I recall not having a study method many years ago. Someone I knew back when I began my college life once showed me ways to study more committedly. However, it took me years to understand these steps and I often fell into the habit of unstructured reading and studying – “lazy reading”, so to speak. Over the years, I’ve learned a thing or two, and would like to share that with students who are beginning their studies in college and are facing new academic challenges.

Reading articles, novels and textbooks efficiently requires concentration. Multitasking impairs effective reading, especially when studying from a textbook for an exam. There are several techniques to improve concentration when studying from a textbook, including breaking down studying into equal portions, separated by brief moments of relaxing “rewards” (the so-called “Pomodoro Technique”), as well as studying in the right environment, whether at a library or a cafe, or at a place where both concentration and pleasure can be found. Meditation before engaging in reading is also important, as well as asking yourself why it is important to go through the process of reading and studying something, especially if it is hard or if you are not particularly motivated by a particular subject.

During the study process, active reading involves engagement. Passive reading is doing so without a plan of action, waiting for whatever comes in the next paragraph, without a real desire to discover what is on the page. Active reading helps create associations which improve long-term memorization. Structuring this process with the SQ3R (S – skim, Q – questions, 3R – read/recite/review) reading method can be very helpful to study as efficiently as possible. It consists on first, going over, or skimming, the reading from a bird’s eye view, paying attention to any titles, subtitles or words in bold present on a particular chapter. While skimming, it is important to ask questions about the reading, taking as many notes as possible throughout the chapter at stake. These questions will later help guide you through the reading, making it easier to understand. Then, of course, comes the reading portion of studying the text, but while doing so (after each section, for example), remember to recite in your mind (or out loud) important parts of the reading as you go over it. Finally, it is necessary to review what has been read. Recapitulating a section of a chapter at a time, and then doing so for the entire chapter, is crucial to interiorize the material.

Last but not least, it is crucial to study with time in advance. Always pay attention to lectures and try to read a certain section that you know will be covered during lecture beforehand. I advise you to start dedicated study for an exam two weeks in advance. Doing so earlier might lead to forgetting the contents if not reviewing adequately, and doing so in less than two weeks might cause you not to cover all the material in a way that will be effective for the exam. Starting dedicated study the weekend before the exam is usually a terrible idea.

Sources:

Lesson: Module 4, slide 5

It is well known that Buddhism embraces the idea that living in the present moment while not dwelling on the past or anguishing about the future is necessary to live in harmony with oneself and follow the path to enlightenment. Does instant gratification help us live in the present moment? It briefly appeaces our anxiety, for certain, but doesn’t help us seize the present in a righteous way, as living in the here-and-now must be accomplished with a perspective of the consequences of our current actions.

Wild animals fulfill their basic needs in generally simple ways. They do so by feeding themselves when hungry, finding shelter when cold, or sleeping when tired. They don’t worry about the past or stress about the future in unnecessary ways (e.g. a bird builds a nest as it plans to brood its eggs on it, which is necessary for the continuation of its species). Thus, one could say that wild animals succeed at living mainly in the present moment and at times in the future because their survival depends on it. Unlike them, many people tend to avoid facing foreseeable uncomfortable challenges in the future by irresponsibly engaging in distracting activities. This illogical and contradictory reasoning process is the phenomenon known as procrastination. In my opinion, it ensues from a lack of evolutionary neurological development of the human brain.

I believe the human brain is not a final product, so to say. It is still evolving, which explains, for instance, why there are so many psychiatric disorders that wild animals don’t present, and why we often fail to succeed in our interpersonal relationships, whether in romance, our relationships with coworkers, or the interaction among groups of individuals (e.g. differences among ethnic groups, which often leads to armed conflict). Our emotions and analytical thinking grapple with one another. In the case of procrastination, anxiety brought up by several reasons (e.g. perfectionism and fear of failure, fear of success and rebellion against authority) blinds objectivity and practicality.

Additionally, with the advent of the internet, smartphones and social media, the world in which we live today is increasingly full of distractions that encourage the procrastinator to triumph in his misdeeds. Likewise, there is a tendency to engage in multiple life projects simultaneously, especially in highly developed countries (which coincidentally suffer from higher levels of stress). To illustrate the latter statement, students in the US often have the opportunity to double major in college, and they have the opportunity to join integrated programs (e.g. BS/MS, MS/PhD, Medical Residency/MS), thus doubling their amount of academic workload and fueling on stress and anxiety.

In order to avoid procrastination effectively, I advise students and working professionals to address the anxiety that causes it. Simplifying one’s life when possible, and engaging in meditation or mindfulness can certainly help. Pursuing cognitive behavioral therapy might also be a smart strategy to challenge the natural tendency for procrastination that afflicts many.

I have written an article that deals with the subject of anxiety and depression, also from an evolutionary neurological standpoint, back in April 23, 2019, titled The Neurological Source of Depression, which I believe can bring interesting additional insights: https://u.osu.edu/juarez.41/2019/04/23/the-neurological-source-of-depression/

Resources:

Lesson: Module 3, slide 6

Proper online communication is essential for efficient collaboration among team members in any kind of organization. I will focus on collaboration in basic science and medical research.

Basic science research in the laboratory, specifically, that involving experiments, requires continuous data recollection. In experiments involving animals, for instance, this involves skill acquisition (e.g. surgical techniques and peritoneal drug administration) through training. This training requires adequate communication among research team members. Data recollection must be done in a clear and organized manner so that all researchers can access it and understand it. Schedules must be put out with time in advance in order to know when participants will be available for all required weekly interventions so that there won’t be details in required procedures. Group members need to meet, whether in-person or online, so that they can report their progress within their assigned tasks, so they can find answers to arising questions throughout the research, and so that they can be updated on any new procedures and plan changes. The principal investigator must maintain close communication with fellow investigators and other team members, so it can be made sure the research is being conducted according to standards.

Keeping an online schedule with the lab’s weekly activities (meetings, inspections, etc.) is highly recommended, as well as communication via cellphone chat groups and video calls using reliable platforms such as Microsoft Teams and Zoom.

It is important for students that begin working at a laboratory to focus realize that professional communication must be maintained at all times. E-mails must follow an adequate pattern, with an adequate subject line, introductory greeting, a concise, clear message, and a proper closing with the student’s full name. Investigators in a laboratory might friendly and kind, but they will always expect formal and respectful communication.

Resources:

Academic Email (Module 2 – Slide 8)

The last thing I would like to talk about concerning my rotation with Dr. VanKoevering is his research. Dr. VanKoevering, who previously obtained a bachelor’s degree in Biomedical Engineering, is currently involved in very interesting projects, such as 3D printing.  

Three-dimensional printing is an evolving field of biomedical engineering, where certain body parts can be reproduced thanks to a specialized printer which uses materials such as titanium alloy, inert polymers, silicone, and hydrogel. These printers work with sub-millimeter resolution at rapid speed and are able to create highly-detailed structures, tailored to a patient’s anatomical needs. 

With 3D printing, it is possible to create prostheses, wearable devices and implants (bioresorbable or permanent) that make up for missing body parts in certain patients, such as the ear, nose or jaw. Surgical models for preoperative planning and which serve as intraoperative guides can facilitate surgical precision. With this technology it is also possible to manufacture educational models for patients, anatomy students, as well as for the purposes of surgical simulation. Finally, 3D printing can be used in tissue engineering to make scaffolds and even for bioprinting. 

Preoperative planning can now be taken to the next level, through digital planning. Dr. VanKoevering, an otolaryngologist that specializes in facial tumors, uses this technique to determine the exact dimensions and shape of bone grafting he will need to rebuild a mandible, or a parietal bone. Research indicates that surgical/digital planning saves between 62 and 85 minutes of OR time (and up to 100 minutes in head and neck surgery), reduces blood loss, increases reconstructive accuracy, improves bony unions required for a better osteosynthesis, improves tumor localization, and, most importantly, reduces surgical complications. 

I had the privilege of seeing the da Vinci Surgical System in action during one of Dr. VanKoevering’s surgeries at the James Cancer Hospital. This is a minimally-invasive device which allows surgeons to freely operate in narrow or closed spaces where doing so with the naked eye and with the hands would require larger surgical incisions and probably less refined surgical technique.

Even though I had heard about this device, I had never seen it being used in the operating room. The device consists of surgical arms supported by a robotic device which is located right over the operating site. Simultaneously, this robot is operated by the surgeon, who uses manual controls located in another component of the da Vinci Surgical System, that’s across the operating room. This control station allows the surgeon to visually zoom into the surgical site with the help of a camera, and his hand/finger movements are repeated in real time on the robotic arms. The surgeon’s module also has a microphone, which allows the surgeon to speak at a normal volume while the device magnifies the sound of his voice, allowing for better communication across the OR. The device is very versatile, as it even makes corrections in movement, in the event the surgeon makes an accidental hand movement which could harm the patient. The two modules of the device are connected by cables across the OR. There was no use of WiFi to connect the surgeon’s controls to the robotic arms.

The surgeries most commonly performed with the da Vinci robot include, most commonly, gynecologic, renal, and cardiac valve surgeries. This time, though, I had the opportunity to see a tonsillectomy on a tonsillar cancer patient. The procedure lasted about an hour, and it included extraction of local lymph nodes for pathology studies, to test for metastasis.

As one would expect, this device can be used to operate at a distance. For example, patients in rural and isolated parts of a country could benefit from having a surgery without the surgeon being present. The surgeon could be operating from a different city, or even a different country. This technology, however, has not yet become reliable enough to permit this to happen, in part due to concerns regarding loss of wireless signal to maintain the real-time nature of the intervention. A minimal lapse between the movements of the surgeon’s hands and the robotic arm movements could lead to mistakes during the surgery, which may be catastrophic for the patient.

I think this technology, even though it’s already twenty-five years old, has a lot of potential and a bright future, in the field of telemedicine and long- distance surgery.

I had the opportunity to see some interesting cases in last week´s clinic hours. Dr. VanKoevering, whom I shadow, specializes in tumors of the skull base and sinonasal cavity, mostly sees adult patients. I would say the majority of his patients have or have had cancer, and many of them are heavy smokers, which is often a causal factor for this type of disease. 

This time, I was particularly interested in understanding computerized tomographies of the skull base. Previously, I had studied CT scans, but from a medical perspective. Now, I have been reading more about the science behind this essential imagining technique, which consists of sending x-rays across multiple planes of an anatomic structure, such as the skull, producing a three-dimensional image. X-rays, like gamma rays, alfa and beta particles, are a kind of ionizing radiation, able to knock out electrons from atomic nuclei with its high energy (the wavelength of most X-rays lies in the range of 0.01 nm up to 10 nm. This corresponds to an energy range of 100 keV down to 100 eV). Therefore, the CT scan is like a set of multiple planar radiographies taken of a body part, and as such creates a considerably higher amount of ionizing radiation. In excess, this radiation can alter atoms and produce changes in cellular DNA. Therefore, its use must be minimized as much as possible. 

The release of electrons from the atoms x-rays collide with rely on the photoelectric effect, described by Einstein (who won the Nobel Prize for discovering that photon energy is quantized). X-rays occur when electrons are liberated from a heated filament, or cathode, thanks to thermiomic emission. Then, with the help of a high voltage, the liberated electrons move towards a metal target, which acts as the anode. When short-wave electromagnetic radiation reaches its binding energy level and collides with surfaces, it produces the emission of electrons. When these high-energy electrons collide with the atoms of the metal target (anode), X-rays are produced. 

But this science doesn’t yet explain how images are actually imprinted on an x-ray film. A traditional x-ray detector consists of a film based on a silver iodide emulsion. The exposure and development of this film isn’t that different from how photographic films are developed. In the case of digital x-ray detector arrays (in use since the early 2000’s), a scintillator layer converts x-rays to visible light, which is then detected by a pixel array. 

The types of CT scans include sequential, spiral, electron beam tomography, dual energy CT, CT perfusion imaging, and the PET CT. CT scanning of the head is usually used for detection of stroke, tumors, cysts, trauma and hemorrhage. In these images of the head, it is possible to identify dark (hypodense) structures, which indicate the presence of edema and infarction. Often, cancerous tumors are accompanied by peripheral edema and tissular death (infaction). Bright (hyperdense) images could mean either calcifications or the presence of a hemorrhage. 

I think it is fascinating to have the opportunity to understand CT scans both as a physician and as an engineer. Having both a medical and technical understanding of an imaging study such as the CT scan, can give more ideas to the scientist, to improve existing technologies and develop new ones.     

Since mid-January this year, I’ve had the pleasure of shadowing Dr. VanKoevering, an otolaryngologist at The James Cancer Hospital, one of the best medical centers of its kind in the United States, as ranked by U.S. News & World Report. I’m thrilled by this new experience, for which I think writing about is very much worth it.  

As a medical student, and later, as an international medical graduate, I’ve shadowed multiple surgeons in the past, in large hospitals in Vienna, Austria, Aarhus, Denmark, Samara, Russia, and, of course, the US. However, this rotation is different due to the fact that I am able to see patients in surgeries and medical rounds from the perspective of a biomedical engineer, something I’ve never experienced on past rotations. 

As all engineers do, the biomedical engineer applies natural science and math to solve problems in our society and improve already-existing technologies, but, unlike the others, focuses on biological sciences and medicine in a unique manner that addresses human health and disease. As an IMG and future biomedical engineer and researcher, I want to acquire a round understanding of the human body, in order to provide better treatments and develop more efficient medical devices. 

During this ENT surgery rotation, I’ve seen several types of craniofacial cancer, including sinonasal undifferentiated carcinoma, low grade sinonasal adenocarcinoma, sinonasal malignant mucosal melanoma, nasopharyngeal carcinoma. Often, these cancers are highly aggressive and have very poor prognosis. Also, many of these patients (a large portion of them heavy smokers) require partial removal of their larynx, including their vocal chords, which leaves them unable to speak. 

One of the medical procedures I’ve seen thus far in this rotation is the tracheoesophageal puncture, TEP, which allows patients to speak again by connecting the esophagus with the trachea, causing vibrations in the esophagus that mimic the function of the vocal cords as air passes through them. 

Another device I’ve seen during my rotation, which has called my attention, is the flexible nasopharyngoscope, which uses fiberoptic or digital chip-on-the-tip technology. Its scope diameter varies from 1.9 mm (pediatric model) to 6 mm (adult model). It is possible to attach a high-resolution camera to the scope’s viewing port, allowing the health provider to visualize the area of interest as seen from the tip lens of the device. The tip which carries the lens is flexible, providing a field of view of up to 90 degrees by maneuvering the angulation control knobs located in the control body of the device. It is primarily a diagnostic device (e.g. evaluation of sleep apnea, venopharyngeal insufficiency, fiber endoscopic evaluation of swallowing, FEES, done by a speech therapist) with assistive therapeutic applications (e.g. visual tool for excision and debridement of nasopharyngeal cancerous tumors and their biopsy, removal of easily accessible foreign bodies, tracheostomies, and vocal cord injections for vocal cord palsies). It is generally a safe device which doesn’t generate complications; however, it is not totally exempt from them. These include mucosal tearing, bleeding, sneezing, laryngospasm (in less than 1% of procedures), gagging, and damage to anatomical structures, which is extremely rare with the use of flexible scopes, as opposed to rigid ones. The two main contraindications for its use include acute epiglottitis and croup. 

This is the first of four entries I intend to make on this subject. In doing so, I look forward to encouraging people to learn more about this exciting topic.

On previous posts and website updates, I have covered themes pertaining to the learning process as well conditioning learning factors, like mental health. But learning also requires the capability to discern between sources. It is not difficult to imagine there are innumerable articles, posts, and even scientific journal articles of questionable origin. Likewise, the media often distorts scientific findings. For this matter, in this blog post I exemplify this incongruence, by presenting the strengths and weaknesses of a mass media article that is based upon a scientific journal paper from a reliable source.

Mass media article:

Scientific journal article:

The Importance of Accurate Interpretation of

Scientific Findings in the Media

Angelo Juarez

Living in an era where technology has facilitated widespread communication requires that those responsible for the distribution of information ensure it is done in a precise and ethical manner (Comer, 2015), yet there are innumerable instances where knowledge is altered as it transitions from the original source to the receiver. The present essay illustrates how scientific findings can be distorted as they are presented to the general public in a mass media report.

A published, peer-reviewed scientific article from 2018, titled Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study, deals with the issue of electronic devices and television, and their association to the mental health of under-aged individuals, who are considered particularly vulnerable to the negative effects of these gadgets. More than 40,000 American children and adolescents were indirectly analyzed in this study, by surveying their caregivers, to determine their level of well-being in relation to how many hours they spent watching TV or accessing electronic devices during weekdays. Researchers found that, after one hour of use, more hours of daily screen time related to lower psychological health (characterized by less curiosity, lower self-control, more distractibility, less emotional stability, more difficulty making friends, and reluctance to being taken care of), as well as an increasing history of depression and anxiety. This association was greater among adolescents than in younger children (Twenge & Campbell, 2018). The British mass media article that attempts to recount the findings in this study, Smartphones and tablets are causing mental health problems in children as young as TWO by crushing their curiosity and making them anxious, presents the findings in the context of Britain’s so called ‘zombie’ children, who spend an average of five hours a day using electronic devices (Blanchard, 2018).

In general, the mass media article does a fair job warning the public of the dangers that excessive electronic device use could have in the mental health of children and adolescents. It is backed up by commentaries from the study’s authors, and includes recommendations given by the American Academy of Pediatrics on the maximum number of hours children and adolescents should spend watching TV and using portable electronic devices. Nonetheless, the mass media article has major pitfalls, as it distorts important study findings. For one thing, it hastens at finding a causal relationship between the variables ‘screen time’ and ‘well-being.’ Due to the cross-sectional design of the study, it impossible to determine if screen time leads to low well-being, if low well-being results in greater screen time, or if both tendencies can happen simultaneously. Then, the mass media article hurriedly concludes that just an hour a day looking at a device’s screen could damage mental health. This information is incorrect, as the scientific article it is based upon concludes that one hour or less of internet consumption does not seem to correlate with a deterioration in well-being. Even though in the study it was found that curiosity was lower even with one hour of screen usage, the decrease in curiosity wasn’t, as the news media article luridly says, ‘crushing’. In the study, curiosity was only slightly inferior than the other well-being survey items within the first hour of screen utilization and resembled the same pattern in deterioration with increasing hours involved using screen devices or TV.  Also, the mass media article focuses only on the effects portable screen devices supposedly have on well-being, yet the study’s survey was in fact unable to discern between portable screen device use and TV use due to its design. Lastly, the mass media article fails to mention scientific evidence in favor of electronic device use, or studies that don’t find a negative association between portable screen device time and well-being.

An appropriate way to improve the mass media article in question would be to have it revised by editors with a background in science. In other words, people knowledgeful of research theory as well as statistics would be able to interpret scientific findings more accurately and should work alongside the mass media article editors in assuring the final product is clearly understood and precise. Another way to meliorate this science mass media article would be to have it reviewed by the authors of the study it is based upon. On a side note, it is advisable to reduce publication bias (the publication of a study not only because of how groundbreaking its findings are, but also due to how appealing the results could be in the public eye, hence bringing more attention to researchers, increasing revenues for the media, and potentially promoting the researchers’ funding) of scientific journal articles in the first place, by submitting them for peer reviewing without showing the study’s results (Gebelhoff, 2016). In doing so, the number of biased mass media articles would consequently decline in their own accord.

It is pertinent to mention that the authors of mass media articles, such as the one under consideration, can fall in the habit of giving their writing a sensationalist approach, with the intention of attracting a greater audience. Writers of mass media articles based on scientific knowledge should abstain from this practice, as it can turn crucial, potentially life-changing facts biased and misleading, which might have a serious negative impact in people’s lives. To put this in perspective, stating that screen devices will only provoke irreparable harm in the well-being of children and adolescents, could potentially dissuade caregivers from allowing youths the opportunity to gain advantage from the virtues these technologies also possess, such as serving as powerful didactic tools. This is a paramount reason to demand rigor in the media’s portrayal of scientific findings.

References:

Blanchard, S. (2018, November 2). Smartphones and tablets are causing mental health problems in children as young as two by crushing their curiosity and making them anxious. Daily Mail. Retrieved from https://www.dailymail.co.uk/health/article-6346349/Smartphones-tablets-causing-mental-health-problems-children-young-two.html

Comer, R.J. (2015). Abnormal Psychology (9th edition). New York, NY: Worth Publishers.

Gebelhoff, R. (2016, August 17). The media is ruining science. The Washington Post. Retrieved from https://www.washingtonpost.com/news/in-theory/wp/2016/08/17/the-media-is-ruining-science/?utm_term=.1fc0c271ad2c

Twenge, J.M., Campbell, W.K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive Medicine Reports, 12, 271-283. doi: 10.1016/j.pmedr.2018.10.003

As we all know, the incidence of depression worldwide is an increasing problem. We are aware about the problem, but few actually realize the way depression is approached is largely wrong. Antidepressant use is widespread as there is an increasing amount of people using them, among all age groups. I recently saw a reportage on 60 Minutes that intrigued me. Even though it is from 2012 the matter in question is very much still controversial. To what extent are antidepressants used inappropriately? Do people with mild or early forms of depression actually need them? These are questions that require research.

Watch video – Treating Depression: Is there a placebo effect?

This 2012 60 Minutes reportage is about an ongoing medical controversy, regarding antidepressant use and abuse. Irving Kirsch, a psychologist, researcher, and associate director at Harvard Medical School’s Placebo Studies Program, questions the proper use of antidepressants, as he describes evidence in his studies that suggests patients with mild to moderate depression could avoid their intake, since the effect they have is seemingly no greater than that of placebo medication. The repercussion of his statement reverberates broadly among the scientific community, as 17 million Americans, many as young as six years old, currently take antidepressants, and the pharmaceutical industry profits 11.3 billion dollars from their sell every year. He acknowledges that patients taking antidepressant drugs have evident clinical improvement, yet he attributes this recovery to the placebo effect, which is an improvement in signs and symptoms by unknowingly consuming a dummy pill that does not possess any chemically active ingredients. The video describes previous placebo research done in patients with different ailments, which include irritable bowel syndrome, strain injuries, ulcers, Parkinson’s disease, and traumatic knee pain. Professor Kirsch even describes a clinical trial in which a number of patients underwent arthroscopic knee surgery while others merely had trocar knee incisions done to them. The results were staggering, as patients who had the placebo procedure referred greater improvement than those who had the traditional surgery. He adds that the placebo effect is not solely in the mind, as not only symptoms like pain have an improvement (as evidenced in brain neuroimaging), but also clinical signs of blood pressure and heart rate tend to normalize in these patients, and the approach of the clinician also has a pivotal effect in the result of the placebo treatment. The more understanding, communicative and humane the clinician is, the better the results obtained from this technique. Finally, he recognizes there is a clear difference in the effect of antidepressants in cases of major depression, but for the majority of patients, who don’t have this grave condition, more can be done aside from giving antidepressants. Opponents of these studies argue that individual cases must also be taken into consideration before concluding the inefficiency of antidepressants in mild to moderate cases of depression, as in clinical practice patients will show evident improvements due to the effects of the antidepressant, preventing further worsening of their condition.

My initial reaction to this video is moderate, as I agree with professor Kirsch’s studies to only a certain extent. I believe his findings could make many patients who actually need the antidepressants avoid their use, which bringing about negative consequences in their clinical progress, leading to chronicity and even suicide. On the other hand, I believe there is over medication of antidepressants nowadays. Even in mild cases of depression, psychiatrists tend to give antidepressant medication, which might discourage patients from finding other ways to overcome this terrible impairing disease. I think psychiatrists should first give the opportunity to patients to find other alternatives to improve their life problems, by proactively making clinical referrals to other specialists, like psychologists and therapists, even mindfulness experts, and work in an interdisciplinary manner with them.

Another important point I would like to mention is the intrinsic positive effect of antidepressants in neurological functioning. There is extensive research that suggests that these medications are neuroprotective and even neurogenerative, which would be of enormous benefit to these patients.

On the other hand, there is a social aspect of stigma towards the use of antidepressants. Peru, where I come from, has much greater stigma on the use of antidepressants than the United States, and people tend to very easily avoid the use of these drugs. I believe that making public the use of placebo medication for depression might enforce the stigma if not properly exposed to the public.

What could we do at OSU to improve the approach to depressed students? – If I could make public policy, I would make mental health providers be more proactive in searching for depressed patients, at schools, universities and the workplace. There should be better screening for depression. For example, I would like to see a program at The Ohio State University that would engage in calling students whose grades are going down, especially those who are also missing class, to ask them for the reason of their academic troubles, and try to find a solution which could include psychological consultation at the university’s Wellness Center.

Angelo Juarez