Friday
software preisvergleich
Gerade im Bereich der Software gibt es eine rasante Entwicklung. Tag für Tag kommen neue und bessere Software Lösungen auf den Markt, die einem das Leben deutlich erleichtern können. Wer auf der Suche nach einer geeigneten Software ist, sollte stets vorher einen software preisvergleich durchführen, da sich gerade in diesem Bereich eine Menge einsparen lässt.
Kommt man wirklich zum Schnäppchenpreis an gute software? Preisvergleich hin oder her, es kommt natürlich auch darauf an, welche Software man benötigt. Es gibt bekannte und angesehene Produkte von renommierten Entwicklern wie beispielsweise Microsoft und es gibt weniger bekannte Software Lösungen, die noch nicht so verbreitet sind. Ein software preisvergleich bei den bekannten Produkten ist allerdings stets zu empfehlen, da viele Anbieter einfach einen teureren Preis veranschlagen als andere.
Durch den software preisvergleich, der wirklich einfach und schnelle durchzuführen ist, bekommt man auf einen blick alle Daten, die man benötigt, um den günstigsten Anbieter zu finden. Zudem erhält man auch gleich einen passenden Link, den man nur kurz anklicken muss, um direkt auf die Webseite des Anbieters zu gelangen und seine Bestellung aufgeben zu können. Wie bereits oben erwähnt, ist ein solcher software preisvergleich gerade bei bekannten Produkten sehr empfehlenswert, aber dies bedeutet nicht, dass man es nicht auch mit den weniger bekannten Software Produkten ersuchen kann.
Der große Vorteil eines software preisvergleich im Internet ist natürlich, dass man sich eine Menge Zeit spart, da der Algorithmus so konzipiert ist, dass wirklich alle großen und seriösen Anbieter erfasst werden und deren Preis ermittelt wird. So muss man nicht mehr alle Anbieter selbst kontaktieren, bzw. sich auf deren Webseite nach dem aktuellen Preis des Produktes informieren, sondern kann alles automatisch von seinem PC durchführen lassen.
Man sollte lediglich bedenken, dass eine solche Webseite nur darauf ausgelegt ist, die Preise bestimmter Produkte zu vergleichen. Dies schließt das Finden von alternativen Softwarelösungen nicht mit ein. In manchen Fällen ist es so, dass es für bestimmte Software Produkte, günstigere Alternativen gibt, die den gewünschten Zweck ebenfalls erfüllen können. Lediglich darum muss man sich selbst kümmern, bevor man einen software preisvergleich durchführt.
Hotels New York
Wer sich einmal New York anschauen will, sollte sich rechtzeitig um eine geeignete Unterkunft kümmern. Der große Vorteil ist, dass New York so gigantisch groß ist, dass jeder, der auf der Suche nach Hotels in New York oder einer anderen Übernachtungsmöglichkeit ist schnell fündig wird. Dieser Artikel zeigt, was New York alles zu bieten hat und wie es um Übernachtungsmöglichkeiten steht.
New York besteht aus insgesamt vier Stadteilen: Die Bronx, Staten Island, Queens und Manhattan. Egal wo man hin will, man findet in allen Stadtteilen ein enormes Angebot an Hotels New York. Wohin man gehen will steht jedem Touristen frei, jedoch ist es bislang so, dass die meisten Besucher und Touristen auf der Suche nach einem Hotel in Manhattan sind. Dies liegt schlichtweg daran, dass hier die meisten Sehenswürdigkeiten zu finden sind und man somit das meiste aus seinem Urlaub herausholen kann. Wer allerdings hier auf der Suche nach Hotels in New York ist, sollte schneller sein als die anderen und schon rechtzeitig buchen.
New York hat insgesamt knapp 8 Millionen Einwohner und zählt daher zu den größten Städten in Amerika und weltweit. New York ist eine wahre Metropole und hat wirklich für jeden etwas zu bieten. Billige Hotels New York zu finden ist allerdings nicht die leichteste Aufgabe, die sich manche Urlauber und Touristen stellen. Man sollte sich schon früh darum kümmern und sich nicht darauf verlassen, dass man noch eines der heiß begehrten Last Minute Angebote ergattern kann. Am besten man fragt direkt bei einer Agentur nach oder macht sich mit Hilfe des Internet selbst auf die Suche nach günstigen Hotels in New York, damit man auch ausgeschlafen für diesen Urlaub ist.
Man nennt New York auch oftmals, die Stadt die niemals schläft und wenn man ein geeignetes Hotel in New York gefunden hat, kann man sich selbst von diesem Mythos überzeugen. In New York herrscht ein beachtliches Nachtleben mit zahlreichen Kneipen, Bars und Diskotheken, in denen man sich stets vergnügen kann.
Design Hotels in New York sind in den letzten Jahren immer beliebter geworden. Diese Art von Hotels ist zwar etwas kostspieliger, rundet den Urlaub aber ideal ab und man fühlt sich wirklich wie ein König. In diesen Hotels in New York findet man stets eine topmoderne Einrichtung und kann sich regelrecht verwöhnen lassen. Wenn man vorhat mit seiner neuen Flammen die Flitterwochen in dieser Stadt zu machen, empfiehlt es sich ein Designhotel in New York zu buchen, um wirklich das meiste aus den Flitterwochen herauszukitzeln.
Sollte man mit den Kindern nach New York gehen kann man sich auch auf die Suche nach Hotels in New York machen, welche sich auf Kinder spezialisiert haben. Allgemein kann man sagen, dass ziemlich alle Hotels, die man in dieser Stadt finden kann, kinderfreundlich sind und man sich somit keine Sorgen machen muss. Wen man einen Tag mal ohne Kinder unterwegs sein möchte, kann man die Kinder auch betreuen lassen, so dass man einen Tag ganz für sich allein hat.
Thursday
seo consultant and seo for more organic google search traffic
Today the basic aim of any seo consultant is to enhance the business of their clients. For this it must follow certain marketing goals for planning a strong and useful strategies that can give them a winning seo campaign approach. You should know that these consultants must have clear concept and also an eye for understanding the client's business. There are many things which any seo consultant should understand before dealing with their clients such as Business Objectives, Marketing Strategies, Demographics of Target Audience, Media Mix & Flight Dates, Creative considerations, Messaging, Success Metrics, Dependencies, and Methods of Measurement.If you're following any seo industry or want to know about this flourishing business then you must need to its various upcoming consultant firms.
At the very beginning the seo consultant focuses on client's strategic marketing and messaging information such as industry segment, target market, value proposition or offer, etc. This is all important for doing the right selection of keywords and creative development. The main wholesale concept of such consultant is to enhance the overall site visitors and conversions through enhanced keyword rankings. If you want or interested in any such consultants for enhancing your seo business or for availing high traffic then can hire them.These consultants follow seo methodology for increasing the client's traffic, and some of them are Keyword research & Keyword Tracking , Competition Analysis , Baseline reporting, and much more.
So its highly important that the seo consultant should know that they must be skilled in fulfilling all these mentioned task like Understanding Client’s Business Objectives & Strategic Marketing Plan , Comprehensive Website Analysis , Keyword Research and Analysis , Baseline report , Competitive analysis for main keywords/keyword phrases in Search Engines, Content Analysis & SEO Copywriting, Analysis of information architecture and linking structure, and many more. Your hired consultant must have atleast ten years of seo experience, proven track record, affordable pricing, no long term contracts, personal one-on- one service and much more. So its absolutely a business and your hired consultant must able to enhance its client's websites high in search engines and profilerating your business from the web.
Blurbpoint offers Complete Marketing Solutions for your online business. We offer services like Directory submission,seo consultant,Article Submission,search engine optimization services,Social Bookmarking , Search Engine Submission, Squidoo Lens.All our submission done manually.
Article Directory Source: http://www.articlerich.com/profile/HancyRodes/105867
Replica Watches or real swiss made watches?
Obviously, watches have almost become an indispensable part of people¡¯s life nowadays, with Swiss-made-watches being the coveted target. Yet, it is impossible for everyone to buy a new watch of world-famous brand. As a result, the value of second-hand watches slowly comes to light.
As a matter of fact, second-hand watches enjoy much popularity for their irreplaceable advantages over brand-new watches. Although they may look a bit old in appearance, their quality and durability are by no means to be questioned. Valued second-hand watches, especially limited edition ones, are becoming increasingly popular as people pay more and more attention to watches of famous brands.
The basic reason many people choose second-hand watches is that those watches can enable them to reduce expenditure. As we all know, the price of second-hand watches is far less than that of the corresponding new watches. For ordinary consumers,spending a high amount of money to buy a new watch will inevitably disturb the balance between income and expenditure. So the choice of buying a second-hand watch instead could be counted as the wisest decision.
Next, the use value of these watches is the same as that of new ones. At this point there can be no dubiety. The function of these two kinds of watches is entirely the same, which ensures second-hand watches to reach the requirements of consumers in the current watch market.
In addition, used watches have very good collect value, especially some classical watches that will no longer be manufactured. They could also bring unbounded joy, excitement and enthusiasm for collectors. Moreover, sometimes second-hand watches even increae in value as time goes by.
Finally, the commercial effect brought by selling second-hand watches could in no case be undervalued. Take China market for example, it was reported that a man earned tens of thousands of yuan by selling two Rolex second-hand watches in HongKong. In fact, he bought them in Hangzhou for less than 68 thousand yuan each, but sold them at a high price of more than 100 thousand yuan each in Hong Kong market.
To sum up, second-hand watches have a huge market not only for their own irreplaceble advantages over new ones, but also for the huge commercial interests they can bring to investors.
Article Directory Source: http://www.articlerich.com/profile/joe-taylor/102522
Tuesday
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Why Swiss Made Watches?
Swiss made watches are very famous all over the world. Luxury gadgets and fashion design watches are leading
sytles from Switzerland.
There is no other country in the world with so many leading
watch brands. Most of the world famous brands come from
Switzerland.
Precise timegadgets made out of gold or just in silver?
Most of the Swiss made watches come from the French part
in Switzerland.
Only a few and some of the best luxury swiss made watches
come from the German part in switzerland:
IWC is one of them. A nice traditional timepiece.
Watch collectors and watch experts now all these brands...
but what is new in the Swiss made watch industry?
There is a rising design lable from Zurich Switzerland:
Maurice de Mauriac from Zurich. Maurice de Mauriac is the only watch brand
branded with the city name of Zurich.
The designs are very unique and the quality of the watches.
Maurice de Mauriac Zurich produces also custom made watches.
If the client has a very special wish he can talk to the
owner of the company in person and he can get what he wants.
Maurice de Mauriac from Zurich has a great free catalog for
Swiss made watches that you can order here:
Free Watch Catalog
Monday
Billig fliegen – Wie man billig in den Urlaub fliegen kann
In der heutigen Zeit ist das Geld sowieso schon knapp genug und viele Menschen befinden sich im Sparmodus. Billig fliegen ist da die Devise, wenn es um die Planung des Urlaubs geht. In diesem Artikel zeigen wir, dass man durch einen billig fliegen Vergleich stets gute Angebote finden kann, wenn man sich ein wenig Zeit nimmt.
Natürlich hängt es auch davon ab, in welches Land man günstig fliegen möchte. Man sollte sich schon klarmachen, dass eine Reise mit dem Flugzeug nach Amerika weitaus teurer ist als beispielsweise in einem Nachbarland. Dennoch hat man stets die Möglichkeit eines der vielen Last Minute Angebote wahrzunehmen, die von den bekanntesten Flugunternehmen angeboten werden.
Germanwings Ist einer der Topanbieter, bei denen man stets gute Angebote zum billig fliegen bekommen kann. Dies ist aber noch lange nicht der einzige Anbieter, sondern auch Lufthansa und Ryanair veröffentlichen stets gute Angebote, die man sich nicht entgehen lassen sollte. Doch wie findet man am besten die Top Last Minute Angebote? Diese Frage stellen sich viele Menschen, die sich vornehmen billig zu fliegen.
Dabei gibt es heute mehr als genug Möglichkeiten zu einem günstigen Flug zu kommen. Eine gute Idee ist es, einmal auf die Seite der Unternehmen zu schauen. Hier werden in der Regel oft gute Angebote hervorgehoben und man hat nicht viel Arbeit, nach den Angeboten zu suchen. Da heute die meisten Menschen nach Möglichkeit billig fliegen möchten, gibt es auch spezielle Webseiten, die einen billig fliegen Vergleich machen.
Der große Vorteil der nächsten Webseiten ist, dass man noch weniger Arbeit hat, die gewünschten Flüge zu ermitteln. Man muss lediglich die Webseite besuchen und der Rest ist fast schon selbsterklärend. Man gibt einfach einen in welches Land man gerne billig fliegen möchte und ab welchem Flughafen man abreist und schon wird einem eine Liste mit Last Minute Angeboten und weiteren Möglichkeiten geliefert.
Zudem hat man die Möglichkeit, die Ergebnisse nach bestimmten Kriterien zu sortieren. So kann man beispielsweise, wenn das oberste Ziel billig fliegen ist, sie günstigsten Angebote an oberster Stelle anzeigen lassen. Je weiter die Liste nach unten geht, desto teurer werden die Angebote. Hier finden sich alle möglichen Fluggesellschaften wie Lufthansa, Ryanair, Airberlin, Germanwings und viele weitere.
Das Beste an diesem Angebot ist, dass solche Webseiten völlig kostenfrei sind und andere die Benutzung keinen Cent zahlen muss. Dies macht es natürlich sehr angenehm, nach günstigen Angeboten zu suchen. So muss man nicht mehr in eine Reiseagentur gehen und sich an deren Öffnungszeiten halten. Man kann die Webseite jederzeit besuchen, egal ob morgens, mittags oder abends. Billig fliegen war noch nie so einfach wie es durch die heutigen Möglichkeiten des Internet ist.
Das Gute ist, dass sich dieses Vorhaben auch duplizieren lässt und auf andere Bereiche anwenden lässt so kann man auch, wenn man weiß wie man billig fliegen kann, sich gleich noch auf die Suche nach einem günstigen Hotel machen. Bei diesen Suchmaschinen kann man praktisch nach einem möglichen suchen (nicht nur billig fliegen) und sich die Ergebnisse so anzeigen lassen, wie man sie benötigt.
Zurich
Wenn man nur einmal „günstige Flüge Zürich“ in eine Suchmaschine wie beispielsweise Google oder Yahoo eingibt, bekommt man schnell tausende von Ergebnissen, die einem günstige Flüge nach Zürich versprechen. Allerdings hat kaum jemand die Zeit und vor allem Lust, sich durch all diese Webseiten zu klicken und somit auf ein guten Angebot zu kommen. Es wäre doch prima, wenn man ein Programm oder ein Script hat, das einem diese Arbeit automatisch erledigen lässt, oder?
An dieser Stelle darf der Interessierte Leser, der Flüge nach Zürich sucht aufatmen. Es gibt eine Lösung alle solchen Angebote auf einen Blick zu erhalten. Dabei bedient man sich einfach Webseiten, die sich auf Preisvergleiche spezialisiert haben. Bei diesen Seiten genügt es oft schon Schlagworte wie „günstige Flüge Zürich“ oder zum Beispiel „Flüge Zürich Köln“ einzugeben und schon bekommt man eine Liste mit aktuellen Angeboten der renommierten Fluggesellschaften. Somit kann man sich einiges an Zeit und Nerven sparen und doch noch zu einem günstigen Flug gelangen.
Wenn man durch Eingabe mit Stichworten wie Flüge Zürich oder Billigflüge Zürich keinen Erfolg hat, kann man auch die auf den Webseiten vorhandenen Suchformulare verwenden. Hier hat man die Möglichkeiten den Abflugflughafen und den Zielflughafen einzugeben und sich so die Ergebnisse anzeigen lassen. Wer noch unsicher ist, wann er genau seinen nächsten Urlaub in Zürich verbringen möchte, braucht nichts weiter zu tun und bekommt eine Liste mit allen aktuellen und zukünftigen Angeboten.
Sollte man aber schon ein genaues Datum kennen, wann man die Flüge nach Zürich benötigt, dann gibt es noch ein weiteres Feld auszufüllen, in dem man einfach die Zeitspanne einträgt. So werden die Ergebnisse noch weiter gefiltert und man bekommt auch wirklich nur die Flüge nach Zürich angezeigt, die sich in dem gewünschten Zeitfenster befinden. Die Liste ist natürlich viel kleiner, dafür sind aber nur noch Ergebnisse enthalten, die relevant sind. So sucht man heute schnell und einfach Flüge. Zürich war in diesem Fall natürlich nur ein Beispiel und man kann auch jeden anderen Zielort eingeben.
Zürich buchen ist heute dank dieser ausgereiften Webseiten ein Kinderspiel. Wenn man ein gutes Angebot gefunden hat, braucht man nur noch anzuklicken und kommt direkt auf die Webseite des Anbieters. Dort kann man dann schnell und einfach Zürich buchen, ohne auch nur das Haus verlassen zu müssen. Früher musste man noch in ein Reisebüro um die Ecke gehen und ständig nachfragen, ob es denn gerade wieder Flüge nach Zürich im Angebot hat. Diese Zeiten sind dank des Internet ein für alle mal vorbei.
Das beste daran ist natürlich, dass diese Dienstleistung für den Benutzer völlig kostenlos ist, da sich die Webseiten durch Werbung, die aber nicht störend ist, finanzieren. Wir wünschen jedem viel Spaß in Zürich oder einer anderen Stadt, die er schon lange sehen wollte.
Airport
Adelaide airport can be found in South Australia and right at the city of Adelaide. It is quite a busy airport, ranking fifth in all of Australia. It transports as many as seven million passengers per year. This airport is six kilometers away from the town center, lying near West Beach.
Even if the Adelaide airport is a one-terminal airport, it can cater to everything that as traveler needs. It is also easily accessible, with buses, parking, and private transports available around the clock. From the airport to the heart of the city, take Sir Richard Williams Drive towards the Sir Donald Bradman Highway. It is going to be a 4-mile ride for you but that path would take you right into Adelaide CBD.
When traveling to Adelaide, it is strongly encouraged that you get your own car to ride. Hire a car from any one of the major car rental companies operating right at the airport. Budget, Avis, Thrifty and Hertz have offices always open to assist you with your needs. However, the better option when it comes to renting a car is through the help of online portals.
Log on to the internet and check them out. These online car hire service providers are affiliated with international the car rental companies listed above. They can facilitate your request on your behalf. Through them, you can easily choose the car that you want at the price that you can afford. They can find you the best car hire deal in the town that you're heading for.
Not having a car at Adelaide means you would have to use the taxis and the buses to get to your destination. If so, you would have to hail Skylink airport Shuttle, which travels from the airport to the town center every thirty minutes. For some extra bucks, they can send you a mini coach to take you to your hotel. If you want to take a cab, the taxi ranks are situated at the airport's parking lot. Expect a 15-minute ride to the Adelaide central business district. The taxis around here are metered but it is almost necessary to tip the driver.
Article was compiled by Eamonn Turley who writes for http://www.fastcarhire.co.uk specialized in car rental in Malaysia, Thailand and Australia.
If you are thinking of visiting Thailand for that once in a lifetime trip then http://www.fastcarhire.co.uk/australia_car_hire.asp for more information on car rental options available
Article Source: http://EzineArticles.com/?expert=Eamonn_Turley
Wednesday
Sunday
Seo Schweiz
Do you need a seo in switzerland for organic search?
Seo for organic google traffic and seo/ppc marketing
in switzerland.
Please contact us for further information about seo schweiz/switzerland.
amorsrome seo switzerland
seo schweiz
music by shelly sheaffer
Swiss made watches
All of us know that, Swiss-made watches are the most famous watches in the world. There are many famous Swiss luxury watches brands. Many people prefer Swiss-made watches very much. If you wear a Swiss watch, you are considered as fashionable and stylish. Especial the latest watches are most popular among people. However, the stylish and fashionable watches are sold at heavy price tags. People who are not wealthy enough have no choice but to stand away from those expensive watches.
It is no doubt that the quality of Swiss watches is excellent and the skills are sophisticated. Most Swiss watches are made of costly materials, such as jam, diamond, and carbuncle and so on. All of these reasons result in high prices, and only wealthy people can afford them. A famous watch usually cost thousands of dollars. It is really too expensive to those people who rely on monthly salary. They need to send more than six months of their salary for buying a original watch. It seems that is a little crazy.
It is no doubt that the demands of watches are very huge. How can common people own Swiss watches? Is there any watch that cost a little but looks the same as authentic one? Then replica Swiss watches turned up. Many manufacturers started to imitate those famous watches. The industry of replica watches is glowing very fast.
With the development of imitation techniques, there are multitudinous models of Swiss replica watches in the market. These replica watches are well followed to original ones. They are stylish and up-dated. The most important, they are cheap and quality. These watches are not made of costly materials, but their qualities are really good. Replica watches have the same styles and surface as original watches. Its price is from $100 to $400, which most of us can afford. If you like, you can purchase several pieces to match with your different clothes.
Do you want to join into fashionable group? Swiss replica watches will be your best choice.
Article Source:
swiss made watches
Seo
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We boost your organic traffic with seo. Consultant for seo marketing usa/switzerland.
Seo is a good option to drive more organic traffic to your webshop or website.
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Thursday
Health Care online news
Ever considered a career in nursing? Feeling your opportunity to be in the health care industry has passed? Well, don't count yourself out just yet. You could be just a few steps away from earning an online nursing degree.
The great news about online nursing degrees is that you might be able to graduate in the equivalent of a year and a half of traditional college. How exciting it would be to have a bachelor of science degree in just three semesters! And just think of the possibilities!
Once you have finished your degree, you can go anywhere. Nurses are in high demand. You can choose from many different types of work, including nursing homes, home health agencies, hospitals, and doctors offices, as well as many other places. It is really a wide open field, and no matter what the economy does, nurses are always needed.
In order to break into this wide open field, you should look for certain important aspects of a nursing program. First and foremost, you need to make sure that the online college you choose to take your nursing program from is accredited. An accredited school is very important for your future employment. Employers want to see that you have gone to a school with the correct credentials.
You will also want to find out exactly what is required from the college you enroll in. You may want to find several that you are interested in so that you can compare all their requirements as well as the price involved.
If you will be working while earning your degree, you will also want to take notice of how flexible the classes are. If you can only get online in the evening, you will want to make sure that your classes can be taken when you are available. Maybe you have different times a day when you can work on your lessons. If this is the case, you need to make sure that your classes can be taken whenever you have the opportunity.
No matter what your specific situation, there is almost certainly a college that you can work with. If you start now, you will be amazed at how quickly you can earn your nursing degree online. As a nurse you will have opportunities that you may have never before dreamed. So, get to your search engine and start looking. You're only a few semesters away from a rewarding career!
For more great information about an online college degree, and business degrees online visit our site today.
Health Care Online News
Article Source:
california healthcare foundation
Introduction:
Since the events of September 11, 2001 and the further highlighting of the state of our National vulnerability as demonstrated by the issues raised in the response to Hurricane Katrina in 2004, The Federal Government has focused enormous resources in developing a National Response Framework, Establishing National Preparedness Goals and implementing a National Incident Management System. However, in the midst of all of these changes and improvements, the Nation Disaster Medical System has been tossed like a ping pong ball from the Department of Health and Human Services (HHS) to FEMA, and then Subordinated to the Department of Homeland Security when FEMA was integrated into that new organization, and then tossed back to the Department of Health and Human Services as of January 1, 2007. During this time, publically released documents continue to claim the NDMS has the capacity to respond to National Disasters. This article will look into the foundations of the NDMS, its current standing, and its capacity to respond to the California Earthquake scenario developed by FEMA, in conjunction with the State of California, in 1980.
Background:
After viewing the destruction wrought by the eruption of Mt. St. Helens in Washington State in May 1980, President Carter became concerned about the impacts a catastrophic earthquake in California, and the state of readiness to cope with the impacts of such an event. He directed that the National Security Council conduct a review of the state of preparedness of the Nation to meet such an event. FEMA determined that "the Nation is essentially unprepared for the catastrophic earthquake (with a probability greater than 50 percent) that must be expected in California in the next three decades" (Federal Emergency Management Agency, 1980). Casualties projected for this type of event ranged between three thousand and twenty three thousand dead, and between twelve and ninety-one thousand requiring hospitalization (based upon 1980 census data). The ranges were based upon the location of the epicenter and the time of day that the incident struck. The California Office of Statewide Health Planning and Development (OSHPD) recently found that nearly half of hospital floor space that needs retrofitting to meet current codes and comply with a 2013 state seismic safety deadline is in buildings that are considered vulnerable to collapse during a major earthquake (California Health Care Foundation, 2007). Current FEMA Scenario planning estimates that nearly two thirds of the Hospital Beds in Los Angeles, Orange, Riverside, and San Bernardino County will be non-functional (Science Daily, 2008). Based upon this estimate, a service population of approximately ten million, and that the United States presently maintains 3.6 Hospital Bed per 1000 people (Nationmaster, n.d.); this equates to a loss of approximately 24,000 patient beds, which for the most part are occupied with chronic and or acute patients, as well as the infrastructure to support them. These facilities would simultaneously be experiencing a surge of new patients presenting as a result of the injuries sustained from the Earthquake event. Even assuming occupancy rates of only 60% (low for the industry) approximately 14,400 patients would be displaced and require discharge, inter-facility transfer or evacuation outside the impacted area, without regard to the casualties that were generated by the event.
In 1981, President Ronald Reagan established the Emergency Mobilization Preparedness Board to develop a national medical response system (Kramer & Bahme, 1992). The board consisted of representatives from the Federal Emergency Management Agency (FEMA), the Department of Defense (DOD), the Veterans Administration, and the Public Health Service of the Department of Health and Human Services. This Board developed the National Disaster Medical System (NDMS); which was established by Presidential Directive in 1983. Originally conceived as a partnership to respond to the scenario of large numbers returning military personnel who were injured in an overseas conflict to an overwhelmed Continental United States (CONUS) military medical system; the NDMS was never activated to fulfill this original mission (Franco, E., Waldhorn, Inglesby, & O'Toole, 2007).
The mission of the NDMS evolved to create a system whereby civilian hospital beds, in non affected areas, could be used in the event of a disaster within the U.S. and Disaster Medical Assistance Teams (DMATs) who could respond to the impacted areas of a disaster (National Association of DMATS, n.d.). Prior to the NDMS, the assets available to fulfill these type missions were the one thousand-nine hundred and thirty Civil Defense Emergency Hospitals that had been pre-positioned throughout the country by 1964. The Civil Defense Emergency Hospitals, later renamed Packaged Disaster Hospitals, were 200 bed mobile hospitals based on mobile military hospitals that used the same federally procured military equipment. These hospitals were equipped with supplies for 30 days of operations. According to the 1964 DOD Office of Civil Defense Annual Statistical Report; "the Civil Defense Emergency Hospital (CDEH) is an austere but completely functional 200-bed general hospital designed to be set up within an existing structure such as a school, church, or community center. They required 15,000 square feet of floor space which permitted the separation of wards, operating rooms and other functional sections. The staffing requirement was for 316 personnel, including 10 physicians, 4 administrators and assistants, 34 professional nurses, 18 practical nurses, 6 anesthetists, 2 pharmacists, 128 medical aides and 124 other personnel, including dentists, laboratory technicians, X-Ray technicians, maintenance engineers, clerks, helpers, messengers, and housekeepers to be drawn from local resources" (Civil Defense Museum, n.d.). A little more than one half (25%) of the Civil Defense Emergency Hospitals pre-positioned in 1964 could conceivably have provided a total of 100,000 patient beds, with a staffing requirement of about 150,000 personnel. This number of beds exceeds the worst case scenario of developed by FEMA in 1980.
The NDMS System:
Presently the National Disaster Medical System has fifty-five Disaster Medical Assistance Teams. A Type I DMAT team is able to muster a 35 person roster in 4 hours, has 105 or more deployable personnel assigned including 12 physicians, has a Full Federal DMAT Cache of Equipment and Supplies, and is able to triage and treat 250 mixed category patients per day for three days. The DMAT is not and does not operate a field type hospital, but with augmentation from the national strategic stockpile and with additional personnel being recruited (local survivors with the needed skill sets), they can provide the Triage and Emergency room functions of a field type hospital with the patient holding capacity being provided by a co-located Federal Medical Station. The Federal Medical Station requires a team of 100 personnel and can sustain 250 stable primary care patients who require bedding services (U.S. Department of Health & Human Services, n.d.). Therefore, the maximal number of patient beds that the NDMS system can generate, providing that there was at least one Federal Medical Station (FMS) per DMAT team, and that all DMAT teams were at Type I readiness would be 13,750 patent beds, with a staffing requirement of 11,275 personnel. This number of beds does not even address the 14,400 patients would be displaced and require discharge, inter-facility transfer or evacuation outside the impacted area, without regard to the casualties that were generated by the event.
The rationale behind the apparent lack of concern for the additional 90,000 plus patient beds required for the worst case scenario presented is the over 110,000 pre-committed patient beds from the 1,800 participating National Disaster Medical System fixed facility hospitals. Community, teaching and trauma Hospitals across the nation have joined with the National Disaster Medical System, through Memorandums of Understanding, to make available their empty patient beds in times of disaster. Like the military combat medial delivery system, patients are to be evacuated out of the impacted (combat) area to the safe and secure Zone of the Interior (ZI).
The Challenges:
The challenge for this scenario is that the aero-medical and ground evacuation assets required to perform a mission of this magnitude are scarce. Mission planning factors for the aero-medical evacuation of a maximum of 6,000 patients a day from Iraq during Operation Just Cause accounted for 97% of the aero-medical evacuations assets available to the United States Military. Further, the actual mission accomplishment of 12,632 patents being evacuated on 671 Aero-medial flights averaged less than 20 patents per airframe (Green, n.d.). Thus, at this density, to evacuate even 50,000 patients would require 2500 airframes. Even assuming 250 flights per day, it would require ten days time to evacuate 50,000 patients. Other forms of transportation can also be used, such as railroad and bus assets; but these assets are not pre-configured, and the patients would require beds until such coordination was completed. It is reasonable to expect that a significant number of patients would not be able to be evacuated until at least ten days after the incident and therefore disaster level patient care beds should be planned for as they will be required to maintain the patients until evacuation assets became available.
To further confound the premise of evacuating the majority of patients requiring hospitalization to the Zone of the Interior is the harsh reality that patients must be first stabilized before they can be safely evacuated. Using techniques such as delayed closure, external fixation and the like, definitive care of some orthopedic and surgical patients can be delayed, without a significant increase in morbidity and with the attendant savings of the logistics overhead of providing the required supplies to perform these procedures in the austere medical environment expected within the impacted area. However, stabilization of internal injuries (crush) and other medical conditions must be attained before an aero-medical staging facility, or other evacuation management site will clear a patient for further evacuation. The general rule for military medical evacuation to the zone of the interior has been that the patient was expected to remain stable with onboard care supplies for at least 24 hours. In the case of an overwhelmed medical system within the impacted area, an evacuation policy that facilitated short haul evacuations for further stabilization to the closest medical facilities outside the impacted area could be envisioned; however, these facilities would likewise need to be transfer and evacuate their patients further into the zone of the interior. Additionally, to avoid becoming overwhelmed themselves, and lose their ability to receive new patients from the impacted area for lack of patient beds, they too would need to be augmented by resources from the National Disaster Medical System.
The Reality:
This returns our discussion to the present DMAT teams within the National Disaster Medical System. Unfortunately not all DMAT teams are at the TYPE I level of readiness. In fact, according to David G.C. McCann MD, Former Chief Medical Officer of FL-1 DMAT since 2003, a 2008 Senior Policy Fellow in Homeland Security at George Washington University's Homeland Security Policy Institute, and Current Chair of the American Board of Disaster Medicine (ABODM), the "NDMS is being marginalized as DHHS (Department of Health and Human Service) prepares to upgrade the Commissioned Corps of the USPHS (United States Public Health Service) to serve as the "first-line" in disaster response" (McCann, 2008). To support this assertion Dr. McCann reflects that the number of voluntary members of the DMAT teams has dropped from over 7000 to about 5,000; that the contract that provided the training to DMAT members that was required for teams to be certified as being Type I expired October 31, 2005 and has not been renewed or replaced (University of Maryland, Baltimore County, 2005); that despite a budget increase of 6.3% for FY08 over FY07, teams have had their budgets significantly reduced and their administrative officer is forced to maintain the team's credentials and records on little over 20% of the budget he had last year. Further, he asserts that there had been a complete freeze on hiring new NDMS personnel lasting over 2 years; consequently, "Maybe 10% of the 55 teams are at Type 1". According to the RI-1 DMAT team Deputy Commander, Tom Lawrence, their team is one of the 31% of all NDMS team assets that have reached Type I readiness, and that they are also "very short on nurses" (Rhode Island Hospital, 2008).
Bill Hall, Spokesperson for the Department of Health and Human Services disputes Dr. McCann's claims; he says the department remains "fully committed" to NDMS. "We are not closing down or eliminating teams. In fact, for fiscal 2009, HHS is proposing a $7 million increase for NDMS". The commanders of six Florida-based DMATs posted a letter online on the National Association of DMATS website (Kruschke, et al., 2008) saying they had "confirmed through multiple independent sources" within the department that HHS officials are "engaged in a systematic plan to deemphasize" NDMS and to replace DMATs with new PHS Commissioned Corps Health and Medical Response (HAMR) teams; but Hall insisted that the HAMR teams will play a "complementary role" to DMATs. "Nobody is being replaced". (Garza, 2008)
Regardless of the validity of the claims made by either the Commanders of the Florida DMATS or the Spokesperson of the Department of Health and Human Services, it becomes readily evident that the current status of the DEMAT teams within the National Disaster Medical System is sub optimal. In a presentation on their website targeting elected officials, the National Association of DMATS express their concern over the HAMR teams, Budget Issues, the loss of Warehouse Space, Inability to use Team owned equipment, Training, and Delays in Application Processing. They close their remarks with the statement "NDMS team members feel we are less prepared now to respond to a disaster than before Hurricane Katrina. This is a direct response to action taken by ASPR to dismantle NDMS. As the primary disaster medicine response agency we feel our elected leadership must look into the problems facing NDMS and the citizens of the United States who are the potential victims of the next disaster, natural or man-made" (National Association of DMATS, n.d.) .
In September 2008, The National Biodefense Science Board (NBSB) provided feedback to the U.S. Department of Health and Human Services on the review of the National Disaster Medical System (NDMS) and national medical surge capacity as required by the Pandemic and All-Hazards Preparedness Act (PAHPA) and as specified by Paragraph 28 of Homeland Security Presidential Directive (HSPD)-21. (National Biodefense Science Board, 2008). The report, marked confidential was available on the open web. It made thirteen recommendations which have been condensed and listed below:
1. Strategic Vision: NDMS...does not represent an overall system to provide for the medical needs of patients at a time of national need.
2. DEVELOPMENT OF AN NDMS / ESF-8 ADVISORY GROUP: The establishment of ongoing civilian advisory groups for the National Disaster Medical System.
3. MONITORING AND DOCUMENTING NDMS IMPROVEMENT; previous studies have identified opportunities for improvement in the NDMS... there does not appear to be an organized methodology to track and monitor attempts to address these identified issues.
4. MEDICAL RESPONSE PERSONNEL: To achieve full staffing and operational status for all NDMS response teams... An improved, streamlined application process for DMAT membership is necessary. A training curriculum should be developed, adopted and implemented.
5. NDMS FIELD PERSONNEL CAPABILITY AND GAP ANALYSIS: Consideration should be given to improving the NDMS personnel capability especially in terms of volunteers' conflicting obligations and time to respond, for multiple specified national scenarios.
6. DEFINITION OF THE NDMS PATIENT: The definition of what constitutes an "NDMS patient" should be reviewed and expanded for the purposes of reimbursement.
7. REFINEMENT OF PATIENT MOVEMENT CONCEPT OF OPERATIONS: The ability to implement an effective, smooth mass evacuation of patients from an impacted area remains an unresolved issue.
8. NDMS ELECTRONIC MEDICAL RECORD (EMR): Although the advantages of the EMR are many... Its use must not compromise the efficiency of the healthcare providers in the field.
9. IMPROVED COMMUNICATION WITH STATE/LOCAL REPRESENTATIVES: Serious consideration should be given to returning the DMAT program to its original intent of first building local and state capability, and then exporting these volunteer resources through the NDMS for federal assistance to other parts of the country impacted by a disaster.
10. DEVELOPMENT OF IMPROVED NDMS STANDING CAPACITY: Serious consideration should be given to establishing improved alliances between NDMS and the public/private healthcare sector to provide assistance in field care, patient transport and definitive patient care.
11. FEDERAL REGULATIONS: Criteria should be developed in advance to specify when health-related federal regulations (e.g. HIPPA) should be considered for temporary suspension.
12. OVERALL NDMS FUNDING: It is clear that the funding level for NDMS is inadequate to support even the current level of the NDMS operation.
13. The Department of Health and Human Services is requested to respond to these recommendations in writing during their summer 2009 Public meeting.
Conclusion: The materials presented herein clearly show a National Disaster Medical System that is not ready to respond to an earthquake of major magnitude in California. The NDMS system can currently be safely called broken, and the challenge of the next administration is to address these issues in a timely manner before the system needs to be called upon to respond to the medical needs of our citizens during a major or catastrophic event.
Selected References:
California Health Care Foundation. (2007, January 18). Nearly Half of California Hospitals Unprepared to Meet Deadlines for Seismic Safety. Retrieved October 15, 2008, from California Health Care Foundation Press: http://www.chcf.org/press/view.cfm?itemID=129513
Federal Emergency Management Agency. (1980, November). An Assesment of the Consequences and Preparations for a Catastrophic Californis Earthquake: Findings and Actions Taken. Retrieved September 24, 2008, from The Project Gutenberg: http://www.gutenberg.org/files/18527/18527-h/18527-h.htm
Garza, M. (2008, May). Special Report: DMATS in Danger? Retrieved October 15, 2008, from JEMS.Com: [http://www.jems.com/news_and_articles/articles/jems/3305/dmats_in_danger.html]
Kruschke, G., Hendrickson, B., Wrona, N., Ketchie, K., Caprio, J., Parker, L., et al. (2008, February 1). Florida Commanders Letter. Retrieved October 15, 2008, from National Association of Disaster Medical Assistance Teams: [http://www.nadmat.org/File/FLCommadersLetter.pdf]
McCann, D. G. (2008, February 4). NDMS: Do not Go Gentle into that Good Night. Retrieved October 15, 2008, from The National Emergency Management Summit; Agenda Day One, Monday Febriuary 4, 2008: http://www.emergencymanagementsummit.com/past2008/agenda/day1.html
National Association of DMATS. (n.d.). Presentation to Elected Officials. Retrieved October 19, 2008, from National Association of DMATS: [http://www.nadmat.org/index.cfm/m/5/dn/Presentation] to Elected Officials/
Dan A. Niederman FAEM
Lieutenant Colonel, Medical Service Corps
United States Army Reserve, Retired
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california healthcare foundation
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The Best Swiss Chocolate
Being Swiss somehow seems to make me an expert in matters concerning Chocolate. Friends, colleagues, neighbors who are about to travel to Switzerland never venture there without asking me which Chocolate they should try, buy or bring back. I am usually excited to share my opinion, unless in situations where a Belgium, French or other national from a Chocolate savvy country tries to start degrading the Swiss Chocolate. There I have no choice but to tell them straight out that nothing else reaches the quality (ever heard of Belgium or French Quality?) of Helvetic Chocolate. Just between us, and out of reach of Belgian, French or even Swiss ears, I actually quite enjoy all three, but since I cannot stand biased accusations, I have to result to defending my heritage.
So what do I recommend? First of all, no matter what Chocolate you decide to savor, the main thing is that you give it the attention it deserves. Which means, should your mind be in any way littered by taste crippling thoughts about calories or bikinis, do not even try. You are not worthy of eating chocolate. I am often told that people cannot believe I love chocolate, simply because I do not carry it around my midsection. Once and for all, it is not chocolate that makes you fat, it is you not being able to balance its consumption properly. A 100g bar should last you a week, not a day! And if does not, you are not giving it the respect it deserves.
Which brings me to the next important point: anticipation. Half the joy of eating chocolate is the anticipation. Imagining or remembering what it is going to taste like when it melts in your mouth. I have a chocolate moment every day, not a big one, but a well deserved one. The other great thing about anticipation: it doesn't have any calories either!
Last but not at all least: Quality! Buy the good stuff. No matter wherein North America you live, you can buy chocolate other than the low end Nestle, Hershey or any other of those 'we have to add other stuff because our chocolate is not good enough'-brands. The reason why people tend to eat as many of those evil 'cash registry lane pavers' is because they do not manage to satisfy fully and leave a craving for more.
Trust me. If you have a really good piece of chocolate, and give it the attention it deserves, you will be happy with just one piece. I used to gobble down bars almost unnoticed while reading books. That is the perfect recipe for feeling awful later, as soon as you close that feel-good story book.
Now, having said all that, which one to go for? Well, like anything else, chocolate tastes vary. More expensive does not always mean better. My sister for example prefers a Swiss grocery giant's own brand to an exclusive chocolatier's recipe. Dark chocolate has more of the good stuff and leaves you feeling satisfied with less. Too much of a cocoa content though can turn it rather bitter, which not everybody enjoys. Personally I do not go higher than 70% cocoa content, and even that usually would have to have something else in it counter balance the bitterness. As far as white chocolate, well, I do not consider it chocolate. Unless it is in some dessert mousse, I do not touch it. Here are my personal favorites:
Ovomaltine Chocolate: like the Ovaltine drink powder mixed in with milk chocolate; a pleasurable crunch without being too sweet. I cannot get it in Canada, therefore I guess the anticipation level is so high, it's ranked at first place.
Cailler Cremant Chocolate: my grandmother's favourite as well, dark chocolate, also great for dipping in a cup of warm milk. I am a little upset though that Nestle managed to gobble up Cailler and after my last visit back home, I had a feeling they changed the recipe.
Cailler Chocmel: same brand but milk chocolate with almond splinters and honey. First the chocolate melts on your tongue and then there is a wonderful after crunch.
Minor Chocolate: probably mostly due to the fond memories of accompanying my Dad every Sunday on his drive to the local kiosk at the train station to pick up his weekend paper. Needless to say a "Minor Stengel" always made it to the cashier as well. As their English website reads: The much sought after Branche is more than a delicious praline stick, it is a bite of delight.
Now, none of these widely available grocery store chocolates will compare to freshly made chocolate that you get when you enter a smaller boutique that makes their own. The sweet smell of chocolate in your nose will add much to the pleasure and although prices will dramatically increase, it is well worth it for a truffle or two.
Enjoy!
Anne has been writing for many years, entertaining and educating many around the globe. You can check out more of her writings on landlord house insurance or find out what she has been researching on lumbar support pillows
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Swiss Family Robinson
When we read Swiss Family Robinson, the children gained a greater love for the wilderness. We learned how to make signs with sticks and stones to indicate where we were. We learned how to make emergency shelters. We found out what wild foods were edible, and which weren't. We ate a lot of dandelions (both the leaves and the petals) off the front lawn, but we had to check if they had been sprayed with poison first. (Don't eat them if they have been sprayed!) The dandelions were bitter but very nutritious.
The children's vocabulary expanded as we used words such as "fortitude." We made a spear and arrows using obsidian arrowheads, sticks, twine, and feathers. (I cheated by using hot glue also.) We made a model of a raft using twigs and twine, and we learned how to do lashings. We hung a bag of food from a branch. We hung it so high it was almost impossible to get down. (At least the bears wouldn't have gotten to it either!)
We made traps for catching wild animals. The boys had to invent their own traps. My three-year-old propped up a basket with a stick attached by a rope. He hid behind a tree and looked very sneaky. Another son made a trap with two sticks holding up another stick. (I don't know exactly how the animal got caught; there might have been a hole covered with leaves nearby.)
We made a scarecrow and propped it up next to our vegetable garden. We hollowed out coconuts for bowls, after drinking the milk and baking butterscotch coconut brownies with the shavings. We made a spit for cooking dinner or hanging a kettle. We chose some seashells to use for practical purposes, like for a spoon to eat some soup.
We studied snakes by taping strips of paper together and making the snake the correct length. Then we drew the correct pattern on the back, and the children all colored it while I was reading an encyclopedia description of each snake. We learned which snakes were poisonous and which weren't.
We learned all about simple machines during these three months. Simple machines were mentioned throughout this book, making it an ideal science unit to do concurrently with the book. We built each of the five types of simple machines.
We watched the Disney video for Swiss Family Robinson, and we compared it to the book. There were many differences, the biggest one being the ending. Watching the movie made the children even more excited about building a tree house or fort. The kids each drew a tree house and colored it. After discussing tree houses and forts for many hours with my husband, we decided on making a solid fort with two floors. A rope ladder connected the top of the fort to the ground. The boys liked looking out over the trees from the top of the fort. A pulley was used to lower a bucket from the top of the fort. The children still love that fort to this day. It is our Swiss Family Robinson fort.
If you would like to have more unit study ideas, visit my website and sign up for a free e-book. Go to http://susanevans.org
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Today's women are busier than ever
Today's women are busier than ever, and their need to keep track of time has increased along with their activities. But no matter what they are doing, women want their sense of style to extend from their wardrobes to their watches.
A board meeting requires a woman to dress with taste as well as professionalism. The Cartier Women's Silver-Tone Dial & Stainless Steel Bracelet Watch covers both requirements. The steel case and silver-tone dial shine without being showy, as does the beautiful braid-style stainless steel bracelet. Black Roman numerals mark the hours with their businesslike shapes. Simple black hands are powered by quartz crystals, providing the most accurate movements available in a timepiece.
When the business is a little less formal, a watch with a fun flash of color will carry the businesswoman through her day. The Pink Dial & Stainless Steel Bracelet Watch by Cartier looks feminine and businesslike on her wrist. A pink dial with pink Roman numeral hour markers is easy on the eyes and pleasant to look at when she needs to check the time. Quartz movement powers the watch and a scratch resistant sapphire crystal keeps the hands covered.
Lunch at a dockside restaurant calls for something light on the arm. Cartier's Blue Dial & White Fabric Strap Watch sits pretty on her wrist with its fun fabric strap and steel case. The dial is a lovely blue with white Roman numeral markers at each hour. A date display sits at the three o'clock hour, and everything is tucked beneath a durable sapphire crystal.
If the fashion world is her forte, the Gucci White Dial & Stainless Steel Bracelet Watch will keep her at the top of her industry and on time as well. The round bezel of this timepiece is accented with diamonds as it circles the white dial. A stainless steel case and bracelet provide more shine and the Gucci logo on the band proclaims her sense of style to the world.
If digital and funky is her thing, the Gucci Digital Pink Rubber Strap Watch is a fun and easy to read contemporary timepiece. The case is stainless steel surrounding a silver-tone dial that goes digital with time, date and day of the week front and center. A pink rubber strap features the Gucci logo, and adds that quick flash of fun to her day.
Every woman wants to wear something a little dressy from time to time, and the Cartier Women's Silver-Tone Dial & Stainless Steel Bracelet Watch is just the thing. Overlapping circular links of stainless steel form a comfortable and elegant bracelet that hugs the wrist. A rectangular steel case surrounds a black dial with silver hour and minute hands. The Movado mark sits at 12:00 beneath a sapphire crystal, giving this watch a sophisticated look that can handle the symphony, theater, or a discreet dinner date.
For a daintier look, the Gucci Signoria Stainless Steel Bracelet Watch has a decorative stainless steel strap that skims the wrist like a fine bracelet. The square stainless steel case surrounds a white mother-of-pearl dial that features black markers at each hour. This is the watch to wear with those breezy summer sundresses.
Leather always looks a little sportier when it hugs the wrist. If that's the look the lady wants, then the Renato Women's Beauty Petite Stainless Steel Swiss Quartz Lizard Strap Watch will delight her. A genuine lizard strap in brown fits close to the brushed stainless steel case. Four screw accents add to the sporty look of this timepiece, while the black dial and baguette cut red topaz hour markers ensure its place among fashionable wristwatches. This watch is available in rose-tone with sweeping rose-tone hands or in a similar silver-tone configuration. The movement comes from a Swiss Ronda 763 Quartz and the crystal is sturdy sapphire.
Whimsy comes in hearts and flowers and the Ed Hardy Heart Crush Quartz Bracelet Watch has both-with an edge. The heart-shaped stainless steel case comes in black, gold-tone or silver-tone, each with its own special dial design. Choose a koi fish pattern on the gold-tone dial, a geisha girl on the white dial that comes with the silver-tone bracelet and dial, or a "love kills" design in black on black. Arabic numerals mark the four sides of this timepiece and a Miyota 2025 Quartz movement keeps it running on time. Heart-shaped cutouts provide the final feminine touch to the bracelet of all three choices.
Finally, nothing beats a classic timepiece. The Rotary Women's Quartz Stainless Steel Bracelet Watch is simple but fashionable. The case is round, constructed of stainless steel-as is the bracelet. The hour positions are noted in black Roman numerals and the black hour and minute hands are powered by a Ronda 1069 Quartz movement. This is the watch that can go almost anywhere, keeping up with today's woman.
Wyatt Hume is a freelance writer who writes about jewelry, watches and specific brands such as Android Watches.
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