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Research on the impact of such legislation has found that restraining order laws have reduced intimate-partner homicide in states where authorities have a strong ability to conduct background checks and prevent offenders from purchasing firearms medications like tramadol buy 500 mg divalproex mastercard. One study of gun owners found that "[i]ndividuals who have received firearm training are significantly more likely to keep a gun in the home both loaded and unlocked" (Garbarino et al symptoms retinal detachment proven 250mg divalproex. Furthermore symptoms quivering lips buy divalproex 250 mg on-line, some critics argue that these programs may do more harm than good by giving youths the impression that gun carrying is the norm and increasing their interest in using guns medications while pregnant discount 250 mg divalproex free shipping. In a 2010 review, the World Health Organization found no evidence of effective interventions for gun violence, but did find some emerging. Introducing national legislation can be complicated, but much can be done at the local level. Stiffer enforcement, amnesties, and improved security for state supplies of firearms are some of the other promising approaches. Operation CeaseFire Boston used a gun market disruption strategy that focused on shutting down illegal diversions of new handguns from retail sources. Multivariate regression analyses were used to estimate the effects of the intervention on new handguns recovered in crime. These programs have shown mixed results, with no strong evidence that overall gun violence has been reduced. Large caliber semi-automatic handguns with large magazines represent some 50 percent of all guns associated with violent crimes. The role that violent images in a variety of media, including television and computer games, play in heightening arousal, thoughts, and emotions which make children more likely to engage in aggressive behavior has been well-established by research (Browne & HamiltonGiachritsis, 2005). However, when it comes to violent behavior and violence-related outcomes across different ages, research suggests violent media does not have a universal impact, but rather that factors such as age, sex, and trait aggression influence what effect, if any media has on violence. Some quasi-experimental studies provide supporting evidence for the theory that violent media has a larger impact on those whose personality or experiences predispose them to aggression (Browne & Hamilton-Giachritsis, 2005). Namely, after watching a violent film, high trait-aggressive participants reported more callous and hostile tendencies in their perceptions, and the most extreme reports of aggressive thoughts and actions were from male high trait-aggressive participants (Kiewitz & Weaver Iii, 2001). However, they noticed that across studies, children and teens appeared to have been differentially affected as compared to adults; long-term impacts on aggression were significantly larger for children and teens, while short-term impacts on aggression were larger for adults (Bushman & Huesmann, 2006). When the focus was narrowed to violent video games, a slightly different differential effect based on age emerged. Namely, another review found that for children ages 4-8, playing a violent video game was associated with increased aggression during free play immediately afterwards, but that, because of mixed results and a lack of experimental studies, a relationship between exposure to violent media and violent behavior could not be established for adolescents or young adults (Bensley & Van Eenwyk, 2001). Another consideration with regard to factors that may predispose youth to be aggressive as they relate to exposure to violent media is directionality. That is, it must be determined whether those who are predisposed to aggression are more strongly influenced by violent media than others, or whether their predisposition makes them more likely to prefer violent media, in which case the media itself may have little impact on their aggression. One study found that, among adolescents, a preference for violent video games was associated with significantly more problem behaviors overall and more thought problems, but not significantly more externalizing problems, including aggression (Funk et al. Taken at face value, these findings suggest that choosing to consume violent media, 77 regardless of the reasons for this choice, may not itself be a risk factor for aggressive behavior. Interventions While a number of programs have been created to increase media literacy among youth, some with a particular focus on violent media, few interventions have explicitly targeted violent behavior outcomes. One exception is a school-based German intervention that aims to reduce both exposure to violent media and aggressive behavior among middle school-age children. In order to help students consume violent media less frequently, researchers asked students to monitor their electronic media consumption, discussed the prominence of media in their lives, challenged them to spend a weekend without using electronic media, and suggested alternative leisure activities. Similarly, to help students consume violent media more critically, researchers taught students to identify positive or normalizing presentations of violence in the media and to understand the short-term and long-term impacts that violent media could have on their thoughts and behaviors and guided them in the creation of videos about what they had learned. In the first parent session, similar information was presented to parents, and they were also taught how to set guidelines and monitor media use to help their children decrease their exposure to violent media.
Research into the trafficking of men and boys is extremely limited medicine quiz discount divalproex 500mg fast delivery, save a few examples medications for anxiety discount 500 mg divalproex, though these are again generally limited to reports by non-governmental organizations or advocacy groups and do not include academic works medicine 4h2 generic 250 mg divalproex fast delivery. The Estes and Weiner study is a wider survey of all forms of commercial sexual exploitation of children in the United States medications bipolar divalproex 500 mg cheap, with only a small portion of the study devoted to trafficking of children. When presenting his research at a conference on identifying and serving child victims of trafficking in Houston, Texas in 2004, Estes was not able to differentiate between children who were trafficked across international borders and those who were trafficked within a particular North American country. Data on nativity is important for many reasons, including referral and determination of eligibility for particular services. Nativity and linguistic background are also important in designing culturally sensitive and linguistically appropriate services. The report is based on interviews with three primary groups of informants: law enforcement officials (immigration, police, and district attorneys), service providers (workers at youth shelters, faith-based groups, rape crisis services, and advocacy groups) and observers (mainly academics and journalists). The report is geared toward service providers, policy makers, and advocacy groups looking to gain insight into the phenomenon of child trafficking. It endorses the Unaccompanied Alien Child Protection Act and calls for establishment of housing designated especially for trafficked minors as well as a coordinated response to child victims in order to spare the victims from secondary traumatization through repeated interviews. The monograph is based on content analysis of news articles spanning the period 31 this document is a research report submitted to the U. The full-text review of 585 articles yielded 64 articles relevant to human trafficking. Of the relevant articles, 28 highlighted four concrete cases of human trafficking, all of which involved juveniles engaged in commercial sex. Juvenile victims of sex trafficking in these cases were almost exclusively female, ranging in age from 10 to 17, and were equally likely to be black as white. Almost all were thought to be born and raised in the United States (Wilson and Dalton 2007). In addition to child victims of trafficking for sexual exploitation, the monograph discusses several labor-trafficking cases involving women born outside the United States in countries such as Russia, Ethiopia, Eritrea, Guinea, and Morocco. Existing literature generally focuses on different forms of sexual exploitation of children (prostitution, pornography, and sex trafficking) (Campagna 1988; Barnitz 1998; Farr 2004) or child labor (Bales 2005). Some of these works do address the unique situation of child victims of trafficking specifically, but these works are limited. Researchers examined the use of "survival sex" by runaway and throwaway children to provide for their subsistence needs (Flowers 1994; Greene et al. Works on child trafficking outside the United States are more readily available and include articles that address a variety of issues. Several papers examined trafficking of children into the sex industry in Thailand (Andrews 2004; Arnold and Bertone 2002). In 2003, the Human Rights Watch prepared a report on child trafficking in Togo, in particular the trafficking of girls into domestic and market work and the trafficking of boys into agricultural work. Girls interviewed for this study were typically recruited into domestic or market work either directly by an employer or by a third-party intermediary. Most indicated involvement of family members in the transaction, including parents accepting money from the traffickers, distant relatives paying intermediaries to find work abroad, or parent handing over their children based on the promise of education, vocational training or paid work. Boys interviewed by Human Rights Watch were mainly recruited into agricultural labor in southwestern Nigeria. Traffickers made direct overtures to the boys, tempting them with the promise of a bicycle, a radio, or vocational training abroad. In 2004 Mohammad Anwar prepared a report for the Center for Research and Social Development on child trafficking for camel races with a particular focus on trafficking of children from Pakistan to participate in the age-old Bedouin tradition in many Gulf States (Anwar 2004). The study elucidates the linkages between poverty and vulnerability of marginalized children in the Rahim Yar khan district, one of the most socio-economically impoverished districts in Pakistan which has been neglected by development projects. The paper also points out to the practice in the 1970s of different Sheikhs descending upon this region for hunting and the resulting connections between an area of supply of young children and that of demand for young camel jockeys. Several international research institutions have conducted studies of different service needs of trafficked victims and/or programs serving trafficking victims. It focused on the identification, rehabilitation and reintegration of trafficking 33 this document is a research report submitted to the U. The first three of these reports highlight the troubling fact that in many developing countries in Asia there is no systematic approach to rehabilitating victims of trafficking, with different institutions employing different approaches. The reports outline child-friendly standards and guidelines for the recovery and integration of trafficked children and best practices for implementing the standards.
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The center must maintain a sufficient number of staff at all times to meet the care and service needs of all participants medicine 20 purchase divalproex 500mg. A minimum staffing level of one full-time staff member involved in direct services provision for each six participants must be maintained medications known to cause weight gain discount divalproex 250mg without a prescription. Volunteers must not be used to meet the required staff ratio unless they are professionally trained and/or certified in a health occupation and receive the same orientation and training as other staff medicine recall discount 500mg divalproex with amex. If a participant experiences a poor outcome related to a lack of supervision or unmet care needs treatment brown recluse spider bite purchase divalproex 500mg otc, the Secretary may require the licensee to add staff. New employees must have a minimum of 5 days supervised on-the-job training, volunteers must receive orientation to the program and training on the specific tasks to be performed prior to working with participants, and the director must participate in 8 hours of training annually related to the operation of a center. All employees must have current first-aid and cardiovascular pulmonary resuscitation training. Location of Licensing, Certification, or Other Requirements West Virginia Code of State Rules, Title 64, Series 2: Licensure of Medical Adult Day Care Centers. Office of Health Facility Licensure and Certification, Department of Health and Human Resources. Certification is mandatory for providers who serve one or more participants receiving Medicaid funding. Services may include personal care and supervision, provision of meals, medical care, medication administration, transportation, and activities designed to meet physical, social, and leisure time needs. The building is consistent with the environment in terms of size, architectural style, and type (urban versus rural) and would be attractive and inviting to members of that community. The setting, programs, and physical environment must enhance the dignity and individual respect of participants. Inspection and Monitoring the division conducts on-site inspections once every 2 years to ensure that providers meet applicable certification standards. The self-administration of medications may be supervised by a staff member who may prompt the participant and observe him/her taking the medication. When medications are self-administered (whether supervised or not), the medication list must 296 be reviewed and updated annually by the prescribing practitioner. At least one staff member over the age of 18 years must be on the premises at all times when participants are present. Volunteers may be counted as part of the staff-toparticipant ratio if they have signed a written job description and meet the same standards and training requirements as employees. At least one person over the age of 18 years, designated by the provider, must be on the premises at all times when participants are present; no participant may be designated as in charge. The total number of persons served at any one time must not exceed six; this includes adult family members or others for whom the provider may be responsible. The maximum number of participants by care level for any one provider or staff person is shown in the following table. Severely Impaired 3 2 1 0 Not Severely Impaired 0 2 4 6 Total 3 4 5 6 the provider must not care for children other than his/her own when participants are present. After the first year of employment, all employees who have responsibility for direct care or program activities, including the program director, must receive 10 hours of continuing education annually. Adult day care is a community-based group program designed to meet the needs of adults with physical and mental disabilities through an individual care plan. It is a structured, comprehensive program that provides a variety of health, social, and related support services in a protective setting during any part of a day but for less than 24 hours. Medicaid defines adult day care as services encompassing both health and social needs to ensure the optimal functioning of the individual, which are furnished for 4 or more hours per day, on a regular schedule, for 1 or more days per week (as specified in an individual care plan) but for less than 24 hours each day. A facility may refuse to serve adults with communicable disease, adults who are actively alcoholic or addicted to drugs, adults with a history of violence to self or others and/or whose behavior is not manageable within the group setting, and adults whose 300 need for care requires more time and skill than the individual program is able and qualified to provide. Providers may discharge participants if the program can no longer meet their needs. The Survey Division may also conduct an on-site inspection at any time at its discretion, for example, in response to a complaint. Complaints are triaged to determine how quickly an inspection needs to be scheduled.
Chronic oral administration of magnesium salts may be helpful in some conditions treatment guidelines quality 500mg divalproex, such as in patients receiving loop diuretics medicine vial caps buy divalproex 500mg online. The task of developing new drugs and bringing them to market is fraught with risk medications like adderall buy 250mg divalproex fast delivery, and with antiarrhythmic drugs symptoms webmd effective 500mg divalproex, this risk may be even higher than usual. It is entirely possible that any of the following four drugs might fall by the wayside before they gain final approval for clinical use. Azimilide displays at least two unique and potentially beneficial electrophysiologic properties. Azimilide, on the other hand, blocks both components of the inward potassium current. The more "balanced" blockade offered by azimilide, in theory, may reduce the risk of this type of proarrhythmia. In general, reverse use dependence is a detriment to the effectiveness of antiarrhythmic drugs. Because these drugs are intended to treat tachyarrhythmias, it is generally not a useful thing for them to lose efficacy at faster heart rates. Furthermore, because drugs displaying reverse use dependence produce greater potassium-channel blockade at slower heart rates, these drugs are more likely to produce torsades de pointes at these slower. A potentially very troublesome problem, however, is that rare cases of early neutropenia (within 6 weeks of initiation) have been reported, which, at this time, appears to reverse when the drug is stopped. Several clinical trials with azimilide have been conducted to date testing the drug in the treatment of supraventricular arrhythmias, and several additional trials are ongoing. Interestingly, azimilide is also being evaluated for the treatment of ventricular arrhythmias. New drugs aimed at ventricular arrhythmias have become a rarity in recent years, since the widespread adoption of the implantable defibrillator and the recognition that antiarrhythmic drugs (aside from amiodarone) often increase mortality in patients with underlying heart disease. While it is probably disappointing to the manufacturers of azimilide that this drug did not reduce mortality when used as primary prophylaxis in high-risk patients, it is noteworthy that (unlike virtually every other antiarrhythmic agent except amiodarone) it did not increase mortality in these patients. An additional trial is ongoing to examine the utility of azimilide in reducing recurrent ventricular tachyarrhythmias in patients with implantable defibrillators. Having an effective agent to use in this clinical situation, in addition to amiodarone, would be quite helpful. Dronedarone If one were to ask electrophysiologists to describe the ideal antiarrhythmic drug, most would probably describe a drug that was as effective as amiodarone but without its incredible array of toxicities. Indeed, an "amiodarone without the side effects" is virtually the Holy Grail of antiarrhythmic drugs. Dronedarone (developed by Sanofi-Aventis, also the developer of amiodarone) is a derivative of amiodarone and is held by some to potentially be that Holy Grail. The major difference is that dronedarone lacks the iodine atoms that are a major feature of amiodarone. The iodine in amiodarone is almost certainly responsible for its thyroid toxicity, so it is a good bet that dronedarone will not cause similar thyroid-related side effects. Furthermore, the lack of iodine in dronedarone makes the drug significantly less lipophilic than amiodarone, and much of the organ toxicity of amiodarone is speculated to be due to its affinity for fat. In over 1200 patients presenting with atrial fibrillation or atrial flutter, dronedarone proved significantly more effective than placebo in preventing recurrence of the atrial arrhythmias. Additionally, dronedarone appears to be useful in controlling the ventricular response in patients with chronic atrial fibrillation when therapy with digitalis, beta blockers, and calcium blockers has failed. Often, such patients are referred for atrioventricular nodal ablation and placement of a permanent pacemaker. A pharmacologic solution to rate control in these patients would obviously be an attractive alternative to ablating the patient into a state of permanent complete heart block. Head-to-head trials will be necessary to prove any exceptional antiarrhythmic efficacy. In clinical trials to date, none of the thyroid, lung, or hepatic toxicity so prominent with amiodarone has been seen. Furthermore, neither torsades de pointes nor other forms of proarrhythmia have been seen. Overall, whether or not dronedarone proves to be the Holy Grail thus far it does appear to be a very promising addition to the arsenal of antiarrhythmic drugs.
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