The goal of this study was to investigate the willingness of Medical Reserve Corps (MRC) volunteers to participate in public health emergency-related activities by assessing their attitudes and beliefs. MRC volunteers responded to an online survey organized around the Extended Parallel Process Model (EPPM). Respondents reported agreement with attitude/belief statements representing perceived threat, perceived efficacy, and personal/organizational preparedness in 4 scenarios: a weather-related disaster, a pandemic influenza emergency, a radiological (''dirty bomb'') emergency, and an inhalational anthrax bioterrorism emergency. Logistic regression analyses were used to evaluate predictors of volunteer response willingness. In 2 response contexts (if asked and regardless of severity), self-reported willingness to respond was higher among those with a high perceived self-efficacy than among those with low perceived self-efficacy. Analyses of the association between attitude/belief statements and the EPPM profiles indicated that, under all 4 scenarios and with few exceptions, those with a perceived high threat/high efficacy EPPM profile had statistically higher odds of agreement with the attitude/belief statements than those with a perceived low threat/low efficacy EPPM profile. The radiological emergency consistently received the lowest agreement rates for the attitude/belief statements and response willingness across scenarios. The findings suggest that enrollment with an MRC unit is not automatically predictive of willingness to respond in these types of scenarios. While MRC volunteers' self-reported willingness to respond was found to differ across scenarios and among different attitude and belief statements, the identification of self-efficacy as the primary predictor of willingness to respond regardless of severity and if asked highlights the critical role of efficacy in an organized volunteer response context.
Restraint use is associated with increased severity of injury in hospital patients who fall.
Optimal care of stroke patients cannot be achieved by introducing a stroke care pathway alone. We recommend the urgent establishment of a stroke unit with a specialist consultant-led multidisciplinary stroke team.
For more than a thousand years, starting in 111 BCE, the Vietnamese were vassals of China, part of its frontier province of Jiaozhi (Giao Chi to the Vietnamese). At that time, they resided mostly in and around the Red River Delta. The rest of what is now Vietnam, including its Central and Southern regions, belonged to other ethnic groups. The Vietnamese staged several rebellions during the millennium of Chinese rule; all failed. Only in 939 CE, following the spectacular triumph by Ngo Quyen (898-944) over a Chinese fl eet on the Bach Dang River near Ha Long Bay the year before, did they fi nally regain their independence. Over the next seven decades, rival clans vied to rule the now-sovereign nation. This First Vietnamese Civil War ended in 1009, with the founding of the Ly Dynasty, which branded its kingdom "Dai Viet" in 1054 and made Thang Long, now Hanoi, its capital. For the fi rst time, Vietnamese lived under a government of their own in an ostensibly independent country. Independence remained precarious, however. The Chinese continued to harbor designs over Dai Viet, and invaded again in 1075. They were ousted four years later by forces under the command of General Ly Thuong Kiet (1019-1105), who famously used a poem entitled "Mountains and Rivers of the Southern Country" ( Nam quoc son ha ) to motivate his troops before battle. The poem reads:The Southern country's mountains and rivers the Southern Emperor inhabits.The separation is natural and allotted in Heaven's Book.If the bandits come to trespass it, You shall, in doing that, see yourselves to be handed with failure and shame!
Introduction:In April 2009, the United States Centers for Disease Control and Prevention (CDC) learned that a novel and seemingly lethal strain of H1N1 was present in Mexico and was spreading into US border states. The majority of senior CDC leaders were trained in meta-leadership, a strategy for emergency preparedness and response developed at the Harvard University National Preparedness Leadership Initiative. This study reports on an analysis of senior leaders involved in that response. Methods: Senior CDC leaders involved in the H1N1 response between 22 April and 22 May 2009 were interviewed using a structured interview tool and a qualitative analysis of their responses. Results: Given the short time since the onset of the event, research still is in progress. However, preliminary interviews confirm that senior CDC leaders, including Acting Director, Dr. Rich Besser, were knowledgeable in the five dimensions of meta-leadership and were intentionally practicing and applying the strategy. A public opinion survey indicated an 83% approval rating for public health leaders managing the event. Conclusions:The five dimensions of meta-leadership are: (1) the leader; (2) situational awareness; (3) leading one's silo of responsibility; (4) leading up to one's boss; and (5) leading intra-agency and cross-agency connectivity. When adopted across the government and out to the private sector, metaleadership provides three important advantages: (1) a strategy of action designed to advance coordinated planning and response to major emergencies; (2) a conceptual framework and vocabulary that encourages intentional networking and cohesion to connect the purposes and work of different public and private stakeholders; and (3) a practice method that both instructs and guides multi-dimensional problemsolving. By deploying the skills and abilities of meta-leadership, positive outcomes were achieved during the early phase of the H1N1 outbreak in the US.
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