%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 62 0 R 72 0 R 183 0 R 371 0 R 523 0 R 549 0 R 551 0 R ] /Count 8 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R >> /XObject << /I1 12 0 R /I2 13 0 R /I3 64 0 R /I4 67 0 R /I5 78 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180721152030+00'00') /ModDate (D:20180721152030+00'00') /Title (The Role of Veterans Affairs in Emergency Management: A Systematic Literature Review PLOS Currents Disasters) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 14 0 R 16 0 R 18 0 R 20 0 R 22 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R 38 0 R 40 0 R 42 0 R 44 0 R 46 0 R 48 0 R 50 0 R 52 0 R 54 0 R 56 0 R 58 0 R 60 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 16586 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. There is an )] TJ ET BT 26.250 231.672 Td /F1 9.8 Tf [(urgent need for evidence-based research related to disaster and emergency response processes that VA is likely to engage in. )] TJ ET BT 26.250 219.768 Td /F1 9.8 Tf [(This review thus aimed to explore and summarize the current scientific literature about VA and emergency management and )] TJ ET BT 26.250 207.863 Td /F1 9.8 Tf [(make suggestions for future research.)] TJ ET BT 26.250 171.260 Td /F4 12.0 Tf [(METHOD)] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. There is an )] TJ ET BT 26.250 231.672 Td /F1 9.8 Tf [(urgent need for evidence-based research related to disaster and emergency response processes that VA is likely to engage in. )] TJ ET BT 26.250 219.768 Td /F1 9.8 Tf [(This review thus aimed to explore and summarize the current scientific literature about VA and emergency management and )] TJ ET BT 26.250 207.863 Td /F1 9.8 Tf [(make suggestions for future research.)] TJ ET BT 26.250 171.260 Td /F4 12.0 Tf [(METHOD)] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. There is an )] TJ ET BT 26.250 231.672 Td /F1 9.8 Tf [(urgent need for evidence-based research related to disaster and emergency response processes that VA is likely to engage in. )] TJ ET BT 26.250 219.768 Td /F1 9.8 Tf [(This review thus aimed to explore and summarize the current scientific literature about VA and emergency management and )] TJ ET BT 26.250 207.863 Td /F1 9.8 Tf [(make suggestions for future research.)] TJ ET BT 26.250 171.260 Td /F4 12.0 Tf [(METHOD)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(1)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /Font /Subtype /Type1 /Name /F4 /BaseFont /Helvetica-Bold /Encoding /WinAnsiEncoding >> endobj 12 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 144>> stream x1 0 'ݲ؎"e{dzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAtlM0\ endstream endobj 13 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /SMask 12 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3627>> stream x?b!/w N BU!@rܥ>L%|"ɾeB~qbϧG0 0 0 ü<,a ,a ,a /)܋( daKnW>'IR2 0x1ͽ{0 Z4= 4M޶mY}'IĖ2 0ָML}GQ48Iy>i("u>s6ne0 YfB;S}b 5ba,ZP՚ћuFڶ= 0{ǤbA!>m{wwW׵ApssDZdU,K:fs_׿___qykQbfMii{$̂>}JdB um{Lh'پy2c\ifZypE|,Uݝ,h4ڶ],R*\U-rQ9l PUUQ#G80aef_-mI*gߋlil-d:5ec]RUa0\ͼ$ ֌8jE%4BH\m=ϣfY )!vDL^)4axt=3*E<' _?>>.7DYt]׆0gqwр,ajmۢ(HMB$ [ U5;gfw`2R]u]GQD0g[Tt:a1J#,AU}0hwb>&8V~*ȀIH fuiah aMl7\:\>|,L5w(YqOFsoBy|<3^=6.ym۾%)~`XHnݰ‹IDs'oZ7In}wV|C%H{lDsDQ6]4jcЊͭ;*ٶv&A.09e(ji2btXɄy4?!ZEI"+Yɲy%'hZch@C+q,U1TA+FEe_R18;z.􃰢c ( H| $I.hy {ss&` 26:#(RuGQmZtJӅ˲csоj$}3#rl& j }>  ]x] ъ|G[1lfu ϛIaVz0-mvy2h܉ေA^XD`b"W#ֵU{(Y BAaDL]z_ex6 (nMOÈ%֐m`04Ԝ0aℓ.*"^=KeY~-'iM``v,Z꺞fRf1c+! 85BX,HeEљ @N^ԚG`5p |!L]U).?"l5eFQŞu]ɍK'eW/o҆&(i VM_ = E/J,;sqq0 W>rM=gdќ陞qѼ:2X;.˲j#Ņ뺮fbi\ו.u݋1mgXEQꋋ q@P%~VL0%b`eF4M}'@Sp8v;FߊdY]@u[5 (96 V0~1Gj Ňg֏= >\'ͪ$yX`!dhq%I0fF5x]t,hRˮb"3鈰@'5ؽE2>GI@ KȲLrÿ*1ȰT5ffܱYjuqqC3v(uEsI'c^چ#X,hAk"ZH6`XPW,>}fY6t^C8,Fi#nica Jzlf0 >سX,)m_Bs' c oN c>TT'%x&ߘ fi$W܇g[@ mDZ7]:RQjƘ.ğ$:؝, s{HzxqZKmF|Ϗ~p7@ {1$Xu}p(ĉzZaJ%i&0L@#\}GaT~tTQ,asEOxhy.?,aC9oqE=MS9I%8~WmdG:agO\\$,yHg^Ab%Ĩ7Z}џd2!YmN0X-#*ڈ/&W4MAYT?3;f udJ 6%ag9IxINlȦ|[+ ٘{R0' uT?NP%A wD&1=4L&ĵg-G)+0*V} 62T75yiۣrѰڳ>$'?B'IeY0K1WH]NkiR m<˭XF.xaijT==}~&;ہHA7| \( s\? ~_{ޒ{ O?^AVtї~g~~mVfS XtU6wMUv8|xxG-ü[A܆m!g۾勜*N5,sP=0 cibCub=2xa? Lx"(*׾90?po6EF$|z8oLoݻgV_zqoea&p="Z,ca^T˲l6c0 of+$0 oa wa7 wa7 wa7 wa7_i= endstream endobj 14 0 obj << /Type /Annot /Subtype /Link /A 15 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 557.9760 736.9416 ] >> endobj 15 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 16 0 obj << /Type /Annot /Subtype /Link /A 17 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 280.9230 711.9936 ] >> endobj 17 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 18 0 obj << /Type /Annot /Subtype /Link /A 19 0 R /Border [0 0 0] /H /I /Rect [ 101.3752 674.2101 166.6320 683.8626 ] >> endobj 19 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 20 0 obj << /Type /Annot /Subtype /Link /A 21 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 662.3453 81.5033 672.2659 ] >> endobj 21 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mclaver/) >> endobj 22 0 obj << /Type /Annot /Subtype /Link /A 23 0 R /Border [0 0 0] /H /I /Rect [ 86.9243 662.3453 156.8123 672.2659 ] >> endobj 23 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/darya-friedmanva-gov/) >> endobj 24 0 obj << /Type /Annot /Subtype /Link /A 25 0 R /Border [0 0 0] /H /I /Rect [ 162.2332 662.3453 226.7100 672.2659 ] >> endobj 25 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/aram-dobalianva-gov/) >> endobj 26 0 obj << /Type /Annot /Subtype /Link /A 27 0 R /Border [0 0 0] /H /I /Rect [ 232.1310 662.3453 281.9730 672.2659 ] >> endobj 27 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/karen-ricciva-gov/) >> endobj 28 0 obj << /Type /Annot /Subtype /Link /A 29 0 R /Border [0 0 0] /H /I /Rect [ 287.3940 662.3453 379.4925 672.2659 ] >> endobj 29 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mhornmallersfullerton-edu/) >> endobj 30 0 obj << /Type /Annot /Subtype /Link /A 31 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 557.9760 736.9416 ] >> endobj 31 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 32 0 obj << /Type /Annot /Subtype /Link /A 33 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 280.9230 711.9936 ] >> endobj 33 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 34 0 obj << /Type /Annot /Subtype /Link /A 35 0 R /Border [0 0 0] /H /I /Rect [ 101.3752 674.2101 166.6320 683.8626 ] >> endobj 35 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 36 0 obj << /Type /Annot /Subtype /Link /A 37 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 662.3453 81.5033 672.2659 ] >> endobj 37 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mclaver/) >> endobj 38 0 obj << /Type /Annot /Subtype /Link /A 39 0 R /Border [0 0 0] /H /I /Rect [ 86.9243 662.3453 156.8123 672.2659 ] >> endobj 39 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/darya-friedmanva-gov/) >> endobj 40 0 obj << /Type /Annot /Subtype /Link /A 41 0 R /Border [0 0 0] /H /I /Rect [ 162.2332 662.3453 226.7100 672.2659 ] >> endobj 41 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/aram-dobalianva-gov/) >> endobj 42 0 obj << /Type /Annot /Subtype /Link /A 43 0 R /Border [0 0 0] /H /I /Rect [ 232.1310 662.3453 281.9730 672.2659 ] >> endobj 43 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/karen-ricciva-gov/) >> endobj 44 0 obj << /Type /Annot /Subtype /Link /A 45 0 R /Border [0 0 0] /H /I /Rect [ 287.3940 662.3453 379.4925 672.2659 ] >> endobj 45 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mhornmallersfullerton-edu/) >> endobj 46 0 obj << /Type /Annot /Subtype /Link /A 47 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 557.9760 736.9416 ] >> endobj 47 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 48 0 obj << /Type /Annot /Subtype /Link /A 49 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 280.9230 711.9936 ] >> endobj 49 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/dis-12-0012-the-role-of-veterans-affairs-in-emergency-management-a-systematic-literature-review/) >> endobj 50 0 obj << /Type /Annot /Subtype /Link /A 51 0 R /Border [0 0 0] /H /I /Rect [ 101.3752 674.2101 166.6320 683.8626 ] >> endobj 51 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 52 0 obj << /Type /Annot /Subtype /Link /A 53 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 662.3453 81.5033 672.2659 ] >> endobj 53 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mclaver/) >> endobj 54 0 obj << /Type /Annot /Subtype /Link /A 55 0 R /Border [0 0 0] /H /I /Rect [ 86.9243 662.3453 156.8123 672.2659 ] >> endobj 55 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/darya-friedmanva-gov/) >> endobj 56 0 obj << /Type /Annot /Subtype /Link /A 57 0 R /Border [0 0 0] /H /I /Rect [ 162.2332 662.3453 226.7100 672.2659 ] >> endobj 57 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/aram-dobalianva-gov/) >> endobj 58 0 obj << /Type /Annot /Subtype /Link /A 59 0 R /Border [0 0 0] /H /I /Rect [ 232.1310 662.3453 281.9730 672.2659 ] >> endobj 59 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/karen-ricciva-gov/) >> endobj 60 0 obj << /Type /Annot /Subtype /Link /A 61 0 R /Border [0 0 0] /H /I /Rect [ 287.3940 662.3453 379.4925 672.2659 ] >> endobj 61 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mhornmallersfullerton-edu/) >> endobj 62 0 obj << /Type /Page /Parent 3 0 R /Annots [ 65 0 R 68 0 R 70 0 R ] /Contents 63 0 R >> endobj 63 0 obj << /Length 8187 >> stream 0.271 0.267 0.267 rg q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 64 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 529 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 100753>> stream JFIF,,C  !"$"$CX"V  !1"2AQ#7au6BUVqt$3RSTb%Crs&4v58c ?^T:Y;q biA@}gﻛ[vcvӓ2T %,"w,3݁ 5Y[|GGgTub<ǂư7 06%FԩiQGX}AI]Jŏ3 D ٩yV V>>l:4ϙ\8MsК(/FSʲ|A ޭ$?KY3F%n( ^xwFLWfiX1j³G*}A_f~*RI󏽏hǥXB{as(XI鹷lN;ڻҦۼҤs >Y@=G$wr _`Jx"5np[Ǝ"#O4dŕYSJZ0$.cr8Ӎ͖؝ǐL6>]@T*d!諤B>ҨμH';|4k7#-gHTe;5{.,DRc@Q 0~ H1HIoo͐ܮເMKf5uSBjy iIjGTxI \uO?wuC?8)ff+e+7{{I6كqY&tÔJU, CdpA㻐gܽFܛv,V*^܆g'N32"Gr^3[9ۙjR$ S#(gW-r^[5$uу+U}]-˘CvON9`?l+^9U(Gia>V9}p2e aBbD*bXp@ѬkuW/e_m3`OZǧB3v1ӈ~kaR8+!Z)dc'0s wFY܉Xqk?uʴ9-HK1d `>ëDW'[YX6vjP#8$4M4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4hWdRPn O Q_ LǧOTNw-vnhlgG ı +p@Gfkp8q$||SO\(c _\s=/es))rId4eADGwwtAEy,=W9͐7 fQD<%UXx,Ix Noh|!~x8EZ~8A'xd,|FpÎ4ǣAbnirB:DLI nCǐǒO4h3&~YN ٞ2c ( `uMx$|MΤjK@Hr>NAR2lۙ-f1v+jw* e<8DM(Ԛs>leȑm\/qUp Km'I9av-ט(+n*oJ"4eA?(yq/J,9 ˒jW(ƈޅ,r: RU0дh3ݽ|#p-n طQ2yXǫ 49ynn>ͧ/2iad3%2{#_ y'f$F}[Z nCWp֮ DrXIX2I >D8SV9.+?>z&d4HEǧ<<xѠ̤C-Jnj;s R2ޙvnXsvn|M̴֞^ls#3%”e1ʌ>dyQ} cq{)2x&* $ONQspڛ<-UazM#$9S̲ ?g4h&;tgw 9ڕ݊ȋe]TTR ?<>T{)wὄuf0sD1HU=Nxh{'/ÕM& j)HK?l`ԌK"Zb9G%%xdn%~hSM e]8ߝ;v/WS R3#v x绁Ċ3U?oC N6i9hLSWBΞth3QNr[=3lѲ+1' J 塖m݃VgV)P( oo˧}FFFFFFFFFFFFFFFFFFFFFFFz3d[tqvlν"f^G9ƠMpK8K3>2rOݠmѬBKEjc؝G4ً}?W_@PhiS @Phi&\˶Sl-T Y*5HI<<R5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/Toxv};4<TO441)9wG%NʸxR3ܱ] b䕂5619>J@Phw?%@ףJ@PkMm$ظ{t 4[zj+HA|k-g>[+vF֩V;qOfF9b*ԺɈ<0vvIW@PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS ToZsyᤛj4|T=h4-FW?]MZV>UTo:4mSuAAyccH0E$P26"5a~}3>}jkԩ%m4XojBoi 8OzC.ÝӘuv'T7ܽ݁`7Y7xIi衇j3=[19d[3wFco=H w5m:km`!xms*ar43nC#.5ѐ>Bi^q3b3 ~1G“x*ϓ~ǵc+X$6l,5$ ȽaϓqƭKf# z8g;h+%qobOk10-e;ۉR<ÆƗE :x '<1{wR[XQ: 1| `ʁiU0l/.eo.{/A={{$XnH]m+~`$Tܽvm/"5?8uENN+c!í].)_ge,fV;=SPwSحkd1;k?_4Oc^ s#&c[\V xpNlk%vU1Ll+v{B|*,Wqʶ3zTd#|Z:Jq!b8O5.Gf 7I}=n;O7u/wuczm\yձS5N9i~1O o?,eu=-tuV82$<ܗo-mn,a7]l~T'3`2zݧ*wyWJ4l?{я'aX.=v4X?7mvNglJ5fDIon`}{}̕,jy#}"㵈ܑ~ i=}GnI{>7#+;yO܏O/4/aXpJm-ctK3&F̴l$|z̬}H:i7T:urdKsq\wY:q123gwf6͉a8,U-țBjtiɑ\+zӧ~i'z ˊI"v1J<{;xAGޥuWsif=S'c#;\E9dn3s =y#G6z}.`we},3@7)c" E%axmLG\ܭs14Sω]pOw'VZJ-,aS黯/r!Oq]zi\#q7Yj{4Ì=G?gc٧ؽTnuW P~WTOxʸ~7rקRkd5UG>:ҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|fz+ݿB/ާon܂INEr ?9 A X$>$ca*)#r9ҿX$>v"yT9 s$h0Z=^uny8W ЭRXd!Y!c+w8 8Ž6ԔRd!d-/E_BHX1s;ݑ @)%X#>p$j=);~[ E5VEm)nQYJJx/v_Rg7ݹ1x!T Df,@' ~l\NB܊֚@`/($Alyl6Ser.M2<&`o;;y+q:w~g :Tpn:4TI ]]b{{lf^^0CϨʂCTx'uԻW'erYqA ԻVj¯Ϧ9U\B1)'YP67:G.{LmNǞ91eV,Oߛ[m} B6]fL[]b7gwUwNw=Al8%fIZA"HU?0;HMS2 On!b&6hf aV2ۏ}oCF%tmec&qY4i,ZV&fuLd}$BsM,CGkW`AXO鴌B)=u~e?g&}|^XIrlK7B\ו${MX Ll.2ػZ^(.^:f.AZ6(ZDjl;#ѳ#ySV c~dKC W_O:["E9\9TWb 7%Ou׏ޛk!i[pL"Ivy#] [K]2xn$>msm8fHYR~UJM:N]pT2/-z|Օ"&L#Tfm-{[7Se#$wȓaQ?(%__vN?);f<>=7+]yj̵T1H+?_hYВhv>o떺{˾oBx6 V)JszD$`$#<~@`رkd]2k911N絊SI}I l 33xNOrvØ80:ݍ7P6+q3ɆOODķx=WeBU[vL} ;܊vZZJD !e#ϏmL+y*rcLbq[:;#aI ʓfMhͷ8=%^2;^ @}DJAOƜ~13pA%O Ñ濾Fm/anJxoy'#qmͱn\ٲ -8jLCCwr;,pmGZJ&6AdRB O;O'k!c dh KO:/勇IVE1TvFn{}$9WRpQݟ:-1:#Ux<mApZn E5\n+;!Cb$HUy>qW'j\C/Yk5fĐ':4Dܤ4X^΂lƎI$jIf1qe0Ƞ|m-ٟvwo϶­rX~== 4qWh;6qRAk܆e/pGBIbA/2=C4Ӕ`ت R5Xj$H+# V?+.M楐n֖I\*$b˷ ;'nՋɒV\_Y?ڣ +珙9 _C_ y5WT$&xc{3f c3:ӾY<*~rI <@z[j[ǒ+Ӳ*XzCb9ol&A/ڝܼ7:[b,ub~,8P; Oj{?|3L7jؑ+ckIc4. ܃#4lRn\u8kOMbX +#(?#B^l":_\|JSWA@bF.H!1YKgo\]g-y2]W/-S!b0q|ڟnSJێمDry,G>H#?rnhր(|^9=OO9 ssaea]l}yws ߆콿 QI ^Kإz(^D-cu]:X]Ew$(+=,XK-[5-q(Lr ܤB n{c}Up_/gNxc/B#!YH^9;>=oٞ Zl2eA,e=aBw"]LХByr13T^(vf<)=ʨPG,OT70[L\X '!9{0n \^HP=t6&Sl4k#KХIX})ˀ~<ܘ6ЙZdl_"den"^Yʏru'e&|ĩZ[pKO!4H<}jױ[S%6 t$uioL0bGq:O6⥷ec)s Q4*݊ ޤ.s5rr8̥,|GGڂ69UO[ (b>]rMSd&4@{ϨĞ@^ϖ˺ǂq]Qޠg6eQSӅPį̤Gѭ7/v۳H ;Q{O\7bry6t_-{<T,%x)cڼch $G#,e#JObYMGQ;$cګ>)],$bk_2oCY_"C {[-X|>֛vkdNZECًW6wm\KBq m^n;+q9ίSd+TK[`bj;YݱG?OxҎgmϴZhܸ,GyNѡrd*7[v]୊l+#_-~}%w ~v(H<_u r;b53s\рC#Ysy<JN\}Js->Kv7V r r(Am\.cXF3S3F|sʒAj6qrd$zun 3I=A[ x.]76asQ K^," n;X;:\2֖ަMف,2Q¯QE!>sih< =r0_LLGnyM9ݤ7,Ov jZDf3$qF[A`9 -)n|-+qr)38̹h[&Y+fn¨Uo%x'U0llAwknpkdzȯ0IՔHPp@i7cÏuW gZ%iZyL! D Pgw<|ԙb3z^PF&"{n;j{G7OfLJF1ىج"3zI)a 8|6<^GwǤAgǘ$dXeLRT4Z=LrqU3f٨BDMf.{2[, p{yՖ+w`2鰔-O5}^XT@' (InQV īrdcn`8'Yju]*0)H!-Ġvbo6~ܸ3amX.bأ;9c]W~u!SÂ@$"Mz_:cw,俏JVNF b&B2Iy>Wn-~2Zb}>.#n5Q3~ΜFafG$i_+ʇ9jlV1Ks $5XUWG<V~K=Yw&~Y)HEx~by[7>sG  #$75vNz{ql-_- *L40^|qcdz{(y@۴l!{I0|ܦvp[$Uh삄#[Yx!LIbE5,8F }ʠ?t.s3uka[{})u&wm$ew(>NX[<\:,<#`v SШbB (?0?_W9^zYi?R􃕭R—eQ-U Q܃鿦9~WYX3J sKucvKBo: TscvKiF6BO*ƝxE$I/jNsxmהȍGYz'u)'aH o8~IThmd2^jˑ')==G> {n\fwc>Ѕ$'=ήAνi&\ku&SEJl<I,|ei$P\Ѓ%Q8ܖm%9y"xue@PKקVxcU:)XsإVcn%x?q²;*KgI s-tTbR,"zN@N fL~_#n@[e!c OAjw cUSgI ")Gjv"R#HB""p sѣ@hѣA]JR8 AiKH8 @jr2%!Ն/s'R_==c}j.ߛkrS[fJ@GI´a#:ѕT?sL 1t( r3/oh5}{nrygz UU=/rd^{$QޯnFeOQ>yRYL.[֟4hѠ4hѠ4hѠ4hѠ4hѠ4hѠ4hѠ4hѠ4hѠ4hѠs81zҔV x`vcӎV"BFѣF+ֳһ5WY yW12ue$x!XucFѣFѣFѣFѣFѣFmK\=*i 8%9hExpÐGFS,-8zB?~ЮkѩXL)/{wnYO,lܶ6ڳ%ݶw:o;ڝ9mL-0Kouqz?{;sد1_GՐK^GBD }e^˝اpe| Y9p&[Pbv o y*T.yn#4GYOIYiu6u*5,Zh,2B%.HӮѣFѣFѣF~dKC W_O:{UC+bGGnmVU5Qb}ˀ8b>v2YW_fʕm+f(zD|}(_zO![:p6 lBIۯnзHm\JUd!#*x?]q\RlmfS OB ?)<{>ԷOkϑƾ;;B9Ly:֐pDOFǐA 8<vF̳m, ɏIdD²uSl-L*VH*H?}Gh do2ԣ1EJ>iq<8{K%[XÖl8N2xGh.$LL|_^@cwF3am,vɖScpVCXBy ٧=4444444444444444444444z+ݿͥJo;}0Ѡh*K?ACks="U?a*$~nGc?]MZΐlmMG=:&VVGw1ہϾvOsws|Fs$75icԑp+I*|yՎ3oml5y3eѬ*Uo8_Ԭ8G 4*bla; ocn@PG}',d)W~n7>/;9o{bݹjR+dJ$q"7a ž< \e*YZ I,@ROƠ{v⽷| صwyxF<{>,q(ņUGL1Md3K E2[ԯM+bYc pAPn>lQ\SǏHd^i1WA^IN}ፉJ0 ]7I}WI {kA}۷wUڃ']hYJi|2n=cC'I4t2-ees>q%oWjK)4`ه F1/p9ܑT{5kmV o-ƂiLK"ƅwnstrX$YMLoR_kIf ۠ѨSԚK UbUi[@O--v6GBתd&U>|g!BrIbhR(IIUB'G~}sjflVH:#ƃFU9/5_?!Pa`B]~G I~ϷU8ݕ'C3Yee-sF&tY*8W [K] vۗ--aU~dy#{*6N6oEG 6V 2ik,mŎX*/qGQqK9Z$~FRȁ% <Asž+*醱{=wfdykYA)gƤϜ׫ne{(!< ju6d5z83ؖic^"<]a`89֏p8(m4 ^*rI|I>N[iڂJ, Y^S('@sq*ɉj4<"~>A\hEkrVQ ̖HP㸒u[m[UVeHq]^y)z5?Pd;mh2OӓGwoaGw#{;31|_x# 9C}Gѥ.zC75jY%zs 9GPÎTqyV[1TMn;V}38K7r{jˍU.3 b eR8UGiso 6:LY||sdȖ\B(ݻUL?p,GKװN! TLcSfR8Q>^ EIVOd r{?/}j= ԲŊ+ۄHyn z7e3\,޲ vD <^$k%U}Xl,sOQt1>>.\`G?7>ۭ],Ey T<(wѨqZBzuK<$yE:o+F>Ԗ*dxϷ'hX28F e,@+HU?nArzPd*KjxReg}KѪ3xYw/k,nx<ƻW'jOur T^L>^CL-q2Tڵ3 Ԥ s>vrJÒ&?$b 9 5Si`js- ua ׃jD3C0c 'cn9ѣ@hѣ@hѣ@ig?LYv3 X$>̕P6}. /){HUUx`c^xwI'yͱڹoY̏NE&,sn;[=jk[5ci]'Gp珿]&nR䱁wHϿ'x<g1{ 3J^L<:&ӉibUJGcxVB9UgFllcK ,Hє;Oq=AچVv+,Jr5ҽlŸWOyQ<<K{]˵- .Crihyd \$op|s}?APuwm٧20.c IBR$r:跤vvqlm ~Qfn`g~$Q}%vc*e:5!NBԹ$[u>x<YIJtv֯VZO,<.<S,gg/Q) \d+}Te ,C#ܿp;FqQXgLLzXl$p /}IIgUw+mrY]EMp aFR "92˭Fg9қܙ.j5Z*-fzJ` +4>ۢf'ْ6oZ=zU/Z_Ib$0ӾFTV̟ܿItv2XNLtn\vNqz}%cxvw+ 9Ʒm~փθc|$nma7Xpf[<0^! OȼHϹ2"lM͗wVO2wB+lUYBG1YXkZ4t̜[g ͜᱂f5rRr՞&y<̼ruci$uK{wN鲋c9;*ASzѠo$8ͿJn\_'zʫv F.m(7L7Ljh}%%#Ԑy?5jtgc .g=~*!*4T$ye/QmfFp4%%e3|[ҭ́<;h6ꂮ;bK;n(F"qpXפh3~ۉsj|6WoQxף^;lW !wr Z;mW#`%3@$K")X9Fb@TChc9:t¸֡ S2Kd&XXl rI px +%!5 i墋$E`2d^Tl}gp8lFC;yJxPOts=ŖŶ Ydb@F_7}h0BmBosm#tf&zޒ,i~[c9~PLHwK+ &>ANIkѸ$7` ䷃af[ZmˆXhDK#+sVlHa7mӷe2Ӌ,< Ryb+<'s51%o+X"J`z{Hnw [z)~s_+7|~Px<{v=܎ϒm,>Nc %U3;} m̍. _hJ"KDgN ˭/!v> Z9%` y#H?/>|{yr4l'MfUc'iۊ8+ {8Y,W 374vllڟ y+c^,u׎"! Pr;MCkm/2kIn*K(ʬ<~x:`=@4IMۍ1[ czBxH kz32 r`z۴޳KQYICHI$NrI Ý vkpO\0 >C$bX{}X,|,'0J\1z1 B&>}óO!]t͊Y Ya*Ƞ܆x#|ڛe SAvIܒ[d6:sCif:sWLjG~-}U#+$$)?p$)"r2X ۳j,˯ %h3C$~@۝j7ȥn;oVLن\(Է+Ͼ]20<>ZT;ndpJ51J%*MƶHݣ/V> Q lX̌7R1$~'ҐzX+zOF۹?WIW+(4ޢ?Ҍ6c+,7~cܘbfm^Xݭ3 7A, HL>b)C#ܻ[j-P"bЙYUZFbx'[vm߂f*gʰv9y2<;oeo,L+%>Gw!1x0Ҧ+K/zq6%e#7o'UHz ōnZF<]J^Bdrη߷1yդXRJԸ݌Gk0!R}oood_@W!bē<ꅀA y;woa-owE7&G+e^& An;~c Y4y,<63rvh6ei(]KD w}иL <_ge >xhp 9&ݖo IMVW<2>LuW\MW9 3a0dhmfXpW[<{qTX< |&z'':}4 +/@7PwŮd d+(fT%W&vHvl9&ʔ5Mxޱӫ(T?u߶r}>ۖ~'ޫ8[s5eO+4Dj<Nѥ.O Go'SOoѥ.O Go'SOoѥ.O Go'SOoѥ.O Go'SOo~dKC.O PwP`2 UK(rk??Lѕ1~Vmop~gsr6+$× Dwv[-{+8(6^WRSjdI¹~px:T锛_A-gp[̰Dg<Ysv U]nh6ݯN:0GB,7r `?a%{L{;yb@V}NjNkur]@^GRڳ:emy6I՟j%Ydx #<Ҷ6 z`Qmo9 B$-'!G;oWAk&ݸۛg^ܦ{2heM8Q[qzFˆߵ{g+6bO{wjyE!8Kr :gw1ֶ5;mċHVo^ =Tv_먝-$rW[3Q񁷳%G';x!{mm2J:1'CHr@y>/u1]17j&z(c!6I,TfWe/'+ʽy O:rƛ%7?$\̱«208QN.Lo$[{9 VZV8s'S~ǁƺܞp\;ɲiגt۹&%'U,8% 쩻7n} m+D܄ aPȖG<:=Mg w-jlUq$zgY#~Yu==4tov˷rC*B{U?y sZH$`woZYmݓqFe^BjA $y2{uR|sy(? (<؋]cMW&|_2B[HiUv}Þع5-pۧ+Zs5DYb\+p9^x<G#R9im/cz}I9@c= o-żk.6՘̙wG2sǹd0z+fntQ$Gb֩3l5q8yg緍$ܹ{oNۊ%/T Cv|<=wڧqb| ^G>ބpUW%_"Ga$&5<<ϋS L6GU^EA%(_ĥv>uoAҬ ڗ1gz,NvB$L?xP8x_6~^RBb8 rHU"c">xp/t/tVB跟47+CPYL\1,9ᕗ5ڹ\,e˘\NSH^RG%$1 ' !Jn۵cqrMI)*$v;gfz6:m(0i>3;rIwJvo'V,g%fHgG4XljZOLw)'Vv/cdP٪cJW "2X2~0@F9Q/hahC<㯅*܏8bIJ;[Kv%(ڮVXq,Pᗏq7@MϧNŚ+h$-QKO ?fu=kƱ@2>Go}{6:tY?o`w} M#H+&4Qb؍T<(϶'e7g!o- 0qO40WS!N*EEAf:{5 vnAvjKrZ2A+*G+ xU ̼}*Pнe%GL e G6oVFrV0z|8:tk-f>dmh KA=/mJaENY+ưd=D ;[܎?nK۟ӎZ3|TؓMJ %J@RFn,(Iֹc0T ܏تJ8,K=5o>]dǵƼi; !̒{P)O:vMa={6b4fC/@P y,ltiނGRz4ǫr. Bk;銸vFcbhRGVrAy 8Qmy:YwrG58$=lGYa 8=@Rdy1lwy5M+KYV'>9P>R4 ŝ ȭ:-d( rZR,\y<2߳f1MuZ]oo%$y-@j)ȒpS/*Y9~cioG\[+њ=z!TOw u 8bwxr]'g3ܶz</Hb>Ӡ]=kgmgwQ_JHncsw:9a/p@GFå.O Go'SOoѥ.O Go'SOoV%{>~v~e?]~Y ֯.)j@L.s5p>Hj#F@.s20Fb<7~Iw;}3ؑHdIT3w9խWgmyW%oϏG,D{2O>Wko]-HfɌIeM!9n$t];nm%r73O3 "`r=cڛڦ75`ۑwI'U_.YX2ʖ^Τԋ+n tP\AʉQb|sj/폈vG7I;jLc,LbY[~v!|ΑreqdXI (*HI{lMߚF72n,>4J\][vexw.Q-f!$Qʎ_G2>8~QrbQ6\@"2A25cSpt my:xRMެCt 嚼&|ߋfΙmݯ-``[&3M~+q47zz,`֕sgqvϏi֚DvrRA~dKC W_O: [KP1nzfF($<)`p+~ufGs?^ek1SHOo%<x,Lc\xZp7q*UE:PޛnUan|nUd9D Y!A`~I&O^{K^xYi"sb-x,8bWyM$rUpz{Ipŕ_NOcx @[|^۷9_1bq=JcІ2`x5[n]oja[!#"4SCbi{Y]=PG v ^7Ml 'vY  P{ڹ1Y#ܻc>$XYfhnJ94v̕=*l~Hnb&C b=aѝڲl55 σIN{L=߬MV8ۇ#I,=<9TCۇNbbAK/TX 1@T^Q˒96m6w3nZW`cf؁è~c1c)l\y-گ7.$uQ (OQV2Uy|-HbT|pPUz/ĊK3G>Ccf[F+6)8% f9%I#9s8vMonfx^:zYytS9 iֱ[ܯK5Vu (n9`w}uOv9ɔ"ĖoҘ$f 鴣#A쬆7y{ijڙ3P&Qѡ(9?U{c#9.\>N\팶7qKb6TIl<㘏]C6T6h&; Uᒤ4F8wH찳@>`~ԉz㫎Ē}%%jCNFbT2,FP}{u5]ڛ%pcV-r7%QXRB܅w2Gs/zͥC#^h{6jC9R=WDZb@FXdkd`dU-&XȞDAR9 璝v={7kUɲYgD>r98;~͠p;|6ajSn 8վ {;oe܎/uύIwrG,}$y!H@< 5_[ӣ+e$Ͷ޸0kk#+Y6UVqnΒ!e2MkIX`ju'nLCm~q˶9Xت;WTnIQ [wYcزҘ}v):Dtv ;bX5w$&wk1 G[&@fņliU29u9dT.K}\vL ̛%CiZ(CG̪c!Y!s{7zæɜe*hYA`T7|-;]d1Ð$e"Qy BߧP&K=ن[Cx\c]` -*'x`+ܹI-`dD2C0ȶbE ʠ |ğϤʛtICulp{W,0GXنry}q'`$_2XHZ4ۿwOS}9 WR+"w5(G$7 UnvceȘ%2 UxVJ A {mL~a:*u1br=EKtݽDA"J;b#xS󛇩B6zlK i M4bQتĐx{ot/drVnVZ7u2M +,m{#]n;9ۘK9̓[U;D#Q($8n>vl폶sx,E0+Ppy>4ɴ3yɆpfߗpGy#Y{upz7&)k @̧%B fRBFحJBZѻW%[擴|:o;FZ.|kRf N1Og][y ~8BN,,X]7xVJn.̢>4c%x ܎9Fz^|ءb!)'d`ʤ<K62+pׄ史6 "([1N,wmzV{/ Hքf 9@ jܛ[/'oi1*c>kq%~PnG I o1͏672Y-i#~~ Ju>nќ6bs3efV2CehxnY'> 4h 4h ,gWACK=YwPa@ѠUx~5ZLK;"GsHIYx~V:nu;@h3|2ľ2!n)qyK|ŋp>2rYB5B÷w wx<`vܞC"Y*`oAaXrIUl/.eo.~f)ߒǒi3g#⫬2#*qJ"Ki ~N8j, \B`X< -녝3JAZC%Dnd<:AWRGFa$O- `dxn 郬f3M98->+5",K|e#O!@7adX*8+",3 AO=gT`/ouJ[&jЖ+u$?"$s3{%;k|4d{P_pVk.G1v"%Sx!nٕ0YkSӯ ZoSHĘ|x]xY,"ׅ/,J1B]/lH~=ھc;խkg Ax&ߞ!>i~7%j9ؽGYGC_"BL*¤,zU O=&֫qVeEʪʦ9^6 HP+ nauwJb YxgTp,1$$rԽ>rYݽɾZB?KH۴l)DS'xP9'4vL<-[]hy7C x&<8FfjWY髛ILjހn+4w^OUOˎ2zUi.R1_'c$UP\6^`b9䕲Hp3EUC x|÷ ʖunu'mf80vC+K㱰ު|d-F J5&n>nld$4,̍9#4H-ɇ<wqvvEPE+r@zO2Ȁv;Rwh=Ije{ͻ>Ms8K~zb`Y&R*G,tTRq,,Fj:= Li4q1- 2G݅X@: WEyHcۀY*$?9fӸ,ËIb[yc tmXX$b*[/Sͷ޻=6 $Sı& agpyGvgV>:5?euwfNIqY:V#f >NAB2̥)wEhn;!ǣƲDO,Hc=GPbLNK-c)}hTC<4FK}=<u/gDR.0edfU6TY9dtRlmLv#/_k5z@%t 9XgɗOʉDH=tz''s'Lʬ(ƒ$%2>~}2c{T+ڒ^hFn=HnGp<9^pBcznܵZKfBʒ;BH3`ҌnG92ķ'4ˢʻ20nIG<nLܷ79W(&y'j V3`ٳH%-" W϶J;77vq6*!.壭-ᙞGA0AaO|u6?ٛr{iG5[?UY ΃\^/t9 ~"wrޜyGn,fHtvj +B0oϭ@hѣ@hѣ@hѣ@hѣ@hѣ@hѣ@hѣ@ig?LYv3 X$>.sy/$H]C+>@a B;GqPI~9':Z1׆8P9X(,Y$NNۓl\5ʛm堋хqnU9&N"G8ֽ[7$S1ƾyهl;DLzT_-(V"äbOaMhuCmܑz+ا=Or6.,Qj^I䒺J!\wH?(9ewR\m5l^-%FD2c![= L%Ks!ڰi#T1/r[1,[93$ rGS/|m\v߷M,q*a*/y$ @Vgl~%y 8 O%.Z7J%{GH A4D&%&V9ClF6ԃw,H,Y<|rc !e+rhOhI G*  IO0xٔ}V>}~=:[P컕\|dBE&, nc uzmCb>kGVX;C}q?\.`pwgyaex~ZsϦIW<{k4 7w&3-k0[΁q,E珚&x,9Mŷ+| zzY|+2|,Z ytu2'3nx{ "Xq?y/mn^ؒZ|J8s׽\V2' )%xG?ٖ:.FdExN=`B6, Ir}ݩ4 _nf( fh_#R8z U4Iu㲕| a # ȼ0#JѠ1A1PSAWWQ㤦ޅF¥ƥh|UUPP8]FSOhM_O{ggvqǎ5ݣAZ aL.5qby绞;}{lF*l9IXrMѠ1xVQAdp}Bb#QZ>T PHƬh ,gFe00nGs|34[~ ,djǙ%c; i$gƓᇑ41E{PQ<5k3qX'p3a"I%X@X¬`ٱ%hUtFK/9A>GFOe\rH'άth+(ݿE)`RE* D@H< O@cCFPg^QO<'ƥ#n헕YL-Wd3$L|AxIo9(Tjԓ-S/ኵ؂e̫ DVby'DѠ`+W2"Jޯoh32D٘|:4h 4h 4h 4h 4h 4h 4h 4h ,gWACK=YwPa@ѠUx~ }-كbmpefW{s[W%I摤cǁ|qS鵜r6퓟DLܬ}DwԀI#꒺=F:6H3.sTEv)`;A<϶,nD)BA{dt5_s9d3(i=[(W< Ib|ki]2զY$0 A4h W_O:~dKC; 7u$rQqS6Oz{Ob{~!:T(U9ͅ~Ҏo7l(id;61U'J " c؁۝8m,:nW!ڶLdU /-uB <nr#w}1| K9GpRyGuaGum{M[j)aHCq<˷h%U\pFf 2r~NxUso͏ O,nGf@8@S@Io~G:ן]8[ 4 xRV.U#=AU 6_&cȻeGy2nͭ*ܸduעΪ b$xAsUn-.,YceӼ~OhN{O'ǿh6ҫ͏̮C׎)"4= d0*AhK\uҺYyBĶb%t|~e7r{y;}r͡& EksTIyC0(d`!!K]Xa{/1Zޫp3Ɏ`#3|]{wm|6-r(%VC%k)4~lUzѨ ec!nxݔOqټkfq[XAiL9Y;A紂oo: ,| Z/oFʣYX #>񪍿/:O1t([,jޣwq 87==ն.G<=ױ](n_X}϶7 <>dlhVr)'j{{G m}тޯb._KUor ~ (i Xw5MefwKc *}q,̝a _Fw/ Z Y׫73ӫI 弐?Y@'Q,wQ{i- .a5dɈ:t_ÐO#Z5gs0磺` :R_^hR@[* fA[[{f rI<4tj\[raEC[;ѲWr y?)υGҏxwpX}Ѥ}{&#Vh[|ꘐ8'G/$r}>ꜷy: uimH.K(u rWPfӽ$-BWce|ύ_)"1tK9ˢp^>o7ulkN9BފQNFmn8uI,[(Ӱ(>dnOp~&6wbjP0,&(?'h5 Lz[U-^r}*Ӻr IcW9J]A}J1-! l[Ta]ƮdJ!Ӏ /w% 7g1*XiO{~ooo> =Ϻ8vglp֯d\UJhb1g }`G{toL<\Y)FbfbBI_$O ƁF׼3\LU5PbrDeK[#[-ύԡ7 b {2$$-v)!30UHWAvEXO^8m$k" `}Yv6z+ݿ F@.s{I3ƥD.υ0t.s6>ޝ4F31ff%ʰ[PL 8`"3G HSn]3O9f ō{ӻ3`# ݌! *Ѡ#ugþϻ(WҨ2R3$/qޚdJպ;*rdpT@`]VAnXG-u~ 6Wqطr"ZAwY!dE{rHxܑlPo_1j(OF2t' 5ha[ wa6ۗ i1c.̕HJJW7Gz _~dNXXLkKT𬤃 DXT k4|Fw#[otnHDӖ=ĵ)2HX}Al6Z--S7fvVcrmۘ'5|eafJv B#rUfb^P ?䞸v`Z Ú*UWNmul9=Z֡I~ҽ<7b);ލ@Ե+ ޑ1uP1xf{ԙ}W1ka`U+4O7t2(;[sd]Icq飌Q !bga|nx㎛!zƒ2d1pڼ{e-W{ LR=CUR}L5bY=#/Nw>8R2mkg(T=)9aJ㺹c%Z Z:אIOw*U功81mPc2vѣtՒ)`rեX-vQ(DOU%pMe1dLFBBiVHʲG/AMշ6^ޔ6JM϶L 'iY+XHLqΨ++o~n,V;r9L\ 0?q7y:y:9:Wo(֑|| hBFu< sa!akҥu3"{R $ *1U,A!mkJ:|E]֕eyAʺ7*>;Fs.nq+T-pٕX8U>t\} O'k֯fc,Bh&X*9G{rOb5׊Pye':JO ?EY-:zO#veSi<|80--ˤYGom̾6j`eDa<::#*O+ڣk0cUb; qï!{ l٭1۳'-,3M#H#WC ^KGݮ.lXAbj x㱘IH#Z=.M^,l5hmfS|LZP&R֍✏#vFu&4'iC+66|q͛٪myd&LVp 5dPV-g(T6rJx#HVdT.X;}8o]O-8v|BAD# D{5 grY^oo^eUܥe^I~ܢm 6=.5.L߭ r19:A0mwՐb^&7pSpRSGtZϱr[MH\bbX'ڪw0^fPx+2#@M"Mz|LkգQm;*wpE5:͇8[ͻo)k#V&YfhTeVrSxZ}퇵nױf\ se*=qP:fB)F%Hx=} "a@ rɸ7.`w]kD+"ZJ޸yDf`FP.Cy'xnKj ve6+#AZ)܁>XT^Al} BlsC0xq< a7'Fcc팮F sn NԵY ,`#dzsJn{2RX"7& KaV=\x]=b[m ӮW0Ȑp) 7Nnn{w𑉫jk%pHq(x'nT 66SS` hQϟh+w$RŘ*?ȑvUP,l-bS7 뾷; ;mwXRH0d&v^)V#Zg[/>*~&NH'X,ce2ENmzְX3&3ؔ%Lp4[unXs&moz@FD6n9};ٛqHd3,F&}9U,d ?6<ޛ{rc.͔%k R86D*X H<5a:m;c1sS[2 跬1ht`RvqV<rV5>B h~buBm/g zubܘv'`᾿-yߘ-qcKgRHfep~yUo?n.mvlֱK&fȖ7L 8pXC7M̊OW6r LQIfY |~OM08̾Gz{0alV%85o™9IR{G'ߞ=#l%nd 5HSҏ@ n[+BL;7?gڞA t]"Wb` H© x4Ѡ7 LߺkE'k\$ꨘ?H=:\~'v>=zPɷ0e_Z#E5y8#9$w)G|F܆k*V4 h{V-ǹy k#zݕmg719ҙZEOJwu龥la6g)S%Sf `j8>s*I py]fE(oZ;qs0p|3pcle5U}ayyanA@4K{v0R7\TTd{)_%X?@ Uc;=->2aOZЂnr%{x,}K;,#{h~Y {*T+'\迈~+;JMpy=pWh3~QwNF?aS>$HdCR|vt]ø fH]f{|!^T9 Ӊ[Xl|.:5K\>H園|I%Fx| F>kRmaE1}_~|N2??ZTJ$B%0W1vG )tn rpc9 $%lE YtyGz#ϠBëH3%I(jޱԍyxTxCB\gZ /9>9O绞x {զ8/pFEq&Gw>; }ǝ}ꘞ? ҉q w{([#N¼#'Znw;nW,<"Uчu>C) Alkiִ,Kv1A<PyyLVn~&C$KcJ {:X6-lNP],Kb HWx\e<>6u+B_9񠙣FFFJo;}3ig?@4h4 aw?PdjTl]J^&B$*OAIw;}4ȉ$mea h2.C6§ P̳Ї}eD#S7h L'$Dlqm=Ӝb᳔\y2)CUI<;rGg^ibԒ-qH))f<7z8}Ig1Dv]_^FhIޔȌ<{!Nlna3{Œ%Y`` n#r5iP5KIrx3(|T;*Tt_khdh]ӧā)dylI9<Y|9ƳY{3ndNV;0BH~Y_=G<ష.,{~Lt^MJQ^a'e7gRV!#R;|jkpbY,O!B1!oi&U otzu<\F>G="+MVHIEPh7'Rqf\NS#HfrO&*ܩq##brWaq2`wi`V#5@` /R  {uoYxaXL]?Bo)e,3%!)YA A)y](Onj{SGXB  {VnςT]FlksZp(p|̝{ǿ RYoݷj:ۍbc')D|B߰wfgqdIc2K_VԖ drKe?++d9{!-Ig%'mJʐG.44/s'R_Xjr2%!E_\ߪ]*՜dX;{7. w uȪ^Q<<ʭ[ [K#< 6 w; nX{RDO#!yk๑6ViЛe66ۍ[bk]0#紕/?TO}al1'dnYij9N_D}ʁe4]AVl8/6I*b-r;E2)YHe(5t+C)4rTr HCY{Ld[ӑz,|ԱSsdvH]$ @"B{K7hݥ;28ZFXEi#w#k:ط-GpokLZ/o Xx!z2+I/=9g[b6ɦVZlV\ b@/ b;R`v_g}ˑڧk}%=+<&PHT A<76Ms[ޭ{ҾL-n;T;nA!Gy^HHR7-lFrؕ+ G @-V ^cω&k'9{#rI^STPX':;'%m۶TC5'w-%XN9 ~o0.c1鎵QVy!{etR@^y<;o)wogq Eڡő; ~Ҡ;lm>/F^ _Қu#{?]!9ݷo>e}[̪Vq,s7r?=ñ~h[97vggۓ#cv=?E8,] JxG<:6'zOܙva:`I$zrňέvcv%}w9+,ܒJV3t/KV%EȨvJ_/@7M-嵫VV9d+U,R4r#v99'2y o[ W~JV\$qD<l];VLE畲7.'v ~9x;Sgg4[QV+d*W$6:i|ʃXI/G,9<)pv&lz msdjY; YPdDv`O;Rrx< x$i2K37Ȕ.wU HD \88*'M=6lك S(2 ؈ʧǨX|HFoڙl݊4))Aj7(YʮdV7h(;<Ռd.>J$ϭi=&VCTG9.vCoȷ{\>F{֪؇P!=&1OJ\r9omZh=bNyӻdg,Yn|rhq8ƻ?p|VZ9'f^8VW0fp@F*䟪b@kzM)Qŵk%r{|Aw h6 *8ւv'KJ,6k̨^6N}'yX\|{rlf\Boݐ-vwqGS?c9'x?t-Ն6Wo_gJJ3R~eIc(ݧ zŴ\vb-2v_@ $%d@{]B(ag3ٞ64P$pb'~~vW=3WIC]V |D;A<u6v*쥗h3 [12nZ1Э~j" nRbʝ@4{ޡZ{j:]Jnܟ>foeF{YG>g{x^}Ns?n;ozB2HEQ357@9J>v y#F^;Q{}؂P2}QX>$Ued^ٽ'*'*@ǻd؝/b|m6ߞƔǞGt۪qi6a$j*^oMpqܤ a-=C2wV;+Fz6T`iوsQQc 5q:?7G<٠4hѠ4՟^wm,gWACFW?]L.aDy=UIGKaw?Pj(tzɾ͌<3Ѝ,V(R$.ѿ% @>Ixhf&m968]g %Wu*XH< ˺m ۛ%[Zv$Βybx?4Pr|jW|t !W!J-a=rxa YuZB۸lT#q#N=DW<חzUq'Գt˞$bQ2@ Upz+)vm!Ȯi^BYk?e*6^Gwo#~4Q,u潦Բ}@C|7MӯU5c,AÖj瀪|ʼ-e,,>+/.fjJ"e XZ%08Hw+!_u,mS%,h+}~!AP>( `[G(Vt BS! nmNeoLghN| NFFFFU9/5_?"/.eo.b2>v+W2)$FE/]"n4)1U*Ġ zs7{k-`P_"ٿUH)%8!9$ yӧ٬T=H!۸%oZruӄ6@fӁƾ-礩n:{f;}9Lg7=[ ;fDP9$θKve((Aזb"ٸ\=6J:2cgF?FK};[^w.0M׸GpݧcjtO*r qܼ;s x*GP6嬕%[YZȤLXY'@ m`1|E]{j݆֤X9=ŕ`;+8 @yrہ2Hܰ?)>~9lgc80s[j1V%PT=;/ T庽{~ dKQaNIS#SΗ-zN{m琭V9t}Ƴ}nj9|b95+3FOPh+vfw6kkX^g'RF љ]A@̖ab:%TOhUϬͺaf =ÄvRKsJf^]pX{ C+ zqzn1Uq]$1} сcҼ>^?'MWV8ܖ/+]ENR|M7LpBWwdU=H .o}vՌ _G=ƗYB @9}S5t.W2HCbɐK:5Է sF'"KbmPio3I蟋 w!W§Tp\FPSgk-縺p;x0pI3s ;mZ*u #HGfby)vғp ~d:Gf =_5f{NeIb($DU3vG4%@uts[BXp Dq-䷅Y6vV[ꏮy_S6hllG+g4E*%xT/o ,{@'ƒw':֚;[:bIRRΉjXȿ:h# +G9ѿ],֗|n|x>u3y[[onB݅h ‚9q̣BqG-rn;x.w}|MUd#(_w_[tVZM&DMn8eb!J C>$Fckbj|R)ի@I?zFXR9`HG qoʫ|TE?0 v9Fma*VKp^- =jqZ/h3 d;8Rzwwo>Oޠ Wsx_pGιt<͵ptֲw ΃wb;vח1y%vo9REEԻclȔձ$ Fݣ=IAuvQk%n& |D n {[4 %x^Q RT8ۃ!8gu17Xdq+=x_+TP8ַs*ZWX&J ݽЏ S{!vfFԻV;xNHqo?nu x yN9j'e 3I5t(DXǟ+#|{c#Q`SLMF>ƿp#A~G=x#azC';:<6^)~58$ vIz/=K~u%gwOͅ7.s,!KS5Gkthc3J,FDk ZT|/s{}n ˽&Ok3crYYY[ BeXo3.Gkc?`ȏZѣFѣFV%{>՟^wf4 ^%}s'6gQ%~flגc"V|?bmH>܏}6ig^jֻokmۗo;Oo7^$r ̝ ϰ5S=n|5m2<~۠cI bcK{1#IAk2}|k'ۣ%3Wj޳DI+BD.A`[wt6ndX::gZ!7q/凸'}sM: or85igUՙ=m5}ݝ[ } W2H FTswkgYH syH{i]YON'ۻ%>bLb[~C=gOiTUy$#M;䲔VԮ޾>jZWhU Unҧ߾?m~Ύn֛tfm\kcݼ fy0?1?xN9ܩrdi.cgxI1fe(I#Ͼ~qM:;Zo~qM:;Zo~qM:[z >^&;8jr2%!*1}_wq],myG>@g jf?FVR'_ut Qrm襝T%u, ,0r!R*%WIܘU% T KC#iOhr8V/y|{hKorA5#~ξp+֛ugl[daQZ ]CIuZqv95mۖ~%)]^N1T'NP߾?m~Ύn֛uNnJzY{R"46#2IyX>/u!w݉Z, _e3C)DG;t wq[n#ۯ78p1!՝%Z Lܬ$^twf婺pW/Uf׳,2Df=*à6ig_f5mGoyMnYnGpCjxis,Vw׮/O ҰLyM_`Z,͙5i`adh=2$/A|ۿq}S${m;(0a}zsuUە0fsln "#{U#G,ZF+𦟪{SoBcѪI5,zٻyEy |ۿp3o?TFb^LsnlSgtc/(a2z@O%CK7tSfm~mco -V 8oA|h4}:ow<6y+ r-dÜ!/׋h@w${WUs5ڠVXzX𧟪y_Dc+]777 A\f*/QU&[` tѸwg sKsXg޴ov1Y?)7}ͽ$e=VY ͼd-,n,`~{|g'ػW)S34w\ bCw(`8ax&fU:wJ;-W|}XF~_s t sϿ77'y[= n7}7d,SN쒲T{l ݍ~niav_#}&q鬠ăw'{zpL~ξow߳Vn纀S(⥵[VS+ χD?a$n-Ѻ'h| ,R%+-d*Cutg~qM:;Zoי_k7Ym{x0 -X4ξ FO143WC'^1\?`O&Ol;f@T<džs6igY̬p܇erd"w:vu|Ĕ (@>PYn^brV8u;0{.{+mx^X_*xnT=76ig\er+YVIj+Q/Gbr7$jÄc-mIe;;Xf5b*)}<xYs?g_{Zo6WK) f[PݲlI"G$ޔbOM%FF Bi2;vm[v`e̲XXEa (nxw<>`¶߳nS6ڥadwWqQjIDUi&^UB! _[Ux#W `3:LC z<gN;Xۑ\s֛t&JWfbb-v2/{D^C8Bn}Oqa r=K DdfDvpx@}sM:߾?m~ΐ=M8ۂ|˜^TUPjϿ|ۿeCX]n\$QUܘPΠ12C$0b#ƑwVxn݈Ʈ^jbH{/0 (ZozkϷ3>W@oH6]Ü9|M3+^ $>\e^ƔrWx:w$[yc ztigEDvDIwEXrbw߳~,_`QlO%kƒؠ < G=Z\SZfYGAjʁp.n֛t_=?C\ M1nE4͵Yܽ,VJ i\ʮ#,`xX'nwy:v3mX$>%ca*+2G:Wx~DCVB{?a#܍Lvd[oI涯aHiG$xJ#Wݙx빴VG,e3!, Q|=1;e<`qK_=kX0 )2Hyf>9;jl=FkF7RVpxjog)^|L]3Ą=(ݽwv9 yjޜǼ$㏘Fq (=9_vN- ^ "oMB< # f+eviD=Ŋo^٣%q"SWm2ͷrR_|ׁ&E]]Jzg@h#Gݽp`wF`Vh߬$G*H>-5߻wV{խ kcݖW2+$lBP#i#k.aϾ2!OvL-+n;Jă^`6!fW3*mGVgJ< 5cvmk5}eIf ^(D1i!$Y}bss{+?pvT8PXW$2M"Y{#^KI*FѪYw;gr_5oZHL#*dTuےܻ{J lDgil ]O<XxѪW_O:R~Πn_O: [KOd$ijOKG.28u≻ ڄ -ﰿѕTumڧWqbM,(ޒw[GpH: r6^|&^i'lLYXI fd$s1PGJ6.΂XfvY%, L;(pnY%0[폽3cn۫K{O_1o1B uOз%X8rx=܎8qZvˑj,b4 ^sO8;sLmفݹY*d8$[!%;dp5}?(~?]{s<<8YZ d,JsX@>7%vիRP`,[qLOnf+qa.TC fRHS>9^+y좎x9<\o]Vt,n,V}8ZaH^ 8Usn<9t͚ǑA Vk $i w =~n=KV&le5YW1HV%h*0,{<}mv9r) #*G5K>ŗ-k ?c;[ 2٫]G a>:H ؜{ gU7ٸhMoY(qXJO #Jƪ|>Ѫlŷq1Y:ULHwG'k< 8cc,JܙX7D:V"Qlp*SHq~j\C-R=4Q eU 8:r^mUxxퟟ859`@=D*Ay[r=K, FўPy9 zx<;;vVJm"4ڐ-Y<pS)rnr=;ם_KNbvn"xǨ{/s0=09]oS+I`5#+zjXίn*8HQx .X?9@nmKqE+ȏ% !,,H[n շN(dgJ\(K^t3ѯ #Ns QVIhHeifCjFF,uF ZUL8UUi h'ɻg{p(jLD1'sFZdY$i-xC{%7\e$湒ޟ8ӎ|O<۷kْu*W,TDx"yfS}6{ S.Z%{ŦQ1ϟ/] q^(r+vgѹ% #dR;Y$Oo 8g\|Ȯz<)jqz)ؖ/(6`8=[#+لYc#ջx%#iHܛ|;JHKGtfy՘Zvhb7p$wyGELy+wKmYR8EޞA%ny#jomo!_Wua'jWc<*y$v ~Kmǀ\5&ĵMK({>n=U =R\ckܲc>G#Fpoq>Y5F^W)܁ *0O۬nbSsGPJ~`[K[VN8Ȃ0" J叧嫪[vv3-k#/YܤobNx20jf HVL֩r!kU($h%c4r/ <v 3rG`N>)~! 4qYd2I!X?}G6lƬyAfe'{plA3y1؄4Fh<#9>Αz?3ehG^&ľ՘UI}twOkleqkJcѽWAƁ{#De##wlڊw.x24TZ;H˯=#ԥb\3;Z4be3̆.9ߴ억״ #G%1ءY  `<<):+ݿͥJo;}0Ѡh*K?ACi(^VU':Xx~=VgUA$`9ya0Wm-H29(.63rE{pf1%fMO9%|8ׁ@h̡ISA5rYV|47VNOr>8-Wfj yO KvH?06n9~NIE;+8H9ܤC* ʻKF?fk;\kզg0v"{3ܽ۵S/nJlƗR~fA` 0hv>힝glӵbFx!s%s#|r f+pluK#WWaO@IjkhjTeUCC+p~@ {9*b#Y8Σ`9' KmBZTv2Ss"<0{u21*;N|y]v.Z[O=6꧐pU|Vb,AN;{y$5͇)lB m^]¢vx΃%G+'M7$;s5 KiiX'Sv3sǓȰnݭyNf;N6uvkd!gywdNDqpݣ[e`wgL'I9=Ljkq٬,L6d^Ooiסh2SilxmR x /bx Gv-~փx,|7C[d]Ux9r=۸tnȣSG!y'++OiC-%,[~;ׯ~N bdOSOo< TzӼ=+G>>z{EXDHUغܒyRAln&>CjRFٖj `܆En R޻;ppU K۳# R^ XىP;f.sFܸݷ`||MrID++FA8K(ףhss,1Z>{R|n?!XXr-9c, -xJ9UB@ @mh4Xw`RYN( p]]O<2;[C~ޗw3=no:6%jݲWxx/|]m胗`9'$zN߽SCls ncɷIM+-~d.p\2<V_1w2;q;ZqV(䪥+EAlB@{[QK}agX#vB*ƃ!Tvw l Vh՚%$#y/[ EF ש3R=£ڙŃ*D}kjVJ |,xHwc*O5 9K(Ve/Wdfy#XEw^AǿC6W}p;dni3X̴{ I"¤NL׏nF-XE!XpR̨O?+-78#F+MR WY$ES'rAxFN|n:B:VM+,l*I {N[S-k \[|94\!f OX:tu?3e|&fFoX@֎9y.*ZVn{%HfR nBC8:޶n_mÔa28[F>-G,.,"A.]3XHd%eZD/$=,ǂ0$3ЊhˇlV&y+_ 2OHk *Xxf.OrCVy76_S͛v%PEEs[`})^XqڕU ѲȠ/p&om$>"7f$K$6$<#>Q~QG8Ul&x\]x ޽ǭbI 9yZn|%}.ݞً!=R#e+\Gg#{Wݸ,܊&,*MFxl7= {V:+zYg1㦚 aۂAHEUv >=Ts>.̃Ւd{e~;]oaXZOLu/|UIP}bѠ4՟^wm,gWACFW?]MZUx~V>PS dm>srA7qK!a:k2ye:%+6_ 8 Dh/̓qSZ\uIZ@` JʜxN6& Jif1Ľ$#{;3t=|:TVtfIEC=,A1Ha -gٻ+<ߜ՘~Dx*(R܀K<`56nI#pHGbdU_dV>X(λWjmuTîÌm)Vj$VWDX >t'ɹ6˘rKrJzq 37ybJ8 *gί%J23ğܳ0!^dOKa.Tiڽ'nh+oav>ξ8u1u&/nH Tkq{9f0L绽:;ӻ)^zzCkӘ p8a_͐ߔo͛P\tS*G4^A/gcClmiܨ68/N,Xƞ%b >C`|λ[jl0˅ǢcJOy=܀ysIVO ۚ 5FR.Cv+J*dgD)o $pȓK{~ 1ZLf滅:ҢE{% 콩>6:| jRuxs'%srO%8t=i܀n/%+V6HU$Q![ +43v7GF.޻̹I(Oe$OK~?"yYϞ:yG'*d _3.cn^biV>Uag<q<PObn{as"WµH#V=n]Dgk7YФqH޷+*p^GY{LJpX"`4\YGkbmںe欯} HP< |6M+[_5,]K4O!]\;Q6p[[UE N2RiN$#`S;7.Wp~5v)ZgrKTY=@A  ͳ6A64?q?㷏W}u>uXv^zex<嗁>GFb>N[=ÿg?W۷:tmprH{+H}<]R[:h"VSQŋ3lojR±Q%iǞ=ۏ}f{u^oF=%h+R5jfPyX xzC 6c0kK0^2AՏ%S>A5ۋ{w-qxU/1koZq }̅@'ۿG~C̓c~/^C}~a;n7{d۩ &eJY~01<apxьb1#+S9T55҂W8W,QTĢywҼ1;~w7y%jσnIHX0d?'i&5%. jiDA0J@-#W20ϑ\eG'׼&J*?Ju&2E^DPq%ALjX# +|=Ϸȯ@~p±N  i>9x>K9ru*z*s"pMaJpVg~^嵪&#p׿M2w/r0eoAڷ/% {ΐވ__iu 3p8#i+ Î ǿn]76ҳ{# bXV,؊T>Ny$G8 &4[F"8HuTfަW|lM jjY"|~м@XRf~ i\c8'Y5ϪQٱNfMwJR_d2uf1x 1joԐXH<#Cm#?Z)-(Ke0$O.U"鼻enUR,֕r=V$Y>_#ϩiievڛ_lӵJMb,TW 2j5%WI]d8e#E~?2՗/dd'YVILqAg7Gp6z -lO9p}5v8|GT^PXRm6Ne I*FV~an koG\a1^~rϗϏmM=L~0XA2z@s}P tOU7f锖Ⲗ+[g!Dٮފ;<.6j{Hq_-fkIˡU 0>[gVj% = ^yXTrxuѷ66۶㹃XbPUUY xPsx|Vnf1o$pUןfama7حԭȶXUCc2TuF~ 2mj  Gb_KLą8P>nA`≌3p=FnZNOƺ_oK H"Zwy/i΂J3fwvҫ:tc5wx%8,RrS8c^ *_p[[Fe࣌7o!/NqI3T)՟^wf4 ^Iw;}5iW?]MZ=p@7;K~_;sKk/OY}bB;#` *GLelml^D98Ȯ#U^=rUO+;5^IվV-P9R*r!Oɟ6"g/zXY!G U7i+w/{YxvSWw{u߸0!V Nt-M]ɺ ط]wl18oG` .x-͖u_kemj,mC+$3D'$`I_Ƀ}9CƄ~ +"x+˹3[{զ[-Hin#)RDMmrq88~*jpE/2`>x<O.=I?|Ov_-jPL U*OQGv3hRK7+7rΝܙX> !oѺ+lNm [--if zVcF<%{T|Pv{4[V$iP*[Ձ_Js1ѱsnǟisA&c7jfYBEocws=JH^TI;fNH^G'Af,za9p沙LFWI؛軁g^H ?p 9 6}m`+b"^Y;Z3q$>x(Jsnm+\pkX+؝DG 廘c$8#~z5H }9w.Y<,;BB@c0\?`}MG)ܵ='k+2H KkdmWbܘ]*i,H9^ 9Tqᡜ\Y&Te(ApA:Ht.W_LZ;pU^z`c@b8 X/a'Skѵp8DfYVvV RX)N$p1?tm [Qx)WoY%' 4v/iONu6S5g:7,q+W+Mc$V ;5&{sd)fj\V$U}8;8̬Ua3E\N󧃽KdW49'"dr#2?#N:ewl2Ya`ykgTWPxUz_-n[9Hw64F &1zqwJģ'ߖ[f<ٽ Yɯ }389U9/5_?"lBF=Iέ {h񸌶Z|2ݖ.`%RDF'"; 3|s،aYbO_Ҭ Gї 9,|#&F̐?q̓rR>fR}}_m~;ϏImJ*nMdѷqV^ +=ՈGkE.x ughHc lqa(o蛙 lc-K~iʡ|+mt"E&r J̵~/׊XvI7$mWfVW6M;?B݇*@>PڲFOqLgnj8j׿JK0LZ2@ߍXR@7=>uˎmF]B#glr>1"J!Hdq/idNG>=ٳ ۾ViVLi$?ѫ7bA]$gB(cZ֒% - y<){㷾'tE3S2MکTn(-,(Wh"9,nAc^~,O=nOݮl+7R_˿0u `w|[7_N-nT ^ڻæU3߆UIAH6r ⥆ԥ%vߡu sHwzb2c0Y e b|&.;xEedE1 ?,QX;V'(X`I&2- Fr:.EHj/7ő 9$p@:#Lʿl~o9'BBk *έ:Y%FP{;3eޘ0C#OuSIFdw/#Ox"Kgd7M6*T*eGUlHĞ[$p|7=nmT-rJlѷ޻z$׬M=BE)<`{y~:7pX]Ü9VXZ񖛴7q=Tô 'Z&٭e2DK0$;sAtp߳MV|RC~֏߼I-# q}Zvٷ6%aZR'vWκ:1+JR($lTҴ&B+D IUM;kc1sJTa&c*;` $7 0vн+.a3# _>$dtvAVjDxMo+w#rHduuvnofmGrbPS%L%b+/ <K#P/+˘,k5R 8̌꧕c.K،e*n;$ ZZ }5zѺeqNt;}YG2KbB}\f:ߵ1-9x컾fVKr7|=fFS":s,$x+'_J6Gt s+}u*MRQuVzfCI^A 㻟A\w,\&ڻL33ZUY (ȱHbT)o J~kC"Y"SO1wy!fvcuw /5<b/Z#ƨ2>БB"I'3?tNl.>Gh⊳H*Dp|<[lǥw190MbK)"*$4n`hRZnڸ[[9C#)] +ÐG r|ڛ?N'F6l" YTo%!{e9}O{օ4V_ !nǮ}"K|wkppK?OL}zy{~^yns9_n,dUlp>r;G8>)%7FR\6ks+ujsAR>T8)/[M7}<8dM<Lm_=y2/)x'_흇.g0A `3eFܶa|xAS?9Սӊ,f"w'5YCF*Cp9:.vy 0;ΞF)Mzi>z,X]]J nIq߻(n rco.7p'y(hX9heNGr:Rmݭj2p`I,?j?( 8΃Y͌^ʥ7>곾-n_O'rj1pܞ9OX"b@G^ɑz[y<5# ) )@:Iѩv‘)xl:9)ؒwvNddeO{l,ڋ!a !Bb@ics:Wp3P۵^kie;wה0BH,X CfWJ~{-|Y^y@ ~^GL:so`܊,Vbc8? pOH^Xb#B^+44z+ݿͥJo;}0Ѡh*K?ACJaw?PjgSmɍ1{vw"x]aA1Ֆ/OT/+ݯQmj0 "㼏ߍyX=;l[7گ^Q ;H]GȅMvn2mc'RsJNHȆUiYv3< }~,}+ $Uh *=AH59mhu A8qÂ|'ZD5XΎmkś`TcKyD<qr_9o92W 5c058FE +[\0ڀVۍ|8jmvZ@μJ[#.2٘m۞I'$,|RWJz8㼓mX7.TE -ʎZ+ѤgU_![U]AԁYAK0_9vݙŵxײG `EirEhcUUh-ޣw]lصzisڅA=}Oh+MvX XԴTYS$|ʬ,d|6>9zl|ԸȑlH8TD}f؛L!?{!C7%)qfSIʪG>}]÷("ĪKNbڊ^D(!fSp|=*%Y@r>= 0OҸ)zWY~;nKch"Ԇw;U/Q"zlhfZ "+Ϩd}Kv&";6U$2G{WP0~>>| 񵻬a ϟkf:Y'l3:oX^oOll ,\|TYDULUᇺ@D`3?+1Ðv\o! qBջl*Õ K=l8ȮAJ ZۉlR(Ro=ՌxQ%@'O%ܰCThr> EKޜb.}4"o Ar2%!Ն/s'R_]~Ւ^K\>)ǿp8{ap+~uL7wn:Jj6#w jdnH@uZPDfHVR|<ut隚;QyX,`PKp{`G A_ ~_5|Dn-1% >P=8AU*|[مkKcƁjXY@1ۏ^{۸vOrf>9H{KLHd)e(|L2;&聂cUbؙARId[ T*wG;x}L5h~+7dR*b^q緗Eӽ0.4"~+d=eq(8ny:\S8J_q8ۮaN葀 ʌ<'f:a q[z;6f\kFJvHrOhoɲ['3Q)|,*ݢHF㴫b[nktrfc{Z'EJ;2Hw݈A* h 99h-n^1P/ؔڨ131x?no 1W=nY,ʼ Yg^ >`Kubǀ~Y^ -,pecܒY}BQY7\ j<1^`M&Xv\9o)}Fܝ-),ow8vG$r1Ȯ{-V8G\]Wӎv$=GRqxSMaC ,$qA:űobjt{%)7{aNY+D\W#Jy(o \Ku63DjFIb!y,'ƃ|l>{-O,d6<[? qL-=E H=Q==z\0;}ԑV޾xFl[BCvnV,YVkWPN$"OAt|llجYd؋8ap?k[S՛"z|$Ye3P F[Q2:ǯjK Jg#s-4lEf->_e^ÜNdrqduvo+-j:#p΃|[r#|H=lWn=pߏYv;z貕&+PyԁR8R9 +9k2VۻMWcVBT_ȥtuP<2Wc,үy j7I#Y#utpYO ATW)fZBGoznxVYS( !!c xx{p8כLmČ4[n=;բV1J{{Y9;`7*MXY@OD'=Ǐr81WbDG^~>x^y,&f̒ͽ(Y !O{o (Ѝ3<sw>-FMR צ\,W9$(:y։3t.,oY:[kH}X&ڙ=ԞP^BժxA%,A޵YKTp?sp,fkZ&jIvF8!Y~RmяٿR1񙻘ϨkapWxM@>םzt0#srdm)vleGt2qugv^㵸w8䥯qY6ߏF;x!s4XXO`UH.9#vidOS#c(Z*YK5i`n㨬%H`y;G@hѣ@ig?LYv3 X$>.s<؋fZpR&hccw?4 Ѷepjڅ #GHRyƕvl֝ IC+-ر?}ǤYB[w2-rcyq'y?*5ҽucv +0v$2 QƅIiXUUGCiѬs}'Ŋ并#fJ#%HpgMr[[ RlWcYS 4L#q@aϐc7Sn=0-n<>3o]qsnC=%U^IQ+5S-C%-d7FބJ` yWf15rػq[n%7)"00?qcsU /V z1W^GCY^X.Qyo[$ ,Q#w *x&ݙNէ ȲحcArcI\(bx †h6S-iՉ{V 9@ԵeaʐG$x?h?vn˩Px=\{ZK7ZQZk4Ā܏#fYC2dͼoW$d bC>Q8 ˱2݋Э+T(gϏQwŽcy*βRTE, =Xr9UY_rA$xMr}Y>ʠ)FB(PlOXƤリԌKwf̊WDOֆڡ$'ÿ4sXd+_޼A uYP>|kvbݕ!FWpEj^~9͵pɍF\d]AV:J$@Z@<fvjdmɝNJKN;7?cs"=aa |GXV*nDFERFy:qXяZ"k-"jy*iڰ*os2' 4mu-\nUUTI<%XF&n+лXIJȀJ3X/ SA9DkU[uP^~{ H)!/d8˂TQ1ZqO#z=̀G07[Vd\{gؚ:v|G~ >!bxRɏ i`:2DqISdmfu;qh#'ntǟ1jI/M~yEg&PIJHjrS`%澾/nT7s2̊Xy@iys1񯍈C vn_8m˷3S0VFQ[qp??gޫPqzxoe|d(eT"2eGcB)0!&2?35HU/@|$=;;{-&bU7Ssp}ΓtVV?aUY1O"Ϋ/w'rs;xQ$;KGЕDUM1K j,rOGlAWrYWYݙ3Y b`t-\dSP@B1qtew#O3M,+jF?{;s%T?ofGCjY*8dp<`>>xǷ:vyS-ÉK9Z{rb~j ծ;m*jZ?}ԒdB1\znOw*$(A~ީ&:]36@Z'iYyr8O*8gdܐdq rQOji"/eB ;H^=[[s7,w4lKi-w:hpx$y%#eF)gmN7.Rm!m37{yRX2KDLqT$N{A'R= fyNv7/HR['}EÍf{*kșvlZJZFй*g7M۞5|KeO5YA$q噂_btVx̅"@dbrIc$>Xhv6w!"; H_y*X'S+u mQx^yV RxXb{bx6hnbw>wqnch W VXTAՖѣF~dKC W_O: xI雥{1!~WIbf RsH.ʃ{:z9#3c\T_E$!VQI<u+ ő6Cz/IДhiA9RءPl'FLORW''bŏp y_u# ӝ^:9!aUkarXycw>uw}zŚթJUHRԆ*#(C` Iyvx[Dwd`2Kc:^ߓ˳crfWv|LT62܆ ?*X8xpҭspS hl&Bu^܎/zYǓ8_S:qm<%fK6^gXKC(#j5CbO;+y,9,I$ONkq\kFɋs tZƅǪF$h#Nݛg[ջAdYջ>U>;O}%|S[nu@HFg[?-K F*H`f|\.OV:GV'Qx}5/ɳvfֺk0ܚ/Z%$ʊ%xcyͣ"*KbTڕb5c1T~;S͗UR ȯJEy5eKnnMcd<Ȑ~=~a]c1JLXa1c˹$<i^m_/EFRL&Nu{ Cw ה=҉R/Ic23$%epeWuWnyay_0K7n&۰M1FRn=^G @h`6ɯ&:5l1/h1K h݌0V*ĎG<38ɎIRXY,z{^8^hq}77ar9"(Z"8eÎ<|<5q#kbN+ T3c[R}I\#3|s$V4 =X۷}@`(qÀ VS;;#I7e-QꈦFY9ԳbOq-yf͙m;Jsj7&ޜ9퓸sN3{O8Jd0-Jr||jFFlv qIdP=Uve@Ǎ]ŀEܱщrJ/gGgTù>=J9lHi&&iFݜX!WT8 .ٯ%k'ֿT{r=_\DX~xo0FBMvuh\jɠZ_^eUG 8Upӷ3q2ބ`_`ǖ'ܓiM)7lkG=z!b5NF 0IPн(ɗLpdh)`E$dC HzwٹqO6%,[=ɦ/$ܺ7*G p|i\QlձjF{2Ke21gѠ5E6=zFXjߩ;Av@K:KLhsfZ"; }I9S=nbpW21؎l[a$݊;*"jF)p<#;vMÙ h4hz%~!qYA<Wx~V5oOeٸ9W;ѿnާ sL24hÀ{j-w=Lۊq)otd-ϏcjCG4qOʰ' y-N 9F^[^p28L'> k-{K1^Ca;%tuO Rl5K4\ Pޟ8:7umO%5qi"qQD|arud[ zmqXi^hHQx-| 7JQ>uO0G+'g>d!d.9>#9Hb `]f{XϝG㞔sJ7oXbqwIUp29P l% >ʾ^$63U*2p%CS9#q(bCJ*#Kh9瀪u'A_N̞sKVt 0 Xhlg>:&-|S=i]VAVZ̩}ʝxTI$1~[wjl xȱsR[KfƺAr ʸ@[lolGlmpHNџ#@Pp8ֱ@\qR]bz}Hx>M|PGqǒѣF~dKC W_O: [K7,vvi%bU|{Ma4oK%e *YI2]y`n77 EOX˒y>:A/O3Kٌ+3s)p&zϏmKlSoVhd쒳G 1U*ܐp Uc-EnVjܤÕ`~,fn< "ٛKk\gzjmw4RHGq!{Q{|y%T ($ywKnɱ5ąsW #/q c@=#iћ#]ٻL.SR_eyXj7fVVI$XWQ_4CPBG(TD^@aFFFFFFFFFFFFFFFFFFFFFJo;}3ig?@4h4 aw?Pc5}+k$L&6 .uK?ACA~漕,GE9mDrK$qX` 7V$ r|5MÐܐ l#nLo,FjR#ڧZwODW95ja0ق)>"_82[{lzg#;5fI$1I̮y&4$5/62{vm[5wflei|w$@WXES"s&5bW~1b);xƾX46"XC#2{؊!b#jEfU1,80AȽ}U\\SK^ʲ[X䄆r1_<*Q1AڧrvU~=1VM՗g*uRJ^~`Ic_i`{/]~Ym` [jT患\(q/o 37k9VR95**kBTH(8'u(02DJ<dxRc/ѥMnɢF[2ytvvXcq{}fߘ9bY2ӎV4]^dO#0ݣ%<<9,.['eeܥ#{lbfX6D_ b ynD2ǻ}~,[xI!I#(L;bumzr[#w o> UH1'q^; vݻX}%}3IP ?0G4ߙLQ*^}"qM<Qyn=鍧w Ux²: h1'OV6,ygKa6rް!Bݬ\yf<结=c6~t7)_$vJ{А Ny&%c"8\%o/1e*Mvҹ{)P8#Vnc.ޟlqrUOji#"2c-$WЊ }tSgsBcCSI `U@fÒFѝzwyǙaf&溑Mvĵ;V+hB$2DG*CwOsFomڋ|u9%YH`G 9:Vo Ջ3ł{"`TC؝v/oq8͌4a cn[PP~T@P Z̟ܿIuaTA`p+~um~ai3.HeMpnXG\;,\,4݅~~m?y8؈q9nbnCfWI2 *R%f~ܹڔg=Gj<>gT8u2 샍m$6%<&1[xcu=^ zcQ BK_'wu:frPonKr~1h8.ܞA@q`W9K Y 00JI1+3W OU6;STw5\^FX\g\pPh^Ax#Uzg{yzҁbIÂ"PH|@'+~m,V/+FaYX1S$A#Ugg9ۚm㫥EOWAb$E䐀@ytTq*w&C~󰨪ٚW92by:H%k^mJ!T%n8cKqc7e.߭,+WT^beӎy =>yYk'ۑ9p y<?Sνv*6ʳ \E@ by({WIkXbPn!sFEvT܌}/'S6_I*KX\ȬaO4ޔpGy qnmܵboUDayVeP.}8I?|(~+ZI2si z3Y{{y㷖[;G0(gr3I1Oi?_+2G9LO}XqZu=Ȏ WF IUWmXm,N,oȕa0I9LnAu'nߘg30[f$4ן,*,<fbC y_M'+l&;H$pSY wd\,G'?gj.ญʾY.,WUHUIRO uG ,BD75,#464T$wͧB  ymNw͸0*7dձ%= 3CK) ~8QV` =vd^-r=;43-edP+v'q஁[NS|zoz]l*HYb$B8S:u5O*Y^kpIt;ن!F,IAb;؟$<4444444444444z+ݿͥJo;}0Ѡh*K?ACa).!+:8sX$>apQK] $`9: }H9}#scI"hnUij.H%{/< 5/w.ޢmH) z >Xp˻bcXıX -a\1= eWS ԟ~ |M<с Ov—JxpAn&fs++MNd-v~ߖ3Z) ,Ow<(O'jF^lMiGZ8w=owo{Z'#c)QVfK$< vCwnoPv>ԿW+]$oAl3;@*}d je1U00\:K<1/("e_HR[F^{ώVzuGc /x7]jd\0Q3ʝ + VA 6匍2֍WF,JT@Os$[v ^$ #F%E,Auu4hѠ4hѠ5_?U9/.?FVRT [KFFFFFFFFFFFFFFFFFFFFFFFFFJo;}3ig?@4h4 aw?PjүX$>m(-/w_S+޷P'v=zY q2$;>4^ J%f% 20O"_Ѭ@JO"OXIϞ}GƤEzcdsv3 gs7F b4Pv[5vfQ7lH K^ "` 8#7X}Ӻsݗnl&T',2TV*;R;© zjaI% 0H HNA?Pn 3#W-VU}DW?+Gop>h;}nKE\ kk wW+zB2rT6AkbڐIV?$ݮ_ۅ9#X;vaUdzaIҹRtSC.cʆS=Ó}n(iGx̜{2y0ƥeʳ,{$sA=srpLTv]Q#"AY&Y 8{vܱ{{[ÑKq,oHꉤ/1:$!?o _ "3X! O3͌||I&*q^'NɄqvJr>-5(O^8bՈ# yx+;D` gO?G$?ihhѠ4hѠ5_?U9/.?FVRT [KFFFFFFFFFFFFFFFFFFFFFFFFFJo;}3ig?@4h4 aw?PjүX$>D$.d Td`A΂n9K9%ՎͶ/l %#Ҡ!dnB6KrWp`cK8b&XeX8>Nq@w,>6F^XgM23{ 2nj[#zluK< bzbC*cU|xd,;/c6 g8_e4ET˼P;A<Iv}}&mb,Hǂ;kGwx6ѐdTQ-T17,,h`0}Q/]3qɝz"FXo,;a} TڃT8hT1=*8>uڛ/jL f?Y8I{QS*p H9x]y,@{E-!Y v =Ý'cnJ[i>+׻q $L#HVR۽-o V[$TP8+Sl]O2FGԪaG %|x;Q>Gkn˟ltv:Pㅞbg cWv#?.6Q$VÌr9bRT A0̨B{_/r}?y,:ū^#$^ g:U1{1[c˸=p@#z#ή[={xy/rlXkW|Y,weOcpFH(VG> endobj 66 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/11/Figure-1.-Literature-Search-Flow-REVISED-PDF.jpg) >> endobj 67 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 154 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 10027>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   ," }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?R&)h&(s}淫qq$r[;#"Afzw_gi' Q??M9?g' Q??L9?g' Q??L9?`h2-rz6":U͸W u`@df;|Q4ZDEVtKkI%Y!e  p:ךHQ\6ݦݳyr?@:ъ?hlzNѰHiqִ|ct3v͟f|q7?tM,+F+vXF!d;UL2EP5QYI F|ЭW@Hc!ޅa]*7@563mT$lږN8{>o⋛Utִ|ya2'2 "XB mnTmNjﴭgM;iijF^AJ\h??vWC[{}6mN[EUC1I)95.R4ma{1@)1\nI3ϾH" ۖBTG=~{^եi,3 2HHpp{:Qײ=DHV"]U HiҮ>1z!v(sjvnѶ6~8osZ.te\ቮ!ZHI,RF^DIF+b-FArG??L9?lbr>O;@cy!7}?v61F+zkQ~ 8[[VS8&#H3@b{QF(?)*Oʀ1ROG+\ɯ ~ķMm x`H4lb\6NӀHV 4_D?Q7 ox֙kJ7OsJpd(Y]QAUP2.7WSM5;+cgPFH˖tkU&|5hQ7 f4.k{fM6]ۍK6@'K@Nu>(G!-pVUm%K07ෆIdV8Գ7ؤڶ!n!IPC)2JxwEumVRiKmr]Qk'gKn13IU??@3G4/IzZ(3F}Ͻ>gތџz3F}Ͻ>gތњ3F}Ͻ&}ϽϽ&}>>HBom㮛>-/6uOAGsjSJczn*xڭ@z3Pٛiڼu| ;7۞q56}Ͻ4f}Ͻ>g޹լ" B|U7bK'ޚG!ˢhf3*1a)4UbSj١I|>OP|]-WKO_5p-i2ü8!Lc$zs+_ƺO>"g{xo&ay4/,@`fy'(4??P_j2׮"a\]\y%{T[SdHbNU3jύ6uA,7V,oX'Tq$$EfyG|:uO Q$ d G^^Y,SA?١Q"=isEF()?@'jWwZ6s;7ۥ*^ß/G?qa *@s/hß/[_ _A9BQ4s/kk xJV߅|@XB\Qoi)˳*X7Ƒeq+LE+`yȃ1waKh(<'ž"ңmm8v-0)5xNm?F+<+@;A ܊VQNQ=OkdX%gӷ ļ10WsPqY5$i>Tɳ(lI쿅'h.$1i]9`n_%0~2,k5Op #eސE7+g ;1,h#5FãSFV`3y@(%O3@9ៈw:RkmLe[x] 찼yBQU_Q /iֺOV&e|KhUH]' oSIa/F*ci Fl_ҺoS?r~.W;t>Z!U2C=1C)w>|?!$vX* ($W5~€1 _G??_ ?& O€1 _G??_ ?&Ghּѯ4Eg)f4E3\.y?OgOP)?KJ)i(? c(Y&t*ܻc(Obz`OAK( j?_EkQ+bZG Կ憎ע2?&֥}EQ7//" 5Q`OAGJZG憎d`MAGo j__ElQ@kQ(ZZho j?_Ecx @YiRHP daT=эv=+"}w 5Q`MAKzZZG憎I@kR(Z[47/" 5Q?-&uRddA᧹Hdu&E*||0m$DP 7#5zZy:Fbn' z3X[J.1#4=-f)? _€)? ? ? _“()? ? _“)? ? ? _“)? ? _¹O]" IKtxPgA]W\ğ뽷 *h.?T?]]'G@+OЩ&VSCt?Mtsе:e℞67 9Z3xsQ:^i足Z©q @E@0cޕEgD3̒=Wq &74RyDOoۉT0ÐN| ӘZF⵸fV+ _Wj J.ȧS4s,ҤZ!C%1rd+8|lwϧؚ., ?w`ҴuEc oʊmcTIVF3&5* s{d =6fUb6%X~h@&k'GWD_??uc oʏʲuEcGWD_?'GWD_??uGc oʃVO@,4h@ak:ӾHk hjȁ=FFhJ?*_ƌ3E4dP'?qBU-mUm.tH/V2ȥ^GRT` oIV&6տ[7G&6տ[7@aco@[4ao@[4ߵ'X_?VlM?VlMnT~U o ogK#}Z\vot du1׽p:mk\M<“YE A5ao@[4ao@[40GK KKu 6 q=g"(mVb}I'`vi B ?1~ٿ?1~ٿu6sNcVs Ǔ3xvrWPGG'sqz @H, p/%M&6տ[7G&տ[7@ zR5ޑհ]^q* fh fhw/Lmo&L-o&7*;/Lmo&Lmo&7zzQV&6տ[7G&6տ[7@aco@[4co@[4P&.+ UTW:e1麳I$.?%H[j<:un]bU 8cғ'ҌJ_ΏΏJ;PGz?:?:;P{P~t4~t~t ~tvփ@P~4P~t~tFhRG?:OΔR_ΏΎP@QAhގwh@@ endstream endobj 68 0 obj << /Type /Annot /Subtype /Link /A 69 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 120.9525 260.2500 236.4525 ] >> endobj 69 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/11/Figure-1.-Literature-Search-Flow-REVISED-PDF.jpg) >> endobj 70 0 obj << /Type /Annot /Subtype /Link /A 71 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 120.9525 260.2500 236.4525 ] >> endobj 71 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/11/Figure-1.-Literature-Search-Flow-REVISED-PDF.jpg) >> endobj 72 0 obj << /Type /Page /Parent 3 0 R /Annots [ 74 0 R 76 0 R 79 0 R 81 0 R 83 0 R 85 0 R 87 0 R 89 0 R 91 0 R 93 0 R 95 0 R 97 0 R 99 0 R 101 0 R 103 0 R 105 0 R 107 0 R 109 0 R 111 0 R 113 0 R 115 0 R 117 0 R 119 0 R 121 0 R 123 0 R 125 0 R 127 0 R 129 0 R 131 0 R 133 0 R 135 0 R 137 0 R 139 0 R 141 0 R 143 0 R 145 0 R 147 0 R 149 0 R 151 0 R 153 0 R 155 0 R 157 0 R 159 0 R 161 0 R 163 0 R 165 0 R 167 0 R 169 0 R 171 0 R 173 0 R 175 0 R 177 0 R 179 0 R 181 0 R ] /Contents 73 0 R >> endobj 73 0 obj << /Length 25128 >> stream 0.271 0.267 0.267 rg q 15.000 28.717 577.500 748.283 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(research and practice. The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. Finally, an examination of )] TJ ET BT 26.250 43.003 Td /F1 9.8 Tf [(emotional distress among veterans following the 1994 Northridge Earthquake )] TJ ET 0.267 0.267 0.267 rg BT 362.235 44.510 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 371.872 43.003 Td /F1 9.8 Tf [(found that, similar to the above findings, pre-)] TJ ET Q q 15.000 28.717 577.500 748.283 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(research and practice. The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. Finally, an examination of )] TJ ET BT 26.250 43.003 Td /F1 9.8 Tf [(emotional distress among veterans following the 1994 Northridge Earthquake )] TJ ET 0.267 0.267 0.267 rg BT 362.235 44.510 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 371.872 43.003 Td /F1 9.8 Tf [(found that, similar to the above findings, pre-)] TJ ET Q q 15.000 28.717 577.500 748.283 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(research and practice. The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. Finally, an examination of )] TJ ET BT 26.250 43.003 Td /F1 9.8 Tf [(emotional distress among veterans following the 1994 Northridge Earthquake )] TJ ET 0.267 0.267 0.267 rg BT 362.235 44.510 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 371.872 43.003 Td /F1 9.8 Tf [(found that, similar to the above findings, pre-)] TJ ET Q q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(3)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 74 0 obj << /Type /Annot /Subtype /Link /A 75 0 R /Border [0 0 0] /H /I /Rect [ 480.3367 684.8484 485.1554 693.6667 ] >> endobj 75 0 obj << /Type /Action >> endobj 76 0 obj << /Type /Annot /Subtype /Link /A 77 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 467.4525 260.2500 640.7025 ] >> endobj 77 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/10/Figure-2.-Data-abstraction-tool-7.27.12.jpg) >> endobj 78 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 231 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 23341>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   ," }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?'7o{NH,l1+ʻP,v(OZ;# mY]鳿nIzӚ5YtMoWk{vK&ӨgfmiLv!Α̗#z dXq(Z6>)_7N` T*zq5 /=\kK{.[$r~Ar9Ӛq[xhseۦ!KoAGC7R4_]Z$]%nq&7F(ɕўvWgx\K(G+/l!{*Xl|#=v䨮UA~.y$$rY''tQ?߈€&&A=?ǩW::دn-n#{c2R tnXaigo!fҠsl?1(gcޛb 4Otȭn|S,P$rx;{яz xZ3q!Iq $>O5[]:Zmբ_ۙg д5dK+(ǽ:^-%F[ 9zsP~^[)fSpVb1kM͎ތ{~6?ύ3ݟ#ScX^E}2 xfCkp!yTb8(ǽ/).wyP! r9AJY>7>T`ڔC@,8c޸[>ӠyU}KDH$(\d9$8Oƿ,eύt<hy8] EQUK5mhļQvf%Ɯ-.ߛ쬅ﷵDb^߻o3OQ7j7w^JRA8؋hW\|<{敂l g3C_5 Aũy$jڻ$2)R16  8=kNxn1<'jK Sy#!+ou? kKGUwiku, -&$§;6vZڀO Æ3&>IfawR4=u'KMW1G1•` p1|=C&?ّ71扂F3 N0;daE_-?IY/]cYs#y"9[`#iIy$YW'uᴎ߿gj*ܣ2h_xKQKeoNX)o,~yhmna0 L2wdO[W0"H<#$H!@JdY@[Zt͎cb[ri.m(Gu@X[yÕ=[h>%O"Em65K/X 30@4rZ66~lzhۡ2/HQ37> ihǩBYYæ$C YlFV36~(kQrj^Yq.(vW]smܢ(Zy1yzMUrI$1.0F00ov' 4)8\̾NF78}k5;;k<=3"M>N p+nxG{ZZI\*ᘑ,0󓞇 Rז󄌲ObH.H3BӴA Ӵ[&7XV=3 ?7wn EVݽHvö AX;ƙiw]׎ZwU#'2zK[5>ˣ:}V ܅p98=( j&=7pF;,ԑInz xkx1=4 ɱB*r-&D𽭌LfHTp T`q=Eb?ݏր<U?4շE=y̅6M]#k"լ`G e|I;#qӽnyyxcZN_D>. W?_^?V폏ր%U+)% s(p9s'vkG#J%X#ART0YHjsYAҷ% ]LqNqp֌ZkxHm8.PHuy {(nEp y3Yo IU`28 .X$~?廘y>Z0d q<$rE6;;xe.Er#o'ʡN~` [SXmÀIһtv( <{}jGg5u".2*[;DXz@8QxOME/c,H6YC<*Un-5򽏀<@&/ (sZB啛v `zc=$2ƞ|5Q&H >Qxl[!GzWM DP 9炠"<qmP|DmcD27( q9> K5I$D!W`1`8Cķ/(wUFL:OB+[Fw/AH0N0:WFjwz237c3"*u6ֶ͌D^?Wbyѵ{+]+ aO kVڳ{lb-u)xuϗa8Hy^`O/'q$[jFbTP~P?4w/d`uew7q|ekyk}k늷k?݂  3d:Z0=iqF(0hǽg붷v^p-<>a8†A k4 kQti| GU*@t7ϖ5U=AE>w8JASJ<5+_>ךzyggYY7vk@6|xZ06Sˤ,"oD2|0 yE\VVOK{XL6 06+pq⯿ ",$bG&y.UaYTlqIOmZdmg'ܸe@~Z#MGMbq 9'pJśO1G#S쑛 2f8O7"'#z1@}5*ɮoͼb?8y SKz1@ F rr|Y\<i6I(D&e$7XA+ Kϋ~ Xoi)J Wpݺ91+`7}+bj:=woKGUWeo޵q@iXIg ؘ#'%; <sfvF$u<:{- itz{I%@B1888 OI |keGDe24vO PTx.(ܶ9g,qMĺx;(*dmyqp $+WMD.nm Gشkv{OW{scMӤZٖO1>^~x aF]rE_+9`h~ޒ?8 Ksu]l,^)feh8B@ E[T-#8?rRȋC,f0ҳ#1b$S8 w/ ΅s+~;$vB݅''v3^} ?3^}>@{t:e4rg~I=k[9ΌQH QL.c1m;VEZ itn_l enӀ:Piw6Ai3rJ_4 p߽?McxOCI1ewA8oc ]QO8Aޟ&xeͱToW%eI ZsSO[,RD,g U#9V p1:f^it$aBf_di񥄺ż9vɤ& #$aXcqR8 Cmv1xIn7F~Up˻!g$4ãq6extG1c3 ]w>#>=^:B,Gvp``G pHQ}qKY$CT#1Fё rOYfn`NK:㢲瑞8:fxsS LӣᩯV/ 3.T[p?sAxQԖk?^Gv>תc0le6A9y RǙ?O,Uǩi[g)a8$=Ehj/wg<~{iS?Ay\^|OV/2w`pHqҤo xiʣh>eE*lktJ 9j~<1>r<W;MJ 2{{x^3)jUBU +ɬ? kx(oxv' Ns#Ҁ9Zzjzer~O(cr49wzwiI//JUMuȶʨ)'35=")OS/4 M6ө`Gb:S:9CO,ruTf91i_R7ԖŜZ-6G;ϙ=AɓÞ8n 8~=u#qZ[uhr9u6^}a{]̈́oqu#DadUH!Gϸ^YivvVAmmCjTP@2 v>u(w8(k|i3"҉F"RFy??Wc]6Eiv~Rz5Ȯ[Q!5'ڤ퉺L۳($y_<WYmJZPaHpd1lm΋10]Gz 7A< g",*;H;KuM`2Kḏu`)1=+[i?<4<v c@8Q4eš6sȤ`H}+ф[S`~%y񖟣Rj̘ăofp (18ޠ/-J;Qɐ lTy pc R>Q4bQ_$Je/O\%h~+J-/&]e"lp C0k7mN^hO$@H2߿a?El;N:ևG_$@iFW'y}xxAQAz[IK+F6lEN2%mmki ga%dVv]h.qP+^K}~5H .91'gTOgkMSSZxciFqD|ya~rhɣ#ҌJ\њMm=jYIcMEy}tN17͒x:ѝnk$N\de[b'"|wYE ZTιjhC°G,9P%mYY[/SX$iF XNH8=];OLt)%۶+3揸Sm ;lB[]hf &/Vé2 :cڢi Ǘ"!9c( (V,`3LJٌm,YRwsfڈ"jB3 RcדޝK> Q'o|㙤zrQt8[$Z{]\Y#-]ANx9q:?wO$c@+P=ZxPEe{:_f#:>:& xjMOk@ 'OJ2=!hZcx"|@mA.!!8=+Q <&wxȢV?j뇓"dg/tڌQ(bENڸ-Ή9$eJ-²|˟`G=;5S]9iZHeTpzn<:K;`tVcmoP҅$pdG(<#t;IxDsF_ԟ7+9t{=ZDžn'("Kw?(&6;) >Yf|fK9W'vWMѭ 1@#Rǫ984Ĵ-$%SI0j,vd(Tp0H%J:^ y Q@zu%}Zu8/U v?Ee9U9%{qӞ:/ '5nyV<6:( vz='WVlx%\q#bLmMۺFiCy}{ct7-k Ī $8 '{q7gKD3*4r06ckIǁ,LӯKE&*&_)w'38S3IhIϥP$_vYK{}*ծvUR=?_scFtBB7e^)ʜ_h4FT=v~`\q# ͞Cÿ Ymƭc [G#s7EܐWcyzPOXCUI!/hpB*Fџ :vh|C; ²J֓kRD/-Vbtns€,F8bGb1.@<1q^c^In?nnMPqbX7q7?û=ԿT .2~h{?({+hrǜw{՝k+/Z$1J^A z]IFĠ\OlP}u#OanNb~pXp˹~E%NFUN8j\g&; xjvS^~]cȏ׵M˼'@{t=|4 2)v|+e_M [ 8C,~Dz,,ʎ̑yl2K:,|wC7m+MݿWûi,L|dSgχ3I7d̝ cZq?Zt߆V)$~i]Lf.KH TS]?S;á^4lv #hu#|F'e4b3# o5iv;Ƞ[F0@…WOqƱ@-Qz?b@V$}ډ$ )ʱLzT:/0$,SL9sߓzǜw۟.oA@@P"4f4iqޙR0%$cJ˂|!kC]KP䴋$r@݁K^ZE-Au?cOޯ{-.cH}E qB(cmi9J2}(ȣ"25Y";ev\qo~8o87vHaKR%q +W98 &Hڎ7\E4pponH9f_pIEa:t3:o[%7|('1õ^ZO ͦyb c{mqNUxA&t8vm&6GMHۼps)񈻼7>8%5GeD;vfB$37ᑢPV/Y7|zdpGCSJN|!$e+ln62=pyzqֵtmź4]J&jqcLiğ ҿi/#1}VJ-;"iJ$1@F=rs N_[GnK$;%9o?_G=>[-_A?%*QO@ \]ς}uܾlSxO|,$;x8 ^Df?yi%W` .ߛzFEه&1OݿlVO.E|NxKoh34lɔ#S75u6cxA 7g$umomgFIn OǼL*~l?(a#kMgNҼ (blёDg'_|/7Eu1H$8Tii֯}]4=Ib 20yy _ 8N6F!;*C*2ZyLJg,cl\G<@BA44oX@lϯJ֟K M>!e/!'BOp[_jG|!8c g <'o8$Ҭ (#HP 0$K(K, L@lI9$MJlgٜ}>J#6JmPĺq@u{Be-l-I9Qa}x0m\@vzFOp56; >#%qw9OMB f.Z9?D Y Ǣ䎄YB78XY^)mQxCND|xAB O3_'5WDЭ<[k59 Ș\_Laʝ5lb9[V17+p~l*e nmCs5*UsFMssꭩ\s9È #7R%E{ mW1yf+jȦS B|;W3@~ \j_k x»+2 dtJp{|ïX`miD(}Ğr KBk}u,t+ )?/>g@iH? yѐa?S4`L{a9h_&!TE[te2F3vn6`ү[fȾ\(.vU[;WR7M,}W%VeG x݌~iWMZDa$nTm3ߒO4QKFE&`P?OOMu+FzDToHF qȯ8f-es+ 드dgĿ7K]*4_1֙M: ֗CTi" # G$(,89.x݀=Ee>%tH_U[x[7-K I!Y邘( eķmŻYKI%0c BG\3Vp=ip(cǺ[juKjn75ܦ=c6X W?&kh/> Xrkn1Nu^?G:RxqH&#ܑjp =/w餃ӕGޛ|_r(mokϧ91 >y\siyPu4<_r(m^ t-'Qk#o߼qh<&ؐD׊L#o*j7?iX"UF9>#/x,R*+K aŏ_ &7yK0# >t[aᏈ C5I>ܠ6?},tw]N?*S*>0!ET]?"iV_vr2*O6FkVvg(Ka8p8ʀq9rX|Q<Y %Gd 1/!4(u|9OJcT?? $G!4(R?e3Ytc\<ÅbNΨ0֓ᶥ_Q"#ya~K7Kңm#CqN 78dԚ^g+eX#JE\֗ L0iy>.jKN쿷x$U.1#3Kmu` ]elg»:nT1<> CWw}>a6G9?k欋_)V8>v>["X{]?VP[id|4Y˴!9=6Qi:{kP=BNixA|?ay^ Ox^eỆ宗ΈhbdErڕ輓zpRNNFxlj,%zaeo{xKF$l+b#^h0hh0k a^T/m<+-Fߟrq6/3j|s-4ћuJ7a퐠ۂ 6~/O<7S2Cq6-L㼀v& tZݯ#~#I1q&GLD};ꏽld` $ EZ񇋮_Od^]J ղF*ύN?Gmu m>ڥܐEtbH԰r0xlK-|4$UR.!@$ےr YpG&Ϯ61 ;@fOj3CaJWJJȭį>'b {53ih7ܑqsxve o_w\^\gP0k+$ nE?) O zwO޳:$1rx/gO ODwd G)pQ8__l[HE:,.b}sQz@v*id+01}o yA@y!-€I6W!< H!u ,:(YV1c?.1 \ ڽ<2n"ΐȦ=H;p8+YmPnlc>!>^?JD@8[9HmSdDw Nkd,.n-/lJA˛!؍CF)%uAߣ&c0M56\yq͝wK$wz [2ES Bryk%vZFI.t@R 8.X7<QF /4s@ 󮧎ʾdrHdSdzUmGOխ/: @8 ހ9xKťiZՌm08Z<43Kuim@!#!z C:,fXK4[ц YA 0u`_Y[-Ogs*F`W'uW|){?a* U TqQxSM5({PHc.T*!y'?>"EnrxOI~QUo!H?#JTр6j{FK4}̠ͫE8o˻t_XŐ軨^\> |J/lf,$BYetj׋>"l6qLVVYC!>f=H&m$ͩ$D+ (IOZjGmlO[dO޷zxzk֫oCF}]\ RV`X]ex"֏ oF宭#,3>An;mI?ie$!>ѻ4s$1VļLḰe3Ac/ _מK8^P@ğ 炪G a|"\ iMVb0qT† *PF{iTm8`|۫+Fr4x`2-*dڨO\QZnO <oMw#DFA=q^{{\X zs'ڲo2NbB`sCL6/un6M?Jƪ R89 Au-K"S?,4H$!*z Դ/u@"JõE! e'r pX@|Meꖿ䰖1GQPΐxgFk?â|E8čMXyFq_6acW*VĭngAiȕ"\ FЂ~SQh?h(_)awn5imHA; q~{XZOq-B8bi3A$m7B3q[WI'"œ9+K_0xL/,wwr0 x7dzW ;N[Ů\F_7C$$uوt+"ডh5[i$GiFBv;kc ^՜kys$Mg=ö$hXnC9goobѾ \S 6Bc-vŗZ|ATci"B\g$rŏv4z\5Y@q"_^]$mKq7h/P o1.?;yecuFG44`_snuY[{w<ürl M{ xm,C'^G)mi3MfldMTI2KnC(?`+ćo>g@~#\c* rPrz+ji>'H-HĸR183umcLԒ;zRC.dW c`*O:CTMjR X"["[5g]͝;#XaF݃H¶q@|+S!; 6pz>q]y7XHs?^g -_W| CI-ŶϖA+3mUbI$sdYFl- -Pn>Xq?@7Y?,8Ȗr?O-{>뭿r” ,9#>g9A%Wn7W *A46{-asۏqmfxuωē_4W}PģoF|}ݫխ^=2&W9 vaQVt _u ?p+_;tz.k I-޽cm` O*@  \"^IXf msAA>o.?i :ޟlue- W"2P͍q G5iYwk]yFF2MEgR2ByhYxJwQ_|UKi پ0A`$x,68-;Eieeyd"o!%YR@$PچmZIm}բYVan|#RPh)#k?AaN ,I)'X~~9Hێ¾4oos.jm!gBޜC[;14>?UfhZŌ7iu%\A;r*C&H*.wq*9o*+J( {|UN?* w|bh}tnnaoZhjrJ`$AnFeB>n?,^/YK Wz¥UPDq}jKxjǧƅe[v̧de?pr zVZGjkH6 If'83IF .@ F&7PQI`Rnu.@ F&7PQIq&'É&ln'~ݪO{Zq^ ОdpݫDžP[uT㼻s{녞Be`$*Fqz`8I{zOw\\;$$ƀ8-Um原,]+$*.IC3_^YF@dqAX`x1xNI%vy2B-xB+qm9̇po-W#84~;6y1K#p@1j,F{㵏o¶zj0h6P_o[r=g$^W )֣?mQj}p?ڟQFf4(3qMh;WK?aQ凔2<NۤxMĬ{ʄ 3me tW}>osJ,R#FVR0A5@x?F`O*_>K1&wZs6wc[re"Op?-Hmx.0`?Ul[yV>W?kǝ@'5Q+DziiIsFBsڝOQTm=[:c"lxak:Zdl=̢(>YG1ʹj_ }> F-vIK>\cxg(:b>8u8`Rnu/U m.w4v$Sڧɨ/l+v @H98<_<'=M%?,8 J27}2*+~iRPG]0P$g H= Y~:x-zEϪ )mmm6y`O5ҷt'cmN()ncV=ENKy#€φuef ܤcEtc>Y@āQ7o^*ԾgO&e$3аCql1Q>:x]RM]]B{Imc$qȁBdҠ9V"#F>]&żeÔ #1]kCA\4d-NO3'ˇ#X3OyXQq’ʼnZ_ hsisˢOe2>Qc㠠 “&_“&_“&_“&_“&_“&_“&_“&6Ѷ(F(mh m6Ѷ(F(mh m6Ѷ(F(mh m6Ѷ(F(mh m6Ѷ(F(mh? endstream endobj 79 0 obj << /Type /Annot /Subtype /Link /A 80 0 R /Border [0 0 0] /H /I /Rect [ 214.8150 261.0894 219.6337 269.9078 ] >> endobj 80 0 obj << /Type /Action >> endobj 81 0 obj << /Type /Annot /Subtype /Link /A 82 0 R /Border [0 0 0] /H /I /Rect [ 219.6337 261.0894 224.4523 269.9078 ] >> endobj 82 0 obj << /Type /Action >> endobj 83 0 obj << /Type /Annot /Subtype /Link /A 84 0 R /Border [0 0 0] /H /I /Rect [ 272.1493 261.0894 276.9680 269.9078 ] >> endobj 84 0 obj << /Type /Action >> endobj 85 0 obj << /Type /Annot /Subtype /Link /A 86 0 R /Border [0 0 0] /H /I /Rect [ 151.9762 249.1847 156.7949 258.0030 ] >> endobj 86 0 obj << /Type /Action >> endobj 87 0 obj << /Type /Annot /Subtype /Link /A 88 0 R /Border [0 0 0] /H /I /Rect [ 137.3415 237.2799 142.1602 246.0983 ] >> endobj 88 0 obj << /Type /Action >> endobj 89 0 obj << /Type /Annot /Subtype /Link /A 90 0 R /Border [0 0 0] /H /I /Rect [ 142.1602 237.2799 146.9788 246.0983 ] >> endobj 90 0 obj << /Type /Action >> endobj 91 0 obj << /Type /Annot /Subtype /Link /A 92 0 R /Border [0 0 0] /H /I /Rect [ 276.0645 225.3752 280.8832 234.1935 ] >> endobj 92 0 obj << /Type /Action >> endobj 93 0 obj << /Type /Annot /Subtype /Link /A 94 0 R /Border [0 0 0] /H /I /Rect [ 289.1003 182.1609 293.9189 190.9793 ] >> endobj 94 0 obj << /Type /Action >> endobj 95 0 obj << /Type /Annot /Subtype /Link /A 96 0 R /Border [0 0 0] /H /I /Rect [ 47.3783 146.4467 52.1969 155.2650 ] >> endobj 96 0 obj << /Type /Action >> endobj 97 0 obj << /Type /Annot /Subtype /Link /A 98 0 R /Border [0 0 0] /H /I /Rect [ 166.6110 134.5419 171.4297 143.3602 ] >> endobj 98 0 obj << /Type /Action >> endobj 99 0 obj << /Type /Annot /Subtype /Link /A 100 0 R /Border [0 0 0] /H /I /Rect [ 213.7425 122.6372 218.5612 131.4555 ] >> endobj 100 0 obj << /Type /Action >> endobj 101 0 obj << /Type /Annot /Subtype /Link /A 102 0 R /Border [0 0 0] /H /I /Rect [ 371.4293 91.3277 376.2479 100.1460 ] >> endobj 102 0 obj << /Type /Action >> endobj 103 0 obj << /Type /Annot /Subtype /Link /A 104 0 R /Border [0 0 0] /H /I /Rect [ 503.0369 91.3277 512.6743 100.1460 ] >> endobj 104 0 obj << /Type /Action >> endobj 105 0 obj << /Type /Annot /Subtype /Link /A 106 0 R /Border [0 0 0] /H /I /Rect [ 205.0747 67.5182 214.7121 76.3365 ] >> endobj 106 0 obj << /Type /Action >> endobj 107 0 obj << /Type /Annot /Subtype /Link /A 108 0 R /Border [0 0 0] /H /I /Rect [ 445.1587 55.6134 454.7961 64.4317 ] >> endobj 108 0 obj << /Type /Action >> endobj 109 0 obj << /Type /Annot /Subtype /Link /A 110 0 R /Border [0 0 0] /H /I /Rect [ 362.2350 43.7087 371.8723 52.5270 ] >> endobj 110 0 obj << /Type /Action >> endobj 111 0 obj << /Type /Annot /Subtype /Link /A 112 0 R /Border [0 0 0] /H /I /Rect [ 480.3367 684.8484 485.1554 693.6667 ] >> endobj 112 0 obj << /Type /Action >> endobj 113 0 obj << /Type /Annot /Subtype /Link /A 114 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 467.4525 260.2500 640.7025 ] >> endobj 114 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/10/Figure-2.-Data-abstraction-tool-7.27.12.jpg) >> endobj 115 0 obj << /Type /Annot /Subtype /Link /A 116 0 R /Border [0 0 0] /H /I /Rect [ 214.8150 261.0894 219.6337 269.9078 ] >> endobj 116 0 obj << /Type /Action >> endobj 117 0 obj << /Type /Annot /Subtype /Link /A 118 0 R /Border [0 0 0] /H /I /Rect [ 219.6337 261.0894 224.4523 269.9078 ] >> endobj 118 0 obj << /Type /Action >> endobj 119 0 obj << /Type /Annot /Subtype /Link /A 120 0 R /Border [0 0 0] /H /I /Rect [ 272.1493 261.0894 276.9680 269.9078 ] >> endobj 120 0 obj << /Type /Action >> endobj 121 0 obj << /Type /Annot /Subtype /Link /A 122 0 R /Border [0 0 0] /H /I /Rect [ 151.9762 249.1847 156.7949 258.0030 ] >> endobj 122 0 obj << /Type /Action >> endobj 123 0 obj << /Type /Annot /Subtype /Link /A 124 0 R /Border [0 0 0] /H /I /Rect [ 137.3415 237.2799 142.1602 246.0983 ] >> endobj 124 0 obj << /Type /Action >> endobj 125 0 obj << /Type /Annot /Subtype /Link /A 126 0 R /Border [0 0 0] /H /I /Rect [ 142.1602 237.2799 146.9788 246.0983 ] >> endobj 126 0 obj << /Type /Action >> endobj 127 0 obj << /Type /Annot /Subtype /Link /A 128 0 R /Border [0 0 0] /H /I /Rect [ 276.0645 225.3752 280.8832 234.1935 ] >> endobj 128 0 obj << /Type /Action >> endobj 129 0 obj << /Type /Annot /Subtype /Link /A 130 0 R /Border [0 0 0] /H /I /Rect [ 289.1003 182.1609 293.9189 190.9793 ] >> endobj 130 0 obj << /Type /Action >> endobj 131 0 obj << /Type /Annot /Subtype /Link /A 132 0 R /Border [0 0 0] /H /I /Rect [ 47.3783 146.4467 52.1969 155.2650 ] >> endobj 132 0 obj << /Type /Action >> endobj 133 0 obj << /Type /Annot /Subtype /Link /A 134 0 R /Border [0 0 0] /H /I /Rect [ 166.6110 134.5419 171.4297 143.3602 ] >> endobj 134 0 obj << /Type /Action >> endobj 135 0 obj << /Type /Annot /Subtype /Link /A 136 0 R /Border [0 0 0] /H /I /Rect [ 213.7425 122.6372 218.5612 131.4555 ] >> endobj 136 0 obj << /Type /Action >> endobj 137 0 obj << /Type /Annot /Subtype /Link /A 138 0 R /Border [0 0 0] /H /I /Rect [ 371.4293 91.3277 376.2479 100.1460 ] >> endobj 138 0 obj << /Type /Action >> endobj 139 0 obj << /Type /Annot /Subtype /Link /A 140 0 R /Border [0 0 0] /H /I /Rect [ 503.0369 91.3277 512.6743 100.1460 ] >> endobj 140 0 obj << /Type /Action >> endobj 141 0 obj << /Type /Annot /Subtype /Link /A 142 0 R /Border [0 0 0] /H /I /Rect [ 205.0747 67.5182 214.7121 76.3365 ] >> endobj 142 0 obj << /Type /Action >> endobj 143 0 obj << /Type /Annot /Subtype /Link /A 144 0 R /Border [0 0 0] /H /I /Rect [ 445.1587 55.6134 454.7961 64.4317 ] >> endobj 144 0 obj << /Type /Action >> endobj 145 0 obj << /Type /Annot /Subtype /Link /A 146 0 R /Border [0 0 0] /H /I /Rect [ 362.2350 43.7087 371.8723 52.5270 ] >> endobj 146 0 obj << /Type /Action >> endobj 147 0 obj << /Type /Annot /Subtype /Link /A 148 0 R /Border [0 0 0] /H /I /Rect [ 480.3367 684.8484 485.1554 693.6667 ] >> endobj 148 0 obj << /Type /Action >> endobj 149 0 obj << /Type /Annot /Subtype /Link /A 150 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 467.4525 260.2500 640.7025 ] >> endobj 150 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/10/Figure-2.-Data-abstraction-tool-7.27.12.jpg) >> endobj 151 0 obj << /Type /Annot /Subtype /Link /A 152 0 R /Border [0 0 0] /H /I /Rect [ 214.8150 261.0894 219.6337 269.9078 ] >> endobj 152 0 obj << /Type /Action >> endobj 153 0 obj << /Type /Annot /Subtype /Link /A 154 0 R /Border [0 0 0] /H /I /Rect [ 219.6337 261.0894 224.4523 269.9078 ] >> endobj 154 0 obj << /Type /Action >> endobj 155 0 obj << /Type /Annot /Subtype /Link /A 156 0 R /Border [0 0 0] /H /I /Rect [ 272.1493 261.0894 276.9680 269.9078 ] >> endobj 156 0 obj << /Type /Action >> endobj 157 0 obj << /Type /Annot /Subtype /Link /A 158 0 R /Border [0 0 0] /H /I /Rect [ 151.9762 249.1847 156.7949 258.0030 ] >> endobj 158 0 obj << /Type /Action >> endobj 159 0 obj << /Type /Annot /Subtype /Link /A 160 0 R /Border [0 0 0] /H /I /Rect [ 137.3415 237.2799 142.1602 246.0983 ] >> endobj 160 0 obj << /Type /Action >> endobj 161 0 obj << /Type /Annot /Subtype /Link /A 162 0 R /Border [0 0 0] /H /I /Rect [ 142.1602 237.2799 146.9788 246.0983 ] >> endobj 162 0 obj << /Type /Action >> endobj 163 0 obj << /Type /Annot /Subtype /Link /A 164 0 R /Border [0 0 0] /H /I /Rect [ 276.0645 225.3752 280.8832 234.1935 ] >> endobj 164 0 obj << /Type /Action >> endobj 165 0 obj << /Type /Annot /Subtype /Link /A 166 0 R /Border [0 0 0] /H /I /Rect [ 289.1003 182.1609 293.9189 190.9793 ] >> endobj 166 0 obj << /Type /Action >> endobj 167 0 obj << /Type /Annot /Subtype /Link /A 168 0 R /Border [0 0 0] /H /I /Rect [ 47.3783 146.4467 52.1969 155.2650 ] >> endobj 168 0 obj << /Type /Action >> endobj 169 0 obj << /Type /Annot /Subtype /Link /A 170 0 R /Border [0 0 0] /H /I /Rect [ 166.6110 134.5419 171.4297 143.3602 ] >> endobj 170 0 obj << /Type /Action >> endobj 171 0 obj << /Type /Annot /Subtype /Link /A 172 0 R /Border [0 0 0] /H /I /Rect [ 213.7425 122.6372 218.5612 131.4555 ] >> endobj 172 0 obj << /Type /Action >> endobj 173 0 obj << /Type /Annot /Subtype /Link /A 174 0 R /Border [0 0 0] /H /I /Rect [ 371.4293 91.3277 376.2479 100.1460 ] >> endobj 174 0 obj << /Type /Action >> endobj 175 0 obj << /Type /Annot /Subtype /Link /A 176 0 R /Border [0 0 0] /H /I /Rect [ 503.0369 91.3277 512.6743 100.1460 ] >> endobj 176 0 obj << /Type /Action >> endobj 177 0 obj << /Type /Annot /Subtype /Link /A 178 0 R /Border [0 0 0] /H /I /Rect [ 205.0747 67.5182 214.7121 76.3365 ] >> endobj 178 0 obj << /Type /Action >> endobj 179 0 obj << /Type /Annot /Subtype /Link /A 180 0 R /Border [0 0 0] /H /I /Rect [ 445.1587 55.6134 454.7961 64.4317 ] >> endobj 180 0 obj << /Type /Action >> endobj 181 0 obj << /Type /Annot /Subtype /Link /A 182 0 R /Border [0 0 0] /H /I /Rect [ 362.2350 43.7087 371.8723 52.5270 ] >> endobj 182 0 obj << /Type /Action >> endobj 183 0 obj << /Type /Page /Parent 3 0 R /Annots [ 185 0 R 187 0 R 189 0 R 191 0 R 193 0 R 195 0 R 197 0 R 199 0 R 201 0 R 203 0 R 205 0 R 207 0 R 209 0 R 211 0 R 213 0 R 215 0 R 217 0 R 219 0 R 221 0 R 223 0 R 225 0 R 227 0 R 229 0 R 231 0 R 233 0 R 235 0 R 237 0 R 239 0 R 241 0 R 243 0 R 245 0 R 247 0 R 249 0 R 251 0 R 253 0 R 255 0 R 257 0 R 259 0 R 261 0 R 263 0 R 265 0 R 267 0 R 269 0 R 271 0 R 273 0 R 275 0 R 277 0 R 279 0 R 281 0 R 283 0 R 285 0 R 287 0 R 289 0 R 291 0 R 293 0 R 295 0 R 297 0 R 299 0 R 301 0 R 303 0 R 305 0 R 307 0 R 309 0 R 311 0 R 313 0 R 315 0 R 317 0 R 319 0 R 321 0 R 323 0 R 325 0 R 327 0 R 329 0 R 331 0 R 333 0 R 335 0 R 337 0 R 339 0 R 341 0 R 343 0 R 345 0 R 347 0 R 349 0 R 351 0 R 353 0 R 355 0 R 357 0 R 359 0 R 361 0 R 363 0 R 365 0 R 367 0 R 369 0 R ] /Contents 184 0 R >> endobj 184 0 obj << /Length 36904 >> stream 0.271 0.267 0.267 rg q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(disaster emotional status was a strong predictor of individual perception of earthquake impact, as well as post-disaster distress. )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(Findings make salient the impact of disaster on vulnerable populations )] TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. Overall, these studies point to the importance of outreach and service provision to disaster survivors who )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(struggle with or are at risk for emotional illness following disasters.)] TJ ET BT 26.250 712.357 Td /F4 9.8 Tf [(Effects of Disaster on General Health Services Use)] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(Eight studies address general health services use affected by disaster. From the providers perspective, it is challenging to )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(provide continuity of care because of several barriers including limited or compromised communication infrastructure )] TJ ET 0.267 0.267 0.267 rg BT 530.169 682.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 539.806 681.048 Td /F1 9.8 Tf [(, lack of )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(records )] TJ ET 0.267 0.267 0.267 rg BT 61.467 670.650 Td /F4 8.7 Tf [(15)] TJ ET BT 71.104 670.650 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 80.742 669.143 Td /F1 9.8 Tf [( and uncertainty regarding best practices )] TJ ET 0.267 0.267 0.267 rg BT 259.576 670.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 269.214 669.143 Td /F1 9.8 Tf [(. Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. Volunteer practitioners should be thus versed in treating pediatric )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(patients and knowledgeable about types of post-disaster conditions they would likely treat through the mobile clinic and DAC )] TJ ET 0.267 0.267 0.267 rg BT 564.918 591.722 Td /F4 8.7 Tf [(16)] TJ ET BT 26.250 579.817 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 578.310 Td /F1 9.8 Tf [(. Despite reports of effective response immediately following the disaster, there was a call for increased provision of follow-up )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(healthcare services after the first 72 hours following disaster )] TJ ET 0.267 0.267 0.267 rg BT 287.979 567.912 Td /F4 8.7 Tf [(15)] TJ ET BT 297.616 567.912 Td /F4 8.7 Tf [(16)] TJ ET BT 307.254 567.912 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 316.891 566.405 Td /F1 9.8 Tf [(. One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. Prior to the Northridge earthquake, published information about )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(data collection during a disaster was particularly sparse. Ten years later the VA Computerized Patient Record System \(CPRS\) )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(was implemented, technology that made it possible for every VA provider across the nation to access any veterans health care )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(records, was released and is credited with making the VA response to Hurricane Katrina a successful one. CPRS supported )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(continuity of care because the electronic medical records included not only prescriptions and lab results, but also case notes )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(and other documents critical to care provision )] TJ ET 0.267 0.267 0.267 rg BT 225.121 338.627 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 234.758 337.119 Td /F1 9.8 Tf [(. Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. In some )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(cases, administrators may not be available, so staff should be empowered to make decisions, if necessary. Moreover, the )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(normal chain of command needs to be modified in the case of a disaster )] TJ ET 0.267 0.267 0.267 rg BT 340.024 204.579 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 349.662 203.072 Td /F1 9.8 Tf [(. There was a call for a redefinition of essential )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(personnel during a disaster, placing emphasis on the importance of facilities management for tasks such as laundering and )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(those with experience arranging transfer of patients, such as social workers, case managers and medical administrators )] TJ ET 0.267 0.267 0.267 rg BT 545.369 180.770 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 555.007 179.262 Td /F1 9.8 Tf [(. The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. Pre-existing agreements with community )] TJ ET BT 26.250 136.048 Td /F1 9.8 Tf [(resources and hospital facilities that could host evacuated veterans was cited as critical to the evacuation )] TJ ET 0.267 0.267 0.267 rg BT 482.004 137.555 Td /F4 8.7 Tf [(26)] TJ ET BT 491.641 137.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 501.279 136.048 Td /F1 9.8 Tf [(, as was on-the-)] TJ ET BT 26.250 124.143 Td /F1 9.8 Tf [(spot collaboration with local entities, such as the fire department and other medical centers )] TJ ET 0.267 0.267 0.267 rg BT 420.218 125.651 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 429.856 124.143 Td /F1 9.8 Tf [(. It was noted in one case )] TJ ET 0.267 0.267 0.267 rg BT 543.131 125.651 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 552.768 124.143 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 112.239 Td /F1 9.8 Tf [(though, that despite pre-arrangements with local hospitals, the plan was negated by local city government. The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. Challenges to )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(disaster emotional status was a strong predictor of individual perception of earthquake impact, as well as post-disaster distress. )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(Findings make salient the impact of disaster on vulnerable populations )] TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. Overall, these studies point to the importance of outreach and service provision to disaster survivors who )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(struggle with or are at risk for emotional illness following disasters.)] TJ ET BT 26.250 712.357 Td /F4 9.8 Tf [(Effects of Disaster on General Health Services Use)] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(Eight studies address general health services use affected by disaster. From the providers perspective, it is challenging to )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(provide continuity of care because of several barriers including limited or compromised communication infrastructure )] TJ ET 0.267 0.267 0.267 rg BT 530.169 682.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 539.806 681.048 Td /F1 9.8 Tf [(, lack of )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(records )] TJ ET 0.267 0.267 0.267 rg BT 61.467 670.650 Td /F4 8.7 Tf [(15)] TJ ET BT 71.104 670.650 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 80.742 669.143 Td /F1 9.8 Tf [( and uncertainty regarding best practices )] TJ ET 0.267 0.267 0.267 rg BT 259.576 670.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 269.214 669.143 Td /F1 9.8 Tf [(. Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. Volunteer practitioners should be thus versed in treating pediatric )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(patients and knowledgeable about types of post-disaster conditions they would likely treat through the mobile clinic and DAC )] TJ ET 0.267 0.267 0.267 rg BT 564.918 591.722 Td /F4 8.7 Tf [(16)] TJ ET BT 26.250 579.817 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 578.310 Td /F1 9.8 Tf [(. Despite reports of effective response immediately following the disaster, there was a call for increased provision of follow-up )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(healthcare services after the first 72 hours following disaster )] TJ ET 0.267 0.267 0.267 rg BT 287.979 567.912 Td /F4 8.7 Tf [(15)] TJ ET BT 297.616 567.912 Td /F4 8.7 Tf [(16)] TJ ET BT 307.254 567.912 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 316.891 566.405 Td /F1 9.8 Tf [(. One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. Prior to the Northridge earthquake, published information about )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(data collection during a disaster was particularly sparse. Ten years later the VA Computerized Patient Record System \(CPRS\) )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(was implemented, technology that made it possible for every VA provider across the nation to access any veterans health care )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(records, was released and is credited with making the VA response to Hurricane Katrina a successful one. CPRS supported )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(continuity of care because the electronic medical records included not only prescriptions and lab results, but also case notes )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(and other documents critical to care provision )] TJ ET 0.267 0.267 0.267 rg BT 225.121 338.627 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 234.758 337.119 Td /F1 9.8 Tf [(. Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. In some )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(cases, administrators may not be available, so staff should be empowered to make decisions, if necessary. Moreover, the )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(normal chain of command needs to be modified in the case of a disaster )] TJ ET 0.267 0.267 0.267 rg BT 340.024 204.579 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 349.662 203.072 Td /F1 9.8 Tf [(. There was a call for a redefinition of essential )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(personnel during a disaster, placing emphasis on the importance of facilities management for tasks such as laundering and )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(those with experience arranging transfer of patients, such as social workers, case managers and medical administrators )] TJ ET 0.267 0.267 0.267 rg BT 545.369 180.770 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 555.007 179.262 Td /F1 9.8 Tf [(. The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. Pre-existing agreements with community )] TJ ET BT 26.250 136.048 Td /F1 9.8 Tf [(resources and hospital facilities that could host evacuated veterans was cited as critical to the evacuation )] TJ ET 0.267 0.267 0.267 rg BT 482.004 137.555 Td /F4 8.7 Tf [(26)] TJ ET BT 491.641 137.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 501.279 136.048 Td /F1 9.8 Tf [(, as was on-the-)] TJ ET BT 26.250 124.143 Td /F1 9.8 Tf [(spot collaboration with local entities, such as the fire department and other medical centers )] TJ ET 0.267 0.267 0.267 rg BT 420.218 125.651 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 429.856 124.143 Td /F1 9.8 Tf [(. It was noted in one case )] TJ ET 0.267 0.267 0.267 rg BT 543.131 125.651 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 552.768 124.143 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 112.239 Td /F1 9.8 Tf [(though, that despite pre-arrangements with local hospitals, the plan was negated by local city government. The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. Challenges to )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(disaster emotional status was a strong predictor of individual perception of earthquake impact, as well as post-disaster distress. )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(Findings make salient the impact of disaster on vulnerable populations )] TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. Overall, these studies point to the importance of outreach and service provision to disaster survivors who )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(struggle with or are at risk for emotional illness following disasters.)] TJ ET BT 26.250 712.357 Td /F4 9.8 Tf [(Effects of Disaster on General Health Services Use)] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(Eight studies address general health services use affected by disaster. From the providers perspective, it is challenging to )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(provide continuity of care because of several barriers including limited or compromised communication infrastructure )] TJ ET 0.267 0.267 0.267 rg BT 530.169 682.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 539.806 681.048 Td /F1 9.8 Tf [(, lack of )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(records )] TJ ET 0.267 0.267 0.267 rg BT 61.467 670.650 Td /F4 8.7 Tf [(15)] TJ ET BT 71.104 670.650 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 80.742 669.143 Td /F1 9.8 Tf [( and uncertainty regarding best practices )] TJ ET 0.267 0.267 0.267 rg BT 259.576 670.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 269.214 669.143 Td /F1 9.8 Tf [(. Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. Volunteer practitioners should be thus versed in treating pediatric )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(patients and knowledgeable about types of post-disaster conditions they would likely treat through the mobile clinic and DAC )] TJ ET 0.267 0.267 0.267 rg BT 564.918 591.722 Td /F4 8.7 Tf [(16)] TJ ET BT 26.250 579.817 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 578.310 Td /F1 9.8 Tf [(. Despite reports of effective response immediately following the disaster, there was a call for increased provision of follow-up )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(healthcare services after the first 72 hours following disaster )] TJ ET 0.267 0.267 0.267 rg BT 287.979 567.912 Td /F4 8.7 Tf [(15)] TJ ET BT 297.616 567.912 Td /F4 8.7 Tf [(16)] TJ ET BT 307.254 567.912 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 316.891 566.405 Td /F1 9.8 Tf [(. One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. Prior to the Northridge earthquake, published information about )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(data collection during a disaster was particularly sparse. Ten years later the VA Computerized Patient Record System \(CPRS\) )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(was implemented, technology that made it possible for every VA provider across the nation to access any veterans health care )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(records, was released and is credited with making the VA response to Hurricane Katrina a successful one. CPRS supported )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(continuity of care because the electronic medical records included not only prescriptions and lab results, but also case notes )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(and other documents critical to care provision )] TJ ET 0.267 0.267 0.267 rg BT 225.121 338.627 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 234.758 337.119 Td /F1 9.8 Tf [(. Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. In some )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(cases, administrators may not be available, so staff should be empowered to make decisions, if necessary. Moreover, the )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(normal chain of command needs to be modified in the case of a disaster )] TJ ET 0.267 0.267 0.267 rg BT 340.024 204.579 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 349.662 203.072 Td /F1 9.8 Tf [(. There was a call for a redefinition of essential )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(personnel during a disaster, placing emphasis on the importance of facilities management for tasks such as laundering and )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(those with experience arranging transfer of patients, such as social workers, case managers and medical administrators )] TJ ET 0.267 0.267 0.267 rg BT 545.369 180.770 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 555.007 179.262 Td /F1 9.8 Tf [(. The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. Pre-existing agreements with community )] TJ ET BT 26.250 136.048 Td /F1 9.8 Tf [(resources and hospital facilities that could host evacuated veterans was cited as critical to the evacuation )] TJ ET 0.267 0.267 0.267 rg BT 482.004 137.555 Td /F4 8.7 Tf [(26)] TJ ET BT 491.641 137.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 501.279 136.048 Td /F1 9.8 Tf [(, as was on-the-)] TJ ET BT 26.250 124.143 Td /F1 9.8 Tf [(spot collaboration with local entities, such as the fire department and other medical centers )] TJ ET 0.267 0.267 0.267 rg BT 420.218 125.651 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 429.856 124.143 Td /F1 9.8 Tf [(. It was noted in one case )] TJ ET 0.267 0.267 0.267 rg BT 543.131 125.651 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 552.768 124.143 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 112.239 Td /F1 9.8 Tf [(though, that despite pre-arrangements with local hospitals, the plan was negated by local city government. The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. Challenges to )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 185 0 obj << /Type /Annot /Subtype /Link /A 186 0 R /Border [0 0 0] /H /I /Rect [ 332.4293 756.2769 342.0666 765.0952 ] >> endobj 186 0 obj << /Type /Action >> endobj 187 0 obj << /Type /Annot /Subtype /Link /A 188 0 R /Border [0 0 0] /H /I /Rect [ 342.0666 756.2769 351.7039 765.0952 ] >> endobj 188 0 obj << /Type /Action >> endobj 189 0 obj << /Type /Annot /Subtype /Link /A 190 0 R /Border [0 0 0] /H /I /Rect [ 530.1690 681.7532 539.8063 690.5715 ] >> endobj 190 0 obj << /Type /Action >> endobj 191 0 obj << /Type /Annot /Subtype /Link /A 192 0 R /Border [0 0 0] /H /I /Rect [ 61.4670 669.8484 71.1043 678.6667 ] >> endobj 192 0 obj << /Type /Action >> endobj 193 0 obj << /Type /Annot /Subtype /Link /A 194 0 R /Border [0 0 0] /H /I /Rect [ 71.1043 669.8484 80.7417 678.6667 ] >> endobj 194 0 obj << /Type /Action >> endobj 195 0 obj << /Type /Annot /Subtype /Link /A 196 0 R /Border [0 0 0] /H /I /Rect [ 259.5762 669.8484 269.2135 678.6667 ] >> endobj 196 0 obj << /Type /Action >> endobj 197 0 obj << /Type /Annot /Subtype /Link /A 198 0 R /Border [0 0 0] /H /I /Rect [ 487.9613 657.9437 497.5986 666.7620 ] >> endobj 198 0 obj << /Type /Action >> endobj 199 0 obj << /Type /Annot /Subtype /Link /A 200 0 R /Border [0 0 0] /H /I /Rect [ 564.9180 590.9199 574.5553 599.7382 ] >> endobj 200 0 obj << /Type /Action >> endobj 201 0 obj << /Type /Annot /Subtype /Link /A 202 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 579.0152 35.8873 587.8335 ] >> endobj 202 0 obj << /Type /Action >> endobj 203 0 obj << /Type /Annot /Subtype /Link /A 204 0 R /Border [0 0 0] /H /I /Rect [ 287.9790 567.1104 297.6163 575.9287 ] >> endobj 204 0 obj << /Type /Action >> endobj 205 0 obj << /Type /Annot /Subtype /Link /A 206 0 R /Border [0 0 0] /H /I /Rect [ 297.6163 567.1104 307.2537 575.9287 ] >> endobj 206 0 obj << /Type /Action >> endobj 207 0 obj << /Type /Annot /Subtype /Link /A 208 0 R /Border [0 0 0] /H /I /Rect [ 307.2537 567.1104 316.8910 575.9287 ] >> endobj 208 0 obj << /Type /Action >> endobj 209 0 obj << /Type /Annot /Subtype /Link /A 210 0 R /Border [0 0 0] /H /I /Rect [ 136.2398 543.3009 145.8771 552.1192 ] >> endobj 210 0 obj << /Type /Action >> endobj 211 0 obj << /Type /Annot /Subtype /Link /A 212 0 R /Border [0 0 0] /H /I /Rect [ 84.2332 519.4914 93.8706 528.3097 ] >> endobj 212 0 obj << /Type /Action >> endobj 213 0 obj << /Type /Annot /Subtype /Link /A 214 0 R /Border [0 0 0] /H /I /Rect [ 361.5861 519.4914 371.2234 528.3097 ] >> endobj 214 0 obj << /Type /Action >> endobj 215 0 obj << /Type /Annot /Subtype /Link /A 216 0 R /Border [0 0 0] /H /I /Rect [ 371.2234 519.4914 380.8608 528.3097 ] >> endobj 216 0 obj << /Type /Action >> endobj 217 0 obj << /Type /Annot /Subtype /Link /A 218 0 R /Border [0 0 0] /H /I /Rect [ 121.6148 507.5867 131.2521 516.4050 ] >> endobj 218 0 obj << /Type /Action >> endobj 219 0 obj << /Type /Annot /Subtype /Link /A 220 0 R /Border [0 0 0] /H /I /Rect [ 547.5142 456.8724 557.1516 465.6907 ] >> endobj 220 0 obj << /Type /Action >> endobj 221 0 obj << /Type /Annot /Subtype /Link /A 222 0 R /Border [0 0 0] /H /I /Rect [ 225.1207 337.8249 234.7581 346.6433 ] >> endobj 222 0 obj << /Type /Action >> endobj 223 0 obj << /Type /Annot /Subtype /Link /A 224 0 R /Border [0 0 0] /H /I /Rect [ 443.5013 314.0154 453.1386 322.8338 ] >> endobj 224 0 obj << /Type /Action >> endobj 225 0 obj << /Type /Annot /Subtype /Link /A 226 0 R /Border [0 0 0] /H /I /Rect [ 506.9348 227.5869 516.5721 236.4053 ] >> endobj 226 0 obj << /Type /Action >> endobj 227 0 obj << /Type /Annot /Subtype /Link /A 228 0 R /Border [0 0 0] /H /I /Rect [ 340.0245 203.7774 349.6618 212.5958 ] >> endobj 228 0 obj << /Type /Action >> endobj 229 0 obj << /Type /Annot /Subtype /Link /A 230 0 R /Border [0 0 0] /H /I /Rect [ 545.3692 179.9679 555.0066 188.7862 ] >> endobj 230 0 obj << /Type /Action >> endobj 231 0 obj << /Type /Annot /Subtype /Link /A 232 0 R /Border [0 0 0] /H /I /Rect [ 381.7253 168.0632 391.3626 176.8815 ] >> endobj 232 0 obj << /Type /Action >> endobj 233 0 obj << /Type /Annot /Subtype /Link /A 234 0 R /Border [0 0 0] /H /I /Rect [ 391.3626 168.0632 400.9999 176.8815 ] >> endobj 234 0 obj << /Type /Action >> endobj 235 0 obj << /Type /Annot /Subtype /Link /A 236 0 R /Border [0 0 0] /H /I /Rect [ 482.0040 136.7537 491.6413 145.5720 ] >> endobj 236 0 obj << /Type /Action >> endobj 237 0 obj << /Type /Annot /Subtype /Link /A 238 0 R /Border [0 0 0] /H /I /Rect [ 491.6413 136.7537 501.2787 145.5720 ] >> endobj 238 0 obj << /Type /Action >> endobj 239 0 obj << /Type /Annot /Subtype /Link /A 240 0 R /Border [0 0 0] /H /I /Rect [ 420.2183 124.8489 429.8556 133.6672 ] >> endobj 240 0 obj << /Type /Action >> endobj 241 0 obj << /Type /Annot /Subtype /Link /A 242 0 R /Border [0 0 0] /H /I /Rect [ 543.1311 124.8489 552.7684 133.6672 ] >> endobj 242 0 obj << /Type /Action >> endobj 243 0 obj << /Type /Annot /Subtype /Link /A 244 0 R /Border [0 0 0] /H /I /Rect [ 387.1950 45.9204 396.8323 54.7387 ] >> endobj 244 0 obj << /Type /Action >> endobj 245 0 obj << /Type /Annot /Subtype /Link /A 246 0 R /Border [0 0 0] /H /I /Rect [ 490.0521 45.9204 499.6894 54.7387 ] >> endobj 246 0 obj << /Type /Action >> endobj 247 0 obj << /Type /Annot /Subtype /Link /A 248 0 R /Border [0 0 0] /H /I /Rect [ 332.4293 756.2769 342.0666 765.0952 ] >> endobj 248 0 obj << /Type /Action >> endobj 249 0 obj << /Type /Annot /Subtype /Link /A 250 0 R /Border [0 0 0] /H /I /Rect [ 342.0666 756.2769 351.7039 765.0952 ] >> endobj 250 0 obj << /Type /Action >> endobj 251 0 obj << /Type /Annot /Subtype /Link /A 252 0 R /Border [0 0 0] /H /I /Rect [ 530.1690 681.7532 539.8063 690.5715 ] >> endobj 252 0 obj << /Type /Action >> endobj 253 0 obj << /Type /Annot /Subtype /Link /A 254 0 R /Border [0 0 0] /H /I /Rect [ 61.4670 669.8484 71.1043 678.6667 ] >> endobj 254 0 obj << /Type /Action >> endobj 255 0 obj << /Type /Annot /Subtype /Link /A 256 0 R /Border [0 0 0] /H /I /Rect [ 71.1043 669.8484 80.7417 678.6667 ] >> endobj 256 0 obj << /Type /Action >> endobj 257 0 obj << /Type /Annot /Subtype /Link /A 258 0 R /Border [0 0 0] /H /I /Rect [ 259.5762 669.8484 269.2135 678.6667 ] >> endobj 258 0 obj << /Type /Action >> endobj 259 0 obj << /Type /Annot /Subtype /Link /A 260 0 R /Border [0 0 0] /H /I /Rect [ 487.9613 657.9437 497.5986 666.7620 ] >> endobj 260 0 obj << /Type /Action >> endobj 261 0 obj << /Type /Annot /Subtype /Link /A 262 0 R /Border [0 0 0] /H /I /Rect [ 564.9180 590.9199 574.5553 599.7382 ] >> endobj 262 0 obj << /Type /Action >> endobj 263 0 obj << /Type /Annot /Subtype /Link /A 264 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 579.0152 35.8873 587.8335 ] >> endobj 264 0 obj << /Type /Action >> endobj 265 0 obj << /Type /Annot /Subtype /Link /A 266 0 R /Border [0 0 0] /H /I /Rect [ 287.9790 567.1104 297.6163 575.9287 ] >> endobj 266 0 obj << /Type /Action >> endobj 267 0 obj << /Type /Annot /Subtype /Link /A 268 0 R /Border [0 0 0] /H /I /Rect [ 297.6163 567.1104 307.2537 575.9287 ] >> endobj 268 0 obj << /Type /Action >> endobj 269 0 obj << /Type /Annot /Subtype /Link /A 270 0 R /Border [0 0 0] /H /I /Rect [ 307.2537 567.1104 316.8910 575.9287 ] >> endobj 270 0 obj << /Type /Action >> endobj 271 0 obj << /Type /Annot /Subtype /Link /A 272 0 R /Border [0 0 0] /H /I /Rect [ 136.2398 543.3009 145.8771 552.1192 ] >> endobj 272 0 obj << /Type /Action >> endobj 273 0 obj << /Type /Annot /Subtype /Link /A 274 0 R /Border [0 0 0] /H /I /Rect [ 84.2332 519.4914 93.8706 528.3097 ] >> endobj 274 0 obj << /Type /Action >> endobj 275 0 obj << /Type /Annot /Subtype /Link /A 276 0 R /Border [0 0 0] /H /I /Rect [ 361.5861 519.4914 371.2234 528.3097 ] >> endobj 276 0 obj << /Type /Action >> endobj 277 0 obj << /Type /Annot /Subtype /Link /A 278 0 R /Border [0 0 0] /H /I /Rect [ 371.2234 519.4914 380.8608 528.3097 ] >> endobj 278 0 obj << /Type /Action >> endobj 279 0 obj << /Type /Annot /Subtype /Link /A 280 0 R /Border [0 0 0] /H /I /Rect [ 121.6148 507.5867 131.2521 516.4050 ] >> endobj 280 0 obj << /Type /Action >> endobj 281 0 obj << /Type /Annot /Subtype /Link /A 282 0 R /Border [0 0 0] /H /I /Rect [ 547.5142 456.8724 557.1516 465.6907 ] >> endobj 282 0 obj << /Type /Action >> endobj 283 0 obj << /Type /Annot /Subtype /Link /A 284 0 R /Border [0 0 0] /H /I /Rect [ 225.1207 337.8249 234.7581 346.6433 ] >> endobj 284 0 obj << /Type /Action >> endobj 285 0 obj << /Type /Annot /Subtype /Link /A 286 0 R /Border [0 0 0] /H /I /Rect [ 443.5013 314.0154 453.1386 322.8338 ] >> endobj 286 0 obj << /Type /Action >> endobj 287 0 obj << /Type /Annot /Subtype /Link /A 288 0 R /Border [0 0 0] /H /I /Rect [ 506.9348 227.5869 516.5721 236.4053 ] >> endobj 288 0 obj << /Type /Action >> endobj 289 0 obj << /Type /Annot /Subtype /Link /A 290 0 R /Border [0 0 0] /H /I /Rect [ 340.0245 203.7774 349.6618 212.5958 ] >> endobj 290 0 obj << /Type /Action >> endobj 291 0 obj << /Type /Annot /Subtype /Link /A 292 0 R /Border [0 0 0] /H /I /Rect [ 545.3692 179.9679 555.0066 188.7862 ] >> endobj 292 0 obj << /Type /Action >> endobj 293 0 obj << /Type /Annot /Subtype /Link /A 294 0 R /Border [0 0 0] /H /I /Rect [ 381.7253 168.0632 391.3626 176.8815 ] >> endobj 294 0 obj << /Type /Action >> endobj 295 0 obj << /Type /Annot /Subtype /Link /A 296 0 R /Border [0 0 0] /H /I /Rect [ 391.3626 168.0632 400.9999 176.8815 ] >> endobj 296 0 obj << /Type /Action >> endobj 297 0 obj << /Type /Annot /Subtype /Link /A 298 0 R /Border [0 0 0] /H /I /Rect [ 482.0040 136.7537 491.6413 145.5720 ] >> endobj 298 0 obj << /Type /Action >> endobj 299 0 obj << /Type /Annot /Subtype /Link /A 300 0 R /Border [0 0 0] /H /I /Rect [ 491.6413 136.7537 501.2787 145.5720 ] >> endobj 300 0 obj << /Type /Action >> endobj 301 0 obj << /Type /Annot /Subtype /Link /A 302 0 R /Border [0 0 0] /H /I /Rect [ 420.2183 124.8489 429.8556 133.6672 ] >> endobj 302 0 obj << /Type /Action >> endobj 303 0 obj << /Type /Annot /Subtype /Link /A 304 0 R /Border [0 0 0] /H /I /Rect [ 543.1311 124.8489 552.7684 133.6672 ] >> endobj 304 0 obj << /Type /Action >> endobj 305 0 obj << /Type /Annot /Subtype /Link /A 306 0 R /Border [0 0 0] /H /I /Rect [ 387.1950 45.9204 396.8323 54.7387 ] >> endobj 306 0 obj << /Type /Action >> endobj 307 0 obj << /Type /Annot /Subtype /Link /A 308 0 R /Border [0 0 0] /H /I /Rect [ 490.0521 45.9204 499.6894 54.7387 ] >> endobj 308 0 obj << /Type /Action >> endobj 309 0 obj << /Type /Annot /Subtype /Link /A 310 0 R /Border [0 0 0] /H /I /Rect [ 332.4293 756.2769 342.0666 765.0952 ] >> endobj 310 0 obj << /Type /Action >> endobj 311 0 obj << /Type /Annot /Subtype /Link /A 312 0 R /Border [0 0 0] /H /I /Rect [ 342.0666 756.2769 351.7039 765.0952 ] >> endobj 312 0 obj << /Type /Action >> endobj 313 0 obj << /Type /Annot /Subtype /Link /A 314 0 R /Border [0 0 0] /H /I /Rect [ 530.1690 681.7532 539.8063 690.5715 ] >> endobj 314 0 obj << /Type /Action >> endobj 315 0 obj << /Type /Annot /Subtype /Link /A 316 0 R /Border [0 0 0] /H /I /Rect [ 61.4670 669.8484 71.1043 678.6667 ] >> endobj 316 0 obj << /Type /Action >> endobj 317 0 obj << /Type /Annot /Subtype /Link /A 318 0 R /Border [0 0 0] /H /I /Rect [ 71.1043 669.8484 80.7417 678.6667 ] >> endobj 318 0 obj << /Type /Action >> endobj 319 0 obj << /Type /Annot /Subtype /Link /A 320 0 R /Border [0 0 0] /H /I /Rect [ 259.5762 669.8484 269.2135 678.6667 ] >> endobj 320 0 obj << /Type /Action >> endobj 321 0 obj << /Type /Annot /Subtype /Link /A 322 0 R /Border [0 0 0] /H /I /Rect [ 487.9613 657.9437 497.5986 666.7620 ] >> endobj 322 0 obj << /Type /Action >> endobj 323 0 obj << /Type /Annot /Subtype /Link /A 324 0 R /Border [0 0 0] /H /I /Rect [ 564.9180 590.9199 574.5553 599.7382 ] >> endobj 324 0 obj << /Type /Action >> endobj 325 0 obj << /Type /Annot /Subtype /Link /A 326 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 579.0152 35.8873 587.8335 ] >> endobj 326 0 obj << /Type /Action >> endobj 327 0 obj << /Type /Annot /Subtype /Link /A 328 0 R /Border [0 0 0] /H /I /Rect [ 287.9790 567.1104 297.6163 575.9287 ] >> endobj 328 0 obj << /Type /Action >> endobj 329 0 obj << /Type /Annot /Subtype /Link /A 330 0 R /Border [0 0 0] /H /I /Rect [ 297.6163 567.1104 307.2537 575.9287 ] >> endobj 330 0 obj << /Type /Action >> endobj 331 0 obj << /Type /Annot /Subtype /Link /A 332 0 R /Border [0 0 0] /H /I /Rect [ 307.2537 567.1104 316.8910 575.9287 ] >> endobj 332 0 obj << /Type /Action >> endobj 333 0 obj << /Type /Annot /Subtype /Link /A 334 0 R /Border [0 0 0] /H /I /Rect [ 136.2398 543.3009 145.8771 552.1192 ] >> endobj 334 0 obj << /Type /Action >> endobj 335 0 obj << /Type /Annot /Subtype /Link /A 336 0 R /Border [0 0 0] /H /I /Rect [ 84.2332 519.4914 93.8706 528.3097 ] >> endobj 336 0 obj << /Type /Action >> endobj 337 0 obj << /Type /Annot /Subtype /Link /A 338 0 R /Border [0 0 0] /H /I /Rect [ 361.5861 519.4914 371.2234 528.3097 ] >> endobj 338 0 obj << /Type /Action >> endobj 339 0 obj << /Type /Annot /Subtype /Link /A 340 0 R /Border [0 0 0] /H /I /Rect [ 371.2234 519.4914 380.8608 528.3097 ] >> endobj 340 0 obj << /Type /Action >> endobj 341 0 obj << /Type /Annot /Subtype /Link /A 342 0 R /Border [0 0 0] /H /I /Rect [ 121.6148 507.5867 131.2521 516.4050 ] >> endobj 342 0 obj << /Type /Action >> endobj 343 0 obj << /Type /Annot /Subtype /Link /A 344 0 R /Border [0 0 0] /H /I /Rect [ 547.5142 456.8724 557.1516 465.6907 ] >> endobj 344 0 obj << /Type /Action >> endobj 345 0 obj << /Type /Annot /Subtype /Link /A 346 0 R /Border [0 0 0] /H /I /Rect [ 225.1207 337.8249 234.7581 346.6433 ] >> endobj 346 0 obj << /Type /Action >> endobj 347 0 obj << /Type /Annot /Subtype /Link /A 348 0 R /Border [0 0 0] /H /I /Rect [ 443.5013 314.0154 453.1386 322.8338 ] >> endobj 348 0 obj << /Type /Action >> endobj 349 0 obj << /Type /Annot /Subtype /Link /A 350 0 R /Border [0 0 0] /H /I /Rect [ 506.9348 227.5869 516.5721 236.4053 ] >> endobj 350 0 obj << /Type /Action >> endobj 351 0 obj << /Type /Annot /Subtype /Link /A 352 0 R /Border [0 0 0] /H /I /Rect [ 340.0245 203.7774 349.6618 212.5958 ] >> endobj 352 0 obj << /Type /Action >> endobj 353 0 obj << /Type /Annot /Subtype /Link /A 354 0 R /Border [0 0 0] /H /I /Rect [ 545.3692 179.9679 555.0066 188.7862 ] >> endobj 354 0 obj << /Type /Action >> endobj 355 0 obj << /Type /Annot /Subtype /Link /A 356 0 R /Border [0 0 0] /H /I /Rect [ 381.7253 168.0632 391.3626 176.8815 ] >> endobj 356 0 obj << /Type /Action >> endobj 357 0 obj << /Type /Annot /Subtype /Link /A 358 0 R /Border [0 0 0] /H /I /Rect [ 391.3626 168.0632 400.9999 176.8815 ] >> endobj 358 0 obj << /Type /Action >> endobj 359 0 obj << /Type /Annot /Subtype /Link /A 360 0 R /Border [0 0 0] /H /I /Rect [ 482.0040 136.7537 491.6413 145.5720 ] >> endobj 360 0 obj << /Type /Action >> endobj 361 0 obj << /Type /Annot /Subtype /Link /A 362 0 R /Border [0 0 0] /H /I /Rect [ 491.6413 136.7537 501.2787 145.5720 ] >> endobj 362 0 obj << /Type /Action >> endobj 363 0 obj << /Type /Annot /Subtype /Link /A 364 0 R /Border [0 0 0] /H /I /Rect [ 420.2183 124.8489 429.8556 133.6672 ] >> endobj 364 0 obj << /Type /Action >> endobj 365 0 obj << /Type /Annot /Subtype /Link /A 366 0 R /Border [0 0 0] /H /I /Rect [ 543.1311 124.8489 552.7684 133.6672 ] >> endobj 366 0 obj << /Type /Action >> endobj 367 0 obj << /Type /Annot /Subtype /Link /A 368 0 R /Border [0 0 0] /H /I /Rect [ 387.1950 45.9204 396.8323 54.7387 ] >> endobj 368 0 obj << /Type /Action >> endobj 369 0 obj << /Type /Annot /Subtype /Link /A 370 0 R /Border [0 0 0] /H /I /Rect [ 490.0521 45.9204 499.6894 54.7387 ] >> endobj 370 0 obj << /Type /Action >> endobj 371 0 obj << /Type /Page /Parent 3 0 R /Annots [ 373 0 R 375 0 R 377 0 R 379 0 R 381 0 R 383 0 R 385 0 R 387 0 R 389 0 R 391 0 R 393 0 R 395 0 R 397 0 R 399 0 R 401 0 R 403 0 R 405 0 R 407 0 R 409 0 R 411 0 R 413 0 R 415 0 R 417 0 R 419 0 R 421 0 R 423 0 R 425 0 R 427 0 R 429 0 R 431 0 R 433 0 R 435 0 R 437 0 R 439 0 R 441 0 R 443 0 R 445 0 R 447 0 R 449 0 R 451 0 R 453 0 R 455 0 R 457 0 R 459 0 R 461 0 R 463 0 R 465 0 R 467 0 R 469 0 R 471 0 R 473 0 R 475 0 R 477 0 R 479 0 R 481 0 R 483 0 R 485 0 R 487 0 R 489 0 R 491 0 R 493 0 R 495 0 R 497 0 R 499 0 R 501 0 R 503 0 R 505 0 R 507 0 R 509 0 R 511 0 R 513 0 R 515 0 R 517 0 R 519 0 R 521 0 R ] /Contents 372 0 R >> endobj 372 0 obj << /Length 33547 >> stream 0.271 0.267 0.267 rg q 15.000 25.087 577.500 751.913 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(continuity of care in these and other disasters included pain management )] TJ ET 0.267 0.267 0.267 rg BT 344.909 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 354.547 767.476 Td /F1 9.8 Tf [( and providing care despite adverse weather )] TJ ET 0.267 0.267 0.267 rg BT 549.098 768.983 Td /F4 8.7 Tf [(26)] TJ ET BT 558.735 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(and loss of water and power )] TJ ET 0.267 0.267 0.267 rg BT 150.894 757.079 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 160.531 755.571 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(All of the studies detailed lessons learned and modifications in disaster planning that have been made since the disaster. These )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(include increased training, stocking indoor supplies, and the development of mitigation teams that supervise improvements in )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(disaster preparedness )] TJ ET 0.267 0.267 0.267 rg BT 125.417 713.864 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 135.055 712.357 Td /F1 9.8 Tf [(. The development of plans should take into account the need for prolonged recovery above and )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(beyond the acute disaster event )] TJ ET 0.267 0.267 0.267 rg BT 167.167 701.960 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 176.804 700.452 Td /F1 9.8 Tf [(, though plans should be flexible enough to allow for creative, on-the-spot problem solving [)] TJ ET 0.267 0.267 0.267 rg BT 26.250 690.055 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 35.887 688.548 Td /F1 9.8 Tf [(, p.156].)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(A disaster response framework )] TJ ET 0.267 0.267 0.267 rg BT 163.335 670.650 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 172.972 669.143 Td /F1 9.8 Tf [( makes salient the need to provide comprehensive care during evacuation, especially for )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(vulnerable nursing home residents. The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 15.000 25.087 577.500 751.913 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(continuity of care in these and other disasters included pain management )] TJ ET 0.267 0.267 0.267 rg BT 344.909 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 354.547 767.476 Td /F1 9.8 Tf [( and providing care despite adverse weather )] TJ ET 0.267 0.267 0.267 rg BT 549.098 768.983 Td /F4 8.7 Tf [(26)] TJ ET BT 558.735 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(and loss of water and power )] TJ ET 0.267 0.267 0.267 rg BT 150.894 757.079 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 160.531 755.571 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(All of the studies detailed lessons learned and modifications in disaster planning that have been made since the disaster. These )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(include increased training, stocking indoor supplies, and the development of mitigation teams that supervise improvements in )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(disaster preparedness )] TJ ET 0.267 0.267 0.267 rg BT 125.417 713.864 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 135.055 712.357 Td /F1 9.8 Tf [(. The development of plans should take into account the need for prolonged recovery above and )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(beyond the acute disaster event )] TJ ET 0.267 0.267 0.267 rg BT 167.167 701.960 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 176.804 700.452 Td /F1 9.8 Tf [(, though plans should be flexible enough to allow for creative, on-the-spot problem solving [)] TJ ET 0.267 0.267 0.267 rg BT 26.250 690.055 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 35.887 688.548 Td /F1 9.8 Tf [(, p.156].)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(A disaster response framework )] TJ ET 0.267 0.267 0.267 rg BT 163.335 670.650 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 172.972 669.143 Td /F1 9.8 Tf [( makes salient the need to provide comprehensive care during evacuation, especially for )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(vulnerable nursing home residents. The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 15.000 25.087 577.500 751.913 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(continuity of care in these and other disasters included pain management )] TJ ET 0.267 0.267 0.267 rg BT 344.909 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 354.547 767.476 Td /F1 9.8 Tf [( and providing care despite adverse weather )] TJ ET 0.267 0.267 0.267 rg BT 549.098 768.983 Td /F4 8.7 Tf [(26)] TJ ET BT 558.735 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(and loss of water and power )] TJ ET 0.267 0.267 0.267 rg BT 150.894 757.079 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 160.531 755.571 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(All of the studies detailed lessons learned and modifications in disaster planning that have been made since the disaster. These )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(include increased training, stocking indoor supplies, and the development of mitigation teams that supervise improvements in )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(disaster preparedness )] TJ ET 0.267 0.267 0.267 rg BT 125.417 713.864 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 135.055 712.357 Td /F1 9.8 Tf [(. The development of plans should take into account the need for prolonged recovery above and )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(beyond the acute disaster event )] TJ ET 0.267 0.267 0.267 rg BT 167.167 701.960 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 176.804 700.452 Td /F1 9.8 Tf [(, though plans should be flexible enough to allow for creative, on-the-spot problem solving [)] TJ ET 0.267 0.267 0.267 rg BT 26.250 690.055 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 35.887 688.548 Td /F1 9.8 Tf [(, p.156].)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(A disaster response framework )] TJ ET 0.267 0.267 0.267 rg BT 163.335 670.650 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 172.972 669.143 Td /F1 9.8 Tf [( makes salient the need to provide comprehensive care during evacuation, especially for )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(vulnerable nursing home residents. The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(5)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 373 0 obj << /Type /Annot /Subtype /Link /A 374 0 R /Border [0 0 0] /H /I /Rect [ 344.9092 768.1817 354.5466 777.0000 ] >> endobj 374 0 obj << /Type /Action >> endobj 375 0 obj << /Type /Annot /Subtype /Link /A 376 0 R /Border [0 0 0] /H /I /Rect [ 549.0981 768.1817 558.7354 777.0000 ] >> endobj 376 0 obj << /Type /Action >> endobj 377 0 obj << /Type /Annot /Subtype /Link /A 378 0 R /Border [0 0 0] /H /I /Rect [ 558.7354 768.1817 568.3727 777.0000 ] >> endobj 378 0 obj << /Type /Action >> endobj 379 0 obj << /Type /Annot /Subtype /Link /A 380 0 R /Border [0 0 0] /H /I /Rect [ 150.8940 756.2769 160.5313 765.0952 ] >> endobj 380 0 obj << /Type /Action >> endobj 381 0 obj << /Type /Annot /Subtype /Link /A 382 0 R /Border [0 0 0] /H /I /Rect [ 125.4172 713.0627 135.0546 721.8810 ] >> endobj 382 0 obj << /Type /Action >> endobj 383 0 obj << /Type /Annot /Subtype /Link /A 384 0 R /Border [0 0 0] /H /I /Rect [ 167.1668 701.1579 176.8041 709.9762 ] >> endobj 384 0 obj << /Type /Action >> endobj 385 0 obj << /Type /Annot /Subtype /Link /A 386 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 689.2532 35.8873 698.0715 ] >> endobj 386 0 obj << /Type /Action >> endobj 387 0 obj << /Type /Annot /Subtype /Link /A 388 0 R /Border [0 0 0] /H /I /Rect [ 163.3350 669.8484 172.9723 678.6667 ] >> endobj 388 0 obj << /Type /Action >> endobj 389 0 obj << /Type /Annot /Subtype /Link /A 390 0 R /Border [0 0 0] /H /I /Rect [ 498.2670 535.8009 507.9043 544.6192 ] >> endobj 390 0 obj << /Type /Action >> endobj 391 0 obj << /Type /Annot /Subtype /Link /A 392 0 R /Border [0 0 0] /H /I /Rect [ 301.5217 511.9914 311.1591 520.8097 ] >> endobj 392 0 obj << /Type /Action >> endobj 393 0 obj << /Type /Annot /Subtype /Link /A 394 0 R /Border [0 0 0] /H /I /Rect [ 120.5325 488.1819 130.1698 497.0002 ] >> endobj 394 0 obj << /Type /Action >> endobj 395 0 obj << /Type /Annot /Subtype /Link /A 396 0 R /Border [0 0 0] /H /I /Rect [ 492.6943 488.1819 502.3317 497.0002 ] >> endobj 396 0 obj << /Type /Action >> endobj 397 0 obj << /Type /Annot /Subtype /Link /A 398 0 R /Border [0 0 0] /H /I /Rect [ 502.3317 488.1819 511.9690 497.0002 ] >> endobj 398 0 obj << /Type /Action >> endobj 399 0 obj << /Type /Annot /Subtype /Link /A 400 0 R /Border [0 0 0] /H /I /Rect [ 511.9690 488.1819 521.6063 497.0002 ] >> endobj 400 0 obj << /Type /Action >> endobj 401 0 obj << /Type /Annot /Subtype /Link /A 402 0 R /Border [0 0 0] /H /I /Rect [ 72.3090 452.4677 81.9463 461.2860 ] >> endobj 402 0 obj << /Type /Action >> endobj 403 0 obj << /Type /Annot /Subtype /Link /A 404 0 R /Border [0 0 0] /H /I /Rect [ 81.9463 452.4677 91.5837 461.2860 ] >> endobj 404 0 obj << /Type /Action >> endobj 405 0 obj << /Type /Annot /Subtype /Link /A 406 0 R /Border [0 0 0] /H /I /Rect [ 459.5292 452.4677 469.1665 461.2860 ] >> endobj 406 0 obj << /Type /Action >> endobj 407 0 obj << /Type /Annot /Subtype /Link /A 408 0 R /Border [0 0 0] /H /I /Rect [ 114.5655 440.5629 124.2028 449.3812 ] >> endobj 408 0 obj << /Type /Action >> endobj 409 0 obj << /Type /Annot /Subtype /Link /A 410 0 R /Border [0 0 0] /H /I /Rect [ 310.7355 409.2534 320.3728 418.0717 ] >> endobj 410 0 obj << /Type /Action >> endobj 411 0 obj << /Type /Annot /Subtype /Link /A 412 0 R /Border [0 0 0] /H /I /Rect [ 320.3728 409.2534 330.0102 418.0717 ] >> endobj 412 0 obj << /Type /Action >> endobj 413 0 obj << /Type /Annot /Subtype /Link /A 414 0 R /Border [0 0 0] /H /I /Rect [ 330.0102 409.2534 339.6475 418.0717 ] >> endobj 414 0 obj << /Type /Action >> endobj 415 0 obj << /Type /Annot /Subtype /Link /A 416 0 R /Border [0 0 0] /H /I /Rect [ 166.0747 385.4439 175.7121 394.2622 ] >> endobj 416 0 obj << /Type /Action >> endobj 417 0 obj << /Type /Annot /Subtype /Link /A 418 0 R /Border [0 0 0] /H /I /Rect [ 431.0700 373.5392 440.7073 382.3575 ] >> endobj 418 0 obj << /Type /Action >> endobj 419 0 obj << /Type /Annot /Subtype /Link /A 420 0 R /Border [0 0 0] /H /I /Rect [ 536.7113 361.6344 546.3486 370.4527 ] >> endobj 420 0 obj << /Type /Action >> endobj 421 0 obj << /Type /Annot /Subtype /Link /A 422 0 R /Border [0 0 0] /H /I /Rect [ 144.3810 337.8249 154.0183 346.6432 ] >> endobj 422 0 obj << /Type /Action >> endobj 423 0 obj << /Type /Annot /Subtype /Link /A 424 0 R /Border [0 0 0] /H /I /Rect [ 344.9092 768.1817 354.5466 777.0000 ] >> endobj 424 0 obj << /Type /Action >> endobj 425 0 obj << /Type /Annot /Subtype /Link /A 426 0 R /Border [0 0 0] /H /I /Rect [ 549.0981 768.1817 558.7354 777.0000 ] >> endobj 426 0 obj << /Type /Action >> endobj 427 0 obj << /Type /Annot /Subtype /Link /A 428 0 R /Border [0 0 0] /H /I /Rect [ 558.7354 768.1817 568.3727 777.0000 ] >> endobj 428 0 obj << /Type /Action >> endobj 429 0 obj << /Type /Annot /Subtype /Link /A 430 0 R /Border [0 0 0] /H /I /Rect [ 150.8940 756.2769 160.5313 765.0952 ] >> endobj 430 0 obj << /Type /Action >> endobj 431 0 obj << /Type /Annot /Subtype /Link /A 432 0 R /Border [0 0 0] /H /I /Rect [ 125.4172 713.0627 135.0546 721.8810 ] >> endobj 432 0 obj << /Type /Action >> endobj 433 0 obj << /Type /Annot /Subtype /Link /A 434 0 R /Border [0 0 0] /H /I /Rect [ 167.1668 701.1579 176.8041 709.9762 ] >> endobj 434 0 obj << /Type /Action >> endobj 435 0 obj << /Type /Annot /Subtype /Link /A 436 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 689.2532 35.8873 698.0715 ] >> endobj 436 0 obj << /Type /Action >> endobj 437 0 obj << /Type /Annot /Subtype /Link /A 438 0 R /Border [0 0 0] /H /I /Rect [ 163.3350 669.8484 172.9723 678.6667 ] >> endobj 438 0 obj << /Type /Action >> endobj 439 0 obj << /Type /Annot /Subtype /Link /A 440 0 R /Border [0 0 0] /H /I /Rect [ 498.2670 535.8009 507.9043 544.6192 ] >> endobj 440 0 obj << /Type /Action >> endobj 441 0 obj << /Type /Annot /Subtype /Link /A 442 0 R /Border [0 0 0] /H /I /Rect [ 301.5217 511.9914 311.1591 520.8097 ] >> endobj 442 0 obj << /Type /Action >> endobj 443 0 obj << /Type /Annot /Subtype /Link /A 444 0 R /Border [0 0 0] /H /I /Rect [ 120.5325 488.1819 130.1698 497.0002 ] >> endobj 444 0 obj << /Type /Action >> endobj 445 0 obj << /Type /Annot /Subtype /Link /A 446 0 R /Border [0 0 0] /H /I /Rect [ 492.6943 488.1819 502.3317 497.0002 ] >> endobj 446 0 obj << /Type /Action >> endobj 447 0 obj << /Type /Annot /Subtype /Link /A 448 0 R /Border [0 0 0] /H /I /Rect [ 502.3317 488.1819 511.9690 497.0002 ] >> endobj 448 0 obj << /Type /Action >> endobj 449 0 obj << /Type /Annot /Subtype /Link /A 450 0 R /Border [0 0 0] /H /I /Rect [ 511.9690 488.1819 521.6063 497.0002 ] >> endobj 450 0 obj << /Type /Action >> endobj 451 0 obj << /Type /Annot /Subtype /Link /A 452 0 R /Border [0 0 0] /H /I /Rect [ 72.3090 452.4677 81.9463 461.2860 ] >> endobj 452 0 obj << /Type /Action >> endobj 453 0 obj << /Type /Annot /Subtype /Link /A 454 0 R /Border [0 0 0] /H /I /Rect [ 81.9463 452.4677 91.5837 461.2860 ] >> endobj 454 0 obj << /Type /Action >> endobj 455 0 obj << /Type /Annot /Subtype /Link /A 456 0 R /Border [0 0 0] /H /I /Rect [ 459.5292 452.4677 469.1665 461.2860 ] >> endobj 456 0 obj << /Type /Action >> endobj 457 0 obj << /Type /Annot /Subtype /Link /A 458 0 R /Border [0 0 0] /H /I /Rect [ 114.5655 440.5629 124.2028 449.3812 ] >> endobj 458 0 obj << /Type /Action >> endobj 459 0 obj << /Type /Annot /Subtype /Link /A 460 0 R /Border [0 0 0] /H /I /Rect [ 310.7355 409.2534 320.3728 418.0717 ] >> endobj 460 0 obj << /Type /Action >> endobj 461 0 obj << /Type /Annot /Subtype /Link /A 462 0 R /Border [0 0 0] /H /I /Rect [ 320.3728 409.2534 330.0102 418.0717 ] >> endobj 462 0 obj << /Type /Action >> endobj 463 0 obj << /Type /Annot /Subtype /Link /A 464 0 R /Border [0 0 0] /H /I /Rect [ 330.0102 409.2534 339.6475 418.0717 ] >> endobj 464 0 obj << /Type /Action >> endobj 465 0 obj << /Type /Annot /Subtype /Link /A 466 0 R /Border [0 0 0] /H /I /Rect [ 166.0747 385.4439 175.7121 394.2622 ] >> endobj 466 0 obj << /Type /Action >> endobj 467 0 obj << /Type /Annot /Subtype /Link /A 468 0 R /Border [0 0 0] /H /I /Rect [ 431.0700 373.5392 440.7073 382.3575 ] >> endobj 468 0 obj << /Type /Action >> endobj 469 0 obj << /Type /Annot /Subtype /Link /A 470 0 R /Border [0 0 0] /H /I /Rect [ 536.7113 361.6344 546.3486 370.4527 ] >> endobj 470 0 obj << /Type /Action >> endobj 471 0 obj << /Type /Annot /Subtype /Link /A 472 0 R /Border [0 0 0] /H /I /Rect [ 144.3810 337.8249 154.0183 346.6432 ] >> endobj 472 0 obj << /Type /Action >> endobj 473 0 obj << /Type /Annot /Subtype /Link /A 474 0 R /Border [0 0 0] /H /I /Rect [ 344.9092 768.1817 354.5466 777.0000 ] >> endobj 474 0 obj << /Type /Action >> endobj 475 0 obj << /Type /Annot /Subtype /Link /A 476 0 R /Border [0 0 0] /H /I /Rect [ 549.0981 768.1817 558.7354 777.0000 ] >> endobj 476 0 obj << /Type /Action >> endobj 477 0 obj << /Type /Annot /Subtype /Link /A 478 0 R /Border [0 0 0] /H /I /Rect [ 558.7354 768.1817 568.3727 777.0000 ] >> endobj 478 0 obj << /Type /Action >> endobj 479 0 obj << /Type /Annot /Subtype /Link /A 480 0 R /Border [0 0 0] /H /I /Rect [ 150.8940 756.2769 160.5313 765.0952 ] >> endobj 480 0 obj << /Type /Action >> endobj 481 0 obj << /Type /Annot /Subtype /Link /A 482 0 R /Border [0 0 0] /H /I /Rect [ 125.4172 713.0627 135.0546 721.8810 ] >> endobj 482 0 obj << /Type /Action >> endobj 483 0 obj << /Type /Annot /Subtype /Link /A 484 0 R /Border [0 0 0] /H /I /Rect [ 167.1668 701.1579 176.8041 709.9762 ] >> endobj 484 0 obj << /Type /Action >> endobj 485 0 obj << /Type /Annot /Subtype /Link /A 486 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 689.2532 35.8873 698.0715 ] >> endobj 486 0 obj << /Type /Action >> endobj 487 0 obj << /Type /Annot /Subtype /Link /A 488 0 R /Border [0 0 0] /H /I /Rect [ 163.3350 669.8484 172.9723 678.6667 ] >> endobj 488 0 obj << /Type /Action >> endobj 489 0 obj << /Type /Annot /Subtype /Link /A 490 0 R /Border [0 0 0] /H /I /Rect [ 498.2670 535.8009 507.9043 544.6192 ] >> endobj 490 0 obj << /Type /Action >> endobj 491 0 obj << /Type /Annot /Subtype /Link /A 492 0 R /Border [0 0 0] /H /I /Rect [ 301.5217 511.9914 311.1591 520.8097 ] >> endobj 492 0 obj << /Type /Action >> endobj 493 0 obj << /Type /Annot /Subtype /Link /A 494 0 R /Border [0 0 0] /H /I /Rect [ 120.5325 488.1819 130.1698 497.0002 ] >> endobj 494 0 obj << /Type /Action >> endobj 495 0 obj << /Type /Annot /Subtype /Link /A 496 0 R /Border [0 0 0] /H /I /Rect [ 492.6943 488.1819 502.3317 497.0002 ] >> endobj 496 0 obj << /Type /Action >> endobj 497 0 obj << /Type /Annot /Subtype /Link /A 498 0 R /Border [0 0 0] /H /I /Rect [ 502.3317 488.1819 511.9690 497.0002 ] >> endobj 498 0 obj << /Type /Action >> endobj 499 0 obj << /Type /Annot /Subtype /Link /A 500 0 R /Border [0 0 0] /H /I /Rect [ 511.9690 488.1819 521.6063 497.0002 ] >> endobj 500 0 obj << /Type /Action >> endobj 501 0 obj << /Type /Annot /Subtype /Link /A 502 0 R /Border [0 0 0] /H /I /Rect [ 72.3090 452.4677 81.9463 461.2860 ] >> endobj 502 0 obj << /Type /Action >> endobj 503 0 obj << /Type /Annot /Subtype /Link /A 504 0 R /Border [0 0 0] /H /I /Rect [ 81.9463 452.4677 91.5837 461.2860 ] >> endobj 504 0 obj << /Type /Action >> endobj 505 0 obj << /Type /Annot /Subtype /Link /A 506 0 R /Border [0 0 0] /H /I /Rect [ 459.5292 452.4677 469.1665 461.2860 ] >> endobj 506 0 obj << /Type /Action >> endobj 507 0 obj << /Type /Annot /Subtype /Link /A 508 0 R /Border [0 0 0] /H /I /Rect [ 114.5655 440.5629 124.2028 449.3812 ] >> endobj 508 0 obj << /Type /Action >> endobj 509 0 obj << /Type /Annot /Subtype /Link /A 510 0 R /Border [0 0 0] /H /I /Rect [ 310.7355 409.2534 320.3728 418.0717 ] >> endobj 510 0 obj << /Type /Action >> endobj 511 0 obj << /Type /Annot /Subtype /Link /A 512 0 R /Border [0 0 0] /H /I /Rect [ 320.3728 409.2534 330.0102 418.0717 ] >> endobj 512 0 obj << /Type /Action >> endobj 513 0 obj << /Type /Annot /Subtype /Link /A 514 0 R /Border [0 0 0] /H /I /Rect [ 330.0102 409.2534 339.6475 418.0717 ] >> endobj 514 0 obj << /Type /Action >> endobj 515 0 obj << /Type /Annot /Subtype /Link /A 516 0 R /Border [0 0 0] /H /I /Rect [ 166.0747 385.4439 175.7121 394.2622 ] >> endobj 516 0 obj << /Type /Action >> endobj 517 0 obj << /Type /Annot /Subtype /Link /A 518 0 R /Border [0 0 0] /H /I /Rect [ 431.0700 373.5392 440.7073 382.3575 ] >> endobj 518 0 obj << /Type /Action >> endobj 519 0 obj << /Type /Annot /Subtype /Link /A 520 0 R /Border [0 0 0] /H /I /Rect [ 536.7113 361.6344 546.3486 370.4527 ] >> endobj 520 0 obj << /Type /Action >> endobj 521 0 obj << /Type /Annot /Subtype /Link /A 522 0 R /Border [0 0 0] /H /I /Rect [ 144.3810 337.8249 154.0183 346.6432 ] >> endobj 522 0 obj << /Type /Action >> endobj 523 0 obj << /Type /Page /Parent 3 0 R /Annots [ 525 0 R 527 0 R 529 0 R 531 0 R 533 0 R 535 0 R 537 0 R 539 0 R 541 0 R 543 0 R 545 0 R 547 0 R ] /Contents 524 0 R >> endobj 524 0 obj << /Length 17950 >> stream 0.271 0.267 0.267 rg q 15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(6)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 525 0 obj << /Type /Annot /Subtype /Link /A 526 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 526 0 obj << /Type /Action >> endobj 527 0 obj << /Type /Annot /Subtype /Link /A 528 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 528 0 obj << /Type /Action >> endobj 529 0 obj << /Type /Annot /Subtype /Link /A 530 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 530 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 531 0 obj << /Type /Annot /Subtype /Link /A 532 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 532 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 533 0 obj << /Type /Annot /Subtype /Link /A 534 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 534 0 obj << /Type /Action >> endobj 535 0 obj << /Type /Annot /Subtype /Link /A 536 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 536 0 obj << /Type /Action >> endobj 537 0 obj << /Type /Annot /Subtype /Link /A 538 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 538 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 539 0 obj << /Type /Annot /Subtype /Link /A 540 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 540 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 541 0 obj << /Type /Annot /Subtype /Link /A 542 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 542 0 obj << /Type /Action >> endobj 543 0 obj << /Type /Annot /Subtype /Link /A 544 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 544 0 obj << /Type /Action >> endobj 545 0 obj << /Type /Annot /Subtype /Link /A 546 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 546 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 547 0 obj << /Type /Annot /Subtype /Link /A 548 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 548 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 549 0 obj << /Type /Page /Parent 3 0 R /Contents 550 0 R >> endobj 550 0 obj << /Length 21982 >> stream 0.271 0.267 0.267 rg q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(7)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 551 0 obj << /Type /Page /Parent 3 0 R /Annots [ 553 0 R 555 0 R 557 0 R ] /Contents 552 0 R >> endobj 552 0 obj << /Length 20191 >> stream 0.271 0.267 0.267 rg q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: https://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. PLoS )] TJ ET BT 26.250 114.250 Td /F1 9.8 Tf [(Currents: Disasters 2011;3:RRN1270.)] TJ ET Q q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: https://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. PLoS )] TJ ET BT 26.250 114.250 Td /F1 9.8 Tf [(Currents: Disasters 2011;3:RRN1270.)] TJ ET Q q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: https://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. PLoS )] TJ ET BT 26.250 114.250 Td /F1 9.8 Tf [(Currents: Disasters 2011;3:RRN1270.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(8)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 553 0 obj << /Type /Annot /Subtype /Link /A 554 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 144.0112 91.2600 151.6425 ] >> endobj 554 0 obj << /Type /Action /S /URI /URI (https://www.cochrane.org/cochrane-reviews/evidence-aid-project) >> endobj 555 0 obj << /Type /Annot /Subtype /Link /A 556 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 144.0112 91.2600 151.6425 ] >> endobj 556 0 obj << /Type /Action /S /URI /URI (https://www.cochrane.org/cochrane-reviews/evidence-aid-project) >> endobj 557 0 obj << /Type /Annot /Subtype /Link /A 558 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 144.0112 91.2600 151.6425 ] >> endobj 558 0 obj << /Type /Action /S /URI /URI (https://www.cochrane.org/cochrane-reviews/evidence-aid-project) >> endobj xref 0 559 0000000000 65535 f 0000000008 00000 n 0000000073 00000 n 0000000119 00000 n 0000000430 00000 n 0000000467 00000 n 0000000701 00000 n 0000000944 00000 n 0000017583 00000 n 0000017690 00000 n 0000017798 00000 n 0000017909 00000 n 0000018022 00000 n 0000018410 00000 n 0000022295 00000 n 0000022422 00000 n 0000022613 00000 n 0000022740 00000 n 0000022931 00000 n 0000023059 00000 n 0000023180 00000 n 0000023306 00000 n 0000023408 00000 n 0000023535 00000 n 0000023650 00000 n 0000023778 00000 n 0000023892 00000 n 0000024020 00000 n 0000024132 00000 n 0000024260 00000 n 0000024380 00000 n 0000024507 00000 n 0000024698 00000 n 0000024825 00000 n 0000025016 00000 n 0000025144 00000 n 0000025265 00000 n 0000025391 00000 n 0000025493 00000 n 0000025620 00000 n 0000025735 00000 n 0000025863 00000 n 0000025977 00000 n 0000026105 00000 n 0000026217 00000 n 0000026345 00000 n 0000026465 00000 n 0000026592 00000 n 0000026783 00000 n 0000026910 00000 n 0000027101 00000 n 0000027229 00000 n 0000027350 00000 n 0000027476 00000 n 0000027578 00000 n 0000027705 00000 n 0000027820 00000 n 0000027948 00000 n 0000028062 00000 n 0000028190 00000 n 0000028302 00000 n 0000028430 00000 n 0000028550 00000 n 0000028648 00000 n 0000036888 00000 n 0000137811 00000 n 0000137938 00000 n 0000138087 00000 n 0000148283 00000 n 0000148410 00000 n 0000148559 00000 n 0000148686 00000 n 0000148835 00000 n 0000149331 00000 n 0000174513 00000 n 0000174641 00000 n 0000174677 00000 n 0000174804 00000 n 0000174948 00000 n 0000198458 00000 n 0000198586 00000 n 0000198622 00000 n 0000198750 00000 n 0000198786 00000 n 0000198914 00000 n 0000198950 00000 n 0000199078 00000 n 0000199114 00000 n 0000199242 00000 n 0000199278 00000 n 0000199406 00000 n 0000199442 00000 n 0000199570 00000 n 0000199606 00000 n 0000199734 00000 n 0000199770 00000 n 0000199896 00000 n 0000199932 00000 n 0000200060 00000 n 0000200096 00000 n 0000200225 00000 n 0000200262 00000 n 0000200391 00000 n 0000200428 00000 n 0000200557 00000 n 0000200594 00000 n 0000200722 00000 n 0000200759 00000 n 0000200887 00000 n 0000200924 00000 n 0000201052 00000 n 0000201089 00000 n 0000201219 00000 n 0000201256 00000 n 0000201385 00000 n 0000201530 00000 n 0000201660 00000 n 0000201697 00000 n 0000201827 00000 n 0000201864 00000 n 0000201994 00000 n 0000202031 00000 n 0000202161 00000 n 0000202198 00000 n 0000202328 00000 n 0000202365 00000 n 0000202495 00000 n 0000202532 00000 n 0000202662 00000 n 0000202699 00000 n 0000202829 00000 n 0000202866 00000 n 0000202994 00000 n 0000203031 00000 n 0000203161 00000 n 0000203198 00000 n 0000203328 00000 n 0000203365 00000 n 0000203494 00000 n 0000203531 00000 n 0000203660 00000 n 0000203697 00000 n 0000203825 00000 n 0000203862 00000 n 0000203990 00000 n 0000204027 00000 n 0000204155 00000 n 0000204192 00000 n 0000204322 00000 n 0000204359 00000 n 0000204488 00000 n 0000204633 00000 n 0000204763 00000 n 0000204800 00000 n 0000204930 00000 n 0000204967 00000 n 0000205097 00000 n 0000205134 00000 n 0000205264 00000 n 0000205301 00000 n 0000205431 00000 n 0000205468 00000 n 0000205598 00000 n 0000205635 00000 n 0000205765 00000 n 0000205802 00000 n 0000205932 00000 n 0000205969 00000 n 0000206097 00000 n 0000206134 00000 n 0000206264 00000 n 0000206301 00000 n 0000206431 00000 n 0000206468 00000 n 0000206597 00000 n 0000206634 00000 n 0000206763 00000 n 0000206800 00000 n 0000206928 00000 n 0000206965 00000 n 0000207093 00000 n 0000207130 00000 n 0000207258 00000 n 0000207295 00000 n 0000208118 00000 n 0000245077 00000 n 0000245207 00000 n 0000245244 00000 n 0000245374 00000 n 0000245411 00000 n 0000245541 00000 n 0000245578 00000 n 0000245706 00000 n 0000245743 00000 n 0000245871 00000 n 0000245908 00000 n 0000246038 00000 n 0000246075 00000 n 0000246205 00000 n 0000246242 00000 n 0000246372 00000 n 0000246409 00000 n 0000246537 00000 n 0000246574 00000 n 0000246704 00000 n 0000246741 00000 n 0000246871 00000 n 0000246908 00000 n 0000247038 00000 n 0000247075 00000 n 0000247205 00000 n 0000247242 00000 n 0000247370 00000 n 0000247407 00000 n 0000247537 00000 n 0000247574 00000 n 0000247704 00000 n 0000247741 00000 n 0000247871 00000 n 0000247908 00000 n 0000248038 00000 n 0000248075 00000 n 0000248205 00000 n 0000248242 00000 n 0000248372 00000 n 0000248409 00000 n 0000248539 00000 n 0000248576 00000 n 0000248706 00000 n 0000248743 00000 n 0000248873 00000 n 0000248910 00000 n 0000249040 00000 n 0000249077 00000 n 0000249207 00000 n 0000249244 00000 n 0000249374 00000 n 0000249411 00000 n 0000249541 00000 n 0000249578 00000 n 0000249708 00000 n 0000249745 00000 n 0000249875 00000 n 0000249912 00000 n 0000250040 00000 n 0000250077 00000 n 0000250205 00000 n 0000250242 00000 n 0000250372 00000 n 0000250409 00000 n 0000250539 00000 n 0000250576 00000 n 0000250706 00000 n 0000250743 00000 n 0000250871 00000 n 0000250908 00000 n 0000251036 00000 n 0000251073 00000 n 0000251203 00000 n 0000251240 00000 n 0000251370 00000 n 0000251407 00000 n 0000251537 00000 n 0000251574 00000 n 0000251702 00000 n 0000251739 00000 n 0000251869 00000 n 0000251906 00000 n 0000252036 00000 n 0000252073 00000 n 0000252203 00000 n 0000252240 00000 n 0000252370 00000 n 0000252407 00000 n 0000252535 00000 n 0000252572 00000 n 0000252702 00000 n 0000252739 00000 n 0000252869 00000 n 0000252906 00000 n 0000253036 00000 n 0000253073 00000 n 0000253203 00000 n 0000253240 00000 n 0000253370 00000 n 0000253407 00000 n 0000253537 00000 n 0000253574 00000 n 0000253704 00000 n 0000253741 00000 n 0000253871 00000 n 0000253908 00000 n 0000254038 00000 n 0000254075 00000 n 0000254205 00000 n 0000254242 00000 n 0000254372 00000 n 0000254409 00000 n 0000254539 00000 n 0000254576 00000 n 0000254706 00000 n 0000254743 00000 n 0000254873 00000 n 0000254910 00000 n 0000255040 00000 n 0000255077 00000 n 0000255205 00000 n 0000255242 00000 n 0000255370 00000 n 0000255407 00000 n 0000255537 00000 n 0000255574 00000 n 0000255704 00000 n 0000255741 00000 n 0000255871 00000 n 0000255908 00000 n 0000256036 00000 n 0000256073 00000 n 0000256201 00000 n 0000256238 00000 n 0000256368 00000 n 0000256405 00000 n 0000256535 00000 n 0000256572 00000 n 0000256702 00000 n 0000256739 00000 n 0000256867 00000 n 0000256904 00000 n 0000257034 00000 n 0000257071 00000 n 0000257201 00000 n 0000257238 00000 n 0000257368 00000 n 0000257405 00000 n 0000257535 00000 n 0000257572 00000 n 0000257700 00000 n 0000257737 00000 n 0000257867 00000 n 0000257904 00000 n 0000258034 00000 n 0000258071 00000 n 0000258201 00000 n 0000258238 00000 n 0000258368 00000 n 0000258405 00000 n 0000258535 00000 n 0000258572 00000 n 0000258702 00000 n 0000258739 00000 n 0000258869 00000 n 0000258906 00000 n 0000259036 00000 n 0000259073 00000 n 0000259203 00000 n 0000259240 00000 n 0000259370 00000 n 0000259407 00000 n 0000259537 00000 n 0000259574 00000 n 0000259704 00000 n 0000259741 00000 n 0000259871 00000 n 0000259908 00000 n 0000260038 00000 n 0000260075 00000 n 0000260205 00000 n 0000260242 00000 n 0000260370 00000 n 0000260407 00000 n 0000260535 00000 n 0000260572 00000 n 0000261251 00000 n 0000294853 00000 n 0000294983 00000 n 0000295020 00000 n 0000295150 00000 n 0000295187 00000 n 0000295317 00000 n 0000295354 00000 n 0000295484 00000 n 0000295521 00000 n 0000295651 00000 n 0000295688 00000 n 0000295818 00000 n 0000295855 00000 n 0000295983 00000 n 0000296020 00000 n 0000296150 00000 n 0000296187 00000 n 0000296317 00000 n 0000296354 00000 n 0000296484 00000 n 0000296521 00000 n 0000296651 00000 n 0000296688 00000 n 0000296818 00000 n 0000296855 00000 n 0000296985 00000 n 0000297022 00000 n 0000297152 00000 n 0000297189 00000 n 0000297317 00000 n 0000297354 00000 n 0000297482 00000 n 0000297519 00000 n 0000297649 00000 n 0000297686 00000 n 0000297816 00000 n 0000297853 00000 n 0000297983 00000 n 0000298020 00000 n 0000298150 00000 n 0000298187 00000 n 0000298317 00000 n 0000298354 00000 n 0000298484 00000 n 0000298521 00000 n 0000298651 00000 n 0000298688 00000 n 0000298818 00000 n 0000298855 00000 n 0000298985 00000 n 0000299022 00000 n 0000299152 00000 n 0000299189 00000 n 0000299319 00000 n 0000299356 00000 n 0000299486 00000 n 0000299523 00000 n 0000299653 00000 n 0000299690 00000 n 0000299820 00000 n 0000299857 00000 n 0000299987 00000 n 0000300024 00000 n 0000300152 00000 n 0000300189 00000 n 0000300319 00000 n 0000300356 00000 n 0000300486 00000 n 0000300523 00000 n 0000300653 00000 n 0000300690 00000 n 0000300820 00000 n 0000300857 00000 n 0000300987 00000 n 0000301024 00000 n 0000301154 00000 n 0000301191 00000 n 0000301321 00000 n 0000301358 00000 n 0000301486 00000 n 0000301523 00000 n 0000301651 00000 n 0000301688 00000 n 0000301818 00000 n 0000301855 00000 n 0000301985 00000 n 0000302022 00000 n 0000302152 00000 n 0000302189 00000 n 0000302319 00000 n 0000302356 00000 n 0000302486 00000 n 0000302523 00000 n 0000302653 00000 n 0000302690 00000 n 0000302820 00000 n 0000302857 00000 n 0000302987 00000 n 0000303024 00000 n 0000303154 00000 n 0000303191 00000 n 0000303321 00000 n 0000303358 00000 n 0000303488 00000 n 0000303525 00000 n 0000303655 00000 n 0000303692 00000 n 0000303822 00000 n 0000303859 00000 n 0000303989 00000 n 0000304026 00000 n 0000304156 00000 n 0000304193 00000 n 0000304321 00000 n 0000304358 00000 n 0000304488 00000 n 0000304525 00000 n 0000304655 00000 n 0000304692 00000 n 0000304822 00000 n 0000304859 00000 n 0000304989 00000 n 0000305026 00000 n 0000305156 00000 n 0000305193 00000 n 0000305323 00000 n 0000305360 00000 n 0000305490 00000 n 0000305527 00000 n 0000305655 00000 n 0000305692 00000 n 0000305820 00000 n 0000305857 00000 n 0000305987 00000 n 0000306024 00000 n 0000306154 00000 n 0000306191 00000 n 0000306321 00000 n 0000306358 00000 n 0000306488 00000 n 0000306525 00000 n 0000306655 00000 n 0000306692 00000 n 0000306822 00000 n 0000306859 00000 n 0000306989 00000 n 0000307026 00000 n 0000307156 00000 n 0000307193 00000 n 0000307323 00000 n 0000307360 00000 n 0000307535 00000 n 0000325540 00000 n 0000325670 00000 n 0000325707 00000 n 0000325837 00000 n 0000325874 00000 n 0000326002 00000 n 0000326174 00000 n 0000326301 00000 n 0000326441 00000 n 0000326571 00000 n 0000326608 00000 n 0000326738 00000 n 0000326775 00000 n 0000326903 00000 n 0000327075 00000 n 0000327202 00000 n 0000327342 00000 n 0000327472 00000 n 0000327509 00000 n 0000327639 00000 n 0000327676 00000 n 0000327804 00000 n 0000327976 00000 n 0000328103 00000 n 0000328243 00000 n 0000328310 00000 n 0000350347 00000 n 0000350450 00000 n 0000370696 00000 n 0000370824 00000 n 0000370938 00000 n 0000371066 00000 n 0000371180 00000 n 0000371308 00000 n trailer << /Size 559 /Root 1 0 R /Info 5 0 R >> startxref 371422 %%EOF