What is an Anesthesiologist

The field of anesthesiology is a medical specialty that focuses on the relief of pain and total care of the surgical patient as well as the immediate postoperative period. Anesthesiologists are medical doctors who must complete 4 years of undergraduate school, four years in an accredited medical school, one year as a general surgery intern, three years at a minimum in an anesthesia residency program and one or two years in a critical care medicine fellowship. This adds up to 11-13 years after high school before you can even apply for a job as an anesthesiologist!

What do Anesthesiologists do?

Anesthesiologists utilize their extensive education to provide what is termed “total patient care”. In addition to managing the airway and ensuring proper breathing during surgery, anesthesia providers also manage pain, fluid and electrolyte balance, body temperature, prevention of cardiac arrest, patient transport to the operating room and post-operative management.

Anesthesiologists are not limited to what goes on in the operating room though. They are also responsible for what happens before surgery, during the preoperative visit with a surgeon who may or may not be an anesthesiologist themselves!

For further information about what an anesthesiologist is and what they do, please check out this fine article.

Post residency training - Fellowships

Anesthesiology is a very competitive field for medical students, and many of the most talented individuals go on to do fellowships. There are different types of fellowship programs available for people interested in specializing further in anesthesiology.

Here are a few of the most popular Anesthesiology Fellowships:

Anesthesia critical care: requires 2-3 years following residency after completing at least 3 years of anesthesiology residency. This track typically leads to board certification for both anesthesia and critical care medicine, which allows you to work in academic institutions where research applications will be strongly considered. The two separate specialties must be completed back-to-back and an anesthesiology residency is typically expected for this track.

Obstetric anesthesiology: requires board certification in anesthesia followed by an additional 2 years of training after an anesthesiology residency, is necessary for this fellowship. This program is designed to train people to become experts in pain management and anesthesia during labor or cesarean delivery. A person going into this field must already have a strong knowledge of anesthetic drugs and their pharmacokinetics, as well as an interest in the endocrine system and physiology.

Pediatric anesthesiology: this option consists of an anesthesiology residency, followed by a 3-4 year pediatric anesthesia fellowship accredited by the Accreditation Council for Graduate Medical Education (ACGME). A family medicine or pediatrics residency is required prior to applying. Once you’ve completed all that, you can then take advantage of advanced training opportunities while working towards board eligibility and certification in pediatric anesthesiology. This type of job typically includes caring for children with congenital heart disease, infants with neurologic problems within the neonatal intensive care unit (NICU), and children undergoing surgical procedures.

Neuromuscular anesthesiology: this fellowship program is designed for people who want to become an anesthesiologist who specializes in neuromuscular-blocking agents (NMBA). You must complete an anesthesiology residency and the American Board of Anesthesiologists’ exam for certification before you can apply to a neuromuscular fellowship. A neuromuscular anesthesiology fellowship requires completion of an intensive clinical requirement, research project, or prior experience with NMBA titration.

Pain medicine: this track typically takes three years after an anesthesiology residency, during which time fellows gain surgical expertise in pain management techniques under an anesthesiologist who has an interest in the field. The anesthesiologist in pain management is often an expert in regional anesthesia and procedural techniques, with an in-depth understanding of neuromodulators like local anesthetics.

Cardiothoracic anesthesiology: this fellowship requires completion of an anesthesiology residency, followed by two years of training that focus on perioperative care for patients undergoing cardiothoracic surgery or thoracic pain management. You must be board certified to apply for a cardiothoracics anesthesiology fellowship associated with a university hospital or large medical center.

Regional anesthesia: this option provides continuing education opportunities and clinical experience in anesthesiology and pain management. The program lasts one year and requires an anesthesiology residency and certification in anesthesiology to apply.

For more information about Anesthesiology fellowships please visit: https://www.asahq.org/education-and-career/asa-resident-component/residentfellows-in-training/fellowship-opportunities

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The Path To Becoming a Psychiatrist

Psychiatrists focus in mental health, however they all receive the same basic medical training. The educational path to become a psychiatrist is long and requires hard work and dedication. To become a Psychiatrist, a person must complete college prerequisites, then complete medical school and a residency at which time passing boards completes the path to state licensure. 

The American Psychiatric Association, says this educational path allows doctors to diagnose both mental and physical causes of illness.  Psychotherapy, psychoanalysis, and prescribing  medicine are among the treatments they employ.

Prerequisites for Medical School

As part of their preparation for medical school, aspiring psychiatrists must complete coursework that is required for entrance into medical school.  Most times this includes a four-year bachelor’s degree.  English, mathematics, biology, chemistry, and physics are all required undergraduate courses. 

Even though there is no requirement for a specific major before enrolling to med school, many candidates choose to major in chemistry or biology.  Because medical school is so competitive, you’ll need good grades. Participate in extracurricular activities to increase your chances of acceptance.  Volunteering at a hospital or medical facility is also an favorably looked upon by medical school admission specialists.  In addition, scoring well on a standardized test called the MCAT is a must as getting accepted into medical schools is highly competitive.

The next four years at medical school

Medical school is a four-year program that leads to a doctor’s degree. Some colleges may integrate a bachelor’s and a medical degrees in one program. During medical school, the first two years are spend mostly in class work in courses such as physiology, anatomy, and pharmacology, chemistry, biochemistry, neuroscience, psychiatry, and neuroscience.
The next two years of medical school are spent is clinical rotations at teaching hospitals where they assist patient care in different specialties of which psychiatry is one such rotation.

Residency After Medical School

After graduating from medical school and passing appropriate board examinations, a person must match into a residency.  This is a four year process of which the first year is spent in a general hospital residency, where you will treat patients with a variety of ailments. Future psychiatrists must then spend three more years working with patients with mental health problems under the supervision of licensed Psychiatrists.  After completing residency, top students may want to apply for a Fellowship where they can specialize in a subspecialty of Psychiatry such as addiction psychiatry. The final step to becoming a licensed and practicing Psychiatrist is to pass board examinations.  This entire process is usually a minimum of 12 years but offers an outstanding career with great pay and the opportunity to help many people

For a more in depth article please check out this article about how to become a psychiatrist

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— Internet Domination (@InternetDominat) September 23, 2021

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ISIF targets €1bn in climate action projects in next five years

The Ireland Strategic Investment Fund (ISIF), which is managed by the National Treasury Management Agency, is to invest €1 billion in climate action projects over the next five years.

Among the programme’s targeted investments, which will take place between 2021 and 2026, are energy efficiency, energy storage, renewables, transport, forestry and waste.

“Climate change is set to be the greatest challenge facing our society in our lifetimes and beyond. The urgency of the challenge is driving the far-reaching actions being taken by societies, governments, businesses, consumers and investors to create a more sustainable economy and way of living. Our society needs better technology, better ways of doing things and better ways to sustain our natural environment and the climate we depend on,” said ISIF director Nick Ashmore.

“Our planned investment programme reflects the urgency of the climate challenge and the significant opportunities that exist to back Irish businesses and projects that are developing new and more sustainable ways of doing things.”

He said ISIF plans to make both “direct and fund-based investments aligned with this strategy, partnering with major global investors where appropriate, and will make further announcements over the coming months.”

The fund also published its report for the fist half of the year, which showed total investment returns of 5.2 per cent in first half of 2021, an increase of €450 million in six months. That brings total gains to €1 billion over the last 18 months

Investments

The first half of the year saw 10 new investments, bringing total commitments in Ireland to €5.2 billion across 151 investments. More than 48,000 jobs have been supported and €1.2 billion in gross value added to the Irish economy.

Among the investments made by the ISIF in the first half of the year were €42 million in Stripe to support the global payments technology company’s growth plans; €15 million to a new Beach Point Capital fund; a €50 million investment to DunPort Captial Management Fund; and a €13 million investment to existing investee Genesis, an Irish aircraft leasing company to support its ongoing operations.

The ISIF also made a €15 million investment in Ocuco – a software provider to the eyecare industry to primarily support continued research and development as well as product development; a €3 million follow-on investment to Vectra – an artificial intelligence cybersecurity company who are expanding their presence in Ireland; €19 million to Lightstone, a specialist US-based venture capital fund focused on medical devices and biopharmaceuticals; and $30 million to Illumina Ventures which invests in transformative, industry disruptive, technology driven companies in life and physical sciences.

It also provided provided Irish payments and technology company Fexco with a €20 million debt facility to support the company’s ongoing operations and growth, and made a €3 million follow-on investment to AMCS – a domestic company which develops and sells technology for environmental management.

Since the establishment of the fund in 2015, ISIF has notched up gains of €2.2 billion, split between its Irish portfolio at €1.4 billion and its global portfolio at more than €800 million.

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Record-setting $175 million donation will propel UMass Medical School in Worcester on level with elite global institutions

For more than 30 minutes, some of the state’s most powerful men attempted to put into words the importance behind a $175 million investment to the UMass Medical School in Worcester.

Then Chioma Okwara walked to the podium as a living example.

Okwara, an immigrant born in Kenya, is now a physician at Brigham and Women’s Hospital and Harvard Medical School as well as a trustee on the board at UMass. It all became possible after she graduated from UMass Medical School.

Okwara immigrated to Lowell before enrolling at Middlesex Community College. When she relayed to a peer that she wanted to become a doctor, she was initially laughed at.

But after her 9-year-old brother died when he was unable to access medical care for injuries suffered in a car crash in Kenya, she pursued her dream regardless of the odds.

“I share my story today not to tell of my achievements, but to highlight the transformational power of public high education. Without UMass, I’m not sure who I would be today,” Okwara said.

With a “history-making” $175-million gift from the Morningside Foundation, which officials announced on Tuesday, UMass plans to help others like Okwara realize their dream.

“[Okwara] is exactly the success story that this gift will ensure is repeated over and over again, UMass President Martin Meehan said.

Okwara and Meehan joined Gov. Charlie Baker, medical school Chancellor Michael Collins, Chairman and CEO of Morningside Group Gerald Chan and Chairman of UMass Trustees Robert Manning for the announcement on Tuesday in Boston.

Rendering of UMass Chan Medical School

The donation from The Morningside Foundation more than doubles the medical school’s endowment.

As part of the donation from the Chan family of investors, the school in Worcester will be renamed the UMass Chan Medical School.

Its three graduate schools will be renamed the T.H. Chan School of Medicine, the Tan Chingfen Graduate School of Nursing, and the Morningside Graduate School of Biomedical Sciences.

“Our medical school is stronger than ever, and yet in decades to come, the generosity of the Morningside Foundation and the Chan family will propel UMass Medical School to new heights and allow our medical school to compete with the most elite institutions in the world,” Collins said.

The name of T. H. Chan, the late patriarch of the Chan family, will now appear on the name of the medical school. Chan was deeply committed to supporting higher education, his son Gerald said.

The Graduate School of Nursing will be named for the family’s matriarch, Tan Chingfen, who was a nurse and is still active today at 101. The family said she administered vaccines to neighborhood children in the 1950s.

Renaming the Graduate School of Biomedical Sciences to include “Morningside” reflects the name of the Chan family’s investment group and foundation.

“The present gift from the Morningside Foundation is intended to draw attention to the urgent need for supporting our state universities at a time when resources available to them lag far behind the resources available to the elite private universities,” Gerald Chan said. “We as a society must renew our support for the public universities now.”

Chan said the gift was inspired by his father who helped those who were less fortunate earn an education.

“I grew up watching him change the trajectory of many young lives by supporting their education,” Chan said.

The donation to UMass comes seven years after the Chan family donated $350 million to the Harvard School of Public Health. The investment was the largest in the university’s 378-year history. The school was renamed the Harvard T.H. Chan School of Public Health.

“At that time I was asked by many, why public health? The Harvard gift shone a spotlight on public health and the discipline’s importance to society,” Chan said. “…Six years later, the COVID-19 pandemic would prove that gift most prescient. Today, everybody understands why public health.”

All of the $175 million is unrestricted, which Collins referred to as a dream come true.

He said the university will use the money to recruit and retain world-class employees, continue groundbreaking research, offer financial support to qualified students and expand its mission of public service.

“A strong and vibrant medical school that educates doctors, nurses, leaders and scientists stand to benefit countless people, be they in Worcester, in Boston or the far corners of our world,” Collins said.

Meehan began the announcement with a smile and said it was a pretty good week for UMass.

On Sept. 1 the university announced a $50 million donation from Robert and Donna Manning. At the time, the total was a record for the school.

On Tuesday, Chan and Morningside more than tripled it.

“Today is a very important day for UMass,” Baker said. “But I’ll tell you something, it’s just the beginning of what will be the next act of an incredibly important medical institution, not just here in the Commonwealth, not just around the country, but across the world.”

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South Georgia couple, beloved business owners die of COVID-19 on the same day – WSB-TV Channel 2

BAINBRIDGE, Ga. — A Georgia couple who were well-known business owners in their small community died on the same day of COVID-19.

Edwin (66) and Linda (58) McCullers both died at Memorial Hospital in Bainbridge on Aug. 28.

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Edwin McCullers was the owner of Flint River Outfitters, which sells hunting, fishing and other outdoor equipment. The business was closed until further notice after his death. Linda McCullers owned a hair salon.

Family members said they died of COVD-19.

They were both of the Methodist faith.

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There were dozens of tributes to the couple on social media.

“Edwin and his dear wife Linda McCullers were two of the hardest working people I ever knew,” one friend wrote on Facebook. “They built several highly successful businesses over the years, but they always took the time to personally attend to each customer.”

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The family encouraged everyone to wear masks in their joint obituary. Their funeral service will be private.

Bainbridge is a close-knit community that is home to around 13,000 people. It is the county seat of Decatur County and the hometown of UGA head football coach Kirby Smart.

A total of 66 people in Decatur County have died of COVID-19 since the start of the pandemic.

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Make your money a force for good | Business

I lived as a Benedictine monk for 20 years, hoping I would love the world and the people in it more freely by renouncing all material goods and worldly ambitions. Monks are supposed to be “free agents” of mercy and kindness, serving the divine all day, in all things — without ulterior motives.

However, after surviving the bankruptcy of our community and watching my fellow monks not be able to afford essential health care for many years, I’ve learned there is another way forward.

What if, instead, we each had a little bit of wealth? Wouldn’t that allow you to achieve the same objective of being a “free agent” of love and kindness, beholden to no one? With no strings attached.

You don’t need any money to make that happen, but having a robust financial plan and adequate savings makes this life much more manageable. Otherwise, you’ll live a precarious existence.

Wealth, wisely and sustainably invested, allows you to live your values more fully rather than be stuck working paycheck to paycheck, a grind that leaves many of us frustrated and exhausted. Too much of that and you LOSE at life — you Live Only Sad Experiences.

A life where your most profound spiritual values shape each day is what I call a LOVE life — Live Only Value-based Experiences.

Buying stuff will not make you happy. However, meaningful, value-based experiences do make us happy. They also make the world a better place, and the more wealth you have, the more valuable experiences you can pack into your life.

Wealth can help make life LOVE-ly.

Is a LOVE life always pleasant and happy? Nope. Not at all.

For example, someone who needs cancer treatment will value that treatment highly, even though it is devastating. They need to focus on their health and quality time with family instead of wasting that precious energy paying medical bills, earning an income or even cleaning the house.

Money can remove the unvaluable experiences from your life, allowing you to focus on what brings deeper meaning. The list of value-based experiences is endless. You may value working in an animal shelter, raising foster children, running aid missions around the world or training service dogs for veterans struggling with post-traumatic stress disorder.

This list could also include, in moderation, spending time on a tropical beach sipping fruity cocktails with your friends and family. Why? Because such experiences add value to your life, strengthen social and family bonds, and bring joy into the world.

One of my favorite LOVE stories is when a group of students at Santa Fe Preparatory School, where I once worked, chose to bake a cake and throw a party for a 7-year-old girl whose family moved into a homeless shelter on her birthday. That was LOVE-ly, and I value every moment of that day.

I still get teary-eyed every time I think about that little girl’s surprise and the joy it gave to every guest in the shelter that night. What had been a tragically dreary day felt like a celebration.

And if you don’t think that was a real moment of happiness — just ask the child’s mother.

That LOVE story required a little money but mostly time and energy. And it’s hard to find the time or money when all your energy is devoted to making ends meet. With a little bit of wealth, your entire day can be filled with LOVE stories rather than merely clocking hours at a job you don’t enjoy. We all are required to do unpleasant tasks each day, but money used wisely can drastically reduce our suffering and provide us with the time and resources to help others more effectively.

I believe that we are all the hands of the divine. In the monastic tradition, the divine loves us, and we are responsible for transmitting the divine love that eternally surrounds us.

With time, resources and compassion in our hearts, we can make our money a force for good and be a powerful tool for change in the world. And God knows, our world certainly needs it.

Doug Lynam is a partner at LongView Asset Management in Santa Fe and a former monk. He is the author of From Monk to Money Manager: A Former Monk’s Financial Guide to Becoming A Little Bit Wealthy — And Why That’s Okay. Contact him at douglas@longviewasset.com.

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Why are Biostatistics Essential for Successful Clinical Trial Management?

The role of biostatisticians goes far beyond analyzing data at the end of a clinical study. Instead, they should be involved in clinical trial management right from the start to maximize the chances for a new drug’s market approval.

Biostatisticians in clinical trial management have a long to-do list. They advise on study design, calculate the right sample size, and ensure that the enrolled patients are correctly randomized. They help define endpoints, provide definitions for data analysis and create tables and figures for the clinical study report.

Malin Schollin, Director of Biostatistics at LINK Medical

“People often think that biostatistics comes in at the end of a clinical trial, but this can lead to a lot of issues, for example, when you find out too late about missing data or incorrect randomization.”

“There is great value in having a statistician on board during the entire project because then we can take part in the decision making, and help assess how it will affect analyses, evaluation, or results,” said Malin Schollin, Director of Biostatistics at LINK Medical, a Swedish contract research organization.

Meaningful data at manageable costs

Christina Ehrenkrona, Senior Biostatistician at LINK Medical

The work of biostatisticians starts with the preparation of the clinical study protocol.

“The clinical study protocol is really the core of any clinical study. We need precise calculations to ensure we enroll the right number of patients – not too many to keep costs manageable, but enough to obtain statistically relevant data,” explained Christina Ehrenkrona, Senior Biostatistician at LINK Medical.

In addition, the clinical study protocol defines the objectives and endpoints to be assessed during the clinical trial. Biostatisticians need to understand the scientific question underlying the study to give input to suitable parameters that can be measured with statistical relevance.

“Sometimes, we do real detective work in order to find the necessary input for the sample size calculation,” said Ehrenkrona. “Together with the clinicians, we research the studies that have been done before for similar treatments and how the data in these previous studies have been collected and analyzed.” 

Gunnar Danielsson, Senior Regulatory Advisor at LINK Medical

Biostatisticians also suggest exploratory endpoints in early phases that might be useful in future studies.

“You often see that the primary endpoint changes between early and late clinical phases to apply the knowledge gained along the way. We provide guidance on what is measurable, analyzable, and clinically relevant,” added Gunnar Danielsson, Senior Regulatory Advisor at LINK Medical. 

Avoiding bias in clinical study data

Another essential task for biostatisticians is to support the randomization and stratification of study participants to avoid bias in the resulting data. Bias can occur when clinical trial results are affected by factors not related to the treatment being tested. 

Stratification of patient subgroups – those receiving either the treatment or placebo – ensures that the subgroups are sufficiently homogeneous to be comparable.

Especially with sites in different countries or environments, it is essential to ensure that subgroups should contain a representative partition of the local population.

“A classic example is the initial association between alcohol consumption and lung cancer – not considering that many people who regularly consume alcohol also smoke a lot. We need the input from clinicians on what might be affecting the treatment to obtain meaningful data on the treatment effect,” Schollin explained.

Biostatistics for successful market authorization

Maybe the most important document that biostatisticians create is the statistical analysis plan. It outlines in detail how the collected data will be used, analyzed, and displayed in tables and figures. 

To pave the way for successful market authorization, the information the biostatisticians prepare for the clinical study report must be both statistically valid and compliant with regulatory requirements.

“The statistical analysis plan is a document that contains all our recipes,” Ehrenkrona explained. “It is finalized and signed before the database is locked and the data unblinded, meaning that we can assign the patients to the treatment groups. If we haven’t prepared our plan carefully, there’s no second chance.”

Clinical trial management is a team effort

Conducting a clinical development program is a team effort that includes input from medical, clinical operations, pharmacovigilance, and regulatory professionals, as well as a continuous involvement of biostatistics and data management experts.

Maintaining the same team throughout different clinical trials increases shared knowledge and allows lessons learned to be taken to the next clinical phase – saving time and cost while increasing the overall quality of the trial, and, ultimately, the chances for successful market authorization. 

“At LINK Medical, our biostatistics team includes professionals with expertise in biostatistics, programming, and senior advisors with knowledge of regulatory requirements, giving our clients the broadest possible knowledge base,” Danielsson concluded.

Read more about how the biostatisticians at LINK Medical can support your clinical trial management! 

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