As Pandemic Wears On, Massachusetts Residents Have Increased Risky Behaviors, Survey Finds | News – Harvard Crimson

Over the past seven months, Massachusetts residents have relaxed their adherence to COVID-19 prevention guidelines, according to a new survey conducted by researchers from Harvard, Northeastern, Northwestern, and Rutgers.

The report published Nov. 13 and titled The Trajectory of Health-Related Behaviors in Massachusetts analyzed survey data to characterize how individual behavior has changed in the state over the course of the pandemic.

Overall, the survey showed a substantial relaxation of many of the behaviors that helped slow the spread of the disease in the spring. Such behaviors include avoiding public and crowded spaces, frequent hand washing and disinfecting, and limiting contact with non-household members.

The survey also showed that people have increased participation in activities outside of their homes, such as going to restaurants and bars, exercising at gyms, and visiting friends.

In April and May, for example, the number of respondents who reported activities like spending time in close proximity to non-household members and going to restaurants in the past 24 hours was low, at 22 and 5 percent, respectively. By October, those figures had doubled and tripled, to 45 percent and 15 percent.

Matthew A. Baum, a professor at the Harvard Kennedy School and a researcher on the team, said the findings disappointed him.

But I wouldn't say it's surprising, he said. It's really hard for people to stay on their guard for a really, really long period of time. It's exhausting.

Mask-wearing is the only exception to the trend, having increased in Massachusetts since April. In October, 80 percent of respondents reported wearing a mask outside of the home, among the highest levels of adherence anywhere in the country, per the report.

The report on Massachusetts is the 24th in a series of research reports launched in March and entitled The State of the Nation: A 50-State COVID-19 Survey that aims to find links between social behavior and COVID-19 transmission in every state.

There was basically an almost complete lack of information around the country as to where the emerging hotspots were and how the virus spread, Baum said.

Though Baum said the series of reports isnt a true substitute for epidemiological data on virus transmission, he and fellow researchers thought it might be the next best thing.

Mauricio Santillana, another member of the team and a professor at Harvard Medical School, acknowledged that the desire to congregate and the tendency to become fatigued after months of isolation are natural.

We love congregating, and we'll do our best to do it, and that's part of humanity, Santillana said. Unfortunately, in this crisis, that will play against us.

David M. J. Lazer, a professor at Northeastern University and first author of the report, said the team also hopes to study how colder temperatures will affect social distancing behaviors and virus transmission rates this winter.

Tracking both the behaviors and attitudes around this will be important as we go through the winter, because part of the problem we're confronting is that we can't do the things we could do in summer, Lazer said. So how do people react to the constraints the environment like the climate is putting on us?

Though there may be new challenges this winter like spending the holidays away from family and increasing mental health concerns researchers said they hope to encourage Americans to stay vigilant about adhering to public health guidelines.

Preventable deaths may happen because of our fatigue, and so were trying to encourage people to not give up too soon, Santillana said.

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Young people with disabilities focus of COVID-19 testing grant – Washington University School of Medicine in St. Louis

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$5 million grant to fund saliva tests for students, teachers, staff in schools operated by Special School District of St. Louis County

Researchers at Washington University School of Medicine in St. Louis have received a grant allowing them to offer 50,000 saliva tests for the SARS-CoV-2 virus to students, teachers and staff in the six special education schools operated by the Special School District of St. Louis County.

Researchers at Washington University School of Medicine in St. Louis have received a two-year, $5 million grant to offer 50,000 saliva tests for the SARS-CoV-2 virus to students, teachers and staff in the six special education schools operated by the Special School District of St. Louis County (SSD).

The pandemic has disproportionately impacted students with special needs, especially those with intellectual and developmental disabilities, in part because they rely on daily structure and in-person support for learning and social growth. The researchers also will assess educational disparities affecting families whose children have intellectual, emotional and developmental disabilities. Due to underlying medical conditions experienced by many such students, this population of students is at a higher risk for developing COVID-19 and severe complications of the virus.

The grant will serve about 750 families in the district who have children in kindergarten through the 12th grade. The saliva tests will be voluntary and offered weekly to teachers, staff and students over the next year, starting this fall.

Our partnership with the Special School District strives to remove the obstacles related to testing and decrease the burden of COVID-19 for this vulnerable segment of the population, said grant co-investigator Christina A. Gurnett, MD, PhD, the A. Ernest and Jane G. Stein Professor of Developmental Neurology and director of the Division of Pediatric and Developmental Neurology.

The funding stems from $500 million awarded by the National Institutes of Health (NIH) to 32 medical centers as part of the agencys Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative to provide underserved communities with rapid testing for COVID-19. This award supplements the Washington University Intellectual and Developmental Disabilities Research Center (IDDRC), which aims to advance research in neurodevelopmental disorders and is funded by NIHs Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Remote school is difficult for most families, but particularly so for parents who have children with disabilities, said Gurnett, who serves as neurologist-in-chief at St. Louis Childrens Hospital. Parents, especially if theyre working and if they have other children, may not be able to provide full-time caregiving. Their children may have trouble interacting with computer screens, and their behavior may be negatively affected by feelings of confusion and isolation. Children with disabilities may also require ongoing assistance with basic skills such as eating or using the bathroom.

Such caregiving duties also put teachers at an increased risk of exposure to the coronavirus and present additional hurdles if families and teachers need to quarantine for two weeks.

The widespread closure of schools has significantly impacted the well-being of children in general and this population in particular, saidJason Newland, MD, co-principal investigator of the grant and a professor of pediatrics in the Division of Pediatric Infectious Diseases. He has advised multiple school districts in Missouri on plans for reopening schools.

It is a major priority to get children with disabilities back into the schools while providing a safe environment for the students and staff, said Newland, who treats patients at St. Louis Childrens Hospital. A key component of achieving this goal in this vulnerable population is ample testing that can rapidly detect COVID-19 infections within the school community.

The saliva test provides easy and fast testing with same-day results, ideal for screening large communities. It was developed by the School of Medicines Department of Genetics and the McDonnell Genome Institute, in collaboration with a biotechnology company.

The Special School District is eager to partner with Washington University to improve the lives of students with disabilities, especially during this time of COVID, said Elizabeth Keenan, PhD, SSDs superintendent.

SSDs special education schools serve students from all school districts in St. Louis County, including those residing in socioeconomically stressed neighborhoods, where many families have heightened exposure to COVID-19, as well as disproportionate vulnerability to its most serious consequences. SSDs students returned part time to in-person learning in November.

The project will be shaped by ongoing advice from a community advisory board made up of diverse members of the public and convened by the Institute for Public Health, the Institute of Clinical and Translational Sciences and the IDDRC. The grant also involves faculty members from the Brown School and investigators at the University of Missouri-Kansas Citys Institute for Human Development, and Kennedy Krieger Institute in Baltimore to survey national attitudes about the impact of COVID-19 on the health, wellness and education of children with intellectual and developmental disabilities.

John N. Constantino, MD, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics and psychiatrist-in-chief at St. Louis Childrens Hospital, is a co-principal investigator. He and Gurnett co-direct the IDDRC, which is one of 15 research centers funded by the NICHD to advance understanding of conditions related to intellectual and developmental disabilities.

Among noninfected people in the United States, few are more adversely affected by COVID-19 than individuals with intellectual and developmental disabilities, given that a vast proportion require in-person care or critical therapeutic support within their living environments, with little backup or systematic coverage for prolonged interruption of services, wrote Constantino in a letter published Aug. 28 in The American Journal of Psychiatry, on behalf of the directors of the nations 15 Eunice Kennedy Shriver IDDRCs. Many have temporarily lost access to trained caregivers or community service providers and now face evolving threats to the return of baseline service, given uncertainties in state and agency budgets. Therefore, a first priority relates to restoration of in-person support services or comparable alternatives.

This research is supported by the National Institutes of Health (NIH), grant numbers P50HD103525 and P50HD103525S1, and the NIHs National Center for Advancing Translational Sciences, grant number UL1TR002345 to the Washington University Institute of Clinical and Translational Sciences.

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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Young people with disabilities focus of COVID-19 testing grant - Washington University School of Medicine in St. Louis

Honor Student Sierra King Nominated for The Congress of Future Medical Leaders – Focusdailynews

Duncanville,TX Sierra King, a Senior at Duncanville High School of Duncanville, TX is a Delegate to the Congress of Future Medical Leaders on November 21st and November 22nd, 2020.

The Congress is an honors-only program for high school students who want to become physicians or go into medical research fields. The purpose of this event is to honor, inspire, motivate and direct the top students in the country interested in these careers, to stay true to their dream and, after the event, to provide a path, plan and resources to help them reach their goal.

Sierras nomination was signed by Dr. Mario Capecchi, winner of the Nobel Prize in Medicine and the Science Director of the National Academy of Future Physicians and Medical Scientists to represent Duncanville High School based on her academic achievement, leadership potential and determination to serve humanity in the field of medicine.

During the two-day Congress, Sierra King will join students from across the country and hear Nobel Laureates and National Medal of Science Winners talk about leading medical research; be given advice from Ivy League and top medical school deans on what to expect in medical school; witness stories told by patients who are living medical miracles; be inspired by fellow teen medical science prodigies; and learn about cutting-edge advances and the future in medicine and medical technology.

This is a crucial time in America when we need more doctors and medical scientists who are even better prepared for a future that is changing exponentially. Focused, bright and determined students like Sierra King are our future and she deserves all the mentoring and guidance we can give her.

The Academy offers free services and programs to students who want to become physicians or go into medical science. Some of the services and programs the Academy offers are online social networks through which future doctors and medical scientists can communicate; opportunities for students to be guided and mentored by physicians and medical students; and communications for parents and students on college acceptance and finances, skills acquisition, internships, career guidance and much more.

The National Academy of Future Physicians and Medical Scientists was founded on the belief that we must identify prospective medical talent at the earliest possible age and help these students acquire the necessary experience and skills to take them to the doorstep of this vital career. Based in Washington, D.C. and with offices in Boston, MA, the Academy was chartered as a nonpartisan, taxpaying institution to help address this crisis by working to identify, encourage and mentor students who wish to devote their lives to the service of humanity as physicians, medical scientists.

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Honor Student Sierra King Nominated for The Congress of Future Medical Leaders - Focusdailynews

Members of medical community call for shift from race-based to race-conscious medicine – Yale Daily News

Yale Daily News

Advocating for the transition of medicine away from race-based practices and toward a more race-conscious approach, Yale Medical School MD-PhD student Jessica Cerdea GRD 21, Yale Emergency Medicine physician Jennifer Tsai and Howard University PhD student Marie Plaisime recently co-authored an editorial for The Lancet, a peer-reviewed medical journal, this month about reforming medical education for future doctors.

The editorial characterizes the current practice of medicine as race-based, stating that physicians often infer that race has inherent biological significance, whereas in actuality race is merely a social construct. The authors say the future of medicine should move from this race-based approach to a race-conscious approach, with the end goal being a reduction in health inequities across racial lines. They advocated for emphasizing institutional inequities in healthcare during medical education, which they said would raise the cultural competency of future physicians.

Race-based medicine uses and treats race as an essential biological variable that has utility in medical education and clinical practice, Cerdea said. Race-conscious medicine understands that race is a social and power construct that changes for political utility over time, and that it is a poor proxy for human genetic variation. Instead, the more salient variable when it comes to differences in human groups that have been socially categorized in this way is the experience of racism and racialization This idea that there are biological differences between racial groups comes from colonization. This is how white supremacy operates.

The editorial was published in The Lancet after the prominent medical journal released a statement supporting the Black Lives Matter movement and its continuing commitment to advancing racial equality. This editorial was also published following a summer of racial unrest and protests around the country that advocated for putting an end to police brutality against Black Americans. The timing of the publication was significant to the authors.

Certainly we were motivated by the very apparent murders of George Floyd, Ahmaud Arbery and Breonna Taylor, among others, Tsai said. But also because this is a very long-standing problem that I think all three of us have been working on, thinking about and advocating against beforehand.

The article presented a wide range of examples in which race heavily influences physicians medical assessment of patients, such as the Atherosclerotic Cardiovascular Disease risk calculator equation. This online tool determines a given patients risk of having a cardiovascular event within ten years, Cerdea said. These calculations involve categorizing the patient as either Black or not Black. If the patient is Black, the predicted risk is significantly increased, and the patient is more likely to start taking a certain medication earlier than patients of other racial groups.

The prescription dosage for certain drugs can also vary based on racial groups. According to Cerdea, medical practitioners consider East Asian people to have different metabolisms, which means that a drug like Eltrombopag, a bone marrow stimulant, is started at half the normal dose for these people. This type of race-based medicine is condemned in the article.

You cant know someones pharmacokinetics, or the way that they metabolize a drug, by looking at them, or by their race, Cerdea said. Thats the problem with race-based medicine.

The Lancet piece includes different policy recommendations for researchers, clinicians and practitioners. According to Plaisime, It was crafted with care towards its intended audience of physicians, picking and choosing words that would be most accessible. The most important step in moving forward, Tsai said, is to change the curriculum of medical schools to be more race-conscious.

The authors also wrote this editorial from the perspective of their own experiences as women of color within the American healthcare system. Cerdea is Italian and Chilean with Indigenous Mapuche ancestry, Plaisime is Haitian American and Tsai is Taiwanese American.

As a Black woman, for sure there have definitely been times where Ive been treated differently based on how I appeared in the clinical room, how I was spoken to, Plaisime said. Also being the daughter of Haitian immigrants, I know first-hand what its like to have your accent judged. Not just one isolated event that kind of sparked this, its my story, and I want to make sure that all people receive equitable care.

The authors also emphasized that even research studies are subjected to racialization, despite undergoing objective screening processes instituted by peer-reviewed journals. Although race has no inherent biological significance, countless epidemiological studies include race as a critical variable when mapping out the prevalence of certain diseases.

In their article, the authors urged clinical research journals to include instructions in their publication guidelines that denounce the use of race as a proxy for biological variables such as genetics, pharmacokinetics and metabolism.

Prestigious publications continue to allow research that [uses] problematic versions of race in their research, Tsai said. They still allow that to be published, which means this kind of data and this kind of thinking is continually generated and perpetuated.

Plaisime, who is a medical sociologist studying the impacts of race and racism in clinical decision-making processes, explained that biologizing race is harmful. Prior to this collaboration, she had published a piece about the implications of using race in medicine.

She emphasized the need for using evidence-based treatments that do not rely solely on race as a factor of consideration, as this can often be detrimental to members of racial minority groups.

The different biomarkers and tools they use arent necessarily based on science, but more on racist assumptions, Plaisime said. My work was based on how that kind of training impacts later on how patients receive care, and how medical students are trained.

Cerdea and Plaisime are both Robert Wood Johnson Foundation Health Policy Research Scholars, and Tsai is completing her residency at the Yale New Haven Hospital.

Anjali Mangla | anjali.mangla@yale.edu

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Harvard-Wide Task Force ‘Students vs. Pandemics’ Expands into National Initiative | News – Harvard Crimson

Students vs. Pandemics which began as a Harvard-wide task force formed in response to COVID-19 has grown into a national initiative with branches in 10 universities across North America.

Jacob J. Ingber, the national president of Students vs. Pandemics and a graduate student at the Harvard Medical School, said students formed the task force in March to foster a sense of mutual support during the pandemic.

There is a widespread feeling of a loss of agency and a lot of disjointed response efforts across the different Harvard schools, Ingber said. And so we started because we want to give Harvard students and now students across America a community and a space where they could come together and identify the problems that they're going through, and then try to work towards finding a solution.

While the organization initially focused on compiling resources related to COVID-19, SvP has expanded its efforts to include a public speaker series, policy research initiatives, a public health blog, and partnerships with other organizations, Harvard chapter president and Extension School graduate LisaMichelle Pecaro said.

Pecaro explained that through a partnership between SvP and nonprofit Get Us PPE, chapter members sent over 100 shipments of personal protective equipment to Boston area hospitals.

SvP national vice president Grant S. McComb said that chapter members worked with State Sen. Eric P. Lesser 07 to improve the states response to the pandemic.

He was actually able to use a lot of the research we conducted to inform his own policymaking on COVID-19 for his jurisdiction, McComb added.

McComb emphasized that the function of the national branch is to provide the funds, information, resources, and connections necessary for chapters to spearhead their own projects.

Because this organization is really volunteer-run and really volunteer-led, we as a national organization will have minimal initiatives ourselves, but will primarily be supporting our chapters in that way moving forward, he said.

McComb also said SvP plans to broaden its scope to address systemic issues in the public health sector beyond the ongoing COVID-19 pandemic.

We're putting a lot of work into developing this organization, to tackle other problems that will probably come as a result of COVID-19 in the future, but then also other social issues and other health issues that will spring up, but really have nothing to do with COVID, McComb said. We really want this to be an organization that is sustained past this current pandemic.

The SvP team is currently preparing to apply for nonprofit status. Ingber said that the organization has been working with the Harvard Law Schools Transactional Law Clinics during the process.

Growing the initiative in a completely virtual setting has been both a significant challenge and a memorable experience, Ingber said.

Most of us have never met in person and didn't know each other beforehand, he said. Now we find ourselves running a five-hundred person organization together from different states, different parts of the country. And it's been a lot of fun. It's been really cool, but it's definitely challenging.

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Harvard-Wide Task Force 'Students vs. Pandemics' Expands into National Initiative | News - Harvard Crimson

Why I Want to Be a Doctor Now: Med Students Discuss What Makes Them Want to Help and Heal – Newswise

Students Write White Coat Ceremony Oath Pledging to Serve as Agents for Social Justice

*Students Available for Interviews*

Newswise (New York, NY October 15, 2020 - The White Coat ceremony represents a rite of passage, launching first-year medical students on their formal careers in a gathering of faculty, colleagues, and family. In this era of social distancing, the Icahn School of Medicine at Mount Sinais White Coat ceremony takes place via Zoom on Tuesday, October 13.

But why become a doctor now, in a pandemic, when providing care can be potentially life-threatening to the clinician? Incoming students describe what makes them want to help and heal, and the oath they have written togetherat this unprecedented time in the history of American medicineas a guide to their future careers as physicians.

Candida Damian, who is Black/Guamanian and was raised in Alabama, never went to the doctor as a young girl because her single mom could not afford health insurance. All I knew about doctors was what I saw on TV, she says. I wanted to work and care for patients at an intimate level. It was in nursing school that I gained the exposure I needed to realize that I not only wanted to change careers to become a doctor, but I needed to do it so I could provide the level of care necessary for my patients.

Candida says that inequities in health care have always been there but are just more visible now, making this a critical time to join the profession. My deepest ambition as a doctor is to ensure that everyone, no matter who they are, has access to health care. As a Black /Guamanian future physician, who will represent diverse and under-resourced communities, it will be my duty to use my voice to advocate for change and to remove the barriers that I experienced as a young girl," she says.

Stephen McCroskery suffered for years with untreated sleep apnea before it was noticed by his brother on a visit home from college. The diagnosis, delivered by a tactful physician, would set him on a path into medicine. The doctors style was so gentle, says Stephen. While I did have a weight problem, the way he suggested that I lose weight helped me understand my diagnosis and the need to lose the necessary weight to control the sleep apnea. It had been wreaking havoc in my life for years, he says.

Stephen begins medical school with a running start, having graduated from the Icahn School of Medicines Master of Science in Biomedical Science (MSBS) program. While studying for his Masters, he worked in the lab of Peter Palese, PhD, a world-renowned microbiologist who oversees a lab committed to understanding viruses, their makeup, and how they spread.

While working on a universal influenza vaccine, the lab has also pivoted to understanding the Sars-Cov2 virus and developing a vaccine candidate. We are hopeful it will go to clinical trials. One thing we like about this vaccine is that it would be manufactured in chicken eggs, making it much less expensive to produce and therefore more accessible to countries that are not as wealthy as the United States, he says. Unfortunately a lot of people dont believe in vaccines. In light of this, I want to advocate for science and medicine and give my patients the best information on which to make the best decisions for their health.

Jerrel Catlett says the pandemic served as a major turning point in his life and career. I would sayas an African Americanthe pandemic has made me acutely aware of how vulnerable my community is, he says. Teaming up with three other Icahn students, he developed an anti-racism discussion series open to faculty, physicians, and hospital administrators across the Mount Sinai Health System to engage in small group conversations focusing on how anti-Black biases and prejudices manifest in medical practice and research. I feel more empowered now because we are gaining the literacy and language to describe what is happening around us, and identifying ways to be a part of the solution.

He wants to be a physician-scientist in pediatric oncology. Prior to embarking on the MD program at the Icahn School of Medicine, he worked at the Broad Institute of MIT and Harvard, and Dana-Farber Cancer Institute. However, it was the young patients he met conducting research in childhood bone tumors who started him on a medical career. I was incredibly moved by the kids I met while shadowing at Dana-Farber, he says. The extent to which they seemed to be aware of the impact of their disease on themselves and their families at such a young age was heartbreaking, but they are among the strongest people I have ever met. Knowing them made me really want to help.

Calista Dominy represented one of 18 writing groups working together to write the oath to be recited by her classmates at the White Coat ceremony. Crafting the oath is an annual process to reflect the sentiments and promises of the class of 140 incoming students.

Her group wanted to focus on empathy and humility. We wanted to use the word ally to reflect that we as doctors must be on the same level with our patients, she says. Weaving into the oath a strong commitment to fighting the inequities that surround us became a collective priority. I think we all really feel an incredibly strong commitment to social justice as a collective group. This year, for the first time, the oath references current events, including police brutality.

The schools commitment to social advocacy was one of the prominent reasons she was drawn to Mount Sinai. My eyes have been open to several injustices as a woman who is half Filipina. In my search for a medical school, finding an environment committed to racial justice was extremely important. I am so happy to be at Mount Sinai now because the hospital and the school are really doing as much as they can to eradicate racism, especially in medicine, and especially now.

Suvruta Iruvanti works as a volunteer at Mount Sinais clinic for the uninsured, the East Harlem Health Outreach Partnership (EHHOP), helping patients who require specialized care or financial assistance navigate the hospital system. Removing barriers and helping under-resourced patients obtain care has long been a career priority. As an undergraduate pursuing simultaneous degrees in Molecular and Cell Biology and Business at the University of California, Berkeley, he led a team of students into the northern Himalayan region of India to set up a clinic that would provide dental care for rural residents, many of whom had never seen a dentist.

Having studied prostate and ovarian cancer at the Broad Institute, he is interested in the possibilities of medicine to uncover new treatments for patients with advanced stage diseases. The why in disease has always intrigued me and propelled me toward medicine to find answers, he says.

Suvruta, who took on the role of scribe in writing the school oath, says the writing process was remarkably smooth as groups came together to submit contributions, then collaborated on editing through remote tools. Zoom is definitely a different modality, but we are still moving at the same pace even though we are not physically together.

One of the positives of a virtual White Coat ceremony, he says, is that he can invite as many family members from as many far-flung locations as he wishes to witness his big moment, via Zoom.

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About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality carefrom prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty by U.S. News & World Report.

For more information, visithttps://www.mountsinai.orgor find Mount Sinai onFacebook,TwitterandYouTube.

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Why I Want to Be a Doctor Now: Med Students Discuss What Makes Them Want to Help and Heal - Newswise

Research Finds Few Links Between Schools And COVID-19 Cases – NPR

Students attend the first day of school in the small town of Labastida, Spain, on Sept. 8. A recent study found no link between coronavirus spikes and school reopenings in the country. Alvaro Barrientos/AP hide caption

Students attend the first day of school in the small town of Labastida, Spain, on Sept. 8. A recent study found no link between coronavirus spikes and school reopenings in the country.

Despite widespread concerns, two new international studies show no consistent relationship between in-person K-12 schooling and the spread of the coronavirus. And a third study from the United States shows no elevated risk to childcare workers who stayed on the job.

Combined with anecdotal reports from a number of U.S. states where schools are open, as well as a crowdsourced dashboard of around 2,000 U.S. schools, some medical experts are saying it's time to shift the discussion from the risks of opening K-12 schools to the risks of keeping them closed.

"As a pediatrician, I am really seeing the negative impacts of these school closures on children," Dr. Danielle Dooley, a medical director at Children's National Hospital in Washington, D.C., told NPR. She ticked off mental health problems, hunger, obesity due to inactivity, missing routine medical care and the risk of child abuse on top of the loss of education. "Going to school is really vital for children. They get their meals in school, their physical activity, their health care, their education, of course."

While agreeing that emerging data is encouraging, other experts said the United States as a whole has made little progress toward practices that would allow schools to make reopening safer from rapid and regular testing, to contact tracing to identify the source of outbreaks, to reporting school-associated cases publicly, regularly and consistently.

"We are driving with the headlights off, and we've got kids in the car," said Melinda Buntin, chair of the Department of Health Policy at Vanderbilt School of Medicine, who has argued for reopening schools with precautions.

Emerging evidence

Enric lvarez at the Universitat Politcnica de Catalunya looked at different regions within Spain for his recent co-authored working paper. Spain's second wave of coronavirus cases started before the school year began in September. Still, cases in one region dropped three weeks after schools reopened, while others continued rising at the same rate as before, and one stayed flat.

Nowhere, the research found, was there a spike that coincided with reopening: "What we found is that the school [being opened] makes absolutely no difference," lvarez told NPR.

What we found is that the school [being opened] makes absolutely no difference.

Enric lvarez, researcher at the Universitat Politcnica de Catalunya

Spain does extensive contact tracing, so lvarez was also able to analyze how much schools are contributing to the spread of the coronavirus. lvarez said his research suggests the answer is: not much. He found that, for all the students and staff who tested positive, 87% of them did not infect anyone else at the school. They were single cases.

"We are not sure that the environments of the schools may not have a small and systematic effect," said lvarez, "But it's pretty clear that they don't have very major epidemic-changing effects, at least in Spain, with the measures that are being taken in Spain."

These safety measures include mask-wearing for all children older than 6, ventilation, keeping students in small groups or "bubbles," and social distancing of 1.5 meters slightly less than the recommended 6 feet in the United States. When a case is detected, the entire "bubble" is sent home for quarantine.

Insights for Education is a foundation that advises education ministries around the globe. For their report, which was not peer reviewed, they analyzed school reopening dates and coronavirus trends from February through the end of September across 191 countries.

"There is no consistent pattern," said Dr. Randa Grob-Zakhary, who heads the organization. "It's not that closing schools leads to a decrease in cases, or that opening schools leads to a surge in cases."

Some countries, such as Thailand and South Africa, fully opened when cases were low, with no apparent impact on transmission. Others, such as Vietnam and Gambia, had cases rising during summer break, yet those rates actually dropped after schools reopened. Japan, too, saw cases rise, and then fall again, all while schools were fully reopened. But the United Kingdom saw a strong upward trend that started around the time of reopening schools.

"We're not saying at all that schools have nothing to do with cases," Grob-Zakhary said. What the data suggests instead is that opening schools does not inevitably lead to increased case numbers.

What about the U.S.?

On Oct. 14, the Infectious Diseases Society of America gave a briefing on safe school reopenings. Bottom line? "The data so far are not indicating that schools are a superspreader site," said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan's medical school.

One place in the U.S. where systematic data gathering is happening Utah seems to echo the conclusions drawn by the new international studies. Utah's state COVID-19 database clearly reports school-associated cases by district. And while coronavirus spread is relatively high in the state, State Superintendent of Public Instruction Sydnee Dickson believes that schools are not, for the most part, driving spread.

"Where you see cases on the rise in a neighborhood, in a county, we see that tend to be reflected in a school," Dickson said. "[But] we're not seeing spread by virtue of being in school together."

Tom Hudachko of the state's health department said that after both colleges and schools reopened in early September, there was a rise in cases among the 15-24 age group. But with targeted public health messaging those cases have started to come down.

For the most part, Hudachko said, K-12 school clusters have been concentrated at high schools. "We have had some outbreaks in middle schools. They've been far less frequent. And elementary school numbers seem to be one-offs here and there."

And these clusters including one large reported outbreak with at least 90 cases have largely been traced to informal social gatherings in homes, not to classrooms. (lvarez, in Spain, also said that clusters among young people there have been traced to social gatherings, including rooftop and beach parties).

Few states are reporting school-related data as clearly as Utah. And that's a shame, said Buntin at Vanderbilt. "One might argue that we're running really a massive national experiment right now in schools," Buntin said, "and we're not collecting uniform data."

The largest centralized effort at such data collection in the United States the unofficial, crowdsourced COVID-19 School Response Dashboard has gotten a lot of publicity. But it is self-reported, not a representative sample of schools.

Buntin and other experts said it's likely that the dashboard is biased toward schools that are doing an exemplary job of following safety precautions and are organized enough to share their results. Also, the dashboard doesn't yet offer the ability to compare coronavirus cases reported at schools with local case rates.

In the absence of data, there are scary and tragic anecdotes of teachers around the country dying of COVID-19. But it's hard to extrapolate from these incidents. It's not immediately clear whether the educators contracted the virus at school, whether they are part of school-based clusters, or what safety precautions were or were not followed by the schools in question.

A recent study from Yale University could potentially shed some light on these questions. It tracked 57,000 childcare workers, located in all 50 states, Washington, D.C., and Puerto Rico, for the first three months of the pandemic in the United States. About half continued caring for very young children, such as the children of essential workers, while the other half stayed home. The study found no difference in the rate of coronavirus infections between the two groups, after accounting for demographic factors.

Walter Gilliam, lead author of the study and a professor of psychology at the Yale Child Study Center, cautioned that it's difficult to generalize this report to a K-12 schools setting, because the children were mostly under the age of 6 and kept in very small groups and, he said, the childcare workers were trained in health and safety and reported following strict protocols around disinfection. However, he said, "I think it would be great to do this study with school teachers and see what we can find out."

Risk and benefit

When you add up what we know and even what we still don't know, some doctors and public health advocates said there are powerful arguments for in-person schooling wherever possible, particularly for younger students and those with special needs.

"Children under the age of 10 generally are at quite low risk of acquiring symptomatic disease," from the coronavirus, said Dr. Rainu Kaushal of Weill Cornell Medicine. And they rarely transmit it either. It's a happy coincidence, Kaushal and others said, that the youngest children face lower risk and are also the ones who have the hardest time with virtual learning.

"I would like to see the students, especially the younger students, get back," said Malani at the University of Michigan. "I feel more encouraged that that can happen in a safe and thoughtful way."

Chicago Public Schools, one of the largest districts in the country, seemed to take that guidance into consideration when it announced recently a phased reopening starting with pre-K and special education.

Kaushal said it's important to keep in mind that Black, Latinx and Native American communities are much more severely affected by COVID-19. And that many of the "children that are at the severest risk of disease, are also at the severest risk of not having a school open, whether it be for food security, adult time, security, losing the time to learn or losing the skills that they have acquired over the last year or so."

Any decision made on school reopening, she said, has to focus on equity as well as safety. There are no easy trade-offs here.

Link:
Research Finds Few Links Between Schools And COVID-19 Cases - NPR

Child and adolescent psychiatry: Interview with Dr. Laurel Williams – Baylor College of Medicine News

Editors note: This blog post is part of an ongoing Progress Notes series featuring individuals who work in clinical psychiatry. In the following interview, third-year medical student Jessica C. Sheu interviews Dr. Laurel Williams.

Dr. Laurel Williams is the director of residency training for Baylor College of Medicines Child and Adolescent Psychiatry Fellowship, and the medical director of the Texas Child Mental Health Care Consortiums Centralized Operational Support Hub, Texas Child Health Access Thru TeleMedicine, and the Community Workforce Expansion. She is also an associate professor with special expertise in treating youth with suicidal behaviors and pregnant and post-partum adolescents.

In the following interview, Dr. Williams highlights her journey toward child and adolescent psychiatry and shares advice on staying physically distant but socially connected.

Q: Why did you pursue psychiatry?A: I have been interested in learning about the totality of a person. When I was in elementary and junior high school, I was quiet, observant, and always fascinated by what other kids were doing. Because of this, people often came up to me and shared their stories, and through that, I learned more about people and found it interesting.

In addition, my dad is a physician and went to medical school and residency while I was growing up, so I was able to see him in that journey. This greatly influenced me, so I went to college with the idea that I wanted to go to medical school and become a psychiatrist.

Q: Can you elaborate on your role in child and adolescent psychiatry?A: While I am in child and adolescent psychiatry, I think it has been mislabeled in my opinion I think we should really call ourselves family psychiatry. A lot of what we know about the human condition is that we are connected by so many influences, including ones genetics and society, nature and nurture.

Therefore, when I evaluate a young person during a visit, I am evaluating more than just the person. I am trying to understand as much as possible about all of the pieces of the puzzle in this young persons life We know that patients are genetically more likely to have a relative with a mental health disorder as well, so we can better understand our patients by understanding their family and social structures. If a family member needs help, we can help get him or her connected with professional support.

Q: What drew you to child and adolescent psychiatry?A: In adult psychiatry, the individual patient is the only person you talk to.. Unless given permission, a psychiatrist is not able to talk to the people in the patients life although they could provide a broader viewpoint of whats going on. It can be difficult to know all of the pieces.

In contrast, gaining other viewpoints is actually a requirement in child and adolescent psychiatry. You have to reach out and speak to people who are important in that persons life in order to get a better picture. This creates more opportunities for change and the ability to improve a situation, particularly with children.

Q: What is your role on a mental healthcare team?A: While other members on a mental healthcare team are experts in their respective specialties, I think the training of child and adolescent psychiatrists provides us with different layers of education so that we are expected to approach a situation with different angles. It often means that psychiatrists are in a team-lead position not because they are experts in every single aspect, but because they hopefully are experts in pulling together the biopsychosocial, cultural, religious, and economic model.

Regardless, I always take the opinions of my team experts in certain tasks, and I understand how all the roles should fit together.

Q: What are some ways that you balance work and personal life?A: I try to disconnect from the work after hours and on weekends. I love my work, but I also need to make sure that work doesnt consume me. In this time, I am ensuring that I engage in things that I enjoy, such as spending time with my daughter, reading, or playing with my animals.

Also, a lot of being a child psychiatrist is hard. You hear difficult stories, and sometimes families are broken in ways that are painful to hear about. I also think it is important to create a culture within work where you are able to share how youre feeling, and there is a safe space to decompress from the days events so you dont take it home with you. In this way, we all can be deliberate and mindful about disconnecting.

Q: In light of COVID-19 and current social issues, what advice would you give to others going through hard times?A: Time and time again, we know that when people have better social connections, their overall physical health and psychological well-being improve. Therefore, focusing on the social connections in your life right now is an important way to get through hard times.

I like to say physically distant, but socially present. Even if you cannot see someone in person because you need to stay physically distant, you can find other ways to be socially connected. While I personally am not active on social media, I have Zoomed more than Ive ever wanted to in my life. And while Im more than satisfied with my level of social media presence, I like that social media is available for those who are physically apart from each other.

Everyone has a different setpoint as to how much social connection they need, but really making sure that you stay connected is to me the biggest ingredient.

By Jessica C. Sheu, third-year medical student at Baylor College of Medicine

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Child and adolescent psychiatry: Interview with Dr. Laurel Williams - Baylor College of Medicine News

Victoria I. Gordon: Sharing time, talents with those most in need – American Medical Association

The AMA Members Move Medicine series profiles a wide variety of doctors, offering a glimpse into the passions of women and men navigating new courses in American medicine.

On the move with: Victoria I. Gordon (@futuredocgordon), a medical student at Kansas City University of Medicine and Biosciences. She also is a member of theAMA Ambassador Program, which equips individuals with the skills and knowledge to confidently speak to the AMA's initiatives and the value of membership. The program also increases overall awareness about what the AMA does for physicians and their patients.

AMA member since: 2017.

What inspired me to pursue a career in medicine: The decision to pursue medicine was a culmination of a lifetime of experiences including seeing disparities in my community, my brothers experience being diagnosed with type 1 diabetes, and a desire to help those around me. The opportunities to change peoples lives are endless in medicine, and I want to spend the rest of my life trying to give back to those around me by providing competent and considerate care.

How I move medicine: When I share my time and talents with those who need it most. More specifically, I move medicine currently when I help new members feel included at meetings with the execution of the Buddy Pairing Program in the MSS [AMA Medical Student Section] so that they feel comfortable sharing their own time and talents with the AMA in the future.

Career highlights: Being voted Region 2 secretary, being selected as the chair of MERC [AMA Membership, Engagement & Recruitment Committee], and being selected for the 2020 Ambassador Steering Committee are all things that I am very proud of. Additionally, I was selected to participate in the anatomy fellowship at my school and was inducted into the Sigma Sigma Phi National Osteopathic Society.

Advice Id give to those interested in pursuing a career in medicine: To not give up and to not get discouraged. Throughout my time in medical school, I have seen so many people from all different walks of life with different strengths and weaknesses succeed, thrive, and grow. They have taught me that if you work hard and believe in yourself that you can accomplish whatever you want to.

How I give back to the community: By participating in my state medical society, by voting in all elections (local and national), and by volunteering with various organizations including my local community kitchen, a student-run clinic, and with various organizations that support younger students in my city. I also advocate by staying active in the AMA and sharing my time and talents to help accomplish the AMAs goals.

Aspect of my work that means the most: Currently, I am working as an anatomy fellow at my school, where I teach anatomy to first-year students, conduct research, and take extra courses separate from medical school. Taking a step back from simply studying has been so incredible, and I am enjoying watching my students grow and learn.

More than anything, I love watching my students succeed and helping them to reach their full potential! There is nothing more rewarding than seeing the lightbulb go on in the students head as they realize that they have learned something.

My hope for the future of medicine: That it is brighter and better than today. I hope that physicians, as a community, can continue to give more patients competent and kind care, and I hope that the work we are doing today helps to accomplish those goals.

VisitMembershipMovesMedicine.comtolearn more about other AMA members who are relentlessly moving medicine through advocacy, education, patient care and practice innovation, andjoin or renewtoday.

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Victoria I. Gordon: Sharing time, talents with those most in need - American Medical Association

Medical researcher credits Rugby High with helping to shape career – Pierce County Tribune

Dr. Caleb Skipper poses for a photo in North Dakota Medicine, the University of North Dakotas School of Medicine and Health Sciences Fall 2020 magazine.

A 2005 Rugby High School graduate credits experiences from his hometown with shaping his work as a medical doctor and researcher.

Dr. Caleb Skipper and a team of University of Minnesota infectious disease researchers made news on the healthcare front last spring when they tested the effects of a controversial treatment for COVID-19.

Skipper said the idea to test hydroxychloroquine, a medication commonly used for malaria, on patients exposed to the novel coronavirus came to his team when they found themselves stranded in the United States and away from their work in Uganda.

When coronavirus hit, I had come back to the US for a routine medical conference, Skipper said. That week was the week everything shut down and everything changed. But, since we were (in the United States), my team actually had some infectious disease researchers who were all here, and our stuff was in Uganda, which was shut down like most of the world.

We asked ourselves, What can we contribute while were here in light of whats going on?' Skipper added.

Caleb Skippers senior photo appeared in Rugby High Schools 2005 yearbook.

So, we studied hydroxychloroquine. Youve probably heard of that. We were interested in it because as infectious disease doctors, thats a drug traditionally used to treat malaria, and we had some familiarity with it, Skipper said, noting he had been a part of a team in East Africa studying malaria.

There were some papers that had come out where, when they looked at it, at least in a test tube, the hydroxycholorquine had efficacy against the SARS COV-2 virus (a name for the virus that causes the disease known as COVID-19), Skipper said. It was very early on, and there were no treatments yet, so we rallied together and decided that we were going to launch a randomized clinical trial to study the hydroxychloroquine to see if that could be an efficacious treatment. We actually ended up turning our trial into three independent trials, each asking a different question but all using hydroxychloroquine.

We did try to set up trials to basically remove bias as much as possible. Thats what good scientists should do. We did randomized, double-blinded placebo trials. We actually gave our patients a placebo or hydroxychloroquine. They were blinded (didnt know what they were receiving), and we were blinded as well. Thats the most robust trial you can do to remove bias, Skipper added.

We found basically, in all three trials, looking at whether you can prevent getting the disease after youd been exposed to someone with it, called post-exposure prophylaxis, and another arm was, looking at once someone had gotten the virus, if you gave it early to them in the course, if it could mitigate the disease and prevent them from needing to go to the hospital and ICU.

Skipper said of the trials, We found hydroxychloroquine was no better than a placebo in doing that. Our randomized clinical trials failed to find a benefit.

My specific team are now not doing any active COVID research, Skipper said. Were back to doing HIV/AIDS research. Thats been restarted back in Uganda.

Skipper, whose father, Dr. Ronald Skipper serves as a surgeon for Heart of America Medical Clinic, said medicine has always figured prominently in his life.

Its definitely an influence, for sure. Growing up in Rugby, wed go to the grocery store and someone would come up to my dad and say, Dr. Skipper, thank you so much for helping me. So, growing up, I saw my dad was well appreciated and respected in the community and made an impact on people. That was attractive to me, Skipper said. That was definitely an influence.

An Ohio native, Skipper said, I consider myself being from Rugby because I spent all my formative years there fifth grade through high school.

Skipper said his time in Rugby shaped his life One hundred percent. Like I said, I feel like all my formation as a young man was in Rugby. So, between the different opportunities I had being involved in activities (had a benefit).

Its funny, he added. In a small town, there may not be as much of a breadth of opportunities as there are in a larger city but in some ways those opportunities are more available. There are only so many of you. Even if youre not good at sports, you can be on the teams. So, I have very fond memories of growing up in Rugby and going to school there, and the high school in particular.

Rugby Highs 2005 yearbook features Skipper on several pages; he served on the student council and participated on the schools Science Olympiad team.

I remember Jan Hagen, Skipper said. She was one of the science teachers. She in particular was a really key figure in my interest in the sciences and ultimately going to medical school.

But I think there are a bunch of people in Rugby (who were influential), Skipper added.

After graduating from RHS, Skipper studied at the University of North Dakota, moving to Ethiopia for a year after receiving his bachelors degree.

But I think what really got me particularly into the infectious diseases piece was after college, I went to Ethiopia for a year, kind of out in the middle of nowhere, working on some malaria projects, Skipper said.

Thats what cemented my interest in medicine, but it kind of shifted my focus into infectious diseases, he added.

Skipper said hes returned to his work on HIV and AIDS in Africa now. However, he still thinks of his youth in Rugby often. I feel like Rugby and my high school experience were very pro-family impactful on me becoming the man I am today, he said.

Skipper said he still follows stories about the global COVID-19 pandemic, too.

In Rugby, things seem pretty stable there, he said, referring to the communitys health. But in North Dakota as a whole, the coronavirus isnt being kept well-controlled there. I think, in a small town, people sometimes have perspectives. What applies to a larger city doesnt apply to a small town, Skipper added. In North Dakota, people are very independent, and in my opinion, I appreciate that independence. But at the same time, sometimes Mother Nature throws a curve ball bigger than politics or bigger than what you think the world should be.

I would encourage people to take COVID-19 seriously and protect their neighbors by wearing masks and doing small things, he added. I hope people basically look at this as something they have a part to play in as well. They can do the small things to help each other out.

Its such a small inconvenience to potentially provide some benefit, you know? Skipper added.

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Medical researcher credits Rugby High with helping to shape career - Pierce County Tribune

In Fauci, a Doctor Whose Work and Mission Have Been Shaped by Politics – The New York Times

In the early 1980s, reports began to surface of gay men dying of a form of pneumonia. Although Fauci was quick to raise the alarm and to investigate the role of the immune system in the new syndrome, he became the public face of the medical establishments sluggishness and indifference to the plight of gay men, the poster boy for the agency that denied dying men experimental drugs. The playwright and Act Up founder Larry Kramer was relentless in his criticism. Fauci was a murderer, he raged. Fauci was Eichmann.

Fauci did embody the paternalism of medicine at the time, Specter writes. Patients were rarely consulted in their treatment, not even AIDS activists so formidably self-educated about the disease. But their anger made an impression on the doctor. He flinched from it, yet wanted to understand. Fauci began to listen. He went to Act Up meetings. He heard stories of desperation, of men boiling their blood and shooting it back into their veins.

Fauci changed course, confounding his colleagues. He advocated for the activists, and revamping the clinical trial system. He was persuaded by the facts, Specter says, a vanishing art in this country.

They were all New York guys, Fauci has recalled of the activists. I had a little affinity to them because Im a New Yorker. And I said, What would I do if I were in their shoes? And it was very clear: I would have done exactly the same thing. Theyre all New York guys in this story Fauci, Trump, Kramer. The reason to listen to, rather than read, this story is for the texture of the voices, the archival audio that distills the panic and resolve of the era.

Specters own voice a bit breathless, a bit reedy rather surprisingly turns out to be one of the books most effective instruments. On the page, he can be as professionally impassive as Fauci at a news conference. But in the recording, there is no tamping his emotion and exasperation. The book becomes an indictment of Faucis great adversary, the adversary he shares with Kramer and with Specter, too. That adversary is not a virus or a particular administration. Its apathy.

Our continued existence depends on just how angry you can get, Kramer wrote in a fiery 1983 editorial, addressing gay men. Unless we ght for our lives we shall die. In his milder way, Fauci has been making the same point for years where viral epidemics are concerned. Why arent we more prepared? Why isnt there a universal vaccine for the flu, which kills tens of thousands of Americans each year? A vaccine of this kind could defend against all strains and provide a decade of protection, like a tetanus shot. Where is the political will to make this a reality? Why has America suffered so many lucky breaks spared the worst of avian flu and SARS while learning nothing? As incredible as it may be to imagine, this pandemic will pass; will we learn nothing again? How close to extinction must we come? Its the question Specter himself has posed in his work, that he poses again here, in telling the story of a celebrated physician and the heroic trait of changing ones mind.

Excerpt from:
In Fauci, a Doctor Whose Work and Mission Have Been Shaped by Politics - The New York Times

U of M Medical School Researchers Found Traces Of COVID-19 On Beaches – FOX 21 Online

DULUTH, Minn. Researchers at the University of Minnesota Medical School Duluth are reporting they have found traces of the COVID-19 virus in water from four area beaches.

The group has been taking samples from eight local beaches since July.

Researchers have found evidence of the genetic makeup of the COVID-19 virus at Leif Erikson, Park Point, Brighton, and 42nd Avenue beaches between the weekend of September 11th and 18th.

It is still unclear where the source or sources are coming from, but experts say testing samples might help answers some unresolved questions about COVID-19 in the area.

By watching for its presence may be able to show how long it stays or if it goes away. It will help understanding lake processes and levels of infection, said Dr. Richard Melvin, assistant professor of Biomedical Sciences. All of those things will help us find out how the virus ends up in the water.

U of M Medical School researchers will be continuing to monitor and take samples from all beaches for the next four to eight weeks.

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U of M Medical School Researchers Found Traces Of COVID-19 On Beaches - FOX 21 Online

Diversity in health care starts at the beginning – Nevada Today

Since 1968, National Hispanic Heritage Month has been recognized by the federal government and celebrated across the United States annually, from Sept. 15 to Oct. 15 to acknowledge the history, culture, and contributions of Americans whose ancestry can be traced to over 20 countries in Latin America, including Mexico, Central and South America, and the Caribbean. There are approximately 60 million people residing in the U.S. representing approximately 18% of the population, who have ancestries connected to these countries.

The University of Nevada, Reno School of Medicine (UNR Med) and University Health join in celebrating this annual commemoration as part of our commitment to diversity and inclusion and our ongoing efforts to increase the representation of Hispanics, and others from populations underrepresented in medicine, who serve our community as healthcare providers.

Diversity in health care benefits students and their future patients.

Diversity enhances the learning experience of all students through broadened perspectives, intellectual engagement, social skills, empathy, and racial understanding all critical components of medical education for future physicians. Ultimately, diversity helps equip future physicians to combat health care disparities, which will positively impact health care outcomes for their patients.

The future of medicine doesnt just lie in technological advancements or scientific discoveries, says first-year medical student, Leanne Perez. The future of medicine is about diversity, and reflecting a new, dynamic generation of doctors who represent every and any patient.

UNR Med is making great strides in training a broader spectrum of future physicians, capable of relating to patients and speaking their language, both literally and figuratively.

For second-year UNR Med medical student Sergio Trejo, being Hispanic and a Spanish speaker has been an enormous asset in understanding cultural subtleties and prominent social health determinants. I volunteer as an interpreter and student provider for clinics that serve underserved communities and interact with English language-challenged patients in navigating the health care field. When patients are able to precisely describe what brings them into the clinic in their own language with a health care professional who understands them, theyre overcome with a sense of relief and gratefulness. This is my motivation for dedicating my career to serving underserved populations, especially those who face massive language barriers.

Diversity in health care advances academic excellence.

The Association of American Medical Colleges (AAMC) reports that Hispanic matriculation to U.S. medical schools was 6.2% for the 2018-19 academic year. At UNR Med, the number of enrolled Hispanic medical students has more than doubled since 2011, reaching 20% for the 2020-21 academic year. In addition, more than half of the UNR Med Class of 2024 medical students represent UNR Med Mission-Based Diversity Groups, reflecting Nevadas diverse population. During this same period of time, the size of our application pool continued to grow and the average academic credentials of incoming students remained consistent or improved.

Commitment to diversity starts with engaging in outreach that exposes young people from groups underrepresented in medicine to role models and that inspires them to pursue a career in healthcare, said Tamara Martinez-Anderson, director of admissions. It is also reflected in a holistic admissions process that requires academic and professional readiness for medical school, but also considers how each candidates diverse competencies, attributes and backgrounds align with our mission and values. We know that achieving our vision of a healthy Nevada benefits when we enroll future doctors who are collaborative, resilient and adaptable and who are committed to providing compassionate, sensitive and culturally competent care.

UNR Meds total enrollment of Hispanic students is around 54 students, including the School of Medicine, Physician Assistant Studies Program and Speech Pathology and Audiology student bodies. Over the past four years, UNR Med has nearly tripled Latinx and Black faculty representation.

Diversity in health care starts long before medical school.

Pre-med pipeline programs and initiatives have been shown to help underrepresented students better prepare for the medical school admissions process. Developing and expanding these avenues of educational support continue to be a strong priority for UNR Meds Office of Admissions.

The mission of the Community of Bilingual English-Spanish Speaker Exploring Issues in Science and Health (CBESS) program is to create opportunities to position bilingual high school students as insiders into STEM-healthcare fields. CBESS aims to increase diversity in the health care workforce by providing programming for Spanish-English bilingual high school juniors through networking events with health care professionals, medical school tours, and a variety of other activities. The initiative is collaboration between the Universitys College of Education, Raggio Research Center, School of Community Health Sciences and School of Medicine.

Sergio Trejo became involved with CBESS, and his experience as a student in the program led him to choose UNR Med for medical school. Ive always been interested serving underserved communities, especially those who face prominent language barriers. I decided to attend UNR Med because Tamara Martinez-Anderson and other faculty demonstrated how UNR Med has similar goals in striving to alleviate health disparities for Nevada's underserved populations and beyond.

In support of first-generation and low-income undergraduate students who are preparing for the medical school application process, the Office of Admissions has partnered with the University of Nevada, Reno TRiO Scholars Program to offer pre-med advising and learning support. Also available is a one-year Post-Baccalaureate Certificate that provides a small and select group of students, frequently from non-traditional or underrepresented backgrounds, with the opportunity to demonstrate their academic readiness in a pipeline program that mimics the intensity of medical school.

Another pipeline program involves early interventions to make reaching the goal of medical school more sustainable over the long term. The BS-MD Program grants exceptional high school students conditional direct-entry admission to UNR Med upon completion of all requirements of a structured, four-year undergraduate pre-med program at the University of Nevada, Reno.

As a first-generation medical student, Leanne Perezs dream of becoming a physician felt discouraging at first, so the BS-MD program was key to guiding her throughout her undergraduate degree all the way to medical school. I am honored to represent the Hispanic community, as it is so important for minority populations to identify with their physicians. Coming from an underrepresented community, I am so proud to attend a medical school that prioritizes diversity and outreach.

Our commitment to diversity is a pledge to seeing that all members of our community are able to access the quality health care they need, said UNR Med Dean, Thomas L. Schwenk, M.D. In northern Nevada, we not only have great health care infrastructure but a School of Medicine that is actively partnering with our health care community to build relationships and increase access to, and equity in health care for all.

UNR Meds success in recruiting, enrolling and graduating increasing Hispanic medical students is reflective of the broader University of Nevada, Reno goal to become a Hispanic-Serving Institution, with Hispanic students making up at least 25% of the undergraduate, full-time student population.

Link:
Diversity in health care starts at the beginning - Nevada Today

We Need a Radically Different Approach to the Pandemic and Our Economy as a Whole – Jacobin magazine

Interview by Nicole Aschoff

For the better part of a year the world has battled SARS-CoV-2, a novel coronavirus that has killed nearly a million people and sickened tens of millions. In the United States the virus has wreaked havoc, particularly on older members of the population. Americans aged fifty-five and older account for more than 90 percent of the nearly two hundred thousand US COVID-19 deaths, while roughly 0.2 percent were people under twenty-five.

Efforts to quell the virus have brought additional pain. As of late August, roughly nineteen million Americans were out of work as a result of the pandemic, and food and housing insecurity has increased dramatically. But the pain caused by lockdowns has not been shared equally.

Elites have seen their stock portfolios balloon in value, and many professionals have been able to keep their jobs by working from home. It is the countrys poor and working-class households, particularly those with children, who have borne a disproportionate share of the burden. Lower-income Americans were much more likely to be forced to work in unsafe conditions, to have lost their livelihoods due to business and school shutdowns, or to be unable to learn remotely.

Jacobin editorial board member Nicole Aschoff sat down with two public health experts to discuss the challenge of keeping Americans safe without forcing working people to bear the lions share of pain and risk.

Katherine Yih is a biologist and epidemiologist at Harvard Medical School where she specializes in infectious disease epidemiology, immunization, and post-licensure vaccine safety surveillance. Yih is also a founding member of the New World Agriculture and Ecology Group, a former and current member of Science for the People, and a long-time activist in farm labor and anti-imperialist struggles.

Martin Kulldorff is a professor of medicine at Harvard Medical School. Kulldorff has developed methods for the detection and monitoring of infectious disease outbreaks which are used by public health departments around the world. Since April, he has been an active participant in the COVID-19 strategy debate in the United States, his native Sweden, and elsewhere. This interview has been lightly edited for clarity.

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We Need a Radically Different Approach to the Pandemic and Our Economy as a Whole - Jacobin magazine

Deion Sanders can sell recruits on one thing Power 5 schools cannot: community – The Undefeated

Historically Black colleges and universities (HBCUs) have produced 29 players who ended up in the Pro Football Hall of Fame. Everyone from Jerry Rice (Mississippi Valley State) to Michael Strahan (Texas Southern) to Aeneas Williams (Southern), but if were honest, football at HBCUs is an afterthought these days.

Deion Sanders can change all of that.

Seriously.

Jackson State named him its 21st coach on Monday at an on-campus news conference full of the pomp and circumstance you would expect from Sanders and an HBCU, arriving behind a marching band, police escort and luxury SUVs for his formal introduction.

Before Sanders takes on his first college job, he will finish this season as offensive coordinator at Trinity Christian School in South Dallas, where his son, Shedeur, plays quarterback and has committed to Florida Atlantic.

Sanders replaces John Hendrick, who was fired last month with a record of 6-9. Jackson State, which has not had a winning year since 2013, will start its season with the rest of the Southwestern Athletic Conference in the spring because of COVID-19.

Sanders, the only man to play in a Super Bowl and World Series, has always welcomed challenges.

This is one of the biggest challenges Sanders has ever faced because of the scrutiny that accompanies his new job and the critics waiting for him to fail, in part, because he didnt take a traditional path to getting this job.

After all, Sanders has never coached at the collegiate level.

Then again, neither had Todd Dodge when the University of North Texas hired him in 2007 after he won three consecutive state Class 5A championships at Southlake Carroll in suburban Dallas.

And neither had Gerry Faust when Notre Dame hired him in 1981 after 18 seasons at perennial powerhouse Moeller High School in Cincinnati, so precedence exists for this type of bold move.

This is what Ive been doing my whole life. Ive been called to take things to another level, Sanders said Sunday on his podcast 21st & Prime. What God is calling me to now, Im ecstatic. Its my people. Its my people I get to touch. A multitude of the parents are the same age as me.

I cant wait. Im so excited. I cant wait to touch the grass. I cant wait to put that whistle in my mouth. I cant wait to start drawing up plays.

The biggest question is whether Sanders can be CEO of a college program and manage more than 100 players, assistant coaches and support staff.

It all starts with his staff.

Sanders said he expects his staff to have eight assistant coaches who either played or coached in the NFL.

They must be grinders, because theres nothing glamorous about coaching college football. Youre either preparing for a practice, a game or recruiting. Downtime is for other people.

Sanders most important staff member will be his NCAA compliance officer because of the organizations draconian rules. Plus, any prominent player who signs with Jackson State is going to have his recruitment scrutinized like none other.

Now, Sanders made mistakes at Prime Prep Academy, the charter school he co-founded in 2013 that closed after months of controversy in 2015. Among a few issues with the school was financial mismanagement, according to an investigation by the Dallas Morning News in 2016.

Building a school from scratch is something Sanders doesnt have to do at Jackson State.

Sanders has made it clear he wants to recruit some of the nations best players. His name and credentials will get him in the home of almost any recruit.

And no better time exists for Sanders to recruit elite Black athletes to an HBCU.

In June, Makur Maker, a five-star basketball player, committed to Howard over UCLA, and in August, 6-foot-3 twin volleyball players Cimone and Bria Woodard changed their verbal commitment from Texas A&M to Howard.

Sanders has shown his commitment to HBCUs. He announced the HBCU combine earlier this year, which was organized to highlight 50 hand-picked athletes from HBCUs ahead of the NFL draft, but the event was canceled due to COVID-19.

Our country is fractured, and too many folks think its cool to cheer for Black athletes when they score touchdowns as long as they arent dating their sons or daughters or straying too far off campus.

What if Sanders signed some of the best college football players because he can sell the one thing Power 5 schools cant: a sense of community and belonging?

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At HBCUs, Black students get a sense of community that doesnt happen at predominantly white schools. History lessons go beyond Harriet Tubman and Martin Luther King Jr. It can be hard to love yourself when you dont really know who you are and where you came from.

At an HBCU, its cool to be unapologetically Black and embrace all that means.

Why not? Isnt this the time? Sanders said. Isnt this the moment? Isnt this whats needed? To match what [Jackson State president Thomas Hudson] so eloquently said, its a match made in heaven. This is a God move.

Jean-Jacques Taylor, a native of Dallas, is an award-winning journalist who has covered the Dallas Cowboys and the NFL for 25 years and is president of JJT Media Group.

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Deion Sanders can sell recruits on one thing Power 5 schools cannot: community - The Undefeated

Is there a cure for my nightly snoring? – Harvard Health – Harvard Health

Q. My partner says I've been snoring lately. Are there any home remedies I can use to help me stop?

A. Snoring occurs when muscles in your airway relax during sleep, narrowing the airway and making your breath sounds louder as the air forces its way through. There are a number of strategies that can help. Try sleeping on your side instead of your back, which pushes your tongue to the back of your mouth. Clear nasal congestion resulting from allergies or a stuffy nose. Avoid alcohol (which may act as a sedative) and sleep medications known as benzodiazepines, which may cause your airway tissues to relax, making snoring worse. Losing weight can also help, because surplus tissue, caused by weight gain, can put pressure on and compress the airway, making snoring worse. However, if your snoring does not improve, your partner notices that you have periods during the night where your breathing -appears to stop, or you regularly feel drowsy during the day, it may be time to pay a visit to your doctor. You could have a condition called obstructive sleep apnea, which may require treatment.

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Medical schools tweak application process due to COVID-19 – Universe.byu.edu

Medical students studying in a lab. Recent surveys indicate medical school applications have become more flexible in the pandemic, but potentially even more competitive. (Kaplan, Inc.)

Survey results show that the majority of medical school admission officers have made their admission process more flexible because of the impacts of COVID, but it hasnt made the process any less competitive.

The survey was conducted by Kaplan, a corporation that provides educational services to students and universities. It showed 93% of medical school admission officers and teams made their admissions process more flexible because of the pandemic.

Petros Minasi, the senior director of pre-health programs for Kaplan, said the Medical College Admission Test (MCAT) score submission deadline has been extended to January 2021 for people wanting to attend in the fall. Usually the test is taken in the spring; however, it was not being administered at all in May due to lockdowns.

Savanah Hardcastle, a BYU senior who took the MCAT this summer, said the first big change was the MCAT test dates getting pushed back. She said the normal timeline is to take the test in April or May and then start on your primary application.

So that was tricky because it was really hard to focus on the application while studying for the MCAT. So my application process kind of got pushed back as well because its hard to do both, Hardcastle said.

Medical schools have also accommodated for limited clinical and volunteer hours caused by social distancing regulations.

Traditionally pre-meds would say, I want to become a doctor, Im going to go volunteer at a hospital so I can shadow some physicians and see the clinical setting in person. Well right now, hospitals, for the most part, want to limit the number of people, Minasi said.

Hardcastle said she wasnt able to do many shadowing hours in hospitals because of COVID. She said this gave her and other students the opportunity to get creative with other ways to serve the community.

I was able to get some of the young women in my ward who I also served with as a young womens leader to help me make a heart with phrases of love and encouragement. And then we pasted the hearts on the windows of the old folks home, Hardcastle said.

Medical schools are also accepting pass/fail grades for pre-requisite courses, which has not been the case in the past. Minasi said they will most likely allow pass/fail courses for some time due to the impact of COVID.

Another significant change has been the interview process for potential medical school students. Medical school interviews are normally in person, but this year schools had to adjust and many did virtual tours or campus walks, Minasi said.

According to the University of Utah School of Medicine admissions overview, because of COVID and local and state health guidelines, interviews would be virtual for the 2020-2021 application cycle.

Minasi said although there has been a lot of changes, the medical school admissions process is not getting any easier.

The accommodations have made it possible, and maybe more accessible, for applicants to continue the process despite the impacts of COVID. The Association of American Medical Colleges released a report showing the number of applicants is 17% higher than usual.

Were already seeing in this 2020 application year, an increase as far as the number of applicants. What were not seeing is an increase in the number of first year medical school seats. So its very possible that this year will actually be more competitive than others, Minasi said.

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Medical schools tweak application process due to COVID-19 - Universe.byu.edu

Survey finds doctors have negative perception of patients with disability – Harvard Gazette

More than 80 percent of U.S. physicians reported that people with significant disabilities have worse quality of life than nondisabled people, an attitude that may contribute to health care disparities among people with disability, according to recent research published in the February issue ofHealth Affairs.

The first-of-its-kind study surveyed 714 practicing physicians from multiple specialties and locations across the country about their attitudes toward patients with disabilities.

That physicians have negative attitudes about patients with disability wasnt surprising, said Lisa I. Iezzoni, lead author of the paper and a health care policy researcher at Harvard-affiliated Massachusetts General Hospital (MGH). But the magnitude of physicians stigmatizing views was very disturbing.

For more than 20 years, Iezzoni has studied health care experiences and outcomes of people with disability and is herself disabled by multiple sclerosis diagnosed in 1980, her first year in medical school.

Only 40.7 percent of surveyed physicians reported feeling very confident about their ability to provide the same quality of care to patients with disabilities as their other patients received. And just 56.5 percent strongly agreed that they welcomed patients with disabilities into their practices. The physicians who reported being most welcoming to patients with disability were female and practiced at academic medical centers. The Americans with Disabilities Act of 1990 requires that people with disability receive equitable health care.

That most surveyed physicians did not give socially desirable answers about their perceptions of people with disability indicates their certainty in their beliefs, said Iezzoni. We wouldnt expect most physicians to say that racial or ethnic minorities have a lower quality of life, yet four-fifths of physicians made that pronouncement about people with disabilities. That shows the erroneous assumptions and a lack of understanding of the lives of people with disability on the part of physicians.

Our results clearly raise concern about the ability of the health care system to ensure equitable care for people with disability, added senior author Eric G. Campbell, professor of medicine and director of research for the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.

Studies of people with disability show that most dont view their lives as tragic.

Lisa I. Iezzoni

The paper cites examples from Iezzonis and others research demonstrating that individuals with disabilities often receive inferior care. Many surgeons assume, for example, that women with early-stage breast cancer who use wheelchairs want a mastectomy instead of breast-conserving surgery, believing that women with disability dont care about their appearance. And during the surge of the COVID pandemic in March, when resources such as ventilators were scarce, the Office for Civil Rights at the U.S. Department of Health and Human Services felt compelled to issue a warning to health care providers that people with disabilities should not be denied medical care on the basis of disability or perceived quality of life.

The research is a wake-up call for physicians to recognize their biases so they dont make erroneous assumptions about the values of patients with disability, thereby limiting their health care options and compromising care, said Iezzoni, a professor of medicine at Harvard Medical School.

Studies of people with disability show that most dont view their lives as tragic, she added. Theyve figured out how to get around in the world that wasnt designed for them and view their lives as good quality.

The authors call for all levels of medical education, including continuing education for practicing physicians, to include training about disability. Currently, most medical schools dont include disability topics in their curricula. Implicit Association Tests (which measure unconscious bias) related to disability can also raise physicians awareness of how their perceptions about disability may be affecting how they practice medicine.

In future research, the investigators plan to explore the extent to which physicians perceptions about people with disability contribute to disparities in care, said Campbell. Our ultimate goal is to ensure equality in care for people with disabilities.

Funding for this research was provided by the Eunice Kennedy Shriver National Institute for Child Health and Human Development.

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Yale Internal Medicine Partners with Two Federally Qualified Health Centers in Innovative New Care Consortium < Internal Medicine – Yale News

By Saphia Suarez

Last Monday, faculty members from the Yale Section of General Internal Medicine helped open the doors of the New Haven Primary Care Consortium, beginning an innovative journey of collaborative medicine with the goal of revolutionizing primary care in the New Haven area.

The NHPCC is located at 150 Sargent Drive in Long Wharf, New Haven and is a partnership of Yale New Haven Hospital, Cornell Scott-Hill Health Center, and Fair Haven Community Health Center that will have critical input and leadership from Yale School of Medicine faculty.

This collaboration is unusual, says Bradley Richards, MD, assistant professor of medicine (general medicine) and assistant medical director for the NHPCCs Cornell Scott-Hill Health Center Adult Medicine Practice.

It is unusual to have two Federally Qualified Health Centers (FQHCs) under the same roof, says Richards, referring to the Cornell Scott-Hill and Fair Haven Community Health Centers. Thats the unique nature of what were doing here, where theres a lot of collaboration.

Unusual though it may be, discussions of this collaboration have been happening on and off for at least 30 years, says Patrick OConnor, MD, MPH, MACP, Dan Adams and Amanda Adams Professor of General Medicine and chief of General Internal Medicine.

The idea has been out there but it didnt gain traction until about three years ago, says OConnor.

Now that it has, the excitement across the department is palpable.

This is a great opportunity for us to work closely with our colleagues in the community, says OConnor. And undoubtedly it will be a two-way learning process. This unique partnership will combine the expertise of community and academic physicians and other health care professionals to the benefit of our patients and community more broadly.

For Brita Roy, MD, MPH, MHS, assistant professor of medicine (general medicine) and director of Population Health for Yale Medicine, the excitement around this collaboration lies in the opportunity to improve population health.

The hope is that with all of these clinics merged together serving the lower income population in New Haven, well be able to really collaborate and coordinate to develop robust population health systems to better support our most vulnerable, says Roy.

She names the expansive data and resources from the networks of these three care providers as key to co-designing programs to improve systemsand, therefore, health outcomes.

OConnor agreed. The opportunity for us to leverage this collaboration and think creatively about building highly innovative approaches to population health is very exciting.

John Moriarty, MD, FACP, associate professor of medicine (general medicine) and program director for the Primary Care Internal Medicine Residency Program, is particularly excited about what this new consortium will mean for his residents.

Education in this environment will change, says Moriarty. One of the more effective ways to educate residents and students about primary care is to have a team-based approach to education, and understanding that high functioning primary care teams are made up of much more than the physician. Theres the pharmacist, the nurse, the medical assistant, etcetera. You need everyone working at the highest level to optimize care plans for patients. The NHPCC gives residents the opportunity to look at true inter-professional care at a high level.

One new aspect of that inter-professional care at the NHPCC is an integrated behavioral health team. This team includes psychiatrists, psychologists, and licensed clinical social workers who will now work side by side.

In the past we've struggled to get patients the behavioral mental health care they need when they needed it, says Daniel Tobin, MD, FACP, associate professor and medical director of Primary Care alongside Laura Whitman, assistant professor of medicine (general medicine). So having access to an integrated behavioral health team is a significant enhancement. Theyre right next door, so if we have a patient who needs to see someone for an urgent behavioral health issue, we can send them right over.

And, says Moriarty, that integrated behavioral health will teach residents how to effectively care for patients, thereby improving the next generation of physicians in primary care.

So far, the response from patients has been a positive one.

I have seen quite a few patients in the new space already, says Tobin. I think everyones really excited, the space is beautiful, the physical plant is just a significant upgrade from what were used to, so everyones impressed.

Looking forward, OConnor is focused on creating a seamless patient transition from outpatient, inpatient, and community health care.

The transmittal of information in large medical centers like ours can be fragmented at times, says OConnor.

We want to build comprehensive teams who will assure that patients transition between the clinic, and the hospital, and the community with the goal of achieving high quality and cost effective care for the benefit of all patients and their families.

OConnor says he and his team are already beginning to design a more robust approach to seamless care as they simultaneously settle into the new NHPCC space and explore how this collaboration will elevate the collective care the consortium is able to provide to the New Haven community.

The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.

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Yale Internal Medicine Partners with Two Federally Qualified Health Centers in Innovative New Care Consortium < Internal Medicine - Yale News

Op-ed: Doctor, mentor to Black men, urban renewal champion. Frank Lloyd was that and more – IndyStar

The Indiana Historical Society is collecting documents from Hoosiers ahead of an exhibit and online archive for Indianapolis' bicentennial. Indianapolis Star

With the city celebrating 200 years, the Encyclopedia of Indianapolis assigned profiles of civic leaders, including the late Dr. Frank Lloyd. I recalled him as a prominent doctor, medical researcher and the first African-American president of Methodist Hospital.

He was all that, but also as a quiet and effective civic leader. He joined with a handful of others who transformed Indy from minor- to major-league status.

Born in South Carolina in 1919, Dr. Lloyd graduated from Howard University School of Medicine in Washington, D.C. He served as a Rockefeller Fellow at Columbia Presbyterian Medical Center in New York City, teaching at Columbia University.

Paying respects: Indy's black history makers

Coming to Indianapolis, he established his medical practice, delivering babies and doing research in gynecology and obstetrics.

Dr. Lloyd became one of the first African-American doctors on staff at Methodist Hospital in 1954. He launched a new era as director of medical research in 1963, laying the groundwork for Methodist to become a teaching/research facility in addition to patient care.

In 1981, Dr. Lloyd became the first African-American president of the hospital. Leading the hospital through a major expansion, he hoped Methodist could become an Indiana version of the famous Mayo Clinic in Minnesota.

Photo of Dr. Frank Lloyd, president of Methodist Hospital, 1992(Photo: Rich Miller, Indianapolis Star)

The hospital pioneered the states first adult open-heart surgery in 1965, then the use of an artificial kidney in 1966, and kidney transplants in 1972.

He also taught at medical schools as a visiting professor. In his spare time he joined other civic entrepreneurs who put Indianapolis on the national map beyond the Indianapolis 500 Mile Race and high school basketball.

He was a great physician, said a subsequent Methodist Hospital president, Sam Odle. But he also understood the bigger context of the community the need for African-Americans to have access to information, financial capital and quality education. He was a quiet, reflective man. He didnt wear his smarts on his sleeve.

He was the first chairman of the White River State Park Development Commission, paving the way for the downtown park as an anchor for urban renewal. He also served as co-chair of the Greater Indianapolis Progress Committee, the key organization for the citys revitalization in that era.

He was the key founder of the Midwest National Bank, expanding lending opportunities when traditional banks restricted lending to African-Americans.

He joined with other investors to start radio station WTLC-FM, offering a new African-American perspective in the radio market. He served as president of the Metropolitan Planning Commission during the 1970s, as city fathers were laying the groundwork for the citys growth spurt in subsequent decades.

He also was one of the founding members of 100 Black Men, for mentoring young African-American men.

Sam Jones, then the president of the Indianapolis Urban League, summed him up this way on Lloyds death in 2002: He was a giant among men, not just African-American men, but a giant among men, period.

RussPulliam is associate editor of The Star. Follow him on Twitter at RBPulliam@twitter.com. Email him at Russell.Pulliam@indystar.com.

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