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Governments face the challenge of developing and implementing sustainable development strategies (SDSs) that can be used to satisfy the needs of present generation without unduly compromising the ability of future generations to meet their needs. In developing SDSs, the first step is to obtain the support of senior managers before enlisting the support of more and more people. It is also important to understand the activities and issues involved in designing policies and programs. A model has been developed that contains building blocks, or activities to be followed for managing sustainable development., Governments can meet the increasing demands of their citizens only through significant changes in the way they function in terms of both policy and operations. Growing evidence of global changes, [...]

natural and cultural environments. 4.5g Use tourism's financial leverage as a catalyst and source of income and capital to address local problems to the mutual benefit of the local community [...]

Background: Because of its seriousness, many individuals have used B. anthracis contamination as a threat. In Florida, last year, there were over 35 anthrax threats reported to the F.B.I. All were proven to be hoaxes. We report 2 such cases involving a community hospital. Case 1: A letter, in a meat processing plant, was opened that dispersed brown powder in the room. The letter said they've been exposed to anthrax and to call '911.' EMS/HAZMAT/Police/F.B.I./ and Dept. of Health arrived on the scene. The hospital was alerted and a 'Code Orange' (Mass Casualty/Natural Disaster) was called for the hospital, which required the whole hospital staff to stay on notice. 14 victims, were decontaminated, placed in tyvek suits and transported to the E.D. After being medically evaluated, all were discharged. Only those who came in to direct contact with the letter/powder received prophylaxis. After 72 hr, testing revealed the substance to be B. pharagirus, an organic pesticide. Case 2: Two months later, a letter was opened at a collection agency, which contained a white powder and the words 'Anthrax- Die.' 4 pts were again decontaminated by HAZMAT, and medically cleared after an E.D. evaluation. Anthrax testing was negative 24 hr later. Discussion: After the 1st hoax, multiple meetings took place to improve performance against biological threats. These were implemented in Case 2. The Command Center agreed to notify the hospital on any environmental precautions needed, based on the substance. Arrangements were made to secure personnel 'contaminated' belongings. The hospital created a 'Code Grey', specifically for biologic threats. It limited the number of staff involvement and educated them regarding their personnel risk. Antibiotic prophylaxis would be based on F.B.I.'s threat assessment. Conclusion: By creating a separate plan for Biologic (vs. Chemical/Nuclear/Mass Casualty) Disasters, hospital resources can be better utilized., Dougherty T, Greene T, Lafferty K, Schultz C. Cape Coral Hospital, Cape Coral, [...]

Objective: There are approximately 1800 stingray envenomations annually in the US. Although many textbooks recommend prophylactic antibiotics (ABX), few studies have evaluated this. The goal of this pilot study is to determine the characteristics of patients with stingray envenomations and the use of ABX. Our null hypothesis is that patients prescribed prophylactic ABX will have better outcomes as compared to those that did not. Methods: We performed a retrospective chart review on all reported southern stingray (Dasyatis Americana) envenomations that presented to a Gulf coast community based ED during 1997-1999. Data collection included patient demographics, local and systemic effects, ABX use, and outcomes. We compared patients who received prophylactic ABX with those that didn't. The treating physician decided on the use of ABX. Outcome measures were: need for subsequent hospitalization or need for further medications. At this institution, it is departmental policy to obtain telephone or direct follow up for all discharged patients. Results: 66 patients identified. All were treated as outpatients. 53% (35/66) were males. 89.4% (59/66) were stung in the lower extremity. 36.3% (24/66) were lost to follow up. Of the 42 patients who had follow-up: 4 patients were prescribed ABX for cellulitis diagnosed on initial presentation. 66.7% (28/42) were prescribed prophylactic ABX. One patient prescribed prophylactic ABX was later treated for Clostridium difficile. No other patient required further medications or hospitalization. There were no statistical differences between the measured outcome of the two groups (Fisher's exact test, p = 0.736). Conclusion: Patients with envenomations from southern stingrays may be treated as outpatients. We did not detect a significant difference in outcomes between patients who received prophylactic ABX versus those that did not., Dougherty T, Greene T, Lee DC. Cape Coral Hospital, Cape Coral, FL; North Shore University Hospital, Manhasset, [...]

Background: Over 25,000 homicides are reported annually in the United States (US). It is unknown what percentage of these homicides are due to poisonous substances although it is assumed that homicide by poisoning (HBP) is an uncommon event. This study provides a current update regarding the incidence of HBP in the US. Methods: Data was gathered via telephone survey of official Offices of Medical Examiners (OMEs) in 10 regions of the US. Each OME contacted was questioned regarding the incidence of documented HBP in their region during the previous 10 years. Survey questions identified specific substances involved in homicide cases as well as OME laboratory testing for specific substances of homicidal intent. Results: Average OME cases/site was 3500 (n = 1000-7000) with an average of 1600 (n = 500-2500) autopsies (with toxicology tests)/OME site annually. The average number of cases of HBP within the past decade was 0.7/region. This results in an incidence rate of 2 HBP/100,000 OME deaths. Specific substances identified in HBP included: arsenic, cocaine, cyanide, pancuronium, paraquat, and thallium. Toxicology testing for 'homicidal substances' is not undertaken on a routine basis by all OMEs. None of the OMEs surveyed routinely tested for heavy metals, strychnine, digoxin, nondepolarizing muscle relaxants, or paraquat. Additionally, while many OMEs utilize computers resources for testing and data compilation, some OMEs use manual resources exclusively. Conclusions: This study validates earlier assumptions that HBP is a relatively uncommon event. Significant variability in OME procedures makes regional comparisons difficult. The complete lack of standardization of procedures nationwide may result in under-detection and under-reporting of HBP., Snowman P, Greene T, Greenberg MI, Dougherty T. MCP-HUH, Philadelphia, [...]

Background: GBL, a precursor of [Gamma]-hydroxybutyrate (GHB), is a naturally occurring metabolite of [Gamma]-amino butyric acid (GABA) and is a common drug of abuse. Once ingested GBL is metabolically converted to GHB and alters the regulation of GABA, dopamine, 5-hydroxytryptophan, and acetylcholine. While acute intoxication with GBL or GHB is well described in the literature, GBL withdrawal is not well characterized. This report details acute psychiatric manifestations of GBL withdrawal in the absence of metabolic disturbances. Case Report: A 36-year-old woman using 10-15 cc/d of 'Invigorate[TM]' (3.5 g GBL/oz) for a 90 day period presented to the ED 48 hours after her last use with an acute psychosis. She had no past medical or psychiatric history and denied alcohol or other drugs. Physical exam: T 98.2F, RR 20, BP 130/84, P 64. Psychiatric findings included thought-blocking, tangential cognition, delusions, and visual and auditory hallucinations. Remainder of the exam was unremarkable. CT scan, ECG, and serum chemistries were unremarkable. CBC was significant only for WBC of 13,400/[mm.sup.3]. Urine drug, hallucinogen screen, and GHB were negative. Her mentation improved with a single dose of lorazepam (1 mg) and haloperidol (2 mg). Collateral confirmation of return to baseline mentation occurred 48 hours after admission. Conclusion: GBL/GHB withdrawal has been described as alcohol/benzodiazepine-like with resultant sympathetic hyperactivity, fully absent in this case. GBL/GHB may produce pure psychiatric withdrawal symptoms without autonomic dysfunction or metabolic derangement seen with alcohol or sedative hypnotic withdrawal., Greene T, Dougherty T, Rodi A. Cape Coral Hospital, Cape Coral, FL; Mercy Hospital of Philadelphia, Philadelphia, [...]