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By G. Nerusul. Michigan State University. 2018.

This paper has also shown a breadth of examples of what is happening between the arts and health felds in Cleveland discount malegra dxt plus 160mg amex. While not exhaustive buy generic malegra dxt plus 160mg on-line, this white paper s goal was to defne and identify a sampling of the strong body of work that is resulting from collaboration among the wealth of local arts and health assets discount 160mg malegra dxt plus amex. While Cleveland s legacy as an industrial city has left it with signifcant challenges, it is also responsible for giving the city key assets that are defning its future. The intersections of its arts and culture assets and health and human services institutions are driving innovative partnerships that are positively affecting the well-being of individuals, as well as the health of the broader place they call home. In order to foster the arts and health connection, a number of policy issues merit consideration: Research. Greater attention must be given to the valuable contributions arts and culture provide to the health and human services feld. Through the design of research studies that quantify both the individual and public benefts of the intersection, practitioners will be positioned to teach others that arts and culture activities are not simply entertainment or something that is nice to have, but are an essential and necessary element of true patient- centered care and recovery. Community Partnership for Arts and Culture 64 Creative Minds in Medicine Communications. All events and activities that illustrate the arts and health intersection must be promoted publicly through outreach to media outlets, medical practitioners and caregivers who may not be fully aware of the intersection s value. Such outreach will further demonstrate the powerful momentum in Cleveland that is uniting the arts and health felds. Opportunities for practitioners to network, share research and discuss best practices must also be frequently organized and made open to all, from those already doing arts and health work to those who are looking to get involved. By uniting the arts and health sectors, greater attention can be called to the specifc needs facing practitioners of arts and health as well as to possible strategies for addressing them. Such networking will also help the arts and health feld build a united force through which common cause issues can be addressed. In addition, strategies to further validate arts and health activities as medical practice, such as the development of state licensures for art and music therapists, can be explored as avenues for obtaining recognition and reimbursements from insurance sources. The development of local, formalized educational programs, such as the University of Florida s Certifcate in Arts in Medicine or Certifcate in Arts in Public Health,258 can help bolster expertise in the work of the arts and health feld. It is also important for colleges and universities to make opportunities available to students from diverse academic backgrounds to learn about creative intersections and the roles their specialized knowledge can play in the arts industry. Conversely, for students studying arts and culture-related subjects, employment opportunities in sectors such as health and human services and community development should also be promoted. Community Partnership for Arts and Culture 65 Creative Minds in Medicine Conclusion Creative Minds in Medicine At this juncture, returning to the World Health Organization s defnition of health is useful Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infrmity. The health of a place is beholden to factors that span the economic, educational, social and environmental needs of the people living there. Satisfying such conditions is one essential element to improving the health of a city and consequently laying the foundation for supporting individual health. However, this is only one side of the equation, because the health needs of each individual are unique to that person s life experiences and the point where they stand on their personal health journey. Personal experiences ultimately drive health needs, which in turn defne what factors of place are needed to meet those needs. The ability of arts and culture to draw connections to a particular place, unite communities and mobilize individuals in support of common causes directly affects community health. Yet, on a deeper level, the arts and health intersection also grows from the inherent creativity that lives within the mind of every person. It lives in the doctor who is conducting clinical research in pursuit of a new treatment. It lives in patients and their caregivers who are trying to make sense of a diagnosis. This shared purpose is what ultimately eases the tension between art and science, as each offers a different, but inseparable, path to improving the conditions inherent to our common humanity. Community Partnership for Arts and Culture 66 Creative Minds in Medicine case study Billy Bear s Honey Chase Billy Bear s Honey Chase Main Menu Screen capture courtesy of the Cleveland Institute of Art Community Partnership for Arts and Culture 67 Creative Minds in Medicine designing for the future The words computer game may mean pretty much the same thing as lurid murder to a lot of people. Nearly all screen games seem to involve bloody, nonstop shootings, beatings or explosions, usually carried out with high-tech metal weapons the size of Godzilla. The Cleveland Institute of Art Associate Professor of Biomedical Art and Chair of the Game Design program makes a point now of encouraging her students to design nonviolent entertainments. She s even started revising the curriculum standards for the program to encourage courses focused on Games for Change, aiming for game design that promotes learning instead of virtual violence. So when Jared Bendis, Co-Owner of the app development company Lemming Labs Limited, needed an artist to design the images for an application that teaches sick children how to manage their pain, Almon came to mind faster than a wand comes to hand in a Harry Potter game. Bendis calls her an amazing illustrator who came in and added the favor to the game app, a task that perfectly married the skills and benefts of art with the goals of community health. What the app needed frst was a metaphor, explains Bendis, manager/designer for the project. Because its purpose is to teach young children timing and strategy in the context of their pain management to develop a sense of timing and understand the nature of how best to plan and use any relief that can be afforded the game had to have a premise that paralleled the situations and decisions children would need to face, but did so in an appealing, entertaining way.

Involving them early on in the process collaboration and provide a high standard of timely care quality 160mg malegra dxt plus. Confdentiality is central to the practice of medicine and must Physicians being patients be maintained malegra dxt plus 160 mg lowest price. Physicians need health promotion and disease Moving from a position of authority (practising physician) to prevention services 160 mg malegra dxt plus overnight delivery. These fears can lead Key references physicians to delay seeking care, or to minimize symptoms or Bleiberg E. Bulletin of the Menninger physician s ability to provide appropriate care and may, in turn, Clinic. Professional boundaries the case in relation to problems that are stigmatized, such as in the physician patient relationship. Journal of the American mental illness, substance misuse or blood-borne disease (e. The patient must have a physi- cian who can be honest and forthright in a sensitive, empathic and caring fashion. The physician must be careful that their own personal beliefs and perspectives do not interfere with effective care. Coping with an adverse event, complaint or litigation Canadian Medical Protective Association Objectives Physicians invest inordinate amounts of time and energy This chapter will in their work, and their self-image is often centred on their discuss the effects of medical errors, complaints and litiga- status as a physician. Legal allegations and patient complaints tion on physicians in training and throughout their career frequently depict doctors as callous, negligent or incompetent; in medicine, and physicians may feel this is a direct assault on their essence as present an approach to dealing with errors and complaints a person. The legal claim is made by the family coverage of the clinical event, their trial, or college hearing. Internal emotions sorrow The physician scans the document quickly but has to get guilt back to work. The physician has diffculty completing the loss of self-esteem shift and experiences feelings of insecurity bordering on shame panic. Although the physician believes his family will be fear supportive, the physician is ashamed to tell them about External pressures the legal action and the mistakes the physician presumes social isolation from friends and family to have made in the case. Physicians are also susceptible to feelings of isolation during Approximately two per cent of physicians are named in a legal diffcult moments in their career. Far more are involved in a wide variety of it hard to maintain a social network of friends and colleagues other medico-legal diffculties. Patients or other parties may with whom they can commiserate and share experiences. They complain about a physician to a regulatory authority (college), may also feel shame or embarrassment about presumed medi- hospital or privacy commissioner or to the Human Rights cal errors. Physicians may be referred for college disciplin- as a failure, they may be inclined to keep the matter from their ary hearings or have their practice reviewed. Maintaining perspective Although it is impossible to erase a physician s sadness and Medico-legal diffculties are stressful for physicians for several regret associated with a poor patient outcome, feelings of reasons. In some cases, the problem arises from a clinical out- guilt, inadequacy or fear can be greatly attenuated by keeping come that is unexpected and even disastrous to the patient. Physicians may be consoled by the is normal for a doctor to feel distressed when a patient dies following facts and observations. Physicians ex- perience empathy and sorrow for the patient and family when A poor patient outcome, even if unexpected, does not signify a tragic clinical outcome occurs. Doctors may beat up on themselves and won- sis or a surgical complication does not equate with negligence. In spite of a deep commitment to patient care counsel, so as to maintain legal privilege. Provincial and university- or community-based physician health programs are available to provide support and assistance to Doctors often work in suboptimal conditions; they may be physicians going through diffcult moments. A physician may be loath to use fatigue as an excuse for a poor outcome, but the reality is that fatigue and Practical considerations other system and organizational issues often contribute to the Most physicians do cope reasonably well with adverse events occurrence of adverse events. Many come to realize that a medico- legal diffculty is not the cataclysmic event they may have All colleagues and most patients are aware that any physician, imagined. A medico-legal diffculty may induce a physician to even the most competent and knowledgeable among them, may appraise their practice and lifestyle and to implement construc- encounter a medico-legal diffculty at one time or another. Doctors should endeavour to achieve a satisfying unusual for patients to leave a physician s practice because of work life balance, and if a phase of practice becomes par- another patient s complaint or legal action. Colleagues, patients, ticularly stressful they may wish to modify their practice to other health professionals, family and friends are appreciative allow for more time to invest in and take care of themselves. It can also be helpful to engage the services cian are rarely affected by a medico-legal diffculty. Physicians worries about the effect of a lawsuit or patient complaint on their career are often exaggerated. However, Positive practice changes can enhance patient safety, but physi- even when the medico-legal problem is reported in the me- cians should also avoid the urge to practise overly defensive dia, in most cases it is quickly forgotten by all but the parties medicine with excessive and clinically unwarranted investiga- involved.

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For example buy malegra dxt plus 160 mg line, he has twice testified before Congress and was a leader in the successful Proposal 2 campaign to protect stem cell research in Michigan s state constitution discount 160 mg malegra dxt plus amex. Nichols is a professor of anesthesiology/critical care medicine and pediatrics and the Mary Wallace Stanton Professor of Education generic 160 mg malegra dxt plus mastercard. Since joining the School of Medicine faculty in 1984, he has held numerous leadership posts in both the Department of Anesthesiology and Critical Care Medicine and school-wide. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease guidelines; restructure graduate medical education; oversee the design of a new $50 million medical education building; and enhance diversity throughout Johns Hopkins Medicine. Nichols was associate director of the residency education program in the Department of Anesthesiology and Critical Care Medicine. Nichols became a full professor of anesthesiology/critical care medicine and pediatrics in 1998 and became the recipient of the Mary Wallace Stanton Professorship for Education in 2005. He has written more than 80 professional journal articles and abstracts, held 17 guest professorships, headed more than 20 symposia and delivered more than 115 guest lectures. He also has been editor in chief of the leading textbooks in pediatric critical care medicine and edited Rogers Textbook of Pediatric Intensive Care and Critical Heart Disease in Infants and Children. Maynard Olson is Professor Emeritus of Medicine and Genome Sciences, at the University of Washington. His research interests focus on studies of natural genetic variation in both bacteria and humans. Olson was involved in shaping scientific policy toward the Human Genome Project, serving on the National Research Council Committee on Mapping and Sequencing the Human Genome, the Program Advisory Committee of the National Center for Human Genome Research Institute. Charmaine Royal is an Associate Research Professor in the Institute for Genome Sciences & Policy and the Department of African and African American Studies at Duke University. She subsequently completed her postdoctoral training in the Bioethics and Special Populations Research Program at the National Human Genome Research Institute of the National Institutes of Health, and in the Division of Epidemiology and Behavioral Medicine at the Howard University Cancer Center. Royal was Assistant Professor of Pediatrics and Director of the GenEthics Unit in the National Human Genome Center at Howard University. She serves on the: Bioethics Advisory Committee of the March of Dimes Foundation; Social Issues Committee of the American Society of Human Genetics; Editorial Board of the American Journal of Bioethics; and various other professional Committees and boards. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 90 ethnicity, and identity. She has taught, presented, published, and received funding in these and other related areas. A key objective of her research program is to advance a more holistic and ethical approach to understanding and improving human health and well-being through increased integration of genetic and genomic research with behavioral, social science, and humanities research. Yamamoto s research is focused on signaling and transcriptional regulation by intracellular receptors, which mediate the actions of several classes of essential hormones and cellular signals; he uses both mechanistic and systems approaches to pursue these problems in pure molecules, cells and whole organisms. Yamamoto was elected as a member of the American Academy of Arts and Sciences in 1988, the National Academy of Sciences in 1989, the Institute of Medicine in 2003, and as a fellow of the American Association for the Advancement of Sciences in 2002. Hook-Barnard is a program officer with the Board on Life Sciences of the National Research Council. She came to the National Academies from the National Institutes of Health where she was a Postdoctoral Research Fellow from 2003 to 2008. Her graduate research examined translational regulation and ribosome binding in Escherichia coli. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease she contributes to projects in a variety of topic areas. Much of her current work is related to issues of molecular biology, microbiology, biosecurity and genomics. She was study director for the 2010 report Sequence-Based Classification of Select Agents: A Brighter Line, and continues to direct the U. How would a New Taxonomy of human disease enable more cost effective and rapid development of new, effective and safe drugs in the pharma/biotech setting? How would a New Taxonomy of human disease promote integration of clinical and research cultures in the pharma/biotech industry? How would a New Taxonomy of human disease promote public/private partnerships between industry and academia? What are key factors that would limit the implementation of a New Taxonomy of human disease in the pharma/biotech setting? Such studies involve testing hundreds of thousands of genetic variants called single nucleotide polymorphisms throughout the genome in people with and without a condition of interest. In addition, the consortium includes a focus on social and ethical issues such as privacy, confidentiality, and interactions with the broader community. Data Sharing Guiding Principles: All data sharing will adhere to 1) the terms of consent agreed to by research participants; 2) applicable laws and regulations, and; 3) the principle that individual sites within the network have final authority regarding whether their site s data will be used or shared, on a per-project basis. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 100 administered by the National Institutes of Health. In addition each Member agrees to report in writing to the other Members any use or disclosure of any portion of the data of which it becomes aware that is not permitted by this Agreement including disclosures that are required by law.

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Inhibitors of Cell Wall Synthesis E-lactamase and E-lactams The efficacy of the antibiotic hangs on 2 parameters: The rapidity of the drug entrance The rate of enzymatic hydrolysis Periplasmic Space Entry x The periplasmic space represents a mine field for -lactams due to the presence of -lactamase enzymes (defense enzymes) x -lactamases are found in all bacteria purchase 160 mg malegra dxt plus with amex, although in variable amounts and with varying levels of activity (they can even be found in wild-type E order malegra dxt plus 160 mg visa. The rate of this hydrolysis depends on the rate on entry of the drug and the level of -lactamase activity order malegra dxt plus 160 mg with amex. Glycopeptides: Lipoglycopeptide Spectrum of Action nd Dalbavancin: (Vicuron) 2 generation lipoglycopeptide. Inhibits cell wall synthesis and inhibits bacterial phospholipid membrane synthesis. Inhibitors of Cell Wall Synthesis Mode of Action of Glycopeptides Vancomycin bioMrieux,Inc. Use this property in Microbiology in several ways: Check Gram reaction - growth around Vancomycin disk would indicate a Gram-negative organism (resistant to Vancomycin). Inhibitors of Cell Wall Synthesis Beta-lactams Penicillins Cephalosporins Monobactams Carbapenems Glycopeptides Fosfomycins Inhibitors of Cell Wall Synthesis Fosfomycins Spectrum of Action Fosfomycin: Acts to inhibit cell wall synthesis at a stage earlier than the penicillins or cephalosporins. Mode of Action: Inhibits the first step of the peptidoglycan synthesis process bioMrieux,Inc. Must combine an aminoglycoside (Gentamicin or Streptomycin) with a penicillin, ampicillin or vancomycin for severe enterococcal infections (Synergy Testing). It is important to control the serum level for peak and trough to ensure the bactericidal effect and avoid side effects. Inhibitors of Protein Synthesis Protein SynthesisProtein Synthesis A quick review of protein synthesis before we begin. Inhibitors of Protein Synthesis Entry of Aminoglycosides - - + - + Aminoglycoside + - - - - -- Outer Membrane n Peptidoglycan Cytoplasmic Membrane o Respiratory Enzymes Aminoglycoside Mode of Action Target = Ribosome in cytoplasm 1. Outer Membrane entry: Aminoglycosides are positively charged molecules which means they rapidly enter bacteria (negatively charged) since the two charges attract each other. Cytoplasmic Membrane entry: The drugs cross the cytoplasmic membrane via respiratory enzymes (involved in aerobic respiration). This is why bacteria without respiratory enzymes (strict anaerobes or facultative anaerobes like streptococci) are naturally resistant to aminoglycosides. The resulting change in ribosome structure affects all stages of normal protein synthesis. The incorporation of such abnormal proteins into the cytoplasmic membrane compromises its function. The bactericidal activity of aminoglycosides ultimately stops protein synthesis and dramatically damages the cytoplasmic membrane. Streptogramins: Quinupristin/Dalfopristin (Synercid): consists of an A and B component (Synergistic). Ketolides: Telithromycin: Represents a novel class that has received much attention recently due to their excellent activity against resistant organisms. Inhibitors of Protein Synthesis Tetracyclines Glycylcyclines Tetracyclines International Common Name Tetracycline Minocycline Doxycycline Glycylcyclines Tigecycline Inhibitors of Protein Synthesis Tetracyclines: Spectrum of Action: Broad spectrum, but resistance is common which limits its use. Primarily for treatment of genital infections (chlamydiae) and atypicals (Rickettsiae, Mycoplasma). Not recommended for pregnant women and children (less than 2 years old) because of the toxicity on bones and teeth of the fetus. Tetracycline = Short acting Minocycline and Doxycycline = Long acting Minocycline and Doxycycline are more active than Tetracycline. Inhibitors of Protein Synthesis Mode of Action - Tetracycline Mode of Action Effect Tetracyclines Irreversibly binds to Inhibits elongation the 30S ribosomal sub-unit step of protein synthesis Tetracycline exists as a mixture of two forms - lipophillic and hydrophillic. Inhibitors of Protein Synthesis Phenicols Chloramphenicol Inhibitors of Protein Synthesis Phenicols: Chloramphenicol Spectrum of Action: Very active against many Gram-positive and Gram-negative bacteria, Chlamydia, Mycoplasma and Rickettsiae. Toxicity: High toxicity, causes bone marrow aplasia and other hematological abnormalities. Inhibitors of Protein Synthesis Chloramphenicol Mode of Action Effect Chloramphenicol Binds to the 50S Inhibits elongation ribosomal sub-unit step of protein synthesis Relativelysmallmolecule,easilyenters Gram-positive and Gram-negative bacteria TargetisRibosome Bindsto50Ssubunitwhereitinhibitselongation step of protein synthesis bioMrieux,Inc. Inhibitors of Protein Synthesis Ansamycins Rifampin (Rifampicin) Inhibitors of Protein Synthesis Ansamycins Rifamycins Rifampin (Rifamipicin): Spectrum of Action: PrimarilyGram-positiveorganisms and some Gram-negatives Usedincombinationswithother drugs to treat tuberculosis UsedtotreatcarriersofN. It has come into recent use for treating multi-drug resistant Acinetobacter infections. Inhibitors of Membrane Function Mode of ActionMode of Action ofof PolymyxinsPolymyxins Lipopeptides Polymyxins Polymyxin B Colistin CyclicLipopeptides Daptomycin bioMrieux,Inc. Outer and Cytoplasmic Membrane Effect: Polymyxins are positively charged molecules (cationic) which are attracted to the negatively charged bacteria. The antibiotic binds to the cell membrane, alters its structure and makes it more permeable. This disrupts osmotic balance causing leakage of cellular molecules, inhibition of respiration and increased water uptake leading to cell death.

The predominant organisms responsible for secondary bacterial pneumonia vary with Hemophilus influenza order malegra dxt plus 160 mg overnight delivery, beta-hemolytic streptococci and Streptococcus pneumonia during the 1918 influenza pandemic; Staphyloccus aureus during the 1957 pandemic; and S pneumonia generic 160 mg malegra dxt plus free shipping, Staphylococcus aureus (26%) and Hemophilus influenza during the 1968 pandemic order malegra dxt plus 160 mg visa. The mortality rate in mixed viral bacterial pneumonia is as high as for primary viral pneumonia (>40%)7,6,9,10. The current recommendation during a pandemic flu alert is to treat with an appropriate antiviral medication early on in the presentation of flu-like symptoms and fever (< 2 days). Corpses do not need to be buried or burned rapidly and instead victims should be identified and dealt with consistent with legal, cultural and religious beliefs thereby, diminishing psychological stress for the large number of potentially-affected survivors. Malnutrition is associated with higher mortality rates from diarrheal illness, measles, malaria, and acute respiratory illness. The interdependency between malnutrition and infectious disease on mortality rates is most evident in vulnerable populations such as children and patients with pre-existing co-morbidity. During a disaster, the majority of all infectious disease mortality is related to diarrheal disease (not the subject of this review), respiratory infections18 and measles. Clinical field data should be routinely collected, shared, collated, and disseminated at regular meetings among various relief organizations to inform and respond to potential outbreaks. Surveillance case recognition should be based on easily identified clinical scenarios. Immediately after Hurricane Andrew hit Florida in 1992, a surveillance system was initiated utilizing data from over 40 sites. Surveillance focused on five presenting complaints (diarrhea, cough, rash, animal bite and other infectious symptoms ) that were targeted for rapid intervention with the result that morbidity and proportional mortality was not increased for diarrhea or cough. Poor hygiene, overcrowding and malnutrition add to the risk for endemic infections becoming epidemic. Tuberculosis22 can also occur in refugee camps in the developing world but, mortality is typically low. Measles, prior to mass immunization programs, was the infection most associated with high mortality rates. The incubation period is 7 to 14 days from exposure to first signs of disease and patients are contagious from approximately one to two days prior to onset of illness until approximately four days after the rash appears. Respiratory complications include pneumonia from measles and bacterial super-infection. Disaster-induced disruption in a region s routine vaccination program may lead not only to measles but to other respiratory diseases such as pneumococcal pneumonia, Hemophilus influenza and pertussis, especially in areas where large numbers of displaced persons are crowded together and pre-disaster immunization programs were ineffective. Standard post-disaster immunization recommendations emphasize measles immunization program in areas with low pre-disaster immunization rates. For children older than nine months, vitamin A should be given simultaneously, because it can decrease ophthalmic complications, disease severity and mortality by 30 - 50%. However, large areas of stagnant water and suspension of pre-existing vector control programs may increase breeding sites, and were the cause of increased malaria rates in Haiti after Hurricane Flora in 1963. Louis encephalitis, eastern or western equine encephalitis, West Nile encephalitis and Dengue fever. Dengue hemorrhagic shock syndrome is the most serious consequence of this infection and is likely to occur by cross infection with multiple serotypes of the virus. Infections related to adverse weather conditions can also be caused by other vectors or environmental exposures. For example, the increased incidence of Hantavirus (deer mice in New Mexico following flooding)29 and coccidioidomycosis (dust clouds in California following the Northridge earthquakes). However, following the large earthquake in Indonesia in December 2004, over 100,000 people were swept away by a massive tsunami. In this setting, aspiration pneumonia was common but, exact numbers were difficult to record. The initial manifestation of "submersion injury" (early aspiration pneumonia) is aspiration of 3-4 ml/kg of liquid due to reflex laryngospasm. Chronic sequelae may include hyperreactive airways dysfunction, bronchiectasis, and recurrent infection. Late tsunami-lung includes necrotizing pneumonia and empyema secondary to aspiration of "tsunami water", mud, and particulate matter. Pathogens are polymicrobial and indigenous to the region, including aeromonas, pseudomonas, and streptococcal species. Fungi such as Pseudeallescheria boydii can result in disseminated brain abscesses. Burkholderia pseudomallei, the etiology of meliodosis, require prolonged antibiotic therapy. Sufficient evidence has been found for an association between damp indoor spaces and mold and upper respiratory symptoms (nasal congestion and throat irritation) and lower respiratory symptoms (cough, wheeze and exacerbation of asthma), and opportunistic fungal infection in immunocompromised patients. IgG-mediated responses and cell-mediated immunity against inhaled fungal proteins can result in development of hypersensitivity pneumonitis. This abnormal response may result after short or long-term exposure, but usually requires the inhalation of large quantities of fungal protein. A very limited number of pathogenic fungi may cause pulmonary and systemic infection in non-immune compromised subjects. Other fungi, such as Aspergillus and Candida have been associated with systemic infection in immune-compromised individuals.