Sudan has declared a state of emergency in part of the conflict-ridden western region of Darfur after violence and unrest in two towns, state news agency SUNA said. The African Union-United Nations Mission in Darfur Unamid said it had sent a team to Kutum town in North Darfur state following the reported burning of a police station and cars by unidentified protesters. It gave no details. Protesters demanded on Sunday better security and a civilian state government, a resident said.
State governor positions are held in Sudan by military officers despite the toppling of autocrat Omar al-Bashir in April. Separately, another resident told Reuters an unidentified militia had attacked on Monday another sit-in in Fatabarno, a village in the same area. Peaceful sit-ins have sprung up in towns across Darfur and in other parts of Sudan, which also protest the presence of armed militias. Conflict started in Darfur in after mostly non-Arab rebels rose up against the Khartoum government.
Government forces and mainly Arab militia, which moved to repress the revolt, were accused of widespread atrocities. Somepeople were killed in the conflict, according to UN estimates. There has been no serious fighting for years but the conflict remains unresolved as Arab militias are still present and have control over land they seized. You can find our Community Guidelines in full here.
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A high proportion of deaths in intensive care occur after withdrawal or withholding of life support. Although limitation of life support before death is common in most intensive care units, there are wide variations in approaches to end of life care.
In this article, we review the empirical research that can guide physicians in deliberations over whether to withdraw life support, maximising patient and family involvement in the decision making process, and negotiating conflicts that may arise. This gave citations. We reviewed all abstracts and selected relevant, research based articles. Clinicians and families generally make the decision as most patients are too ill to participate, but who takes the lead role varies greatly.
Conflict about withholding or withdrawing life support is common between clinicians and families and negotiation of these conflicts requires good communication skills. Withdrawal of life support is a clinical procedure that requires good medical skills, cultural sensitivity, attention to ethical principles, and close collaboration with patients' families.
Physicians also have poor understandings of patients' preferences, and most patients do not discuss their preferences with their physicians.
Another complication of the decision making process is that patients want proxy decision makers to use their judgment rather than be bound by the specifics of advance directives.
Conflict surrounding decision making in intensive care units is common. Conflict can arise about issues such as communication styles, interpersonal interactions, and pain control as well as about treatment decisions.
The evidence on the best way to resolve conflicts suggests that communication, negotiation, and consensus building are the most important tools. Physicians use varying communication and negotiation strategies to resolve conflicts with dying patients. Conflict can be constructive, uncovering differences in values and legitimate concerns that have been inadequately discussed.
Improved communication about goals, prognoses, and treatment options will successfully resolve most conflicts and may minimise unrealistic requests by patients or families. In caring for critically ill patients, situations often arise in which further life sustaining treatments have a very low likelihood of success. At this point, further intervention may be described as futile, and clinicians may feel strongly that life sustaining therapy should be stopped.
Ms R, a 52 year old woman with severe rheumatoid arthritis and chronic immobility, was brought to the emergency department. Her health was poor, although stable, until the morning of admission, when she became disoriented and lethargic. She was admitted to intensive care, where she was treated for septic shock secondary to decubitus ulcers and for acute renal failure. On the day after admission she was requiring increasing doses of vasopressor drugs and developed acute respiratory distress syndrome.
Most of the literature on medical futility examines the ethical and legal aspects rather than its use in clinical practice. If the medical futility rationale is part of physicians' decision making processes, it should be clearly defined and supported by published data.
Any determination of futility should be discussed with the patient or family members. In most cases, patients or families will agree 2 w15 and may appreciate not having to choose to forego a treatment that is not indicated.
Families of critically ill patients consistently rate communication with intensive care clinicians among their most important concerns—more important even than clinical skills.
Few studies provide empirical evidence to guide clinicians on improving communication. The study to understand prognoses and preferences for outcomes and risks of treatments SUPPORT showed that a nurse led communication intervention had no effect on the care that dying patients received in intensive care. A better understanding of families' needs and concerns may help clinicians to communicate more effectively.
The goal of withdrawing life support when death is expected is to remove treatments that are no longer desired or indicated and that do not provide comfort to the patient.Click here to sign up for our news.
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Otherwise you will be prompted again when opening a new browser window or new a tab. Other external services. Accept settings Hide notification only.Carroll County Government announced the hire of McCoy as the first fire and emergency medical services director Thursday.
As director, McCoy is tasked with launching a combination paid and volunteer fire department to serve Carroll County as a whole. McCoy moved to Carroll County indrawn to the area by his family. He lives on the same street in Taneytown as his parents, who have lived in the county for 11 years, McCoy said. His children and grandchildren are also nearby. The veteran firefighter joined Taneytown Volunteer Fire Company in September ofbut once he became interested in the fire and EMS director position, McCoy said he took a step back so he could be unbiased if he got the job.
Stephen Wantz, president of the Board of Commissioners, said it was that very experience that made McCoy stand out. Wantz acknowledged McCoy as being someone who was relatively under the radar in the county. McCoy also made a good impression on Wantz long before he ever applied for the fire director position.
McCoy told him about his experience and offered to help the community however he could, Wantz recalled.
Wantz said he never called on him, but he remembered that email when McCoy applied for the job. However, McCoy realizes there is much to learn and plans to spend part of the first six months in his role getting to know the leaders in the existing volunteer fire companies, including CCVESA. He envisions the paid fire company members supporting volunteers. The countywide department is not meant to take away from the identities of existing volunteer companies, according to McCoy.
Large fundraisers, which are often the lifeblood of volunteer fire companies, may not be as crucial if the county funding is there, McCoy suggested.
His goal is to develop a staffing plan in his first year to submit to the Board of Commissioners so that the department can have a budget next year. As volunteers have decreased over the years across the industry, McCoy said more fire companies are adapting to a combination model.
That may look like assigning paid staff to certain shifts at a fire station, he said. McCoy anticipates offering an incentive or preference to existing volunteers or paid personnel who wish to be hired by the county. There are already some paid staff at volunteer fire companies, but they do not work for the county, McCoy said. In York, the road to a combination regional department took about two years, concluding with their first joint labor contract, according to McCoy.
He has a list of tasks that need to be addressed in Carroll County, beginning with simple logistics like getting himself a radio and vehicle. He hopes to hit the ground running Thursday, his first official day. I enjoyed going to work. Skip to content. Carroll County Breaking News Newsletter. You are now following this newsletter. See all newsletters. Latest Carroll County News. Draft of Carroll County schools reopening plan expected at Wednesday meeting.
Recommended on Baltimore Sun.Den Hartog said the course will explore how the United States has made decisions to operate in the wider world. The Stanton Foundation supports such applied history courses as part of its mission to help develop informed citizens.
The United States in the Worldto be offered starting inwill address these and other vitally important objectives. Den Hartog said grant funds will be used for course development and also to bring foreign policy practitioners into the classroom—either digitally or in person—to interact with students.SDI Target 10: #8 Emergency Preparedness and Response
Emergency mail ballots available in Middletown
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SG15 - Optical transport networks and access network infrastructures SG16 - Multimedia coding, systems and applications SG17 - SecurityBallots are available at Town Hall during regular business hours Monday — Friday 8a. Because of the COVID pandemic, the Town Hall building is restricted to public access for health and safety reasons, so there are special instructions for anyone who wishes to fill out an Emergency Ballot for the June 2 Presidential Preference Election.
Each voter must come to Town Hall prepared to fill out a mail ballot application and vote. The voter should ring the front doorbell, and staff from the Town Clerk's office will assist from there. There are three ways to vote by emergency ballot at Town Hall:. The voter may take the emergency ballot to their car and fill it out while in the parking lot, then return the ballot to the Town Clerk.
The voter may come into Town Hall to fill out the ballot, but must be willing to take their temperature and record it in the visitor log, wear a mask and practice social distancing. The voter may call the Canvassing Office at or to schedule anappointment to come to Town Hall to vote.
Supreme Court lifts injunction blocking first federal execution in 17 years. Amazon is rolling out grocery carts that let shoppers skip checkout lines, bag their groceries and walk out. Emergency mail ballots available in Middletown. Load Error. Found the story interesting? Like us on Facebook to see similar stories. I'm already a fan, don't show this again. Send MSN Feedback.
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