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If the bullying is persistent erectile dysfunction herbal supplements buy cialis black pills in toronto, it may affect social and emotional development erectile dysfunction pills new buy cialis black once a day, especially if it occurs during adolescence erectile dysfunction caused by radiation therapy cheap 800mg cialis black mastercard, which is an important time for developing these social and emotional skills. It can also impact on an individuals participation and performance in their classwork and school activities (Dodd, 2005). However, because individuals on the autism spectrum may have fewer friends, reduced social skills, difficulty understanding unspoken social cues (such as facial expression, body language) that provide information about how to respond appropriately in social situations, or have repetitive behaviours that appear different to their peers, they are a higher risk of being bullied than their neurotypical peers (Shore et al. Give specific examples of behaviours that are considered bullying, including: physical aggression. Ensure that the individual understands that all of the above behaviours are not acceptable, and that they should inform someone, ideally you or their teachers, if these behaviours occur, whether it is at school or outside of school (Dodd, 2005). Use tailored tales or a visual list of steps to encourage the individual not to retaliate against the bully, but to walk away from them (Dodd, 2005; Volkmar et al. If the bullying is occurring at school, discuss the individuals reports of bullying with your childs teacher(s). The teachers can then monitor the situation during class time to ensure that the bullying is prevented as much as possible, and also to ensure that the individual does not retaliate or respond aggressively to the bully (Dodd, 2005). It may also be helpful to discuss with school staff whether a "buddy system" or another form of peer support can be arranged, to ensure that the individual has someone looking out for them at break times/lunchtime, when a teacher may not be present (Dodd, 2005). Sarah gets upset about not going to the museum the same as I get upset about not going to the football. Adapt this story to refer to an actual event or situation which the individual had difficulty viewing from another persons perspective. If someone says something mean to me, or laughs at me, I can say "I dont like that" or "Im leaving", or I can just walk away from the person. People can look different, speak differently, think differently or act differently to one another, and that is fine. If we all looked, spoke, thought and acted the same, the world would be very boring! Cognitive-behavioral therapy for anxiety disorders: Mastering clinical challenges. Girls growing up on the autism spectrum: What parents and professionals should know about the pre-teen and teenage years. The everything parents guide to children with autism: Know what to expect, find the help you need, and get through the day. Handbook of autism and pervasive developmental disorders: Assessment, intervention, and policy (3rd ed. A practical guide to autism: What every parent, family member, and teacher needs to know. Taking care of myself; A hygiene, puberty and personal curriculum for young people with autism. References 49 Faculty of Health Sciences La Trobe University Victoria, Australia 3086 T +61 3 9479 0000 F +61 3 9479 0000 E xxx@latrobe. While every effort is made to provide full and accurate information at the time of publication, the University does not give any warranties in relation to the accuracy and completeness of the contents. The University does not accept responsibility for any loss or damage occasioned by use of the information contained in this publication. The University also reserves the right to discontinue or vary arrangements, courses, subjects (units), assessment requirements and admission requirements. While the University will try to avoid or minimise any inconvenience, changes may also be made to courses, subjects (units), assessment requirements and staff after enrolment. The University may also set limits on the number of students in a course or subject (unit). There are also unpredictable contaminants in these products since they are manufactured illicitly. Moreover, the availability of synthetic cannabinoids has surged since 2010, as indicated by the number of laboratory reports issued in January through June in 2010 (469) compared to January through June in 2013 (17,241). Public health concerns remain heightened because synthetic cannabinoids have evolved and increased in number over time, even as regulatory action has been taken to ban specifically identified chemicals. This was a statistically significant increase from 2010, when 11,406 visits occurred (Figure 1). Visits for female patients tripled from 2,576 visits in 2010 to 8,608 visits in 2011. For patients aged 18 to 20, visits increased fourfold, from 1,881 visits in 2010 to 8,212 visits in 2011. Although the number of visits appears to have increased for patients aged 21 to 24 and aged 25 to 29 between 2010 and 2011, the difference was not statistically significant. For older age groups, 2011 was the first year that visits involving synthetic cannabinoids reached a measurable level. The rate per 100,000 population for those aged 18 to 20 had a statistically significant increase of more than four times, from 13. Approximately a quarter of all visits were made by patients aged 12 to 17 (7,584 visits, or 27 percent), and 29 percent of visits were made by patients aged 18 to 20 (8,212). The remaining 4 percent of visits were made by those aged 45 or older (1,090 visits). Synthetic cannabinoids were combined with illicit drugs in 21 percent of visits among patients aged 20 or younger and in 27 percent of visits among patients aged 21 or older. In 2011, synthetic cannabinoids were combined with pharmaceuticals in 16 percent of visits among patients aged 12 to 20 and in 26 percent of visits among patients aged 21 or older. In comparison, 26 percent of marijuana-related visits involved patients aged 12 to 20, with 13 percent aged 12 to 17. Among patients who were admitted or transferred, 21 percent were aged 12 to 17, and 23 percent were aged 18 to 20. Patients aged 21 to 29 and those aged 30 to 44 each made up about one-fifth of visits resulting in admission or transfer (20 and 22 percent, respectively). This is consistent with information published in a summarized review of adverse events, medical treatments and outcomes. There is little information about the health effects and toxicity following chronic use of synthetic cannabinoids, but several cases of new-onset psychosis after multiple uses of synthetic cannabinoids have recently been reported. Reports in scientific literature indicate a wider appeal of synthetic cannabinoids among those not only seeking what is advertised as a legal high, but also by those in parole and probation situations and by those in workplaces that require drug testing. Recent survey results show that such interventions may have already resulted in teens being less likely to use "synthetic marijuana" because past year use among 12th graders dropped from 11. Most importantly, medical professionals need to understand the effects of synthetic cannabinoids, so that supportive care and treatment can be provided to patients who experience their adverse effects.
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Understanding why these symptoms are occurring and how long they are likely to erectile dysfunction natural foods buy generic cialis black pills last for will help increase your daughters sense of stability and control over these changes to erectile dysfunction treatment options in india buy cialis black on line amex her body (Nichols et al erectile dysfunction effects on relationship order cialis black 800 mg on line. Use specific language and terminology and avoid colloquialisms when explaining these symptoms. For example, say "you might have a sore stomach" instead of "you might feel a bit funny in the tummy". The expression of frustration, anger, or fear in individuals on the autism spectrum can often take the form of behaviours that are disruptive, aggressive and violent (Fouse & Wheeler, 1997). Emotional Changes In many cases, the individual is not wishing to disrupt or harm themselves or others, but simply to express their needs, wants, and feelings. For example, a temper tantrum may be the individuals way of expressing their frustration at not being able to communicate and make themselves understood (Fouse & Wheeler, 1997). For example: An individual on the highfunctioning end of the autism spectrum may display anxiety by fidgeting, nervousness, muscle tension, or excessive giggling (Fouse & Wheeler, 1997). An individual with a moderate intellectual disability on the autism spectrum may display their anxiety through increased movement and activity, excessive giggling or crying, or making strange or loud noises (Fouse & Wheeler, 1997). Some individuals may prefer increased levels of sensory information, and may require textured clothing or objects to provide them with sensory stimulation. Tantrums or behavioural problems may be the individuals way of expressing their dislike of a particular type of sensory information (Tilton, 2004). Social pressure and expectations: difficulty knowing which behaviours are socially acceptable, as well as those that are socially expected, can cause anxiety, as well as agitation and frustration, in individuals on the autism spectrum. These emotions can often translate into aggressive or violent behaviours (Fouse & Wheeler, 1997). Communication difficulties: similarly, difficulty understanding what is being said to them or difficulty expressing themselves can also cause distress and frustration in these individuals (Fouse & Wheeler, 1997). This often results in aggressive or violent behaviour, but alternatively may cause some individuals to withdraw from social situations (Tilton, 2004). Deviation from routine and structure: just as changes to routine can cause anxiety, they may also cause frustration, temper tantrums, or other Factors that may cause/worsen aggressive or problematic behaviours As a parent, guardian, or carer of individual on the autism spectrum, the task of determining the reason for the problematic behaviour or the message that the individual wishes to convey can be very difficult. However, there are a number of factors to consider when looking for the cause of the behaviour: Sensory issues: individuals on the autism spectrum may react differently to the sensations of touch, sight, hearing, smell and taste, and may have behavioural issues surrounding any of these senses (Fouse & Wheeler, 1997). Similarly, interrupting an individuals repetitive behaviour patterns can often cause frustration and aggression (Fouse & Wheeler, 1997). Strategies for managing problematic behaviours If the individual is able to communicate verbally, encourage them to tell you what is wrong so that you can understand why they are behaving in this way. Through their aggression, the individual may be trying to tell you they need or want something (Dodd, 2005). The individual should not feel like they are being punished for trying to communicate with you, but that there are nicer and more efficient ways to communicate their wants and needs. If the individual is not able or willing to stop and communicate with you about what is distressing them, the best thing to do during the tantrum itself is wait, and try to minimise the risk of harm to themselves or others (Fouse & Wheeler, 1997). Tailored tales (for example, the story about dealing with anger described in Strategies for helping the individual to determine between emotions) can encourage the individual to replace their problematic behaviours with a structured list of acceptable behaviours (Fouse & Wheeler, 1997). Create a list of tasks (for example, taking deep breaths, asking an adult for help) with pictures for the individual to follow; explain that they should try to follow the list instead of reverting to temper tantrums or other problematic behavioural habits. When the problematic behaviour occurs, encourage them to follow the list, and reward them with praise and/or an activity they enjoy (Dodd, 2005). Look for patterns: does the problematic behaviour always occur in the same situation, or every time they are exposed to a particular sight, sound, smell, taste, touch or texture? If you can identify a sensory issue that they have with a particular object or situation, you can then avoid or modify the objet or situation, and hopefully eliminate the problematic behaviour (Fouse & Wheeler, 1997). If these symptoms interfere with the individuals participation in activities of daily living such as education, work, or community activities. They may experience difficulty with being different from their peers, and determining how they fit in with and relate to their peer group (Nichols et al. Depending on the level of care and support the individual needs from family and carers, they may find it difficult to understand, or may not be able to understand, the reasons that they are not likely to achieve total independence. It also involves building self-esteem; that is, viewing yourself as a valuable part of society, with individual values, skills and strengths. These are issues that face all adolescents, but people on the autism spectrum may have greater difficulty with self-identity and self-esteem than their neurotypical peers, for several reasons (Mesmere, 2007): They may have problems with emotional regulation, making it more difficult for them to determine how they feel about themselves, how they feel about certain issues, and what their values are surrounding these issues (Geller, 2005; Matson & Sturmey, 2011). The development of their self-identity and self-esteem may be negatively influenced by bullying or by being treated differently by their peers, teachers, or others in the community (Serhan, 2011; Shore, Rastelli & Grandin, 2006). It is important to discuss self-identity and self-esteem with the individual, and encourage them to share any questions or problems that they have. They may prefer to share this information and ask for advice from professionals or people that they do not know personally or socially (instead of coming to their parents, carers or teachers). Therefore, it may be helpful to let the individual know that there are other sources of information and advice, and provide them with a list of contacts. It will also encourage the development of social skills, which is likely to help their self-esteem in the long run (Gabriels & Hill, 2008). Encourage the individual to consider their likes, dislikes, personality, and how they would describe themselves to others. You can also discuss words that they would use to describe themselves, and include these in the book (Nichols et al. It is important to understand that it may take individuals on the autism spectrum longer than their neurotypical peers to develop a true sense of who they are and what they are worth (Serhan, 2011). Strategies to encourage selfidentity and self-esteem Discuss with the individual the fact that everybody is different, and that is what makes us interesting as people. Discuss the idea that, although they may feel different to the other children at school, or people might tell them that theyre different, they are not the only ones who are different (Serhan, 2011). This will allow them to gain a greater understanding of autism itself and the ways that it can affect different people, and to share their own experiences with an understanding audience. It will also provide them with opportunities to interact with others in a social environment (Volkmar et al. Bullying can significantly increase the risk of low self-esteem and depression (Sanders & Phye, 2004). Suggested treatment recommendations include intravenous fluids, administration of benzodiazepine medications, and possibly antipsychotic medication if symptoms are severe. Furthermore, the changing composition of products containing synthetic cannabinoids, and the inability of routinely used clinical laboratory tests to detect these substances, makes it difficult for treating physicians to make a clear diagnosis and establish a treatment plan for the intoxicated patient. Schedules of controlled substances: Temporary placement of four synthetic cannabinoids into Schedule I. Spice drugs are more than harmless herbal blends: A review of the pharmacology and toxicology of synthetic cannabinoids. Withdrawal phenomena and dependence syndrome after the consumption of "Spice Gold".
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The thieves new erectile dysfunction drugs 2013 cialis black 800 mg low cost, in fact anyone erectile dysfunction treatment pumps order cialis black cheap, can make themselves invisible on the Internet erectile dysfunction doctor michigan order cialis black 800mg otc, a perfect condition for carrying out a crime (Denning and Baugh 2000). The literature on computer criminals who are hackers is replete with one primary motivation: to "beat" the computing system (Clough and Mungo 1992). It differs from Stealth which is sneaky and secretive, whereas anonymity is a common way of doing business, such as, for example, when one pays for an item with cash in a retail store. There is research evidence linking anonymity to deindividuation, a psychological condition that allows individuals to act irresponsibly or criminally (Wortley 1997). Perhaps the most important element in the choices that a criminal makes in carrying out a crime is the choice of a suitable target. The Internet makes it possible to scan thousands of web servers and even millions of personal computers that are connected to the web, looking for "holes" or gaps in security. Fraudsters can peddle their scams to millions of email users for virtually no cost (though legislation has recently increased the penalties for spamming). The crime-inducing aspects of the information system environment of anonymity, deception and stealth combine to make it extremely difficult for law enforcement to link the crime to the individual perpetrator, especially when the crime itself may never be detected, even by its victims (Ahuja 1997). We have also seen how the theft of identity can be used to facilitate the commission of a variety of other crimes. Thus, the opportunities available to offenders to commit identity theft are major factors that account for both the commission of the crime and its apparent increase in recent years. Exploiting Opportunities: Techniques of Identity Theft Offenders have developed various techniques to exploit the opportunities of the information age. The techniques used by identity thieves may be divided into roughly two categories: techniques they use to steal the identities, and techniques they use to convert these identities into the rewards they seek. Mail that is useful to offenders includes preapproved credit card applications, energy or telephone bills, bank or credit card statements, and convenience checks. It should be noted that, except where indicated, the data on which these lists of techniques are derived are taken mostly from Internet sources of varying kinds. These include newspaper and magazine reports, media interviews with fraud investigators and law enforcement personnel, and information provided on various advocacy web sites seeking to either help victims or to sell services designed to prevent victimization by identity theft. The exceptions to this observation are the studies on check and credit card fraud by Mativat and Tremblay (1997) and Lacoste and Tremblay (2003). For example, just one act of hacking into a database may reap thousands of credit card numbers and other personal data. The high percentage in Figure 5 of victims reporting that they did not know how they lost their personal information suggests that the loss could have occurred via the Internet or other electronic means over which the victim has no control. They break into homes to find personal information on paper or on personal computers. They hack into corporate computers and steal customer and employee databases, then sell them on the black market or extort money from for their return. The offender immediately runs up charges on the account, knowing that the victim will not receive the bill for some time, if ever. They buy identities on the street for the going rate (about $25), or buy credit cards that may be either counterfeit or stolen. All the technology for reproducing plastic cards, including their holograms and magnetic strips, can be bought on the Internet (Newman and Clarke 2003). Note: this graph represents only those victims who knew and reported how their information was stolen. The Better Business Bureau website (2005) contains a similar, but more detailed graph for a 2004 study conducted by Javelin Strategy & Research. Theft Note: Nearly a quarter of all victims who knew how their information was obtained reported that their information had been lost or stolen: 14% of all victims reported that their wallet, checkbook or credit card had been lost or stolen; 4% of all victims cited stolen mail as the source of their information. Transaction Note: 13% of all victims who knew how their information was obtained reported that their information had been taken during a transaction, either through the credit card receipt or through a purchase made via Internet, mail or phone. They often open multiple accounts in multiple places, and write bad checks on each. Kathleen Soliah, wanted for various bombings and attempted murder in relation to her activities in the Symbionese Liberation Front in the late 1960s, assumed the identity of Sara Jones Olson (a common Scandinavian surname in Minnesota). Terrorism is the most recently cited example of stealing identities to conceal illegal activities, and to make tracking their true identities much more difficult after they have committed crimes. All 19 of the September 11th terrorists were involved in identity theft in some way (Willox and Regan 2002). Financial gain and other anticipated rewards Perusal of cases reported on the Internet suggest two "motives" or anticipated rewards of identity theft: financial gain (Case 13), and revenge (Case14). We hasten to add that there is little formal academic research in respect to identity theft that supports (or does not support) this assertion. When we consider that it is mainly access to financial information and records that makes the stealing of the identity possible, and then the opening of bank accounts and use of credit cards that leads to financial gain of the offender, it is reasonable to conclude that the primary motive is in fact financial gain. However, it bears repeating that the co-primary reason why identity theft is the crime of choice for many offenders, compared to other means of theft, is because it is easier to commit. In other words, identity theft is safer and more convenient than other kinds of theft. Indeed, the police often perceived the problem as not one that they, the police, should be dealing with. It was, after all, the credit card issuing companies and banks who were taking the bulk of the financial loss. Furthermore, it was also well known that retail stores and banks and merchants generally, along with individual cardholders, rarely reported theft or misuse of a credit or bank card to the police. And it is further well known that merchants and banks rarely report to the police the crimes that occur on their premises or in their workplace (Clarke 2001). Retailers especially are wary of police presence on their place of doing business for fear it will scare away customers. So the perception by police that identity theft was not primarily their responsibility but that of business factored into the casual way in which individual victims were treated. Another equally important reason why victims were given the runaround (see Case 10) was that established reporting and recording practices in most if not all police departments were not set up to record these crimes. Identity theft is a crime that in the course of its commission may span several jurisdictions. Thus, the legal and bureaucratic structures of many police departments were not equipped to deal with this complex crime. With the passing of the 1998 Identity theft federal law, and other laws since then (see Section 8), much more attention has been given to dealing with individual victims by local police. Recent legislation that requires credit reporting agencies to respond quickly to victims to correct their records88 will likely increase the number of individuals reporting the crime to police, since they are required by credit reporting agencies to submit an Identity Theft Affidavit, which requires a police report. As noted, information concerning identity theft lies in many different places, and it may be a prime or facilitating motive in a number of traditional crimes such as robbery, mugging, pick-pocketing, theft from cars, burglary etc. Do the crime incident reporting systems that police departments currently use have sufficient flexibility to collect such information, and if so is the necessity to be on the lookout for such information communicated to line officers by way of a simple form or procedures for recording these events? Is the crime incident database structure used by the police department set up in such a way that allows for the crime analyst to check across many different crime types or incidents to see if in fact there are any identity theft related issues or patterns?
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After giving a valid rape report and fully cooperating with the police natural erectile dysfunction treatment remedies cialis black 800 mg with mastercard, a woman may find herself in the unexpected and bewildering predicament of having come to erectile dysfunction doctors in nj order generic cialis black online the police for aid which antihypertensive causes erectile dysfunction purchase cialis black 800 mg visa. One of the most important, and highly criticized, decisions made by the police is the decision whether to unfound the charges. If, on the other hand, the officer does not believe the victim`s story and therefore concludes that a crime did not occur, the case is unfounded. Technically, cases can be unfounded only if the police determine that a crime did not occur. In reality, police may use the unfounding decision to clear-or erase (Konradi, 2007)- cases in which they are convinced that a crime occurred but also believe that the likelihood of arrest and prosecution is low. According to Martin (2006), police departments are evaluated in terms of clearance rates, which encourages officers to unfound ambiguous or difficult cases, including those where a victim is reluctant, emotional, uncooperative, or compromised in some way. There is very limited research on police unfounding decisions in sexual assault cases and most of the research that does exist is dated (LaFree, 1989; Kerstetter, 1990; McCahill et al. An early study by the Law Enforcement Assistance Administration (1977), in which police officers were asked to identify the factors that affected their decisions, found that the two most important predictors of whether cases would be founded or unfounded were proof of penetration and the suspect`s use of physical force. A later study (Kerstetter, 1990) examined sexual assaults reported to the police 6 this document is a research report submitted to the U. Kerstetter (1990) differentiated between cases in which the identity of the suspect was not known and those in which the victim and the suspect were acquainted in some way. In the identity cases, the most important predictors of the police founding decision were the complainant`s willingness to prosecute, whether the victim physically resisted the attack, whether a weapon was used, and whether the suspect was in custody. In contrast, in cases in which the victim and suspect were acquainted, the police were more likely to label the case a crime if the suspect was in custody, if the victim suffered collateral injury, and if there was no discrediting information, such as a pattern of alcohol or drug use, a history of mental illness, or a record of false complaints, about the victim. These findings led Kerstetter (1990) to conclude that the police unfounding decision was affected by a combination of legally relevant instrumental factors and legally irrelevant victim characteristics. A somewhat different approach was taken by Frazier and Haney (1996), who examined case attrition in 569 sexual assaults reported during 1991 to a Midwestern metropolitan police department. They focused on whether a suspect was identified by the police, whether an identified suspect was questioned by the police, and whether the suspect was referred to the prosecuting attorney for charging. They found that suspects were identified in 273 (48%) of the cases, that the police questioned suspects in 187 (68%) of these cases, and that 68 percent of the suspects who were questioned were referred to the prosecutor (p. Their analysis of the factors that affected these outcomes revealed that identified suspects were more likely to be questioned by the police if they were strangers to the victim, if there was evidence of penetration, if the victim was injured, and if there was a witness to the crime. The only variables that affected whether the case would be referred to the prosecutor for charging were whether the victim was injured and whether the suspect verbally threatened the victim. Similar results were found in studies examining the police decision to make an arrest (Bachman, 1998; Bouffard, 2000; Du Mont & Myhr, 2000; LaFree, 1981; Horney & Spohn, 1996). LaFree`s (1981) analysis of sexual assaults reported to the police in a large metropolitan jurisdiction in the Midwest revealed that the arrest decision was influenced by a combination of legal and extra-legal factors: the victim`s ability to identify the suspect, the victim`s willingness to prosecute, whether the victim engaged in any type of misconduct at the time of the incident, the promptness of the victim`s report, whether the victim was assaulted by an acquaintance rather than a stranger, and the suspect`s use of weapon. On the other hand, the arrest decision was not affected by the victim`s race, whether the victim resisted, the location of the incident, whether there was a witness who could corroborate the victim`s allegations, or whether the victim was injured. These findings led LaFree (1981: 592) to conclude that, at least in this jurisdiction, the emphasis on the role played by the victim`s attributes and the interpersonal context of the crime was greatly overstated. Although Bouffard (2000) found that crimes involving African American suspects and White victims were not more likely than other crimes to result in arrest, he did find that arrest was more likely if the victim and suspect had a prior relationship, if the victim agreed to undergo a sexual assault exam, and if the credibility/seriousness score of the crime (which measured whether other crimes were committed during the sexual offense, whether a weapon was used, and whether the crime occurred outdoors) was higher. He concluded that the positive effect of the credibility scale might indicate increased police effort devoted to investigating the offense, because they believed the claim was 8 this document is a research report submitted to the U. Evidence of the role played by victim characteristics also surfaced in a study where police officers evaluated vignettes in which the beverage consumption (beer or cola) of the victim and suspect was systematically varied (Schuller & Stewart, 2000). The authors of this study found that whereas officers` perceptions of the suspect`s level of intoxication had no effect on their evaluation of the suspect`s credibility, blame, or guilt, perceptions of the victim`s intoxication did affect their assessment of the case. In fact, the more intoxicated the respondents perceived the victim to be, the less blame they attributed to the alleged perpetrator and the more likely they were to believe that the perpetrator honestly believed that the complainant was willing to engage in intercourse (Schuller & Stewart, 2000: 547). All of the decision makers in the American criminal justice system have a significant amount of unchecked discretionary power, but the one who stands apart from the rest is the prosecutor. The prosecutor decides who will be charged, what charge will be filed, who will be offered a plea bargain, and the type of bargain that will be offered. As Supreme Court Justice Jackson noted in 1940, "the prosecutor has more control over life, liberty, and reputation than any other person in America" (Davis, 1969: 190). None of the discretionary decisions made by the prosecutor is more critical than the initial decision to prosecute or not, which has been characterized as "the gateway to justice" (Kerstetter, 1990: 182). Prosecutors have wide discretion at this stage in the process; there are no legislative or judicial guidelines on charging and a decision not to file charges ordinarily is immune from review. Research on prosecutors` charging decisions in sexual assault cases reveals that these decisions are strongly influenced by legally relevant factors such as the seriousness of the crime, the offender`s prior criminal record, and the strength of the evidence in the case (Kingsnorth, MacIntosh & Wentworth, 1999; Spohn & Holleran, 2001; Spohn & Spears, 1996). A consistent theme found in research on sexual assault case outcomes is the role played by legally irrelevant factors, especially the relationship between the victim and offender, the racial composition of the suspect/victim dyad, and stereotypes regarding real rapes and genuine victims. Consistent with Black`s (1976) relational distance theory, a number of studies conclude that reports of sexual assaults by strangers are more likely than reports of sexual assaults by acquaintances or intimate partners to be investigated thoroughly (McCahill et al. Stranger assaults also are less likely to be unfounded by the police (Kerstetter, 1990) or rejected by the prosecutor (Battelle Memorial Institute, 1977; Loh, 1980; Spohn et al. Some research, on the other hand, concludes that prosecutors` charging decisions in sexual 10 this document is a research report submitted to the U. Rather, different predictors affect charging decisions in stranger and acquaintance cases (Kingsnorth et al. Adding to the already complicated dynamics particular to sexual assault case processing is the role played by the race of the victim and the race of the suspect. The sexual stratification hypothesis (LaFree, 1989) posits that reactions to crimes will vary depending upon the race of the suspect and the race of the victim. More to the point, the hypothesis is that sexual assaults involving White women and African American men will be treated more harshly-and thus will be more likely to result in the filing of charges by prosecutors-than those involving other racial combinations. Some scholars argue that the effect of race is unambiguous and omnipresent (Brownmiller, 1975; Spohn, 1994; Kennedy, 1997), whereas others conceive of it in contextspecific circumstances that emerge both directly and indirectly (LaFree, 1980, 1989; Kingsnorth et al. In other words, extant research indicates that the effect of race on charging decisions is mitigated by both the relationship between the victim and offender and by victim characteristics such as blame and believability and moral character (Holleran et al. A number of scholars contend that the response of the criminal justice system to the crime of rape is predicated on stereotypes about rape and rape victims (Estrich, 1987). LaFree (1989), for example, asserts that nontraditional women, or women who engage in some type of "risk-taking" behavior, are less likely to be viewed as genuine victims who are deserving of protection under the law. Frohmann (1991) similarly maintains that the victim`s allegations will be discredited if they conflict with decision makers` repertoire of knowledge about the 11 this document is a research report submitted to the U. We know very little about the patterns and causes of case attrition in sexual assault cases, and studies of police and prosecutorial decision making in these types of cases reach somewhat different conclusions. These studies indicate that while legal factors-particularly the seriousness of the crime and the strength of evidence in the case-play an important role in sexual assault case processing decisions, victim characteristics-especially the relationship between the victim and the offender-may also influence these decisions. Some studies conclude that the effect of stereotypes concerning real rapes and genuine victims may not be as pronounced as previous research has suggested, or that the influence of victim characteristics may be conditioned by the nature of the case. Considered together, the results of these studies suggest that additional research designed to untangle the effects of evidence factors and victim characteristics on sexual assault case processing decisions is needed. Although research on all stages of case processing is required, there is a particular need for research on police decision making, especially the decision to unfound the charges and, in cases in which a suspect has been identified, the decision to clear a case with an arrest or by exceptional means. Despite its importance, we know very little about either the prevalence of unfounding or the factors that affect unfounding in sexual assault cases; similarly, there is little research investigating whether unfounded reports are in reality false or baseless, as required by the Uniform Crime Handbook (2004).
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Contact with infected animals should be avoided, especially female animals that have aborted or are giving birth. Pasteurization of dairy products for human consumption is important to prevent disease, especially in children. Airway infections in people with infected with no change in the rate of pulmonary decompensation or can experience an accelerated decline in pulmonary function or an unexpectedly rapid deterioration in clinical status that results in death. In patients with chronic granulomatous disease, pneumonia is the most common manifestation of B cepacia complex infection; lymphadenitis also occurs. Disease onset is insidious, with low-grade fever early in the course and systemic effects occurring 3 to 4 weeks later. Pleural effusions are common, and lung abscesses can pneumonia also have been reported, and clusters of disease have been associated with contaminated nasal sprays, mouthwash, and sublingual probes. Its geographic range is expanding, and disease now is known to be endemic in Southeast Asia, northern Australia, areas Indian Ocean Islands, and some areas of South and Central America. Melioidosis can be asymptomatic or can manifest as a localized infection or as fulminant septicemia. Genitourinary infections including prostatic abscesses, skin infections, septic arthritis and osteomyelitis, and central nervous system involvement including brain occurs frequently in children in Thailand and Cambodia but is less commonly seen in other endemic areas. In severe cutaneous infection, 1 American Academy of Pediatrics, Committee on Infectious Diseases, Committee on Nutrition. In disseminated infection, hepatic and splenic abscesses can occur, and relapses are common without prolonged therapy. Additional members of the complex con- Burkholderia include Burkholderia pseudomallei, Burkholderia gladioli, and Burkholderia mallei (the agent responsible for glanders). Burkholderia thailandensis and Burkholderia oklahomensis are rare human pathogens. Depending on the species, transmission may occur from other people (person to person), from contact with contaminated fomites, and from exposure to environmental sources. The source of acquisition of B cepacia complex by patients with B cepacia complex most often is associated with contamination of disinfectant solutions used to clean reusable patient equipment, such as bronchoscopes and pressure transducers, or to disinfect skin. In areas with highly endemic infection, B pseudomallei is acquired early in life, with the with more than 75% of cases occurring during the rainy season. Disease can be acquired by direct inhalation of aerosolized organisms or dust particles containing organisms, by percutaneous or wound inoculation with contaminated soil or water, or by ingestion of contaminated soil, water, or food. People also can become infected as a result of laboratory exposures when proper techniques and/or proper personal protective equipment guidelines are not followed. Symptomatic infection can occur in children 1 year or younger, with pneumonia and parotitis reported in infants as young as 8 months; in addiB pseudomallei also has been reported to cause pulmonary infection in the incubation period can be prolonged (years). The likelihood of successfully isolating the organism is increased by culture of sputum, throat, rectum, and ulcer or skin lesion specimens. A direct polymerase chain reaction assay may provide a more rapid result than culture but is less sensitive, especially when performed on blood, and is not recommended for routine use as a diagnostic assay. Serologic testing is not adequate for tive result by the indirect hemagglutination assay for a traveler who has returned from an still requires isolation of B pseudomallei from an infected site. Other rapid assays are being developed for diagnosis of melioidosis but are not yet commercially available. Some experts recommend combinations of antimicrobial agents that provide synergistic activity against B cepacia complex. The majority of B cepacia complex isolates are intrinsically resistant to aminoglycosides and polymyxins. The drugs of choice for initial treatment of melioidosis depend on the type of clinical infection, susceptibility testing, and presence of comorbidities in the patient (eg, diabetes, invasive infection should include meropenem, imipenem, or ceftazidime (rare resistance) for a minimum of 10 to 14 days. Amoxicillin clavulanate and doxycycline are considered second-line oral agents and may be associated with a higher rate of relapse. Prevention of infection with B pseudomallei in areas with endemic disease can be difwater in these areas, and it is recommended that they stay inside during weather that could result in aerosolization of the organism. Wearing boots and gloves during agriculbe educated regarding their risk for infection when traveling to regions where B pseudomallei is endemic. In neonates and young infants, bloody diarrhea without fever can be the only manifestation of infection. Pronounced fevers in children can result in febrile seizures that can occur before gastrointestinal tract symptoms. Abdominal pain can mimic that produced by appendicitis Bacteremia is uncommon but can occur in elderly patients and in patients with underlying conditions. Immunocompromised hosts can have prolonged, relapsing, or extraintestinal infections, especially with Campylobacter fetus and other Campylobacter species. Other Campylobacter species, including Campylobacter upsaliensis, Campylobacter lari, and Campylobacter hyointestinalis, can cause similar diarrheal or systemic illnesses in children. The gastrointestinal tracts of domestic and wild birds and animals are reservoirs of the bacteria. C jejuni and C coli have been isolated from feces of 30% to 100% of healthy chickens, turkeys, and water fowl. Many farm animals, pets, and meat sources can harbor the organism and are potential sources of infection. Transmission of C jejuni and C coli occurs by ingestion of contaminated food or water or by direct contact with fecal material from infected animals or people. Improperly cooked poultry, untreated water, and unpasteurized milk have been the main vehicles of transmission. Campylobacter infections usually are sporadic; outbreaks are rare but have occurred among school children who drank unpasteurized milk, including 1 Centers for Disease Control and Prevention. American Academy of Pediatrics, Committee on Infectious Diseases and Committee on Nutrition. Person-to-person transmission also has occurred in neonates of infected mothers and has resulted in health care-associated outbreaks in nurseries. In perinatal infection, C jejuni and C coli usually cause neonatal gastroenteritis, whereas C fetus often causes Campylobacter as 7 weeks.
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These innovations may occur erectile dysfunction treatment doctors in bangalore buy cialis black 800mg online, but erectile dysfunction 43 order generic cialis black, because of their novel nature discussing erectile dysfunction doctor cheap cialis black line, it is not possible to prescribe how to appropriately leverage them in advance in a roadmap process. The roadmap is intended to be the beginning of an evolving, collaborative, and necessarily dynamic process. These periodic reviews will assess effects and redirect activities as necessary and appropriate through 2050 to optimize adaptation to changing technology, markets and political factors. High-level roadmap areas are summarized in Table 4-1 and the related high-level actions are summarized in Text Box 4-1. Appendix M provides a more granular description of the roadmap actions, including potential stakeholders and possible timelines for action. Risk of Inaction the analytical results of Chapter 3 reveal significant overall cumulative job, health, carbon, environmental, and other social benefits at deployment levels in the Wind Vision Study Scenario. Wind operations will continue, but manufacturing will remain vibrant only as long as there are domestic markets to serve. If domestic markets for new installations deteriorate, manufacturing may move to other active regions of the world. Wind Vision Roadmap Strategic Approach Summary Core Challenge Wind has the potential to be a significant and enduring contributor to a cost-effective, reliable, low carbon, U. Continuing declines in wind power costs and improved reliability are needed to improve market competition with other electricity sources. Key Themes Issues Addressed Capture the enduring value of wind power by analyzing job growth opportunities, evaluating existing and proposed policies, and disseminating credible information. Collect and analyze data to characterize offshore wind resources and external design conditions for all coastal regions of the United States, and to validate forecasting and design tools and models at heights at which offshore turbines operate. Develop next-generation wind plant technology for rotors, controls, drivetrains, towers, and offshore foundations for continued improvements in wind plant performance and scale-up of turbine technology. Develop and validate a comprehensive suite of engineering, simulation, and physics-based tools that enable the design, analysis and certification of advanced wind plants. Develop and sustain world-class testing facilities to support industry needs and continued innovation. Invest research and development (R&D) into high-risk, potentially high-reward technology innovations. Increase domestic manufacturing competitiveness with investments in advanced manufacturing and research into innovative materials. Develop transportation, construction and installation solutions for deployment of next-generation, larger wind turbines. Increase reliability by reducing unplanned maintenance through better design and testing of components, and through broader adoption of condition monitoring systems and maintenance. Collect wind turbine performance and reliability data from wind plants to improve energy production and reliability under normal operating conditions. Collect data, develop testing methods, and improve standards to ensure reliability under severe operating conditions including cold weather climates and areas prone to high force winds. Develop and promote best practices in operations and maintenance (O&M) strategies and procedures for safe, optimized operations at wind plants. Develop aftermarket upgrades to existing wind plants and establish a body of knowledge and research on best practices for wind plant repowering and decommissioning. High-Level Wind Vision Roadmap Actions(continued) 5Wind Electricity Delivery and Integration Action 5. Collaborate with the electric power sector to encourage sufficient transmission to deliver potentially remote generation to electricity consumers and provide for economically efficient operation of the bulk power system over broad geographic and electrical regions. Optimize wind power plant equipment and control strategies to facilitate integration into the electric power system, and provide balancing services such as regulation and voltage control. Develop optimized subsea grid delivery systems and evaluate the integration of offshore wind under multiple arrangements to increase utility confidence in offshore wind. Improve grid integration of and increase utility confidence in distributed wind systems. Develop impact reduction and mitigation options for competing human use concerns such as radar, aviation, maritime shipping, and navigation. Continue to develop and disseminate accurate information to the public on local impacts of wind power deployment and operations. Develop commonly accepted standard siting and risk assessment tools allowing rapid pre-screening of potential development sites. Foster international exchange and collaboration on technology R&D, standards and certifications, and best practices in siting, operations, repowering, and decommissioning. Develop comprehensive training, workforce, and education programs, with engagement from primary schools through university degree programs, to encourage and anticipate the technical and advanced-degree workforce needed by the industry. Refine and apply policy analysis methodologies to understand federal and state policy decisions affecting the electric sector portfolio. Better insight into the flow physics has the potential to guide technology advancements that could increase wind plant energy capture , reduce annual operational costs, and improve project financing terms to more closely resemble traditional capital projects. Realizing these opportunities will require diverse expertise and substantial resources, including high fidelity modeling and advanced computing. In order to validate new and existing high fidelity simulations, several experimental measurement campaigns across different scales will be required to gather the necessary data. These may include wind tunnel tests, scaled field tests, and large field measurement campaigns at operating plants. The data required include long-term atmospheric data sets, wind plant inflow, intra-wind plant flows. Such measurement campaigns will be essential to addressing wind energy resource and site characterization issues and will yield improvements in models that bridge the applicable spatial-temporal scales. Significant effort will be required to store simulation results and data sets, enabling additional research and analysis in a user-friendly and publicly accessible database. More and better observations, improved modeling at all four spatial and temporal scales, and an integrated bridging of the four spatial-temporal scales are needed. Research Needs for Wind Resource Characterization  describes this topic in more detail. Remote sensing technology that measures distance by illuminating a target with a laser and analyzing the reflected light. This will contribute to reducing the cost of wind power and improve cost competition in the electricity sector. Incorrect simulations of intra-plant flows can indirectly result in wind plant energy losses from wakes, complex terrain, and turbulence, as well as unknown turbine loading conditions that can result in over-designed turbine components.
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Infant toddler early intervention programs also are now required to erectile dysfunction injections cost buy cialis black online from canada collect and report family outcome data (Hebbeler erectile dysfunction age factor buy 800mg cialis black with mastercard, Bailey impotence webmd buy cheap cialis black line, & Bruder, 2006). Media attention to school readiness initiatives, kindergarten screening efforts, statewide testing against academic benchmarks, and state "report cards" in education have brought accountability squarely into the public consciousness. The emphasis on measurable outcomes has significant implications related to assessment aligned with standards, for every professional working in early childhood: "When assessment is for. The Early Learning and Development Benchmarks provide a set of general developmental expectations for what youngsters should know and be able to do at 18 months, 36 months, 60 months, and kindergarten entry, in five interrelated areas of development: p physical/health/motor; p social and emotional; p approaches toward learning; p cognition and general knowledge; and p language, literacy, and communication. These benchmarks are aligned with Head Start and K-12 standards, and provide a set of expectations that frame a general learning continuum for all young children (birth through kindergarten) in Washington State. They have been disseminated as a printed document and on line for use by parents and other adults who work with children at home, in childcare centers, or attending public or private preschool classrooms. Having a concrete framework of standards for early learning and development, promotes continuity for children across early opportunities, and promotes consistency in selecting and measuring the child outcomes to be achieved across all programs in the state. Whether a program is serving toddlers or children in primary grades, children from low-income homes or those with identified disabilities, learning activities and child outcomes can be aligned with early learning standards that provide a consistent point of departure for curriculum development, instruction, and assessment. Early learning standards tell us in a general sense what all youngsters should know and be able to do. The next step for early educators is to determine what to teach to whom (curriculum), and to measure whether or not children are learning and developing to expectations. A guide to assessment in early childhood can provide valuable information and resources to a variety of early childhood professionals. Four primary purposes for gathering information on young children will be described in the overview: p screening; p informing instruction and monitoring progress; p diagnosing special needs; and p evaluating programs. Subsequent sections provide details on recommended practices, procedures, and selected instruments for each purpose. Every section begins with questions relating to the type of assessment information being described, and ends with recommended instruments for the specific purpose. The sections on screening, instruction, diagnosis, and program evaluation are designed to stand alone so that readers can find all the information on a specific purpose and associated practices, requirements, and appropriate instruments in one location. The organization of the guide lends itself to selective use of the various sections, depending on which purposes of assessment are of interest. The sections on screening and instruction will be particularly useful for teachers; administrators might be more interested in the section on program evaluation and accountability; school psychologists and early learning assessment teams will probably find that the section on diagnostic assessment best matches their responsibilities. Some readers will want to focus on the narrative descriptions of assessment for a particular purpose; others will be searching for particular instruments. This section contains a table that lists numerous tools and describes important information about each, including, among other items, the primary purpose, domains assessed, publication and ordering information, and availability of technical data. National Association for the Education of Young Children, & National Association of Early Childhood Specialists in State Departments of Education. Many young children are assessed only during well-child visits; others have thick fi les containing medical and developmental assessment reports from birth. Some early childhood professionals have devoted considerable energy to assuring that young children are spared inappropriate testing experiences; others spend a significant portion of their professional lives conducting and interpreting assessments. Assessment in early childhood can be confusing because we assess children in many different ways for many different purposes, using literally hundreds of different instruments. T Assessment = Getting to Know Children Assessment is often used as a synonym for testing-not an appealing notion when construed as a young child sitting in silence with a paper and pencil. Early childhood has historically used informal assessments in the form of naturalistic observations and anecdotal records. This guide will present assessment as a continuous process that is an integral aspect of teaching and learning, with an emphasis on the specific purposes for which assessments are conducted. In one way or another, all early childhood assessments involve a process of gathering information about children in an attempt to better understand and support learning and development. Assessment results can describe some informative details of what youngsters know and can do, but can never fully portray who they are as individuals. Meaningful assessment involves thoughtful choices on the part of professionals among the many purposes, types, methods, and instruments available to assist us in getting to know more about young children. Think of the actual assessment resources as analogous to the internet browsers used to fi nd information on the computer. An assessment instrument, like a browser, is only as good as the information it yields. This section is designed to provide a foundation for understanding the purposes, types, and methods of assessment as a framework for developing a system that meets the needs of the children you serve. In addition to parents, we are the people responsible for the well-being of young children. Many professionals have legitimate concerns about misuse of assessment practices and instruments, and the potential for inequitable consequences for the children in our programs. Before discussing the various purposes, types, and methods of assessment, it is important to consider some implications of the unique nature of early development and learning: 1. Complete and meaningful assessment in early childhood necessitates an understanding of family context, including getting to know family language and culture, gathering developmental information from parents, and conducting home visits with parent approval. This principle applies to all youngsters and families, but is especially critical for children whose families may not share the language or some of the economic advantages of the dominant culture. Younger children present some complex challenges and require flexible procedures for gathering meaningful and useful assessment information. Constitutional variables such as fatigue, hunger, illness, and temperament can easily overshadow the abilities of a young child. Time of day, setting, testing materials and other situational factors also affect performance. The younger a child, the more likely he or she is to fall asleep, become distressed, refuse to comply with directions, or be distracted from assessment activities. Professionals should be prepared to modify activities, explore alternative procedures, and/or reschedule rather than risk gathering faulty information that compromises assessment results. Young children learn by doing, and demonstrate knowledge and skills through action-oriented activities. Authentic assessment of youngsters as they participate in daily activities, routines, and interactions generally produces the most valuable information for assessment. To the extent possible, assessment methods should allow for observation of young children engaged in spontaneous behaviors in familiar settings and with familiar people. More assessments and increased data do not necessarily result in better assessment information. Early childhood professionals should only gather information they need, and know ahead of time how they will use all the information collected. It is generally most desirable to identify a set of appropriate methods and instruments that provide necessary information, and refine the use of those procedures over time. Factors such as purpose, content, reliability and validity, efficiency, cost, and availability of professional development are all more important than appealing packaging and effective advertising. Of primary importance is the quality of information gathered and the decisions made as a result of assessment.
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Patients are generally forthcoming and frequently pleased to erectile dysfunction hormone treatment purchase cialis black on line finally have an opportunity to erectile dysfunction drugs trimix generic cialis black 800mg tell their trauma story to erectile dysfunction blogs forums discount 800mg cialis black with visa someone who appears sufficiently knowledgeable and sensitive to ask about it. For all the reasons mentioned earlier, however, telling the trauma story can be difficult. More distressing material will come later after the therapist has established trust and safety and has shown that he or she has the courage, wisdom, and empathy to listen to such material and sufficient positive regard for the patient to encourage further disclosure. Therapists can signal patients through their questions and responses that they understand the behavioral and emotional impact of a rape, natural disaster, or war. Such signals are readily perceived by patients who usually respond positively now that they have been reassured that it will be safe and productive to tell the full trauma story to this therapist at this time. At one extreme, affected individuals may exhibit a high level of interpersonal, social, and vocational function. Such patients may be misdiagnosed as having chronic schizophrenia and may be indistinguishable from such patients unless the clinician has undertaken a careful trauma history and diagnostic assessment. Two reports on psychotic female state hospital inpatients (Beck & Van der Kolk, 1987; Craine et al. Furthermore, they could be distinguished from non-abused state hospital patients by the prominence of sexual and abusive themes in their thoughts and behavior. Therapists working with patients who have survived a variety of traumatic events (war, natural disasters, etc. It should be noted that patients who reach the third phase have integrated post-traumatic events and are ready to concentrate, almost exclusively, on here-and-now issues concerning marriage, family, and other current issues (Herman, 1992; Lindy, 1993;Scurfield, 1993). The normal stress response occurs when healthy adults who have been exposed to a single discrete traumatic event in adulthood experience intense intrusive recollections, numbing, denial, feelings of unreality, and arousal. Such individuals usually achieve complete recovery following individual or group debriefing (Armstrong, et al. Next, there is an open discussion of symptoms that have been precipitated by the trauma. Acute catastrophic stress reactions are characterized by panic reactions, cognitive disorganization, disorientation, dissociation, severe insomnia, tics and other movement disorders, paranoid reactions, and incapacity to manage even basic self care, work, and interpersonal functions (Marmar, 1991). Treatment includes immediate support, removal from the scene of the trauma, use of anxiolytic medication for immediate relief of anxiety and insomnia, and brief supportive aggressive dynamic psychotherapy provided in the context of crisis intervention. During the past ten years we have come to appreciate the powerful therapeutic potential of positive peer group treatment as practiced in Vet Centers for military veterans and in rape crisis centers for sexual assault and domestic violence victims. It can be argued that the peer-group setting provides an ideal therapeutic setting for trauma survivors because their post-traumatic emotions, memories, and behaviors are validated, normalized, understood, and de-stigmatized. They are able to risk sharing traumatic material in the safety, cohesion and empathy of fellow trauma survivors. It is often much easier to accept confrontation from a fellow sufferer who has impeccable credentials as a trauma survivor than from a professional therapist who never went through those experiences first-hand. As group members achieve greater understanding and resolution over traumatic themes, they are remoralized. As they climb out of the pit of trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past (Herman, 1992; Scurfield, 1993). Through the retelling of the traumatic event to a calm, empathetic, compassionate and non-judgmental therapist, the patient achieves a greater 35 P a g e sense of self-cohesion, develops more adaptive defenses and coping strategies, and more successfully modulates intense emotions that emerge during therapy (Marmar, et al. The therapist needs to constantly address the linkage between post-traumatic and current life stress. There are two cognitive-behavioral approaches, exposure therapy and cognitive-behavioral therapy. Exposure therapy includes systematic desensitization on the one hand and imaginal and in-vivo techniques such as flooding, on the other. In general, flooding has been much more effective than systematic desensitization. The second approach, cognitive-behavioral therapy, includes a variety of anxiety management training strategies for reducing anxiety such as relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques (see Hyer, 1994; and Foa, et al. They have also speculated that a combination of both treatments might be more effective than either treatment alone. In most but not all trials, improvement has been achieved with imipramine, amitriptyline, phenelzine, fluoxetine, and propranolol. Sometimes the co-morbid disorder is the presenting complaint that requires immediate attention. Post-traumatic personality disorder is found among individuals who have been exposed to prolonged traumatic circumstances, especially during childhood, such as childhood sexual abuse. Such patients exhibit behavioral difficulties (such as impulsivity, aggression, sexual acting out, eating disorders, alcohol/drug abuse, and self-destructive actions), emotional difficulties (such as affect liability, rage, depression, panic) and cognitive difficulties, (such as fragmented thoughts, dissociation, and amnesia). Treatment generally focuses on behavioral and affect management in a here-and-now context with emphasis on family function, vocational rehabilitation, social skills training, and alcohol/drug rehabilitation. Long-term individual and group treatments have been described for such patients by Herman (1992), Koller, et al. Trauma-focused treatment should only be initiated after long therapeutic preparation. Inpatient treatment may be needed to provide adequate safety and safeguards before undertaking therapeutic exploration of traumatic themes. Traumatized patients have suffered greatly and the therapeutic process often opens old wounds with alarming intensity. It is difficult, if not impossible, to maintain a stance of therapeutic neutrality when a patient tells you how s/he was brutally abused as a child, tortured by political enemies, or was forced to watch loved ones be murdered. Therapists sometimes find themselves having intrusive thoughts or nightmares about the events recounted by their patients. Therapists may experience guilt that they were personally spared from such horrors. They may feel profoundly powerless because they could not protect patients from previous trauma and present distress. Such feelings can produce a number of inappropriate responses that interfere with therapy and disturb the therapist on a personal level. Herman (1992) notes that powerful emotions generated during therapy may prompt the therapist to engage in rescue attempts, boundary violations, or attempts to control the patient. Therapists may also activate a number of avoidant/numbing coping strategies such as doubting, denial, avoidance, disavowal, isolation, intellectualization, constricted affect, dissociation, minimization, or avoidance of traumatic material (Danieli, 1988; Herman, 1992; Lindy, 1988). McCann and Pearlman (1990) have called this phenomenon "vicarious traumatization," while Figley (1995) has called such secondary traumatization "compassion fatigue. They may experience (secondary) traumatic nightmares, guilt, feelings of powerlessness, rescue fantasies, or avoidant/numbing behavior as described above. This can set up a vicious cycle in which the more symptomatic, maladaptive, and ineffective therapists become, the more they plunge themselves into their work. When this occurs they are less likely to recognize that they have a serious problem and, unfortunately, are less likely to seek supervision or assistance from colleagues. Since exposure to trauma is not a rare event and since mental health professionals have no more immunity from such exposure than anyone else, such countertransference reactions should be expected to arise often enough to warrant careful monitoring by therapists and supervisors alike. Third, therapists are themselves exposed to the same kind of traumatic experiences for which they attempt to assist others. An example would be offering treatment to survivors of a natural disaster to which the therapist him or herself has also been exposed.
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Subscales: For ages 5 - 8: Vocabulary erectile dysfunction pills cape town cheap cialis black 800mg amex, Word Analysis erectile dysfunction drugs recreational use order cheap cialis black on line, Listening impotence webmd buy cialis black toronto, Language, Reading Words, Reading Comprehension, Spelling, Mathematics, Math Concepts, Math Problems, Math Computation, Social Studies, Science, Sources of Information, Composite, Reading Total, Math Total, Reading Profile Total, Survey Battery Total, Core Total. Norming Sample: Approximately 170,000 students in spring; 76,000 students in fall. Scores Available: Age-based standard scores, age equivalents, and percentile ranks, Score Summary Table, Graphic Profi le, Narrative Report, Planned Clinical Comparisons, Ability/Achievement Discrepancy Subscales: Short Term Memory, Visual Processing, Long-Term Storage and Retrieval, Fluid Reasoning, and Crystallized Ability, scales, yielding a Fluid-Crystallized Index composite. Scores Available: Standard scores, 90% confidence intervals, percentile ranks, descriptive categories, and age-equivalents. Scores Available: Age-based standard scores, percentile ranks, descriptive categories, and age equivalents. Performance on the Articulation Survey subtest can be interpreted using descriptive categories (Normal, Below Average, Mild Difficulty, or Moderate to Severe Difficulty) and item error analysis procedures. Subscales: Expressive Skills, Receptive Skills, Number Skills, Letter & Word Skills, plus an Early Academic and Language Skills composite. Subscales: Reading Composite: Letter and Word Recognition, Reading Comprehension; Other Reading Related subtests: Phonological Awareness, Nonsense Word Decoding, Word Recognition Fluency, Decoding Fluency, Associational Fluency, Naming Facility; Math Composite: Math Concepts and Applications, Math Computation; Oral Language Composite: Listening Comprehension, Oral Expression; Written Language Composite: Written Expression, Spelling; Other Composites: Comprehensive Achievement, Decoding, Oral Fluency, Reading Fluency, Sound-Symbol Norming Sample: 3,025 children, closely representing U. Scores Available: Standard Score, Percentiles, Test-Age Equivalents, and percent-of-occurrence. Subscales: Fine Motor (Writing, Manipulation), Cognitive (Counting, Matching), Language (Naming, Comprehension), Gross Motor (Body Movement, Object Movement) Norming Sample: 2,099 children (1,124 English-speaking; 975 Spanish-speaking) from five areas throughout the U. Scores Available: Raw scores, standard scores, descriptive ratings and percentages based on standard scores, percentile ranks, age equivalents, and grade equivalents. Subscales: Isolating Phoneme Patterns, Tracking Phonemes, Counting Syllables, Tracking Syllables, Tracking Syllables and Phonemes. Scores Available: Standard scores, percentiles, age equivalents, growth scores, and growth score profi le. Derived scores are recorded on the Summary Report and may be plotted to indicate patterns of strengths and weaknesses. Subscales: Expressive Language, Social-Emotional Development, Social-Emotional Temperament, Self-HelpAdaptive, Cognitive Battery, and Gross Motor Skills. Scores Available: Percentile ranks, stanines, normal curve equivalents, scaled scores, and standard scores. Subscales: Beginning Reading Skill Area (Visual Discrimination, Beginning Consonants, Sound-Letter Correspondence, Aural Cloze with Letter), Story Comprehension, Quantitative Concepts and Reasoning, Prereading Composite Norming Sample: May be available in the Technical Manual. Scores Available: T score; confidence intervals, percentile rank, age equivalent, developmental stage, descriptive category, profi le analysis; an early learning composite can be derived Subscales: Gross Motor, Visual Reception, Fine Motor, Receptive Language, Expressive Language. Population with regard to race, socioeconomic status, region, and community size (1990 U. Subscales: Reflexes (8 items), Stationary (30 items), Locomotion (89 items), Object Manipulation (24 items), Grasping (26 items), Visual-Motor Integration (72 items); plus Fine Motor, Gross Motor and Total Motor Quotients. Record forms include a Developmental Score Profi le for profiling age and grade equivalents and a Standard Score Profi le for profiling for age- or grade-based standard scores. Subscales: General Information, Reading Recognition, Reading Comprehension, Mathematics, Spelling, Written Expression. Norming Sample: Varied by subtest from low of 1,285 for Written Expression to high of 2,809 for Mathematics Application. Scores Available: Raw scores are converted to age equivalencies, percentile ranks, and standard scores. Subscales: Rhyming, segmentation, isolation, deletion, substitution, blending, graphemes, decoding, invented spelling Norming Sample: 1,582 reflecting the national school population with regard to race, gender, age, and educational placement (2004 Census). Note: Manual provides information on using test scores for instructional planning. Scores Available: Standard scores, age equivalents, and percentile ranks, Pictorial Intelligence Quotient Subscales: Verbal abstractions, form discrimination, and quantitative concepts Norming Sample: 970 children in 15 states, intended to be representative of the U. All items use a multiple-choice format, allowing examinees to indicate their choice via pointing or eye gaze; no verbal expressive skill required. Basic understanding of the principles of education and psychological testing needed for interpretation. Scores Available: Raw scores are converted to standard scores, percentile ranks, and risk levels. Social Skills section is further broken down into 3 subscales: Social Cooperation, Social Interaction, and Social Independence. Problem Behaviors section is broken into two subscales: Externalizing Problems and Internalizing Problems. In addition, 5 supplementary problem behavior subscales are available for optional use, including Self-Control-Explosive, Attention ProblemsOveractive, Antisocial-Aggressive, Social Withdrawal, Anxiety-Somatic Problems). Scores Available: Standard scores, percentile ranks, and age equivalencies Subscales: Norm referenced: Matching, Analysis, Reordering, Reasoning, Receptive Mode, Expressive Mode, plus a Discourse Ability Score gives an overall estimate of performance. Scores Available: Standard scores, percentile ranks, and age equivalents are available for birth to 11 months (3-month intervals) and 1 year through 6 years, 11 months (6-month intervals). The Articulation Screener provides age-appropriate cut-points that help a clinician determine if further articulation testing is advisable. Three supplemental assessments: Language Sample Checklist, Articulation Screener, and Caregiver Questionnaire. Norming Sample: 2,400 children at 357 sites in 48 states, representative of the U. Note: Designed to measure the development of cognitive processes that are critical to learning math skills and actual math performance. Examples include: Alphabet Writing, Copying, Compositional Fluency; Expository Note-Taking, Expository Report Writing, Verbal Working Memory, Written Sentences, Pseudoword Decoding, Rapid Automatized Naming-Letters, Rhyming. Note: Developed to facilitate the creation of assessment driven interventions in the areas of reading and writing. Subtest scores are coded by risk category: Green (low risk), Yellow (moderate risk), and Red (high risk). Record form provides a graph for plotting the raw scores and manual provides scaled growth scores for assessing growth over time (minimum of 6-month interval). Subscales: Includes Rapid Naming, Phonological Discrimination, First Letter Sounds, Rhyming, Sound Order, Bead Threading, Shape and Letter Copying, Corsi Frog (working memory), Balance, Postural Stability, Digit Span, Repetition, Teddy and Form Matching, Receptive Vocabulary, Digit Naming, and Letter Naming. About 4% of the children were diagnosed with language impairment, developmental delay, or risk for delay. Scores Available: Standard scores, percentile ranks, and age equivalents Subscales: Receptive Language, Expressive Language, Inventory of Vocabulary Words. Population on the basis of age, gender, race, ethnicity, geographic location (2000 Census); 2% had language disabilities; 7% had other disabilities. Administration requires no specialized training, but a high level of training is required for proper interpretation. Three forms: full scale (259 items), short form (40 items), and early development form (40 items, 0:3 to 6:11 years). Scores Available: Age equivalent scores, cluster W scores, standard scores, percentiles, Relative Mastery Indexes, Adaptive Behavior Skill Levels, Support Score, Instructional and Developmental Ranges, Functional Limitations Index, four Maladaptive Behavior Indexes Subscales: See Technical Manual for full list. Examples include Adaptive Behavior (Gross Motor, Fine Motor, Social Interaction, Language Comprehension, Language Expression, Eating and Meal Preparation, Toileting); Problem Behavior (Hurtful to Self, Unusual/Repetitive Habits, Withdrawal/Inattentive, Disruptive).
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It is important to erectile dysfunction treatment levitra purchase cialis black on line emphasize that mental retardation is characterized by the particular complexity of its clinical manifestations; it is a matter of the underdevelopment of the highest forms of cognitive activity common causes erectile dysfunction buy generic cialis black 800 mg, which cannot develop without the participation of the ontogenetically and phylogenetically youngest brain structures erectile dysfunction causes and solutions discount cialis black 800mg without prescription. These structures mature late and are formed most intensively during the first few years of postnatal development. That is why a disease process that attacks the central nervous system of a child during his first years of life can lead not only to the destruction of previously formed systems, but also to the underdevelopment of those structures that, at the time, have not yet taken final shape. In view of this the forms of mental retardation should include, in addition to the hereditary and congenital forms, those forms acquired in the first few years of life (up to three years of age). If this concept of the essence of mental retardation were adopted, the boundaries of the condition would become more clear-cut. The forms should exclude, first, all those intellectual disturbances that occur at later stages in the development of the child during various progressive pathological processes affecting the brain, or in the residual period, and that represent the decay of intellectual functions that have already been formed; and second, milder forms of disturbances in intellectual activity that are due to a slow rate of development (infantilism), incorrect child rearing, asthenia from somatic causes, and behavior disorders. A T h r e e - G r o u p Classification these were my initial assumptions when I undertook a classification of mental retarda- tion (appendix 1). Considering it to be a special form of dysontogenesis of the brain, and sometimes of the body as a whole, I thought it essential to take into account the laws governing the occurrence of developmental defects in general. Experimental research has shown that a developmental defect depends not only on the nature, intensity, and acuteness of the pathogenic factor, but also, and mainly, on the time of exposure, i. For this reason two criteria-the time of exposure and the nature of the pathogenic agent (its etiology)-were put forward as a basis for differentiating mental retardation into different clinical forms. In accordance with this, all of the clinical forms of mental retardation are divided into three groups, depending on the time of exposure to the harmful factor. The first group is caused by a pathological condition of the reproductive cells of the parents, i. The second group is dependent on harmful factors acting during the intrauterine period (embryopathies and pathologies of the fetus). The third group includes those forms of mental retardation caused by damage to the central nervous system in the perinatal period or in the first three years of life, i. Within each of these three groups different clinical forms are distinguished on the basis of etiology. Conclusions the scheme proposed here for the classification of mental retardation cannot be considered to be perfect and exhaustive. In addition to the forms listed here, the causes of which are more or less clear, there are a number of other forms (the so-called undifferentiated forms of mental deficiency) for which no accurate findings are available on the causes and origins. The difficulty of differentiation on the basis of pathogenesis is also due to the fact that some clinically welldefined forms of mental retardation have been insufficiently studied with respect to etiology. In addition, forms are quite often seen in clinical practice that have multiple causes, and it is difficult in each concrete case to isolate the principal cause of the disease. At the present time it is still not clear what forms of enzymopathy can be considered to be mental deficiences. It is often difficult to make a differential diagnosis between an enz y m o p a t h y form of mental retardation and dementia caused by a progressive enzymop a t h y disease. It can only be said that the earlier the hereditary chemical defect is discovered, the more often are observed symptoms of the underdevelopment of cognitive activity of a mental deficiency type. In other words, it is still difficult to determine a classification of mental retardation that can be accepted as completely satisfactory. The only thing that is clear is the way we should proceed if we wish to solve this problem in the future. The systematics of mental retardation, as of other forms of disease, must mainly be based on data regarding pathogenesis. T h e p a t h o g e n e s i s of v a r i o u s t y p e s of mental retardation depends not only on the severity and nature of the etiological factor, but also, and mainly, on the stage of ontogenesis at which the organism was damaged. The more carefully we study the type of reactivity of the nervous system at various periods in antenatal and postnatal development, the easier it will be to establish a classification of mental retardation, and the better that classification will be. Mental retardation combined with the disturbance of endochondral ossification, with congenital epiphyseal dysplasia 8. Mental retardation caused by damage to the reproductive cells of the parents through exposure to exogenous factors. Other genetic forms Enzymopathic F o r m s of Mental R e t a r d a t i o n Disturbances of Protein Metabolism 1. Maple syrup urine disease (disorders in the metabolism of valine, isoleucine, and leucine) 3. Arginosuccinicaciduria (disturbed metabolism of arginine) Disturbances of Carbohydrate Metabolism 9. Galactosemia (a disturbance in the action of the enzyme galactose-L-phosphate-uridyltransferase) 10. Methemoglobinemia (blockage of the enzyme needed to convert methemoglobin into hemoglobin) 13. Deficiency of glucuronyl transferase and incapability of converting indirectly acting bilirubin into the directly acting form (CriglerNajjar syndrome) Clinical Forms of Mental R e t a r d a t i o n Caused by C h r o m o s o m a l Aberrations 1. Mental retardation caused by a chromosomal aberration in Group A chromosomes (ring chromosomes) 2. Mental retardation caused by an aberration in Group B that is connected with the deletion of the short arm of the fourth pair of chromosomes (Wolfs syndrome) 3. Mental retardation connected with deletion of the short arm of the fifth pair of chromosomes ("Cri du chat" syndrome) 4. Group 2 the second group is comprised of types of mental retardation caused by harmful factors acting during the intrauterine period. Making a distinction between the various clinical forms of mental retardation on an etiological basis is considerably more difficult in this group than in the previous one, since it is not always possible to determine which pathogenic factor is preventing the establishment of the optimum environment for the development of the embryo and the fetus (the supply of nutritive substances and of oxygen). These pathogenic factors may be different at different stages in intrauterine development. There is no doubt that disturbances in uteroplacental blood circulation, cardiovascular diseases in the mother, diseases of the kidney and liver, and late pregnancy toxemia are of great importance in this respect. In defining this group a distinction has been drawn only between those clinical forms of mental retardation whose etiology has been more or less clearly determined. Mental retardation arising under the influence of immunopathological factors-incompatibility of the antigenic properties of the maternal and fetal blood with regard to blood type and rhesus factors 2. Mental retardation caused by the mother catching measles during pregnancy (embryopathia rubeolaris) 4. Mental retardation caused by other viruses (influenza, mumps, infectious hepatitis, cytomegalic inclusion disease) 5. Clinical forms of mental retardation caused by hormonal disturbances in the mother and by toxic factors (exotoxins and endotoxins) 8. Group 3 the third group is comprised of types of mental retardation caused by harmful factors acting during the perinatal period and the first three years of the postnatal period. The clinical forms in this group occur following exposure to various exogenous factors. These clinical forms of mental retardation are more complex in structure since, in their clinical and morphological characteristics, signs of underdevelopment are combined with residual manifestations of the disease concerned.