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pstrongCelebrating a storied tradition of clinical care, education and research/strong/p
pThe UAB Division of Pulmonary, Allergy, and Critical Care Medicine was founded in 1955 by Ben Vaughan Branscomb who served as its Director until 1970.nbsp; Dick Dowling Briggs, Jr. (Division Director, 1971 ndash; 1992) succeeded Dr. Branscomb and continued to build on the strong foundation set by him to develop the Division into one of the premier programs in the country.nbsp;span id=more-2499/spannbsp;/p
pTo celebrate the legacy and contributions of Drs. Branscomb and Briggs, the Division established the inaugural Branscomb-Briggs lectureship on March 5, 2010 at UAB.nbsp; The first lecturer was Dr. Stephen Rennard, Larson Professor of Medicine in the Pulmonary and Critical Care Medicine Section at the University of Nebraska Medical Center.nbsp; Dr. Rennardrsquo;s lecture on ldquo;COPD in the Emerging Era of Personalized Medicinerdquo; was well received by all, including the honorees who are also his close friends.nbsp; The evening celebration shifted to the Harbert Center where Drs. Branscomb and Briggs were ldquo;toasted and roastedrdquo; by former fellows, colleagues, and friends.nbsp; The event was attended by over 100 guests from Birmingham and surrounding communities, many who were trainees under these former Division Directors./p
pThe Division has continued to grow under the subsequent leadership of K. Randall Young, Jr. (1992-2007), James E. Johnson (2007-2009; Interim Director), and Victor J. Thannickal, the current Division Director.nbsp; The Division currently holds 36 full-time faculty members with a primary appointment in the Department of Medicine.nbsp; The Division is committed to excellence in clinical care, integrated approach to education, and innovative research./p
pstrongExcellence in Clinical Care ndash; Focus on Critical Care/strong/p
pThe Division is responsible for the care of critically ill patients in our Medical Intensive Care Unit (MICU), hospitalized patients in a dedicated pulmonary in-patient service (6-South), and consultant support for patients on other wards and ICUs.nbsp; All of our clinical faculty see ambulatory patients in the Kirklin Clinic, accounting for over 12,500 patient visits per year.nbsp; Other specialized services include diagnostic and interventional bronchoscopy services, pulmonary function testing, cardiopulmonary exercise testing, sleep-wake disorders center, and specialized clinics related to cystic fibrosis, lung transplantation and interstitial lung disease.nbsp; We are working with the UAB Health System in expanding these specialized ldquo;pulmonary service linesrdquo; as well as in providing comprehensive and coordinated care for critically ill patients in our ICUs./p
pThe MICU currently carries three housestaff teams with thirty to thirty five critically ill patients at any given time.nbsp; These patients have a variety of illnesses, including acute respiratory failure, severe sepsis, acute respiratory distress syndrome, renal failure and cardiac failure.nbsp; Protocols have been implemented to ensure that patients consistently received evidence-based care.nbsp; Patients with severe infections are managed with a sepsis protocol.nbsp; Patients on mechanical ventilators are managed with a lung-protective ventilator strategy.nbsp; Patient safety interventions are employed and measured for compliance.nbsp; These include prophylaxis for venous thrombosis, gastrointestinal bleeding and a bundle of interventions for prevention of ventilator-acquired pneumonia and central line infections.nbsp; Adherence with all of these exceeds the goal of 90%.nbsp; The MICU rotation has repeatedly been selected by internal medicine residents as being among the best educational experiences of their inpatient rotations./p
pstrongIntegrated Approach to Education/strong/p
pThe Division is committed to training the next generation of pulmonary and critical care specialists by ensuring the acquisition of requisite diagnostic and procedural skills in the evaluation and management of patients with pulmonary disorders and critical illness. The Division has a history of outstanding teaching with numerous awards from the Department of Medicine.nbsp; Over the past year, a number of new faculty have been recruited to the Division who have expanded the educational activities in interventional bronchoscopy and interstitial lung disease.nbsp; The Divisionrsquo;s educational mission benefits greatly from the wide range of expertise among the faculty in the areas of airways disease, including COPD, asthma and cystic fibrosis, lung transplantation, bronchoscopic procedures (e.g. endobronchial ultrasound-guided biopsies), and sleep disorders.nbsp; The educational mission also benefits from the inter-disciplinary interactions with teaching faculty in the Departments of Pathology, Anesthesiology, Radiology and Surgery./p
pScholarship and research is expected during fellowship training and faculty mentorship is fostered.nbsp; Two training tracks ndash; the Clinician-Educator and Physician-Scientist ndash; have been implemented to facilitate this goal.nbsp; Recent and current fellows have pursued graduate degrees through the Department of Public Health and the Department of Physiology and Biophysics.nbsp; An NIH T32 Training Grant in Lung Biology and Translational Medicine was submitted this year to facilitate the development of physician investigators./p
pstrongInnovation in Research/strong/p
pResearch in the Division spans studies on basic cellular/molecular and immunologic bases for lung disease, translational approaches in biomarker/drug discovery, and clinical trials for patients with sepsis, IPF, CF, and COPD.nbsp; Total research funding in the Division is now over $8.8 million per year, which represents a more than doubling of funding during the previous year.nbsp; Here, we highlight research in the laboratories of Dr. Chad Steele and Dr. Ed Blalock./p
pResearch in the Dr. Steele laboratory is broadly based in lung immunology and host defense.nbsp; A particular focus of the laboratory is on understanding myeloid cell-mediated innate immune responses against opportunistic fungal pathogens that cause life-threatening lung infections in immunocompromised individuals with such diseases as HIV, COPD and leukemia.nbsp; Dr. Steelersquo;s research on the fungal pathogen Pneumocystis carinii has uncovered a novel Src tyrosine kinase signaling pathway that regulates the magnitude of the lung inflammatory response as well as change the pattern of alveolar macrophage activation.nbsp; This pattern of macrophage activation, termed M2a, is associated with more efficient elimination of P. carinii from the lungs, yet has not been described in P. carinii host defense.nbsp; Dr. Steelersquo;s research team is currently characterizing multiple M2a-associated innate host defense molecules in an effort to understand what influences alveolar macrophage effector responses against P. carinii.nbsp; The overarching goal of this work is to uncover new innate immune pathways that can be therapeutically augmented in the setting of immunosuppression and immunodeficiency for the treatment of P. carinii pneumonia.nbsp; In a second project, Dr. Steelersquo;s research team has discovered an essential role for a myeloid-associated fungal recognition receptor, Dectin-1, in lung innate immune responses to the fungal pathogen Aspergillus fumigatus.nbsp; Dectin-1, which recognizes beta-glucan carbohydrates found in the cell wall of all medically-important fungi, controls the production of multiple inflammatory cytokines, including IL-17.nbsp; Dr. Steelersquo;s lab has recently reported a role for IL-17 in A. fumigatus lung defense and has recently been awarded a 2-year ARRA R01 and a new, 4-year R01 focusing on the lung cell source of IL-17, which pathways drive the development of this cell population and the downstream IL-17-associated mechanisms that promote elimination of A. fumigatus from the lungs./p
pResearch in the Blalock group has focused on pathways of pulmonary inflammation.nbsp; Specifically, Dr. Blalock and colleagues have described a novel neutrophil chemoattractant, proline-glycine-proline (PGP), in chronic inflammatory lung disorders.nbsp; In addition, this group has also determined the specific proteolytic cascade involved in PGP liberation from collagen, highlighting numerous potential therapeutic targets in this unique inflammatory pathway.nbsp; This work has been published in Nature Medicine, Journal of Immunology, and Journal of Neuroimmunology.nbsp; In more recent work (under review at Science), Dr. Blalock and Wellcome Fellow, Dr. Rob Snelgrove, in collaboration with pulmonary faculty members Drs. Amit Gaggar, Pat Jackson, and Steve Rowe, have demonstrated a novel endogenous anti-inflammatory pathway for PGP.nbsp; This work focuses on the enzyme, leukotriene A4 hydrolase (LTA4H), which is known to generate the pro-inflammatory molecule, leukotriene B4 (LTB4) via its hydrolase activity.nbsp; In contrast, the Blalock group discovered that the aminopeptidase activity of LTB4 mediates anti-inflammatory effects by degrading PGP.nbsp; These findings have implications for therapeutic strategies that target LTA4H to prevent LTB4 generation since this may inadvertently lead to elevations in PGP and neutrophilic inflammation.nbsp; This work was made possible through a state-of-the art Pulmonary Proteomics facility and Drug Discovery Program affiliated with the UAB Lung Health Center.nbsp; Dr. Blalock will be honored with the Max Cooper Award for Excellence in Research for 2010 at a reception to be held on Tuesday, May 25, 2010./p
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pRichard Epstein, director of the law and economics program at the University of Chicago Law School, agrees. #8220;Nobody is as hospitable to potential liability as we are in this country,#8221;nbsp;he told emAmerican Medical News, /empublished by the American Medical Association. #8220;The unmistakable drift is we do much more liability than anybody else and the evidence on improved care is vanishingly thin.#8221;/p
pMedical liability claims in the U.S. make up 10 percent of all tort cases, with half of the expenses for such cases going to pay off legal costs. Epstein also believes that the fate of medical liability cases resting with juries and not judges plays a significant role in how doctors approach their jobs, according to emAmerican Medical News/em./p
p#8220;Standards of care as a matter of law are decided by a jury, thumbs up or thumbs down,#8221; Epstein said. #8220;No other country does that, and no other country has the legal fear that has created. If it#8217;s a legitimate claim, let be compensated#8230;.It#8217;s the unreliability that#8217;s counterproductive here.#8221;nbsp;/p
pTo learn more:br /- read this Jackson Healthcare press releasebr /- read this emAmerican Medical News/em article/p
pstrongRelated Articles:/strongbr /Three factors that can make or break the physician-patient relationshipbr /Cardiologists admit to practicing defensive medicinebr /Doctors#8217; fear of lawsuits takes a hefty financial tollbr /Defensive medicine in Mass. costs at least $1.4 billionbr /The philosophy behind Michigan#8217;s #8216;I#8217;m Sorry#8217; program/p