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At t he head end anxiety symptoms cold hands 5mg emsam visa, t he rope ends in a grommet w hich t akes ext ra purchase f rom t w o brass eyelet s let int o t he canvas anxiety symptoms guilt best 5 mg emsam. At t he f oot end of t he rope is a galvanised iron ring w hich is secured t o t he st ret cher by a span going t o brass eyelet s in t he canvas anxiety symptoms when not feeling anxious buy emsam 5mg lowest price. When more rigidit y in t he st ret cher is required anxiety symptoms hypertension generic emsam 5mg online, as in moving t hose w it h injuries t o t he back, a couple of broom handles, slipped t hrough t he ropes underneat h, w ill f ulf il t his purpose admirably. Some st ret chers have a rope about 9 f t long f ixed t o t he galvanised ring at t he f oot end. This is a st eadying rope f or use in craf t below, or on quay, w hen t he pat ient is low ered over t he side of t he ship. When t he pat ient is carried about t he ship, t his rope can be passed under t he various st raps t o keep it f rom t railing on t he deck or ot herw ise get t ing in t he w ay. The pat ient should be lif t ed on t o and secured in t he st ret cher as show n in Figures 1. Cases of f ract ure of t he spine or ot her back and pelvic injuries should be t ransf erred t o t he st ret cher as direct ed under spinal injury. With only three attendants, the w rists of an unconscious patient have to be tied together ­ but not tightly. At diff icult corners, t he st ret cher should be low ered at t he f oot end, and t he casualt y passed by t w o of t he men t o t he ot hers. When passing t he casualt y t hrough a narrow hat ch, or lif t ing him up over a height, or lowering him to a boat alongside, put the lifting hook or a rope through the grommet at the head end and a further steadying rope through the galvanised ring at the foot end (Figures 1. Note: to steady the stretcher, a rope goes from the foot of the stretcher to a seafarer below. M oving an unconscious casualty If possible, carry an unconscious casualt y in t he unconscious posit ion and alw ays w it h a head-dow n t ilt. The t ilt is also necessary w hen carrying a casualt y suff ering f rom shock or loss of blood. Toxic hazards Ships carry a number of subst ances ot her t han cargo w hich are pot ent ially t oxic. For inst ance, medicines are not generally poisonous but can become so if t aken in a manner not prescribed, such as in an overdose. Then t here are subst ances like cleaners, degreasers and disinf ect ant s w hich can give rise t o t oxic hazards on t heir ow n or t hrough misuse. Not es on various specif ic t oxic subst ances are given at t he end of t his sect ion. They may cause local burns or irrit at ion if t hey come int o cont act w it h skin or eyes. They may be absorbed int o t he body and cause int ernal damage or syst emic poisoning. Not e Toxic hazards Inhaled poisons Sw allow ed poisons Skin cont act Eye cont act General not es Not es on specif ic t oxic subst ances the commonest rout e f or a t oxin t o ent er t he body onboard a ship is by breat hing it in. Poisons are less commonly sw allow ed, usually by accident during rout ine dut ies, but somet imes deliberat ely. The eff ect s of t oxins are of t en sudden and dramat ic, but may be subt le, gradual and cumulat ive. The lat t er is especially t rue of inhaled t oxins or t hose absorbed t hrough t he skin. Prompt, saf et y conscious t reat ment can avoid many of t he complicat ions of poisoning. This group includes carbon monoxide, carbon dioxide, hydrogen and some ref rigerant gases. Gases such as carbon dioxide and carbon monoxide may also be poisonous, part icularly in a conf ined space, because t hey replace oxygen in t he air and t heref ore in t he blood. The main sympt oms of exposure are: diff icult y in breat hing; nausea, headache, dizziness; conf usion or even unconsciousness in severe cases.

A layoff can be considered a major life event and stressor that impacts the individual being laid off anxiety 7 year old cheap emsam, his/her family anxiety network purchase 5 mg emsam with amex, his/her community anxiety in children symptoms order genuine emsam on line, and society at large anxiety krizz kaliko lyrics generic emsam 5 mg visa. Jobs are an economic necessity and provide many psychological and social benefits. Results of a case study assessing the impact of layoffs in a small community in Texas showed that 58% of study participants reported having increased health problems after the layoff (Virick, 2003). Unemployment has been linked to the following stress-related negative health outcomes: higher mortality rates, increased risk of heart attack, low-birthweight offspring, infectious diseases, chronic respiratory diseases, gastrointestinal disorders, depression, alcoholism, and suicide (Broadhead et al. Based on studies on the effects of unemployment in several industrial countries, Brenner (1983, 1987a, 1987b, 1987c) calculated that for every 1% increase in the unemployment rate in the United States (an additional 1. Results of a study by Benson and Fox (2004) showed that unstable employment increases the risk of intimate partner violence. For couples where the male was always employed, the rate of intimate partner violence was 4. Work hours can lead to work­family conflict if there is insufficient or inadequate time for workers to spend with family and friends. Although some human factors research and practice have taken social and economic issues into account, they have typically not paid much attention to the environment (Steimle and Zink, 2006). Recently, macroergonomic approaches have embraced the broader system in which people work, including the environment (Hendrick and Kleiner, 2002). Corporate social responsibility is therefore a key element of corporate sustainability: A company is more likely to grow and thrive over time. For example, many countries have a rapidly aging population, especially in Europe and to a lesser extent in the United states. In these countries, companies should develop policies and implement programs aimed at protecting their human capital, in particular older workers. A sustainable organization has the flexibility and adaptability to respond readily to both internal and external influences. This might include shifts in the business climate, market opportunities, or the labor market as well as new ideas or challenges that may develop internally. Without full employee engagement, the organization will lack the flexibility and adaptability to respond in a timely manner to changing circumstances. A sustainable organization has employee stability and engagement as well as effective formal and informal communication channels and work processes that enable it to adjust to changing circumstances in an ongoing manner. To take it a step further, we believe the United States is now in the midst of a major societal shift that has implications for how effective organizations will be in attracting and retaining the most talented and creative people in the workforce. These individuals have high expectations for themselves; enough talent to find alternatives to the traditional career in a large organization; and a desire to find meaning, balance, authenticity, and spiritual fulfillment in their lives. Organizations that are viewed as hampering these human desires will find it difficult to attract and keep the best employees to the long-term detriment of the organization. In 1989, Smith and Carayon-Sainfort (1989) proposed the work system model that defines various elements of work and the interactions between the work elements (see Figure 1). Because the work system model is anchored in the discipline of human factors and ergonomics, the person is at the center of the work system: the person has physical, cognitive, and psychosocial characteristics and needs that can influence his/her interactions with the rest of the work system. The person performs tasks using various tools and technologies in a specific physical environment. There are a number of organizational conditions that can influence the person and the rest of the work system. The work system model encompasses all three domains of human factors specialization. For instance, relevant topics for physical ergonomics include working postures: Working postures are defined by the interactions between the individual, the tasks, the physical environment, and the design of tools and technologies. In addition, there has been increasing recognition of the importance of psychosocial work factors as determinants of physical stress: A worker who is under psychosocial stress. However, it has become clear that mental workload is also influenced by larger organizational issues that can affect specific task demands (MacDonald, 2003). For instance, an organization may restrict the number of rest breaks taken by workers and increase the time pressure put on workers; this will definitely increase the task demands and will likely lead to increased mental workload. Therefore, from a human factors perspective, it is important to consider all elements of the work system and their interactions.

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Separately anxiety of influence emsam 5mg for sale, it was identified that the majority of the formal risk assessment methods need to be applied by a facilitator with experience in the use of the method (although the other participants may not require that same level of experience anxiety symptoms dsm discount emsam 5 mg with visa, being reliant on the skill of the facilitator) anxiety worse in morning order emsam 5 mg visa. The Preliminary Risk Assessment tool was designed such that it does not require an experienced facilitator anxiety x rays order emsam 5 mg mastercard, although one would add value. Instead, it was structured with the assumption that the risk owner will undertake the preliminary assessment in order to be confident that the risk assessment is appropriate, and to understand the necessary resources. The comprehensive risk assessment tool assumes that a trained facilitator will lead the assessment. It was considered inappropriate to attempt to capture the subtleties of complex risk assessment within a short document. It is possible that the risk owner also could be the facilitator, if they have the necessary training and experience, but it is not necessary. Incorporating a screening process Risk assessment approaches in other industries apply a screening process to identify the elements of the system on which the risk assessment should focus. Typically this screening process will be based on consequence ­ with only high-consequence risks being sentenced for further assessment. It is noted that this approach potentially could screen out low-consequence high-probability risks, which may merit further assessment, and this is a further reason why it is important both for the screening process to be explicit, and for the risk owner to participate. The preliminary risk assessment process supports this screening process, and enables the team to make explicit their decisions whether to include something for further analysis or to screen it out. By providing an audit trail for the risk decisions, it is possible subsequently to revisit the assessment if the need arises. The screening process also provides a mechanism for engaging with other stakeholders, such as those who control required resources for the assessment. The approach adopted within the Toolkit is to guide the user during the preliminary risk assessment to consider the significance of identified failure modes. Rather than prescribe a decision-tree, the Toolkit supports a broader consideration of the same issues. It is also a process that, despite the formality of a number of well-validated methods, is also reliant on the manner in which the team-based assessment is managed, and hence is sensitive to team dynamics, individual knowledge and competence, and engagement with the process. Consequently it is important that the risk assessment process is properly and actively managed. The Toolkit includes guidance on how to determine who should be involved in the process, and the guidance on the individual methods provides a structure for how the information is elicited and assessed. A judgement was required in respect of the level of guidance within the Toolkit, and hence generic guidance on facilitation was excluded from the Toolkit as it is not specific to risk assessment. System mapping Given the diversity and complexity of the healthcare system, earlier sections in this report have described the need for better application of diagrammatic representation approaches to healthcare ([Clarkson et al. In order to take full advantage of diagrammatic representations for the Toolkit, the following questions need to be explored first: · · What types of diagrammatic representations are available and how are they different? These methods include process maps, activity cycle diagrams, stock flow diagrams, just to name a few [Bozarth and Handfield, 2005; Pidd, 2003]. System mapping methods shortlist and selection Jun made an attempt to apply various diagram types to healthcare and identified ten distinct diagram types potentially applicable to healthcare [Jun et al. Their perceived usefulness was evaluated by healthcare managers and clinicians, and researchers in healthcare. These perceptions were measured in terms such as ease of understanding the diagrams, and the degree to which they were perceived to help identify various types of hazard in healthcare. Such associations also influenced the shortlist of six diagram types in the Toolkit. Figure 29 shows the six different diagram types and what each of them represents in terms of process, information and people. This highlights the relative suitability of different diagram types for capturing specific attributes of a system. A large tick indicates a significant match between the diagram type and characteristic, a small tick a partial match and no tick indicates there is no match. This set would be flexible enough to analyse a suitable range of situations in healthcare. It was therefore recognised that those methods selected for inclusion in the Toolkit would be a subset of the totality of methods, and may not include certain methods that users of the Toolkit are already familiar with.

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The psychotherapist helped the client to become "emotionally divorced" from her abusive father by engaging in a ritualized spiritual ceremony anxiety depression symptoms buy cheapest emsam and emsam. Jay (1994) reminds victimized individuals that their traumatic memories are not to be forgotten anxiety symptoms with menopause buy emsam 5 mg free shipping, but rather contained and sanctified anxiety 7 reasons cheap emsam 5mg overnight delivery. Your personal trauma becomes resonant (one with) history and part of a life cycle of recovery anxiety symptoms pain in chest order emsam amex. We need a place and a way for individuals to give further voice of their knowledge of dread, instead of hearing it alone in nightmares. Meichenbaum (1994) has reviewed several ways Art Expressive techniques, metaphorical story telling and cognitive-behavior play therapy can be used to help traumatized children and their families. The spiritually-oriented interventions in this Handout can be used to supplement these psychotherapeutic interventions, as illustrated by Kataoka et al (2006). Kataoka et al (2006) describe how a faith-based community intervention can be used to treat children who have been exposed to violence. The need for such an intervention was 339 highlighted by the high incidence of violence exposure, especially in minority, urban, poor populations. As one mother observed: "My boy was very afraid and from that day he was terrorized. I remember at night he would pray and ask Jesus to give him comfort" (as reported by Kataoka et al, 2006) 14. Latino everyday language is filled with invocations of God, angels and saints with multiple references to "God willing". Spirituality which is communal in Latino culture can provide sustenance, hope, a sense of belonging, and a reason to live. Comas-Diaz provides a number of examples of Latino healing procedures that culturally-sensitive and culturally ­competent psychotherapists can include in order to help traumatized clients develop spiritual resilience and move from being " sufferers to seekers". These healing procedures may include: Conduct assessment of culturally-specific distress. For example, among Mexican American "nervios" that center on various somatic sensations of shortness of breath and trembling which are thought to indicate dysregulation of nerves or called "ataque de nervios" among Puerto Ricans. Use of imagery and fantasy in therapy (see De Rios (1997) who uses "magical realism", which is a mixture of reality and fantasy. Cultural heroes and heroines are used to help traumatized Latino children image safety and reconfigure traumatic events). The deceased can continue a relationship with the living through dreams, visions, visitation, and through the intercession of folk healers. Use Spanish proverbs or "Dichos" which are culturally accepted communications that discourage the expression of negative feelings and can act as learning tools for cognitive restructuring. Illustrative Dichos "When one door closes another one opens" "A bad thing can turn into something good" "God helps those who help themselves" 341 Use storyteller icons, folktales, folk tapestries to create personal narratives that lead to healing and transformation (See Agosin, 1996; Ginaturco & Turtle, 2000). Attend celebrations, ceremonies, communicate with dead relatives, repeat story of namesake. Comas-Diaz indicates that Latino clients may invite the psychotherapist to attend and participate in such celebrations. Engage in testimonial activities that may lead to political activities (See Agger & Jensen 1990, Meichenbaum, 2012) Conduct culturally-appropriate burial rites. For many Latinos, affiliation with dead relatives through dreams, visions and feelings helps them cope with grief. Native Americans view the relatives who have gone before them as part of their lives and relationships with ancestors help to guide present-day actions. The folk healer may use purifications rituals, herbs, prayer, community ceremonial activities to foster healing. The client may choose to communicate with God directly without the intercession of a folk healer. Several other psychotherapists who work with Latino populations have also demonstrated that treatment can be culturally adapted and involve spiritual elements. For example: Organista et al (1994) and Munoz and Mendelson (2005) have culturally adapted cognitive behavior therapy to treat Latino depressed outpatients. Costantino et al (1986, 1994) have used story-telling and folktales (Cuento Therapy) with Puerto Rican children. Koss-Chioino and Vargas (1999) have demonstrated how restoring a spiritual connection helped Latino youth who were struggling with psychological and acculturative distress, alienation and substance abuse.

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