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Staff need to understand the distinctive nature of sexual abuse involving children and teens and its potential consequences definition of arthritis rheumatoid discount 400 mg pentoxifylline with amex. Their responsibilities-including a duty to report any information about abuse-must be clear arthritis fingers diet quality 400mg pentoxifylline, and they must be informed that they will be held accountable for their actions and omissions arthritis in feet hands and knees buy cheap pentoxifylline 400mg online. Administrators must uphold these policies and ensure that every report of abuse is promptly investigated rheumatoid arthritis specialist new zealand trusted 400 mg pentoxifylline. Although research has yet to pinpoint the characteristics of youth who are at greatest risk of being victimized or perpetrating sexual abuse in juvenile facilities, many of the factors associated with vulnerability to sexual abuse among adults also appear to place juveniles at risk. In addition to screening all youth, facilities can take a simple step to protect youth from sexual abuse: encourage all residents during intake to tell staff if they fear being abused. Youth may be segregated only as a last resort and for short periods of time when less restrictive measures are inadequate to keep them safe. Reducing sexual abuse also requires creating conditions that encourage youth to report abuse. Internal reporting procedures must be simple and secure; victims and witnesses must have unimpeded access to their families, attorneys, or other legal representatives; and facilities must provide parents and lawyers with information about the rights of residents and internal grievance procedures. Because many youth fail to recognize certain coercive and harmful behaviors as "abuse," juvenile facilities must improve sexual education programs and sexual abuse prevention curricula. Youth who perpetrate sexual violence in juvenile facilities present a challenge for facility administrators who must apply developmentally appropriate interventions. Studies have shown that youth who commit sexual offenses typically have a history of severe family problems. Correctional medical and mental health practitioners must be trained to recognize the signs of sexual abuse and to provide age-appropriate treatment. And because young victims may lack the confidence to seek help from corrections staff, they must have access to victim advocates in the community to ensure that they are not left without support and treatment. More than any other group of incarcerated persons, youth incarcerated with adults are probably at the highest risk for sexual abuse. Civil rights attorney Deborah LaBelle told the Commission that 80 percent of the 420 boys sentenced to life without parole in Michigan, Illinois, and Missouri reported that, within the first year of their sentence, they had been sexually assaulted by at least one adult male prisoner. Because of the extreme risk of sexual victimization for youth in adult facilities, the Commission urges that individuals under the age of 18 be held separately from the general population. Hope lies in the fact that necessary precautions and remedies are clear and rehabilitation remains a guiding principle in the field of juvenile justice. The nature and consequences of the abuse are no less severe, and it jeopardizes the likelihood of their successful reentry. As both Federal and State governments attempt to reduce incarceration costs in the face of looming deficits, the number of individuals under some form of community supervision-before, after, or in lieu of confinement-is likely to rise. The Commission has developed a full set of standards governing community corrections. Community corrections encompasses a diverse array of agencies, facilities, and supervision structures on the Federal, State, and local levels. Supervision can occur in halfway houses, prerelease centers, treatment facilities, and other residential settings. Nonresidential supervision can include probation, parole, pretrial supervision, court-mandated substance abuse treatment, court diversionary programs, day-reporting centers, B Community corrections agencies, just like prisons and jails, have a special responsibility to protect the individuals they supervise from sexual abuse. As in other correctional settings, courts have found that sexual abuse in community corrections violates the Eighth Amendment of the U. As a result, community corrections agencies, like prisons and jails, have a special responsibility to protect the people they supervise. Courts also have determined that the authority staff have over the individuals they monitor makes a truly consensual sexual relationship impossible. Community corrections agencies are accountable for sexual abuse incidents, regardless of whether the circumstances in which the abuse occurred were under the direct control of the agency or a separate organization working under contract with the agency. Her supervisor on the job sexually assaulted her, and the court ruled that important "penological responsibilities" had been delegated to him. Although individuals under correctional supervision in the community may experience sexual abuse at the hands of other supervisees, the dynamics of supervision make them particularly vulnerable to abuse by staff. Coercion and threats carry great weight because individuals under supervision are typically desperate to avoid being incarcerated.

As he underwent multiple reconstructive procedures to save his upper limbs arthritis elbow discount pentoxifylline 400mg online, the specialist team began the extensive rehabilitation for his lower limb amputations arthritis in feet pictures buy 400mg pentoxifylline with amex. It is well know that there are numerous negative effects of immobility arthritis in lower back after surgery order pentoxifylline 400mg, which early rehabilitation interventions can help mitigate arthritis in upper neck pentoxifylline 400mg on line. These negative effects include bone loss leading to osteopenia and osteoporosis, joint contractures which impair mobility and function, metabolic abnormalities, cardiovascular deconditioning, electrolyte and fluid imbalances, orthostatic hypotension, muscle weakness and atrophy, skin breakdown and pressure ulcers, increased risk of infection, poor wound healing, and vascular thrombus formation. As illustrated in this case, combat casualties with limb loss often experience multiple complex challenges. Evidence suggests, however, that the implementation of a comprehensive rehabilitation care program is effective in improving outcomes. This can only be achieved by caring for a high volume of patients with similar complex problems. It must also be recognized that the complex set of problems commonly encountered by Wounded Warriors with limb loss and their families are unique and not often seen in civilian settings. For example, nearly all amputations that are performed in the United States in both civilian and Veteran Affairs affiliated hospitals are the result of vascular disease and/or diabetes, not from blast injuries. Further, most amputations performed in civilian hospitals are to the lower limb below the knee, whereas among our military amputee population, a significant percentage of combat casualties sustained upper limb (20%), multiple limb (30%), and above knee (40%) amputations. Centers of excellence bring medical experts together, as well as patients, families, and often former patients who serve as peer mentors. This construct is enormously powerful in promoting healing, recovery, and quality of life. There are tremendous benefits in the development of a therapeutic milieu for a group of Wounded Warriors going through their rehabilitation, recovery, and reintegration as a team. Military service members are trained to be part of a unit and function as a member of a team. After injury, they are taken from their combat team through medical evacuation and now must join another team-a team motivated to recover and rejoin the fight. Serving as a peer mentor allows team membership to continue, even after discharge. Their coordinated efforts help support specific geographic regions within the United States in order to provide accessible, highly specialized care to the most complex patients. Given the complexities of the problems encountered by combat casualties, the integrated team includes physicians, nurses, medics, corpsmen, social workers, case managers, behavioral health providers, pain specialists, therapists, prosthetists, orthotists, technicians, plastic surgeons, dermatologists, ophthalmologists, audiologists, pharmacists, and dentists across numerous disciplines who must collaborate to provide interdisciplinary care. In addition to healthcare providers, numerous support structures must be in place within the institution to ensure access to expert intensive critical care and reconstructive surgery; highly specialized diagnostics; 3D printing and fabrication; state-of-the-art prosthetic and orthotic fitting and adjustment; computer assistive accessibility for patients with vision, hearing, or extremity impairment; interventional pain suites to apply novel interventions for complex pain syndromes; highly sophisticated gait, motion analysis, and virtual reality platforms; as well as access to complementary and alternative medicine. Of equal importance to having trained and experienced providers with cutting edge technology is having engaged and effective leadership teams with supportive administrative staff. Unless the providers are resourced and supported appropriately by their leadership, efficient and effective care cannot be delivered. Facilitating these actions is a well-coordinated performance/quality improvement program. Having a mechanism where the members of the interdisciplinary team and leadership can meet regularly to critically evaluate what processes and interventions work well and which should be improved can greatly 80. This is a very effective method of proving to those still in rehabilitation that there is life after injury and that they can also achieve great success, no matter what the challenge. Evidence supports this approach, as graduates of the program have consistently lauded their care and specifically described the peer support that they received as beneficial. This unprecedented practice has had an enormously positive effect on the rehabilitation of Wounded Warriors. As previously reported in caring for Vietnam Veterans,14 promoting independence is critical to successful rehabilitation. Creating situations where an injured service member becomes dependent on a loved one for basic functions, such as feeding, dressing, and hygiene, can have a negative effect on self-esteem and motivation. While therapists work daily with patients to teach and train independent skills, reinforcement by family members during times when the patient is not in therapy can greatly enhance the effectiveness of rehabilitation.

Please identify all correspondence arthritis medication nabumetone buy generic pentoxifylline 400 mg on line, memoranda arthritis relief walking workout cheap pentoxifylline 400 mg otc, email messages arthritis pain weather buy cheap pentoxifylline 400 mg on line, postings arthritis is back purchase pentoxifylline 400mg, or other communications, whether in writing or made orally, that (a) were made by, to , and/or between You and any other person, including without limitation (i) any political party or body, political committee, political action committee, non-profit organization, or other body of citizens; (ii) any voter/elector in the Commonwealth of Pennsylvania; (iii) any other County Election Board; (iv) any District Election Board; (v) any of Your employees, agents, or other representatives acting on Your behalf; and/or (vi) Secretary Boockvar and/or the Elections Department; and (b) concern, relate to , describe, explain, or justify the Procedures, Practices, Rule, Regulations, and/or Instructions identified in Your answer to the preceding Interrogatory, including without limitation any incidents, complaints, concerns, changes, modifications, or supplementation to such Procedures, Practices, Rules, Regulations, and/or Instructions. For the reasons stated above, the Board of Elections also objects to this Request as untimely, unduly burdensome, and Affidavit of Amber McReynolds - Exhibit 1 35 disproportional. Please identify all Procedures, Practices, Rules, Regulations, and/or Instructions You implemented, used, followed, and/or communicated in the June 2, 2020 Primary Elections, and all Procedures, Practices, Rules, Regulations, and/or Instructions that You intend to implement, use, follow, and /or communicate in the November 3, 2020 General Election, Affidavit of Amber McReynolds - Exhibit 1 36 concerning or relating to the return or delivery by electors of voted absentee and/or mail-in ballots, including without limitation whether You frank or prepay the postage for any or all absentee ballots and/or mail-in ballots and/or whether third parties may deliver in person absentee and/or mail-ballots cast by non-disabled electors, and if there are any differences, please identify the reasons why You are making a change in such Procedures, Practices, Rules, Regulations, and/or Instructions for the November 3, 2020 General Election. Subject to and without waiving these objections, the Board of Elections states that it followed the Pennsylvania Election Code, 25 Pa. At all times, the Board of Elections will strive to administer an orderly election while protecting the franchise for all Philadelphians. In the week before the Primary Election, the Board of Elections established and administered three categories of drop-off locations, at which voters who had received an absentee or mail-in ballot could return their ballots in person: (1) 24/7 Drop-Off Locations at the two County Board of Elections Offices, City Hall and 520 N. Affidavit of Amber McReynolds - Exhibit 1 38 24/7 Drop-Off Locations the Board of Elections created two 24/7 Drop-Off Locations for voters to return their absentee and mail-in ballots in person. Each 24/7 Drop-Off Location consisted of a converted mail box, bolted to the ground. At each 24/7 Drop-Off Location, ballots were collected at least daily, with more frequent ballot collections closer to Primary Day. On Primary Day, Board of Elections personnel made the last ballot collection at each location at 8:00 p. During ballot collection, Board of Elections personnel maintained custody of returned absentee and mail-in ballots at all times. Immediately after collection, Board of Elections personnel transported returned ballots directly to the Board of Elections for verification and processing. The City Commissioners therefore approved establishing, for ten "zones" of Philadelphia, 1 a two-hour Mobile Drop-Off Location at which voters could return their absentee and mail-in ballots in person before Primary Day. Mobile Drop-Off Locations were staffed by City Commissioner Al Schmidt and/or three members of his staff: Chief Deputy Commissioner Seth Bluestein, Deputy Commissioner Michelle Montalvo, and Election and Voter Registration Clerk 2 Darrylisha Flippen (collectively the "Mobile Drop-Off Location Personnel"). Commissioner Schmidt and Deputy Commissioner Bluestein each attended part or all of each Mobile Drop-Off Location. Mobile Drop-Off Location Personnel provided for the security of ballots returned at each Mobile Drop-Off Locations by, inter alia, using secured ballot bags manufactured by A. Each secured ballot bag features a doublesealing mechanism which, once employed, prevents the removal of ballots from the secured ballot bag or addition of ballots to the secured ballot bag without breaking the seals. Mobile Drop-Off Location Personnel used two secured ballot bags at each Mobile DropOff Location. When a secured ballot bag was filled, Mobile Drop-Off Location Personnel would For the June Primary, Philadelphia Polling Places were divided into ten "zones. The Board of Elections did not provide a Mobile Drop-Off Location in Center City because Center City already had two 24/7 Drop-Off Locations. The Board of Elections also provided two Mobile Drop-Off Locations in the "North" zone, to ensure access to Spanish speaking residents via Spanish language outreach and instructions. At the same time, other Mobile Drop-Off Location Personnel remained at the Mobile Drop-Off Location using the second secured ballot bag. At the end of the day, Commissioner Schmidt or Deputy Commissioner Bluestein would return both secured ballot bags to the Board of Elections for verification and processing of their contents. Only Mobile Drop-Off Location Personnel handled secured ballot bags at each Mobile Drop-Off Location. Mobile Drop-Off Location Personnel maintained possession of each secured ballot bag up to and including bringing each sealed, secured ballot bag to the Board of Elections for verification and processing. The Board of Elections partnered with a nonprofit, nonpartisan group, the Committee of Seventy, in implementing the Mobile Drop-Off Locations. The Committee of Seventy helped advertise the locations and provided a vehicle, the "votesmobile," that carried a table and canopy and served as a prop at the locations.

This book describes the emergence of such networks from the shadows of the criminal world into the world of national and international security arthritis treatment machine discount pentoxifylline 400 mg line. This chapter examines a frequently mentioned but infrequently elaborated new and disturbing development: the emergence of the criminal state arthritis in knee diagnosis code buy pentoxifylline 400mg lowest price. We begin with a prefatory discussion of some of the impediments to clear analysis and understanding of converging criminal networks arthritis pain barometric pressure discount 400mg pentoxifylline with mastercard, as well as the unique obstacles to full comprehension that criminal states pose arthritis in dogs with diabetes buy pentoxifylline 400mg online. These have been iterated in previous works of one of the authors,1 but they bear reiteration to serve as the backdrop for the further discussion. We argue that state criminalization exists along a spectrum characterized by varying degrees of corruption and various functions of corruption within the state. At one end of the spectrum is "criminal penetration," which occurs when an illicit network, be it criminal, terrorist, or insurgent, is able to place "one of its own" into the state structure. That agent may carry out formal functions on behalf of the state but also carries out actions in support of an illicit network or criminal enterprise. When this penetration becomes pervasive and affects critical nodes of decisionmaking, it becomes an advanced pathology of dysfunctional governance characterized by the presence of criminals and criminal agents in positions of state authority where they facilitate and implement criminal activities for the illicit networks for which they ultimately work, thus undermining the pillars of government legitimacy and functionality. We describe "Criminal capture" as the condition of dysfunctional governance in which criminal agents are so sufficiently prominent in positions of state authority that their criminal actions cannot effectively be restrained by the state. At some point, it may become part of state or substate institutional doctrine to engage in illicit activity. At this level, the state is not only subverted by illicit elements but is directly complicit in those activities and endorses those activities. Pervasive institutionalization defines the fully "Criminal sovereign," which functions effectively as a criminal enterprise with the apparatus of the state itself engaged directly in criminal activity as a matter of policy. Such a state exists outside the realm of the family of states, which is governed if only nominally by the international law regime and associated norms. Such a state is a threat to all other states, to the international rule-based system of states, and to the contemporary structure of global order. To animate this spectrum, we discuss examples of the various stages along the spectrum. Conceptual Challenges Networks of criminals, smugglers, counterfeiters, insurgents, and terrorists are not a new phenomenon. Indeed, such networks have operated on the criminal fringe of communities in all societies and at all times. Yet our understanding of the operations and structures of the organizations that dominate these trades is woefully inadequate. There is a crippling shortage of reliable data regarding the operations and structures of illicit networks. This does not refer to technically advanced computer models, but to the absence of the fundamental conceptual models required for a disciplined analytic approach. A basic and widely accepted taxonomy of the objects of study-illicit networks and organizations-is lacking. This conceptual underdevelopment has many causes, but professional, bureaucratic, and international fragmentation are important sources of confusion and poor analysis when studying transnational illicit networks. Sociologists perceive the phenomena from the vantage point of intellectual frameworks and models emerging from their discipline, emphasizing the dynamics of collective human behavior. Criminologists are prone to view transnational criminal networks as an extension of individual criminality, best addressed within a law enforcement framework. Anthropologists, political scientists, and international relations specialists all perceive the phenomenon through the lenses of their disciplines; none owns it, yet none can dismiss it. This leads inevitably to conceptual confusion, competing models, and interdisciplinary competition for the right to claim the correct or best analysis. If you speak with lawyers, you will discover that they see a world that the people in finance do not see, or see in a completely different way. If you are speaking with finance professionals, you will find that they perceive the problems in a way completely unlike those in law enforcement. Those officials responsible for containing the international trade in counterfeits see yet a different world-they worry about different things and use different tools than people who are worried about international licit trade. The many agencies involved in countering transnational criminal networks in each country have their own organizational cultures, methods, mandates, authorities, and idiosyncrasies. In the United States, the effort to counter illicit networks involves the State Department, Department of Defense, Department of Homeland Security, Treasury Department, and Department of Justice, as well as national intelligence organizations such as the Central Intelligence Agency, Federal Bureau of Investigation, and the Defense Intelligence Agency. Also involved are specialized agencies such as the Drug Enforcement Administration, the Bureau of Alcohol, Tobacco, Firearms, and Explosives, and U.