E. Iomar. Waynesburg College.
Targeted tuber- ty scale for clinical practice discount 20 mg levitra mastercard impotence solutions, observational studies order levitra mastercard erectile dysfunction doctors in louisville ky, and culin testing and treatment of latent tuberculosis infection. Discovery With Metrics Capital Population 26 33 Goals and References Targets 35 42 51 54 56 Appendix 1: Appendix 2: Appendix 3: Appendix 4: Appendix 5: Alignment with Learning from Research Research Acknowledgments Arthritis and Complementary Advisory and Strategic Related Disease Approaches Committee Planning Organizations Task Theam 4 “Science has Arthritis on the Run. Population tatistics show that arthritis and related rheumatic conditions (23 percent, mostly vasculi- The facts presented here are serious, and fnding diseases probably affect every family tis), and rheumatoid arthritis (22 percent). Approximately 22 the 20-year period, an additional 585,446 people always will be, a priority for the Arthritis Founda- Spercent of U. We believe that science is advancing every More than 5 million people) aged 18 years or older self-report as an associated cause of death. These estimates day, and the optimism and energy we pour into doctor-diagnosed arthritis. Prevalence estimates for systemic lupus 2 problems and heart trouble are among the top erythematosus range as high as 1. In addition, complica- trouble walking a distance equal to walking from 294,000 tions from treatment of arthritis can result in death. Another instance of scientifc discov- a request for letters of interest open to every- Trelated diseases. Scientifc research ery is the knowledge made available by genomics, one everywhere to submit their scientifc ideas We are collaborating and development holds the key to fnding better proteomics, imaging and other technologies. Please building For almost 70 years, the Arthritis Foundation has knowledge to accelerate real-world applications of refer to the appendices for more information about initiated and supported scientifc discoveries that scientifc fndings to improve human health. The Arthritis Foundation continues to with information to choose the correct biological scientifc strategy includes three interconnected lead the way in advancing scientifc discoveries and targets so that a therapeutic product will work scientifc pillars: delivering on discovery, decision seeking solutions that will positively impact the lives against the disease it is intended to treat. Our commitment to fnding a For this strategy, arthritis refers to more than 100 For our scientifc strategic planning process, cure is unwavering. Together, we can have “arthritis on the For the purposes of this scientifc strategy, scien- of interviews with a wide range of experts and run” by accelerating the movement of scientifc tifc discovery includes a continuum of scientifc constituents, including people with arthritis and 13 knowledge to a faster cure. Each stage related diseases, fndings documented in scientifc research of scientifc research and development can infu- ence the other stages. Each scientifc discovery for arthritis and stage is informed by people with arthritis and Scientifc Strategy Goals related diseases. People with arthritis beneft from The scientifc strategy is the direction the Arthritis Foundation Science Department is going each stage in the continuum. The goal for each pillar is the impact of the inputs and outputs for each pillar (see Figures 2-4). To illustrate the continuum of scientifc discovery, consider the following examples. Decision Studies Scientific Making Discovery Continuum Population Systematic Health Reviews/ Surveillance Synthesis & Studies 10 “Science has Arthritis on the Run. In the past, it took an average complexities of clinical research and practice, as Tof 17 years for only 14 percent of new well as the many other challenges that occur on the scientifc discoveries to be available to the people in scientifc discovery continuum. A key to medicines and therapies for the prevention, early delivering on discovery is that each team — no matter detection, diagnosis and treatment of disease. Whether we main repository of medical images, patient data are facilitating better evidence-based decision and bio-samples. Data from the Million candidates to: development of new diagnostics and pharmaceutical Veteran Program26 are being analyzed to create a. Plan for translation of scientifc knowledge into the products people need to treatments. Measure metrics that matter and validating the most promising biological targets diagnosing arthritis earlier. When the algorithms are Provide leadership and oversight in building collaborative, interdisciplinary teams who 03 for rheumatoid arthritis and systemic lupus erythe- confrmed, clinicians can use the decision-making achieve meaningful results and accelerate scientifc discovery to fnd a faster cure for matosus (lupus). These new targets will inform the tools to diagnose people with arthritis and identi- people with arthritis and related diseases development of new diagnostics and drugs to treat fy those who need to be referred to rheumatol- Engage people with arthritis and related diseases in the scientifc discovery process 04 people with rheumatoid arthritis and lupus. Eventually the tools will be ready to use for telehealth and may even lead to pre-clinical diagno- In our collaborations with the Patient-Centered sis. The data and Discovery and translation of scalable new products, tools and technologies of the process, from study design to study imple- methods for this demonstration project are made for diagnostics, interventions and a cure mentation and interpretation of the fndings. Every possible by years of scientifc discovery and technol- person, no matter how arthritis affects their life, is ogy research and development. The demonstration Improved decision making and better lives through improved prevention, welcome to participate. There is an ongoing need for updated and awareness and use of advanced medical imaging. The Bone and Joint Initiative published a a combination of metrics, but not enough data are burden of disease report that included economic available to fully answer the questions. Although many of treating these individuals in addition to the cost to physical and social benefts are enjoyed by people society in the form of decreased wages is estimated playing sports, more than 2. If the arthritis Health to fnd ways to answer questions that have outcomes associated with chronic conditions registries in the United States agree to collecting not yet been answered, as well as continuing to such as arthritis and related conditions standardized core metrics, then the data can be update existing facts as new information becomes A specifc source of data to produce metrics for public pooled together to have statistical power to answer available. The Arthritis Foundation is a Healthy health surveillance and health research is registries. Registries provide People Consortium Partner to take actions to A registry is a collection of information about individ- overall acceleration of the research process and also strengthen policies and improve practices that are ual people, usually focused around a specifc diagno- 15 expertise from existing efforts such as Outcome provide data to design more effective clinical trials. For highly reliable, precise measures of patient-reported injury and premature death. One option discretionary social activities and satisfaction with prevention and treatment of comorbidities, such as arthritis can be prevented. Each registry has a focus for developing such a pain index is by combining social roles. Travel to in-person trainings will be research for arthritis and related diseases covered for both trainees and experts. This training has a strong interdisciplinary pipeline program would be symbiotic with existing training Tof scientists to implement our frst two and mentoring programs. For example, this new program can opportunities is a challenge for many investigators. This challenge was intended to crowd- and development for arthritis and related diseases source human genetics with the ultimate objective by recruiting 1) trainees who are experts in arthritis of identifying genetic predictors that could improve research but would beneft from training in interdis- treatment for those suffering from rheumatoid ciplinary scientifc research and development skills, arthritis. To steer the tors interested in applying their talents to arthritis investigators into the validation phase, Sage Bionet- research, and would beneft from understanding works quickly realized the need to provide training the history and current needs in the feld of arthri- about the history and needs of rheumatoid arthritis tis research (Figure 4). The Arthritis Foundation will research so that investigators new to arthritis could provide curriculum for the interdisciplinary trainings build upon existing knowledge and improve the and identify experts who will be paid for their time deliverables being produced. Arthritis research history and current needs Trainees and experts Curriculum b. Interdisciplinary skills to turn scientifc discoveries into real-world uses 03 Pilot test the training program Local connections are strengthened 04 Evaluate the pilot training program Quality proposals Successful scientifc research and development that accomplishes a 05 Revise the training program based on evaluations specifc scientifc goal 06 Implement the training program including ongoing evaluation 07 Track the impact of the training program Scientifc research pipeline is strengthened and scientifc discovery is catalyzed and accelerated for arthritis and related diseases Building Human Capital: How You Can Be Involved 01 Spread the word about the interdisciplinary training program 02 Be a trainee 03 Identify and provide lessons learned from other mentoring and training programs 04 Volunteer to be an expert who develops or teaches the curriculum 05 Volunteer to assist with planning, implementation and/or evaluation of the program 06 Donate and/or raise funds to support the mission of the Arthritis Foundation 24 “Science has Arthritis on the Run” Arthritis Foundation Scientifc Strategy 2015-2020 25 Goals and Targets he Arthritis Foundation’s mission is to improve lives through leadership in the prevention, control and cure of arthritis and related diseases.
Finally buy generic levitra pills erectile dysfunction treatment alprostadil, the addition of a relatively type of environment as a method to install high dose of phage (108–1010 plaque-forming another hurdle to pathogen entry to the units) reduced experimentally inoculated E order levitra discount erectile dysfunction xanax. One of the most signiﬁcant contain phages due to the common use of pathogens associated with bioﬁlms is Listeria, Lactococcus and Streptococcus in cheese and which can form or take part in other bacterial yogurt production (Coetzee et al. Other harbour pathogenic bacteria and have caused common foodborne pathogenic bacteria such outbreaks of human illness, and studies have as Salmonella, Campylobacter and E. Contact the nature of phage activity, they have been between foods or equipment and these proposed for a variety of uses to improve bioﬁlms can transfer the bacteria to the human public health through a variety of foodstuﬀ, thus ensuring the presence of mechanisms. Phage therapy oﬀers a natural, spoilage organisms or, more signiﬁcantly, safe and eﬀective means to treat and in some foodborne pathogenic bacteria. Furthermore, cases prevent bacterial disease, as pathogens the presence of a bioﬁlm can isolate bacteria can be speciﬁcally targeted without aﬀecting from these kinds of physical treatments, commensal ﬂora in the environment. By using phage as Phages are an alternative treatment that treatments in the ﬁeld, on animals and crops has the potential to obviate some of the as they enter the processing facility, as a protective beneﬁts of bioﬁlms (Abedon, cleaning spray and as a preparation on 2011). Of note, phages can produce poly- ready-to-eat foods, we can use phage as an saccharide depolymerases to degrade the adjunct to existing pathogen-reduction extracellular polysaccharide matrix of the strategies. Accordingly, sumers, we can signiﬁcantly reduce human phages were used to eliminate Pseudomonas illnesses. As can be seen by the wide variety ﬂuorescens bioﬁlms in the ﬁrst 5 days of of approaches of phage treatment and usage development (up to 80% of bioﬁlm removal) in the food industry, we are well on the way in a model system (Sillankorva et al. Applied and Environmental Micro- Further research is under way into this biology 74, 6230–6238. Foodborne points from the farm to the fork (known as Pathogens and Disease 7, 1363–1371. Role of Phages in the Control of Bacterial Pathogens in Food 249 Canadian Communicable Disease Report 26, Bicalho, R. Isolation and lytic activity estimation of prevalence of Escherichia coli O157:H7 and bacteriophages. Food Science Isolation and characterization of Campylobacter and Thechnology 23, 30–32. Bacteriophage isolated from feedlot cattle can Journal of Chemical Thechnology and reduce Escherichia coli O157:H7 populations in Biotechnology 76, 677–682. Foodborne Pathogens and formation by Escherichia coli O157:H7 at Disease 8, 261–266. Regulatory Toxicology and O157:H7 infections among livestock exhibitors Pharmacology 43, 301–312. Clinical Micro- addition to food for human consumption; biology and Infection 17, 326–330. Annals harvest and contamination of preintervention of Internal Medicine 130, 202–209. Applied of Campylobacter jejuni bacteriophages and and Environmental Microbiology 69, 5032– their hosts from broiler chickens. Current Pharmaceutical Biotechnology antibiotics: utilization of bacteriophage to treat 11, 15–27. In: Proceedings Application of Bayesian techniques to model the of the 4th International Symposium and burden of human salmonellosis attributable to Workshop on Shiga toxin (Verocytotoxin)- U. Applied experimental enterotoxigenic Escherichia coli and Environmental Microbiology 76, 5327– O149 infection of pigs. Emerging Infectious swine waste lagoons for removing Salmonella Diseases 13, 1908–1911. Applied and Environmental Escherichia coli contamination of root and leaf Microbiology 71, 6554–6563. Journal of Applied distribution, and probable fate of Escherichia Microbiology 107, 646–656. Applied cytogenes during production and postharvest and Environmental Microbiology 75, 1271– processing of cabbage. Applied and Environmental (2005) Use of bacteriophages in combination Microbiology 72, 5359–5366. Journal of utilize bacteriophage to combat Salmonella Applied Microbiology 110, 1323–1331. Applied and Environmental encapsulated bacteriophages targeted Microbiology 76, 48–53. Escherichia coli O157:H7 strains that do not Role of Phages in the Control of Bacterial Pathogens in Food 255 produce Shiga toxin from bovine, avian and range. Salmonella phage cocktail with increased host Journal of Applied Microbiology 101, 857–863. Phage therapy, or phage-based bacterial 2010), application and experimentation that biocontrol (Abedon, 2009c), is the use of should only be deviated from for explicit bacteriophages to combat nuisance or patho- reasons rather than avoided due solely to a genic bacteria. This is done to augment the lack of appreciation of their importance or use of chemical antibacterials or, especially, to utility. Phage therapy ‘best practices’, principles that have therapy is useful, particularly: (i) in light of been formulated in the course of reviewing bacterial evolution to antibiotic resistance; (ii) the modern phage-therapy and phage-based given the limitations to chemical antibacterial bacterial biocontrol literature (Abedon and eﬃcacy such as against bacterial bioﬁlms; (iii) Thomas-Abedon, 2010; Kuter et al. These ideas I antibiotic release into municipal sewage present as answers to a series of questions, systems following disposal or elimination twelve in all, which I believe should be ‘down the drain’, or due to the use of chemical generally considered over the course of antibacterials outdoors to control bacterial phage-therapy research and development. Four more issues are also presented at the Phage therapy can be impressively safe, end of the chapter – those of host range, highly eﬃcacious and even relatively unusual results, the dependence of phage- economical; see Olszowska-Zaremba et al. It is also important, titres – I will be redundant in noting that it is nevertheless, for phage formulations and phage densities in particular that determine protocols to be developed knowledgeably. Abedon) Phage-therapy Best Practices 257 In addition to helping guide the design terms of pharmacodynamics and pharma- of more eﬀective phage-therapy experi- cokinetics. Pharmacodynamics in particular mentation, the ideas presented can also be can be diﬀerentiated into positive versus used towards rational debugging of phage- negative consequences of drug action on the therapy protocols that have proven to be body, such as control of bacterial infections insuﬃciently eﬃcacious. Thus, for example, we can consider of phage-therapy pharmacology (Abedon, the impact of antibiotic densities found in the 2009b,c, 2010a 2011a,b,d, 2012; Abedon vicinity of bacteria-infected tissues on those and Thomas-Abedon, 2010; Curtright and bacteria (anti-bacterial eﬀects) as well as side Abedon, 2011; Ryan et al. Drug density in turn is a consequence of a combination of dosing and pharmacokinetic Phage-therapy Pharmacology considerations. Speciﬁcally, most drugs fol- In phage therapy, phages are applied to lowing dosing will access the systemic cir- bodies speciﬁcally to impact on the con- culation of the blood (absorption), penetrate stitution of a bacterial community. As bodies into non-blood tissues (distribution), be exist, pharmacologically, as a combination of subject to inactivation (metabolism) and may both body cells and associated ﬂora (see also be eliminated from the body (excretion). Letarov, Chapter 2, this volume), this use of For certain drugs, including phages as well as phages as antibacterial agents can be viewed pro-drugs, metabolism – that is, chemical as a form of body modiﬁcation intentionally reactions as they occur in for example human undertaken for the sake of combating disease. As the As with most antibacterials, successful primary goal of pharmacology is to enhance bacterial control can require substantially drug utility, so too should the perspective of more phages than there are bacteria present. Accordingly, in this section, dosing alone has been described as a ‘passive’ I provide an introduction to the ideas of treatment, whereas the harnessing of phage pharmacology in general and phage-therapy population growth to achieve phage densities pharmacology in particular. Just activity with phage therapy is accomplished also as ecological interactions can be via a bactericidal action and, other than in considered as occurring between environ- terms of phage properties, is entirely ments and organisms (Abedon, 2011c), so too dependent on the establishment of suﬃcient can drugs be viewed in terms of impacting on phage densities within the vicinity of the bodies or, instead, in terms of bodies target bacteria, such as the achievement of impacting on drugs. In pharmacology, these densities of approximately 108 free phages distinct views are described respectively in ml–1.
Part of that artistic process of learning is levitra 20 mg with visa erectile dysfunction protocol pdf download free, ‘Don’t push that button order levitra 20mg mastercard impotence 23 year old, I want to push it myself’. Or by silence, as children examine an animal skull and then draw pictures of its teeth, reinforcing their memories by turning them to art. Or by hilarity, when Gambol plays stand-up comic and challenges a class of teenagers to consider how darned odd she feels, talking about private parts to roomful of perfect strangers. Its namesake, Abraham Flexner, was a former teacher and educational expert hired by the Carnegie Foundation to identify key ways of improving the structure of medical training. During this period, the Carnegie Foundation was focusing its resources on improving the nation’s healthcare feld and conjectured that the poor state of medical training was a key weakness. To test this hypothesis, Flexner traveled the country to carry out a survey Key Benefts on the quality of U. Johns Hopkins School of practitioners: Medicine in Baltimore had already implemented such a German-style model218 and served as the “gold standard” by which Flexner measured other • Develop higher levels of empathy, trust and 219 medical schools. Without of patients enforceable medical curriculum standards, any group • Deliver patient-centered care of physicians could establish a for-proft medical • Alleviate personal stress school and grant “degrees [that] were scarcely worth the paper they were written on. In this environment, the concept of a “full- time” system in medical schools also took hold, Community Partnership for Arts and Culture 54 Creative Minds in Medicine Medical Training and Medical Humanities establishing the idea that “the advancement of knowledge was to trump all other involvements in the academic physician’s life. This chapter will explore the development of medical humanities programs and the ways art and culture are enriching medical students’ education. Medical Humanities In the United States, the oldest medical humanities programs emerged in the 1960s and 1970s as a reaction to perceived shortcomings in the teaching, practice and evaluation of medicine. While clinical medicine undeniably provides the essential knowledge medical practitioners need to describe symptoms, diagnose illness and determine its causes and treatment options, it has limits in its ability to fully represent a patient’s personal experience of living and coping with a disease. Arts and Culture in the Medical Field In many ways, arts and culture serve to enrich the practices of community healthcare professionals by strengthening their practical skills; raising their awareness of cultural issues; and introducing doctors to artists working in healthcare settings. When working with real patients, attention to the most minute of details can yield more accurate diagnosis. Medical students learn patient-centered care by shadowing artists working with hospital patients, which enhances the students’ understanding of the benefts that arts and artists can bring to healthcare settings, while also engaging doctors in the creation of arts and culture activities for their patients. Wheelchair dance performances prompt discussions among frst-year medical students about the nature of disability. This results in better care for patients, but it also benefts medical students: Researchers in the Netherlands found that arts training reduced medical students’ performance anxiety during examinations, presentations and training. Students also developed the ability to engage with and relate to people from diverse backgrounds. Through the program, trained art educators and docents from the museum teach students the “Observe, Describe, Interpret, and Prove” strategy to develop critical thinking processes. The program engenders empathy, builds team cohesion, increases students’ tolerance for dealing with unexpected situations and sharpens observational skills. For example, the Cleveland Clinic Lerner College Art of Analysis of Medicine’s Program in Medical Humanities allows medical students to explore the ethical, program, trained societal and historical dimensions of their work. Also, with the support of the Cleveland art educators and Foundation, the Clinic’s Medical Humanities programs provide opportunities for medical docents from students to work with local artists, academics and community leaders to construct stories of the museum 243 health and well-being in Cleveland. At Case Western Reserve University, medical students teach students may take an elective course in music therapy and the “Observe, explore research on music and medicine with music therapists from University Hospitals. For example, the Cleveland Museum of Art’s “Art to Go” program lets Case Western Reserve University medical students view objects from the museum’s collection to help improve their diagnostic skills through observation, deduction and teamwork. Great Lakes Theater and the Baldwin Wallace University’s Department of Theater and Dance have collaborated with the Cleveland Clinic and University Hospitals to offer educational workshops in 2012 for internal medicine residents, helping them develop better relationships with their patients and engage with diverse populations. Doctors as Artists As arts and culture activities play an increasingly signifcant role in medical education, it is not uncommon for practicing doctors to identify as artists themselves in one or both of two ways. This seems natural in light of the practice of medicine being identifed by many as both science and art,252 a practice whose “structure for analyzing medical decision making,” cannot by itself account for the “messy details, such as context, cost, convenience, and the values of the patient” in pursuing courses of action for a particular patient’s case. In the second way, some doctors view themselves literally as artists, reporting their direct engagement in artistic and creative practices for myriad purposes ranging from the examination of personal emotions that arise from their practice of medicine to the use of arts activities to Community Partnership for Arts and Culture 57 Creative Minds in Medicine Medical Training and Medical Humanities relieve stress and distract from job-related pressures. Those specializing in “performance arts medicine” focus on treating the specifc needs of actors, dancers and musicians. Locally, the Cleveland Clinic’s Medical Center for Performing Artists treats voice, hearing and neuromuscular disorders common in performing artists. In numerous ways, the skills of arts and culture are informing the practice of medicine and arts and culture organizations are increasingly serving as resources for the medical community. Cleveland has an opportunity to further promote partnerships between its arts and culture organizations and with the medical community to inform practices and encourage engagement by doctors in such activities. Community Partnership for Arts and Culture 58 Creative Minds in Medicine case study devising healthy communities Katherine Burke leading a session at Rainey Institute Photo courtesy of Katherine Burke Community Partnership for Arts and Culture 59 Creative Minds in Medicine humanizing medical training For a little while during his 2011-12 academic year, medical student Vincent Cruz stopped reading textbooks and played with clay, instead. Cruz and a classmate were fnding out how making art with clay helps brain-injured patients get better. The pair had already sat in on a number of sessions with the Art Therapy Studio’s Traumatic Brain Injury clay-studio group, observing “the amazing ability of the human brain to ‘rewire’ - how the physical act of working with clay (using hand- eye coordination and motor skills) helped promote this process,” he writes in a recent e-mail. He believes that being a doctor means more than being a fact-driven scientist; it is important for medical professionals to understand not only their patients’ humanity, but also their own. Kohn long ago recognized that the arts can be one of the keys to the personal meaning often locked away in the name of objectivity. To help data-swamped future doctors get in touch with the creative, cultural and emotional sides of human beings and recognize that those areas directly affect health, Kohn devised an arts-based qualitative-research experience for frst-year med students in collaboration with Katherine Burke, an adjunct member of Kent State University’s theater faculty. The idea is to give students opportunities to observe artists working with patients and other members of the community and see the effects of arts activity on people as well as the communities in which they live. They develop research and reporting skills in the process, write personal refections and, at program’s end, relate the story of that community-arts experience to others. It also helps students fnd their own voices, express their own feelings and share their own stories with the people around them, Burke explains: “The way in which one tells a story has a way of forming an identity” for both the storyteller and the community listening to him or her. As Cruz writes, observing the clay studio “was an important exercise to see how art in the community – much like nursing homes, outpatient offces and rehab facilities – is integral to the well-being The Medical and recovery of patients weeks/months/years after leaving the hospital, since this is often Humanities diffcult to appreciate when we are so focused on the immediate tasks of in-patient medicine. Kohn’s commitment to helping members of – mundane and medical communities express themselves profound – of their goes back to his early years at Northeast Ohio Medical University, where he founded an chosen profession. But it wasn’t until he had co-founded and begun co-directing the Center for Literature in Medicine at Northeast Ohio’s Hiram College that he had a real epiphany about arts and medicine. He had started collaborating with the then-named Great Lakes Theater Festival, working with theater artists on a narrative bioethics program and “It just opened up my world,” he said. In this way, his Medical Humanities program has sought to help students refect on their identity, their role in society and larger cultural patterns as they face the issues – mundane and profound – of their chosen profession. Kohn’s approach helps turn a young doctor like Bryan Sisk into a different type of physician: one who is not only a scientist, but a human being, as well. He found that the group writing exercises, thought-provoking speakers and the wide range of arts and media that made up his training in humanities at Lerner have given him the ability to cope better with his patients’ feelings and his own. The following best practices are important considerations when developing and implementing programs that bring together the arts and culture and the health and human services sectors: • Understanding context. Before embarking on an arts and health program, it is essential for all parties involved to develop a solid understanding of what populations will be served, what their specifc needs are and what available resources exist for implementing the program. It is essential that arts and culture practitioners recognize the unique strengths, challenges and backgrounds of each participant, as well as the resources and limitations of each healthcare setting.