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Proud Boys member from Vancouver appears in court – The Columbian

Posted on September 6, 2020 by Danzig

A prominent Vancouver member of the right-wing Proud Boys group appeared Monday morning in Clark County Superior Court on a fugitive from justice charge.

Tusitala Tiny Toese, 24, who was booked late Friday into the Clark County Jail, is wanted in Oregon for allegedly violating the conditions of his probation related to a misdemeanor assault conviction.

Toese agreed to waive extradition, meaning he will be turned over to authorities in Oregon. In the meantime, he is being held without bail.

According to reports from The Columbians media partner KATU-TV, Toese is known to engage in violence at ongoing protests in Portland and Seattle, where he was arrested after allegedly participating in an assault near the Capitol Hill Autonomous Zone.

He was on supervised probation for a fourth-degree assault charge out of Multnomah County, Ore., when he was recently seen participating in a brawl between Black Lives Matter protesters and those demonstrating in support of police and the Trump administration, KATU reported.

Toeses probation agreement had barred him from taking part in any protests in Multnomah County and required that he get permission before leaving Clark County, according to KATU.

After he was spotted participating in the brawl, an updated warrant for Toeses arrest was issued. Toeses supervising officer has recommended the court revoke his probation and sentence him to a year in jail, KATU reported.

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Proud Boys member from Vancouver appears in court - The Columbian

Activists say Kalamazoo blew it with preliminary report on police response to Proud Boys rally – MLive.com

Posted on September 6, 2020 by Danzig

KALAMAZOO, MI Activists who came out to oppose a Proud Boys rally in Kalamazoo last month say a recently released city review of the police response failed to acknowledge the mistakes that prompted a surge of criticism.

Kalamazoo City Manager Jim Ritsema and Public Safety Chief Karianne Thomas were among a handful of city leaders who discussed the preliminary report earlier this week.

Both said there were several areas for improvement as the city plans for the possibility of future public protests, demonstrations and rallies high among them accountability.

Related: City review of police response to Kalamazoo Proud Boys rally finds areas for improvement

The lack of specifics in the preliminary report of where police could have done better exemplifies just how far the city and public safety department have to go when it comes to accountability and transparency, some of the activists said.

Were supposed to trust that they are going to do the right thing every time in every scenario, no matter how unrealistic that may be, but they cant even acknowledge to the public that some of their officers during the last event may have acted inappropriately whether it be from their own personal implicit bias or whatever the case may be? asked Tyrone Burnett, 42, who attended the rally to observe and protest the presence of the Proud Boys.

Community activist Quinton Bryant echoed Burnetts sentiments.

I think they need to be transparent on what they are saying they need to improve on, Bryant said. Anybody can say, I need to learn and figure out what I can do better, but if you are not bullet-pointing actions, its kind of hard to know what you are talking about.

Thats part of the frustration in the community. We keep hearing the same words transparency and accountability but where is it? You need to show us what you mean by that. Because, without action, they are just words.

Burnett said aside from adjustments to communications and media relations there was a complete lack of specifics in the report and that many of the key issues that arose Aug. 15 appeared to be flat-out ignored.

I want to know who gets to police the police, he said. I want to see my local department be the model across the country and build a true relationship with the community.

If you have that, if you know the people down there, they are going to be less apt to try to get in fights with people down there and more apt to do their doggone job and protect the people who had a permit. They completely blew it.

Related: None of them saw a single repercussion, counter-protester says of Proud Boys who rallied in Kalamazoo

The lack of arresting of Proud Boys and arrest of an MLive journalist gave the impression to Burnett that police didnt want the media showing who was coming out of the parking garage.

And while public safety officials have discussed how there was over-watch on the event and numerous details given about an assault involving a counterprotester, he questioned where the over-watch was for the Proud Boys and why no assaults were mentioned involving Proud Boys, despite ample time to review videos and reports.

Where was the information on how 200-plus people came into town, how did they move in, where did they move from? Theres complete silence on that and as a community member thats what leads to distrust, Burnett said.

Im not buying the Were being transparent and open part, he said. It seems like spin, and covering your own behind to me.

Burnett said it is easier to forgive someone when they specifically acknowledge where they failed and where they need to do better.

You have to acknowledge your mistakes, own your mistakes, move forward and do better, he said.

Bryant said he was still upset over how Kalamazoos Black Lives Matter protests were handled by police on June 1.

He said peaceful protesters were treated like the bad guys by police then. At the same time, the Proud Boys, defined as a hate group by the Southern Poverty Law Center, did not get the same treatment when they came to town.

There has been no ownership of that, Bryant said, which is a problem.

The impression that I got is that the police did not protect and serve the residents of Kalamazoo, Bryant said. It seemed like they were more interested in protecting the Proud Boys and making sure that they were safe. They got to terrorize the town safely. They got to leave the town safely, without any of them getting arrested.

Related: Police chief says Proud Boys completed their mission by causing chaos in downtown Kalamazoo

Terror was a key word missing from the report, said the Rev. Nathan Dannison of Kalamazoos First Congregational Church.

Dannison, who organized and sought a city permit for a prayer vigil at Arcadia Creek Festival Place held to counter the presence of the Proud Boys, has served as the vice chairman of the citys police oversight board for the past three years.

In that role, Dannison said, he has become intimately familiar with the activities of KDPS and their capabilities.

From over here, where I stand, it seems that they used none of those capabilities to enforce the laws of our city, and I want to know why, he said. I think the city needs to start addressing the issue of domestic terror and riots. Those are the main words that were missing from that report.

Dannison said he was confused as well as to why the report did not address any facts of what occurred on the ground that day.

He also expressed concern at the city attorneys office being directed to look into potential changes to the citys permitting process or ordinances to help legally deter groups like the Proud Boys from selecting a city like Kalamazoo for their next march.

I dont know why we need new laws, Dannison said. I feel like we just need to enforce the laws that we already have on the books no parades without permits, no traveling across state lines with the attempt to incite a riot. And if people are driving around without license plates, you should stop them and ask them for identification.

The pastor said he was also alarmed the report suggested potential vetting of legal observers and members of the press that would be allowed to cover events, which could prevent members of independent news media from being able to cover events.

Most of all, the pastor said, he is still upset about why a cordon was not set up to separate the unlawful assembly of Proud Boys from his prayer vigil.

It just looks bad, Dannison said. It looked like they were protecting the Proud Boys.

Dannison said he asked Thomas in June to do an internal investigation of her department and to his knowledge it is yet to be done.

What I want to see is an investigation into white supremacy in the Kalamazoo Department of Public Safety, he said. I want to know 100% that there are zero known affiliates of white supremacy groups in KDPS.

I dont know why that is a hard ask.

Also on MLive:

Kalamazoo police chief responds to criticism of handling of Proud Boys rally

Kalamazoo City Commission forms committee to guide police force in response to protests

$300-per-week in federal unemployment to Michigans jobless wont last long

I have never and will never run, says Kalamazoo pastor sought by police

Coronavirus in local schools is inevitable, Kalamazoo County health director says

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Activists say Kalamazoo blew it with preliminary report on police response to Proud Boys rally - MLive.com

Good Morning, News: Portland Protest Shooting Suspect Killed by Officers, Proud Boys to Return, and Trump Insults Vets & Amputees – The Portland…

Posted on September 6, 2020 by Danzig

We need your help. The economic fallout of the coronavirus crisis is threatening our ability to keep producing the quality reporting you've come to love. If youre able, please consider making a monthly contribution to the Mercury.

Officers investigating the scene following the shooting of suspect Michael Forest Reinoehl. Nathan Howard / Getty News

The MAGA movement hits the streets and Trump latches on – POLITICO

Posted on September 6, 2020 by Danzig

Though the narrative of American cities being overrun with violence has percolated through conservative media, its picked up in the past few years as anti-Trump, pro-BLM, and anti-police protests have snowballed. Scenes of looting, vandalism and property destruction only bolstered this worldview, and last year, right-wing extremists started clashing with antifa groups in Portland.

But after the killing of George Floyd in May, racial justice protests exploded across the country, with occasional instances of looting and vandalism. These destructive moments turbocharged the far-right calls to proactively defend private property that was being targeted.

While extremely few high-profile voices openly called for people to take to the streets and push back against protesters, there was an undercurrent of approval for those who did. Several videos emerged on the internet of police officers across the country chatting amiably with far-right militia members, often armed, during racial justice protests. Members of the Proud Boys, the main far-right group that brawled with antifa protesters in Portland last year, were spotted mingling with police union audience members during an appearance by Vice President Mike Pence earlier this summer.

And the St. Louis couple who went viral after a photo emerged of them waving guns at BLM protesters outside their house soon became MAGA superstars, getting a speaking slot at the Republican National Convention last week.

How shocked are we that 17-year-olds with rifles decided they had to maintain order when no one else would? Fox News host Tucker Carlson told his millions of viewers last week. His colleague Laura Ingraham on Tuesday asked why people were rushing to vilify Rittenhouse for exercising his God-given right to defend himself.

If thats the case, we are going to be in for a really, really long and protracted period of complete chaos and destruction which I dont think the American people want, she added.

From the beginning of the summer of protests, Trump, who won the endorsements of numerous law enforcement unions and interest groups in 2016, quickly embraced the protests as a culture wars issue, saying the words Black Lives Matter were a symbol of hate and calling racial justice protesters looters and anarchists. He has also accused Democratic rival Joe Biden of leading a party hellbent on destroying LAW & ORDER throughout the country.

And Trumps refusal to condemn Rittenhouse, or to stop armed right-wing militia members from traveling to cities seeking out fights with BLM protesters, has only encouraged his fans.

The situation came to a head recently in Portland and Kenosha.

In Portland, the home of months of clashes between law enforcement and local protesters, an avowed antifa supporter allegedly shot and killed a member of Patriot Prayer, an independent group that had descended in a miles-long caravan on the city over the weekend in an attempt to show support for law enforcement and the president. On Thursday night, police shot and killed the primary suspect in that shooting as they attempted to arrest him.

And in Kenosha, there has been a rise of ad hoc, questionably legal militia groups such as the Kenosha Guard, a Facebook group heavily criticized for posting a call to arms against protesters on its page just days before the Rittenhouse shooting. In an interview with Kenosha News last Thursday, the groups leader, Kevin Mathewson, stood by his belief that the failure from local leaders to secure their neighborhoods prompted him to make the post.

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The MAGA movement hits the streets and Trump latches on - POLITICO

Violence in the streets politics, 2020-style – Salon

Posted on September 6, 2020 by Danzig

That we are in a time of great political divide is not news.

That those divides are turning physical, and sometimes dangerous, is developing as a major theme before the elections, perhaps predictably.

That we have a bunch of loose words from our candidates for president is neither calming the streets nor helping to establish credibility in government to consider the grievances of the public. Indeed, all it seems to be doing is to give the candidates platforms for more sloganeering.

Worse, the candidates don't seem to be getting at who is responsible for now nightly fighting that witnesses report are more between leftist anarchists and right-wing white supremacists than warring with police.

There are agrowing number of reported clashes, real and imagined. The real ones have included the incidents in Kenosha, Wis., of course, where a white teen committed to defending police, has been charged for killing two protesters and a shooting overnight of a man in a Portland caravan who was wearing a Trump hat, and the less real one of note this week involved Sen. Rand Paul (R-Ky.), who reported that he was assaulted by a "mob," which turned out to be 100 people shouting at him and his wife.

Facts are overly short, and slogans are ruling the day. Meanwhile, ought we not be concerned that whatever violence there is in localized single blocks of different U.S. cities is spreading to fistfights over mask-wearing in stores or protests that are meant to be vocal, but specifically not violent?

Violence real and imagined

For Donald Trump, peaceful protests that turn violent in the early morning hours are all from one side:"You know what I say? Protesters your ass," Trump said to cheers at an airport rally in New Hampshire on Friday. "I don't talk about my ass. They'renotprotesters, those aren't protesters. Those are anarchists, they're agitators, they're rioters, they're looters."

Opponent Joe Biden, who is seen as decrying violence in too general a manner,told CNN thatTeam Trump is"rooting for violence" in American streets because it allows them to drive fear for political gain.Biden cited a quote from Kellyanne Conway that "the more chaos and anarchy and vandalism and violence reigns, the better news for the very clear choice on who's best on public safety and law and order."

Trump seized on the footage of protesters near the White House who gathered around Sen. Paul, who was escorted away by police.

Butvideoof the incident appears to show a much smaller crowd that didn't touch Rand Paul or his wife, and they seem to have sustained no injuries. Actually, several videos of the incident were posted to social media; oneshowsa denser crowd while anothervideoby reporter shows a smaller crowd shouting "Breonna Taylor," a Paul Kentucky constituent who was killed in a mistaken police raid into her Louisville home, and "say her name."

In any event, there was no violence here.

Growing violence

By contrast, nightly violence is continuing in Portland, Ore., "between a core of pro-Black Lives Matter and anti-fascist protesters and law enforcement,"reports The Guardian.There is a pattern of politically polarized street violence with broadly leftwing and anti-fascist activists sometimes facing off against far-right groups.

Last weekend, a right-wing "Say No to Marxism in America" rally including members of far-right groups like the Proud Boyssaw serious, widespread violence directed not only at leftist counter-protesters, but also reporters.One right-wing protester drew a firearm, others carried knives and guns, some had wooden shields with nails driven through.

The Washington Post recordedexchanges from Kalamazoo, Mich., and Bloomington, Ind., to Chicago and Portland, withpeople on both sides of the divide punching and beating each other,often with police appearing to be little more than observers.Some of the violence has been linked to pro-gun groups and far-right extremist organizations.

In Weatherford, Texas, heavily armed protesters, including members of several far-right Texas-based groups, clashed with demonstrators seeking removal of a Confederate statue from the grounds of the Parker County Courthouse.The next day, brawls erupted at a local campaign event in Tyler, 100 miles east of Dallas. A week later, police were called to break up a gathering of hundreds of motorists, many flying Trump and Confederate flags, who descended on a historical Black church in Dallas that displays a two-story Black Lives Matter sign.

This week, in central Pennsylvania, a man marching from Wisconsin to D.C. for this week's anniversary of the 1963 March on Washingtonwas shot and wounded. Protesters have also been shot, in some cases fatally, A group of peopleberated customers at D.C. restaurantsthis week who refused to raise their fist in solidarity with the Black Lives Matter movement, though the confrontations were nonviolent.

What to do

Trump and Vice President Mike Pence have made much of spreading fear of violence in Joe Biden's America but taking no responsibility for violence in Trump's America. More, they are pointedly singular-focused on violence that arises from protest from Black Lives Matter and other left causes, without seeing participation by right-wing groups.

As president, Trump's remarks in New Hampshire underscore that he is not even distinguishing between peaceful, lawful protest and "looting." He is more focused on protecting the rights of gun-toting thugs than he is on whether there is any intelligent discussion of policing abuses, systematic racism or the dozens of questions raised by street protests.

Biden and Vice Presidential candidate Kamala Harris are getting hit by not being vocal enough, while winning some political points for actually paying attention to what the protests are about.

"We are not just a polarized society we are increasingly a confrontational society now,"Mark Pitcavage, a historian and senior research fellow at the Anti-Defamation League's Center on Extremism told The Washington Post.

As voters, we ought to be doing more, and demanding that leaders do more to make the divide more debate than physical confrontation.

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Violence in the streets politics, 2020-style - Salon

The real threat to law and order is Trump himself – Anchorage Daily News

Posted on September 6, 2020 by Danzig

To be re-elected, Donald Trump knows he has to distract the nation from the pandemic that he has flagrantly failed to control leaving more than 180,000 Americans already dead, tens of millions jobless and at least 30 million reportedly hungry.

So hes counting on the reliable Republican dog whistle. Your vote, Trump said in his speech closing the Republican convention last Thursday night, will decide whether we protect law-abiding Americans, or whether we give free rein to violent anarchists, agitators and criminals who threaten our citizens.

We will have law and order on the streets of this country, Vice President Pence declared the previous evening, warning you wont be safe in Joe Bidens America.

Neither Trump nor Pence mentioned the real threats to law and order in America today, such as gun-toting agitators like Kyle Rittenhouse, a white 17-year-old who traveled to Kenosha, Wisconsin, last week during protests over the police shooting of a Black man, and then shot and killed two people and wounded a third.

Rittenhouse, perhaps not coincidentally, occupied a front-row seat at a Trump rally in Des Moines, Iowa, last January.

Last Saturday night, a pro-Trump caravan that included members of the neo-fascist Proud Boys drove into Portland, Oregon, shooting protesters with pepper spray and driving into crowds. Someone wearing the hat of a far-right group called Patriot Prayer was shot dead.

Trumps reaction? Rather than condemn the violence, he tweeted GREAT PATRIOTS! in support of the pro-Trump agitators, and, The big backlash going on in Portland cannot be unexpected. ... The people of Portland wont put up with no safety any longer. Trump also retweeted a claim that this coup attempt is led by a well funded network of anarchists trying to take down the President.

For the first time in history, a United States president is openly justifying violence by some Americans against other Americans.

The threat to the nations law and order also comes from conspiracy theorists such as Marjorie Taylor Greene, the recently nominated Republican candidate for Georgias 14th congressional district and promoter of QAnon, whose adherents believe Trump is battling a cabal of deep state saboteurs who worship Satan and traffic children for sex. Trump has praised Greene as a future Republican star, and claimed that QAnon followers love our country.

The threat also comes from people such as Mary Ann Mendoza, a member of Trumps campaign advisory board, who was scheduled to speak at the Republican convention until she retweeted an antisemitic rant about a Jewish plan to enslave the worlds peoples and steal their land.

Clearly the threat also comes from hotheaded, often racist police officers who fire bullets into the backs of Black men and women or kneel on their necks so they cant breathe. Needless to say, there was little mention at the Republican convention of Jacob Blake, and none of George Floyd or Breonna Taylor.

And the threat comes from Trumps own lackeys, who have brazenly broken laws to help him attain and keep power. Since Trump first promised to hire only the best people, 14 Trump aides, donors and advisers have been indicted or imprisoned.

Trumps personal lawyer, Rudy Giuliani who ranted at the Republican convention about rioting and looting in cities with Democratic mayors has repeatedly met with pro-Russia Ukrainian parliamentarian Andriy Derkach, whom American intelligence has determined is spreading claims about corruption ... to undermine former Vice President Bidens candidacy and the Democratic Party.

In addition, federal prosecutors are investigating Giulianis business dealings in Ukraine, with two men arrested in an alleged campaign finance scheme.

Trumps Postmaster General, Louis DeJoy, who had been a major Trump campaign donor before taking over the Postal Service, is being sued by six states and the District of Columbia for allegedly seeking to undermine the postal service as millions of Americans plan to vote by mail during the pandemic.

Not to forget Secretary of State Mike Pompeo, who spoke to the Republican convention while on an official trip to the Middle East in apparent violation of the Hatch Act, which prohibits officials of the executive branch other than the president and vice president from engaging in partisan politics.

In short, the real threat to American law and order is found in Donald Trumps above-the-law, race-baiting, me-first presidency. This nation is in serious need of protection from him, and from the bottom-dwellers whose behavior he incites and justifies.

President Trump trip sparks tempers, tension and taunts in Kenosha but also efforts to heal – Chicago Sun-Times

Posted on September 6, 2020 by Danzig

KENOSHA, Wis. The crowd that awaited President Donald Trumps visit here on Tuesday mirrored much of the American political climate over the past four years: loud, angry, bitter and divided.

But on the block where Jacob Blake was shot in the back by a Kenosha police officer barely a week ago, it was a party still loud, but focused on healing.

Were trying to turn something good out of all this, Anthony Garden said, slathering sauce over racks of ribs on a grill set up outside Blakes apartment complex near 40th Street and 28th Avenue.

A few hundred neighbors, activists and relatives of Blake took part in the community block party that made the neighborhood feel more like a Labor Day weekend gathering than the current epicenter of the nations latest reckoning with police violence and racism.

Instead, kids jumped in bounce houses, dance music blared, and residents shared water bottles, snacks, and face masks. Organizers also set up tables for people to register to vote, and even get tested for COVID-19.

Organizer Tanya McLean said they were out providing the services that have been denied Black communities for generations.

We still dont have the care, safety, and support that every one of us needs, McLean said, denouncing the language of hate and fear that Trump and others like him use to divide us.

Craig Young, a Chicago native who lives a few blocks from where Blake was shot, said Trump shouldve stayed where he was. But its good to see people taking a tragedy and turning it into something fruitful. Its sad it had to happen this way.

People are healing here, Kenoshan Joquin Gomez said.

But elsewhere in town and across the region, both supporters and opponents of Trump were busy making their feelings known and often competing to see who was loudest.

Grid View

Upon arrival at Waukegan National Airport across the state line, Trumps motorcade was greeted by people holding signs, some cheerfully bearing his name, some declaring Black Lives Matter and others, simply labeling the president Liar.

Others chose to forego signs altogether, instead holding up their middle fingers.

In Kenosha, the city square thats been home to days of raucous protest and bloodshed was mostly quiet through the afternoon as Trump made the rounds a few blocks away to survey areas of damage.

National Guard members kept watch outside the Kenosha County Courthouse while a plane flew overhead trailing a banner that read: Reject Trumps violence. Vote him out.

Two groups of demonstrators eventually converged, with about 100 waving Trump flags and shouting all lives matter in response to the crowd on the other side that roughly doubled them in size, chanting Black Lives Matter.

The discourse devolved from there to name-calling and mutual insults, from Marxists and communists to racists and Karens.

Some Trump supporters also chanted for the release of Kyle Rittenhouse, the 17-year-old accused of killing two protesters during a chaotic night last week. Trump has declined to denounce the Antioch teens actions.

Steven Fani, 51, said he brought his family with him to thank the president.

It was very disheartening and frightening to see all the looting and rioting happening around me, the Kenosha resident said. I never thought I would see that kind of destruction in my life here in America. I hope he sees the devastation and helps out these businesses and these people hurt by the riots.

Fani said he wanted all the facts out first before hed make up his mind on whether the police shooting of Blake was justified.

But 18-year-old Kenosha resident Shamell Green said Trumps visit only brought brutality and chaos.

Green clashed repeatedly with the supporters of Trump, asking how they could back such a divisive person.

For years he has stoked flames where there was no need to, Green said. He separates children from migrant families, he joked about [sexually] assaulting women, and he is now defending a kid who crossed state lines and ended up killing two people here.

As theyve been every day since the Rittenhouse shooting, the protests were peaceful as the downtown crowd dwindled to about a hundred by 4 p.m.

The tensest moment came when the remaining Black Lives Matter protesters were approached by a man wearing clothing of the Proud Boys, which the Anti-Defamation League calls a right-wing extremist group whose activity has attracted white supremacists.

Protesters shouted down the man and chased him to a nearby gas station, drawing a dozen squad cars of police who up until that point had been conspicuously absent from all the demonstrations.

After a brief but tense shouting match with police, protesters headed back to the city square while officers escorted the apparent Proud Boy away.

Manny Ramos is a corps member in Report for America, a not-for-profit journalism program that aims to bolster Sun-Times coverage of issues affecting Chicagos South and West sides

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President Trump trip sparks tempers, tension and taunts in Kenosha but also efforts to heal - Chicago Sun-Times

The Institute of the Cosmos – Announcements – e-flux – E-Flux

Posted on September 6, 2020 by Danzig

The Institute of the Cosmos

http://www.cosmos.art

The Institute of the Cosmos presents an online library of essential readings on and about Russian Cosmism. Until very recently, many of these key essays, treatises, poems, and novelshave not been available in English. Those that have been translated have been scattered and difficult to find. The Institutes researchers assembled this selection of historical and contemporary texts to make the intellectual context surrounding cosmism accessible. This library will continue expanding: subscribe to our newsletter to receive updates on new titles.

Topics:Accelerationism, Anarchism, Architecture, Art, Artificial Intelligence, Astro-Linguistics, Biocosmism, Communism, Constructivism, Cryogenics, Cybernetics, Earth, Ecology, Energy, Film, Futurism, Gender, God-Building, Immortalism, Labor, Machine Learning, Marxism, Materialism, Monism, Museology, Noosphere, Occult, Poetry, Productivism, Religion, Reproduction, Resurrection, Revolution, Rocketry, Science, Science Fiction, Socialism, Soviet Union, Space Exploration, Suprematism, Technology, Time, Transhumanism, Weather

Authors:Abba & Wolf Gordin, Aleksandr Svyatogor, Aleksei Gastev, Alexander Bogdanov, Alexander Chizhevsky, Alexander Yaroslavsky, Alexandre Kojve, Anastasia Gacheva, Anatoly Lunacharsky, Andrei Platonov, Anton Vidokle, Arkady Strugatsky, Arseny Zhilyaev, Boris Groys, Boris Strugatsky, Fred Berthold Jr., Friedrich Nietzsche, George Young, Georges Bataille, Gilgamesh, Herman Potonik Noordung, Hermann Oberth, Hito Steyerl, Irmgard Emmelhainz, Johannes Kepler, Kazimir Malevich, Keti Chukhrov, Konstantin Tsiolkovsky, Marina Simakova, Mckenzie Wark, Mikhail Bulgakov, Nel Grillaert, Nikolai Berdyaev, Nikolai Fedorov, Nikolay Zabolotsky, Pavel Florensky, Peter Kropotkin, Pierre Teilhard De Chardin, Sergei Bulgakov, Sergei Eisenstein, Trevor Paglen, Valerian Muraviov, Vasily Chekrygin, Velimir Khlebnikov, Vladimir Mayakovsky, Vladimir Odoyevsky, Vladimir Solovyov, Vladimir Vernadsky, Vsevolod Meyerhold, Walter Nunzio Sisto

The cinema of the Institute of the Cosmos is pleased to present Immortality for All: A film trilogy on Russian Cosmismby Anton Vidokle.

In this three-part film project, Anton Vidokle probes Cosmisms influence on the twentieth century and suggests its relevance to the present day. In This is Cosmos(2014), the artist returns to the foundations of Cosmist thought. The second chapter, entitled The Communist Revolution Was Caused By The Sun(2015), explores the links between cosmology and politics. The film's third chapter, Immortality and Resurrection for All! (2017), re-stages the museum as a site of resurrection, a central Cosmist idea.

Combining essay, documentary, and performance, the trilogy quotes from the writings of Cosmisms founder Nikolai Fedorov and other philosophers and poets. Vidokle's wandering camera searches for traces of Cosmist influence in the remains of Soviet-era art, architecture and engineering, moving from the steppes of Kazakhstan to the museums of Moscow. Music by John Cale and liane Radigue accompanies these haunting images, conjuring up the yearning for connectedness, social equality, material transformation and immortality at the heart of Cosmist thought.

Watch the films here.

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The Institute of the Cosmos - Announcements - e-flux - E-Flux

Rosh HashanahThe Jewish New Year – farmingdale-observer.com

Posted on September 6, 2020 by Danzig

It is the Judaic belief that on Rosh Hashanah, the Jewish New Year, the Almighty decides the destiny of each and every Jew individually, as well as the fate of the nation collectively, for the span of that year.As such, Jews ask the Almighty to grant them and their loved ones a sweet New Year. One of Rosh Hashanahs many names is the Day of Remembrance, because we use it to process the past year and pray for a new and purposeful upcoming year.

Jews believe that all people are created in the Almightys image. We know that humans, unlike animals, have the ability to choose and can thus be held responsible for their actions.Professor Victor Frankl, the author of Mans Search for Meaning and the inventor of Logo Therapy, along with Aaron T. Beck, who co-founded Cognitive Behavioral Therapy, believe that we are not defined by what happens to us but rather by how we respond to what happens to us. Our brain was created with a certain plasticity that gives us the power to choose how we feel and how we act.

The essence of the Jewish faith is the belief that through repentance, prayer and charity, one can change his or her fate and sever any harsh decrees. Prayer is at its most powerful when Jews pray together collectively, though solitary prayer is also valued.Allow me to give some encouragement as we enter the next season of our lives. Never compromise your ideals. Never give in to defeat or despair. Never stop journeying merely because the way is long and hard. Moses did not lose the vision that made him a fighter for justice. He did not become embittered or sad when things did not unfold as he expected. He accepted that there were things he would not live to achieve and proceeded to teach the next generation how to achieve them. His body was old but his mind stayed young. Moses, a mortal, achieved immortality through the legacy of his transmission. He taught us that the good we do lives on and that the blessings we bring into the lives of others never die.

The language of hate is capable of creating enmity between people of different faiths and ethnicities. The most destructive force in history, it is the unmistakable mark of toxic leadership.The Jewish way is to learn to love and forgive. While we acknowledge the evil men do, we stay focused on the good that is in our power to do. Only thus can we raise the moral compass of mankind and help redeem the world we share.

Within every family, every community and every organization there are trials, tests and tribulations. Strong families and communities have a clear sense of what their ideals are and are not blown off course by the winds of change. Who are we? Where do we stand on the important issues? What are we trying to achieve and what kind of people do we aspire to become? These are the questions Jews strive to ask and answer on Rosh Hashana.

Best wishes for a happy and healthy New Year if you are of the Jewish faith and continued luck in the new fall season if you do not celebrate.May G-d hear our prayers at the start of the Jewish year 5781 and fulfill our most dearly-held wishes.LShana Tovato a good year ahead,

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Rosh HashanahThe Jewish New Year - farmingdale-observer.com

Development in a cube. 20 new digital education centers opened in the country – Pledge Times

Posted on September 5, 2020 by Danzig

IT Cubes are opening all over the country. This new project aims to develop digital education for children. This became possible thanks to the implementation of the national project Education.

The key goal of the project is the availability of quality education regardless of where the child lives. At the same time, a good education includes not only the opening of new modern schools, but also the development of additional education for children, including in promising areas. Special attention in the national project is paid to the development of a digital educational environment, including the creation of digital education centers IT-cube.

IT-cube is a center for the education of children for programs aimed at accelerating the development of relevant and demanded knowledge, skills and competencies in the field of information technology. The project forms a modern educational ecosystem that brings together leading companies in the IT market, experienced mentors and novice developers from 7 to 18 years old. Education in such centers is free of charge and available to every child. The project is a modern educational ecosystem that unites the leaders of the IT market, experienced mentors who have been trained by partners participating in the project, and most importantly, schoolchildren who plan to connect the future with modern technologies and the digital economy. Now there are more than 20 such cubes in the country, by the end of 2020 there will be 70, and in 2024 340.

On September 1, the IT-cube of Tambov was opened. It has, according to the first visitors, a qualitatively new level of equipment and modern design of educational spaces. Training here will go in six areas: Mobile Development, Python Programming, VR-AR Development, Cyberhygiene and Big Data, System Administration and Robot Programming. In addition, the site includes a coworking area and a chess lounge. It is planned that annually 400 children and adolescents aged 7 to 17 will be able to study at the center. More than 1,500 children from all cities and districts of the region will be involved in the events held by IT-cube of Tambov together with partners.

In the Republic of Tatarstan, on September 1, a new center for digital education of children IT-cube.Almetyevsk was opened. This is the second such center in Tatarstan. 400 students aged 8 to 18 years will be trained here this year. At the center, children will be taught the basics of programming in JAVA, programming in the SCRATCH language, developing VR / AR applications, cyberhygiene and big data, mobile development, PYTHON programming and system administration.

In the Chuvash Republic, from September 1, classes will continue in IT-cube.Kanash. With the support of Yandex.Lice, the guys will learn programming in Python, and with the support of the Samsung school, mobile development. Also for children are available directions for developing VR / AR applications, system administration, basic programming skills in C-like languages. According to Anna Keshko, head of IT-Kub.Kanash: The goal of IT-Cuba is to interest the child. Small victories that motivate a person to do something are given almost immediately in IT. We give what a person will encounter in the profession, so that the guys can actually work in their specialty, so that they immediately have an idea of industrial programming. Now knowledge of a programming language is the same as knowledge of at least one foreign language. The threshold for children to enter the IT specialty is getting lower.

In the Lipetsk region IT-cube. Lipetsk is also ready to teach children in the new academic year. In addition to programming and mobile development, children here can get acquainted with artificial intelligence technologies: schoolchildren will perform laboratory work using a pre-trained set of neural network models and will take a full production course for creating a neural network model. They will develop standard gaming networks for chess, checkers and a chat bot for communication, which will respond to key phrases, conduct a simple dialogue, and answer questions using search engines.

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Development in a cube. 20 new digital education centers opened in the country - Pledge Times

FIDE declares India and Russia joint winners of the Online Olympiad – Chessbase News

Posted on September 5, 2020 by Danzig

by Carlos Alberto Colodro

8/31/2020 The 2020 FIDE Online Olympiad came to an end on Sunday, with an internet outage prompting FIDE to declare finalists Russia and India as joint winners. The match had started with a tie in the first six-game mini-match. In the second encounter of the day, however, Nihal Sarin and Divya Deshmukh disconnected towards the end of their games and lost on time. First, the Russians were declared champions, but after Indias appeal, on the grounds that their players lost connection as a consequence of a massive internet outage, FIDE President Arkady Dvorkovich decided to grant gold medals to both teams.

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It was a strange end to a unique edition of the traditional Chess Olympiad. Due to the restrictions imposed amid the covid-19 crisis, FIDE decided to organize a massive online event in which each national team had to present a lineup including a mix ofmen, women, juniors and girls. Organizing such a large-scale tournament online was a brave decision, given the difficulties related to potential cheaters and unpredictable internet-connection problems.

Already during the Magnus Carlsen Chess Tour, connectivity issueshad slightly disrupted the normal flow of the events, with Ding Liren losing a couple of games on time after his connection was lost. Luckily, the problems were solved and normal service was restored.

In the Olympiad, things did not go as smoothly, particularly in the incident that involved India and Armenia during the quarterfinals. Nihal Sarin had defeatedHaik Martirosyan after the latter had lost his connection. The Armenian team appealed the result, pointing outthat the specified player was connected to the Zoom call during the whole incident, and the video call was not interrupted.

Citing that the quality of the internet connection is the responsibility of the player, the Appeals Committee rejected Armenias request, noting that the Indian national teamhad previously lost two games against Mongoliafor similar reasons.

Fast forward to Sundays final, which kicked off with a thrilling first mini-match. All games ended drawn, but only after Ian Nepomniachtchi and Kateryna Lagno showed great resourcefulness in defence to save half points against Vidit Gujrathi and Humpy Koneru respectively. Nepo gave up his rook to muddy the waters in a complex position:

Winning against the Grnfeld

The Grnfeld is a highly dynamic opening in which Black's position often seems to hang together by a single thread; and yet, this apparently precarious equilibrium appears to be enough to make it entirely viable up to the highest level.

White is a pawn up and has the initiative. Vidits best move here was 24.c5, the kind of crucial manoeuvre that can only be precisely calculated with plenty of time on the clock. The Indian went for thenatural 24.Qe5 instead, and saw his opponent lash out with 24...Rxf2 the engines do not like this picturesque sacrifice, but from a human perspective Black is now the one calling the shots. In the end, it was Vidit who gave perpetual check to secure the draw.

After the 3:3 result in the exciting first mini-match, the teams made key substitutions for the second round. Anand and Praggnanandhaa replaced Harikrishna and Nihal Sarin in the Indian squad, while Dubov, Goryachkina and Esipenko replaced Artemiev, Lagnoand Sarana among the Russians.

The one decisive result that was nota direct consequence of a disconnection in round two saw Aleksandra Goryachkina beating Humpy Koneru with the white pieces. Nonetheless, Humpy did lose her connection for a while, and although she managed to reconnect she had lost some valuable time in the 15-minute game.

Then came the main incident of the day. Nihal Sarin andDivya Deshmukh lost on time against Andrey Esipenko and Polina Shuvalova after losing their connections. Nihal had equalized what had been a worse position for most of the game, while the young Indian girl had a superior position with the white pieces.

The Fashionable Caro-Kann Vol.1 and 2

The Caro Kann is a very tricky opening. Blacks play is based on controlling and fighting for key light squares. It is a line which was very fashionable in late 90s and early 2000s due to the successes of greats like Karpov, Anand, Dreev etc. Recently due to strong engines lot of key developments have been made and some new lines have been introduced, while others have been refuted altogether. I have analyzed the new trends carefully and found some new ideas for Black.

The Indian team immediately sent an appeal to the committee formed by Arkady Dvorkovich,Michael Khodarkovsky and Sava Stoisavljevic. Since Dvorkovich is Russian, he recused himself from involvement in the decision. Nevertheless, after the remaining two members were unable to reach a unanimous decision, the FIDE President declared both teams as joint winners and published the following official statement:

The Online Chess Olympiad has been impacted by a global internet outage, that severely affected several countries, including India. Two of the Indian players have been affected and lost connection, when the outcome of the match was still unclear.

The Appeals Committee has examined all the evidence provided by Chess.com, as well as information gathered from other sources about this internet outage. After being informed of their considerations and in absence of aunanimous decision, and takinginto account these unprecedented circumstances, as FIDE President I made the decision to award Gold Medals to both teams.

In their official report, FIDE mentions thatthe internet outage was caused by a Cloudflare crash.

Of course, the fact that Dvorkovich is Russian put him in a particularly propitious spot to negotiate with the team that would have been granted tournament victory had the appeal been rejected it was informed that Russias team captain was contacted and accepted the decision. Had other teams been involved, it would have been more difficult for the FIDE President to make that call.

Not all members of the Russian team were happy with the decision, however. Ian Nepomniachtchi tweeted:

Smart decision to please Indian chess community, meanwhile forgetting about other fans & players. Selective nobleness.

Former womens world champion Alexandra Kosteniuk also shared her thoughts:

Lets clarify one thing: India didnt win the Olympiad, but was rather named by FIDE a co-champion. Imho, there is a huge difference between actually winning the gold or just being awarded one without winning a single game in the final.

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Let us not forget that, although the Russians are the traditional chess superpower, they have not won the Olympiad since 2002, so getting this gold medal without controversy would have been a major success and would have rewarded the fact that they presented an impressively strong lineup inthe online event.

For India, on the other hand, this was a great achievement. As it is already indisputable, the incredible work made to promote the game in the Asiancountry during the last decade or so has shown impressive results. Once over-the-board chess fully returns, the Indian squad will be surely among the favourites to take gold in the next Olympiad, when they will most likely fight neck in neck with chess superpowers Russia, China andUnited States not to mention Ukraine, Armenia, Azerbaijan, Poland and others.

Vishy Anand, the man who started it all,spoke to DD News:

Obviously Im thrilled with this result. Today was quite eventful, and its one of the features of the new format, but I think, in the whole, in the Olympiad the Indian team showed a lot of spirit. Especially I can say that [to get] this medal the biggest contribution came from the youngsters and it shows the bright future we have for chess in India.

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FIDE declares India and Russia joint winners of the Online Olympiad - Chessbase News

University subject profile: medicine – The Guardian

Posted on September 5, 2020 by Danzig

What youll learnMedicine degrees are for students ready to make a long-term commitment to becoming a doctor. Youll spend five years at university (four if youre on a graduate course), then youll work with patients. Further training will be required as you specialise in a particular branch of medicine.

Some courses are divided into pre-clinical and clinical parts; others are more integrated. Some adopt a systems-based approach (the cardiovascular system, the nervous system, etc); others a problem-based approach.

The early part of the course will develop your basic skills and knowledge to prepare you for your hospital experience. There will be teaching in general medicine and surgery, while subsequent years will cover major clinical specialities (such as renal medicine, oncology, and neurology).

By the time you graduate you should be fit to begin on-the-job training. You wont be expected to know it all, but you should be able to assess a patient and manage treatment. You will understand disease and advise on healthy living.

You should have developed a certain level of compassion for your patients. Delivering bad news to a patient or their family will never be easy, but a caring attitude and an interest in the patients needs are important aspects of being a doctor. You will gain an understanding of the legal and ethical issues that come with a career in medicine.

How youll learnYou will learn through lectures, seminars, tutorials, lab work and bedside demonstrations. Your study includes hospital placements. Expect a challenging workload, with constant assessment through written and practical (clinical) exams, as well as coursework.

Entry requirementsMost universities demand top grades. If you have good A-levels (or equivalent) in chemistry, biology, maths and physics, you should have all the medical schools open to you.

Work experience in a health or social care setting will help your application. You need to apply early (in October) and youll be required to sit a test and attend an interview as part of admissions processes.

What job can you get?After graduation youll begin a two-year training programme in a hospital. Youll then train to specialise in a specific field, perhaps surgery or general practice. The length of training depends upon what you choose. You always have the option of moving into research.

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University subject profile: medicine - The Guardian

Telemedicine: The art of innovative technology in family medicine – DocWire News

Posted on September 5, 2020 by Danzig

This article was originally published here

Int J Psychiatry Med. 2020 Sep;55(5):341-348. doi: 10.1177/0091217420951038.

ABSTRACT

Technology in medicine has been rapidly evolving over the past decade, greatly improving the quality and types of services providers can offer to patients. Physicians in training are eager to embrace these novel innovations, and medical school and residency educators strive to offer learning experiences of a high standard that are relevant. One example of an emerging healthcare innovation is telemedicine, which permits the provision of medical care to patients away from clinics and hospitals, bringing patient-centered care to the patient. It has proven to be cost-effective, improve health outcomes, and enhance patient satisfaction. This article describes the development and structure of our family medicine residency programs telemedicine curriculum, first created in 2016 in response to the growing demand for this type of healthcare delivery model. There is discussion about the history of telemedicine, and about what contributed to its growth. A timeline of the steps taken to create our new telemedicine residency curriculum is reviewed, along with the key components that contributed to its success. The Lessons Learned section provides other educators insight into the strengths and opportunities revealed during the creation of the curriculum, and guidance on how the curriculum could be further enhanced.

PMID:32883143 | DOI:10.1177/0091217420951038

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Telemedicine: The art of innovative technology in family medicine - DocWire News

Sovah Family Medicine-Brosville to reopen Tuesday | Business News | godanriver.com – GoDanRiver.com

Posted on September 5, 2020 by Danzig

Sovah Family Medicine-Brosville will reopen Tuesday with certified family nurse practitionerKristen Grabowski as the provider.

The facility closed in July 2018 after a provider left, according to Kelly Fitzgerald, a spokesperson for Sovah-Health.

"Were thrilled to reopen next week,"Fitzgerald wrote in a Friday email to the Register & Bee.

Grabowski will specialize in general health, preventative medicine, hypertension, diabetes, geriatrics and womens health at the clinic that will be open from 8 a.m. to 5 p.m. Monday-Friday, with the exception of lunch from noon to 1 p.m.

Walk-ins, appointments and telehealth visits will be available.

Grabowski worked in the intensive care unit at Sovah Health before she joinedSovah Family Medicine-Danville in November 2009. She received her Master of Science degree in nursing fromSouth University in Savannah,Georgia, and herBachelor of Science degree in nursing fromWestern Governor University in Salt Lake City, Utah.

The practice is at 10390 Martinsville Highway. For more information, call (434)799-2500.

With a weekly newsletter looking back at local history.

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Sovah Family Medicine-Brosville to reopen Tuesday | Business News | godanriver.com - GoDanRiver.com

Morehouse School of Medicine students get surprise news that $26M gift will help pay off their debt – 11Alive.com WXIA

Posted on September 5, 2020 by Danzig

The funds will be used to reduce medical school loan debt for Black students currently enrolled and receiving financial aid - totaling about $100,000 per student.

ATLANTA It's a major gift to an Atlanta-based historically Black college aimed at helping close the gap in medical disparities in America.

On Wednesday, Morehouse School of Medicine announced they received a $26.3-million donation from Bloomberg Philanthropies, the organization founded by former New York City Mayor Michael Bloomberg.

The donation is part of a greater $100-million fund for students attending the nation's four historically Black medical schools, including Morehouse School of Medicine.

According to the school, the funds will be used to reduce medical school loan debt for Black students currently enrolled and receiving financial aid - totaling about $100,000 per student.

Bloomberg himself taped a video message to highlight why the investment is so critical for the country, and the communities of color that are often at high-risk when it comes to healthcare.

The statistics are troubling.

It's already a well-established trend that the coronavirus pandemic has been particularly deadly and devastating for Black Americans. But, according to a 2015 study by the Centers for Disease Control and Prevention, the population had higher death rates than Whites for all-cause mortality in all groups less than 65 years old.

And while studies have shown that Black infants are already more likely to die than their White counterparts, when they are cared for by Black doctors, that rate is cut in half, according to one most recent study.

But, Black doctors only make up 6 percent of physicians in America. Congress has introduced a bill that would put $1 billion toward diversifying medical schools, but Bloomberg's donation will go directly toward medical students studying in the field.

"That's why I made this gift," Bloomberg said. "America urgently needs more Black doctors."

"The data is clear, more Black doctors will mean more Black lives saved and more economic opportunity," Bloomberg said in a video statement announcing the donation. "So much is at stake, and the burden of school debt should never stand in the way."

According to the Association of American Medical Colleges, the average cost for medical school in 2016 was $232,800 at public institutions and $306,200 for private institutions - a steep barrier, and possible deterrent, for those who may not be able to afford medical school financially.

11Alive spoke to a few of those students who will benefit from the gift. They said they are still stunned by the surprise.

"It's a range of emotions," Kamron Robinson said. "From overly excited and joyous to very thankful. I think I woke up everybody in the house."

"It's just an overwhelming sense of gratitude," said Nikki Jones. "Just thankful to have some of the stress relieved of the debt that I have accumulated going through this journey of medicine.

According to the school, this is the largest scholarship it has ever received.

The financial gift comes after a flurry of other similar recent donations to Historically Black Colleges and Universities, including Spelman and Morehousecolleges, also here in Atlanta.

Morehouse School of Medicine students get surprise news that $26M gift will help pay off their debt - 11Alive.com WXIA

Unraveling the use of CBD in veterinary medicine – Jill Lopez

Posted on September 5, 2020 by Danzig

It was about the 3rd week into Bastions recovery from his TPLO surgery and he was already having a rough time. Bastion was a gregarious yellow Labrador who had his injured stifle about 25 days ago. Fortunately, his family elected for him to have his stifle surgically reconstructed. Initially, he had recovered well from surgery. But one day in particular, he presented to the hospital because he had a brief setback. He was limping far more severely than what would be normally expected at this stage of recovery.

The osteotomy from his surgery had not yet completely healed and he was still in the middle of his prescribed 5 weeks of exercise strict restriction. His family was trying their best but Bastion wasnt having it. He was too active at home and his humans were growing frustrated. Anti-anxiety medications had been dispensed but they were not given. Instead, his family had decided to give him CBD oil at home. When I asked why the prescribed medications had not been given, the client responded, I found CBD oil at the local farmers market and I figured it would work just as well.

Like Bastion, an increasing number of pets are receiving cannabidiol (CBD) supplements. The popularity of CBD continues to rise and many clients are incorporating CBD as part of the medication protocol for their pets, either as an adjunct or, as alternative treatment option.

Perhaps the initial interest in the benefits of CBD can be traced back to 1998, or possibly earlier, when scientists at the National Institutes of Health discovered that CBD could protect cells from oxidative stress. These findings fueled interest in the human medical field and, in large part, that appeal has been transmuted into veterinary medicine. The regard for this molecule has risen to such levels that in many homes, CBD is being used as the sole treatment option for a variety of medical conditions.

Veterinarians are becoming more fluent in the fascinating pharmacology regarding the use of this phytocannabinoid. A recent survey indicated that most veterinarians (61.5%) felt comfortable discussing the use of CBD with their colleagues, but only 45.5% felt comfortable discussing this topic with clients.1 Furthermore, veterinarians and clients in states with legalized recreational marijuana were more likely to talk about the use of CBD products to treat canine ailments than those in other states.2 Lastly, CBD was most frequently discussed as a potential treatment for pain management, anxiety and seizures.1 At first glance, the use of CBD has tangential or limited relevance in the world of veterinary surgery. However, as one takes a closer look at the putative, and proven benefits, it is clear that we are just scratching the surface of its therapeutic benefits. This article takes a brief dive into the world of CBD and its promise in the field of veterinary surgery.

Pain

Whether you perform surgery within a specialty discipline (oncology, orthopedics, neurology, soft tissue surgery, mixed animal, oral/dental, etc), or surgery is only a small part of your general practice, every veterinarian endeavors to aggressively manage pain. The first choice for pain relief among many clinicians are the medications that have been more extensively studied including, but not limited to, anti-inflammatories, gabapentinoids, opioids, local anesthetics, and other analgesics (acetaminophen, amantadine, cerenia etc). These medications or a combination thereof, have been prescribed to treat pain from orthopedic surgery, soft tissue surgery, surgical neuropathic conditions, pain from intestinal surgery, to name just a few. In the most basic schema, pain is divided into four categories: nociceptive pain (a response to damaged tissue), neuropathic pain (a response to directly-damaged sensory or spinal nerves), centralized pain (the result of pain signals being improperly amplified), and inflammatory pain.1 Cannabinoids may have a role to play in mediating all four of these types of pain states. When tissue is damaged, histamine, serotonin, TNF-alpha, IL-1-beta, IL-6, and Il -17 6, and interleukin 17 are released.2 Cannabinoids bind to the CB1 receptors and attenuate the pain signal by slowing down the release of those neurotransmitters.3 This process can take place locally or in the central nervous system.3 Cannabinoids have also been shown to inhibit the release of GABA, a well known neurotransmitter associated with pain.3 Although there is a paucity of clinical research on the use of CBD to treat postoperative pain in the veterinary medical setting, there has been heartening research conducted in humans. Indeed, National Academies of Sciences, Engineering, and Medicine concluded that there is, substantial evidence that cannabis is an effective treatment for chronic pain in adults.

Opioids have long been the go to option, or cornerstone of pain management, however, the potential for the adverse events associated with the use of opioids in veterinary patients is universally accepted.38 I have seen how distressing it can be for a family to see their pet experiencing any of the unpleasurable side effects of opioids including urine retention, delayed bowel movements, whining, panting, disorientation, or other manifestations of dysphoria. Those are just some of the challenges that clinicians face when using opioids for chronic pain management. Considering the ongoing consequences of the opioid epidemic, there is a search for pain management solutions that are innovative, prone to less adverse events, and are more effective. As the scientific community begins to evaluate the evidence for use of CBD , it is clear that more research is needed.

Anecdotal reports of CBDs efficacy as a pain reliever are ubiquitous but more are turning to scientific data for evidence of CBDs efficacy. A study in 2020 evaluating effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients found that over half of chronic pain patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD-rich hemp extract to their regimens.5 Almost all CBD users (94%) reported quality of life improvements.5 And in a recent study evaluating orally consumed cannabinoids for long-lasting relief of allodynia in a mouse model, found that cannabinoids reduced hyperalgesia and a similar effect was not found with morphine.4 Mouse vocalizations were recorded throughout the experiment, and mice showed a large increase in ultrasonic, broadband clicks after sciatic nerve injury, which was reversed by THC, CBD, and morphine.4 The study demonstrated that cannabinoids provide long-term relief of chronic pain states.4 If research shows that use of cannabinoids in animals, specifically, CBD, can help to decrease the use of opioids for pain management, that would help make more animals comfortable and potentially help to fight the tragic epidemic of human prescription opioid abuse. Further research is needed in a variety of species, specifically, both the canine and feline species.

Bone Healing

Both general veterinary practitioners and veterinary surgeons commonly diagnose and treat fractures. A large retrospective study of fracture incidence in dogs in North America has not been published since 1994; however, the findings from that study are still informative regarding the frequency of bone injuries. That study demonstrated that approximately 24% of all patients in the population studied over a 10 year period were affected by a disorder of the musculoskeletal system, with fractures contributing the largest proportion (over 29%) of all of the diagnosis of the appendicular skeletal system.7 Although that research is dated, the conclusions from this study - at the very least, indicate that fractures are commonplace in the clinical veterinary setting.7 Fracture repair has gradually become more straightforward due to improvements in technology. Because of these innovations, speciality surgeons and general practitioners who repair fractures have begun to see better surgical outcomes. So whether you primarily stabilize fractures with implants, or if external coaptation of fractures with the intention to refer (or perhaps as the primary means of fixation) is your treatment of choice, all veterinary practitioners aim to help fractured bones heal quickly. Despite these technological improvements, bone healing can be protracted or non existent with some fractures. There are a variety of options at a veterinarians disposal to kick-start the healing process but perhaps in the near future, CBD may be added to that armamentarium. The effect of CBD in fracture healing has been investigated evaluating bone callus formation in femur fractures in a rat model.8 The findings demonstrated enhanced biomechanical properties of healing fractures in those given CBD compared with a control group.8 This effect was not found in those only given 9-THC. Moreover, the bone forming effects (osteogenic) of CBD were weakened when test subjects were given equal amounts of CBD and 9-THC.6 Another in vivo research study indicated that when CBD is incorporated into a surface that promotes bone growth (osteoconductive scaffold) it can stimulate stem cell migration and osteogenic differentiation.9 Further studies are needed to better evaluate the role of CBD in healing and bone metabolism of companion animals so that these findings can be applied in the clinical setting.

Additionally, cannabis has been shown to be a useful addition in treatment plans optimized to improve bone health in laboratory studies. A study endeavored to more closely understand the role of CB2 receptors in maintaining bone health. CB2 receptors in bone cells have been linked to maintaining bone density and stimulating growth, and may therefore have a part in reversing the effects of osteoporosis.10 One study evaluating role of CB2 receptors, found that in mice whose genes had been altered to remove the CB1 or CB2 receptors, those that developed signs of bone weakness that were far more pronounced than those in the control group.12 Another study in 2009, investigated the relationship between CB2 expression and bone disease in humans. The study found that people with dysfunctional CB2 receptors to have significantly weaker hand bones.11

Arthritis

Osteoarthritis (OA) affects many dogs, large and small. Most often, OA is the consequence of a developmental orthopedic disease that often affects a single joint or a pair of joints, and, less often, affects multiple joints. It is axiomatic that Mother Nature likes symmetry thus developmental orthopedic diseases frequently affect both left and right joints. For example, hip dysplasia is reportedly bilateral in >60% of affected dog,s13 and elbow dysplasia is bilateral in approximately 50% of affected dogs.14 Osteoarthritis occurs secondary to a myriad of primary orthopedic conditions that affect a variety of joints including: the hip (most common causes of OA in the hip: hip dysplasia, Perthes disease); stifle (patellar luxation, cranial cruciate ligament disease, osteochondritis dissecans [OCD]); elbow (elbow dysplasia, elbow OCD, fragmentation of the medial coronoid process, incomplete ossification of the humeral condyle); shoulder (shoulder OCD, developmental shoulder subluxation); tarsus (OCD of the talus), and carpus (carpal laxity, carpal subluxation secondary to chondrodystrophy); and metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joint degenerative osteoarthritis (digital osteoarthritis) .

Cannabinoids were found to treat pain secondary to inflammation in a variety of studies on humans. Some of the most compelling research has shown that cannabis can reduce the inflammation in the joint caused in human patients diagnosed with immune mediated arthritis.15 One study found that cannabinoids could simultaneously reduce the secretion of cytokines involved in inflammation from one type of TH immune cells, which were being under-produced, while also increasing their numbers to correct their scarcity.15 Furthermore in a study in 2003, researchers found that plant-based cannabinoids could suppress the expression of interleukin-1betaone of the most prominent markers for inflammation in patients with rheumatoid arthritisby as much as 50%.16 And finally, in 2006, transdermal applications of CBD were shown to decrease biomarkers that can contribute to neurogenic inflammation in a sample of arthritic rats. 17

A report published in the journal of PAIN, lead by researchers at Baylor College of Medicine revealed the results of a large, double blinded, placebo controlled study on the positive effects CBD had in the fight against osteoarthritis.18 The study was designed with two main goals: The first portion of the research studied the effect CBD had on the inflammatory molecules and cells in mice.18 The second portion of the study, investigated whether CBD improved the quality of life in dogs diagnosed with osteoarthritis. In lab tests and in mouse models, CBD significantly decreased the production of natural chemicals that promote inflammation and it increased the natural chemicals that fight inflammation.18 Essentially, what they saw was a drop in proinflammatory cytokines and an increase in anti-inflammatory cytokines. 18 For dogs with osteoarthritis, CBD significantly decreased pain and increased mobility in a dose-dependent fashion. Importantly, A lower dose of liposomal CBD was as effective as the highest dose of nonliposomal CBD, indicating that the effect of CBD was quicker and more effective when CBD was delivered encapsulated in liposomes than without.18 Blood samples indicated no significant harmful side effects, or adverse events, over the 4-week analysis period.18 Although this study is very promising and it supports the safety and therapeutic potential of hemp-derived CBD for relieving arthritic pain in dogs, it is important to consult with your pets veterinarian before giving any supplement or medication.

In the veterinary population, use of cannabidiol and other alternative treatments may have the potential to obviate the need for other medications, and thus spare patients from adverse effects associated with their use. More likely, the use of cannabinoids could be additive or synergistic in a multimodal treatment strategy and could increase quality-of-life issues associated with painful arthritic conditions.

Intervertebral Disk Disease

As our patients age, discs in the spine also undergo degenerative changes. Thus, degeneration of intervertebral discs is evitable. This process of degeneration is multifactorial process and it involves hypoxia, inflammation, neoinnervation, accelerated catabolism, and reduction in water and glycosaminoglycan content.39 The magnitude and severity of disc degeneration can vary widely between patients. The most common locations of clinically relevant disc disease are located in the cervical spine, thoracolumbar spine, and the lumbosacral spine.40 Although there are various manifestations of disc disease, broad classifications of Hansen Type I and Type II are typically used to describe the condition. In short, disc material may either extrude (acute herniations) or protrude (chronic herniations), both of which compress the spinal cord which ultimately can cause pain, paresis, paralysis and other neurological deficits.40 The prevalence of thoracolumbar disc disease dogs has been estimated at 3.5%.40 Depending on the neurologic examination, diagnosis, severity, prognosis, and other factors, surgery may be recommended to decompress the spinal cord.

After surgical decompression, there are a host of challenges that the the patient, the family, and the surgeon, may have to work through including a potentially protracted recovery, recurrence of neurological signs, post surgical pain, spinal instability, urinary disorders, (cystitis, urinary tract infection, urinary retention, micturition disorders), ascending myelomalacia, and others.41 Could CBD play a part in helping to improve those affected by disc disease pre-, intra-, or post-operatively and what types of spinal disorders could benefit from CBD? A study conducted on the use of CBD in mice with degenerative disc disease showed promise in mitigating the effect of disc damage and wear.19 Instead of being ingested orally, CBD was injected at the site of the disc. Researchers investigated the effects of cannabidiol intradiscal injection using a combination of MRI and histological analyses.19 A puncture was created in the disc and then CBD was injected into the disc (30, 60 or 120 nmol) shortly after.19 The effects of intradiscal injection of cannabidiol were analyzed within 2 days by MRI.17 Fifteen days later, the group that received cannabidiol 120 nmol was resubmitted to MRI examination and then to histological analyses after the cannabidiol injection.19 What they found was that cannabidiol significantly decreased the effects of disc injury induced by the needle puncture.19 These results suggest that this compound could be useful in the treatment of intervertebral disc degeneration perhaps using a novel route of administration.

Unfortunately, the exact mechanism for how CBD oil helped protect disc damage is still being investigated. The hope is that the neuroprotective properties of cannabidiol can also be found in the study of canine and feline disc disease to ultimately improve functional recovery.

References:

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Manzanares J, Julian MD, Carrascosa A. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes Curr Neuropharmacol. 2006 Jul; 4(3): 239257.

Abraham AD, Leung EJ, Brenden A, Wong BA, Rivera ZM, Kruse LC, et al. Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. 2020 Jun;45(7):1105-1114. doi: 10.1038/s41386-019-0585-3. Epub 2019 Dec 7.

Capano A, Weaver R, Burkman E. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad Med. 2020 Jan;132(1):56-61. doi:10.1080/00325481.2019.1685298. Epub 2019 Nov 12.

Abraham AD, Leung EJ, Wong BA, Rivera ZM, Kruse LC, Clark JJ, Land BB. Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. Neuropsychopharmacology. 2020: 45:11051114.

Johnson, J., Austin, C., & Breur, G. Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989. Veterinary and Comparative Orthopaedics and Traumatology, 07(02), 5669. (1994). doi:10.1055/s-0038-1633097

Kogan NM, Melamed E, Wasserman E. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts J Bone Miner Re. 2015 Oct;30(10):1905-13. doi: 10.1002/jbmr.2513. Epub 2015 May 10.

Kamali, A., Oryan, A., Hosseini, S., Ghanian, M. H., Alizadeh, M., Baghaban Eslaminejad, M., & Baharvand, H. Cannabidiol-loaded microspheres incorporated into osteoconductive scaffold enhance mesenchymal stem cell recruitment and regeneration of critical-sized bone defects. Materials Science and Engineering: (2019). C, 101, 6475. doi:10.1016/j.msec.2019.03.070

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Meliha Karsak et al. The Cannabinoid Receptor Type 2 (CNR2) Gene Is Associated with Hand Bone Strength Phenotypes in an Ethnically Homogeneous Family Sample. Human Genetics. 2009. 5:629-36 doi:10.1007/s00439-009-0708-8.

Loder, R. T., & Todhunter, R. J. The Demographics of Canine Hip Dysplasia in the United States and Canada. Journal of Veterinary Medicine. 2017 115. doi:10.1155/2017/5723476

ONeill DG, Brodbelt DC, Hodge R,. Church DB, Meeson RL. Epidemiology and clinical management of elbow joint disease in dogs under primary veterinary care in the UK. Canine Medicine and Genetics. 2020 volume 7:1

Susan H. Pross et al. Differential Suppression of T-cell Subpopulations by THC (delta-9- tetrahydrocannabinol). International Journal of Immunopharmacology 12, no. 5 (1990): 539-44. doi:10.1016/0192-0561(90)90118-7

Robert B. Zurier et al. Suppression of Human Monocyte Interleukin-1 Production by Ajulemic Acid, a Nonpsychoactive Cannabinoid. Biochemical Pharmacology. 2003 4:649-55. doi:10.1016/s0006-2952(02)01604-0.

D.c. Hammell et al. Transdermal Cannabidiol Reduces Inflammation and Pain-related Behaviours in a Rat Model of Arthritis. European Journal of Pain. 2015 6:936-48. doi:10.1002/ejp.818

Verrico, C. D., Wesson, S., Konduri, V., Hofferek, C. J., Vazquez-Perez, J., Blair, E., Halpert, M. M. A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain. 2020. Pain. doi:10.1097/j.pain.0000000000001896

Silveira, J. W., Issy, A. C., Castania, V. A., Salmon, C. E. G., Nogueira-Barbosa, M. H., Guimares, et al. Protective Effects of Cannabidiol on Lesion-Induced Intervertebral Disc Degeneration. 2014. PLoS ONE 9:12 doi:10.1371/journal.pone.0113161

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Arora A, Taliyan R, Sharma PL. Ameliorative Potential of Cannabis Sativa Extract on Diabetes Induced Neuropathic Pain in Rats. International Journal of Pharmaceutical Sciences and Research 1. 2010 https://www.researchgate.net/publication/216536386_Ameliorative_potential_of_cannabis_sativa_extract_

Mark S. Wallace et al., Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. 2015. Pain 16(7): 616-27 doi:10.1016/j.jpain.2015.03.008.

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Mateus M. Bergamaschi et al. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Nave Social Phobia Patients. Neuropsychopharmacology. 2011 36(6):1219-26 doi:10.1038/npp.2011.6.

Jos Alexandre S Crippa et al. Neural Basis of Anxiolytic Effects of Cannabidiol (CBD) in Generalized Social Anxiety Disorder: A Preliminary Report. Journal of Psychopharmacology. 2010. 25: 1doi:10.1177/0269881110379283.

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Pamplona, F. A., da Silva, L. R., & Coan, A. C. Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis. 2018. Frontiers in Neurology, 9. doi:10.3389/fneur.2018.00759

Palmieri B, Laurino C, Vadal M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Mar-Apr 2019;170(2):e93-e99. doi: 10.7417/CT.2019.2116.

Sangiovanni, E., Fumagalli, M., Pacchetti, B., Piazza, S., et al.. Cannabis sativa L. extract and cannabidiol inhibit in vitro mediators of skin inflammation and wound injury. (2019). Phytotherapy Research. doi:10.1002/ptr.6400

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Giovanni Appendino et al. Antibacterial Cannabinoids From Cannabis Sativa: A StructureActivity Study. 2008. Journal of Natural Products 71(8):1427-430, doi:10.1021/np8002673

McIver, V., Tsang, A., Symonds, N., Perkins, N., et al. Effects of topical treatment of cannabidiol extract in a unique manuka factor 5 manuka honey carrier on second intention wound healing on equine distal limb wounds: a preliminary study. 2020. Australian Veterinary Journal. doi:10.1111/avj.12932

White, D. M., Mair, A. R., & Martinez-Taboada, F. Opioid-free anaesthesia in three dogs. Open Veterinary Journal. 2017 7(2), 104. doi:10.4314/ovj.v7i2.5

Hansen T, Smolders LA, Tryfonidou MA, et al: The Myth of Fibroid Degeneration in the Canine Intervertebral Disc: A Histopathological Comparison of Intervertebral Disc Degeneration in Chondrodystrophic and Nonchondrodystrophic Dogs. Vet Pathol 2017 Vol 54 (6) pp. 945-952.

40. Jeffery ND, Levine JM, Olby NJ, et al: Intervertebral disk degeneration in dogs: consequences, diagnosis, treatment, and future directions. J Vet Intern Med 2013 Vol 27 (6) pp. 1318-33.

41. Balducci F, Canal S, Contiero B, et al: Prevalence and Risk Factors for Presumptive Ascending/Descending Myelomalacia in Dogs after Thoracolumbar Intervertebral Disk Herniation. J Vet Intern Med 2017 Vol 31 (2) pp. 498-504.

Unraveling the use of CBD in veterinary medicine - Jill Lopez

Laughter is the best medicine and Dr. Stichter makes house calls – Las Cruces Bulletin

Posted on September 5, 2020 by Danzig

By Jess Williams

Las Cruces is a long way from Burbank, but what Johnny Carson and Jay Leno did for national TV, local host Sam Stichter is working to do for viewers here.

Stichter said the show has built an audience of about 25,000 viewers since debuting April 18. He agreed to answer some questions about it.

Bulletin: What was the motivation to start the show?

Stichter: My producer, Chris Soular, who is also the owner and operator of the Las Cruces Channel, was looking to do a uniquely local late-night TV show using a "Tonight Show" style formatthat features an opening monologue, interviews with guests on the couch and entertainment segments on each show, includinglocal musicians/bands, magicians and artists.

Bulletin: When did the show start, and how do you keep it going?

Stichter: The first show aired Saturday, April 18. We keep it going by building awareness of the show on Facebook, Twitter, YouTube, Comcast/Xfinty Channel 98 and by word ofmouth. Eachshow has grown in viewership. Our Aug. 15, 2020 was our most-viewed show with more than 25,000 viewers!

Bulletin: Who has been, in your opinion, the best guest youve had on so far, and why?

Stichter:While all our guests gave been great, I truly enjoyed having country singer Frank Ray on the show. He was very willing to do an interview segment, sing several songs andevenparticipate in a "skit" that featured him singing a song. Just an all-around nice guy who, although he's had some major success in the country music industry, is still veryhumble and wants to entertain the people of Las Cruces.

Bulletin: Who would you like to have on who has not agreed?

Stichter: While most everyone we have contacted has agreed to be on the show, we are still working on getting former WBA Light Middle Weight Champion boxer Austin "NoDoubt"Trout. Weare hopingtohave him on the show to promote his next fight. We would also like to have Las Cruces country singer BriBagwell on the show.

Bulletin: What are your criteria when choosing your guests?

Stichter: We look for a variety of people. Some are known in the Las Cruces area as entertainers, politicians, business owners, etc. Some are people who have a greatstoryoraninterestingprofession. Our main criteria is that when viewers tune into the show, they will be entertained by the guests on the show.

Bulletin: Whats your job history?

Stichter: From 1993 - 2002, I hosted a TV show in Reading, Pennsylvania (my original hometown), called "Community Calendar." It featured local guests from the city and county who werepromoting eventsthat were coming into the area, such as the Shriner's Circus, sporting events, fairs and carnivals, etc. In 2000, I received my certification in education. I taught for two years in Reading, PA as an elementary school teacher while continuing to host my TV show. In 2004, I moved to Las Cruces to teach at Las Cruces Public Schools. Today, I'm a computer science teacher at Lynn Middle School. I received my Ph.D. in curriculum and instruction from NMSU in 2019. I have taught at NMSU in the past as an adjunct instructor.

Bulletin: What are some typical questions you ask your guests?

Stichter: Some typical questions include: What is your connection to Las Cruces? Were you born in Las Cruces?How long have you been (acting, singing, performing, etc.)? When and where are you going to performing next? What got you into (politics, magic, business, etc.)? Where are some of the places you (worked, performed, visited, etc.)? What is your motivation?

Bulletin:Whats the craziest thing thats happened on the show since it started airing?

Stichter: When we first started planning the show in February, the plan was for me to have a sidekick. Then COVID-19 hit and we realized that we couldn't have somebody on the show next to medue to social-distancing protocols. As we were getting to ready to air our first show in April, everyone in the community was rushing to the stores to get toilet paper, hand sanitizer,etc.I decided that I was going to bring a roll of toilet paper on the show with me as a joke. My wife, Bonnie, said, in reference to the toilet paper, "Is that your sidekick?" I grabbed aSharpie and drew a "happy face" on the side of the roll of toilet paper and gave him the name Scott. "Scott" now appears with me on every show and the guests often talk to him.

Bulletin:What platforms and/or cable providers do people need to watch the show?

Stichter:Facebook, Twitter, YouTube (Search for Las Cruces Channel). Also on Comcast/Xfinity Channel 98. New shows air Saturday nights at 9 p.m.

Bulletin: What are your top three goals in doing the show?

Stichter: To continue to feature the "movers and shakers" of Las Cruces on each show, tTo offer a variety of entertainment segments each (avoid being stale and predictable) and to entertain the great people of Las Cruces during a time that entertainment choices in the area are extremely limited.

Bulletin: What else should our readers know?

Stichter: I write my own opening monologue, including my own jokes, which can be very challenging, and all of the interview questions. I sometimes ad-libbased on the guests and their reactions to certain questions. I have been asked to sing along with guests and dance, I give it my best, but I don't do either well. My students at Lynn Middle School think it'spretty cool when I show them clips from the show.

To contact Stichter, call 575-202-0616

See the article here:

Laughter is the best medicine and Dr. Stichter makes house calls - Las Cruces Bulletin

In the precision medicine era, the line between products and services is blurred – PMLiVE

Posted on September 5, 2020 by Danzig

Precision and personalised medicines are more than products, they are services in their own right. So, how should pharma approach this uncharted territory to ensure targeted therapies work for patients?

Personalised and precision medicines are exciting fields that focus on the development of treatment and prevention strategies for a single patient or patient group. The treatments are developed using cutting- edge technologies such as genomic sequencing and genetic engineering, helping to account for the individual variability in both patient and disease characteristics.

This has gained a lot of attention in recent years due to revolutionary breakthroughs in debilitating chronic diseases such as cancer. Traditionally, cancer patients are treated using one size fits all interventions like chemotherapy, radiotherapy and surgery. These vary in their effectiveness and result in damage to healthy tissues.

Personalised and precision medicine, however, can offer specialised treatments that target the patients unique cancer subtype, its genetic mutations, and the affected tissues.

These therapies involve novel pathways and complex processes to aid and deliver treatment, making each therapy a service in its own right. They depend on many touchpoints, stakeholders, partnerships and interdependencies to treat patients.

As a result, designing suitable services to support patients, caregivers and healthcare providers throughout the treatment pathway is essential. However, doing so successfully depends on understanding how to best approach the design of services in this challenging landscape.

Optimising the service behind the personalised and precision medicine is crucial for turning the treatment into a viable and differentiated option for patients. To make a real difference and ensure the therapy is competitive, we need to adopt a service design approach.

Service design is a multidisciplinary art and science that enables us to take a holistic view of the service experience, along with a deep understanding of the target groups, such as patients and healthcare professionals, and the context they operate in. This can include using empathic methodologies, such as in-depth interviews and field studies.

Gaining a comprehensive understanding of the customers needs, how they experience the current service, and how future services address their unmet needs.

Involving different stakeholders throughout the design process to gain a wide range of knowledge and expertise, and to further drive customer-centricity across the business.

Using visual tools such as sketches, maps and prototypes to improve and ease communication and collaboration between the different stakeholders involved in the creative process (surpassing language and knowledge boundaries).

Following a learning-by-doing approach via continuous prototyping and testing to evaluate solutions before investing time and resources on development.

Understanding how the customer experiences the whole service journey and then identifying insight gaps and opportunities for service innovation by looking at the big picture.

Personalised and precision medicines are naturally patient-centred (compared to traditional pharmaceuticals), as the individual patient is central to the product design. Taking this empathic approach throughout the design process provides a deeper understanding of those needs as well as their context.

This means not only adopting collaborative thinking during the design phase but also during production and development.

To deliver these unique therapies to patients, pharmaceutical companies must partner with a wide range of specialised third parties including laboratories, manufacturers, shipping and storing providers.

Looking at the entire service and all of its touchpoints from above is crucial

By engaging with multidisciplinary teams from all levels across the organisation, as well as numerous stakeholders during the co-creation process, you will increase the organisations knowledge and expertise, resulting in better and more fit-for-purpose solutions. Bring this sense of collaboration into the design process to encourage a higher level of consistency, placement and commitment to the patient and ensure they are at the centre of the service philosophy.

Novel therapies require designers to be adaptive. New developments such as changes in the supply chain, shorter genomic sequencing process or the need for an additional quality assurance step, often lead to changes to the envisaged treatment pathway. As a result, it is necessary to have a view of the whole service, in one place, which can be continuously updated.

Visual tools such as customer journey maps and service blueprints are a core part of service design. Journey maps (such as the one featured on p.16) provide an overarching view of the customer experience, along with the pain points, gaps, unmet needs and opportunities for engagement. Service blueprints visualise the process behind the service and the people impacted by it. These tools not only make it easier to understand the service, but they can also help simplify communication and increase alignment between the many individuals engaged in the project.

For personalised and precision medicines, patient journeys and service blueprints can help capture the front-end of the service, which is visible to patients, and the back-end processes, which are used by healthcare professionals. This gives us insights into the interactions, touchpoints and relationships between the patient and various stakeholders, such as the different healthcare professionals, carers and patient groups. Looking at the entire service and all of its touchpoints from above is crucial for making improvements that enrich the customer experience.

CAR-T is a new individualised cancer immunotherapy that has taken precision medicine to a new level. In a nutshell, CAR-T therapy involves extracting T-cells (a type of white blood cells that play a key role in immune response) from the patient, genetically engineering them to target the cancer cells and infusing them back into the patients body.

The CAR-T treatment pathway for a blood cancer involves a uniquely large number of stakeholders, touchpoints and interdependent processes that take place both in the front-end (i.e. visible to the patient) and back-end (i.e. visible to healthcare professionals). Below is a high- level overview of a typical CAR-T journey that can illustrate this complexity:

1. After the patient has identified as a suitable candidate for CAR-T therapy, they are referred by their primary oncologist to a specialised treatment centre to further assess treatment eligibility

2. Once eligibility has been established, the patient undergoes leukapheresis to extract T-cells

3.The samples are sent to a separate facility where they are frozen and prepared for shipping

4. The cells are then sent to a manufacturer where they are genetically engineered to target the patient's cancer cells and multiplied - to create the CAR-T product

5.The product needs to be shipped back to the treatment centre and stored frozen until the patient is ready for infusion

6. The shipping and manufacturing processes can take 34 weeks, during which the patient receives bridging therapy (to slow down disease progression)

7.A few days before the infusion, the patient undergoes lymphodepleting chemotherapy to prepare their body

8. After the infusion, the patient needs to be closely monitored for side effects for 1-3 weeks. Some side effects (e.g. Cytokine Release Syndrome) can require hospitalisation

9. The post-infusion period involves continuous tumour assessment and long-term follow-up

We recently pitched to a pharmaceutical company preparing to launch their new CAR-T therapy to help them design a set of patient-and caregiver-supporting services. We quickly became aware ofthe complicated nature of this therapy and decided to kick off by mapping the treatment pathway and the actors involved.

We normally kick off this type of project by conducting primary research with customers (using empathic methodologies) to generate insights that can inform the journey design. However, due to its novelty, it was difficult to access patients who have recently undergone CAR-T therapy. Instead, we carried out in-depth interviews with different types of stakeholders who had considerable experience working on early CAR-T therapies and clinical trials. This gave us insights into the healthcare professionals experience and visibility into the back-end processes.

The insights we gathered allowed us to understand the experience of patients and their caregivers. We could identify their emotional, practical and information-related needs and highlight the pain points that need to be addressed by the future services.

We also created empathy maps, another tool from the service design toolkit, to visually articulate what we know about the customers.

Once we completed the CAR-T patient and caregiver empathy maps, we created the CAR-T journey. The process relied heavily on co-creation by gathering input from key collaborators from the client company, including both medical and commercial personnel.

The continuous consolidation of insights from primary research, secondary research and stakeholder research was highly iterative. This ensured that the journey captured the envisaged treatment pathway in an accurate and comprehensible manner and that we were able to identify insight gaps as they emerged. From there we could then initiate the required steps to address them through additional research.

When executed correctly, a good customer journey is also adaptive and can be re-worked to reflect the changes that naturally occur over time. This is particularly important for journeys that have beencreated pre-launch and need to be revised, post-launch, to align with the emerging reality of the treatment, and for dealing with complicated treatments that are prone to nuanced changes. Both of these scenarios were true in the case of the CAR-T treatment.

The patient journey can also be used in collaborative design workshops with the client and their partners, as it successfully communicates a complicated pathway in a structured, easily digestible visual manner. It acts as a common language that different collaborators from different roles and backgrounds can use to achieve a shared understanding of the envisaged process and the end-to-end customer experience.

Last and perhaps most importantly it can be used to inform and generate new service ideas collaboratively using the journey as a stimulus, by focusing on key pain points and unmet needs.

This type of work is not possible without service design methodologies. These tools enable a diverse group of professionals from different roles and companies to come together and benefit from holistic, visual, customer-centred tools like empathy maps and customers journeys that make iteration and co-creation possible.

To find out how we can help you design a service for a complex medicine, contactsimon.young@fishawack.com

If you would like to request a free, full copy of our CAR-T Service experience map (snippet pictured above) please get in touch withnatasha.cowan@fishawack.com

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In the precision medicine era, the line between products and services is blurred - PMLiVE

How to use precision medicine to personalize COVID-19 treatment according to the patient’s genes – The Conversation US

Posted on September 5, 2020 by Danzig

Tom Hanks and his wife, Rita Wilson, were among the earliest celebrities to catch the novel coronavirus. In an interview at the beginning of July, Hanks described how differently COVID-19 had affected each of them in March.

My wife lost her sense of taste and smell, she had severe nausea, she had a much higher fever than I did. I just had crippling body aches, he said. I was very fatigued all the time and I couldnt concentrate on anything for more than about 12 minutes.

Why does COVID-19 present such different symptoms or none at all in different people?

Preexisting conditions can only be part of the story. Hanks is over 60 and is a Type 2 diabetic, putting him in a high-risk group. Nevertheless, he survived his brush with the virus with no pneumonia and apparently without any long-lasting effects. Knowing what causes variation in different patients could help physicians tailor their treatments to individual patients an approach known as precision medicine.

In recent years, a gene-centric approach to precision medicine has been promoted as the future of medicine. It underlies the massive effort funded by the U.S. National Institutes of Health to collect over a million DNA samples under the All of Us initiative that began in 2015.

But the imagined future did not include COVID-19. In the rush to find a COVID-19 vaccine and effective therapies, precision medicine has been insignificant. Why is this? And what are its potential contributions?

We are a physician geneticist and a philosopher of science who began a discussion about the promise and potential pitfalls of precision medicine before the arrival of COVID-19. If precision medicine is the future of medicine, then its application to pandemics generally, and COVID-19 in particular, may yet prove to be highly significant. But its role so far has been limited. Precision medicine must consider more than just genetics. It requires an integrative omic approach that must collect information from multiple sources beyond just genes and at scales ranging from molecules to society.

Inherited diseases such as sickle cell anemia and Tay-Sachs disease follow a predictable pattern. But such direct genetic causes are perhaps the exception rather than the rule when it comes to health outcomes. Some heritable conditions for instance, psoriasis or the many forms of cancer depend on complex combinations of genes, environmental and social factors whose individual contributions to the disease are difficult to isolate. At best, the presence of certain genes constitutes a risk factor in a population but does not fully determine the outcome for an individual person carrying those genes.

The situation becomes yet more complicated for infectious diseases.

Viruses and bacteria have their own genomes that interact in complex ways with the cells in the people they infect. The genome of SARS-CoV-2 underlying COVID-19 has been extensively sequenced. Its mutations are identified and traced worldwide, helping epidemiologists understand the spread of the virus. However, the interactions between SARS-CoV-2 RNA and human DNA, and the effect on people of the viruss mutations, remain unknown.

Tom Hanks and his wife caught the virus and recovered in a matter of weeks. Presumably each was infected over the course of a few minutes of exposure to another infected person, involving cellular mechanisms that operate on a timescale of milliseconds.

But the drama of their illness, and that of the many victims with far worse outcomes, is taking place in the context of a global pandemic that has already lasted months and may continue for years. People will need to adopt changes in their behavior for weeks or months at a time.

What should a precision medicine approach be in a pandemic? The gene-centric vision of precision medicine encourages people to expect individualized gene-targeted fixes. But, genes, behavior and social groups interact over multiple timescales.

To capture all the data needed for such an approach is beyond possibility in the current crisis. A nuanced approach to the COVID-19 pandemic will depend heavily on imprecise population level public health interventions: mask-wearing, social distancing and working from home. Nevertheless, there is an opportunity to begin gathering the kinds of data that would allow for a more comprehensive precision medicine approach one that is fully aware of the complex interactions between genomes and social behavior.

With unlimited resources, a precision medicine approach would begin by analyzing the genomes of a large group of people already known to be exposed to SARS-CoV-2 yet asymptomatic, along with a similar-sized group with identified risk factors who are dying from the disease or are severely ill.

An early study of this kind by Precisionlife Ltd data mined genetic samples of 976 known COVID-19 cases. Of these, 68 high-risk genes were identified as risk factors for poor COVID-19 outcomes, with 17 of them deemed likely to be good targets for drug developments. But, as with all such statistical approaches, the full spectrum of causes underlying their association with the disease is not something the analysis provides. Other studies of this kind are appearing with increasing frequency, but there is no certainty in such fast-moving areas of science. Disentangling all the relevant factors is a process that will take months to years.

To date, precision medicine has proven better suited to inherited diseases and to diseases such as cancer, involving mutations acquired during a persons lifetime, than to infectious diseases. There are examples where susceptibility to infection can be caused by malfunction of unique genes such as the family of inherited immune disorders known as agammaglobulinemia, but these are few and far between.

Many physicians assume that most diseases involve multiple genes and are thus not amenable to a precision approach. In the absence of the kind of information needed for a multi-omic approach, there is a clear challenge and opportunity for precision medicine here: If it is to be the future of medicine, in order to complement and expand our existing knowledge and approaches, it needs to shift from its gene-centric origins toward a broader view that includes variables like proteins and metabolites. It must consider the relationships between genes and their physical manifestations on scales that range from days to decades, and from molecules to the global society.

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How to use precision medicine to personalize COVID-19 treatment according to the patient's genes - The Conversation US

Michigan Medicine Pediatric Experts to Answer Back-to-School Questions in live Q&A – University of Michigan Health System News

Posted on September 5, 2020 by Danzig

ANN ARBOR, Mich. This back-to-school season is unlike any other as many families make decisions about sending their children back to school in person or trying to navigate how to support their childs remote learning from home.

With many families anxious about starting the school year during a pandemic, a panel of experts from Michigan Medicine C.S. Mott Childrens Hospital will help answer parents top questions during a live Q & A.

The live discussion will be held on Thursday, Sept. 3 at 12 p.m. EST on both the @MottChildren and @MichiganMedicine Facebook pages as well as the @UMichMedicine and @MottChildren Twitter accounts and Michigan Medicine YouTube channel.

The video of the chat will also be available on these platforms for those who would like to view it afterwards.

Experts will address such topics as socialization concerns, supporting emotional and mental health during remote learning, advice for families of children with special learning needs, screen time and safety surrounding learning "pods" with neighbors and classmates.

Attendees may ask questions live at the time of the event or add them to the event discussion area on Facebook to be considered.

The discussion will be moderated by developmental behavioral pediatrician Jenny Radesky, M.D. Other panelists include pediatric psychologist Melissa Cousino Hood, Ph.D., pediatric psychiatrist Sheila Marcus, M.D. and pediatric infectious disease specialist Alison Tribble, M.D.

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Michigan Medicine Pediatric Experts to Answer Back-to-School Questions in live Q&A - University of Michigan Health System News

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