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Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova, Division of Clinical Infectious Diseases, can i buy cipro online Research Center Borstel, Leibniz Lung Center, Borstel, Germany 2. Treatment Action Campaign, Cape Town, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USAPublication date:01 September 2021More about this publication?. The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as buy antibiotics, asthma, COPD, child lung health and can i buy cipro online the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication can i buy cipro online of certain articles as preprints prior to their publication. Read fast-track articles.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websitesNo AbstractNo Reference information available - sign in for access. No Supplementary Data.No Article MediaNo MetricsDocument Type. EditorialAffiliations:1.

Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico, Tradate 2. Paediatric Clinic, Pietro Barilla Children´s Hospital, Department of Medicine and Surgery, University of Parma, Parma, ItalyPublication date:01 September 2021More about this publication?. The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as buy antibiotics, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details. The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health.

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buy antibiotics has evolved rapidly into a cipro with global impacts how to get cipro over the counter. However, as the how to get cipro over the counter cipro has developed, it has become increasingly evident that the risks of buy antibiotics, both in terms of rates and particularly of severe complications, are not equal across all members of society. While general risk factors for hospital admission with buy antibiotics include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by buy antibiotics in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME how to get cipro over the counter groups, even before the current cipro there were already significant mental health inequalities.2 These inequalities have been increased by the cipro in several ways. The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general.

This difficulty will increase how to get cipro over the counter pre-existing inequalities where there are challenges to engaging people in care and in providing early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care how to get cipro over the counter and support.In addition, there is growing evidence of specific mental health consequences from significant buy antibiotics , with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, buy antibiotics seems to deliver a double blow. Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little buy antibiotics-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of buy antibiotics on BAME staff in mental healthcare settings, with how to get cipro over the counter guidance on assessment and management of risk using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately.

Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the buy antibiotics cipro. While syntheses of the existing guidelines how to get cipro over the counter are available about buy antibiotics and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the cipro.To fill this gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available. Address culturally grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order how to get cipro over the counter to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of buy antibiotics in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent how to get cipro over the counter research in the area of buy antibiotics and mental health8 and also a clear need for specific research focusing on the post-buy antibiotics mental health needs of people from the BAME group.

Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe. Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of buy antibiotics for health professionals is also useful for patients, until more refined decision how to get cipro over the counter support and prediction tools are developed. A recent Public Health England report on ethnic minorities and buy antibiotics9 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and buy antibiotics , integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on how to get cipro over the counter mental health, buy antibiotics and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we also need how to get cipro over the counter to focus on an equally important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

buy antibiotics has evolved rapidly into a cipro with global can i buy cipro online impacts. However, as the cipro has developed, it has become increasingly evident that the risks of buy antibiotics, both in terms of rates and particularly of severe complications, are not equal can i buy cipro online across all members of society. While general risk factors for hospital admission with buy antibiotics include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by buy antibiotics in the UK and the USA.

The ethnic can i buy cipro online disparities include overall numbers of cases, as well as the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current cipro there were already significant mental health inequalities.2 These inequalities have been increased by the cipro in several ways. The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general. This difficulty will can i buy cipro online increase pre-existing inequalities where there are challenges to engaging people in care and in providing early access to services.

The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant buy antibiotics , with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 can i buy cipro online Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, buy antibiotics seems to deliver a double blow. Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little buy antibiotics-specific guidance on the needs of patients in the BAME group.

The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of buy antibiotics on BAME can i buy cipro online staff in mental healthcare settings, with guidance on assessment and management of risk using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately. Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the buy antibiotics cipro. While syntheses of the existing guidelines are available about buy antibiotics and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the cipro.To fill can i buy cipro online this gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available.

Address culturally grounded explanatory models and illness perceptions to allay fears and can i buy cipro online worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of buy antibiotics in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in the area of buy antibiotics and mental health8 and also a clear can i buy cipro online need for specific research focusing on the post-buy antibiotics mental health needs of people from the BAME group.

Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe. Application of a can i buy cipro online race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of buy antibiotics for health professionals is also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and buy antibiotics9 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates.

Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and buy antibiotics , integrated care systems that work well for susceptible and can i buy cipro online marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on mental health, buy antibiotics and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender. Now we also need to focus can i buy cipro online on an equally important aspect of vulnerability.

As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

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Former Editor-in-Chief of the Postgraduate Medical Journal Dr Barry Ian Hoffbrand died suddenly on April 24, 2020 at the age of 86.A prominent member of a generation of very bright young doctors at University College Hospital Ventolin nebules price (UCH) in London who went on to distinguished careers, he was much admired for his keen intellect, clinical perception and skills, gentle good hacienda del cipres eventos guadalajara humour and kindly nature, combined with a wonderfully sharp intelligence. Professor Dame Jane Dacre remembered him as ‘a kind, witty, clever man, and a great physician’.He was born in Bradford, West Yorkshire, to Philip Hoffbrand, a bespoke tailor, and Minnie (née Freedman), both from Jewish families from Eastern Europe. After Bradford Grammar School, he went up to read medicine from 1952 to 1956 hacienda del cipres eventos guadalajara at The Queen’s College, Oxford, where he was a keen member of the college cricket team—the Quondams. He was pleased to feature in the 1950s on the silver Quondams Cup. Clinical training on a Goldsmid scholarship followed from 1956 to 1958 at UCH Medical School, London, where he was awarded prizes in clinical pathology and haematology.

His postgraduate medical training was mainly at UCH, hacienda del cipres eventos guadalajara where he was house physician to Max (later Lord) Rosenheim, after an initial 6 months at St Luke’s Hospital, Bradford. He also spent a year as senior research fellow from 1967 to 1968 at the Cardiovascular Research Institute, at the University of California Medical Center in San Francisco. Barry’s research on cardiovascular physiology lead to a DM in 1971 from Oxford University.Barry was appointed in 1970 as a consultant physician at the Whittington Hospital and honorary senior clinical lecturer at UCH Medical School, with interests in general and …INTRODUCTIONAs cardiac arrest occurs in around 20% of the patients with severe buy antibiotics, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in buy antibiotics cipro has become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving for patients, appears hacienda del cipres eventos guadalajara as an aerosol-generating procedure risking lives of HCPs caring for patients with buy antibiotics. Protected code blue algorithm has been formulated to address both performer and patient safety.3POCUS-INTEGRATED CPR.

WHY THE NEED IN hacienda del cipres eventos guadalajara buy antibiotics?. Danilo Buonsenso and colleagues have described buy antibiotics era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility. This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation and thus HCP exposure. Bedside ultrasound could act as visual stethoscope in the described hacienda del cipres eventos guadalajara scenario. Sono-CPR in buy antibiotics can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts.

Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk of transmission. Various algorithms are described for sono-cardiopulmonary resuscitation (sono-CPR) during cardiac arrest, but none are discussed to hacienda del cipres eventos guadalajara address patients with buy antibiotics.5 It would hence be wise to integrate bedside point-of-care ultrasound (POCUS) in the code blue algorithm.HOW THE BEDSIDE TOOL HELPS?. Hypoxemia and respiratory failure attribute over 80% aetiology of cardiac arrest in patients with buy antibiotics.1 Prioritising oxygenation and ventilation using definitive airway and use of high-efficiency particulate air filters reduces airborne transmission, thereby making early intubation the dictum of resuscitation.3 Considering poor visualisation due to fogging with the goggles and face shield, inability to use stethoscope and lack of availability of end-tidal CO2 (EtCO2) in resource constraint settings, ultrasound-guided real-time intubation by trained HCP or endotracheal tube (ETT) placement confirmation post intubation could prove beneficial. Confirming ETT placement and direct hacienda del cipres eventos guadalajara visualisation of oesophagal lumen can be done using a linear ultrasound probe.6 In cases of oesophageal intubation, tissue-air hyperechoic lines are visualised in both trachea and oesophagus, referred to as ‘double-track sign’.State of hypercoagulability and myocardial dysfunction exist in patients with buy antibiotics, hence increasing the likelihood of myocardial infarction or pulmonary thromboembolism as aetiologies of cardiac arrest.7 Regional wall motion abnormality, dilated right atrium or right ventricle, plethoric inferior vena cava are easily identified by goal-directed echocardiography. Pneumothorax has been reported in patients with buy antibiotics, and ultrasound can identify absence of lung sliding, helping in quick needle thoracocentesis in arrest and peri-arrest cases.

Few cases of cardiac tamponade owing to myopericarditis have also been reported and bedside ultrasound can help diagnose and perform pericardiocentesis in such patients.Literature suggests that the chances of Return Of Spontaneous Circulation (ROSC) and survival to hospital admission at 24 hours is better in patients with baseline cardiac activity rather than no baseline cardiac activity. In patients with no baseline cardiac activity on arrival, one can withhold CPR, thereby protecting the HCP in this resource-intensive, aerosol-generating futile resuscitative effort.8 Asystole could be the disguised entity of fine ventricular hacienda del cipres eventos guadalajara fibrillation, which can be confirmed by fibrillatory cardiac activity on transthoracic echocardiography and can be defibrillated, thereby increasing the chances of earlier ROSC.9POCUS-INTEGRATED CPR. THE PROPOSED ALGORITHMCPR is a chaotic scenario, and to prevent added chaos, there is a need for a well-trained ultrasound performer placed in an appropriate area (figure 1). Intubating room needs to consist of minimal necessary number of HCPs, and all of them should be equipped with full PPE. Ultrasound device could be a potential fomite facilitating cross-transmission and requires adequate protection of machine and its components with a transparent hacienda del cipres eventos guadalajara cover, sheet or bag.

When unavailable, low-level disinfectant solution should be used between each patient.Proposed algorithm for integration of POCUS during CPR in patients with buy antibiotics with team dynamics. The illustration is original work of the authors hacienda del cipres eventos guadalajara Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional. POCUS, point-of-care ultrasound hacienda del cipres eventos guadalajara.

PPE, personal protective equipment. RA, right atrium. RV, right hacienda del cipres eventos guadalajara ventricle. VF, ventricular fibrillation. USG, ultrasonography." data-icon-position data-hide-link-title="0">Figure 1 Proposed algorithm for integration of POCUS during CPR in patients with buy antibiotics with team dynamics.

The illustration is original work of the authors hacienda del cipres eventos guadalajara Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional hacienda del cipres eventos guadalajara. POCUS, point-of-care ultrasound. PPE, personal protective equipment.

RA, right atrium hacienda del cipres eventos guadalajara. RV, right ventricle. VF, ventricular fibrillation. USG, ultrasonography.When a patient experiences cardiac arrest, there is hacienda del cipres eventos guadalajara a need for HCPs with full PPE to check pulse and begin CPR as per standard guidelines. After 2 min of CPR, if there is no ROSC, during the 10 second pause for rhythm assessment, a trained HCP can perform POCUS in a stepwise manner.

Each step needs to be performed individually during 10 second pause without prolonging hacienda del cipres eventos guadalajara delay between chest compressions and compromising the quality of CPR. Any treatable aetiology identified during the algorithm requires immediate intervention.Step 1. Assess cardiac activity—Sub-xiphoid view can be procured and cardiac activity assessed. If absent, hacienda del cipres eventos guadalajara consider termination of efforts, and if present, resuscitative efforts can be continued.After repeating 2 min cycle of CPR, if there has been no ROSC, consider hypoxic aetiology as the cause of arrest in patients with buy antibiotics and intubate without delay. Withholding chest compressions during intubation is recommended.3Step 2.

Assess ETT placement—At the level of thyroid gland, above the suprasternal notch, place ultrasound probe transversely and visualise the oesophagus.10 If the posterior wall of oesophagus is obscured by a dark acoustic shadow or if there is ‘double-track’ sign, consider failed endotracheal intubation and perform immediate re-intubation.Step 3. Assess lung for pneumothorax—Assess hacienda del cipres eventos guadalajara lung sliding, and if absent look for ‘stratosphere sign’ in M-mode of ultrasound.10 If detected, perform immediate needle thoracocentesis.Step 4. Assess for Cardiac etiology of arrest—Obtain sub-xiphoid window preferably, and look for the presence of cardiac tamponade, chamber dilatation or collapse, regional wall motion abnormality and cardiac contractility.Availability of trained personnel and smaller portable ultrasound devices makes its use during cardiac arrest plausible.CPR with the help of POCUS could thus prove to improve chances of ROSC and also reduced transmission to HCP by early identification, treatment of reversible causes and avoidance of prolonged efforts. Sono-CPR appears to be more HCP-friendly than prolonged blind CPR and necessitates its utility in the era of buy antibiotics addressing performer safety as well as patient safety..

Former Editor-in-Chief of the Postgraduate Medical Journal Dr Barry Ian Hoffbrand died suddenly on April can i buy cipro online 24, 2020 at the age of 86.A prominent member of a generation of very bright young doctors at University College Hospital (UCH) in London who went on to distinguished careers, he was much admired for his keen intellect, clinical perception and skills, gentle good humour and kindly nature, combined with a wonderfully sharp intelligence. Professor Dame Jane Dacre remembered him as ‘a kind, witty, clever man, and a great physician’.He was born in Bradford, West Yorkshire, to Philip Hoffbrand, a bespoke tailor, and Minnie (née Freedman), both from Jewish families from Eastern Europe. After Bradford Grammar can i buy cipro online School, he went up to read medicine from 1952 to 1956 at The Queen’s College, Oxford, where he was a keen member of the college cricket team—the Quondams. He was pleased to feature in the 1950s on the silver Quondams Cup. Clinical training on a Goldsmid scholarship followed from 1956 to 1958 at UCH Medical School, London, where he was awarded prizes in clinical pathology and haematology.

His postgraduate medical training was mainly at UCH, where he was house physician to Max (later Lord) can i buy cipro online Rosenheim, after an initial 6 months at St Luke’s Hospital, Bradford. He also spent a year as senior research fellow from 1967 to 1968 at the Cardiovascular Research Institute, at the University of California Medical Center in San Francisco. Barry’s research on cardiovascular physiology lead to a DM in 1971 from Oxford University.Barry was appointed in 1970 as a consultant physician at the Whittington Hospital and honorary senior clinical lecturer at UCH Medical School, with interests in general and …INTRODUCTIONAs cardiac arrest occurs in around 20% of the patients with severe buy antibiotics, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in buy antibiotics cipro has become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE can i buy cipro online and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving for patients, appears as an aerosol-generating procedure risking lives of HCPs caring for patients with buy antibiotics. Protected code blue algorithm has been formulated to address both performer and patient safety.3POCUS-INTEGRATED CPR.

WHY THE can i buy cipro online NEED IN buy antibiotics?. Danilo Buonsenso and colleagues have described buy antibiotics era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility. This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation and thus HCP exposure. Bedside ultrasound could act as can i buy cipro online visual stethoscope in the described scenario. Sono-CPR in buy antibiotics can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts.

Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk of transmission. Various algorithms are can i buy cipro online described for sono-cardiopulmonary resuscitation (sono-CPR) during cardiac arrest, but none are discussed to address patients with buy antibiotics.5 It would hence be wise to integrate bedside point-of-care ultrasound (POCUS) in the code blue algorithm.HOW THE BEDSIDE TOOL HELPS?. Hypoxemia and respiratory failure attribute over 80% aetiology of cardiac arrest in patients with buy antibiotics.1 Prioritising oxygenation and ventilation using definitive airway and use of high-efficiency particulate air filters reduces airborne transmission, thereby making early intubation the dictum of resuscitation.3 Considering poor visualisation due to fogging with the goggles and face shield, inability to use stethoscope and lack of availability of end-tidal CO2 (EtCO2) in resource constraint settings, ultrasound-guided real-time intubation by trained HCP or endotracheal tube (ETT) placement confirmation post intubation could prove beneficial. Confirming ETT placement and direct visualisation of oesophagal lumen can be done using a linear ultrasound probe.6 In cases of oesophageal intubation, tissue-air hyperechoic lines are visualised in both trachea and oesophagus, referred to as ‘double-track sign’.State of hypercoagulability and myocardial dysfunction exist in patients with buy antibiotics, hence increasing the likelihood of myocardial infarction or pulmonary thromboembolism as aetiologies of cardiac arrest.7 Regional wall motion abnormality, dilated right atrium can i buy cipro online or right ventricle, plethoric inferior vena cava are easily identified by goal-directed echocardiography. Pneumothorax has been reported in patients with buy antibiotics, and ultrasound can identify absence of lung sliding, helping in quick needle thoracocentesis in arrest and peri-arrest cases.

Few cases of cardiac tamponade owing to myopericarditis have also been reported and bedside ultrasound can help diagnose and perform pericardiocentesis in such patients.Literature suggests that the chances of Return Of Spontaneous Circulation (ROSC) and survival to hospital admission at 24 hours is better in patients with baseline cardiac activity rather than no baseline cardiac activity. In patients with no baseline cardiac activity on arrival, one can withhold CPR, thereby protecting the HCP in this resource-intensive, aerosol-generating futile resuscitative effort.8 Asystole could be the disguised entity of fine ventricular fibrillation, which can be confirmed by fibrillatory cardiac can i buy cipro online activity on transthoracic echocardiography and can be defibrillated, thereby increasing the chances of earlier ROSC.9POCUS-INTEGRATED CPR. THE PROPOSED ALGORITHMCPR is a chaotic scenario, and to prevent added chaos, there is a need for a well-trained ultrasound performer placed in an appropriate area (figure 1). Intubating room needs to consist of minimal necessary number of HCPs, and all of them should be equipped with full PPE. Ultrasound device could be a potential fomite facilitating cross-transmission and requires adequate protection of machine and can i buy cipro online its components with a transparent cover, sheet or bag.

When unavailable, low-level disinfectant solution should be used between each patient.Proposed algorithm for integration of POCUS during CPR in patients with buy antibiotics with team dynamics. The illustration is original work of the can i buy cipro online authors Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional. POCUS, point-of-care can i buy cipro online ultrasound.

PPE, personal protective equipment. RA, right atrium. RV, right ventricle can i buy cipro online. VF, ventricular fibrillation. USG, ultrasonography." data-icon-position data-hide-link-title="0">Figure 1 Proposed algorithm for integration of POCUS during CPR in patients with buy antibiotics with team dynamics.

The illustration can i buy cipro online is original work of the authors Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional can i buy cipro online. POCUS, point-of-care ultrasound. PPE, personal protective equipment.

RA, right can i buy cipro online atrium. RV, right ventricle. VF, ventricular fibrillation. USG, ultrasonography.When a patient experiences cardiac arrest, there is a can i buy cipro online need for HCPs with full PPE to check pulse and begin CPR as per standard guidelines. After 2 min of CPR, if there is no ROSC, during the 10 second pause for rhythm assessment, a trained HCP can perform POCUS in a stepwise manner.

Each step needs to be performed individually during 10 second pause can i buy cipro online without prolonging delay between chest compressions and compromising the quality of CPR. Any treatable aetiology identified during the algorithm requires immediate intervention.Step 1. Assess cardiac activity—Sub-xiphoid view can be procured and cardiac activity assessed. If absent, consider termination of efforts, and if present, resuscitative efforts can be continued.After repeating 2 min cycle of CPR, if there has been no ROSC, consider hypoxic aetiology can i buy cipro online as the cause of arrest in patients with buy antibiotics and intubate without delay. Withholding chest compressions during intubation is recommended.3Step 2.

Assess ETT placement—At the level of thyroid gland, above the suprasternal notch, place ultrasound probe transversely and visualise the oesophagus.10 If the posterior wall of oesophagus is obscured by a dark acoustic shadow or if there is ‘double-track’ sign, consider failed endotracheal intubation and perform immediate re-intubation.Step 3. Assess lung for pneumothorax—Assess lung sliding, and if absent look for ‘stratosphere sign’ in M-mode of ultrasound.10 can i buy cipro online If detected, perform immediate needle thoracocentesis.Step 4. Assess for Cardiac etiology of arrest—Obtain sub-xiphoid window preferably, and look for the presence of cardiac tamponade, chamber dilatation or collapse, regional wall motion abnormality and cardiac contractility.Availability of trained personnel and smaller portable ultrasound devices makes its use during cardiac arrest plausible.CPR with the help of POCUS could thus prove to improve chances of ROSC and also reduced transmission to HCP by early identification, treatment of reversible causes and avoidance of prolonged efforts. Sono-CPR appears to be more HCP-friendly than prolonged blind CPR and necessitates its utility in the era of buy antibiotics addressing performer safety as well as patient safety..

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The role of personality in health has where can you get cipro been http://hochzeiteninmiami.com/where-to-buy-levitra-pills/ under speculation for decades. The rise of coherent theories of personality and the inclusion of modern personality trait measures in large-scale epidemiological studies has only rather where can you get cipro recently enabled to examine this question profoundly. Numerous studies have shown that from the five major personality traits, conscientiousness—describing individual differences, for example, in self-regulation, orderliness and carefulness—has emerged as maybe the most important personality factor in lifespan health with low consciousness being associated with a wide range of measures of health and well-being,1 including reduced life expectancy.2 This has sparked several calls highlighting the policy relevance of personality traits.3 4 However, personality traits are typically not included in health guidelines, and the potential causality between personality traits and health outcomes has remained inconclusive.The study by Singh-Manoux et al5 makes an important contribution ….

The role of personality in health has can i buy cipro online been under speculation for Where to buy levitra pills decades. The rise of coherent theories of personality and the inclusion of modern personality trait measures in large-scale epidemiological studies has only rather recently enabled can i buy cipro online to examine this question profoundly. Numerous studies have shown that from the five major personality traits, conscientiousness—describing individual differences, for example, in self-regulation, orderliness and carefulness—has emerged as maybe the most important personality factor in lifespan health with low consciousness being associated with a wide range of measures of health and well-being,1 including reduced life expectancy.2 This has sparked several calls highlighting the policy relevance of personality traits.3 4 However, personality traits are typically not included in health guidelines, and the potential causality between personality traits and health outcomes has remained inconclusive.The study by Singh-Manoux et al5 makes an important contribution ….

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Shutterstock U.S constipation after cipro Cheap propecia. Reps. David Kustoff (R-TN) and Abigail constipation after cipro Spanberger (D-VA) re-introduced the Criminalizing Abused Substance Templates (CAST) Act Wednesday.

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As this public health crisis significantly worsens as a constipation after cipro result of the buy antibiotics cipro, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and sold on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit constipation after cipro drugs, we would take another step in the fight against fentanyl-related deaths.”Shutterstock U.S.

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€œEven before the cipro took its toll, we had been in the midst of the worst drug overdose crisis in our nation’s history, and we’re witnessing skyrocketing rates of suicide, but buy antibiotics has deepened these constipation after cipro epidemics, which sadly feed on isolation and despair. With the convergence of antibiotics emergencies, we are failing those most vulnerable to addiction and mental health challenges.” Durbin spoke about a Lake County, Ill., resident who struggled with substance use disorder and committed suicide after being unable to access treatment and about the increase in suicides among African-American residents in Cook County, Ill.In 2020, 437 Cook County residents committed suicide, and more than 700 died from opioid overdoses between January and June 2020. The opioid death rate is double 2019’s rate constipation after cipro.

Durbin also urged support for President Joe Biden’s American Rescue Plan, which includes nearly $4 billion in addiction and mental health treatment grants.Shutterstock The Delaware Department of Health and Social Services plans to offer a training program on treating opioid use disorder (OUD) among Medicaid recipients. The program is open to medical providers and practice managers in psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups from March 23 constipation after cipro through Sept. 23.

Participants will learn about the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be taught by addiction-medicine experts and will be offered in two phases.OBOT involves prescribing safe, effective, Food and Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov. John Carney said. €œEquipping our medical providers to manage the treatment of these patients is an important part of this effort.”The U.S.

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Shutterstock can i buy cipro online U.S. Reps. David Kustoff (R-TN) and Abigail Spanberger (D-VA) re-introduced the can i buy cipro online Criminalizing Abused Substance Templates (CAST) Act Wednesday. The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit drugs using a pill press.

Currently, the law bans the practice but can i buy cipro online doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with the intent to make counterfeit schedule I or II substances a crime and establish a sentence of up to 20 years for possession alone. €œThe opioid epidemic has ravaged our communities in West Tennessee and across can i buy cipro online our nation. Unfortunately, as we continue to battle buy antibiotics, the opioid crisis has only grown worse.

We owe it to our loved ones to take stronger action to fight back can i buy cipro online against this public health emergency. The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will increase penalties against possession of harmful drugs and pill press molds, helping to combat the illegal drug market and the dangers it presents to our citizens and our brave law enforcement officers across the nation.”The can i buy cipro online Congressmembers said the law would prevent overdoses and reduce fentanyl-related deaths. €œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse.

As this public health crisis significantly worsens as a result of the buy antibiotics cipro, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and sold can i buy cipro online on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would can i buy cipro online take another step in the fight against fentanyl-related deaths.”Shutterstock U.S. Sen.

Dick Durbin (D-IL), Senate Democratic whip and Senate Judiciary Committee chairman, recently spoke about the dramatic increase in suicides and opioid overdose deaths associated with the buy antibiotics cipro.“While the human suffering of buy antibiotics has captured our attention, as it can i buy cipro online should, two other deadly epidemics in America still rage on. Opioids and the mental health crises,” Durbin said. €œEven before the cipro took its can i buy cipro online toll, we had been in the midst of the worst drug overdose crisis in our nation’s history, and we’re witnessing skyrocketing rates of suicide, but buy antibiotics has deepened these epidemics, which sadly feed on isolation and despair. With the convergence of antibiotics emergencies, we are failing those most vulnerable to addiction and mental health challenges.” Durbin spoke about a Lake County, Ill., resident who struggled with substance use disorder and committed suicide after being unable to access treatment and about the increase in suicides among African-American residents in Cook County, Ill.In 2020, 437 Cook County residents committed suicide, and more than 700 died from opioid overdoses between January and June 2020.

The opioid death rate is double can i buy cipro online 2019’s rate. Durbin also urged support for President Joe Biden’s American Rescue Plan, which includes nearly $4 billion in addiction and mental health treatment grants.Shutterstock The Delaware Department of Health and Social Services plans to offer a training program on treating opioid use disorder (OUD) among Medicaid recipients. The program is open to medical can i buy cipro online providers and practice managers in psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups from March 23 through Sept. 23.

Participants will learn about can i buy cipro online the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be taught by addiction-medicine experts and will be offered in two phases.OBOT involves prescribing safe, effective, Food and Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov. John Carney said. €œEquipping our medical providers to manage the treatment of these can i buy cipro online patients is an important part of this effort.”The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services supports the program through a $3.58 million grant awarded to the state..

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Start Preamble Federal medicamento cipro Emergency Management Agency, DHS. Notice. The Federal Emergency Management Agency (FEMA) announces the activation of a Plan of Action to establish a National Strategy for the manufacture, allocation, medicamento cipro and distribution of Personal Protective Equipment (PPE) to respond to buy antibiotics implemented under the Voluntary Agreement for the manufacture and distribution of critical healthcare resources necessary to respond to a cipro.

This Notice contains the text of the Plan of Action. Start Further Info Robert Glenn, Office of Business, Industry, Infrastructure Integration, Federal Emergency Management Agency, (202) 212-1666, and email OB3I@fema.dhs.gov. End Further Info End Preamble Start Supplemental Information Authority medicamento cipro Section 708 of the Defense Production Act (DPA), 50 U.S.C.

4558, allows the President to provide for the formation of voluntary agreements and plans of action by the private sector to help provide for the national defense. This authority was delegated to the Secretary of Homeland Security generally in section 401 of Executive Order 13603,[] “National Defense Resources Preparedness,” and specifically for response to buy antibiotics in section 3 of Executive Order 13911,[] “Delegating Additional Authority Under the Defense Production Act With Respect to Health and Medical Resources To Respond to the Spread of buy antibiotics.” The Secretary of Homeland Security has delegated these authorities to the FEMA Administrator in Department of Homeland Security (DHS) Delegation 09052 Rev. 00, “Delegation of medicamento cipro Defense Production Act Authority to the Administrator of the Federal Emergency Management Agency,” (Jan.

3, 2017), and DHS Delegation 09052 Rev. 00.1, “Delegation of Defense Production Act Authority to the Administrator of the Federal Emergency Management Agency” (Apr. 1, 2020), medicamento cipro respectively.

Background FEMA sought and received approval from the Attorney General, after consultation with the Federal Trade Commission (FTC), to begin consultation with the private sector, as required by Section 708(c)(2). Pursuant to that approval, on May 12, 2020, FEMA posted an announcement of a public meeting and request for comments to develop a Voluntary Agreement in the Federal Register (85 FR 28031). FEMA held a public meeting on May 21, 2020, and accepted public comments until June 5, 2020.[] FEMA received 34 public comments and considered these comments when preparing the Voluntary Agreement.[] The Attorney General, medicamento cipro in consultation with the Chairman of the Federal Trade Commission, made the required finding that the purpose of the Voluntary Agreement may not reasonably be achieved through an agreement having less anticompetitive effect or without any Voluntary Agreement.

Pursuant to Sec. 708(f)(1)(B) of the DPA, the Department of Justice separately published this finding in the Federal Register on August 17, 2020 as a notice (85 FR 50049). The FEMA Administrator, as the Sponsor of the agreement, medicamento cipro certified in writing that the agreement was necessary to help provide for the national defense.

FEMA provided notice of the formation and the Start Printed Page 79021text of the Voluntary Agreement in the Federal Register on August 17, 2020 (85 FR 50035). On October 13, 2020, FEMA held a virtual meeting to implement the Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (see 85 FR 63567). A portion of the meeting was open to the public medicamento cipro.

One objective of this meeting was to discuss the activation of the first Plan of Action under the Voluntary Agreement to identify more efficient methods of allocating and distributing Personal Protective Equipment to meet national demand and ways of expanding the production of critical healthcare resources, with an initial focus on the manufacture of N95 masks. From this meeting, FEMA incorporated public comments and feedback from the U.S. Department of Justice and the Federal Trade Commission to develop the Plan medicamento cipro of Action.

The Attorney General, in consultation with the Chairman of the Federal Trade Commission, made the required finding that the purposes of section 708(c)(1) of the DPA cannot reasonably be achieved without any Plan of Action, or by a plan of action having less anticompetitive effects than the proposed Plan of Action. Pursuant to section 708(f)(1)(B) of the DPA, the Department of Justice is separately publishing this finding in the Federal Register as a notice. The FEMA Administrator has certified in writing that this Plan of Action is necessary medicamento cipro to help provide for the national defense.

Text of the Plan of Action to Establish a National Strategy for the manufacture, allocation, and distribution of Personal Protective Equipment (PPE) to respond to buy antibiotics implemented under the voluntary agreement for the MANUFACTURE AND DISTRIBUTION OF CRITICAL HEALTHCARE RESOURCES NECESSARY TO RESPOND TO A cipro Table of Contents Preface I. Purpose II. Authorities III medicamento cipro.

General Provisions A. Definitions B. Plan of medicamento cipro Action Participation C.

Effective Date and Duration of Participation D. Withdrawal E. Plan of Action Activation and Deactivation medicamento cipro F.

Rules and Regulations G. Modification and Amendment H. Expenses I medicamento cipro.

Record Keeping IV. Antitrust Defense V. Terms and medicamento cipro Conditions A.

Plan of Action Execution B. Information Management and Responsibilities C. Oversight VI medicamento cipro.

Establishment of the Sub-Committees VII. Application and Agreement VIII. Assignment Preface medicamento cipro Pursuant to section 708 of the Defense Production Act of 1950 (DPA), as amended (50 U.S.C.

4558), the Federal Emergency Management Agency (FEMA) Administrator (Administrator), after consultation with the Secretary of the Department of Health and Human Services (HHS), the Attorney General of the United States (Attorney General), and the Chairman of the Federal Trade Commission (FTC), developed a Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (Voluntary Agreement), 85 FR 50035 (August 17, 2020). The Voluntary Agreement, which operates through a series of Plans of Action, maximizes the manufacture and efficient distribution of Critical Healthcare Resources nationwide to respond to a cipro by establishing unity of effort between Participants and the Federal Government for integrated coordination, planning, information sharing with FEMA, as authorized by FEMA, and allocation medicamento cipro and distribution of Critical Healthcare Resources. This document establishes a Plan of Action (Plan) for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics.

This Plan will be implemented under the Voluntary Agreement by several Sub-Committees. (1) Sub-Committee to Define buy antibiotics PPE Requirements, (2) Sub-Committee for N-95 and other Medical medicamento cipro Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings. FEMA may establish additional Sub-Committees under this Plan of Action, so long as.

(1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) The Sub-Committee is recommended by the Sub-Committee medicamento cipro to Define buy antibiotics PPE Requirements. The purpose of the Plan and the Sub-Committees is to maximize the manufacture and efficient distribution of selected types of critical PPE and create a prioritization protocol for End-Users based upon their demonstrated or projected requirements including geographic and regional circumstances.

The primary goal of the Plan is to create a mechanism to immediately meet exigent PPE requests anywhere in the Nation and to ensure that actions to support PPE stockpiling and reserves do not interfere with immediate requirements that would result in an unacceptable risk to healthcare providers or other potential PPE recipients. When the requirements of the Plan are met, it affords Sub-Committee Participants defenses to civil and criminal actions brought under the antitrust medicamento cipro laws (or any similar law of any state) for actions taken within the scope of the Plan. The Plan is designed to foster a close working relationship among FEMA, HHS, and Sub-Committee Participants to address national defense needs through cooperative action under the direction and active supervision of FEMA.

I. Purpose A cipro may present conditions that pose a direct threat to the national defense of the United States or its preparedness programs such that, pursuant to DPA section 708(c)(1), an agreement to collectively coordinate, plan, and collaborate medicamento cipro for the manufacture and distribution of PPE is necessary for the national defense. This Plan of Action to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics is established under the Voluntary Agreement and establishes five Sub-Committees to oversee and implement the Plan.

The Plan and Sub-Committees will optimize the manufacture and the efficient distribution of selected types of critical PPE and create a prioritization protocol for End-Users based upon their demonstrated or projected requirements and taking into account geographic and regional circumstances for stabilization and reduction of buy antibiotics exposure. II. Authorities Section 708, Defense Production Act (50 U.S.C.

4558). Sections 402(2) &. 501(b), Robert T.

Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121-5207). Sections 503(b)(2)(B) &.

504(a)(10) &. (16) of the Homeland Security Act of 2002 (6 U.S.C. 313(b)(2)(B), 314(a)(10) &.

(16)). Sections 201, 301, National Emergencies Act (50 U.S.C. 1601 et seq.).

Section 319, Public Health Service Act (42 U.S.C. 247d). Executive Order (E.O.) 13911, 85 FR 18403 (March 27, 2020).

Prioritization and Allocation of Certain Scarce or Threatened Health and Medical Resources for Domestic Use, 85 FR 20195 (April 10, 2020). Pursuant to DPA Start Printed Page 79022section 708(f)(1)(A), the Administrator certifies that this Plan is necessary for the national defense. III.

General Provisions A. Definitions Administrator The FEMA Administrator is the Sponsor of the Voluntary Agreement. Pursuant to a delegation or redelegation of the functions given to the President by DPA section 708, the Administrator proposes and provides for the development and carrying out of the Voluntary Agreement, including through the development and implementation of Plans of Action.

The Administrator is responsible for carrying out all duties and responsibilities required by 50 U.S.C. 4558 and 44 CFR part 332 and for appointing one or more Chairpersons to manage and administer the Committee and all Sub-Committees formed to carry out the Voluntary Agreement. Agreement The Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (Voluntary Agreement).

Allocation The process of determining and directing the relative distribution among one or more competing requests from End-Users for the same PPE. Through the Allocation process, FEMA—with participation from Sub-Committee Participants—will assess the actual needs of End-Users and determine how to divide the available and projected supply of PPE to minimize impacts to life, safety, and economic disruption associated with shortages of critical PPE. Allocation will take place only under Exigent Circumstances.

FEMA retains decision-making authority for all Allocation under this Plan. Attendees Subject matter experts, invited by the Chairperson or a Sub-Committee Chairperson to attend meetings authorized under the Voluntary Agreement or this Plan of Action, to provide technical advice or to represent other government agencies or interested parties. Invitations to attendees will be extended as required for Committee or Sub-Committee meetings and deliberations.

Chairperson FEMA senior executive(s), appointed by the Administrator, to chair the Committee for the Distribution of Healthcare Resources Necessary to Respond to a cipro (Committee). The Chairperson shall be responsible for the overall management and administration of the Committee, the Voluntary Agreement, and Plans of Action developed under the Voluntary Agreement while remaining under the supervision of the Administrator. Shall initiate, or approve in advance, each meeting held to discuss problems, determine policies, recommend actions, and make decisions necessary to carry out the Voluntary Agreement.

Appoint one or more co-Chairpersons to chair the Committee, and otherwise shall carry out all duties and responsibilities assigned to him. With the approval of the Administrator, the Chairperson may create one or more Sub-Committees, and may appoint one or more Sub-Committee Chairpersons to chair the Sub-Committees, as appropriate. Committee Committee for the Distribution of Healthcare Resources Necessary to Respond to a cipro established under the Voluntary Agreement.

Competitively Sensitive Information Competitively Sensitive Information that is shared pursuant to this Plan of Action may include any Document or other tangible thing or oral transmission that contains financial, business, commercial, scientific, technical, economic, or engineering information or data, including, but not limited to Financial statements and data, customer and supplier lists, price and other terms of sale to customers, sales records, projections and forecasts, inventory levels, capacity and capacity utilization, cost information, sourcing and procurement information, manufacturing and production information, delivery and shipping information, systems and data designs, and methods, techniques, processes, procedures, programs, codes, or similar information, whether tangible or intangible, and regardless of the method of storage, compilation, or recordation, if the owner thereof has taken reasonable measures to protect the information from disclosure to the public or competitors. These measures may be evidenced by marking or labeling the items as “competitively sensitive information” during submission to FEMA or in the Participant's customary and existing treatment of such information (regardless of labeling). All Competitively Sensitive Information provided by a Sub-Committee Participant as described herein is deemed Competitively Sensitive Information, except for Information that.

A. Is published or has been made publicly available at the time of disclosure by the Sub-Committee Participant. B.

Was in the possession of, or was lawfully and readily available to, FEMA from another source at the time of disclosure without breaching any obligation of confidentiality applicable to the other source. Or c. Was independently developed or acquired without reference to or reliance upon the Sub-Committee Participant's Competitively Sensitive Information.

Where information deemed Competitively Sensitive Information is required to be disclosed by law, regulation, or court order, the “Competitively Sensitive” (or substantially similar) label will continue to attach to all information and portion(s) of documents that are not made public through the required disclosure. Document Any information, on paper or in electronic/audio/visual format, including written, recorded, and graphic materials of every kind, in the possession, custody, or control of the Participant and used or shared in the course of participation in the Voluntary Agreement or a subsequent Plan of Action. End-User This includes all direct and ancillary medical support including, but not limited to, hospitals, independent healthcare providers, nursing homes, medical laboratories, dental care providers, independent physician offices, first responders, alternate care facilities and the general public that reasonably represents the totality of the nation's professional or medical response to buy antibiotics.

€œEnd-User” may also include essential workers necessary to maintain or restore critical infrastructure operations, including but not limited to law enforcement, education, food and agriculture, energy, water and wastewater, and public works personnel. Exigent Circumstances As determined by the Chairperson, the actual or forecasted shortage of a particular type or types of PPE which Start Printed Page 79023likely cannot be fulfilled via usual market mechanisms for an acute, critical time period, and where immediate and substantial harm is projected to occur from lack of intervention. cipro A cipro is defined as an epidemic that has spread to human populations across a large geographic area that is subject to one or more declarations under the National Emergencies Act, the Public Health Service Act, or the Robert T.

Stafford Disaster Relief and Emergency Assistance Act, or if the Administrator determines that one or more declarations is likely to occur and the epidemic poses a direct threat to the national defense or its preparedness programs. For example, antibiotics Disease 2019 (buy antibiotics). Participant An individual, partnership, corporation, association, or private organization, other than a federal agency, that has substantive capabilities, resources or expertise to carry out the purpose of the Voluntary Agreement, that has been specifically invited to participate in the Voluntary Agreement by the Chairperson, and that has applied and agreed to the terms of the Voluntary Agreement.

€œParticipant” includes a corporate or non-corporate entity entering into the Voluntary Agreement and all subsidiaries and affiliates of that entity in which that entity has 50 percent or more control either by stock ownership, board majority, or otherwise. The Administrator may invite Participants to join the Voluntary Agreement at any time during its effective period. Personal Protective Equipment (PPE) Objects that provide measures of safety protection for healthcare workers, first responders, critical infrastructure personnel and/or the general public for the response to the cipro.

These PPE items may include, but are not limited to, face coverings, filtering facepiece respirators, face shields, isolation and surgical gowns, examination and surgical gloves, suits, and foot coverings. Plan of Action (Plan) This document. A documented method, pursuant to 50 U.S.C.

4558(b)(2), proposed by FEMA to implement a particular set of activities under the Voluntary Agreement, through a Sub-Committee focused on a particular Critical Healthcare Resource, or cipro response workstream or functional area necessary for the national defense. Plan of Action Agreement A separate commitment made by Participants upon invitation and agreement to participate in a Plan of Action as part of one or more Sub-Committees. Completing the Plan of Action Agreement confers responsibilities on the Participant consistent with those articulated in the Plan of Action and affords Participants a defense against antitrust claims under section 708 for actions taken to develop or carry out the Plan of Action and the appropriate Sub-Committee(s), as described in Section IV below.

Representatives The representatives the Administrator identifies and invites to the Committee from FEMA, HHS, and other federal agencies with equities in this Plan, and empowered to speak on behalf of their agencies' interests. The Attorney General and the Chairman of the FTC, or their delegates, may also attend any meeting as a Representative. Sub-Committee A body formed by the Administrator from select Participants to implement a Plan of Action.

Sub-Committee Chairperson FEMA official, appointed by the Chairperson, to chair a Sub-Committee to implement a Plan of Action. The Sub-Committee Chairperson shall be responsible for the overall management and administration of the Sub-Committee in furtherance of this Plan of Action while remaining under the supervision of the Administrator and the Chairperson. Sub-Committee Members Collectively the Sub-Committee Chairperson(s), Representatives, and Sub-Committee Participants.

Jointly responsible developing and executing this Plan. Sub-Committee Participant A subset of Participants of the Committee, that have been specifically invited to participate in a Sub-Committee by the Sub-Committee Chairperson, and that have applied and agreed to the terms of this Plan and signed the Plan of Action Agreement. The Sub-Committee Chairperson may invite Participants in the Committee to join a Sub-Committee as a Sub-Committee Participant at any time during the Plan's effective period.

B. Plan of Action Participation This Plan will be carried out by a subset of the Participants in the Voluntary Agreement through several Sub-Committees. (1) Sub-Committee to Define buy antibiotics PPE Requirements, (2) Sub-Committee for N-95 and other Medical Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings.

FEMA may establish additional Sub-Committees under this Plan of Action, so long as. (1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) The Sub-Committee is recommended by the Sub-Committee to Define buy antibiotics PPE Requirements.

Each Sub-Committee will consist of the (1) Sub-Committee Chairperson(s), (2) Representatives from FEMA, HHS, the Department of Justice (DOJ), and other federal agencies with equities in this Plan, and (3) Sub-Committee Participants that have substantive capabilities, resources or expertise to carry out the purpose of this Plan and have signed the Plan of Action Agreement. The Chairperson shall invite Sub-Committee Participants who, in his or her determination, are reasonably representative of the appropriate industry or segment of such industry. Other Attendees—invited by the Sub-Committee Chairperson as subject matter experts to provide technical advice or to represent the interests of other government agencies or interested parties—may also participate in Sub-Committee meetings.

The naming of these Sub-Committees does not commit the Administrator to creating them unless and until circumstances dictate. C. Effective Date and Duration of Participation This Plan is effective immediately upon satisfaction of the requirements of DPA section 708(f)(1).

This Plan shall remain in effect until terminated in accordance with 44 CFR 332.4. It shall be effective for no more than five (5) years from August 17, 2020, when the requirements of DPA section 708(f)(1) were satisfied for the Voluntary Agreement, unless otherwise terminated pursuant to DPA section 708(h)(9) and 44 CFR 332.4 or extended as set forth in DPA section 708(f)(2). No action may take place under this Plan until it is activated, as described in Section III(E), below.

D. Withdrawal Participation in the Plan is voluntary, as is the acceptance of most obligations under the Plan. Sub-Committee Participants may withdraw from this Start Printed Page 79024Plan or from an individual Sub-Committee at any point, subject to the fulfillment of obligations previously agreed upon by the Participant prior to the date of withdrawal.

Note that the obligations outlined in V.B regarding information management and associated responsibilities apply once a party has shared or received information through a Sub-Committee, and remain in place after the party's withdrawal from the Sub-Committee or Plan. If a Sub-Committee Participant indicates an intent to withdraw from the Plan due to a modification or amendment of the Plan (described below), the Sub-Committee Participant will not be required to perform actions directed by that modification or amendment. Withdrawal from the Plan will automatically trigger withdrawal from all Sub-Committees.

However, a Participant may withdraw from a Sub-Committee without also withdrawing from the Plan or other Sub-Committees. To withdraw from the Plan or from an individual Sub-Committee, a Participant must provide written notice to the Administrator at least fifteen (15) calendar days prior to the effective date of that Sub-Committee Participant's withdrawal specifying the scope of withdrawal. Following receipt of such notice, the Administrator will inform the other Sub-Committee Participants of the date and the scope of the withdrawal.

Upon the effective date of the withdrawal from the Plan, the Sub-Committee Participant must cease all activities under the Plan. Upon the effective date of the withdrawal from one or more Sub-Committee(s), the Sub-Committee Participant must cease all activities under the Plan that pertain to the withdrawn Sub-Committee(s). E.

Plan of Action Activation and Deactivation The Administrator, in consultation with the Chairperson and Sub-Committee Chairperson, will invite a select group of Participants in the Voluntary Agreement to form the following Sub-Committees, which will be responsible for implementing this Plan. (1) Sub-Committee to Define buy antibiotics PPE Requirements, (2) Sub-Committee for N-95 and other Medical Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings. FEMA may establish additional Sub-Committees under this Plan of Action, so long as.

(1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) The Sub-Committee is recommended by the Sub-Committee to Define buy antibiotics PPE Requirements. This Plan will be activated for each invited Participant when the Participant executes a Plan of Action Agreement, and a Participant may not participate in a Sub-Committee until the Plan of Action Agreement is executed.

Participants will be invited to join this Plan at the discretion of the Chairperson or the Sponsor to the Voluntary Agreement. Participants will be further invited to attend specific meetings of one or more Sub-Committees at the discretion of the Chairperson. F.

Rules and Regulations Sub-Committee Participants acknowledge and agree to comply with all provisions of DPA section 708, as amended, and regulations related thereto which are promulgated by FEMA, the Department of Homeland Security, HHS, the Attorney General, and the FTC. FEMA has promulgated standards and procedures pertaining to voluntary agreements in 44 CFR part 332. The Administrator shall inform Participants of new rules and regulations as they are issued.

G. Modification and Amendment The Administrator, after consultation with the Attorney General and the Chairman of the FTC, may terminate or modify, in writing, this Plan at any time. The Attorney General, after consultation with the Chairman of the FTC and the Administrator, may terminate or modify, in writing, this Plan at any time.

Sub-Committee Participants may propose modifications or amendments to the Plan or to the Sub-Committees at any time. Where possible, material modifications to the Plan or a Sub-Committee will be subject to a 30 calendar day delayed implementation and opportunity for notice and comment by Sub-Committee Participants to the Chairperson. This delayed implementation period may be shortened or eliminated if the Administrator deems it necessary.

The Administrator shall inform Sub-Committee Participants of modifications or amendments to the Plan or to the Sub-Committees as they are proposed and issued. The Administrator, after consultation with the Attorney General and the Chairman of the FTC, may remove Sub-Committee Participants from the Plan or from a Sub-Committee at any time. The Attorney General, after consultation with the Chairman of the FTC and the Administrator, may remove Sub-Committee Participants from this Plan or from a Sub-Committee at any time.

If a Participant is removed from the Plan or from a Sub-Committee, the Participant may request written notice of the reasons for removal from the Chairperson, who shall provide such notice in a reasonable time period. H. Expenses Participation in this Plan or in a Sub-Committee does not confer funds to Sub-Committee Participants, nor does it limit or prohibit any pre-existing source of funds.

Unless otherwise specified, all expenses, administrative or otherwise, incurred by Sub-Committee Participants associated with participation in this Plan or a Sub-Committee shall be borne exclusively by the Sub-Committee Participants. I. Record Keeping Each Sub-Committee Chairperson shall have primary responsibility for maintaining records in accordance with 44 CFR part 332 and shall be the official custodian of records related to carrying out this Plan.

Each Sub-Committee Participant shall maintain for five years all minutes of meetings, transcripts, records, documents, and other data, including any communications with other Sub-Committee Participants or with any other member of the Sub-Committee, including drafts, related to the carrying out of this Plan or incorporating data or information received in the course of carrying out this Plan. Each Sub-Committee Participant agrees to produce to the Administrator, the Attorney General, and the Chairman of the FTC upon request any item that this section requires the Participant to maintain. Any record maintained in accordance with 44 CFR part 332 shall be available for public inspection and copying, unless exempted on the grounds specified in 5 U.S.C.

552(b)(1), (3) or (4) or identified as privileged and confidential information in accordance with DPA section 705(d), and 44 CFR 332.5. IV. Antitrust Defense Under the provisions of DPA subsection 708(j), each Sub-Committee Participant in this Plan shall have available as a defense to any civil or criminal action brought for violation of the antitrust laws (or any similar law of any State) with respect to any action to develop or carry out this Plan, that such action was taken by the Sub-Committee Participant in the course of developing or carrying out this Plan, that the Sub-Start Printed Page 79025Committee Participant complied with the provisions of DPA section 708 and the rules promulgated thereunder, and that the Sub-Committee Participant acted in accordance with the terms of the Voluntary Agreement and this Plan.

Except in the case of actions taken to develop this Plan, this defense shall be available only to the extent the Sub-Committee Participant asserting the defense demonstrates that the action was specified in, or was within the scope of, this Plan and within the scope of the appropriate Sub-Committee(s), including being taken at the direction and under the active supervision of FEMA. This defense shall not apply to any actions taken after the termination of this Plan. Immediately upon modification of this Plan, no defense to antitrust claims under Section 708 shall be available to any subsequent action that is beyond the scope of the modified Plan.

The Sub-Committee Participant asserting the defense bears the burden of proof to establish the elements of the defense. The defense shall not be available if the person against whom the defense is asserted shows that the action was taken for the purpose of violating the antitrust laws. V.

Terms and Conditions As the sponsoring agency, FEMA will maintain oversight over Sub-Committee activities and direct and supervise actions taken to carry out this Plan, including by retaining decision-making authority over actions taken pursuant to the Plan to ensure such actions are necessary to address a direct threat to the national defense. The Attorney General and the Chairman of the FTC will monitor activities of the Sub-Committees to ensure they execute their responsibilities in a manner consistent with this Plan and their actions have the least anticompetitive effects possible. A.

Plan of Action Execution This Plan will be used to support the following objectives to respond to a cipro by maximizing the manufacture and efficient distribution of selected types of critical PPE and creating a prioritization protocol for End-Users based upon their demonstrated or projected requirements and taking into account geographic and regional circumstances. Each Sub-Committee will undertake the following Objectives for the PPE item(s) within its area of jurisdiction. 1.

Objectives (1) Optimize the timely production of sufficient quantities of PPE to reduce loss of life and transmission of the buy antibiotics cipro. (2) Ensure PPE is distributed effectively across the whole community nationally based on risk. (3) Balance restoration and maintenance of the nation's stockpile of PPE with near-term requirements.

(4) Establish a process for FEMA Allocation of PPE nationwide. (5) Ensure ongoing competition in the manufacture and distribution of PPE to the greatest extent possible under the DPA. 2.

Actions Sub-Committee Participants may be asked to support these objectives by taking the following specific actions. (1) Assist the Chairperson in identifying which types of critical PPE should be included within each Sub-Committee. Identification will be based upon each item's importance to the national response to buy antibiotics and whether it can be reasonably inferred, based upon the best evidence available, that that current and projected supply measured against current and projected demand may not adequately meet the PPE requirements to all identified End-Users or regional or geographic areas of the country as result of measures taken to respond to buy antibiotics.

(2) Provide input to the Chairperson in creating a prioritized list of PPE End-Users by categories for each type of critical PPE identified by each Sub-Committee, and ascertaining the relative demand and supply of PPE among and within those End User categories. Prioritization shall be decided by the Chairperson, based upon each item's importance, reflecting the consensus views of the Sub-Committee Members that it represents the most effective way to save lives and prevent the transmission of the buy antibiotics cipro. This list may be updated throughout the life of the Plan of Action based upon either short term or long-term demands.

These categories should be considered holistically in terms of the Whole-of-Nation response to buy antibiotics. (3) Evaluate the domestic supply of PPE and identify when the expansion of the domestic manufacture of PPE may be necessary, as directed and decided by the Chairperson. (4) Provide information, assist, and validate, as necessary as decided by the Chairperson, demand projections for PPE.

(5) Create a process for and collaborate in the evaluation of competing claims for PPE from End-Users. (6) Prepare a general strategy to accomplish the activities listed in V(A)(2)(7) below regarding activities in Exigent Circumstances consistent with the decisions made by the Chairperson. (7) In Exigent Circumstances, with review and concurrence in all possible instances by DOJ in consultation with FTC.

Facilitate maximum availability of PPE to the nation or particular geographies by deconflicting overlapping demands from the collective Participants' customer base, as directed and decided by the Chairperson. Facilitate maximum availability of PPE to the nation or particular geographies by deconflicting overlapping supply chain demands placed upon Members, as directed and decided by the Chairperson. Facilitate the efficient distribution of PPE by deconflicting overlapping distribution chain activities of Members, as directed and decided by the Chairperson.

Create a process for and collaborate in the Allocation of PPE nationwide or in particular geographies consistent with the decisions made by the Chairperson. Create a process for and collaborate in meeting any other exigent requirements throughout the nation or particular geographies consistent with the overall strategy prepared by this Sub-Committee. (8) Provide data and information necessary to validate the efforts of the Sub-Committee including the actual and planned amounts of PPE to be distributed throughout the Nation, as determined by the Chairperson.

(9) Provide feedback to the Sub-Committee on the outcomes of the collective efforts of the Sub-Committee Members and any impediments or bottlenecks. (10) Advise the Chairperson whether additional Participants or Attendees should be invited to join this Plan of Action and Sub-Committee. (11) Carry out other activities regarding critical PPE as identified by Sub-Committees under this Plan as determined and directed by the Chairperson necessary to address the buy antibiotics cipro' direct threat to the national defense, where such activities have been reviewed and approved by DOJ and FTC and received concurrence from Sub-Committee members.

B. Information Management and Responsibilities FEMA will request only that data and information from Sub-Committee Participants that is necessary to meet the objectives of the Plan and consistent with the scope of the relevant Sub-Start Printed Page 79026Committees. Upon signing a Plan of Action Agreement for this Plan, FEMA requests that Participants endeavor to cooperate with diligence and speed, and to the extent permissible under this Plan, and share with FEMA data and information necessary to meet the objectives of this Plan.

Sub-Committee Participants agree to share with FEMA the following data with diligence and speed, to the extent permissible under this Plan, and abide by the following guidelines, where feasible and consistent with the data that is owned by each Sub-Committee Participant. (1) In general, Participants will not be asked to share Competitively Sensitive Information directly with other Participants. (2) FEMA will only request direct sharing of Competitively Sensitive Information among Participants during Exigent Circumstances where there is a mission critical need or timeline such that sharing only through FEMA is impractical or threatens the outcome of the Plan or Sub-Committee action.

Such requests, if made, will be only among Participants whose participation is necessary to meet the objectives of the Plan, will be limited in scope to the greatest extent possible, and will be shared only pursuant to safeguards subject to prior review and audit by DOJ and FTC. Direct sharing of Competitively Sensitive Information with other Participants will be limited in scope and circumstances to the greatest extent possible. Participants may not share Competitively Sensitive Information directly with other Participants unless specifically requested by FEMA, in consultation with DOJ and FTC.

All Competitively Sensitive Information delivered to FEMA or to another Sub-Committee Participant shall be delivered by secure means, for example, password-protected or encrypted electronic files or drives with the password/key delivered by separate communication or method or via upload to an appropriately secure web portal as directed by FEMA. All data delivered to the web portal designated by FEMA is deemed to be Competitively Sensitive Information. (3) To allow FEMA to identify and appropriately protect documents containing Competitively Sensitive Information by the Sub-Committee Participant providing the documents, the Sub-Committee Participant will make good faith efforts to designate any Competitively Sensitive Information by placing restrictive markings on documents and things considered to be competitively sensitive, the restrictive markings being sufficiently clear in wording and visibility to indicate the restricted nature of the data.

The Sub-Committee Participant will identify Competitively Sensitive Information that is disclosed verbally by oral warning. Information designated as competitively sensitive will, to the extent allowed by law, be presumed to constitute trade secrets, or commercial or financial information, and be provided by the Sub-Committee Participant to FEMA with the expectation that it will be kept confidential by both parties, as such terms are understood in accordance with 5 U.S.C. 552(b)(4) of the Freedom of Information Act and federal judicial interpretations of this statute.

FEMA agrees that to the extent any information designated as competitively sensitive by a Sub-Committee Participant is responsive to a request for disclosure under the Freedom of Information Act, FEMA will consult with the Sub-Committee Participant and afford the Participant ten (10) working days to object to any disclosure by FEMA. (4) FEMA will make good faith efforts to appropriately recognize unmarked Documents containing Competitively Sensitive Information as Competitively Sensitive Information. However, FEMA cannot guarantee that all unmarked Documents will be recognized as being Competitively Sensitive Information and protected from disclosure to third parties.

If the unmarked Documents have not been disclosed without restriction outside of FEMA, the Sub-Committee Participant may retroactively request to have appropriate designations placed on the Documents. If the unmarked Documents have been disclosed without restriction outside of FEMA, FEMA will, to the extent practicable, remove any requested information from public forums controlled by FEMA and will work promptly to request that a receiving party return or destroy disclosed unmarked Documents if requested by the Sub-Committee Participant. (5) Competitively Sensitive Information may be used by FEMA, alone or in combination with additional information, including Documents and Competitively Sensitive Information received from third parties, to support FEMA's implementation of this Plan of Action as determined by the Chairperson.

In all situations, FEMA will aggregate and anonymize Competitively Sensitive Information to the greatest extent possible to protect the interests retained by the owners of the data while still allowing the objectives of the Plan of Action and Sub-Committee to be achieved. To the greatest extent possible, such aggregation will render the competitively sensitive nature of the Competitively Sensitive Information of the Sub-Committee Participant no longer recognizable in a commercially sensitive manner, and without sufficient information to enable, by inference or otherwise, attribution to Sub-Committee Participant or its affiliates (as clearly identified and disclosed to FEMA). Any disclosure of Competitively Sensitive Information by FEMA, within or outside a Sub-Committee, will be subject to review and approval by DOJ and FTC.

(6) Except as otherwise expressly permitted by applicable federal law, FEMA shall not disclose any Competitively Sensitive Information or use any Competitively Sensitive Information for any purpose other than in connection with the purposes of this Plan of Action, and FEMA will not sell any Competitively Sensitive Information of any Sub-Committee Participant. (7) Except as described below, FEMA may disclose Competitively Sensitive Information only to its employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors). Any individual with access to Competitively Sensitive Information will be expected to comply with the terms of this Plan of Action.

A. Information Sharing within the Sub-Committee. FEMA may share Competitively Sensitive Information with Sub-Committee Participants and Federal Representatives of the Plan of Action, and their respective employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors) where there is a need to know and where disclosure is reasonably necessary in furtherance of implementing the Plan of Action.

FEMA will aggregate and anonymize data prior to sharing with the Sub-Committee Participants to the greatest extent possible while still allowing the objectives of the Plan of Action to be achieved, and will not share data—particularly to competitors of the submitter—prior to consultation with and approval by the DOJ and FTC. I. Sub-Committee Participants, when providing Competitively Sensitive Information to FEMA, may request that this Information not be shared with other Sub-Committee Participants.

Where these requests are made in good faith and are reasonable in nature, FEMA will respect these requests to the greatest extent possible and will consult the owner of the data prior to any release made to Sub-Committee Participants.Start Printed Page 79027 b. Restricted Reports. FEMA may communicate Competitively Sensitive Information to appropriate government officials through Restricted Reports.

The information contained in Restricted Reports shall be aggregated and anonymized to the greatest extent possible, while recognizing that these officials may need a certain amount of granularity and specificity of information to appropriately respond to buy antibiotics. FEMA will aim to aggregate data to the County level, and will not share Restricted Reports prior to consultation and approval from the DOJ and FTC. FEMA may disclose Restricted Reports to relevant White House and Administration officials and State Governors, and their respective employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors) who have a need to know and to whom such disclosure is reasonably necessary solely in furtherance of the implementation of this Plan of Action.

FEMA shall take appropriate action (by instructions, agreement, or otherwise) to ensure that receiving parties comply with all data-sharing confidentiality and obligations under this Plan of Action as if such persons or entities had been parties to this Plan of Action. C. Public Reports.

FEMA may share information with the public through Public Reports. Data contained in Public Reports shall be fully aggregated and anonymized. Public Reports shall be aggregated to at least a state level and may be publicly disclosed after consultation and approval from the DOJ and FTC.

(8) Where possible and not obviated by Exigent Circumstances, FEMA will notify Sub-Committee Participants prior to the release of any Competitively Sensitive Information that has not been fully aggregated and anonymized. In consultation with DOJ and FTC, FEMA will consider any good-faith requests made by Sub-Committee members to hold the release of data or requests for further aggregation or anonymization. In general, FEMA will not provide notification prior to the release of Public Reports, under the presumption that the data in these reports has already been fully anonymized and de-identified.

(9) Any party receiving Competitively Sensitive Information through this Plan shall use such information solely for the purposes outlined in the Plan and take steps, such as imposing previously approved firewalls or tracking usage, to prevent misuse of the information. Disclosure and use of Competitively Sensitive Information will be limited to the greatest extent possible, and any party receiving Competitively Sensitive Information shall follow the procedures outlined in paragraph 7 above. (10) At the conclusion of a Participant's involvement in a Plan—due to the deactivation of the Plan or due to the Participant's withdrawal or removal—each Participant will be requested to sequester any and all Competitively Sensitive Information received through participation in the Plan.

This sequestration shall include the deletion of all Competitively Sensitive Information unless required to be kept pursuant to the Record Keeping requirements as described supra, Section I, 44 CFR part 332, or any other provision of law. C. Oversight Each Sub-Committee Chairperson is responsible for ensuring that the Attorney General, or suitable delegate(s) from the DOJ, and the FTC Chairman, or suitable delegate(s) from the FTC, have awareness of activities under this Plan, including activation, deactivation, and scheduling of meetings.

The Attorney General, the FTC Chairman, or their delegates may attend Sub-Committee meetings and request to be apprised of any activities taken in accordance with activities under this Plan. DOJ or FTC Representatives may request and review any proposed action by the Sub-Committee or Sub-Committee Participants undertaken pursuant to this Plan, including the provision of data. If any DOJ or FTC Representative believes any actions proposed or taken are not consistent with relevant antitrust protections provided by the DPA, he or she shall provide warning and guidance to the Sub-Committee as soon as the potential issue is identified.

If questions arise about the antitrust protections applicable to any particular action, FEMA may request DOJ, in consultation with the FTC, provide an opinion on the legality of the action under relevant DPA antitrust protections. VI. Establishment of the Sub-Committees This Plan establishes Sub-Committees to implement the Plan to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics to provide the Federal Government and the Participants a forum to maximize the manufacture and efficient distribution of selected types of critical PPE and to create a prioritization protocol based upon identified types of PPE End-Users and their demonstrated or projected requirements, and demonstrated or projected geographic and regional areas of need.

The outcome should include a framework to expeditiously meet any PPE needs in Exigent Circumstances anywhere in the Nation, and to ensure that actions to support PPE stockpiling and reserves do not interfere with immediate requirements that would result in an unacceptable risk to healthcare providers or other potential PPE recipients. A Sub-Committee Chairperson designated by the Chairperson will convene and preside over each Sub-Committee. Sub-Committees will not be used for contract negotiations or contract discussions between the Participants and the Federal Government.

Such negotiations or discussions will be in accordance with applicable federal contracting policies and procedures. However, this shall not limit any discussion within a Sub-Committee about the operational utilization of existing and potential contracts between the Participants and Representatives when seeking to align their use with overall manufacturing and distribution efforts consistent with this Plan. Each Sub-Committee will consist of designated Representatives from FEMA, HHS, other federal agencies with equities in this Plan, and each Sub-Committee Participant.

The Attorney General and Chairman of the FTC, or their delegates, may also join each Sub-Committee and attend meetings at their discretion. Attendees may also be invited at the discretion of a Sub-Committee Chairperson as subject matter experts, to provide technical advice, or to represent other government agencies, but will not be considered part of the Sub-Committee. To the extent necessary to respond to the cipro, only at the explicit direction of a Sub-Committee Chairperson, and subject to the provisions of Section V(B), Sub-Committee Members may be asked to provide technical advice, share information, help identify and validate places and resources of the greatest need, help project future manufacturing and distribution demands, assist in identifying and resolving the allocation of scarce resources amongst all necessary public and private sector domestic needs under Exigent Circumstances, and take any other necessary actions to maximize the timely manufacture and distribution of PPE as determined necessary by FEMA to respond to the cipro.

A Sub-Committee Chairperson or his or her designee, at the Sub-Committee Chairperson's sole discretion, will make decisions on these issues in order to ensure the maximum efficiency and effectiveness in the use of Sub-Start Printed Page 79028Committee Member's resources. All Sub-Committee Participants will be invited to open Sub-Committee meetings. For selected Sub-Committee meetings, attendance may be limited to designated Sub-Committee Participants to meet specific operational requirements, as determined by FEMA.

Each Sub-Committee Chairperson shall notify the Attorney General, the Chairman of the FTC, Representatives, and Participants of the time, place, and nature of each meeting and of the proposed agenda of each meeting to be held to carry out this Plan of Action. Additionally, each Sub-Committee Chairperson shall provide for publication in the Federal Register of a notice of the time, place, and nature of each meeting. If a meeting is open, a Federal Register notice will be published reasonably in advance of the meeting.

A Sub-Committee Chairman may restrict attendance at meetings only on the grounds outlined by 44 CFR 332.5(c)(1)-(3). If a meeting is closed, a Federal Register notice will be published within ten (10) days of the meeting and will include the reasons why the meeting is closed pursuant to 44 CFR 332.3(c)(2). The Sub-Committee Chairperson shall establish the agenda for each meeting, be responsible for adherence to the agenda, and provide for a written summary or other record of each meeting and provide copies of transcripts or other records to FEMA, the Attorney General, the Chairman of the FTC, and all Sub-Committee Participants.

The Chairperson shall take necessary actions to protect from public disclosure any data discussed with or obtained from Sub-Committee Participants which a Sub-Committee Participant has identified as a trade secret or as privileged and confidential in accordance with DPA sections 708(h)(3) and 705(d), or which qualifies for withholding under 44 CFR 332.5. VII. Application and Agreement The Sub-Committee Participant identified below hereby agrees to join in the Federal Emergency Management Agency sponsored Plan of Action to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) under the Voluntary Agreement for the Manufacture and Distribution of Healthcare Resources Necessary to Respond to a cipro and to become a Participant in one or more Sub-Committees established by this Plan.

This Plan will be published in the Federal Register. This Plan is authorized under section 708 of the Defense Production Act of 1950, as amended. Regulations governing the Voluntary Agreement for the Manufacture and Distribution for the Manufacture and Distribution of Healthcare Resources Necessary to Respond to a cipro and all subsequent Plans of Action appear at 44 CFR part 332.

The applicant, as a Sub-Committee Participant, agrees to comply with the provisions of section 708 of the Defense Production Act of 1950, as amended, the regulations at 44 CFR part 332, and the terms of this Plan. VIII. Assignment No Sub-Committee Participant may assign or transfer this Plan, in whole or in part, or any protections, rights or obligations hereunder without the prior written consent of the Sub-Committee Chairperson.

When requested, the Sub-Committee Chairperson will respond to written requests for consent within 10 (ten) business days of receipt. (Company name) (Name of authorized representative) (Signature of authorized representative) (Date) Sub-Committee Chairperson (Date) Start Signature Pete Gaynor, Administrator, Federal Emergency Management Agency. End Signature End Supplemental Information [FR Doc.

2020-26986 Filed 12-7-20. 8:45 am]BILLING CODE 9111-19-P.

Start Preamble can i buy cipro online Federal http://www.ec-capuciniere-obernai.ac-strasbourg.fr/Adm/?p=237 Emergency Management Agency, DHS. Notice. The Federal Emergency Management Agency (FEMA) announces can i buy cipro online the activation of a Plan of Action to establish a National Strategy for the manufacture, allocation, and distribution of Personal Protective Equipment (PPE) to respond to buy antibiotics implemented under the Voluntary Agreement for the manufacture and distribution of critical healthcare resources necessary to respond to a cipro.

This Notice contains the text of the Plan of Action. Start Further Info Robert Glenn, Office of Business, Industry, Infrastructure Integration, Federal Emergency Management Agency, (202) 212-1666, and email OB3I@fema.dhs.gov. End Further Info End Preamble Start Supplemental Information Authority Section 708 of the can i buy cipro online Defense Production Act (DPA), 50 U.S.C.

4558, allows the President to provide for the formation of voluntary agreements and plans of action by the private sector to help provide for the national defense. This authority was delegated to the Secretary of Homeland Security generally in section 401 of Executive Order 13603,[] “National Defense Resources Preparedness,” and specifically for response to buy antibiotics in section 3 of Executive Order 13911,[] “Delegating Additional Authority Under the Defense Production Act With Respect to Health and Medical Resources To Respond to the Spread of buy antibiotics.” The Secretary of Homeland Security has delegated these authorities to the FEMA Administrator in Department of Homeland Security (DHS) Delegation 09052 Rev. 00, “Delegation of Defense Production Act Authority to the Administrator can i buy cipro online of the Federal Emergency Management Agency,” (Jan.

3, 2017), and DHS Delegation 09052 Rev. 00.1, “Delegation of Defense Production Act Authority to the Administrator of the Federal Emergency Management Agency” (Apr. 1, 2020), respectively can i buy cipro online.

Background FEMA sought and received approval from the Attorney General, after consultation with the Federal Trade Commission (FTC), to begin consultation with the private sector, as required by Section 708(c)(2). Pursuant to that approval, on May 12, 2020, FEMA posted an announcement of a public meeting and request for comments to develop a Voluntary Agreement in the Federal Register (85 FR 28031). FEMA held a public meeting on May 21, 2020, and accepted public comments until June 5, 2020.[] FEMA received 34 public comments and considered these comments when preparing the can i buy cipro online Voluntary Agreement.[] The Attorney General, in consultation with the Chairman of the Federal Trade Commission, made the required finding that the purpose of the Voluntary Agreement may not reasonably be achieved through an agreement having less anticompetitive effect or without any Voluntary Agreement.

Pursuant to Sec. 708(f)(1)(B) of the DPA, the Department of Justice separately published this finding in the Federal Register on August 17, 2020 as a notice (85 FR 50049). The FEMA Administrator, as the Sponsor of the agreement, certified in writing that the agreement was necessary to help provide for can i buy cipro online the national defense.

FEMA provided notice of the formation and the Start Printed Page 79021text of the Voluntary Agreement in the Federal Register on August 17, 2020 (85 FR 50035). On October 13, 2020, FEMA held a virtual meeting to implement the Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (see 85 FR 63567). A portion of the can i buy cipro online meeting was open to the public.

One objective of this meeting was to discuss the activation of the first Plan of Action under the Voluntary Agreement to identify more efficient methods of allocating and distributing Personal Protective Equipment to meet national demand and ways of expanding the production of critical healthcare resources, with an initial focus on the manufacture of N95 masks. From this meeting, FEMA incorporated public comments and feedback from the U.S. Department of Justice and the Federal Trade Commission to develop the can i buy cipro online Plan of Action.

The Attorney General, in consultation with the Chairman of the Federal Trade Commission, made the required finding that the purposes of section 708(c)(1) of the DPA cannot reasonably be achieved without any Plan of Action, or by a plan of action having less anticompetitive effects than the proposed Plan of Action. Pursuant to section 708(f)(1)(B) of the DPA, the Department of Justice is separately publishing this finding in the Federal Register as a notice. The FEMA Administrator has certified in writing that this Plan of Action is necessary to can i buy cipro online help provide for the national defense.

Text of the Plan of Action to Establish a National Strategy for the manufacture, allocation, and distribution of Personal Protective Equipment (PPE) to respond to buy antibiotics implemented under the voluntary agreement for the MANUFACTURE AND DISTRIBUTION OF CRITICAL HEALTHCARE RESOURCES NECESSARY TO RESPOND TO A cipro Table of Contents Preface I. Purpose II. Authorities III can i buy cipro online.

General Provisions A. Definitions B. Plan of Action Participation can i buy cipro online C.

Effective Date and Duration of Participation D. Withdrawal E. Plan of Action Activation and Deactivation can i buy cipro online F.

Rules and Regulations G. Modification and Amendment H. Expenses I can i buy cipro online.

Record Keeping IV. Antitrust Defense V. Terms and can i buy cipro online Conditions A.

Plan of Action Execution B. Information Management and Responsibilities C. Oversight VI can i buy cipro online.

Establishment of the Sub-Committees VII. Application and Agreement VIII. Assignment Preface Pursuant to section 708 of the Defense Production Act of 1950 (DPA), as amended can i buy cipro online (50 U.S.C.

4558), the Federal Emergency Management Agency (FEMA) Administrator (Administrator), after consultation with the Secretary of the Department of Health and Human Services (HHS), the Attorney General of the United States (Attorney General), and the Chairman of the Federal Trade Commission (FTC), developed a Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (Voluntary Agreement), 85 FR 50035 (August 17, 2020). The Voluntary Agreement, which operates through a series of Plans of Action, maximizes the manufacture and efficient distribution of Critical Healthcare Resources nationwide to respond to a cipro by establishing unity of effort between Participants and the Federal Government for integrated coordination, planning, information sharing with FEMA, as authorized can i buy cipro online by FEMA, and allocation and distribution of Critical Healthcare Resources. This document establishes a Plan of Action (Plan) for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics.

This Plan will be implemented under the Voluntary Agreement by several Sub-Committees. (1) Sub-Committee to Define buy antibiotics PPE Requirements, can i buy cipro online (2) Sub-Committee for N-95 and other Medical Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings. FEMA may establish additional Sub-Committees under this Plan of Action, so long as.

(1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) can i buy cipro online The Sub-Committee is recommended by the Sub-Committee to Define buy antibiotics PPE Requirements. The purpose of the Plan and the Sub-Committees is to maximize the manufacture and efficient distribution of selected types of critical PPE and create a prioritization protocol for End-Users based upon their demonstrated or projected requirements including geographic and regional circumstances.

The primary goal of the Plan is to create a mechanism to immediately meet exigent PPE requests anywhere in the Nation and to ensure that actions to support PPE stockpiling and reserves do not interfere with immediate requirements that would result in an unacceptable risk to healthcare providers or other potential PPE recipients. When the requirements of the Plan are met, it affords Sub-Committee Participants defenses to civil and criminal actions brought under the antitrust laws (or any similar law of any state) for actions taken within the scope of the can i buy cipro online Plan. The Plan is designed to foster a close working relationship among FEMA, HHS, and Sub-Committee Participants to address national defense needs through cooperative action under the direction and active supervision of FEMA.

I. Purpose A cipro may present conditions that pose a direct threat to the national defense of the United States or its preparedness programs such that, pursuant to DPA section 708(c)(1), an agreement to collectively coordinate, plan, and collaborate for the manufacture and distribution of PPE is necessary for can i buy cipro online the national defense. This Plan of Action to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics is established under the Voluntary Agreement and establishes five Sub-Committees to oversee and implement the Plan.

The Plan and Sub-Committees will optimize the manufacture and the efficient distribution of selected types of critical PPE and create a prioritization protocol for End-Users based upon their demonstrated or projected requirements and taking into account geographic and regional circumstances for stabilization and reduction of buy antibiotics exposure. II. Authorities Section 708, Defense Production Act (50 U.S.C.

4558). Sections 402(2) &. 501(b), Robert T.

Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121-5207). Sections 503(b)(2)(B) &.

504(a)(10) &. (16) of the Homeland Security Act of 2002 (6 U.S.C. 313(b)(2)(B), 314(a)(10) &.

(16)). Sections 201, 301, National Emergencies Act (50 U.S.C. 1601 et seq.).

Section 319, Public Health Service Act (42 U.S.C. 247d). Executive Order (E.O.) 13911, 85 FR 18403 (March 27, 2020).

Prioritization and Allocation of Certain Scarce or Threatened Health and Medical Resources for Domestic Use, 85 FR 20195 (April 10, 2020). Pursuant to DPA Start Printed Page 79022section 708(f)(1)(A), the Administrator certifies that this Plan is necessary for the national defense. III.

General Provisions A. Definitions Administrator The FEMA Administrator is the Sponsor of the Voluntary Agreement. Pursuant to a delegation or redelegation of the functions given to the President by DPA section 708, the Administrator proposes and provides for the development and carrying out of the Voluntary Agreement, including through the development and implementation of Plans of Action.

The Administrator is responsible for carrying out all duties and responsibilities required by 50 U.S.C. 4558 and 44 CFR part 332 and for appointing one or more Chairpersons to manage and administer the Committee and all Sub-Committees formed to carry out the Voluntary Agreement. Agreement The Voluntary Agreement for the Manufacture and Distribution of Critical Healthcare Resources Necessary to Respond to a cipro (Voluntary Agreement).

Allocation The process of determining and directing the relative distribution among one or more competing requests from End-Users for the same PPE. Through the Allocation process, FEMA—with participation from Sub-Committee Participants—will assess the actual needs of End-Users and determine how to divide the available and projected supply of PPE to minimize impacts to life, safety, and economic disruption associated with shortages of critical PPE. Allocation will take place only under Exigent Circumstances.

FEMA retains decision-making authority for all Allocation under this Plan. Attendees Subject matter experts, invited by the Chairperson or a Sub-Committee Chairperson to attend meetings authorized under the Voluntary Agreement or this Plan of Action, to provide technical advice or to represent other government agencies or interested parties. Invitations to attendees will be extended as required for Committee or Sub-Committee meetings and deliberations.

Chairperson FEMA senior executive(s), appointed by the Administrator, to chair the Committee for the Distribution of Healthcare Resources Necessary to Respond to a cipro (Committee). The Chairperson shall be responsible for the overall management and administration of the Committee, the Voluntary Agreement, and Plans of Action developed under the Voluntary Agreement while remaining under the supervision of the Administrator. Shall initiate, or approve in advance, each meeting held to discuss problems, determine policies, recommend actions, and make decisions necessary to carry out the Voluntary Agreement.

Appoint one or more co-Chairpersons to chair the Committee, and otherwise shall carry out all duties and responsibilities assigned to him. With the approval of the Administrator, the Chairperson may create one or more Sub-Committees, and may appoint one or more Sub-Committee Chairpersons to chair the Sub-Committees, as appropriate. Committee Committee for the Distribution of Healthcare Resources Necessary to Respond to a cipro established under the Voluntary Agreement.

Competitively Sensitive Information Competitively Sensitive Information that is shared pursuant to this Plan of Action may include any Document or other tangible thing or oral transmission that contains financial, business, commercial, scientific, technical, economic, or engineering information or data, including, but not limited to Financial statements and data, customer and supplier lists, price and other terms of sale to customers, sales records, projections and forecasts, inventory levels, capacity and capacity utilization, cost information, sourcing and procurement information, manufacturing and production information, delivery and shipping information, systems and data designs, and methods, techniques, processes, procedures, programs, codes, or similar information, whether tangible or intangible, and regardless of the method of storage, compilation, or recordation, if the owner thereof has taken reasonable measures to protect the information from disclosure to the public or competitors. These measures may be evidenced by marking or labeling the items as “competitively sensitive information” during submission to FEMA or in the Participant's customary and existing treatment of such information (regardless of labeling). All Competitively Sensitive Information provided by a Sub-Committee Participant as described herein is deemed Competitively Sensitive Information, except for Information that.

A. Is published or has been made publicly available at the time of disclosure by the Sub-Committee Participant. B.

Was in the possession of, or was lawfully and readily available to, FEMA from another source at the time of disclosure without breaching any obligation of confidentiality applicable to the other source. Or c. Was independently developed or acquired without reference to or reliance upon the Sub-Committee Participant's Competitively Sensitive Information.

Where information deemed Competitively Sensitive Information is required to be disclosed by law, regulation, or court order, the “Competitively Sensitive” (or substantially similar) label will continue to attach to all information and portion(s) of documents that are not made public through the required disclosure. Document Any information, on paper or in electronic/audio/visual format, including written, recorded, and graphic materials of every kind, in the possession, custody, or control of the Participant and used or shared in the course of participation in the Voluntary Agreement or a subsequent Plan of Action. End-User This includes all direct and ancillary medical support including, but not limited to, hospitals, independent healthcare providers, nursing homes, medical laboratories, dental care providers, independent physician offices, first responders, alternate care facilities and the general public that reasonably represents the totality of the nation's professional or medical response to buy antibiotics.

€œEnd-User” may also include essential workers necessary to maintain or restore critical infrastructure operations, including but not limited to law enforcement, education, food and agriculture, energy, water and wastewater, and public works personnel. Exigent Circumstances As determined by the Chairperson, the actual or forecasted shortage of a particular type or types of PPE which Start Printed Page 79023likely cannot be fulfilled via usual market mechanisms for an acute, critical time period, and where immediate and substantial harm is projected to occur from lack of intervention. cipro A cipro is defined as an epidemic that has spread to human populations across a large geographic area that is subject to one or more declarations under the National Emergencies Act, the Public Health Service Act, or the Robert T.

Stafford Disaster Relief and Emergency Assistance Act, or if the Administrator determines that one or more declarations is likely to occur and the epidemic poses a direct threat to the national defense or its preparedness programs. For example, antibiotics Disease 2019 (buy antibiotics). Participant An individual, partnership, corporation, association, or private organization, other than a federal agency, that has substantive capabilities, resources or expertise to carry out the purpose of the Voluntary Agreement, that has been specifically invited to participate in the Voluntary Agreement by the Chairperson, and that has applied and agreed to the terms of the Voluntary Agreement.

€œParticipant” includes a corporate or non-corporate entity entering into the Voluntary Agreement and all subsidiaries and affiliates of that entity in which that entity has 50 percent or more control either by stock ownership, board majority, or otherwise. The Administrator may invite Participants to join the Voluntary Agreement at any time during its effective period. Personal Protective Equipment (PPE) Objects that provide measures of safety protection for healthcare workers, first responders, critical infrastructure personnel and/or the general public for the response to the cipro.

These PPE items may include, but are not limited to, face coverings, filtering facepiece respirators, face shields, isolation and surgical gowns, examination and surgical gloves, suits, and foot coverings. Plan of Action (Plan) This document. A documented method, pursuant to 50 U.S.C.

4558(b)(2), proposed by FEMA to implement a particular set of activities under the Voluntary Agreement, through a Sub-Committee focused on a particular Critical Healthcare Resource, or cipro response workstream or functional area necessary for the national defense. Plan of Action Agreement A separate commitment made by Participants upon invitation and agreement to participate in a Plan of Action as part of one or more Sub-Committees. Completing the Plan of Action Agreement confers responsibilities on the Participant consistent with those articulated in the Plan of Action and affords Participants a defense against antitrust claims under section 708 for actions taken to develop or carry out the Plan of Action and the appropriate Sub-Committee(s), as described in Section IV below.

Representatives The representatives the Administrator identifies and invites to the Committee from FEMA, HHS, and other federal agencies with equities in this Plan, and empowered to speak on behalf of their agencies' interests. The Attorney General and the Chairman of the FTC, or their delegates, may also attend any meeting as a Representative. Sub-Committee A body formed by the Administrator from select Participants to implement a Plan of Action.

Sub-Committee Chairperson FEMA official, appointed by the Chairperson, to chair a Sub-Committee to implement a Plan of Action. The Sub-Committee Chairperson shall be responsible for the overall management and administration of the Sub-Committee in furtherance of this Plan of Action while remaining under the supervision of the Administrator and the Chairperson. Sub-Committee Members Collectively the Sub-Committee Chairperson(s), Representatives, and Sub-Committee Participants.

Jointly responsible developing and executing this Plan. Sub-Committee Participant A subset of Participants of the Committee, that have been specifically invited to participate in a Sub-Committee by the Sub-Committee Chairperson, and that have applied and agreed to the terms of this Plan and signed the Plan of Action Agreement. The Sub-Committee Chairperson may invite Participants in the Committee to join a Sub-Committee as a Sub-Committee Participant at any time during the Plan's effective period.

B. Plan of Action Participation This Plan will be carried out by a subset of the Participants in the Voluntary Agreement through several Sub-Committees. (1) Sub-Committee to Define buy antibiotics PPE Requirements, (2) Sub-Committee for N-95 and other Medical Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings.

FEMA may establish additional Sub-Committees under this Plan of Action, so long as. (1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) The Sub-Committee is recommended by the Sub-Committee to Define buy antibiotics PPE Requirements.

Each Sub-Committee will consist of the (1) Sub-Committee Chairperson(s), (2) Representatives from FEMA, HHS, the Department of Justice (DOJ), and other federal agencies with equities in this Plan, and (3) Sub-Committee Participants that have substantive capabilities, resources or expertise to carry out the purpose of this Plan and have signed the Plan of Action Agreement. The Chairperson shall invite Sub-Committee Participants who, in his or her determination, are reasonably representative of the appropriate industry or segment of such industry. Other Attendees—invited by the Sub-Committee Chairperson as subject matter experts to provide technical advice or to represent the interests of other government agencies or interested parties—may also participate in Sub-Committee meetings.

The naming of these Sub-Committees does not commit the Administrator to creating them unless and until circumstances dictate. C. Effective Date and Duration of Participation This Plan is effective immediately upon satisfaction of the requirements of DPA section 708(f)(1).

This Plan shall remain in effect until terminated in accordance with 44 CFR 332.4. It shall be effective for no more than five (5) years from August 17, 2020, when the requirements of DPA section 708(f)(1) were satisfied for the Voluntary Agreement, unless otherwise terminated pursuant to DPA section 708(h)(9) and 44 CFR 332.4 or extended as set forth in DPA section 708(f)(2). No action may take place under this Plan until it is activated, as described in Section III(E), below.

D. Withdrawal Participation in the Plan is voluntary, as is the acceptance of most obligations under the Plan. Sub-Committee Participants may withdraw from this Start Printed Page 79024Plan or from an individual Sub-Committee at any point, subject to the fulfillment of obligations previously agreed upon by the Participant prior to the date of withdrawal.

Note that the obligations outlined in V.B regarding information management and associated responsibilities apply once a party has shared or received information through a Sub-Committee, and remain in place after the party's withdrawal from the Sub-Committee or Plan. If a Sub-Committee Participant indicates an intent to withdraw from the Plan due to a modification or amendment of the Plan (described below), the Sub-Committee Participant will not be required to perform actions directed by that modification or amendment. Withdrawal from the Plan will automatically trigger withdrawal from all Sub-Committees.

However, a Participant may withdraw from a Sub-Committee without also withdrawing from the Plan or other Sub-Committees. To withdraw from the Plan or from an individual Sub-Committee, a Participant must provide written notice to the Administrator at least fifteen (15) calendar days prior to the effective date of that Sub-Committee Participant's withdrawal specifying the scope of withdrawal. Following receipt of such notice, the Administrator will inform the other Sub-Committee Participants of the date and the scope of the withdrawal.

Upon the effective date of the withdrawal from the Plan, the Sub-Committee Participant must cease all activities under the Plan. Upon the effective date of the withdrawal from one or more Sub-Committee(s), the Sub-Committee Participant must cease all activities under the Plan that pertain to the withdrawn Sub-Committee(s). E.

Plan of Action Activation and Deactivation The Administrator, in consultation with the Chairperson and Sub-Committee Chairperson, will invite a select group of Participants in the Voluntary Agreement to form the following Sub-Committees, which will be responsible for implementing this Plan. (1) Sub-Committee to Define buy antibiotics PPE Requirements, (2) Sub-Committee for N-95 and other Medical Respirators, (3) Sub-Committee for Gloves, (4) Sub-Committee for Gowns, and (5) Sub-Committee for Eye and Facial Coverings. FEMA may establish additional Sub-Committees under this Plan of Action, so long as.

(1) The Sub-Committee addresses one specific and well-defined category of PPE. And (2) The Sub-Committee is recommended by the Sub-Committee to Define buy antibiotics PPE Requirements. This Plan will be activated for each invited Participant when the Participant executes a Plan of Action Agreement, and a Participant may not participate in a Sub-Committee until the Plan of Action Agreement is executed.

Participants will be invited to join this Plan at the discretion of the Chairperson or the Sponsor to the Voluntary Agreement. Participants will be further invited to attend specific meetings of one or more Sub-Committees at the discretion of the Chairperson. F.

Rules and Regulations Sub-Committee Participants acknowledge and agree to comply with all provisions of DPA section 708, as amended, and regulations related thereto which are promulgated by FEMA, the Department of Homeland Security, HHS, the Attorney General, and the FTC. FEMA has promulgated standards and procedures pertaining to voluntary agreements in 44 CFR part 332. The Administrator shall inform Participants of new rules and regulations as they are issued.

G. Modification and Amendment The Administrator, after consultation with the Attorney General and the Chairman of the FTC, may terminate or modify, in writing, this Plan at any time. The Attorney General, after consultation with the Chairman of the FTC and the Administrator, may terminate or modify, in writing, this Plan at any time.

Sub-Committee Participants may propose modifications or amendments to the Plan or to the Sub-Committees at any time. Where possible, material modifications to the Plan or a Sub-Committee will be subject to a 30 calendar day delayed implementation and opportunity for notice and comment by Sub-Committee Participants to the Chairperson. This delayed implementation period may be shortened or eliminated if the Administrator deems it necessary.

The Administrator shall inform Sub-Committee Participants of modifications or amendments to the Plan or to the Sub-Committees as they are proposed and issued. The Administrator, after consultation with the Attorney General and the Chairman of the FTC, may remove Sub-Committee Participants from the Plan or from a Sub-Committee at any time. The Attorney General, after consultation with the Chairman of the FTC and the Administrator, may remove Sub-Committee Participants from this Plan or from a Sub-Committee at any time.

If a Participant is removed from the Plan or from a Sub-Committee, the Participant may request written notice of the reasons for removal from the Chairperson, who shall provide such notice in a reasonable time period. H. Expenses Participation in this Plan or in a Sub-Committee does not confer funds to Sub-Committee Participants, nor does it limit or prohibit any pre-existing source of funds.

Unless otherwise specified, all expenses, administrative or otherwise, incurred by Sub-Committee Participants associated with participation in this Plan or a Sub-Committee shall be borne exclusively by the Sub-Committee Participants. I. Record Keeping Each Sub-Committee Chairperson shall have primary responsibility for maintaining records in accordance with 44 CFR part 332 and shall be the official custodian of records related to carrying out this Plan.

Each Sub-Committee Participant shall maintain for five years all minutes of meetings, transcripts, records, documents, and other data, including any communications with other Sub-Committee Participants or with any other member of the Sub-Committee, including drafts, related to the carrying out of this Plan or incorporating data or information received in the course of carrying out this Plan. Each Sub-Committee Participant agrees to produce to the Administrator, the Attorney General, and the Chairman of the FTC upon request any item that this section requires the Participant to maintain. Any record maintained in accordance with 44 CFR part 332 shall be available for public inspection and copying, unless exempted on the grounds specified in 5 U.S.C.

552(b)(1), (3) or (4) or identified as privileged and confidential information in accordance with DPA section 705(d), and 44 CFR 332.5. IV. Antitrust Defense Under the provisions of DPA subsection 708(j), each Sub-Committee Participant in this Plan shall have available as a defense to any civil or criminal action brought for violation of the antitrust laws (or any similar law of any State) with respect to any action to develop or carry out this Plan, that such action was taken by the Sub-Committee Participant in the course of developing or carrying out this Plan, that the Sub-Start Printed Page 79025Committee Participant complied with the provisions of DPA section 708 and the rules promulgated thereunder, and that the Sub-Committee Participant acted in accordance with the terms of the Voluntary Agreement and this Plan.

Except in the case of actions taken to develop this Plan, this defense shall be available only to the extent the Sub-Committee Participant asserting the defense demonstrates that the action was specified in, or was within the scope of, this Plan and within the scope of the appropriate Sub-Committee(s), including being taken at the direction and under the active supervision of FEMA. This defense shall not apply to any actions taken after the termination of this Plan. Immediately upon modification of this Plan, no defense to antitrust claims under Section 708 shall be available to any subsequent action that is beyond the scope of the modified Plan.

The Sub-Committee Participant asserting the defense bears the burden of proof to establish the elements of the defense. The defense shall not be available if the person against whom the defense is asserted shows that the action was taken for the purpose of violating the antitrust laws. V.

Terms and Conditions As the sponsoring agency, FEMA will maintain oversight over Sub-Committee activities and direct and supervise actions taken to carry out this Plan, including by retaining decision-making authority over actions taken pursuant to the Plan to ensure such actions are necessary to address a direct threat to the national defense. The Attorney General and the Chairman of the FTC will monitor activities of the Sub-Committees to ensure they execute their responsibilities in a manner consistent with this Plan and their actions have the least anticompetitive effects possible. A.

Plan of Action Execution This Plan will be used to support the following objectives to respond to a cipro by maximizing the manufacture and efficient distribution of selected types of critical PPE and creating a prioritization protocol for End-Users based upon their demonstrated or projected requirements and taking into account geographic and regional circumstances. Each Sub-Committee will undertake the following Objectives for the PPE item(s) within its area of jurisdiction. 1.

Objectives (1) Optimize the timely production of sufficient quantities of PPE to reduce loss of life and transmission of the buy antibiotics cipro. (2) Ensure PPE is distributed effectively across the whole community nationally based on risk. (3) Balance restoration and maintenance of the nation's stockpile of PPE with near-term requirements.

(4) Establish a process for FEMA Allocation of PPE nationwide. (5) Ensure ongoing competition in the manufacture and distribution of PPE to the greatest extent possible under the DPA. 2.

Actions Sub-Committee Participants may be asked to support these objectives by taking the following specific actions. (1) Assist the Chairperson in identifying which types of critical PPE should be included within each Sub-Committee. Identification will be based upon each item's importance to the national response to buy antibiotics and whether it can be reasonably inferred, based upon the best evidence available, that that current and projected supply measured against current and projected demand may not adequately meet the PPE requirements to all identified End-Users or regional or geographic areas of the country as result of measures taken to respond to buy antibiotics.

(2) Provide input to the Chairperson in creating a prioritized list of PPE End-Users by categories for each type of critical PPE identified by each Sub-Committee, and ascertaining the relative demand and supply of PPE among and within those End User categories. Prioritization shall be decided by the Chairperson, based upon each item's importance, reflecting the consensus views of the Sub-Committee Members that it represents the most effective way to save lives and prevent the transmission of the buy antibiotics cipro. This list may be updated throughout the life of the Plan of Action based upon either short term or long-term demands.

These categories should be considered holistically in terms of the Whole-of-Nation response to buy antibiotics. (3) Evaluate the domestic supply of PPE and identify when the expansion of the domestic manufacture of PPE may be necessary, as directed and decided by the Chairperson. (4) Provide information, assist, and validate, as necessary as decided by the Chairperson, demand projections for PPE.

(5) Create a process for and collaborate in the evaluation of competing claims for PPE from End-Users. (6) Prepare a general strategy to accomplish the activities listed in V(A)(2)(7) below regarding activities in Exigent Circumstances consistent with the decisions made by the Chairperson. (7) In Exigent Circumstances, with review and concurrence in all possible instances by DOJ in consultation with FTC.

Facilitate maximum availability of PPE to the nation or particular geographies by deconflicting overlapping demands from the collective Participants' customer base, as directed and decided by the Chairperson. Facilitate maximum availability of PPE to the nation or particular geographies by deconflicting overlapping supply chain demands placed upon Members, as directed and decided by the Chairperson. Facilitate the efficient distribution of PPE by deconflicting overlapping distribution chain activities of Members, as directed and decided by the Chairperson.

Create a process for and collaborate in the Allocation of PPE nationwide or in particular geographies consistent with the decisions made by the Chairperson. Create a process for and collaborate in meeting any other exigent requirements throughout the nation or particular geographies consistent with the overall strategy prepared by this Sub-Committee. (8) Provide data and information necessary to validate the efforts of the Sub-Committee including the actual and planned amounts of PPE to be distributed throughout the Nation, as determined by the Chairperson.

(9) Provide feedback to the Sub-Committee on the outcomes of the collective efforts of the Sub-Committee Members and any impediments or bottlenecks. (10) Advise the Chairperson whether additional Participants or Attendees should be invited to join this Plan of Action and Sub-Committee. (11) Carry out other activities regarding critical PPE as identified by Sub-Committees under this Plan as determined and directed by the Chairperson necessary to address the buy antibiotics cipro' direct threat to the national defense, where such activities have been reviewed and approved by DOJ and FTC and received concurrence from Sub-Committee members.

B. Information Management and Responsibilities FEMA will request only that data and information from Sub-Committee Participants that is necessary to meet the objectives of the Plan and consistent with the scope of the relevant Sub-Start Printed Page 79026Committees. Upon signing a Plan of Action Agreement for this Plan, FEMA requests that Participants endeavor to cooperate with diligence and speed, and to the extent permissible under this Plan, and share with FEMA data and information necessary to meet the objectives of this Plan.

Sub-Committee Participants agree to share with FEMA the following data with diligence and speed, to the extent permissible under this Plan, and abide by the following guidelines, where feasible and consistent with the data that is owned by each Sub-Committee Participant. (1) In general, Participants will not be asked to share Competitively Sensitive Information directly with other Participants. (2) FEMA will only request direct sharing of Competitively Sensitive Information among Participants during Exigent Circumstances where there is a mission critical need or timeline such that sharing only through FEMA is impractical or threatens the outcome of the Plan or Sub-Committee action.

Such requests, if made, will be only among Participants whose participation is necessary to meet the objectives of the Plan, will be limited in scope to the greatest extent possible, and will be shared only pursuant to safeguards subject to prior review and audit by DOJ and FTC. Direct sharing of Competitively Sensitive Information with other Participants will be limited in scope and circumstances to the greatest extent possible. Participants may not share Competitively Sensitive Information directly with other Participants unless specifically requested by FEMA, in consultation with DOJ and FTC.

All Competitively Sensitive Information delivered to FEMA or to another Sub-Committee Participant shall be delivered by secure means, for example, password-protected or encrypted electronic files or drives with the password/key delivered by separate communication or method or via upload to an appropriately secure web portal as directed by FEMA. All data delivered to the web portal designated by FEMA is deemed to be Competitively Sensitive Information. (3) To allow FEMA to identify and appropriately protect documents containing Competitively Sensitive Information by the Sub-Committee Participant providing the documents, the Sub-Committee Participant will make good faith efforts to designate any Competitively Sensitive Information by placing restrictive markings on documents and things considered to be competitively sensitive, the restrictive markings being sufficiently clear in wording and visibility to indicate the restricted nature of the data.

The Sub-Committee Participant will identify Competitively Sensitive Information that is disclosed verbally by oral warning. Information designated as competitively sensitive will, to the extent allowed by law, be presumed to constitute trade secrets, or commercial or financial information, and be provided by the Sub-Committee Participant to FEMA with the expectation that it will be kept confidential by both parties, as such terms are understood in accordance with 5 U.S.C. 552(b)(4) of the Freedom of Information Act and federal judicial interpretations of this statute.

FEMA agrees that to the extent any information designated as competitively sensitive by a Sub-Committee Participant is responsive to a request for disclosure under the Freedom of Information Act, FEMA will consult with the Sub-Committee Participant and afford the Participant ten (10) working days to object to any disclosure by FEMA. (4) FEMA will make good faith efforts to appropriately recognize unmarked Documents containing Competitively Sensitive Information as Competitively Sensitive Information. However, FEMA cannot guarantee that all unmarked Documents will be recognized as being Competitively Sensitive Information and protected from disclosure to third parties.

If the unmarked Documents have not been disclosed without restriction outside of FEMA, the Sub-Committee Participant may retroactively request to have appropriate designations placed on the Documents. If the unmarked Documents have been disclosed without restriction outside of FEMA, FEMA will, to the extent practicable, remove any requested information from public forums controlled by FEMA and will work promptly to request that a receiving party return or destroy disclosed unmarked Documents if requested by the Sub-Committee Participant. (5) Competitively Sensitive Information may be used by FEMA, alone or in combination with additional information, including Documents and Competitively Sensitive Information received from third parties, to support FEMA's implementation of this Plan of Action as determined by the Chairperson.

In all situations, FEMA will aggregate and anonymize Competitively Sensitive Information to the greatest extent possible to protect the interests retained by the owners of the data while still allowing the objectives of the Plan of Action and Sub-Committee to be achieved. To the greatest extent possible, such aggregation will render the competitively sensitive nature of the Competitively Sensitive Information of the Sub-Committee Participant no longer recognizable in a commercially sensitive manner, and without sufficient information to enable, by inference or otherwise, attribution to Sub-Committee Participant or its affiliates (as clearly identified and disclosed to FEMA). Any disclosure of Competitively Sensitive Information by FEMA, within or outside a Sub-Committee, will be subject to review and approval by DOJ and FTC.

(6) Except as otherwise expressly permitted by applicable federal law, FEMA shall not disclose any Competitively Sensitive Information or use any Competitively Sensitive Information for any purpose other than in connection with the purposes of this Plan of Action, and FEMA will not sell any Competitively Sensitive Information of any Sub-Committee Participant. (7) Except as described below, FEMA may disclose Competitively Sensitive Information only to its employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors). Any individual with access to Competitively Sensitive Information will be expected to comply with the terms of this Plan of Action.

A. Information Sharing within the Sub-Committee. FEMA may share Competitively Sensitive Information with Sub-Committee Participants and Federal Representatives of the Plan of Action, and their respective employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors) where there is a need to know and where disclosure is reasonably necessary in furtherance of implementing the Plan of Action.

FEMA will aggregate and anonymize data prior to sharing with the Sub-Committee Participants to the greatest extent possible while still allowing the objectives of the Plan of Action to be achieved, and will not share data—particularly to competitors of the submitter—prior to consultation with and approval by the DOJ and FTC. I. Sub-Committee Participants, when providing Competitively Sensitive Information to FEMA, may request that this Information not be shared with other Sub-Committee Participants.

Where these requests are made in good faith and are reasonable in nature, FEMA will respect these requests to the greatest extent possible and will consult the owner of the data prior to any release made to Sub-Committee Participants.Start Printed Page 79027 b. Restricted Reports. FEMA may communicate Competitively Sensitive Information to appropriate government officials through Restricted Reports.

The information contained in Restricted Reports shall be aggregated and anonymized to the greatest extent possible, while recognizing that these officials may need a certain amount of granularity and specificity of information to appropriately respond to buy antibiotics. FEMA will aim to aggregate data to the County level, and will not share Restricted Reports prior to consultation and approval from the DOJ and FTC. FEMA may disclose Restricted Reports to relevant White House and Administration officials and State Governors, and their respective employees, officers, directors, contractors, agents, and advisors (including attorneys, accountants, consultants, and financial advisors) who have a need to know and to whom such disclosure is reasonably necessary solely in furtherance of the implementation of this Plan of Action.

FEMA shall take appropriate action (by instructions, agreement, or otherwise) to ensure that receiving parties comply with all data-sharing confidentiality and obligations under this Plan of Action as if such persons or entities had been parties to this Plan of Action. C. Public Reports.

FEMA may share information with the public through Public Reports. Data contained in Public Reports shall be fully aggregated and anonymized. Public Reports shall be aggregated to at least a state level and may be publicly disclosed after consultation and approval from the DOJ and FTC.

(8) Where possible and not obviated by Exigent Circumstances, FEMA will notify Sub-Committee Participants prior to the release of any Competitively Sensitive Information that has not been fully aggregated and anonymized. In consultation with DOJ and FTC, FEMA will consider any good-faith requests made by Sub-Committee members to hold the release of data or requests for further aggregation or anonymization. In general, FEMA will not provide notification prior to the release of Public Reports, under the presumption that the data in these reports has already been fully anonymized and de-identified.

(9) Any party receiving Competitively Sensitive Information through this Plan shall use such information solely for the purposes outlined in the Plan and take steps, such as imposing previously approved firewalls or tracking usage, to prevent misuse of the information. Disclosure and use of Competitively Sensitive Information will be limited to the greatest extent possible, and any party receiving Competitively Sensitive Information shall follow the procedures outlined in paragraph 7 above. (10) At the conclusion of a Participant's involvement in a Plan—due to the deactivation of the Plan or due to the Participant's withdrawal or removal—each Participant will be requested to sequester any and all Competitively Sensitive Information received through participation in the Plan.

This sequestration shall include the deletion of all Competitively Sensitive Information unless required to be kept pursuant to the Record Keeping requirements as described supra, Section I, 44 CFR part 332, or any other provision of law. C. Oversight Each Sub-Committee Chairperson is responsible for ensuring that the Attorney General, or suitable delegate(s) from the DOJ, and the FTC Chairman, or suitable delegate(s) from the FTC, have awareness of activities under this Plan, including activation, deactivation, and scheduling of meetings.

The Attorney General, the FTC Chairman, or their delegates may attend Sub-Committee meetings and request to be apprised of any activities taken in accordance with activities under this Plan. DOJ or FTC Representatives may request and review any proposed action by the Sub-Committee or Sub-Committee Participants undertaken pursuant to this Plan, including the provision of data. If any DOJ or FTC Representative believes any actions proposed or taken are not consistent with relevant antitrust protections provided by the DPA, he or she shall provide warning and guidance to the Sub-Committee as soon as the potential issue is identified.

If questions arise about the antitrust protections applicable to any particular action, FEMA may request DOJ, in consultation with the FTC, provide an opinion on the legality of the action under relevant DPA antitrust protections. VI. Establishment of the Sub-Committees This Plan establishes Sub-Committees to implement the Plan to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) to Respond to buy antibiotics to provide the Federal Government and the Participants a forum to maximize the manufacture and efficient distribution of selected types of critical PPE and to create a prioritization protocol based upon identified types of PPE End-Users and their demonstrated or projected requirements, and demonstrated or projected geographic and regional areas of need.

The outcome should include a framework to expeditiously meet any PPE needs in Exigent Circumstances anywhere in the Nation, and to ensure that actions to support PPE stockpiling and reserves do not interfere with immediate requirements that would result in an unacceptable risk to healthcare providers or other potential PPE recipients. A Sub-Committee Chairperson designated by the Chairperson will convene and preside over each Sub-Committee. Sub-Committees will not be used for contract negotiations or contract discussions between the Participants and the Federal Government.

Such negotiations or discussions will be in accordance with applicable federal contracting policies and procedures. However, this shall not limit any discussion within a Sub-Committee about the operational utilization of existing and potential contracts between the Participants and Representatives when seeking to align their use with overall manufacturing and distribution efforts consistent with this Plan. Each Sub-Committee will consist of designated Representatives from FEMA, HHS, other federal agencies with equities in this Plan, and each Sub-Committee Participant.

The Attorney General and Chairman of the FTC, or their delegates, may also join each Sub-Committee and attend meetings at their discretion. Attendees may also be invited at the discretion of a Sub-Committee Chairperson as subject matter experts, to provide technical advice, or to represent other government agencies, but will not be considered part of the Sub-Committee. To the extent necessary to respond to the cipro, only at the explicit direction of a Sub-Committee Chairperson, and subject to the provisions of Section V(B), Sub-Committee Members may be asked to provide technical advice, share information, help identify and validate places and resources of the greatest need, help project future manufacturing and distribution demands, assist in identifying and resolving the allocation of scarce resources amongst all necessary public and private sector domestic needs under Exigent Circumstances, and take any other necessary actions to maximize the timely manufacture and distribution of PPE as determined necessary by FEMA to respond to the cipro.

A Sub-Committee Chairperson or his or her designee, at the Sub-Committee Chairperson's sole discretion, will make decisions on these issues in order to ensure the maximum efficiency and effectiveness in the use of Sub-Start Printed Page 79028Committee Member's resources. All Sub-Committee Participants will be invited to open Sub-Committee meetings. For selected Sub-Committee meetings, attendance may be limited to designated Sub-Committee Participants to meet specific operational requirements, as determined by FEMA.

Each Sub-Committee Chairperson shall notify the Attorney General, the Chairman of the FTC, Representatives, and Participants of the time, place, and nature of each meeting and of the proposed agenda of each meeting to be held to carry out this Plan of Action. Additionally, each Sub-Committee Chairperson shall provide for publication in the Federal Register of a notice of the time, place, and nature of each meeting. If a meeting is open, a Federal Register notice will be published reasonably in advance of the meeting.

A Sub-Committee Chairman may restrict attendance at meetings only on the grounds outlined by 44 CFR 332.5(c)(1)-(3). If a meeting is closed, a Federal Register notice will be published within ten (10) days of the meeting and will include the reasons why the meeting is closed pursuant to 44 CFR 332.3(c)(2). The Sub-Committee Chairperson shall establish the agenda for each meeting, be responsible for adherence to the agenda, and provide for a written summary or other record of each meeting and provide copies of transcripts or other records to FEMA, the Attorney General, the Chairman of the FTC, and all Sub-Committee Participants.

The Chairperson shall take necessary actions to protect from public disclosure any data discussed with or obtained from Sub-Committee Participants which a Sub-Committee Participant has identified as a trade secret or as privileged and confidential in accordance with DPA sections 708(h)(3) and 705(d), or which qualifies for withholding under 44 CFR 332.5. VII. Application and Agreement The Sub-Committee Participant identified below hereby agrees to join in the Federal Emergency Management Agency sponsored Plan of Action to Establish a National Strategy for the Manufacture, Allocation, and Distribution of Personal Protective Equipment (PPE) under the Voluntary Agreement for the Manufacture and Distribution of Healthcare Resources Necessary to Respond to a cipro and to become a Participant in one or more Sub-Committees established by this Plan.

This Plan will be published in the Federal Register. This Plan is authorized under section 708 of the Defense Production Act of 1950, as amended. Regulations governing the Voluntary Agreement for the Manufacture and Distribution for the Manufacture and Distribution of Healthcare Resources Necessary to Respond to a cipro and all subsequent Plans of Action appear at 44 CFR part 332.

The applicant, as a Sub-Committee Participant, agrees to comply with the provisions of section 708 of the Defense Production Act of 1950, as amended, the regulations at 44 CFR part 332, and the terms of this Plan. VIII. Assignment No Sub-Committee Participant may assign or transfer this Plan, in whole or in part, or any protections, rights or obligations hereunder without the prior written consent of the Sub-Committee Chairperson.

When requested, the Sub-Committee Chairperson will respond to written requests for consent within 10 (ten) business days of receipt. (Company name) (Name of authorized representative) (Signature of authorized representative) (Date) Sub-Committee Chairperson (Date) Start Signature Pete Gaynor, Administrator, Federal Emergency Management Agency. End Signature End Supplemental Information [FR Doc.

2020-26986 Filed 12-7-20. 8:45 am]BILLING CODE 9111-19-P.