text: DRUM Community: Geology http://hdl.handle.net/1903/2243 2014-09-30T10:19:18Z Constraining Lithospheric Structure across the Continental Borderland using Receiver Functions http://hdl.handle.net/1903/15394 Title: Constraining Lithospheric Structure across the Continental Borderland using Receiver Functions Authors: Reeves, Zachary Anthony Abstract: Due to its complex history of deformation, which includes subduction, rifting, and transtensional motions, the California Continental Borderland provides an interesting geological setting for studying how the structure of oceanic and continental plates responds to deformation. We calculate Ps and Sp receiver functions at permanent stations of the Southern California Seismic Network as well as ocean bottom seismometer data gathered as part of the ALBACORE seismic experiment in 2010-2011. Our results indicate that the Outer Borderland has been translated with little to no internal deformation, while the Inner Borderland underwent significant crustal thinning to compensate for the 90 degree clockwise rotation of the western Transverse Range block. We detect an oceanic seismic lithosphere-asthenosphere boundary at 58 km depth west of the Patton Escarpment. Sp common conversion point stacks confirm wholesale lithospheric thinning of the Inner Borderland and suggest the presence of a slab fragment beneath the Outer Borderland. 2014-01-01T00:00:00Z DETERMINATION OF SIDEROPHILE ELEMENT CHARACTERISTICS THROUGHOUT LUNAR HISTORY: IMPLICATIONS FOR THE LUNAR MAGMA OCEAN AND LATE HEAVY BOMBARDMENT http://hdl.handle.net/1903/15345 Title: DETERMINATION OF SIDEROPHILE ELEMENT CHARACTERISTICS THROUGHOUT LUNAR HISTORY: IMPLICATIONS FOR THE LUNAR MAGMA OCEAN AND LATE HEAVY BOMBARDMENT Authors: Sharp, Miriam Abstract: Examining the chemical behavior of highly siderophile elements (HSE) in impact events and during planetary differentiation can illuminate geologic processes that have affected the Moon. This dissertation addresses impactor compositions during the putative late heavy bombardment and the chemical composition of the evolving lunar magma ocean at both the times of core segregation and crust formation. Concentrations of the HSE Re, Os, Ir, Ru, Pt, and Pd and 187Os/188Os isotopic compositions are reported for seven Apollo 17 and four Apollo 16 impact melt rocks. Most Apollo 17 samples examined here as in prior studies are characterized by very similar HSE signatures, consistent with a common impactor that had suprachondritic Ru/Ir, Pd/Ir, and Re/Os. In contrast to the Apollo 17 signature, the Apollo 16 impact melts have a wider range of Ru/Ir, Pd/Ir, and Re/Os. This compositional range might be the result of sampling at least three impactor signatures at this site. Experimentally determined plagioclase-melt partition coefficients are also presented. These partition coefficients are used to estimate the concentrations of Sr, Hf, Ga, W, Mo, Ru, Pd, Au, Ni, and Co in a crystallizing lunar magma ocean at the point of plagioclase flotation. Plagioclase-melt derived concentrations for Sr, Ga, Ru, Pd, Au, Ni, and Co are also consistent with prior estimates. Estimates for Hf, W, and Mo, however, are higher. These elements may have concentrated in the residual liquid during fractional crystallization, due to their incompatibility. Experimentally determined metal-silicate partition coefficients are used to constrain the concentrations of W, Mo, Ru, Pd, Au, Ni, and Co in the lunar magma ocean at the time of core formation. The resulting lunar mantle estimates are generally consistent with previous estimates for the concentration of these elements in the lunar mantle. Together, these new results are used to present a compositional timeline for the Moon between the crystallization of the lunar magma ocean and the late heavy bombardment. 2014-01-01T00:00:00Z Petrogenesis of Peraluminous Granites from the Fosdick Mountains, Marie Byrd Land, West Antarctica http://hdl.handle.net/1903/14964 Title: Petrogenesis of Peraluminous Granites from the Fosdick Mountains, Marie Byrd Land, West Antarctica Authors: Brown, Caitlin R. Abstract: Granites from the Fosdick Mountains, West Antarctica were analyzed for major and trace elements as well as Sr-Nd isotopes ratios in order to investigate the sources and processes associated with granite formation at a former convergent margin. U-Pb ages from zircon separates are consistent with previous results and yield ages of ~360 Ma and ~100Ma. Major and trace elements indicate that paragneiss and orthogneiss samples are the high-grade equivalents of the Swanson Formation and the Ford Granodiorite site. Granites produced from the Devonian-Carboniferous melting event are derived primarily from the Ford Granodiorite suite while granites produced from the Cretaceous melting event are derived from melting of the Ford Granodiorite suite or mixing between the two putative sources. Cretaceous granites show evidence of early crystallized minerals. There is no chemical evidence for a source other than the Ford Granodiorite suite or the Swanson Formation. 2013-01-01T00:00:00Z GLOBAL AND REGIONAL REFERENCE MODELS FOR PREDICTING THE GEONEUTRINO FLUX AT SNO+, SUDBURY, CANADA http://hdl.handle.net/1903/14917 Title: GLOBAL AND REGIONAL REFERENCE MODELS FOR PREDICTING THE GEONEUTRINO FLUX AT SNO+, SUDBURY, CANADA Authors: Huang, Yu Abstract: Determining the radiogenic heat power that is driving plate tectonics and mantle convection is fundamentally important to understanding the Earth's heat budget and its thermal and chemical evolution. The radiogenic heat power is coupled to the chemical composition of the Bulk Silicate Earth (BSE), which has been debated for decades. Geoneutrinos produced by beta-minus decays in U, Th and K decay systems are correlated to the radiogenic heat power in the Earth. Measured geoneutrino signals at different locations can be used to investigate the distributions and abundances of U and Th, given appropriate reference Earth models. Here I construct both a global and regional scale reference model to predict the geoneutrino signal at the SNO+ detector in Sudbury, Canada. The primary objective of this dissertation is to predict the geoneutrino detection rate for this soon to be operational geoneutrino detector and evaluate its asymmetric uncertainty caused by the log-normal distributions of U and Th in the crust. The focus of both models are on the geoneutrino signal from the continental crust, which determines SNO+'s sensitivity to the mantle geoneutrino signal, which is key to testing different BSE compositional models. The total geoneutrino signal at SNO+ is predicted to be 40 +6 -4 TNU by combining the global and regional reference model predictions and assuming the contribution from continental lithospheric mantle and convecting mantle is 9 TNU. It is not feasible for SNO+, on its own, to provide experimental result that will determine the mantle geoneutrino signal and refine different BSE compositional models because of the large uncertainty associated with the crustal contribution. The regional crust study presented here lowers the uncertainty on the geoneutrino signal that originates from bulk crust when compared to the global reference model prediction ( 30.7 +6.0 -4.2 TNU vs. 34.0 +6.3 -5.7 TNU). A future goal is to increase the resolution of the model in proximal area to the detector (e.g., 50 km by 50 km), which will further reduce the uncertainty. To obtain useful data on the mantle geoneutrino signal, detections of geoneutrinos carried out on the oceans, such as the proposed ocean-bottom Hanohano experiment, will be of significant scientific value. 2013-01-01T00:00:00Z


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Posts Tagged 'impotence'
Talisman for ProtecionTalisman for Protecion
Written by Frances on Sunday, July 29, 2012 | No Comments
Categories: Electro stress, Purification Program, Sex, Spirits Tags: addictions, black magic, brujeria, cell phone radiation, curses, electrostress, emotional violence, evil eye, frigidity, hechizos, impotence, inccubus, Labradorite, migrans, Sex, sexual chakra, sexuality, succubus, talisman, throat chakra
Labradorite Talisman
You need protection from spirits when you visit places that are particularly susceptible to spirit invasion. That includes places where people are very sick or have died, such as funeral homes, hospitals, nursing homes and cemeteries. When you must go to a place of this nature, make sure you use all of your Labradorite Talisman to protect your aura against invading spirits looking for a new host.
Mantras for Sex
Written by Frances on Wednesday, April 11, 2012 | No Comments
Categories: Mantras, Sex Tags: impotence, Mantras, Sex, sex mantras
Point specific mantras are the most effective technique I have found in all my years of searching for simple and inexpensive modalities of healing. Please go the link Mantras to learn how to do the mantras properly.
Below is a short list of potential mantras to help heal issues your sexual chakra may be holding:
Please God help me with my intention to heal my sexuality.

subset: commoncrawl


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I have always been a strong Second Amendment supporter.
It's not that I have any particular love for guns; I have never fired a gun. I don't really like guns and I don't particularly like it when people bring guns around me. If you want to know the whole truth, people who are really enthusiastic about their love for guns and shooting weird me out a little bit.
But the same way President Obama seems to think people "cling to guns," I cling to the Constitution and am loath to see "the right of the people to keep and bear arms" messed with, especially in an ad hoc or knee-jerk manner.
How does one react to the tragedy that occurred in Newtown, Connecticut last Friday?
It didn't take long for the anti-gun lobby to jump to the conclusion that the massacre of 20 young children and six women members of the faculty and staff at the Sandy Hook Elementary School illustrates the need for stricter controls on guns. In fact, one congressman issued a press release within an hour of the announcement of the event, literally before any facts were known. Perhaps he has a press release prepared "just in case".
By MARIA SHANAHAN
PROVIDENCE – Rhode Island's tax amnesty program generated more than $17 million following its conclusion last month, according to the Rhode Island Division of Taxation.
The amnesty provided Rhode Islanders with the opportunity to pay delinquent state taxes without penalties and with an interest rate reduction of 25 percent.
"We're delighted that so many Rhode Island taxpayers took advantage of this opportunity to clean their slates and get a fresh start," David M. Sullivan, Rhode Island tax administrator, said in a statement.
By MARTHA SMITH
Special to the Standard
NORTH KINGSTOWN – On a brisk Sunday morning in various corners as well as the yard of the Quonset Air Museum, eight teenagers are enthusiastically polishing, cleaning, sanding and painting pieces of history.
Working with the museum's older members who serve as mentors – sharing technical information and personal knowledge – the youngsters spend five hours every weekend contributing a high level of energy to normally drawn-out projects.
By PAUL J. SPETRINI
PROVIDENCE— North Kingstown resident Frank Mattos may have only founded his Massachusetts-based company Platinum Fire Protection & Services, LLC with co-owner Rob Pereira in 2010 but, already, his company has made waves in Rhode Island's hospitality industry.
And now he has the hardware to prove it.
Social media has changed the way society works, from everyday communications with friends and family members to the way employers screen potential job interviews and single men and women look for possible dating matches.
Now, it may begin changing police work as well.
For the second time in recent months, the North Kingstown Police Department is turning to Facebook in an attempt to solve a long-thought-unsolvable cold case.
NORTH KINGSTOWN – A memorial service celebrating the life of Carla Neubert Benoist, 67, longtime animal welfare advocate and dedicated public servant, who died suddenly on Dec.3, will be held Sunday at the Cold Spring Community Center.
Correction: The Narragansett Times originally reported that auditions for the "Road Show" would be held through Dec. 17. Auditions will be held today only, Dec. 14, through 4 p.m. The Times regrets the error.
SOUTH KINGSTOWN – The Courthouse Center for the Arts has changed its name to Courthouse CenterStage.
The Quonset Development Corporation has been lauded over the past few years for its long-term planning and commitment to its future vision of the Quonset Business Park and, thanks to some much-needed federal money, one of the QDC's main objectives—maintaining and repairing infrastructure— is about to get a whole lot easier.
After a long and arduous negotiating process that often spilled over in public and on editorial pages across the area, the North Kingstown School Committee and its Educational Support Professionals union finally reached a new three-year contract Tuesday night.
The new deal, which will save the school district an estimate $1,760,000, does not include or settle the issue of the controversial outsourcing of 26 custodial employees in the district, a source of great debate between the two sides which will ultimately be played out in the courts.


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Hai, I got the following error when i tried to shrink my warehouse database in my job.
"Msg 3140, Level 16, State 5, Line 1 Could not adjust the space allocation for file 'WarehouseDb'. Msg 3023, Level 16, State 2, Line 1 Backup, file manipulation operations (such as ALTER DATABASE ADD FILE) and encryption changes on a database must be serialized. Reissue the statement after the current backup or file manipulation operation is completed."
But neither i was using those files nor i was running out of disk space.I have arround 43GB free space on my drive...and also let me know what system phantom health records are because one of my maintainance plan deletes these records
asked May 15, 2011 at 11:46 AM in Default
edited May 15, 2011 at 12:02 PM
Grant Fritchey ♦♦
add new comment (comments are locked)
Some other operation must be currently occurring for this error to be evident. Check sys.dm_os_waiting_tasks and see if there are things currently waiting on the system. Something else has to be running.As far as the deletes goes, I don't understand what you're asking about.
answered May 15, 2011 at 12:01 PM
Grant Fritchey ♦♦
when my Job is running i came across this in profiler "SYSTEM PHANTOM HEALTH RECORDS ARE DELETED".my job has nothing to do with this.I was wondering whether are these system generated records !!
May 16, 2011 at 11:03 AM GMC
add new comment (comments are locked)


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|Thomas Gardner in
Great Migration
Thomas Gardner has 6 pages (Vols I-III, pg 731).updated 06/17/2013
The study proposes that Margaret was Thomas' second wife; we'll continue with Dr Frank A's hypothesis (Margaret arrived with Thomas at Cape Ann in 1624) until proven otherwise.
While looking at some issues with one family, one researcher referenced what was written by this project. In a sense, it may be the new bible concerning the early times.
Don't worry, we'll check this work out. In one case, I've already noticed an oversight. But, trying to address that type of thing will await some more review.
Modified: 07/21/2013


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Howard Bryant discusses Rafael Nadal's outlook for the Asian tournaments in his return from injury.
Use a Facebook account to add a comment, subject to Facebook's Terms of Service and Privacy Policy. Your Facebook name, photo & other personal information you make public on Facebook will appear with your comment, and may be used on ESPN's media platforms. Learn more.


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The Town and Country Garden Club held their final meeting of the year on May 10, 2011 at Aiken's Nursery on East King's HIghway in shreveport. President Yvonne Jackson opened the meeting by introducing the speakers from Aiken's Nursery, Joyce O'Hearn and Donna Shield.
Mrs. O'Hearn and Mrs. Shield had examples of more than twenty plants including annual and perennial flowers and shrubs and trees. The ladies gave a description of each plant and where it could best be used in the garden.Subscribe to Read!


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National Local Home Improvement Specialists
Below is a list of LOCAL home improvement professionals that Housetrends.com is proud to present to you for your home projects. The professionals listed on the Housetrends.com professionals page must be recommended by other professionals that Housetrends.com knows and trusts. They must also be open to reviews from people like you who visit our site and contact them for work.


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A-Z Index
Type above to search for any page within St. Thomas University, or click any link to the right to go straight there. The list will automatically shorten as you type.
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Annual Security Report for Clery Act Compliance:
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8.1 Policy Statement Addressing Timely Warnings
Timely Warnings
In the event that a situation arises, either on or off campus, that, in the judgment of the Vice President of Administrative Affairs or his/her designee, constitutes an ongoing or continuing threat, a campus wide "timely warning" will be issued. The warning will be issued through the university's STU Alert Emergency Notification System (e.g., text, e-mail & vmail messages) to students, faculty, staff and The City of Miami Gardens Police Department. The "timely warning" may be posted on the university's web page and information line: 1-877-STU-PLAN.
Depending on the particular circumstances of the crime, especially in all situations that could pose an immediate threat to the community and individuals, the Office of Public Safety may also post a copy of the notice in each residence hall, and on doors of each on-campus building. Anyone with information warranting a timely warning should report the circumstances to STU's:
Office of Public Safety by phone (305) 628-6500, or
In-person to any uniformed Public Safety Officer, or
Office of Public Safety Gate House at the main gate, or
Office of the Director of Public Safety located in Lewis Hall.
8.2 Policy Statement Addressing Preparation of Disclosure of Crime Statistics
Policy for Reporting The Annual Disclosure of Crime Statistics
The University's Office of Public Safety prepares this report to comply with the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act. The full text of this report is located on
our web site
. This report is prepared in cooperation with the local law enforcement agencies surrounding our main campus and alternate sites, Housing and Residential Services, the Judicial Affairs Officer, the Division of Business Affairs, and the Division of Student Affairs. Each entity provides updated information on their educational efforts and programs to comply with the Act.
Campus crime, arrest and referral statistics include those reported to the STU Office of Public Safety, designated campus officials (including but not limited to directors, deans, department heads, psychologist, judicial affairs, advisors to students/student organizations, athletic coaches), and local law enforcement agencies. The licensed health care providers in the Health & Wellness division inform student - clients of the procedures to report crime to the University's Office of Public Safety, or local law enforcement on a voluntary or confidential basis, should they feel it is in the best interest of the client. A procedure is in place to anonymously capture crime statistics disclosed confidentially during such a session.
Each year, an e-mail notification is made to all enrolled students and employees that provides the web site to access this report. Copies of the report may also be obtained at the University's Office of Public Safety located in Lewis Hall, or by calling (305) 628-6793.
8.3 Policy Statement Addressing the Reporting of Criminal Offenses
To report a crime:
Contact the Office of Public Safety at (305) 625-6500 (non-emergencies), or by using the Code Blue telephones located near Parking Lots, or by some buildings.
Dial 9-1-1 (emergencies only).
You may also use the RED Emergency Phones located throughout campus: Any suspicious activity or person seen in the parking lots or loitering around vehicles, inside buildings or around the Residence Hall should be reported to the Office of Public Safety. In addition, you may report a crime to the following areas:
Associate Dean of Students:
(305) 628-6855 Student Center – Student Affairs
Assoc. Director of Student Health Center:
(305) 628-6690
Director of Human Resources:
(305) 628-6517
Assoc. Director of Residence Life:
(305) 628-6554
8.4 Policy Statement Addressing Voluntary Confidential Reporting
Confidential Reporting Procedures
If you are the victim of a crime and do not want to pursue action within the University System or the criminal justice system, you may still want to consider making a confidential report. With your permission, the Director of Public Safety or a designee can file a report on the details of the incident without revealing your identity. The purpose of a confidential report is to comply with your wish to keep the matter confidential, while taking steps to ensure the future safety of yourself and others. With such information, the University can keep an accurate record of the number of incidents involving students, determine where there is a pattern of crime with regard to a particular location, method, or assailant, and alert the campus community to potential danger. Reports filed in this manner are counted and disclosed in the annual crimes statistics for the institution.
8.5 Policy Statement Addressing Limited Voluntary Confidential Reporting
Crime Reporting
The university encourages anyone who is the victim or witness to any crime to promptly report the incident to the Office of Public Safety. Confidential reports for purposes of inclusion in the annual disclosure of crime statistics can be made to the Office of Public Safety, as identified below:
Office of Public Safety by phone (305) 628-6500, or
In-person to any uniformed Public Safety Officer, or
Office of Public Safety Gate House at the main gate, or
Office of the Director of Public Safety located in Lewis Hall.
Because police reports are public records under state law, the Miami Gardens Police Department cannot hold reports of crime in confidence.
Confidential reports of crime may also be made to Crime Stoppers at (305) 471-8477 (471-TIPS), or the Miami Gardens Police Department Non-emergency number: (305) 474-6473 (474-MGPD). The Miami Gardens Police Department is located at: 1020 NW 163rd Drive, Miami Gardens, FL 33169
8.6 Policy Statement Addressing Security and Access
Access Policy
During business hours, the university (excluding certain housing facilities) will be open to students, parents, employees, contractors, guests, and invitees. During non business hours access to all university facilities is by key, if issued, or by admittance via the Office of Public Safety or Residence Life staff. In the case of periods of extended closing, the university will admit only those with prior written approval to all facilities.
Over extended breaks, the doors of all halls will be secured around the clock. Some facilities may have individual hours, which may vary at different times of the year. Examples are the Library, the Student Center, and the Weight Room. In these cases, the facilities will be secured according to schedules developed by the department responsible for the facility.
Emergencies may necessitate changes or alterations to any posted schedules. Areas that are revealed as problematic have security surveys conducted of them. Administrators from the Office of Physical Plant, Emergency Management, Residence Life, and other concerned areas review these results. These surveys examine security issues such as landscaping, locks, alarms, lighting, and communications. Additionally, during the academic year, the Associate Dean of Students, the Directors of Physical Plant and Residence Life and Resident Assistants meet weekly to discuss issues of pressing concern.
8.7 Policy Statement Addressing the Authority of Non-Sworn Public Safety Officers on Campus
St. Thomas University Public Safety Officers have the authority to ask persons for identification and to determine whether individuals have lawful business at St. Thomas University. University Public Safety Officers have the authority to issue parking tickets, which are billed to financial accounts of students, faculty, and staff. University Public Safety Officers do not possess arrest power. Criminal incidents are referred to the Miami Gardens Police Department who have jurisdiction on the campus. The Offices of Public Safety and Emergency Management at St. Thomas University maintain a professional working relationship with the Miami Gardens Police Department. All crime victims and witnesses are strongly encouraged to immediately report the crime to the Office of Public Safety and the appropriate police agency. Prompt reporting will assure timely warning notices on-campus and timely disclosure of crime statistics.
8.8 Policy Statement Addressing the Encouragement of Accurate and Prompt Crime Reporting
General Procedures for Reporting a Crime or Emergency
Community members, students, faculty, staff, and guests are encouraged to report all crimes and public safety related incidents to the Office of Public Safety in a timely manner. This policy focuses on the Office of Public Safety because it patrols the campus.
To report a crime, emergency or non-emergency on the University campus call extension 6500 or, from outside the University phone system, (305) 628-6500.
Public Safety Officers are available at these respective telephone numbers 24 hours a day to answer your call. In response to a call, the Office of Public Safety will take the required action, dispatching an officer or requesting that an Officer from the Miami Gardens Police be dispatched to campus.
All Office of Public Safety incident reports are forwarded to the Vice President of Administrative Affairs and Assistant Dean of Students offices for review and potential action by the Office of Judicial Affairs. The Office of Public Safety will investigate a report when it is deemed appropriate. Additional information obtained via the investigation will also be forwarded to the Office of Student Judicial Services.
The Office of Public Safety will seek the assistance of the Miami Gardens Police Department, as necessary. If a sexual assault or rape should occur, staff on the scene will contact the Student Health Center, the Associate Dean of Students or the Associate Director of Residence Life.
This policy contains information about on-campus and off campus resources. That information is made available to provide STU community members with specific information about the resources that are available in the event that they become the victim of a crime.
Crimes should be reported to the Office of Public Safety to ensure inclusion in the annual crime statistics and to aid in providing timely warning notices to the community, when appropriate. For example, a crime that was reported only to the Miami Gardens Police Department would not be included in STU crime statistics.
8.9 Policy Statement Addressing Counselors
As a result of the negotiated rulemaking process which followed the signing into law, the 1998 amendments to 20 U.S.C. Section 1092 (f), clarification was given to those considered to be campus security authorities. Campus "Pastoral Counselors" and Campus "Professional Counselors", when acting as such, are not considered to be a campus security authority and are not required to report crimes for inclusion into the annual disclosure of crime statistics. As a matter of policy, they are encouraged, if and when they deem it appropriate, to inform persons being counseled of the procedures to report crimes on a voluntary basis for inclusion into the annual crime statistics.
The rulemaking committee defines counselors as:
Pastoral Counselor:
An employee recognized by that religious order or denomination or student of the University affiliated to the Campus Ministry or in the pastoral ministry program, who provides confidential counseling and who is functioning within the scope of that recognition as a pastoral counselor or a student in pastoral ministries or of campus ministry.
Professional Counselor:
An employee of an institution whose official responsibilities include providing psychological, psychiatric, social work, mental health counseling or marriage and family therapy services, to members of the institution's community and who is functioning within the scope of his or her license or certification.
8.10 Policy Statement Addressing Security Awareness Programs
Security Awareness Programs
During orientation in August and January students are informed of services offered by the Office of Public Safety. The Director of Public Safety or his/her designee outline ways to maintain personal safety and residence hall security. Students are told about crime on-campus and in surrounding neighborhoods. Similar information is presented to new employees. Crime Prevention Information and Sexual Assault Prevention Information are offered on a continual basis.
Annually, the Office of Public Safety, in cooperation with other University organizations, departments, and Miami Gardens Police Department present crime prevention awareness sessions on sexual assault (rape and acquaintance rape), Rohypnol abuse, theft, and vandalism, as well as educational sessions on personal safety and residence hall security.
A common theme of all awareness and crime prevention programs is to encourage students and employees to be aware of their responsibility for their own security and the security of others.
In addition to workshops, students, faculty and staff are reminded by signs posted throughout campus that safety and security is everyone's responsibility; non/emergency numbers are also noted: Public Safety (305) 628-6500 and 9-1-1.
When time is of the essence, information is released to the university community through the STU Alert! Emergency Notification System (e.g., text, email & vmail messages), security alerts posted prominently throughout campus, and via the 1-877-STU-PLAN information line.
8.11 Policy Statement Addressing Crime Prevention Programs
Crime Prevention Programs
Crime Prevention Programs on personal safety and theft prevention are sponsored by Public Safety, Emergency Management, Student Health Center and Residence Life and campus organizations throughout the year. Officers from the Miami Gardens Police Department facilitate these programs for student organizations, and faculty/staff providing a variety of educational strategies and tips on how to protect themselves from sexual assault, theft and other crimes.
To enhance personal safety, and especially after an evening class, walk with friends or someone from class that you know well, or call Public Safety for a security escort.
8.13 Policy Statement Addressing Alcoholic Beverages
Policy on Alcoholic Beverages
The possession, sale or the furnishing of alcohol on the University campus is governed by the University Alcohol Policy and Florida state law. Laws regarding the possession, sale, consumption or furnishing of alcohol are controlled by The Division of Alcoholic Beverages and Tobacco pursuant to Chapter 210, Chapters 561-565 and Chapters 567-569 of Florida Statutes. The enforcement of the University's alcohol policy on-campus is the primary responsibility of the Office of Public Safety, Director of Food Services, Residential Life Staff and the Assistant Dean of Students. The STU campus has been designated "Drug-Free" in keeping with the intent of the Drug-Free Workplace Act of 1998 and the Drug-Free School and Communities Act Amendments of 1989 and only under certain circumstances is the consumption of alcohol permitted. It is unlawful to sell, furnish or provide alcohol to a person under the age of 21. The possession of alcohol by anyone less than 21 years of age in a public place or a place open to the public is illegal. Students of legal age are permitted to use/possess alcoholic beverages within their own rooms, or the rooms of other residence who are of legal age. There are to be no bulk containers in excess of 1 liter in the residence halls. It is also a violation of the University Alcohol Policy for anyone to consume or possess alcohol in any public area of campus without prior University approval. Organizations or groups violating alcohol/substance policies or laws may be subject to sanctions by the University.
The possession, sale, manufacture or distribution of any controlled substance is illegal under both state and federal laws. Such laws are strictly enforced by the Office of Public Safety, Residence Life, Assistant Dean of Students and the Miami Gardens Police Department. Violators are subject to University disciplinary action, criminal prosecution, fine and imprisonment.
8.14 Policy Statement Addressing Illegal Drugs
Policy on Illegal Drugs
The St. Thomas University campus has been designated "Drug free" and only under certain circumstances is the consumption of alcohol permitted. The possession, sale, manufacture or distribution of any controlled substance is illegal under both state and federal laws. Such laws are strictly enforced by the Offices of Campus Public Safety and Residence Life. Violators are subject to University disciplinary action, criminal prosecution, fine and imprisonment.
8.15 Policy Statement Addressing Substance Abuse Education
Alcohol and Substance Abuse Information & Prevention Programs
The University has developed a program to prevent the illicit use of drugs and the abuse of alcohol by students and employees. The program provides services related to drug use and abuse including dissemination of informational materials, educational programs, counseling services, referrals and University disciplinary actions.
The Student Health Center provides the overall coordination of Alcohol and Substance Abuse Information. However, related services are available in other areas of the institution. These include:
Alcohol and Drug Education:
UNI 101 course; Residence Life; Health and Wellness; Student Development and Persistence
Referral Services:
Student Health Center designated staff members
University Disciplinary Actions:
Assistant Dean of Students; and Chief Judicial Affairs Officer
Legal Sanctions – Laws Governing Alcohol
The State of Florida sets 21 as the minimum age to purchase or possess any alcoholic beverage. Specific ordinances regarding violations of alcohol laws, including driving while intoxicated, are available from the Office of Public Safety.
A violation of any law regarding alcohol is also a violation of the University's Student Code of Conduct and will be treated as a separate disciplinary matter by the University.
9.1 Policy Statement Addressing Sex Offenses
Sexual Assault Prevention and Response
The University educates the student community about sexual assaults and date rape through mandatory freshman orientations and/or UNI 101 classes each fall and spring. The Student Health Center offers sexual assault education and information programs to University students and employees upon request. Literature on date rape education, risk reduction, and University response is available through the Student Health Center.
If you are a victim of a sexual assault at this institution, your first priority should be to get to a place of safety. You should then obtain necessary medical treatment. The University strongly advocates that a victim of sexual assault report the incident in a timely manner. Time is a critical factor for evidence collection and preservation. An assault should be reported directly to an STU Public Safety Officer, the Office of Residence Life, Assistant Dean of Students, or to the Miami Gardens Police Department. Filing a police report will not obligate the victim to prosecute, nor will it subject the victim to scrutiny or judgmental opinions from officers. Filing a police report will
ensure that a victim of sexual assault receives the necessary medical treatment and tests, at no expense to the victim
provide the opportunity for collection of evidence helpful in prosecution, which cannot be obtained later (ideally a victim of sexual assault should not wash, douche, use the toilet, or change clothing prior to a medical/legal exam)
assure the victim has access to free confidential counseling from counselors specifically trained in the area of sexual assault crisis intervention.
When a sexual assault victim contacts the Office of Public Safety, a representative from the Student Health Center, the Assistant Dean of Students, or Residence Life will also be notified. The victim of a sexual assault may choose for the investigation to be pursued through the criminal justice system and the University's Judicial System, or only the latter. A University representative from the Student Health Center, Residence Life or the Assistant Dean of Students Office will guide the victim through the available options and support the victim in his or her decision. Various counseling options are available from the University through Student Health Center, or Campus Ministry. Counseling and support services outside the University system can be obtained through the National Sexual Assault Hotline at 1-800-656-HOPE or
or The Switchboard of Miami Crisis Hotline at (305) 358-1640.
Student Handbook
provides, in part, that the student charged may be assisted or represented during the proceedings by an advisor of his/her choice from within the University community (current student or University employee). Both the victim and accused will be informed of the outcome of the hearing. A student found guilty of violating the University sexual misconduct policy could be criminally prosecuted in the state courts and may be suspended or expelled from the University for the first offense. Student victims have the option to change their academic and/or on-campus living situations after an alleged sexual assault, if such changes are reasonably available.
9.2 Policy Statement Addressing Sex Offender Registration
Sexual Offender Registration
In accordance with the "Campus Sex Crimes Prevention Act" of 2000, which amends the Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act, the Jeanne Clery Act and the Family Educational Rights and Privacy Act of 1974, STU Public Safety is providing a link to the FDLE Sex Offender and Predator Registry. This act requires institutions of higher education to issue a statement advising the campus community where law enforcement information provided by a State concerning registered sex offenders may be obtained. It also requires sex offenders already required to register in a State to provide notice of each institution of higher education in that State at which the person is employed, carries a vocation, or is a student. In the State of Florida, convicted sex offenders must register with the Sex Offender and Predators Registry maintained by the Sheriff in the county where they reside.
The FDLE Sex Offender and Predators Registry is available via Internet pursuant to FL Statue, Title XLVI, Ch. 775, Sect. 21. Information provided under this section shall be used for the purposes of the administration of criminal justice, screening of current or prospective employees, volunteers or otherwise for the protection of the public in general and children in particular.
Unlawful use of the information for purposes of intimidating or harassing another is prohibited and willful violation shall be punishable as a Class 1 misdemeanor.
The FDLE is responsible for maintaining this registry. Follow the link below to access the FDLE website:
Student Code of Conduct
XII. Violations of University Standards
Student Code - Misconduct resulting in disciplinary action:
Use of cell phones, PDA's and other electronic communication devices (i.e., initiating phone calls, sending email, or text messages, etc.) in classrooms or during University sponsored events. Students are permitted to receive emergency text messages, but all notification must be either silent or in vibrate mode and not disturb the class.
Policy approved 4/17/08 by Senior Staff.
E: Response & Recovery Operations (CEMP, 10/1/13, pgs. 30-38)
Incident Identification & Threat Assessment
The most critical steps in the emergency response process are incident identification and threat assessment. The ST. THOMAS UNIVERSITY CEMP assumes that most emergency incidents on campus are going to be identified by students, faculty, staff or visitors. When students, faculty, staff, or visitors are involved in or witness a life-threatening emergency, it is essential for them to immediately call 911 and Campus Public Safety (x6500 from campus phone, or (305) 628-6500 from cell). This notification is the first step in the activation of the ST. THOMAS UNIVERSITY CEMP and emergency response. The local 911 Public Safety Access Point and Campus Public Safety will dispatch the appropriate resources to the incident scene. The first responding campus Public Safety Officers are responsible for safely assessing the scene for threats, reporting known threats to other responding officers and confirming the emergency severity and type to the dispatcher. The campus dispatcher is then responsible for initiating the major emergency notification process as outlined in the below "Alert and Notification" section.
A non-life threatening emergency should be immediately reported to the Campus Public Safety Office. When doubt exists or if a non-life threatening emergency has potential to become more dangerous, always take action consistent with the below guidelines.
Once the appropriate University personnel are notified of an incident, the threat assessment process begins. University Personnel must assess the emergency incident and any known threats to determine the appropriate level of response. The following sources of information should be used to assist in the threat assessment process:
Type of incident
Location of incident
Time of incident
Information received from local law enforcement, fire rescue and emergency management agencies
Information received from ST. THOMAS UNIVERSITY Public Safety personnel on scene
Information received from local, regional, state, and federal intelligence report
Emergency Response Levels
In responding to any emergency it is important for University personnel to identify and classify the severity of incident to ensure the appropriate resources are allocated and organizational structure is implemented in a timely fashion. There are three levels of emergency response. The lower the level of emergency the larger the scale of the incident and the more resources and coordination required to manage it. Any given level may be bypassed if necessary to allow a response to proceed to a higher level. The responsibility of classifying emergency levels starts at the campus level and proceeds to local law enforcement and fire rescue agencies as the severity of the emergency increases.
Level 3 - Minor Emergency
A MINOR EMERGENCY is defined as a localized incident with a limited threat to life/safety and no impact normal University operations. Response to a MINOR EMERGENCY is managed at the campus level with limited support from external resources. The ST. THOMAS UNIVERSITY CEMP is not activated for a MINOR EMERGENCY, but certain sections can be used as standard operating guidelines to the extent necessary.
Level 2 - Major Emergency
A MAJOR EMERGENCY is defined as an incident that threatens life/safety and/or severely impacts normal University operations. Response to a MAJOR EMERGENCY can be managed at the campus level and could require significant resources internal and external to ST. THOMAS UNIVERSITY. The ST. THOMAS UNIVERSITY CEMP is activated for a MAJOR EMERGENCY. The Miami-Dade County Department of Emergency Services Duty Officer (305-468-5800) will be notified immediately of a MAJOR EMERGENCY occurring on campus.
Level 1 – Disaster
A DISASTER is defined as an incident that results in the catastrophic loss of life and/or closure of the campus for an extended period of time. Response to a DISASTER is managed at the University level and requires mutual aid from external agencies. The ST. THOMAS UNIVERSITY CEMP is fully activated for a DISASTER. The Miami-Dade County Department of Emergency Services Duty Officer (305-468-5800) will be notified immediately of a DISASTER occurring on campus.
To aid students, faculty, staff, and visitors in their awareness of emergencies, ST. THOMAS UNIVERSITY combines all of its emergency notification systems into a single system concept called STUALERTS! Regardless of which notification methods/technologies are utilized, to the recipient, all emergency notification and warning messages come from ST. THOMAS UNIVERSITY ALERTS!
Emergency Communication Methods
The ST. THOMAS UNIVERSITY ALERTS! emergency notification system consists of the following delivery methods, listed in order of effectiveness (activation, delivery speed, audience reach, etc). ST. THOMAS UNIVERSITY recognizes that emergency information will travel via word-of-mouth. However, this method is unreliable and cannot be controlled, so it is not considered an official communication method.
Primary (immediate)
Public Address System, SMS Text Message, Global Email, Facebook / Twitter, Emergency Alert Radios in Classrooms / Common Areas
STUAlerts! Portal on University Website (i.e., main web page, Web Advisor, EM page), 1-877-STU-PLAN
Voicemail Message to phone numbers provided by recipient in Web Advisor
Emergency Phone Trees (see Emergency & Safety Preparedness Manual)
Media Release / Press Conference Secondary (15 minutes and beyond)
University Hotline
The delivery methods listed above will be initially activated by the Vice President for Administration and Chief Financial Officer / Finance-Administration Section Chief, and if unavailable or unable, the Director of Emergency Management in accordance with the established guidelines listed below. Once the Crisis Management Team is activated, these methods of notification will be used by the Vice President for Administration and Chief Financial Officer / Finance-Administration Section Chief as directed by the Incident Commander.
Decision Criteria
Five criteria must be considered to determine if activation of the STU-ALERTS! system is warranted, which communications delivery methods will be utilized, and who authorizes activation of the system:
1. Hazard Type
What is the hazard? (Room fire, tornado, hurricane)
What is the impact to ST. THOMAS UNIVERSITY? (Minor, major, disaster)
What is the potential for the situation to worsen?
Is the situation under control?
2. Life Safety I Property Protection
What is the potential for death?
What is the potential for serious injury?
What is the potential for minor injury?
What is the potential for damage?
What is the potential for disruption to normal course of business?
3. Urgency
How soon does the message need to go out? (Seconds, hours, days)
Is there time for approval?
4. Audience
Who needs to be alerted? (Administration, faculty, staff, students, visitors)
How many people need to be alerted? (dozens, hundreds, thousands)
5. Capabilities I Limitations
What are the limitations of the system? (audience, delivery time, mass panic)
Which system should be used? (Press conference, bulk text message, public address system)
How quickly can the messages be sent? (Immediately, minutes, hours)
Activation Approval for Emergency Notification System
Activation of the ST. THOMAS UNIVERSITY ALERTS emergency notification system must be approved by the appropriate University officials. The ST. THOMAS UNIVERSITY CEMP was developed under the assumption that there is a need to streamline the activation process for an emergency notification system to ensure timely notification and warning. Seconds count! A cumbersome activation and/or approval procedure may result in injury or loss of life. As such, this process serves to establish a flexible, but controlled, activation approval hierarchy.
The only reason ST. THOMAS UNIVERSITY will not immediately issue a notification for a confirmed emergency or dangerous situation is if doing so will compromise efforts to:
Assist victim(s);
Contain the emergency;
Respond to the emergency, or
Otherwise mitigate the emergency. For example, ST. THOMAS UNIVERSITY may agree to a request of law enforcement or fire department officials.
Activation Approval for Campus Public Address System Delivery Method
The following individuals are trained and authorized to activate the campus public address system delivery method during a life-threatening MAJOR EMERGENCY. As practical and without jeopardizing life safety, the Director of Public Safety is the primary person responsible for activating the campus public address system delivery method during a MAJOR EMERGENCY. If he/she is not available or capable of activating the system proceed down the list to the next available individual:
Director, Public Safety (786) 402-7522
Public Safety Supervisor On-Duty (305) 628-6500
As practical and without jeopardizing life safety
, the following individuals shall be consulted prior to STUALERT! message dissemination. If the preceding individual is not available or is not capable, proceed down the list to the next available individual:
1. Vice President for Administration and Chief Financial Officer / Finance-Administration Section Chief - (786) 423-0431
2. Director of Emergency Management - (561) 901-1114
3. Public Safety Superv., On-Duty (305) 628-6500 Main Gate; (786) 295-9692 Cell
Authorized users are permitted to send only Prepared Alerts without prior consultation with one of the individuals listed above. Situations or messages that do not fall within the prescribed parameters of a Prepared Alert must be approved individually by at least one of the individuals above prior to dissemination.
Activation Approval for All Other ST. THOMAS UNIVERSITY ALERTS Delivery Methods
The following individuals are trained and authorized to activate all other ST. THOMAS UNIVERSITY ALERTS delivery methods during a life-threatening MAJOR EMERGENCY. As practical and without jeopardizing life safety, the Vice President for Administration and Chief Financial Officer / Finance-Administration Section Chief is the primary person responsible for activating all other ST. THOMAS UNIVERSITY ALERTS delivery methods during a MAJOR EMERGENCY. If he/she is not available or is not capable of activating the system, proceed down the list to the next available individual:
Director of Emergency Management - (561) 901-1114
Public Safety Supervisor On-Duty - (305) 628-6500 Main Gate; (786) 295-9692 Cell
As practical and without jeopardizing life safety
, the following individuals shall be consulted prior to ST. THOMAS UNIVERSITY ALERTS message dissemination. If the preceding individual is not available or is not capable, proceed down the list to the next available individual:
Vice President for Administration and Chief Financial Officer / Finance-Administration Section Chief (786) 423-0431
Director of Emergency Management (561) 901-1114
Public Safety Supervisor, On-Duty (305) 628-6500 Main Gate; (786) 295-9692 Cell
Authorized users are permitted to only send Prepared Alerts without prior consultation with one of the individuals listed above. Situations or messages that do not fall within the prescribed parameters of a Prepared Alert must be approved individually by at least one of the individuals above prior to dissemination.
Prepared Alerts
The following emergency scenarios and associated prepared STUALERT! sample messages were approved by the appropriate university officials. These prepared alerts are eligible for immediate activation by an authorized user only if a University emergency falls within the prescribed parameters listed below. When a Prepared Alert is issued, every consideration should be given to following up with an STUALERT! message, which issues appropriate protective actions. Information about protective actions is available in the corresponding section below and through the ST. THOMAS UNIVERSITY website at
Any intentional human-generated hazard, generally of a criminal nature, occurring or imminent, that poses an immediate threat to the health and safety of individuals on campus and requires response from local law enforcement.
active shooter, suicide bomber, hostage situation, civil unrest, terrorist attack, credible bomb or terrorist threat.
Campus Public Safety or Municipal Police Department.
Immediate (seconds)
Potentially fatal or serious injuries to individuals on campus.
Sample Dangerous Situation Prepared Message for Public Address Delivery Methods:
"Attention! Attention Please! A Dangerous Situation has been confirmed on campus. The appropriate personnel are responding. Seek shelter immediately in a secure location and await further instruction."
Sample Dangerous Situation Prepared Message. Delivery Methods for
SMS Text Message, Email, Emergency Alert Radios in Classrooms / Common Areas, University Web Site, Web Advisor, Facebook and Twitter:
*STUAlert!* DANGEROUS SITUATION! If on campus, seek secure location and await further instruction. If off campus, avoid area. Go to www.stu.edu for details.
Any technological situation, generally as the result of an unintentional accident or natural occurrence, occurring or imminent, that poses a threat to the health and safety of individuals on campus.
gas leak, chemical spill, biological hazard, radiological hazard, large fire.
Campus Public Safety, Municipal Police Department, or Miami-Dade County Health Department.
Immediate (seconds)
Potentially fatal or serious injuries to individuals exposed to the hazard.
Sample Hazardous Condition Prepared Message for Public Address Delivery Methods:
"Attention! Attention Please! A Hazardous Condition has been confirmed on campus. The appropriate personnel are responding. Seek shelter immediately in a safe location in the nearest building away from doors and windows and await further instruction."
Sample Hazardous Condition Prepared Message. Delivery Methods for
SMS Text Message, Email, Emergency Alert Radios in Classrooms / Common Areas, University Web Site, Web Advisor, Facebook and Twitter:
*STUALERT!* HAZARDOUS CONDITION! If on campus, seek shelter indoors. If off campus, avoid area. Details at www.stu.edu/ and 1-877-STU-PLAN for details.
Any natural weather hazard that immediately threatens life safety.
Tornado Spotted, Flood Warning, Severe Lightning (During Outdoor Events)
National Weather Service (NWS) -Miami, NOAA Weather Radios, Emergency Alert System, local media.
Immediate (seconds -5 minutes)
Potentially fatal or serious injuries to individuals located outdoors on campus.
Sample Weather Emergency Prepared Message for Public Address Delivery Methods:
"Attention! Attention Please! A Weather Emergency has been reported in the area. Seek shelter immediately in the nearest building away from windows and doors. Await further information before going outdoors."
Sample Weather Emergency Prepared Message. Delivery Methods for
SMS Text Message, Email, Emergency Alert Radios in Classrooms / Common Areas, University Web Site, Web Advisor, Facebook and Twitter:
STUALERT! WEATHER EMERGENCY! Seek shelter immediately in the nearest building away from windows and doors. Go to www.stu.edu or 1-877-STU-PLAN for details.
Emergency Declaration
Declaring a University State of Emergency
The University President has the authority to declare a University State of Emergency. This declaration activates the University Crisis Management Team with the authority to implement actions for the protection of life and property warranted by the scope, location, and/or magnitude of the emergency. If the University President is unavailable, the Vice President for Administration may declare a University State of Emergency and activate the University Crisis Management Team.
Once the University President and/or VP for Administration have been notified of a major emergency incident, they should assess the situation to determine if a University State of Emergency should be declared. Refer to Hazard Analysis (pp. 21-22) for a list of hazards that may require an emergency declaration. The following questions should be asked to assist in assessing the situation.
Are lives threatened?
Is there significant property damage?
Has a campus State of Emergency been declared?
Are standard University operations departments able to manage the incident?
Are specialized emergency services needed? (i.e. Bomb Squad, Urban Search and Rescue, SWAT, HazMat)
Are significant outside mutual aid services needed from the City, County or State?
Are University operations and/or events severely impacted?
When a University State of Emergency is declared, the Crisis Management Team is activated, and the Miami-Dade County Emergency Management Duty Officer
is notified of the Emergency. The Incident Commander is responsible for the proper and expeditious handling of major University emergencies according to the guidelines set forth in the University CEMP. The Incident Commander will provide the overall leadership for a University-wide response and set University¬-wide priorities. All personnel assigned to the Crisis Management Team will come under the authority of the Incident Commander. University personnel not assigned a specific crisis management responsibility are required to take action as directed by the University Crisis Management Team.
Procedures for Testing Emergency Response and Evacuation
An evacuation drill is coordinated by the Office of Emergency Management, Residence Life, the Campus-Community Emergency Response Team and Public Safety each year for all residence halls on campus. Thus, the emergency response and evacuation procedures are tested a minimum of once each year. Students learn the locations of the emergency exits in the building, the sound of the alarm and, are provided guidance about the direction they should travel for the closest exit, and the location of the exterior primary area of refuge for a short-term building evacuation.
(Comprehensive Emergency Management Plan, October 1, 2013, p. 40)
One of the protective actions that may be issued by Campus Public Safety or University Crisis Management Team personnel is a building, or campus-wide EVACUATION. An EVACUATION protective action may be issued in response to a fire, hazardous materials spill/release, or active shooter situation. An EVACUATION protective action should not be issued for a bomb threat unless there is credible and specific information regarding the location and time of the threat. This protective action is aimed at keeping students, faculty, staff and visitors safe by creating distance between them and the hazard area. EVACUATION means immediately leaving the area in which you are located for another designated safe location. If a campus-wide EVACUATION is issued, everyone on a campus is required to immediately leave on foot in an orderly manner and should not try to leave by car. Specific information regarding how to properly EVACUATE can be accessed on the Public Safety portal of the ST. THOMAS UNIVERSITY website at
or can be requested at the Public Safety offices located on campus.
Copyright (c) 2014 St. Thomas University
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by Gerber | Item #: 593947 |Model #: 12172790 | (1) |
Developmentally appropriate for crawlers, toddlers and preschoolers. Nutritious and delicious so mom can feel good about serving them. Toddler portion serving sizes that fit into a healthy toddler diet.
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Dr. Gitlin receives funding from the Alzheimer's Association (NPSASA-10-174265). Dr. Freedman has reviewed this editorial and found no evidence of influence from this relationship.
The Alzheimer's Association had no role in the preparation, review, or approval of this editorial.
From the Department of Health Systems and Outcomes, School of Nursing, Department of Psychiatry and Division of Geriatrics and Gerontology, School of Medicine, and Center for Innovative Care in Aging, Johns Hopkins University, Baltimore.
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, 2012.
These interventions should be central to the clinical management of behavioral symptoms.
Dementia has devastating social, economic, and emotional consequences not only for patients but also for their family caregivers (1, 2). It is a critical public health concern for which the global burden by the year 2050 is expected to exceed 115.4 million people worldwide and 16 million in the United States (1, 2). The near future is poised to yield new diagnostic criteria, assessments for early detection, and treatments postponing disease progression, resulting in an even greater number of people who will be diagnosed and living longer with the disease than current estimates indicate.
Most patients with dementia are cared for at home by family members living with or near them. In the United States, this represents 15 million informal family members who provide protracted care to people with dementia extending over the course of the disease until the end of life (1, 3). One of the most demanding and difficult aspects of care is managing multiple troublesome behaviors associated with the disease. Behaviors such as wandering, repetitive questioning, shadowing, aggressiveness, apathy, sleep disorders, hoarding, and resistance to help with daily activities are often more challenging for families to prevent, reduce, or manage than the cognitive decline of the disease (4, 5).
These behavioral symptoms are nearly universal and occur at any disease stage, with multiple behaviors often occurring simultaneously (4). For patients, the consequences are profound; if untreated, behavioral symptoms are associated with more rapid disease progression, greater disability, higher health care utilization and costs, poor quality of life, and nursing home placement. Equally disturbing are the effects on families. Behaviors are associated with increased caregiver upset, burden, depression, time in daily oversight, and care costs (6).
Given the numbers of patients and family members affected by dementia, the pervasiveness of behavioral symptoms, and their poor prognosis, behavioral management should be a clinical priority. Nevertheless, there is no systematic, coordinated, uniform, or agreed-upon approach to clinically managing behavioral symptoms. Typically, when behaviors are presented in a medical setting, an antipsychotic prescription—specifically the off-label use of an atypical antipsychotic—is provided. Although use of antipsychotics for dementia has declined, there is still an overreliance on these medications and other pharmacologic treatments (7). Their use occurs despite known risks (e.g., cerebrovascular events, mortality) outweighing the benefits and a Food and Drug Administration boxed warning. Importantly, no pharmacologic treatments exist for the behaviors that families identify as the most troublesome (5).
Clinical guidelines from numerous medical organizations for managing behavioral symptoms recommend nonpharmacologic approaches, including caregiver supportive interventions, as first-line treatment (8). Interventions for caregivers may include skills training, education, activity planning, environmental redesign, and social and emotional support, tested either singly or in combination. However, nonpharmacologic approaches are not widely implemented, largely because of lack of provider knowledge concerning their efficacy and limitations imposed by reimbursement mechanisms.
Given the crisis in dementia care (9), the study by Brodaty and Arasaratnam (10) in this issue of the Journal is significant and welcome news. A robust corpus of research demonstrating the efficacy of psychosocial and environmental interventions directed toward family caregivers has emerged over the past two decades. Yet, this body of strong evidence has been largely ignored by the medical community. Furthermore, it has been unclear whether interventions targeting family caregivers yield patient benefits. Brodaty and Arasaratnam conducted a meta-analysis of 23 high-quality caregiver intervention studies to evaluate their combined effects on behavioral symptoms and caregiver distress. Of these, 16 (69.6%) met criteria for a randomized clinical trial and seven, although using random allocation, were considered pseudorandomized because of unclear explication of methods. Collectively, these studies involved 3,279 family caregivers of community dwelling individuals with dementia.
Significant treatment effects were demonstrated for reductions in behavioral symptoms (effect size=0.34, 95% confidence interval [CI]=0.20–0.48; z=4.87, p<0.01) and caregiver negative reactions (effect size=0.15, 95% CI=0.04–0.26; z=2.76, p=0.006). Although effect sizes were small to medium, improvements compared more than favorably with pharmacologic trials and are clinically meaningful. Even small changes in behaviors can help families keep a relative with dementia living at home longer with improved quality of life. Notably, these gains were achieved with no adverse events or known risks. Characteristics of the most successful interventions included tailoring to specific behaviors, needs, and contexts, providing an average of nine to 12 sessions, and assessing needs from which to link intervention strategies. Of three studies (13%) reporting neutral outcomes, other positive outcomes for caregivers were demonstrated; one of these studies included behavioral management training in both the intervention and comparison arms, with both groups improving. Only one study, a cognitive-behavioral intervention, reported negative outcomes, with both the intervention and comparison groups declining similarly over time.
Two key conclusions can be drawn from this study. First, the meta-analysis provides the strongest evidence to date that caregiver interventions have a twofold advantage: they reduce distress in caregivers, and they reduce behavioral symptoms in individuals with dementia. This quantitative synthesis of high-quality studies provides confirmation that helping families is an important vehicle for helping patients. As such, these interventions should be central to the clinical management of behavioral symptoms. The primary challenge remains how to widely implement and financially sustain delivery of these interventions to address the urgent need of families.
The second key point is that in order to optimize clinical potency, relevance of interventions, and the implementation potential of interventions, much more research is required. For example, cost analyses for almost all of the included interventions are woefully missing, yet an economic perspective could guide implementation considerations. Additionally, as Brodaty and Arasaratnam indicate, "fine-grained questions" concerning dosing, start and stop rules, and which interventions and their components are most effective for improving which behavioral symptoms need greater clarification. It is difficult to discern whether any one intervention is more effective than another and which intervention works best for which service setting, specific behavior, disease stage, or caregiver and patient profile. How is a clinician to choose which intervention to invest in and learn to use? At this stage of the evidence and until clarity, decision rules, and more precision are achieved, it may be preferable to consider all of these interventions as part of a tool kit for addressing behavioral symptoms. Clinicians may want to pick and choose the interventions showcased in the meta-analysis based on the specific family needs they encounter and their context of care delivery, such as the available professional and financial resources for delivering any one intervention.
This article is timely in view of the 2012 World Health Organization report urging countries to develop dementia plans that balance searching for a cure with advancing evidence-based quality care (2). Current health care reform initiatives in the United States to reduce nursing home placements and overreliance on psychotropic medications and the 2011 National Alzheimer's Project Act, suggest cautious optimism that policy change may move caregiver interventions into real-world settings.
In an editorial concerning the main outcomes of the National Institutes of Health multisite Resources for Enhancing Alzheimer's Caregiver Health initiative, one of the 23 trials included in the meta-analysis, Covinsky and Johnston (11) concluded that "if these interventions were drugs, it is hard to believe that they would not be on the fast track to approval. The magnitude of benefit and quality of evidence supporting these interventions considerably exceed those of currently approved pharmacologic therapies (for dementia)." This statement, 6 years later, applies. It raises the question, If not now, then when will these proven programs be made available to families who continue to receive suboptimal care or no treatment at all for behavioral symptoms? Brodaty and Arasaratnam's meta-analysis provides strong evidence that helping families is good news for dementia care.
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The ProMinent group is manufacturer of components and systems for the metering technology, and a reliable water treatment solutions partner. ProMinent offers components, systems and technologies for highly efficient, environmentally friendly, sustainable and user-centric metering and water treatment.ProMinent concentrates on components and complete solutions for the ...
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Standard Pump is a premium manufacturer of Drum Pumps, Air Operated Double Diaphragm Pumps (AODD) and Metering Systems serving the Chemical, Sanitary and Automotive industries. As a leading pump manufacturer, Standard is known for our commitment to Quality, Safety and Innovation. All Standard Pump products adhere to stringent guidelines set forth by agencies such as ...
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Home > PHOTOVOLTAICS > Soitec takes another step forward in its HCPV expansion in ...
Nov 6th, 2012
Soitec takes another step forward in its HCPV expansion in South Africa
Soitec (Euronext), a world leader in generating and manufacturing revolutionary semiconductor materials for the electronics and energy industries, has announced the signature of a power purchase agreement covering the electricity generated at the Touwsrivier power plant it is to build in South Africa.
This signature represents a decisive step for the project submitted by Soitec in connection with the first call for projects from independent power producers (IPPs) launched by the South African Ministry of Energy for which Touwsrivier was pre-selected in December 2011. ! Following the signature of the power purchase agreement, Soitec will now seek to refinance the project and launch the construction of the power plant.
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Local man cited for drunk drivingJanuary 08,2013RUTLAND A local man was cited for driving under the influence of alcohol after a one-vehicle crash on Sunday morning, according to Senior Trooper Aron McNeil of the Vermont State Police.
Around 4 a.m., members of the West Rutland Fire Department and Vermont State Police were dispatched to Exit 6 of Route 4 in West Rutland. At the scene, police determined that a car had slid off the roadway. There were no injuries or damages to the vehicle.
Investigation found that Eric Reid, 21, of Rutland, had been driving a 2010 Mazda MZ3 west on Route 4 when he slid off the lightly-snow-covered roadway at Exit 6.
Police said Reid had been drinking alcohol before the crash.
Reid was arrested at the scene and processed at the Rutland barracks of the Vermont State Police. He was released with a citation to appear in Rutland criminal court Jan. 28.
His car was towed from the scene.MORE IN This Just InThe Associated Press Full StoryThe Associated Press Full StoryStaff Report Full Story
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Reader Comments (Page 1 of 1)
dashrendar72 said...
I prefer Fail Barad
I just had the 'pleasure' of visiting Fail Barad for the first time. The criticisms in this article are dead on. (I've been talking to most of the Horde WG veterans and majority hate the white 'failephant' that is TB).
This is coming from someone that has read and understood Sun Tzu's Art of War and Machiavelli's Prince.
I've played easily 300+ WinterGrasps on various toons and given that Ghostlands US owns it 71.0% that makes 213+ wins.
Lol Barad in comparison is a crock of horseshit.
Heck simplest modification that Blizzard could make is 2 buildings need to be controlled. Requiring the capture of all 3 with the defender's GY in the middle is utterly ridiculous.
In the mean time, servers will need to have teams ready to win just after server reset so that their side can keep the zone owned for a week, even tenacity + the balancing mechanics of WinterGrasp meant that Alliance on Ghostlands managed to capture WG about 1 out of 8.5 battles (or just under once a day).
Here all the defending side has to do is zerg between 2 nodes - it is mathematically unlikely that attackers have a chance to win, and if you figure in afker-honor leeches, and the confusion caused by noobs who haven't read up on the battle... yeah whomever thought this 'balancing' act up is an idiot.