PREMEDICAL CROSSWORD - CHALLENGING
Volume II Issue II
Across
1. The neural processing of noxious or painful stimuli. 5. The neural processing allowing for the perception of one’s body position. 6. A chemical that transmit signals from neurons to a target across a synapse. 8. The epithelial cells that line the cerebrospinal fluid-filled ventricles in the central nervous system. 10. A force that can rotate an object about a fulcrum. 12. An SN1 reaction is likely to produce a mixture that is _________. 13. A hormone secreted by the thyroid that reduces blood calcium levels. 19. This cytoskeleton component provides a platform for intracellular transport, i.e. vesicles in neurons. 20. The brain cannot only utilize glucose for energy. _________ work as well. 21. The system of membranes that envelopes the central nervous system. 24. The kidneys and lungs are in _________ in the circulatory circuit. 27. The amino acid that is a precursor for dopamine, epinephrine and norepinephrine. 28. The right carotid artery and left jugular vein are in ________ in the circulatory circuit. 30. The enzyme that catalyzes the decomposition of hydrogen peroxide to water and oxygen. 31. A peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein.
We Never Skip a Beat...
December 2011
Down
The Pitt Pulse Staff Editor in Chief
2011-2012
Abdul-Kareem Ahmed
Managing Editor Deborah Chen
2. These are essentially removed from sugars and dumped onto NAD and FAD during metabolism. 3. Used to describe two molecules that do not have exactly the opposite stereochemistry at each chiral center. 4. A bone cell that removes bone tissue. 7. The amino acid serotonin is derived from. 9. These mechanoreceptors serve a feedback loop from the circulatory system to the central nervous system to maintain pressure. 11. The process by which the liver constructs glucose from precursor molecules. 14. This protein complex binds calcium during the initiation of muscle contraction. 15. A state in a chemical reaction in which there is no net creation or utilization of reactants or products. 16. A bone cells responsible for bone formation. 17. Arterial plaque necessitates a higher blood _________ in order to maintain constant flow. 18. The system of blood vessels that link the hypothalamus and anterior pituitary gland. 22. The process by which the eye changes optical power to maintain a clear image of an object. 23. This reticulum stores calcium in muscle cells. 25. Skeletal and cardiac muscle is __________ whereas smooth muscle is not. 26. The __________ effect states that a local increase of speed of a fluid occurs with a local decrease in pressure. 29. Using these, the veins can shuttle blood against gravity.
MCAT Answers 1)c 2)c 3)a 4)a 5)d
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Is There a Doctor in the Sky? Malawi, A Flea Market Economy Free Will, Illusion and Neuroscience Transplantation, When Money is Not the Problem School Spotlight - The Commonwealth Medical College
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How Well Do You Know Anatomy?
Take your Pitt experiences to new heights with STATMedEvac Dan Bowman Contributing Writer Whether it’s getting a head start on your bedside manner as a friendly visitor or exploring a specialty like Gamma Knife Neurosurgery, volunteering and shadowing can mean much more than ticking a box on your pre-med checklist. In today’s overly competitive pool of qualified medical school applicants, it is becoming increasingly important to find experiences that can help to influence and establish your niche in a field as vast and multidisciplinary as medicine. It is a lot to shoulder, given the already busy schedule of classes, research, and extracurricular activities we prioritize each day, but shouldn’t the pre-med’s equivalent of the job search still be exciting and even fun? What if I told you the most thrilling medical experience you’ll find has been hovering right over your head ever since PittStart? I’m serious, that is not a metaphor; you can actually spend a day riding shotgun as a crew member of the STATMedEvac helicopter flight team. The program is open to any pre-med, rehabilitation science, nursing, or EMS student at Pitt, so the only thing keeping you from getting involved is a fear of heights. STATMedEvac is a specialized division among paramedics and pre-hospital caregivers, utilizing specialized pediatric physicians, respiratory therapists and second year medical residents to stabilize a patient before more thorough treatment can be administered at the nearest appropriate trauma center. UPMC Mercy and Presbyterian are both Level I Trauma Centers, while UPMC Children’s Hospital of Pittsburgh is a Level I Pediatric Trauma Center. What does it mean to be a level I trauma center? The hospital generally needs to be affiliated with a university medical school that includes trauma research, surgical residency, and an annual volume of at least 650 major cases. In most instances, a team of one flight nurse and one medic is sufficient to establish an airway and infuse stabilizing drugs, but certain cases like high-risk pregnancy and pediatrics require specialists to fly along as well. I recently took advantage of this program, spending the day with STATMedEvac 3, a unit based just north of Pittsburgh, in Cranberry Township. As you can imagine, when you’re on the precipice of your first helicopter flight or seeing first-hand a MedEvac team in action, it becomes easy to wake up to a 5 a.m. alarm. Once I arrived on base, the team briefing began promptly at 6:30 a.m. The ex-Navy pilot went over weather
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STATMedEvac hovering over downtown Pittsburgh Photo Courtesy of STATMedEvac team
and flight protocol in the orderly fashion you might expect of a military veteran; he didn’t need a cup of coffee to get going that morning, and when the alarm rang for my first dispatch, I found that the adrenaline coursing through my veins was more powerful than strongest cup of coffee anyways. In less than three minutes we were airborne. I was speechless. The dispatcher for the STATMedEvac team relayed critical information as the Ohio River came into view. Our orders were to pick up an auto accident victim for transport to the nearest adult Level I Trauma Center, in this case, UPMC Presbyterian right here in Oakland. My prior stint as a volunteer in the Presby E.R. was helpful in preparing for the circumstances of the accident. I had seen the type numerous times before, but the adrenaline of landing on the highway made this instance much more visceral. The mixture of excitement and heartfelt worry for the victim was a feeling many in the emergency medical field have to reason with, and by my understanding, is something best left alone until your job is not only complete, but done to the best of your ability. What really amazed me was the level of professionalism amidst controlled chaos. As I had seen previously from expert E.R. doctors and Presby’s trauma personnel, the teamwork and baffling speed these caregivers work with is nothing short of astonishing. With the victim stabilized and ready for transport, we were back in the air in no more than 10 minutes, en route to the Presby rooftop helipad. The flight nurse and medic had drips and the airway under control while the pilot got the go for landing next in line on the helipad. If you ever volunteer in Presby E.R., look for the black and gold flight suits of STATMedEvac. The flight nurse and medic both wheeled the patient off the rooftop, into an elevator and into
the E.R. where the head physician took the lead. As the flight medic brought the trauma team up to speed, our pilot circled over Schenley Park allowing other MedEvac’s to make their drops at the frantically busy Presby helipad. With that, MedEvac 3’s job was complete, leaving the patient in the hands of UPMC’s trauma unit. Despite the fact I had done nothing but take up space, I couldn’t help but feel pride in what the crew had accomplished. The flight back to base was again utterly breathtaking, topping off a truly inspiring morning. Particularly relevant for many of The Pitt Pulse readership is the experience STATMedEvac gives to second year medical residents. While in their emergency medicine rotation the burgeoning E.R. doctors are exposed to the fullest spectrum of trauma cases. The physician-in-training gains a great deal of insight by following treatment from the scene of an accident through to the bedside. This experience and understanding of the pre-hospital techniques and protocols can only help to smooth the translation of critical patient information between flight and trauma teams. Although I wasn’t qualified to be anything more than extra weight during my time aboard MedEvac 3, the experience I gained was as influential and memorable as any I’ve had. Although the commitment of aspiring to a career in medicine takes a great deal of work and effort, it is not without its own reward. Thanks to the evergrowing health science community established by UPMC and Pitt, opportunities like the one I’ve described really are accessible. So take advantage of all the resources around you and let those remarkable professional experiences fuel your desire to become someone great.
1) A block slides across a plane for 15 m during which time it encounters a constant force of 100 N. If the average velocity of the block across the plane is 5 m/s, what is the power exerted on the block in Watts? a) 200 W b) 300 W c) 500 W d) Not enough information given 2) How many grams of CO2 are produced in the reaction of Al2(CO3)3 → Al2O3 + CO2 (unbalanced) if you start with 3 moles of Al2(CO3)3 and the reaction yield is 60%? a) 5.4 g b) 79 g c) 238 g d) 397 g
MCAT Questions 3) The pancreas is responsible for the release of a significant amount of digestive enzymes which assist in the absorption of nutrients from food. The pancreas often stores these enzymes in their nonactive, zymogen form. When the enzymes are pumped into the small intestine, they can be activated through cleaving enzymes. Which of the following correctly explains why these enzymes would be released in a zymogenic form? a) To prevent from pancreatic damage b) To ensure that activation occurs prior to food entry into the duodenum c) To prevent the retrograde flow of enzymes from the small intestine to the pancreas d) To increase the catalytic rate of the digestive enzymes Answers on back Questions adapted from www.mcatquestion.com
4) A novel enzyme was discovered in bacterial family. The enzyme was structurally dissimilar to any other protein produced by the bacteria. It had novel function as well. Which of the following types of mutations is most likely to result in such an enzyme? a) Frameshift mutation b) Silent mutation c) Point mutation d) Reversion mutation 5) An unknown substance was shown to have a half-life of 5.0 seconds. If you observe 12.5 g of the substance after 15.0 seconds, how much of the substance was there initially? a) 12.5 g b) 25.0 g c) 50.0 g d) 100.0 g
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— School Spotlight —
The Commonwealth Medical College Rashmi Sagaram Staff Writer About the School The Commonwealth Medical College (TCMC) was established in 2008 and welcomed its first class in 2009. TCMC is one of the nation’s newest medical schools emphasizing a community-based, patient-centered approach to medical education with the goal of providing a greater number of qualified physicians, both primary care and specialists, in order to improve healthcare for the population of Northeastern Pennsylvania. The faculty of TCMC is comprised of over eighthundred physicians and scientists and is affiliated with twenty-three hospitals for clinical rotations and residency programs within its three regional campuses. TCMC is also home to a medical sciences building consisting of a clinical skills and human patient simulation laboratory, gross anatomy laboratory, small group study rooms, student lounges with smart boards, medical library with wireless internet access, faculty research laboratories, and café. Setting The medical school is located in Northeastern Pennsylvania and has three regional campuses: Scranton Regional Campus, Wilkes-Barre Regional Campus, and Williamsport Regional Campus. Medical students spend the first two years of medical school in the Scranton Regional Campus studying the medical science curriculum and select one of the regional campuses for their third and fourth year clinical rotations prior to matriculation. All three regional campuses have historic downtown centers with a variety of cultural and community events and concerts occurring throughout the year as well as numerous parks, rivers, and mountains such as the Susquehanna River and the Bald Eagle Mountain for nature lovers. For prospective medical students who do not wish to live in large, crowded cities with multiple medical schools and hospitals, TCMC would be a viable option to consider. Special Features TCMC offers three separate degree programs for its students: Doctor of Medicine (M.D.), Doctor of Medicine and Master in Health Administration (M.D.-M.H.A), and Master of Biomedical Sciences (M.B.S.). The M.D. program at TCMC is a traditional four year program. The first year and second year consists of students studying the structure and function of the human body focusing on the twelve main organ systems as well as
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courses studying medical ethics, clinical decision making, and the profession of medicine. Additionally, first and second year medical students shadow physicians, work on community public health projects, and are assigned a volunteer multi-generational family to follow throughout their four years in order to gain an understanding of healthcare issues as well as how to establish long term relationships with patients. Before the third year, students experience a two-week transitional clerkship prior to beginning clinical education. Third year medical students spend approximately four to five hours per week in direct patient contact in six core medical disciplines while also participating in educational lectures, patient case-based learning in small groups, and human simulation laboratory experiences. The fourth year is designed for medical students to train in advanced medical disciplines and prepare for residency programs. Fourth year medical students spend a minimum of thirty-seven weeks in clinical rotations and complete a clinical subinternship with a resident team at a TCMC affiliated hospital.
The M.D.-M.H.A. program at TCMC is a five year program which is divided by having students studying the medical science curriculum during their first and second years, studying for the M.H.A. at the University of Scranton’s Department of Health Administrations and Human Resources during their third year, and then returning back to one of TCMC’s regional campuses to complete clinical rotations during their fourth and fifth years. The M.B.S. program at TCMC is a one year post-baccalaureate program tailored to students who wish to improve their academic credentials for medical school as well as graduate schools of public health, health and rehabilitation sciences, biomedical research, and education. Students in the M.B.S. program complete upper-level medical science courses that are taken by first year medical students and are taught by the same faculty. A further highlight of the M.B.S. program includes an opportunity to improve MCAT scores with The Princeton Review’s “The Hyperlearning MCAT” course which consists of over onehundred hours of extensive, personalized MCAT preparation through twelve full-length practice exams. In addition to academics and test preparation, students in the M.B.S. program are involved in community public health projects, have opportunities to participate in simulated medical school interviews, and receive individualized academic and career advising. Student Life First and second year medical students are able to access an off-campus and community living guide online which consists of apartment complex listings and roommate questionnaires for incoming and returning students looking
for housing and roommates. Second year medical students meet with TCMC’s Student Affairs staff halfway through the year for housing transitions to one of the three regional campuses to spend their third and fourth years. TCMC has an array of student clubs and organizations with a wide range; students may choose from medical discipline interest groups, sports clubs, painting, and even medical and graduate student councils. Additionally, many students volunteer in service organizations in the Northeastern Pennsylvania area, choosing from thirteen different agencies such as Big Brothers, Big Sisters and The Salvation Army. Admissions Statistics, Class of 2015
IS = In-State, OOS = Out-of-State
Applying to and Interviewing at TCMC In order to apply to TCMC, students must complete the primary AMCAS application and submit letters of recommendation, official transcript, resume of extracurricular activities, and a personal statement. Afterwards, students may be invited to complete a secondary AMCAS application specifically for TCMC which consists of additional essays in order to be considered for an interview. Students selected for an interview arrive at the Scranton Regional Campus of TCMC and the interview day typically lasts for six hours. Upon arrival, students are given a general overview of TCMC and student life before interviewing with a faculty member and a fourth year medical student. After the interviews are complete, students go on a campus tour with a brief question and answer period following the campus tour. Throughout the interview day, students are able to speak with faculty members about their research and current TCMC students about their personal experiences with the school. Further Information
If you would like to learn more about The Commonwealth Medical College, please visit http://www.thecommonwealthmedical.com.
A Flea Market Economy Lauren Hasek Staff Writer We cautiously followed the man as he stepped away from the street. He moved elegantly through the small shantytown. Vendors woke from their mid-day slumbers and eagerly pressed towards us, goods in hand. We ducked beneath an aluminum overhang to enter a large three-sided structure built on an uneven cement slab. At either end, tailors sat at worn, wooden Singer sewing machines, cradling brightly colored fabrics in their hands, finished skirts and shirts hanging overhead. Between them, women sat behind rows of tables, stacked with folded chitenjes (elaborately designed fabrics worn as wrapped skirts). The vibrant cloths were folded into small rectangles and placed neatly next to one another, forming rows of bold colors and ornate patterns. Some of the women made great efforts to hassle each customer, eagerly unraveling any fabric our eyes would linger on. Others remained passive, watching as we ran our fingers over the rows.
occurring in infants and young children. Without intervention there is a 20-45% chance an HIV-positive woman in Malawi will pass the virus to her child during pregnancy, delivery, or through breastfeeding. Over the past decade, Malawi has been inundated with HIV education programs; despite the success of near 100% awareness across the country, there is no evidence the HIV prevalence has changed. Unfortunately, what women are being told and what nearly all of them have been found to know, often contradicts what they see occurring in their communities. Prolonged breastfeeding for up to three to four years is still very much an ingrained aspect of Malawian rearing practices. In a country where poverty is prevalent, breastfeeding ensures a child is receiving a meal regardless of economic constraints; the guarantee of food outweighs any perceived risk of mother-to-child infection. As a result, the reduction of prolonged infant feeding is heavily dependent on first increasing the accessibility of alternative feeding methods. Until poverty is reduced, those with economic constraints will pursue the feeding option that offers the most immediate benefit to the health of their child, regardless of the known risks.
The average Malawian citizen is far more educated concerning HIV-related risks then the average American. However, education alone cannot transcend the barriers to preventative actions amongst the Malawian people. Conquering the drastic global health care disparity begins by liberating the flea market economy that dominates much of the developing world. Until some degree of monetary freedom is achieved, no amount of education will change the calculated decisions women make to improve their immediate situations. Aide work makes us smile and warms our hearts, but it inevitably but it does nothing but place a BandAid on a gaping wound. Improving the global health disparity begins not with foreign clinics and eager aide workers, but rather with mobilization of the populations themselves and providing them with the opportunities and resources necessary to actively improve their own socioeconomic situations.
A series of meek cries caught our attention. A baby tossed its tiny fists as its mother tugged at its cloth diaper, fastening it with two rusting pins. He was trapped between reams of fabric, comically resembling a turtle on its shell. His cheeks were sunken into delicate dimples that quivered as he breathed. His belly ballooned. The mother’s tired eyes followed us closely. Let us say that hypothetically, that mother is HIV positive. It is not an uncommon scenario in Lilongwe, Malawi, where 20% of all pregnant women have been infected. Despite a decrease in instances of positive HIV diagnosis since 1998, the national HIV prevalence has remained at 11.9% since 2007, although it has been shown to be as high as 17.1% in urban centers throughout the country. With the ninth highest infection rate globally, Malawi is a large contributor to the growing percentage of new infections
Hasek Two young children residing in a small village in rural Lilongwe, Malawi
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Free Will, Illusion and Neuroscience
Transplantation, When Money Isn’t the Problem
energy expensive process. Oxygen is absolutely necessary. You have probably heard of Magnetic Resonance Imaging (MRI), a radiological technique used to visualize the internal body. Functional MRI, or fMRI, is a type of MRI that scans for oxygenated blood. The basic tenet of this technique is that active brain regions require more oxygenated blood. During an experiment, a participant performs an activity. A concurrent fMRI scans for oxygenated blood in the brain, and thus reveals brain regions used during that activity.
the basis for the formation of the God Committee: character and social factors. But sometimes these factors can be indicators of transplant success rate, not arbitrary judgments made by society. For example, organization and cleanliness are useful qualities to have with respect to following medication timetables and preventing infection, respectively. Patients with higher levels of independence are able to medicate themselves, attend their follow-up appointments, and maintain lifestyle changes without being nudged by those around them. Not of least importance, patients prone to anxiety and depression typically do not fare well under the stress of post-transplantation states. Not only do personal qualities potentially affect transplant success rates, but social factors can also impact transplant efficacy. Even with the most independent individuals, a strong support system serves as a great resource in transplant cases. Not only does it lend physical and practical support post-surgery, but just as importantly, it helps to keep the patient’s emotional well-being in check. To learn more about the kidney distribution process, I spoke with Dr. Ron Shapiro, a medical doctor, professor of surgery, and the Robert J. Corry Chair in Transplantation Surgery at the Thomas E. Starzl Transplantation Institute in UPMC. We discussed the events leading up to placement on the UNOS list. “The evaluation process is fairly extensive…You have to make sure the recipient is in good enough shape to get a transplant. They jump through large numbers of hoops: [we have to] make sure their heart’s okay; they have a social service consult; they have a psych consult often…So it’s a whole production before you can actually get listed.” He also reinforced the necessity for some sort of support, with an emphasis on the practical aspects of recovery, such as transportation, running errands, and helping manage medications. Dr. Shapiro noted the importance of medical adherence, and he said it is an issue that still has the ability to plague healthcare providers, especially those who work with transplantation patients who must take their immunosuppressants religiously. The best way to alleviate the limitations of the current organ distribution method is to increase donor awareness, thereby increasing the supply of organ banks. Though a distribution scheme would still be necessary, we would not need to rely upon it to such a degree. Most likely, physicians and bioethicists will always be making distribution decisions, but expanding the selection pool would naturally make the process less strenuous for them. Greater organ availability ultimately yields more potential transplants, leading to more people getting organs and fewer remaining on the UNOS list for extended periods of time, which can be fatal.
Abdul-Kareem Ahmed Editor “Give me liberty or Give me death!” demanded Patrick Henry at the 1775 Virginia Convention, swaying the vote to deliver Virginia troops to participate in the Revolutionary War. It is a wellknown cry, but perhaps its antiquity does it injustice. Sentimental cries for freedom usually conjure images of men in stockings and wigs, men usually only seen on the likes of coins and dollar bills. Even if it is not as apparent to us today, we are just as passionate about the idea of freedom. We assure ourselves that we have the inherent right to self-determination and the ability to choose freely. Free will is, after all, of the very essence of being human. Yet, neuroscientists have momentarily left their laboratories to inform us we don’t even have that. Free will is an illusion. Not surprisingly, some philosophers are tickled by the very notion. They’ve been arguing over free will’s definition for millennia. Others are nervous, as they sense the now unavoidable presence of brain science in the academic realm they used to command. John-Dylan Haynes, a neuroscientist at the Bernstein Center for Computational Neuroscience in Berlin published a study he led in Nature Neuroscience in 2007. The study, “Unconscious determinants of free decisions in the human brain” was a venture to determine if supposedly ‘free’ decisions are preempted in the brain, and if so, by how long. To understand his study requires some neuroscience knowledge. The prefrontal cortex lies just beneath your forehead. It is implicated in executive function: mediating conflicting decisions, determining right and wrong, better and best, and other relations. This part of your brain is the bottleneck decisions must go through, including motor decisions: to move or to not. Many decisions are filtered, so maladaptive actions can be inhibited. The parietal cortex is the superior (top) portion of your brain. This cortex is somatotopically organized, where senses from different parts of the body are integrated and represented in exact parts of the cortex. This map will eventually correlate to another cortex, your motor cortex. Sensory information from your hand goes to the parietal cortex which will relay to the hand section of the motor cortex. Thus, the parietal cortex is implicated in relaying motor activities, like picking up a hot cup of coffee. These are two of many parts of the brain. But how do scientists know which part of our brain we are using and when? A neuron firing is an
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The frontopolar cortex is Brodmann’s area 10, the precuneus area 7, and the posterior cingulate cortex areas 23 and 31. Haynes’s study of free will used fMRI to examine motor decisions. Participants were presented with a letter stream on a screen, where letters changed every 500ms. These letters would flash one by one. The participant was required to press a left or right button to choose a letter. This choice was spontaneous and represented an impulsive motor decision. In a second experiment, the participant had to make a voluntary decision. The requirement was to press the left or right button at a time indicated by the investigators. Thus, this was a conscious decision. The determination to press a button was developed far ahead of the motor decision. The imaging shows that two main regions are involved in such rapid decisions. These were the frontopolar cortex, a part of the prefrontal cortex, and the area between the precuneus and posterior cingulate cortex, parts of the parietal cortex. Activity in these areas is subconscious and precedes activity in regions indicative of conscious awareness of decisions by up to 10 seconds. In the second experiment, activity in
the frontopolar cortex preceded that in the precuneus. So, the frontopolar cortex could be responsible for the origination of the decision, and the precuneus the storage. Thus, both impulsive and conscious decisions require activity in these areas before the motor act of pressing a button. A participant is physically performing the action, but doesn’t have awareness of the decision to start doing so. They click a button after they decide to choose a letter, but the initiation to do so is not represented in areas considered conscious. Does that mean free will is an illusion? Well, the results certainly pose this question, but perhaps the waters are a little murkier than we think. Let’s think like a philosopher for a minute. To answer this question we need to define what we mean by “self,” “conscious,” and “free will.” Scholarship on these definitions alone can fill tomes. But at least for now we can consider this; if you possess the neural substrate, the cortices through which an action is initiated, but that neural substrate is unconsciously used, is that substrate still part of “you”? Does a cortex have to be consciously used for you to claim control over it? If not then to whom does that neural substrate, those two cortices belong? Who is responsible for actions they initiate? Thus, claiming free will an illusion is premature. Purporting these results undermine the notion of free will assumes free will is defined by our conscious decisions only. Our unconscious decisions are our own, whether we are aware of it or not. Maybe there is a reason behind having unconscious decisions. Being aware of every mundane decision you make is a waste of resources. Some must be relegated to the unconscious. This is not the first time an issue that philosophers have historically dominated has been questioned by the empirical sciences. Take morality for example. Up until the 20th century, certain human values were taken to be truths of intuition. These were grand truths one simply could not deny, like utilitarianism: one should act in a way to maximize a good outcome. However, in recent years neuroscience challenged the very idea of morality. Behaviors like morality are instead manifestations of levels of neurotransmitters like serotonin, a measly chemical in the brain. What then will happen to the idea of free will? Neuroscience has yet to shatter the idea of free will. And perhaps such human qualities can’t be reduced to cells and molecules. In history, science has often replaced folk wisdom with hard facts and lucid explanations. But what science cannot explain, man will always ponder. Philosophy can rest easy on this one, at least for now. The Founding Fathers had a grand idea in mind when they started this country. Freedom. Perhaps it is fitting that the current argument of free will was not had in the late 18th century. It might have been difficult to develop the American philosophy had the Founders been neuroscientists and philosophers.
Natalie Ernecoff Staff Writer The year was 1962, and four patients stood before a committee, but not in person. Their lives had been condensed to folders, papers, and medical records. This committee—consisting of seven anonymous laymen—would select one of them to continue living based on their contributions to society, their dependents, their character, and their potential. This was the basic structure behind the Seattle Swedish Hospital Admissions and Policies Committee, which came to be known as the “Seattle God Committee.” Established in 1962, this was the nation’s first major attempt in rationing healthcare. The committee was responsible for choosing which Washington state locals with kidney failure would receive access to the first hemodialysis machines. Physicians selected patients who were strong candidates from the biomedical perspective, and sent them to the committee for character and social evaluation. This was America’s first brush with distribution ethics, and it made the nation uncomfortable. The scene changed quickly when the God Committee started receiving publicity in the national media. Congress was quick to institute a policy that covered all patients who needed hemodialysis (no matter their condition) to avoid developing a rationing scheme, making the God Committee obsolete. This mitigated the issue of distribution ethics temporarily, but then organ transplantation abilities and facilities spread across the country. The limited number of organs forced bioethicists and physicians—in addition to policy makers and the public—to think about rationing, because no amount of money could make more organs available to them. Someone had to find a way to decide who got the organs and who did not. One of the most practical ways to start was to follow Seattle Swedish Hospital’s first step when they selected patients to go before the God Committee: select a pool of patients based on biomedical and geographical viability. This is the basis of the United Network for Organ Sharing (UNOS) list, which is used in practice today. Physicians must determine if their patients are likely to survive the procedure and have acceptable projected recovery, based on each patient’s own quality of life goals. They award points by consideration of these criteria, then place patients on the UNOS list, where they roll on a first-comefirst-serve basis within their point groupings. This system neglects something that was
Opposite the United States’ system, Europe’s current donor system requires citizens to opt out of being a donor if they so desire, in other words, they are donors by default under the presumed consent process. A change in the U.S. default status is unlikely, but public awareness would also be an effective improver of the modest donor pool. A change this drastic at the public health level may not be necessary, Shapiro suggested. Spain has the highest rate of donation although they have not instituted a presumed consent format. There, it is part of the job of nephrologists to identify potential donors in the hospital and notify them. This may have a better chance of adoption in the United States. Ultimately, there is no perfect way to select recipients of organs. The nature of the procurement rates in the United States requires that these decisions be difficult and unclear at times. There may, however, be multiple ways to optimize donation under the current circumstances. The scene of distribution ethics has changed since the days of the Seattle God Committee fifty years ago. The focus has shifted to primarily biomedical factors in addition to likelihood of success, while still considering the other aspects of viability. We, as physicians, ethicists, and members of society, face the dilemma of making decisions in ways that reach beyond biomedical classification. This will not change, since medicine has never been—and presumably never will be—a straightforward science.
Try the crossword on the back Then check back here for the answers
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Free Will, Illusion and Neuroscience
Transplantation, When Money Isn’t the Problem
energy expensive process. Oxygen is absolutely necessary. You have probably heard of Magnetic Resonance Imaging (MRI), a radiological technique used to visualize the internal body. Functional MRI, or fMRI, is a type of MRI that scans for oxygenated blood. The basic tenet of this technique is that active brain regions require more oxygenated blood. During an experiment, a participant performs an activity. A concurrent fMRI scans for oxygenated blood in the brain, and thus reveals brain regions used during that activity.
the basis for the formation of the God Committee: character and social factors. But sometimes these factors can be indicators of transplant success rate, not arbitrary judgments made by society. For example, organization and cleanliness are useful qualities to have with respect to following medication timetables and preventing infection, respectively. Patients with higher levels of independence are able to medicate themselves, attend their follow-up appointments, and maintain lifestyle changes without being nudged by those around them. Not of least importance, patients prone to anxiety and depression typically do not fare well under the stress of post-transplantation states. Not only do personal qualities potentially affect transplant success rates, but social factors can also impact transplant efficacy. Even with the most independent individuals, a strong support system serves as a great resource in transplant cases. Not only does it lend physical and practical support post-surgery, but just as importantly, it helps to keep the patient’s emotional well-being in check. To learn more about the kidney distribution process, I spoke with Dr. Ron Shapiro, a medical doctor, professor of surgery, and the Robert J. Corry Chair in Transplantation Surgery at the Thomas E. Starzl Transplantation Institute in UPMC. We discussed the events leading up to placement on the UNOS list. “The evaluation process is fairly extensive…You have to make sure the recipient is in good enough shape to get a transplant. They jump through large numbers of hoops: [we have to] make sure their heart’s okay; they have a social service consult; they have a psych consult often…So it’s a whole production before you can actually get listed.” He also reinforced the necessity for some sort of support, with an emphasis on the practical aspects of recovery, such as transportation, running errands, and helping manage medications. Dr. Shapiro noted the importance of medical adherence, and he said it is an issue that still has the ability to plague healthcare providers, especially those who work with transplantation patients who must take their immunosuppressants religiously. The best way to alleviate the limitations of the current organ distribution method is to increase donor awareness, thereby increasing the supply of organ banks. Though a distribution scheme would still be necessary, we would not need to rely upon it to such a degree. Most likely, physicians and bioethicists will always be making distribution decisions, but expanding the selection pool would naturally make the process less strenuous for them. Greater organ availability ultimately yields more potential transplants, leading to more people getting organs and fewer remaining on the UNOS list for extended periods of time, which can be fatal.
Abdul-Kareem Ahmed Editor “Give me liberty or Give me death!” demanded Patrick Henry at the 1775 Virginia Convention, swaying the vote to deliver Virginia troops to participate in the Revolutionary War. It is a wellknown cry, but perhaps its antiquity does it injustice. Sentimental cries for freedom usually conjure images of men in stockings and wigs, men usually only seen on the likes of coins and dollar bills. Even if it is not as apparent to us today, we are just as passionate about the idea of freedom. We assure ourselves that we have the inherent right to self-determination and the ability to choose freely. Free will is, after all, of the very essence of being human. Yet, neuroscientists have momentarily left their laboratories to inform us we don’t even have that. Free will is an illusion. Not surprisingly, some philosophers are tickled by the very notion. They’ve been arguing over free will’s definition for millennia. Others are nervous, as they sense the now unavoidable presence of brain science in the academic realm they used to command. John-Dylan Haynes, a neuroscientist at the Bernstein Center for Computational Neuroscience in Berlin published a study he led in Nature Neuroscience in 2007. The study, “Unconscious determinants of free decisions in the human brain” was a venture to determine if supposedly ‘free’ decisions are preempted in the brain, and if so, by how long. To understand his study requires some neuroscience knowledge. The prefrontal cortex lies just beneath your forehead. It is implicated in executive function: mediating conflicting decisions, determining right and wrong, better and best, and other relations. This part of your brain is the bottleneck decisions must go through, including motor decisions: to move or to not. Many decisions are filtered, so maladaptive actions can be inhibited. The parietal cortex is the superior (top) portion of your brain. This cortex is somatotopically organized, where senses from different parts of the body are integrated and represented in exact parts of the cortex. This map will eventually correlate to another cortex, your motor cortex. Sensory information from your hand goes to the parietal cortex which will relay to the hand section of the motor cortex. Thus, the parietal cortex is implicated in relaying motor activities, like picking up a hot cup of coffee. These are two of many parts of the brain. But how do scientists know which part of our brain we are using and when? A neuron firing is an
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The frontopolar cortex is Brodmann’s area 10, the precuneus area 7, and the posterior cingulate cortex areas 23 and 31. Haynes’s study of free will used fMRI to examine motor decisions. Participants were presented with a letter stream on a screen, where letters changed every 500ms. These letters would flash one by one. The participant was required to press a left or right button to choose a letter. This choice was spontaneous and represented an impulsive motor decision. In a second experiment, the participant had to make a voluntary decision. The requirement was to press the left or right button at a time indicated by the investigators. Thus, this was a conscious decision. The determination to press a button was developed far ahead of the motor decision. The imaging shows that two main regions are involved in such rapid decisions. These were the frontopolar cortex, a part of the prefrontal cortex, and the area between the precuneus and posterior cingulate cortex, parts of the parietal cortex. Activity in these areas is subconscious and precedes activity in regions indicative of conscious awareness of decisions by up to 10 seconds. In the second experiment, activity in
the frontopolar cortex preceded that in the precuneus. So, the frontopolar cortex could be responsible for the origination of the decision, and the precuneus the storage. Thus, both impulsive and conscious decisions require activity in these areas before the motor act of pressing a button. A participant is physically performing the action, but doesn’t have awareness of the decision to start doing so. They click a button after they decide to choose a letter, but the initiation to do so is not represented in areas considered conscious. Does that mean free will is an illusion? Well, the results certainly pose this question, but perhaps the waters are a little murkier than we think. Let’s think like a philosopher for a minute. To answer this question we need to define what we mean by “self,” “conscious,” and “free will.” Scholarship on these definitions alone can fill tomes. But at least for now we can consider this; if you possess the neural substrate, the cortices through which an action is initiated, but that neural substrate is unconsciously used, is that substrate still part of “you”? Does a cortex have to be consciously used for you to claim control over it? If not then to whom does that neural substrate, those two cortices belong? Who is responsible for actions they initiate? Thus, claiming free will an illusion is premature. Purporting these results undermine the notion of free will assumes free will is defined by our conscious decisions only. Our unconscious decisions are our own, whether we are aware of it or not. Maybe there is a reason behind having unconscious decisions. Being aware of every mundane decision you make is a waste of resources. Some must be relegated to the unconscious. This is not the first time an issue that philosophers have historically dominated has been questioned by the empirical sciences. Take morality for example. Up until the 20th century, certain human values were taken to be truths of intuition. These were grand truths one simply could not deny, like utilitarianism: one should act in a way to maximize a good outcome. However, in recent years neuroscience challenged the very idea of morality. Behaviors like morality are instead manifestations of levels of neurotransmitters like serotonin, a measly chemical in the brain. What then will happen to the idea of free will? Neuroscience has yet to shatter the idea of free will. And perhaps such human qualities can’t be reduced to cells and molecules. In history, science has often replaced folk wisdom with hard facts and lucid explanations. But what science cannot explain, man will always ponder. Philosophy can rest easy on this one, at least for now. The Founding Fathers had a grand idea in mind when they started this country. Freedom. Perhaps it is fitting that the current argument of free will was not had in the late 18th century. It might have been difficult to develop the American philosophy had the Founders been neuroscientists and philosophers.
Natalie Ernecoff Staff Writer The year was 1962, and four patients stood before a committee, but not in person. Their lives had been condensed to folders, papers, and medical records. This committee—consisting of seven anonymous laymen—would select one of them to continue living based on their contributions to society, their dependents, their character, and their potential. This was the basic structure behind the Seattle Swedish Hospital Admissions and Policies Committee, which came to be known as the “Seattle God Committee.” Established in 1962, this was the nation’s first major attempt in rationing healthcare. The committee was responsible for choosing which Washington state locals with kidney failure would receive access to the first hemodialysis machines. Physicians selected patients who were strong candidates from the biomedical perspective, and sent them to the committee for character and social evaluation. This was America’s first brush with distribution ethics, and it made the nation uncomfortable. The scene changed quickly when the God Committee started receiving publicity in the national media. Congress was quick to institute a policy that covered all patients who needed hemodialysis (no matter their condition) to avoid developing a rationing scheme, making the God Committee obsolete. This mitigated the issue of distribution ethics temporarily, but then organ transplantation abilities and facilities spread across the country. The limited number of organs forced bioethicists and physicians—in addition to policy makers and the public—to think about rationing, because no amount of money could make more organs available to them. Someone had to find a way to decide who got the organs and who did not. One of the most practical ways to start was to follow Seattle Swedish Hospital’s first step when they selected patients to go before the God Committee: select a pool of patients based on biomedical and geographical viability. This is the basis of the United Network for Organ Sharing (UNOS) list, which is used in practice today. Physicians must determine if their patients are likely to survive the procedure and have acceptable projected recovery, based on each patient’s own quality of life goals. They award points by consideration of these criteria, then place patients on the UNOS list, where they roll on a first-comefirst-serve basis within their point groupings. This system neglects something that was
Opposite the United States’ system, Europe’s current donor system requires citizens to opt out of being a donor if they so desire, in other words, they are donors by default under the presumed consent process. A change in the U.S. default status is unlikely, but public awareness would also be an effective improver of the modest donor pool. A change this drastic at the public health level may not be necessary, Shapiro suggested. Spain has the highest rate of donation although they have not instituted a presumed consent format. There, it is part of the job of nephrologists to identify potential donors in the hospital and notify them. This may have a better chance of adoption in the United States. Ultimately, there is no perfect way to select recipients of organs. The nature of the procurement rates in the United States requires that these decisions be difficult and unclear at times. There may, however, be multiple ways to optimize donation under the current circumstances. The scene of distribution ethics has changed since the days of the Seattle God Committee fifty years ago. The focus has shifted to primarily biomedical factors in addition to likelihood of success, while still considering the other aspects of viability. We, as physicians, ethicists, and members of society, face the dilemma of making decisions in ways that reach beyond biomedical classification. This will not change, since medicine has never been—and presumably never will be—a straightforward science.
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— School Spotlight —
The Commonwealth Medical College Rashmi Sagaram Staff Writer About the School The Commonwealth Medical College (TCMC) was established in 2008 and welcomed its first class in 2009. TCMC is one of the nation’s newest medical schools emphasizing a community-based, patient-centered approach to medical education with the goal of providing a greater number of qualified physicians, both primary care and specialists, in order to improve healthcare for the population of Northeastern Pennsylvania. The faculty of TCMC is comprised of over eighthundred physicians and scientists and is affiliated with twenty-three hospitals for clinical rotations and residency programs within its three regional campuses. TCMC is also home to a medical sciences building consisting of a clinical skills and human patient simulation laboratory, gross anatomy laboratory, small group study rooms, student lounges with smart boards, medical library with wireless internet access, faculty research laboratories, and café. Setting The medical school is located in Northeastern Pennsylvania and has three regional campuses: Scranton Regional Campus, Wilkes-Barre Regional Campus, and Williamsport Regional Campus. Medical students spend the first two years of medical school in the Scranton Regional Campus studying the medical science curriculum and select one of the regional campuses for their third and fourth year clinical rotations prior to matriculation. All three regional campuses have historic downtown centers with a variety of cultural and community events and concerts occurring throughout the year as well as numerous parks, rivers, and mountains such as the Susquehanna River and the Bald Eagle Mountain for nature lovers. For prospective medical students who do not wish to live in large, crowded cities with multiple medical schools and hospitals, TCMC would be a viable option to consider. Special Features TCMC offers three separate degree programs for its students: Doctor of Medicine (M.D.), Doctor of Medicine and Master in Health Administration (M.D.-M.H.A), and Master of Biomedical Sciences (M.B.S.). The M.D. program at TCMC is a traditional four year program. The first year and second year consists of students studying the structure and function of the human body focusing on the twelve main organ systems as well as
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courses studying medical ethics, clinical decision making, and the profession of medicine. Additionally, first and second year medical students shadow physicians, work on community public health projects, and are assigned a volunteer multi-generational family to follow throughout their four years in order to gain an understanding of healthcare issues as well as how to establish long term relationships with patients. Before the third year, students experience a two-week transitional clerkship prior to beginning clinical education. Third year medical students spend approximately four to five hours per week in direct patient contact in six core medical disciplines while also participating in educational lectures, patient case-based learning in small groups, and human simulation laboratory experiences. The fourth year is designed for medical students to train in advanced medical disciplines and prepare for residency programs. Fourth year medical students spend a minimum of thirty-seven weeks in clinical rotations and complete a clinical subinternship with a resident team at a TCMC affiliated hospital.
The M.D.-M.H.A. program at TCMC is a five year program which is divided by having students studying the medical science curriculum during their first and second years, studying for the M.H.A. at the University of Scranton’s Department of Health Administrations and Human Resources during their third year, and then returning back to one of TCMC’s regional campuses to complete clinical rotations during their fourth and fifth years. The M.B.S. program at TCMC is a one year post-baccalaureate program tailored to students who wish to improve their academic credentials for medical school as well as graduate schools of public health, health and rehabilitation sciences, biomedical research, and education. Students in the M.B.S. program complete upper-level medical science courses that are taken by first year medical students and are taught by the same faculty. A further highlight of the M.B.S. program includes an opportunity to improve MCAT scores with The Princeton Review’s “The Hyperlearning MCAT” course which consists of over onehundred hours of extensive, personalized MCAT preparation through twelve full-length practice exams. In addition to academics and test preparation, students in the M.B.S. program are involved in community public health projects, have opportunities to participate in simulated medical school interviews, and receive individualized academic and career advising. Student Life First and second year medical students are able to access an off-campus and community living guide online which consists of apartment complex listings and roommate questionnaires for incoming and returning students looking
for housing and roommates. Second year medical students meet with TCMC’s Student Affairs staff halfway through the year for housing transitions to one of the three regional campuses to spend their third and fourth years. TCMC has an array of student clubs and organizations with a wide range; students may choose from medical discipline interest groups, sports clubs, painting, and even medical and graduate student councils. Additionally, many students volunteer in service organizations in the Northeastern Pennsylvania area, choosing from thirteen different agencies such as Big Brothers, Big Sisters and The Salvation Army. Admissions Statistics, Class of 2015
IS = In-State, OOS = Out-of-State
Applying to and Interviewing at TCMC In order to apply to TCMC, students must complete the primary AMCAS application and submit letters of recommendation, official transcript, resume of extracurricular activities, and a personal statement. Afterwards, students may be invited to complete a secondary AMCAS application specifically for TCMC which consists of additional essays in order to be considered for an interview. Students selected for an interview arrive at the Scranton Regional Campus of TCMC and the interview day typically lasts for six hours. Upon arrival, students are given a general overview of TCMC and student life before interviewing with a faculty member and a fourth year medical student. After the interviews are complete, students go on a campus tour with a brief question and answer period following the campus tour. Throughout the interview day, students are able to speak with faculty members about their research and current TCMC students about their personal experiences with the school. Further Information
If you would like to learn more about The Commonwealth Medical College, please visit http://www.thecommonwealthmedical.com.
A Flea Market Economy Lauren Hasek Staff Writer We cautiously followed the man as he stepped away from the street. He moved elegantly through the small shantytown. Vendors woke from their mid-day slumbers and eagerly pressed towards us, goods in hand. We ducked beneath an aluminum overhang to enter a large three-sided structure built on an uneven cement slab. At either end, tailors sat at worn, wooden Singer sewing machines, cradling brightly colored fabrics in their hands, finished skirts and shirts hanging overhead. Between them, women sat behind rows of tables, stacked with folded chitenjes (elaborately designed fabrics worn as wrapped skirts). The vibrant cloths were folded into small rectangles and placed neatly next to one another, forming rows of bold colors and ornate patterns. Some of the women made great efforts to hassle each customer, eagerly unraveling any fabric our eyes would linger on. Others remained passive, watching as we ran our fingers over the rows.
occurring in infants and young children. Without intervention there is a 20-45% chance an HIV-positive woman in Malawi will pass the virus to her child during pregnancy, delivery, or through breastfeeding. Over the past decade, Malawi has been inundated with HIV education programs; despite the success of near 100% awareness across the country, there is no evidence the HIV prevalence has changed. Unfortunately, what women are being told and what nearly all of them have been found to know, often contradicts what they see occurring in their communities. Prolonged breastfeeding for up to three to four years is still very much an ingrained aspect of Malawian rearing practices. In a country where poverty is prevalent, breastfeeding ensures a child is receiving a meal regardless of economic constraints; the guarantee of food outweighs any perceived risk of mother-to-child infection. As a result, the reduction of prolonged infant feeding is heavily dependent on first increasing the accessibility of alternative feeding methods. Until poverty is reduced, those with economic constraints will pursue the feeding option that offers the most immediate benefit to the health of their child, regardless of the known risks.
The average Malawian citizen is far more educated concerning HIV-related risks then the average American. However, education alone cannot transcend the barriers to preventative actions amongst the Malawian people. Conquering the drastic global health care disparity begins by liberating the flea market economy that dominates much of the developing world. Until some degree of monetary freedom is achieved, no amount of education will change the calculated decisions women make to improve their immediate situations. Aide work makes us smile and warms our hearts, but it inevitably but it does nothing but place a BandAid on a gaping wound. Improving the global health disparity begins not with foreign clinics and eager aide workers, but rather with mobilization of the populations themselves and providing them with the opportunities and resources necessary to actively improve their own socioeconomic situations.
A series of meek cries caught our attention. A baby tossed its tiny fists as its mother tugged at its cloth diaper, fastening it with two rusting pins. He was trapped between reams of fabric, comically resembling a turtle on its shell. His cheeks were sunken into delicate dimples that quivered as he breathed. His belly ballooned. The mother’s tired eyes followed us closely. Let us say that hypothetically, that mother is HIV positive. It is not an uncommon scenario in Lilongwe, Malawi, where 20% of all pregnant women have been infected. Despite a decrease in instances of positive HIV diagnosis since 1998, the national HIV prevalence has remained at 11.9% since 2007, although it has been shown to be as high as 17.1% in urban centers throughout the country. With the ninth highest infection rate globally, Malawi is a large contributor to the growing percentage of new infections
Hasek Two young children residing in a small village in rural Lilongwe, Malawi
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How Well Do You Know Anatomy?
Take your Pitt experiences to new heights with STATMedEvac Dan Bowman Contributing Writer Whether it’s getting a head start on your bedside manner as a friendly visitor or exploring a specialty like Gamma Knife Neurosurgery, volunteering and shadowing can mean much more than ticking a box on your pre-med checklist. In today’s overly competitive pool of qualified medical school applicants, it is becoming increasingly important to find experiences that can help to influence and establish your niche in a field as vast and multidisciplinary as medicine. It is a lot to shoulder, given the already busy schedule of classes, research, and extracurricular activities we prioritize each day, but shouldn’t the pre-med’s equivalent of the job search still be exciting and even fun? What if I told you the most thrilling medical experience you’ll find has been hovering right over your head ever since PittStart? I’m serious, that is not a metaphor; you can actually spend a day riding shotgun as a crew member of the STATMedEvac helicopter flight team. The program is open to any pre-med, rehabilitation science, nursing, or EMS student at Pitt, so the only thing keeping you from getting involved is a fear of heights. STATMedEvac is a specialized division among paramedics and pre-hospital caregivers, utilizing specialized pediatric physicians, respiratory therapists and second year medical residents to stabilize a patient before more thorough treatment can be administered at the nearest appropriate trauma center. UPMC Mercy and Presbyterian are both Level I Trauma Centers, while UPMC Children’s Hospital of Pittsburgh is a Level I Pediatric Trauma Center. What does it mean to be a level I trauma center? The hospital generally needs to be affiliated with a university medical school that includes trauma research, surgical residency, and an annual volume of at least 650 major cases. In most instances, a team of one flight nurse and one medic is sufficient to establish an airway and infuse stabilizing drugs, but certain cases like high-risk pregnancy and pediatrics require specialists to fly along as well. I recently took advantage of this program, spending the day with STATMedEvac 3, a unit based just north of Pittsburgh, in Cranberry Township. As you can imagine, when you’re on the precipice of your first helicopter flight or seeing first-hand a MedEvac team in action, it becomes easy to wake up to a 5 a.m. alarm. Once I arrived on base, the team briefing began promptly at 6:30 a.m. The ex-Navy pilot went over weather
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STATMedEvac hovering over downtown Pittsburgh Photo Courtesy of STATMedEvac team
and flight protocol in the orderly fashion you might expect of a military veteran; he didn’t need a cup of coffee to get going that morning, and when the alarm rang for my first dispatch, I found that the adrenaline coursing through my veins was more powerful than strongest cup of coffee anyways. In less than three minutes we were airborne. I was speechless. The dispatcher for the STATMedEvac team relayed critical information as the Ohio River came into view. Our orders were to pick up an auto accident victim for transport to the nearest adult Level I Trauma Center, in this case, UPMC Presbyterian right here in Oakland. My prior stint as a volunteer in the Presby E.R. was helpful in preparing for the circumstances of the accident. I had seen the type numerous times before, but the adrenaline of landing on the highway made this instance much more visceral. The mixture of excitement and heartfelt worry for the victim was a feeling many in the emergency medical field have to reason with, and by my understanding, is something best left alone until your job is not only complete, but done to the best of your ability. What really amazed me was the level of professionalism amidst controlled chaos. As I had seen previously from expert E.R. doctors and Presby’s trauma personnel, the teamwork and baffling speed these caregivers work with is nothing short of astonishing. With the victim stabilized and ready for transport, we were back in the air in no more than 10 minutes, en route to the Presby rooftop helipad. The flight nurse and medic had drips and the airway under control while the pilot got the go for landing next in line on the helipad. If you ever volunteer in Presby E.R., look for the black and gold flight suits of STATMedEvac. The flight nurse and medic both wheeled the patient off the rooftop, into an elevator and into
the E.R. where the head physician took the lead. As the flight medic brought the trauma team up to speed, our pilot circled over Schenley Park allowing other MedEvac’s to make their drops at the frantically busy Presby helipad. With that, MedEvac 3’s job was complete, leaving the patient in the hands of UPMC’s trauma unit. Despite the fact I had done nothing but take up space, I couldn’t help but feel pride in what the crew had accomplished. The flight back to base was again utterly breathtaking, topping off a truly inspiring morning. Particularly relevant for many of The Pitt Pulse readership is the experience STATMedEvac gives to second year medical residents. While in their emergency medicine rotation the burgeoning E.R. doctors are exposed to the fullest spectrum of trauma cases. The physician-in-training gains a great deal of insight by following treatment from the scene of an accident through to the bedside. This experience and understanding of the pre-hospital techniques and protocols can only help to smooth the translation of critical patient information between flight and trauma teams. Although I wasn’t qualified to be anything more than extra weight during my time aboard MedEvac 3, the experience I gained was as influential and memorable as any I’ve had. Although the commitment of aspiring to a career in medicine takes a great deal of work and effort, it is not without its own reward. Thanks to the evergrowing health science community established by UPMC and Pitt, opportunities like the one I’ve described really are accessible. So take advantage of all the resources around you and let those remarkable professional experiences fuel your desire to become someone great.
1) A block slides across a plane for 15 m during which time it encounters a constant force of 100 N. If the average velocity of the block across the plane is 5 m/s, what is the power exerted on the block in Watts? a) 200 W b) 300 W c) 500 W d) Not enough information given 2) How many grams of CO2 are produced in the reaction of Al2(CO3)3 → Al2O3 + CO2 (unbalanced) if you start with 3 moles of Al2(CO3)3 and the reaction yield is 60%? a) 5.4 g b) 79 g c) 238 g d) 397 g
MCAT Questions 3) The pancreas is responsible for the release of a significant amount of digestive enzymes which assist in the absorption of nutrients from food. The pancreas often stores these enzymes in their nonactive, zymogen form. When the enzymes are pumped into the small intestine, they can be activated through cleaving enzymes. Which of the following correctly explains why these enzymes would be released in a zymogenic form? a) To prevent from pancreatic damage b) To ensure that activation occurs prior to food entry into the duodenum c) To prevent the retrograde flow of enzymes from the small intestine to the pancreas d) To increase the catalytic rate of the digestive enzymes Answers on back Questions adapted from www.mcatquestion.com
4) A novel enzyme was discovered in bacterial family. The enzyme was structurally dissimilar to any other protein produced by the bacteria. It had novel function as well. Which of the following types of mutations is most likely to result in such an enzyme? a) Frameshift mutation b) Silent mutation c) Point mutation d) Reversion mutation 5) An unknown substance was shown to have a half-life of 5.0 seconds. If you observe 12.5 g of the substance after 15.0 seconds, how much of the substance was there initially? a) 12.5 g b) 25.0 g c) 50.0 g d) 100.0 g
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PREMEDICAL CROSSWORD - CHALLENGING
Volume II Issue II
Across
1. The neural processing of noxious or painful stimuli. 5. The neural processing allowing for the perception of one’s body position. 6. A chemical that transmit signals from neurons to a target across a synapse. 8. The epithelial cells that line the cerebrospinal fluid-filled ventricles in the central nervous system. 10. A force that can rotate an object about a fulcrum. 12. An SN1 reaction is likely to produce a mixture that is _________. 13. A hormone secreted by the thyroid that reduces blood calcium levels. 19. This cytoskeleton component provides a platform for intracellular transport, i.e. vesicles in neurons. 20. The brain cannot only utilize glucose for energy. _________ work as well. 21. The system of membranes that envelopes the central nervous system. 24. The kidneys and lungs are in _________ in the circulatory circuit. 27. The amino acid that is a precursor for dopamine, epinephrine and norepinephrine. 28. The right carotid artery and left jugular vein are in ________ in the circulatory circuit. 30. The enzyme that catalyzes the decomposition of hydrogen peroxide to water and oxygen. 31. A peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein.
We Never Skip a Beat...
December 2011
Down
The Pitt Pulse Staff Editor in Chief
2011-2012
Abdul-Kareem Ahmed
Managing Editor Deborah Chen
2. These are essentially removed from sugars and dumped onto NAD and FAD during metabolism. 3. Used to describe two molecules that do not have exactly the opposite stereochemistry at each chiral center. 4. A bone cell that removes bone tissue. 7. The amino acid serotonin is derived from. 9. These mechanoreceptors serve a feedback loop from the circulatory system to the central nervous system to maintain pressure. 11. The process by which the liver constructs glucose from precursor molecules. 14. This protein complex binds calcium during the initiation of muscle contraction. 15. A state in a chemical reaction in which there is no net creation or utilization of reactants or products. 16. A bone cells responsible for bone formation. 17. Arterial plaque necessitates a higher blood _________ in order to maintain constant flow. 18. The system of blood vessels that link the hypothalamus and anterior pituitary gland. 22. The process by which the eye changes optical power to maintain a clear image of an object. 23. This reticulum stores calcium in muscle cells. 25. Skeletal and cardiac muscle is __________ whereas smooth muscle is not. 26. The __________ effect states that a local increase of speed of a fluid occurs with a local decrease in pressure. 29. Using these, the veins can shuttle blood against gravity.
MCAT Answers 1)c 2)c 3)a 4)a 5)d
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Is There a Doctor in the Sky? Malawi, A Flea Market Economy Free Will, Illusion and Neuroscience Transplantation, When Money is Not the Problem School Spotlight - The Commonwealth Medical College
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