel Deaconess Organization, have joined in as well.3,4 The major problem with ACOs is setting benchmarks, which has to hit the same golden mean as the bundled payment system. Also, coordinating physicians create their own set of problems since each physician has their own particular method of treatment, particular tests they wish to have done, and particular brands of medicine they prescribe. There are alternatives to the traditional fee-for-service system, and many are in the experimental phase, being implemented on smaller scales. The Affordable Care Act has the Department of Health and Human Services looking into these alternatives, but it is now too early to tell if the small scale tests are working. However, by the time our readers get into the healthcare work force, some of these alternatives may be in full force. Whether you will be wearing a lab coat or the hospital gown, it is in your best interest to know the economics of healthcare and the changes sweeping the system.
TVISSHA GOEL of education and Medicaid or no health insurance, and most prominently, in people who do not exercise."3 Dr. Katan suggests that exercise and vaccinations could reduce the risk of cognition and memory problems.3 Another study showed that the herpes simplex virus may be a strong risk factor for Alzheimer’s disease.1 Using immunohistochemistry and polymerase chain reactions, researchers located the DNA of herpes simplex virus type 1 within plaque in the brains of people with Alzheimer’s disease.1 Science is getting closer to a cure for herpes. Bryan Cullen, a researcher at the Virology Center at Duke University, and his team have discovered the pathway of infection and how the virus evades treatment.2Antiviral agents such as acyclovir, valacyclovir, and famiciclovir have been mentioned as efficacious treatments for the disease.2 All in all, there is still hope for the discovery of a cure for herpes in the future.
REFERENCES Cover Image: http://www.forskningsradet.no/servlet/Satellite? blobcol=urldata&blobheader=image% 2Fjpeg&blobkey=id&blobtable=MungoBlobs&blobwhere=1274487256241&ssbinary=t rue Page 5 The Cost of a Long Night:: Long Hospital Shifts and Poor Healthcare 1 Cardillo, D. (2011, Mar 28). [Web log message]. Retrieved from http:// www.americannursetoday.com/BlogView.aspx?bl=6268&bp=8040&viewall=true 2 Geiger-Brown, J. (2012). Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses.Chronobiology International, 29(2), 211-219. Retrieved from http:// www.ncbi.nlm.nih.gov/pubmed/22324559 3 Landrigan, C. (2004).Effect of reducing interns' work hours on serious medical errors in intensive care units.New England Journal of Medicine, 351(18), 1838-1848. Retrieved from http:// www.ncbi.nlm.nih.gov/pubmed/15509817 4 Nuñez, S. (2006). Unscheduled returns to the emergency department: an outcome of medical errors?. Quality and Safety in Healthcare, 15(2), 102-108. Retrieved from http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2464826/ Page 9 How to Have Your Cake and Eat It Too 1 Meisel. F, Siddiqui. G. “Can Doctors Have Work-Life Balance? Medical Students Discuss”. Retrieved on April 1st 2013 from http://healthland.time.com/2011/11/15/can-doctorshave-work-life-balance-medical-students-discuss/#ixzz2PFLCEtHG 2 Vickerstaff. B. “Doctor Dad: Balancing Medicine and Family”. Retrieved on April 1 st 2013 from http://studentdoctor.net/2007/06/doctor-dad-balancing-medicine-and-family/ 3 Verlander. G. “Female Physicians: Balancing Career and Family”. Retrieved on April 1st 2013 from http://ap.psychiatryonline.org/article.aspx?articleid=48138 Page 10-11 A Taste of Medical School 1 Bein, B. (2010, 06 15). Integrated curriculum leads to student success on usmle step 1, study finds. Retrieved from http://www.aafp.org/online/en/home/publications/news/news-now/ resident-student-focus/20100615utmbcurriculum.html 2 Divita, L. (2010, 01 24). Medical school 101: What medical school is really like. Retrieved from http://studentdoctor.net/2010/01/medical-school-101-what-medical-school-is-really-like/ 3 Freedman, J. (2009, 03 12). The residency scramble: How it works and how it can be improved. Retrieved from http://studentdoctor.net/2009/03/the-scramble-how-it-works-and-how-itcan-be-improved/ 4 How the matching algorithm works. (2012, 02 06). Retrieved from http://www.nrmp.org/ res_match/about_res/algorithms.html 5 Kuther, T. (n.d.). What is medical school really like? what to expect. Retrieved from http:// gradschool.about.com/od/medicalschool/f/MedSchool.htm 6 The four years of medical school [Web]. (2011). Retrieved from http://www.youtube.com/watch? v=IeSW2Gg1qIY 7 The medical school experience. (n.d.). Retrieved from http://www.startmedicine.com/app/ typicalday.asp Page 11 Should Doctors Ever Turn a Blind Eye to Torture? 1 Moqbel, S. (2013, April 14). Gitmo is killing me. The New York Times. Retrieved from http:// www.nytimes.com/2013/04/15/opinion/hunger-striking-at-guantanamo-bay.html 2 Glynn, K. R., Weinstein, H., Weinstein, B., O'Hara, M., Moore, M., Weinstein Company., Dog Eat Dog Films., ... Genius Products, Inc. (2007). Sicko. New York, N.Y.: Weinstein Co. Home Entertainment. 3 ACLU. (2012, 01 05). American civil liberties union. Retrieved from http://www.aclu.org/national -security/guantanamo-numbers 4 Finn, P., & Tate, J. (2013, April 1). Hunger strike at guantanamo bay spreads. Washington Post. Retrieved from http://www.washingtonpost.com/world/national-security/hunger-strike-at -guantanamo-bay-spreads/2013/04/01/bba2f102-9afc-11e2-a941a19bce7af755_story.html 5 Kevi Brannely. (2006). Report: Torture and cruel, inhuman, and degrading treatment of prisoners at guantanamo bay | center for constitutional rights. Retrieved from http://ccrjustice.org/ learn-more/reports/report:-torture-and-cruel,-inhuman,-and-degrading-treatmentprisoners-guantanamo6 Lifton, R. (2004). Doctors and Torture. The New England Journal of Medicine, 351, 415-416. Retrieved April 15, 2013, from http://www.nejm.org/doi/full/10.1056/NEJM 7 Conners, S. (2011, April 27). Us doctors 'hid signs of torture' at guantanamo. The Independent. Retrieved from http://www.independent.co.uk/news/world/americas/us-doctors-hidsigns-of-torture-at-guantanamo-2275214.html 8 Medical complicity in torture at guantánamo bay: Evidence is the first step toward justice. (2011). PLoS Medicine. Page 15 Unrest in Syria 1 Abdelaziz, LateefMungin and Salma. (2 April 2013) "Opposition: March Deadliest Month in Syrian Civil War." CNN. Cable News Network.Retrieved from<http:// www.cnn.com/2013/04/02/world/meast/syria-civil-war/?hpt=hp_t4>. 2 Chossudovsky, Michel. (3 May 2011) "Syria: Who Is behind the Protest Movement." Global Research. Global Research.Retrieved from<http://www.globalresearch.ca/syria-who-isbehind-the-protest-movement-fabricating-a-pretext-for-a-us-nato-humanitarianintervention/24591>. 3 (4 September 2012) "Guide: Syria Crisis." BBC News. BBC.Retrieved from<http:// www.bbc.co.uk/news/world-middle-east-13855203>. 4 MacFarquhaur, Neil. (23 March 2013) "In Syria's War, Doctors Find Themselves at Cross Hairs." NYTimes. New York Times.Retrieved from<http:// www.nytimes.com/2013/03/24/world/middleeast/on-both-sides-in-syrian-war-doctorsare-often-the-target.html?>. 5 News, CBC. (5 March 2013) "Syria's Civil War: Key Facts, Important Players." CBCnews. CBC/ Radio Canada.Retrieved from<http://www.cbc.ca/news/interactives/syria-dashboard/>. 6 Soumaskanda, Sumi. (13 March 2012) "Syrian Forces Target Doctors and Patients." USATODAY.COM. USA Today.Retrieved from<http:// usatoday30.usatoday.com/news/world/story/2012-03-12/syria-doctors-patients-hospitalattacked/53504614/1>. 7 (1 April 2013) "UN Food Agency Reports 20 Syria Attacks since 2011." The Jakarta Post.Associated Press.Retrieved from<http://www.thejakartapost.com/news/2013/04/02/ un-food-agency-reports-20-syria-attacks-2011.html>. Page 15 Tanning Beds: Our Beloved Carcinogens 1 Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning
and risk of melanoma: a case-control study in a highly exposed population.Cancer Epidemiology, Biomarkers and Prevention 2010;19(6):1557–1568 U.S. Food and Drug Administration. (2012, August 9). “Indoor Tanning: The Risks of Ultraviolet Rays.” U.S. Food and Drug Administration: For Consumers. Retrieved from :www.fda.gov/forconsumers/consumerupdates/ucm186687.htm 3 Center for Disease Control and Prevention. (2013, February 15). “Skin Cancer: Prevention.” Center for Disease Control and Prevention. Retrieved from www.cdc.gov/cancer/skin/ basic_info/prevention.htm 4 Center for Disease Control and Prevention. (2013, March 21). “Skin Cancer: Indoor Tanning.” Center for Disease Control and Prevention. Retrieved from www.cdc.gov/cancer/skin/ basic_info/indoor_tanning.htm 5 Gillen M, Markey C.The Role of Body Image and Depression in Tanning Behaviors and Attitudes.Behavioral Medicine, 2012.Vol 38.3. Retrieved from www.tandfonline.com/ doi/full/10.1080/08964289.2012.685499 6 Kim, E. (2012, June 28). “Obamacare's 'tanning tax' is here to stay. CNN Money. Retrieved from http://money.cnn.com/2012/06/28/pf/taxes/tanning-tax/index.htm 7 National Conference of State Legislatures. (2013, April). “Indoor Tanning Restrictions for Minors - A State-by-State Comparison.” National Conference of State Legislatures. Retrieved from www.ncsl.org/issues-research/health/indoor-tanning-restrictions.aspx 2
Page 16 Harder, Better, Faster, Stronger: Alternatives to Standard CPR 1 Cooper, J.A., Cooper, J.M., and Cooper, J.D. (2006). Contemporary reviews incardiovascular medicine: Cardiopulmonary resuscitation: History, current practice, and future direction.Circulation, 114:2839-2849. Retrieved from http://circ.ahajournals.org/ content/114/25/2839.full 2 Shmerling, R. (2012). CPR: Less effective than you might think. Aetna InteliHealth. Retrieved from http://www.intelihealth.com/IH/ihtIH/WSIHW000/35320/35323/372221.html? d=dmtHMSContent 3 Venere, E. (2007). New CPR promises better results by compressing abdomen, not chest. Purdue University News. Retrieved from https://news.uns.purdue.edu/ x/2007b/070905GeddesCPR.html Page 16 Overcoming the Outbreak: The Norovirus in the US 1 Hensley, Scott. (2013, March 31). Norovirus is Now the Leading Cause of Gastroenteritis in US Children. NPR. Retrieved from http://www.npr.org/blogs/ health/2013/01/25/170249648/new-norovirus-strain-rips-through-the-u-s 2 CDC. (2013, March 31). New Norovirus Strain Rips Through US..Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/media/releases/2013/ p0321_norovirus_children.html 3 Schnirring, Lisa. (2013, March 31). Norovirus Overtakes Rotavirus as Leading GI Illness in Kids. CIDRAP. Retrieved from http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/ news/mar2113norovirus.html 4 Sifferlin, Amanda. (2013, March 31). Norovirus is Leading Cause of Intestinal Disorders in American Kids. TIME: Health and Family.. Retrieved from http:// healthland.time.com/2013/03/22/norovirus-is-leading-cause-of-intestinal-disorders-inamerican-kids/ Page 17 Polio—Last Vestiges 1 Mahr, Krista. "How India Fought Polio — and Won." TIME. 13 Jan 2013: n. page. Web. 7 Apr. 2013. <http://world.time.com/2013/01/13/how-india-fought-polio-and-won/>. 2 "Vaccines and Immunizations ."Polio Disease - Questions and Answers. Center for Disease Control and Prevention, 18 Mar 2011. Web. <http://www.cdc.gov/vaccines/vpd-vac/ polio/dis-faqs.htm>. 2 "CNN."Polio .Mayo Foundation for Medical Education and Research. Web. 3 Apr 2013. <http:// www.cnn.com/HEALTH/library/polio/DS00572.html>. 3 "Post-Polio Syndrome Fact Sheet."National Institute of Health. National Institute of Neurological Disorders and Stroke . Web. 3 Apr 2013. <http://www.ninds.nih.gov/disorders/ post_polio/detail_post_polio.htm>. 4 "Poliomyelitis." Media Centre. World Health Organization . Web. 3 Apr 2013. <http:// www.who.int/mediacentre/factsheets/fs114/en/>. 5 Chang, April, Edgar Chavez, SadikaHameed, Robert Lamb, and Kathryn Mixon. "A report of the csis global health policy center." Eradicating Polio in Afghanistan and Pakistan. Center for Strategic and International Studies . Web. 2 Apr 2013. <http://csis.org/files/ publication/120810_Chang_EradicatingPolio_Web.pdf>. Page 18 The Shift in Healthcare from Traditional Fee-for-service Systems 1 Aging statistics. (2011, Sept 01). Retrieved from http://www.aoa.gov/Aging_Statistics/ 2 Burns, J. (2011, Jan). Unitedhealthcare’s bold effort to deal with cancer drug costs. Managed Care, Retrieved from http://www.managedcaremag.com/ archives/1101/1101.cancerdrugs.html 3 Calsyn, M., & Lee, E. (2012, Sept). Alternatives to fee-for-service payments in health care. Retrieved from http://www.americanprogress.org/wp-content/uploads/2012/09/ FeeforService4.pdf 4 Frequently asked questions. (n.d.). Retrieved from http://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/sharedsavingsprogram/downloads/MSSP_FAQs.pdf 5 World health statistics 2012. (2012). Retrieved from http://apps.who.int/iris/ bitstream/10665/44844/1/9789241564441_eng.pdf Pg 18 is Herpes hurting Our Brains? 1 Cheng S.B., Ferland P., Webster P.,& Bearer E.L. Herpes simplex virus dances with amyloid precursor protein while exiting the cell. PLoS One. 31 March 2013. Retrieved from <http://www.alzforum.org/pap/annotation.asp?powID=116169>. 2 CNN Health. (2010). When will we see a herpes cure? 31 March 2013. Retrieved from <http:// thechart.blogs.cnn.com/2010/02/25/when-will-we-see-a-herpes-cure/>. 3 James, Steve. Cold sores may be tied to memory loss, study suggests. Vitals NBC News. 31 March 2013. <http://vitals.nbcnews.com/_news/2013/03/25/17459529-cold-sores-maybe-tied-to-memory-loss-study-suggests?lite>. 4 Miller, Tracey. (2013). Cold Sores and other forms of herpes linked to memory loss and cognitive problems. New York Daily News. 31 March 2013. <http://www.nydailynews.com/lifestyle/health/cold-sores-linked-memory-loss-study-article-1.1299328>. 5 Siddique, Ashik. Herpes Virus Infection can cause memory loss, cognitive impairment along with cold sores. Medical Daily. 31 March 2013. <medicaldaily.com/ articles/14398/20130325/herpes-virus-infection-cause-memory-cognitiveimpairment.htm>.
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