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What Are the Common Causes of Parathyroid Disease in Pediatric Patients?

Pediatric Education — Sun, 13 Apr 2025 20:32:46 -0400

Patient Presentation
A 14-year-old female came to clinic for her well-child examination. She was active in school sports, and social groups and was an average student.

The past medical history was positive for hypothyroidism due to thyroidectomy due to a suspicious large nodule that was determined to be benign after excision. The pathologists also identified 1 parathyroid gland that had been also excised. She had had transient hyperparathyroidism and hypercalcemia after surgery but this resolved within a month of surgery. She was stable on her thyroid hormone replacement and was being monitored regularly by her endocrinologist. The review of systems revealed no problems with constipation, fatigue/malaise, cold intolerance, and hair or skin changes. She denied any problems with muscle cramps, or bone or abdominal pain.

The pertinent physical exam showed a healthy female with growth parameters at the 25% and tracking. HEENT showed a well-healed surgical scar at the base of her neck without adenopathy. The rest of her examination was normal.

The diagnosis of a healthy female with appropriately treated hypothyroidism was made. The pediatrician reminded her that it was important to also remember that she not only had had her thyroid removed but that a parathyroid gland was also removed. “It hasn’t and shouldn’t cause any problems for you, but just so you know as you grow up in case it becomes important,” he remarked.

Discussion
The parathyroid glands are small, oval, anatomic structures that are about 5-6 mm in length and with a weight of 50 micrograms. They are located just posterior to the thyroid and during surgery are clinically indistinguishable from the thyroid visually; they can be located within the thyroid also. Usually there are four glands with 2 upper and 2 lower in 80% of people, but there can be fewer (14-15%) or more glands (5-6%). The glands are often ectopic (~16% found in the neck or mediastinum).

The parathyroid glands function to maintain calcium and phosphate homeostasis. Parathyroid hormone (PTH) is secreted when hypocalcemia is detected. PTH has a short half-life of 2-5 minutes. PTH acts on the bones, kidney and intestine to increase calcium. Rising calcium levels have a negative feedback loop on PTH production.

PTH stimulates osteoclast within the bone to resorb bone causing the release of calcium and phosphate. Calcitonin (from the thyroid gland) is the hormone that decreases osteoclast activity and prevents bone resorption. PTH increases renal reabsorption, mainly in the proximal convoluted tubule, but also in the loop of Henle. PTH also stimulates active Vitamin D production which acts to increase calcium reabsorption from the proximal tubules and also the intestine.

Hypercalcemia can cause arrhythmias, bone pain and osteoporosis, constipation, renal stones or nephrocalcinosis, and fatigue and depression. Some people remember the problems using the phrase: “bones (bone pain/osteopenia), groans (constipation, abdominal pain, pancreatitis), moans (fatigue and lethargy) and psychiatric overtones (depression).”

Metabolic evaluation for hypercalcemia usually includes: PTH, calcium, phosphorus, Vitamin D, magnesium, and albumin to better characterize the potential cause. Parathyroid ultrasound and scintigraphy are often used for locating the parathyroid gland prior to surgery, but other modalities are sometimes used.

Learning Point
Hyperparathyroidism
Primary hyperparathyroidism is not very common in pediatric patients compared to the adult population. In pediatric patients there is a bimodal distribution with neonatal and infantile hyperparathyroidism more commonly due to genetic abnormalities (e.g. familial hypocalciuric hypercalcemia, neonatal severe hyperparathyroidism, Williams syndrome, etc.), and subcutaneous fat necrosis, while uncommon, can follow a traumatic birth with subcutaneous pain nodules. Primary hyperparathyroid pediatric disease is seen in ages > 6 years usually due to single adenomas which are usually sporadic and not syndrome associated. Less commonly but more often in adults causes include multiple adenomas, hyperplasia and polyclonal hyperfunction. Parathyroid carcinoma is rare especially in pediatric patients. Treatment often is parathyroidectomy. Adenomas are slightly easier to identify at surgery as they are much larger than the regular sized glands.

Secondary hyperparathyroidism is due to elevated PTH as a compensatory response to hypocalcemia due to another pathological process such as renal failure or Vitamin D deficiency. This is treated by treating the underlying pathological process but parathyroid surgery can also be an option. Tertiary hyperparathyroidism is due to continued elevated PTH despite resolution of the underlying secondary hyperparathyroidism process. Usually this resolves with time, but parathyroid surgery can also be an option.

Hypoparathyroidism
The most common cause of hypoparathyroidism is iatrogenic due to parathyroid removal during surgery. This is more common in pediatric patients than adults. Pediatric patients are also more likely to have temporary hypoparathyroidism after neck surgery than adults but most do not have permanent hypoparathyroidism (0.6%). Other causes include congenital absence of the parathyroid glands, genetic causes, infiltrative or autoimmune processes. Medical management with calcium and Vitamin D is used for temporary or permanent problems.

Questions for Further Discussion
1. What causes hypercalcemia? A review can be found here
2. What are causes of thyroid nodules? A review can be found here
3. How much Vitamin D is in milk? A review can be found here

Related Cases

Parathyroid Disorders

Thyroid Diseases

Calcium

Health Maintenance and Disease Prevention

Endocrinology

Teenager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Parathyroid Disorders and Thyroid Diseases.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Jamshidi R, Egan JC. Pediatric parathyroid disease. Seminars in Pediatric Surgery. 2020;29(3):150923. doi:10.1016/j.sempedsurg.2020.150923

Khalatbari H, Cheeney SHE, Manning SC, Parisi MT. Pediatric hyperparathyroidism: review and imaging update. Pediatr Radiol. 2021;51(7):1106-1120. doi:10.1007/s00247-021-05050-7

Gorvin CM. Genetic causes of neonatal and infantile hypercalcaemia. Pediatr Nephrol. 2022;37(2):289-301. doi:10.1007/s00467-021-05082-z

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Four Ways to Highlight Your Strengths in Your Application Essays

Dr. Sundas Ali — Sat, 12 Apr 2025 11:33:21 -0400

One of the most important pieces of advice you’ll ever get regarding your personal statements and application essays is this: Show, don’t tell.

It’s a classic writing lesson, and you’ve probably heard it before, but how do you actually “show, not tell,” in your essays?

Simply “telling” is ineffective, because it usually involves boastful claims such as “I am a wonderful team leader” or “I have excellent communication skills.” These are not convincing if they’re not backed up with evidence. Empty claims are perilously bland and unpersuasive.

Instead, demonstrate your strengths through vibrant, compelling details. Here are four tips to help you do just that:

1. Tell a story that reveals your strengths.

Admissions committee readers are just like you and me: they love a good story. And at its core, a good story needs a problem – one with some emotion or tension. It needs a main character who confronts the problem, struggles with it, and finds a resolution. In application essays, you, as the applicant, are the main character coping with a challenge or problem. You reveal your strengths by showing how you figured out a solution to your challenge or problem. In doing so, you might have benefited others and set yourself on a path to further personal and professional growth.

When you tell a story that explains your initial challenge or dilemma, outlines the steps you took to resolve it, reveals your strengths, and engages your reader via colorful details, your essay will greatly enhance your chances of admission.

2. Explain the steps you took.

If you are writing about a goal you achieved or a project you completed, spell out the process you followed. This will add depth and validity to your claims. The statement “Within six months, I was promoted to Junior Account Manager” is generic and dull. Consider this rewrite: “After completing my training in record time and doubling sales in my territory, I was promoted to Junior Account Manager after only six months on the job.” There, isn’t that better? Explaining the specific measures you took to earn that promotion shows how you did it.

Similarly, if you are asked to discuss a weakness, don’t just tell the adcom what your weakness is and state that you have overcome it. Instead, show concrete examples of specific steps you’ve taken to improve. For example, let’s say the weakness you are highlighting is a tendency to procrastinate, and you have worked hard to become more efficient. Do you now plan your projects when you get them and stick to the schedule you set for yourself? Do you check your calendar at least twice daily to ensure that you don’t miss a task, call, or appointment? Show both your system for success and the results you’ve achieved, such as the fact that you haven’t pulled an all-nighter since you implemented these changes.

3. Provide examples of strengths and skills.

You say that you are creative, mature, and an excellent leader. But what have you done specifically that proves it? What impact have you had on your teammates, coworkers, company, or community? Remember, simply claiming that you’re creative isn’t convincing. Sharing a story or painting a picture (with words) that truly depicts the creative workings of your mind is. Leadership is a quality that is highly valued by most graduate schools, so make sure to provide these programs with an example of your leadership and impact.

4. Offer relevant, compelling details.

Supporting details make your success story more believable and memorable. They show your achievements at a much higher level than just telling about them would, and they help fill out the picture of who you are and what you’ve done.

Details can include the number of people on your team, the amount of money you raised, the butterflies you felt in your stomach when launching your new product, the fear you experienced when you botched a project, and your extreme remorse and resolve to do better. These specifics make your story come alive.

If you’d like additional help showing the adcom what you’re all about, our experienced consultants can support you! Discover how to create an application that will get you accepted! Schedule a free consultation with an Accepted admissions expert.

Dr. Sundas Ali has more than 15 years of experience teaching and advising students, providing career and admissions advice, reviewing applications and conducting interviews for the University of Oxford’s undergraduate and graduate programs. In addition, Dr. Ali has worked with students from a wide range of countries, including the United Kingdom, the United States, India, Pakistan, China, Japan, and the Middle East. Want Sundas to help you get Accepted? Click here to get in touch!

Related Resources

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U.S. News & World Report 2025 MBA Rankings [Full-Time & Part-Time]

Kelly Wilson — Fri, 11 Apr 2025 14:25:36 -0400

As we have come to expect with the U.S. News & World Report MBA rankings, movement is the name of the game. The Wharton School holds the top spot this year, while the Stanford GSB shifts down to tie with Northwestern Kellogg at #2. Chicago Booth also moves down one spot, to the #4 place, while MIT Sloan remains at #5 in the survey. Tying for #6 in the rankings are Harvard Business School (HBS), NYU Stern, and Dartmouth Tuck, while Columbia Business School (CBS) returns to the top ten, at #9. Rounding out the top group is the Yale SOM at #10.

U.S. News’ metrics continue to encompass career placement success (50%), quality assessment by deans/directors and corporate recruiters/company contacts (25%), and selectivity (25%). The ranking maintains its composition of career-related factors for career placement success. Subcategories of this section of the survey include salary by profession (10%), which compares salaries by industry and acknowledges that varying pay scales exist for different occupations; the employment rate at graduation (7%); the employment rate three months after graduation (13%); and the mean starting salary and bonus (20%). U.S. News collected scores for both the traditional and new versions of the GMAT for the first time this year. It used percentiles as components for the selectivity analysis, along with GRE scores, GPAs (undergraduate), and acceptance rates.

Regardless of the outcomes or the changes in methodology, applicants, students, and alumni continue to study the rankings insatiably. Interestingly, U.S. News encourages prospective students to consider factors beyond the rankings, including “location, campus culture, strength of specific programs, and cost after tuition and financial aid.” We encourage you to do the same and have created a free resource to help you do so: .

U.S. News reached out to 508 U.S. universities accredited by AACSB International for its survey, receiving 337 responses. The publication then ranked the 133 full-time, in-person, and hybrid programs that had submitted sufficient data. It’s worth noting that U.S. News largely adheres to the data reporting standards set by the Graduate Management Admission Council (GMAC) and the MBA Career Services and Employer Alliance (MBACSEA). GMAC’s GME Admissions Reporting Standards and the MBACSEA’s are publicly available.

Notable Changes This Year

Wharton claimed the top spot after tying with the Stanford GSB last year. The program boasts an overall starting salary and bonus of $200,724 this year, falling behind the Stanford GSB, Chicago Booth, and NYU Stern for the highest salary (two-year average). The school achieved a 90.4% placement rate three months after graduation, ranking among the top two placement rates. Wharton maintained a median GMAT score of 740 (old scale) and a 3.7 GPA, positioning it among a group of seven schools with the highest median GMAT scores, just behind the Stanford GSB and Northwestern Kellogg’s GPA.
The Stanford GSB slipped from #1 to share the #2 spot with Northwestern Kellogg, which was tied at #3 last year. Stanford surpasses Kellogg in salary ($206,995 versus $199,146, respectively) but lags behind in the three-month placement rate (80.6% versus 89.6%, respectively), and has the best admit rate in the rankings, well ahead of Kellogg’s (6.80% versus 28.6%, respectively). However, Stanford and Kellogg both have a median GMAT of 740 and a median GPA of 3.8.
While Chicago Booth slipped one spot to #4, MIT Sloan (#5) and HBS (#6) retained their positions from last year. However, HBS shares the #6 spot in a three-way tie with NYU Stern and Dartmouth Tuck. CBS is the only newcomer in the top ten this year, moving up from #12 to #9. Falling out of the top ten this year are UVA Darden and Berkeley Haas, which are tied at #11.
Looking at the top 25, Ohio State (Fisher) made the biggest jump from #30 to #24. Cornell Johnson and Texas McCombs held their relative spots of #15 and #16, respectively. The remaining programs generally shifted up or down one or two spots.

The ranking of part-time MBA programs remained relatively static this year. Northwestern Kellogg joins Chicago Booth and Berkeley Haas to tie for the #1 spot. NYU Stern and UCLA Anderson held their places of #4 and #5, respectively, while Michigan Ross (now #7) and Texas McCombs (now #6) swapped places this year. Entering the top ten are the University of Minnesota (Carlson) and Georgia Institute of Technology (Scheller), tied at #10.

The part-time rankings were based on survey responses from which 241 schools qualified for the 2025 ranking. According to U.S. News, “The weights of the ranking indicators used in the 2024 part-time MBA methodology were unchanged from last year’s ranking.” Ranking factors included peer assessment (50%), part-time student ratio (12.5%), part-time students total (12.5%), GMAT/GRE scores (10%), undergraduate grade point average (10%), and work experience (5%).

U.S. News 2025 Top 10 Full-Time MBA Programs

2025 Rank	2024 Rank	School	Location
1	1 (tie)	University of Pennsylvania (Wharton)	Philadelphia, PA
2 (tie)	1 (tie)	Stanford University	Stanford, CA
2 (tie)	3 (tie)	Northwestern (Kellogg)	Evanston, IL
4	3 (tie)	University of Chicago (Booth)	Chicago, IL
5	5	Massachusetts Institution of Technology (Sloan)	Cambridge, MA
6 (tie)	6	Harvard University	Allston, MA
6 (tie)	7 (tie)	New York University (Stern)	New York, NY
6 (tie)	10 (tie)	Dartmouth College (Tuck)	Hanover, NH
9	12 (tie)	Columbia University	New York, NY
10	7 (tie)	Yale University	New Haven, CT

U.S. News 2025 Top 10 Part-Time MBA Programs

2025 Rank	2024 Rank	School	Location
1 (tie)	1	University of Chicago (Booth)	Chicago, IL
1 (tie)	2	University of California, Berkeley (Haas)	Berkeley, CA
1 (tie)	3	Northwestern University (Kellogg)	Evanston, IL
4	4	New York University (Stern)	New York, NY
5	5	University of California, Los Angeles (Anderson)	Los Angeles, CA
6	7	University of Texas, Austin (McCombs)	Austin, TX
7	6	University of Michigan, Ann Arbor (Ross)	Ann Arbor, MI
8	10 (tie)	Ohio State University (Fisher)	Columbus, OH
9	8	University of Southern California (Marshall)	Los Angeles, CA
10 (tie)	9	Georgetown University (McDonough)	Washington, DC
10 (tie)	17	Georgia Institute of Technology (Scheller)	Atlanta, GA
10 (tie)	15	University of Minnesota – Twin Cities (Carlson)	Minneapolis, MN

Hoping to start business school in 2025 at one of these top-ranked programs? Sign up for a free consultation, and be sure to check out our MBA Admissions Consulting Services and work one-on-one with an expert consultant to create an application that will get you accepted!

As the former executive director of admissions at Carnegie Mellon’s Tepper School and assistant dean of admissions at Georgetown’s McDonough School and the University of Pittsburgh’s Katz School, Kelly Wilson has 23 years’ experience overseeing admissions committees and has reviewed more than 38,000 applications for the MBA and master’s programs in management of information systems, computational finance, business analytics, and product management. Want Kelly to help you get accepted? Click here to get in touch!

Related Resources

Accepted’s MBA Selectivity Index, a free tool
The Best MBA Programs: A Strategic Guide to Selecting the Right One, a free guide
Admissions Straight Talk Podcast for MBA Applicants

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How to Choose the Right Graduate School

Karin Ash — Fri, 11 Apr 2025 10:28:35 -0400

Many people who think about advancing their skills or changing their career direction via a graduate degree believe they must attend a “prestigious” graduate school – one that is ranked highly in the surveys conducted by U.S. News & World Report, Bloomberg Businessweek, and other media outlets. These candidates apply to the schools in the top ten of whichever ranking they are relying on to make their decision. Although this is certainly one way to select a school, it is rarely your best strategy.

So, how do you know whether a program you’re considering would be a good one for you? A lot depends on your career track. Are you seeking a master’s degree that offers you the opportunity to conduct your own research, perhaps leading to a PhD? Or are you looking for a program that will give you the skills necessary to advance in your current career? Your existing qualifications are also a significant factor in selecting the right program.

Let’s first discuss the research degree. Often, you can learn about program options from your undergraduate professors. And you’ll be able to identify graduate school professors with similar interests as you take classes and conduct your undergraduate research. Those professors’ names will keep appearing in your readings. Targeting the schools at which these professors teach would allow you to continue your research with instructors whose research interests align with yours. In this way, selecting the right program is easier for candidates who want a research degree than it is for applicants desiring a career outside academia.

If you are seeking a non-thesis degree to advance your career, the choices can be a bit overwhelming. As you are considering your options, here are some key factors to look into:

Curriculum – What courses attract you and why?
Length of program – Is it one year, 18 months, or two years?
Location – Studying in a location where you ultimately want to live can make it easier to network and find internships that can lead to full-time offers.
Academic reputation
Cost and available funding
Career placement – Where are graduates finding work and in what jobs? Are there appealing internship opportunities if the program is longer than one year? Are there extracurricular activities or groups that support your career goal?

From my experience working with clients from around the world for the past ten years, and with students for many more years, curriculum is critical. When the time comes to apply, you’ll need to be able to cite specific courses that you plan to take to demonstrate to the admissions committee why you are interested in the school. You’ll likewise need to name professors you want to study with and any student organizations you’d like to join. So, researching schools with this in mind will help you narrow in on options that would be a good fit with your personality, needs, and goals.

At the same time, the schools will ultimately be evaluating your qualifications, so targeting programs that seek what you have to offer as a candidate is a good approach. Research how your GPA and GRE scores compare to the average scores of each school’s accepted students, read the graduate student profiles on their website, and apply primarily to schools where you are competitive.

Completing graduate school applications takes time and thoughtful planning. Consider hiring a consultant who has worked with candidates who were accepted to your target schools. These consultants have read hundreds of applications and know how to help you present your strengths and accomplishments, motivations and goals.

With 30 years of career and admissions experience at four universities, including Cornell’s College of Engineering and Johnson Business School, Dr. Karin Ash facilitated students’ entry into the world’s best companies. As an adcom member, she also evaluated applications and therefore knows what schools and employers seek. Want Karin to help you get Accepted? Click here to get in touch!

Related Resources

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Federally Funded Medical Research: Life-Saving Heart Devices

Harvard Medical School — Thu, 10 Apr 2025 12:18:45 -0400

Harvard Medical School Federally Funded Medical Research: Life-Saving Heart Devices Millions of people worldwide benefit from devices that regulate heart rhythm and shock the heart out of lethal arrhythmias to prevent sudden cardiac death. These devices, including the pacemaker and defibrillator, were developed by Paul Zoll in the 1950s while a professor at Harvard Medical School and a cardiologist at Beth Israel Hospital (now Beth Israel Deaconess Medical Center). Zoll’s work could not have been possible without federal funding and support. Research supported by the National Institutes of Health has created many lifesaving treatments. If this funding is stopped, it will imperil scientific progress and future innovation will be lost. Today’s research creates tomorrow’s treatments.

Acing the PsyD Interview: The 3-P Plan

Alice Diamond — Thu, 10 Apr 2025 09:55:59 -0400

Congratulations! You have successfully made the cut at your target doctor of psychology (PsyD) program and have been invited to interview. You are one of the applicants being seriously considered for acceptance.

As you start preparing for your interview, ask yourself the following questions:

Which of my experiences should I mention?
How should I highlight my strengths?
What questions should I ask?
How do I manage my nervousness when so much is on the line?

None of these questions are new to me. As an admissions consultant, I regularly provide interview guidance to clients, and over the years, I have developed an action plan that has helped many PsyD applicants ace their interviews. I refer to it as the 3-P Plan: Purpose, Preparation, Performance.

Step 1: Purpose

Understanding the reasons schools interview candidates is a good place to start in your preparations. The purpose of admissions interviews for the admissions committee is to help them

learn more about an applicant’s academic, clinical, and research background;
determine whether the applicant’s disposition, personality, and communication skills are conducive to a career in professional psychology;
gauge whether the candidate would be a good fit with the PsyD program, faculty, and cohort of students;
assess the likelihood that the applicant will be successful in the PsyD program; and
match the applicant’s clinical and research interests with available faculty mentors.

The purpose of admissions interviews for you, the interviewee, is to help you

learn more about the curriculum and faculty;
assess the academic, clinical, and professional learning environment;
gauge whether the PsyD program, faculty, and cohort of students would be a good fit for you; and
determine whether the program has faculty members whose clinical and research interests match yours.

Step 2: Preparation

You obviously need to prepare for the big day. As part of that preparation, be sure to do the following:

Read the school’s website in full, including faculty profiles and curriculum listings, and any other available materials related to the university, school, and PsyD program. You must be ready to demonstrate your knowledge of the program and any of its special features during your interview. This might include interdisciplinary opportunities, concentrations, faculty research, scholarly conferences, and community outreach programs. Review the program’s mission or goals.
Review the PsyD program’s data on student admissions and outcomes on its website.
Learn about field placement requirements. This is an essential part of your doctoral studies. Do field placements start in the first or second year? When will you do your internship(s)? Many schools have a field placement guide online that you can review.
Carefully review the agenda and any materials the program sent you before the interview. If you are given the names of the individuals with whom you will be meeting, look them up online. If any are faculty members, read one or two of their publications, if possible.
Your PsyD interview might be in person or virtual, so prepare for both. The interview format could involve one-on-one meetings in addition to group sessions with fellow applicants. You might meet faculty members, admissions staff, advisors, field placement staff, and/or students.
Compile a list of questions that you believe you might be asked during your PsyD interview, and create a list of talking points for possible answers. However, do not write your answers out word for word, because you want to sound spontaneous and natural, rather than scripted and stilted. The questions you receive will likely relate to the following categories: personal background, work experience, research interests, clinical experience, diversity, social justice, and interest/fit. A list of sample questions appears at the end of this article.
Prepare questions that you will ask during your interview. Be sure to ask questions that demonstrate your knowledge of the school and program, and avoid questions that can be answered with a one-word response or a quick check of the school’s webpage.
Carefully consider what you will wear to the interview. Choose attire that emphasizes your professionalism. Be sure to wear comfortable shoes for in-person interviews that might include a campus tour. If you will be interviewing on Zoom, test the lighting and audio in advance, and ensure that your background is appropriate for an interview setting. Eliminate anything in the field of vision that is obtrusive or inappropriate in a professional setting. What appears suitable in your mirror might not come across as such on the recording. Bright prints are best avoided on video, and solid colors are usually better.
Review your statement of purpose and any other materials (e.g., research paper, article) you submitted with your application, in case your interviewer asks about them.
Practice some cognitive restructuring (positive self-talk, visualization, and modeling) as well as relaxation techniques to use before the start of your interview.
Approach this experience as a wonderful opportunity to present yourself, rather than as an obstacle, test, or challenge.

Step 3: Performance

To optimize your performance in your PsyD interview, follow these tips.

Keep in mind that the evaluation of you as a candidate includes all your interactions with program faculty, staff, current students, and fellow applicants.
Listen carefully, and take in all the information you are offered so you can learn as much as possible about the school’s curriculum, culture, and resources.
Avoid one-word answers, even if the interviewer asks a closed-ended question. Take advantage of behavioral interviewing techniques by providing specific examples or short anecdotes that exhibit your strengths and/or experiences. Prepare anecdotes to share that will demonstrate the skills you have related to the field of clinical psychology.
Effective eye contact is critical in interviewing. Make eye contact with each and every committee member and with your fellow applicants if you have a group interview. Doing so will help convey your passion, attentiveness, and willingness to engage in academic discourse. If you have a Zoom interview, practice looking into the camera, rather than at the interviewer on the screen. Take a short sample Zoom recording before your interview to make note of your eye positioning. Practice with a friend, or take advantage of Accepted’s Mock Interview Package to get feedback and suggestions for improvement.
Monitor your posture and movement. Sit up straight, and lean in ever so slightly. This will indicate that you are fully engaged and deeply interested in the interview.
Speak at a moderate rate and volume. The last thing you want is to make the interviewer uncomfortable with a “too loud” voice, “whisper soft” voice, or “rapid fire” rate of speech. Be aware of whether you tend to overtalk or undertalk. Overtalkers need to avoid rambling, and undertalkers need to expand their responses.
Share your passion for the field of study, and smile when appropriate. A warm manner and an engaging personality will make a positive impression.
Ask thought-provoking questions about the curriculum, clinical training, and research opportunities.
Speak in your own voice, from your heart. Your sincerity, honesty, and authenticity will shine through. At the same time, remember that clinical psychology is a field in which maintaining professional boundaries is important.

After Your PsyD Interview

Here’s a final, bonus “P”: Post interview. You might be done with your interview, but that doesn’t mean you’re done with the admissions process!

Write down the names of each of your interviewers, and be sure to get their contact information so you can send them follow-up thank-you notes.
Personalize each note so that it is clear that you really remember the interviewer; reference something specific from your meeting. Interviewers sometimes compare notes, so don’t write the same thing to each interviewer. Make each message personal. For example, “I really enjoyed our conversation about X.”
Do a quick assessment of your performance. Be honest, but don’t beat yourself up for any missteps you might have made. Learn from the experience.

Sample PsyD Interview Questions

Tell me about yourself.*
Why do you want to be a clinical psychologist?
Why are you interested in this program?
What are your career goals?
Describe an accomplishment that you are proud of.
What are your strengths?
Is there any area of weakness in your application that you would like to address?
Describe a time when you used your communication skills in a challenging interpersonal situation.
What personal attributes would you bring to our program?
What does social justice mean to you?
What does cultural competence mean to you?
What questions do you have for us?

* Be sure that your “Tell me about yourself” response is not too long; it is meant to be only an intro. Think of it as an opportunity to give an overview of yourself and your path thus far; do not include too much detail.

By Alice Diamond, former associate dean for career and community service at Lesley University. Alice has a BA from Colgate University, an MA from Bryn Mawr College, and an MS from Cornell University. She has extensive experience in career and admissions advising for undergraduate and graduate candidates. Alice’s clients have been accepted to top programs in a wide range of fields. Want to work with Alice? Click here to get in touch!

Related Resources

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How to Make Standout Application Videos

Michelle Stockman — Wed, 09 Apr 2025 10:30:11 -0400

Creating compelling video content that you star in yourself is an essential skill in our social media–dominated world. From Zoom meetings to TikTok, the first time people meet you these days will likely be on video. Many colleges and business schools have now added video elements to their applications. The good news is that most schools don’t expect you to submit a video that has been highly produced, so your focus just needs to be on presenting yourself authentically and giving the adcom a feel for who you are.

Here are the three main types of videos you might encounter during the application process:

Recorded video interviews on school software (e.g., KIRA): For these videos, you speak live into the camera in response to a question or prompt provided by the school. Your video submission is recorded and sent to the adcom, who will watch it later.
Recorded video submissions: For these videos, which are not live, you record your submission using your own software and then upload it to the application site when you feel it is ready.
Live video interviews: You and a school representative (e.g., a graduate, student, or adcom member) meet via Zoom or another video conferencing platform and have a live conversation that lasts 30-60 minutes.

For all of these formats, there are two main things the adcoms want to learn about you:

Can you communicate an idea concisely?
Do you have mastery of conversational English?

Tips for Your Application Videos

Regardless of the type of video you need to submit to your target school, the following tips will help you prepare to succeed.

Brainstorm in advance to identify approximately eight stories from your life that could apply to probable questions:

An accomplishment you’re proud of
A time when you worked on a team
A new skill you taught yourself
A time that you failed and what you learned about yourself
A value that you acted on
An example of your leadership style in action
An activity or subject area you’re obsessed with
How you might introduce yourself at a party

Make sure that the stories you prepare are about you. You don’t want to waste valuable video time flattering the school or talking about someone else. Keep the focus on you, your values, and stories in which you are the star.

Map out your stories so they follow a logical sequence. People like to hear about processes. Here’s an effective structure:

A clear introduction that restates the school’s question and sets the stage for you to offer a real-life example
What you learned about yourself through this activity or value
Your impact on others through this activity or value

Outline your stories as “storyboards.” An easy way to do this is by creating a table. In one column of the table, write the text of your story. In the adjacent columns, draw pictures that illustrate what you want to say. This is a trick that broadcast journalists use when preparing for a live segment. Pictures tend to stick in our minds better than text. Rather than memorizing what you want to say verbatim, use the pictures you created to jog your memory as you practice. This can help you appear more natural on camera.

Start practicing your stories two weeks before the deadline or video interview date. The more you practice, the more comfortable and natural you’ll appear on camera. For the first week, I recommend running through all of your stories twice a day. You can read from a script at this point, but do not start over if you make a mistake. Just keep going. Also, time yourself. If you take longer than a minute to get through any of your stories, trim your story back. For the second week, do a daily run-through of each story without the script, and stop and restart whenever you make a mistake.

Pay attention to what your background will be when recording your video, and make sure there are no distracting or inappropriate items behind you. Record in a well-lit room, with a light either facing you or bouncing off a wall in front of you. Close windows to keep out noise. Ask the other people in your household to remain quiet while you’re recording. Make sure your laptop is on a steady surface, and use a tripod when recording with a smartphone, rather than holding it in your hand.

Put a little sticker or piece of tape near the camera on your laptop or smartphone to remind you to look there, rather than at yourself. Leave a little space above your head on the screen, but not too much, so you appear to be speaking at eye level to the viewer.

Dress for success. In most cases, that will mean business casual. Avoid low-cut shirts, and style your hair.

Make sure to answer the question that the adcom has asked you to answer. Do not prioritize telling a story that you want to tell over providing the information the adcom has requested. From your stories you’ve prepared in advance, select the one that best fits the question.

Do not read your responses/stories. The schools want to see authenticity and how you are able to express yourself naturally. That said, in the case of live recordings, it’s a good idea to keep a pen and paper close at hand. Once you’ve received the question, think about which story you’ve practiced best fits the question. Quickly jot down three points, maximum. Then, turn the paper over and look straight at the camera so you won’t be tempted to read from the paper when the recording starts.

Pay attention to the time, and respect any limits the school has set. You need to be concise and show the school that you can deliver the necessary information in a clear and effective way.

Consider listening to podcasts such as This I Believe, This American Life, and The Moth to hear how people tell their stories in a condensed, authentic, and entertaining way – and without sounding as though they’re reading from a page.

Don’t be afraid to incorporate some humor into your responses if this comes naturally to you and reflects who you genuinely are and how you typically communicate. Use appropriate language that you would actually use in normal conversation and sprinkle in a little humor if it fits the situation.

Always do a test video to ensure that your equipment is working properly and ready to go. For Zoom, Skype, or other online platform interviews, make sure your software is fully updated in advance. For prerecorded videos that you will upload to the school’s site, do a 30-second test shoot, transfer the footage into CapCut or another editing program, and then export the clip into a format the school accepts. If you are able to do all that, you should be technically ready to record your video.

If you make a mistake when recording a live video or during a live interview, simply smile, laugh, and start again. Mistakes can be charming if you show a quick recovery.

We hope these tips will prepare you to create a standout video for your application, whether it’s a prerecorded submission, a live recording, or a video interview. However, if you have questions or would like further assistance with a video element for your target schools, a knowledgeable Accepted consultant would be happy to help.

Michelle Stockman is a professional journalist, former Columbia Business School admissions insider, and experienced admissions consultant. Want Michelle to help you get Accepted? Click here to get in touch!

Related Resources

The post How to Make Standout Application Videos appeared first on Accepted Admissions Blog.

Inside the Emory PA Program: Admissions, Curriculum, and Keys to Success [Episode 603]

Accepted — Tue, 08 Apr 2025 08:00:00 -0400

Show Summary

In this episode of Admissions Straight Talk, the Assistant Professor and Director of Admissions at the Emory University Physician Assistant Program, Allan Platt, offers an insightful look into the Emory University’s Physician Assistant Program. He breaks down the program’s distinctive curriculum, including its unique approach to anatomy, and shares valuable advice for prospective students. Allan dives into Emory’s PA program admissions process, emphasizing the importance of clinical experience, community service, and thoughtful personal narratives. He also explains the blinded Multiple Mini Interview (MMI) format and highlights common mistakes applicants should avoid.

Show Notes

Welcome to the 603rd episode of Admissions Straight Talk.

This interview is all about getting accepted to PA school, specifically to the Emory PA program. In addition to listening to today’s interview, I’d like to invite you to download Accepted’s free guide, The Ultimate Guide to Becoming a Physician Assistant. Grab your free copy for advice on selecting the best PA programs for you, writing your personal statement, interviewing effectively and simply presenting the best application you possibly can.

Today’s guest, Allan Platt, graduated with a bachelor’s in health systems engineering from the Georgia Institute of Technology with a BS in medical science from the Emory University School of Medicine Physician Assistant Program in 1979, and a Masters of Medical Science and Career Physician Assistant from Emory in 2006. From 1984 until 2004, he was the program coordinator and physician assistant at the Georgia Comprehensive Sickle Cell Center at Grady Health Systems. He has co-authored or authored several books and publications. In 2002, Allen received the Paragon Teacher of the Year Award from the AAPA, the SAAPA President’s Award in May 2007, the Dean’s Teaching Award for the Emory University School of Medicine, and the GAPA Circle of Honor Award in 2015. He’s a distinguished fellow of the AAPA since 2018. He is currently Director of Admissions at the Emory University’s Physician Assistant Program and teaches Hematology and Professional Issue Topics.

I’m really honored to have you on the podcast, Allan. That’s a lot of awards.

It’s been a good career.

I’m going to ask you my usual opening question and that is, can you give an overview of the Emory PA program focusing on its more distinctive elements?

Yes, we’re part of the original group of PA programs that started in the early 70s. Duke was number one, but the doctor who started the Duke program came from Emory. I want to set that record straight. He was an Emory undergraduate. He was an Emory medical student. He did his residency at some Harvard place. Then he came back as chief of medicine here at Emory. And then he got the idea to take medical school from four years to three, which sounds like PA. Then Duke recruited him away and that’s where he actually started the PA profession. So Duke will always be number one. But just know, yes, the founder came from Emory.

Okay, I’ll remember that.

So really we’ve been around a while, we have an integrated healthcare system that our students can learn in that is fabulous. We’ve been doing this a while, so we’re stable. We’re ARC-PA certified and even with COVID hit, we could go to Zoom in a day and all our students graduated on time. So we have a lot of horsepower to get our students to the finish line. So I think that makes Emory fairly unique.

We also have dissecting anatomy, which a lot of programs don’t. Our students get a body and they dissect it, which takes a lot of time. It’s pretty intense. We have an integrated POCUS program, which is ultrasound training, which is the next big thing in technology. And I think our program is just getting started with that. We’ve been doing it now for about four or five years. So those are the things that I think keep us unique. We’ve got a great healthcare system here in Atlanta and across the Southeast. And we don’t have much snow, we just had a little bit, so.

Well, I’m in Los Angeles. We don’t even have rain.

Could you just talk a little bit about the curriculum itself? You’ve given a great overview of the background, which is definitely distinctive. But could you talk about the curriculum a little bit?

Yeah, our curriculum starts fall semester when our students get here. They go through the dissecting anatomy, learn the whole physical exam, the whole history, medical ethics course, and then a little foundations course. And then we go through modules. We go through every body system just like specialties, just like we practice. And those go for a whole year. We talk about cardiology, pulmonary, neurology. And within those modules, they’re learning everything about the pharmacology, the physiology, the diseases, then how to prevent them, how to treat them. So we like that kind of model because it really makes sense when you learn in context. And by the end of first year, they’re pretty prepared to go out into the clinics and actually take care of patients. Even during our first year, we have our students going into hospitals and seeing real patients.

They aren’t responsible for them, but they do a history, a physical, and it’s all graded and proctored and it gets them comfortable in the hospital environment, and we give them good guidance for that. We have actors that come and will play roles as patients. That’s our sim center and our ASC suites all through their first year. So we do a lot of simulation. We like to do things where nobody gets hurt and our students feel comfortable when they get out into the clinics and actually are taking care of patients.

The clinical year is totally different. Again, it’s all rotating through all the different clinics and hospitals here in Atlanta through the Emory Healthcare System. And we have ties all over the Southeast, all over the US also, where students can rotate.

Now, when I was preparing for the call, I saw on the curriculum description something that looked very, very intriguing to me, and it was the Learning Society component. What is that?

You know, we break up our students into groups of eight to nine and pair them with two faculty, one who’s one of the teaching faculty, and then we have a community PA who’s helping us out, who’s doing 40 hours of work and, you know, taking care of patients. Faculty may be working one day a week. So it gives a good yin-yang perspective for the students. And we meet with them weekly. We have Wednesday afternoons, and we do case-based learning. We’ll just throw up a case on a whiteboard and just talk about it.

How do we try and diagnose and treat this patient in a practical way? And it’s more for mental relief. We go sit on the lawn, we go out and take walks. But it’s not in the traditional classroom. It’s more relaxed. And the faculty advisors get to really know their students. Students know their faculty. They can write recommendations for them for future jobs and whatever. So it is a great way for not having the whole class involved, but you get a personal relationship.

That sounds nice. And are these groups set up the same throughout the two years or is it…

Same groups through the whole two years. So even when they’re out on clinic land, they all come back to campus, at least at the end of the rotation. And we’ll meet up for coffee and just see how things are going.

What kind of academic background do you like to see in your students?

Well, you can have a degree in anything. We’ve had music majors, nuclear engineers, you name it. We’ve had every background. As long as you get the prereqs, you’re great. My philosophy is the best bachelor’s degree to get today is BS in nursing. And you say, what? A nurse? Yes. One, the high demand. comes out as a bachelor’s degree. You get instantly hired. You get excellent clinical training at a high pay and you can apply to nurse practitioner or PA school. So that’s the degree that I think is the best one for your money. Absolutely. But really anything else, as long as you get our prereqs and get the clinical experience, which we highly value, you’re ready for PA school.

Is there any GPA that you’d like to see? I have a bet, but besides that.

Yeah, the minimum is 3.0. If you don’t have that, your application stops. So there’s no further review. But really the average of someone who gets an interview and gets admitted is 3.6 to 3.7. So it is a factor in our scoring system. However, people with low GPAs can counterbalance that with clinical experience hours and high patient responsibility, like combat medics and RNs and ICUs. You know, they’re going to rate really high on our scale as far as the clinical experience. Most people have MA experience, which is our level one experience.

So it sounds like you have a fairly quantitative scoring system.

We try, it’s a 360 look at not only GPA, that’s one component, but also we look at leadership and being involved in community service. We are a mission to underserved populations. That’s part of the heart of our program. So we look at what did you do in volunteering? Missions speak a lot to us, like going abroad and doing healthcare. Those things rank high in points. So we score all those things, your narratives aside, did you really look at us, did people come to our open houses, did they talk to our students, so they really investigated us. That ranks high for us. I can kind of tell when somebody just reads our website, you know, and they never visit us. But we have so many opportunities for them to come see us, talk to us, and really see what we’re about, and we want people to apply to us that our mission fits with their mission.

And I noticed that you don’t require the GRE or the PA-CAT. What should an applicant do? I’m sure that’s a tremendous relief to most of your applicants, but what should an applicant do who doesn’t have a great GPA? Let’s say they did take the prerequisites. They don’t have a great GPA. They’ve been out of school for several years. What can they do to show that they can handle the academics, the curriculum?

I think mainly if they just take the prerequisites and show us that they’re doing well in that because the anatomy, physiology, those are the courses that they’re going to be hit with in PA school. So seeing that they can do that is that’s a good tell.

They would retake. Take a few of those if they haven’t taken them.

Exactly. And their clinical experience, like I say, would trump GPA. So knowing they’ve been in years taking care of patients at a high level, that really helps their score. So we have athletic trainers and combat medics, like I say, and paramedics who’ve been in the job five, six years, who may not have had a stellar, you know, 3.2, 3.1. But I would say the clinical hours and what they did would help their whole score and raise them up to levels where we want.

Okay, great, great advice. Does the Emory PA program value shadowing?

Shadowing’s okay. I recommend people do it because then they meet PAs and nurse practitioners, doctors, talk to them all and decide this is the path for them. But we don’t count those hours at all. We count hands-on clinical care of patient hours. So I know some schools only require shadowing, but we require really taking care of patients. Because that’s what we found the most valuable.

Shadowing, again, it’s valuable to make sure you know you’re getting, you’re picking the right profession. You’ve got to get it behind the doors. And it’s hard to get behind the doors and just shadow. Because with HIPAA rules, you just can’t walk in and say, hey, I want to shadow a PA Really, you have to get a job or volunteer at a hospital or clinic and get the badge, the name badge, wear the appropriate vest and then you can go behind the doors and really see what goes on and talk to the different professions.

Right, I sometimes say that shadowing is a good place to start your explanation of a healthcare field. It’s a terrible place to end it.

Yes.

Now you mentioned community service a minute ago. What role does non-clinical community service play in the admissions process? And I wonder if you could distinguish this. There’s serving in a soup kitchen or a homeless shelter or something like that, but there also might be tutoring underprivileged kids. There might be, I don’t know, translating for lower income individuals or people who don’t speak English, period. Is that valued the same or are there differences?

No, we value all of that. All those hours count for us. We look at what did you do? So the description of what you did in service, because I’ll see that, okay, you served an underserved population here doing what you did. And that ranks five higher points. So we do add multipliers to the hours. It gives you bonus points. If you work with underserved people and you’re, again, doing healthcare things, we like that, but you can be doing other things, not healthcare related, and are you working out of your comfort zone?

We like to see people who will step out and maybe do work at a homeless shelter or just step out of their comfort zone. So those are kind of the things we look for and we’ll actually add bonus points to the hours that you accumulate. So all hours count. And most of our students have over 700-800 hours of community service. That’s a lot, but that’s what we do in our program; it has a farm worker project and a good Samaritan clinic. We give back to the community as students.

Beautiful. That’s great. Now the MRPA website lays out pretty clearly the minimum amount of clinical experience. I think it was 2000 hours. That’s a year of work. You’re a full-time worker.

Can you provide suggestions on effectively portraying that experience in the CASPA or in the supplemental application?

Yeah, you really want to put a description of what did you do in your job. Because I’ll give you an example. One job is like a clinical research coordinator. Well, for research, we don’t count bench research. For us, that’s not patient care. But some clinical coordinators do all the vital signs, EKGs, talk to patients, educate them. And see, that is clinical care, that’s working with the patient. So as long as your description is there, we can read it and say, yes, that is at an MA level or clinic assistant level. And we do count that. That’s important. So if there’s ever any question, we have people just send us an email, say, hey, does this count? And we’ll let you know. Most things do count. Even dental assisting, yes, dentist the mouth is medical. So that works. We even count scribing.

A lot of people don’t know about scribing. It’s probably an easy job for college students to get because they’ll train you in medical technology. You know how to work on iPa

What Questionnaires Can Help Diagnose Fibromyalgia?

Pediatric Education — Sun, 06 Apr 2025 20:01:06 -0400

Patient Presentation
A 15-year-old female came to clinic for her health supervision visit. She had recently moved to the area and was known to have fibromyalgia. She said she had already seen a local rheumatologist, psychologist and physical therapist and was happy with her care as was her mother.

The past medical history showed she had been diagnosed at age 13 after about 15 months of extremity pain, fatigue, academic/concentration problems and depressed mood. The family history was positive for hypermobility, general musculoskeletal problems, migraine, gastrointestinal issues and juvenile rheumatoid arthritis.

The pertinent physical exam showed a smiling female with normal vital signs. Her growth was 50% for weight and length. Her examination was normal except for pain in her lower extremities and wrists. There was no specific warmth or edema, and there was full range of motion and strength.

The diagnosis of of a healthy teenager with fibromyalgia was made. “I usually try hard not to complain but thought as I was meeting you, you should know where I hurt. It’s not bad today. It gets bad if I don’t exercise. If I do that then things go better. Sometimes it is too much and I have to stay home from school but that doesn’t happen a lot. I like playing softball and swimming so I do those. The girls on my old teams were super supportive. I hope the girls are here too,” she commented. “I hope they are too. If you are having more problems please let me know and then I’ll see what I can do to help,” the pediatrician offered.

Discussion
Juvenile fibromyalgia syndrome (JFM) is a “…noninflammatory condition and typically presents as a primary chronic pain disorder, but can also present as a secondary pain syndrome in patients who have an underlying autoimmune condition such as juvenile rheumatoid arthritis or systemic lupus erythematosus….it is characterized as a centralized or nociplastic (ie, altered nociception in the absense of tissue damage or lesion) pain condition.” Basically, it is a chronic, diffuse, musculoskeletal pain that is non-inflammatory and out of proportion to the stimuli. It is a clinical diagnosis and can be quite challenging as the symptoms are non-specific, can change overtime, and overlap with other diagnoses.
Patients are more often female (84%), have a family history of chronic pain (possible genetic component), and symptoms may be preceding by an environmental trigger such as illness, injury or stressful event. Prevalence is unknown for JFM but in adults it is about 2.5%. Age range is as low as 5 years, but average age when diagnosed is 15 &pm; 2 years for JFM. It can be difficult to diagnose JFM so the patients take longer to diagnose (average symptoms of > 1 year).

The etiology is unclear. It is hypothesized that the neuroregulation of pain is disrupted for one or many reasons including genetic variation. While externally this is a non-inflammatory condition, there could be neuroinflammation.

Pain is the promient symptom, but other cardinal symptoms include fatigue, sleep disturbance and cognition problems. Many other symptoms have also been reported by patients. JFM impacts patients’ lives and overall prognosis is that many patients have a chronic course but only a small proportion have worsening symptoms.

Other conditions to consider instead of JFM include inflammatory conditions (juvenile idiopathic arthritis), thyroid disease, inflammatory bowel disease, hypermobility, unrecognized fracture or soft tissue problem, Raynaud’s disease, myopathies and others.

Treatment is multidisciplinary. Education to better understand the condition (for example: it is real pain, movement will not make it worse), physical therapy to increase movement, flexibility and strength, and cognitive behavioral therapy to assist with coping and skill building often provide a great deal of relief. A variety of other treatments have been used including psychiatric medications to assist with anxiety/depression that patients may also have.

Learning Point
JRM is a clinical diagnosis therefore a patient should have widespread pain for a period of time (some use > 3 months), with normal lab testing and an alternative diagnosis not being appropriate. A 2016 study of adolescent female patients using the 2010 American College of Rheumatology (ACR) Adult Fibromyalgia Criteria found very high sensitivity (89.4%) and specificity (87.5%) for diagnosing JFM. “…[T]he positive predictive value was 87.5%, and the negative predictive value 89.4%. Positive and negative likelihood ratios were 7/14 and 0.12, respectively.” While there have been updated guidelines since this time, there has not been a study specifically for adolescents using these criteria.

The questionnaires below are relatively quick to use and could be helpful gathering data to help in diagnosing a patient. They can be found here.

The ACR criteria uses the Widespread Pain Index questionnaire which asks about having any pain in the last week in any of 19 body areas. One point is given for each body area affected. The criteria also use the Symptom Severity Score questionnaire which has two parts. The first part asks about how much of a problem the three cardinal symptoms of JFM of fatigue, waking still feeling tired and concentration or memory problems the patient has experienced in the past week on a 0-3 scale (0 = no problem, 3 = severe, score range = 0-9). The second part asks about having any of 40 different symptoms that the patient may have had in the past 3 months. Examples include diarrhea, rash, blurred vision, thinking problem, oral ulcers, etc. This is scored as 0 = no symptoms to 3 = a great deal of symptoms. Fibromyalgia is diagnosed if widespread pain index is ≥ 7 and symptom score is ≤ 5, OR widespread pain index = 3-6 and symptom score ≥ 9.

Tender point examination has also been used as an evaluation method and can be good. However it can be difficult to consistently perform the examination and specific pressure needs to be applied, making it easy to be inconsistent with this examination. In the study above, the authors note that tender point examination does not need to be completed to make the diagnosis. They do note that patients with JFM had more tender points than controls though (average of 11 vs 2-3, total tender points available = 18).

Questions for Further Discussion
1. What is chronic fatigue syndrome?
2. What other chronic pain syndromes have you encountered in your practice?
3. What is the criteria for diagnosing juvenile rheumatoid arthritis?

Related Cases

Physical Medicine and Rehabilitation / Physical Therapy

Teenager

To Learn More
To view pediatric review articles on these topics from the past year check PubMed – Fibromyalgia,
and PubMed – Chronic Fatigue Syndrome.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Fibromyalgia and Chronic Pain.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Ting TV, Barnett K, Lynch-Jordan A, Whitacre C, Henrickson M, Kashikar-Zuck S. 2010 American College of Rheumatology Adult Fibromyalgia Criteria for Use in an Adolescent Female Population with Juvenile Fibromyalgia. J Pediatr. 2016;169:181-7.e1. doi:10.1016/j.jpeds.2015.10.011

Weiss JE, Kashikar-Zuck S. Juvenile Fibromyalgia. Rheum Dis Clin North Am. 2021;47(4):725-736. doi:10.1016/j.rdc.2021.07.002

Coles ML, Weissmann R, Uziel Y. Juvenile primary Fibromyalgia Syndrome: epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis. Pediatr Rheumatol Online J. 2021;19(1):22. doi:10.1186/s12969-021-00493-6

Coles ML, Uziel Y. Juvenile primary fibromyalgia syndrome: A Review- Treatment and Prognosis. Pediatr Rheumatol Online J. 2021;19(1):74. doi:10.1186/s12969-021-00529-x

Author
Donna M. D’Alessandro, MD
Professor of Pediat

Ten Tips for Short-Listing and Visiting B-Schools

Michelle Stockman — Sat, 05 Apr 2025 08:00:00 -0400

You’re about to make one of the biggest decisions of your life. It will shape your future in many ways, including where you might work, where you could live, and the people who will become a part of your journey. Choosing the right business school is a major decision that will influence your career and personal growth. But it’s also a huge opportunity to turn your vision into reality.

Here are ten tips to help you short-list your program choices through research and school visits to find the best fit.

1. Define your business school goals.

Consider where you want your MBA journey to lead. Do you want to pivot into finance or consulting? Jump straight into entrepreneurship? Become a product manager at a tech company? Many schools, including Harvard, Stanford, and Wharton, publish annual reports on their students’ recruitment and student-led start-ups.

Consult your network and start asking some key questions. What skills are recruiters in these industries looking for? What gaps do I need to fill to scale my business idea? Who would be the ideal mentor as I take over my family’s business?

Then, review schools’ curricula to find matching academic programs, leadership development resources, career assistance, and networking opportunities. You might feel overwhelmed at first, and that’s okay. The goal is to familiarize yourself with your options.

2. Be real about where you thrive.

Do you want to compete against top-tier peers in a dynamic, urban environment? If so, consider schools such as Harvard, Columbia, Wharton, Chicago Booth, London Business School (LBS), and IESE.

Want to be immersed in the start-up ecosystem and innovative culture of Silicon Valley? In that case, Stanford GSB and Berkeley Haas could be ideal. Prefer a supportive, tight-knit campus community? Look into Duke Fuqua, Dartmouth Tuck, Cornell Johnson, UVA Darden, Yale SOM, and HEC.

Think about where you have friends or family, because they can help you settle in. If you’re an international applicant, consider schools near major airport hubs for easier travel home. An MBA is a major investment, so you want to make sure you’ll be comfortable and supported wherever you choose to study.

3. Compare your stats.

Your GMAT, GRE, or EA scores and GPA should ideally be at or above the average for students at your target school. However, a strong application can still stand out, even if your test scores and GPA are slightly below the average. Exceptional work experience, leadership, and unique personal qualities can compensate for lower numbers.

4. Ask yourself whether you need an internship.

If you don’t need a summer internship to change career paths, a one-year or accelerated MBA might be the best option. This is often ideal for applicants coming from family businesses, entrepreneurs, company-sponsored candidates, and experienced professionals who can effectively network on their own.

Check out top U.S. and international one-year MBAs such as IBEAR, LBS, MIT Sloan Fellows, and Stanford MSx.

5. Consider a STEM program if you’re international.

STEM-designated MBA programs allow international students to work in the United States for up to three years after graduation without requiring employer sponsorship. This can be a significant advantage for career planning.

6. Network with the community.

Once you’ve narrowed your list to eight to ten schools, start networking. Demonstrating your understanding of your target school’s culture and network can strengthen your application.

Meet with students, alumni, and faculty for insights. Attend online events, webinars, and MBA fairs. Schools track digital engagement, which signals genuine interest.

Campus visits are also valuable. Schedule a tour of the school, meet with student ambassadors, and attend on-campus events. These experiences will provide firsthand insights into whether the school is the right fit for you.

Push yourself to strike up conversations with people hanging out in common areas or riding transportation to campus. These chance meetings can give you valuable information that can help you decide whether attending the program is a good investment in your future.

7. Come prepared with questions for admissions officers.

Before visiting campus or participating in a virtual event, prepare thoughtful questions. Admissions officers are often busy handling inquiries from many prospective students, so be strategic. Raise your hand early in Q&A sessions to ensure that your question is heard.

If possible, thank the session leader afterward and exchange contact information for future follow-ups.

8. Polish your image and elevator pitch.

First impressions matter. Dress in business casual attire for campus visits and networking events. Practice your elevator pitch – a one-minute self-introduction covering where you’re from, what you do, and what you hope to achieve with an MBA. A well-rehearsed pitch makes a strong impression. Keep it concise and engaging, and show genuine curiosity by asking insightful questions.

9. Be respectful of others’ time.

Avoid showing up unannounced at the admissions office. Schedule any meetings in advance. Similarly, don’t frequently message students or alumni asking for application advice unless they are long-term contacts. You want to leave the people you meet with a positive impression, not a memory of persistent requests.

10. Follow up with a thank you.

After you meet with someone, send them a short thank-you email or handwritten note expressing your appreciation and continued interest in the MBA program. Schools take note of these interactions, which reinforce your genuine enthusiasm.

Finalizing Your List

Narrow your list of target programs down to four to six schools that offer a mix of selectivity:

Reach: Where your scores and GPA are below the school’s average
On Par: Where your scores and GPA match the school’s average
Safety: Where your scores and GPA are above the school’s average

Finally, reflect on your recruitment research, networking experiences, and campus visits. Where did you make the strongest connections? Where did you feel the best fit? These factors – combined with your academic and career goals – will help determine the best business school for you.

Michelle Stockman is a professional journalist, former Columbia Business School admissions insider, and experienced MBA admissions consultant. Want Michelle to help you get Accepted? Click here to get in touch!

Related Resources

The post Ten Tips for Short-Listing and Visiting B-Schools appeared first on Accepted Admissions Blog.

Rejected by Harvard Business School – Now What?

Christie St-John — Fri, 04 Apr 2025 10:04:09 -0400

January 29, 2025, was either an exciting day or a tearful one for Harvard Business School (HBS) Round 2 (R2) applicants: the school’s MBA admissions board notified candidates as to whether they were invited to interview or had merited “early release.” As euphemistic as it sounds, meriting early release should really be viewed by R2 applicants as a kind of blessing. They now know that they and about 30,000 others are out of the running for the HBS program and are free to consider other options. So if you were among HBS’s early release candidates this year, dab your eyes with a tissue, patch up the wall you punched, and take a look at what some of those other options are.

Options for U.S. Citizens and Permanent Residents

If you are a U.S. citizen or permanent resident, you can still consider applying in Round 3 (R3) at a few top programs, especially if you have a unique background or profile that these schools might be seeking to round out the diversity in their classes. MIT Sloan’s R3 deadline is April 7, and the Stanford GSB’s is April 8. Some great programs have a fourth round, including Carnegie Mellon Tepper on May 5, Texas McCombs on May 15, and UNC’s Kenan-Flagler on April 29. Vanderbilt Owen even has a Round 5 deadline on May 15.

Did you steer growth in Africa, lead a new product in Eastern Europe, or pioneer a revolutionary health program in Mongolia? These are the kinds of unique experiences and insights that many top MBA programs would love to have represented in their student body. While visa challenges tend to discourage R3 and R4 applicants who need an F-1 Visa to study in the United States, if you have U.S. residency, you might be a prime candidate for one of these later rounds.

Moreover, if you are living in the United States, you might find one of the many top MBA programs with part-time options to be a great alternative if there are weak points in your profile. Students in Berkeley Haas’s full-time program have a median GMAT of 730 (Class of 2026), but those in its part-time program have a median GMAT of only 700 (with 80% of students falling within the 610-750 range). The average GMAT score for students in Northwestern Kellogg’s full-time program is 733 (Class of 2026), while the average GMAT for Evening and Weekend MBA program students is 694. Kellogg waives test requirements for applicants with an undergraduate GPA of 3.4 or higher in a business, economics, or STEM field, and for candidates who graduated from a Northwestern undergraduate program. Chicago Booth’s full-time students have a 729 average GMAT (Class of 2026), but the average for students in its part-time program is only 692. If you believe your GMAT score held you back at HBS, you might consider part-time programs, which offer the opportunity to graduate with the same degree without making another attempt – or several! – to improve your GMAT scores.

If you have more than eight years of work experience, you could consider applying to an EMBA program; most of those have rolling admissions every month. However, for this option, you must be actively employed and able to present a letter to the program from your employer stating that appropriate allowances will be made for you to attend the program as needed. Non-U.S. candidates are not eligible for EMBA programs unless they are working in the United States. You cannot get a student visa for a part-time program.

Options for Non-U.S. Citizens

If you are an international student, you are not a good R3 candidate for U.S. fall-entry MBA programs because of possible visa issues. However, there are alternatives that might put you in a business school classroom in the coming year. First, if your heart is set on building your career in the United States, then there are some program options to consider here. For example, if your goals are in finance, you might consider a Master of Financial Engineering degree from Berkeley-Haas (the R3 deadline is June 5) or an MS in finance from Georgetown (the R5 deadline is May 2, and R6’s is June 20). Columbia offers a Master of Applied Analytics whose final deadline is June 1.

Options Available Outside the United States

MBA aspirants who wish to pursue international careers might consider top MBA programs in Europe and Canada. Cambridge Judge has one remaining deadline for this year: May 6. And IESE has an R4 deadline of May 6. Similarly, opportunities are still available to apply for INSEAD’s August intake, for which the R2 deadline is April 22, R3’s is June 17, and R4’s is August 5.

Opportunities to Address Your Weaknesses

Finally, if your heart is still set on HBS and its full-time U.S. program peers, early release offers you time to assess your application profile and address any weaknesses over the next seven months. Many applicants find Accepted’s rejection review the perfect starting point in identifying the parts of their application and profile that would benefit from improvement.

Have you made a noticeable impact beyond the norm in your professional role? Have you demonstrated deep community engagement? Is your GMAT/GRE score meeting (or ideally, exceeding) your target program’s average score? If not, this is a great time to take action and patch those holes.

If you would like a free profile review to identify weaknesses in your profile or shortcomings in your previous applications, register for a free consultation.

Dr. Christie St-John has more than 25 years of higher ed and admissions experience, including ten years in admissions at Dartmouth Tuck. She was formerly the director of MBA recruiting and admissions, director of international relations, and an adjunct faculty member at Vanderbilt University. Having also served on the board of directors of the MBA Career Services & Employer Alliance and the Consortium for Graduate Studies in Management, Christie has a deep knowledge of MBA and other graduate admissions. Want Christie to help you get Accepted? Click here to get in touch!

Related Resources

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Graduate School Options for STEM Candidates

Karin Ash — Thu, 03 Apr 2025 10:34:53 -0400

Would you like to strengthen or update your technology skills? Perhaps move into management? Maybe even start your own business? Or shift your career out of the technology space?

If you answered yes to any of these questions, this might be the perfect time for you to apply to graduate school. According to research from the , jobs in the computer and information technology fields are expected to grow much faster than the average rate for all occupations between 2023 and 2033, with as many as 356,700 openings expected annually. Companies are seeking software engineers, product designers, machine learning and artificial intelligence (AI) experts, data scientists, product managers, and sales managers. There is ever-increasing demand for AI skills as organizations integrate AI into their business practices.

You might be committed to a career in technology but would like to lead project teams and therefore need to develop your skills in leadership, negotiation, and communication. Or maybe you’re thinking about starting your own venture and would benefit from courses in entrepreneurship, finance, and marketing. There are many good options in graduate education – from an MS or MEng in engineering, computer science, or AI, to a master’s in engineering management, a combination program of a STEM field/MBA, or a PhD.

If you are seeking a research degree – an MS or PhD – you’ll need to demonstrate that you have research experience, either as an undergraduate student or at your workplace. Gaining acceptance to a research program requires that you have an excellent academic record and have published research, or at least have experience with the research process. You’ll want to secure letters of recommendation from your former professors or someone from your work who has a PhD and has supervised your research. Your recommenders need to be able to vouch for your research skills and the probability of your success in a graduate research program. You will also want to clearly state what your research focus will be and your career goal upon graduation.

To select a school and program, start by identifying your end goal. How do you want to make a difference? What work will bring you the greatest satisfaction? You should choose a program (theoretical or applied) based on which one offers a curriculum that will provide you with the skills you need to achieve your end goal. You must also decide whether you want to commit one or two years to pursuing your degree as a full-time student, or whether you prefer to keep working – in which case, you should enroll in an online, part-time program instead. Other factors to consider are the program’s required qualifications, location, and cost, as well as where its graduates are employed and the extent of the career services available to support you in your job search.

For the past nine years, I have worked with STEM clients who have been accepted to highly ranked programs in many engineering fields, data science, computer science, AI, environmental science, and statistics. Applying to graduate school is a complex process. Consider hiring a consultant to help you evaluate your options, develop a plan, think strategically about your statement of purpose, edit your essays, and rework your resume for an academic setting. Ultimately, earning a graduate degree will offer you new and challenging career opportunities.

Related Resources

The post <strong>Graduate School Options for STEM Candidates</strong> appeared first on Accepted Admissions Blog.

Can You Use the Same Essays for Different Schools?

Kelly Wilson — Wed, 02 Apr 2025 11:59:24 -0400

As admissions consultants, we often hear college and graduate school applicants ask, “I’m applying to multiple schools, and each one requires essays/personal statements. Can I use the same essay for different schools?” Understandably, applicants want to maintain the quality of their essays and avoid burnout when having to write so many drafts. We can sympathize. Even better, though, we have some practical solutions for determining when and how to use an essay for more than one school. The good news is that what makes practical sense in terms of efficiency also makes sense in terms of quality – if you view the process as “adapting” rather than “reusing.” Reusing an essay more or less verbatim is very rarely advisable. On the other hand, the core content of some application essays – personal statements, in particular – includes information that is central to your candidacy and would naturally be relevant to share with multiple schools. And sometimes when you rework an essay/personal statement for additional applications, its quality improves as you reflect further and discover new subtleties.

So, if multiple schools ask similar questions, it’s logical to consider adapting some or perhaps even a significant portion of an essay you wrote for one program to fit another program’s prompt. One thing to keep in mind is that required essay lengths tend to differ from school to school, and your messaging will likely vary according to the nuances of each question. Most importantly, many application essays/personal statements demand some discussion of the specific program the candidate is applying to, so this content would certainly need to be revised for each school.

When considering revising an existing essay for a different school, start by reading the new question out loud to make sure you clearly hear and understand exactly what the school is asking. Many times, an essay prompt will have more than one question within it, and you don’t want to overlook any of them and not deliver the information the admissions committee has requested. I also suggest highlighting key words in each school’s essay prompts and checking against them later in the review process to ensure that your essay touches on all the main points. Be guided first by the question and then, more broadly, by your understanding of the character of the school/program – and adapt your essay content accordingly.

Here are some additional tips to keep in mind when attempting to adapt an essay for one school into a submission for a different school:

1. Create a list of the essays you need to submit and the qualities you wish to highlight in each one.

When juggling multiple essays/personal statements, consider using a spreadsheet to track each question, the school asking it, and which experiences, accomplishments, and skills you can associate with each question. This will help you see where you might be able to adapt one school’s essay for a different application.

2. If you do any name-dropping, always be sure to double-check the names!

Always check very carefully (and then check again) to make sure you have the correct school and resource names in your revised essay. You don’t want, for example, to refer to the University of Michigan in an essay you’re planning to submit to the University of Chicago. Sending an essay that discusses why you want to go to UPenn to the Yale adcom won’t be good for your chances of being admitted! And believe me, it happens.

3. Never simply cut and paste an entire essay, even if two schools have very similar questions.

As I noted earlier, some schools ask similar essay questions, but no two questions will ever be exactly alike. Whenever you are writing, adapting, or editing an essay/personal statement, keep the school you are writing for front and center in your mind. Tailor each essay as much as you can to discuss and apply to each program’s unique culture, personality, and “flavor.” And when you feel you are nearly done, reread the essay prompts and go back to those highlighted words to ensure that you have truly answered every question the adcom posed.

Do you need help writing (or adapting) your application essays? Could you benefit from an expert’s assistance in identifying the strongest elements of your experience and profile? Schedule a free consultation with an Accepted admissions expert.

Related Resources

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Soma Weiss Student Research Day

Harvard Medical School — Mon, 31 Mar 2025 10:19:55 -0400

Harvard Medical School Soma Weiss Student Research Day Medical students at HMS are learning to conduct research that will improve the health of patients, and save lives through clinical interventions in diagnostics, therapies, and health care delivery. More than 60 of them presented their projects at the 85th annual Soma Weiss Student Research Day.

What Physical Examination Sign Can Be The Most Helpful for Assessing Brachial Plexus Birth Injury?

Pediatric Education — Sun, 30 Mar 2025 20:58:27 -0400

Patient Presentation
A term female was born by Cesaarean section to a G1P1 female after prolonged labor, failure to progress and a difficult extraction. The Apgar scores were 8 and 9, but the infant was noticed to not be moving her right arm very well.

The pertinent physical exam showed respirations of ~30/minute, and a heart rate ~150 beats/minute. Her weight was 3.890 kg (75%),with a head circumference of 32 cm (10%) and length of 54 cm (90%). She was pink and had caput and molding of her head making the head circumference and length probably not entirely accurate. Her eyes were normal with reactive pupils. She was holding her head turned to the left and her arm at her side with an extended elbow and pronation of the forearm. She would move her fingers and wrist spontaneously. There were no spontaneous movements of her elbow or shoulder. She did not like being handled in general and especially with examination of her head or arm. The rest of her examination was normal.

The diagnosis of a brachial plexus injury or possible fracture was made. The radiologic evaluation had normal radiographs of the right upper extremity and the chest without any obvious fracture. The infant was swaddled and she fed vigorously. She cried much less once these were done. Orthopaedic consultation at about 4 hours of age already showed her improving with spontaneous movement of her arm including abduction at the shoulder and flexion of the elbow. The biceps flexion increased when activated. She now would also hold her head in midline and cried less with examination of her head. By 24 hours of age, she was holding her arm in a normal elbow hyperflexed position and was moving her shoulder more. She still would become fussy with some handling of that area but was easily consoled. Her examination continued to improve and by followup with her pediatrician at 1 week of age, she had a normal examination and was not overly fussy with examination. There were no concerns from the parents nor the orthopaedic surgeon at her followup appointment at 1 month of age.

Discussion
Brachial plexus birth palsy (BRBP) is a flaccid paralysis due to injury of one or more brachial plexus roots during the delivery process. It is more common in infants who have shoulder dystocia (strongest risk factor), fetal macrosomia (especially > 4500 grams), prolonged labor, labor induction or mechanical assistance and maternal gestational diabetes. Up to 15 to 20% (or higher in some studies) do not have an identifiable risk factor. BRBP has an incidence of about 0.9/1000 live births. It occurs more on the right side than left but bilateral BRBP can occur.

The brachial plexus is a combination of ventral nerve roots mainly from C5 to T1 (although with anatomic variation other adjacent nerve roots can also be involved, and different combinations can also occur). They combine into trunks that branch anteriorly and posteriorly and provide motor and sensory function to the upper extremity. C5 and C6 mainly innervate the shoulder and elbow flexion and extension. C7 is its own trunk and is involved with elbow extension. C8 and T1 innervate mainly the hand.

Most cases (~60%) involve C5-C6 known as Erb palsy or Waiter’s tip, where patients have “…the shoulder internally rotated, elbow extended, and wrist flexed and pronated.” When C7 is also involved with C5-C6 then this is called Erb palsy extension and occurs in 20-30% of patients. These have more shoulder and finger involvement. Klumpke palsy involves C8-T1 and fortunately occurs only in about 1% of patients as patients have more severe problems affecting the hand and wrist. Horner syndrome can also occur with C8-T1 palsies. The Horner syndrome classic triad is ipsilateral ptosis, miosis and anhidrosis of the eye. About 15-20% have total plexus palsies involving C5-T1.

There are three types of injuries. Neuropraxia occurs with a stretching or compression injury resulting in focal demyelination but there is no disruption of the axon. Axonotmesis happens when the axons are severed but the epineurium remains contiguous. Neurotmesis injuries have the entire nerve disrupted and therefore, the problem is more severe and spontaneous recovery is very unlikely.

Learning Point
Observation of the infant is important as it provides a great deal of information: how much does the patient move the arm, what parts of the arm are moved and what is the position of the head all can provide good information. An infant with a C5-C6 injury usually has a characteristic position with “…the shoulder in abduction and internal rotation, elbow in extension contrasting with the usual physiologic hyperflexion at this age, forearm in pronation and wrist in extension…. the grasping reflex is present and finger function is preserved.” Note that the phrenic nerve can be involved with C5-C6 injuries so respiratory status also needs to be assessed. Fortunately, most patients have transitory problems with 65-90% having recovery. Studies report 65% complete recovery, 20-30% with some functional problems and 10-15% with considerable functional problems. On physical examination the biceps functionality is one of the most important to assess. Patients who regain biceps function usually have a higher lesion and also less severe lesion, therefore it is used as a marker for many treatment decisions, and can be easily reassessed.

The speed of resolution is one of the most helpful prognostic factors also. The earlier the patient recovers some or all function, the better the outcome. The most common situation is a patient who has total resolution within the first month. Treatment is usually monitoring early on with possible physical therapy to decrease risk of muscle imbalances and potential stiffness, subluxation or other similar problems especially in the shoulder joint. Orthoses and other treatments are also sometimes used. Most patients recover at least some function by 2-3 months of age. Timing of surgical interventions depends on the actual problem and severity with potential surgery occurring as early as 3 months but potentially at older ages. Note that in the initial hours to days, the patient may have pain with movement/handling and therefore some immobilization such as swaddling and/other pain control may be needed for comfort.

Questions for Further Discussion
1. What problems are associated with fetal macrosomia?
2. What are indications for an instrumented delivery or Cesarean section?
3. How are neonatal clavicle and humerus fractures treated?

Related Cases

Arm Injuries and Disorders

Peripheral Nerve Disorders

Upper Extremity Trauma

Neonatology

Obstetrics / Gynecology

Orthopaedic Surgery and Sports Medicine

Newborn

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Brachial Plexus Injuries and Peripheral Nerve Disorders.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Duff SV, DeMatteo C. Clinical assessment of the infant and child following perinatal brachial plexus injury. J Hand Ther. 2015;28(2):126-133; quiz 134. doi:10.1016/j.jht.2015.01.001

Abid A. Brachial plexus birth palsy: Management during the first year of life. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S125-132. doi:10.1016/j.otsr.2015.05.008

Lin JS, Samora JB. Brachial Plexus Birth Injuries. Orthop Clin North Am. 2022;53(2):167-177. doi:10.1016/j.ocl.2021.11.003

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, Unive

The Basics of Postbac Programs: What You Need to Know

Mary Mahoney — Sat, 29 Mar 2025 09:00:00 -0400

You know you want to become a doctor, but you also realize that you’re not quite ready for medical school. Whether that’s because your academic profile isn’t as competitive as it needs to be; your GPA or MCAT score needs attention; you’re low on clinical, volunteer, or research hours; or you’re a career changer (in need of more time to study basic sciences, offset low grades, or update them since graduating), a postbac could be just right for you.

A postbac can be an ideal way to regroup, focus, or demonstrate commitment to your goal of becoming a doctor. Postbacs are legitimate ways to improve your candidacy for your future in medicine.

Any student who would like to can benefit from completing a postbac master’s program or earning a postbac certificate.

Let’s jump right in and determine whether a pursuing a postbac is the right path for you, which type of program would be a good fit, and what steps you need to take to get started.

Eight Postbac Benefits

Completing a postbac program or coursework can help you with all of the following:

1. Fulfilling your premed prerequisite requirements

Some students take additional coursework to complete the required prerequisite courses to apply to medical school. If you’re a career changer, there are postbac programs that offer classes and services specifically for you.

2. Improving your GPA (cumulative and science)

Some students take additional science courses to improve their academic record.

3. Boosting your MCAT score

If you have a low MCAT score, simply retaking the MCAT – after completing a prep course – might be the best approach for you, unless you need assistance in other areas as well. Many postbac programs include MCAT prep as part of their curriculum.

4. Generating more activities

If you need to participate in more health-oriented clubs, shadowing, clinic(al) volunteering, community service, or research to strengthen your application, consider pursuing a program that offers what you need. Most formal postbac programs offer a variety of opportunities and activities, including research.

If you choose to pursue postbac courses individually (non-matriculating, supplemental, and/or repeating classes at a local or online college) rather than attending a formal program, arrange supplemental activities and opportunities early so you can maximize the number of hours you can complete in your gap year while taking courses.

5. Securing impressive letters of recommendation

The additional coursework you complete (with stellar grades) will provide opportunities for you to request letters of recommendation from your new science professors.

6. Strengthening your team-building skills

Including your postbac program or coursework on your med school application boosts your candidacy, because it indicates that you thrive on teams in a classroom setting. Taking lab classes or completing research will show the admissions committee that teamwork is a strength of yours, that research and collaboration are areas of depth brought about by steady academic progress (note that you need to have achieved competitive grades and a strong MCAT score). Ideally, “team building” research experience results in publication. Many postbac students achieve publication by the end of their program.

7. Building your confidence

Taking additional classes and excelling in them will boost your confidence. If you find yourself struggling, ask for help. Enlist the help of tutors and study groups. Balance your schedule, including making time to unwind and exercise.

8. Continuing to grow and mature

By taking additional time to prepare for medical school, you will gain more life experience and therefore approach your professional education with greater maturity and more clearly defined goals.

Additionally, most postbac programs’ application requirements mirror those of the AMCAS and AACOMAS applications. Therefore, writing a postbac application is good practice for what’s ahead and can reduce the anxiety that tends to accompany completing the medical school application.

The Types of Postbac Programs Available

There are multiple types of premedical postbaccalaureate programs. They are all designed to assist students with matriculating in medical school, but they provide varying levels of support and target different parts of the application.

Single-Focus Programs

This type of program allows students to concentrate exclusively on improving their academic record or taking premed requirements. This option is great for students who already have an extensive record of long-term service in multiple areas but who simply need to demonstrate that they are ready for the rigorous curriculum of medical school.

Dual-Focus Programs

While taking coursework, students in dual-focus programs are encouraged to participate in research, clinical, or volunteer work. This combination allows students to strengthen their academic record as well as their activities section. Students often take coursework only part-time in these programs, which frequently provide outstanding opportunities in community outreach or research.

Multifocus Programs

This type of program provides the most comprehensive level of support – often in multiple areas. Depending on your needs, this might significantly increase your success in the medical school application process. The programs might help with general advising, class selection, study skills, academic achievement, MCAT preparation, and activity opportunities, as well as the application process.

Linkage Programs

Some postbac programs have linkage agreements with their own or other medical schools. This means that if a postbac student meets the criteria for linkage (usually a GPA of 3.6 or above and a minimum MCAT score), they are automatically guaranteed an interview or a seat in the following year’s M1 class without needing to submit a medical school application.

Getting Accepted to a Postbac Program

The following tips can help you formulate an effective strategy for applying to postbac programs.

1. Do your research on each program’s requirements.

Before applying to a program, check its website to confirm that you fulfill all of its basic requirements. You don’t want to spend hours on an application, only to find out that you are not eligible for the program because of a technicality.

2. Attend informational workshops.

At these events, faculty or staff members give presentations about their program, often providing inside information that is not available on the program’s website. Sometimes, students will host a panel to answer any questions prospective applicants at the workshop might have. In addition to being a valuable source of information, these events are an opportunity to network.

3. Request letters of recommendation early.

The most common reason that students’ applications are not given serious consideration is that they are missing letters of recommendation. Recommenders often need significant time to write and submit their letters, so you want to be sure that you give them plenty time to . Request your letters early. It can also be helpful to explain your reasoning for taking a postbac route to medical school and to provide some basic information about what you accomplished while working with your recommender to refresh their memory and make writing their letter easier.

4. Use all the space available.

Check the word or character limits on all essays and use the maximum amount of space allowed. Using only half the allotted word limit for your essay(s) could make you look lazy, inattentive, or both (read our next post in this series for more advice on writing your postbac application essays).

You can also schedule a free consultation to learn more about working with an admissions expert to create a postbac application that gets you accepted.

Securing Strong Letters of Recommendation

Your letters of recommendation (LORs) can make a strong impact on the admissions committee, potentially making or breaking your review. Given their importance, you might feel concerned that you do not have much control over them. However, how you request your LORs, and from whom, can ensure that you will get the best letters to support your application’s success.

1. Request your LORs as early as possible.

Approach your potential recommenders as early as you can to request letters from them. Most professors are not easily accessible during the summer months or toward the end of each semester or quarter. The earlier in the term you can secure your letters, the better.

2. Choose your letter writers strategically.

Request letters only from professors in whose classes you earned A grades and/or from mentors with whom you established a strong rapport. Make a thorough list, and think carefully about who knows you very well and is therefore in the best position to write about you knowledgeably. If you have only a couple of names on your list, start going to office hours and networking to find a suitable mentor. Reach out sincerely to favorite professors if it has been a while since you’ve worked together.

3. Request your letters in person, if at all possible.

It is always best to request LORs face-to-face. Doing so will demonstrate the respect you have for the person and how much this opportunity means to you. When you request the letter, look the person in the eyes. Based on the person’s response, you can then provide them with the materials they need.

4. Prepare a letter packet.

Prepare a packet for each LOR writer that includes a copy of your personal statement, a copy of your resume or CV, and any other information they might need to write you a strong recommendation. If your recommender is not familiar with or confident about writing a letter for a medical school applicant, feel free to share this resource with them: How to Write a Letter of Recommendation for Medical School: Nine Tips for Recommenders.

Be sure to always send a thank-you note/email to your recommenders after they submit their LORs, and thank them again after you’ve been accepted to medical school.

Next Steps

You’ve decided that a postbac is a wise move for you. Now it’s time to create an application that will get you accepted. Schedule a free consultation and collaborate one-on-one with an expert advisor who will work with you to create your winning postbac application.

Dr. Mary Mahoney, PhD, is the medical humanities director at Elmira College and has more than 25 years of experience as an advisor and essay reviewer for med school applicants. She is a tenured English professor with an MFA in creative writing from Sarah Lawrence College and a PhD in literature and writing from the University of Houston. For the past 25 years, Mary has served as a grad school advisor and essay reviewer for med school applicants. Want Mary to help you get Accepted? Click here to get in touch!

Related Resources

Five Fatal Flaws to Avoid in Your Grad School Statement of Purpose, a free guide
Applying to Medical School with a Low Science GPA
How to Apply Successfully to Med School from Postbac Programs, podcast Episode 526

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It’s A Match 2025

Cydney Foote — Fri, 28 Mar 2025 08:00:00 -0400

On one eagerly anticipated day each March, after years of study and hours of applications and interviews, thousands of medical school students and graduates discover where they will begin their specialty training. This Match Day – March 21, 2025 – 47,208 applicants got their answer.

The National Resident Matching Program (NRMP), which oversees the matching process to pair eligible applicants with available residency training positions, reported that this was the largest Match in the program’s 73-year history, with 52,498 registered applicants (a 4.1% increase in applicants over 2024). Participating specialties offered 43,237 PGY-1 and PGY-2 training positions (a 4.2% increase from last year), and 40,764 of these were filled by from the pool of 47,208 “active” applicants (those who submitted a rank-order list) on Match Day.

Accepted would like to congratulate the successful participants who will now take the next step in their training. We also have noted a number of interesting results that could be important for current or future medical students who hope for successful matches in the years to come.

Closing Gap Between DOs and MDs

Osteopathic medical students (DO Seniors) had their most successful year ever, with a match rate of 92.6%, despite having more active applicants in the Match than ever before. This group significantly increased their presence in several specialties including Child Neurology (4.9% increase), Medicine-Pediatrics (2.9% increase), and Orthopedic Surgery (1.3% increase). Meanwhile, allopathic medical students (MD Seniors) maintained last year’s match rate of 93.5%.

When you consider that just a decade ago, DO Seniors matched at 77.7% versus 94.4% of MD Seniors (2014 Match), this is a remarkable achievement in leveling the playing field between these two medical educational approaches. With the gap between allopathic and osteopathic training continuing to close, any lingering stigma against osteopathic training is clearly out of date.

International Medical Graduatess Lag Behind

While fewer US citizen international medical graduates (US-IMGs) participated in the 2025 Match, their overall match rate increased slightly to 67.8%. In contrast, a huge increase (14.4% over 2024) in non-US citizen IMGs pushed their match rate down slightly to 58%. Most went into Internal Medicine, Pediatrics, and Family Medicine.

Primary Care Remains a Popular Choice

Primary care fields matched strong overall, with a 93.5% overall fill rate. Internal Medicine, Internal Medicine-Pediatrics, and Pediatrics all increased their match rates over last year, even while adding significant numbers of new positions – 877 overall. However, Family Medicine only filled 85% of its 5,357 positions, which the NRMP attributes to the addition of 144 new positions in the Match.

Emergency Medicine Recovers After Covid

Also of note is that Emergency Medicine, which had record numbers of unfilled spots immediately following the Covid pandemic, continued to rebound. This year’s 97.9% match rate isn’t quite the 100% fill rate it achieved in the 2022 Match, but it’s far better than any year since.

OB/GYN Continues to Appeal to Applicants

Despite fears that the current political climate might depress the training of future OB/GYNs, Obstetrics and Gynecology proved to be another popular specialty in the 2025 Match. With 1,604 positions offered, only one categorical position and nine preliminary PG1 positions remained unfilled.

NRMP President and CEO Donna L. Lamb, DHSc, MBA, BSN, praised the applicants in this year’s match: “This year’s Main Residency Match marks a milestone of continued success for the graduate medical education community as a record number of applicants and residency training programs matched.”

Accepted would also like to extend a hearty congratulations to everyone who matched, and we wish you continued good fortune in your future training. For more information about this year’s Match, please visit the NRMP website.

If you are planning to apply to the match next year, and would like guidance and assistance with your application and essays, schedule a free consultation today!

Since 2001, Cydney Foote has advised hundreds of successful applicants for medical and dental education, residency and fellowship training, and other health-related degrees. Admissions consulting combines her many years of creating marketing content with five years on fellowship and research selection committees at the University of Washington School of Medicine. She’s also shared her strategy for impressing interviewers in a popular webinar and written three books and numerous articles on the admissions process.

Related Resources

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Writing an Engaging Essay Introduction

Kara Keenan Sweeney — Wed, 26 Mar 2025 09:32:59 -0400

In today’s world, where everything moves at lightning speed, we’re constantly making fast decisions.

This applies to admissions committees, too. The pressure of their job forces them to make very quick decisions about whose applications they will invest more time in and whose will merit only an obligatory but cursory review before being set aside.

Their reality is one of managing an overwhelming volume of applications with limited time for review, so when you’re applying to business school, medical school, graduate school, or college, you must capture your reader’s attention with the very first lines of your essay. Your opening sentence cannot fall flat. It needs to pull your reader immediately into your narrative. Every word counts.

Engaging Your Readers Right From the Start

Think of your essay’s first line as the opening of a great novel. You want your reader to think, “I need to know more!” Let’s take a look at some good examples:

Horns blare as tiny auto rickshaws and bicycle-powered school buses weave through the crowded streets of Old Delhi.
After a near disaster on my first week as a case manager at a community center for women and children, I realized that to succeed, I’d have to suppress my anger at how poorly things were being run.
My aunt’s cancer had spread throughout her body before anyone had diagnosed it properly – too late for treatment. That moment changed everything for me, making my interest in science personal.
From the age of seven, while struggling with math but excelling in spelling tests and writing stories, I knew I was meant to be a writer.

Notice a trend? Three out of these four openers are personal stories. There’s no mention of GPAs or scientific breakthroughs. The first example is so vibrant and full of action that we instantly want to know who’s experiencing this scene. In each case, the reader’s curiosity is piqued, and that’s what you want.

A strong opener will include three key elements:

A glimpse of your theme or story – who you are, what you’re passionate about, and the path you’re on
Creative details or descriptions – something that paints a picture and grabs attention
Energetic writing – language that makes the reader feel like they can’t stop until they’ve read the entire essay

Your opening should show a connection between where you’ve been and where you’re heading. Here are a few more examples:

It was pitch black when we quietly climbed into the back of a truck, beginning our journey to freedom.
Only six months after launching my start-up, I realized the money wasn’t flowing in – just out the window.
Finding a green, scratched 1960s Cadillac in a junkyard last summer made me realize that mechanical engineering was my calling.

These lines pull you in. You can’t help but want to know the rest of the story. When done right, these kinds of personal anecdotes don’t just offer facts – they paint a picture, making your story more real and engaging.

Having read these examples, you might now have some ideas for your own essay introduction. Start by jotting down some key moments in your life that helped shape your career or academic goals. Maybe it was a job experience, a family event, or a “light bulb” moment that made you realize what you wanted to do.

For example, an electrical engineering applicant might remember the first time their home lost power and realize that that was the moment they discovered their career path. A future MBA student might recall a pivotal time when they helped a struggling person understand financial basics, which sparked their interest in nonprofit work. A law school applicant might recount witnessing a courtroom scene during an internship that inspired them to specialize in criminal law.

Once you’ve created a list of these defining moments, dig deeper. What stood out about each one? How did it make you feel? What sensory details can you include (what did you see, hear, or smell)? These tiny details will help you build a narrative that draws your reader in.

Still struggling to find that perfect hook? Our team of experts is here to help! We can guide you through crafting an essay that stands out, from brainstorming a compelling opening line to polishing the final draft. You’ve got a great story to tell. Let’s make sure the admissions committee doesn’t miss it.

Kara Keenan Sweeney has more than 15 years of experience in MBA admissions, having worked for some of the world’s top business school programs, including Columbia Business School, INSEAD, and The Lauder Institute’s joint degree MA/MBA program with The Wharton School and the MA/JD program with Penn Law at the University of Pennsylvania. Kara has guided, coached, and counseled thousands of MBA and EMBA applicants, reviewed innumerable applications, sat on admissions committees, and interviewed countless applicants, including while running Wharton’s Team Based Discussions both virtually and in person. Want Kara to help you get Accepted? Click here to get in touch!

Related Resources

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Is a BS/MD Program Right for You?

Mary Mahoney — Tue, 25 Mar 2025 09:42:37 -0400

Do you have a very clear picture of where you want to go with your career? Is medical school calling your name? If this is the case, then a combined BS/MD degree program might be for you! In this post, we explore the pros and cons of such programs and provide tips to help you determine whether to pursue the BS/MD pathway.

Most students who apply to college don’t have any idea what their long-term goals are and plan on using their undergraduate careers as a springboard for thinking about their futures. Some students, however, have a very clear picture of where they are going. Becoming a doctor, for a few, is a goal that’s evolved and solidified over the course of many years, maybe even from their earliest memories. As high schoolers, these students likely focus on the sciences and work toward accumulating as much exposure to the medical field as possible. Some might refer to their desire to become a doctor as a calling. Highly competitive BS/MD programs were created for these students. If you know (or are pretty sure, at least) that you want to enter the medical field, and you’re a motivated, hard-working, goal-oriented high school student who has earned high marks in your coursework and on relevant achievement tests (e.g., SAT, ACT), then a combined BS/MD program might be perfect for you.

Choosing a Major

“I’m going to be pre-med,” is what many students aspiring to a career in medicine say when asked about their anticipated major. However, there are multiple pathways to a major for students with medical school aspirations. At many colleges, pre-med is not a major; it is a series of courses that students must take to sit for the MCAT (Medical College Admission Test) and apply to medical school. Many of these classes dovetail with university requirements for a biology-related major, but you don’t need to major in science to apply to medical school. Generally, according to the AAMC (Association of American Medical Colleges), the MCAT requires introductory biology, general chemistry, organic chemistry, physics, and first-semester psychology, sociology, and biochemistry. Research methods and statistics concepts are often prerequisites to science classes and labs, as are introductory psychology and sociology courses.

As long as you have the prerequisites for the MCAT, you can pursue any major you wish. In fact, some medical schools encourage applicants with majors outside of biology or chemistry. Consider the value of a major such as English, anthropology, or sociology, for instance, and what that brings to the table about understanding health, illness, health disparities, and social determinants of health. Be honest with yourself about where you stand with multidisciplinary perspectives toward healthcare, because healthcare is multidisciplinary. Are you interested in biomechanical engineering? Health policy? Sports medicine? Human nutrition? Economics? It’s all good, as long as you can talk about the connections meaningfully, and you have strong grades in the med school/MCAT prerequisites.

If you are considering a pre-med path in college, your opportunities to explore medicine and healthcare start in high school. Spend time shadowing a physician. Gain bench research experience, if possible. Spend part of a summer with a nonprofit mission focusing on bringing healthcare access to those who do not have it. Volunteer in a hospital, clinic, or shelter. Participate in a community-based, educational outreach program – anything that makes sense. Meanwhile, enroll in demanding high school science courses. Participate in health-related volunteer work. These activities will further enhance your profile and help you understand and articulate your desire to become a physician.

Advantages and Disadvantages of BS/MD Programs

If you are committed to the idea of pursuing a medical career, a combined BS/MD program might seem to offer the best of both worlds – an abbreviated amount of time as an undergraduate while having a guaranteed seat in medical school without having to apply. With one BS/MD or BS/DO application, you can assure yourself a future medical career and eliminate uncertainty and stress during your undergraduate years. And not having to complete the full medical school application process, which is daunting and time-consuming, can potentially save you thousands of dollars. With so many benefits, it’s easy to see why these combined programs are so highly sought after. Admission to many of these hybrid programs is more competitive than for even the most selective colleges. These programs do not obligate you to attend medical school, but with such competitive applicant pools, universities do not want to waste resources on students who are not committed to a career in medicine. If you have top-notch high school credentials, including a high GPA and test scores, a track record of challenging curriculum, and demonstrated interest in medicine (through volunteer service, research, and clinical shadowing), one of these programs might be a good fit for you.

For other applicants, following the traditional route of pursuing a bachelor’s degree and then completing their pre-medical requirements before applying to medical school makes more sense than attending a combined BS/MD program. Consider this: The additional few years of undergraduate education and life perspective can truly help you determine which educational environment is best for you. Is there an area of the country that you prefer? Are you interested in serving a specific population? Some medical schools emphasize family practice, while others focus more on scientific research, academic careers, or medical innovation (e.g., technology). If you choose to pursue a combined program, be certain that you are doing so with your goals in mind while assessing the undergraduate experience they offer.

Gaining Admission to BS/MD Programs

Early planning is essential to being accepted to BS/MD programs, which vary in their admission requirements. Here are three tips that can improve your chances of being successful with your application.

Consider your math and science curriculum.

Outstanding grades are a must, as is a commitment to maintaining them in college. Many BS/MD programs will look carefully at your entire transcript, paying extra attention to your math and science preparation

Plan for standardized testing.

Test requirements vary by school. Find out what the programs you’re considering targeting require. If you need time to prepare for the SAT or ACT, allow for it, and research your test prep options.

Your exposure to the healthcare field is paramount in confirming your commitment to the field of medicine. Volunteer experience and physician shadowing are two ways of gaining experience in a healthcare setting. Scientific research will give you the tools you’ll need as a medical student to understand changes in the field of medicine. While many science fair projects will guide you through the scientific method, a more complex, longer-term project under the mentorship of a local college professor will offer more exposure to the type of scientific study you’ll do in medical school.

If you’re applying to medical school this season, the year ahead could change your life forever. Get started right, and stay on top of things, and you’ll be able to make sure the year is both enjoyable and momentous.

Dr. Mary Mahoney, PhD, is the medical humanities director at Elmira College and has more than 20 years of experience as an advisor and essay reviewer for med school applicants. She is a tenured English professor with an MFA in creative writing from Sarah Lawrence College and a PhD in literature and writing from the University of Houston. For the past 20 years, Mary has served as a grad school advisor and essay reviewer for med school applicants. Want Mary to help you get Accepted? Click here to get in touch!

Related Resources

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Match Day 2025

Harvard Medical School — Mon, 24 Mar 2025 14:40:11 -0400

Harvard Medical School Match Day 2025 Congratulations to HMS graduating students on your residency matches! At this year's Match Day celebration, 164 HMS students learned where they would spend the next chapter in their journey, dedicated to improving the lives of patients. 78 students placed at an HMS-affiliated training, internship, or residency program, while the rest placed in programs across the country.

Which MBA Option Is Best for You: Full-Time, Part-Time, EMBA, or Online?

Natalie Grinblatt — Mon, 24 Mar 2025 10:02:35 -0400

At its core, the MBA is a business administration graduate program for professionals seeking knowledge, skills, a credential, and a network to help them advance in their career and maximize their professional performance. Although many people automatically think of a two-year, full-time program when they hear the term “MBA,” in recent years, program options have multiplied in response to students’ and organizations’ changing needs and interests.

In this post, we offer a roundup of available MBA program options and their benefits and drawbacks.

Full-Time MBA Programs

In the United States, full-time MBA programs are two-year programs in which students complete an internship over the summer between their first and second years. These programs target business (and sometimes other) professionals who have roughly three to eight years of work experience. They are ideal for 25- to 30-year-old career changers who can afford the opportunity cost of leaving their jobs to immerse themselves in education and experience. Most students’ primary focus is obtaining a new position after graduating, and recruiting by potential employers is a significant benefit of attending a full-time MBA program.

A business school’s reputation often relies on the brand value of its full-time MBA program. Full-time programs consume the majority of a school’s budget and rarely generate revenue. MBA programs dedicate more than 90% of their scholarships, fellowships, and other resources, such as career services, to full-time students.

Full-Time Program Pros

Students have close and sustained interaction with other full-time students, which is ideal for career changers, internship opportunities, recruiting, company presentations, fellowships, and scholarships.
Programs tend to feel like undergraduate programs, with comparable clubs and social activities.

Full-Time Program Cons

Attending a full-time program comes with significant opportunity cost, including time away from industries that are undergoing rapid change.
Families often get the short end of the stick, though schools typically have resources to support students’ spouses/significant others.

An alternative to the traditional two-year program would be a one-year or one-year plus accelerated program in the United States, such as those offered by Kellogg, Emory, and Columbia (J-Term), or a European MBA program.

Part-Time MBA Programs

Part-time programs are ideal for people who don’t want to leave their company or industry for a significant period of time or who can’t afford to stop working. Such programs target individuals who are employed full-time. These students’ sustained professional efforts shape classroom discussions and projects. Part-time MBA students tend to be a little older than full-time MBA students. While these programs traditionally serve local students, they increasingly offer varied structures and online components to attract distance students. They do not generally provide as much access to recruiters. Often, admission is less competitive than for the same school’s full-time program, which allows part-time students to obtain a “brand” they might not qualify for otherwise.

Part-time MBA programs take very few resources but often share the same faculty as a school’s full-time program. Generally, the part-time applicant pool is less competitive or diverse because schools typically receive fewer applications and are limited to their immediate region and to the industries that dominate that region. Furthermore, part-time programs can serve at least as many – and often more – students than their full-time counterparts.

As much as schools say that the quality of their full-time and part-time students is the same, that quality truly depends on the school’s location and how that location generates applications. Schools in larger cities have an easier time attracting great applicants to their part-time programs. They can maintain higher-quality standards, but full-time programs evaluate applications from around the globe, so choosing candidates for admission is easier.

Part-Time Program Pros

Students can continue to work/earn and can apply their learnings in real time.
Companies often fully or partially sponsor part-time students, lessening their financial burden.

Part-Time Program Cons

Completing the program takes longer, internships are not offered, and many schools don’t offer access to recruiting. Working and studying simultaneously can be grueling.
Most part-time programs do not offer scholarships or fellowships to part-timers.
Part-timers typically have less access to comprehensive career services than students in full-time programs, because companies usually hold their presentations and interviews during the day.

Executive MBA programs

Executive MBA programs (EMBAs) are part-time programs targeting seasoned managers and entrepreneurs – typically, people in their mid-30s to late 40s (depending on the program) whose rise to senior level is imminent or who are already in senior management. These programs vary in terms of desired/required length of experience. Although the coursework covers the same topics as traditional MBA programs, it’s developed and presented with a higher-level perspective. A great benefit of EMBA programs is the chance to network and form relationships with peers from various industries. Students are at a career phase when a fresh perspective is valuable but sometimes difficult to obtain. These programs don’t target career changers but are increasingly used by and open to them, even though most EMBA programs don’t offer formal recruiting.

EMBA programs are also lucrative, because the schools charge a premium for their EMBA programs, which are typically smaller than their full-time programs. EMBA courses are commonly offered every other weekend, and the programs tend to be less generous with financial aid than their full-time counterparts.

EMBA Program Pros

Students can immediately apply what they learn at work, gaining breadth of exposure at a pivotal professional moment, a valuable credential.
Students tend to bond well with their cohorts and faculty members.

EMBA Program Cons

Managing school plus a demanding career and personal/family responsibilities can be challenging.
Usually, no formal recruiting is available for career changers.
Students rarely interact with either part-time or full-time students.

Online MBA Programs

Online and hybrid MBA programs have surged in popularity in an ever-evolving education landscape, particularly for individuals aged 32-37, offering flexibility and accessibility that traditional MBA programs cannot match. While there are many ways a school can deliver an online MBA experience, I focus here on the two major categories: synchronous and asynchronous.

Synchronous online MBA programs closely mimic the traditional classroom setting, in which students and instructors interact in real time. Classes are scheduled at specific times, requiring attendees to log in simultaneously for live lectures, discussions, and group work.

Synchronous Program Pros

Students enjoy real-time interaction with faculty and classmates.
The program follows a structured schedule.
Networking opportunities are available.

Synchronous Program Cons

Students have less flexibility.
Differences in time zones can introduce constraints.
Accessibility can be limited for students with other commitments (e.g., work, caregiving).

Asynchronous online MBA programs allow students to access course materials, lectures, and assignments on their own schedule – and sometimes advance through them at their own pace – without the need for live participation.

Asynchronous Program Pros

Students have a great deal of flexibility in accessing and completing courses.
Accessibility is more equal for all students, regardless of time zone, irregular schedule, or other commitments.
Sometimes programs are even self-paced.

Asynchronous Program Cons

Interaction among students is lacking.
A higher level of self-discipline is required.
Feedback and responses to questions can be delayed, which can disrupt the pace of a student’s studies.

Specialized Graduate Management Programs

These programs offer MBAs that focus on a specific industry or function. They vary in both format and approach. Boston University’s full-time Social Impact MBA is an example of a two-year specialized MBA, and the Executive MBA in Healthcare at the University of California, Irvine, is an example of a specialized EMBA. The Cornell Tech MBA is an example of a one-year specialized MBA.

Specialized Program Pros

Students can focus intensely on a specific area of interest, with coursework adapted accordingly and a network of colleagues with related experience and goals.

Specialized Program Cons

Students could miss out on the diverse perspectives of others from different industries/sectors that can refresh and invigorate one’s thinking.

Although most schools don’t allow you to apply to multiple types of MBA programs within the same admissions cycle (Stanford GSB is one exception), you can apply to different programs in separate cycles. Moreover, if you fall between a traditional MBA and an EMBA in terms of age or experience, you might apply to traditional MBA programs that skew older, EMBA programs that admit younger candidates, and/or online programs. Similarly, you should consider applying to full-time MBA programs while also keeping a nearby part-time program in mind as a backup. By strategically diversifying your applications, you can maximize your chances of finding the right fit for your experience, goals, and lifestyle.

By Natalie Grinblatt, a former admissions dean/director at three top business schools. Natalie has reviewed more than 70,000 applications, interviewed more than 2,500 candidates, and trained nearly 700 admissions directors and alumni volunteers to select outstanding candidates for admission. Her clients gain admission to top programs, including those at Harvard, Stanford, Wharton, MIT, Cornell, Columbia, Berkeley, Chicago, Northwestern, and NYU. Natalie holds an MBA from Michigan Ross. Want Natalie to help you get Accepted? Click here to get in touch!

Related Resources

EMBA: The Ultimate Guide for Applicants
Business School Selectivity Index, a free tool
Admissions Straight Talk Podcast for MBA Applicants

The post Which MBA Option Is Best for You: Full-Time, Part-Time, EMBA, or Online? appeared first on Accepted Admissions Blog.

How Do You Diagnose a Premenstrual Disorder?

Pediatric Education — Sun, 23 Mar 2025 20:22:43 -0400

Patient Presentation
A 15-year-old female came to clinic for her sports physical examination. She was overall well and had no complaints. During her menstrual history she stated that she had some increased fatigue starting at ~1 day before her period, and pain during the first 24-36 hours. She denied cramping, hypermenorrhagia, mood changes or breast tenderness. She had consistent cycles of about 30-31 days that she kept track of. The past medical history showed menarche at age 11.5 years.

The pertinent physical exam showed normal growth parameters around the 50-75% and normal vital signs. Her examination was normal and she was Tanner V for breast and public hair.

The diagnosis of a healthy female with menstrual symptoms was made. With further questioning she said that she felt that the pain was manageable with no treatment or with some over-the-counter ibuprofen. The pediatrician recommended that if the pain increased she could try to start using the ibuprofen ahead of her period for its anti-inflammatory properties and not just its pain-relieving properties. She also reviewed general healthy life-style changes. “Some people find eating a little more carbohydrate just before and first couple of days their periods also helps,” she offered. The teenager laughed, “I thought I was being crazy because sometimes I get the munchies and just want to eat bread and pasta for those couple of days. Now I know that is normal.

Discussion
Menstruation is a normal function of human females. It begins generally between 9 – 16 years of age. There are three levels of menstrual problems:

Menstrual symptoms (MS)
- Symptoms: acne, abdominal bloating, breast tenderness, food crazing, fatigue, irritability, depression, mood swings, heavy menstrual bleeding, dysmenorrhea, dissatisfaction with appearance, feeling stressed and other mood changes. Up to 200 symptoms have been ascribed as MS.
- Prevalence – overall 80-90% of women have some symptoms
Premenstrual syndrome (PMS)
- Symptoms: same as MS but has impaired functioning
- Prevalence – 15 – 40%
Premenstrual dysphoric disorder (PMDD)
- Symptoms: same as MS but has severe functional impairment especially psychosocial
- Prevalence – 1.2 – 8.0%

Premenstrual disorders ((PMDs) includes PMS and PMDD) symptoms occur during the luteal phase (i.e. from ovulation until menses or ~ Day 13-14 until Day 0), subsides with menses, and women are symptom free during the follicular phase (from menses until ovulation or ~ Day 0 – Day 13-14). The cause is not fully understood, but felt to be due to some individuals being more sensitive to the hormonal fluctuations, not necessarily a steady state of the same hormone. Abnormal serotonin activity which through different mechanisms decreases serotonin could be another reason. Gamma aminobutyric acid (GABA) activity regulates progesterone and also anxiety, and may be lower during the luteal phase thereby causing MS.

For these reasons, treatment is often targets menstrual regulation or suppression, and neurotransmitter regulation. Examples are contraceptive hormones, gonadotropin agonists, and selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. Other symptomatic treatment is often used such as nonsteroidal anti-inflammatory medications for dysmenorrhea. Spironolactone is used to treat bloating/fluid retention, and breast tenderness and it also can improve patient’s mood. Other non-pharmacological treatments include increased or timed carbohydrate consumption and exercise. Vitamins and herbals have varying quality of evidence to support their use. Benefits have been shown for cognitive behavioral therapy and acupuncture. Regular sleep, decreasing caffeine, smoking and other drugs are also good lifestyle interventions.

Obviously MS have a significant impact on women. In a study of over 42,000 women aged 15-45, dysmenorrhea was the most common symptom (85%), psychological problems (77%) and fatigue (71%). Approximately 40% were unable to perform at least some normal tasks and > 50% did not tell their family the reason for the task omission or transferring the responsibility for the task.

Learning Point
The diagnosis of PMDs is harder as this is a clinical diagnosis. While it may seem obvious, the key to diagnosing PMDs is that they occur in menstruating women (not premenarchal, preovulatory, nor menopausal), and occur during the luteal phase only. Therefore there should be a symptom free period during each menstrual cycle. Generally this symptom-free time is at least 1 week and usually more like 2 weeks. In adults, PMDs diagnoses are “required” to be made prospectively after 2 menstrual cycles. Some people use this for adolescents as well but adolescents have anovulatory cycles which may make the 2 cycle requirement difficult for someone with a very irregular cycle. For PMDs diagnoses, symptoms must be present (but not all symptoms present as there are up to 200 have be ascribed to PMDs) nor does a specific combination of symptoms must be present. For adolescents, ovulatory cycles often begin at the same time as the normal mid-adolescence psychosocial conflict with parents also occurs. The moody teenager could be moody but could also have a PMD.

Note that some people have some of the problems listed below making PMDs diagnosis more difficult.
The differential diagnosis, especially if there is no symptom-free period, includes:

Anemia
Autoimmune disorders
- Diabetes mellitus
- Hypothyroidism
Collagen vascular disease
Seizure disorders
Endometriosis
Anxiety and depression disorders
- Generalized anxiety
- Major depression
- Bipolar disorder
- Panic disorder
Eating disorders
Substance use

Questions for Further Discussion
1. What advice do you generally offer for teenagers with mild menstrual symptoms?
2. What criteria do you use to refer to adolescent medicine or gynecology for a possible PMD?
3. How do you treat dysmenorrhea?

Related Cases

Menstruation

Premenstrual Syndrome

Fatigue

Health Maintenance and Disease Prevention

Pain

Adolescent Medicine

Obstetrics / Gynecology

Teenager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Premenstrual Syndrome and Period Pain.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Akgul S, Kanbur N. Premenstrual disorder and the adolescent: clinical case report, literature review, and diagnostic and therapeutic challenges. International Journal of Adolescent Medicine and Health. 2015;27(4):363-368. doi:10.1515/ijamh-2014-0051

Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019;220(6):569.e1-569.e7. doi:10.1016/j.ajog.2019.02.048

Itriyeva K. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Probl Pediatr Adolesc Health Care. 2022;52(5):101187. doi:10.1016/j.cppeds.2022.101187

Liu X, Li R, Wang S, Zhang J. Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019. Hum Reprod. 2024;39(6):1303-1315. doi:10.1093/humrep/deae081

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Five Tips to Get You Off a Law School’s Waitlist

Daniel Waldman — Thu, 20 Mar 2025 11:33:49 -0400

It’s the time of year for acceptances – and waitlists. But getting waitlisted is a positive thing, right? All things considered, it is. It shows that the admissions committee recognizes the strengths in your application. Unfortunately, though, getting waitlisted can be mentally more difficult than being rejected, because you find yourself in limbo. What can you expect without a firm “yes” or “no” status? And what should you do in the meantime to maximize your chances of ultimately being accepted? It’s never a sure thing, but here, we offer five tips to improve your chances of getting off the waitlist with an offer in hand.

1. Take stock of your weaknesses.

Think about what you believe the flaws in your candidacy are before you take any further steps. You need to be honest with yourself, but don’t start imagining weaknesses where they don’t exist. As difficult as it is to hear, the admissions process sometimes comes down to numbers, and there aren’t as many spots available as there are qualified applicants. With any shortcoming you identify, ask yourself what you have done to mitigate it and then share this information with the school – but make sure to focus on your takeaways and improvements, not your flaws, when drafting your letter of continued interest (see tip #2).

2. Submit a letter of continued interest.

Every communication you have with the school at this point should highlight an update or recent achievement that is not mentioned in your application, and you should reiterate your interest in the school. You don’t want to flood the admissions office with calls or essays, but a well-written letter (sent via email) can explain what you are doing (or have done) to mitigate your weaknesses, spotlight your accomplishments, and reaffirm both your interest in the program and your reasons for having applied there. Schools want to know that the applicants they accept from the waitlist are truly committed and will actually attend.

3. Proofread all communications with the school!

You don’t want to send any correspondence that’s sloppy, rambling, or filled with errors. This is your last chance to make a good impression, and you don’t want to blow it by being messy.

4. Remember that the waitlist process is a marathon, not a sprint.

A law school’s waitlist process generally begins after its deposit deadlines and can last until the first day of orientation – from April to August. There’s a reason it is called the waitlist. Be prepared to sit tight. And remember that patience is a virtue.

5. Don’t be a stalker.

Do not write or call the admissions office every day. Once you’ve submitted your letter of continued interest, prepare a schedule of correspondence, reaching out to the school approximately once a month. Make sure to follow any guidance the admissions committee gives for how, and how often, to be in contact. When you write to the school, mention anything new that has occurred since you filed your LSAC application or since your previous outreach, such as a new honor, a new internship, a new job, or a promotion. Every correspondence you have with the admissions office should concern a timely update, so don’t feel compelled to write a letter just because “it’s time.” It’s typically better to say nothing at all than to write just for the sake of writing.

If you are ultimately not accepted to your dream school, you might want to consider starting your studies at a different school and then transferring. If the LSAT or the timing of your application was the problem this year, and you’re able to take a year off and reapply with a new score or earlier in the cycle, go for it.

Being waitlisted at the school of your dreams is undoubtedly frustrating, but it can also be an opportunity! Contact us to schedule a free consultation and learn how Accepted can help you strategically navigate the waitlist process. We can assist you in writing a great letter of continued interest and answer any questions you might have about positioning yourself to get accepted!

Daniel Waldman is a graduate of Harvard Law School and an experienced law school admissions consultant with a background in corporate income tax and large-scale securitization taxation issues.

Related Resources

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VMCAS Is Open! What’s New on the 2025-2026 Application?

Valerie Wherley — Wed, 19 Mar 2025 09:50:26 -0400

The Veterinary Medical College Application Service (VMCAS) opened on January 22, 2025, this year. The final VMCAS application deadline is September 15. With advanced planning, knowledge of the new and changed aspects of the VMCAS, and a competitive, holistic application, you will be ready!

VMCAS Timeline

The following suggested timeline highlights important VMCAS dates, provides reminders regarding academic transcript requests, and includes lots of critical writing time in the overall process.

Date	Activity
Jan. 22	VMCAS application opens
Jan. 22 – May 9	Work on completing Personal Information, Academic History, and Supporting Information sections of the application Begin to request transcripts
May 1	TMDSAS opens
May 9	Select programs in VMCAS
June 2	First day to submit for Fee Assistance Program
May 9 – June 15	Request transcript to include spring 2025 grades Begin to work on program-specific questions
June 15 – July 15	Finalize Academic History section and any other sections, as necessary
July 15 – Aug 15	Work on/finalize all sections, including program-specific questions
Aug. 14	Last day to submit for Fee Assistance Program
Aug. 30	TMDSAS deadline
Sept. 15	Submit VMCAS application

*Information adapted from the VMCAS application webinar presented by the AAVMC.

Changes to the 2025-2026 VMCAS

While many aspects of the VMCAS remain the same, a few changes have been made to the application for this next cycle. A list of these changes follows, with a brief description of each.

Additional School of Veterinary Medicine

VMCAS is the common application that simplifies the process of applying to schools of veterinary medicine. In the 2025-2026 cycle, VMCAS is applicable to 33 U.S. schools, including the newest AAVMC member Rowan University, as well as accredited veterinary institutions in Australia (3), Canada (2), Great Britain (3), the Caribbean (2), Scotland (2), Ireland (1), and New Zealand (1).

Additional Question

A question has been added to the Personal Information section, in the Other Information subsection. The question reads,

Organization Participation

Indicate whether you were a participant in any of the organizations below.

Your responses in this section are confidential, will not be shared with programs, and in no way affect your application. Your responses will only be used to help the AAVMC evaluate current and potential partnerships with organizations that aim to increase awareness about career opportunities in health professions for students in grades K-16.

Applicants have the opportunity to choose from any of the following:

American Pre-Veterinary Medical Association (APVMA)
HOSA – Future Health Professionals
National FFA Organization
4-H
Society for the Advancement of Chicanos/Hispanics and Native Americans in Science (SACNAS)
Annual Biomedical Research Conference for Minoritized Scientists (ABRCMS)
Minorities in Agriculture, Natural Resources, and Related Sciences (MANRRS)
National Society for High School Scholars (NSHSS)
Girl Scouts or Boy Scouts
The Duke of Edinburgh’s Award

For each of these items, applicants can choose “Yes,” “No,” or “I Don’t Know” from a drop-down menu.

Phonetic Name Option

In the Personal Information section, in the Biographic Information subsection, applicants can input a Phonetic Name. The prompt states that interested applicants can create an account with a site called Namecoach, which is a technology-enhanced learning tool that allows users to record the pronunciation of their name, thereby promoting inclusivity.

Applying to schools of veterinary medicine requires not only exemplary academic preparation and clinical exposure but also knowledge of VMCAS and a thoughtful timeline to prepare a well-crafted, unique application.

As the former assistant dean of student affairs and career development at the William Beaumont School of Medicine, Dr. Valerie Wherley worked directly with the dean of the School of Medicine, the associate dean of student affairs, the associate dean of clinical curriculum, and the assistant dean of admissions, as well as with Year 4 students on both residency application reviews/critiques and mock interview preparation. Work with Valerie! Schedule a free consultation today!

Related Resources

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Vanderbilt University School of Medicine Secondary Application Essay Tips [2024-2025]

Mary Mahoney — Tue, 18 Mar 2025 08:36:41 -0400

The Vanderbilt University School of Medicine (VUSM) places special emphasis on the relationships students form during medical school with their classmates and professors. Students join one of four colleges on campus to participate in small group learning activities. In their first two years of medical school, students create their own project to self-direct their learning process, with mentorship. The school seeks individuals who will contribute to the diversity of the class and share successful strategies in building communication skills and a solid foundation of scientific knowledge. The VUSM’s secondary application involves three required essay responses and three optional responses.

VUSM Secondary Essay #1

Please reflect on the upbringing, background, and experiences in your life that have shaped who you are as a person and will help define the person you want to be in the future. In other words, what makes you who you are? (800 words)

Family, culture, norms, expectations, and experiences all play a role in shaping who we are as individuals. This is a reflection answer. What in your past has influenced who you are today? You could answer this question in broad strokes, focusing on a value that was constant through your childhood, or you could tell a story about a specific event that defined or changed you (with a positive outcome, ultimately). What makes you tick? What makes you the introspective person you are? This prompt aims to help the adcom get to know you by revealing your humanity, empathy, and/or compassion, or your leadership, advocacy, and investment in the well-being of others.

VUSM Secondary Essay #2

Tell us about a time when you interacted with someone who is different than you. What did you learn? What would you do differently? (600 words)

Meeting someone who is very different from you and moving forward with a bond and an understanding of difference requires being a secure and aware individual. Perhaps you learned something, not only about yourself or the other individual but also about how to interact to foster a safe and productive exchange for both of you. Perhaps you learned something about how to build a respectful friendship that includes sharing norms and traditions.

VUSM Secondary Essay #3

Everyone needs help at various times in their lives. Describe a time you asked for help and what you gained from that experience that has influenced your approach to asking for help. (600 words)

Asking for help, especially for something meaningful, is difficult. Who are the people you can rely on? Who are the resources and contacts you feel comfortable reaching out to in a time of need? What does this say about you? What was the outcome when you reached out to others? This prompt seeks a personal story about vulnerability and finding support, resources, and strength.

VUSM Secondary Essay #4 (Optional)

If you have completed your undergraduate education, please comment on what you have done or have been doing since graduation. (200 words)

You must demonstrate how engaged you are, or have been, during a gap year or two. How has the activity you present improved your immersion in medicine? If you have been drawn into personal responsibilities, such as caring for a family member, this would also be a valid answer here.

VUSM Secondary Essay #5 (Optional)

Why are you interested in Vanderbilt University School of Medicine? (200 words)

Why VUSM? When did you know you were interested in the program? What led you to apply to the school? Vanderbilt prides itself on having a “cutting-edge curriculum” and a “vibrant” social mission, and on its website, it profiles its students in warm tones, sharing connections and activities that foster the program’s mission while promoting relationships with peers, building legacy bonds within families, and encouraging outreach initiatives among its medical students that are inclusive and antiracist. In fact, the profiles convey “why us?” as genuine, personal connections and affiliations with the school, alumni, faculty, and mission. So how did you develop an affinity for Vanderbilt? Let the adcom know, personally and with warmth.

VUSM Stats

All data are taken from the US News & World Report in 2024.

Average MCAT score: 521

Average GPA: 3.95

Acceptance rate: 5.2%

Has this blog post helped you feel more confident about approaching your VSUM secondary application? We hope so. It’s our mission to help smart, talented applicants like you gain acceptance to your top-choice medical school. With so much at stake, why not work with a consultant whose expertise and personalized guidance can help you make your dream come true? We have several flexible consulting options — click here to get started today!

Dr. Mary Mahoney, PhD, is the medical humanities director at Elmira College and has more than 20 years of experience as an advisor and essay reviewer for med school applicants. She is a tenured English professor with an MFA in creative writing from Sarah Lawrence College and a PhD in literature and writing from the University of Houston. For the past 20 years, Mary has served as a grad school advisor and essay reviewer for med school applicants. Want Mary to help you get Accepted? Click here to get in touch!

Related Resources

Accepted’s Medical School Acceptance Calculator, a free tool
Prewriting Secondaries for Medical School
Admissions Straight Talk Podcast for Med School Applicants

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What Do Kids Choke On?

Pediatric Education — Sun, 16 Mar 2025 20:20:43 -0400

Patient Presentation
A 34 month-old male came to the emergency room with a history of acute choking/coughing and the mother was worried he has swallowed a coin. She had left him unattended for a couple of minutes and found him playing with her purse. She used both choking and coughing to describe him seeming to have an acute problem with something in his mouth. He was breathing and turned red, but never stopped breathing and didn’t turn other colors. She tried a couple of back blows and he did not cough up any specific object nor could she see anything in his mouth. He had some increased saliva after the back blows and was crying normally and appeared scared to the mother, but was not coughing/choking after this time. She also found some tissues, a dime and some gum in his hands. She was able to calm him down and he continued to breath normally. His speech was also normal for his age. She brought him to the emergency room as she was worried that he had swallowed a coin or other object.

The past medical history showed that he was a former 27 week premature infant who had required significant respiratory support, gastric tube feedings and had chronic pulmonary aspiration in the past. He had a history of more recent bronchospasm, but the aspiration had resolved and he was eating normally.

The pertinent physical exam showed a weary male clinging to his mother. His vital signs were normal with a respiratory rate of 28 and saturation of 98%. His examination was normal including HEENT, lungs and abdomen.

The diagnosis of of a possible acute aspiration of an unknown object was made in a normally appearing male. The radiologic evaluation of chest and abdominal radiographs revealed a round radioopaque object that was likely a coin. The patient’s clinical course over his time in the emergency room found him to have no respiratory distress, was able to speak normally and drink some fluids without difficulty. His mother was very certain that her purse had not had any other round objects such as a button battery or a magnet. After again commending his mother that she did a great job doing the emergency procedures for choking, he was sent home to monitor his patient’s stools and to followup with his regular doctor if the object was not found within a week, or if he had any abdominal problems.

Figure 143 – CXR shows a round radiopaque foreign body in the antrum of the stomach.

Discussion
Chronic pulmonary aspiration is the entry of a material into the lower airways that recurrently occurs. The material is often upper airway secretions, food/fluid or gastric contents. Patients are unable to protect their airway because of anatomic problems (e.g. laryngomalacia, craniofacial abnormalities), swallowing dysfunction (e.g. esophageal dysmotility), or neuromuscular problems (e.g. muscular dystrophy, cerebral palsy), or other problems (e.g. prematurity, viral bronchiolitis, bottle propping).

The lung damage severity from the aspiration is felt to be mainly due to the volume of the aspirate and the pH. Acid pH causes more problems as does higher volumes. A study of dogs found that 2 ml/kg could cause severe damage. Note that this volume relative to body size can be a small amount in a small patient. Aspiration can cause epithelial damage, edema, hemorrhage, atelectasis, and pulmonary fibrosis and chronic changes. These can occur quickly with epithelium potentially being involved within seconds, atelectasis within 3 minutes, acute pneumonia changes within hours and granulomatous changes within 48 hours.

Caregivers can describe symptoms as choking with feeds or increased secretions, wheezing that isn’t responsive to bronchodiliators, cough, and recurrent respiratory illnesses. Some patients, especially infants and young children may present with apnea or bradycardia or unresponsive events. Some children, especially those with neuromuscular problems, may have silent aspiration as they are not able to protect their airway effectively by choking, coughing, wheezing, etc.

Physical examination may show problems during feeding such as problems sucking, swallowing, choking, drooling or coughing. There may be wet sounds in the lungs or wheezing after feeding which may predominate in the dependent lung fields (i.e. upper lobes and posterior lower lobes). Chest radiograph is usually the first imaging study which may show hyperinflation, bronchial wall thickening, and/or diffuse/localized infiltrates. The chest radiograph could also be normal. Dysphagia (the transfer of the food bolus from the mouth to the esophagus) is a common reason for chronic aspiration. Fluoroscopic swallow studies of the patient swallowing different liquids and textured foods are done with a radiologist and speech pathologist to discern if aspiration is occurring during, and what material viscosity may be tolerated. The material viscosity (sometimes called thickness or texture) can help clarify a potential treatment plan for a patient.

Treatment depends on many factors but includes proper positioning, use of viscous materials that do not cause aspiration, non-oral feedings bypassing the upper airway through use of a temporary or permanent feeding tube, and oral rehabilitation. Surgical treatments are sometime used such as stomach fundoplication. Oral secretions can be a big problem for some patients and treatment options include medications, botulinum toxin, or surgical treatment. Prompt evaluation and treatment of pneumonia is also important.

Learning Point
Acute choking is usually more easily identifiable than chronic problems but the materials are often similar which are upper airway secretions, gastric contents, and food. Acute choking also includes foreign bodies.

In 1994 in the US, the Child Safety Protection Act required choking hazard labels on small toys and other items, and banned production of toys that pose choking, aspiration or ingestion hazards for children < 3 years of age. Additional regulations have been made since including requiring batteries to be inaccessible in products intended for children < 3 years old. Regulations have made many of these products safer.

A 15 year review of the Consumer Product Safety Commission’s National Electronic Injury Surveillance System was conducted in 2016 of consumer products that children ingested or aspirated and were reported. This did not include organic items such as food.

During 2000-2014 there were an estimated 73,000 cases/year of acute aspiration/ingestion, with about 84% of these for ingestions. During 2010-14 there were an estimated 85,500 cases/year, with about 87% of these for ingestions. Children < 5 years accounted for the highest number of cases with 2-3 year olds being the most common ages during both time frames. Most children during 2000-2014 were treated and released with about 11% requiring admission. Almost all of the cases had occurred in a home environment.

From the table below it is obvious that children will put just about anything into their mouths as they explore the world. Between the two time periods the percentage of coins decreased for both aspiration and ingestion, while jewelry increased for aspiration and remained steady for ingestion. The authors hypothesize that this may be due to increased use of cashless payment methods and therefore decreased need for coinage. Coins overall still remained a common item.

Batteries also doubled for ingestion, and again the authors hypothesize that there are more battery operated items in the home, therefore increased exposure. While the table below notes 0% for batteries being aspirated, there were a few cases reported.

The authors also compare their data to another study from 1988-90 before the regulation of balloons, and during that time period the reported mortality from balloons was 0.3%. In the current study the authors specifically note that their data does not show “no balloon related aspiration” but state that it is clear that there is a dramatic decline after regulation in 1994.

	2000-2004 Aspirated	2010-2014 Aspirated	2000-2004 Ingested	2010-2014 Ingested
Other	36	42	25	32
Coins	38	11	54	44
Jewelry	14	29	7	6
Paper	6	8	0	0
Batteries	0	0	4	8
Bobby Pins	3	2	0	0
Baby Bottle Tops	2	2	0	0
Building sets	1	4	0	0
Nails, Screws, Bolts	0	0	6	5
Kitchen Items	0	0	1	3
Marbles	0	0	3	2
Action Figures	0	2	0	0

The “Other” category above includes additional miscellaneous items such as chalk/crayons, Christmas decorations, cleaning materials, floor materials, pens/pencils/erasers, needles/pins, and other consumer products.

Questions for Further Discussion
1. What are the emergency procedures for someone who is choking?
2. What common foods do people choke on?
3. How do you counsel parents regarding choking and other toddler safety issues?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Choking and Lung Diseases.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Hanba C, Cox S, Bobian M, et al. Consumer product ingestion and aspiration in children: A 15-year review. Laryngoscope. 2017;127(5):1202-1207. doi:10.1002/lary.26216

Torres-Silva CA. Chronic Pulmonary Aspiration in Children: Diagnosis and Management. Curr Probl Pediatr Adolesc Health Care. 2018;48(3):74-81. doi:10.1016/j.cppeds.2018.01.004

Tutor JD. Dysphagia and Chronic Pulmonary Aspiration in Children. Pediatrics In Review. 2020;41(5):236-244. doi:10.1542/pir.2018-0124

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Should I Take a Gap Year Before Medical School?

Mary Mahoney — Fri, 14 Mar 2025 08:45:08 -0400

Predictably, the rate at which aspiring medical school students are taking a gap year is rising. According to the AAMC’s 2024 student questionnaire, 74.3% of M1s took at least one gap year between their undergraduate education and starting medical school. That rate was 60% in 2017. Clearly, the takeaway from this data is that the percentage of medical school applicants who took a gap year to improve their scores, experiences, or research before being accepted to medical school is overwhelmingly greater than the percentage who did not. Additionally, the length of the gap for most of these applicants was brief – one or two years.

Reasons to Take a Gap Year

Rather than fretting about whether to take a gap year, you should focus your energy on determining what would turn a gap year into a growth year for you – and then plan accordingly. Many premed students use the gap year to work on improving what they see as their weakest application credential. A gap year gives you the opportunity to retake the MCAT, enroll in a postbac program to improve your GPA, volunteer, or gain clinical exposure. During a gap year, some premed students become emergency medical technicians. Others work to save up money (to decrease their future medical school debt) while volunteering, performing community service, or building research and publication achievements. Others engage in medical mission opportunities to bolster their experience with diverse populations and global health.

Determining How to Spend Your Gap Year

Clearly, as the percentages I noted earlier in this post demonstrate, the admissions committees do not view gap years negatively. But the key is ensuring that whatever you do during your gap makes sense with respect to your interest in becoming a doctor. For some people, that means dealing with practical issues and addressing whatever they need to do in preparation for applying to medical school.

What you might do during a gap year also needs to make sense for you personally, separate from your medical career aspirations. This means being inspired. What do you intuitively feel would facilitate your growth and satisfaction as a person and/or a future doctor? For example, would you like to gain experience with a particular patient population? Volunteer with Doctors Without Borders? Work at the NIH to help with policy and research initiatives?

Other people use the time to assume personal responsibility for a family matter, such as taking care of an ailing family member. They might pursue certification in a complimentary therapy, such as acupuncture. Or they might consider studying Latin.

Still other aspiring medical school students choose to get involved with activities and opportunities that show their commitment and enthusiasm for their intended career. What else could you do that would help you achieve your ultimate goal of becoming a doctor – something that would serve humanity and increase your humility? You could go on an international trip to service the health needs of people in a country/culture other than your own, one where people speak a different language. You might work on gaining more community service or research opportunities. Another option would be attending a postbac program or an “ancillary health” graduate program (e.g., one in human nutrition or narrative medicine) or retaking the MCAT with the help of a prep program.

Whatever you decide makes sense for you, consider speaking with your premed advisor to discuss their recommendations for ways to boost your candidacy. As tempting as it might be to take a gap year to rest, get a break from academia, or go on an overdue vacation with family or friends, do not “underwhelm” the admissions committee with minimal professional commitments during this time. You must demonstrate that you spent your gap year(s) well, working to improve your candidacy via growth, achievements, and experience – with full dedication.

Addressing the Gap Year in Your Application

If you take a gap year, you will need to explain what you did during that time to the medical schools you apply to, either in writing or in person. So, it is a good idea to take notes about your activities along the way. Practice writing about your experiences, and make connections between challenges and growth. Show how your gap year was time well spent and beneficial to your advancement. Explain how the experiences you had during that time changed you and have made you a stronger medical school applicant and future physician.

Also, if you have any ambivalence about becoming a doctor, taking a gap year or two makes perfect sense. Medical students who suffer a change of heart professionally find themselves unhappy and stressed. And medical students experiencing significant stress often demonstrate a progressive decline in empathy, which is a red flag. If they decide to drop out of medical school as a result, they often do so with sizable debt – and with no profession to show for it. So take your personal inventory early and strategically. Examine the reasons you want to be a doctor. If you feel you need some time to confirm that this path is truly the right one for you, take a gap year or two before applying to explore your commitment to medicine and patient care, and your motivation for and dedication to the profession.

It’s never too early to start working on your admissions strategy for your medical school application. Schedule a free consultation, and work one-on-one with an expert advisor who will help get you accepted!

Related Resources

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Things to Consider When Choosing an MBA Admissions Consultant

Kelly Wilson — Thu, 13 Mar 2025 11:27:29 -0400

An MBA from a top business school can be the ticket to achieving your professional dreams, but getting accepted to an elite program is not easy. Hiring an MBA admissions consultant to assist you in delivering your best possible application can give you a major assist, but is it worth the investment? And how do you find a good one? In this post, we’ll explain what you should look for in determining whether a consultant is the right one for you – and what to steer clear of.

The Benefits of Working with an MBA Admissions Consultant

You can find endless discussions on forums and message boards about the value of admissions consulting. One of the more common arguments against using a consultant runs something like this: “I know so many MBA students at top schools who got in without an admissions consultant. It’s just not necessary to hire one.”

If you were to take a poll of business school admissions consultants, you would find that the majority of them were accepted to the MBA programs they attended without the assistance of a consultant. Some, especially the more senior ones, likewise did not take a GMAT prep course. However, over the past 30 years, preparing to take one’s admission exam via a course or tutor has gone from being an act of desperation to a strategic choice that offers a competitive edge, to a mainstay of the application process. And a similar trend has occurred with admissions consulting. At this point, working with a consultant is not crucial for every applicant, but it is definitely helpful. The question is not whether it’s possible for an candidate to get accepted to a top MBA program without a consultant, but rather whether the advantages of hiring a consultant are worth the cost.

So, let’s look at some of the benefits of working with an experienced admissions consultant:

You improve your chances of being accepted to a “better” school. By “better,” we mean one that offers more professional opportunities in your area of interest, a higher probability of increased earnings, a deeper and more valuable network, and an educational experience more to your liking.
A stronger application can help you secure a scholarship. Such funding could save you tens of thousands of dollars.
You’re less likely to have to reapply. Applying to business school, when you include application fees, test fees, and travel expenses, can cost several thousand dollars. Applying successfully the first time will save you from having to expend even more money and time reapplying in the future.
The process will be not only less time-consuming but also less stressful and frustrating (for both you and those close to you). A good admissions consultant will keep you on track and advancing efficiently through the admissions process. Plus, you won’t need to spend time figuring out everything they already know about how to navigate it.

The experience, objectivity, and skill an admissions consultant provides can often be worth many times the cost.

Evaluating Potential MBA Admissions Consultants

When assessing whether a consultant might be a good match for you and your admissions-related needs, pay attention to their experience, process/working style, differentiating factors, accessibility, candor, and cost. However, do not assume that an individual must have earned an MBA themselves (and one from your target school, in particular) or been a member of a school’s admissions committee to be an effective consultant.

Experience

Absolutely ask about the consultant’s level of experience with your programs of interest, your demographic group, and your industry. At the same time, understand that a really good consultant is always discovering new programs, learning about significant changes in existing programs, and staying up-to-date with the types of applicants competing for seats in the class. A consultant at the top of their game will be current with all the trends and know how to help you present yourself as a distinct, fully realized individual – beyond the stats and the stereotypes. They will be able to guide you in sharing your story in a compelling way and highlighting your valuable qualifications.

Process/Working Style

Ask how the services you are considering will be provided in practical terms. Learn about turnaround times for edits, how long you should expect to spend on each application, what forms of communication are used or preferred, and who exactly you’ll be working with. If you start out talking to a salesperson, before you sign on, be sure to ask to speak with the consultant with whom you would be working. You’ll want a chance to evaluate your potential connection with that consultant before you commit.

Differentiating Factors

Ask what the consultant considers special and uniquely valuable about their offerings and expertise. You should clearly understand what makes their service different. Look for testimonials on their website, especially those that are recent and, whenever possible, from applicants who were accepted to your target school(s).

Accessibility

Ask about the consultant’s accessibility. When can you expect to be able to reach them? Are they available on weekends and/or holidays? In the evenings?

Candor

Will the consultant be fully honest with you throughout the application process? For example, if you target an MBA program that they believe is beyond your reach or draft an essay they feel is off target, will they tell you frankly? You want to know that the feedback and advice you’ll receive will be genuine.

Cost

Most consulting firms list their prices on their websites, but the services offered can often be multifaceted or complex, so ask questions to confirm exactly what you would be getting for your investment. Make sure you understand whether the fees are for package or hourly services.

Unnecessary Qualifications

An admissions consultant needs to know how to help you tell your story in a clear, coherent, and compelling way. To be qualified to do this, they do not need to have attended — or worked in admissions at — the school you’re applying to. Likewise, they do not need to have earned an MBA themselves.

A consultant’s degree and alma mater are irrelevant to their ability to help applicants present themselves effectively to an admissions committee. So focus instead on their experience with and insight into the admissions process, their editing skills, and their capacity to serve as a mentor.

A Note About Essay Writers and Application Agents

When researching your options for getting support with your MBA applications, be aware that essay writing services and application agents are not the same thing as admissions consultancies. Consultants guide and mentor applicants through the application process, helping them brainstorm for, revise, and polish their essays. On the other hand, essay writers actually create essays for applicants – serving as ghostwriters, rather than advisors. And business school administrators all agree that submitting ghostwritten essays is unethical.

Application agents counsel candidates on selecting the programs they should apply to. However, schools pay these agents to procure applications. Sometimes, agents are paid by both the school and the applicant. This creates a clear conflict of interest. Applicants should be counseled to apply to MBA programs where their goals will be supported and they have a reasonable chance of getting accepted – not to ones that benefit the agent or school instead.

Next Steps

You’ve taken an important step toward creating a successful application by reading this post, and the next logical step is seeking personalized advice tailored just for you. Consider scheduling a free, 30-minute free consultation with an experienced Accepted MBA admissions consultant today.

Related Resources

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How Common Are Stretch Marks in Children and Teens?

Pediatric Education — Sun, 09 Mar 2025 20:37:55 -0400

Patient Presentation
A 10-year-old female came to clinic because of a rash. The mother said that she had noted it about 6 weeks previously but it was not going away and it was spreading. She denied any new soaps, lotions, detergents or hygiene products including insect repellent or sunscreen. It was occasionally itchy but overall the child hadn’t noticed it. The family history was positive for diabetes mellitus type II, hyperlipidemia and heart disease. The review of systems was negative.

The pertinent physical exam showed an obese female with normal vital signs. Her weight had increased over the last year from 43.1 kg (95%) to 60.2 kg (95% for an 11.5 year old). Her length had increased the normal 5 cm over the past year and was at the 75%. Her skin showed several parallel linear lesions on her abdomen, buttocks and upper legs. Some were pink-red (legs and buttocks) and others were mixed with both reddened lesions and some that were whiter on the abdomen. She had no other skin findings. She was Tanner 1 for breast and public hair. The rest of her examination was normal.

The diagnosis of striae was made. The mother herself noted that she had striae mainly from when she was pregnant. She was very upset that her daughter had striae and wanted a referral to dermatology immediately. The pediatrician discussed the natural history of striae and said that since this was considered a normal process he would send the consultation but it was unlikely that the appointment would happen immediately. He also discussed her overall weight increase and recommended to have screening labs for obesity and hyperlipidemia completed. “We did those a year ago but she had gained a lot of weight since then. Given your family history I think it would be important to do,” he said. “Let’s talk some more about her lifestyle and her food and exercise and see how we can improve the weight gain, and maybe help to decrease the stretch marks,” he remarked.

The patient’s clinical course at followup 3 months later showed that the dermatology appointment was scheduled in another 3 months. Her initial laboratory testing was normal but her glucose and hemoglobin A1c were elevated compared to previous year. She was still gaining weight at the same rate, and additional counseling was given.

Discussion
Stretch marks or striae distensae (SD) are dermal scars which form linear, atrophic lesions, usually in parallel, that occur due to changes in connective tissue. They have an initial pink/red/purple stage (striae rubrae and have inflammation occurring) and then turn a paler color and more wrinkled (striae albae, where there is atrophy). They are associated with growth spurts, pregnancy, obesity and excess steroids. The specific mechanisms are unknown but it is believed to be due to a disruption of the collagen fibrils and elastic fibers within the skin. Basically the collagen fibrils usually line up in parallel and provide structural support to the skin while elastic fibers allow stretching of the skin. Collagen fibrils are disrupted providing less structure, and the disrupted area is filled by newly synthesized collagen. Elastin fibers are also disrupted and are not able to form their normal structure.

SD are caused by traction on the skin especially in times of rapid growth such as linear growth in puberty, pregnancy, or weight gain. Genetic factors do play a part. SD is considered a normal process. However the lesions can be quite disfiguring and cause emotional distress.

Treatment options can include enhanced collagen production, decreasing vascularity and increasing melanin production. Various laser treatments are likely overall the most effective. Radiofrequency, microdermabrasion and needling can also be used. Treatment is most effective during the striae rubra stage.

Learning Point
SD occur in approximately 50- 90% of women. In adolescence the reported prevalence is 6 to 86%. Females more commonly have striae on the calves, thighs, and buttocks whereas males have them on the lower back, knees, and buttocks. Physiologic striate which occurred during the adolescent growth spurt often become less conspicuous with time and have excellent prognosis when compared to other forms of striae.

In one study the most common dermatosis in overweight and obese children, and with those with increased insulin were keratosis pilaris, SD, hyperhidrosis, acanthosis nigricans, and plantar hyperkeratosis. They also found that the darker toned skin the individual had, the more likely they had acanthosis nigricans or keratosis pilaris.

Questions for Further Discussion
1. What are treatment options for scars and keloids?
2. What prevention options are there for SD?
3. What does acanthosis nigricans appear like and what is the typical location?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Skin Conditions and Scars.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Schuck DC, de Carvalho CM, Sousa MPJ, et al. Unraveling the molecular and cellular mechanisms of stretch marks. J Cosmet Dermatol. 2020;19(1):190-198. doi:10.1111/jocd.12974

Elsedfy H. Striae distensae in adolescents: A mini review. Acta Bio Medica Atenei Parmensis. 2020;91(1):176-181. doi:10.23750/abm.v91i1.9248

Kus MM, Mulayim MK, Kus C, et al. Dermatoses in overweight and obese children and their relationship with insulin and skin color. Journal of Cosmetic Dermatology. 2023;22(10):2791-2798. doi:10.1111/jocd.15773

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

What Causes Papilledema?

Pediatric Education — Sun, 02 Mar 2025 19:31:58 -0500

Patient Presentation
A pediatric resident was presenting a patient to the attending, who was A 14-year-old male who presented for well care and was being followed by ophthalmology for optic disc drusen. “Optic disc drusen? Really? I just had a teenage girl with that last week. It isn’t the same family is it?” she asked. They looked at the patient identifiers and found it to be two different families. “I know we work at an academic health center, but what are the chances we see this twice so close together?” she mused. She continued, “I think my fundoscopic exam skills are being put to the test as I also had a patient we were worried about a potential brain tumor this week too.”

Discussion
Optic disc drusen (ODD) are acellular deposits in the optic disc that can simulate true papilledema. They are often buried in young children and become more superficial with aging (average age ~12 years). The prevalence is 0.4% in children and in adults is 0.5 – 2.4%. They are inherited with family members having a 10x increased risk. Many patients are asymptomatic and ODD is discovered on incidental examination. Patients need to be monitored as visual field defects (up to 50% of children) can occur especially with aging. Other complications can include retinal vascular occlusions, hemorrhages, and anterior ischemic optic neuropathy. True papilledema can occur concomitantly with ODD. “[ODD] in children are typically bilateral and are more likely to be buried than in adults. Thus, they may be difficult to distinguish from true optic disc edema, which mandates exploration for secondary causes of increased intracranial pressure, such as a mass lesion of the brain or pseudotumor cerebri syndrome. Ancillary testing, …may be helpful in distinguishing between [ODD] and true disc edema, although these tests may be less sensitive for detecting buried drusen in children. It is important to consider [ODD] in the differential for papilledema, as 50 to 55% of children initially diagnosed with papilledema have [ODD] as their final diagnosis.”

Learning Point
Papilledema is the swelling of the optic nerves due to increased intracranial pressure. It can manifest as transient and then a loss of visual fields which can be permanent. On physical examination “[f]undoscopy, true papilledema is characterized by the presence of optic disc hyperemia, peripapillary retinal nerve fiber layer hemorrhaging and edema, distension of retinal veins, loss of spontaneous pulsations of retinal veins close to the optic disc, and disc elevation.”

For the generalist physician, pediatric fundoscopic examination is hindered due to patient age, and cooperation. Often only fleeting glimpses can be visualized. Generalists therefore often will refer patients to ophthalmology for a more complete examination and determination of true papilledema and additional evaluation if needed.

The causes of papilledema include:

Idiopathic intracranial hypertension (IHH, aka Pseudotumor cerebri)
Secondary
- Central nervous system tumor
- Obstructive hydrocephalus or other obstruction of the CSF outflow tract
- Craniosynostosis
- Dural venous sinus thrombosis
- Meningitis
- Medication
Optic disk drusen (ODD)

In a major pediatric academic health center, they had an estimated rate of ~8 patients/year with IHH, and ~17 patients/year with a secondary cause which was mainly due to brain tumors (37%).

Pseudotumor cerebri is more common in females and obesity. This is true for adolescents and adults. This is not true in prepubertal children where there is no difference in gender or obesity presence.

Questions for Further Discussion
1. What are causes of red eyes? A review can be found here
2. What medications can cause pseudotumor cerebri? A review can be found here
3. What are common causes of blindness in children? A review can be found here

Related Cases

Eye Diseases

Vision Impairment and Blindness

Health Maintenance and Disease Prevention

Ophthalmology

Teenager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Eye Diseases and Vision Impairment and Blindness.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Chang MY, Pineles SL. Optic disk drusen in children. Surv Ophthalmol. 2016;61(6):745-758. doi:10.1016/j.survophthal.2016.03.007

Heidary G. Pediatric Papilledema: Review and a Clinical Care Algorithm. Int Ophthalmol Clin. 2018;58(4):1-9. doi:10.1097/IIO.0000000000000242

Mathis S, Le Masson G, Soulages A, et al. Papilledema and Peripheral Neuropathies. Neurologist. 2019;24(6):185-193. doi:10.1097/NRL.0000000000000250

Chang MY, Binenbaum G, Heidary G, et al. Imaging Methods for Differentiating Pediatric Papilledema from Pseudopapilledema: A Report by the American Academy of Ophthalmology. Ophthalmology. 2020;127(10):1416-1423. doi:10.1016/j.ophtha.2020.03.027

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Creating the World’s First CRISPR Medicine, for Sickle Cell Disease

Harvard Medical School — Tue, 25 Feb 2025 17:00:38 -0500

Harvard Medical School Creating the World’s First CRISPR Medicine, for Sickle Cell Disease People with sickle cell disease experience excruciating pain crises, tissue and organ damage, and shortened life expectancy. The lab of Stuart Orkin made crucial discoveries that, in the hands of CRISPR Therapeutics and Vertex Pharmaceuticals, became an FDA-approved gene therapy that is making a monumental impact on patients with sickle cell disease. Watch the full video to learn how HMS and industry scientists produced a life-changing therapy for sickle cell disease.

How Much Dietary Fiber Should a Child Have?

Pediatric Education — Sun, 23 Feb 2025 19:00:16 -0500

Patient Presentation
A 30-month-old male came to clinic for his health supervision visit. The mother was concerned because of infrequent bowel movements and picky eating. “All he’ll eat is pasta and chicken nuggets. No fruit and no vegetables practically. He’ll drink milk and no water,” she explained. “He has hard stools and hides when he is having them in his diaper. They are large too and he seems to have some pain before he poops,” she said. The past medical history showed a healthy male, who was “strong-willed,” per his mother.

The pertinent physical exam revealed normal vital signs and growth was between 75-90%. His examination was normal.

The diagnosis of a healthy child with constipation and poor dietary habits was made. The pediatrician recommended several things to help including starting Miralax® to help with softening the stool. He also recommended some ways to increase dietary fiber including using whole grain foods, increasing the few vegetables he would eat such as corn, and trying some others that the mother could put on his plate or put into other foods such as pasta sauce or blend into a milk-based smoothie.

Discussion
Fiber is an important dietary component. It has many health benefits including decreasing overall mortality and cardiovascular events, improving metabolic profiles such as lipids and glucose and decreasing malignancies especially those of the gastrointestinal tract. Fiber improves constipation, functional abdominal pain, irritable bowel syndrome, and inflammatory bowel disease.

There are several different definitions of dietary fiber, however it is basically recognized as “… a heterogeneous group of non-carbohydrate plant cell wall components (lignin, chitins, and waxes) and carbohydrate polymers that are neither digested nor absorbed by the human intestine (non-starch polysaccharides, resistant oligosaccharides, and resistant starch).”

Dietary fiber comes in many forms but can be divided into insoluble fibers which act as bulking agents within the gastrointestinal tract entrapping water and improving gut transit, or soluble fibers which act as substrate for fermentation within the gut and produce a variety of components which then can be used as their own substrates for gut health. Soluble fibers dissolve in fluid, and slow down gastric emptying and the digestion of starch and other macro nutrients.

Insoluble fibers include “…cellulose, hemicellulose, lignin, chitin and wheat bran.” They are present mainly in fruits, vegetables and whole grain.

Soluble fibers include psyllium, Beta-glucans, guar gum, glucomannan, and pectic polysaccharides. They are found in barley, nuts, oats, pulses (beans, lentils, peas) and some fruits and vegetables.

Although increased fiber can improve many gastrointestinal problems, excessive fiber intake could lead to early satiety and therefore decreased nutrient intake, or increased fermentation leading to potential adverse problems ing “…diarrhea, abdominal distension, flatulence, and vomiting.” Fortunately, usually these problem are not serious.

Learning Point
Fiber in a Western diet is relatively limited overall and about 50% or more children and adults do not get the recommended amount of fiber in their daily diet. In the United States the usual intake is 15 g/ day of fiber.

Adults are generally recommended to have 25-35 g/day of fiber. There is not consensus on the total amount of dietary fiber a child should have. The amount varies depending on age and gender. For example in one to three-year olds leading references vary from 4.5 to 19 grams per day and in 14 to 18 year olds from 19 to 38g per day. The American Health Foundation does use a simple form which = (Age in years) + 5-10g per day. The American Academy of Pediatrics uses 0.5 g fiber/ kilogram/ day as its standard.

As one author noted, “[C]hildren should ingest a variety of fibers from fruits, vegetables, legumes, seeds, nuts, and cereal grains to ensure and achieve the benefits and synergies of different dietary fibers.”

Questions for Further Discussion
1. What are causes of constipation? A review can be found here
2. How do you counsel families to increase their fiber consumption?
3. What are indications for referral to a gastroenterologist?
4. What do picky eaters really eat? A review can be found here

Related Cases

Dietary Fiber

Constipation

Constipation and Encopresis

Gastroenterology

Nutrition / Dietetics

Preschooler

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Dietary Fiber and Constipation.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Korczak R, Kamil A, Fleige L, Donovan SM, Slavin JL. Dietary fiber and digestive health in children. Nutrition Reviews. 2017;75(4):241-259. doi:10.1093/nutrit/nuw068

Stephen AM, Champ MMJ, Cloran SJ, et al. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutr Res Rev. 2017;30(2):149-190. doi:10.1017/S095442241700004X

Snauwaert E, Paglialonga F, Vande Walle J, et al. The benefits of dietary fiber: the gastrointestinal tract and beyond. Pediatr Nephrol. 2023;38(9):2929-2938. doi:10.1007/s00467-022-05837-2

Salvatore S, Battigaglia MS, Murone E, Dozio E, Pensabene L, Agosti M. Dietary Fibers in Healthy Children and in Pediatric Gastrointestinal Disorders: A Practical Guide. Nutrients. 2023;15(9):2208. doi:10.3390/nu15092208

Author
Donna M. D’Alessandro, MD
Professor of Pedia

The Science of Love

Harvard Medical School — Thu, 20 Feb 2025 09:13:37 -0500

Harvard Medical School The Science of Love What can research tell us about the science of love? Jacquie Olds and Richard Schwartz, who are both psychiatrists at Massachusetts General Hospital and McLean Hospital, study how love evolves and how it can fall apart. They also work as couples therapists.

Mercury and Fish Ingestion: How Much?

Pediatric Education — Sun, 16 Feb 2025 19:19:53 -0500

Patient Presentation
A 6-year-old male came to clinic for his health maintenance visit. His mother asked about how much fish he should or could be eating. She had recently seen something on social media about how children should not have fish because of the risk of mercury.

The pertinent physical exam showed normal vital signs and growth parameters were in the 10-25%. His examination was normal.

The diagnosis of a healthy male was made. The pediatrician recommended that the family could eat fish in moderation like once or twice a week as it had good protein and nutrition in it. But that eating a lot of it could put the family at risk for mercury or other possible toxins. “It’s okay for him to eat the fish he and your husband catch in the lake, but not every day. There should be a balance of different types of food over the week, just like you should have a variety over a day too” he recommended.

Discussion
Mercury (Hg) is a heavy metal that is used for a variety of products as it is very dense requiring small spaces. It is a liquid at room temperature and easily can expand therefore it is used for thermometers and barometers. It is also used in fluorescent lighting as it is electroconductive. Mercury also has anti-infective properties. Hg is also highly toxic and can affect all organ systems but is especially neurotoxic. It can result in organ failure or permanent damage. There is no specific Hg level that is considered safe at any age. However, Hg in the environment is common because of manufacturing and a large reservoir in the world’s marine systems.

Toxicity depends on many variables, all of which are not fully elucidated.

Mercury types
- Elemental mercury (Hg⁰) in its liquid state is poorly absorbed, but in its vapor state (which it can easily do at room temperature) is very easily absorbed by the lungs. Elemental Hg can pass through cell membranes including the placental and blood brain barrier.
- Mercuric ion – Elemental mercury in the blood stream though is oxidized to mercuric ion (Hg²⁺) which does not cross cell membranes as well including the blood brain barrier. Hg²⁺ still interacts with a variety of cellular functions.
- Methyl mercury (MeHg) is mercury that has been vaporized and then absorbed and methylated by the earth’s marine systems. MeHg then moves through the food chain and is ingested in the form of fish and other marine products. (Note that this can take a long time and therefore it can be difficult to measure the amount of Hg and also what its effects are.) It is the most common type of dietary mercury.
  MeHg is highky absorbable by the intestine and also highly absorbed across the placenta and blood brain barrier.
Timing of exposure – fetus and young children have growing neurological systems and therefore are more at risk for the potential neurotoxin effects.
Amount of exposure – higher amounts of Hg of MeHg or Hg²⁺ and other states increases the risk of problems.
Individual genetics – there is some data supporting that some individuals have more or less risk of toxic effects because of their genetics.

Learning Point
A systematic review of prenatal mercury exposure and neurological development of the exposed children up to age 5 years reported “..the evidence for an association …. was weak. No pattern was identified by the age of child or study methodology. Any adverse effects may also be too small to be clinically detectable. Fish contains many essential nutrients involved in brain development, so where fish is the main source of dietary Hg, these other nutrients may compensate against the toxic effects of mercury. ” In this statement the authors are not discounting that there can be toxic effects, but are noting that the conclusions of individual studies may not be as robust or as clear to say that prenatal exposure is causing neurodevelopmental problems. It is a good example of trying to disentangle the multiplicity of the issues involved in understanding the potential Hg risks.

Fatty fish have higher levels of mercury and therefore the pros and cons of eating fatty fish must be balanced with the overall nutrition and risk of Hg. Two servings of fatty fish (3-4 ounces/serving) are recommended weekly that is broiled or baked. Frying is not recommended. High levels of mercury are found in shark, swordfish, king mackerel, and tile fish (also called golden snapper or golden bass) but low levels are found in anchovies, catfish, sardines, salmon, pollock, clams, oysters and shrimp. The fish listed as having high levels of mercury are not recommended to be consumed during pregnancy, breastfeeding and for young children.

Questions for Further Discussion
1. What heavy metals are considered the “big 5” for potential toxicity for humans?
2. What are the classes of environmental pollutants? A review can be found here
3. What are the benefits of Omega-3 fatty acids? A review can be found here

Related Cases

Mercury

Health Maintenance and Disease Prevention

Nutrition / Dietetics

Pharmacology / Toxicology

Physical Medicine and Rehabilitation / Physical Therapy

School Ager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Mercury

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Andreoli V, Sprovieri F. Genetic Aspects of Susceptibility to Mercury Toxicity: An Overview. IJERPH. 2017;14(1):93. doi:10.3390/ijerph14010093

Kadawathagedara M, de Lauzon-Guillain B, Botton J. Environmental contaminants and child’s growth. J Dev Orig Health Dis. 2018;9(6):632-641. doi:10.1017/S2040174418000995

Dack K, Fell M, Taylor CM, Havdahl A, Lewis SJ. Prenatal Mercury Exposure and Neurodevelopment up to the Age of 5 Years: A Systematic Review. IJERPH. 2022;19(4):1976. doi:10.3390/ijerph19041976

Fish and shellfish. nhs.uk. February 23, 2022. Accessed November 4, 2024. https://www.nhs.uk/live-well/eat-well/food-types/fish-and-shellfish-nutrition/

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

How Does Sarcoidosis Present?

Pediatric Education — Sun, 09 Feb 2025 19:35:30 -0500

Patient Presentation
A 5-year-old African-American female came to clinic for her kindergarten well-child exam. Her mother had no concerns until the physician reviewed the family history. She then became tearful as she said her mother had just been diagnosed with sarcoidosis and was having a lot of respiratory problems. She was worried that her daughter could also get it when she was older. The past medical history showed a history of mild intermittent asthma that was well-controlled with albuterol. The family history also showed the grandmother’s sister had died of some unknown lung problem in her 40s. There was diabetes in both sides of the family, and heart disease and stroke on the parental side. The review of systems was negative.

The pertinent physical exam revealed a talkative school-age child with growth parameters around the 75% and tracking. Her vital signs were normal. Her examination was normal.

The diagnosis of a healthy kindergartener was made and immunizations and patient education was given. The pediatrician noted that sarcoid was not very common but was more common in African-American patients. The mother also disclosed that she had a lingering cough from a recent upper respiratory infection and was afraid that she may also have sarcoidosis. They talked more about some of her fears including not wanting to see her own doctor because she was afraid. In the end the mother said she was going to make an appointment with her own doctor, and lived close enough to go with her mother to her next doctor’s appointment. “Maybe hearing it first-hand I can understand better and get some piece of mind for myself,” she said.

Discussion
Sarcoidosis is a chronic granulomatous disease causing multiorgan system disease of unknown pathophysiology. It appears that it has a genetic predisposition that may be triggered by an environmental cause such as contact with organic and inorganic materials.

Sarcoid is rare in adults and even rarer in children. The exact epidemiology is difficult to discern because of the rarity and also lack of international databases to chronicle the disease. In series, the incidence decreases with decreasing age generally. Estimates include 0.29 – 4.9/100,000 pediatric-aged patients. Some studies show male and female genders are the same, but other support an increased incidence in females. Also black children usually have higher incidence but it also depends largely on the population the patients are drawn from. There is a strong familial predisposition. Peak incidence is in 25-40 year olds.

There is no specific test for sarcoidosis. Chest radiograph shows a range of disease from nothing to intraparenchymal fibrosis. Mediastinal lymphadenopathy is common. Ultrasound of the liver and spleen may identify organ involvement. Skin, lymphatic and joint manifestations may be easier to note from physical examination. Laboratory testing is non-specific but may show signs of inflammation with elevated erythrocyte sedimentation rate, inflammatory anemia, hypergammaglobulinemia, and elevated transaminases. Angiotensin converting enzyme may be elevated as well. Biopsy of identified granulomas may show the more typical central follicle with peripheral macrophages and no necrosis. Biopsy also helps to rule out other diagnoses.

Treatment is based on adult disease and usually involves using corticosteroids. Other immunomodulator/suppressor therapy also is used. Although many children will have remission with no active disease and no treatment, it is a chronic disease which may recur and patients need to be monitored for long periods of time. There are no specific prognostic factors but children with pulmonary problems and those with more severe pulmonary problems, unsurprisingly, appear to have worse outcomes.

Some other diseases which have granulomatous manifestations include:

Crohn’s disease
Drug induced
Granuloma annulare
Immunodeficiency states
- Chronic granulomatosis disease
- Histiocytosis
- Tumor
Pneumonitis – aspiration, hypersensitivity
Mycobacterium infections including tuberculosis
Wegner’s granulomatosis

Learning Point
Sarcoid commonly presents with non-specific symptoms including fever, fatigue, weight loss or non-weight gain are very common. Chest problems include cough, chest pain and dyspnea.
Other potential signs include lymphadenopathy, hepatomegaly, splenomegaly, eye changes (uveitis), joint pain, and skin problems (nodules, plaques and papules).
Other systems can be affected as well but are less common. Young children often present with more non-specific symptoms and adolescents present more similar to adults which have more pulmonary manifestations.

Questions for Further Discussion
1. What is in the differential diagnosis of chronic cough? A review can be found here
2. What is in the differential diagnosis of weight loss or not gaining weight? A review can be found here
3. What are indications for a genetics consultation?

Related Cases

Sarcoidosis

Health Maintenance and Disease Prevention

Allergy / Pulmonary Diseases

Immunology

School Ager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Sarcoidosis

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Lakdawala N, Ferenczi K, Grant-Kels JM. Granulomatous diseases: Kids are not just little people. Clinics in Dermatology. 2017;35(6):555-565. doi:10.1016/j.clindermatol.2017.08.006

Nathan N, Sileo C, Calender A, et al. Paediatric sarcoidosis. Paediatric Respiratory Reviews. 2019;29:53-59. doi:10.1016/j.prrv.2018.05.003

D’Ascenzi F, Valentini F, Pistoresi S, et al. Causes of sudden cardiac death in young athletes and non-athletes: systematic review and meta-analysis. Trends in Cardiovascular Medicine. 2022;32(5):299-308. doi:10.1016/j.tcm.2021.06.001

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Endowed Professorships at Harvard Medical School

Harvard Medical School — Fri, 24 Jan 2025 11:18:47 -0500

Harvard Medical School Endowed Professorships at Harvard Medical School An endowed professorship is the highest distinction that can be bestowed upon an HMS faculty member. For more than 240 years, these exclusive honors have provided critical financial support to leaders in their fields who exemplify the School’s mission to alleviate suffering and improve health and well-being for all. This brief history of endowed professorships at the school is narrated by HMS Dean George Q. Daley, the Caroline Shields Walker Professor of Medicine in the Blavatnik Institute at HMS, with comments from Mercedes Becerra, the Jeffrey Cheah Professor of Global Health and Social Medicine at HMS; Jean Schaffer, the HMS Ory Family Professor of Medicine at Beth Israel Deaconess Medical Center; and Oluwaseun Johnson-Akeju, the HMS Dr. Henry Isaiah Dorr Professor of Research and Teaching in Anaesthetics and Anaesthesia at Massachusetts General Hospital.

5+ Tiny House Exterior Ideas that Pack a Punch • 333+ Art Images

Sun, 29 Dec 2024 19:09:11 -0500

5+ Tiny House Exterior Ideas that Pack a Punch • 333+ Art Images

Explore 10 inspiring small house designs that showcase the beauty of residential architecture! These innovative homes maximize space without sacrificing style, featuring open floor plans, clever storage solutions, and sustainable materials. Discover how e

Sun, 29 Dec 2024 19:05:48 -0500

Explore 10 inspiring small house designs that showcase the beauty of residential architecture! These innovative homes maximize space without sacrificing style, featuring open floor plans, clever storage solutions, and sustainable materials. Discover how elements like large windows, outdoor living areas, and smart layouts create a sense of spaciousness in compact living. Whether you're dreaming of a cozy cottage or a modern tiny home, these designs will inspire your next project! #ResidentialArchitecture #SmallHouseDesign #TinyHome

Sun, 29 Dec 2024 19:05:03 -0500

Cottage layout front porch with door to left and gabled covered porch

Sun, 29 Dec 2024 19:03:46 -0500

Cottage layout front porch with door to left and gabled covered porch

Medicine in the Age of Generative AI

Harvard Medical School — Mon, 16 Dec 2024 14:25:56 -0500

Harvard Medical School Medicine in the Age of Generative AI Multiple studies have shown that doctors spend most of their day writing or reading notes, rather than interacting with the patients described in those notes. Can generative AI help? Adam Rodman, an HMS assistant professor, says the vast knowledge that large language models hold could help doctors with the overwhelming cognitive load and provide a second opinion for diagnoses. “Never have I been so hopeful about a future where technology truly helps me be a better human being instead of trying to convert me into a data entry clerk whose primary job is to collect information,” Rodman said.

Rising Breast Cancer Rates Among Younger Women

Harvard Medical School — Sat, 14 Dec 2024 13:29:48 -0500

Harvard Medical School Rising Breast Cancer Rates Among Younger Women Breast cancer rates are rising, with steeper increases for women under 50 and Asian American and Pacific Islander women, according to a recent American Cancer Society report. HMS Professor Ann Partridge shares what doctors should think about given that the current screening recommendations may miss early diagnoses in younger women.

How HIV Research Has Reshaped Modern Medicine

Harvard Medical School — Wed, 04 Dec 2024 15:44:58 -0500

Harvard Medical School How HIV Research Has Reshaped Modern Medicine The impact of HIV research has turned a devastating illness into a manageable one. The work has also helped scientists understand other pathogens, infectious diseases, and the immune system. On World AIDS Day, Ruanne Barnabas, an HMS professor and Chief of the Division of Infectious Diseases at Massachusetts General Hospital, shares what the future of HIV research looks like.

A New Artificial Intelligence Tool for Rare Diseases

Harvard Medical School — Fri, 22 Nov 2024 16:05:14 -0500

Harvard Medical School A New Artificial Intelligence Tool for Rare Diseases There are more than 7,000 rare diseases that affect more than 300 million people worldwide. Only about 5 to 7% of those diseases have FDA-approved treatments. A new AI model created by researchers at Harvard Medical School identifies new candidate drugs from existing medicines for thousands of diseases. The tool can also “explain” its recommendations and provide the rationale for its choices.

What AI skills should students in science and medicine learn?

Harvard Medical School — Fri, 08 Nov 2024 15:00:45 -0500

Harvard Medical School What AI skills should students in science and medicine learn? Artificial intelligence is changing education for students in science and medicine. As doctors and researchers incorporate AI into their workflows, the adaptability of students trained in these technologies will stand out. “Tomorrow’s most successful physicians and researchers will be the ones who can harness generative AI for innovation and strategic planning,” says Taralyn Tan, assistant dean for educational scholarship and innovation in the HMS Office for Graduate Education.

Did AI solve the protein-folding problem?

Harvard Medical School — Thu, 31 Oct 2024 10:07:13 -0400

Harvard Medical School Did AI solve the protein-folding problem? Proteins start out in cells as strings of amino acids, kind of like strings of beads. Then they fold into complex structures — structures that reflect the key functions they play in health and disease. But the way these proteins fold into their final structure is incredibly difficult to predict. The so-called “protein-folding problem” stumped scientists for generations, and was even considered biology’s biggest mystery, until a machine learning model called AlphaFold2 appeared to crack the code a few years ago. Despite the success of AlphaFold and other AI models in predicting protein structures, HMS senior research fellow Nazim Bouatta argues that important aspects of the so-called “protein-folding problem” remain unsolved. Bouatta and HMS colleagues are building machine learning models that incorporate a deeper knowledge of protein dynamics and that are fully open-source, so they can be adapted by the wider scientific community.

Harvard Medicine magazine: AI in Medicine

Harvard Medical School — Tue, 29 Oct 2024 11:22:44 -0400

Harvard Medical School Harvard Medicine magazine: AI in Medicine Artificial intelligence is changing medicine, and it’s happening fast. From neural implants connecting brains with computers, to chatbots weighing in on diagnoses, today’s researchers and physicians are grappling with innovations that not long ago would have sounded like science fiction. As AI generates demand for doctors with skills in data and machine learning, medical education is also shifting. HMS is building AI into the curriculum to prepare students for a medical system transformed by AI. Explore how emerging technologies like generative AI are reshaping medicine in the latest issue of Harvard Medicine magazine: https://bit.ly/3YnGaSG Read the articles in the issue: How Generative AI Is Transforming Medical Education: https://bit.ly/3YHA29e Did AI Solve the Protein-Folding Problem?: https://bit.ly/4hleeaD Designing Brain-Computer Interfaces That Connect Neurons to the Digital World: https://bit.ly/4fpEJKq Can AI Make Medicine More Human?: https://bit.ly/4hozSe4 Machine Learning Can Predict the Weather — and Human Health: https://bit.ly/4f05pS8 Providing Thoughtful Leadership on AI in Medicine: https://bit.ly/40npqO3 A Biomedical Researcher on AI’s Promises and Pitfalls: https://bit.ly/3YmHWmR

Harvard Medical School Scientist Gary Ruvkun Receives Nobel Prize for Discovery of microRNA

Harvard Medical School — Tue, 08 Oct 2024 15:47:47 -0400

Harvard Medical School Harvard Medical School Scientist Gary Ruvkun Receives Nobel Prize for Discovery of microRNA Ruvkun shares award with Victor Ambros for elucidating a fundamental principle in gene activity regulation. Learn more: https://hms.harvard.edu/news/harvard-medical-school-scientist-gary-ruvkun-receives-nobel-prize-discovery-microrna

29 Berry Pink Hair Ideas to Refresh Your Look in 2024

Mon, 15 Jul 2024 15:51:42 -0400

29 Berry Pink Hair Ideas to Refresh Your Look in 2024

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Mon, 15 Jul 2024 15:50:42 -0400

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