John M. Murkin, MD, FRCPC
- Professor of Anesthesiology (Senate)
- Director of Cardiac Anesthesiology Research
- Schulich School of Medicine
- University of Western Ontario
- London, Ontario, Canada
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The National Logistics Coordination Forum will serve as an umbrella organization to discuss ongoing high level logistics challenges; integrated working groups will be formed to identify and develop solutions. It directly supports combatant commanders, the Chairman of the Joint Chiefs of Staff, the Secretary of Defense, and the President in the command of U. In conjunction with monitoring the current worldwide situation, the Center alerts the Joint Staff and other national agencies to developing crises and will initially coordinate any military response required. Military responses under these conditions require a streamlined chain-of- 10/27/08 798 command that integrates the unique capabilities of active and reserve military components and civilian responders. The two components of the goal are (1) to substantially increase public awareness of natural hazard risk so that the public demands safer communities in which to live and work, and (2) to significantly reduce the risk of loss of life, injuries, economic costs, and destruction of natural and cultural resources that result from natural hazards. Risk reduction measures ensure long-term economic success for the community as a whole rather than short-term benefits for special interests. Risk reduction measures for one natural hazard must be compatible with risk reduction measures for other natural hazards. Risk reduction measures must be evaluated to achieve the best mix for a given location. Risk reduction measures for natural hazards must be compatible with risk reduction measures for technological hazards and vice versa. Disaster costs and the impacts of natural hazards can be reduced by emphasizing proactive mitigation before emergency response; both pre-disaster (preventive) and postdisaster (corrective) mitigation is needed. Building new Federal-State-local partnerships and public-private partnerships is the most effective means of implementing measures to reduce the impacts of natural hazards. Those who knowingly choose to assume greater risk must accept responsibility for that choice. Risk reduction measures for natural hazards must be compatible with the protection of natural and cultural resources. Department of Energy responsible for enhancing national security through the military application of nuclear science. Navy with safe and effective nuclear propulsion; and responds to nuclear and radiological emergencies in the United States and abroad. The 1968 plan provided the first comprehensive system of accident reporting, spill containment, and cleanup, and established a response headquarters, a national reaction team, and regional reaction teams. National Plan For Civil Defense Against Enemy Attack: A national plan for catastrophic disaster, preceding the National Catastrophic Earthquake Plan, the Federal Response Plan, National Response Plan, and National Response Framework. It defined the role required of the Federal Government, the States and their political subdivisions, and of families and individuals to attain this objective. The 40 elements of the National Plan are being implemented by developing appropriate operational annexes providing for its detailed application by governments, families, and individuals. Each State, 240 metropolitan areas within the States, and approximately 50 percent of the counties have plans supporting it. Subsequently, the Homeland Security Council published the Federal Response to Hurricane Katrina: Lessons Learned in February 2006. One significant exception was DoD, which had long used formal planning processes to conduct operations within the branches of the military. The Scenarios are planning tools and are representative of the range of potential terrorist attacks and natural disasters and the related impacts that face our nation. The objective was to develop a minimum number of credible scenarios in order to establish the range of response requirements to facilitate preparedness planning. The 15 Scenarios include terrorist attacks, major disasters, and other emergencies. Planners are not precluded from developing their own scenarios to supplement the National Planning Scenarios.
Many other new members had similar interests treatment 3 nail fungus discount xalatan 2.5 ml line, and the time we put in together began to symptoms cervical cancer cheap 2.5 ml xalatan mastercard pay big dividends for all of us symptoms joint pain and tiredness xalatan 2.5ml sale. For over 20 years the collective wisdom in this excellent publication has continued to acute treatment discount xalatan 2.5 ml mastercard reach out Tapping the Resources of the Internet 575 to an increasingly large number of people in the stuttering and professional communities with personal accounts, advice, theories, poems, words to the wise, reports and successes, messages of hope, inspiration-literally, millions of words. When people enter into dialogue, ideas shoot back and forth as one thought quickly triggers another. Moreover, until now there has been little opportunity for those who stutter to dialogue directly with the professional community. The listserv had about 60 or so subscribers from the university and the clinical communities; however, some of the most interesting exchanges were taking place between the professionals and the sprinkling of people from the stuttering community who had found their way onto the subscriber list. Today, there are a number of very active listservs and chat rooms on stuttering with hundreds and hundreds of subscribers from all over the world. The volume of dialogue and data that races back and forth within and between the various stuttering communities is truly staggering. The first resource that helped me in this area was a book published in the early 60s titled Psycho-Cybernetics and written by Maxwell Maltz. Maltz was a plastic surgeon who noted that after surgery, some people manifested a substantial change in self-esteem while others seemed not to change at all. Soon after, I became involved with general semantics which provided me with further mind management resources. Bob also moderates the neurosemanticsofstuttering Yahoo group in which people are learning to approach their stuttering from a holistic perspective and work with mind management techniques. You will learn an enormous amount, thanks to the candor of the participants and their willingness to share their personal experiences. Furthermore, your own efforts will be supported by some highly aware people who will be there to support and coach you. The discussions about the stuttering experience are on a level of sophistication that I have seldom seen elsewhere. Tapping the Resources of the Internet 577 Like other forums, members can choose to receive emails individually, or via a daily collective digest. StutteringChat is composed almost exclusively of people who stutter with only a minimum of speech professionals involved. They have live, online chat sessions quite often, and it really is cool to be able to connect in real time to someone else who stutters. You may subscribe to and participate in discussions by logging onto this address: groups. Once your subscription request is processed, you will receive an automated confirmation email message. The site provides information on all aspects of stuttering treatment, research, and support groups as well as breaking news and articles about stuttering related matters. You can even see a video of one of my Toastmaster presentations in which I recount how I relocated to San Francisco. All this is just a few keystrokes away on the Stuttering Home Page at Mankato State University. Developed by Professor Emeritus Judy Kuster, this huge and constantly growing archive was the first resource on stuttering to be instantly accessible from anywhere in the world. Here are some other useful web sites: the National Stuttering Association is the largest stuttering self-help group in the U. The Stuttering Foundation of America offers a wide variety of books and brochures on stuttering- Additional web sites are listed on the Stuttering Home Page or you can access them through any of the many web browsers. You also need an opportunity to share yourself-your ideas, fears, hopes and ambitions-and to see that you have the power to reach and influence others. This is all part of the process of empowerment, of discovering that you are no longer a victim but a potential agent of change. Self-help organizations, and especially the Internet, provide the venues you need to make all this happen.
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Diabulimia is shockingly common; as many as a third of women with type 1 diabetes report insulin restriction medicine river xalatan 2.5 ml overnight delivery, with higher levels among those between the ages of 15 and 30 world medicine buy discount xalatan 2.5ml line. Once insulin restriction or other disordered eating behaviors become engrained symptoms 3 weeks into pregnancy xalatan 2.5ml on-line, a cycle of shame symptoms retinal detachment generic 2.5 ml xalatan mastercard, guilt, and other negative feelings can make it difficult to get help and the condition difficult to treat. A team-based approach is the gold standard, with inclusion of a mental health professional along with the other team members (endocrinologist, nurse educator, nutritionist, etc. In severe cases, hospitalization may be necessary until mental and medical stability are achieved. Monthly or more frequent appointments with members of the care team may be needed. I Knew How to Play the Game "As a type 1 diabetic from the age of 7, I just knew I was an expert on this disease. I rolled my eyes at countless nurses, endocrinologists, and educators who lectured me endlessly on ways to manage my diabetes. I had multiple retinopathy surgeries to stop the bleeding in my eyes, I only had four toes left, and yet, diabulimia was still strong. I would live at my threshold, taking the tiniest basal amounts of insulin just to skirt by, exhausted and thirsty. The ignorance of the public, my friends, and some of my family was frustrating and hurtful. When I was pregnant, I was singularly focused on having a healthy pregnancy, bringing my A1C down to 5. I was sacrificing my entire life to diabulimia, until my daughter was diagnosed at the age of 2 with type 1 diabetes. I cannot let her grow up feeling the same way I did: alone, frustrated, misunderstood, and judged. More than anything, I wanted her to enjoy her life, which had just begun, and I wanted to be alive and well enough to get her to adulthood. I wanted to be a great Mental Health mother but I was too tired to play, too sick to give her all the attention she deserved. They are often up a lot at night checking blood glucose levels and therefore are sleep deprived. It is common for these parents to have anxiety, higher distress levels, and even depression after the diabetes diagnosis and even down the road. If you are having these feelings, please reach out to your diabetes team for help and support. Parents often describe behavior changes with low and high blood glucose levels, which complicates the decision to discipline bad behavior. If it is time to check a blood glucose or get an injection, do not allow the child to delay it with whining, debate, or tantrums. It is important to reward and reinforce children when they work to subscribe to their diabetes management tasks. Reinforcing positive behaviors and decisions can go a long way to helping to ingrain in your child more optimal decisions throughout their lives. We all have the hard times, but most of the time, we can find silver linings from the most painful parts. As kids grow older, the family learns to walk a fine line between the parent taking all of the responsibility for care and the growing child becoming independent. Getting enough support during these times from your diabetes health-care team, family, and even vital peers is important. In some families, a parent and a child (or children) will have type 1 diabetes and diabetes management is truly a "family affair. As children move through the various developmental stages of youth, certain family issues may arise (Table 9. During this part of life, a person typically moves out on their own for the first time. In addition to all the normal increases in responsibilities, the young adult with type 1 diabetes is suddenly fully in charge of managing a chronic disease.
Natural disasters: earthquakes treatment lupus purchase xalatan 2.5ml, floods medications that cause pancreatitis order xalatan 2.5 ml overnight delivery, hurricanes medications 319 discount xalatan 2.5 ml on line, tornadoes medicine logo cheap 2.5 ml xalatan overnight delivery, tsunami, sea surges, freezes, blizzards of snow and ice, extreme cold, forest fires, drought, and range infestation. Internal disturbances: civil disorders such as riots, demonstrations run amok, large-scale prison breaks, strikes leading to violence, and acts of terrorism. Energy and material shortages: from strikes, price wars, labor problems, and resource scarcity. Attack: the ultimate emergency-nuclear, conventional, chemical, or biological warfare. Such measures include organization, direction, and provision of services to be instituted before attack, in the event of strategic or tactical evacuation, and after attack in the event of evacuation or of refuge in shelters. Under the Stafford Act section related to essential 10/27/08 390 assistance, emergency work is defined to include clearance and removal of debris and wreckage, and temporary restoration of essential public facilities and services. Unlike other risks, emergent risks do not have a track record which can be used to estimate likely probabilities and expected losses. This training includes controlled detonations of improvised explosives providing responders first-hand understanding of and experience with a range of improvised explosive devices from letter bombs to vehicle bombs. Layered, mutually supporting capabilities at Federal, State, tribal, and local levels allow for planning together in times of calm and responding together effectively in times of need. Engaged partnership includes ongoing communication of incident activity among all partners to the Framework, and shared situational awareness for a more rapid response. In particular, the potential for terrorist incidents requires a heightened state of readiness and nimble, practiced capabilities baked into the heart of our preparedness and response planning. This approach is what we call "Engaged Partnership" and it is guiding our plans and our actions. Business services are defined by the agency business model and include the foundational mechanisms and back office services used to achieve the purpose of the agency. A resilient organization effectively aligns its strategy, operations, management systems, governance structure, and decision-support capabilities so that it can uncover and adjust to continually changing risks and better endure disruptions. All entities face uncertainty, and the challenge for management is to determine how much uncertainty to accept as it strives to grow stakeholder value. Uncertainty presents both risk and opportunity, with the potential to erode or enhance value. Enterprise risk management enables management to effectively deal with uncertainty and associated risk and opportunity, enhancing the capacity to build value. In sum, enterprise risk management helps an entity get to where it wants to go and avoid pitfalls and surprises along the way. The capability minimizes human exposures to environmental public health hazards. The capability provides the expertise to run fate and transport models; design, implement, and interpret the results of environmental field surveys and laboratory sample analyses; develop protective guidance where none exists; and use available data and judgment to recommend appropriate actions for protecting the public and environment. Environmental Health identifies environmental hazards in the affected area through rapid needs assessments and comprehensive environmental health and risk assessments. Limitations of the technique include the current focus on post-event impact assessment and not promoting its use as part of the planning process, although the results can feed into future planning. An unusual increase in the number of cases of an infectious disease which already exists in the region or population concerned. The appearance of a significant number of cases of an infectious disease introduced in a region or population that is usually free from that disease. It includes exposure and disease (both deliberate release and naturally occurring) detection, rapid implementation of active surveillance, maintenance of ongoing surveillance activities, epidemiological investigation, analysis, and communication with the public and providers about case definitions, disease risk and mitigation, and recommendation for the implementation of control measures. Items may be eliminated on the Information Collection Plan depending on the phase of the disaster. For example, during the initial phases of an event, the boundaries of the disaster area are of critical importance. Toward the end of the recovery effort, this item is dropped as the boundaries have become stable. However, mitigation and recovery statistics and items take on greater importance in the later stages of an event and, therefore, will be listed and likely expanded.
References
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- Gleicher S, Kauffman EC, Kotula L, et al: Implications of high rates of metastatic prostate cancer in BRCA2 mutation carriers, Prostate 76(13):1135n1145, 2016.
