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When the Surgeon Is a Mom – The New York Times

Gifty Kwakye, 38, an assistant professor of surgery at the University of Michigan, was told by her medical school classmates that she was too nice for surgery. She never questioned her own drive to operate, but she did worry that it would be difficult to balance her work with dreams of being a mother. She hoped to start a family during the research phase of her training, when she had more control over her schedule, but things didnt go as planned. Overcoming medical problems, she became pregnant three months before she was scheduled to return to clinical residency.

Transitioning from maternity leave back to clinical work felt like having cotton wool stuck in your brain, Dr. Kwakye said. She woke up every two hours at night to feed her baby. She was so dazed that she covered her home in sticky-note reminders: Bring the pump to work, the nipple protectors, the ice packs to keep the milk cold.

Worst was the guilt she felt spending 12-hour shifts away from her child. When Dr. Kwakye squeezed in a pickup at day care to relieve her husband, she watched her daughter run to the teacher and call her Mommy. That prompted a day care administrator to ask Dr. Kwakye whether she was on the list of adults approved for pickup, and the doctor had to explain that she was indeed the mother.

The kid didnt want to go to me, and I was like O.K., I deserved that, that was fair, you have no idea who I am, Dr. Kwakye said. But what that does to a mother is painful. I had a moment when I was like, I cant do this anymore; Im failing as a resident and Im failing as a mom.

One morning she sat in her car crying because she didnt want to leave her baby. She wondered if she should have heeded the warnings not to pursue surgery. She told herself, Maybe they saw something you didnt see and youre not tough enough.

As health care providers, surgeons are painfully aware of the ways in which their professional commitments can harm their own health and their familys. Alex Moore, a surgical resident at Brigham and Womens Hospital, said that spending long days away from her 6-month-old baby was especially upsetting because she has studied the medical importance of mother-child bonding. Returning to the operating room after a 10-week leave felt like your soul is getting ripped out, she said.

A surgeons schedule isnt just psychologically taxing, it also takes a physical toll. A resident spends most of the day on her feet. She may go eight to 12 hours without eating, or even drinking water. As one surgical resident put it, health often comes down to Do as I say, not as I do for doctors in training. Dr. Rangel, who had two babies, both born prematurely, wondered whether she was to blame for neglecting her health while pregnant.

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When the Surgeon Is a Mom - The New York Times

Beyond The Numbers: Where Business School Meets College Football – Poets&Quants

Michigan vs. Ohio State

As a University of Michigan alum and the former director of admission at that institutions medical school, Im still reeling from the 56-27 thrashing that marked the Wolverines eighth straight loss to their college football archrival, the Ohio State University Buckeyes.

Yet while I was consumed by the football game, two of the sports mortal enemies were competing in a matchup that literally determines life or death. In its annual blood drive with Ohio State, Michigan actually won although everyone involved was a winner in their own right, from recipients to donors to volunteers to the universities themselves.

In fact, academia is a space where traitors become allies. Take the Big Ten conference. University of Minnesota and University of Wisconsin partner on a $6.3 million grant for advancing evidence-based education practices. Purdue University and Indiana University jointly research the development of life-saving medical devices. Overcoming the tensions of all rivalries, the Big Ten Academic Alliance produces research breakthroughs by leveraging resources from across the consortiums campuses.

This healthy competition brings to mind the numbers that stoke passions in my industry far more than college football scores: business school rankings. In the 2019-2020 Poets & Quants list of the top 100 U.S. MBA programs, my alma maters Ross sits a comfortable 24 spots ahead of Ohio States Fisher.

But even as a higher education technology executive who specializes in business school admissions, I try to look beyond those numbers. Its all about perspective. In a time of declining applications to Americas MBA programs, the college admissions offices that I work with cant afford to get caught up in the rankings. MBA applications are down even at elite programs like Stanford Universitys GSB, Harvard Universitys HBS and University of Pennsylvanias Wharton. Those business schools will need to put aside their rivalries with Massachusetts Institute of Technologys Sloan, Northwesterns Kellogg and University of Chicagos Booth if they want to get serious about the future vitality of their academic discipline as a whole.

Accordingly, Im witnessing business school leaders ramp up their participation in professional networks and associations which provide them with platforms to share best practices. Meanwhile, initiatives like the Big Ten Plus Case Competition bring together MBA programs for competitions that prioritize academic excellence over wins and losses.

The nature of the outcomes at stake also motivates healthy competition. When the football game is over, the players, coaches and fans on both sides will ultimately move on with their lives. But everyone loses if business schools cant fill their seats, as Americas largest companies and the countrys entire economy will be left wondering where the next generation of business leaders will come from.

Even on the football field, the fiercest of rivals end the game with a handshake. They fight hard. They inflict unspeakable pain on one another. And still, they somehow manage to exhale, accepting the outcome and acknowledging their common humanity.

At the same time, if opposing teams cant unite to promote their games to drive fans to stadiums and viewers to televisions, what do schools stand to lose? The very funds that support their research towards discovering solutions for societys greatest problems, like Penn State Universitys pursuit of water sustainability through self-cleaning toilets, Michigan State Universitys use of drone technology to enhance food sustainability and the cutting-edge lung cancer research conducted at University of Nebraska.

Business school leaders can also stand to learn from college football fans. The beloved Iowa Wave, in which University of Iowa Hawkeye fans wave to kids who watch the game from the windows of the adjacent childrens hospital, has also been adopted by Northern Illinois University Huskie fans. MBA programs, too, cant spurn the implementation of their competitors effective strategies purely out of pride.

In an era when so many fault lines threaten to divide us, were much better off not only tolerating each other, but even collaborating with our rivals. From Champaign to College Park, football fans and business school leaders alike should look beyond the numbers this holiday season. Dont be blinded by your schools colors. Whether your passions are ignited by Michigan maize, Indiana crimson, or Rutgers scarlet, its time to work together to generate the prosocial outcomes that transcend scores and rankings.

Robert Ruiz is the managing director of BusinessCAS at Liaison International.

DONT MISS: AN OPEN LETTER TO B-SCHOOL DEANS ON MBA APP DECLINES or WHAT MOST SURPRISED GMACS CHIEF IN 2019

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Beyond The Numbers: Where Business School Meets College Football - Poets&Quants

In sickness and in health: Access to nearby, quality health care is a growing priority in Greater Minnesota (copy) – Southernminn.com

In January 2017, the Minnesota State Demographic Center published the report Greater Minnesota: Refined & Revisited. The 68-page document took a hard look at the state outside the population hub of the metro area in order to identify trends driven by Minnesotas changing demographics.

Among the most significant is that Greater Minnesotans are aging faster than their urban counterparts. The findings noted residents of rural and small-town Minnesota are more than twice as likely to be age 80 or older than residents in urban parts of the state. More than 1 in 20 residents in rural and small-town areas in Minnesota were 80 or above, and 44 percent of rural residents were over 50 at the time of the report, compared to 32 percent of urban dwellers.

Unfortunately, as individuals age, they need more health care services, but rural residents are finding fewer care providers available to them. They also report higher rates of perceived fair and poor health and face higher mortality rates than do their urban counterparts. Thats according to the 2017 Minnesota Department of Healths Office of Rural Health publication, Snapshot of Health in Rural Minnesota.

All of those things put together just make [Greater Minnesota] a more complicated environment to provide health care in, says Carrie Henning-Smith, deputy director at the Us Rural Health Research Center, part of the Division of Health Policy and Management in the School of Public Health. Not better or worse, just more complicated.

Bringing doctors into rural Minnesota

The Us Rural Health Research Center studies access to and quality of health care and population health outcomes in rural areas. Its one of seven such health research centers across the country funded by the federal government to improve health outcomes in areas that have unequal access to providers, compared to more urban locations.

Although areas in Greater Minnesota with larger cities such as St. Cloud, Rochester, Duluth, or Mankato have robust health care systems that are easily accessible to nearby residents, more rural areas of the state do not. And as residents in those areas age, they often must travel farther and farther to seek health care.

During a recent trip to Worthington, a town of roughly 12,500 located in far southwestern Minnesota, U of M President Joan Gabel says one of the things she heard from local residents is that they need more help bringing doctors to the area. They asked her if there were ways in which the U could facilitate that?

Henning-Smith says recruiting health care providers to rural clinics is harder now than it was decades ago. Part of the reason is because those providers cant be as flexible in their daily practice as they can in bigger cities.

You cant specialize in any one particular population or health problem, Henning-Smith says about providers in smaller communities. You need to be able to do the full range of practice, and health providers arent always comfortable with that.

That full range of practice is often delivered by primary care doctors, who offer routine, preventative services on a regular basis, and also help patients better navigate the complex health care system. But according to the federal Health Resources & Services Administration, which tracks what are known as Health Professional Shortage Areas, Minnesota has 133 areas with a shortage of medical professionals, including primary care physicians. Only two such areas are in the metro the rest are in Greater Minnesota.

The HRSA lists Lonsdale/Erin/Shieldsville in Rice County, Oshawa in Nicollet County and St. Mary in Waseca County as medically underserved areas. Nearly every Minnesota county aside from the Twin Cities metro and Rochester area is listed as having to have a shortage of mental-health professionals as determined by federal guidelines.

Ironically, at the same time the state notes a shortage of doctors in Greater Minnesota, it also estimates there are between 250 and 400 foreign-trained doctors who cannot practice medicine here without first completing a U.S. residency. And finding a residency in the U.S. can be expensive, time-consuming, and difficult for a physician who may not be a native English speaker or familiar with this countrys medical requirements.

As a first step to helping foreign-trained doctors qualify for a U.S. residency, the U offers a program called BRIIDGE, or Bridge to Residency for Immigrant International Doctor Graduates through clinical Experience. This nine-month program is open to individuals who have a medical doctors degree or the international equivalent; who were born outside the U.S., but who have been permanent, lawful residents of Minnesota for at least two years; and who meet other requirements. BRIIDGE helps those who qualify complete pre-residency requirements so they can proceed to the next step in seeking U.S. licensure.

Michael Westerhaus, M.D., an assistant professor at the U of M Twin Cities campus and director of the program, says that in the first year, four out of four participants in BRIIDGE matched into Minnesota-based residencies. In year two, two of six have so far matched into residencies; the other four are currently applying.

Another related program in which the University participates, the International Medical Graduate Program, offers funding to help international doctors pursue their residencies. IMG was started by the Minnesota Department of Healths Office of Rural Health and Primary Care and currently funds six residency positions, three of which are at the medical school. Students who receive funding agree to work for five years in one of the states underserved areas after they complete their schooling.

Khaled Mohammed, M.D., who attended medical school in his native Egypt, is a current IMG-funded resident who expects to graduate from the medical school next spring. After 10 years of training in his home country, Mohammed came to the U.S. in 2011 for a research scholarship at the University of Pittsburgh. He went to the Mayo Clinic for a research fellowship in 2013, then enrolled in his residency at the U of M in 2017.

While his first two years in residency kept him in rotations in the Twin Cities, for his last year, he is planning an elective rotation in rural Minnesota, although hes not sure where yet. How that rotation goes will factor into where he practices after graduation. (He could also stay in the metro to practice in an underserved area through Childrens Hospitals and Clinics of Minnesota and Hennepin Health care.)

After Im done with my elective, I will have an understanding about practicing in rural settings, Mohammed says.

Another program the U offers to help introduce medical professionals to practice areas in Greater Minnesota is the Rural Physician Associate Program (RPAP). RPAP was established in 1971 as a collaboration between the medical school and the Minnesota Legislature, in response to a shortage of medical providers in rural parts of the state even then.

Kirby Clark is a family physician who has been leading the program for the last two years. He said medical education has long been very metro-centric. The point of RPAP can be summed up in a quote that Clark attributes to the late Jack Verby, another family doctor who helped establish the program: You dont train somebody to work in forestry by training them in a lumberyard.

Clark explains: You want to get [students] serving in a community, learning in a community that looks like where theyre going to practice. RPAP places third-year medical school students on rotations for nine months in clinics across the state. Positions stretch from as far north as Roseau, near the Canadian border, to as far south as Luverne, near the South Dakota and Iowa borders. RPAP is optional, but allows students to meet their third-year requirements. Roughly 35 students, or 20 percent of the U of M-Twin Cities class, participate in the program each year.

Clark adds that about 50 percent of students who participate in RPAP will go on to work in rural clinics after residency.

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In sickness and in health: Access to nearby, quality health care is a growing priority in Greater Minnesota (copy) - Southernminn.com

Women Outnumber Men in Medical School – The Realist Woman

For the first time, women outnumber men in medical school. According to a new report from the Association of American Medical Colleges, women made up 50% of medical students in 2019, while men made up 49% of students.

Overall, men still make up the majority of doctors with 64% dominating in the profession, as compared to 36% of women. A joint report between the AAMC and the American Medical Association found disparities among men in women in their chosen fields.

Male doctors outnumber female doctors in the orthopedic, neurological and interventional radiology fields. Female doctors dominate in pediatrics, obstetrics and gynecology, allergy and immunology. Fields with an equal amount of men and women include pathology, psychiatry, sleep medicine and preventive medicine.

Theres also an age disparity among doctors with 80% of doctors age 65 or older in 2017 being men and 60% of younger doctors under the age of 35 being women.

The Realist Womans take:

Women surpassed men as students in medical school for the first time ever. Its incredible. I specifically love the fact that 60% of doctors under age 35 are female. Women really are making their mark in the world of medicine and I hope this story inspires young girls who dream of being doctors.

I noticed in the report that female doctors dominate in the fields that serve female patients, which makes sense because female doctors understand women's issues in a way that men cannot. But I'm sure that women in the fields that male doctors dominate are just as excellent as their male counterparts as women can do everything men can.

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Women Outnumber Men in Medical School - The Realist Woman

Glasscock joined the Navy in 1943 – Miami News Record

GLASSCOCK, THOMAS Interviewed 3 Dec 2019 by Joe L. Todd Ponca City, OK

Todd: Today is December 3, 2019. My name is Joe Todd and this is an interview with Thomas Glasscock in Ponca City, Oklahoma. Sir, where were you born?

Glasscock: I was born in Finland, North Dakota.

T: When is your birthday?

G: May 2, 1918.

T: Who was your father?

G: Dr. Timothy Glasscock.

T: And your mother?

G: Sadie G. Glasscock.

T: What was her maiden name?

G: Savre.

T: Did you go through school in Finland?

G: I went to grade school in Finland then we moved to Haywood, Iowa. I went to high school there then back to North Dakota to college.

T: What year did you graduate high school?

G: 1934, I think but it has been so long I have forgotten.

T: Where did you go to college?

G: The University of North Dakota.

T: What did you study?

G: Pre-med. I got my degree then I transferred to the University of Chicago for medical school. I finished my MD in 1942.

T: Do you remember when the Japanese bombed Pearl Harbor?

G: Yes.

T: Where were you?

H: I was in Chicago in school.

T: When you heard about the attack, what did you think?

G: Not much of anything other than we were at war.

T: After you got your MD, what did you do?

G: I took my internship in Chicago and following that, I took a residency in Chicago then I joined the Navy.

T: When did you join the Navy?

G: I joined in 1943 as a medical officer. I was sent to New Orleans to the Higgins Boat Company and assigned to Squadron 30 in New Orleans.

T: What were your duties with the Higgins Boat Company. I was organizing the medical department for the men, getting their records straightened out.

T: How long did it take to get all the medical records for the squadron?

G: It took about three months. I had three hospital corpsmen working with me at the Higgins Boat Company.

T: From New Orleans, where did you go?

H: Got all the records together and organized the men for the squadron. The hospital corpsmen got the records straightened out and organized the medical department for the whole group of boats.

T: How many men were in the medical department?

G: There was a chief, two first classes and myself. That was the medical department for the boats.

T: What was your rank at this time?

G: Lieutenant.

T: From New Orleans, where did you go?

G: We went to New York in the inland water way and put out boats in the group that was going to England. They were put in an attack transport ship. They were lifted and put on the ship.

T: Do you recall the name of the ship you were on?

G: I have no idea.

T: Tell me about the trip to England.

G: It was cold and we did a lot of maneuvering around the North Atlantic to avoid the German submarines. We were lucky, we didnt have any real bad storms. It took a while to get there because of all the maneuvers we had to make, we had to zig zag.

T: Where were your quarters on the ship?

G: Mine were in the sick bay with the doctor. We were in the sickbay and some sailors studied with us.

T: Did many guys get seasick?

G: I dont remember but Im sure they did. I dont remember anyone so sick we had a bad Glasscock - page 3

problem.

T: How did you pass the time on the trip?

G: Doing medical work on the boys that were sick, but none were real sick. We played cards and ate and wondered what we were going to do next.

T: How long did the trip take?

G: I think it was at least eight days.

T: Where did the ship land?

G: We landed on the north coast of England. I think it was Liverpool. Some of the boys were put on boats down to the south part of England and some of us got on a train and went south. All the officer went by train. We went down to Southampton and the British had built a building for the PT boats to come into. They had a real nice area called tent city and they had everything we needed. They had a place where we practiced and eating and sleeping were pretty nice.

T: How did you prepare for D-Day?

G: We werent too involved with that.

T: When did you get to France?

G: We got there on D-Day.

T: Tell me about going to France.

G: We got on the boats and cruised and kept in touch with the other boats. We were going to do what we had been practicing doing.

T: What did you practice to do?

G: Taking aboard the injured and identifying what should be done. It was kind of vague because no one had done that before. We had no specific identification except if someone was injured, we took care of them. We were on the PT Boats doing sea rescue.

T: When you treated the wounded, where were they sent?

G: We sent them to a hospital ship.

T: Tell me about D-Day.

G: It wasnt an organized thing as far as taking care of the wounded. We took care of them and shipped them to the hospital ship.

T: How did you get the wounded on the PT Boat?

G: We fished them out of the water.

T: You were off which beach, Omaha or Utah?

G: We were in the English Channel off all the beaches at Normandy.

T: How long were you off Normandy?

G: We were there until things quieted down. I cant remember the number of days.

T: Did you land in France or got back to England?

G: Our base was in England. We really didnt have a base there, we just anchored the boats in England.

T: What did you do when you went back?

G: We got them back in the water and sent them back to pick up survivors.

T: Were you in a hospital in England?

G: No, we stayed on the boats all the time.

T: Did you land in France?

G: Not early in the invasion. We landed later and took medicine where needed it. We then were based in Cherbourg. The wounded were brought in and we treated them and went sent some to the field hospital in Cherbourg and if they were not badly wounded, they were sent back to their unit.

T: How long were you at Cherbourg?

G: That was our base the whole time. We never got orders to go anyplace else. We never went any place in France except Cherbourg. There was the hospital in Cherbourg that the United States used.

T: Did you get to Germany?

G: No, I spent the rest of the war in Cherbourg. I remember, we had just finished Christmas Ever dinner and we were notified to get to the boats at five oclock in the morning and head out. We were in Cherbourg and a troop ship had sunk but when we got there everyone we pulled out of the water was dead from the cold. Our whole squadron went out and worked all night long. We never pulled anyone out of the water that survived. We put some in the engine room but none of them but they never came to. That was a cold night.

T: That was the SS Leopoldville. It was a Belgian troop ship taking troops to France from England for the Battle of the Bulge. Don Shaub in Bartlesville survived the Leopoldville by getting on a British destroyer that was escorting he Leopoldville.

G: We found no one alive in the water.

T: What did you do on V-E Day?

G: I dont remember. I suspect I celebrated like everybody else, but I dont remember.

T: Did you think you would go to the Pacific?

G: There were a lot pf PT Boats in the Pacific and we wondered if we were going there. But we didnt. The whole group came back to the United States.

T: How long were you in the Navy?

G: Four years.

T: When you left the Navy, where did you go?

G: There was a group in Chicago that were helping veterans find a place to go. There was a clinic in Ponca City and I interviewed with them and came to Ponca City in 1946. I was with the clinic for five years then I moved out to my private practice.

T: Would you join the Navy again?

G: I would join the Navy over the other services.

T: Today when you hear the name Franklin Roosevelt, what is your reaction?

G: We took the advice of what they told us to do. It is hard to evaluate him because things were not too well organized.

T: Harry Truman.

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Glasscock joined the Navy in 1943 - Miami News Record

Proton therapy as effective as standard radiation with fewer side effects – Washington University School of Medicine in St. Louis

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Lower hospitalization rates following proton therapy could offset its higher upfront cost compared with standard radiation therapy

A new study suggests proton therapy is as effective as traditional X-ray radiation therapy while causing fewer serious side effects. Pictured is proton therapy equipment at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

Cancer patients who receive high-tech proton therapy experience similar cure rates and fewer serious side effects compared with those who undergo traditional X-ray radiation therapy, according to a study led by Washington University School of Medicine in St. Louis and the Perelman School of Medicine at the University of Pennsylvania.

The reduction in side effects particularly lower hospitalization rates and fewer emergency room visits could offset the higher initial cost of proton therapy, which often is not covered by private insurance because of its higher upfront expense and limited data on its effectiveness compared to X-ray radiation, according to the researchers.

The study is published Dec. 26 in JAMA Oncology. Some of the findings also were presented in June at the American Society of Clinical Oncologys annual meeting, in Chicago.

We observed significantly fewer unplanned hospitalizations in the proton therapy group, which suggests the treatment may be better for patients and, perhaps, less taxing on the health-care system, said first author Brian C. Baumann, MD, an assistant professor of radiation oncology at Washington University and an adjunct assistant professor of radiation oncology at Penn. If proton therapy can reduce hospitalizations, that has a real impact on improving quality of life for both our patients and their caregivers.

While radiation therapy can be curative for certain cancers, it also causes severe side effects such as difficulty swallowing, nausea and diarrhea that reduce quality of life and can, in some cases, require hospitalization, said Baumann, who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

The study, which included almost 1,500 patients from Penn Medicine, is the first large review of data across several cancer types including lung, brain, head and neck, gastrointestinal and gynecologic cancers to show a reduced side-effect profile for proton therapy compared with X-ray radiation therapy for patients receiving combined chemotherapy and radiation. None of the patients had metastatic cancer, in which a tumor has spread to other parts of the body.

The researchers found no differences between the two groups in survival and cancer control, suggesting that proton therapy is just as effective in treating the cancer even as it caused fewer side effects. Overall survival at one year for the proton therapy group was 83 percent versus 81 percent for the X-ray radiation therapy group. This difference tipped slightly in favor of proton therapy but was not statistically significant.

The difference in side effects was more pronounced. Forty-five of 391 patients receiving proton therapy experienced a severe side effect in the 90-day time frame (11.5 percent). In the X-ray radiation therapy group, 301 of 1,092 patients experienced a severe side effect in the same period (27.6 percent). The patients receiving proton therapy experienced fewer side effects despite the fact that they were, on average, older and had more medical problems than those receiving standard X-ray radiation therapy. After taking steps to control for these differences, the researchers found that patients receiving proton therapy experienced a two-thirds reduction in the relative risk of severe side effects within the first 90 days of treatment, compared with patients receiving X-ray radiation therapy.

Both types of radiation therapy are approved by the Food and Drug Administration for cancer treatment. X-ray beams are made up of photons, which are electromagnetic particles that have almost no mass, allowing them to travel all the way through the body, passing through healthy tissue on the way out. Protons are relatively heavy, positively charged particles that hit their target and stop, essentially eliminating the exit dose of radiation.

Since the study found proton therapy to have fewer adverse events, Baumann said it could prompt radiation oncologists to design clinical trials to investigate whether increasing the dose of proton radiation would help patients do better, while still maintaining acceptable levels of side effects.

Similarly, the reduced side effects of proton therapy could allow older patients with additional medical conditions who are typically excluded from clinical trials because of their frailty to participate in trials investigating more intensive treatments that could be beneficial.

Clinical trials often are limited to patients who have serious cancers but are otherwise quite healthy, and thats not the real-world cancer population, said Baumann. Doctors, rightly, are concerned about toxicity. But with the reduced toxicity that we found with proton therapy, this might open the doors to the possibility of older patients with multiple medical problems getting cancer therapy they can tolerate that is more likely to be curative.

With our aging population, this could have a big impact on a lot of patients, he added. To me, thats an exciting implication of this research.

A new study led by Brian Baumann, MD, of Washington University School of Medicine in St. Louis, found that proton therapy (bottom) is associated with fewer severe side effects than conventional X-ray radiation therapy (top) for many cancer patients. Protons are relatively heavy, positively charged particles that hit their target a lung tumor in this example and stop. X-ray beams consist of photons, much smaller particles that can travel all the way through the body and its healthy tissue including the heart in this example on the way out.

This work was supported by research funds from the University of Pennsylvania.

Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, ODwyer PJ, Bekelman JE, Metz JM. Comparative effectiveness of proton therapy versus photon therapy as part of concurrent chemo-radiotherapy for locally advanced cancer. JAMA Oncology. Dec. 26, 2019.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Proton therapy as effective as standard radiation with fewer side effects - Washington University School of Medicine in St. Louis

The House of God, a Book as Sexist as It Was Influential, Gets a Sequel – The New Yorker

In 1978, the psychiatrist Stephen Bergman published the novel The House of God, written under the pen name Samuel Shem. Based on Bergmans experiences as an intern at Harvards Beth Israel hospital, the book rapidly became a staple of any medical residents required-reading list; to date, it has sold more than two million copies. A 2003 edition included an introduction by John Updike, who wrote that The House of God could probably not be written now, at least so unabashedly; its lavish use of freewheeling, multiethnic caricature would be inhibited by the current terms racist, sexist, and ageist. Its 70s sex is not safe.

For Updike, for those who made this argument before him, and for those who continue to make it today, a measure of freedom has been lost in a culture that requires writers to watch their words for unintended cruelty. An army of chiding librarians seems to have arisen, tsk-tsk-ing the poor writers bawdy, outrageous imagination. Updikes concern is embodied in the real phenomena of Twitter pile-ons and sensitivity readers, but it is also Foucauldian: the chiding librarian is within us, suppressing the writers creativity before it even makes it to the page. In the panopticon where every action can be seen, known, and embedded in a tweet, no actual chains are required. Ultimately, we control ourselves.

The House of God is not a great book, the literary critic Kathryn Montgomery has written, but it is an important book. Bergman claims that it shows how residents are dehumanized in the course of their sleepless, gruelling medical training, and in turn begin behaving cruelly or carelessly toward their patients. As the physician and poet Jack Coulehan has pointed out, however, Bergman undercuts his argument somewhat when his narrator, Roy Basch, refers to patients as a heifer and a hippo on his first day of work. If the narrators callous attitude toward patients is a product of the dehumanizing power of residency training, how did Basch get there so quickly? Coulehan argues that the novel does a disservice to medical-student readers, who internalize the message that clinical training is dehumanizing without sufficiently noticing that the group most dehumanized is patients. Others, such as the emergency physician Jay Baruch, argue that the novels descriptions of the disgust, shame, and horror that patient care sometimes evokes comprise a badly needed articulation of the lived experience of residents. The House of God likely contributed to some of the reforms in medical training that have come about since the nineteen-seventies, particularly in regard to long work hours that lead to sleep deprivation. The book is taught in medical schools and quoted by physicians; whether we realize it or not, we are quoting The House of God when we say, for example, The first procedure in any cardiac arrest is to take your own pulse.

More than forty years after its publication, many of the books episodes, such as the suicide of an intern, still feel contemporary. Other bits are frighteningly dated or always felt slanted, particularly the portrayal of women. The books nurses have none of the clinical insight or skill of actual nurses, but theyre eager to reveal their montes pubis for the interns. There is just one female physician, a frigid, universally loathed character named Jo. The last of the women is Roy Baschs partner, Berry, who is intelligent but inexplicably content to serve as a surrogate mother for Basch, while displaying no expectation that he might broaden her horizons in turn, or even refrain from copulating with nurses.

As sympathetic as I am to Updikes concerns about social control, and as nostalgic as I may be for the time when I wrote like a childblithe, mindless of consequence, the only audience in my mind an audience of people who already loved meI am no longer a child. These days, I write not only for my best friends but for general readers. Growing up involves coming to realize that others are as human as oneself, with inner lives at least as rich as ones own. The realization that others have inner lives is a developmental milestone that we humans are supposed to achieve around age four. But, as it turns out, many of us are still working on it, decades later. Or perhaps we gain the ability to imagine the lives of others around age four, but we may or may not put that ability into practice.

I look to literature to attune my mind to the inner lives of other people, and it is painful when a book falls so short of deeply imagining the other that it portrays some whole wings of the world as flat, airless, not truly worth inhabiting. It is ironic, in a sick way, when the art that ought to bring us closer accidentally insists that some of us are not really worth the effort. I read The House of God in medical school, as many of us do, and was left looking askance at my chosen field. Because the book is lionized so uncritically in my profession, I could only suspect that my future colleagues did not hold women in particularly high regard.

Bergman and his apologists (including many of my women colleagues in medicine) say that The House of God was simply a novel of its time. When asked about the novels sexism in a recent interview, Bergman replied, I was roundly criticized for the way women were seen in the book, then launched into an anecdote about a doctor and nurse having sex in an on-call room in the nineteen-seventies. Things have changed, Bergman added. The anecdote is telling, with its implication that feminist thinkers object to sex itself, rather than to the portrayal of women as sex objects. The accusation that women who display the capacity for critical thought must be frigid is a tired one, and one given full treatment in the character of Jothe only woman in House who occupies a position of authority, the lonely single woman whose supervision of Basch and her other male subordinates equates to lop[ping] a bit off his schlong daily by telling him what hed failed to do.

Other authors have managed to see women in health care as complex humans: Aleksandr Solzhenitsyn, in Cancer Ward; Michael Ondaatje, in The English Patient; Elizabeth Norman, in the beautiful and deeply researched We Band of Angels. As more women have trained as medical professionals, physician writers such as Danielle Ofri, Pauline Chen, the former Surgeon General Joycelyn Elders, and the Navajo surgeon Lori Arviso Alvord have told our stories in memoirs. Part of a books essential work is to bring readers deeply into the worlds of others, and thus it is fair to criticize authors who make no attempt to examine the worlds of whole categories of people. As Eudora Welty said of her stories and novels, What I do in writing of any character is to try to enter into the mind, heart, and skin of a human being who is not myself. Whether this happens to be a man or a woman, old or young, with skin black or white, the primary challenge lies in making the jump itself. It is the act of a writers imagination that I set most high. It is odd to blame the times, then, for a failure of imaginationthat freewheeling, unabashed thing that Updike prized.

The other defense of The House of God that I commonly hear is But its satire! And The House of God is wonderfully effective satire insofar as it points an accusatory finger at systems of power in medicine. But the spectacle of the male Harvard Medical School graduate satirizing women colleagues is painful; good satire deflates systems of power, not the people who toil and suffer in those systems.

Naturally, I turned to Mans 4th Best Hospital, the recent sequel to The House of God, with cautious curiosity. I wondered if a forty-year career as a psychiatrist could have acquainted Bergman with the notion that women have inner lives. The novels first sentenceExcept for her eyes, Berry is fully clotheddimmed my hopes only somewhat. Roy Basch is back, and his life in the years between the two books maps closely with Bergmans. Both men married a psychologist who believes that profound and fixed differences between genders not only exist but also can begin to be bridged by using the word we more frequently; both adopted a daughter from overseas; both became psychiatrists with a special focus on addiction medicine; both wrote a novel called The House of God.

In the first chapter, Basch and Berry are staying at their Costa Rican finca, and Basch requires stitches from a Tica physician. When she bent over to examine me, he describes, I could not help noticing that her purple blouse wasto use a line from The Houseunbuttoned down past Thursday, breasts cradled in the lace palms of a pink bra.... As she left... I noticed she was wearing tight bright pink pants and red high healsmake that heels. For Basch, this is familiar ground: sex and death. Especially in the Medical Intensive Care Unit, in the daily horror of lingering disease and death, the healthy sex with the nurses, orgasms crying out Were still alive and young! At the threat of disease and death, the sensual, the vitaland, yes, the hope.

Now, I happen to be a woman physician. I cant speak for the whole crowd of us, but I think that most of us do not wish for our breasts to be ogled while we stitcheven if it makes our septuagenarian patients feel sensual and vital.

Even if Baschs ogling of the doctor is nauseating, his point about the erotics of medicine has something true in it. All that death does make one wish to prove that one is alive oneself, and that life offers something more exalted than excretion and suffering. Sex is a high line to pleasure, and I have friends both male and female who did fornicate their ways around the cities of their internship. Mostly we were too tired for fornication, though, or we were in love with our spouses and sensible enough to be faithful to the ones who kept us fed and sane. There is an actual orgy in the call room in The House of God which, in retrospect, feels quaint. What intern has time for an orgy these days? You would get paged out of it within ten minutes.

(It occurs to me that I am a pediatrician, and it could just be that childrens hospitals are particularly undersexed. Perhaps, in adult hospitals, the loamy must of sex luffs up around bedpans and ventilators, and interns must splash through puddles of semen to get to their call-room beds. Ive no way to know!)

Although many of the characters, including the physicians, in Mans 4th Best Hospital are women, and, although Bergman has gotten beyond the trope of nurse as dumb mons, his depiction of gender is still old-fashioned. Men are strong and zany and ha-ha funny; women are sensitive and moral and wise, happy either to bed the men or to mother them. (Berry refers to Baschs moral education as her full-time job in the medical field.) In one memorable scene, a nurse named Molly allows Basch to come up to her apartment and fondle her remarkably caressable breasts and strangely long nipples, for old times sake, then does him the service of reminding him of his wifes existence, putting an end to the dalliance before penetration can occur. The virile Baschs formidable sex drive is thwarted, but later he is grateful and falls to his knees on the sidewalkthank goodness Berry never needs to know! Molly goes on to work alongside Berry when she, too, joins the clinic. There is minimal drama and no consequences for Bascha male fantasy fulfilled, even if there was no penetration.

The other aspects of Baschs privilege also go unexamined, and his flaunting of his privilege as a doctor and a wealthy person makes me, as a fellow-physician, cringe. At one point in Mans 4th Best, Basch develops an abnormal heart rhythm and has to go to the hospital. He calls a fellow-doctor en route, and that doctor promises to get a cardiologist to come in and care for Basch. Once at the hospital, Basch continues to lobby for special treatment:

I had learned that if Ior any of my familygo to a doctor, its helpful to say Im a doctor, and when they ask what kind, I tell them and then ask, Have you heard of the novel The House of God? Almost always they perk up and say, Oh, yeah, its my favorite book! Well, I wrote it. And then the word spreads throughout the [emergency ward] and we all get a lot of attention. Docs and nurses crowd the room, want to chat, almost always telling me where they were when theyd read my novel.

For anyone who has struggled to receive proper attention from physicians, this passage could be a little hard to take. It is also difficult to feel sympathy with the Basch family for their financial troubles, which condemn them to owning a vacation finca and also a large Boston-area estate and confine them only to the carriage house of the estate while they rent out the main house. Basch goes into an alcoholic tailspin from the stress of working extra shifts in order to afford their adopted daughters private preschool. (My 24,000 dollar city taxes would have paid for excellent public school, he explains. But wed tried it with Springit didnt work. She was terribly shy.)

I have many shortcomings as a human, and one of them is my failure to sympathize with the struggles of the wealthy to secure private-school spots for their children. I was so shy that my preschool teachers thought that I had a developmental disability, and I still managed to survive public school in rural Texas, where abstinence-only sex education ruled the day and where we dissected a single rat that we shared as a class. Now I am not only a doctor but also some kind of arbiter of taste, called upon by The New Yorker to review this book. All this unexpected glory, despite having shared the rat. Im sure that I was protected by old-fashioned white privilege in public school; I was urged to the front of the class. The parents who really have to worry about the fates of their children in public school rarely have the luxury of choice.

Nor should Updike have worried that the racist label would eliminate free-wheeling multiethnic caricature from Bergmans writing. House employed caricatures of black and Irish-American people, among others. Bergman portrays Navajo people as fully realized characters in Mans 4th Best, but a Latino physician character is still a racist parody whose Spanish is incorrect. Mia madre! he says, and Esta mucho discombobulay, and El segundo causa, and Merck Vioxx kill my madre!and it is unclear if this Spanish is deliberately incorrect or if it has simply been believed to be correct, in a country where literate Spanish speakers are abundant and could correct it.

Basch frequently nods to the struggles of the working class, or, as he refers to them, all the poor and middle-class patients Id seen who were only one illness away, in our nations piss-poor health-care system, from bankruptcy. And the explicit mission of the book is to make medicine humane again. (Boring!) The book advocates, in its way, for universal access to health care as a cure not only for physical suffering and injustices in the system but also for the misery of physicians. Given these explicit missions, Shems tone-deaf approach to the narrative effects of privilege-flaunting is unfortunate.

In recent months, since I finished residency and began working as an attending physician, my way has been smoothed by the grunt work and flattery of trainees. My residents mine the electronic medical record for data and compose my notes; my medical students actually laugh out loud at my jokes. I recognize the precarity of all this, the seductive notion that this deference is not a consequence of a pernicious hierarchy but rather a consequence of my own hard work, wisdom, and virtue. I hope always to deserve the respect of my team. I hope never to be the dupe making sexist jokes that arent funny, to whom nobody in the room is willing to tell the truth. I hope to remember that I am a wealthy person now, and hand-wringing about the cost of private preschool would render me as unsympathetic as a self-appointed advocate for the oppressed.

Perhaps forty years of deference explain why Shem, like Updike, writes as a child would, imagining an audience that will express only adoration. Perhaps it explains why Basch presumes that his book is everybodys favorite, and that the doctors and nurses in the E.R. are gathering round to admire him. Some of them undoubtedly are, but a good portion of them are just staring at a fascinating specimen. We medical folk are simple people, and a famous writer in the E.R., like a case of Sydenhams chorea or an interestingly shaped object lodged in a rectum, excites our general interest.

So what is enough to ask of an elder male writer in this era? I think we women want revenge; we want blood on the ceiling, as Patricia Lockwood gave us in her recent epic takedown of Updike, in the London Review of Books. But also, perhaps, we want the possibility of individual moral progress, particularly among powerful men who have used their power to demean us. We want to recognize that progress when it comes, even as we continue to deserve real justice. Even if I would not wish to be or know the women in Bergmans book, I recognize an effortful appreciation of women here. In medicine, we are only just beginning to reckon with our gender-based wage gap, our failure to promote women leaders, our utter indifference to the needs of working mothers, and the systematic harassment of women trainees. Led by groups like Times Up Healthcare, we are beginning to discuss these things. It is all too slow, and, on my more exhausted days, I wish for torches and pitchforks rather than just these words.

Jo, the only female resident in The House of God, is also the only resident from that book who does not reappear in Mans 4th Best Hospital; she doesnt even rate a mention. Her character was instructive to me when I first read The House of God, because she symbolized so precisely the implicit threats levied against women who seek a career in medicine: that, if we do this unfeminine work, we will become hard and cold. If we assume leadership positions, the men we supervise will see us as schlong-lopping harpies.These threats are powerful tools of social control, instructing women in medicine that we must contort ourselves somehow into sexually available playthings, even as we thread catheters into femoral arteries and stuff tubes down the throats of the dying. For refusing to be pretty or sexy or soft, Jo was hated.

I would have liked to see Jo return, to see the consequences of her treatment in The House of God explored many years later. I would like to know if we women in medicineparticularly those who have been harassed and demeaned and underpaidget to live full lives, after all. I would like to know if we ever get to be both women physicians and people, or if the two conditions are incompatible.

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The House of God, a Book as Sexist as It Was Influential, Gets a Sequel - The New Yorker

Duquesne Universitys New Medical School To Be Built On Forbes Avenue – CBS Pittsburgh

PITTSBURGH (KDKA) A new medical school is coming to Pittsburgh.

On Forbes Avenue, opposite the soon-to-open UPMC Cooper Fieldhouse, Duquesne University will construct a five-story building to house a new medical school.

We like to say we educate the mind, body, and spirit of the individual here at the university, Duquesnes Provost Dr. David Dausey told KDKA money editor Jon Delano on Wednesday. It met our mission. It met a regional need. We have a shortage of family care practitioners in this region.

(Photo Credit: KDKA)

Its a College of Osteopathic Medicine, the first at a Catholic university in the state, and the second medical school in Pittsburgh.

Delano: What is osteopathic medicine?

Dause: Its very similar to allopathic. A lot of times, people try to emphasize the difference. The medical doctors go through the same boards. They go through the same training.

The same four years of medical schooling, followed by internships, lead to a D.O., doctor of osteopathy.

But while M.D.s often specialize, these doctors prefer family practice and general internal medicine.

Theres a shortage in this state of people that focus on primary care, said Dausey.

The current Lifes Works building will be replaced by a brand new structure.

Itll be a new front door on Forbes Avenue for Duquesne University, and its something were truly excited about, said Dausey.

Dr. John Kaufmann, who opened up North Carolinas first medical school in 35 years, has just been hired to start up this college.

If all goes according to plan, the new Dean of Osteopathic Medicine will be here on Jan. 1st.

And with a lot of work ahead, this new college will admit its first students for classes in the fall of 2023.

Continued here:

Duquesne Universitys New Medical School To Be Built On Forbes Avenue - CBS Pittsburgh

A group of black Tulane University medical students posed at a plantation to show how the past inspired their future – CNN

Russell Ledet, a medical student at Tulane University, tells CNN he got the idea after a conversation with his eight-year-old daughter about a trip they took to Whitney Plantation in Edgard, Louisiana.

"Her insight [to the visit] was, "This is not fair. This is not supposed to happen,"' Ledet said. "So I had this idea that we need to get the black medical students at Tulane and we need come here. We need to do this for ourselves."

He decided to pitch the idea of taking a group tour of the plantation to his classmates, along with taking pictures in their white coats, and it turned out better than imagined.

Ledet said his peers had "no hesitation," and they knew it could have an impact. Fifteen of the 65 black medical school students showed up, and he said the most amazing thing was that all of them had a different takeaway.

"As physicians in training, we stood on the steps of what was once slave quarters for our ancestors. This was such a powerful experience, and it honestly brought me to tears.

For black people pursing a career in medicine, keep going. For our entire community, keep striving. Resilience is in our DNA."

The photo started making the rounds and quickly grabbed the Internet's attention.

"You just get a feeling, and you think this is going to be impactful and this is going to mean something," Labat told CNN. "It's not about going viral or the attention ... it's about being inspirational."

Labat said that if she would have seen these photos as a child it would have motivated her further as she dreamed of becoming a doctor.

"To see people that look like me on this photo would have been so substantial for me as a younger student, and that is the whole purpose."

They hope the photo will inspire generations

The students hope the photo will make a difference for all black students. The plan is to put them in 100,000 schools across the country so that future students can be inspired.

They also hope it shows older generations in their field that the hardship was all worth it.

"We hope that we will make a lifelong impact ... and let [students] know: Yes, you can be smart. Yes, you can be successful ... and you can also do that while being unapologetically black and proud of where you come from and proud of where you are going," Labat said.

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A group of black Tulane University medical students posed at a plantation to show how the past inspired their future - CNN

The science of scheduling: When to do key medical school rotations – American Medical Association

When you enter the clerkship phase of medical schooltraditionally during the third yearyou are getting exposure to your future in the form of your core clinical rotations.

Lasting between four and eight weeks, at most schools, the core clinical clerkships consist of internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine, psychiatry, neurology and radiology.

Students have autonomy in their clinical rotations in that they can schedule them as they see fit. Is there a right way to do it? A medical student and resident offered insight on that question.

Kevin Perez is a second-year medical student at A.T. Still University School of Osteopathic Medicine in Arizonaone of 37 member schools of theAMA Accelerating Change in Medical Education Consortium.

When Perez begins his clinical rotations, he plans to start with the ones that are the most broadly applicable.

Im going to pick the most holistic ones first, Perez said. So, Im probably going to pick family medicine. Its slower paced, and it gives you a better understanding of what being a doctor is. So, surgery and EM [emergency medicine] would probably be what Ill do toward the end.

According to Luke Burns, MD, a second-year ob-gyn resident at Michigan Medicine, the rotations that give you the best knowledge base to build upon are going to depend on your preferred medical specialty.

If you want to do ob-gyn, youre going to want to do surgery first, so youre really good at surgery and know how to scrub into a case, Dr. Burns said. Likewise, if you want to do pediatrics, maybe do medicine first, so you have some inpatient experience before you go to the wards.

Perez is planning on going into emergency medicine. Because of that, he plans to do that rotation later in his training.

It's graded kind of subjectively, Perez said. Because of that, your performance and how much you know coming in, are going to define how well you do. If you want to do EM, you want to do well in that rotation for when you apply to EM residencies later. Picking it as your first one wouldnt be a great idea, unless you are truly ready. You only get one shot.

The key metric on which clerkship performance is evaluatedand one which residency programs take into considerationis a medical students scores on shelf exams, which come at the conclusion of a core rotation.

One really important thing I didnt realize would happen is I got better at taking shelf exams, Dr. Burns said. My shelf scores improved as the clinical year went by. If you feel a little shaky taking exams, theres some advantage to making it so your most important exams come at the end.

You may not know what you want to do when youre entering clerkships. But youre likely to know a few specialties you dont want to do. It makes sense to load those at the front of your clerkship schedule.

The common philosophy is to schedule the things you dont want to do first, Dr. Burns said. If you dont want to be a pediatrician, do that rotation first. Because its the one youll cut your teeth on, youll mess up on it, and by the time you get to the next thing, the theory goes, youll know what to do and how to impress attendings and residents.

In Dr. Burns case, he scheduled his ob-gyn rotation as his second-to-last rotation.

That was always the plan, he said, because then it would mean that it wasnt the very last thing, so I had time to change my mind and I had time to get my [subinternships], those important rotations for my fourth year, in order.

When thinking about scheduling core rotations, Dr. Burns acknowledged that it can be a difficult for people who dont know what they want to go into. But, he added, its not the end of the world if medical students wind up doing clerkships early on in specialties they decide to pursue for residency.

For additional tips on a number of relevant medical school topics, including scheduling clinical clerkships, visit the AMA Career Planning Resource.

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The science of scheduling: When to do key medical school rotations - American Medical Association

UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester – MassLive.com

UMass Medical School and GE Healthcare Life Sciences have announced the companies plan to establish a new large-scale viral vector manufacturing facility that will be housed on the Worcester campus of the medical school.

The facility will be able to provide large quantities of high-quality recombinant adeno-associated virus vectors for preclinical research, according to a news release from the medical school.

The potential of gene therapy to treat human disease has finally become a reality, said Terence R. Flotte, the Celia and Isaac Haidak Professor of Medical Education, executive deputy chancellor, provost and dean of the School of Medicine and professor of pediatrics. However, the ability to move the field forward to treat additional serious diseases remains limited by the efficiency and flexibility of producing gene therapy vectors suitable for testing in new disease models."

A lack of large-scale vector manufacturing facilities has limited preclinical research capabilities, according to the news release.

Researchers often wait 12 to 24 months to secure enough vector for their research. With this facility, researchers will have access to GE Healthcares processing equipment, helping get research to the clinic faster, the medical school said.

Accelerating research that brings novel cell and gene therapies to patients is the mission of our business, said Catarina Flyborg, the general manager of cell and gene therapy at GE Healthcare Life Sciences. By partnering with UMass Medical School to create this large scale AAV manufacturing facility, we will provide researchers with the tools and AAV needed for pre-clinical research that will advance the cell and gene therapy industry and get therapies to patients faster.

The facility will be 3,220 square feet and will be fully operational in 2020. Four to six professional staff members will manage day-to-day operations, with Sylvain Cecchini, an associate professor of microbiology and physiological systems, as the core director, the statement said.

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UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester - MassLive.com

Cracking the Fever-Autism Mystery – Harvard Medical School

For many years, the parents of children with autism have reported that behavioral symptoms diminished when the child had a fever. The fever phenomenon has been documented in at least two large-scale studies over the past 15 years, but the reasons behind it have continued to mystify scientists.

Now, a new study by researchers at Harvard Medical School and MIT sheds light on the cellular mechanisms that appear to underlie this phenomenon.

In a study of mice, published Dec. 18 inNature, the researchers found that in some cases mimicking bacterial infection, an immune molecule called IL-17a is released and suppresses a small region of the brains cortex linked to social behavioral deficits in animal models.

Our findings finger the signaling cascade that leads to temporary alleviation of autism-like symptoms upon exposure to inflammatory conditions, highlighting the complex interplay between the nervous and immune systems in neurodevelopmental disorders such as autism, said study co-corresponding authorJun Huh, assistant professor of immunology in the Blavatnik Institute at HMS.

People have seen this phenomenon before [in people with autism], but its the kind of story that is hard to believe, which I think stems from the fact that we did not know the mechanism, saidGloria Choi, the Samuel A. Goldblith Career Development Assistant Professor of Applied Biology and an assistant professor of brain and cognitive sciences at MIT. Now the field, including my lab, is trying hard to show how this worksall the way from the immune cells and molecules to receptors in the brainand how those interactions lead to behavioral changes.

Although findings in mice do not always translate into humans, the study may help guide the development of strategies that could help reduce some behavioral symptoms of autism or other neurologic disorders, said Choi, who is also a faculty member of MITs Picower Institute for Learning and Memory.

The lead authors of the research are MIT graduate student Michael Douglas Reed and MIT postdoctoral fellow Yeong Shin Yim.

Immune influence

Choi and Huh previously explored other links between inflammation and autism. In 2016,they showedthat mice born to mothers who experience severe infections during pregnancy are much more likely to show behavioral symptoms such as deficits in sociability, repetitive behaviors and abnormal communication. They found these symptoms stem from exposure to maternal IL-17a, which produces defects in a specific brain region of the developing embryo. The brain region, S1DZ, is part of the somatosensory cortex and believed to be responsible for sensing where the body is in space.

Immune activation in the mother leads to very particular cortical defects, and those defects are responsible for inducing abnormal behaviors in offspring, Choi said.

A link between infection during pregnancy and autism in the offspring has also been documented in humans. A 2010 study that included children born in Denmark between 1980 and 2005 found that severe viral infections during the first trimester of pregnancy led to a threefold increase in risk for autism, and serious bacterial infections during the second trimester were linked with a 1.42-fold increase in risk. These infections included influenza, viral gastroenteritis and severe urinary tract infections.

In the new study, Choi and Huh turned their attention to the often-reported link between fever and reduction of autism symptoms.

We wanted to ask whether we could use mouse models of neurodevelopmental disorders to recapitulate this phenomenon, Choi said. Once you see the phenomenon in animals, you can probe the mechanism.

The researchers began by studying mice that exhibited behavioral symptoms due to exposure to inflammation during gestation. They injected these mice with a bacterial component called LPS, which induces a fever response, and found that the animals social interactions were temporarily restored to normal.

Further experiments revealed that during inflammation these mice produce IL-17a, which binds to receptors in S1DZthe same brain region shown to be affected by maternal inflammation. The experiments showed that IL-17a reduces neural activity in S1DZ, making mice temporarily more interested in interacting with fellow mice.

When researchers inhibited IL-17a or knocked out the receptors for IL-17a, mice did not experience a reversal of symptoms, a finding that pinpointed IL-17a as the responsible trigger. The experiments also showed that simply raising mices body temperature did not have any effect on behavior, offering further evidence that IL-17a is, indeed, the critical player behind reversal of symptoms.

This suggests that the immune system uses molecules like IL-17a to directly talk to the brain, and it actually can work almost like a neuromodulator to bring about these behavioral changes, Choi said. Our study provides another example as to how the brain can be modulated by the immune system.

Whats remarkable about this paper is that it shows that this effect on behavior is not necessarily a result of fever but the result of cytokines being made, said Dan Littman, the Helen L. and Martin S. Kimmel Professor of Molecular Immunology at New York University, who was not involved in the study. Theres a growing body of evidence that the central nervous system, in mammals at least, has evolved to be dependent to some degree on cytokine signaling at various times during development or postnatally.

Behavioral effects

The researchers then performed the same experiments in three additional mouse models of neurologic disorders. These mice lack a gene linked to autism and similar disorderseitherShank3,Cntnap2orFmr1. These mice all show deficits in social behavior similar to those of mice exposed to inflammation in the womb, even though the origin of their symptoms is different.

Injecting those mice with LPS did produce inflammation, but it did not have any effect on their behavior. The reason for that, the researchers found, is that in these mice, inflammation did not stimulate IL-17a production. However, if the researchers injected IL-17a into these mice, their behavioral symptoms did improve.

This suggests that mice who are exposed to inflammation during gestation end up with their immune systems somehow primed to more readily produce IL-17a upon exposure to other inflammatory conditions later in their life. Choi and Huh havepreviously shownthat the presence of certain bacteria in the gut can also prime IL-17a responses. They are now investigating whether the same gut-residing bacteria contribute to the LPS-induced reversal of social behavior symptoms that they found in the newNaturestudy.

Huh and Chois labs are also exploring whether any immune molecules other than IL-17a may affect the brain and behavior.

Whats fascinating about this communication is the immune system directly sends its messengers to the brain, where they work as if theyre brain molecules, to change how the circuits work and how the behaviors are shaped, Choi said.

It was amazing to discover that the same immune molecule, IL-17a, could have dramatically opposite effects depending on context: Promoting autism-like behaviors when it acts on the developing fetal brain and ameliorating autism-like behaviors when it modulates neural activity in the adult mouse brain, Huh said. This is the degree of complexity we are trying to make sense of.

The research was funded by the Jeongho Kim Neurodevelopmental Research Fund, Perry Ha, the Hock E. Tan and K. Lisa Yang Center for Autism Research, the Simons Center for the Social Brain, the Simons Foundation Autism Research Initiative, the Champions of the Brain Weedon Fellowship, and a National Science Foundation Graduate Research Fellowship.

Adapted from an MITnews release

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Cracking the Fever-Autism Mystery - Harvard Medical School

$20M gift from Maxine and Stuart Frankel Foundation to fund innovative research – University of Michigan Health System News

The University of Michigan has received a $20 million gift from the Maxine and Stuart Frankel Foundation of Bloomfield Hills, Michigan, to support the research and development of life-saving therapies at Michigan Medicine in collaboration with other institutions. The gift, which will be used to establish the Maxine and Stuart Frankel Innovation Initiative, will advance U-M faculty-led, collaborative projects that have the potential for rapid clinical application.

We hope this gift will create an environment that will support collaboration among professionals, said Stuart Frankel. We encourage doctors, researchers, people from engineering and other areas, to work together in hopes of achieving monumental, life-saving research. We want the best minds from the University of Michigan and around the world to collaborate on the most innovative research and take scientific discovery to a new level.

Maxine and Stuart Frankelsgift will ensure that the University of Michigan advances its leadership in cutting-edge research that saves lives in our communities, said U-M President Mark Schlissel. The gift will help us translate scientific discoveries into treatments that can reach patients in need. I appreciate the Frankels generosity and their commitment to both innovation and U-Ms very special role as a top public university.

The Initiative will build on best practices of the standout programs developed at U-M and other top institutions, capitalizing on the universitys extensive biomedical research enterprise as the top public university in research spending in the United States.

We are extremely grateful for this gift, which will allow our researchers to move their cutting-edge therapies and other innovative approaches to improving health faster into the life-saving hands of clinicians and scientists everywhere, said Marschall S. Runge, M.D., Ph.D., executive vice president for medical affairs, dean of the University of Michigan Medical School and CEO of Michigan Medicine.

Michigan Medicine is a leader in translational medicine, and our researchers are renowned for their enthusiasm and expertise when it comes to collaboration, both here at the university and globally. This generous support from the Frankels will go a long way toward accelerating this creative engagement and resulting research to market, said Steven L. Kunkel, Ph.D., executive vice dean for research of the Medical School and chief scientific officer of Michigan Medicine.

The Initiative will be administered by Fast Forward Medical Innovation (FFMI), a unit of Michigan Medicine with deep expertise in moving medical technologies from idea to commercialization.

Through FFMI and a host of other established resources at Michigan Medicine, we are committed to bringing together biomedical innovation and entrepreneurship. As such, we are well-positioned to partner with other institutions to transform the Frankels generosity into results moving from the early stages of research into life-saving therapies, said Bradley Martin, Ph.D., managing director of FFMI.

Maxine and Stuart Frankel, both graduates of U-M, have a long history in philanthropy.

Their latest gift is inspired in part by the groundbreaking work of Robert Bartlett, M.D., professor emeritus in the department of surgery, who is known as the father of ECMO (extracorporeal membrane oxygenation), a revolutionary machine used to replace the function of the heart and lungs in critically ill patients.

Bartlett, with continued support from the Frankels through this gift, is currently working with several collaborators throughout U-M to develop other life support technologies, including work that could increase the viability of organs for transplantation.

More recently, the Frankels have supported the translational research program of H. David Humes, M.D., professor of internal medicine, and his group. This program has developed innovative devices to treat a variety of inflammatory conditions, including systemic infections and sepsis, with very high mortality rates. This gift will continue to support Humes program to develop and evaluate miniaturized devices to treat neonates and infants, the tiniest of patients in the intensive care unit.

Humes and Bartletts work are examples of the collaborative spirit behind the new gift. A clinical trial of Humes pediatric sepsis device is underway at seven hospitals around the country, illustrating that the innovative research pursued at one institution can be bolstered by the work of multiple researchers and institutions. Bartlett is leading a worldwide group of scientists who are trying to solve the limitations to prolonged organ perfusion. Typically, organ preservation by perfusion is limited to six hours, but in laboratory tests, the Michigan team has perfused hearts of animal models for three days.

After meeting Bartlett, Humes, and others, the Frankels recognized that similar high-risk, high-reward research occurring throughout the university could benefit from investment by private enterprise. The gift will be used to fund five to seven projects per year, which will be selected by an oversight committee of internationally renowned scientists and venture capitalists external to U-M. The Frankels will also be involved in this process.

We were most interested in funding research at the initial stages so the scientists are able to have the support to get where they need to go, said Maxine Frankel.

Ultimately, the Initiatives goal is to improve health and save lives. Said Maxine Frankel of the researchers who will be supported through the gift, Theres no stopping them once they have the support that they need. The results could be monumental.

About Michigan Medicine:At Michigan Medicine, we advance health to serve Michigan and the world. We pursue excellence every day in our three hospitals, 125 clinics and home care operations that handle more than 2.3 million outpatient visits a year, as well as educate the next generation of physicians, health professionals and scientists in our U-M Medical School.

Michigan Medicine includes the top ranked U-M Medical School and the University of Michigan Health System, which includes the C.S. Mott Childrens Hospital, Von Voigtlander Womens Hospital, University Hospital, the Frankel Cardiovascular Center and the Rogel Cancer Center. Michigan Medicines adult hospitals were ranked no. 11 in the nation by U.S. News and World Report in 2019-20 and C.S. Mott Childrens Hospital was the only childrens hospital in Michigan nationally ranked in all 10 pediatric specialties analyzed by U.S. News and World Report for 2019-20. The U-M Medical School is one of the nation's biomedical research powerhouses, with total research spending of more than $500 million annually.

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$20M gift from Maxine and Stuart Frankel Foundation to fund innovative research - University of Michigan Health System News

Medicine as a Profession Is Imperiled, States the Journal of American Physicians and Surgeons – Yahoo Finance

TUCSON, Ariz., Dec. 18, 2019 (GLOBE NEWSWIRE) -- Many American physicians are wondering whether they still can be physicians. We physicians have lost control of our profession, our patients safety, and our ability to freely practice patient-centered Hippocratic medicine in the United States, writes San Antonio ophthalmologist Kristin Held, M.D., in the winter issue of the Journal of American Physicians and Surgeons. Dr. Held is president of the Association of American Physicians and Surgeons (AAPS).

In 1984, a semesters tuition at the University of Texas Medical School at San Antonio, one of the lowest-cost schools in the nation, was $300. In 2018-2019, tuition was $19,783. According to the Association of American Medical Colleges (AAMC), the average cost for one-year tuition, fees, and health insurance at a public medical school was $37,556 for in-state students. The median student medical school debt was $194,000 in 2018.

Encumbered with such debt, young physicians are no longer free to set up practice on their own. The AMA reported that 47.4% of practicing physicians were employed, and only 45.9% owned their own practices in 2018.

Many young physicians are leaving medicine before they start, and are being replaced by midlevel providers, nurse anesthetists, nurse practitioners,optometrists, and a never-ending cascade of eligible clinicians promoted to physician by politicians, bureaucrats, and private-equity corporations. Physicians, unlike these physician extenders, are subjected to never-ending, costly certification requirements. Sometimes the only work they can find is part-time and unpredictable. And while their costs keep going up, payment keeps going down.

A rapid-fire succession of new government rules has turned physicians into glorified data-entry clerks to benefit third-party payers. Medicare for All is the next step in destroying patient-centered medicine in favor of serving the system.

Dr. Held writes that to preserve the profession of medicine and the patient-physician relationship, Its time to opt out of government-corporate-medical-industrialcomplex-run medicine. As a cataract surgeon, she faced a daunting challenge in declaring her Medical Independence Day.

Physicians need to work together for solutions that preserve individual freedom,common sense, compassion, and respect for life, she concludes.

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

Contact: Kristin S. Held, M.D., kksheld@al.com, or Jane M. Orient, M.D., (520) 323-3110, janeorientmd@gmail.com

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Medicine as a Profession Is Imperiled, States the Journal of American Physicians and Surgeons - Yahoo Finance

Scientists find way to supercharge protein production – Washington University School of Medicine in St. Louis

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Discovery promises to aid production of protein-based drugs, vaccines, other biomaterials

Tubes of green fluorescent protein glow more brightly when they contain more of the protein. Researchers at Washington University School of Medicine have found a way to increase protein production up to a thousandfold, a discovery that could aid production of proteins used in the medical, food, agriculture, chemical and other industries.

Medicines such as insulin for diabetes and clotting factors for hemophilia are hard to synthesize in the lab. Such drugs are based on therapeutic proteins, so scientists have engineered bacteria into tiny protein-making factories. But even with the help of bacteria or other cells, the process of producing proteins for medical or commercial applications is laborious and costly.

Now, researchers at Washington University School of Medicine in St. Louis have discovered a way to supercharge protein production up to a thousandfold. The findings, published Dec. 18 in Nature Communications, could help increase production and drive down costs of making certain protein-based drugs, vaccines and diagnostics, as well as proteins used in the food, agriculture, biomaterials, bioenergy and chemical industries.

The process of producing proteins for medical or commercial applications can be complex, expensive and time-consuming, said Sergej Djuranovic, PhD, an associate professor of cell biology and physiology and the studys senior author. If you can make each bacterium produce 10 times as much protein, you only need one-tenth the volume of bacteria to get the job done, which would cut costs tremendously. This technique works with all kinds of proteins because its a basic feature of the universal protein-synthesizing machinery.

Proteins are built from chains of amino acids hundreds of links long. Djuranovic and first author Manasvi Verma, an undergraduate researcher in Djuranovics lab, stumbled on the importance of the first few amino acids when an experiment for a different study failed to work as expected. The researchers were looking for ways to control the amount of protein produced from a specific gene.

We changed the sequence of the first few amino acids, and we thought it would have no effect on protein expression, but instead, it increased protein expression by 300%, Djuranovic said. So then we started digging in to why that happened.

The researchers turned to green fluorescent protein, a tool used in biomedical research to estimate the amount of protein in a sample by measuring the amount of fluorescent light produced. Djuranovic and colleagues randomly changed the sequence of the first few amino acids in green fluorescent protein, generating 9,261 distinct versions, identical except for the very beginning.

The brilliance of the different versions of green fluorescent protein varied a thousandfold from the dimmest to the brightest, the researchers found, indicating a thousandfold difference in the amount of protein produced. With careful analysis and further experiments, Djuranovic, Verma and their collaborators from Washington University and Stanford University identified certain combinations of amino acids at the third, fourth and fifth positions in the protein chain that gave rise to sky-high amounts of protein.

Moreover, the same amino-acid triplets not only ramped up production of green fluorescent protein, which originally comes from jellyfish, but also production of proteins from distantly related species like coral and humans.

The findings could help increase production of proteins not only for medical applications, but in food, agriculture, chemical and other industries.

There are so many ways we could benefit from ramping up protein production, Djuranovic said. In the biomedical space, there are many proteins used in drugs, vaccines, diagnostics and biomaterials for medical devices that might become less expensive if we could improve production. And thats not to mention proteins produced for use in the food industry theres one called chymosin that is very important in cheese-making, for example the chemical industry, bioenergy, scientific research and others. Optimizing protein production could have a broad range of commercial benefits.

Verma M, Choi J, Cottrell KA, Lavagnino Z, Thomas EN, Pavlovic-Djuranovic S, Szczesny P, Piston DW, Zaher HS, Puglisi JD, Djuranovic S. A short translational ramp determines the efficiency of protein synthesis. Nature Communications. Dec. 18, 2019. DOI: 10.1038/s41467-019-13810-1

This work is supported by the National Institutes of Health (NIH), grant numbers R01 R01GM112824, R01GM51266, R01GM113078, R01DK115972 and T32GM007067; the Skandalaris Center LEAP Award; JDRF, award number 3-APF-2018-573-A-N; and Stanford University Bio-X Fellowship.

SD holds US Provisional Patent #62/540,897 Methods to modulate protein translation efficiency. This patent is owned by Washington University and managed by the Washington University Office of Technology Management (reference numberT061889)

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Scientists find way to supercharge protein production - Washington University School of Medicine in St. Louis

A group of black medical students posed at a plantation to show how the past inspired their future – WDSU New Orleans

A picture is worth a thousand words and a group of black medical students at Tulane University are hoping their pictures speak volumes about how far they've come.Russell Ledet, a medical student at Tulane University, tells CNN he got the idea after a conversation with his 8-year-old daughter about a trip they took to Whitney Plantation in Edgard, Louisiana."Her insight was, "This is not fair. This is not supposed to happen,"' Ledet said. "So I had this idea that we need to get the black medical students at Tulane and we need to come here. We need to do this for ourselves."He decided to pitch the idea of taking a group tour of the plantation to his classmates, along with taking pictures in their white coats, and it turned out better than imagined.The idea takes offLedet said his peers had "no hesitation," and they knew it could have an impact. Fifteen of the 65 black medical school students showed up, and he said the most amazing thing was that all of them had a different takeaway.Ledet's classmate Sydney Labat shared the photos on Instagram with the caption:"As physicians in training, we stood on the steps of what was once slave quarters for our ancestors. This was such a powerful experience, and it honestly brought me to tears.For black people pursing a career in medicine, keep going. For our entire community, keep striving. Resilience is in our DNA."The photo started making the rounds and quickly grabbed the internet's attention."You just get a feeling, and you think this is going to be impactful and this is going to mean something," Labat told CNN. "It's not about going viral or the attention ... it's about being inspirational."Labat said that if she would have seen these photos as a child it would have motivated her further as she dreamed of becoming a doctor."To see people that look like me on this photo would have been so substantial for me as a younger student, and that is the whole purpose."They hope the photo will inspire generationsThe students hope the photo will make a difference for all black students. The plan is to put them in 100,000 schools across the country so that future students can be inspired.They also hope it shows older generations in their field that the hardship was all worth it."We hope that we will make a lifelong impact ... and let know: Yes, you can be smart. Yes, you can be successful ... and you can also do that while being unapologetically black and proud of where you come from and proud of where you are going," Labat said.

A picture is worth a thousand words and a group of black medical students at Tulane University are hoping their pictures speak volumes about how far they've come.

Russell Ledet, a medical student at Tulane University, tells CNN he got the idea after a conversation with his 8-year-old daughter about a trip they took to Whitney Plantation in Edgard, Louisiana.

"Her insight [to the visit] was, "This is not fair. This is not supposed to happen,"' Ledet said. "So I had this idea that we need to get the black medical students at Tulane and we need to come here. We need to do this for ourselves."

He decided to pitch the idea of taking a group tour of the plantation to his classmates, along with taking pictures in their white coats, and it turned out better than imagined.

Ledet said his peers had "no hesitation," and they knew it could have an impact. Fifteen of the 65 black medical school students showed up, and he said the most amazing thing was that all of them had a different takeaway.

Ledet's classmate Sydney Labat shared the photos on Instagram with the caption:

"As physicians in training, we stood on the steps of what was once slave quarters for our ancestors. This was such a powerful experience, and it honestly brought me to tears.

For black people pursing a career in medicine, keep going. For our entire community, keep striving. Resilience is in our DNA."

The photo started making the rounds and quickly grabbed the internet's attention.

"You just get a feeling, and you think this is going to be impactful and this is going to mean something," Labat told CNN. "It's not about going viral or the attention ... it's about being inspirational."

Labat said that if she would have seen these photos as a child it would have motivated her further as she dreamed of becoming a doctor.

"To see people that look like me on this photo would have been so substantial for me as a younger student, and that is the whole purpose."

The students hope the photo will make a difference for all black students. The plan is to put them in 100,000 schools across the country so that future students can be inspired.

They also hope it shows older generations in their field that the hardship was all worth it.

"We hope that we will make a lifelong impact ... and let [students] know: Yes, you can be smart. Yes, you can be successful ... and you can also do that while being unapologetically black and proud of where you come from and proud of where you are going," Labat said.

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A group of black medical students posed at a plantation to show how the past inspired their future - WDSU New Orleans

More women in med school; still get paid less than men – KELOLAND.com

SIOUX FALLS, S.D. (KELO) The number of women enrolled at the University of South Dakota Sanford School of Medicine is increasing.

A 2019 study by the Association of American Medical Colleges said for the first time ever there are more women then men in medical school. The national average for females in medical school is 50.5%

The study said 45.7% of USD students for the 2019-2020 school year are women.

The national average is 50.5%. Thats an increase of 49.5% from 2018. The average was 46.9% in 2015.

While the percentage of women enrolled in medical school increased in the U.S., fewer women than men are applied to USD for the 2019-2020 school year.

USD had 836 applicants for the 2019-2020 school year. Of the applicants, 47.6% were female and 52.4% were male.

The number of female versus male applicants is similar at some neighboring medical schools.

The University of Iowa had 3,879 applicants. Of those applicants, 44.7% were female. The university has a 50-50 split between female and male students for the school year.

The University of North Dakota medical school had 1,718 applicants. Of those, 47.2% were women. Women made up 41.6% of the enrolled students.

Creighton University in Omaha, Nebraska, had 6,375 applicants and 45.3% of those were women. Of its enrolled students, 50.6% are women.

The University of Nebraska in Lincoln had 1,590 applicants and 45.7% were women. Of its enrolled students, 49.2% are women.

The University of Minnesota Mayo Medical School in Rochester had 7,265 applicants and 46.2% were women. The universitys enrollment is 51% female.

The University of Minnesotas overall medical school program other than Mayo had 5,561 applicants and 49.6% of those were female. Women made up 54.2% of the enrollment.

The overall makeup of the 142 residents at USD Sanford is 72 female students and 70 male students.

Although there are more women in medical school, chances are when they graduate they will earn less than men.

Studies show that in most categories of medical practice, if not all, women make less than men.

In many cases of research, its the doctors themselves reporting the pay to reveal the inequities.

A 2019 study by Doximity, an online network of medical professionals, said that on average male doctors earn $1.25 for every $1 earned by women.

USD said that of its female residents, 16 chose family medicine or psychiatry while 13 chose internal medicine or pediatrics. The rest chose specialties of pathology, cardiovascular, general surgery, geriatrics, transitional year or family medicine.

South Dakota had 2,121 active doctors, including 674 female doctors, in 2018, the 2019 State Physician Workforce Data Report said. The most were in family medicine/general practice at 188. Eighty-one were in internal medicine, 62 in obstetrics and gynecology, and 58 in pediatrics. The remainder were in other practices, except none were practicing in cardiovascular care or orthopedics.

A 2019 Medscape study showed the male primary care physicians earn 25% more than females. The income was $258,000 compared to $207,000 for women.

The gap did decrease in specialty pay from 36% in 2018 to a 33% difference between men and women. Men were paid $372,000 in specialty practice compared to $280,000 for women.

Specialty practices were identified as plastic surgery, orthopedics, internal medicine and similar. Medscape said while women tended to choose lower paying specialties than higher paying ones such as plastic surgery, orthopedics, cardiology and urology, that doesnt explain the overall disparity in specialty pay.

Additional research by Dr. Malgorzata Skaznik-Wikiel, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine, and others show similar pay gaps between female and male doctors.

Several studies prompted the Association of Women Surgeons to release a formal statement on the gender pay equity gap. Women in academic medicine make 90 cents for every dollar earned by their male counterparts. Although this salary gender gap is not as large as the 82 cents per dollar noted in the overall US Economy 21 it reflects inequities in compensation, and must be addressed. If change continues at the current slow rate, women will not reach pay equity with men until 2152, the statement said.

But there are some indications that doctors who practice in rural areas, including South Dakota and in neighboring states, may be getting paid more than those who practice in some urban areas.

Research called Income and Age Profiles of Urban and Rural Physicians in the United States conducted through the University of Chicago shows that rural physicians have higher incomes, lower housing costs, and shorter commutes than urban physicians.

A 2018 study by Merritt Hawkins on healthcare recruitment said the Midwest and Great Plains ranked high when it came to pay for psychiatry, family practice, radiology and internal medicine, which were listed as top areas of recruitment. The salary list did not breakdown male versus female pay. Merritt Hawkins is a physician recruiting and consulting firm.

Despite higher pay, rural areas have about a third fewer physicians per capita than the nation as a whole, the University of Chicago study said. And most rural doctors are men.

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More women in med school; still get paid less than men - KELOLAND.com

Michigan Medicine kicks off celebration of 150th anniversary – University of Michigan Health System News

One hundred and fifty years ago this month, something extraordinary happened at the University of Michigan. Its effects have reverberated down through history not only on the campus, but across the state and nation.

In December 1869, the first patients checked in to the universitys first hospital.

It wasnt a fancy facility just 20 beds in a converted former professors house on North University Avenue, where the Chemistry Building now stands.

Its patients had to travel across the Diag, to the Medical School building built 20 years before, to have an operation or examination by a professor with hundreds of medical students looking on.

The professor's house that was converted to become the first U-M hospital.

But its opening marked the first time an American university had run a hospital, adding patient care to its missions of medical education and research. The birth of the academic medical center now known as Michigan Medicine began a movement that spread to universities across the country, and accelerated medical innovation.

A celebration of that 150th birthday begins today, and will continue through most of 2020, marking many of the medical and life sciences milestones and achievements that have happened at U-M and helped transform care everywhere.

A new timeline of historical events has just launched on the Michigan Medicine website, along with links to resources to explore U-Ms medical history further and a new overview video.

Theres also a video of a recent lecture by Joel Howell, M.D., Ph.D., co-author of the 2017 book Medicine at Michigan: A History of the University of Michigan Medical School at the Bicentennial and the Elizabeth Farrand Collegiate Professor in Medical History, as well as a professor of internal medicine, history, and health management and policy.

Throughout the coming months, new stories and social media posts will bring Michigan Medicines history to life, linked by the hashtag #michmed150 on Twitter, Facebook, LinkedIn and Instagram. Anyone at the university interested in receiving updates when new stories or updates are available may join an email list.

Michigan Medicine faculty, staff, retirees, alumni and patients will be invited to share their memories, and interact with historical content, too. Units within Michigan Medicine can tap into the celebration by noting events in their own past all have firsts or major national contributions of their own.

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Michigan Medicine kicks off celebration of 150th anniversary - University of Michigan Health System News

Dell Med team working to improve community health in Mexico and Texas – KXAN.com

AUSTIN (Nexstar) A team of health scholars from The University of Texas at Austin and institutions in Mexico are working to improve health on both sides of the U.S.-Mexico border.

Researchers participated in a summit recently to continue discussions over various projects aimed at this goal.

What we wanted to do was create an environment, a space that would be able to creatively engage these problems and to use the skills, the talent and the expertise of people from all over campus, said Ricardo Ainslie, Ph.D., director of the LLILAS Mexico Center at UT Austin and an affiliate faculty member at Dell Medical Schools Department of Population Health.

One of the projects focuses on providing expectant dads with more information about pregnancy and life after their baby is born.

The Fathers Playbook app, available both on the iPhone and the Android, was developed by the team led by Michael Mackert, Ph.D. Mackert is the director of the Center for Health Communication, a joint center between Dell Med and UT Austins Moody College of Communication. The Texas Safe Babies team also includes The University of Texas Health Science Center at Tyler and the SAGA Lab at UT Austin.

The free app is bilingual in English and Spanish and provides information about financial planning, ways pregnancy can affect men, staying healthy and preparing for the babys arrival.

Dads are everywhere, Ainslie said.

Dr. Jonathan Lugo, an obstetrician and gynecologist at Tey Womens Health Center, says it could benefit soon-to-be fathers.

What we do see is a lot of fathers not being as engaged or involved, he said.

Mackert said the inspiration for creating the app came from personal experience. When his wife was first pregnant, he saw that most of the conversations around prenatal care were centered around the mother. Ainslie says back then, he also felt that he didnt quite have all the information needed when he was preparing for his children.

As a father myself I have four children I know that it can be a little scary, it can be a little daunting to have a very young child, especially when you dont know exactly how to optimally engage, Ainslie said.

Experts hope having this app and bringing more fathers on board about their role in pregnancy can help improve family engagement, since dynamics are changing both in Texas and in Mexico.

We are a long way from that era of the nuclear family where dad goes to work and mom stays home and raises children, Ainslie said. We live in a society and this is increasingly true in Mexico as well, where most families have both parents working.

Studying community trauma

Carmen Valdez, Ph.D., who is an associate professor at Dell Meds Department of Population Health and at the Steve Hicks School of Social Work, is leading a team studying community trauma after natural disasters like hurricanes and earthquakes. Theyre also looking at human-made events like mass shootings.

Researchers are continuing to travel between Texas and Mexico and will be conducting studies. Previously, a team joined Ainslie in visiting the areas impacted by the 2017 Puebla earthquake in Mexico.

Valdezs background is in psychology.

As a psychologist, I was trained to think about trauma as an individual experience, someone who is exposed to or who has directly experienced a disturbing event, she said. And although there is indeed a psychological consequence to experiencing trauma, what we are seeing entire communities that are migrating or are being displaced because of large societal events. What were hoping to do in this project is to collaborate with others who have different areas of expertise architecture, engineering nursing, health, mental health, education, sociology, to better understand how entire communities are affected by natural disasters, especially when communities are disadvantaged to begin with.

She says its important to not only provide immediate help but to also find concrete, long-term solutions in these cases.

What is the social impact? Valdez said. What is the economic impact and what is the impact on the environment in the place we live, where we go to church, where we work, where we play and what are initiatives that we can do as a community to improve the resources that are available?

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Dell Med team working to improve community health in Mexico and Texas - KXAN.com

Invisible Ink Could Reveal whether Kids Have Been Vaccinated – Scientific American

Keeping track of vaccinations remains a major challenge in the developing world, and even in many developed countries, paperwork gets lost, and parents forget whether their child is up to date. Now a group of Massachusetts Institute of Technology researchers has developed a novel way to address this problem: embedding the record directly into the skin.

Along with the vaccine, a child would be injected with a bit of dye that is invisible to the naked eye but easily seen with a special cell-phone filter, combined with an app that shines near-infrared light onto the skin. The dye would be expected to last up to five years, according to tests on pig and rat skin and human skin in a dish.

The systemwhich has not yet been tested in childrenwould provide quick and easy access to vaccination history, avoid the risk of clerical errors, and add little to the cost or risk of the procedure, according to the study, published Wednesday in Science Translational Medicine.

Especially in developing countries where medical records may not be as complete or as accessible, there can be value in having medical information directly associated with a person, says Mark Prausnitz, a bioengineering professor at the Georgia Institute of Technology, who was not involved in the new study. Such a system of recording medical information must be extremely discreet and acceptable to the person whose health information is being recorded and his or her family, he says. This, I think, is a pretty interesting way to accomplish those goals.

The research, conducted by M.I.T. bioengineers Robert Langer and Ana Jaklenec and their colleagues, uses a patch of tiny needles called microneedles to provide an effective vaccination without a teeth-clenching jab. Microneedles are embedded in a Band-Aid-like device that is placed on the skin; a skilled nurse or technician is not required. Vaccines delivered with microneedles also may not need to be refrigerated, reducing both the cost and difficulty of delivery, Langer and Jaklenec say.

Delivering the dye required the researchers to find something that was safe and would last long enough to be useful. Thats really the biggest challenge that we overcame in the project, Jaklenec says, adding that the team tested a number of off-the-shelf dyes that could be used in the body but could not find any that endured when exposed to sunlight. The team ended up using a technology called quantum dots, tiny semiconducting crystals that reflect light and were originally developed to label cells during research. The dye has been shown to be safe in humans.

The approach raises some privacy concerns, says Prausnitz, who helped invent microneedle technology and directs Georgia Techs Center for Drug Design, Development and Delivery. There may be other concerns that patients have about being tattooed, carrying around personal medical information on their bodies or other aspects of this unfamiliar approach to storing medical records, he says. Different people and different cultures will probably feel differently about having an invisible medical tattoo.

When people were still getting vaccinated for smallpox, which has since been eradicated worldwide, they got a visible scar on their arm from the shot that made it easy to identify who had been vaccinated and who had not, Jaklenec says. But obviously, we didnt want to give people a scar, she says, noting that her team was looking for an identifier that would be invisible to the naked eye. The researchers also wanted to avoid technologies that would raise even more privacy concerns, such as iris scans and databases with names and identifiable data, she says.

The work was funded by the Bill & Melinda Gates Foundation and came about because of a direct request from Microsoft founder and philanthropist Bill Gates himself, who has been supporting efforts to wipe out diseases such as polio and measles across the world, Jaklenec says. If we dont have good data, its really difficult to eradicate disease, she says.

The researchers hope to add more detailed information to the dots, such as the date of vaccination. Along with them, the team eventually wants to inject sensors that could also potentially be used to track aspects of health such as insulin levels in diabetics, Jaklenec says.

This approach is likely to be one of many trying to solve the problem of storing individuals medical information, says Ruchit Nagar, a fourth-year student at Harvard Medical School, who also was not involved in the new study. He runs a company, called Khushi Baby, that is also trying to create a system for tracking such information, including vaccination history, in the developing world.

Working in the northern Indian state of Rajasthan, Nagar and his team have devised a necklace, resembling one worn locally, which compresses, encrypts and password protects medical information. The necklace uses the same technology as radio-frequency identification (RFID) chipssuch as those employed in retail clothing or athletes race bibsand provides health care workers access to a mothers pregnancy history, her childs growth chart and vaccination history, and suggestions on what vaccinations and other treatments may be needed, he says. But Nagar acknowledges the possible concerns all such technology poses. Messaging and cultural appropriateness need to be considered, he says.

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