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My research is focused on overtreatment in the United States health care system. Overtreatment is a term that refers to unnecessary medical care, or the provision of medical interventions, such as tests, medications, procedures, and surgeries, that provide little benefit to patients, or even cause harm. I identified the main consequences of overtreatment as the broader economic harm –contributing to the inflated health care market— and the direct patient harms such as unintended consequences, financial burdens, and emotional stress. My research further described the prevention of overtreatment through addressing its main contributors: physician culture, fear of malpractice, and the fee-for-service model. I concluded that overtreatment was a major contributor to the US medical health care system lagging behind other high-income countries, but that there were tangible steps that could be taken to curb it.

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-       Recommended reading is the book by Marty Makary, The Price We Pay. For anyone interested in understanding the American healthcare system, this is a great introduction. It covers overtreatment too, but many other topics. It provides an important but comprehendible breakdown of the stakeholders and payment models that exist within the American health care systems. It is very readable with many personal anecdotes.

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This video is helpful in outlining the patient action that can be taken to curb overtreatment. It helps with explaining and understanding in more simple terms.

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Why your doctor needs your help to battle over-treatment | Christer Mjåset | TEDxOslo

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Lyu, Heather et al. “Overtreatment in the United States.” PloS one vol. 12,9 e0181970. 6 Sep. 2017, doi:10.1371/journal.pone.0181970., out of all the sources, this one was the one that I used most in my paper. It truly gives a unique perspective using a survey of physicians in the United States to speak on overtreatment.

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Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.2,106 physicians from…

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For the best comparative analysis of the US health care as a whole go to this report.

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The 2021 edition of Mirror, Mirror was constructed using the same methodological framework developed for the 2017 report in consultation with an expert advisory panel. Another expert advisory panel was convened to review the data, measures, and methods used in the 2021 edition.

Using data available from Commonwealth Fund international surveys of the public and physicians and other sources of standardized data on quality and health care outcomes, and with the guidance of the independent expert advisory panel, we carefully selected 71 measures relevant to health care system performance, organizing them into five performance domains: access to care, care process, administrative efficiency, equity, and health care outcomes. The criteria for selecting measures and grouping within domains included: importance of the measure, standardization of the measure and data across the countries, salience to policymakers, and relevance to performance-improvement efforts. We examined correlations among indicators within each domain, removing a few highly correlated measures. Mirror, Mirror is unique in its inclusion of survey measures designed to reflect the perspectives of patients and professionals - the people who experience health care in each country during the course of a year. Nearly three-quarters of the measures come from surveys designed to elicit the public's experience of its health system.
Changes Since 2017
The majority of measures included in this report are the same as in the 2017 edition of Mirror, Mirror ( Appendix 2). Seventeen measures were dropped if a survey question was no longer included in the Commonwealth Fund International Health Policy Survey or if we had reason to believe the response to the measure might be less valid because of effects of the COVID-19 pandemic, such as questions in the timeliness subdomain related to wait times, which were being fielded during the spring of 2020. Ten measures were considered "modified" in the 2021 report because the wording of a survey item was altered since the 2017 version.

We worked to include new measures to fill previously identified gaps in performance measurement across the 11 countries and considered a wide array of potential new measures related to topics such as quality of behavioral and mental health care, hospital care, pediatric care, and safety. We considered the data availability of new measures, how recently they had been updated, and how they correlated with other measures in each domain. In the end we included 16 new measures across the five domains (see How We Measured Performance for details).
Data
Data for this report were derived from several sources. Survey data are drawn from Commonwealth Fund International Health Policy Surveys fielded during 2017, 2019, and 2020. Since 1998, in collaboration with international partners, the Commonwealth Fund has supported these surveys of the public's and primary care physicians' experiences of their health care systems. Each year, in collaboration with researchers in the 11 countries, a common questionnaire is developed, translated, adapted, and pretested. The 2020 survey was of the general population; the 2017 survey surveyed adults age 65 and older. The 2020 and 2017 surveys examined patients' views of the health care system, quality of care, care coordination, medical errors, patient-physician communication, wait times, and access problems. The 2019 survey was administered to primary care physicians and examined their experiences providing care to patients, use of information technology, and use of teams to provide care.

The Commonwealth Fund International Health Policy Surveys (2017, 2019, and 2020) include nationally representative samples drawn at random from the populations surveyed. The 2017 and 2020 surveys' sampling frames were generated using probability-based overlapping landline and mobile phone sampling designs and in some countries, listed or nationwide population registries; the 2019 survey was drawn from government or private company lists of practicing primary care doctors in each country, except in France, where they were selected from a nationally representative panel of primary care physicians. Appendix 9 presents the number of respondents and response rates for each survey, and further details of the survey methods are described elsewhere.

In addition to the survey items, standardized data were drawn from recent reports of the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO). Our study included data from the OECD on screening, immunization, preventable hospital admissions, population health, and disease-specific outcomes. WHO data were used to measure health care outcomes.
Analysis
The method for calculating performance scores and rankings is similar to that used in the 2017 report, except that we modified the calculation of relative performance because the U.S. was a distinct and substantial outlier (see below).

Measure performance scores: For each measure, we converted each country's result (e.g., the percentage of survey respondents giving a certain response or a mortality rate) to a measure-specific, "normalized" performance score. This score was calculated as the difference between the country result and the 10-country mean, divided by the standard deviation of the results for each measure (see Appendix 3). Normalizing the results based on the standard deviation accounts for differences between measures in the range of variation among country-specific results. A positive performance score indicates the country performs above the group average; a negative score indicates the country performs below the group average. Performance scores in the equity domain were based on the difference between higher-income and lower-income groups, with a wider difference interpreted as a measure of lower equity between the two income strata in each country.

The normalized scoring approach assumes that results are normally distributed. In 2021, we noted that the U.S. was such a substantial outlier that it was negatively skewing the mean performance, violating the assumption. In 2017, we had included all 11 countries to calculate the mean and standard deviation of each measure. After conducting an outlier analysis (see below), we chose to adjust the calculation of average performance by excluding the U.S., using the other 10 countries as the sample group for calculating the mean performance score and standard deviation. This modification changes a country's performance scores relative to the mean but does not affect the ranking of countries relative to one another.

Domain performance scores and ranking: For each country, we calculated the mean of the measure performance scores in that domain. Then we ranked each country from 1 to 11 based on the mean domain performance score, with 1 representing the highest performance score and 11 representing the lowest performance score.

Overall performance scores and ranking: For each country, we calculated the mean of the five domain-specific performance scores. Then, we ranked each country from 1 to 11 based on this summary mean score, again with 1 representing the highest overall performance score and 11 representing the lowest overall performance score.

Outlier analysis: We applied Tukey's boxplot method of detecting statistical outliers and identified several domains or subdomains (affordability, preventive care, equity, and health care outcomes) in which the U.S. was a statistical outlier. The test identified isolated instances of other countries as statistical outliers on specific measures, but the pattern for other countries was inconsistent and the outlier differences were smaller than in the U.S.

Sensitivity Analysis. We checked the sensitivity of the results to different methods of excluding the U.S. as an outlier (see above). We removed the U.S. from the performance score calculation of each domain in which it was a statistical outlier on at least one indicator (otherwise keeping the U.S. in calculation of other domains where it was not an outlier (see Appendix 3). In another sensitivity analysis, we excluded the U.S. and other countries from the domains in which they were outliers, but the results were essentially similar.

We tested the stability of the ranking method by running two tests based on Monte Carlo simulation to observe how changes in the measure set or changes in the results on some measures would affect the overall rankings. For the first test, we removed three measure results from the analysis at random and then calculated the overall rankings on the remaining 68 measure results, repeating this procedure for 1,000 combinations selected at random. For the second test, we reassigned at random the survey measure results derived from the Commonwealth Fund International Health Policy surveys across a range of plus or minus 3 percentage points - approximately the 95 percent confidence interval for most measures - recalculating the overall rankings based on the adjusted data and repeating this procedure 1,000 times.

The sensitivity tests showed that the overall performance scores for each country varied but that the ranks clustered within several groups similar to that shown in Exhibit 2. Among the simulations, Norway, the Netherlands, and Australia were nearly always ranked among the three top countries; the U.S. was always ranked at the bottom, while Canada, France, and Switzerland were nearly always ranked between eighth and tenth. The other four countries varied in order between the fourth and seventh ranks. These results suggest that the selected ranking method was only slightly sensitive to the choice of indicators.

Four OECD indicators from the health care outcomes domain (30-day in-hospital mortality rate following acute myocardial infarction, 30-day in-hospital mortality rate following ischemic stroke, maternal mortality, and deaths from suicides) are included in the OECD measures of treatable and preventable mortality. To evaluate the potential impact of double-counting these four measures, we examined the correlations between each of the four measures and the two composite measures and recalculated the performance scores after removing these four measures. The correlations were modest or low. We found little difference in the overall performance scores for the 11 countries after removing the four potentially duplicative OECD indicators.
Limitations
This report has limitations. Some are particular to our analysis, while some are inherent in any effort to assess overall health system performance. No international comparative report can encapsulate every aspect of a complex health care system. As described above, our sensitivity analyses suggests that country rankings in the middle of the distribution (but not the extremes) are somewhat sensitive to small changes in the data or indicators included in the analysis.

Second, despite improvements in recent years, standardized cross-national data on health system performance are limited. The Commonwealth Fund surveys offer unique and detailed data on the experiences of patients and primary care physicians but do not capture important dimensions that might be obtained from medical records or administrative data. Furthermore, patients' and physicians' assessments might be affected by their expectations, which could differ by country and culture. Augmenting the survey data with standardized data from other international sources adds to our ability to evaluate population health and disease-specific outcomes. Some topics, such as hospital care and mental health care, are not well covered by currently available international data.

Third, we base our assessment of overall health system performance on five domains - access to care, care process, administrative efficiency, equity, and health care outcomes - which we weight equally in calculating each countries' overall performance score. Other elements of system performance, such as innovative potential or public health preparedness, are important. We continue to seek feasible standardized indicators to measure other domains.

Fourth, in defining the five domains, we recognize that some measures could plausibly fit within several domains. To inform action, country performance should be examined at the level of individual measures in addition to the domains we have constructed.

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The 2021 edition of Mirror, Mirror was constructed using the same methodological framework developed for the 2017 report in consultation with an expert advisory panel. Another expert advisory panel was convened to review the data, measures, and methods used in the 2021 edition.

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I went into this thinking how difficult any health care related procedure was in my personal experience in the United States. I felt at the mercy at the system, which is precisely why I wanted to study ways to improve it. The outcome was multifaceted as compared to my expectations. On the one hand, the problems in the system itself are just as real as I had anticipated, or even more so. There is so much to be said for the high cost and low result and the people suffering from the disparity. On the other hand, I discovered that a lot of it has to do with a combination of structural and direct problems. For overtreatment the structural part is really in the way the system incentivizes overtreatment, and the direct is the day-to-day decisions that people are making that are contributing to overtreatment. A good direction would be to research a different aspect of waste in the system, that is administrative waste. There is little data on overtreatment, and much of it is included in this paper. I would definitely suggest taking a different angle such as administrative waste, which has more data available.

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The focus of my project is mass incarceration and its negative impacts in the United States. I discussed its problems by highlighting disproportional rates, internal abuse that occurs in prisons, & the aftermath of going to jail. My passion for this topic stems from my interest in understanding injustices that occur in the US and how we can decrease the high rates that appear. Mass incarceration isn't widely discussed even though its rates in the US surpass any other country in the world. This injustice does not only affect individuals who go to jail it also as it affects families too. This is only one example of the impact of Mass incarceration I've discovered. Not only do I critique and point out the issues with mass incarceration, I also propose a solution, which is rehabilitation. I support this solution by providing evidence of its positive effects. In addition, I compare the US to countries that use rehabilitation methods to see how it lowers recidivism rates & more.

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For my independent study, I looked into how to start a business and what that would look like. I researched the different types of businesses and then information more specific to online businesses. I researched the different things you can sell and even interviewed someone with a small business.

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I recommend reading The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander. This book is only focused on one of my points I bring up in my essay. It discusses the American Justice system and its foundation. It highlights how incarceration rates in the US have been continuously increasing. This book also critiques the lack of attention from important positions in the US. It gives perspective on how important it is to decrease this injustice in action.

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This video outlines the steps of starting a small business from home. I really liked this video because it was not only entertaining but it taught me the process before having a business. This video was by QuickBooks which is a well-known financial service.

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How to start a small business from home | Start your business

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This article does a great job of explaining the essentials of businesses. It is by American Express and it goes into business planning in a bit more detail. Its great for researching more about small businesses in general.

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American Express Business Blueprint Resource Center

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Starting a small business begins with an idea. The trick is turning that business idea into a successful stream of income that you can scale.

The good news is many successful entrepreneurs find it easier than they feared to get a new business up and running. The key is to break the business structure down into small tasks, checking them off one at a time. Here, we cover some of the steps to take to start a small business, the pitfalls to avoid, and how to manage risks. By following these steps, you will have a good shot at success in your endeavor.

The basic steps to start a small business

There are basic steps you can take to start a small business. First, you want to define your overall vision. When you come up with small business ideas, you need to think of the end goal. What do you envision as a successful business ? Are you looking to just make money on the side, or is financial independence your final goal?

Next, write a mission statement. A mission statement outlines and defines the entire reason your business exists. It's the product or service you offer and the way in which you want to offer it. It's what sets you apart from other businesses and makes you stand out from the competition.

Third, set your individual business goals. How can you get to the final vision you have for your business? Keep your goals small and manageable and outline a business strategy to follow. Check off each item on the list as you go.

Finally, put it all together in a solid plan of action. This will give you an organized way in which you can approach your business. It can also be a solid outline to create a more detailed business plan.
Small Business Market Analysis
This initial step to starting your business is called your strategic plan. After you have it in place, jot down some notes analyzing the market. Consider who your customers will be, your competition, what hurdles you have to overcome and the barriers you face. In light of these obstacles, what's your approach to marketing? How can you incorporate media and technology? How are you going to generate new leads and sales?
Establishing a Budget and Financing
Once you have your basic plan of action down, you'll need to think about financing and what you can spend to get your business started. To run a business , and run it well, you will need to make an investment and provide for additional resources .

Certainly, you want to control costs as much as possible, especially at first. This means you need to be realistic about your budget , your expenses and what you can afford. Add an extra 20 percent on top of your costs to give yourself a realistic rate of burn.
Naming Your Business
Before you start your business, you'll want to make sure the name you want is available. You can do a trademark search to make sure your business name isn't already being used by someone else offering a similar service. It's best to avoid any name that's already in use.

You may also want to start using a trademark for your name. The moment you begin using your business name in commerce, you can protect it with a trademark, or the ™ designation. This provides a level of protection against others stealing your name, slogans and the like, but you must be consistent in use.

In addition, you may want to investigate registering your trademark to provide the full level of government protection. This will ensure that nobody can steal your name or even your business by creating a substantially similar mark and causing brand confusion.
Make Sure Your Business Entity is Legal
You can certainly start a business under your own name, or even just use an alias. This is called "DBA" or "doing business as." However, it doesn't provide you much legal protection. If you run into problems with your business, all your personal assets are often at stake.
Types of Business
You're better off filing official paperwork to incorporate your business. The costs for doing this can vary by state and by the type of business you want to register, but in the end, it's an important investment. Incorporating your business helps protect your business name, but, more important, it helps to shield your personal assets from business liability.

If someone, for example, gets hurt using one of your products, and you're working under a DBA, they can come after your personal assets. If you're incorporated, your personal assets are protected, and they can only come after your business assets.

The most common business structures are a sole proprietorship, a partnership, an LLC, or an S-corp / C-corp (standard corporation). Every structure has pros and cons that go with it, and you'll need to determine the best option for you. LLCs are typically the most popular form of small business.

Sole Proprietorship: This kind of business is owned and run by just one person, the sole proprietor . There's no distinction between the person and the business. This is the "DBA" we discussed above. You can create this kind of business just by starting to do business. You may have trouble raising capital, and typically you'll be taxed as a self-employed individual on your personal tax return. You will also be personally responsible for the liabilities associated with the business.

Partnership: Two or more people can get together to form a partnership. It's an easy kind of business to start up and lets you pool resources, get additional skills and expertise, and share responsibility. Again, if things go poorly, everyone involved shares full liability, and your personal assets are at stake.

LLC: The LLC, or limited liability company, is relatively new. It's somewhat more complex than a proprietorship or partnership but isn't as complicated as a corporation. It's often referred to as a "pass-through entity" because it's not subjected to a separate level of business tax. Most states don't put ownership restrictions on LLCs, so the members can include just about anyone and can be one or multiple people.

These types of companies protect you from personal responsibility related to financial and legal issues that arise. This also protects your house, your car and your personal finances from liability. In addition, you still don't have to file separate taxes; you'll file business taxes right along with your personal taxes.

Corporation: A corporation is a legal entity unto itself, separate from owners and staff. It has many of the rights of an individual person: it can enter into contracts, borrow and lend money, be sued and file lawsuits, pay taxes, etc. It's more complex to set up and is usually best for bigger companies with many employees. It's often easier to get financing for a corporation, and you have the maximum separation of your personal assets. However, it can be complicated to set up and run. It's also subject to the most expensive level of business tax.

Open a Business Checking Account

Separating your business and personal finances is crucial when you start a business. Every business should have a business bank account . However, finding the right business checking account for your business needs may be a bit confusing at first.

First and foremost, find an FDIC-insured company that offers you protection. If you are a small business, you should look for a company that provides the best interest rates, minimal or no monthly fees and small or no opening deposit requirements. These options may seem daunting when you are comparing against the bigger banks. However, there are options out there.

You will also want to make sure that whatever company you start with, you have access to your business checking account at all times.

American Express Business Blueprint™ offers a great banking solution for small businesses. An online checking account without strings, extra fees and compelling rates. Find out how easy it is to sign up with a business checking account for your small business.

Determine Employee Staffing

Another important question to consider is employee staffing. Can you do this on your own, or will you need help? Understand that the first stages are going to be expensive and time-consuming. Don't hire people you can't afford just to make things easier. Start with management and support where you aren't capable of doing it on your own.

If you plan to hire employees, the best thing to do is file for your employer identification number (EIN.) Even if you do not think you will need employees, you can get the EIN for possible use later on.

Establish Your Business Location

You've heard it said many times: it's all about location, location, location. This also comes down to the kind of business you're running. If you're running a craft business that will only sell online, your living room might suffice for now. But if you're looking to have an on-the-ground location, you'll want affordable office space.

If you're offering a service-based business, you'll want an office to meet with customers; it will make you look more professional. More important, it'll give you a place to have your business mail delivered so you don't have to hand your home address out to potential customers .

You don't have to spend a fortune to get office space. Just about every major city now has shared-space locations where you can lease your own space for a reasonable rate.

Purchase Your Business License

As you set up your location, check into any permits or licenses you need to operate your business in your state. Depending on your business type , will also determine what business license you will need. The last thing you want is fines for failing to have the proper permits, licenses and certifications. Failure to get such licenses can ruin your small business.

Set Up an Online Presence

It doesn't matter what kind of business you're starting, if you don't have an online presence, you're not likely to succeed in today's market. A lot of people consider it a red flag if a company doesn't have a website and social media presence. Many popular online hosting platforms offer inexpensive options for setting up a website and even templates that can get you up and running fast.

Set up a Facebook account, an Instagram account and a Twitter account. Make sure you use the right social media channels that pertain to your business. You can connect all of your various accounts together.

Business Cards

Business cards are important, and they're often overlooked until they're needed. The last thing you want is to have to scribble your name, number and email on a napkin. You can get inexpensive business cards through a variety of services both online and at office supply stores. You can even get templates you can use to print your own if you have a knack for graphic design.

Experiment With Marketing and Sales

Now it's time to experiment with your operations.

Get the word out as creatively as you can. Get involved with local professional organizations, such as the chamber of commerce and small business chapters in the area. Look for resources in your network to get the word out.

Use your social media to drive traffic to your website. Use Facebook, Google AdWords and any other avenues you know. Just be aware of your budget, and if something isn't working, don't push it.

Getting Help to Start a Small Business

If you follow, these steps you should be able to easily start your small business. To make sure your small business can hit the ground running, your first step should be to apply for a small business loan. With the right loan in place, you should be able to cover your starting expenses and kickstart your small business.

Starting a small business can be an intimidating investment and also an awesome adventure. American Express Business Blueprint™ helps you with many resources to hit the ground running. Find out how we can help you get started with an online business checking account , the ability to accept payments and other financial resources.

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How to Start a Small Business | Business Blueprint Resource Center

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Starting a small business begins with an idea. The trick is turning that business idea into a successful stream of income that you can scale. The good news is many successful entrepreneurs find it easier than they feared to get a new business up and running.

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Overall I learned a lot about the legalities of businesses. The resources online were very helpful and with the support of advisors, this was a reasonable course. Knowing what you want to do is the most helpful skill and then after that, everything will fall into place. After the business proposal, I feel very confident that the goal of starting a small business is very achievable.

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I recommend looking at this to further comprehend the definition of recidivism. It uses an example of the country Norway and its methods to their prison system. Through the methods used, incarceration rates are lower than in the US. Though the population differs significantly from both countries the evidence stated in this article poses the understanding of how it can positively impact and or even change the increasing incarceration rates in the US.

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An Overview of Norway's Prison System

One of the biggest differences between the incarceration systems of Norway and the USA is that Norway does not have large, centralized . Instead, Norway utilizes a system of small, community-based correctional facilities that focus on rehabilitation and reintegration into society.

An Overview of Norway's Prison System

One of the biggest differences between the incarceration systems of Norway and the USA is that Norway does not have large, centralized . Instead, Norway utilizes a system of small, community-based correctional facilities that focus on rehabilitation and reintegration into society.

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Rehabilitation Lessons from Norway's Prison System

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In the 1990's, Norway had a problem. Roughly 70% of all released prisoners recommitted crimes within two years of release. That rate is nearly equal to the recidivism rate in the United States today. At that time, Norway's prison system was structured similarly to the prison system in the United States.

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This resource helps us understand the benefits of rehabilitation. Some may look at incarceration as something that is completely beneficial to society. What is brought up in this article completely contradicts the perceived notion of its ultimate benefit. It helps readers understand that we should cultivate better methods to create a better society.

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I understood that mass incarceration was an issue in the US. I just didn't understand its severity and its significant difference in rates compared to any other country in the world. All of this new information came to me through my intensive research. I was disheartened by how mass incarceration is a continuous trend in the US and there is barely attention brought to it. Through my overall research, I was also introduced to new terms. To serve as an example, recidivism is a term I’ve learned about and how it can be lowered through implementing more rehabilitation methods. My paper was written to motivate people to take action and understand the problems with just throwing large amounts of people in our prisons and jails. We must advocate for change! Mass incarceration impacts people on a much larger scale than what is perceived.

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My Independent Study is focused on Fibromyalgia, what it is, and why it is such a mystery within the medical community. My research and format to the whole project begins with basic definitions about Fibromyalgia, and what the wide range of symptoms are. Using sources like the Mayo Clinic, and Healthline, I have learned how different Fibromyalgia can be for people, especially amongst women. The next point in my research about the Fibromyalgia is about the Fibro-Flares, and this portion of my research went into how Fibro-Flares are caused, and how much they truly vary from person to person. This was followed by a brief history of Fibromyalgia and how it was perceived in order to give some context to how Fibromyalgia was even more misunderstood centuries ago. After that, I went in depth about how current treatments, which are mainly opioids are effective and do work, but the risks that opioids present are great. This leads to a bulk of the research being about the drug-free solutions that are being currently developed and are going through clinical trials. This includes MRI diagnosis, Nueromodulators, and Human Growth Hormone Therapy.

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This video is a basic rundown from the Mayo Clinic about Fibromyalgia. The woman in the video goes in depth with how misunderstood Fibromyalgia is, and that it can be in the tens of millions of people that live with Fibromyalgia in the United States.

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Here is a works cited of where you can find all of the information I used in my essay and presentation. This includes journal articles and clinical trials that describe where the focus on Fibromyalgia was and where it is right now.

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In conclusion,
This was one of the most difficult projects I have ever completed, and almost every minute of it was worth it. My inspiration came from my mother, and without her insight and my experience with seeing her going through her daily struggles, this project would never have flown in to my head. Before beginning, I only knew about what Fibromyalgia was and how it affected certain people, but I did not know the scale to how it affected people, the history behind Fibromyalgia, and the newly found treatments that shy away from drug usage. Overall, this project was a good representation was what I want to do as an engineer. I want to be in a lab. I would love the honor of being tasked with engineering and figuring out to make medicine do what it is supposed to do, and to make it affordable as well. Lastly, this project taught me how to read medical journals and clinical trials, and that will go a long way in my career. Overall a project with great purpose for me.