Mount Sinai Hospital of Queens, Mount Sinai School of Medicine
New York, New York
Maier gastritis diet peanut butter buy discount motilium 10mg online, who spent more than thirty years studying participative group problem solving and training managers in how to use this participative approach (Maier gastritis diet effective 10mg motilium, 1950 gastritis gallbladder motilium 10mg amex, 1967 gastritis yahoo answers buy discount motilium 10 mg on-line, 1970) gastritis fiber purchase motilium 10mg otc. Maier defined two critical questions that can be posed with respect to a problem situation to determine whether group participation in problem solving is desirable chronic gastritis operation purchase motilium 10mg with mastercard. The first question is "Will acceptance or rejection of the solution to the problem by any of the workers involved in carrying out the solution make a difference in how well it is carried out When acceptance is an issue, it is important to provide workers with some means of influence or control over the solution that is chosen. If the group leader and members have some basic skills in group problem solving, the group should have no trouble reaching consensus. If quality is important but acceptance is not, it is appropriate for a manager to solve the problem alone, without group involvement. However, in their model of problem solving and decision making, Vroom and Yetton (1973) point out that in such cases a manager may sometimes wish to involve subordinates participatively on a oneto-one basis. This kind of employee participation can be appropriate, according to Vroom and Yetton, if the manager needs additional information in order to develop a good solution. Finally, when both worker acceptance and the quality of the solution are important, Maier suggests that participative group problem solving is appropriate though difficult. In such cases, the leader must facilitate and integrate the discussion while taking into account both the needs of the employees and the requirements of management. Although leading such discussions is not easy and does require skill, Maier and his associates have demonstrated repeatedly and conclusively that managers can learn such skills. Skill in two activities is crucial: (a) posing the problem and (b) encouraging participants to share information (Maier & Sashkin, 1971). Participation in problem solving can have the same effects, but often has some additional benefits. First, workers involved in participative problem solving are engaging in a new aspect of work-an 334 the Pfeiffer Library Volume 20, 2nd Edition. Second, problem solving is, of necessity, a complete task activity, involving gathering information, interpreting that information, developing alternatives, weighing and selecting a specific solution from among the alternatives, and developing implementation strategies. This form of participation not only adds meaning to the work but also represents a complete cycle of work activities in which the employees are involved from the beginning to final completion. In this manner, participation in problem solving can have a positive impact on worker satisfaction, because one basis for satisfaction is the successful completion of meaningful tasks. Thus, participation in problem solving goes beyond the simpler forms discussed earlier. Participation in Change: Research Results the crucial importance of employee participation in planning and carrying out organizational changes is so widely recognized by behavioral scientists that it is hard to comprehend why managers so often attempt to institute such changes unilaterally, with little or no employee participation. In fact, examination of research studies conducted in the 1940s on participation in change reveals that one important reason for attempting to involve workers in developing change was to manipulate them into accepting changes that management wanted. Through group discussion, housewives were manipulated into "solving" the problem of unavailable meats by agreeing to change their food buying and preparation habits to make use of available but less desirable food products. P French (1948) successfully manipulated workers into identifying and agreeing to the exact changes that management had wanted prior to the involvement of the workers. Perhaps the greatest value of these early studies was to demonstrate the tremendous power of group participation for making change work. The firm that Coch and French worked for continued and expanded participative management until, by the 1960s, it was absolutely real, not merely a manipulative sham. By that time, all forms of participative management had spread throughout the organization. However, positive experiences with the methods he devised for reporting data back to both management and employees laid the groundwork for more extensive research. Mann wanted to report the results of this survey in a way that would best lead to acceptance by the employees. Eventually, the employees would use the data gained from the results to solve problems and make changes. Managers and their immediate subordinates were provided with summaries of their own survey data. These data were the basis for group discussions in which problems were identified and changes recommended. The formal experiment was based on the first survey as well as two subsequent surveys conducted in 1950 and 1952. The 1950 effort surveyed more than eight hundred employees in eight accounting departments. Data comparing the results with those of the 1948 survey were provided to the departments. In four departments, the researchers helped to conduct a series of feedback meetings. These meetings focused on supervisors and their immediate subordinate groups and were carried out in much the same manner as the organizational feedback done in 1948. This allowed the researchers to establish a "control group"-a yardstick to determine whether changes were the result of feedback efforts or normal evolution over a period of time. Furthermore, employees in the survey-feedback departments reported that their supervisors got along better with department members than did the supervisors in departments in which no action was taken. In the experimental survey-feedback departments, supervisors held more meetings, and these meetings were judged to be more effective than meetings in the other two departments. Finally, Mann reported the greatest change in those departments in which the members were all extensively involved in the survey-feedback experiment. The greater the degree of involvement, the greater the positive change (Mann, 1957). By now it should be clear that the four approaches to participative management are not independent of one another. Rather, each progressively more complex approach seems to depend on the concepts and skills developed in the simpler approaches. Thus, effective use of participation in change seems to require understanding and mastery of participation in problem solving, decision making, and goal setting. Similarly, productive use of participation in problem solving is based on the skills and knowledge needed to apply participation in decision making and goal setting. Thirty-two hospital laundry workers were involved in planning and carrying out changes. As the project proceeded, the laundry workers also participated in decision making. Although goal setting does not seem to have been involved, participation in problem solving and decision making were clearly part of the participation in change approach and led to increased productivity, improved attitudes, and decreased absenteeism and turnover. The Special Importance of Groups the two more complex types of participative management-participation in change and participation in problem solving-are consistently associated with group methods of operation. This is not simply coincidence; there are several good reasons why groups are most commonly used to implement participation in problem solving and change. First, groups have the potential to develop more good ideas than the same number of individuals working independently. The simplest way to get ideas from a group is through the widely known "brainstorming" procedure. Second, group methods provide a tool for dealing with the complexity of the problems and issues involved in creating organizational change. In organizations today, especially those that rely on the applications of advanced technologies, people in groups are more dependent on one another than ever before. Such interdependencies become especially important in dealing with problems and with the planning and implementation of change. Under such circumstances, the need for coordination is greater, but it is impossible to coordinate effectively simply by using the "standard" methods-written reports, the chain of command, or informal contacts between managers. The sociologist James Thompson (1967) has suggested that in these cases there is a need for coordination by "mutual adjustment. The third reason is that the involvement of individuals in face-to-face group discussions develops social support for decisions, solutions, or changes. This was the primary discovery of the research studies conducted by Kurt Lewin (1947) and his group. Lewin discovered the tremendous effect that group norms-shared beliefs about how people ought to behave-actually have on the behavior of individual group members. This is especially true for behaviors that are overt and easily observed and 337 the Pfeiffer Library Volume 20, 2nd Edition. Coch and French observed, in their early study on participation in change, that resistance to change was more easily overcome when all workers were involved in the discussion than when only representatives of the workers were allowed to take part. Mann also found that when more workers were more involved in the survey-feedback discussions, and when more discussions were held, the change effects were strongest. Perhaps this factor of involvement is so important for effecting change simply because of the basic human need for social interaction. Most of us are so used to spending a large portion of our time with other people and take social interaction so much for granted that we tend to forget what social creatures we really are. A factor that bears careful consideration, then, is the common isolation of workers while doing their work. For many workers, especially those at low levels, there is little opportunity to obtain the social satisfaction that can come through doing a job with other people. Participation in group tasks such as problem solving or developing changes may fulfill these needs. In any case, group-based norms are extremely important; they play a part in determining what we see, how we interpret what we see, and how we behave in response to these perceptions and interpretations. In summary, the use of groups to implement participation in problem solving and change will greatly strengthen the results and impact of such participation and may even be a requirement for the effective use of participative methods for problem solving and change. The Industrial Revolution of the Nineteenth Century changed our work lives as well as our private lives. Work became fragmented into tiny, meaningless, repetitive bits, and workers became socially isolated rather than members of a work unit. Each of these three major changes in the nature of work acts in direct opposition to a basic human work need. Effectively implemented participative management can reverse these changes and can result in improved performance, productivity, and worker satisfaction. Powerlessness Early sociologists observed how the development of the industrial organization contributed to the creation of a new class of relatively powerless workers. It was not until the 1950s, however, that behavioral scientists began to explore seriously the implications of such powerlessness. The Harvard psychologist David McClelland (1975), whose work 338 the Pfeiffer Library Volume 20, 2nd Edition. Meaninglessness One of the most profound treatments of the meaninglessness of work as a consequence of industrialization is found in the writings of Emile Durkheim (1893/1947), a French sociologist whose major work was done at the turn of the century. Earlier, it had been observed how decisions and problems became the province of the supervisor, leaving the worker powerless and contributing to feelings of meaninglessness. When Durkheim worked and wrote, the Industrial Revolution had had its major impact on society. Durkheim noted the increasing fractionation of work itself, partly through application of the scientific-management approach developed by Frederick W. Furthermore, the efforts of time-and-motion-study engineers such as Frank Gilbreth (1911) made the loss of meaning through less involvement in decisions and problems appear to be a relatively minor issue. The fractionation of jobs into minute sets of activities that were repeated over and over, unendingly, was an absolute guarantee of meaninglessness, carried to the ultimate. The very structure of the human brain seems to press individuals to achieve a sense of completion or closure with respect to perceptions, tasks, and activities (Zeigarnik, 1927). It is not surprising, then, that the problem of meaningless work is alleviated when workers engage participatively in solving problems and creating changes. Literally hundreds of research studies by Maier and his associates clearly demonstrate that workers involved participatively in group problem solving find this activity meaningful and interesting and become more satisfied with the work situation. Mann reached the same conclusions in his experiments on the use of group participation in creating changes. One approach to this persistent problem is to make the work itself more meaningful, either by "enriching" the job through methods such as those pioneered by Frederick 339 the Pfeiffer Library Volume 20, 2nd Edition. Another approach, developed by Rensis Likert (1961, 1967) and his associates, is to maximize the use of participative methods so that participation-in all four forms-is to the greatest extent possible the central focus of work activities. In fact, Likert specifically labels the system of management and organization that he advocates as "participative. That is, the negative effects of meaningless work will be reduced temporarily but, unless the work itself is redesigned so as to provide more workers with the opportunity to accomplish a complete task, or unless management practices are extensively refocused to emphasize worker participation, the relief will be only temporary. Isolation Various sociologists have observed and commented on the social isolation of workers imposed by modern industrial organizations. Indeed, Durkheim suggested that it was the combination of social isolation and meaningless work that led to such feelings of alienation as to provoke suicide. However, it was Elton Mayo, a multi-faceted man perhaps best thought of as a social philosopher, whose work was most directed toward resolving the social isolation of workers. In a sense, this brings us full circle, for it was Mayo who was the primary off-site advisor at Harvard to the Hawthorne researchers. Mayo was particularly opposed to the scientific management advocated by Frederick Taylor.
Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis gastritis diet buy cheap motilium 10mg on-line. Diagnosis of Pneumocystis pneumonia using serum (1-3)-beta-D-Glucan: a bivariate meta-analysis and systematic review prepyloric gastritis definition generic motilium 10mg amex. Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia gastritis xarelto quality motilium 10mg. A Pneumocystis jirovecii pneumonia outbreak in a single kidneytransplant center: role of cytomegalovirus co-infection gastritis pepto bismol effective 10mg motilium. A randomized trial of three antiPneumocystis agents in patients with advanced human immunodeficiency virus infection gastritis shoulder pain proven 10 mg motilium. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection gastritis complications discount motilium 10mg overnight delivery. A randomized trial of daily and thrice-weekly trimethoprimsulfamethoxazole for the prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected persons. A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. Discontinuation of primary prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus type I-infected patients: the changes in opportunistic prophylaxis study. A prospective multicentre study of discontinuing prophylaxis for opportunistic infections after effective antiretroviral therapy. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine. Sulfa use, dihydropteroate synthase mutations, and Pneumocystis jiroveccii pneumonia. The National Institutes of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia. Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Clindamycin-primaquine versus pentamidine for the second-line treatment of Pneumocystis pneumonia. Pentamidine aerosol versus trimethoprim-sulfamethoxazole for Pneumocystis carinii in acquired immune deficiency syndrome. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. Life-threatening immune reconstitution inflammatory syndrome after Pneumocystis pneumonia: a cautionary case series. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Long-term safety of discontinuation of secondary prophylaxis against Pneumocystis pneumonia: prospective multicentre study. The teratogenic risk of trimethoprim-sulfonamides: a population based case-control study. Failure of trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia with concurrent leucovorin use. A difference in mortality rate and incidence of kernicterus among premature infants allotted to two prophylactic antibacterial regimens. Respiratory failure in pregnancy due to Pneumocystis carinii: report a successful outcome. Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum-endemic subSaharan Africa. Because the demyelinating lesions can involve different brain regions, specific deficits vary from patient to patient. The focal or multifocal nature of the pathology is responsible for the consistency of clinical presentations with distinct focal symptoms and signs, rather than as a more diffuse encephalopathy, or isolated dementia or behavioral syndrome, all of which are uncommon without concomitant focal findings. Headache and fever are not characteristic of the disease, and when present may indicate presence of another opportunistic infection. The lesions are hyperintense (white) on T2-weighted and fluid attenuated inversion recovery sequences and hypointense (dark) on T1weighted sequences. Although contrast enhancement is present in 10% to 15% of cases, it is usually sparse with a thin or reticulated appearance adjacent to the edge of the lesions. Sensitive assays that detect as few as 50 copies/ ml are now available, with some research labs exceeding this level of sensitivity. Neurological deficits often persist, but some patients experience clinical improvement. Similarly, cidofovir initially was reported to have a salutary clinical effect, but several large studies-including retrospective case-control studies, an open-label clinical trial, and a meta-analysis that included patients from five large studies-demonstrated no benefit. The trial was later halted by the sponsor, because demonstration of efficacy was futile. No clear guidelines exist for the timing of follow-up assessments, but it is reasonable to be guided by clinical progress. Histopathology typically demonstrates perivascular mononuclear inflammatory infiltration. In the absence of comparative data, adjuvant corticosteroid therapy should be tailored to individual patients. A taper may begin with a dose of 60 mg per day in a single dose, tapered over 1 to 6 weeks. If corticosteroid therapy is initiated during pregnancy, blood sugar monitoring should be included as insulin resistance is increased during pregnancy. Progressive multifocal leukoencephalopathy revisited: Has the disease outgrown its name Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases. A case of progressive multifocal leukoencephalopathy in a patient treated with infliximab. Predictive factors for prolonged survival in acquired immunodeficiency syndrome-associated progressive multifocal leukoencephalopathy. Inflammatory reaction in progressive multifocal leukoencephalopathy: harmful or beneficial Spinal cord lesions of progressive multifocal leukoencephalopathy in an acquired immunodeficiency syndrome patient. Hyperintense cortical signal on magnetic resonance imaging reflects focal leukocortical encephalitis and seizure risk in progressive multifocal leukoencephalopathy. Metabolite abnormalities in progressive multifocal leukoencephalopathy by proton magnetic resonance spectroscopy. Diagnosis of progressive multifocal leukoencephalopathy by stereotactic brain biopsy utilizing immunohistochemistry and the polymerase chain reaction. Progressive multifocal leukoencephalopathy: improved survival of human immunodeficiency virus-infected patients in the protease inhibitor era. Clinical course and prognostic factors of progressive multifocal leukoencephalopathy in patients treated with highly active antiretroviral therapy. Clinical outcome of long-term survivors of progressive multifocal leukoencephalopathy. Predictors of survival and functional outcomes in natalizumab-associated progressive multifocal leukoencephalopathy. The atypical antipsychotic agents ziprasidone [correction of zisprasidone], risperdone and olanzapine as treatment for and prophylaxis against progressive multifocal leukoencephalopathy. Progressive multifocal leukoencephalopathy in a haploidentical stem cell transplant recipient: a clinical, neuroradiological and virological response after treatment with risperidone. Favourable outcome of progressive multifocal leucoencephalopathy in two patients with dermatomyositis. Mirtazapine use in human immunodeficiency virus-infected patients with progressive multifocal leukoencephalopathy. Progression of progressive multifocal leukoencephalopathy despite treatment with beta-interferon. Progressive multifocal leukoencephalopathy: current treatment options and future perspectives. Neurological immune reconstitution inflammatory response: riding the tide of immune recovery. Is maraviroc beneficial in paradoxical progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome management Immune reconstitution inflammatory syndrome in a patient with progressive multifocal leukoencephalopathy. Clinical and immunologic effects of maraviroc in progressive multifocal leukoencephalopathy. The most common manifestations of secondary syphilis are mucocutaneous lesions that are macular, maculopapular, papulosquamous, or pustular, can involve the palms and soles, and are often accompanied by generalized lymphadenopathy, fever, malaise, anorexia, arthralgias, and headache. Lues maligna is a rare manifestation of secondary syphilis, characterized by papulopustular skin lesions that can evolve into ulcerative lesions with sharp borders and a dark central crust. Latent syphilis is defined as serologic reactivity without clinical signs and symptoms of infection. Tertiary syphilis includes cardiovascular syphilis and gummatous syphilis, a slowly progressive disease that can affect any organ system. Neurosyphilis can occur at any stage of syphilis with different clinical presentations, including cranial nerve dysfunction, auditory or ophthalmic abnormalities, meningitis, stroke, acute or chronic change in mental status, and loss of vibration sense. A presumptive serologic diagnosis of syphilis is possible based upon non-treponemal tests. Serologic diagnosis of syphilis traditionally has involved screening for non-treponemal antibodies with confirmation of reactive tests by treponemal-based assays. This latter strategy may identify those with previously treated syphilis infection, persons with untreated or incompletely treated syphilis, or those with a false positive result in persons with a low likelihood of infection. If a second treponemal test is positive, persons with a history of previous treatment appropriate for the stage of syphilis will require no further treatment unless sexual risk history suggests likelihood of re-exposure. In this instance, a repeat non-treponemal test 2 to 4 weeks after the most recent possible exposure is recommended to evaluate for early infection. Unless history or results of a physical examination suggest a recent infection. If the second treponemal test is negative and the risk of syphilis is low, no treatment is indicated. By definition, persons with latent syphilis have serological evidence of syphilis (nontreponemal and treponemal testing) in the absence of clinical manifestations. Early latent syphilis is defined by evidence of infection during the preceding year by 1. A documented seroconversion or four-fold or greater increase in nontreponemal titer; or 2 Symptoms of primary or secondary syphilis; or 3. Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis. Treatment can prevent disease progression in the individual and transmission to a partner. Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis more than 90 days before the diagnosis should be treated presumptively for early syphilis if serologic test results are not immediately available and the opportunity for follow-up is uncertain. If serologic tests are positive, treatment should be based on clinical and serologic evaluation and stage of syphilis. Sexual partners of infected persons considered at risk of infection should be notified of their exposure and the importance of evaluation. The use of any alternative penicillin treatment regimen should be undertaken only with close clinical and serologic monitoring. Limited clinical studies and biologic and pharmacologic evidence suggest that ceftriaxone may be effective; however, the optimal dose and duration of therapy have not been determined. Although systemic steroids are used frequently as adjunctive therapy for otologic syphilis, such therapy has not been proven beneficial. Because neurosyphilis treatment regimens are of shorter duration than those used in late-latent syphilis, 2. Syphilis treatment recommendations are also available in the 2015 Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines. If clinical signs or symptoms recur or there is a sustained four-fold increase in non-treponemal titers of greater than 2 weeks, treatment failure or re-infection should be considered and managed per recommendations (see Managing Treatment Failure). The potential for re-infection should be based on the sexual history and risk assessment. Response to therapy for late latent syphilis should be monitored using non-treponemal serologic tests at 6, 12, 18, and 24 months to ensure at least a four-fold decline in titer, if initially high (1:32), within 12 to 24 months of therapy. However, data to define the precise time intervals for adequate serologic responses are limited. Most persons with low titers and late latent syphilis remain serofast after treatment often without a four-fold decline in the initial titer. If clinical symptoms develop or a four-fold increase in nontreponemal titers is sustained, then treatment failure or re-infection should be considered and managed per recommendations (see Managing Treatment Failure). The potential for reinfection should be based on the sexual history and risk assessment. Antipyretics can be used to manage symptoms but have not been proven to prevent this reaction. The Jarisch-Herxheimer reaction occurs most frequently in persons with early syphilis, high non-treponemal antibody titers, and prior penicillin treatment. Managing Possible Treatment Failure or Re-infection Re-treatment should be considered for persons with early-stage syphilis who have persistent or recurring clinical signs or symptoms of disease, or a sustained four-fold increase in serum non-treponemal titers after an initial four-fold decrease following treatment. The assessment for potential reinfection should be informed by a sexual history and syphilis risk assessment including information about a recent sexual partner with signs or symptoms or recent treatment for syphilis.
Questionnaire on the Possible Creation of a System of Electronic Recording of Entries and Exits of Third Country Nationals in the Schengen Area gastritis diet oatmeal cookies motilium 10 mg visa. Modern borders: condition gastritis diet cheap 10 mg motilium visa, performance gastritis xarelto cheap 10 mg motilium overnight delivery, management 196 Houtum gastritis diet motilium 10mg with mastercard, van Henk gastritis diet rice buy 10 mg motilium free shipping, and Roos Pijpers gastritis symptoms pdf purchase motilium 10 mg. Adaptation of the population and the economy to these new borders is a long and far from complete process. The objectives of this chapter are, firstly, to show the specificity of post-Soviet borders in the light of modern theoretical approaches to the study of state borders (limology) and, secondly, to consider their symbolic role and the importance of public perception in legitimizing and equipping the new borders. The importance and priority of the different functions of the border depend on the size and nature of the state and the historical stage of its development. Foucher, in his important book on the world system of state borders (1991), identified three types of states: "regular" sovereign states, "states under construction" and "empires" and, accordingly, has divided world borders into six types: between empires, between empires and sovereign states, between empires and "states under construction", and so on. Confrontation of "empires" determined the length of the existence of so-called frontal borders with dominant barrier functions. In addition, different borders have different meanings from different points of view. Research on borders and on social representations of borders are often combined with traditional analyses of their morphology, functions, and role in international relations; the need for a synthesis of "traditional" and "new" approaches has been convincingly proved by the study of post-Soviet borders. The huge variety of functions and types of post-Soviet borders is determined by the great variety of natural conditions, population density and differentiation of economic activities in the territories they cross. So, part of the Ukrainian border runs along the Seversky Donets River and the border with Lithuania along the Neman. However, perhaps the most famous Russian border on a large river is a significant portion of the Russian-Chinese border along the Amur, being now in accordance with the generally accepted norms of international law along the thalweg, although previously the entire river belonged to Russia / Soviet Union, so that the line of demarcation coin1 M. Modern borders: condition, performance, management 200 cided with the Chinese coast. The border with Georgia runs along the inaccessible Main Caucasian Range, although a small part of Georgian territory (Kazbegi district) is located on the northern slope of the ridge. There are few passes that are suitable for the construction of modern roads or railways. At the same time, many thousands of kilometers of post-Soviet borders cross relatively flat plains, especially in the areas of steppes and deserts. This contributes to daily contacts between the neighboring regions, but also makes it more difficult to protect the border. Polycentric disintegration, caused by the creation of new foci in the network, has led to negative consequences in the peripheral parts of the old system with a simpler topological structure. Although sooner or later transport networks adapt to new political borders and new capitals, this kind of adaptation usually takes a lot of time. Some parts of the transport system of the newly independent states are still fragments of a vanished integrated network, suffering from serious imbalances. In Central Asia and Kazakhstan railway networks have been divided by borders into a large number of separate segments. The result was a strong mutual dependence of the newly independent states on transit through neighboring countries. In Uzbekistan, the new state border divided the railway network into five independent units. To get from the west to the east of the country, it was necessary to cross the territory of Tajikistan and Turkmenistan. To resolve this issue, since 1995 a few new lines have been built with a total length of nearly 700 km. The Ferghana Valley is now the only area where there is a railway section separated by the mountains and the territory of Tajikistan from the rest of the network. In 2016, with the completion of the Agren-Pape line (129 km, including 19 km of tunnel), this problem will be resolved. The lack of direct communication between regions, caused by the configuration of the new borders and terrain features, is a major threat to the territorial integrity of Tajikistan and Kyrgyzstan, where the railway network has also undergone fragmentation into three and six isolated segments respectively. The very existence of these countries, the poorest in Central Asia, depends on communication between their northern and southern regions, which differ in their economic specialization, ethnic structure, cultural and religious characteristics. The shortest rail route between the two cities crossed seven national borders and passed through the territory of Kazakhstan, Uzbekistan and Tajikistan. For the same reason there is now no rail link between Dushanbe and northern Tajikistan (the cities of Khujand and Penjikent). The newly independent states are investing heavily in railway construction to gain access to foreign networks. This is accelerated by the competition between the different corridors and logistic schemes of relations being put forward by China and other countries of the Asia-Pacific and Western Europe. But probably one of the most ambitious projects runs from the city of Kashgar in the Xinjiang Uygur Autonomous Region of China and through the mountainous regions of Kyrgyzstan to Uzbekistan, with possible extensions into Iran and Turkey. However, its implementation is dependent on solving a number of complex political and financial problems. Since the beginning of the Georgian-Abkhaz war in 1992, the railway connection of Russia with Armenia and Georgia, along the Black Sea through Sochi and Sukhumi, was blocked. Another line from Armenia to Russia, running along the Caspian coast via Baku, is also blocked as a result of conflict over NagornoKarabakh. Transcaucasian roads were closed or used only for part of the year, even before the war in South Ossetia in 2008. Thus, reliable communication between Armenia and other countries of the Eurasian Union is only possible by air. Isolation is one of the main factors slowing down the development of the Armenian economy. Russia is affected less than other countries by the deformation of transport networks caused by the emergence of 201 Section 3. However, the eccentricity2 of the railway system increased, connectivity between its European and Asian territories decreased, and the railways of the Kaliningrad region are completely separate from those of "mainland" Russia. Russian strategic railway communications towards its east cross the territory of Kazakhstan. More than 100 km of the Trans-Siberian Railway between Kurgan and Omsk pass through Kazakhstan. Two more routes also lay partially in the territory of Kazakhstan, of 700 and 1200 km respectively. The only route that runs entirely through the territory of Russia is not able to fully ensure communication between European Russia, Eastern Siberia and the Far East. Between the Volgograd and West-Kazakhstan regions the railways also cross the border many times. More than 300 km of railways in the Russian borderlands belong to the state company "Kazakhstan Temir Zholy", while Kazakhstan is actively building detours through its national territory. The shortest train journey from Moscow to Rostov and then to the North Caucasus, which in Soviet times was mostly used for passenger services, now crosses Eastern Ukraine. To avoid delays caused by border controls since the mid-1990s, many trains connecting St. Petersburg and Moscow with the resorts on the Black Sea, go through Voronezh, although this way is longer. But even this line, wholly-owned by "Russian Railways", crosses 50 kilometers of Ukrainian territory. In April 2015, due to the worsening situation in the Donetsk and Lugansk regions of Ukraine, Russian railway troops began the construction of a bypass with a total length of about 150 km. As a rule, the longer a political border exists, the more it is organically integrated into national and ethnic identity, and the better a population and economy become adapted to the characteristics of the border areas. Golunov, Rossiysko-kazakhstanskaya granitsa: problemy bezopasnosti i mezhdunarodnogo sotrudnichestva [Russian-Kazakh border: security issues and international cooperation] (Volgograd: Publishing House of Volgograd University Press, 2005). However, most of the new state borders in the former Soviet Union can be classified as postadministrative, having arisen in place of the administrative borders that existed between the former republics of the Soviet Union. The degree of historical maturity is another important characteristic of borders, which often change their status and functions, but not position. Many of the new Russian borders already played the role of state borders in the past. Among the most mature historically are the RussianLithuanian and Russian-Estonian borders. The first already in the thirteenth century functioned as a border between Prussia and Lithuania (Poland), and after the transfer of Lithuania to Russia in the eighteenth century it turned into a Prussian-Russian border. Only in 1945 did this section of the border lose its status as a state border, becoming an administrative border between Soviet republics. Thus, most of the Russian-Lithuanian border (with the exception of its extreme western section near Klaipeda) has existed for about 700 years, although in different forms. For nearly seven centuries the Russian-Estonian border has existed, dating back to the historical boundaries between ancient territory of Novgorod and the ethnic Estonians. In the middle of the thirteenth century this was the border of Novgorod Territory with Denmark, then with the Livonian Order. In 1721, when Russia annexed Estland, the functions of this part of the border have changed: it became the border of Revel (since 1783 the Estland) province. The Russian-Belarusian border is a relatively mature one, which for most of its length in the past represented the border of the Principality of Polotsk, and was then used as the Russian-Polish border. It goes back to the border of Novgorod and Pskov lands with the Principality of Polotsk, which later evolved into the RussianPolish border, and lost its status as the state border in 1772. Thus, this border has a historical analog, which existed for at least five hundred years. The border of Russia in the Caucasus can be considered as historically mature, which for centuries divided the Georgian and Turkish states from the semi-independent state for- 203 Section 3. Modern borders: condition, performance, management mations of the North Caucasian highlanders. This border finally lost its status in the nineteenth century, when the entire Caucasus finally became part of Russia. The border with Azerbaijan on the Samur has a low degree of maturity, being the state border of the Derbent and Quba Khanates for less than a hundred years in total, from 1747 to 1765, following which the Khanate of Derbent lost independence almost for 30 years, and then from 1791 to 1806, when the two Khanates were in fact annexed to Russia. In the mideighteenth century, on the Orenburg and Chelyabinsk sections of the border, was created Cossack Orenburg-Uiskaya Line, and at the Chelyabinsk, Kurgan, Tyumen and Omsk sections, the Presnogorkovskaya Line. The last was fairly close to the current Russian-Kazakh border, but to consider it as a state border is not quite correct, because in those years the nomadic Kazakh tribes took Russian citizenship. Thus, its northern part was established a long time ago, as tends to the boundary between ancient historic-geographical areas, the "lands" within the principalities. In contrast, the center and southern part of the RussianUkrainian borderland, formerly called the "Wild Field", were regularly devastated by nomads, and later by the Crimean Tatars, with the support of the Ottoman Empire. This area was populated by Ukrainian and Russian peasants only from the seventeenth century, after the Russian government ensured its security. In this historical region, called Slobozhanschina and now divided between Russia and Ukraine, administrative borders changed frequently. These changes took place within the same state and depended on the gravity of lands to the main cities, not on ethnic or linguistic boundaries. In addition, Russian and Ukrainian villages were often situated side by side with one another. Administrative borders generally followed lines of delineation between Cossack regiments in the seventeenth and eighteenth centuries, the military-territorial units around the fortified cities that served as centers of administration and self-defense. When passing through the border the share of Russians there is reduced only by a third, although the proportion of Ukrainians changes more significantly. The most densely populated and urbanized area of the southern stretch of the Russian-Ukrainian border is the Donbas, the majority of which belongs to Ukraine, and the smaller, eastern part to Russia. In the course of industrialization, which began at the end of the nineteenth century, the Donbas was settled by immigrants from first Russian, and then the Ukrainian regions. Mixed marriages were common, and the division into "self" and "others" was mainly due to kinship and social, rather than ethnic differences. Most of the 48 thousand km of new post-Soviet borders divides "states under construction. For about twenty years, there have existed the partially recognized or unrecognized republics of Abkhazia, South Ossetia, Nagorno-Karabakh and Pridnestrovian Moldavian Republic. Thus, significant parts of the populations of Georgia, Azerbaijan and Moldova did not recognize the legitimacy of the borders of these countries. The mosaic structure of settlement created by the various ethnic groups made it impossible to unite ethnic, political and administrative boundaries, although in some cases the Soviet ethnic policy sought to achieve such a goal.
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For Chemical events gastritis and diarrhea diet generic 10 mg motilium fast delivery, assume 100% of exposed population gastritis diet ppt buy motilium 10 mg visa, with 25% of exposed population requiring transport (up to 75% of victims in a major incident will self-transport) gastritis diet purchase motilium 10mg with visa. For Radiological Dispersion Device events gastritis hiatal hernia diet purchase 10mg motilium amex, assume 180 fatalities gastritis symptoms mayo generic motilium 10mg overnight delivery, 270 injuries gastritis diet 6 pack 10 mg motilium sale, up to 20,000 exposed/ potentially exposed, with 50% of injured requiring transport. For Nuclear events (10 kiloton), assume several hundred thousand victims over thousands of square miles. Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. This includes providing definitive care to individuals at the appropriate clinical level of care, within sufficient time to achieve recovery and minimize medical complications. The capability applies to an event resulting in a number or type of patients that overwhelm the day-to-day acute-care medical capacity. Planners must consider that medical resources are normally at or near capacity at any given time. Medical Surge is defined as rapid expansion of the capacity of the existing healthcare system in response to an event that results in increased need of personnel (clinical and non-clinical), support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logistical support (clinical and non-clinical equipment and supplies). Preparedness Tasks and Measures/Metrics Activity: Develop and Maintain Plans, Procedures, Programs, and Systems Critical Tasks Res. Plans to operate without public utilities for 72 hours are in place Plans for the set up, staffing, and operation of alternate care facilities are in place Plans address the treatment of Medical Surge personnel, site staff, and their families. Plans address dissemination of accurate, timely, accessible information to public, media, support agencies A data base to track the status of medical surge resources. Emergency Operations Center Management also provides resources to Medical Surge as needed. Medical Surge capability receives patients from Emergency Triage and Pre-Hospital Treatment. Medical Surge capability receives medical resources from Medical Supplies Management and Distribution. Medical Surge capability receives resources from Critical Resource Logistics and Distribution. Medical Surge receives perimeter security from Emergency Public Safety and Security Response. Medical Surge provides medical personnel to Mass Care (Sheltering, Feeding, and Related Services) to conduct treatment of people in shelters. Medical Surge sends patients to Mass Prophylaxis to receive appropriate protection (countermeasures) and treatment. Staffing and support functions will be more efficient as similar patients are treated at individual facilities. The capacity to maintain, in negative-pressure isolation, at least one suspected case of a highly infectious disease or a febrile patient with a suspect rash or other symptoms of concern who might be developing a highly communicable disease. The capacity to support the initial evaluation and treatment of at least 10 total adult and pediatric patients at a time in negative-pressure isolation. Adequate personal protective equipment to protect current and additional healthcare personnel. Triage done in the field will have a significant impact on the subsequent healthcare surge capacity system. This capability applies to a wide range of incidents and emergencies including accidental or deliberate disease outbreaks, natural disasters, nuclear, chemical, and conventional explosive events. The professionals listed in the following have basic skill sets commensurate with their professional training and experience qualified by professional licensure and/or industry standards. There will be a significant problem locating and providing information on displaced family members as well as victims at treatment facilities. These are community facilities that do not necessarily provide a medical function outside of an emergency, but have the space and access needed to house patients (armories, auditoriums, conference centers, firehouses, etc. Secondary bacterial infections following any mass casualty event will stress antibiotic supplies. There will be critical shortages of healthcare resources such as staff, hospital beds, mechanical ventilators, morgue capacity, temporary holding sites with refrigeration for storage of bodies and other resources. Victims and responder monitoring and treatment may be required over a long time frame. A large number (75 percent plus) of victims could self-present without field triage or evaluation. Hospital logistical stores will be depleted in the early hours from any large scale event. Blood supplies will be taxed and significant regional shortages could materialize quickly following a catastrophic incident. Blood manufacturing, infectious disease-testing, and distribution of tested blood will be problematic. There will be a significant increase and demand for specialty healthcare personnel and beds (biological contagious, burn, trauma, pediatrics) depending on the specific event. A large number of patients may self-refer to a healthcare facility requiring decontamination. Healthcare providers are subject to the effects of disasters and may need decontamination, prophylaxis, or immunization measures before being able to perform their response roles. Public anxiety related to a catastrophic incident will require effective risk communication and may require mental health and substance abuse services. During a catastrophic incident, medical support will be required not only at medical facilities, but in large numbers at casualty evacuation points, evacuee and refugee points, and shelters as well as to support field operations. Sub-State regions are able to provide and sustain medical surge capacity in a large-scale public health emergency or bioterrorism event. Ideally, each sub-State region will contain one acute care hospital, one emergency medical services agency, and one public health department/district and work with a multitude of various public agencies as well as private and faith based groups, all of which would respond to a wide-scale event. Vaccine availability will be insufficient and time to produce additional vaccine unacceptably long. There is a critical need for containment measures to prevent additional disease spread. Specific counter measures such as social distancing, masks, and hand hygiene should be instituted. Because of the limited supply and production capacity, there is a need for explicit prioritization of influenza vaccine based on the risk of influenza complications, the likelihood of benefit from vaccination, role as an influenza pandemic responder, and impact of the pandemic on maintenance of critical infrastructure. Persons of all ages will likely need 2 doses of vaccine, 3-4 weeks apart in order to be protected. Primary prevention including masks, hand hygiene, and social isolation may be the primary mode of preventing the spread of disease if vaccine and viral agents are not available in adequate quantities. Chemical: Most likely route of introduction of a chemical exposure in a mass casualty event will be inhalation. All chemicals are toxic depending on the concentration and time spent in that concentration. Chemical events will result in immediate and potentially life threatening injuries. Appropriate response will rely on rapid decontamination and a locally deployable, pharmaceutical cache. As a rule of thumb, the sooner the onset of symptoms and the higher the dose received the less likely the victim will survive. Generally, invasive (open) procedures should be performed within the first 48 hours on those receiving significant doses of radiation exposure due to follow on progressive immunocompromised state. Critical infrastructure and personnel will be damaged and rendered ineffective for a three mile radius. Tens of thousands will require decontamination and both short-term and long-term treatment. Healthcare facilities and emergency workers in the affected area will be overwhelmed. The effects of the radiation will be prevalent for years creating long term health issues. Healthcare facilities involved in the affected area will have to be replaced and relocated. Triage may identify a significant number of patients who have received lethal doses of radiation with zero chance of survivability who will require palliative care only. There is a lack of palliative care resources and planning for large numbers of victims. Timely and accurate emergency public health information/crisis information news releases are vital for mitigation and prevention of further health issues. Model Trauma System Planning and Evaluation, self-assessment tool for States, Department of Health and Human Services, Health Resources and Services Administration. Outcome Critical medical supplies and equipment are appropriately secured, managed, distributed, and restocked in a timeframe appropriate to the incident. On-Site Incident Management identifies medical resource shortages and issues and communicates this to Medical Supplies Management. Emergency Public Safety and Security Response provides perimeter security for Medical Supplies and Management, including transport, warehouse, and distribution site security. Medical Supplies Management provides the stockpiling, storage, and distribution of medication, durable medical equipment, and consumable medical supplies that may be needed at general population shelters and functional and medical support shelters. Critical Resource Logistics and Distribution provides non-medical resources to Medical Supplies Management Following a re-supply request from Mass Prophylaxis, Medical Supplies Management provides the request medical resources. Manage Coordinate Supervise Safety Resource Requests Medical resources returned appropriately Demobilize Medical Supplies Management and Distribution End: Return to pre-incident "ready" status Target Capabilities List 471 Resource Element Description Resource Elements Components and Description Experts in medicine and public health to determine what is required in the various stockpiles or needs to be supplemented in the existing supply chain. Includes staff for operations management, inventory control, distribution dispatch, and repackaging. Includes staff necessary to activate, set up and manage warehouse and inventory; includes inventory management equipment and systems required to efficiently run warehouse. Team includes: 1) staff necessary to activate, set up and manage warehouse and inventory and 2) inventory management equipment and systems required to efficiently run warehouse. Irrigation Solutions (Normal Saline Irrigation Solution- 2000cc; Sterile Water Irrigation Solution- 2000 cc). Patient Personal Care Supplies (Bath Basin; Emesis Basin; Facial Tissues; Bedpan; Urinal; Belonging Bag; Regular Soap; Mouth Care Supplies). Patient Personal Care Supplies (Bath Basin, Cotton Swabs; Facial Tissues; Diapers; Pacifier; Belonging Bag; Cotton Balls). Respiratory System Supplies (Nasal Airways; Oral Airways; Oxygen Cannulas; Oxygen Masks). Miscellaneous (Sterile Lubricant; Alcohol Wipes; Alcohol Swab Sticks; Tongue Blades; Heel Warmers; Tape Measure; Body Bag; Disposable Linen Savers; Safety Pins; Povodine Iodine Swab Sticks; Povodine Iodine Wipes; Hydrogen Peroxide; Individual Bottled Drinking Water). Radiological Disaster Supply Formulary Supplies needed to supplement the Core or Pediatric Formulary for radiological disasters. Nuclear Disaster Supply Formulary Supplies needed to supplement the Core or Pediatric Formulary for nuclear disasters. Explosive Disaster Supply Formulary Supplies needed to supplement the Core or Pediatric Formulary for explosive disasters. Protective Gear (Sterile Gloves- all sizes- 1 box per 100 casualties; Exam Gloves, Medium- 1 box per 25 casualties; Latex Free Gloves Medium- 1 box per 25 casualties; Fluid Resistant Gowns; Masks; Goggles; Shields; Balanced Salt Solution for Eye Wash; Isolation Gown- 4 per staff member; Fluid Resistant Gowns- 1 per staff member; hair Cover; Liquid Scrub Soap; Individual Bottled Drinking Water). Planning Assumptions For contagious and/or pandemic diseases (and possibly other scenarios), there will be limited or no implementation of cooperative agreements due to quarantine or actual or perceived contamination and/or widespread infection. Prior to dying, many people would use considerable healthcare resources because of their critical condition at admission. Even surge production capacity is likely to be inadequate for shortterm requirements. Surge capacities of pharmaceutical and medical product manufacturers and distributors will diminish compared with projected capabilities due to high absenteeism in all commercial sectors resulting from employees being directly affected by the scenario or choosing to stay home with families. Transport of medical supplies, pharmaceuticals, and laboratory supplies from a Federal mobilization base camp to the State staging area is the responsibility of the State unless otherwise negotiated with the Federal Government. The originating entity is responsibly for transporting non-federally owned supplies to an interagency warehouse unless otherwise negotiated with Federal or State organizations. Any of the services, performance measures, or capabilities can and should be applied to the supply chain for laboratory testing materials as well. Although this does not necessarily fall directly under medical supplies, it is crucial that the diagnostic supplies to support medical functions are not forgotten or ignored. This program can serve as a viable model for beginning such a program with medical supply distributors and manufacturers. This process absolutely must be initiated as soon as possible with the government providing necessary assurances to maintain commercial confidentiality. Planning Factors from an In-Depth Analysis of a Scenario with Significant Demand for the Capability Resource Organization Stockpile Content Management Group Strategic National Stockpile (including vendor managed inventory) Estimated Capacity Scenario Requirement Values Continuous open dialogue to determine the current requirements Response capability will leverage both Federal stockpiles and commercial capabilities. Modular Emergency Medical System: Concept of Operations for the Acute Care Center. This capability includes the provision of appropriate follow-up and monitoring of adverse events, as well as risk communication messages to address the concerns of the public. Outcome Appropriate drug prophylaxis and vaccination strategies are implemented in a timely manner upon the onset of an event to prevent the development of disease in exposed individuals. Public information strategies include recommendations on specific actions individuals can take to protect their family, friends, and themselves. Target Capabilities List 485 Linked Capability Emergency Operations Center Management Medical Supplies Management and Distribution Emergency Public Safety and Security Response Epidemiology Surveillance and Investigation Relationship Emergency Operations Center Management provides situation reports to Mass Prophylaxis, which provides situation reports in return. Epidemiology Surveillance and Investigation provides information for Mass Prophylaxis. Additional geographic locations would require resource considerations according to population estimates in affected areas.
References
Warren BF, Shepherd NA. Surgical pathology of the intestines: the pelvic ileal reservoir and diversion proctocolitis. In: Lowe DG, Underwood JCE (eds), Recent Advances in Histopathology, 18th edn. Edinburgh: Churchill Livingstone, 2000: 63.
Culclasure TF, Bray VJ, Hasbargen JA: The significance of hematuria in the anticoagulated patient, Arch Intern Med 154(6):649-652, 1994.
Spodick DH. The Pericardium: a Comprehensive Textbook. New York: Marcel Dekker, Inc.; 1997.
Debono M, et al: Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery, Eur J Endocrinol 164:413-419, 2011.
Badalamente MA, Cherney SB. Periosteal and vascular innervation of the human patella in degenerative joint disease. Semin Arthritis Rheum 1989; 18(4 Suppl 2):61-6.
