Essays about Evaluation.

Background

In this particular scholarly paper, it is needed to evaluate the crisis in sports and its impact on the parties engaged in the sports. Critically, it can be stated that the implementation of crisis management in the sports and the public relations tactics needed to be explained simultaneously. In case of doctoral studies of the stated problem, one need to follow many steps to deliver a standard paper helpful for the research work (Semyachkina-Glushkovskaya et al., 2013). It is vital to know the known parameters related to subject to evaluate a thorough investigation of the problem. As per the requirement the research questions and theoretical framework have to be worked out to find the best possible results.

Problem Statement

Crisis management and public relations tactics can be considered as two of the most important factors to be countered in sports. One has to understand, how these two factors are directly related to the sports. People attached to the games might find some situation that can lead to an unknown crisis. At this very point in time, the essentiality of crisis management needs to become out of the frame (Al-abed, Tamil & Al-Dubai, 2012). At some point knowledge of public relation can be considered as highly valuable as tactics regarding public relation may come handy to control the crisis on and off the field. Communication is the key to success in crisis management (Dekker, 2007). On the other hand, it needs to be mentioned that commonly in a field of sports some relations can be built around the places within the players, the governing body and even with the fans. The trust and believe to each human relation is very important in such cases. For a famous sports personality, it is the fans that made some sportsman a popular person. So it is the responsibility of the sports person to protect his public image (Al-Qudah, 2009). The main point of the topic is to understand how the knowledge of public relations can effectively act in crisis management. Lack of public relations tactics among the management can be considered as a serious problem, and it is essential to find why management and sports authorities pay less attention to this very topic. Therefore, it is important to consider serious research among the public those are involved in the sports to find out the results (Harkke, 2006). The methodology can be considered as one of the most important tools to make effective data collection regarding the topic.

Purpose Statement

Considering the factors involved in the process, one of the major purposes of the study is to find out how the knowledge of crisis management and public relations tactics effectiveness in every sport. In case of effective communication, the paper will be designed in the way to make out the importance of communication as a public relations management tactic. Identically it is very obvious to know how effectively these parameters can be used to control any crisis (Mizanur Rahman, Mamun, Delwar Hossain & Kante, 2005). Finally a comparison of the moves needed to be explained by evaluating the central research question is given below theoretically (Hung, Altschuld & Lee, 2008). As this a doctoral research paper, purpose statement can define the path to be followed to achieve the preferred target.

Central Research Questions

The central research questions of the paper have been presented below on the basis of which the commencement of the project has to be done. Questions are prepared for the purpose of quantitative analysis.

What is the main motive of acquiring the knowledge of crisis management and public relations tactics?

According to you, to what scale the knowledge of crisis management and public relations tactics are helpful in the sports?
Rate importance of public relations tactics in sports.
How the management and sport’s governing body can come into the frame in order to improve the situation?
Note: In case of scale rating, rate from 1 to 5.

Conceptual Framework

The conceptual framework of a doctoral study paper is a very important part to be considered as it will define the success of the research paper. After defining the research problem, it is important to follow the theoretical framework to complete the research paper. After assessing the problem a theoretical rationality is needed to be established (Onuminya, 2006). Now in this section, a pointwise theoretical viewpoint is needed to be presented that disclose the professional authenticity on the basis of which the research has to be concluded (Ostriker, Kuh & Voytuk, 2003). Afterward, the research design and implementation of the research outline have to be organized in such a way that the most effective outcome can be achieved. The research frames and the research questions must be mapped to get the effective results (Säfsten, 2002). At the end, the conceptual conclusion needed to be drawn to produce the outcome of the research work. In case of games and sports a project that puts emphasis on crisis management and public relations, it is essential to predict the outcome of research questions. It must be answered by people attached to the high level of management in sports clubs and sectors. Statistical analysis of the given answers as a quantitative proof can successfully provide the targeted result. That is why prompt conceptual framework has been needed to complete the job as presented above.

Significance of Study

In the last segment of the research paper, it is essential to present the significance of the conceptual work on the basis of data available. By completing critical analysis of the given data, one can verify how rationale it is to acquire the knowledge of crisis management and public relations tactics. Conclusive evidence and supportive theories will certainly back the research outcome to make a solid conclusion about the effective use of knowledge of crisis management and public relations tactics. The process to apply the method can also be revealed successfully after completion of the research study. The evaluation of the project can be successfully done by verifying quantitative data. It is eminent to put a value on public relations tactics to tackle crisis management in any sports considering factors controlling circumstances.

References

Al-abed, A., Tamil, A., & Al-Dubai, S. (2012). Case control study on risk factors associated with esophageal cancer in Yemen. BMC Public Health, 12(Suppl 2), A11. doi:10.1186/1471-2458-12-s2-a11
Al-Qudah, H. (2009). Evaluating the Position of Active Public Relation Office at Private Jordanian Hospitals from Internal Personnel Perspective: Analytical Study. Eco, 23(2), 99-139. doi:10.4197/eco.23-2.5
Dekker, J. (2007). Zion's rock-solid foundations. Leiden: Brill.
Harkke, V. (2006). Knowledge freedom for medical professionals. Åbo: Åbo Akademi University Press.
Hung, H., Altschuld, J., & Lee, Y. (2008). Methodological and conceptual issues confronting a cross-country Delphi study of educational program evaluation. Evaluation And Program Planning,31(2), 191-198. doi:10.1016/j.evalprogplan.2008.02.005
Mizanur Rahman, M., Mamun, A., Delwar Hossain, M., & Kante, M. (2005). Peptic ulcer perforation: management of high-risk cases by percutaneous abdominal drainage. Trop Doct, 35(1), 30-31. doi:10.1258/0049475053001822
Onuminya, J. (2006). A prospective evaluation of the diagnostic value of sinus specimen cultures in chronic osteomyelitis. Trop Doct, 36(1), 38-39. doi:10.1258/004947506775599003
Ostriker, J., Kuh, C., & Voytuk, J. (2003). Assessing research-doctorate programs. Washington, D.C.: National Academies Press.
Säfsten, K. (2002). Evaluation of assembly systems.
Semyachkina-Glushkovskaya, O., Lychagov, V., Bibikova, O., Semyachkin-Glushkovskiy, I., Sindeev, S., & Zinchenko, E. et al. (2013). The experimental study of stress-related pathological changes in cerebral venous blood flow in newborn rats assessed by doct. Journal Of Innovative Optical Health Sciences, 06(03), 1350023. doi:10.1142/s1793545813500235

The institutional affiliation

Nursing is tightly connected to work with people. That is why it is of great importance to make the services provided highly qualified. Data feedback or, in other words, data received from patients would be the best evaluation tool for considering how effective the efforts taken for safe administration of medications are (Braldey, 2003). Performance evaluation tool is one more essential component to provide the most qualified patient’s care. In this way, patients are given the chance to express their opinion on the quality of the services provided (Mayhew, 2015).
According to the first approach, patients are suggested

Female sexual problem is one of the most challenging topics for health care providers as the patient may feel discomfort in discussing the topic or misattribute sexual dysfunction to depression (Nurnberg, Hensley, Lauriello, Parker, & Keith, 1999). On the other hand, health care providers may have inadequate training and insufficient experience to have in-depth sexual discussion with the patient and deal with this problematic issue (Wright & O'Connor 2015). It has been estimated that fewer than 20% of health care providers ask about the sexual activity including enjoyment, difficulties, and frequency (Loeb, Aagaard, Cali, & Lee, 2010). Female sexual dysfunction is better treated with psychological treatment of the patient, and more studies are required for pharmacological treatment.

Causes of Female Sexual Dysfunction

Female sexual dysfunction is an important patient concern that can be ongoing or can occur occasionally. It has been reported that nearly 40% of women have sex related issues in the U.S. and nearly 12% have sexual problems (Shifren, 2013). Female sexual dysfunction may include a number of problems such as absence of sexual desire, inability to arouse the feelings, absence of sexual climax or orgasm, painful intercourse (Wright & O'Connor 2015), or combination of these problems. These problems may arise as a result of physical and/or psychological issues. Physical causes can be the presence of certain biological problems such as diabetes, nerve disorders, heart disease and/or hormonal disturbances. Some medicines can also affect sexual desire and function. Studies have shown that antidepressants such as selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclics can result in sexual dysfunction (Nurnberg et al., 1999). On the other hand, psychological problems can be stress as well as anxiety. Psychological problems may also include depression and relationship problems. However, occasional problems can occur in sexual functions but long term problems need proper checkup.

Management of Female Sexual Dysfunction

Females may go through the problem of sexual dysfunction at any stage of life. It is important to know the evaluation and management strategies that can help in dealing with the problem of sexual dysfunction. One of the best strategies to deal with the problem is to know the physical aspects of the body. The more a female and her partner know her body, the more they will be able to cope with the problem and find ways to ease sexual difficulties. In order to know more about the body and the problem, it is important to gather as much information as possible. So, a female and her partner can ask their doctor or get help through educational materials to know more about several issues that can affect sex life such as aging, pregnancy, illnesses, menopause, and medicines. It is also important for a female to communicate openly with her partner. Both of them can work together on areas that can improve intimacy and bring them together.

Treatment of Female Sexual Dysfunction

Medical treatment is insufficient
Studies have shown that topical testosterone can help in the treatment of hypoactive sexual desire. However, magnitude of the treatment is small, and there is no long-term safety data. Moreover, studied testosterone replacement preparations have not been approved by the Food and Drug Administration (FDA) (Wright & O'Connor 2015). SSRIs, which are commonly used to treat depression and anxiety, can also result in sexual problems. Studies have shown that sexual dysfunction as a result of SSRIs can be treated with the help of bupropion, which is also used to treat depression or stop smoking, or slidenafil, which is helpful in treating erectile dysfunction (Wright & O'Connor 2015). In order to treat atrophic vaginitis, which usually results in pain during intercourse, topical estrogen is effective (Wright & O'Connor 2015).
Before starting a treatment for sexual problem, it is important to address all medical problems, mental health problems, or relationship problems. Usually, pharmacologic therapy is used for those women, who meet diagnostic criteria for a sexual problem or who have distressing problems or who are unable to respond to non-pharmacologic interventions (Shifren, 2013).

Psychological treatment could work better

Researchers have noted that female sexual dysfunction is adversely affected by psychological factors and problems in male sexual activities. So, it has been reported that many cases of female sexual dysfunction can be managed by considering the attitudes and sexual problems of her male partner, i.e. psychological treatment (Shaeer, Shaeer, & Shaeer, 2012).
It can be noted from above mentioned studies that medicinally or pharmacologically it is still difficult to cope with the problem of female sexual dysfunction. So, psychological therapy is best with occasional use of medicines especially for pain.

Concluding Remarks

Sexual problems are often found in women. It can be in different forms usually caused by physical or psychological issues. It is one of the most important issues to consider for normal life of females. Careful evaluation and treatment strategies can help in dealing with this problem. Evaluation can be done by considering all the sex-related issues and other physical as well as psychological aspects of the women, but limited therapeutic options are among the most important challenges for health care providers to deal with female sexual dysfunction. No pharmacologic agent for desire, arousal and/or orgasmic problem has been approved by FDA, probably due to safety problems. So, further studies are required to deal with various issues of female sexual dysfunction and treat them medicinally. Consequently, it can be said that psychological treatment of the female and her sexual partner are essential to deal with the problem of sexual dysfunction.

References

Loeb, D. F., Aagaard, E. M., Cali, S. R., & Lee, R. S. (2010). Modest impact of a brief curricular intervention on poor documentation of sexual history in university-based resident internal medicine clinics. J Sex Med, 7(10), 3315-3321. doi: 10.1111/j.1743-6109.2010.01883.x
Nurnberg, H. G., Hensley, P. L., Lauriello, J., Parker, L. M., & Keith, S. J. (1999). Sildenafil for Women Patients With Antidepressant-Induced Sexual Dysfunction. Psychiatric Services, 50(8), 1076-1078. doi: 10.1176/ps.50.8.1076
Shaeer, O., Shaeer, K., & Shaeer, E. (2012). The Global Online Sexuality Survey (GOSS): female sexual dysfunction among Internet users in the reproductive age group in the Middle East. J Sex Med, 9(2), 411-424. doi: 10.1111/j.1743-6109.2011.02552.x
Shifren, J. L. (2013). Sexual dysfunction in women: Management. Retrieved July 26, 2015, from http://www.uptodate.com/contents/sexual-dysfunction-in-women-management
Wright, J. J., & O'Connor, K. M. (2015). Female sexual dysfunction. Med Clin North Am, 99(3), 607-628. doi: 10.1016/j.mcna.2015.01.011

CONTENTS
I. EXECUTIVE SUMMARY 2

A. Purpose 2

B. Introduction 2
C. Problem Statement 5
D. Essential Research Questions 6
II. RESEARCH DESIGN AND DATA COLLECTION 7

A. Research Methodology 7

B. Statistical Tests 8
III. ANALYSIS 8
C. Test for the Correlation Coefficient of the Medium Sized Companies for Data Breaches and Associated Financial Impact. 10
D. Test for the Correlation Coefficient of the Large Sized Companies for Data Breaches and Associated Financial Impact 10
IV. CONCLUSION 11

Works Cited 12

EXECUTIVE SUMMARY
Purpose
This statistical research report has been completed to explore the validity of claims that the use of cloud computing technologies may potentially make the

1a) Name and describe sex-specific forms of obesity with regard to body shape. What are the differences, if any, in health risks, associated with each shape?
Answer : There are various forms of obesity that are signified by age, gender and genetic predisposition. The sex-specific forms of obesity include Android obesity and Gynoid obesity. Both are in contrast with each other with respect to human tendency of developing adipose tissue in the body. The Android obesity is signified by fat deposit in "apple-shape" including shoulder, nape of neck, chest in the upper abdomen which is more evident in males than females. On the other hand, gynoid distribution of fat is signified by causing a "pear-shape" fat deposit around the hip, waist and love handles in the lower abdomen. Gynoid obesity is more prevalent in females than males (Insel, Turner & Ross, 2003).
1b) Name and describe three different methods—among the various existing methods—of assessing body fatness (not BMI). What are some of the key strengths and limitations of each method?
Answer: There are many ways of fat assessment that is level of obesity in a body of a specific individual with respect to nutrition assessment, ways other than BMI include;

Skin fold Thickness - This refers to the measurement of fat in the subcutaneous layers of skin. It is measured using calipers by grasping a fold of skin in the caliper teeth. Is an easy and quick way to measure body fat

Inexpensive
Just measures the relative percentage of fat
Requires instrument and some training
Waist to Hip Ratio
This is the ratio of waist and hip measurements; it helps to evaluate fat distribution as well as helps in identification of potential risks to health with respect to level of obesity. Very easy, requires minimal calculation

No training required
Bio Impedance
This is a technical method that involves opposition or impedance of the body against a minimal electrical current that passes through the body. The lean tissue mass in the body acts as a conductor while the fat mass acts as an insulator hence depicting changes in voltage which in turn signify body fat.

Quick method

Measures from legs only thus may be inaccurate
Costly
1c) See the attached body mass index (BMI) growth chart. This graph has been plotted for an individual. What can you describe about this individual (including sex, age, height, weight, BMI, and BMI percentile)? How would you evaluate her or his health risks with regard to BMI percentile? Is there an indication, based on current understanding, for further assessment for this individual?

Answer: The growth chart shows statistical data of a 16 year old boy with weight 160.6 pounds and height 67inches. According to the Harris benedict BMI formula, his BMI calculates to 25.1 kg’s per meter square. The BMI percentile of this individual falls in the 75th percentile. The BMI signifies a trend towards obesity since it is already in the overweight range (Insel, Turner & Ross, 2003).
1d) For the same individual above, what are the known health risks going into adulthood if his or her condition remains unchecked, compared to an individual who doesn't have any of the health risks outlined in 1c? What does the CDC say about this?
Answer: The BMI signifies a tendency of obesity. The individual is already over weight which indicates a further vulnerability to fat related diseases and illnesses including high blood pressure and high blood cholesterol levels. This indication can reiterate the fact and need of further assessment of blood lipid profile and blood pressure to check out the fat and obesity status. CDC suggests close dietary monitoring as the risk of weight gain increases with increased consumption of energy yielding nutrients. Physical activity on regular basis is also advised (Insel, Turner & Ross, 2003).

1e) Select just one of the factors leading to obesity and describe its characteristics, explaining why it may be important in an individual's development of obesity.
Answer: The prime cause of obesity is the lifestyle pattern of the individual. This includes dietary habits as well as the inclusion of physical activity in the routine. Dietary habits based on consumption of energy dense foods, high saturated fat intake and more of junk food that is not nutrient dense leads to fat deposition in the adipose tissue of body (Insel, Turner & Ross, 2003). Similarly, lack of daily physical activity in routine on regular basis also contributes to inability of fat loss, and weigh gain. These factors are extremely important and crucial to an individual's tendency of developing obesity since these are major contributive factors which increase the risk of weight gain drastically.

2. Four specific pathways have been outlined for the metabolism of carbohydrate (glucose). In your own words, list and describe key components / characteristics of each:2a) Glycolysis: The other name for glucose degradation which converts glucose C6H12O6, into pyruvate, CH3COCOO− + H+. This process thus produces free energy which is then used to make high energy compounds like ATP- Adenosine Triphosphate. In simpler words, glycolysis is a non-oxygen dependent metabolic pathway which ensures that energy is provided to the body at all times throughout the day and night (Insel, Turner & Ross, 2003). 2b) Pyruvate to acetyl CoA: Pyruvate is a complex compound that helps the transformation of acetyl Co enzyme A as part of a characteristic phase in the citric acid cycle. It acts as a catalyst to complete the cycle and make energy utilization possible. 2c) Citric acid cycle: This is a successive sequence of reactions chemically taking place in all aerobic i.e. oxygen dependent organisms in order to ensure smooth generation of energy through the oxidation of acetate. This acetate is derived from energy yielding nutrients such as proteins, fats and carbohydrates into chemical energy. 2d) Electron transport chain: An Electron Transport Chain, also known as ETC is a successive sequence of reactions chemically taking place through compounds that transfer electrons from electron donors to electron receivers. This process takes place through redox reactions with the help of a membrane creating an electrochemical gradient of protons. Eventually it reaches molecular oxygen to complete the process
2e) In sports/fitness nutrition, what is meant by carbohydrate loading? When is considered useful, if at all? Give an example.

Answer: Carbohydrate also known as the Carb-Loading is usually used by sport men and endurance building athletes. It helps them in maximizing the energy stored in muscles. This stored form energy called glycogen found in liver as well as muscles is maximized by consumption of low glycemic index foods that slowly release glucose in the blood without causing disturbance in the serum glucose level. An example is an athlete consuming large meals in diet including fruits, vegetables and whole grains a day before his race so that he can 'load' his carbohydrate store for the upcoming exertion in marathon (Insel, Turner & Ross, 2003).

Question 3: Please provide a detailed explanation of how the body derives energy from the fat at cellular level? List the key steps (e.g. Beta-Oxidation), the part of cell in which the reaction occurs. What is meant by term ‘lipo-genesis’?
The body derives its energy from fats in the form of fatty acids, as they are stored as triglycerides. Fatty acids are both reduced and anhydrous, giving energy to the body. The fatty acids are found in the form of molecules that are water free. One gram of fatty acid generates 9kcal of energy as compared to 4kcal energy from a gram of carbohydrates. Lipases carry out the lipolysis and then the fatty acids are freed from the glycerol. The free fatty acids can easily enter into blood stream and provide energy to the body. The next step involves Beta-Oxidation, in which the long carbon chains of the fatty acid are broken down into acetyl CoA, enabling the latter enter the TCA cycle. This process takes place in ‘mitochondria’ of the cell. Lipogenesis means such a process that converts acetyl-CoA to fatty acids. This is a stage where the energy is stored in the form of fats, as in acetyl-CoA, energy is present in the form of sugars only. Triglyceride synthesis is an integral part of lipogenesis.

REFERENCES

Insel, P., Turner, R., & Ross, D. (2003). Discovering nutrition. Sudbury, Mass.: Jones and Bartlett Publishers.

Month and Year

Brain imaging techniques are useful to study different areas of the brain. There are many popular imaging techniques present in the media. Any technique that deals with the structure of the brain and evaluate the mechanism of the brain comes in cognitive brain imaging techniques. In a research study, I read about two techniques PET and MRI. PET stands for positron emission tomography. It helps in identifying disease, working of organs and tissues in the body. MRI stands for magnetic resonance imaging. It also scans the detailed images of organs and tissues present in the body. However, these brain

Executive Summary

Uber was founded in 2009 by Garrett Camp and Travis Kalanick in San Francisco. Both were tech veterans who invented Uber to be a competitor of the traditional taxi services. It first started as a private luxury car service that was used by top executives. Whenever one of these executives needed a ride, they would email Kalanick for a code that allowed them access to the smartphone app. This app connected passengers with drivers. Uber works the same way that Expedia connects passengers to airlines. By March 2014, Uber was operating in 85 cities and 33 countries. The company

Introduction:

Stakeholders are the pillars of any project. The analysis of this important aspect of a project helps the organization to identify information for evaluation and assess stakeholder information in order to create relevant policies or design the inherent activities of the institution. There may be two implications of the results thus generated; a general implication because of the broad understanding of required change or specific information on prospective concrete steps that may be suitable for the present scenario (Case.edu, 2015). Stakeholder analysis thus facilitates the planning, implementing, evaluating and managing functions of an organizational and a project.
In the

Disasters most commonly elicit the response of city, local, state, and federal aid agencies to meet the mitigation of destruction during various phases of an emergency event. Public health legal authority, during a hazardous substance discharge, may call for both public and private agency involvement. Thrusting personnel and materials in the area must operate under the auspices of inter-jurisdictional protocol and legal authority. The objectives in this written exercise are to alert the learner, in anticipation of future professional behavior, about gaining an understanding for legal protocols in public health/hazardous emergencies while maintaining the highest levels of public safety during a disastrous event – involving dangerous substance discharges. In an effort to explore questions pertaining to the assigned case study, this essay seeks to posit descriptions, and explanations for procedural legal authorities in an emergency response situation.

Background: Question 1 & 2

At the outset it is important to present a brief overview of the definition of law, in matters of public health authorizations and preparedness. Kamoie et al. (2008) states that law can be defined “as a rule of conduct derived from federal or state constitutions, statutes, local laws, judicial opinions, administrative rules and regulations, international codes, or other pronouncements by entities authorized to prescribe conduct in a legally binding manner” (p. 23). In the event of a mass-casualty bio-chemical event a Governor can declare an emergency under the legal authority of health agency directives, for types comprising “natural disaster,” or those associated with public health disease/emergencies, according to a document Fact Sheet published by The Association of State and Territorial Health Officials (Emergency Declarations, Authorities”). Since according to Kamoie et al. (2008) law is a key component of the legal public health core.

So as the situation warrants, the Governor may declare such given an assessment of the dire urgency in bio-chemical type of disaster. Although, under the Public Health Service (PHS) Act the Feds may establish such declaration. The criteria and procedures for requesting emergency response aid from state/local jurisdictions obviously varies from region to region. However, the general process allows the Governor to: (a) declare the status of emergency for a specific period of time, (b) act within state rules/regulations, and (c) coordinate/request help from neighboring states usually under authority of federal agencies gathering logistical, financial, and “technical assistance” (“Emergency Declarations, Authorities”). The extent of help and exact funding from federal government, must be coordinated.

October 1, Train Derailment: Questions 3 & 4

When multiple jurisdictions are affected by a disaster of the burgeoning greenish-yellow toxic chem-cloud formations (from the train wreck), communications are the key to releasing authorities. Inevitably, the CDC will be involved at the federal level. But as Kamoie et al. (2008) note, “at the state level, the primary legal authority to respond to emergencies has been the police power,” to act as arms of the state to regulate protections for “the health, safety, and welfare of citizens” (p. 24). This might be viewed as a first-line of immediate security. Of course, common sense dictates that some of the key legal concerns regarding first responders and volunteers, would be their safety and legal qualifications. But, just as the case of 9/11 demonstrated, first responders at the local level are on the scene initially. In critical ways, they are the key link to administrating crucial communications to multi-jurisdictional authorities and federal agencies.

The local sheriff’s office will most likely coordinate the police powers and localized actions of authority to secure the area from onlookers, and interested panicked people from further clogging up the access pathways to the areas immediately affected. In coordination of HAZMAT teams, in consideration of the gas plumes quickly proliferating and spreading, a series of communications systems will be implemented, with local Fire Department and local Public Works Department. As demonstrated in a real-life case as documented by the National Transportation Safety Board (NTSB), in a similar train accident, fire, “heat, smoke, and fumes had restricted access to the tunnel for several days” (“Railroad Accident Brief, 2004, p. 1). The conditions involved a similar flooding, with multiple millions of gallons of water having burst from a water main. As in the case pertaining to our case study question, the situation cited in this Railroad Accident Brief which occurred in Baltimore, Maryland, the train of course was in motion at the time of derailment, having had “eight fully loaded tank cars containing hazardous materials” – all of which were “regulated by the U.S. Department of Transportation (DOT)” (“Railroad Accident Brief, 2004, p. 1). As indicated in the initial paragraph of this Question-Section, communications in these types of public health emergencies are critical. Chief dispatchers and communication centers necessitate a variety of coordinated responses including: site evaluations, assessment of toxins, analysis of potential for explosions, prevention of further damage/injuries, and charting clear legal permissions for authorizations to act.

October 1, Health Consequences at Valley High School: Questions 5 & 6

Competencies and responses are at urgency levels when students begin to experience symptoms of toxic poisoning, especially with maximal exposure to chemical contamination from the nearby train derailment. Given the factor that deaths have already ensued, with a plethora of 9-11 calls to the local hospital, obviously the situation calls for immediate action. The Governor must proceed along the proper criteria for declaration of a state of emergency in the area specifically constituting a public health emergency. The actual local procedures for the Governor may demonstrate an urgent approval by the legislative body and/or State executive officers (“Emergency Declarations, Authorities”). Also, within the rubric of the situation it may additionally be necessary to declare an emergency of several types, in the areas of both public health and disaster depending upon how that particular State jurisdiction is established to respond.
What constitutes a public health emergency? According to federal authorities, a public health emergency is defined by the statute under portion 319 of the Public Health Service (PHS) Act as aforementioned. The situation is described as involving disease or any type of urgent public health disorder, which may also include “significant outbreaks of infectious disease or bioterrorist attacks” (“Public Health Emergency Declaration,” 2015). The federal government extensively lists all such examples which may include, but not be limited to, tornadoes, floods, flu outbreaks, hurricanes, or anything threatening to spread contaminants of disease or toxins.

Mutual aid agreements can be used both during an absent an emergency declaration, but smartly responding to the situation within common-sense legal awareness. In the clear absence of an officially authorized emergency declaration, there are options for improvement of legal competencies. In a scholarly journal article on this aspect, Gebbie et al. (2008) that four key issues may outline a framework. Authors Gebbie et al. (2008) explain that the first such area considers an expansion of sectors requiring “competency in public health law and public health legal preparedness” (p. 53). In other words, since legal ramifications can be complex, as well as the involvement of professionals in critical public health roles, each sector of stakeholders should have identifiable competencies. For example, in the case of the people actually dying within four hours of the train accident, the National Guard may need to exercise evacuation at some point, and the CDC and Red Cross may need to exercise their organizational responses. Therefore, mutual aid agreements can be used and applied in the absence of a declared state of emergency, by adhering to local laws so deemed enforceable on the local or State level on the basis and scope of best practices under the locally deemed jurisdictional statutes. Use of all readily available assessment tools, diagnoses, legal/police protections, and quarantines so available must be coordinated by such mutual aid agreements.

October 1, Further Information: Question 7a, 7b, & 7c

At this point, it is understood that the Fire Chief himself has been nearly overwhelmed by the fumes after arrival on the scene. It is also clear at this juncture that communications have been impaired. The legal and operational considerations which influence the decision to call for an evacuation is due to the ‘Red-Alert’ situation. In the case of the nursing home facility being unable to move their elderly for 24 hours, demands that communications seek another immediate route. Since the disaster has, thus far, rendered contamination covering two states an emergency outreach utilizing the communications system (temporarily) of the third adjacent state – which has not, up to this point been affected. The legal and competencies factors should be considered when deciding upon a shelter-in-place for evacuation. For example, reliance upon the professional expertise of the nursing home director who insists that the elderly dwellers cannot be moved before 24 hours, demonstrates his practical certified competency in his field. Another key factor to be considered, is whether the third state (which has not been affected) can lend help with communications while possibly creating an emergency horizontal community of responders. Gebbie et al. (2008) suggest this method to “stimulate the development of best legal practices in public health emergency preparedness for specific communities and specific types of emergency events” (p. 55). Granted, it would have been wise to have formed the coalition before disaster struck, but an urgent cooperative effort is actually beneficial to the entire hinterland, so as to retard the spread of disaster.
The requirements of the elderly and other special-needs populations must be addressed in terms of speed, safety hazards in moving them, and the quality of evacuation location shelters once there. The requirements are addressed by assessing their numbers, and the availability of suitable evacuation locations, and competent medical or care teams, in addition to police protections – until the National Guard may be authorized and deployed. Choosing between mandatory or voluntary evacuation orders is a common-sense call. For example, in the case of Valley High School students, they need to be evacuated immediately – due to the severe and present implications of illness and because of their dangerous proximity in terms of exposure to fumes. Also, they are young and able-bodied enough to more quickly respond to evacuation than the elderly. An alternative measure may need to seal off the nursing home, and administer oxygen masks temporarily until they can be moved.

October 1, Review of Legal Authorities for Evacuation: Question 8

According to FEMA, on the federal level the agencies so designated enforce or authorize an evaluation or actual shelter-in-place order are as follows. FEMA, DHS, and the Departments of Agriculture, Commerce, Defense, Energy, Health & Human Services, Justice, Transportation, Veterans Affairs, GSA (General Service Administration), American Red Cross, and two others (“Mass Evacuation Index”). Obviously, if no emergency has been declared yet by the Governor in a dire situation the Red Cross may be the best road for immediate action.

October 1, Governor Requests Plan Review & Coordination: Questions 9 & 10

Continuity of the courts and justice system must infallibly and meticulously maintained, despite any emergency disaster situation of the most hazardous nature. The way such legal system of courts and jurisprudence are ensured is to follow the step-by-step guide plan which include typical goals of reducing disruptions to operations, continue court essential function, preserve rule of law, minimize loss of life, help secure preservation of equipment/facilities, and designate specified personnel so that clarity of who is in charge is maintained (“Continuity of Court”). State and national coalitions are in place.
In terms of supplying medical services on the spot, and preservation of an orderly atmosphere at medical care facilities in proximity of the disaster, team members of planning work together with the agency (such as The Red Cross, or FEMA). According to the same aforementioned report, they proceed to “identify possible service providers,” which for example may be the local Department of Health & Human Services division (p. 25). In this way, the logistics can be sufficiently ironed out and kept orderly, by assignment of obtaining additional staff, properly communication channels, and assurance of staff roles and competencies. Competencies are very important in this type of case. When one considers the seriousness of a train and multiple-vehicle derailment over water with leakage of dangerously toxic chemicals, that are airborne, timely coordination and competencies are key.
In fact, in the literature, one journal article breaks down the importance of improving competencies in a public health emergency situation while maintaining focus on legal protocols. Gebbie et al. (2008) indicate that “disseminating competency information to key target audiences,” and “improving measurement and evaluation of practice impact” are two vital areas which must be adamantly addressed in terms of framework for the agenda at hand during such emergency (p. 52). Obviously, when the communications were experiencing trouble in the immediate area of the emergency disaster outbreak in our case study, it was learned that to act quickly with flexibility by using the communication infrastructure of the unaffected state. Once that gap had been closed and control of the situation ensures a smooth recovery of communications, rescue and legal stakeholders may proceed. In this context, the law can function better and decide if isolation or quarantine stipulations must be implemented, in accordance with the right professionals and those authorized to play critical roles in the situation.

October 1, Mass Evacuation Order & Concern for Displaced Persons: Questions 11 & 12

At this point, the Emergency Operations Center along with the Governor has decided to order a mass evacuation. Given assistance by local law enforcement agencies, a house-to-house will be conducted. It is important to know the local legal requirements in the jurisdiction to apply public health emergency management care like food, water, shelter, and medical care. The CDC has mandates for the handling of such. Accordingly, the local government and personnel must abide by the Federal Code of Health and Safety Code Section 34070-34072. This mandates contractual provision for “recognized community organizations” to step up to the plate with provisional shelter, care, and food (“Guide for Local”). The coalition partnership works and functions cooperatively with the Red Cross to help citizens, until (or if) national disaster responders may be mobilized.
Local businesses need safety protections as well. Each local jurisdiction may have slightly differing guidelines in place, in terms of the minute details. But the CDC outlines in its guide the general procedures for ensuring that homes and businesses are safe particularly before allowance that people return home. Local law enforcement agencies and the Fire Department play key roles in assessing the situation, while the probability of federal troop intervention may be deployed to help, depending on governmental agreements in planning.

References

Association of State and Territorial Health Officials – ASTHO. (2015). Emergency Declarations and Authorities [Data file]. Retrieved from http://www.astho.org/Programs/Preparedness/Public-Health-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Emergency-Declarations-and-Authorities-Fact-Sheet/
CDC.gov. (2015). A guide for local jurisdictions in care and shelter planning [Data file]. Retrieved from http://www.cdc.gov/nceh/ehs/Docs/Guide_for_Local_Jurisdictions_Care_and_Shelter_Planning.pdf
FEMA. (2015). Mass Evacuation Incident Index [Data file]. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf_massevacuationincidentannex.pdf
Gebbie, K.M., Hodge, J.G., Meier, B.M., Barrett, D.H., Keith, P., Koo, D., & Winget, P. (2008). Improving Competencies for Public Health Emergency Legal Preparedness. Journal of Law, Medicine & Ethics, 3652-56. doi:10.1111/j.1748- 720X.2008.00261.x
Kamoie, B. Pestronk, R.M., Baldridge, P., Fidler, D., Devlin, L., Mensah, G.A., & Doney, M. (2008). Assessing Laws and Legal Authorities for Public Health Emergency Legal Preparedness. Journal of Law, Medicine & Ethics, 3623-27. doi:10.1111/j.1748- 720X.2008.00256.x
NCSC – National Center for State Courts. (2015). Continuity of Court Operations [Data file]. Retrieved from http://www.ncsc.org/~/media/Files/PDF/Services%20and%20Experts/Areas%20of%20expertise/Emergency%20Preparedness/toolkit.ashx
National Transportation Safety Board. (2004). Railroad Accident Brief [Data file]. Retrieved from http://www.ntsb.gov/investigations/AccidentReports/Reports/RAB0408.pdf
U.S. Department of Health and Human Services. (2015). Public Health Emergency Declaration [Data file]. Retrieved from http://www.phe.gov/Preparedness/legal/Pages/phedeclaration.aspx

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