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Taming Superbugs Insights From Game Theory Professor David McAdams

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Antibacterial Soap

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Antibacterial Soap with Triclosan Useless in practice Creates health risks CDC recommends regular soap!

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Good News 2013: FDA proposes new rules to require soap-makers to demonstrate safety and effectiveness 2014: Bath & Body Works joins others who have removed antibacterials from their products

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A Beautiful Mind John Nash, aka Russell Crowe

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No man is an island, entire of itself. John Donne, 1624

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Game = Any situation with multiple decision-makers (or players) whose choices impact one another..

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Games of Life HOSPITALSCHOOL HOMEOFFICE

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My Own Game-Theory Journey

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Business: mobile payments Public policy: alcohol abuse Foreign policy: Somali pirates

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October 2013: Debt-ceiling crisis My Own Game-Theory Journey Changing the debt-ceiling game New York Times op-ed

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October 2014: Out-of-control western corn rootworm Sorensen Public Policy Lecture at U. Nebraska Lincoln The future of pest-resistant crops My Own Game-Theory Journey

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Turning the tables on terrorist kidnappers January 2015: Terrorist kidnappers New York Times op-ed My Own Game-Theory Journey

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Debt-ceiling crisis Pest-resistant crops Terrorist kidnappers X X X Antibiotic Resistance

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Dr. Mario Raviglione, Director, WHO Global TB Programme Dr. Arjun Srinivasan, Associate Director, CDC Healthcare Associated Infection Prevention Antibiotics discovery team, GlaxoSmithKline Dr. Maria Joyce, Duke hospital, molecular diagnosis expert Professor Gerald Wright, McMaster U, bacterial genome expert Much Help Along the Way

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We are poised to achieve complete and lasting victory over antibiotic resistance.

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Together, We Can Change the Game #1 As Consumers STOP INAPPROPRIATE ANTIBIOTIC USE IN LIVESTOCK #2 As Patients STOP INAPPROPRIATE ANTIBIOTIC USE IN OURSELVES #3 As Citizens/Taxpayers ACCELERATE SCIENCE BEHIND DIAGNOSIS OF RESISTANCE

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The Logic of Rising Antibiotic Resistance Susceptible Bacteria Resistant Bacteria

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The Logic of Rising Antibiotic Resistance Susceptible Bacteria Resistant Bacteria

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The Logic of Rising Antibiotic Resistance Penicillin doesnt work anymore!! Resistant Bacteria

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Things as common as strep throat or a childs scratched knee could once again kill. Dr. Margaret Chan Director-General A Post-Antibiotic Future

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Leading Causes of Death 1900 2012 1.Pneumonia and influenza 2.Tuberculosis 3.Diarrhea and enteritis 1.Heart disease 2.Malignant neoplasms [cancer] 3.Cerebrovascular diseases [stroke] 6.Pneumonia and influenza

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We Can Avoid a Post-Antibiotic Future #1 DISCOVER DRUGS FAST ENOUGH #1 SLOW RISE OF RESISTANCE

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We Can Avoid a Post-Antibiotic Future #2 REVERSE RISE OF RESISTANCE #2 DISCOVER BETTER DIAGNOSTICS

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1928: Accidental Discovery of Antibiotics

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January 2006: Soil-dwelling bacteria Resistance Starts in the Soil Scientific article in Science Microbial resistance to antibiotics currently spans all known classes of natural and synthetic compounds. Soil-dwelling bacteria... are a reservoir of resistance.

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Antibiotic Overuse in Livestock GROWTH PROMOTION SUPERBUGS

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MRSA CC398: Human Pig Human JUMPS TO PIGS EASILY TREATABLE DISEASE

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JUMPS TO PIGS ACQUIRES RESISTANCE EASILY TREATABLE DISEASE MRSA CC398: Human Pig Human

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JUMPS TO PIGS ACQUIRES RESISTANCE RE-INFECTS PEOPLE EASILY TREATABLE DISEASE SUPERBUG MRSA CC398: Human Pig Human

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MRSA in Pigs: Threat to Human Health of grocery carts sampled in Iowa City had MRSA bacteria on them 5% of all meat harbored MRSA as well 3%

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of grocery carts sampled in Iowa City had MRSA bacteria on them 5% of antibiotic-free meat had MRSA 0% MRSA in Pigs: Threat to Human Health

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Game-Changer ANTIBIOTIC-FREE MEAT

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What if Resistance Escapes the Farm? S S S S R R R = resistant bacteria = susceptible bacteria S S S S S

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S S S S R R R = resistant bacteria = susceptible bacteria S S S R R What if Resistance Escapes the Farm?

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RS S S R R Our Bodies are a Battlefield Susceptible bacteria are a natural ally in fight against resistance!!

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S S R R S S S R S S S S Patient #1 Our Bodies are a Battlefield Patient #2 Patient #3

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S S R R R Antibiotic Treatment Our Bodies are a Battlefield Patient #1 Patient #2

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S S R R R R R R R R R R Patient #1 Patient #3 Our Bodies are a Battlefield

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Game-Changer JUDICIOUS ANTIBIOTICS USE

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S S R R What If We Could Diagnose Resistance? Standard Treatment Strategies to Disrupt Transmission S R

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S S R R What If We Could Diagnose Resistance? Standard Treatment Strategies to Disrupt Transmission S

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Game-Changer NEW DIAGNOSTIC TOOLS Takes DAYSTakes ONE HOUR

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Weve Mapped the Resistome Takes ONE HOUR Visualization of the Antibiotic Resistome

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Now Poised to Transform Medicine!! Takes ONE HOUR Visualization of the Antibiotic Resistome

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We Need YOU to Change the Game 1.Buy antibiotic-free meat. 2.Talk with your doctor. Do you really need antibiotics? 3.Support a new frontier in science to detect resistance. 4.Tell your friends what you learned today.