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Because of the recent advances in embryo modeling techniques, and
at the request of the Office of Science Policy in the Office of the
Director at the National Institutes of Health, the National
Academies of Sciences, Engineering, hosted a 1-day public workshop
that would explore the state of the science of mammalian embryo
model systems. The workshop, which took place on January 17, 2020,
featured a combination of presentations, panels, and general
discussions, during which panelists and participants offered a
broad range of perspectives. Participants considered whether embryo
model systems - especially those that use nonhuman primate cells -
can be used to predict the function of systems made with human
cells. Presentations provided an overview of the current state of
the science of in vitro development of human trophoblast. This
publication summarizes the presentation and discussion of the
workshop. Table of Contents Front Matter 1 Introduction and
Overview 2 Mammalian Embryo Research and Pluripotent Stem Cells 3
Examining the Development of Extraembryonic Lineages 4 Stem
CellBased Models of Human Embryos 5 Comparative Embryonic
Development Across Species 6 Exploring Opportunities and Challenges
with Mammalian Embryo Model Systems References Appendix A: Workshop
Agenda Appendix B: Speaker Biographical Sketches Appendix C:
Statement of Task Appendix D: Registered Attendees
Rural America is economically, socially, culturally,
geographically, and demographically diverse. This multidimensional
diversity presents complex challenges and unique opportunities
related to delivering health care and improving health outcomes and
health equity in rural communities. To explore issues related to
population health in rural America, the Roundtable on Population
Health Improvement of the Board on Population Health and Public
Health Practice of the National Academies of Sciences, Engineering,
and Medicine convened a public virtual workshop, "Population Health
in Rural America in 2020" on June 24-25, 2020. The workshop
planning committee was composed of rural health experts
representing public health, health care, and tribal health.
Presentations and discussions focused on rural America in context,
rural health vital signs, rural health care in action,assessment
and implementation strategies for improving the health and health
equity in rural populations, and rural health policy.This
Proceedings of a Workshop summarizes the presentations and
discussions from the workshop. Table of Contents Front Matter 1
Introduction 2 Rural America in Context 3 Rural Health Vital Signs
4 Rural Health Care in Action 5 Assessment and Implementation
Strategies for Improving the Health of Rural Populations 6 Rural
Health Policy Appendix A: Speaker and Planning Committee Member
Biosketches Appendix B: Workshop Agenda Appendix C: References
Immunization against disease is among the most successful global
health efforts of the modern era, and substantial gains in
vaccination coverage rates have been achieved worldwide. However,
that progress has stagnated in recent years, leaving an estimated
20 million children worldwide either undervaccinated or completely
unvaccinated. The determinants of vaccination uptake are complex,
mutable, and context specific. A primary driver is vaccine
hesitancy - defined as a "delay in acceptance or refusal of
vaccines despite availability of vaccination services". The
majority of vaccine-hesitant people fall somewhere on a spectrum
from vaccine acceptance to vaccine denial. Vaccine uptake is also
hampered by socioeconomic or structural barriers to access. On
August 17-20, 2020, the Forum on Microbial Threats at the National
Academies of Sciences, Engineering, and Medicine held a 4-day
virtual workshop titled The Critical Public Health Value of
Vaccines: Tackling Issues of Access and Hesitancy. The workshop
focused on two main areas (vaccine access and vaccine confidence)
and gave particular consideration to health systems, research
opportunities, communication strategies, and policies that could be
considered to address access, perception, attitudes, and behaviors
toward vaccination. This publication summarizes the presentations
and discussion of the workshop. Table of Contents Front Matter 1
Introduction 2 Global Vaccine Uptake During the COVID-19 Pandemic
and the State of Vaccine Confidence 3 Improving Access and Closing
the Global Immunization Gap 4 Assessing Global and Local Drivers of
Vaccine Hesitancy 5 A Systems Approach to Increasing Vaccine
Confidence and Uptake: Opportunities in Research, Communication,
Legislation, and Technology 6 A Systems Approach to Increasing
Vaccine Confidence and Uptake: Opportunities for Community-Based
Strategies 7 Reflections and Ways Forward References Appendix A:
Workshop Statement of Task Appendix B: Workshop Agenda Appendix C:
Speaker and Moderator Biographies
Since the 2014 Ebola outbreak many public- and private-sector
leaders have seen a need for improved management of global public
health emergencies. The effects of the Ebola epidemic go well
beyond the three hardest-hit countries and beyond the health
sector. Education, child protection, commerce, transportation, and
human rights have all suffered. The consequences and lethality of
Ebola have increased interest in coordinated global response to
infectious threats, many of which could disrupt global health and
commerce far more than the recent outbreak. In order to explore the
potential for improving international management and response to
outbreaks the National Academy of Medicine agreed to manage an
international, independent, evidence-based, authoritative,
multistakeholder expert commission. As part of this effort, the
Institute of Medicine convened four workshops in summer of 2015 to
inform the commission report. The presentations and discussions
from the Workshop on Resilient and Sustainable Health Systems to
Respond to Global Infectious Disease Outbreaks are summarized in
this report. Table of Contents Front Matter 1 Introduction 2
Fundamental Principles of Strong Health Systems 3 Health Systems
Strengthening: Building Day-to-Day Care and Public Health
Capacities 4 Strengthening Information Management Systems 5
Strengthening Outbreak Management and Emergency Response Systems 6
Closing Remarks Appendix A: References Appendix B: Statement of
Task Appendix C: Agenda Appendix D: Speaker Biographies
To explore issues related to community-driven power-building
efforts to improve population health, the Roundtable on Population
Health Improvement of the National Academies of Sciences,
Engineering, and Medicine hosted a virtual public workshop,
"Community Power in Population Health Improvement", on January 28
and 29, 2021. Participants discussed the different components and
dimensions of community-led action around different population
health improvement topics such as education, transportation,
environmental health, healthy eating, and active living, among
others. This Proceedings of a Workshop summarizes the presentations
and discussion of the workshop. Table of Contents Front Matter 1
Introduction 2 Daring to Lead 3 Community Power in the Context of
Population Health 4 Community Power: Approaches and Models 5 From
Vision to Action: Effective Ways to Support Grassroots Community
Power Building 6 Community-Led Transformational Narratives 7
Amplifying the Empirical Base Linking Community Power and Health
Equity Appendix A: References Appendix B: Biosketches of Speakers,
Moderators, and Planning Committee Members Appendix C: Workshop
Agenda Appendix D: Readings and Resources
As of 2017, the emergence and spread of antimicrobial resistance
continues unabated around the world, leaving devastating health and
economic outcomes in its wake. Those consequences will multiply if
collaborative global action is not taken to address the spread of
resistance. Major drivers of antimicrobial resistance in humans
have been accelerated by inappropriate antimicrobial prescribing in
health care practices; the inappropriate use of antimicrobials in
livestock; and the promulgation of antibiotic resistance genes in
the environment. To explore the issue of antimicrobial resistance,
the Forum of Microbial Threats planned a public workshop.
Participants explored issues of antimicrobial resistance through
the lens of One Health, which is a collaborative approach of
multiple disciplines - working locally, nationally, and globally -
for strengthening systems to counter infectious diseases and
related issues that threaten human, animal, and environmental
health, with an end point of improving global health and achieving
gains in development. They also discussed immediate and short-term
actions and research needs that will have the greatest effect on
reducing antimicrobial resistance, while taking into account the
complexities of bridging different sectors and disciplines to
address this global threat. This publication summarizes the
presentations and discussions from the workshop. Table of Contents
Front Matter 1 Introduction 2 The Global Momentum to Counter
Antimicrobial Resistance 3 Microbial and Genetic Movements Across
the One Health Domains 4 Applying Social and Behavioral Sciences to
Combating Antimicrobial Resistance 5 Research and Development
Actions for Reducing the Need for Antimicrobials 6 Strengthening
Partnerships and International Cooperation 7 Moving from Knowledge
to Action - Participants' Perspectives References Appendix A:
Statement of Task Appendix B: Workshop Agenda Appendix C:
Biographical Sketches of Workshop Speakers and Moderators
The Forum on Regenerative Medicine of the National Academies of
Sciences, Engineering, and Medicine convened a two-day virtual
public workshop to address knowledge gaps in the understanding of
promising approaches to manipulate the immune system and/or the
regenerative medicine product to improve outcomes of tissue repair
and regeneration in patients. The workshop, titled "Understanding
the Role of the Immune System in Improving Tissue Regeneration,"
explored the role of the immune system in the success or failure of
regenerative medicine therapies. Participants considered potential
strategies to effectively "prepare" patients' immune systems to
accept regenerative therapies and increase the likelihood of
successful clinical outcomes and also discussed risks associated
with modulating the immune system. This Proceedings of a Workshop
highlights the presentations and discussions that occurred during
the workshop.
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Polar Stroke (Paperback)
Anna Nicholson; Foreword by Penelope Blackwell; Edited by Jacki Aston
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R589
Discovery Miles 5 890
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Ships in 10 - 15 working days
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Despite being preventable and curable since the middle of the
twentieth century, tuberculosis (TB) has long persisted as the
world's deadliest infectious disease, with the communities most
devastated by TB among the poorest and most vulnerable in the
world. Only about half of people with TB receive successful
treatment each year. As the global threat of antimicrobial
resistance continues to escalate, so do cases of drug-resistant TB,
or TB that is resistant to various antibiotics that constitute
standard treatment regimens. In response, the National Academies of
Sciences, Engineering, and Medicine's Forum on Microbial Threats
held a two-part virtual workshop on July 22 and September 14-16,
2021 titled Innovations for Tackling Tuberculosis in the Time of
COVID-19. The aims of the workshop were to evaluate the current
status of TB elimination, assess the effects of the COVID-19
pandemic on the global fight against TB, and examine technical and
strategic innovations that could be leveraged to meet the United
Nations High-Level Meeting on Tuberculosis targets in 2022 and The
World Health Organization's END TB Strategy targets by 2030. This
publication summarizes the presentations and discussions of the
workshop. Table of Contents Front Matter 1 Introduction 2 Current
Tools and Challenges 3 Detection 4 Vaccines and Therapeutics 5
Financing, Ambition, and Preparedness Appendix A: References
Appendix B: Workshop Statement of Task Appendix C: Workshop Agenda
To explore issues related to the effects of disasters on children
and youth and lessons learned from experiences during previous
disasters, the virtual workshop From Hurricane Katrina to Paradise
Wildfires, Exploring Themes in Disaster Human Services was convened
on July 22 and 23, 2020, by the National Academies of Sciences,
Engineering, and Medicine. The workshop was designed to focus on
families engaged with federal, state or local supportive programs
prior to disasters. Additional areas of focus were the coordination
of disaster response efforts and the transition to reestablishing
routine service delivery programs post-disaster by human services,
social services, and public health agencies at the state, local,
tribal, and territorial levels. The workshop was also intended to
provide a platform for highlighting promising practices, ongoing
challenges, and potential opportunities for coordinated delivery
and restoration of social and human services programs. This
publication summarizes the presentations and discussion of the
workshop. Table of Contents Front Matter 1 Introduction 2 Exposure
Outliers: Children Coming of Age in an Age of Environmental
Extremes 3 Effect of Disasters on Critical Child Infrastructure 4
Exploring the Gaps in Evidence 5 Case Studies: Effect of Disasters
on Specific Populations 6 Workshop Reflections References Appendix
A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix
C: Speaker Biographies
Regenerative medicine products, which are intended to repair or
replace damaged cells or tissues in the body, include a range of
therapeutic approaches such as cell- and gene-based therapies,
engineered tissues, and non-biologic constructs. The current
approach to characterizing the quality of a regenerative medicine
product and the manufacturing process often involves measuring as
many endpoints as possible, but this approach has proved to be
inadequate and unsustainable. The Forum on Regenerative Medicine of
the National Academies of Sciences, Engineering, and Medicine
convened experts across disciplines for a 2-day virtual public
workshop to explore systems thinking approaches and how they may be
applied to support the identification of relevant quality
attributes that can help in the optimization of manufacturing and
streamline regulatory processes for regenerative medicine. A broad
array of stakeholders, including data scientists, physical
scientists, industry researchers, regulatory officials, clinicians,
and patient representatives, discussed new advances in data
acquisition, data analysis and theoretical frameworks, and how
systems approaches can be applied to the development of
regenerative medicine products that can address the unmet needs of
patients. This publication summarizes the presentation and
discussion of the workshop. Table of Contents Front Matter 1
Introduction 2 Introduction to Systems Thinking Concepts 3
Exploring the Challenges of Critical Quality Attributes: The Role
of Systems Thinking 4 Challenges Associated with Data Collection,
Aggregation, and Sharing 5 Challenges and Opportunities Associated
with Systems-Level Analysis and Modeling 6 Addressing Regenerative
Medicine Manufacturing and Supply Chain Challenges with
Systems-Level Approaches 7 Exploring Issues of Workforce
Development Related to Systems Thinking References Appendix A:
Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix
C: Statement of Task
In November 2018, an ad hoc planning committee at the National
Academies of Sciences, Engineering, and Medicine planned two sister
workshops held in Washington, DC, to examine the lessons from
influenza pandemics and other major outbreaks, understand the
extent to which the lessons have been learned, and discuss how they
could be applied further to ensure that countries are sufficiently
ready for future pandemics. This publication summarizes the
presentations and discussions from both workshops. Table of
Contents Front Matter 1 Introduction 2 Is the World Ready to
Respond to the Next Influenza Pandemic? 3 Global Progress to
Prepare for the Next Influenza Pandemic 4 Reflections on a Century
of Infectious Disease Outbreaks and Pandemics 5 Building Local and
National Capacities for Outbreak Preparedness 6 A Spectrum of
Considerations for Pandemic Vaccines 7 The Development of the PIP
Framework: Global Lessons on Equity and Fairness for Pandemic
Preparedness 8 Overcoming Impediments to Achieving Greater
Preparedness 9 Visions on Potential Priorities and Actions for
Preparedness by 2030 References Appendix A: Commissioned Paper
Appendix B: Workshop Statement of Task Appendix C: Pre-Workshop
Agenda Appendix D: Workshop Agenda Appendix E: Biographical
Sketches of Pre-Workshop and Workshop Speakers and Moderators
To address approaches to the respirator approval process in the
current landscape for both occupational and non-occupational use of
respirators, the National Academies of Sciences, Engineering, and
Medicine's Standing Committee on Personal Protective Equipment for
Workplace Safety and Health convened a virtual workshop, Current
Issues in the Assessment of Respiratory Protective Devices:
Nontraditional Workers and Public Use on August 4?5, 2020.
Additionally, the workshop considered gaps in respiratory
protection for outdoor workers and the general public. This
publication summarizes the presentation and discussion of the
workshop. Table of Contents Front Matter 1 Introduction 2 Lessons
Learned from 100 Years of Respiratory Protection 3 Respiratory
Risks and User Requirements for Nontraditional Workers 4
Respiratory Risks and User Requirements for the Public 5 Assessment
Pathways for Respiratory Protective Devices for Occupational Use by
Nontraditional Workers 6 Assessment Pathways for Respiratory
Protective Devices for the Public 7 Addressing Research and
Communication Gaps References Appendix A: Statement of Task
Appendix B: Workshop Agenda Appendix C: Biographical Sketches of
Workshop Speakers, Moderators, and Staff
On December 4?5, 2019, the National Academies of Sciences,
Engineering, and Medicine held a 1.5-day public workshop titled
Exploring the Frontiers of Innovation to Tackle Microbial Threats.
The workshop participants examined major advances in scientific,
technological, and social innovations against microbial threats.
Such innovations include diagnostics, vaccines (both development
and production), and antimicrobials, as well as nonpharmaceutical
interventions and changes in surveillance. This publication
summarizes the presentations and discussions from the workshop.
Table of Contents Front Matter 1 Introduction 2 Pivotal Role of
Innovations in Tackling Microbial Threats: Lessons from Past
Outbreaks 3 Harnessing Lessons from Emerging Scientific,
Technological, and Social Innovations 4 Overcoming Barriers in the
Field to Bolster Access and Practical Use of Innovations 5 Systems
Approaches to Spur Innovations in Tackling Antimicrobial Resistance
6 Breaking Down Barriers and Fostering Partnerships to Enable
Innovation 7 Nurturing Innovations Through Novel Ecosystems to
Accelerate Research and Development 8 Visionary Statements on
Priorities for Innovation References Appendix A: Workshop Statement
of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographies
The urban built environment is a prime setting for microbial
transmission, because just as cities serve as hubs for migration
and international travel, components of the urban built environment
serve as hubs that drive the transmission of infectious disease
pathogens. The risk of infectious diseases for many people living
in slums is further compounded by their poverty and their
surrounding physical and social environment, which is often
overcrowded, is prone to physical hazards, and lacks adequate or
secure housing and basic infrastructure, including water,
sanitation, or hygiene services. To examine the role of the urban
built environment in the emergence and reemergence of infectious
diseases that affect human health, the National Academies of
Sciences, Engineering, and Medicine planned a public workshop. This
publication summarizes the presentations and discussions from the
workshop. Table of Contents Front Matter 1 Introduction 2
Perspectives on the Prevention and Control of Infectious Diseases
in an Urban and Interconnected World 3 Understanding Infectious
Disease Transmission in Urban Built Environments 4 Translating
Conceptual Models of Infectious Disease Transmission and Control
into Practice 5 Achieving Sustainable and Health-Promoting Urban
Built Environments 6 Bridging Drivers and Interventions to Scale Up
Successful Practices Appendix A: References Appendix B: Workshop
Statement of Task Appendix C: Workshop Agenda Appendix D:
Biographical Sketches of Workshop Speakers and Moderators
As the United States continues to adapt to a more digital, mobile,
and interconnected world, health care and public health
professionals have sought to better prepare for and respond to
long-standing and emerging threats to the nation's health security.
Health security is the collective effort to prevent, protect
against, mitigate, respond to, and recover from the health
consequences of natural, man-made, and technological disasters.
Although substantial progress has been made in the past 15 years
toward improving health care and public health systems and
capacities for health security threats, many complex challenges
persist, and often the nation's preparedness efforts are not
sufficient. On March 8?9, 2017, the National Academies of Sciences,
Engineering, and Medicine's Forum on Medical and Public Health
Preparedness for Disasters and Emergencies hosted a two-day public
workshop to acknowledge these persistent issues; to evaluate past,
and perhaps inadequate, approaches to addressing them; and to
discuss intentional and innovative new solutions. This publication
summarizes the presentations and discussions from the workshop.
Table of Contents Front Matter 1 Introduction 2 A Brief Overview of
Health Security Threats and Programs 3 Proposed Priorities and
Persistent Challenges Related to Health Security 4 Underlying
Issues in Health Security 5 Potential Strategies for Strengthening
the Nation's Health Security 6 Future Opportunities References
Appendix A: Workshop Agenda Appendix B: Statement of Task Appendix
C: Biographical Sketches of Workshop Speakers and Moderators
Countering violent extremism consists of various prevention and
intervention approaches to increase the resilience of communities
and individuals to radicalization toward violent extremism, to
provide nonviolent avenues for expressing grievances, and to
educate communities about the threat of recruitment and
radicalization to violence. To explore the application of health
approaches in community-level strategies to countering violent
extremism and radicalization, the National Academies of Sciences,
Engineering, and Medicine held a public workshop in September 2016.
Participants explored the evolving threat of violent extremism and
radicalization within communities across America, traditional
versus health-centered approaches to countering violent extremism
and radicalization, and opportunities for cross-sector and
interdisciplinary collaboration and learning among domestic and
international stakeholders and organizations. This publication
summarizes the presentations and discussions from the workshop.
Table of Contents Front Matter 1 Introduction and Overview 2
Understanding Violent Extremism 3 Contemporary Approaches to
Countering Violent Extremism 4 The Challenges and Opportunities of
Countering Violent Extremism 5 Applying Public Health Models and
Approaches to Countering Violent Extremism 6 Ways Forward in
Countering Violent Extremism References Appendix A: Workshop Agenda
Appendix B: Workshop Statement of Task Appendix C: Biographical
Sketches of Workshop Speakers and Moderators
Large catastrophic events, or rare acute events, may cause
situations in which a local jurisdiction's medicines and medical
supplies are not sufficient to provide care to the population it
serves. In these cases of natural or engineered disasters, such as
a terrorist attack, influenza pandemic, or earthquake, state or
local authorities can request that the federal government provide
assets from the Strategic National Stockpile to augment the state
and local jurisdictions' resources. The Centers for Disease Control
and Prevention's (CDC's) Strategic National Stockpile (SNS) is the
nation's repository of antibiotics, chemical antidotes, antitoxins,
vaccines, antiviral drugs, and other medical materiel designed to
supplement and resupply state and local public health agencies in
the event of an emergency. The materiel is intended to support
national health security and is managed by the Office of Public
Health Preparedness and Response's (OPHPR's) Division of Strategic
National Stockpile (DSNS). The stated mission of the SNS is to
prepare and support partners and provide the right resources at the
right time to secure the nation's health. The National Academies of
Sciences, Engineering, and Medicine organized a two-day public
workshop to explore opportunities to improve the efficiency,
effectiveness, and sustainable methods used by the CDC's SNS to
distribute medical countermeasures and other supplies during
disasters and other public health emergencies, especially those
which result in disruption of physical infrastructure such as the
electrical grid, central roadways, bridges, and tunnels within the
impacted community. Participants explored relevant distribution
lessons learned from other federal agency stockpiles and the
private sector as well as opportunities to develop public-private
collaborations in the purchase, warehousing, management, and
distribution of medical countermeasures. This report summarizes the
presentations and discussions from the workshop. Table of Contents
Front Matter 1 Introduction, Background, and Context 2 The
Strategic National Stockpile: Origin, Policy Foundations, and
Federal Context 3 Studies and Reports Related to the Strategic
National Stockpile 4 Potential Opportunities for Restructuring
Strategic National Stockpile Scope, Governance, and Decision Making
5 Reaching the Last Mile: Potential Opportunities to Improve
Coordination and Communication Among Local, State, and Federal
Agencies 6 Potential Supply-Chain Opportunities and Lessons from
the Commercial Sector and Government Partners 7 Wrap-Up References
Appendix A: Workshop Agenda Appendix B: Workshop Speaker
Biographies
Brain health affects Americans across all ages, genders, races, and
ethnicities. Enriching the body of scientific knowledge around
brain health and cognitive ability has the potential to improve
quality of life and longevity for many millions of Americans and
their families. The Centers for Disease Control and Prevention
estimate that as many as 5 million Americans were living with
Alzheimer's disease in 2014. That same year, more than 800,000
children were treated for concussion or traumatic brain injuries in
U.S. emergency departments. Each year, more than 795,000 people in
the United States have a stroke. Developing more effective
treatment strategies for brain injuries and illnesses is essential,
but brain health is not focused exclusively on disease, disorders,
and vulnerability. It is equally important to better understand the
ways our brains grow, learn, adapt, and heal. Addressing all of
these domains to optimize brain health will require consideration
about how to define brain health and resilience and about how to
identify key elements to measure those concepts. Understanding the
interactions between the brain, the body, and socioenvironmental
forces is also fundamental to improving brain health. To explore
issues related to brain health throughout the life span, from birth
through old age, a public workshop titled Brain Health Across the
Life Span was convened on September 24 and 25, 2019, by the Board
on Population Health and Public Health Practice in the Health and
Medicine Division of the National Academies. This publication
summarizes the presentation and discussion of the workshop. Table
of Contents Front Matter 1 Introduction 2 Fundamentals of Brain
Health and Resilience 3 BrainBody Interactions 4 Behavioral and
Biological Convergence 5 Measuring Brain Health 6 Brain Health in
the Social Context 7 Brain Health Across the Life Span Appendix A:
Speaker Biographical Sketches Appendix B: Workshop Agenda Appendix
C: References
On June 11 and June 12, 2019, the National Academies convened a
workshop to explore the growing understanding of how the interplay
between humans and microbes affects host physiology and causes
noncommunicable diseases. Discussions included an overview of
colliding epidemics, emerging research on associations between
infectious and noncommunicable diseases, risks posed by chronic
diseases to the development and severity of infectious diseases,
and the influence of the microbiome. Workshop participants also
examined the challenges and opportunities of convergence, the
integration of health care delivery models and interventions,
potential approaches for research, policy, and practice in the
immediate-term, and potential directions for the long-term. This
publication summarizes the presentations and discussions from the
workshop. Table of Contents Front Matter 1 Introduction 2 An
Overview of Colliding Epidemics and Syndemics 3 Emerging Research
on Associations Between Infectious and Noncommunicable Diseases 4
Risks Posed by Chronic Diseases to the Development and Severity of
Infectious Diseases 5 Microbial Dimension to Human Development and
Well-Being 6 Confronting "The Blind People and the Elephant"
Metaphor to Bridge the Silos 7 Integrating Health Care Delivery
Models and Interventions 8 Potential Approaches for Research,
Policy, and Practice in the Immediate Term 9 Visionary Statements
on Potential Priorities to Address the Convergence References
Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix
C: Speaker Biographies
To effectively treat patients diagnosed with drug-resistant (DR)
tuberculosis (TB) and protect the population from further
transmission of this infectious disease, an uninterrupted supply of
quality-assured (QA), second-line anti-TB drugs (SLDs) is
necessary. Patients diagnosed with multidrug-resistant tuberculosis
(MDR TB)-a disease caused by strains of Mycobacterium tuberculosis
(M.tb.) resistant to two primary TB drugs (isoniazid and
rifampicin)-face lengthy treatment regimens of 2 years or more with
daily, directly observed treatment (DOT) with SLDs that are less
potent, more toxic, and more expensive than those used to treat
drug-susceptible TB. From 2000 to 2009, only 0.2-0.5 percent of the
estimated 5 million MDR TB cases globally were treated with drugs
of known quality and in programs capable of delivering appropriate
care (Keshavjee, 2012). The vast majority of MDR TB patients either
died from lack of treatment or contributed to the spread of MDR TB
in their communities. A strengthened global supply chain for SLDs
could save lives by consistently delivering high quality medicines
to more of the people who need them. This public workshop explored
innovative solutions to the problem of how to get the right SLDs
for MDR TB to people who critically need them. More specifically,
the workshop examined current problems and potential opportunities
for coordinated international efforts to ensure that a reliable and
affordable supply of high-quality SLDs is available. Developing and
Strengthening the Global Supply Chain for Second-Line Drugs for
Multidrug-Resistant Tuberculosis: Workshop Summary covers the
objectives of the workshop, which were to review: -To what extent
and in what ways current mechanisms are or are not effectively
accomplishing what is needed, including consideration of
bottlenecks. -The advantages and disadvantages of centralization in
the management of the global drug supply chain, and potential
decentralized approaches to improve operations of the supply chain.
-What can be learned from case studies and examples from other
diseases (e.g., the Affordable Medicines Facility-malaria (AMFm)
and the U.S. President's Emergency Plan for AIDS Relief [PEPFAR]) -
The current allocation of responsibilities and roles of the private
(including industry and nonprofit public health organizations) and
public sectors, and examination of opportunities for enhancing and
optimizing collaboration -Identification of potential innovative
solutions to the problem Table of Contents Front Matter 1
Introduction 2 Logistics, Supply, and Demand 3 Financing of MDR TB
SLDs 4 Innovative Suggestions and Potential Solutions References
Appendix A: Workshop Agenda Appendix B: Participant Biographies
Appendix C: Registered Workshop Attendees
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