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(47) Research on HEALTH: first aid (CPR).

This is Research on HEALTH month on Researchista. It is when Researchers from different medical fields bring their best knowledge and expertise in few words to explain their Research findings and to hopefully help you overcome certain health questions or problems you might have. Please say hi to Sebastian! 

Hi there!

I studied Medicine at the Maastricht University (2010-2016) and became a member of Taskforce QRS (CPR instructor) in 2012. My first cardiopulmonary resuscitation was on a ward in a small town in Germany, where I was at the time following an internship. At that moment, I was a CPR instructor for nearly 3 years and I thought I knew all the steps perfectly. But nothing could prepare me for the real thing….. ☺

 

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Sebastian Sanduleanu, PhD student at Maastricht University

So, what to do when someone has a heart attack? First, let’s distinguish some key concepts:

“Cardiac arrest”

A “cardiac arrest”, not to be confused with a “heart attack” is when the heart stops beating (Figure 1). A heart attack may lead to a cardiac arrest.

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Fig. 1: Cardiac arrest vs. heart attack. Source: http://www.healthzone.org

If a cardiac arrest occurs, blood will stop circulating around the body and breathing will likewise cease within several minutes. Without a supply of oxygen, the cells in the body start to die. Especially brain cells are highly sensitive for low blood oxygen concentrations, after about five minutes of no oxygen brain cells will begin dying leading to brain damage and death.

Other key conceptual differences regarding symptoms:

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Source: http://www.positivemed.com

“CPR”

Cardiopulmonary resuscitation, commonly known as CPR is one of the key elements of first aid. The purpose of CPR is by chest compression to keep oxygenated blood flowing through the body in order to keep the vital organs alive.

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Fig. 2. The BLS/AED algorithm Source: http://www.slideshare.net/adis23/cpr-prezentacija

It is important to know that CPR itself will not restart someone’s heart, it just keeps them alive until a defibrillator (Figure 3) arrives. This is a device which delivers an electrical shock to the heart in order to restart it. These defibrillators are, aside from hospitals, commonly found in sports parks, shopping malls, schools and near to crowded areas. Access is restricted to authorized users, from ambulance workers, (para-) medics to civilians trained in CPR (with a so called BLS = Basic Life Support certification).

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Fig. 3. The automated external defibrilator (AED)

CPR numbers in the Netherlands

Around 10.000 people in the Netherlands face a cardiac arrest outside the hospital every year. A major influence on the survival rate is the high percentage of bystanders, which had already begun CPR before the arrival of the first ambulance (>75%), the connection of an automatic external de-fibrillator (AED) and a shockable heart rhythm early. These findings have been summarized in the chain of survival (Figure 4).

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Fig. 4. The chain of survival.

The survival in the Netherlands is on average 23%, one of the highest in Europe. If there is a shockable rhythm start, the survival rate can be as high as 44%.

For those living in Maastricht: QRS Taskforce Maastricht, purpose and background
In order to improve the survival chances for sudden cardiac arrest (SCA) victims, Taskforce QRS Maastricht (Qualitative Resuscitation by Students), was founded in 2006 by medical students of Maastricht University3. In 2012 a new approach in CPR training, called Maastricht Quantity-orientated Resuscitation Session (M-QRS), was developed that focuses on the number of trained students per training. By comparing the new with the old approach quantitative growth could be assessed. Until now more than 12,937 secondary school students have now been trained by ERC-certified (European Resuscitation Council) CPR instructors with this efficient M-QRS approach. In comparison, a theoretical maximum of 6,469 could have been trained by means of the old approach. Sign up for CPR-training with Taskforce QRS: A civilian rescuer is a CPR trained volunteer that is contacted by 112 emergency rooms per SMS or via a special phone application to directly or after picking up an AED (automatic external defibrillator) go to the location of a victim of a cardiac arrest and to start CPR. Interested? Click on the link! 

(more at: Ghossein, A., Amin, H., Sijmons, J., Olsthoorn, J., Weerts, J., Houben, V. (2014). Taskforce QRS. European Heart Journal, 35(45), 3149-3151).

Heart physiology

The heart pumps oxygen and nutrients around the body through your blood. Waste products, e.g carbon dioxide and urea are removed through your circulation by respectively the lungs (diffusion) and the kidneys (urine filtration). In your lungs, oxygen enters your blood stream and carbon dioxide (a waste product) is removed in a process known as gas exchange (Figure 5).

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Figure 5. Gas exchange in lungs (Pearson, 2013).

All the cells in your body are dependent on oxygen, aside from nutrients to survive. This oxygen is used as energy source in the powerhouses of the cell, the mitochondria in a biochemical activity called metabolism.

 

 Post written by Sebastian Sanduleanu, MAASTRO Clinic, Maastricht University, Maastricht

 

 

With love for Research,

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(44) Research on BRAIN (extended): Misophonia

The quest into the unknown land of ‘misophonia’ continues. It is not included in any diagnostic manuals, it is not widely acknowledged by the medical community. Yet people who suffer from misophonia exist and here is what they are confronted with, in the words of Dr. Jennifer Jo Brout, the founder of International Misophonia Research Network, a New York State Certified School Psychologist, a Connecticut Professional Licensed Counselor, with a Doctorate in School/Clinical-Child Psychology, based here in the Connecticut, the United States of America.

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Dr. Jennifer Jo Brout, International Misophonia Research Network.

Differentiating Disorders: Misophonia and Sensory Over-Responsivity

As all researchers know, almost comically, well, uncovering new scientific knowledge is no easy task. Whether you are engaged in investigating a well-trod topic, or, like me, you are forging relatively new territory, there are often not simple solutions to the complex problems we encounter. Perhaps you have recently read about the disorder I study and advocate for, misophonia, on this blog. Misophonia is a neurologically based disorder in which auditory, and sometimes visual, stimuli are misinterpreted within the central nervous system, leading sufferers to have unpleasant reactions to sounds others would consider barely noticeable.

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Source: internet.

When misophonia sufferers are exposed to particular “trigger sounds,” the fight/flight response is set off within the body. For these individuals, hearing a noxious noise can feel akin to being confronted with a wild animal, as their hearts race and muscles tense.

Because misophonia (does not appear in diagnostic manuals, such as DSM-5 or ICD-10) is only recently gaining wider recognition in the public and scientific communities, studying this disorder presents a unique set of challenges. 

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Though there is a scant amount of research on misophonia at this point, fortunately, there is a large body of research that has been developed over the past 15 years on a similar disorder, Sensory Over-Responsivity (a subtype of Sensory Processing Disorder). Individuals suffering from Sensory Over-Responsivity react to all types of sensory information as thought it were dangerous, and their fight/flight systems can be activated by seemingly inoffensive sights, smells, tastes, touches, or sounds. In both, misophonia and Sensory Over-Responsivity, certain sounds can leave sufferers feeling angry, fearful, disgusted, and “out of control.”

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Source: Internet.

Though it may seem natural that the research on Sensory Over-Responsivity be used to inform our understanding of misophonia, this has, largely, not taken place. We may ask ourselves, why are these two highly similar disorders rarely compared in misophonia academic articles, or articles in the popular press? My answer to this question is an unfortunate one: for the most part, researchers are not used to working within a cross-disciplinary model.

While psychology researchers, audiology researchers, and occupational therapy researchers may be competent and successful within their own fields, they are often not accustomed to reaching beyond them to integrate other types of research into their own work. There is a long pragmatic and political history behind the lack of cross-disciplinary research work that is not necessarily the fault of academic researchers or clinicians. However, in the “age of information” that we are living in, sharing valuable knowledge between researchers from different disciplines should now be as quick and easy as doing a google search, and as common. As it is, this lack of information sharing trickles down to the public, and often leads Misophonia and Sensory Over-Responsivity sufferers to find inaccurate information about their own conditions.

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Unfortunately, another important problem facing both misophonia and Sensory Over-Responsivity is that neither disorder has been accepted into the diagnostic manuals (DSM-5 or the ICD-10). It is difficult to understand the logic behind this fact, as studies have estimated that up to 20% of children are affected by sensory-based disorders. Likewise, tens of thousands of people have gathered on social media platforms to form support groups for misophonia, helping one another fill the gaps left by a large portion of the mental health community. There is a long political history involving how a disorder gains entry into diagnostic manuals, and though the National Institute of Health has taken steps recently to try to change this process, this change comes long after the damage has been done. Therefore, what we are left with is two disorders that “don’t exist,” that are not reimbursable by insurance, and for which research funding is extraordinarily difficult to come by.

Sensory Over- Responsivity and Misophonia share more than symptoms. They share neglect from the medical and psychiatric communities, which has resulted in the dissemination of more than enough inaccurate and confusing information to do damage to sufferers lives. My hope is that going forward, receptive practitioners and researchers from all facets of the healthcare community can work cooperatively to study and treat these disorders, discovering important knowledge and improving sufferers’ quality of life.

This post is written by Dr. Jennifer Jo Brout  (who is also the mother of adult triplets, and is a Misophonia sufferer herself) and Miss Madeline Appelbaum, a recent alumna of Reed College (Oregon, USA), with a particular interest in educational psychology. Madeline wrote an undergraduate thesis on the effects of autonomous and controlled motivation to learn on college students.

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Madeline Appelbaum, Intern at International Misophonia Research Network

International Misophonia Research Network (Amsterdam)

With love for Research,

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(43) Research on Brain (extension): Misophonia.

Hatred of sound: Misophonia.

Have you ever thought that hearing other people’s chewing can be disturbing to the level of a disease? … When I learned from Mercede that there are barely 40 scientific articles published on misophonia the world (her opinion) on this topic, I thought, this simply can not be. How is it possible that in all this detailed investigation of human body to which research progressed until now, only few studies have been made? This is Research on Brain (and its related parts) month on Researchista. Let’s get to learn about something one day, one of us or someone we know could experience. At least we will know what’s it called.

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Dr. Mercede Erfanian.

Misophonia is a relatively new neurobehavioral syndrome or disease. It is characterized by high hearing sensitivity that research shows it can result from exposure to specific sounds like gum chewing, lip smacking, crunching, etc.

Originally, it was described by Pawel and Margarette Jastreboff (2001) . They say that individuals with misophonia show increased physical excitement like sweating, heart racing, high body temprature, which are along with emotional distress. It seems majority of these sounds are repetitive and pattern-based, irrespective of sound strength (decibel level).

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Misophonia. Source: internet.

The potential triggers that can cause misophonia can be:other people’s chewing, throat clearing, slurping, finger tapping, foot shuffling, keyboard tapping, and pen clicking. These sound triggers vary across individuals, and suggesting that learning history, individual differences, and context may play a role in aversive responding.

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Source: internet.

When facing with misophonic triggers individuals also show behavioral responses that often include anger (ranging from irritation to rage), anxiety, and disgust, avoidance, and escape behavior. (called “misophonic responses”).

It is important to know that some individuals can have impairments in daily functioning (e.g., occupationally, interpersonally, academically) and the can develop other behavioral health problems due to misophonia. A group of investigated individuals that have misophonia have developed ways to cope with it, but still report that the condition is very difficult to manage and negatively affects various aspects of their lives.

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Misophonia has not been formally recognized (yet?) as a specific type of neurological, audiological, or psychiatric disorder. However, it has shown high co-occurring appearances? with-non-psychiatric and psychiatric disorders (e.g., tinnitus, hyperacusis, migraine headaches, autism spectrum disorder, posttraumatic stress disorder, borderline personality disorder, and obsessive compulsive disorder).

 

Here at .. Amsterdam… we would like to raise awareness and lead more research in this area. Although, the Netherlands has been very active, the country where this topic has been discussed much more widely than in other parts of the world, we realise that not many know about and would like to carry more research in this area. If it happens that you know neuroscientists or .. or simply wish to learn more about and support our raising awareness campaign, do that here (link gogo)

To be continued…

Post written by Mercede Erfanian, Research Fellow

International Misophonia Research Network (Amsterdam).

 

 

With love for Research,

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(20) Magic element: POLICY.

“The Story of the Magic 3 and the Earth” is prepared to introduce you to more types of Researchers, because Researchers are not only in academic circles (namely, the university). There are so many Researchers in business or in all sorts of organisations (e.g. lobbying organisations, think tanks, international aid organisations) and in all sorts of fields (e.g. electricity, food industry). *They are all coming from the university benches, but let us come back to this topic another time. So, we are many and we are different, read further to get to know us better 🙂

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The story is about the importance of cooperation between policy-academia-business and the overall society when a change needs to take place in society, in a certain area of life. To better remember each party, I associate an element of nature to each of them (just like in “Sailor Moon” 🙂 ). In this post, I will briefly remind/introduce you to the Magic element, called: Policy. 

Figure 1. Public policy cycle (how a policy ideally works in practice).

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So, this is how it approximately and usually works. It can go in many directions and some stages can be skipped by policy makers, but these are roughly the phases through which a policy goes through: first, there is a problem in a certain area of life: for example, no energy supply for an area of a city due to the lack of funding.

The inhabitants of that district will then write complains to human rights organisations or other parties to solve this problem (or one or more organisations will notice and the initiative will come from them). Those organisation discuss further with the authorities in charge of electricity supply, who then discuss with specialized authorities who decide to provide with funding for buying all the electricity supplies. It is then when the problem arrives on the agenda of policy makers (authorities in charge).

If approved to be important enough, the policy is then developed step-by-step from who, when, what, when the electricity in that area is going to be installed. After which, it is then decided who and when will actually do the work (implementation). After the district has been provided with electricity, the policy is evaluated to see how good or bad what was decided by authorities was applied in practice. Now, let us have a look at the following Researcher involved in policy Research to better understand what one might do in this area:

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photo credit: http://www.manorlux.com

 

Olga J. Skriabikova-Coenen, works for local public authorities in the Netherlands. She is Researcher at the Regional government of Limburg, South of the Netherlands [doctorate graduate 2014 at Maastricht University]: “I have a PhD in Economics and since two years I work at Limburg regional government. In my role as Strategy research and evaluation advisor I provide critical reflection on proposed research questions, methods and design. The main difference between fundamental research and policy-oriented, or in other terms, applied research is that policy research should ideally provide directly applicable results which can be used to address urgent policy matters. Formulating research questions in such a way that policy-makers receive information that they can use is therefore crucial. Another issue related to applicability is timeliness, since policy-makers need to be able to react quickly and cannot afford waiting for a year or more to plan a policy action. The other side of the coin is that policy research cannot provide the depth, precision and generality of conclusions of fundamental research. Nonetheless, high quality policy research is crucial for adequate planning, design, implementation and evaluation of policies.”

In my story, Policy is associated with water, because hypothetically speaking, it touches upon all areas of public life and unlike fire (business), it might take a lot of time until it is going to be implemented (since it can involve a lot of bureaucracy, for e.g., approval from many authorities).

With love for Research,

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(19) Magic 3: Policy – Academia – Business

When I was small, “Sailor Moon” was one of my favourite cartoons, especially when she and her girlfriends gathered in a circle and took out their magic sticks with magic powers from the nature: fire, air, water and earth – to unite their powers and fight the evil… When these elements are apart they have one power, but when combined, they can create effects that could never happen independently. Just like in life, Research is useful, but if not discussed and transmitted further into policy or business, it might just stay there for years, without serving it’s purpose.

Please welcome the Magic 3 (fire, air and water) and the earth (you and me and everyone).

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To avoid confusion, policy is not politics, nor police ;). Policy (or public policy or a policy in an area) is a governmental programme addressed to solve or to take care of a specific sector of public life; for example, energy. In the energy sector, there are people who install the electricity in your building and there are people who pay these people to do this work and there are people who decide how much will the electricity cost this month for all the citizens of a country (and by body, I mean, of course a group of people with a specific role, not the actual human bodies 😉 ). Although it might seem as if they do not talk between them, they all function according to a plan. So, that plan  – is a policy – created by the government with budget and right structure to make sure that area of public life will work.

So, here we are… a bunch of Researcher, each of us representing one of the Magic 3 elements (we are 5, since in Academia we are 2 types of Researchers and 1 is myself (how could I leave my humble self out of the photo-shoot). Am I missing a type of Research? What type? Who?

  • Academia: Experienced Researcher and Early-Stage Researcher
  • Policy
  • 50/50 academia-policy and of course,
  • Business Researcher
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Photo credit: http://www.manorlux.com

So, let us start in order of the order with a small description about each beautiful and precious human you see in this picture:

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Magic 1: Academic Researcher (Experienced Researcher, according to European Commission)

Please welcome the most stylish, elegant, classy man of Maastricht (according to me. I know such labeling is dangerous, but I simply can not help it, this gentleman does not stop being elegant probably every day of the year ).

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Antoine P. Simons, doctorate graduate 2010 at Maastricht University: “As a clinical specialist in the cardiovascular field, working both efficiently and effectively demands up-to-date knowledge that can be derived either from basic research or from clinical trials. Without science, health care could never have reached the level it has today, and which I use to save lives. I either use the knowledge gathered by others, accessible via peer-reviewed publications and at scientific meetings, or by simply investigating myself. Setting up my own research helps me to become a better team member, colleague, teacher, supervisor and clinician in order to help those in need: patients I like to become healthy again!”

Magic 1: Academic Researcher (Early-Stage Researcher, according to European Commission)

Representing probably the closest to Researchista’s heart group of Researcher – PhD fellows, otherwise called, Early-stage Researchers. Say hi to one of the most engaging story-teller I know:

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Ibrahima Sory Kaba, PhD fellow at the United Nations University – MERIT, Maastricht University: “Academic research is to economics what stretchers and legs are to a chair. It helps the discipline to stand on solid and firm grounds. As a Ph.D student in macroeconomics of development, the bulk of my work consists of controlling for potential causalities or building mathematical models, all rooted in a strong body of theory, with the main objective of guiding policy-making. Currently I am halfway of completing my Ph.D before moving on to new challenges. But as of now I am simply enjoying myself with collaborative academic research, weekly seminars and eye-opening teaching experiences.”

Magic 3: Policy Researcher.

As a former PhD at Maastricht University, she never ceased to impress with her talents:Photo-4

Olga J. Skriabikova-Coenen, Researcher at the Regional government of Limburg, South of the Netherlands [doctorate graduate 2014 at Maastricht University]: “I have a PhD in Economics and since two years I work at Limburg regional government. In my role as Strategy research and evaluation advisor I provide critical reflection on proposed research questions, methods and design. The main difference between fundamental research and policy-oriented, or in other terms, applied research is that policy research should ideally provide directly applicable results which can be used to address urgent policy matters. Formulating research questions in such a way that policy-makers receive information that they can use is therefore crucial. Another issue related to applicability is timeliness, since policy-makers need to be able to react quickly and cannot afford waiting for a year or more to plan a policy action. The other side of the coin is that policy research cannot provide the depth, precision and generality of conclusions of fundamental research. Nonetheless, high quality policy research is crucial for adequate planning, design, implementation and evaluation of policies.”

Magic 3: Business Researcher.

Maastricht is simply lucky to have Mark Lewis as it’s inhabitant, a genuine promoter and simply a model to follow when it comes to social equity and solidarity. I am honoured and privileged to be his friend.Photo Mark

Mark Lewis, Business Analyst at APG, Netherlands (one of the largest pension funds in the world): “I think Research is really important for business: ..” Listen here to what Mark has to share with us about the role of Research in his area.

Magic 1 & 2: Academia & Policy Researcher.

Welcome to your humble partner in crime for Research, Irina Burlacu aka Researchista.

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Irina Burlacu, Lecturer at the Center for European Studies at Maastricht University and Researcher (in both academia & policy sector: 50%-50%). She believes in the strong (not yet valorified at its fullest) potential of Research in current societies and economies and wishes to promote this vision at more levels. Read more about it here.

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At the end of every movie, the producers always remain with the pieces that are not included in the movie (the extras). Our producer, the professional photographer Manor Lux, whom I would like to thank very much for his patience and this very beautiful pictures, also had some extras, I believe this is one of it 🙂 The location is the good old “Cafe Zondag“, who let us feel like on a shooting platform (the location was chosen for you, my friends, who left Maastricht long ago).

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With love for Research,

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p.s. A special Magic 3 type of event takes place yearly in Maastricht. If you are part of one of the 3 elements, subscribe on their web-page or require information from the organizing group, as the following step is to create an app in the area of circular economy that would match partners from business-academia-policy, powerful….

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p.s.2. You understand that most probably I am missing something in this diagram and that the truth is relative (for example, I did not include the international organisation or local communities and non-governmental organisations), but let us assume for now that it is like that.

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(2) Who is a Researcher?

Researchers are: “Professionals engaged in the conception or creation of new knowledge, products, processes, methods and systems, and in the management of the projects concerned.” (European Commission’s definition).

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If you are doing this kind of work and not sure if qualify as a researcher or how advanced you are as a researcher, this might help:

  • You are an “Early-Stage Researcher”in the first four years (full-time equivalent) of your research activity, including the period of research training.
  • You are an “Experienced Researcher” if you have accumulated at least four years of research experience (full-time equivalent) since gaining a university diploma that gives access to doctoral studies, in the country in which the degree/diploma was obtained or ifthe doctoral degree has already been obtained, regardless of the time taken to acquire it.

A remark: if we talk about academic research (the focus of this blog), clearly a freshly graduated PhD (an “Experienced Researcher”) can not be equal in experience and publications to a “More Experienced” Researcher, such as a Professor. The picture below shows an approximate difference between these two types of both Experienced Researchers, so maybe we need one more definition to make a fully-fledged distinction 🙂 How much experience does an Experienced Researcher need to become “more experienced” if both a PhD and a Professor are Experienced Researchers?