Keith A. Hecht, PharmD, BCOP

• Associate Professor, Department of Pharmacy Practice, School of Pharmacy, Southern Illinois University Edwardsville
• Clinical Pharmacy Specialist, Hematology/Oncology, Mercy Hospital St. Louis, St. Louis, Missouri

https://www.siue.edu/pharmacy/departments-faculty-staff/bio-hecht-keith.shtml

Civil service Refers to the civilian employees of a government in the various ministries and includes teachers and policemen but not the military arthritis in dogs exercise discount plaquenil 400mg with amex, judiciary or those employed in statutory boards or public enterprises rheumatoid arthritis qualify for disability order plaquenil 400mg with visa. The relationship includes a mutual but unequal exchange of favours arthritis relief otc products cheap 200 mg plaquenil fast delivery, which can be corrupt arthritis pain onset generic plaquenil 400mg free shipping. Collusion A usually secretive act of cooperation or collaboration among two or more parties to mislead or defraud others (of their rights). Counterfeit drugs Medicines, which have been deliberately and fraudulently mislabelled with respect to identity and or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging. Cronyism Favouritism shown in treatment of friends and associates, without regard to their objective qualifications; could be treated as a form of corruption. Cultural determinism Refers to a conviction that culture determines and dominates our behavioural and emotional approaches to issues of society and existence. Cultural pluralism A term used when small groups within a larger society maintain their unique cultural identities. In a pluralist culture, unique groups not only coexist side by side, but also consider qualities of other groups as traits worth incorporating into their own culture. Dry departments Government offices that do traditional administrative work and have little contact with the public. Embezzlement the misappropriation of property or money by a person in a formal position of trust or responsibility over those assets. Extortion Unlawful demand or receipt of money or favour through the use of force or intimidation. Extradition Legal surrender by one country to another of an individual accused or convicted of an offence within the jurisdiction of the other country. It can be a form of corruption, for example when a public officer gives priority to his/her family members. Fraud An economic crime involving misrepresentation done to obtain unlawful gains. Free-riders In the context of this report: individuals, concluding that reduced corruption will benefit nearly everyone, leave the hard work and risks of reform to others, knowing they stand to benefit from any successes whether they have participated or not. In some cases, simultaneous or recurring giving serves to circulate and redistribute valuables within a community. Sometimes, there is an implicit expectation of the return of comparable goods or services, political support, or the gift being later passed on to a third party. Ghost institutions Institutions that show up on account books but do not actually exist anywhere. Ghost workers Staff that show up on account books but do not actually exist in reality. Grand corruption Corruption involving substantial amounts of money and usually high-level officials to secure commercial contracts or some other business advantage. Integrity system An integrity system is a political and administrative arrangement that encourages integrity (adherence to a set of moral or ethical principles). Kickback An illegal secret payment made as a return for a favour or service rendered; a form of corruption. Lobbying An attempt to influence an outcome in favour of or against a specific cause, typically directed at government and elected officials. Money laundering the process whereby the origin of funds generated by illegal means is concealed so that it appears to come from a legitimate source. Money laundering is often use to disguise the proceeds of corruption, and aims at inserting them into economic circulation. Nepotism Granting offices, contracts and benefits to friends and relatives, regardless of merit. Perks Refer to entitlements or favours bestowed upon an individual based on the office/position held. Petty corruption Corruption involving smaller sums and typically involving more junior officials; also known as administrative corruption or retail corruption. It covers everyday corruption that takes place at the implementation end of policies, where public officials interact with the public. Petty corruption is bribery in connection with the implementation of existing laws, rules and regulations. Political will the demonstrated and credible intent of political actors to attack perceived causes or effects of corruption at a systemic level. Principal-agent model Explains how corruption occurs when an agent betrays the power entrusted in him/her by a principal to pursue his/her own interest by accepting or seeking a benefit from a service seeker, the client. Ratification Defines the international act whereby a state indicates its consent to be bound to a treaty if the parties intended to show their consent by such an act. Relationship banking A long-term, intimate and relatively open relationship established between a corporation and its banks. Rent seeking Rent seeking generally implies the extraction of uncompensated value from others without making any contribution to productivity, such as by gaining control of land and other preexisting natural resources, or by imposing burdensome regulations or other government decisions that may affect consumers or businesses. Right to information legislation Legislation that gives all citizens and organizations a legal right to demand and obtain information from public bodies and those who are performing public functions, and an obligation on all public bodies to publish, on a proactive or routine basis, key categories of information. Speed money Bribes paid to quicken the delivery of services delayed by bureaucratic holdup (red tape) and shortage of resources. State capture Where the state is held captive to the actions of individuals, groups, or firms who influence the formation of laws, rules, and regulations to serve their private interests by offering private benefits to public officials, changing the rules of the game. System of checks and balances A mechanism that allows each branch of a government to amend or veto acts of another branch so as to prevent any other branch from exerting too much power. Tax haven A country or independent region where there are no or nominal taxes and there is lack of transparency and minimal exchange of information. Wet departments Government offices that deal with many people outside government and are typically concerned with money, planning, banking, or public enterprises. Whistle-blower protection Measures (administrative or legislative) to protect people who alert the public or the authorities about corrupt transactions they have witnessed or uncovered. Whistle-blower protection shields these people from reprisals, from those they expose. The colonial roots of Latin American land inequality in a global comparative perspective: Factor endowments, institutions or political economy A specific book on pediatric nail disorders has never been written before, and although the subject is quite narrow, the gap in the clinical practice that it concerns is large. Whether or not the appearance is significant, clinicians are generally ill prepared to address these concerns. Dermatologists, pediatricians, and family physicians may all be called on to treat these patients, but they may well feel uncertain about aspects that they may think belong to other specialists. We hope all these groups of readers will benefit from the labors of the group of esteemed physicians from many fields who have focused their efforts to bring detailed and useful information on such a small appendage of the body. We also thank our publisher for having granted us confidence to complete our task. Department of Dermatology University of Barcelona Barcelona, Spain Downloaded by [95. In many genetic disorders, the diagnosis is based on the anomalies of other organs. Rarely, changes in nails are characteristic, representing a major clue for the diagnosis. Different terms used to describe are sloppy, such as onychodystrophy or onychodysplasia. Nail Embryology Development the development of nail apparatus begins during the eighth week of gestation and is completed by the fifth month (20 weeks) of intrauterine development. The nail bed on the dorsal digit is the first skin structure to keratinize at around 11 weeks. Keratinization begins distally and then continues over the nail bed toward the proximal nail fold. After 12 weeks, the presumptive nail matrix cells, which will later produce the differentiated nail plate, are found ventral to the proximal nail fold.

Edrophonium chloride is a cholinesterase inhibitor with an effective duration of action of less than five minutes dealing with arthritis in neck purchase plaquenil 400 mg line. For limb muscles rheumatoid arthritis diet youtube generic plaquenil 200 mg with amex, this requires that the patient exert full effort both before and after the test arthritis finger joints relief cheap plaquenil 200mg amex. It is generally considered more reliable to evaluate ptosis or ocular muscle weakness arthritis in the back joints discount plaquenil 200mg free shipping. The test is often done in a blinded or doubleblinded fashion with the use of a placebo, but this may not be practical in an emergency setting. Administration of edrophonium chloride can have cardiac side effects including bradycardia, hypotension, loss of consciousness, and asystole. The test should be performed in a setting with immediate access to a "crash cart" with appropriate resuscitative equipment and medications (including atropine). Furthermore, a number of patients are sensitive to the effects of edrophonium and develop cholinergic side effects (salivation, lacrimation, and increased bronchial secretions). After pretreatment with atropine, 10 mg of edrophonium chloride (available at a concentration of 10mg/mL) 98 Emergency Care Issues is drawn up into a 1cc syringe. Additional syringes of normal saline should be available to be used as placebo (if desired) and as flush. The observer should assess for signs of intolerance and of improvement in the weak muscle. If no effects are noted after 1 minute, the remaining dose is given as aliquots of 3 mg and 5 mg at 1 minute intervals. Any change in the weak muscle is considered a positive test and no further injection is needed. A positive test occurs when the observer notes objective improvement in the weak muscle over a period of 2 to 5 minutes, followed by return of the weakness over the next 5 minutes. Some of these medications are commonly used by the emergency physician and are categorized below by class. The disease state is a function of immunologic and cholinergic tone as the final 99 endpoints in a complex physiologic relationship. Myasthenia exacerbation is a broad term that may be defined as any provoked increase of weakness of bulbar, respiratory, or limb muscles. After the patient has been stabilized, attention can be directed towards discovering the underlying cause of the worsening symptoms. The condition is arguably less common in the current era, in which these drugs are no longer a mainstay of treatment, and are used in smaller doses. However, unintentional overdoses of cholinesterase inhibitor medications can occur. It is also important for the emergency provider to be aware that numerous compounds of commercial, agricultural, military and bioterrorism uses have cholinergic properties (see below). This condition is deEmergency Care Issues the edrophonium test (described above) has been used to assess states of cholinergic excess or deficit. When administration of edrophonium results in worsening of symptoms, cholinergic excess should be suspected. If these resources are not immediately available, the emergency provider should consider referral and transport to an appropriate facility. The emergency provider must be aware of the uses of these compounds and alert to any suspicious circumstances. Critical reappraisal of the use of edrophonium (tensilon) chloride tests in myasthenia gravis and significance of clinical classification. Rapid diagnostic test for myasthenia gravis: increased muscle strength, without fasciculations, after intravenous administration of edrophonium (tensilon) chloride. Rapid sequence intubation without a neuromuscular blocking agent in a 14-year old female patient with myasthenia gravis. Our recent experiences with sarin poisoning cases in Japan and pesticide users with references to some selected chemicals. Emergency Care Issues 102 6 Psychosocial Issues: From Diagnosis to Lifetime Management M yasthenia Gravis, as a chronic disease, has Kimberly M. Johnson psychosocial aspects that are similar to those shared by other disease populations as well as aspects that are unique to the disorder itself. The newly diagnosed patient will spend a lifetime of cycling through these feelings as various life events create challenges for coping with the disease. It is important for the health care provider to incorporate the biopsycho-social approach to treating these patients as psychosocial issues can impact the management of the disease. The challenge for the health care provider is to identify triggers that may lead to problems in disease management, such as stress, extreme heat, medication side effects, etc. These changes can be frustrating and embarrassing for a patient who is very conscientious about being in the public eye. Changes in body image may lower self esteem and some may seek to cope by socially isolating themselves from the public. This may have an even greater impact for the patient who was socially active prior to diagnosis. A patient who withdraws socially may isolate themselves from the informal support network available. Further, a patient may ultimately selfdiscontinue the use of medications if they are dissatisfied with changes in body image associated with their use. A patient may opt out of having a thymectomy if having a surgical scar is an issue. Of critical concern is that the patient may not be forthcoming with this information to their treating physician. This may lead to disease management changes that would not have occurred otherwise and such changes may increase the Psychosocial Issues: From treatment risk. For example, the patient may self-discontinue their immunodulatory treatment and the unknowing physician "increases the medication dosage with the belief that the previous dose was ineffective. Should the patient resume taking the drug the dose may then be "toxic"; increasing the risk for an adverse reaction. It is helpful to assess feelings related to body image to gauge what is important to the patient so that treatment options can be tailored toward the best possible outcome. It is also worthy of noting that sometimes family members may not understand the impact that the disease and side effects of medications may have on a patient. One patient describes the scenario of her husband purchasing a spa membership for her as he found her weight gain while taking prednisone to be unacceptable. She underutilized this spa membership and her husband became angered by the "waste of money". As is noted in the section on Physical Therapy, exercise must be carefully planned for the patient with myasthenia to avoid overexertion and exacerbation of symptoms. The Lifeline emergency response system is a device that may be worn by the patient and when activated, signals calls to individuals that can quickly check on the patient (Lifeline, 2006). This alleviates the fear of not being 104 able to utilize a phone to contact emergency personnel in a crisis situation. The First Alert system can be installed and has an activation fee and monthly service fee. Many medical centers administer this service as well as local Council on Aging agencies. It is also a good idea for a patient to educate their local emergency personnel regarding potential respiratory/ communication issues so that emergency personnel can respond to a call in which a patient may not be able to effectively communicate their needs. Patients with myasthenia gravis should also consider purchasing a MedicAlert (or similar) bracelet ( The patient should keep the original documents in a secure place where they can be easily retrieved by family or friends should the need arise. A Living Will document does not allow for specifications in treatment such as "I would like to be on a ventilator for a week and if no improvement, taken off".

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In Myanmar arthritis in feet running generic 200 mg plaquenil otc, gold-mining enterprises not only pay taxes to the Government but also follow a well-structured system of personal payments to officials who can protect them from any repercussions for contaminating the environment with mercury vitamin d arthritis pain relief plaquenil 200 mg discount. Poor people usually have a greater need for government services whose budget allocations are severely constrained by losses from corruption nightshade vegetables arthritis pain order plaquenil 400mg without a prescription. The Government of Indonesia has estimated that lost forest revenue costs the nation up to $4 billion a year or around five times the annual budget for the Department of Health arthritis diet plan discount plaquenil 200mg with amex. Also, those profiting from overharvesting of forests often belong to powerful elites with little motivation to change the existing market structures. In Indonesia, for example, the market return of commercial logging represents less than one-tenth of the value of the carbon bank its forests constitute. Given the highly cross-border nature of the problem, in addition to national remedies, international cooperation needs to be stressed. Overall the aim should be to empower citizens to have greater control over decision-making, while restricting the hidden power of corporations, concentrating less on efforts to improve efficiency or attract foreign investment and more on ensuring that policy making is not captured by the wealthy for their own self-interest. Experience across the region suggests a number of steps that can combat corruption: Empower Poor People in Resource Management Natural Resource Management In some cases problems have been solved by decentralizing natural resource management. It also encourages more transparency in the management of forests, which has not been exempt from corruption. By 2002, comanagement of forests was underway in 27 states, covering 18 per cent of the total forested area and involving more than 62,000 forest protection committees. Nevertheless, many challenges remain particularly on the marketing side since many forestry products are still marketed through uncompetitive channels that reduce the profits received by low-income household producers. This is due to the economics of large-scale extraction plus the activities of companies that are typically bound with complex laws and regulations. This also works with companies to encourage and support an accountable and transparent presence in resource-rich countries. Multi stakeholder initiatives to improve accountability by equipping citizens, media and private companies can also be of help (Box 5. Resistance by Poor People On a number of occasions the poor themselves have taken direct action to resist natural resource corruption that denies them access to land, fisheries and forests. Such assessments are usually conducted by specialized consulting firms that rely on resource extraction companies for their income and in some cases the conclusions seem suspiciously favourable to their clients. There are however, examples where assessments have been conducted in a meaningful and unbiased manner, with the full involvement of local people and civil society organizations. However, replenishing natural resources needs to be managed carefully, since planted forests compete for land with natural forests. Similarly, fish farms could be avenues for increased pollution into rivers if not managed properly. In other words, expanding supply can bring significant gains but it can also be controversial and has to be carefully designed to protect the environment and avoid penalizing the poor. Increase Transpar ransparency Increase Monitoring and Transparency Increased monitoring and transparency can result from pressure on stakeholders both from within and outside a country. Corrupt exploitation of natural resources often takes place in remote regions, far from official concern and public scrutiny, and precisely in those areas inhabited by the poor. In Cambodia and Indonesia, for instance, remote sensing is being used to identify forest concessions that were awarded illegally. Monitoring and transparency can also be promoted by the use of independent monitors, which is now gaining ground in the forestry sector. Improvements in monitoring can be achieved directly by using new technologies Increase the Supply of Natural Resources Corruption is often driven by scarcity; this is clearly demonstrated in natural resources which may be limited by their natural availability. Scarce resources such as wildlife, water, fish and minerals may generate high prices or demand that opens the way for bribes and kickbacks. It has been estimated that plantation forests managed exclusively for wood and fibre on just 4 per cent of existing forest lands could Alert Stockmarket Investors Extraction processes are capital-intensive and often involve large multinational companies who can be susceptible to international pressure. So far, however, countries in the AsiaPacific region have shown little interest in policing their companies abroad. Malaysian logging companies are prominent in the timber industry throughout Asia and the Pacific. There is potential here for the Government to encourage these companies to commit to a corruption-free environment in their operations abroad. The same recommendation can be levelled at other countries in the region that have companies operating outside their national jurisdictions. Ensure Financial Transparency Ensure Financial Transpar ransparency Companies involved in the extraction of natural resources would also be under more pressure to avoid corruption if all their financial transactions were exposed to public scrutiny. The financial deals can be immensely complex offering companies, and governments numerous ways of concealing corruption. In many cases the deals can only be fully understood in conjunction with contractual agreements which are often confidential. Even if the key information is published, it can be difficult to extract evidence of state capture from floods of extraneous data. Progress at an inter-governmental level is attributed to the Extractive Industries Transparency Initiative Balance Roles of the State and Private Sector Corruption can be driven by failings of the state. This can be tackled both positively by improving state capacity and negatively by limiting the powers of the state. The positive response would take account of generic requirements to improve the state such as improved salaries, merit-based promotion, reduced politicization, better equipment and operational budgets. There are also some specific reforms that natural resource-based agencies can undertake. In many countries in the region, fishery and forestry departments are responsible both for maximizing fish and forest production, as well as monitoring and conserving the resource base. Not surprisingly, this creates a conflict of interest and fertile ground for corruption. Other institutional reforms include rewards and incentives for corruption prevention. As illustrated in Sri Lanka, a financial reward for detection of anything illegal has been used to motivate customs officers to identify illegal exports of ornamental fish and other rare plants and animals. A negative response to state weakness and potential corruption is to limit the ways that the state can gain from corrupt natural resource management. Many natural resource rules allow significant state discretion which creates opportunities for corruption. Discretionary powers of state officials can be limited by simplifying the rules and making greater use of new technology. In Karnataka in India, land registry has been a major source of corruption; village revenue officials often monopolize the revenue records which have frequently been tampered with. Now the Bhoomi programme has facilitated the computerization of the records and so limited the power of state officials to control land transactions. In theory once a company is in the private sector, it will be less prone to stateled corruption. In practice privatization may sometimes only shift the power from one corruptor to another, increasing the power of private companies and the conditions of state capture. A first step is to ensure that open access to natural resources upon which the poor depend are not privatized by elite groups in a defacto way. Such unwanted privatization may occur when traditional systems of regulation on common property use that worked in the past have broken down, partly due to population pressure combined with other factors. It can also happen when public resources such as forests are leased out to commercial-scale operators under concessions agreements which grant exclusive access, driving out the poor. The central issue here is for the government to establish a clear and transparent regulatory framework for resource access rights, whether or not they are publicly or privately held. In this regard, privatization may also have a positive impact as it can provide initiatives for managing resources appropriately and sustainably. However, governments need to enforce laws that prevent private-sector natural resource corruption, imposing sufficient serious punishments to make corruption more costly than non-corrupt behaviour. Combating corruption will require judicial reform and the support of impartial, consistent criminal justice systems along with successful prosecution of the guilty. Fortunately, this is an area that is receiving increasing attention, though it is important to recognize some of the specific obstacles to litigation. Certification One encouraging trend among private companies in the forestry and fishery sector across Asia has been the expansion of schemes of certification.

A government may choose to deregulate a sector after weighing up the political gain and loss for the main governing party arthritis pain relief as seen on tv 200mg plaquenil visa. A business may choose to locate a facility in a hurricane zone if it can secure insurance to defray potential costs if damage occurs rheumatoid arthritis remission buy plaquenil 400 mg line. A civil-society group may advocate building more low-cost housing if the policy appeals to more of its members and funders than it alienates arthritis medication nabumetone buy plaquenil 200 mg low price. However arthritis medication dogs side effects buy plaquenil 400 mg on-line, given the interconnected nature of our globalized systems, these decisions do not exist in isolation and can leak vulnerabilities into other sectors. Externalities can be costs expected to be borne by others (for example insurers, or the government), or costs that will become due past the timeframe under consideration (for example, during another administration or in a future corporate bonus period). For instance, government will for political reasons back or directly insure activities in some sectors that private-sector insurers have deemed too risky to take on. Yet a common theme remains the problem of translating scientific analysis into timely action. Drought, and the food crises that may result, are a classic example of slow-motion crises in which failed rains lead to a failed harvest, after which food reserves and asset bases are eroded as people struggle to feed themselves. Food availability declines and prices rise, leaving the vulnerable populations facing months of severe food insecurity until another harvest is possible. A crucial difference, however, is that in certain regions of the world, most notably West Africa and East Africa, drought is not a high-impact, low-probability event; it is a high-probability, high-impact event. Governments and international agencies often have a very good idea about how a food crisis is likely to evolve and are able to see it coming a long way in advance. What is more, the failure to mobilize resources early meant that agencies were unable to build adequate logistical capacity in anticipation of the crisis peak. The early provision of scientific warnings of drought and crisis, inevitably including uncertainties, is failing to precipitate adequate early action, despite the relative lack of conflicting interests between stakeholders, and their familiarity with these kinds of event. A simplistic explanation that donors are reluctant to mobilize resources until uncomfortable images of starving people are broadcast around the world offers at best only a partial explanation and little in the way of solutions. Attention must also be turned to how information is provided to decision-makers so that it is easier for them to take early action and be held to account. This means translating early warnings into recommended steps, with the clear identification of least- (and no-) regret options able to deliver a minimum level of early action that can be built upon as information improves. Or do you simply choose not to build a nuclear power station in an earthquake zone at all For example, the probability of an accident that results in damage to the core of the European pressurized water reactor, the most modern design being constructed worldwide, is described as 5. It concluded that the risk of a core-damage accident, presumably in the oldest reactors such as those at Fukushima, was less than 10-6/reactor year, and the containment failure frequency was less than 10-7/reactor year. Therefore on average there has been accident every 5,000 reactor years, which is twenty times greater than the probability calculated. The significant difference between the expected and observed risk raises two sets of concerns. Secondly, are the inherent risks of nuclear power, in particular human engagement, adequately considered and how might this change over time, i. As the economic costs grew, pressure mounted on regulators to implement a more nuanced set of measures for dealing with the ash cloud. This brought up another vital issue on which adequate information was necessary in the process of decision-making: the level of ash in which aircraft could operate with a reasonable level of safety. The importance of defining a safe threshold had been raised in industry discussions for many years but little progress had been made. Some stakeholders also suggested that it may not have been in the economic interest of the engine and aircraft manufacturers to set safe ash thresholds, given the higher costs of flying in ash. Information asymmetry between the private sector and the regulators became a serious obstacle to resolving the crisis. To the extent that analysis of safe levels was available, it was held by the manufacturers of aircraft engines and the airlines. During the event data on ash concentration thresholds were shared between the leading engine and aircraft manufacturers for the first time, but details of the arrangement or the results were not made public or released to regulators. Yet although the European Council of Ministers emphasized the necessity of evidence-based decision-making, the decision to moderate the flight ban was eventually made regardless of the absence of a clear statement from the engine and aircraft manufacturers. Predicting the behaviour of the physical world in particular is a growing challenge. With environmental change, past indices are no longer reliable guideposts for future events. The science is good, and getting better, but already it is often marginalized in calculations. Ensuring that government, the private sector and civil society include the new range of science-based variables is extremely difficult, especially as the timeline seems so extended. That date may seem far in the future, but it is well within the lifetime of new infrastructure builds. Often these new variables are simply ignored, thereby increasing the likelihood of future low-probability (according to past geophysics), high-impact events. Additionally, risk assessments themselves are primarily designed to predict the likelihood of a specific event, whereas what is of primary concern is the impact of that event. It is not the hurricane in itself that is the problem; it is the impact of that hurricane on infrastructure, governance, etc. Effects can be mitigated at three stages of a crisis: before (by reducing vulnerability), during (crisis response) and after (post-crisis response). Each sector has a role to play in managing impacts, but which one takes the lead during each phase can vary by country. When trying to reduce the impact of a disruptive event, vulnerabilities can be identified and resilience improved, by examining how the three main sectors are projected to engage with risk before, during and after the crisis, and then working to address deficiencies. In places where the private sector is weak, governments can give support for business continuity planning. In areas where the private sector is dominant, it can engage with civil society over potential regional risks, allowing them to become involved in contingency planning. In areas with strong communities, civil society can organize grassroots paragovernmental emergency units. Transparency and clarity over why and how decisions are taken in a time of crisis are a critical issue for governments and the private sector alike. During a crisis, flexible and transparent processes are required to avoid the emergence of ad hoc structures with limited legitimacy, and to ensure that regulatory structures engage all key stakeholders while maintaining resistance to lobbying pressures. This would help ensure continuous improvement in responses to future crises and, importantly for public confidence, would also enhance the accountability of risk-based decisions. The Battle for the Airwaves measures if authorities do not manage the communications battle. As discussed earlier, one consequence of globalization and interdependence is that crises, risk and uncertainty are far more likely to have international and transnational dimensions than would have been the case in the past. Uncertainties of some kind are very likely to feature in any high-impact event, presenting communication activities throughout a crisis situation with both opportunities and serious challenges. The media attention brought about by any crisis provides an opportunity to inform the public on key scientific issues. However, risks and probability are notoriously difficult to communicate, whether on climate change, bird flu or terrorism threat levels. Scientists deal with uncertainty every day, but for journalists and the general public it can be difficult to understand.

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