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Analysis of public responses to preparedness policies: the cases of H1N1 influenza vaccination and gas mask distribution
Baruch Velan1,
Valentina Boyko2,
Gilead Shenhar3,
Liat Lerner-Geva2,5 &
Giora Kaplan4
During several months in 2009–2010, the Israeli population was asked to take part in two preparedness programs: Acquisition of gas masks against a potential chemical-warfare attack, and vaccination against the A/H1N1 influenza pandemics. Compliance with the first request was moderate and did not attract much attention, whereas compliance with the second request was very low and was accompanied by significant controversy. The aims of this study are to compare the public's attitudes towards these two preparedness campaigns, and to explore the roles of trust, reasoned assessment, and reflexive reactions in the public's response to governmental preparedness policies.
The comparative analysis was based on a telephone survey of 2,018 respondents representing a cross-section of the adult Israeli population. Univariate analysis to describe associations of public response and attitude was performed by Chi-square tests.
A set of queries related to actual compliance, trust in credibility of authorities, personal opinions, reasons for non-compliance, and attitudes towards uncertainties was used to characterize the response to mask-acquisition and vaccination. In the case of mask-acquisition, the dominant response profile was of trusting compliance based on non-conditional belief in the need to adhere to the recommendation (35.6% of respondents). In the case of vaccination, the dominant response profile was of trusting non-compliance based on a reflective belief in the need for adherence (34.8% of respondents). Among the variables examined in the study, passivity was found to be the major reason for non-compliance with mask-acquisition, whereas reasoned assessment of risk played a major role in non-compliance with vaccination. Realization of the complexity in dealing with uncertainty related to developing epidemics and to newly-developed vaccines was identified in the public's response to the H1N1 vaccination campaign.
The newly identified profile of "trusting-reflective-non-complier" individuals should be of concern to policy makers. The public is not accepting governmental recommendations in an unconditional manner. This is not driven by lack of trust in authorities, but rather by the perception of the responsibility of individuals in confronting forthcoming risks. Nevertheless, under certain conditions the public may respond in a non-reflective way and delegate this responsibly to authorities in an uncontested manner. This leaves the policy makers with the complex challenge of interacting with a passive non-involved public or alternatively with an opinionated, reflexive public.
The responsibility of the State for the health of its population entails appropriate preparedness against emerging large-scale health hazards. This includes risk communication as well as provision of the appropriate protection measures. During a period of several months during 2009–2010, the State of Israel exercised this responsibility by launching two national campaigns. The Israeli population was urged to get vaccinated against the developing H1N1 pandemic influenza, and to acquire gas masks and hoods against a potential future attack by chemical or biological warfare.
The A/H1N1 influenza (hereafter, H1N1) of 2009 is considered one of the most widespread pandemics in recent history. In March 2009, the outburst of a novel strain of influenza, linked to swine influenza, was detected in Mexico, and as of January 2010 it had caused nearly 15,000 deaths in 209 countries [1, 2]. H1N1 was declared a pandemic by the World Health Organization on June 2009, as soon as infection had shown sustained human-to-human transmission in different geographic regions [3]. The WHO declaration boosted the implementation of various countermeasure programs by national organizations worldwide, and prompted the development and production of vaccines against the H1N1 virus [4]. The first H1N1 vaccines were licensed in mid-September, and by October 2009 most industrialized countries had rolled out national vaccination programs.
The sequence of the H1N1 events in Israel resembled those observed in other industrialized countries. The first case of H1N1 was identified in Israel on April 24, 2009, and by the end of July 2009, 1500 confirmed cases were reported. The Israeli government placed an order for 7.7 million doses at the earlier stages of the pandemic, and the vaccination program was launched at the beginning of November 2009. Vaccination was offered first to individuals at risk and health care workers, and at later stages to everyone, free of charge, supplying the vaccine progressively [5, 6]. Vaccination was carried on by the Israeli HMOs, and was promoted extensively by the Ministry of Health. Controversies related to vaccination, focusing mainly on the safety of the adjuvant-containing inactivated vaccine preparations purchased by Israel started early on. The government's major efforts to promote the H1N1 vaccine through a widespread campaign involving national TV, newspapers, leaflets, and posters placed in public areas were met with skepticism, resulting in a low compliance rates among Israelis [7].
The decision to provide gas masks to the entire Israeli population can be traced back to the period of the First Gulf War in 1991 [8]. Gas mask distribution was based on accumulating intelligence reports on Iraq's chemical and biological warfare arsenals and on the actual fact that during the First Gulf War, Israel was attacked by 39 Iraqi missiles, all of which turned out to carry conventional missile heads.
The threat of a non-conventional attack reemerged in 2003 during preparations for the Second Gulf War. The Israeli Civil Population was called to acquire new and renewed masks. At a certain point during the war, the public was asked to prepare the masks for use by opening the mask boxes, connecting the filter, and adjusting the mask to the face. Israel was not attacked during the Second Gulf War and the masks were not used. Nevertheless, opening the packaged masks and filters led to their expiration and the need for renewal [9].
During 2007–2008 the masks were collected from the public for aftercare and in 2010 the Israeli government decided to distribute the re-validated gas masks to the Israeli population [10]. Distribution was commissioned to the Israeli Postal Company, which is a commercial enterprise. The distribution, which started in April 2010, was preceded by a two-week long national campaign on the three main TV channels. The campaign urged the population to re-acquire gas masks, offering two options for acquisition: by courier (with a modest payment of $6 per family), or by collecting the masks at appointed distribution points (free of charge).
The responses of the public to the H1N1 vaccination campaign and to the mask distribution campaign were quite different. The vaccination campaign met with much controversy, leading to a very intense public debate and to a very low compliance rate (about 13%) [7]. In contrast, the gas mask acquisition campaign did not lead to debates or discussions, and the compliance rate was moderate (approximately one-third).
The aim of the present study is to analyze the public's attitude to H1N1 vaccination and gas mask acquisition in a comparative way. We realize that these two cases differ along several dimensions, including the severity of the threat and whether it is local or global, the risks and costs involved in adopting the preventive measure, and the nature of the opposition to adoption of the preventive measure. Still, it is useful and important to consider the two cases in a comparative context as they both relate to large-scale public health risks, and provide an opportunity to explore the complexity of the attitudes of the public toward governmental authorities in the face of such risks. This allows the identification of two modes of response to preparedness policies, one characterized by non-reflective compliance and the other by conscious noncompliance.
The study does not purport to be an exhaustive analysis of all the reasons for the incomplete adherence of the Israeli public to governmental recommendations regarding H1N1 and gas mask acquisition, nor does it seek to quantify the independent impact of each of the many factors involved. Instead, it seeks to identify and highlight several key factors that have previously not been noted in the international literature on public response to governmental preparedness policies.
This cross-sectional study was based on a randomly selected representative sample of the Israeli adult population (aged 21 and over). A probabilistic stratified sampling of households was built, based on official statistical areas characterized by socio-demographic characteristics. Areas were then matched with the computerized list of subscribers to the national telephone company, and households were randomly chosen. Excluded were fax numbers, disconnected numbers, and commercial numbers. As of 2009, about 85% of Israeli households had landline telephones [11].
The survey was conducted by telephone during March 2011 by the Cohen Institute for Public Opinion Research at the Tel Aviv University. The telephone interviews were conducted in Hebrew (79.5%), Arabic (15.7%), and Russian (4.8%).
The number of households in the target sample was 4,370; of these 1,112 contacts turned out to be abortive (fax numbers, disconnected numbers, failure to establish contact following up to five tries). Contact was established with 3,258 households. Of these, 1,240 did not agree to take part in the survey. The final sample included 2,018 complete questionnaires, yielding a response rate of 62%. Only one adult in each household was interviewed. This group was also used in a different study addressing responses to other recommendations, including Human Papilloma Virus vaccination, childhood vaccination, and travel vaccines (not presented here).
All interviewees were asked to respond to a series of questions relating to their attitudes towards preparedness against the H1N1 influenza epidemic. In parallel, interviewees were asked about their attitude toward preparedness against a potential non-conventional attack by chemical warfare, and attitudes towards governmental decisions. All participants were also asked about their actual compliance with flu vaccination and gas mask acquisition, and asked to provide explanations for non-compliance with recommendations. The design of the study as well as the questionnaire used was approved by the ethics committee of the Sheba Medical Center.
Statistical analysis was performed using SAS statistical software (Version 9.2, SAS Institute Inc., Cary, NC). Categorical variables were compared by chi-square tests. A two-sided p value <0.05 was considered significant. Degree of agreement between attitudes to different recommendations was measured by calculating Kappa coefficients.
Survey sample
The survey sample included 2,018 adult participants. The socio-demographic characterization of the survey group included: gender (46% males, 54% females), income (38% below average, 23% average, 26% above average, 13% non-disclosure), ethnicity (18% Arabs; 82% Jews), education (43% with ≤ 12 years of schooling; 57% with > 12 years of schooling), and age (34% aged 21–39, 36% aged 40–59, 30% aged 60 and older). Representation of the main socio-demographic variables in the sample was not significantly different from their representation in the adult Israeli population [12] in terms of gender, income, and ethnicity. The exceptions were the over-representation of the ≥60 age group (30% vs. 22% in the general population), and the over-representation of individuals with ≥12 years of schooling (57% vs. 47% in the general population).
Rates of Compliance with H1N1 vaccination and mask acquisition
The survey was conducted during March 2011. All 2,018 participants in the survey were asked if they had been vaccinated against H1N1 influenza during the winter of 2009, and if they had acquired a gas mask during the 12 months preceding the survey. About 22% of the respondents declared that they had complied with the recommendation for H1N1 vaccination, whereas 56% declared that they had complied with the recommendation for gas mask acquirement (Table 1). These rates are higher than the actual compliance rates of the Israeli population, which at that point in time were 13% for H1N1 vaccination [Communicated by Prof. I. Grotto, head of the Public Health Services of the Israeli Ministry of Health] and about 32% for gas mask acquisition when the survey was conducted [Communicated by the spokesman of the Israeli Defense Forces]. It is interesting to note that for both recommendations the same divergence was noted: ~1.7-fold ratio between actual compliance of the Israeli population and declared compliance of the survey group. This bias could be related to social desirability (responders' attempts to provide a response that will presumably please the interviewer), or to a compliance bias in the selection of the survey group (individuals who comply with health recommendations are also the ones that will most likely agree to take part in surveys).
Table 1 Rates of compliance with H1N1 vaccination and gas mask acquisition among 2018 responders
Public's perceptions of authorities' motivations in promoting vaccination and gas mask acquisition
The H1N1 vaccination campaign was launched by the Ministry of Health (MOH), whereas that for mask acquisition was launched by the Home Front Command (HFC). The notable difference in compliance to these two campaigns may be related, in part, to differences in the public's attitudes towards these two institutions. To examine this, respondents were asked to express their opinion on the motivation of the authorities in launching the two campaigns. Four different answers were offered as response options (stated in Table 2).
Table 2 Public's perceptions of the motivations of the authorities in prompting vaccination and gas mask acquisition (N = 2018)
Two response options attribute to authorities a sincere intention to serve the public's interest, and thus express trust and credibility. One of those responses (1) suggests that the authorities have forecasted a real upcoming danger and attempted to provide protection against it. The other response (2) suggests that authorities were uncertain about the developing danger, yet believed that countermeasures should be provided in order to protect the public. The majority of the responders believed that the authorities were motivated by the desire to serve the public in launching both the H1N1 vaccination campaign and the mask campaign (62.9%, 269 respondents; and 64.4%, 229 respondents, respectively). While the percentage of individuals believing in the credibility of authorities is practically identical for both recommendations (p = 0.16), uncertainty in the developing danger (response 2) is associated, to a greater extent, with the mask campaign than with the vaccination campaign (41.7%, 842; and 32.4%, 654, respectively; <0.0001).
The two other response options relate to actions that are not necessarily motivated by a desire to serve public interest. One of those response options (3) suggests that authorities were uncertain about the danger, but acted according to the worst case scenario in order to be protected from future criticism if the danger eventually materializes. The other response option (4) attributes ulterior motives to authorities. The choice of either of these two response options expresses distrust in authorities. Such distrust was expressed by 30.4% of the respondents (614) when addressing the vaccination campaign, compared to 25.7% (519) in the case of the mask campaign (p < 0.0001). The agreement in the attitudes of specific individuals to authorities' motivations in promoting vaccination versus mask acquisition was found to be significant, yet moderate. The number of observed agreements was 1189 (58.9%), and the calculated kappa coefficient was 0.20 (95% CI = 0.16–0.23).
Taken together, these results attest to a rather high degree of trust in the credibility of authorities' decisions related to both campaigns. This also suggests that the difference in compliance between H1N1 vaccination and gas mask acquisition cannot be attributed to major differences in the attitudes towards the MOH and the HFC. Indeed, analysis of the relationship between trust in authorities and actual compliance reveals that distrust is a poor predictor of non-compliance (Table 3). While the majority of compliers with vaccination and gas mask acquisition also expressed trust in authorities (78.7%, 348; and 70.7%, 800, respectively), non-compliance was not necessarily associated with distrust. As many as 58.6% of the responders (911) who did not comply with the H1N1 vaccination recommendation did so despite their belief in the credibility of the authorities. In a similar way, 57.9% (484) of the non-compliers with mask-acquisition appear to exhibit trust towards authorities.
Table 3 Interrelationships between trust in authorities and compliance with vaccination and gas mask acquisition (N = 2018)
Additional insight into the interrelationship between trust and compliance can be gained by grouping the population into distinct subgroups: "trusting compliers", "trusting non-compliers", "distrusting compliers", and "distrusting non-compliers". In the case of vaccination, "trusting-non-compliers" form the largest group: 911 of the respondents who comprise 45.1% of the survey group (Table 3). These are followed by "distrusting-non-compliers" (26.5%, 535), "trusting compliers" (17.2%, 348), and "distrusting-compliers" (3.7%, 75). A similar analysis of the response to mask-acquisition reveals that the leading group is that of "trusting compliers": 800 respondents who comprise 39.6% of the survey population, while only 484 respondents (24%) can be defined as "trusting-non-compliers". These results suggest that trust can be translated into different modes of action, depending on the specific circumstances.
Attitudes towards compliance with H1N1 vaccination and mask acquisition
The notable difference in the behavior of the public in response to the vaccination campaign and the mask campaign could be due, in part, to differences in the public's attitudes towards these two procedures. To examine this, all respondents were asked to express their attitudes towards compliance with vaccinations or mask acquisition by choosing one of four response options: 1) everyone should comply; 2) people at risk should comply; 3) compliance should be left to personal choice; 4) there is no need to comply (Table 4). The first option could be considered as a tendency towards "Non-conditional Acceptance", the second and third options could be considered as a tendency towards "Reflective Acceptance", whereas the last choice expresses "Non-Acceptance".
Table 4 Public's attitude towards acceptance of H1N1 vaccination and mask acquisition (N = 2018)
The distribution of responses (Table 4) indicates that "Non-Acceptance" is a minor attitude-motive for both recommendations (2.2%, 44 for vaccination; and 4.6%, 94 for masks). The vast majority of respondents expressed acceptance of the two recommendations, yet the nature of the acceptance was very different. In the case of gas mask acquisition, 75% of the respondents expressed "Non-conditional Acceptance" and 15.4% expressed "Reflective Acceptance". This ratio was reversed in the case of the attitudes towards H1N1 vaccination. Here, only 23.3% favored "Non-Conditional Acceptance" whereas 72.5% believed that acceptance should be linked to either the personal choice of the individual or the specific risk faced by each individual ("Reflective Acceptance").
It appears that acceptance of H1N1 vaccination is a rather reflective process and is associated with the pre-existence of specific health conditions. In contrast, acquisition of gas masks is being viewed as a procedure that does not require contemplation and analysis. Interestingly, 43% of the respondents (877) believe that H1N1 vaccination should be a matter of personal decision, yet only 11% (234) believe that this is the case for gas mask acquisition.
The analysis of interrelationships between attitude and compliance (Table 5) reveals a varied interrelationship. In the case of mask-acquisition, most compliers (86.2%) believe in "Non-Conditional Acceptance", but this is also the case for the majority of non-compliers (62.8%). In the case of vaccination, compliers are equally divided between those who favor "Non-conditional Acceptance" and "Reflective Acceptance" (48.2% and 48.9%). Notably, non-compliance to vaccination is associated with a belief in "Reflective Acceptance" (79.4%) rather than "Non-Conditional Acceptance" (16.3%).
Table 5 Interrelationships between favorable attitude and compliance with vaccination and mask acquisition (N = 2018)
Grouping of the respondents according to compliance versus attitude (Table 5), reveals that in the case of vaccination the dominant group can be defined as "reflective non compliers", comprising 1235 of the 2018 respondents (61.2%), whereas for gas masks the dominant group consists of "non-conditional acceptors", which consists of 976 respondents (48.4% of the survey group).
Profiling of responses to recommendations for H1N1 vaccination and mask-acquisition
The intricate interrelationship among compliance, attitude, and trust, led us to profile the respondents based on variants related to these three markers. This was achieved by cross-tabulation of Tables 3 and 5 to generate new composite tables, defining response profiles to mask-acquisition (Table 6) and vaccination (Table 7). This allowed the grouping of the survey population into 20 subgroups; 12 groups were found to be small in proportion or ill-defined, leaving us with 8 groups.
Table 6 Profiling of public's response to recommended gas mask acquisition (N = 2018)
Table 7 Profiling of public's response to recommended H1N1 vaccination (N = 2018)
Analysis of the response to recommendations for mask acquisition (Table 6) reveals a predominant attitude of trust in authorities and a belief in non-conditional acceptance. In most cases this is translated into actual compliance, forming a large group of 719 "Trusting-non-conditional-compliers" (35.6% of the survey group). Nevertheless a smaller, yet substantial, group of respondents (348; 17.2%) who trust authorities and believe in non-conditional-acceptance chose not to comply. All other permutations on compliance/attitude/trust were observed as well (Table 6), yet these were represented by groups of small percentage (below 10%).
The response to recommendation for H1N1 vaccination (Table 7) is characterized by a different attitude profile. The dominant attitude here is trust in authorities and belief in conditional reflective acceptance. In most cases this is translated into non-compliance, forming a large group of 702 respondents defined as "Trusting-reflective-non-compliers" (34.8% of responders). A smaller group of non-compliers (456; 22.6%) distrust authorities and believe in reflective acceptance ("Distrusting-reflective-non-compliers"). Other groups were again represented in low proportions.
Reasons for not complying with H1N1 influenza vaccination
To further analyze the reflective nature of the response towards H1N1 vaccination, the actual reasons for not complying with H1N1 influenza vaccination were examined. All 1555 respondents who did not receive the vaccine were asked to specify the reason for not doing so. Respondents were offered a set of 7 fixed responses to choose from. The fixed responses were based on the predominant answers provided previously [7] to an open-ended question about reasons for not complying with H1N1 vaccination. If none of the fixed responses expressed their motivation, respondents were allowed to phrase their own answer. Fixed answers as well as open answers were then grouped into three major categories: Passivity, Reasoning, and Distrust (Table 8).
Table 8 Reasons for not complying with H1N1 vaccination (N = 1555)
Passivity was manifested by 283 respondents out of 1555 (18.2%). Reasoning was manifested by as many as 947 respondents out of 1555 (60.9%), and distrust by 257 respondents out of 1555 (16.5%). It should be noted that 68 (4.4%) participants failed to provide a defined reason for their action (Table 8). These observations suggest that, as indicated previously [7], the major motives in failure to get vaccinated can be traced to reasoned assessments of risks and benefits.
This behavior (Table 8), taken together with the prevalence of an attitude of "Conditional Acceptance" towards H1N1 vaccination (Table 4), suggests that the majority of the respondents did not object to vaccination, but felt that the evolvement of the H1N1 epidemic did not justify their personal compliance.
Motives in the response to gas mask acquisition compared to H1N1 vaccination
All 836 respondents who did not acquire gas masks were asked to specify the reason for not doing so. Respondents were offered a set of five fixed responses to choose from and were also allowed not to disclose their reasons (Table 9). Indifference was manifested by as many as 50.8% (425) of the respondents, whereas distrust was manifested by only 4.7% (39). Reasoning was not a major motive in not complying with mask acquisition; as this applied to only 19.6% (169) of the respondents.
Table 9 Reasons for not complying with gas mask acquisition (N = 836)
The response of the survey group to the recommendation related to gas mask acquisition was quite different from the response related to H1N1 vaccination (see summary in Table 10). The major motive in the response to gas mask acquisition was adherence with the recommendation (56%; 1123) and this was followed by non-adherence base on indifference (21%; 425). Non-adherence based on reasoning or on distrust appears to be of much lower incidence (8%, 164; and 2%, 39, respectively). In contrast, non-adherence based on reasoning appears to be the dominant motive (47%, 947) in the response to H1N1 vaccination, whereas non-adherence based on indifference appears to be of a lower prevalence (14%, 283), and resembles the prevalence of non-adherence based on distrust.
Table 10 Major motives in the actual response to recommendations related to H1N1 vaccination and gas mask acquisition (N = 2018)
The recommendations of the public for preparedness measures against an emerging epidemic
The rational attitude exhibited by the respondents towards H1N1 vaccination together with the low compliance with recommendations suggest that the Israeli public believes in its ability to make the right decisions when dealing with epidemics. To further evaluate this, respondents were asked to provide their recommendations for national preparedness against an emerging outbreak. Two scenarios were offered to the respondents, both of which described a serious epidemic that was supposedly developing in a South American country. In one case the outbreak could be controlled by a well-established vaccine, and in the other case control could be achieved by using a newly developed vaccine. For both scenarios the respondents were asked to state their opinion on purchasing a national vaccine stockpile and on preventive vaccination. Four possible operational options were presented to the public (Table 11). One of the options represents a "wait and see" policy, suggesting that the state should wait and not purchase the vaccine. Another option is a "get prepared" option, suggesting that vaccines should be purchased but not used. The two other options represent an active approach (vaccinate the population); one suggests that individuals at risk should be vaccinated and the other that everyone should be vaccinated.
Table 11 Public's opinion on preparedness policy to an epidemic emerging overseas (N = 2018)
For both scenarios, the majority of respondents did not favor an active vaccination policy (about 40% favored vaccination in the case of an established vaccine, and less than 30% in the case of a new vaccine), and the number of respondents that favor vaccination of everyone was low (less than 10%). A large number of respondents favored a "wait and see" approach expressing a clear distinction between policies related to established vaccines and new vaccines. In the case of a new vaccine, 48.5% of the respondents (978) suggested that the state should refrain from purchasing the vaccine as opposed to 27.7% (559) in the case of an established vaccine (p < 0.0001).
The option of purchasing vaccine but not using it was favored by a substantial number of respondents. This option was more acceptable in the case of an established vaccine than in the case of a new vaccine (22.9%, 462; and 15.5%, 313, respectively; p < 0.0001).
Taken together, these observations suggest that the public is strongly opinionated about vaccination policy (note the low number of respondents who did not express an opinion on the subject, Table 10). Moreover, the public appears to appreciate the complexities and ambiguities related to epidemic preparedness policy.
Preparedness and response to potential large-scale health hazards constitutes one the biggest challenges for policy makers. This challenge is intensified as the certitude about the events and about the outcomes decreases. The accepted practice in many of such cases is to rely on the precautionary principle [13]. This principle establishes an obligation for action; even when the absence of scientific certainty makes it difficult to predict the likelihood of harm occurring, or the level of harm should it occur. In most cases this obligation has to be translated into "institutional" actions such as budget allocation, organization, and active preparedness of the relevant institutions. In certain cases the collaboration of the general public is required as exemplified by the two cases examined here: preparedness against pandemic flu and against a chemical warfare attack. This adds to the complexity of the preparedness challenge, since success is dependent on the compliance of the public.
The willingness of the public to take part in the preparedness efforts depends on the trust that the population has in authorities [14, 15], on the way the public perceives the risk and the proposed countermeasures, and finally on the self-efficiency [16] of individuals, which determines their readiness to perform the active procedure of compliance. As a consequence, several modes of interrelationships between the public and the authorities can be expected.
On one hand, the public may exhibit distrust in authorities, reject expert recommendations altogether and as a consequence decide not to comply. Surprisingly, this was a rare phenomenon in the response to the two campaigns: 2.2% for mask-acquisition and 1.1% for H1N1 vaccination. On the other hand, the public may exhibit confidence in authorities, accept unconditionally the evaluations of formal experts, and exhibit high levels of compliance with governmental recommendations. This combination was manifested by a large number of individuals in their response to the mask acquisition campaign (35.6% of respondents) but was not common in the response to H1N1 vaccination (8.8%).
Our study reveals that the interrelationship between authorities and the public in the response to preparedness programs is more complex. In the case of mask-acquisition, a substantial fraction of the population (17.2%) believes in the credibility of the authorities, believes in the use of gas masks as a countermeasure, but nevertheless fail to actually comply with the recommendation. This discrepancy between beliefs and compliance with gas mask acquisition was found to be linked with low self-efficacy and passivity, an attitude often observed in the reaction to various health recommendations [17].
Contrary to this, low compliance with H1N1 vaccination is mainly related to a divergent evaluation of the situation, rather than passivity. Many respondents (34.8%) trusted the credibility of authorities, believed that one should accept vaccination under certain conditions, yet decide not to comply with vaccination.
Taken together, these observations suggest a major difference in the response towards the recommendation to acquire gas masks and that to get vaccinated against H1V1. The dominant response to the first recommendation can be defined as "trusting-non reflective-compliance", whereas the dominant response to the second recommendation was "trusting-reflective-noncompliance". This difference can be linked in the apparent difference in the attitude of the public to the two recommendations. The attitude towards H1N1 vaccination is characterized by reasoned assessment of the risks involved in failure to get vaccinated. Many people believe that not everyone needs to be vaccinated and that compliance should be left to personal decision. Moreover, when non-compliers were asked to explain their lack of compliance, about half of the respondents provided reasoned argumentation, based on their personal evaluation of risks related to disease and vaccine.
Contrary to this, the response to the gas mask campaign appears to lack sophistication. Only a small number of respondents believed that mask-acquisition is a matter of personal choice (perhaps in part because, as opposed to situation with vaccinations, mask use by one person has no bearing on other individuals). Surprisingly, respondents did not appreciate the relativity of risk (geographic distribution) as a factor in mask-acquisition. This is in contrast to the perception of risk-relativity, which was exhibited by the extensive self-evacuation of the population from Tel-Aviv to Jerusalem during the First Gulf War [18, 19].
The marked difference in the response to H1N1 vaccination and gas mask acquisition can be explained in several ways. The difference can be attributed, in part, to the nature of the recommended intervention: In contrast to acquiring masks, which is merely a procedural event (getting to the distribution center or ordering the mask by phone), vaccination involves a non-pleasant physical intervention, entailing certain risks. Nevertheless, this difference in itself is not a sufficient explanation, since perception of real risk does not deter Israelis from accepting routine, well-established vaccination programs such as childhood vaccination [20, 21]. Another explanation could be a differential attitude towards policies related directly to health and those elated to military defense [22]. Our results suggest, however, that the credibility of the MOH did not differ from the credibility of the HFC. It should be noted that the rejection of vaccination by the public, in general, is a well-recognized phenomenon that accompanies the history of vaccination and is prevalent in many different societies. The rejection of H1N1 vaccine, in particular, was identified in most industrialized countries and the controversy was propagated by popular media worldwide. Interestingly, the controversy over H1N1 vaccination was also manifested by the attitude of health care workers who often refused to get vaccinated. In contrast, the gas mask acquisition campaign was not associated with any notable controversy and was not criticized by the relevant experts.
One possible explanation for the difference in the attitudes towards H1N1 vaccines and gas-mask campaigns could be related to the time-dimensions framing the events. A potential chemical attack is remote and uncertain, and therefore individuals were not faced with the need to make an immediate decision or invest "intellectual efforts" in such a decision. On the other hand, the H1N1 epidemic was an evolving event [23, 24], with new information accumulating every day, much uncertainty about future development, continuous debates among experts, and intense exposure by the media. This could lead to a high level of involvement of lay individuals and pressure to personally confront the vaccination dilemma. All this is reflected in the high awareness, high degree of reasoning, and a reflexive attitude towards the recommendation to comply with vaccination.
Several limitations can be identified in this study: (a) The study was based on a telephone survey and a time when 15% of the population did not have land-line phones; the response rate was 62%. (b) The divergence between the actual compliance of the Israeli population and declared compliance of the survey group is considerable, which could be attributed to social desirability or a sampling bias. This should be taken into consideration in the analysis of data. One should note, however, that this study suggests conformism in the public's response towards mask-acquisition as opposed to non-conformism towards H1N1 vaccination. The potential biases described suggest that non-conformist approaches may actually be more prevalent among the full population than they were among our sample. Accordingly, this point actually strengthens the case for our contention that non-conformism plays a major role in the public response to governmental preparedness policies. (c) There are no analyses to determine if any of the responses to the survey questions differ by demographic variables. In our previous studies, we thoroughly examined the effect of demographic variants on attitudes towards vaccination [7, 20], and demonstrated that non-conformism was associated with younger age and with the Jewish population. In this study, where compliance was juxtaposed to attitude and to trust, the large number of response variables (see Tables 6 and 7) would prohibit a coherent analysis of the effect of demography.
It should be stated that the attitude of the public to vaccination in general, and to H1N1 vaccination in particular has been the subject of many studies [22, 23, 25–29], using a variety of models and identifying a broad range of correlates of compliance. Those correlates include the extent to which H1N1 influenza is perceived to be risky, the extent to which the vaccination is perceived to be risky, and the degree of trust in government. We chose to analyze our data using a model that focuses on the role of reflexivity in the public's response to risk [20, 24, 30, 31]. Thus, the survey did not cover items related to compliance with other vaccines (seasonal influenza vaccines) or to exposure to information provided by formal authorities, nor did it examine in-depth the perception of risks related to vaccination or to diseases.
In the future, it would be useful to develop an integrated model of the public's response to governmental preparedness policies that incorporates both the new factors identified in this article and the more widely recognized factors emphasized in the professional literature to date. It will also be useful to apply such an integrated model in empirical studies of public responses in various types of large-scale health hazards. This could be used to assess how the relative strengths of the possible explanatory factors vary across different types of hazards and societal contexts.
Notwithstanding all these limitations, the major contribution of this study is the identification of a unique interrelationship between trust in authorities, attitudes towards acceptance, and actual compliance with vaccination, which could be defined as a "trusting-reflective-noncompliance" response. The interrelationship between trust and compliance has been the subject of previous studies [25, 26, 32] and the interrelationship between a reflective attitude and compliance with vaccination has been analyzed in the past by us [7, 20, 24] and by others [27–29]. However, to the best of our knowledge, the analysis of the three-way interaction between trust, attitude, and compliance is new.
The newly identified "trusting-reflexive-noncompliance" response profile appears to be an outcome of the shift in responsibility from the State to the individual, which characterizes the era of the so called "reflexive modernity" [30, 31]. In the case of preparedness against forthcoming epidemics, this transitional state is reflected in the observation that people accept the role of the State as a responsible authority but in parallel try to formulate their personal opinion on upcoming risks. Another outcome of this study is the realization that the public distinguishes trust related to belief in the objectivity of authorities ("good will" and lack of bias) and trust related to confidence in the competence of authorities [14]. A large number of respondents believed that the H1N1 vaccination campaign was grounded in honesty and good will, yet the actual behavior during the epidemic suggests that the public did not accept the judgment of the expert authorities.
The emergence of a vaccination-reflexive population, which is also manifested in the changing attitudes of the public to MMR vaccination, HPV vaccination, and childhood vaccination protocols [20, 24], deserves careful consideration. Reasoned-assessment and reflexivity towards vaccination are by no means identical to making the right decisions. In the first paper in this series [7] we have clearly stated that in many cases (about 30%) reasoned non-compliance with swine-flu vaccination was based on wrong assumptions (for example, "I am eating a healthy diet and therefore I am protected against flu").
The trends identified in this study may, therefore, have dangerous implications for the cause of public health. Reflexive assessment of vaccination programs by lay individuals rely, in most cases, on personal perceptions of risks and is most likely based on self-interests. Lay individuals are less likely to take into consideration group-interests related to vaccines, and are less receptive to concepts such as vaccination for the sake of the more vulnerable or vaccination aimed at achieving herd immunity. In addition, assessment of vaccination programs and most specifically new vaccination programs requires high degrees of knowledge and understanding that are in many cases beyond the capability of even the most sophisticated lay individuals. In addition, a judgmental public is more likely to reject a "new vaccine". This is precisely the scenario where the stakes are highest – an emerging infection for which there is no effective treatment other than a newly developed vaccine.
In spite of the anticipated dangers, vaccination-reflexivity can be harnessed to enhance the benefits from vaccination. "Vaccination-reflexivity" should be distinguished from "Anti-vaccination". Recent studies suggest that only 2-8% of the population in developed countries can be defined as "hard anti-vaccinators", whereas the number of individuals that exhibit reflexive attitudes is on the rise [20, 24]. Anti-vaccination movements, which have accompanied vaccination from its very beginning, are mostly based on ideologies, beliefs, and emotional approaches that magnify dangers, and therefore are less amenable to change. Reflexive-vaccination, on the other hand, is based on assessment and evaluation and could be targeted by appropriate communication programs.
Our findings, which indicate that the reflexive public did not lose its trust in the genuine motivation of authorities, and did appreciate the difficulty faced by authorities in dealing with high uncertainties, suggest that the public could be receptive to risk-communication messages. Nevertheless, these messages should take into consideration the fact that the public does not accept recommendations in a non-conditional way.
Policy makers should take into account the fact that the public does not accept authority's recommendations in an unconditional manner. Modern individuals tend to evaluate such recommendations and formulate their mode of response accordingly. Nevertheless, in certain cases the public may respond in a non-reflective way and may delegate this responsibly to authorities in an uncontested manner. The shift between the two reactions is probably not predictable and will depend on the specific characteristics of the risks involved. This leaves the policy makers with the complex challenge of attending to the needs of a passive non-involved public as well as the needs of an opinionated, reflexive public.
The emergence of a "trusting-yet-reflexive" public calls for the redefinition of the vaccination dialogue between the authorities and the public. This dialogue should be respectful towards lay-judgment and assume that individuals are well motivated. Special attention should be given to bridging the gap between expert-knowledge and lay-knowledge. Lay individuals should not be viewed as scientific illiterates but as partially-informed agents, to which new information should be communicated. This becomes a special challenge when an emerging epidemic is identified. In this case, expert authorities should communicate to the public the inherent uncertainties related to the extent of the danger and to the effectiveness of countermeasures, and full transparency should be maintained.
Authors' informations
Liat Lerner-Geva MD, PhD, is a board-certified physician in Epidemiology and Public Health with special emphasis on reproductive epidemiology. Since 2001, she has been director of the Women and Children's Health Research Unit at the Gertner Institute for Epidemiology and Health Policy Research (Ltd,) and since 2009 an associate professor at the School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University.
Gilead Shenhar retired as Colonel from Israel Defense Force (IDF) serving in active duty from 1976 to 2003. In his last position he was the head of doctrine and development in civil protection. Today he is a senior researcher at Gertner Institute, and academic coordinator and teacher at Tel-Aviv University in the Emergency and Disaster Management program. Shenhar also serves as a senior spokesman for Israeli civil protection during emergencies. He has been a member of several delegations to disaster areas with the IDF and UNDAC.
Valentina Boyko, MSc, is currently the senior biostatistician at the Women and Children's Research Unit, at the Gertner Institute for Epidemiology and Health Research, Sheba Medical Center, Israel. She has extensive experience in all fields of biostatistics, with particular interest in women's health, perinatology, and cardiovascular diseases.
Giora Kaplan was born in Argentina and has lived in Israel since 1966. He studied Sociology, Management of Human Services, and has a Ph.D. in Public Health. Since 1975 he has been a researcher in the health system, and has been a senior researcher at the Gertner Institute for Epidemiology and Health Policy Research since its foundation. Dr. Kaplan currently heads Gertner's Psychosocial Aspects of Health Division. His primary research interests include: coping with illness, cultural aspects of health, social consequences of health policy, and consultation with the public regarding issues of health ethics and policy.
Baruch Velan is a career scientist involved in a variety of projects related to the mechanisms of microbial pathogenesis, interactions between hosts and invading microorganisms, immune-evasion strategies, as well as development of classical and recombinant vaccines. Dr. Velan has conducted most of his scientific activities at the Israel Institute for Biological Research, where he also assumed several executive functions. At present, Dr. Velan is studying various aspects in vaccination ethics at the Gertner Institute in the Sheba Medical Center.
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Girard MP, Tam JS, Assossou OM, Kieny MP: The 2009 A (H1N1) influenza virus pandemic: A review. Vaccine. 2009, 2010 (28): 566-574.
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Velan B, Kaplan G, Ziv A, Boyko V, Lerner-Geva L: Major motives in non-acceptance of A/H1N1 flu vaccination: the weight of rational assessment. Vaccine. 2011, 29: 1173-1179. 10.1016/j.vaccine.2010.12.006.
Barach P, Rivkind A, Israeli A, Berdugo M, Richter ED: Emergency preparedness and response in Israel during the Gulf War. Ann Emerg Med. 1998, 32: 224-233. 10.1016/S0196-0644(98)70140-4.
The State Comptroller of Israel. Report A59. 2008,http://www.mevaker.gov.il/serve/contentTree.asp?bookid=532&id=57&contentid=9890&parentcid=undefined&bctype=9887&sw=1366&hw=698.
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Israel Central Bureau of Statistics: Selected Data from the New Statistical Abstract of Israel No. 62. 2011,http://fmx.sagepub.com/content/23/2/188.
Protecting public health & the environment: implementing the precautionary principle. Edited by: Raffensperger C, Tickner JA, Wes J. 1999, Washington, DC: Island Press
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Covello VT, Peters RG, Wojtecki JG, Richard C, Hyde RC: Risk Communication, the West Nile Virus Epidemic, and Bioterrorism: Responding to the Communication Challenges Posed by the Intentional or Unintentional Release of a Pathogen in an Urban Setting. J Urban Health. 2001, 78: 382-391. 10.1093/jurban/78.2.382.
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Shenhar G, Jaffe D, Gidron D, Peleg K: Evacuation Patterns of Ethnic Groups under Fire. J Homel Secur. 2012, 9: 1547-7355.
Velan B, Boyko V, Lerner-Geva L, Ziv A, Yagar Y, Kaplan G: Individualism, acceptance and differentiation as attitude traits in the public's response to vaccination. Human Vaccines & Immunotherapeutics. 2012, 9 (8): 1272-1282.
Porter B, Rosen B, Rishpon S: Development and implementation of vaccine policy. Survey No 14. Health Policy Monitor. 2009,http://www.hpm.org/is/a14/4.pdf.
Vigoda-Gadot E, Mizrahi S: The Performance of the Israeli Public Sector: A Citizens Survey and National Assessment (research paper #9). A working paper. 2009, Haifa, Israel: The Division of Public Administration and Policy, School of Political Sciences, University of Haifa
Brien S, Kwong JC, Buckeridge DL: The determinants of 2009 pandemic A/H1N1 influenza vaccination: a systematic review. Vaccine. 2012, 30: 1255-1264. 10.1016/j.vaccine.2011.12.089.
Velan B: Acceptance on the move: public reaction to shifting vaccination realities. Hum Vaccin. 2011, 7: 1261-1267. 10.4161/hv.7.12.17980.
Casiday R, Cresswell T, Wilson D, Panter-Brick C: A survey of UK parental attitudes to the MMR vaccine and trust in medical authority. Vaccine. 2006, 24: 177-184. 10.1016/j.vaccine.2005.07.063.
Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES: Qualitative analysis of mothers' decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006, 117: 1532-1541. 10.1542/peds.2005-1728.
Haug C: The Risks and Benefits of HPV Vaccination. J Am Med Assoc. 2009, 302: 795-796. 10.1001/jama.2009.1215.
Brewer NT, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND: Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol. 2007, 26: 136-145.
Teitler-Regev S, Shahrabani S, Benzion U: Factors affecting intention among students to Be vaccinated against a/H1N1 influenza: a health belief model approach. Adv Prev Med. 2011, 2011: 353207-10.4061/2011/353207.
Giddens A: Risk and responsibility. Mod L Rev. 1999, 62: 1-10. 10.1111/1468-2230.00188.
Beck U, Giddens A, Lash S: Reflexive Modernization: Politics, Tradition and Aesthetics in the Modern Social Order. 1994, Stanford, CA: Stanford University Press
Velan B: Personal and State Responsibilities in Vaccination: A Two-Way Road. Accountability and Responsibility in Healthcare. Edited by: Rosen B, Israeli A, Shortell S. 2012, Singapore: World Scientific, 513.
We would like to thank Ms Arnona Ziv for designing the survey and management of data. We are also grateful to the Israel National Institute for Health Policy Research for supporting this research (Grant 10/24/R).
Genetic Policy and Bioethics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, 52621, Israel
Baruch Velan
Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
Valentina Boyko & Liat Lerner-Geva
Trauma & Emergency Medicine Research Center, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
Gilead Shenhar
Psychosocial Aspects of Health, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
Giora Kaplan
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
Liat Lerner-Geva
Valentina Boyko
Correspondence to Baruch Velan.
The study was designed by GK, LL, and BV. Data analysis was conducted by VB, BV, GK, LL, and GS. VB performed the statistical analyses and designed the tables. The manuscript was written by BV with the help of all authors. All the authors have read and approved the final manuscript.
Velan, B., Boyko, V., Shenhar, G. et al. Analysis of public responses to preparedness policies: the cases of H1N1 influenza vaccination and gas mask distribution. Isr J Health Policy Res 2, 11 (2013). https://doi.org/10.1186/2045-4015-2-11
H1N1-influenza
Public-trust
Gas-Masks

redpajama_set_name: RedPajamaCommonCrawl


ArTeK proposes an advanced service supporting the preventive conservation of Cultural Property (CP) and bridging a gap in the market where systematic high frequency monitoring over a medium-to-large spatial coverage scale is, to date, not available.
ArTeK system enables the provision of an end-to-end service - going from the collection of geo-physical and site specific parameters for the calculation of key indicators, to the implementation of site-specific risk and decision support models, based on hierarchical / multi temporal / multi-sensory methods. Through the ArTeK services, the monitoring of the state of conservation of Cultural Heritage is more efficient. This improves the decision-making and programmatic capacity of institutions responsible for conservation, reducing in this way maintenance costs.
Moreover, ArTeK aims to support the management of the sites (through the implementation of tools to track visitors' movements and behaviours and analyse their preferences) and valorise them through advanced means of fruition, especially for those cultural sites that need special attention because under-valorised.
Track visitors' movements within the site and analyse their flow.
At the same time, site visitors need means to access geo-localized site information while visiting the site and enhance their visit experience.
valorisation, potentially leading to money earning.
The main users of the service are managers of Italian Cultural Properties. However, the service is not restricted to a particular area but can be used all over the world as space techniques used, operate globally and threats identified for Italian CP are applicable all over the world.
Management, through site visitors monitoring mechanisms.
earth observation data, satellite positioning data and satellite communication services jointly exploited for the provision of an end-to-end service applicable to organizations responsible for the management of cultural properties, from safeguard support to management of visitors and fruition.
Finally, thanks to the joint use of satellites dedicated to (i) earth observation, (ii) airborne remote sensing data, (iii) on-site data, and properly combined with (iv) already existing Institutional and certified databases, site information is performed and results made available to end-users.
"Visitors flow monitoring" and "location-based fruition" services, based on the use of mobile devices equipped with GNSS receivers.
Satellite Communication for data transmission from sensors network, located inside remote sites, to the ArTeK Service Centre.
The ArTeK service can be operated even in remote sites thanks to Satellite Data Communication between the remote site and the Service Centre.
The Final Review was successfully held on 7th Dec 2018. The pilot activities have been completed with very good user feedbacks, including more than 70 hours of on-site training at pilot sites. The consortium is now fine-tuning the commercial agreement among all the private and public partners participating in the ArTeK project. The first baseline of the agreement is expected to be signed in Q1 2019 with NAIS being the service provider.


President and chief content officer Joel Cheatwood has stepped down at TheBlaze, Glenn Beck's digital television network, to form a new media startup with the company's former CEO, Chris Balfe. Beck, Balfe and Cheatwood launched TheBlaze in 2011 after Beck parted ways with FOX News Channel. Follow TheBlaze on Twitter for stories that inspire and news that matters.


text:
By: Peter C. Speers Source: Aramco World Nov 21, 2013 No Comments
Category: Faith & Spirituality Topics: Mecca Views: 1127
In or about the year 570 the child who would be named Muhammad and who would become the Prophet of one of the world's great religions, Islam, was born into a family belonging to a clan of Quraysh, the ruling tribe of Mecca, a city in the Hijaz region of northwestern Arabia.
Originally the site of the Ka'bah, a shrine of ancient origins, Mecca had with the decline of southern Arabia become an important center of sixth-century trade with such powers as the Sassanians, Byzantines, and Ethiopians. As a result the city was dominated by powerful merchant families among whom the men of Quraysh were preeminent.
Muhammad's father, 'Abd Allah ibn'Abd al-Muttalib, died before the boy was born; his mother, Aminah, died when he was six. The orphan was consigned to the care of his grandfather, the head of the clan of Hashim. After the death of his grandfather, Muhammad was raised by his uncle, Abu Talib. As was customary, Muhammad as a child was sent to live for a year or two with a Bedouin family. This custom, followed until recently by noble families of Mecca, Medina, Tayif, and other towns of the Hijaz, had important implications for Muhammad. In addition to enduring the hardships of desert life, he acquired a taste for the rich language so loved by the Arabs, whose speech was their proudest art, and learned the patience and forbearance of the herdsmen, whose life of solitude he first shared and then came to understand and appreciate.
About the year 590, Muhammad, then in his twenties, entered the service of a widow named Khadijah as a merchant actively engaged with trading caravans to the north. Sometime later Muhammad married Khadijah, by whom he had two sons - who did not survive - and four daughters.
During this period of his life Muhammad traveled widely. Then, in his forties he began to retire to meditate in a cave on Mount Hira outside of Mecca, where the first of the great events of Islam took place. One day, as he sat in the cave, he heard a voice, later identified as that of the Angel Gabriel, which ordered him to:
Recite: In the name of thy Lord who created,
Created man from a clot of blood.
Three times Muhammad pleaded his inability to do so, but each time the command was repeated. Finally, Muhammad recited the words of what are now the first five verses of the 96th surah or chapter of the Quran - words which proclaim God the Creator of man and the Source of all knowledge.
The sun rises over Jabal al-Rahmah, the Mount of Mercy, where Muhammad in his farewell sermon told the assembled Muslims, "I have delivered God's message to you and left you with a clear command: the Book of God and the practice of His Prophet. If you hold fast to this you will never go astray."
At first Muhammad divulged his experience only to his wife and his immediate circle. But as more revelations enjoined him to proclaim the oneness of God universally, his following grew, at first among the poor and the slaves, but later also among the most prominent men of Mecca. The revelations he received at this time and those he did so later are all incorporated in the Quran, the Scripture of Islam.
Not everyone accepted God's message transmitted through Muhammad. Even in his own clan there were those who rejected his teachings, and many merchants actively opposed the message. The opposition, however, merely served to sharpen Muhammad's sense of mission and his understanding of exactly how Islam differed from paganism. The belief in the unity of God was paramount in Islam; from this all else followed. The verses of the Quran stress God's uniqueness, warn those who deny it of impending punishment, and proclaim His unbounded compassion to those who submit to His will. They affirm the Last Judgment, when God, the Judge, will weigh in the balance the faith and works of each man, rewarding the faithful and punishing the transgressor. Because the Quran rejected polytheism and emphasized man's moral responsibility, in powerful images, it presented a grave challenge to the worldly Meccans.
Establishment of Quranic State in Medina by the Prophet (PBUH)
Live Coverage - Masjid Al-Haram, Makkah
The Prophetic (s) Ascension and Humanism
Zamzam Water
The Prophet of Islam - His Biography
History of Hijrah: Migration for Peace and Justice
One Day In The Haram - Official Trailer
Islam and Islamic History and The Middle East
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Sauces - Zambezi Spice Co.
A sauce mild on heat; yet flavorful.
Peri-Peri sauce with a twist of lemon and a selection of herbs.
Bold pieces of Garlic that adds flavor for garlic lovers.
Twist of lemon and selections of herbs.


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Vivienne Hsu — Founder and Chief Executive Officer
Vivienne's vision at LENDonate is to create a new ecosystem for nonprofit finances. This idea was a culmination of her 20+ years of experience as an investment professional and a seasoned nonprofit fundraiser.
Prior to her work as a social entrepreneur, Vivienne was Senior Vice President at U.S. Trust, where she advised clients on a wide range of investments. She served a Senior Portfolio Manager for Charles Schwab Investment Management where she oversaw its active equity strategies and was the lead portfolio manager for the Schwab Hedged Equity Fund. Prior to that, she was at American Century Investments where she co-managed mutual funds that totaled more than $10 billion. Rounding out her experience was investment risk consultant at MSCI Barra, and pension actuarial work on retirement plans.
Vivienne's volunteer fundraising experience includes a one-year position as development director at Women's Initiative for Self Employment. She has led three successful capital campaigns ($5m+ total) at her church, among other volunteer positions.
She received an MBA from the Haas School of Business at the University of California, Berkeley, where she also received an undergraduate degree in applied mathematics. She is a Chartered Financial Analyst® (CFA) charterholder.
Brett Ayers – Chief Credit Officer
Brett brings over twenty years of financial industry experience in commercial and investment banking to LENDonate. He has expert knowledge of credit risk, credit underwriting and loan lifecycle processes. Brett has developed a deep understanding of lending policy and procedures with extensive experience working with external regulators and auditors related to credit risk.
Brett started his career at First Bank as the Regional Credit and Portfolio Manager. He continued his growth as Senior Portfolio Manager and Credit Analyst at Fifth Third Bank. At PNC, his role was Senior Credit Risk and Financial Review Officer; his focus was on compliance and risk for commercial and industrial portfolios. At Fidelity Bank as Chief Credit Risk Review Officer, he worked to reduce processing time and overall streamlining of reporting processes.
Brett's main focus has been to develop newer, complete methods of determining risk and automated methods of overall portfolio management. Brett has dual BA degrees in economics and history from Fordham University. While at Fordham University, he was a four-year letter winner as a member of the men's basketball team.
Lynette Pang — Chief Operating Officer
Lynette joins LENDonate after a distinguished career in investment management. She was a member of the disciplined equity team at American Century Investments for 20 years and served as a portfolio manager for over a decade. In addition to her portfolio management responsibilities, Lynette served as the liaison between the Investment team and IT developers and led business continuity and internal audit efforts. Prior experience includes performance reporting and analytics and client support at MSCI Barra and State Street Bank.
Lynette's commitment to the community includes volunteer work such as tax return preparer for low-income households, support line phone counselor, theatre-maker at community theaters, and training coordinator for classroom music education program. Her non-profit experience also includes having served as a board member for Stage 1 Theatre (3 years), and Music For Minors II (7 years).
Lynette graduated from the University of California, Davis with a BS in Agricultural and Managerial Economics and a minor in statistics. She is a Chartered Financial Analyst® (CFA) charterholder.
Marion Askins – Project Manager
Marion brings over twenty years of experience in executive administration, project management and executive recruiting. She has a unique combination of experience with start up companies and large corporate organizations. Marion has knowledge of many industries including financial services, technology, luxury goods, retail, clean-tech, corporate venture and consumer services.
Before joining LENDonate, Marion was an executive recruiter and administrator for Talent Age Associates responsible for client and candidate management for search assignments and overall administrative support including presentations, event planning, social media and projects. Prior to Talent Age Associates, Marion spent ten years in the financial services industry working for Tatum LLC, a professional services organization providing project based, interim and permanent solutions. Marion was the area administrator of the Northern California office comprised of thirty CFO Partners and other Financial Executives.
Earlier on, Marion was an executive coordinator with Odwalla and a Customer Service manager for Briggs & Riley Travelware. Marion started her career in the retail industry in managerial positions with Ross Stores, Lanz of California and Mervyn's.
Sarah Weller — Technical Project Manager
Sarah's career began in technology consulting at CGI, where she built trusting relationships with clients such as the United States Agency for International Development (USAID), Australia New Zealand Bank (ANZ) and Comerica Bank while delivering exceptional customer support and training. Her experience ranges from compiling business and systems requirements, to designing and creating products, to implementing global software solutions.
At the end of 2013, Sarah joined Weller Smith Design, a boutique design studio specializing in creating thoughtful design solutions that reflect the client's vision and mission.
Carrie Dolan, Marketplace Lending Advisor
Carrie Dolan was CFO of Lending Club from 2010-2016. Prior to that, she served as Treasurer for The Charles Schwab Corporation, as well as CFO of Schwab Bank. Ms. Dolan holds a B.S. in finance and accounting, and an MBA from the Haas School of Business at University of California, Berkeley.
Jason Altieri, J.D., Legal and Compliance Advisor
Prior to joining Roofstock, Inc. in 2017 as Chief Legal and Compliance Officer, Jason Altieri was the General Counsel of Lending Club who led the company in legal/compliance strategy and development from start-up to 1,600 person public company. Mr. Altieri received his J.D. – magna cum laude from University of San Francisco School of Law.
Julie Abrams, Nonprofit Advisor
Current CEO of Bay Area Women Leaders Network and former CEO of Women's Initiative for Self Employment, Ms. Abrams is also board member, investor, philanthropist, and consultant to numerous small enterprises. She is co-author of Scrappy Women in Business.
Maureen Downey, Impact Investment Advisor
Ms. Downey is a seasoned private equity executive having managed teams at Pantheon Ventures, Goldman Sachs, and Merrill Lynch. She received her BA from Claremont McKenna College and an MBA from Wharton's Graduate School of Business.
Wingee Sin, Impact Investment Advisor
Ms. Sin is a senior executive with 15+ years of strategy and execution experience who is on a mission to create social impact through revolutionizing financial services and capital markets. She is Managing Director at State Street Global Advisors and is also co-author of Impact With Wings.
Swapan Saha, Ph.D., Technology Advisor
Mr. Saha's 20 years of product development in the San Francisco Bay Area include roles at SAP, Sun Microsystems and Tibco. He has been involved in various non-profit charitable activities including founding global alumni association in the U.S. of his Alma Mater, Indian Institute of Engineering Science and Technology.


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Anis Ben Slimane (Copenhague, Dinamarca, 16 de marzo de 2001) es un futbolista tunecino. Juega de centrocampista y su equipo es el Brøndby IF de la Superliga de Dinamarca. Es internacional absoluto por la  desde 2020.

Trayectoria
Formó parte de ocho clubes durante sus doce años en categorías inferiores. Fue en 2018 cuando debutó a nivel sénior en el AB que militaba en la Segunda División de Dinamarca. Tras su desvinculación del club en 2019, se unió al equipo juvenil del Brøndby IF y fue promovido al primer equipo en la temporada 2019-20.

Selección nacional
En categorías inferiores, fue internacional por la  y la .

El 1 de octubre de 2020 fue citado a la  para los encuentros amistosos contra  y . Debutó ante Sudán y anotó un gol en la victoria por 3-0.

Participaciones en Copa Africana de Naciones

Estadísticas

Clubes
 Actualizado al último partido disputado el 30 de octubre de 2022.

Palmarés

Títulos nacionales

Referencias

Enlaces externos
 Anis Ben Slimane en Soccerway
 Anis Ben Slimane en National Football Teams
 Anis Ben Slimane en Instagram

Futbolistas de Dinamarca
Futbolistas nacionalizados en Túnez
Futbolistas del Akademisk Boldklub
Futbolistas del Brøndby IF
Futbolistas de la selección de fútbol sub-19 de Dinamarca
Futbolistas de Túnez en la Copa Mundial de 2022

redpajama_set_name: RedPajamaWikipedia


text:
Number of times people leave Addenbrooke's A&E without treatment more than doubles in a year
The hospital said demand on it services has risen in the last year
Freya Leng
05:00, 4 JAN 2017
The number of times people have left Addenbrooke's A&E without treatment has more than doubled in a year, according to new figures. (Image: David Johnson)
The number of times people have left Addenbrooke's A&E without treatment has more than doubled in a year, according to new figures.
In September, 360 attendances at Cambridge University Hospitals were recorded as having left the emergency department before being seen for treatment, 2.8 per cent of all 12,771 attendances.
The hospital said for those with minor injury or illness there could be a number of reasons why people leave without treatment such as they not happy with waiting a long time, it is not an urgent condition or perhaps they feel better.
According to the figures from NHS Digital, the number leaving before treatment is 154 per cent higher than the 142 attendances recorded as having left A&E before being seen for treatment in September 2015.
Across England, 3.2 per cent of attendances at A&E departments were recorded as having left A&E before being seen for treatment, a total of 53,000 attendances.
Lack of beds at Addenbrooke's and rising delayed transfers of care are 'symptoms of a hospital under enormous pressure'
This was a quarter higher than the 42,461 recorded in September 2015, when 2.7 per cent of attendances left before treatment, and 49 per cent higher than in 2013, when the number was 35,604, 2.5 per cent of attendances
A Cambridge University Hospitals spokesman said: "The trust has seen a year-on-year increase in demand on our A&E department.
"As we prioritise treating the sickest first, those with non-urgent conditions often have to wait longer and a number leave before receiving treatment.
"We are urging the public to choose the right service first time and, if it isn't an emergency, use alternatives, such as GPs, pharmacies, NHS 111 and minor injury units.
Waits of four hours at Addenbrooke's A&E as hospital is swamped with patients
"Details of alternative treatment and advice for local patients can be found via the Cambridgeshire Choose Well app or being visiting http://www.cambsandpeterboroughchoosewell.co.uk/".
According to the data, the median average time to initial assessment for attendances brought to A&E by ambulance was six minutes in September, with 95 per cent of patients being assessed within 2 hours 25 minutes.
For all patients receiving treatment, the median average time to treatment was 59 minutes with 95 per cent of patients receiving treatment within 3 hours 19 minutes.
The median average total time in A&E for all patients was 2 hours 25 minutes, with 95 per cent of patients departing A&E within 6 hours 30 minutes of arrival, according to the figures.
Addenbrookes Hospital


1998 kawasaki Vulcan 800cc with cobra pipes 34,000 miles title in hand. Bike is in good condition couple small dents on the tank, nothing major could use a rear tire. Clean title in hand with last owners registration.


text:
Significant Danger
Republicans have grown accustomed to Democrat hysteria. We sit and listen to them conjure up endless nightmares depicting an America succumbing to global warming, white privilege, duplicitous relations with Vladimir Putin, too much self-created, individually controlled wealth, the myth of our police being racist as an institution, riot and looting are respectable manifestations of mass assembly to protest, and America itself is a threat to world peace and prosperity. Have I left anything out?
It's not too difficult to understand why we Republicans can become somewhat callous to these rants. If one of us puts a sign up depicting the president with an assault weapon just to antagonize a self-righteous Progressive ["Disturbing Image," Letters, September 3], try to grasp that hyperbole can cut both ways.
When James Ewing spends almost 400 words claiming global warming is a great danger but then foolishly made Lee Zeldin its cause ["We've Been Warned," Letters, 27east.com], it becomes just more of the same. Mr. Ewing, if Rep. Zeldin were to be unelected in November, it won't change your December temperature one degree.
Joe Biden has awakened to the fact that nationwide rioting has taken a toll on his and all Democrat approval ratings. His too-little-too-late appeal for civility in our streets and newfound love for our police are a desperate attempt to put the genie of social disintegration back in the bottle.
The Democrat reaction over the claims from Republicans that mail-in voting will be rife with problems, and even fraud, is another example of them building a case for conspiracy out of thin air, much as they did with their Russian collusion investigation. Mailboxes are rotated out of service all the time. Overtime being pruned back is good business practice for a department losing billions of dollars every year.
Voter fraud is no myth. States with dirty voter rolls, in which there are more registered voters than citizens of voting age, would be ripe for such activity. Los Angeles was sued for just such an issue and forced to clean it up. Voter "harvesting" is a fraudulent way to have mail-in ballots filled out by someone else and then the signature of the voter added. This has and will be a significant danger to a legitimate election.
The counting of millions of mail-in ballots will probably take weeks, and be challenged for months. I'm not sure this country could take anymore anger and distrust.


Safety Slits – allows for expansion of hole. Current size based on average 10lb domestic cat. (If your cat weighs more than an average domestic cat, the slits may be cut with sharp scissors to accommodate weightier breeds).
Non-Toxic Carpet – made from PET post-consumer recycled plastic bottles (e.g. water, soda bottles), the polyester fiber is non-toxic and hypoallergenic. If your cat decides to chew the carpet, (as ours does regularly), the polyester isn't bad.
Non-Slip Coating – The non-toxic rubber coating prevents the rug from slipping when cats pounce on the rug. (We've all seen cats dive across a room and go crashing into the furniture because they just can't brake in time – not with this rug). Fun fact: The latex in the non-slip coating is the same as that used in surgeons' gloves.
Touch-Point Release – Should the Velcro hooks take firm grip of the carpet while your fur-ball rolls inside your rug and decides to struggle, (as if under duress), fear not, the Touch-Points are calibrated to release.
Non-Fray Carpet Design – The special carpet ribbed needle-punch construction is designed not to fray. That means no stray threads to chew on. (Even if you decide to cut the carpet with sharp scissors, the carpet doesn't produce little crumbs/bobbles).


Discussion in 'Offset & Digital Presses for sale' started by Chanokchon, Sep 11, 2018.
We are used offset printing machine dealer from Thailand.
We are now looking for Heidelberg SM74-4, low pile, without perfector, year 2000 or below.
If you would have any availability, please do not hesitate to make and offer with price, details, and photos.
Used 2008 Heidelberg SM74-6P+L with 6.4mm impressions!


Absolutely fabulous 2 bedroom Lafayette Square Condo! Walk across the street to Lafayette Square Park or enjoy the wonderful views of the city including the Arch and Busch Stadium from this top floor corner unit. The rich wood floors throughout really make this unit stand out above the rest. The Living Room offers a cozy wood burning fireplace and a bonus room perfect for an office or den. The Open Kitchen with Skylight flows perfectly into the separate formal Dining room, perfect forentertaining guests. The Master Bedroom has ample closet space and the 2nd Bedroom has built-in bookcase and opens to your private deck with exterior storage space. The full bathroom is illuminated by another skylight. Private in-unit Laundry, extra basement storage, and 1 off street parking space round out this wonderful city condo. Walking distance to all the wonderful amenities Lafayette Square and Park have to offer, makes this truly a condo you don't want to miss!


He knew he had become a poor second in Lorena's affections to the man just in front of him, and the knowledge rankled.
It rankled him that the man was being so little help.
It rankled him continually that Gus had all of Lorena's company, day after day.
I detest that man and it rankles that he got so much of you and I got so little.
IT CAME TO RANKLE CALL that Gus had left his half of the cattle herd to the woman.
There are no more uses of "rankle" in Lonesome Dove.


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Q: Make a blank area clickable in android and then make an image appear over the area clicked Can anyone tell me please how can I make the whole blank screen clickable on the android ? Means wherever I can click on it and then the place where i click there one particular image has to appear where i can then make the notes. I am trying to first find the coordinates of that area and then putting the image. But i am not able to find the code for doing that. Means after finding the coordinates what can be done?
Or if there is some other way then also please help with that!!
For finding coordinates:
public class MainActivity extends Activity implements OnTouchListener{

@Override
protected void onCreate(Bundle savedInstanceState) {
    super.onCreate(savedInstanceState);
    setContentView(R.layout.activity_main);
    final TextView xCoord = (TextView) findViewById(R.id.button1);
    final TextView yCoord = (TextView) findViewById(R.id.button2);

    final View touchView = findViewById(R.id.button3);
    touchView.setOnTouchListener(new View.OnTouchListener() {

        public boolean onTouch(View v, MotionEvent event) {
            final int action = event.getAction();
            switch (action & MotionEvent.ACTION_MASK) {

                case MotionEvent.ACTION_DOWN: {
                    xCoord.setText(String.valueOf((int) event.getX()));
                    yCoord.setText(String.valueOf((int) event.getY()));
                    break;
                }

                case MotionEvent.ACTION_MOVE:{
                    xCoord.setText(String.valueOf((int) event.getX()));
                    yCoord.setText(String.valueOf((int) event.getY()));
                    break;
                }
            }

            return true;

        }

    });

}

A: *

*Create an ImageView (or have one in your Layout)

*Make sure it's invisible on initialisation

*When the user clicks use the coordinates to set the location of the ImageView

*Make the ImageView visible

*Take a sigh of relief.

redpajama_set_name: RedPajamaStackExchange


text:
Ђумрук () је турски израз који се раније, у 19. веку, користио за царину. Назив за особу која је наплаћивала ђумрук је ђумругџија.

Када је књаз Милош Обреновић први пут истакао српску заставу и био оптужен од султана да покушава да од Србије направи државу, за шта му је лако могла "летети глава", Милош се бранио да је заставу истицао само "через ђумрука".

Вук Караџић је током свог живота око годину дана био ђумругџија.

Ђумрукана у Београду је подигнута 1834, служила је преко сто година, срушена је у савезничком бомбардовању 1944.

Види још
 Публикани
 Театар на Ђумруку

Спољашње везе

Турцизми

tr:Gümrük


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Next-Gen Nissan Titan to Get Most Dodge Ram Attributes
Most powertrains and cab configurations are on the table; Ramboxes are not.
ALISA PRIDDLE
No matter how you slice it, Nissan Titan buyers will have more options under an agreement with Chrysler to build the next-generation full-size pickup from the Dodge Ram architecture for sale in 2011.
Nissan will still design the next-generation Titan—the name may change—but its underpinnings will be all Ram for ease of assembly at Chrysler's Saltillo, Mexico, plant. Nissan will stop building the current Titan in 2010.
And while the two automakers are reluctant to divulge too many specifics before an agreement is signed—likely this fall—officials from both companies confirm most aspects of the Ram are subject to negotiation.
Where Nissan really looks to gain is in more available powertrain options and cab configurations.
Currently, the Titan only has one powertrain: the 317-hp, 5.6-liter V-8. The partnership opens the door to a full pantry of potential Chrysler gasoline and Cummins diesel engines. The Ram is available with a 215-hp, 3.7-liter V-6; a 310-hp, 4.7-liter V-8; a 390-hp, 5.7-liter Hemi V-8; and there is a 6.7-liter Cummins turbodiesel in the heavy-duties.
Chrysler officials have confirmed the famed Hemi is available to Nissan—for a price of course. For 2009, the Hemi saw its horsepower grow 13 percent to 390 hp from 345, and torque is now 407 pound-feet from 375.
With high gasoline prices striking a stake in the heart of big-truck buyers, Nissan also embraces the idea of a V-6 for the next Titan.
We'll Do Our Own Heavy-Duty Titan, Thank You
The outlook for diesel sharing is a little murkier. Nissan has for some time said it needs a heavy-duty Titan with a diesel to be competitive, but the idea never came to fruition. And while Chrysler has a heavy-duty Ram, the partnership on the Ram does not extend into heavy-duty pickups, we are told by Toshiyuki Shiga, Nissan's chief operating officer in Japan, and by Larry Dominique, vice president in charge of product planning for Nissan North America.
That is because Nissan announced in April that it will enter the light-commercial vehicle (LCV) market in North America in the first half of 2010 with three new vehicles with Cummins diesels under the hood and ZF automatic transmissions. A heavy-duty Titan for North America would come from the LCV division.
In 2005, Nissan and Renault had 11 global platforms for LCVs. That is shrinking to two: one for trucks and one for vans. For the U.S., Nissan will develop specific vehicles from both architectures. Look for a van to compete with the Dodge Sprinter, and the new truck platform could incorporate aspects of the current F-Alpha truck platform that supports the Titan, Nissan Armada, and Infiniti QX56, to name a few.
All LCVs for North America will be assembled at Nissan's plant in Canton, Mississippi, in space to be vacated by moving production of the Nissan Quest and QX56 back to Japan, as well as the cessation of Titan assembly.
In terms of diesels, the light-duty Ram adds an oil-burner for the 2010 model year, but Nissan may not be interested there either, as the Japanese automaker has created a new engineering division within the LCV unit to develop diesel engines for light-duty trucks.
$600 Stimulus-Check Cars: Window Shop with C/D
See the First Bugatti Chiron Pur Sport in the U.S.
Toyota To Pay Massive Fine for Clean Air Violation
Hyundai Kona N Confirmed for U.S., Specs Revealed
Kia Is Planning to Sell A Lot More EVs
1979 Aston Martin Bulldog Will Try for 200 MPH
Renault 5 EV Concept Is a Blast from the Past
2021 Audi Q5 Sportback Costs Extra


What is the objective of an Addiction Intervention?
Is intervention necessary for successful recovery?
What is the right time for an Drug Intervention/Alcohol Intervention?
How can one determine an appropriate intervention method?
Can an intervention be conducted without professional guidance?
What does the process of intervention involve?
What are the goals of intervention?
Can intervention assure successful recovery?
Is there any alternative for intervention?
What is the role of family and friends in intervention?
Who should be the participants of an intervention?
1. What is the objective of an Addiction Intervention?
Self-destructive behavior is something often seen associated with addiction. The main objective of a Drug Intervention/Alcohol Intervention is to give relief from the sufferings caused by this Substance Abuse. It helps an abuser recognize the gravity of his Alcoholism/Drug Abuse and makes him/her come to terms with the impact of his Substance Abuse on others.
2. Is intervention necessary for successful recovery?
Past records show that only a small percentage of substance abusers have recovered without Drug Intervention/Alcohol Intervention. For the majority, Alcoholism Treatment/Drug Treatment was inevitable. In fact, many consider Addiction Intervention as an indispensable part of the healing process. Along with the dependence on a substance comes a reluctance to admit or tackle the Substance Abuse problem. Addiction Intervention plays an important role in breaking the defense mechanism addicts use to evade treatment.
3. What is the right time for an Drug Intervention/Alcohol Intervention?
The answer is obvious-as soon as alcoholism or drug abuse has been identified. Unnecessary delay can make things worse. In fact, getting the addict to seek treatment as early as possible is the main purpose of intervention. An early Drug Intervention/Alcohol Intervention gives the addict greater chance and more time for successful Alcoholism Treatment/Drug Treatment.
4. How can one determine an appropriate intervention method?
Determining an appropriate Addiction Intervention method depends, to a great extent, on the condition of the patient. Ensuring the safety of the patient is of utmost importance even while addressing the urgency of the situation. Future plans like educating the family comes only later here. However, while dealing with a chronic problem, the traditional or a blend of old and new Alcoholism Treatment/ Drug Treatment approaches can be tried. Proceedings of a preplanned Drug Intervention/Alcohol Intervention depend on many factors like what the family members of an addict are prepared to do or the orientation of the interventionist. It is very important to find out the most realistic and practical approach, which comes to terms with the feelings of the family members.
Theoretically all Addiction Intervention orientations work. However, developing a personalized and sensible approach is imperative for this highly emotional experience.
5. Can an intervention be conducted without professional guidance?
There is nothing wrong in conducting an Addiction Intervention without professional guidance. However, as interventions are highly emotional and deal with delicate matters, it is important that they be done properly and with care. Often people waste a great deal of time and effort trying to organize an Addiction Intervention by themselves, with no results. Moreover, people who quit without expert assistance usually end up back on drugs or alcohol. So, to be on the safe side, seek out the advice and council of a professional Addiction Interventionist.
6. What does the process of intervention involve?
The process of Drug Intervention/Alcohol Intervention involves counselling, therapy, assistance and liaison with the rehabilitation centre, the family and the patient, follow up and after care support.
7. What are the goals of intervention?
The main goals of Addiction Intervention are (a) Realize the nature and degree of substance abuse and the focus of level of Alcoholism Treatment/Drug Treatment and Addiction Interventions. (b) Comprehend the efficiency of different Addiction Treatments and Addiction Intervention methods that are meant to lessen the dependence on a substance. (c) Know more about Alcoholism Treatment/Drug Treatment and Addiction Intervention providers, effectual programs and suitability of these treatments for that particular abuser. (d) Boost community awareness of apt and successful Addiction Treatment and other intervention programs for substance habits.
8. Can intervention assure successful recovery?
No. Even a successful Addiction Intervention does not guarantee recovery from addiction. However, according to the past records up to 85% of addicted people who underwent intervention sought treatment. This shows that professionally conducted interventions often achieve its goals, i.e. make people willing to take Addiction Treatment.
9. Will an intervention make the situation worse?
Normally, a professionally conducted Addiction Intervention is a gentle, conversational process. It is designed to improve the lives and awareness of all involved. It is not an argument or an examination of wills. The risk factor is almost zero in an intervention conducted by a professional. So, given the great gains, intervention is something worth trying.
10. Is there any alternative for intervention?
In 1991, William Miller and Stephen Rollnick proposed a methodological approach that looked at stages of change in the addict and in determining the specific desire or willingness of an addict to change, thereby prescribing the counselors appropriate course of action. The point of view is that professionals must change their behavior according to that of the addict. This is known as Motivational Interviewing.
11. What is the role of family and friends in intervention?
Family and friends have a vital role to play in the process of Substance Abuse intervention. Besides giving support to the addict's efforts to recover, they need to stop protecting him from the consequences of his/her Alcoholism/Drug Abuse. It is important to let him/her fully experience the harmful effects of Substance Abuse. Making the effort a collective one is also very important. The close ones need to find strength in numbers with the help of family and friends and confront the abuser as a group.
12. Who should be the participants of an intervention?
The number of people participating in a Drug Intervention/Alcohol Intervention is less important than who is there. Presence of the person in the family whom the addict respects the most is a must. This person is the one whose opinions are most highly regarded by the addict. And it is this person whose support will be invaluable to the addict in getting help. He would inform the abuser of the actual Drug/Alcohol Rehab Program.
All of the family can be part of the Addiction Intervention team. The addict must know that all his family cherishes him and that they all care for him. The presence of a professional intervention counselor is advisable. Depending largely on individual circumstances, like the presence of pending legal issues, external pressures etc. or complete denial of any Substance Abuse this must be intensely considered.


text:
module.exports = function (d1, d2) {
	return {
		getDep1: function () {
			return d1;
		},
		getDep2: function () {
			return d2;
		}
	}
};
module.exports.autowire = {
	name: 'namedFactory',
	dependencies: ['testfile', 'testObject'],
	transient: true,
	groups: ['testGroup']
};

redpajama_set_name: RedPajamaGithub


text:
Vixen Animated Series Synopsis Revealed
by Jamie Robinson June 28, 2015
by Jamie Robinson June 28, 2015 1 comment
Back in January, an animated series about the superheroine Vixen was announced, set in the same universe, as the CW's Arrow and The Flash shows. While the CW plans to give fans a sneak peek of the series at Comic Con, they have now released an official synopsis for the show.
Originally from Africa, Mari McCabe's parents were killed by local greed, corruption, and wanton violence. But the orphaned Mari refuses to succumb to the terrors surrounding her. Inheriting her family's Tantu Totem, Mari can access the powers of animals-anything from the super-strength of a gorilla to the speed of a cheetah. As Vixen, she fights valiantly to protect the world from threats like those that claimed her family.
The six episode series is set to arrive in the fall and will feature the voices of Stephen Amell (Oliver Queen/Arrow), Grant Gustin (Barry Allen/The Flash), Emily Bett Rickards (Felicity Smoak) and Carlos Valdes (Cisco Ramon).
So far, it is unknown who the voice of Vixen will be or at what time or day the series will air. Stay tuned for further developments as they become available.
Source: flickeringmyth.com
arrow cwcwvixen
Jamie Robinson
Lego Brings Action Comics' Iconic Superman Cover To Life
Introducing Gotham's Tigress


Do you want to work with a company who believe their employees are central to their companies success?
Do you want to join a team who are working in environment where they can continually learn and enhance their own skills and career?
If you answered yes – you don't want to miss out on this opportunity in Ayrshire.
My client is an industry leading manufacturer based in Ayrshire who are looking to add an experienced Project Manager to the talented workforce.


text:
Chinese diocese donates masks to Vatican, Italy, to help fight COVID-19
HONG KONG (CNS) — A Catholic diocese in China's Shaanxi province has donated thousands of face masks to communities in the Vatican and Italy to help them fight the coronavirus.
Ucanews.com reported Xi'an Diocese has donated 24,000 disposable medical masks to the Vatican and religious communities and dioceses in Italy such as Milan and Bologna.
"When mainland China experienced the epidemic, the Holy See and the Italian church group helped by sending medical masks. We have now effectively contained the virus, but Italy is now suffering. It is our turn to help them," Father Chen Ruixue of Xi'an told ucanews.com.
The coronavirus, he said, "is the public enemy of humanity. Only when all people work together to fight the disease can we overcome the pandemic."
The virus was first reported in the central Chinese city of Wuhan in December, slowly spreading across the globe.
In China, the "people's economic life is returning to normal" as the infections have come down, Father Chen said.
As of March 19, China had reported 81,139 COVID-19 cases with 3,253 deaths. However, the number of newly diagnosed cases on March 18 was only 34, all of which were overseas cases. The death toll also came down on March 18, with only eight fatalities.
After China, Italy has become the worst-affected country, with hundreds of deaths and infections in the past few weeks, killing nearly 3,000 people. At least 475 people died in Italy on March 18 alone.
The Vatican has donated masks to China since January.
Father Chen said he was told the masks the Vatican receives in a donation would be distributed to "the needy people on the streets, which is admirable and an urgency."
The Archdiocese of Milan covers the hardest-hit area of Italy, and some groups and families in Milan have supported the students of the Shaanxi Theological Institute for many years, he said.
Father Chen also said that several church members had privately funded the donation.
"Italy needs help now. We will continue to do our best to raise more materials to donate to them to fight the epidemic," he said. "We sincerely hope that these donations, however small they are, will help some people. It will also help promote the friendship between China and the Vatican, and China and Italy."
Editors: The original story can be found at www.ucanews.com/news/chinese-diocese-donates-masks-to-italy-vatican/87503.