Should I be eating more fiber?

High-grade cancer that’s still confined to the prostate is generally treated surgically. But a third of the men who have their cancerous prostates removed will experience a rise in blood levels of prostate-specific antigen (PSA). This is called PSA recurrence. And since detectable PSA could signal the cancer’s return, doctors will often treat it by irradiating the prostate bed, or the area where the gland used to be.

In February, Dr. William U. Shipley and his colleagues at Massachusetts General Hospital reported that radiation is a more effective treatment for PSA recurrence when given in combination with androgen-deprivation therapy (ADT). ADT interferes with the body’s ability to make or use testosterone, which is the hormone (or androgen) that makes prostate tumors grow more aggressively. It targets rogue cancer cells in the body that escape radiation.
Here’s what the study found

The newly published study randomly assigned 760 men with detectable PSA after surgery to one of two groups. One group got radiation plus ADT and the other group got radiation plus a daily placebo tablet. The study recruited patients between 1998 and 2003, and after an average follow-up of 12 years, 5.8% of men in the combined treatment group had died of prostate cancer, compared to 13.4% in the radiation-only group. Rates of metastatic prostate cancer were also lower among men treated with ADT: 14.5% compared to 23% among the placebo-treated controls.

“The take-home message is that ADT has a major and beneficial impact on the risk of death from prostate cancer when added to radiation for PSA recurrence,” said Ian Thompson, M.D., a professor of oncology at the UT School of Medicine, in San Antonio, Texas, and the author of an editorial accompanying the newly published findings.

Men in this study received a high dose of the ADT drug bicalutamide, which doctors use less frequently for PSA recurrence today, instead favoring other testosterone-suppressing medications that have since been shown to be more effective. Therefore this is an instance of a long-term study reporting results after treatment standards — in this case the selection of a specific ADT regime — have changed.
A new treatment standard

Still, some men have difficulty tolerating ADT, and not all of them should get it, particularly if they’re older and more likely to die of something other than prostate cancer. “I’d reserve ADT for younger men with a long life expectancy ahead of them who were diagnosed initially with high-grade or late-stage disease,” Thompson said.

“This important study confirms that combined therapy is superior to radiation alone and should be viewed as the standard treatment for PSA relapse,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “High dose bicalutamide has been associated with cardiovascular side effects, but ongoing and future research is clarifying how best to use ADT in this particular setting.” The prescription retinoid that my dermatologist suggested sounded like a great idea. It was a topical vitamin A-based cream, which has been shown to help reduce fine lines and wrinkles. Now that I’m a middle ager, I thought I’d give it a try. Then I got to the drugstore, and found that the little tube had a huge price: $371! I didn’t want to shell out that much for a mere face cream, so I didn’t fill the prescription.

But my case was only skin-deep. What about people who can’t — or don’t want to — pay for prescription medications to treat chronic or serious illness? “It’s a real problem. Medications only work if people take them, and you can’t take them if you can’t afford them,” says Dr. Joshua Gagne, a pharmacist and epidemiologist with Harvard-affiliated Brigham and Women’s Hospital.

According to a National Center for Health Statistics survey, about 8% of adults in the United States don’t take prescribed medications because they can’t afford them.

Even if cost is not affecting your medication regimen, the following ideas may save you some money.

    Try generics. Generic drugs have the same active ingredients as brand-name medications, but generics are substantially less expensive. For example, the cholesterol-lowering drug Lipitor retails for about $390 for a 30-day supply. The generic version, atorvastatin, is about $10 for a 30-day supply. Always ask your doctor if a generic is available. “If a generic isn’t available, ask if there’s a similar drug with a generic version,” suggests Dr. Gagne.
    Go to a big-box store. Many pharmacies in grocery stores and big-box chains offer hundreds of generic medications for just $4 (for a 30-day supply) or $10 (for a 90-day supply). Ask for the list when you’re at the pharmacy or look it up on the Internet, and bring a copy to your doctor. Don’t be discouraged if your medication isn’t on the list; check a different store. “Different chains have different lists,” says Dr. Gagne.
    Get a bigger dose. Some prescription medications can be divided with a pill splitter. Ask your doctor if that’s the case with your medication, and if it’s possible to get a double dose. For example, you might get 10-milligram (mg) pills that can be split into 5-mg pills. Some medications cannot be split, such as capsules or tablets that are enteric-coated, or those that release medicine over time. “As a general rule, extended-release or slow-release medications should not be split,” says Dr. Gagne. These include drugs like metformin ER (Glucophage XR) for diabetes and pantoprazole (Protonix) for heartburn.
    Get a larger supply. Instead of getting a prescription that lasts for 30 days, and making an insurance copay each time, ask for a 90-day supply so you can make just one copay every three months. This works for medications you take long-term.
    Apply for assistance. There are many kinds of prescription assistance programs, offered by state and local governments, Medicare, nonprofit groups, and even drug makers. The programs typically have income requirements. Nonprofit organizations include: Needy Meds and Partnership for Prescription Assistance. Other resources include state assistance programs and Medicare Extra Help. Another option is to call the manufacturer of your medication directly. You can look up your medication on this Medicare website.
    If you’re on Medicare, consider updating your plan. Medicare plans can change from year to year, including the medications they cover, and the copays and deductible amounts. You have an opportunity to switch Medicare plans during the annual enrollment period from October 15 to December 7. Review the options using Medicare’s personalized plan search on its website.
    Shop around. Medication retail prices vary. Some pharmacies buy directly from drug makers; others use a middleman, which can drive up prices. Call pharmacies in your area to compare prices, or use a computer or smartphone app to do the work for you, such as WeRx or GoodRx. The attorney general’s office in your state may also have a website that provides similar information.

This last strategy is the one that worked for me. My dermatologist directed me to a pharmacy that sold the retinoid cream for less (because of a deal with the drug maker). It wasn’t free by any means, but the price was enough to get me to fill the prescription. Do I look younger yet? Not quite. But thanks to the discount, my wallet is looking a little better. Imagine a chronic medical condition in which the treatment itself has serious side effects. Examples of this are plentiful in medicine. For example, in diabetes, giving too much insulin can cause hypoglycemia (low blood sugar), a dangerous and potentially life-threatening condition. That doesn’t happen very often, but imagine that it was a common complication of treating diabetes because doctors couldn’t really tell how powerful a given dose of insulin actually was. And suppose that doctors and patient safety experts advocated for places where patients with diabetes could be carefully monitored when taking their insulin. Would you be opposed to this idea? Would you blame the patient for developing diabetes, or for needing this carefully supervised medical treatment in order to live? I suspect that the answer is “of course not!”

Now, let’s shift gears and discuss opioid addiction, specifically people who use illicit drugs like heroin and black-market fentanyl. Heroin is the strong opioid substance derived from the poppy seed that has been used for thousands of years. Fentanyl is a synthetic opioid that can be hundreds of times more powerful than morphine or heroin. Increasingly, illicit heroin is adulterated with fentanyl and similar chemicals, which public health experts believe is the reason for the continued rise in opioid-related deaths despite aggressive measures to decrease opioid prescriptions, increase substance use disorder treatment facilities, and widely distribute naloxone, the antidote to opioid overdose.
Saving lives in the face of increased risk for dying of a heroin overdose

People who use heroin are now at significant risk for overdose death, mainly because the opioid content can vary considerably from dose to dose. Previously, a little too much could have caused a decrease in respiratory rate and a high dose could lead to overdose. Now, with the variability of potency from the synthetic opioids, the strength of each dose can be markedly different. Furthermore, the uptake of fentanyl in the brain is so rapid that a fatal overdose can occur much more quickly than with heroin alone.

If we, as a society, are truly serious about saving lives, we have no choice but to allow people who use injectable opioids to do so in safe, monitored locations without fear of negative repercussions (e.g., being arrested). If you had asked me about this several years ago, I never would have believed that I could write the preceding sentence. I would have said, “Why empower junkies to abuse illegal drugs? Why make it easier on them instead of harder? Why should society condone this activity?”

However, I was wrong — dead wrong.
Good reasons for a change of heart

It turns out that addiction (called substance use disorder or, more specifically here, opioid use disorder in medical jargon) is a disease that can affect any one of us, just like diabetes or high blood pressure. It does not discriminate and does not represent a moral failure on the part of the individual who develops it. It is a condition that no one chooses, but when it attacks, it changes the brain of those with the disease. We can actually visualize those changes with tests like functional MRIs. It leads people to make choices that destroy their lives and the lives of others, such as loss of job, isolation and loss of relationships, incarceration, and even death. We also now know that this is a treatable disease, but the window for successful treatment depends on the psychological state of the person. We must be ready to engage them in treatment at that moment when they are ready.

My opinions changed drastically after a visit to a local needle exchange facility. By current law, individuals can’t inject inside the building. They have to take their chances outside and then they can come inside to be monitored after injecting. I initially envisioned the facility to be sterile, dirty, and depressing. Instead, I was surprised to see that it looked like a living room. There were sofas and a television. There was a warm light, and it appeared to be a welcoming place. Across from the sofas were two desks where staff members sat. Their job is to watch for any signs of overdose (a person who is too sleepy or who is breathing too slowly) and then rapidly respond by providing a nasal dose of naloxone to reverse the overdose. More importantly, they are there to help people right when they are open to treatment for substance use disorder. The staff will help connect them to treatment resources, whether it is group therapy or medical treatment like buprenorphine (Suboxone) or methadone.

If that moment of opportunity in which the individual is receptive to treatment passes, the consequences can be deadly.

Furthermore, the facility is all about harm reduction. There are boxes of free supplies: needle kits so that people do not share needles, condoms for safe sex, kits to help treat small skin infections, even little clean cups to freebase injectable drugs. Naloxone kits are also provided free of charge. There is no judgment there. It is only about reducing a person’s risk of serious, life-threatening infections like HIV and hepatitis C, or the risk of death. And it makes sense. If we are going to agree that opioid use disorder is just another medical condition that needs to be treated, then the compassionate thing to do is to remove the stigma associated with it and reduce associated harms while a person is suffering with substance use disorder. Plain and simple: people with this disease are going to use drugs. Is it better for them to use in the shadows, risking transmission of serious infectious diseases, or monitor them when they are using and be there for them to get them treatment at the moment they are ready?

Currently it’s still illegal in the US to allow people to inject in these supervised environments, but the tide is turning. The city of Ithaca, NY is contemplating a safe injection space, as is Seattle. Multiple studies have confirmed that they work. In Vancouver, Canada, where such facilities were implemented in 2003, they concluded: “Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts.” Massachusetts is also contemplating a similar pilot supervised injection facility program. With the crises of the opioid epidemic now claiming more than 30,000 lives every year in the US, it’s time to change our biases and old ways of thinking — people’s lives depend on it.

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Eat only every other day and lose weight?

The alternate-day fasting thing is very popular right now. This gist of it is, basically, feast and famine. You starve one day, then feast the next. Proponents claim that this approach will lead to weight loss, as well as a number of other benefits.

As a physician researcher, this annoys and alarms me. I preach sensible intake of real foods as part of a lifelong approach to health. I also depend on scientific evidence to guide my counseling. So, I welcomed this yearlong study comparing alternate-day fasting with more common calorie restriction.
Some data on alternate-day fasting

Researchers divided 100 obese study volunteers (mostly African-American women, without other major medical issues) into three groups:

    one group followed an alternate fasting plan, which meant on the fasting day they would eat only 25% of their caloric needs and on the non-fasting day they’d eat a little bit more (125% of their caloric needs per day)
    a second group ate 75% of their caloric needs per day, every day
    a third group ate the way they typically did, for six months.

The two diet groups received counseling as well as all foods provided. This “weight loss” period was followed by another six months of “weight maintenance” and observations.

Both diet groups lost about 5.5% of their body weight (12 pounds) by month six, and both regained about 1.8% (four pounds) by month 12, and had significant improvements in blood pressure, blood sugar, insulin, and inflammatory proteins when compared to the people who ate their normal diets.

At the end of the 12 months, there was only one difference between the two diet groups: the alternate fasting day group had a significant elevation in low density lipoprotein (LDL), an increase of 11.5 mg/dl as compared to the daily calorie restriction group. LDL is known as a risk factor for heart attacks and strokes, so that’s not good.
And how would this work in real life?

This was a very small study to begin with, and, more importantly, there was a fairly significant dropout rate. Only 69% of subjects stayed to the end, which decreases the power of the findings. Twelve people quit the alternate-day fasting group, with almost half citing dissatisfaction with the diet. By comparison, 10 people quit the daily calorie restriction group, and none cited dissatisfaction with diet, only personal reasons and scheduling conflicts (eight quit the control group for the same reasons).

It’s not surprising that people disliked alternate-day fasting. Previous studies have reported that people felt uncomfortably hungry and irritable on fasting days, and that they didn’t get accustomed to these discomforts. Interestingly, in this study, over time people in the fasting group ate more on fasting days and less on feasting days. So basically by the end of the study they were eating similarly to the calorie restriction group.

The authors note more limitations. The control group did not receive food, counseling, or the same attention from the study personnel, potential factors that could affect their results, besides how they ate. And this study can’t tell us about the potential benefits for people who have high blood pressure, high cholesterol, or diabetes because the study didn’t include individuals with those conditions.
The bottom line

Usually at this point we say something like “more studies of this approach are needed,” but I won’t. There’s already plenty of evidence supporting a common-sense lifestyle approach to weight loss: ample intake of fruits and veggies, healthy fats, lean proteins, and plenty of exercise. From apples to zucchini, there are over a hundred “real” foods you can eat endlessly, enjoy, and yes, still lose weight.

I would advise against spending any more money on fad diet books. Or processed carbs, for that matter. Rather, hit the fresh or frozen produce aisle, or farmer’s market, and go crazy. Then go exercise. Do that, say, for the rest of your life, and you will be fine. No one got fat eating broccoli, folks. (That said, if you tend to binge or stress-eat sugary or starchy foods, and you feel like you can’t control your habit, talk to your doctor, because that is a separate issue to be addressed.)
In 2012, the US Preventive Services Task Force (USPSTF) took the unprecedented step of recommending against prostate cancer screening for all men, regardless of age, race, or family history. Now this influential group of independent experts is reassessing its position based on more recent data. Instead of discouraging screening altogether, the UPSTF is urging doctors to discuss its potential benefits and harms with men 55 to 69 years of age. The same recommendation applies to all men in this age group, including those at higher risk of prostate cancer, such as African Americans and men with a family history of the disease. The USPSTF continues to recommend against screening men older than 70, since they’re unlikely to experience a survival benefit from treatment during their expected lifespans. The USPSTF was silent on men younger than 55, because Task Force members don’t believe there is sufficient information for them to make a recommendation.

Screening is usually done with a blood test that measures levels of a protein released by the prostate gland called prostate-specific antigen, or PSA. Elevations in PSA may be due to prostate cancer, but other conditions can also cause levels to rise, such as inflammation or an enlarged prostate. PSA levels also vary from man to man and can be unusually high in men who are otherwise healthy. To confirm or rule out a cancer diagnosis, doctors will typically order a biopsy of the prostate. However, prostate biopsies can lead to complications like infection, bleeding, and pain, and they often detect slow-growing, low-risk cancers that may never cause a man any harm during his lifetime. Treating low-risk cancers can leave men impotent and incontinent for years without extending their survival.

The USPSTF recommended against screening five years ago because its members felt the harms of treatment outweighed the benefits. However, newer data make the tradeoffs between potential harms and benefits too close to call. A European study published in 2014 found that PSA tests can prevent three cancers from spreading, and prevent one to two prostate cancer deaths, for every 1,000 men screened over 13 years. Then a study published last year found no difference in 10-year survival among men who were monitored or treated for low-risk prostate cancer. Monitoring, which is also called active surveillance, entails periodic PSA tests and biopsies to check for cancer growth, and thus allows men with low-risk prostate cancer to avoid the harms of treatment, at least temporarily.

It’s important to emphasize that the Task Force is not recommending that men in the 55-69 age group be screened, only that they talk about it with their doctors and then decide personally if it’s something they want to do, in accordance with their own values and preferences.

“Even the most serious student of prostate cancer and prostate cancer screening can appreciate the enormous endeavor that the Task Force undertook,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “Patients should consider shared decision making with their health provider when it comes to screening. But as in 2012, the ability to show an overall survival benefit from any screening recommendation still eludes us, and the cancer-specific survival benefit, if one exists at all, is at best very modest.”
In April, scientists reported encouraging results from a pilot study of men with metastatic prostate cancer, or cancer that has spread beyond the prostate gland. Long considered incurable, these advanced cancers are usually treated by giving men systemic drugs that target new tumors forming in the body. The scientists who led this new study took a more aggressive approach. In addition to giving systemic therapy, they surgically removed the prostate gland and affected lymph nodes, and also treated visible cancer in the bones with radiation. By throwing everything but the kitchen sink at these cancers, they achieved a stunning result: some of the treated men are still cancer-free after four years, and one has lived without evidence of cancer for five years. “If these remissions persist long enough, then we have to ask whether some of these men have been cured of their disease,” said the study’s lead author, Dr. Matthew O’Shaughnessy, a urologic oncologist at the Memorial Sloan Kettering Cancer Center, in New York.
How the study was conducted

The small pilot study enrolled 20 men, and O’Shaughnessy emphasized that follow-up with a larger group is needed to confirm the results. Five of the men had cancer that had spread to lymph nodes in the pelvis, and 15 of them had cancerous lesions in their bones. All the men were treated for between six and eight months with hormonal therapy, which blocks testosterone (the male sex hormone that makes prostate cancer cells grow faster). As noted previously, they also had their prostates and lymph nodes removed, and bone lesions were treated with radiation as needed. What the researchers were aiming for is a complete absence of prostate-specific antigen (PSA) in blood for a minimum of 20 months after the start of hormonal therapy. Prostate cancer cells will shed PSA into blood, but if the gland has been removed and all traces of cancer removed from the body, the levels should drop to zero and stay there, even after testosterone levels return to normal.

Overall, five men had undetectable PSA at 20 months and counting, although that number is too small to draw any conclusions about who might benefit most from the approach. According to O’Shaughnessy, when used together hormonal therapy, surgery, and radiation all contributed to prolonged remissions that would not have been possible if only one treatment was used. A study employing the same methods is planned for later this year.
What this means for treating advanced prostate cancer

Until recently, taking out the prostate and lymph nodes in men with advanced prostate cancer would have been unthinkable. Doctors worried that surgery could release cancer cells into the bloodstream, but newer studies show it can safely lengthen survival. Researchers have also been combining hormonal therapy and radiation with encouraging results, and now giving all three treatments is “consistent with a trend of doing more for advanced prostate cancer than doing less,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. Still, Garnick cautions that cures for advanced prostate cancer can take decades to confirm. “Hopefully follow-up research will support this transformative approach,” he said.

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Safe injection sites and reducing the stigma of addiction

It’s the end of the school year, the time of graduation speeches, of looking back at accomplishments and making plans for new ones. It’s a time when many parents think about their hopes and dreams for their children, whether they are graduating or just learning to walk.

As parents, we tend to think about getting good grades, excelling at athletics, being popular, getting into good schools, and getting good jobs. All of this is great, of course. But there is something that children need if they are going to truly succeed in life, and that’s resilience.

Resilience is the ability to overcome hardship and be okay. It’s the ability to navigate life’s inevitable bumps and still be happy and healthy and stay on track. What worries me sometimes is that our current parenting culture of achievement and obsessing over safety — and the way that electronic devices have become so ubiquitous — may get in the way of learning resilience.

According to Harvard University’s Center on the Developing Child, there are four factors that help children develop resilience. They are:

    Supportive adult-child relationships. This is crucial. All it really takes is one supportive, nurturing relationship to make all the difference. This gives children a buffer, and helps them know that they aren’t alone and that they matter to someone. While all parents want to have a good relationship with their child, the demands of daily life can get in the way. Try to spend regular time with your child when they have your undivided attention. Ask about their day, get involved in activities they enjoy, spend time doing things together. Make sure your child knows that no matter what, you have their back — and you will love them.
    A sense of self-efficacy and perceived control. Basically, you want to help a child learn that they can manage, and that even if things go wrong, they can figure a way through. You can’t do this just by telling your child that he is smart and capable; he needs to learn it himself. Bit by bit, giving independence, letting children make decisions and take risks helps them learn to weather life’s storms. It’s not always easy to let children take risks —we never want them to be hurt, emotionally or physically — but with you at their back, and in a gradual way, most children can and do manage just fine. Learning this also involves shutting off the screens and being active. Learning to be physically capable is important. In being active, in running and climbing and other such activities, children learn not just their strengths and limitations but how to plan and troubleshoot.
    Strong adaptive skills and self-regulatory capacities. This is what we call “executive function.” It’s like the air traffic controller functions of life: the ability to prioritize, not get distracted, make a plan, negotiate, get along with others, and manage emotions. These are not easy tasks, and there is no way to learn them without practice. One of the best ways for children to practice is through unstructured playtime, either alone (so they can find ways to entertain themselves) or with others (so they can learn how to work with others). Consistent discipline, not giving in to tantrums, and helping children manage sadness or frustration rather than just fixing things for them, can also help. The Center on the Developing child also has suggestions on activities to support executive function at different ages.
    Being able to mobilize sources of faith, hope, and cultural traditions. It helps to be part of something bigger, to have community, to have traditions that help you through difficult times. This doesn’t mean that you need to join a faith if you don’t belong to one. But if you do, maybe you could go to services a bit more often. If you don’t, spending time with extended family, joining a community group, taking part in service opportunities together… these activities can help give your child a perspective on life, as well as strategies for handling challenges. Because ultimately, the ability to keep perspective and handle challenges is what gets us through and helps us succeed.
When I was a kid, my summer sport of choice was baseball. Every day I played in marathon neighborhood games until it was too dark to see the ball. It was about fun and not fitness. But now that I’m older, and my Louisville Slugger has been officially retired, I need a summertime sport that recaptures the playfulness of my youth, but also works to keep my physical and mental skills sharp.

So, I picked up a racket.

It turns out that racket sports are not only fun, but they may help me live longer. A study published online by the British Journal of Sports Medicine examined the link between six different types of exercise and the risk of early death. Researched looked at racket sports, swimming, aerobics, cycling, running, and soccer. Study volunteers included 80,306 people, who ranged in age from 30 to 98. Over the course of the study’s nine years, those who regularly played racket sports were 47% less likely to die of any cause and 56% less likely to die of cardiovascular disease.

“In many ways, racket sports like tennis, squash, badminton, racquetball, Ping-Pong, and other variations are the ideal exercise for many older adults,” says Vijay A. Daryanani, a physical therapist and personal trainer with Harvard-affiliated Spaulding Outpatient Center. “Besides offering a good cardiovascular workout, they can help with both upper- and lower-body strength at one time. They can be played at any age, can be modified to fit most fitness levels, and do not involve a lot of equipment.”
Body and mind games

Racket sports offer something other fitness sports do not — lateral movement. “Most of our lives are spent moving forward, and that includes our exercise,” says Daryanani. “Racket sports force you to move both back and forth and side to side. This helps improve balance and weight shifting, which can lower your risk of falls.”

This kind of activity also exercises your mind. From a cognitive standpoint, it sharpens your planning and decision-making skills, as you must constantly anticipate and execute your next shot.

Racket sports also serve up a strong social component. You play against other people — either as a single or part of a doubles team — while other exercises like running, swimming, and cycling are more isolated activities. Frequent social contact is essential for a long and healthy life. In fact, a 2012 study in the Archives of Internal Medicine found that loneliness was associated with functional decline and an increased risk of death among adults older than age 60.
Pick up pickleball

While there are many types of racket sports to try, one of the fastest-growing among older adults is “pickleball.” It’s a hybrid sport that blends tennis, table tennis, and the backyard childhood game of Wiffle ball.

The paddle is between a table tennis paddle and a tennis racket in size and made of lightweight composite material, such as aluminum or graphite, which cuts down on fatigue. The plastic pickleball resembles a larger Wiffle ball and travels about one-third the speed of a tennis ball, so it is easier to see and hit.

Pickleball is played both indoors and outdoors. The court is 20 by 44 feet, or about the size of a double badminton court. The net is shorter than a tennis net, which makes it easier to hit over. Here are the basic rules:

    The ball is served underhanded and must land in the opposite diagonal court just beyond a 10-foot area by the net called the “kitchen.”
    The ball must bounce once before being returned, and again before being returned by the serving team.
    Once the ball has bounced and been returned by each team, volleying may continue with or without bounces, only if participants are outside of the kitchen.
    Games are played to 11 points, with points scored only by the serving team.
    A two-point spread wins the game.
The United States was declared free from ongoing measles transmission in 2000. So why are we still having measles attacks? An outbreak of measles is currently raging in Minnesota. In 2015, 125 cases of measles occurred in California, and in 2014, 383 people were infected with measles in an Amish community in Ohio.
How measles outbreaks happen

There are several reasons why we are still at risk for measles outbreaks. Travelers may get infected overseas, and bring the measles virus back into the country with them unawares. The 2015 measles outbreak in Ohio began when two infected members of the Amish community returned home from typhoon relief work on the Philippines. The California measles outbreak in 2014 started at two Disney theme parks, perhaps after the virus was brought there by a foreign tourist.

In measles, there is an unusually long delay between infection and the development of the rash and other symptoms, typically about two weeks. Measles virus is also highly contagious; patients start to spread the virus to other people about four days before the rash develops. These features make it possible for measles to spread quickly through an unsuspecting population.

The final component to measles outbreaks is inadequate immunity. Many American adults have only received a single dose of the measles, mumps, and rubella (MMR) vaccine, which is only 93% effective at preventing measles. Since 1989, the recommendation has been to give two doses of MMR, which is 97% protective against measles. Vaccination rates have been low among patients in recent US outbreaks. In the current outbreak in Minnesota, most measles cases have occurred in unvaccinated Somali-American children, probably due to the success of anti-vaccine activists in pushing a debunked connection between autism and the MMR vaccine.
Measles infection can still be lethal

So, what’s the big deal about measles? For most people, measles makes for a miserable week of high fever, cough, runny nose, watery eyes, and an impressive total body rash. But for others, it can be a life-threatening, even fatal, condition. One out of every 20 measles patients develops pneumonia, which may be severe. Infection of the brain, or encephalitis, occurs in one out of 1,000 cases. Brain damage, deafness, intellectual disability, or death may result. Before the measles vaccine was available, measles killed 500 people in the US every year, most of them children, and led to 1,000 cases of brain damage per year.

Measles has an especially horrifying late complication known as subacute sclerosing panencephalitis (SSPE). In SSPE, children recover from their initial measles infection, only to develop progressive brain infection with a mutated form of measles virus in their teenage years, leading to a persistent vegetative state.

Many outbreaks of measles could probably be prevented if more travelers received MMR prior to foreign travel. According to a study done in US travel clinics, 16% of pre-travel patients were eligible for measles vaccine, but only a minority of patients received it. The authors of the study cited many reasons that patients didn’t receive the vaccine, with patient refusal being the most common. Next time you plan to travel overseas, think about protecting your community by asking your doctor if you are a candidate for the MMR vaccine before you leave. Imagine a chronic medical condition in which the treatment itself has serious side effects. Examples of this are plentiful in medicine. For example, in diabetes, giving too much insulin can cause hypoglycemia (low blood sugar), a dangerous and potentially life-threatening condition. That doesn’t happen very often, but imagine that it was a common complication of treating diabetes because doctors couldn’t really tell how powerful a given dose of insulin actually was. And suppose that doctors and patient safety experts advocated for places where patients with diabetes could be carefully monitored when taking their insulin. Would you be opposed to this idea? Would you blame the patient for developing diabetes, or for needing this carefully supervised medical treatment in order to live? I suspect that the answer is “of course not!”

Now, let’s shift gears and discuss opioid addiction, specifically people who use illicit drugs like heroin and black-market fentanyl. Heroin is the strong opioid substance derived from the poppy seed that has been used for thousands of years. Fentanyl is a synthetic opioid that can be hundreds of times more powerful than morphine or heroin. Increasingly, illicit heroin is adulterated with fentanyl and similar chemicals, which public health experts believe is the reason for the continued rise in opioid-related deaths despite aggressive measures to decrease opioid prescriptions, increase substance use disorder treatment facilities, and widely distribute naloxone, the antidote to opioid overdose.
Saving lives in the face of increased risk for dying of a heroin overdose

People who use heroin are now at significant risk for overdose death, mainly because the opioid content can vary considerably from dose to dose. Previously, a little too much could have caused a decrease in respiratory rate and a high dose could lead to overdose. Now, with the variability of potency from the synthetic opioids, the strength of each dose can be markedly different. Furthermore, the uptake of fentanyl in the brain is so rapid that a fatal overdose can occur much more quickly than with heroin alone.

If we, as a society, are truly serious about saving lives, we have no choice but to allow people who use injectable opioids to do so in safe, monitored locations without fear of negative repercussions (e.g., being arrested). If you had asked me about this several years ago, I never would have believed that I could write the preceding sentence. I would have said, “Why empower junkies to abuse illegal drugs? Why make it easier on them instead of harder? Why should society condone this activity?”

However, I was wrong — dead wrong.
Good reasons for a change of heart

It turns out that addiction (called substance use disorder or, more specifically here, opioid use disorder in medical jargon) is a disease that can affect any one of us, just like diabetes or high blood pressure. It does not discriminate and does not represent a moral failure on the part of the individual who develops it. It is a condition that no one chooses, but when it attacks, it changes the brain of those with the disease. We can actually visualize those changes with tests like functional MRIs. It leads people to make choices that destroy their lives and the lives of others, such as loss of job, isolation and loss of relationships, incarceration, and even death. We also now know that this is a treatable disease, but the window for successful treatment depends on the psychological state of the person. We must be ready to engage them in treatment at that moment when they are ready.

My opinions changed drastically after a visit to a local needle exchange facility. By current law, individuals can’t inject inside the building. They have to take their chances outside and then they can come inside to be monitored after injecting. I initially envisioned the facility to be sterile, dirty, and depressing. Instead, I was surprised to see that it looked like a living room. There were sofas and a television. There was a warm light, and it appeared to be a welcoming place. Across from the sofas were two desks where staff members sat. Their job is to watch for any signs of overdose (a person who is too sleepy or who is breathing too slowly) and then rapidly respond by providing a nasal dose of naloxone to reverse the overdose. More importantly, they are there to help people right when they are open to treatment for substance use disorder. The staff will help connect them to treatment resources, whether it is group therapy or medical treatment like buprenorphine (Suboxone) or methadone.

If that moment of opportunity in which the individual is receptive to treatment passes, the consequences can be deadly.

Furthermore, the facility is all about harm reduction. There are boxes of free supplies: needle kits so that people do not share needles, condoms for safe sex, kits to help treat small skin infections, even little clean cups to freebase injectable drugs. Naloxone kits are also provided free of charge. There is no judgment there. It is only about reducing a person’s risk of serious, life-threatening infections like HIV and hepatitis C, or the risk of death. And it makes sense. If we are going to agree that opioid use disorder is just another medical condition that needs to be treated, then the compassionate thing to do is to remove the stigma associated with it and reduce associated harms while a person is suffering with substance use disorder. Plain and simple: people with this disease are going to use drugs. Is it better for them to use in the shadows, risking transmission of serious infectious diseases, or monitor them when they are using and be there for them to get them treatment at the moment they are ready?

Currently it’s still illegal in the US to allow people to inject in these supervised environments, but the tide is turning. The city of Ithaca, NY is contemplating a safe injection space, as is Seattle. Multiple studies have confirmed that they work. In Vancouver, Canada, where such facilities were implemented in 2003, they concluded: “Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts.” Massachusetts is also contemplating a similar pilot supervised injection facility program. With the crises of the opioid epidemic now claiming more than 30,000 lives every year in the US, it’s time to change our biases and old ways of thinking — people’s lives depend on it.

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What is addiction?

Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.
A revised view of addiction

It might seem strange to group gambling problems in the same category as a problem with drugs or alcohol. But addiction experts are beginning to move away from the notion that there are multiple addictions, each tied to a specific substance or activity. Rather, the Syndrome Model of Addiction suggests that there is one addiction that is associated with multiple expressions. An object of addiction can be almost anything — a drug or drug-free activity. For addiction to develop, the drug or activity must shift a person’s subjective experience in a desirable direction — feeling good or feeling better.

Several scientific advances have shaped our contemporary understanding of this common and complex problem. For example, brain-imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from ingesting psychoactive substances, such as alcohol and other drugs, or engaging in behaviors, such as gambling, shopping, and sex. Genetic research has revealed that some people are predisposed to addiction, but not to a specific type of addiction.

These findings suggest that the object of addiction (that is, the specific substance or behavior) is less important than previously believed. Rather, the new thinking reflects the belief that addiction is functional: it serves while it destroys. Addiction is a relationship between a person and an object or activity. With addiction, the object or activity becomes increasingly more important while previously important activities become less important. Ultimately, addiction is about the complex struggle between acting on impulse and resisting that impulse. When this struggle is causing suffering related to health, family, work, and other activities of everyday life, addiction might be involved.
There are many routes for recovery, and the road may take time

Addiction is a chronic and often relapsing disorder. It is often preceded by other emotional problems. Nevertheless, people can and do recover from addiction, often on their own. If not on their own, people can recover with the help of their social network or a treatment provider. Usually, recovery from addiction requires many attempts. This can lead to feelings of frustration and helplessness. Smoking is often considered one of the most difficult expressions of addiction to change. Yet, the vast majority of smokers who stopped quit on their own! Others stopped smoking with the help of professional treatment. It is important to remember that the process of overcoming an addiction often requires many attempts. Each attempt provides an important learning opportunity that changes experience and, despite the difficulties, moves recovering people closer to their objectives. There are many pathways into addiction and many routes to recovery. Think about recovery from addiction as a five-year process that will have its ups and downs; after about five years, life can and will be very different. As life becomes more worth living, addiction loses its influence.
Going out for dinner can be a nice way to unwind with family or friends. But if you’re watching your salt intake, restaurants aren’t always so relaxing. Much of their fare is loaded with sodium, a main component of salt. In fact, some entrees at popular chains contain far more than 2,300 milligrams (mg) of sodium — the recommended limit for an entire day’s worth of food.

Limiting sodium is especially important for people with high blood pressure, because excess salt worsens this common condition, leaving you more prone to heart attack and stroke. If you eat out only once a month, you probably needn’t worry too much. But Americans tend to eat out far more frequently — about five times a week, on average.
For starters, do your prep work

But there are plenty of strategies for staying within your salt budget when eating out, starting before you even leave home, says Debbie Krivitsky, director of clinical nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital. When possible, check the restaurant’s website to look up the nutrition information (including sodium) for different menu items beforehand. You can also search for your favorite dishes at CalorieKing, which includes nutrient data for foods from hundreds of popular nationwide chains. Federal law now requires all restaurants with more than 20 locations to provide this information.

Not surprisingly, the highly processed fare at fast-food restaurants is quite salty (for example, a Big Mac has 950 mg of sodium). Beware of unexpected sources: a Dunkin’ Donuts reduced-fat blueberry muffin contains 540 mg of sodium. But sit-down restaurants aren’t all that much better. “The typical meal at a chain sit-down restaurant contains about 2,100 mg of sodium for every 1,000 calories,” says Krivitsky.

Certain cuisines tend to have higher sodium levels than others. Asian restaurants use a lot of sodium-rich soy and fish sauces, and Italian food (especially pizza) has high-sodium sauces, cheeses, and cured meats, such as pepperoni and prosciutto.
Fresher options and menu tweaks

A better option (if available) is a “farm-to-table” restaurant. These newly fashionable eateries focus on fresh and often locally grown or raised foods. While they may not provide nutritional information, these establishments — as well as other neighborhood and smaller “mom-and-pop” places — may be willing to work with you to prepare a lower-sodium meal. These days, with more people following gluten-free and vegan diets, they’re used to making adjustments. And it’s in their best interest to make their customers happy.

If you’re comfortable doing so, tell your server you have a medical condition or are taking medication and need to limit your salt. They may be more inclined to take you seriously, says Krivitsky. Then say, “Please tell the chef to grill, broil, or steam my food with no added seasonings or sauces.” If you’re ordering a piece of meat, chicken, or fish, find out the weight of the serving size. Have the server bring you a plate with only the amount you want to eat and bag the rest to take home.

If you’ve got your heart set on a special entree that’s over your sodium budget, ask the server to box up half of the dish to save for the next day before bringing it to your table. That way, you can enjoy the portion without being tempted to pick at the rest just because it’s in front of you.
Harvard Medical School (HMS) has a bicycle-friendly campus. Faculty, staff, and students who commute by bike can park their wheels in secured cages, wash off road grime in showers, buy new helmets at a discount, and receive a monthly reimbursement for bike maintenance costs. HMS encourages bicycle commuting not just to relieve parking congestion and foster cleaner air, but also because observational studies have suggested that cycling, like other forms of exercise, is good for us.

A recent study suggests that bicycle commuting, like recreational cycling, is not only associated with a lower risk of serious disease, but with a longer life as well. For that study, researchers from the University of Glasgow followed more than 263,450 commuters in England, Scotland, and Wales for an average of five years. The group was composed of 52% women and 48% men ages 40 through 69.

The researchers divided the participants into five groups based on how they got to and from work on a typical day — walking, cycling, riding in a car or on public transportation, mixed walking (a combination of walking and riding), and mixed cycling (cycling and riding). They found that compared with riding to work, bike commuting was associated with a lower risk of being diagnosed with cardiovascular disease or cancer, or dying of any cause during the five-year period. Walking was associated with a lower risk of developing cardiovascular disease.
The benefits of biking outweigh the risks

“The benefits of regular physical activity are well documented, but there have been concerns that traffic crashes may negate the benefits from commuting by bicycle,” says Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, and a bicycle commuter himself. “This study is important because it confirms, with a much larger sample size, previous findings from other countries. Moreover, it shows that the benefits strongly outweigh the risks.”

The study also provides some assurance to cyclists in the US, where biking conditions are similar to those in the United Kingdom and less friendly than in many European countries. For example, in the Netherlands the bicycle is the major mode of transportation for more than a third of the population, who have access to separated cycle tracks, networks of bicycle paths, and ample dedicated bike parking, and where traffic laws give them the right of way over cars, trucks, and buses. A 2015 analysis conducted by researchers at the University of Utrecht determined that cycling prevents about 6,500 deaths each year in the Netherlands and is responsible for adding six months to the life expectancy of the average Dutch person.

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Vita Health Tips to know

Let me just say it was a real struggle figuring out I wanted to feel with like the viewers the background but then the lighting was all under my desk was messy so I didn’t want to have that as a background. So here we are, I’ve got my studio lights up to help support me so I’m hoping that this video turns out okay.
Anyways, as you can see for the title today I’m going to be doing a video all about how to do well at university so I’m going to be talking more about the academic side of things. So once I’ve always talking about the social aspects and the partying on my channel, so I thought I’d bring it back a little and actually give some academic advice. I’m going to be discussing study tips, ways to get organized how to keep on top of things.
So if you’re looking forward to the video, make sure the thumbs up button if you are an idea I would like to see more of my videos don’t forget to
the subscribe button down below and click the subscribe button so it will push notifications are that fair review let’s just go ahead and jump straight into the Tips.
So my first tip on how to do what a university is definitely getting organized and remaining organized throughout the year I’m the best way to do this is getting a plan. Our panelists are so important in helping to keep up with things and knowing what your schedule is week two we actually just get mine from TK Maxx.
I believe this whole candles literally free costs 99 amazing we are getting a tonight is definitely an essential when it comes to university. It’s a great way to see when you have your lectures when you have deadlines, assignments, etc. Particularly in the first time of university it’s very hard to keep up with things because on top of going to lectures you’re also doing societies are going out we’re making friends and socializing and so from that when you’re not keeping track of what you’re supposed to be doing it is very very easy to forget things or forget you have that 9am often get that your assignment still friday so to avoid anything like that happening. I definitely
about getting a planner if you don’t like to write down things it doesn’t necessarily have to be a physical one like the one I showed you I mean there’s so many apps we can actually just use the note section on your iPhone I used to do that all the time via regardless of performance we’re doing yeah I definitely recommend having a plan on write down everything keep on top of thing and ensure that you know exactly what you’re meant to demean each week.
The next tip I’m going to be talking about is something I’ve been doing it since like year nine I want to say by any found out the actual time for this morning apparently it’s called the halo so what the halo effect basically is, is that when you first school or university within the first couple of weeks, just how you’re forming an opinion of your class and your teacher. The teacher is also doing the exact same thing with their students at it from day one of your lectures about the front of the class engagement for teacher having the eye contact, paying up your hand to ask a question for teacher it’s going to immediately see as like a good shooter, someone who’s very keen in the subject, someone that really wants to do well.
Essentially someone that they like. Whereas if you’re sitting in the back of the class, which is a bit noisy, oh, like a group of friends than your teacher might just think, okay, I always recommend getting close on time it’s sitting at the front. I’m just kind of engaging with your teacher from the get go find that once you establish a good connection with your lecture are live on his they get so much easier, they’re often more willing to go above and beyond when it comes to answer your questions. I hope out because they know that you’re genuinely interested in the subject.
But personally I love most about this halo effect is that once you spend a few weeks establishing that good bond that get connection for the rest of the year, I find that you can kind of get away with more things that if you miss your lecture, for some reason, I feel like maybe they’re bit more understanding because they know that you wouldn’t miss it for a stupid reason. You know, they’re just a bit more lenient and understanding throughout the year. So definitely recommend being a good student. Usually at the start of time let your team know that you’re really keen on wants to do well.
Tip number three is more of a study tab and something which I strongly recommend it
And that is pre reading before you going to close this is something I did more towards the end of my A Levels and found it so so helpful that I wish I did it before so it’s definitely something which I recommend doing from the very start University is if you’re unaware of what pre reading so it’s basically reading up on the topic that you’re going to be studying in class I find that doing this makes your lectures make it so much more sense because you’re not trying to grasp everything for the first time we’ve actually already had some prior knowledge so it’s more so confirming it reiterating it and just allow yourself to understand the topic so much better so for my personal University which has a lot of you guys know it is University of the Arts London London College of fashion my uni we have this include noodle where our teachers but done exactly what topic we’re going to be doing each week and I often already have like the reading materials out there if I need that I’m going to do in crisis management for example I can go on to the regional is for that topic and just have every little bit before class so that one are actually in class it will make a bit more sense and what’s amazing about pre reading is I honestly doesn’t have to be long at all actually just fine. minutes of skim reading is enough, it’s just something to do that you just have an overview of the topic before you learn a more in depth. So that hopefully makes it more sense.
You can literally do it on your way to lecture as well sure, having breakfast it doesn’t have to be a task that you have to go to the library for, can literally just do it on the go. And if for some reason your university hasn’t published by the reading materials for it, or like resources that you can use your goal is the thing and I you can actually just type in on Google happened over through and hopefully that allow things to make so much more sense to you.
The fourth tip for today’s video is also a study tip and that is to clarify any doubts that you have immediately say when it comes to university, things move pretty quickly. And so if you’re in class and you don’t understand the topic and you know asking questions because you think it will make sense closer towards exam period or whatever the chances are by the time you get to exam here is will also have certainly other topics that you’re unsure about. I was just getting to the point where you physically don’t have time to go over everything again.
So my best piece of advice to all Asked Questions that maybe don’t understand something obviously for teachers just introduce the topic way into she finishes explaining it until you ask a question but at the end of that class you’re like wait a sec I actually don’t understand this concept either asking cause then in that because chances are other students didn’t understand over you asked that question in front of everyone over may be beneficial to the other students that if you’re perhaps shy or the transition classes past, definitely stay back to the end of the class to ask you a lecture about it. Or if you have tutorials or university awesome then in that as well.
But honestly, the Wise we can do is just leave and definitely want to make sure that you just understand things as you go along that by the time you get to your assessments or sound, you already know the content and you can just focus on exactly the thing I’m going to talk about in today’s video lectures. Lecture.
Our lectures is the lecture Do I go to university? I don’t know. But yeah, in terms of lectures, first and foremost, go to a lecture. It’s like maybe it’s because I never had 9am Like all of my lectures, I don’t some people don’t go to lectures, it’s so much easier to just sit in a room for like an hour and a half then to stay at home and cut off your lecture on your laptop and be making notes and not really understanding what’s going on. Even if we’re completely hung over or you just can’t be bothered. Just drop yourself into unique it’s literally about to sit there like arms folded, and just listen and then to be at home and not greater than lecture and then catch up later while you frantically trying to make notes and piece everything together. Like it’s just not worth it. So personally just go to other artists in my opinion, but the second thing and tells the lectures it’s definitely make good to know one thing that took me quite a long time to graph is that you generally don’t need to write down everything that’s on the board. Literally just write down the most important point I know that if you’re like me that it’s quite hard not to do because you want to get down all of the information but learning to make condensed notes from the get go. It is definitely something which is beneficial because it saves you from condensing your classmates later on in the year and it was me so if you’re looking for quick

information of the answers you can easily find a bullet point which has it as opposed to having to like dissect your class know another thing which makes your lecture notes really amazing is using color I know it’s quite long to bring like a whole purpose okay sometimes so I recommend getting those pens that have like the color wheels around it but you can click for like red and then click for blue and then click for black I love phase I’m making and so if that’s something that’s really important I’ll quickly just switch to read and write that impressive it sounds out there again we’ll come back to your notes you know what’s really important and what keywords you either yeah those are my tips which I hope really hope he was at university also have them a quick and simple it’s really good to just reiterate them and have them fresh in your mind before you start going to an active if you did find the city are helpful if you learn something new then I’d love if you could hit the thumbs up button and let me know in the comments down below if you Are any of you enjoyed the video just getting the scroll down below upload new videos every single Wednesday and Sunday. Yeah that is basically the end of today’s tips. Thank you guys so much for reading and I’ll see you in my next one.

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Year’s Resolutions for Students Study Tips

Hello, my Socratic of friends. We’re here to help you be a great student. Here’s a personal question do you make new year’s resolutions we do both in January, and at the start of the school year, which feels like another new year, doesn’t it? It’s a great feeling, getting a fresh start and thinking about how to improve. That’s really the whole point of the series, isn’t it. So let’s talk about how to make resolutions and how to keep resolutions. First, let’s think about what makes a good resolution. I’m not going to resolve to become president of NASA that’s just not reasonable. A good resolution is one that is actually achievable with a little focused effort on your part. This should also be something that is personally important to you. Make sure your heart is really in it. I’m not personally excited by marathons so I’m not going to make a resolution to take up running my resolutions always seem to be about learning something big surprise here. Don’t make a resolution that’s vague, like I’m going to get healthy or I’ll be a better student pick something very specific you Want to accomplish? break it down into small, concrete doable actions. As in if I want to get better grades, I will set aside 30 minutes every day after class to review my lecture notes. Or if I want to prove my Japanese reading skills, I will study 10 Japanese characters every day, I’ll be able to take very specific actions. To keep this resolution I’ll put 10 flash cards in my pocket every morning. That makes it easy to pull them out and study a little when I’m taking a coffee break done. Another way to pick a resolution is to think about what’s a good habit you want to adopt. I want to take a 20 minute walk every day. Exercise is good for the brain. It reduces stress and it’s a good way to spend breaks between Pompadour sessions. If I genuinely stick to taking a walk in the fresh air every day. I’m going to be much healthier by the end of the year and I’ll have develop the kind of habit that could last a lifetime. Or maybe there’s a bad habit you want to break if you smoke. You really, really I mean, really, you should stop it sticks. It’s expensive.

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It causes cancer. What bad habits do you have? I personally don’t have any. Not that I know. Never heard of them. Now don’t go overboard, trying to remake yourself into a completely different person. Pick one thing, okay, maybe two things. But that’s it. It’s much easier to keep track of one resolution than a whole bunch of them. Especially since people who break resolutions often say it’s because they’re just too busy. There’s just too much going on in my life to pay attention to well, don’t let that happen to you. Let’s keep it real simple. Every day. I’m putting 10 flash cards in my pocket. How hard can that be? It helps if you keep track of your progress. Have you heard of this trick from Seinfeld Don’t break the chain. If you mark off every day successfully kept your resolution on a calendar you see a growing chain of accomplishments. It please a nice little trick on your brain. You can see how much good work you’ve done and you don’t want to mess it up. It’s a little added incentive to keep going. Don’t break the chain.

Our friend Simone Gertz you’ve probably seen her work making interesting robots made a beautiful engineered version of the resolution calendar. You can find it on Kickstarter. It’s seriously like a work of art. Every time you do your resolution, you get to light up a day. And she made this beautiful thing to help her keep her resolution to meditate every day for a year to make that a new healthy habit. And it totally worked for her. Okay, that gives us an idea for another video. How do you meditate? That’s a really useful skill to help you be a great student. Okay, stay tuned, coming soon from Socratic.

Oh, but what if you do break the chain? Don’t beat yourself up, get back on the horse. Tomorrow is another day. Anyway, perfectionism is overrated. If you succeed for 350 days of the year. Isn’t that something to be proud of? Compared with last year? Yeah, remember to be kind to yourself, how would you treat a friend who slipped up you’d be understanding and encouraging be that person for yourself. Another thing that can help is to keep a daily

journal entry about your resolution, make a note of the days that were easy. What did you do that made it so easy? Think about the days that were really hard. Can you figure out what made it hard? Did you forget to pack a healthy lunch? And so you got fast food. instead? Did you forget to write down your assignment in your planner so you didn’t write your paper until the last minute. This kind of self reflection can lead the way to real change where it becomes easier and easier to make a resolution. The true habit is something you always do as a regular part of your life. Have you heard the standard wisdom that it takes 21 days to make a new habit? Okay, we’ll talk here that’s pretty made up number we read that this number came from Maxwell mots, a plastic surgeon who studied amputees in the 60s and he found it took about 21 days for them to adjust to their new routine, missing a limb. Therefore it takes 21 days to adjust to a new habit. That’s a pretty big leap right there max. More recently, psychologist Philippa lolly formally studied habit formation and found that it took on average 66 days to form and

habit, there was a huge variance. However, some tasks were easier and took as little as 18 days to become second nature, while others were more challenging and took as long as 245 days. So don’t worry if you don’t find yourself measuring up to some arbitrary standard. It doesn’t sound like there is one. What else can you do to make it more likely for you to succeed and keeping your resolution, let the people around you help you. It can be much easier to make these changes in your life. If everyone around you is on board. Tell your friends and family what your resolution is. That is if they are genuinely supportive. We know there are some people out there who may not want to see you change for the better. That’s the sad truth about human nature. Please don’t let this stop you. If you feel you need to keep your resolution to yourself. That’s okay too. What’s your New Year’s resolution? Is it something we can help you with? Let us know in the comments below. We’re all learning and growing. Here. At Socratic. We make new year’s resolutions because it’s a little stretch toward becoming that person you’re proud to be.

It’s all part of being a great student. One of our new year’s resolutions here at Socratic is to grow a little bigger so we can make more videos for you. Would you like to help us if you find the work we do here valuable, please consider supporting us on Patreon. With your help we’ll be able to grow our team. Thank you.

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Planners for University Students 2019

Good morning everyone. So today I have something very fun that I’m looking forward to filminit is time to finally invest in a new diary for 2019 I get such a kick out of doing these things. So I’m going to take you shopping with me to find the perfect diary or planner and probably pick up a few extra organizational items. And I’m also thinking of maybe getting a few little goodies for you guys and doing a little giveaway I might do it on Instagram. So stay tuned throughout this video and I’ll let you know more details. But did you notice something different about me? Maybe, maybe not. I got new glasses finally. So if you didn’t know I actually lost my favorite pink pair of frames on the airplane. When I was coming down to Melbourne from Sydney. There was the one thing that I misplaced as I was packing up my entire life so I think I did pretty well but glasses usa.com have come to my rescue. I said me so.

many pairs of glasses I just have to show you this I have glasses drawer right now I’m very excited so as you probably know we’re currently in an Airbnb just for a few more weeks but I had to clean out one of these jewels, my glasses because they sent me six pitches. So I actually think they Sonny’s one of my favorites the ones I’m wearing and also these pink ones Oh and if anyone’s Hilary Duff and she actually did a collaboration with us for glasses usa.com is I have to have her different designs I think there’s over at to choose from there there little bit more expensive than these ones. So I often spend way too much on my glasses. I was really surprised how cheap they are though. So there’s free basic prescription lenses included and frames and lenses started like 30 bucks which is amazing because I used to spend so much on my glasses so I really appreciate being able to save right now and you’re probably thinking okay but clearly you don’t like all six I can’t all fit really nicely. I kid you not. I love I had this little virtual mirror where you can upload a photo of yourself or you can check

out the glasses and the frames on another person’s face. It has a similar shape to yours and you can actually see if they’re going to sit you or not. So they sent me six pairs. I promise you all six look really good and I’m so happy with them. Also, I thought we do a fun little vote between all of my favorite peers. I want to know which ones you prefer the most. We’ve got option one,

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option two. I think these are so cool. I’ve never had clear white plastic frames or option three the pink ones these are very similar to the ones that I had that were my original favorite color which one is your favor guys so if you like my new look, let me know down below but now it’s time to get serious with this video because we’re about to replace my new baby My all baby Why did I say new is not new is a year old and he seemed to be out of date. So I’ve got some pretty strict criteria for what makes for the perfect diary. Yes, I’m pretty hard to place Yeah, but let’s head to one of my favorite stationery stores.

And hopefully I can find the right one for 2019. And look number four. Let’s head out the door.

I’m arriving today I losing my bubbles.

I think I was browsing through the diaries for over half an hour, but I’m really happy with my purchases. So that was a successful little shopping spree, the lady kkk was so helpful and friendly, I picked up a few things that I think are going to make 2019 so much more organized and I’m really excited to show you what I bought and I also picked up a few little prizes for you guys as well so stay tuned for that I’m back and I have to goody bags or one is for me and one is for you. Or it could be yours if you win my little giveaway.

So I’m going to run it on Instagram, I’ve decided. So if you’re not following me at study with Jess, go and follow me now. And I will have all the details for how you can enter to win some very cool little goodies on my Instagram account. So just make sure to be active and checking out my latest post an Instagram story because details will be there. But let me show you what I picked up. All right, let’s start with the diary. Now. Can I just say last year I wanted this exact diary. And I didn’t have it in stock anymore because they only had the weekly layout and not the daily. So let me explain why I chose the stars specifically because I have wanted this one for ages. Right. So the first race that I chose this story is that it has a day per page says plenty of room tried everything down and it has the timestamp in it as well starts at 7am but there’s actually room to write for six or 5am and it finishes at nine but you can also write a little bit later than that and there is a note section as well.

As a line for birthdays now I always need extra room for my reminders my to do’s birthdays when people are traveling where Adam and I travel a lot for work. So I like to keep track of that. And the last year I had this one here, it actually didn’t have any timestamps, so I would write things down, and then I have another appointment that’s a little bit earlier and I’d have to cross it out or raise it and rewrite it because I just didn’t have time to go through 365 pages and number them from 7am to 9pm. It’s just really, really inconvenient for me, whereas this one’s going to save me a lot of time and I think it’s going to be easier to keep tidy and organized. Okay, this is really cool. I’m actually discovering it in more detail as I’m sharing it with all of you, but it has a note section. It has a page for listing website and notes about those sites, books, so section track down titles and authors. If you get book recommendations, you can store them their restaurants and bars, there is a section for riding down and tracking your expenses.

But I did buy something else to use instead of this area of my diary to track my spending. I will share that with you soon. And then when I was in the store I asked the lady if they have any loose leaf shades of stickers to just mark any important things in your diary and she turned to the back of this diary and says to me, um, it already comes with them. How awesome is that? So I’m just really excited to start using my new diary and I think it actually starts for December so I could get cracking right away. It does Wow. The little things that get me excited. Alright, so you know how I said I bought something instead of using the diary section to track my expenses. This is it so it says everyday is a fresh start and it is a photo of organizing all of your receipts and spending so the lady in the store recommended this to me because she uses the same and ha every accountant is going to love me in 2019 and I’m definitely

going to be a lot more on top of my spending and more savvy with how I spend my money. So it comes with different stickers, you can organize all of these following photos according to the months of the year. I think that’s how I’m going to do it rather than different categories. And you just write down the date, the amount of money you spent text involved and the details for items that receipt and you’ve got their seat in the back right so last thing I bought for myself is a wall calendar and actually have this one for 2018. I thought it came in handy so much I want one for next year as well. It does have some beautiful quotes for each month. As you can see on the back that’s little way out there. And I just think I prefer to have a monthly calendar above my desk. Rather than using the monthly spread in my diary, I’ll probably use that monthly spread as well. But I think this is easier just to map out everything and it helps you to feel less overwhelmed especially when you have a really busy month because you can break it all down and say that even though there’s a lot going on, it’s probably early according to specific weeks or days and little chunks throughout the month. It’s not usually a really flat out month although December has been pretty busy for me. So I do think I’m going to use this a lot and I can’t wait to hang it up in Adam and my new apartment. So what little goodies did I pick up for the giveaway. I’ve got two things in here. First thing is the 2019 at daily view diary, which I picked up for myself as well in the past or pink. I just really liked the land and format of the story. I think it’s going to help you stay more organized and there’s plenty of room to write everything down. And then to help you write everything down. I also picked up these really really cute pens says one with ladybirds, one with cats, rainbows and hearts and one with cherries. And I thought that was just a really cute little giveaway to kick start your 2019 So again, just follow me on Instagram and you can check out the details for how to enter their at study with just and also I will leave a link down below of all the glasses that I showed you earlier in this video, including the ones I’m wearing now. Thanks to glasses. usa.com. So do check.

them out. And don’t forget to tune in next week for another video. Just turn on your notifications and I’ll see you very soon.

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Mistakes First Year Med Students Make

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for otter ketone esters new hires have fall but boxes why or external gamma gamma gamma can be strikes on my hand on getting Jojo Hidden Hand for Derek Charlie Popeye and formula by Jeremy Santa Clara Santa Pancho can be found at our public ledger, not collecting any pocket. Raise your hand for me to do here Airplane Mode column salsify and go with challah difficulty. Not difficult to welcome Mr. Kalyan my



America can you put your focus the match match and then promos topic area yellow be effective it okay Petro Canada in Toronto at our calendar invite

you into look Thank you Patricia Kim JD better and also nickel game plan you can see coffee or tea and coffee very adept

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Malaysia I guess yeah Miss Apple shares Mongo Mongo vile suka Joe Papp like like that subscription our post playing a video Pennsylvania so you can make up calm and subscribe Captain idea makeup my other JD automatic channel me then yeah my shareable among law social media Facebook Twitter Don’t be greedy share your knowledge with everyone and I’ll see you guys next tips byeWhat’s up friends welcome to another video to MD journey where my job is to teach you how to succeed in med school, but less time and this video we’re going to talk to all the first year medical students as well as soon to be med students on a what not to do when you first start med school.

And if you want to these medical students that are making these mistakes, like stop like yesterday, please for your sake, but I’m going to talk to you and the most common mistakes that students make six in particular that med students including myself made and it kind of ruins your medical experience because you carry these bad habits throughout. So yeah. Q intro



so six mistakes that first year medical students make now honestly, there’s more than six, but these are the most common, honestly, the most detrimental. So Mistake number one students come in with our predetermine mindset. Now this won’t be every single student but you’ll know who the students are because day one

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They’ll start saying that they want to become a dermatologist, orthopedic surgeon slashed astronauts slash radiologists. Now if you can manage to make those work all power to you, but it’s not about choosing competitive specialties are having high goals. The problem is, is when you have high goals, but then you use it as a crutch throughout your for you experience a why you can’t enjoy the rest of med school.

So these are the students who won’t come out on a Friday night or hang out with their friends and family on a weekend because they need to study or catch up. As I mentioned, they have high achieving goals, which is great and all of you should have those if you aspire to do one of these competitive specialties.

But as soon as you start making every little excuse you can find because all you want to get out of med school is becoming a dermatologist and orthopedic surgeon, a vascular surgeon, whatever you can think of.

That’s when medical school becomes more of a burden, then it becomes an experience. It’s great to have these high achieving goals but make sure you’re not using these goals and excuse of not enjoying other experiences with your classmates, your hobbies, your families and friends.



And one of the worst things that can happen is a third or fourth year. If you decide you don’t want to do that specific specialty, or you don’t want that goal anymore, you realize that you kind of wasted your first and second year on casing and being very narrow minded on this one goal and you use it as a crutch. So have high goals, I’m totally about that. But make sure that you’re also enjoying the experience. So the second mistake that most first year med students make is they don’t know how to study and this is because college creates very bad habits. All of you that are watching this video are very smart individuals. If you’re considering going into medicine, you have the grades you have the intellect, but sometimes we lean too much on our intelligence that we rely on cramming and passive methods. And when a new med student first starts to study in medical school, they’re split between active and passive learning is usually anywhere from 60 to 80% to 42 20%.

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So that means that they’re spending a majority of their time reading, watching lectures, rewriting their notes, but these are not really methods



that are going to help them a long term retention. And just because of the mass volume that you have to learn in that school, they’re often not going to do well in their first couple exams, because they’re relying on the same techniques that they use in college, which helped them as an exam the next day when they started studying the night before, it doesn’t work in med school.

So instead, you have to flip that formula, and you have to spend the majority of your time doing active message. So I personally have already created two videos on how to study effectively in that school. The first one goes over a bunch of active techniques that you can use.

The second one is my personal method that I use to study very efficiently would not very many hours and I give you a very step by step method.

I’ll link both of those below in the description if you’re interested. So just remember that when you start setting in medical schools, spend the majority of your time doing active techniques.

So quizzing yourself, taking practice exams, flashcards, whatever that may be for you. That way you can retain as much info you’re focusing on your weak points as much as your strong points. You’re not doing passive technique assessed. It’s not going to work and that’s cool. So Mistake number three, and this is something



That I see my classmates still make today. And it’s a quote that I’ll give to you that I’ve kind of come through creating them the journey which is try to schedule med school into your life and not your life into med school. Unfortunately, the mistake that a lot of new med students make is that they’ll schedule their life into med school. Now, it’s a common notion that med school is kind of like having a full time job. It’s like an eight to five job. Unfortunately, a lot of new med students will try to work overtime. And so they’ll add additional hours to the end of the day, add additional hours to the beginning of their day. And eventually the whole life becomes just being a med student.

But then they have no time for their hobbies and times for their friends and families. And they really did lose a part of themselves. So something that I really recommend to do to avoid burnout to enjoy your for your experience and still progress and become a great med student is make sure that medicine is only a part of your life. So one thing that I plead people to do is making sure that their priorities before med school are still a big priority while they are meant to do



And a great way that I like to do this is that actually like to schedule my fun first. Now that’s usually opposite of what most med students will think they want to schedule their study time first, then find time for leisure. But if I can schedule a workout in and I can schedule and my TV shows, my video games, my lunch or dinner with families and friends, if I already know when I’m going to enjoy myself, then whatever time I’m not scheduled to do, those are times for me to study and study effectively.

So just make sure that just because you’re a med student, that you don’t lose that old part of your life that made you you afford the mistake that new MIT students make is they listen way too much to their classmates. Now, I love my classmates. But when it comes time for an exam or an important deadline, they’re often the last people I want to be around and I’m probably the last person they want to be around as well because we just stress each other out med students just feed off of each other stress and not in a good way.

So make sure that you take everything your classmates say with a grain of salt. Use your classmates as motivation they’re going to be the smart



Individuals that you’ll probably meet in your life thus far, they’re going to inspire you. They’re going to motivate you to work harder. But once they start shifting to their stress mode, you want to kind of step away and avoid contact at all costs. So for example, if you have your anatomy final coming up, your classmates really stressed and is this talking over and over about how stressed and behind they are on studying for that exam. You know, obviously, listen to them, give them support, but don’t let that stress freak you out.

So just make sure you take your classmates with a grain of salt, especially around stressful events, stressful deadlines. Now, the fifth mistake that new med students make is kind of similar to the last tip, but they were their stress on their sleeves.

So just the same way that we don’t want to be around stressful classmates all the time. Our classmates don’t want to be around a stressful version of us.

So also be very vigilant and be very cognizant of how we come across. It’s fine to use our friends and our classmates to cope with the stresses of med school because



A lot of people on the outside world you could say don’t really understand what the stresses of med school or like. So yes, you can use your classmates as a way to vent and cope. But don’t overdo it. You may think that first year is going to be the hardest thing you ever have to do in your life. But then you’re going to reach the second year med school and you’re going to reach the third year in the fourth year, and it’s going to continually get harder and more challenging. So use your classmates as your support but for their sake, and for your own health. Try not to wear your stress on your sleeve. And the last tip and mistake that new med students make and honestly even old veteran med students like myself make is that you talk about med school and medicine all the time. Going back to the third tip. Don’t forget your old life. So for med school,



you didn’t talk about med school with all your peers and your friends and your family hopefully did it so that same way you’re going to be around your classmates and your colleagues all the time. That’s gonna be very easy for med school to be the topic 99% of time, but when you can avoid it, try your best because then it makes it much easier to picture your life.



Being more than just being a med student, and if you can do that you can meet the challenges of med school head on. But as soon as your test your studying is over, you can go and enjoy the other aspects of your life. But if medicine is a part of your whole day, all of your conversations it can be very easy to reach burnout when you find a series of days and weeks that are much more stressful than the rest so try to have a good balance on your conversations people you hang out with and they’ll help you immensely and having a very stress minimal I’m not going to say stress free first year med school so those are my top tips for new med students on what things to avoid but if you have any questions at all about med school on how to study manager time stress a particular class just let me know comment below. You can also email me at the MD journey. com at gmail. com. I’ll also put that link in the description new videos coming out on a weekly basis. So go ahead and give this video like first and then

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Major Mistakes Students Making During Graduation

About a week ago, I came across a video on my friend Kevin’s channel med school insiders called seven regrets of my 20s and watching his video got me thinking about some of my own regrets and mistakes specifically from my college career. Because by no means that I have a perfect college career. By and large, I’m happy with how things turned out. And I didn’t make any huge mistakes.t

there are definitely some things that I would have done differently if I were magically time. warped back to my freshman year. Now all that is unlikely to happen as I haven’t angered any wizards. lately. I still think that detailing these mistakes and going through what I would have done differently will be useful for other people who might be finding themselves in a similar situation in the near future including possibly you that’s because one of my most important beliefs is that you can learn just as much from the failures of others as you can from your own as long as you can call that little voice in your head that says yeah but that won’t happen to me right then you can start to use the experiences of others to prepare yourself potential situations in your own life so today I’m gonna be sharing eight stupid mistakes that I made in college and the lessons that each one of them taught me

first of my list with mistake I made in both my freshman and my sophomore year, which was starting out the semester way too gung ho, thinking I could do a literally every single reading assignment, every single piece of homework everything and then fizzling out after just a few weeks, I’m not gonna lie, I came into college as a very ambitious student, as is befitting somebody who would make an entire website on academic success. And I wanted to do really well in my classes. I wanted to ace every single test and do all the reading.

So when I started my semesters, I told myself, I’m going to read every single reading assignment and I’m going to take notes on every single thing that I read. But as you can probably guess, that didn’t last for very long and there’s a big difference between say, my first week Mrs. Class Notes, which I’ll show right here, and, well, the market lack of any notes beyond that. Now, I have to say that I did get lucky because a lot of the classes that I went to had a lot of overlap between what was presented in class and when



was in the actual reading assignments and homework. But if I had been in classes where a lot of crucial information was locked the textbook, then that burnout that experienced a few weeks into the semester could have really hurt me.



Mistake number two, which is a bubbly, fizzy and caffeinated mistake all throughout college. until probably my senior year. I was absolutely addicted to energy drinks. And I’d like to tell myself that this wasn’t because of the caffeine content. It probably was. Caffeine is a surprisingly addictive substance.

But I was also addicted to energy drinks because they provided what the author Taylor cork calls and his book Starbucks beverage entertainment, they were something that made a study session just a little bit less boring because I knew I got that colorful, can have fizzy, sugary liquid next to me while I went through my math assignments. The lesson here for those of you who haven’t already gotten addicted to energy drinks is don’t let it happen because it can very well happen both for those beverage entertainment reasons and for the caffeine reasons you don’t need nearly as



much caffeine as you think you might as long as you’re maintaining a good sleep schedule. And if you do want to use caffeine or you enjoy drinks that have it, maybe stick to coffee or tea instead, and they’re a lot healthier. And if you aren’t going to Starbucks and buying $4 lattes, they are a lot cheaper as well.



So the next mistake on my list here is jumping the gun when it came to selecting an internship. So this goes back to my sophomore year of college. I spent the summer before that year and the very beginning of that year going as hard as I could to try to get an internship. I went to every single networking session that I could learn about.

I went to all the career fair. So I went to all the pre career fairs and the pre pre career fair breakfasts, I met recruiters from dozens of different companies. I handed out tons of different resumes and all of this work definitely paid off after the career fair season after all that kind of died down. I was presented with no less than seven interview offers at several different companies. And I was pretty stoked about these but I didn’t end up going to any of them because



Before even my first interview was scheduled, I got a call from one company that said, Hey Thomas, we really liked your resume really liked talking with you at the career fair. We think that we don’t even need to interview we would like to offer you an internship sight unseen because we think you’re a great candidate and I was ecstatic when I got this call. And because I was ecstatic and because I was so stoked that they had offered me an internship. I never been offered an internship before I took it right away. No, I don’t want to say that this decision led me down the wrong path, because I’m very grateful for the experiences I got at that internship.

But as a result of taking it right away, I cancelled all seven of those other interview requests. I didn’t even give them the chance to see if they were going to be a better opportunity than that first one. And I remember later during that summer, talking with other people who are my classmates and friends and asking them what their internship experiences were like, and some of them actually ended up getting internships that paid a lot more than mine did. So I think the lesson here is don’t jump the gun. If you get a job offer. You’re going to think that this is the only one that’s going to come to you, you’re going to say



That if you let this opportunity slip through your fingers, you’re making a horrible decision. But it is totally okay to say thank you so much for the opportunity. Can I take a few days to think about it from there, you start to analyze your options. And since I did this internship, and then I went and started my own business and haven’t worked a full time job since then, I don’t have the personal experience to tell you about how to do this correctly.

But I did come across an excellent answer on Reddit about this exact same question. So I’m going to link to that in description down below. And I highly recommend you give it a read in case you find yourself in this situation in the future.



All right. Mistake number four on my list is dropping my very first programming class. So this goes back to my very first semester of college my freshman year, I ended up taking the engineering level Java programming class. And this was because even though I was a business student, weirdly, the business Java programming class, even though it was easier than the engineering level one had a prerequisite that I wasn’t going to be able to take until my second semester Whereas that engineering one had no prerequisites. And I was like, I want to start learning Java, I want to start programming.

This is what I came to college for. So I started that class. And immediately I found it really, really difficult. The labs are difficult.

The homework was difficult. And I even found it difficult to follow the lecture material while I was sitting in class. So, and it pains me to admit this. After about a couple of weeks, I actually dropped that class and just resigned myself to taking the business level Java class instead. And this mistake is really an echo of a mistake I made back in high school where I didn’t get a very good grade in my calculus class because I shied away from the tough problems. The moment a problem presented itself to me, and I thought, I can’t do that.

I don’t even know where to begin, I would disengage I would basically give up and as I learned the intervening years, this is not how you become a better problem solver.

You can’t just disengage the moment a problem seems like it’s too tough to solve. If you focus on it, you’re eventually going to find the answer. And if you can’t do it on your own, you can ask for help. I didn’t do this, which meant that I wasted a bunch of time during my freshman year because I dropped that class and wasted all the hours



I put into it prior to the day I dropped it. But it also meant that I ended up going into a Java class. That was, frankly, too easy for me. I could have done the engineering level Java class if I had really buckled down and focus on the problems, but I didn’t. So if you find yourself in a class that you feel is just too hard, make sure that you’re actually working to solve those problems. Ask yourself, have I really put in the time? Have I really focused or that I just disengage and tell myself that’s too hard?

related Post: Major Mistakes Students Making During Graduation

All right. Failure number five here, kind of related to number four, I failed to take advantage of Professor office hours for a lot of my college career.

When I got into my junior and senior year I started to get smart and I started to use them a lot more often. But freshman and sophomore year, I hardly ever went to Professor office hours and what’s worse, I remember professors actually offering completely free review sessions you know, after class when people could just come and ask whatever questions they wanted in review for tests and I skipped these two these are



gold mines. I remember going to a couple of these during my again junior and senior year and using them to get really good grades on tests because teachers would essentially answer questions straight from the study guides.

I skipped these in my first couple of years of college and I skipped Professor office hours, which meant that again, when I got stuck on tough problems, I wasn’t utilizing the resources that I had available to me I was just disengaging and telling myself I can’t do that. So if you’re in college, or even if you’re in high school, use the help you have available to you. Professors are there to help you not just by lecturing to you at the front of the classroom, but by working one on one with you as well.



Alright, steak number six. And this is I think, the most emotional one on the list here. I titled it in my list seeking companionship in the wrong places. So to put a long story very short the February of my junior year I ended up breaking up with the girl I was dating at the time and for a while I was totally fine being single but as many people end up finding the start to get lonely after a while and



Remember that my senior year fall started. And I found myself in what I would say is the closest to a depression that I have ever been in. I don’t think that it was a it was a true depression. And I haven’t really experienced what other people have experienced in that realm of things. But it was a very sad and kind of down period of my life. And what I tried to do to fix that.

I thought that I needed to go out and find someone else to date. But I went about it in the wrong way. I started going to bars like almost every single night, and I’m not a huge drinker.

But I would go out there because the only solution to finding someone to date in my mind was that I had to go out to bars, like where else do you meet people who actually want to get in a relationship, right? And this was the complete wrong approach because I would go number one, put myself in an environment where I was very unlikely to find people who had similar interests and passions and values to what I had, but also I psyched myself out every single time I went into a bar nightclub because I went there with the express purpose of finding somebody.



That meant I put a ton of pressure and anxiety on myself. And this went on for a few months. Until one night on a whim, I decided to go to the anime club party at my school because my roommate was the president at the time. So this was just a completely fun thing to do. I had absolutely no expectations from it. And once you know it, that’s where I met Anna, my girlfriend who have been with for six years and I met her there because I put new expectations on myself. I didn’t have any anxiety which allowed me to be myself and that’s why she was attracted to me.

So if there is a lesson here at all, I would say don’t put so much pressure on yourself to find a companion go out, do things with the intention of finding friends and having fun and while you’re doing those things in the process, you’re likely to meet people who again share passion so you might be attracted to and they might be attracted to you and you’re not putting pressure on yourself. So you’re going to be yourself in those situations.



Alright, steak number seven is not doing my due diligence when it came to the costs of college and this is



Typically is referring to the cost of living on campus. But when I was researching what it would take to live on campus because I wanted to live in the dorm, so I can meet as many people as possible and be as close to the opportunities as possible. The first bit of information I found on my colleges website is that I had to pay for the dorm up front for an entire semester, which I believe was about 30, $500



each and every semester. And I didn’t look past that. I said, Okay, I don’t have 30, $500. So I went out and took out student loans to pay for it. Only later in my college career. When I started to really get to know the college’s website for a part time job that I had been hired for did I learned that there was actually a month to month payment option for that dorm.

So to give you some context, my original plan going into college was to get an apartment off campus so I could pay for it month a month with my part time job earnings. I didn’t have parents that could pay for my college. So I knew I would have to basically cover everything myself and I wanted to minimize debt, but eventually decided against the apartment idea because again, I wanted to be in the thick of things I wanted to be on campus and meet me.



Many people as possible, all that good stuff, but I didn’t do my due diligence. I didn’t learn about this month, the month option. And had I done that I probably could have paid for my dorm month a month with my part time job earnings, or at least taken out far fewer dollars in student loans. So the lesson here is, do your due diligence. Don’t take the first bit of information you have at face value, especially if it’s going to involve you taking out a large student loan, dig in, ask questions, challenge your base assumptions, and you might find something that could save you a lot of money.



And that brings us to our final mistake on my list, which was failing to take advantage of what I call the fun opportunities and I call them the fun opportunities because I have to separate them from the professional opportunities in college. I really did take advantage of professional opportunities.

I was in Business Council I started a blog I was in all these like academic standards committees and computer advisory committees, all these things that I had done just basically a boost my resume and that may actually be another mistake that I think about when writing this list.



But when I put off all the things that seemed really fun. So to give you some context here, my college has over 800 student organizations and clubs, including things like downhill, dirt boarding club, skydiving club, all these outdoor adventure clubs. And when I was a freshman, I went to this thing called club best where everyone except these booths, and it was basically this entire event designed to show the freshman just what was available and what they could join.

And I remember seeing all these clubs and thinking these seem awesome. I want to do all of these. But I’m here for four years. I can do them whenever I want. I have all the time in the world.

So of course, I let other things get in the way. Let homework get in the way I let video games with friends get in the way that all these events that I thought would build my professional presence on my resume, get in the way and four years went by without me ever doing any of those things. I never did the skydiving club. I never did the downhill dirt boarding club. I didn’t none of it.

So if you find yourself in a similar situation where there’s something you want to do you feel like you’re all the time in the world to do it. You have to commit to it, find a way to set a date or commit to it with a friend. So it’s actually going to happen. Even if something seems really fun.

If there’s a little bit of friction required to get into it, or if it’s going to take some time, you’re always going to find something that quote unquote, comes up and makes you put it off a week, and then another week, and then another week until one day, you find yourself on your deathbed and you really regret never going downhill dirt boarding.

Now one potential regret that I think we didn’t have to put on this list was failing to use my free time to work on independent learning projects, because this was definitely something that I did in college. While a lot of the guys in my dorm use most of free time to play video games.

I use the vast majority of my free time that wasn’t taken up by classes or projects or part time jobs to work on independent learning projects that really interested me and that really paid off in fact, all the hours that I spent my dorm learning PHP and Photoshop video editing gave me the skills that I needed to build and refine college info geek which eventually turned into a full time business for me so well, I’m not suggesting that you never hang up



Friends are never played video games because I definitely think you should do these things. I do want to leave you with one parting thought. Whether you’re in college or high school, or even in the professional world, make sure that you’re using at least some of your free time to pursue independent learning projects that interest you don’t just come home and spend all your free time on Netflix or video games or hobbies that only result in consumption, learn something, build something. And remember that since you get to pick the project, your higher level of interest in it almost always lead to faster learning and you never know how it’s going to pay off in the future. Now, if you want to accelerate your learning in that project even further, you should also check out skill skill Sure, has library of over 20,000 courses taught by expert teachers and practitioners in a ton of different areas including graphic design, web development, story, crafting, and even marketing. All their classes are hands on with projects that you can immediately sink your teeth into. So you’re learning actively right away. And there’s also a chat area where you can ask questions and get feedback not one class that I want to highlight for you this week is Thomas low risk class. I’m creating a UX design portfolio. And this is partly because creating a portfolio is an essential skill for anyone doing creative work.



But also because the class uses a free tool, call it sigma, which to spoil things a little bit as a tool that I’ve been using to craft a brand new version of the college and booking website. And this tool is amazing. Anybody who wants to get into the field of web design I think should start learning it. So if you want start going through that class, or check out any of the other classes and sculptures library, then click link description down below and sign up and when you do, you’re also going to get a free to month unlimited trial of their service. You can learn as much as you want into months and after that a premium subscription to their service is less than 10 bucks a month and you can cancel at any time so it’s risk free and honestly I think it is an awesome service want to give a big thanks to Scotia for sponsoring this video and being a big supporter of this channel. And as always, guys, thank you so much for watching. If you enjoyed this video and got something out of it, maybe consider leaving a like you can also subscribe right there. If you don’t want to miss new videos when they come out every single week. You can also get a free copy of my book on how to earn better grades right over there. Watch one more video on this channel right around here. Or follow me on Instagram at Tom frankly thanks for reading guys and I will see you in the next one. Major Mistakes Students Making During Graduation | So main idea behind the scenes with a good education industry or job or money actually industry I just after I asked the man to get those game for can overcome Welcome to gv training from two to 10 into monitored for part is for traders go home on the wall graphics animation can the mobile security can turn off our data center candor home or routing switching and the more he did he did he say well filmmaking cannot be have number of workshops for all the Courses with the mama Jama a joke a password tennis PJ or didn’t get it has to be some experience target a job to deliver content to related to the industry scenario based training so in the schema camera he can afford it education sector and the guy doesn’t even talk about it produce content that the end to end up address later borrow a big part of who I am as he can and now I’m done with my for your graduation up investing which accounts mocha the company is absolutely right in the senior

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