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Transcript: British Medical Journal Annals of Rheumatoid Disease Synovial membrane inflamed and thickened. Bones and cartilage gradually begin to erode Stratification Change in MRI Erosion Score from baseline to week 24 with the use of Rituximab! Progression of osseous tissue formation, causing fusion of the bones, this reducing mobility and in resulting in pain Other Signs and Symptoms of RA Baseline MRI scan 14 days before 1st infusion. Images scored by 2 independent radiologists In fact, data presents joint improvement! All secondary outcomes lead to development of primary outcome (Joint erosion) van Elteren test Used to determine primary endpoint Percent change from baseline Study did not have true 'normal' Each patient's baseline was their individual 'normal' ANOVA cannot be used Test is considered inferior to others with a true 'normal' What if they're biologically naive? Randomized 1:1:1 Loss of energy Loss of appetite Low fever Dry eyes/mouth (sjorgren's syndrome) Rheumatoid nodules (elbows/hands) To evaluate the effect of Rituximab + MTX in reducing structural damage and joint inflammation vs. MTX alone in patients with active RA. Progression of RA 3. Fibrous Ankylosis MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab: results from the randomised, placebo-controlled, double-blind RA-SCORE study Impact Factor: 10.38 Authors Professor Charles Peterfy MD, PhD 1. DiCarlo J. Julie Camille DiCarlo - Publications. Researchgatenet. 2015. Available at: Accessed December 1, 2015. 2. A Study of Rituximab (MabThera®/Rituxan®) in Patients With Rheumatoid Arthritis and Inadequate Response to Methotrexate - Full Text View - 2015. Available at: Accessed December 1, 2015. 3. Peterfy C, Emery P, Tak P et al. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab: results from the randomised, placebo-controlled, double-blind RA-SCORE study. Annals of the Rheumatic Diseases. 2014. doi:10.1136/annrheumdis-2014-206015. 4. Vimeo. MabThera (Rituximab) – Mode of action and the role of B cells in rheumatoid arthritis (RA) (1). 2014. Available at: Accessed December 1, 2015. 5. Netter F, Iannotti J, Parker R. Musculoskeletal System. Philadelphia: Elsevier Saunders; 2013. Significant finding: Rituximab 1000 mg exhibited slower progression of joint erosion. Inclusion Criteria Study Objective American Rheumatology Criteria for ≥3 months and ≤10 years Erosion/signs/symptoms of synovitis in a single joint (MRI) IR to MTX at dose 12.5-25mg/wk ≥ 12wks More Analysis Interactive Voice Response System (IVRS) RA RA! Rituximab Against Rheumatoid Arthritis Discussion History of rheumatic autoimmune disease other than RA or significant systemic involvement secondary to RA Previously on another biologic agent that depletes B-cells. Progression of RA 2. Pannus Formation Founder and CEO of Spire Sciences. Attending radiologist at UCSF for 7 years Director of Arthritis Research for the Osteoporosis and Arthritis Research Group. Developed the WOMRS system and co-developed the RAMRIS (Rheumatoid Arthritis MRI Score) and PsAMRIS (Psoriatic Arthritis MRI Score) methods. - Spire Sciences’ mission is to improve world health by helping bring new and better therapies into clinical use faster. They are focused exclusively on central image analysis. <6 months MTX therapy ≥ 6 months MTX therapy +Bone erosion No bone erosion Primary Outcome Article Post-Hoc Analysis CARLOS TDS TIS week 12, 24, and 52 Health Assessment Questionaire Disability Index (HAQ-DI) Antibody to CD-20, which is found on the surface of B-cells Progression of RA 4. Bony Ankylosis Non-Biologic Hydroxychloroquine Sulfasalazine Leflunomide Methotrexate - Drug of Choice for non-biologic DMARDs Folate antimetabolite (anti-inflammatory and immunosuppressive) Most common type of autoimmune arthritis Progression of RA 1. Synovitis Statistical Analysis for Secondary Outcomes Efficacy Assessment Sponsors & Collaborators: Hoffmann-La Roche Rheumatoid Arthritis Symptoms Clinical significance: Rituximab+MTX prevents joint damage in MTX-IR patients with active RA Reductions in synovitis and osteitis --> reduction in erosion and cartilage loss. Will Rituximab slow the progression of joint erosion in patients with active RA, biologically naive, and failed MTX treatment? 75% of those affected are women Preparation Randomization Rheumatoid Arthritis (RA) Genant-Modified Sharp radiographic scoring Range is too narrow (0-4) Study only used biologically naive patients Possible author bias. He co-developed RAMRIS score Research facility focuses on Central Image Analysis Discrepancies between text, tables, and charts. Insignificant p-value in table, while chart and text indicate statistical significance.

Medical powerpoint

Transcript: Characteristics Earn a doctor of medicine (M.D) 4 years of medical school 3 years of general pediatric training (intern or resident) Going into the medical field is going to be a difficult challenge but with determination I will achieve my goal. With some of the experience I already have it will give me a jump start into the medical field. Pediatrician: I am 16 years old my favorite sport is swimming I want to get into a prestigious medical school some of my strengths are: I am very ambitious and this program would be a great opportunity for me. I am a team player and i am happy to work with other people on a project I am very hard working. I put a lot of efforts into what I do and I do my best Master's degree Bachelor's degree in nursing 1-2 years of experience Class of 2017 Health Career Academy Exploration Education plan Registered nurse University of Irvine Salary: $70,590 yearly $33.94 hourly Claudia Lopez period 1 Who am I? My future Skill set Work well with others I know my medical terminology words I know my vital signs Medical abbreviations i am very sociable Want to go straight to a 4 year university I am CPR certified I have completed my 100 hours of externship I have experience in a clinic Nurse practitioner a nurse who is qualified to treat certain medical conditions without the direct supervision of a doctor. $96,460 yearly $46.37 hourly Registered nurse: Education Plan My future Earn a bachelor's of science in nursing (BSN) 4 years at a university 2-3 years to achieve pathway Lesson learned Claudia Lopez Nurse practitioner: Pediatrics Enjoy working with kids $173,000 yearly $74.00 hourly Health Career Academy

Medical Powerpoint

Transcript: Nature Of Work Very similar, yet different compared to an EMT paramedic- a specialized trained medical technician licensed to provide a wide range of emergency services before or during transportation to a hospital this includes assessing the patients condition and determine a course of treatment EMT- a specialized trained medical technician certified to provide BASIC emergency services before or during transportation to a hospital life or death situations often arise work can be physically strenous and stressful can give medication orally and intravenously interprets elecotrocardiograms (EKG`s) used to monitor heart function equipment :monitors, complex equipment, backboards, restraints etc. Work environment inside and outside spend most of their time standing, kneeling, bending and lifting Can work in helicopters with flight crew training/qualifications/advancment must be licensed in the state where the job is held must take 8 hours of training to drive ambulance EMT- 200-250 hours of classroom instructions, skills practice in a laboratory, hospital emergency room and ambulance experience a field internship may become an instructor, a registered nurse, a physician or any other type of healthcare worker Job outlook 33% The number of EMT and Paramedics needed in Florida will grow at an annual average growth rate of 2.4% which is equivalent to 227 openings until the year 2014. Earnings Median is 35,849 per year Bonus: $49 Paramedic located in Orlando, Fl The lowest: 10% 28,090 25% 31,788 75% 40,527 90% 44,705 Related occupations Air Traffic Controllers- coordinates the movement of air traffic to ensure that planes stay safe distances apart Firefighters-protect the public by reponding to fires and other emergencies, they are often the first responders on the scene of an incident Physician Assistant-practice medicine under the direction of physicians and surgeons Police and Detectives- protect lives and communites, gather facts and collect evidence of possible crimes Registered Nurses- provide and coordinate patient care, educates patients/public on various health conditions and provide advice and emotional support OTHER INFORMATION Important Qualities: Compassion Interpretation Skills Listening Skills Physical Strength Problem solving skills Speaking skills Their are four levels of Emergency Medical Technicians (EMT`s) : First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Detection Reporting response On scene care Care in transit Transfer to definitive You most likely have heard of a military paramedic. They are actually simply called medics. Now do you think you've heard that name before? They fly helicopters, planes, and are their in the midst of battle to support their fellow comrades. Unpaid volunteers are being replaced by paid professionals. GRAPHIC IMAGES!!! •There are about 700,000 EMS personnel in the country. employment change for 2010-2020 is 75,400 PARAMEDIC Star of life: •50% of EMT Basics are on volunteer status. Emergency Medical Technician- 2 year associates degree in emergency medical services technology is available Your salary income depends upon your experience and which state you reside in. paramedics attend large sporting events and public gatherings most work at least 50 hours a week but are on call for extended periods of time only 50% of EMT/ Paramedics actually work in ambulances others work in hospitals, other government facilities etc •70% of all EMS personnel are male and 76% are white. •The origin of the word ambulance is from the early 19th century French words meaning 'mobile (horse-drawn) field hospital' - hôpital ambulant. Ambulant is a Latin term for 'walking'. must be certified as basic EMT before becoming a Paramedic 3/4 of people that go to school to become a paramedic graduate Top 5 paying states for Paramedics: •Hawaii •Alaska •Maryland •Oregon •Washington 1,100-1,500 hours of instruction and experience that includes classroom instructions, clinical rotations in hospitals, a field internship aboard an ambulance and laboratory experience By: Nichole Moroz •EMT`s treats approximately 25-30 millions people each year. Paramedic symbol

Medical Magnet PowerPoint

Transcript: -This was a case study about how the experiences of a meth addict had an impact on its family relationships. Ms.September wrote about Nicholas’ journey with the drug Methamphetamine Methamphetamine and the Body -Moreover, the drug meth slowly deteriorates your neurotransmitters such as the dopamine, norepinephrine, epinephrine, and when taking meth it blocks re-uptake within your neurotransmitters, and a gradual chemical buildup occurs. This chemical buildup has many different effects on a person’s behavior. For the meth user the chemical buildup resembles that of an exhilarating rollercoaster ride, and feelings of euphoria begins to rise -The Dopamine System is the neurotransmitter that plays a part in in controlling movement, thought processes, emotions, and the pleasure centers of the brain -The Norepinephrine System is the neurotransmitter that plays a part in controlling alertness, rest cycles, attention, and memory -The main characteristics of meth psychosis are hallucinations and delusions. The most frequent hallucinations are auditory ones, where the patient “hears voices" -Methamphetamine is a very addictive, strong drug. Just like the people I interviewed agreed that Meth can lead to bad habits and ruin lives, even though it might raise your mood for a while, and that it’s not worth it. The risks of methamphetamine is not worth the damage to one’s psychological health -Long-term effects may include severe mental disorders, memory loss, addiction, starvation, and severe dental problems also known as “Meth Mouth,” which can lead to a loss of teeth by decay -People with EDS report mental vagueness, a lack of energy and concentration, memory lapses, and/or extreme exhaustion -Symptoms of Narcolepsy include excessive daytime sleepiness (EDS), cataplexy, hallucinations, and sleep paralysis -Serotonin plays an important role within the body including sleep, appetite, memory, sexual behavior, and mood -The brain contains neurotransmitters, which are chemical messengers that work together to perform many difficult tasks -Methamphetamine is used to treat exogenous obesity in small doses, and in small doses it can help patients lose weight. -Depressives (patient diagnosed with depression) often show exaggerations of helplessness, hopelessness or guilt; depressives believe that they are solely responsible for all of the evil in the world. Depressives may also experience paranoid delusions, feel sad, anxious, and worthless -Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, increased energy, increased self-esteem, self-confidence, sociability, irritability, aggressiveness, excessive feelings of power and invincibility, paranoia, and depression -Command hallucinations are “voices” that may issue commands for violence to others. Sometimes the patient might have a visual or fragrant hallucination where they might see or smell something that is not present in the environment. Other types of hallucinations for people who are diagnosed with meth psychosis are touchable and gustatory; the patient feels bugs on their skin, which can cause physical problems because some begin to scratch their skin until it bleeds leaving scars, and refuses to eat because the taste of their food resembles the taste of poison Introduction to Methamphetamine and Psychology -Delusions are false personal beliefs that are not common to the patients’ cultural background. People diagnosed with meth psychosis can have delusions of persecution, grandeur, reference, being controlled, or somatic delusions. Delusions of persecution is when they believe that others intend to hurt them, delusions of grandeur is when they have an exaggerated feeling of importance, power or knowledge, delusions of reference is unrelated negative events are connected to them, as if they are the cause of the negative event Q: How did you quit? A: I progressively quit over the course of two years. I got in trouble with the law and they began to do drug tests on me, and during this time I began to become more aware of my drug habits and what it was doing to me. The one thing that pulled me out of it all was the bible. I’m a Jehova’s Witness. I started to dissociate with my friends that used the drug meth. I felt lonely, and it was hard to stop seeing my friends. It was hard to stop in general, but you’re always going to meet new people, and I definitely did. I made new friends after and it was the right thing to do -Medication to treat meth psychosis would be Haldol. Haldol is a drug that effective in the treatment of psychosis; however, it has a number of unpleasant side effects such as anticholinergic manifestations (dry mouth, blurred vision, urinary retention and constipation), nausea, skin rash, decreased libido, and weight gain -Methamphetamine can give unfavorable health affects, which include irregular heartbeat, increased blood pressure, diarrhea, excessive sweating and a variety of psychological problems -Nicholas’

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Transcript: Nobody knows babies like we do! Quality products . Good Customer service. Every Kid really loves this store.. BABYLOU ABOUT US About Us BabyLou was established in 2004. It has been more than a decade since we started, where we have ensured to take care of every need and want of every child and infant under one roof, true to the caption “NO BODY KNOWS BABIES LIKE WE DO”. Our benchmark is to provide 100% customer service and satisfaction and continue to deliver the same with a wide range of toys, garments and Baby Products. Play and Create We Are Best 01 02 03 Block games Building Blocks help Kids to use their brain. PLAY TO LEARN in Crusing Adventures Our Discoveries Enjoy a sunny vacation aboard a luxury yacht with the LEGO® Creator 3in1 31083 Cruising Adventures set. This ship has all the comforts you need, including a well-equipped cabin and a toilet. Sail away to a sunny bay and take the cool water scooter to the beach. Build a sandcastle, enjoy a picnic, go surfing or check out the cute sea creatures before you head back to the yacht for a spot of fishing. Escape into the mountains Disney Little Princes in Also available for your Babies..... Also... Out of The World… Our reponsibility BABYLOU…. Our Responsibility All children have the right to fun, creative and engaging play experiences. Play is essential because when children play, they learn. As a provider of play experiences, we must ensure that our behaviour and actions are responsible towards all children and towards our stakeholders, society and the environment. We are committed to continue earning the trust our stakeholders place in us, and we are always inspired by children to be the best we can be. Innovate for children We aim to inspire children through our unique playful learning experiences and to play an active role in making a global difference on product safety while being dedicated promoters of responsibility towards children.

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