Author Interviews, Breast Cancer, Mammograms / 07.12.2022

MedicalResearch.com Interview with: Wendie Berg, MD, PhD, FACR Professor of Radiology University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Mammography misses many cancers in women with a personal history of breast cancer (PHBC). MRI improves early detection of cancer in women with PHBC and the American College of Radiology recommends adding MRI every year for women with PHBC and dense breasts or diagnosis by age 50 but not every woman can tolerate MRI. Contrast-enhanced mammography (CEM) appears to be a good alternative to MRI.  Our study examined performance of CEM after tomosynthesis in women with PHBC.  We first trained our radiologists in CEM (Berg WA et al JBI 2021) and two radiologists interpreted both tomosynthesis and CEM on every participant. (more…)
Author Interviews, Cancer Research, Duke, Heart Disease, Pediatrics / 06.12.2022

MedicalResearch.com Interview with: Amy Berkman, MD Department of Pediatrics Duke University School of Medicine MedicalResearch.com: What is the background for this study? Response: Cancer incidence in adolescents and young adults (AYAs, aged 15-39 years at diagnosis) is increasing, with approximately 90,000 new diagnoses annually in the US. Improvements in 5-year survival have led to a growing population of survivors of AYA cancer, currently estimated at >600,000 survivors. Survivors are at increased risk of treatment related chronic conditions including cardiovascular disease (CVD). We wanted to determine whether certain sociodemographic and medical history factors further increase the risk of CVD in AYA cancer survivors and also compare risk of CVD between AYA cancer survivors and the general population. (more…)
Author Interviews, Heart Disease, JACC, Supplements / 06.12.2022

MedicalResearch.com Interview with: Simin Liu MD MPH ScD Professor of Epidemiology at the School of Public Health, Professor of Medicine (Endocrinology) and Professor of Surgery at the Alpert School of Medicine Brown University MedicalResearch.com: What is the background for this study? Response: Our research team has been researching the roles of environmental and genetic determinants of chronic diseases for nearly three decades, with special emphasis on evaluating micronutrients, minerals, and trace elements in relation to cardiometabolic outcomes, and findings of which have contributed to the design of several large, randomized trials of dietary supplements in the US (Liu JAMA 1999; 2011; Diabetes Care 2005a,b; Diabetes 2006).  Several large intervention trials have consistently shown beneficial effects on clinical cardiometabolic outcomes of a diet pattern rich in micronutrients, although research on micronutrient supplementation has mainly focused on the health effects of a single or a few vitamins and minerals. We decided to take a comprehensive and systematic approach to evaluate all the publicly available/accessible studies reporting all micronutrients including phytochemicals and antioxidant supplements and their effects on cardiovascular risk factors as well as multiple CVDs. (more…)
Addiction, Author Interviews, Pain Research / 01.12.2022

  MedicalResearch.com Interview with: Lavinia Harrison Geisinger Commonwealth School of Medicine Scranton, PA  18509 MedicalResearch.com: What is the background for this study? Response:   The opioid meperidine (Demerol) was widely prescribed in the United States (US) as an analgesic to treat moderate to severe pain. Meperidine was the most used opioid in the US in 1987 and was considered safer than other opioids during acute pancreatitis. Over the past two decades, meperidine has shifted from being frequently prescribed to being used only when patients are experiencing atypical reactions to opioids (e.g., morphine and hydromorphone); to removal from the World Health Organization's essential medication list and receiving strong warnings against its use from many professional organizations including the American Geriatrics Society. The unfortunate Libby Zion (1965-1984) case increased concerns about serotonin syndrome with meperidine. According to a prior pharmacoepidemiology report, the distribution of meperidine in the United States decreased by 95% between 2001 and 2019 [1]. The aim of the study was to include updated information (2020 and 2021) as well as examine the changes among Medicaid patients [2]. (more…)
Author Interviews, Cost of Health Care, Rheumatology, University of Pittsburgh / 01.12.2022

MedicalResearch.com Interview with: Raisa Silva, M.D. Resident physician in Internal medicine University of Pittsburgh Medical Center MedicalResearch.com: What is the background for this study? Response: Systemic lupus erythematosus (lupus for short) is a complex disease that significantly affects patients’ lives. Adherence to medications for lupus is known to be suboptimal (it can be as low as 15% in some studies). Multiple social factors may affect treatment adherence. For example, costs of medications (including copayments, deductibles, co-sharing), polypharmacy (patients with lupus often have comorbid diseases that also need medications), and potential side effects are some of the reasons why patients may have difficulty in taking medications for lupus every day. The costs of insurance copayment may represent a major obstacle to adherence. The lack of adherence to lupus medications is associated with poor control of disease, more symptoms, and worse disease outcomes, such as more hospitalizations and more severe disease. In our study, we examined the association between lupus medications copayment and adherence to these medications (some of the most commonly used medications for lupus). (more…)
Nursing / 01.12.2022

If you have a loved one who needs medical care for a health condition, you might struggle to find the time to provide this care yourself or find adequate carers to visit your loved one at home. Therefore, thinking about care homes can be a useful step. If you or your loved one is unsure about the idea, here are some of the medical benefits that living in a care home can offer. Professional Carers You may have been providing at-home care for your loved one for a while now, but in a care home, there are professionally trained carers who have all the necessary skills and techniques to assist every resident. This gives both the resident and the resident's family peace of mind that they are receiving high-quality care. Nursing Staff Having nursing staff always available makes a care home a far safer environment for someone with a medical condition that needs regular monitoring and assistance. Many care homes employ skilled nurses to give treatments and medications according to residents' needs. The level of planning and consideration that goes into this is usually far superior to any other setting. (more…)
Author Interviews / 30.11.2022

If you find yourself in an emergency situation, then it is important that you have a fully functioning first aid kit to hand. This should be a small kit filled with different supplies that will be helpful for various injuries and ailments.  The Importance of Contents It is incredibly important that the contents of your first aid kit are of high quality and include everything you need – because without them, you will not be able to use the equipment to its fullest extent in an emergency, and you may lack crucial pieces. You can buy complete first aid kits online that are already full of everything you need; however, you will have to keep a list of these supplies so that you can replenish your gear as and when you need to. As such, below, this article will discuss the most crucial components that should make up your first aid kit in more detail. (more…)
Accidents & Violence, Author Interviews, Brigham & Women's - Harvard, Emory, JAMA, Race/Ethnic Diversity / 29.11.2022

MedicalResearch.com Interview with: Chris A. Rees, MD, MPH Assistant Professor of Pediatrics and Emergency Medicine Research Director, Pediatric Emergency Medicine Fellowship Emory University School of Medicine Attending Physician, Children's Healthcare of Atlanta Pediatric Research Scientist, CHAMPS, U.S. Program Office  and Eric W. Fleegler, MD, MPH, FAAP Associate in Pediatrics, Division of Emergency Medicine Director Sedation Service Boston Children’s Hospital Assistant Professor of Pediatrics and Emergency Medicine Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Rates of firearm fatalities in the United States have reached a 28-year high. Yet, an understanding of the specific demographic groups who have been most affected, and where in the United States these fatalities have occurred, has not been clearly described in the past. (more…)
Author Interviews, Mental Health Research / 28.11.2022

Sound healing is an alternative therapy that uses sound waves to heal the mind and body. This therapy is based on the belief that all matter is vibrating at a certain frequency and that disease or ill health occurs when the body’s natural frequency is out of alignment. Sound healing practitioners use a variety of tools, including singing bowls, gongs, and tuning forks, to restore the body’s natural frequency. There are many benefits of sound healing, including reducing stress, promoting relaxation, improving sleep, and reducing pain. Sound healing can also be used to treat a wide range of conditions, such as anxiety, depression, PTSD, and addiction. If you are looking for a non-invasive way to improve your health and well-being, sound healing may be right for you. (more…)
Alzheimer's - Dementia, Author Interviews, Nutrition / 26.11.2022

MedicalResearch.com Interview with: Thomas M Holland, MD, MS Assistant Professor Rush Institute for Health Aging Rush College of Medicine & Rush College of Health Sciences https://www.rushu.rush.edu/faculty/thomas-m-holland-md-ms MedicalResearch.com: What is the background for this study? Response: My late mentor Martha Clare Morris, ScD had published a manuscript investigating leafy green intake, and the nutrients found therein, and cognition. I wanted to take this thought a step further and investigate the potential association bioactives, found in vegetables, like leafy greens, has to cognition. Further, this is a continuation of the research I published in the green journal in 2020 associating flavonols to incident Alzheimer’s dementia. This study extends the understanding that flavonols are not only beneficial for the most detrimental outcome of Alzheimer’s dementia (in decreasing the risk), but also advantageous in mitigating components of the, clinical syndrome i.e. decreasing the rate of cognitive decline. (more…)
Aging, Author Interviews, Brigham & Women's - Harvard, Dermatology, Heart Disease, Herpes Viruses, Stroke / 23.11.2022

MedicalResearch.com Interview with:| Sharon G. Curhan, MD, ScM| Director, CHEARS: The Conservation of Hearing Study Channing Division of Network Medicine Department of Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA 02114 MedicalResearch.com: What is the background for this study? Response:       Herpes zoster, commonly known as “shingles,” is a viral infection that often causes a painful rash. Shingles can occur anywhere on the head or body. Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person has chickenpox, the virus stays in their body for the rest of their life. Years and even decades later, the virus may reactivate as shingles. Almost all individuals age 50 years and older in the US have been infected with the varicella zoster virus and therefore they are at risk for shingles. About 1 in 3 people will develop shingles during their lifetime, and since age is a risk factor for shingles, this number may increase as the population ages. The risk is also higher among individuals of any age who are immunocompromised due to disease or treatment. A number of serious complications can occur when a person develops shingles, such as post-herpetic neuralgia (long-lasting pain), but there was limited information on whether there are other adverse long-term health implications of developing shingles. There is a growing body of evidence that links VZV, the virus that causes shingles, to vascular disease. VZV vasculopathy may cause damage to blood vessels and increase the risk of stroke or coronary heart disease. Although some previous studies showed a higher risk of stroke or heart attack around the time of the shingles infection, it was not known whether this higher risk persisted in the long term. Therefore, the question we aimed to address in this study was to investigate whether shingles is associated with higher long-term risk of stroke or coronary heart disease. To address this question, we conducted a prospective longitudinal study in 3 large US cohorts of >200,000 women and men, the Nurses’ Health Study (>79,000 women), the Nurses’ Health Study II (almost 94,000 women) and the Health Professionals Follow-Up Study (>31,000 men), without a prior history of stroke or coronary heart disease. We collected information on shingles, stroke and coronary heart disease on biennial questionnaires and confirmed the diagnoses with medical record review. We followed the participants for up to 16 years and evaluated whether those who had developed shingles were at higher risk for stroke or coronary heart disease years after the shingles episode. The outcomes we measured were incident stroke, incident coronary heart disease [defined as having a non-fatal or fatal myocardial infarction (heart attack) or a coronary revascularization procedure (CABG, coronary artery bypass graft or percutaneous transluminal coronary angioplasty)]. We also evaluated a combined outcome of cardiovascular disease, which included either stroke or coronary heart disease, whichever came first. (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Sleep Disorders, USPSTF / 23.11.2022

MedicalResearch.com Interview with: Martha Kubik, Ph.D., R.N. Professor, School of Nursing College of Health and Human Services George Mason University Member, U.S. Preventive Services Task Force MedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea is a health condition in which part or all of a person’s airway gets blocked during sleep, causing their breathing to stop and restart many times. Untreated sleep apnea is associated with heart disease, stroke, and diabetes. However, there is currently very limited evidence on screening people who don’t have signs or symptoms like snoring and excessive daytime sleepiness. (more…)
Author Interviews, Dermatology / 22.11.2022

MedicalResearch.com Interview with: Carlota Batres, Ph.D.Assistant Professor, Department of PsychologyDirector, Preferences Lab PreferencesLab.comFranklin and Marshall College MedicalResearch.com: What is the background for this study? Response: Previous research has found that complexion-oriented makeup products, such as foundation and concealer, make the skin appear more even. Interestingly, though, the effect size of perceptual judgements has been found to be larger than the effect size of physical measurements, suggesting that there are factors affecting the perception of skin evenness that are not captured by the physical measurements of isolated skin patches. (more…)
Author Interviews, Cancer Research, COVID -19 Coronavirus / 17.11.2022

MedicalResearch.com Interview with: Amy S. Lee, Ph.D.Professor of Biochemistry and Molecular MedicineUSC/Norris Cancer CenterLos Angeles, CA 90033 MedicalResearch.com: What is the background for this study? Response: Trying to find stable host cell targets to combat SARS-CoV-2 instead of chasing after the ever-mutating virus.    MedicalResearch.com: What should readers take away from your report? Response: When SARS-CoV-2 infects the host cell, it creates stress leading to higher production of GRP78. Blocking GRP78 reduces the ability of the virus to multiple and infect other cells.    (more…)
Alzheimer's - Dementia, Author Interviews, Nutrition / 14.11.2022

MedicalResearch.com Interview with: Alessandro Palmioli PhD Cristina Airoldi PhD Department of Biotechnology and Biosciences, University of Milano-Bicocca, NeuroMI, Center for Neuroscience, University of Milano-Bicocca MedicalResearch.com: What is the background for this study? beer-hopsResponse: We started many years ago by studying some natural and synthetic molecules that were able to counteract the early stages of this disease. With a view to early prevention, we wondered if these molecules could be routinely taken with the diet or dietary supplements. So our studies focused on the search for bioactive molecules present in food and edible plants. Hops are very rich in polyphenolic compounds, and for this reason it is historically used for the production of beer, but also for the preparation of herbal teas and infusions, and its uses in traditional medicine are known. In recent years we have also collected interesting results on Coffee, Sage, Radix Imperatoriae, Cocoa and Cinnamon extracts. (more…)
AHA Journals, Author Interviews, Heart Disease, Technology, Yale / 09.11.2022

MedicalResearch.com Interview with: Lovedeep Singh Dhingra, MBBS Postdoctoral Research Associate Cardiovascular Data Science (CarDS) Lab Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wearable devices are shown to have multiple health-related features, including heart rate and activity monitoring, ECG tracing, and blood pressure monitoring. In our analyses of the nationally-representative Health Information National Trends Survey (HINTS), we discovered that patients with and at risk of cardiovascular disease are less likely to use wearables. Older patients, patients with lower education, and patients with lower incomes are less likely to use wearables. Also, among adults with access to wearables, patients with cardiovascular disease use their devices less frequently as compared to the overall population. (more…)
Aging, Author Interviews, JAMA, Menopause, USPSTF / 09.11.2022

MedicalResearch.com Interview with: James Stevermer, M.D., M.S.P.H. Vice chair for clinical affairs Professor of family and community medicine University of Missouri Medical director of MU Health Care Family Medicine–Callaway Physicians, Dr. Stevermer joined the U.S. Preventive Service Task Force in January 2021. MedicalResearch.com: What is the background for this study? What are the main findings? Response: As people get older, they are more at risk for many chronic conditions like heart disease, osteoporosis, cancer, and diabetes. It’s unclear how much menopause—which typically occurs around age 50—contributes to this risk. Although we all want to stay healthy as we age, the Task Force does not recommend that people who have already gone through menopause use hormone therapy to prevent chronic health problems. (more…)
Author Interviews, Biomarkers, JAMA, Tobacco Research / 09.11.2022

MedicalResearch.com Interview with: Dr. Hongying Daisy Dai, PhD Professor and Associate Dean of Research The College of Public Health University of Nebraska Medical Center. MedicalResearch.com: What is the background for this study? Response: Tobacco use landscape has been changing in the United States with fewer combustible cigarette smokers and more e-cigarette and other emerging tobacco users. Nicotine concentration level is a key product characteristic of modern e-cigarette products and high-nicotine vaping devices have recently become available. This study seeks to examine whether biomarkers of exposure to tobacco-related toxicants have changed since 2013 among adult nicotine e-cigarette users, non-nicotine e-cigarette users, and cigarette smokers. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Nutrition, Occupational Health, Sleep Disorders / 09.11.2022

MedicalResearch.com Interview with: Zhilei Shan, MD, PhD Postdoctoral fellow on Nutritional Epidemiology Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: Unhealthy sleep behaviors and sleep disturbances are associated with higher risk of multiple diseases and mortality. The current profiles of sleep habits and disturbances, particularly the differences between workdays and free days, are unknown in the contemporary US. MedicalResearch.com: What are the main findings? Response: In this nationally representative cross-sectional analysis with 9004 adults aged 20 years or older, differences in sleep patterns between workdays and free days were observed. The mean sleep duration was 7.59 hours on workdays and 8.24 hours on free days (difference, 0.65 hour). The mean sleep and wake times were at 11:02 PM and 6:41 AM, respectively, on workdays and 11:25 PM and 7:41 AM, respectively, on free days (differences, 0.23 hour for sleep time and 1.00 hour for wake time). With regard to sleep disturbances, 30.5% of adults experienced 1 hour or more of sleep debt,46.5% experienced 1 hour or more of social jet lag, 29.8% had trouble sleeping, and 27.2% experienced daytime sleepiness. (more…)
Author Interviews, Gender Differences, PLoS, Social Issues / 04.11.2022

MedicalResearch.com Interview with: Carlota Batres, Ph.D.Assistant Professor, Department of PsychologyDirector, Preferences Lab PreferencesLab.comFranklin and Marshall College MedicalResearch.com: What is the background for this study? Response: Makeup is commonly attributed with increasing attractiveness in female faces, but this effect has not been investigated in male faces. We therefore sought to examine whether the positive effect of makeup on attractiveness can be extended to male faces. (more…)
Author Interviews, COVID -19 Coronavirus, PLoS, Rheumatology / 04.11.2022

MedicalResearch.com Interview with: Professor Tim Vyse Professor of Molecular Medicine and Dr David Morris Non Clinical Lecturer in Molecular Genetics Guy’s Hospital, London MedicalResearch.com: What is the background for this study? What are the main findings? Response: We observed a correlation between the genetic associations with severe COVID-19 and those with systemic lupus erythematosus (SLE, Lupus), and aimed to discover which genetic loci were shared by these diseases and what biological processes were involved. This resulted in the discovery of several genetic loci, some of which had alleles that were risk for both diseases and some of which were risk for severe COVID-19 yet protective for SLE. The locus with most evidence of shared association (TYK2) is involved in interferon production, a process that is important in response to viral infection and known to be dysregulated in SLE patients.  Other shared associated loci contained genes also involved in the defense response and the immune system signaling. These results add to the growing evidence that there are alleles in the human genome that provide protection against viral infection yet are risk for autoimmune disease. (more…)
Author Interviews, OBGYNE, STD / 04.11.2022

MedicalResearch.com Interview with: Sean HughesSean M Hughes MA Department of Obstetrics and Gynecology University of Washington Seattle, WA MedicalResearch.com: What is the background for this study? Response: Young women are at elevated risk of getting sexually transmitted infections at the age when they typically start to have sexual intercourse. It’s not known whether this elevated risk is a consequence of behavioral factors (such as choices around use of barrier protection), physiological factors (such as a difference in the immune system) or a combination of both. In this study, we investigated a physiological factor: the immune system in the vagina. (more…)
Author Interviews, Immunotherapy, JAMA, Melanoma / 03.11.2022

MedicalResearch.com Interview with: Olivier van Not Scientific Bureau, Dutch Institute for Clinical Auditing Leiden, the Netherlands Department of Medical Oncology University Medical Centre Utrecht Utrecht, the Netherlands MedicalResearch.com: What is the background for this study? Response: The introduction of immune checkpoint inhibitors (ICIs) has significantly improved the survival of advanced melanoma patients. Treatment with these ICIs can lead to immune-related adverse events, also known as toxicity. This toxicity is graded from 1 (mild) to 5 (fatal) and examples of these toxicities are hepatitis and colitis. Since these toxicities can be life threatening and become chronic, they require treatment with immunosuppressants such as corticosteroids or anti-TNF. In a previous study of melanoma patients treated with different types of immune checkpoint inhibitors [Verheijden et al, Clin Cancer Research 2020] we found survival to be better for patients experiencing immune-related toxicity, which is in line with many other studies in several cancer types and a recent meta-analysis. (more…)
Mental Health Research, Nursing / 03.11.2022

When thinking about looking after your health, you might not consider your mental health alongside that. It’s just as important, though, as it can affect every area of your life, from your work life to how much rest you get at night. It’s especially important for healthcare professionals to consider how they are doing mentally. That’s because, with such a mentally demanding role, it is all too easy for them to let their mental health slide without realicing it. Unfortunately, that can lead to far more than a slightly stressful workday. Providing access to resources such as a nurses hotline can offer essential support and guidance for those in the healthcare profession, helping them manage their mental well-being effectively. If you’re a healthcare worker, here is why it’s so important to look after your mental well-being. To Show Up to Every Shift healthcare-nursing-burnout Good mental health means you are more likely to take control of your day. Whether you have an early shift or a long one, with a more positive mindset, you are sure to show up and get the work done to the best of your ability. It also means that those that choose their shifts (such as locum pharmacists, GPs, or nurses) will take on more work because they feel like they can manage it. So if you’re a locum healthcare worker, even using a shift-scheduling platform such as Workflare can help you gain more control over your day and, in turn, feel less stressed. (more…)
Author Interviews, HPV, JAMA, Vaccine Studies / 01.11.2022

MedicalResearch.com Interview with: Dr. Didem Egemen PhD Statistician, Division of Cancer Epidemiology & Genetics National Cancer Institute MedicalResearch.com: What is the background for this study? Response: Persistent infection with human papillomavirus (HPV), a sexually transmitted disease, is the cause of virtually all cervical cancers. Various studies have reported high effectiveness of HPV vaccination in preventing HPV infection and cervical cancer, particularly when administered at early ages. In this study, we looked at the proportion of females eligible for vaccination (<26 years of age in 2006 when the vaccine was FDA approved) who were unvaccinated, vaccinated against HPV before sexual debut, and vaccinated after debut. Then we estimated the prevalence of HPV 16 and 18, the two HPV genotypes that cause most cervical cancers, in each subset. (more…)
Author Interviews, Circadian Rhythm, Diabetes, Exercise - Fitness, Hepatitis - Liver Disease / 01.11.2022

MedicalResearch.com Interview with: Jeroen van der Velde, PhD Leiden University Medical Center Dept. Clinical Epidemiology, C7-102 Leiden, The Netherlands MedicalResearch.com: What is the background for this study? Response: We hypothesized that, in addition to the amount of physical activity, the pattern in which physical activity is accumulated over the day is relevant for metabolic health. Several studies previously showed beneficial effects of interrupting sedentary periods with short periods of activity (breaks in sedentary time) on glucose control. In addition, very recently it has been argued that the timing of physical activity during the day may be relevant for metabolic health. This was mainly shown in animal studies and intervention studies with supervised high intensity exercise training in men with impaired glucose control or type 2 diabetes. If timing of physical activity matters in a ‘free-living’ setting in the general population is largely unknown. Therefore, our aim was to investigate associations of timing of physical activity and breaks in sedentary time with liver fat content and insulin resistance in a middle-aged population. (more…)
Dermatology, Lifestyle & Health / 28.10.2022

A recent scientific study found that Botox injections can help reduce the symptoms of mental health conditions like anxiety and depression, according to a report on Euronews. As more people seek non-invasive treatments to achieve beautiful, youthful, and natural looks, market experts predict that the medical spa industry will continue to grow. Currently, medspa therapies range from loose RNA that stimulates regeneration of skin to hydrafacials, microneedling, body sculpting, and laser hair removal. And while many people are embracing these medspa treatments, there are major concerns about their effectiveness. Keep reading to learn the science-backed health benefits of medical spa treatments. (more…)
Dental Research, Pediatrics / 27.10.2022

The British Dental Association stays on top of important trends that affect health. Baby food is the latest research subject in their crosshairs. With infant health a high concern, there is good reason to take a longer look at food consumption. Oral Care Exams Your first infant oral exam at NorthStar Dental Care will go into detail about the dos and don’ts of nutrition. Preventing oral health issues will eliminate some of the most debilitating problems when growing up. This is why the latest research from the BDA is so important, but the devil is still in the details. Before going down the rabbit hole of information, make sure that your baby is scheduled and up to date with all of their dental appointments. The first exam is one of many, with each one after being just as important as the last. (more…)