Don’t be a “Fireworks Fourth Fool” [Video]

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By Dr. David Edward Marcinko MBA


Graphic video image warning!

Back in the day, when I was a surgical resident and fellow, I treated my fair share of electrical, thermal and chemical burn injuries. Some were life, eyeball and limb threatening; but fortunately most were not! Treatment was with local wound care, followed by full, split thickness or postage stamp skin grafts, flaps, or various plastic surgery techniques, etc.

And, many were accidental of course, but a few were simply ill-conceived ideas from dumb or inebriated patients seen through the emergency room of the old Emory University – Northlake Regional Medical Center, in Tucker, GA.

So, for you medical types, here is a recap on the way we doctors classify burns, as referenced in several of my surgical textbooks and related medical publications.

Classification of Burn Depths

A. Superficial burn injury

1st degree burn

  • Limited to the epidermis
  • Presents with erythema and minimal swelling
  • Mild discomfort
  • Commonly treated on outpatient basis

B. Superficial partial-thickness burns

Second Degree Burn

  • Superficial 2nd degree burns
  • Involves the epidermis and superficial portion of the dermis
  • Often seen with scalding injuries
  • Presents with blister formation and typically blanches with pressure
  • Sensitive to light touch or pinprick
  • Commonly treated on outpatient basis; heal in 1-3 wks.

C. Deep partial-thickness burns

Deep 2nd degree burns

  • Involves the epidermis and most of the dermis
  • Patients often require excision of the wound and skin grafting
  • Appears white or poorly vascularized; may not blister
  • Less sensitivity to light touch and pinprick than superficial form
  • Extensive time to heal (3-4 wks)

D. Full-thickness burns

Third Degree Burn

  • Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue
  • Appears dry, leathery, and insensate, often without blisters
  • Can be difficult to differentiate from deep partial-thickness burns
  • Commonly seen when patient’s clothes caught on fire/skin directly exposed to flame
  • Usually require referral to burn surgeon; need skin grafting to heal.

E. Fourth degree burns

Fourth Degree Burn

  • Full-thickness burn extending to muscle or bone
  • Common result of high-voltage electric injury or severe thermal burns
  • Requires hospital admission


So, why do we review this clinical material on Independence Day? It is to remind our readers not to drink and shoot fireworks today; or to stop and re-think before proceeding with same. Don’t be like the fool in this YouTube video. I don’t want to see you in any ER; any where today! GOMER.


ME-P and Independence Day 2010



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PODCAST: Why We Still Need to Celebrate Independence Day?

By Richard Helppie



EDITOR’S NOTE: I first Met Rich Helppie when I was in business school. He was the CEO of Superior Consultant at the time. Today he is a respected philanthropist and publisher of The Common Bridge. This is a much-requested replaying of Rich’s 2021 podcast honoring of Independence Day.  He takes some time to reflect on why we still should celebrate our nation’s birthday even though our history has been imperfect. -David E. Marcinko





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The College Degree [Mortality] Advantage

By the NBER

Working Paper 29328), Anne Case and Angus Deaton



The Persistent Mortality Advantage of a College Degree
In 2019, Americans with a four-year college degree had six years greater life expectancy at age 25 than those without a degree. These educational differences in mortality have been growing in recent decades and are apparent across demographic groups. In Mortality Rates by College Degree before and during COVID-19 (NBER Working Paper 29328), Anne Case and Angus Deaton explore the evolution of these differences during the pandemic.

If every American faced an equal threat of infection and death from COVID-19, then the mortality gap between more and less educated individuals would have narrowed during the pandemic. However, the risks from COVID-19 were plausibly greater for those without a college degree for a variety of reasons. For example, people without college degrees disproportionately work in occupations where working from home to avoid infection is not feasible. They are more likely to use public transportation and to live in crowded housing arrangements, heightening their risk of exposure. Conditional on infection, less educated individuals may experience worse outcomes due to higher average rates of pre-existing conditions and poorer access to health care.

Using provisional mortality data from the National Center for Health Statistics, the researchers determine that a college degree was protective against mortality during the calendar year 2020, which encompassed the first nine months of the pandemic. They express the mortality advantage of a college degree using the ratio of the mortality rate for those without a four-year college degree to the rate for those with a degree. The researchers calculate these ratios for 60 different demographic groups, identified by two genders, five age groups, and six racial/ethnic categories (Hispanic, non-Hispanic White, non-Hispanic Black, Asian, American Indian/Alaskan Native, and those who report two or more races).


The Bulletin on Health summarizes selected recent NBER Working Papers. It is distributed digitally to economists and other interested persons for informational and discussion purposes. The Bulletin is not copyrighted and may be reproduced freely with attribution of source.

To sign up to receive new Bulletin on Health issues by email, please visit:

Prior to creation of the Bulletin on Health, the NBER published the Bulletin on Aging and Health.

Working Papers produced as part of the NBER’s research program are distributed to encourage discussion and suggestions of preliminary work. Neither Working Papers nor issues of the Bulletin on Health are reviewed by the Board of Directors of the NBER.

The Bulletin on Health is edited by Robin McKnight
  Across all demographic groups, the ratios were all above one in 2020, reflecting higher mortality rates for those without college degrees. The ratios were highest for younger age groups: in the 25 to 39 age group, mortality rates for those without college degrees were as much as seven times the rates for those with college degrees. The researchers argue that the association between education and mortality is concentrated among preventable deaths, which are more prevalent causes of death among younger adults. In addition, older Americans are more likely to be retired, so additional risks that less educated workers faced due to occupational differences were less relevant for older age groups.

The overall finding that those without college degrees were at greater risk of death during the pandemic may not seem surprising, given their differential risks of infection, higher rates of pre-existing conditions, and worse access to care. A more unexpected finding is that these differences in mortality risk, as reflected in the mortality ratio, were very similar to the differences in mortality risk in the year prior to the pandemic. The figure, which plots the ratios for each demographic group in 2019 and in 2020, shows that the mortality advantage of a college degree was little changed during the pandemic relative to the prior year.

The figure highlights a few exceptions to this pattern. For Hispanic women aged 25 to 64 and for non-Hispanic American Indian/Alaskan Native women aged 25 to 39, the mortality advantage of a college degree was substantially higher in 2020 than in 2019. But for most demographic groups, the mortality ratios during the pandemic were strikingly similar to those before the pandemic. In fact, for over half of the demographic groups, the ratio was slightly lower in 2020 than in 2019.

The results suggest that the mortality advantage of a college degree during the pandemic was a continuation of pre-existing health differentials between those with and without college degrees. “The mystery,” the researchers conclude, “is not why the [college degree] was protective during the pandemic, but why the effect was proportionately as large before the pandemic.”



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VALUATION: Home Health Agencies [Technological Environment]

By Health Capital Consultants, LLC



Valuation of Home Health Agencies: Technological Environment

With home healthcare providers increasingly being viewed as a critical link in the array of patient-centered healthcare services aimed to bring care back into the community, technology will likely play a more prominent role in managing patient populations in need of home healthcare services.


The final installment of this five-part series on the valuation of home health agencies (HHAs) will discuss the growing role of technology in home healthcare and the challenges of utilizing this technology post-COVID-19. (Read more…) 



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A.I. Examiners and the CERTIFIED MEDICAL PLANNER® Professional Designation Program

Artificial Intelligence and “Robo-Examiners” Let Adult-Learners and Students Take Control of their Career Education and On-Line Matriculation

Dr. David Edward Marcinko MBA CMP®
[Academic Dean and CEO: Institute of Medical Business Advisors, Inc]

Enter the CMPs

[Course Curriculum]

The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers. Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.


In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.

Get a robo advisor on board to help with your investment ...


According to Eugene Schmuckler PhD MBA MEd, Academic Provost of the CERTIFIED MEDICAL PLANNER® professional designation and certification program,

“This option allows the modern adult-learner save both time and money as s/he progresses toward the ultimate goal of board certification as a CMP® mark holder.”

The trend is growing and iMBA, Inc., is leading the way.


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Ann Miller RN MHA CMP®


PH: 770-448-0769




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