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Scholars like Dorothy Roberts have thoughtfully suggested that one way to pulse pressure 46 diovan 160mg on-line heal the adult criminal system pulse pressure tamponade discount diovan 160 mg amex, which is plagued by racism blood pressure 4 year old child order diovan with paypal, is to abolish the system as we know it. Roberts, Constructing a Criminal Justice System Free of Racial Bias: An Abolitionist Framework, 39 Colum. See Ventrell, supra note 22, at 22 ("In the case of the poor, the state felt authorized to remove poor children and apprentice them for the common good. See Patricia Soung, Social and Biological Constructions of Youth: Implications for Juvenile Justice and Racial Equity, 6 Nw. For an illustrative history of this movement leading up to the founding of the juvenile court, see Sanford Fox, Juvenile Justice Reform: An Historical Perspective, 22 Stan. These institutions "offered [their] inmates such employment as will tend to encourage industry, basic education in reading, writing, and arithmetic, and instruction in the nature of their moral and religious obligations. Interestingly, these reformatories "lumped all disorderly and dependent [meaning children without parents] children together and offered them basically the same treatment. See James Bell & Laura John Ridolfi, Adoration of the Question: Reflections on the Failure to Reduce Racial & Ethnic Disparities in the Juvenile Justice System 4 (Shadi Rahimi ed. Minority populations, or youth of color, include American Indian and Alaskan Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and persons of mixed race or ethnicity. See Grossberg, supra note 28, at 18 ("Concern about the jurisdiction and services offered by the reformatories led some parents to protest the incarceration of their children. The subject in this case, Mary Ann Crouse, a minor, was committed to the Philadelphia House of Refuge by a justice of the peace warrant. See Ventrell, supra note 22, at 26-27; see also Scott, supra note 36, at 116 ("[U]nder its historic parens patriae authority, the government has the responsibility to look out for the welfare of children and other helpless members of society. Moreover, the court was designed to separate youth incarceration facilities and courts from those designed for adults, which is not always the situation today. See Charlyn Bohland, Comment, No Longer A Child: Juvenile Incarceration in America, 39 Cap. See Bell & Ridolfi, supra note 28, at 3 (reporting that "the exclusion of Black children from rehabilitation services was rationalized as a waste of resources and a debasement of Whites"). Alexes Harris, the Social Construction of "Sophisticated Adolescents": How Judges Integrate Juvenile and Criminal Justice Decision-Making Models, 37 J. Initially decision makers make a distinction between trouble [sic] and untroubled cases; this categorization helps officials determine whether cases need special handling or could be let go. An issue that affects girls and girls of color significantly, which in turn affects normative views of their morality and thus the attitudes of relevant decisionmakers, is prostitution of minors or sex trafficking. Although a discussion thereof is beyond the scope of this analysis, it is worth mentioning given its disproportionate impact on girls of color. See generally Sherman, supra note 8; Mike Dottridge & Ann Jordan, Children, Adolescence and Human Trafficking: Making Sense of a Complex Problem (Am. Alarmingly, this issue affects young girls in every major city in the United States. Los Angeles County probation office 2010 data identified 174 sexually trafficked youth in the juvenile justice system, of which 92 percent were African American (in a county in which approximately 10 percent of the girls are African American, see American Factfinder, U. See Domestic Minor Sex Trafficking Fact Sheet and Data, Saving Innocence. Juvenile courts usually involve six stages, several of which may be combined: intake, detention, petition, waiver, adjudication, and disposition (or sentencing). For most youth, initial contact with the juvenile justice system begins with a police officer-usually in their community. For example, in California, when a police officer stops a youth, the officer can let him or her go, issue a ticket with notice to appear, or take him or her into temporary custody. An officer has the right to take youth into temporary custody, without a warrant, whenever the officer has reasonable cause to believe that the youth committed an offense, violated a juvenile court order, or is in need of medical attention. When a youth is taken into custody, law enforcement may (a) warn and release him or her without citation; (b) bring the youth to a diversion program, shelter, or counseling program; (c) give the youth a "notice to appear"; or (d) bring the youth to a probation officer at a juvenile hall. Hispanic girls in the juvenile justice system struggle with such things as discrimination, language barriers, and poverty. District Attorney Guidelines for Juvenile Cases, Los Angeles County (on file with author); see Case Flow Diagram, supra note 64.

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Had the district therapeutist administered early maintenance treatment and educated the patient on specific topics of his disease blood pressure medication dosages purchase 40 mg diovan otc, this episode would have been avoided arrhythmia ventricular discount generic diovan canada. Pain is constant blood pressure chart on age discount diovan line, limited to the above-mentioned area, and not influenced by breathing (deep inspiration is troublesome). He has history of periodic episodes of pain (every 2-3 months) with fever over the last 78 years. Physical examination reveals the following: Breathing movements appear to be symmetrical, but shallow; abdominal participation is seen. Pain was accompanied by anxiety, nausea, vomiting, and diaphoresis (clammy sweat). Patient has history of chronic gastritis (over last 6-7 years); however, because the disease caused little or no discomfort, he has never been tested and treated. Before calling his physician, the patient took an analgesic (sedalgine) and nitroglycerin, which gave no relief. Physical examination reveals the following: Clinical Practice Guidelines for General Practitioners 39 Chest Pain Patient is restless; skin and visible mucosa are pale; clammy sweat is observed. She notes that during the last 3 days her right calf muscles grew swollen and became painful. Physical examination reveals the following: Breathing movements appear to be symmetrical (respiration rates-18 breaths per minute). He has no history of such a pain, and before this episode had believed himself to be in good health. Physical examination reveals the following: Patient is anxious, with pale skin and clammy sweat. Clinical Practice Guidelines for General Practitioners 41 Chest Pain Abdomen is soft and painless on palpation. Five years ago "cardiac murmur" was occasionally identified during a routine examination; however, further testing was not performed. Abdomen is 42 Clinical Practice Guidelines for General Practitioners Chest Pain soft and painless on palpation; hepatomegaly is identified. Breathing movements appear to be symmetrical; vesicular respiration is heard on auscultation. Cardiovascular system: Heart is not enlarged on percussion; apex beat is hyperdynamic. In the left intercostal space near the sternal edge, a scratching systolic murmur is heard, being accompanied by thrill. Care (symptomatic treatment) is provided; patient is hospitalized in cardiology department. Clearly, negligence of primary health care physician resulted in late diagnosis and complications. Education of patients and their families Education of patients and their families is aimed to provide them with easy-to-understand information to ensure that they have adequate knowledge to be able to prevent diseases that may cause chest pain. Specialty referral: Primary health care physicians should refer their patients to cardiologists, neurologists, surgeons, and endocrinologists, as outlined in this clinical practice guideline. Assessment of the Impact of the Application of Clinical Practice Guideline (pre- and post-testing examples) 10. All of the following are incorporated into the concept of unstable angina except: a) exertional angina of recent occurrence (usually within last 4-8 weeks) b) progressive angina c) resting angina d) chronic stable angina 2. The most frequent radiographic finding in patients with pulmonary embolism is: a) elevation of diaphragmatic cupola b) local infiltrates c) cuneate pulmonary infarction d) pleural effusion e) normal roentgenogram 6. Pain in dry pleurisy: a) is sharpened by ill-side bend b) is sharpened by healthy-side bend c) is sharpened equally by ill- and healthy-side bend d) does not influenced by side bends 10. Pain is pressing in nature, is located retrosternally, and radiates to left blade bone and left shoulder.

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From Sinaloa to pulse pressure 33 best order for diovan Tirana to hypertension kidney damage purchase diovan 40mg with amex Caracas to blood pressure up generic diovan 40 mg amex Lagos, as transnational criminal organizations and "third-generation gangs"-gangs that have morphed from local groups of individual actors to cross-border, networked entities that toe the line between crime and war-increasingly forge alliances with corrupt government officials, undermine competition in key global markets, and diversify their illicit portfolios with ventures into legitimate commerce, they are unraveling the social fabric of the community of nations. It is therefore critical that the international community work together in a coordinated manner to staunch this flow and dismantle the criminal opportunity structure at every node, pipeline, and channel across the global illicit landscape. By combining forces in response to the relentless convergence of illicit threat networks and reducing their ability to exploit market opportunities, we will have a much greater chance of success if we target their center of gravity in this landscape including their financial flows-the whole indeed can be greater than the sum of all parts. Translating Threat Awareness into Threat Management the United States has recently taken steps to make countering the convergence of illicit threats a national security priority. It undermines the integrity of vital governmental institutions meant to protect peace and security. While the problem of transnational illicit networks is as ancient as the trade routes that many such networks still employ today, the United States and its partners recognize the importance of net-centric partnerships to confront converging threats and the lethal nexus of organized crime, corruption, and terrorism along global illicit pathways and financial hubs. Illicit financial hubs and sanctuaries help to create the permissive environment that enables illicit funds to enter through vulnerable points in the system and be transferred very rapidly, often with little control or regulation, anywhere in the world. All it takes is a single illicit actor or bank to accept an unsavory client for illicit funds or goods to spread and disguise themselves across the globe. These illicit channels are also allowing kleptocrats, criminals, and in some cases terrorists or their sympathizers to inject billions of dollars of illicit wealth into the stream of licit commerce and business, corrupting markets, financial institutions, officials, and communities. The international community can no longer turn a blind eye on the complicity of facilitators and super fixers who perhaps unwittingly construct illicit financial hubs and permissive sanctuaries by converting illicit financial flows into licit investments and legal liquid assets, or injecting illicit goods into legitimate commerce. Globalization and Horizontal Diversification of Illicit Networks Since the end of the Cold War, the world has witnessed the expansion of transnational criminal organizations beyond their traditional boundaries. They are quick to identify new opportunities and spread into new geographic areas where national and international responses have yet to pose a credible threat to the survival of their operations. Today, the major organized crime groups have become even more global in reach, operating not only in the United States and Latin America, but also in West Africa, Southeast Europe, Asia, and Russia, integrating within and across networks in all regions of the world. Central America and West Africa have become central areas of concern as safe havens for converging threats where trafficking in drugs, people, weapons, and other illicit commodities fuels instability and insecurity. Colombian drug cartels, which have long been viewed as a major security threat in the Western Hemisphere, are now expanding their activities beyond traditional areas of operation. Multi-ton shipments of Colombian cocaine now flow through West Africa as a transit point for moving the product to Europe and beyond. At the same time, West African drug traffickers have recently been spotted moving South American cocaine as far away as South Asia. West African drug mules have been caught at ports of entry from Florida to Thailand. Piracy in the waters off the Horn of Africa remains a serious challenge to humanitarian aid and commerce, and the problem is getting worse. Piracy presents a clear and present danger to the international maritime shipping industry, on which much of the global economy depends; to fragile political progress and development in Somalia; and to humanitarian assistance and trade in the region. The security threats of today are more sophisticated and complex than in the past; converging threat networks are forming alliances where previously the parties acted alone. The illicit proceeds of global drug trafficking are among the funds used for arms trafficking to the Taliban in Afghanistan and the Revolutionary Armed Forces of Colombia, while drug traffickers themselves engage in countless other illicit activities-from antiquities smuggling to human trafficking-to launder money. Ideologically motivated terrorists such as al Qaeda in the Islamic Maghreb, Lebanese Hizballah, and al-Shabaab in the Horn of Africa are in some instances engaging with or benefiting from criminal organizations following a strict profit motive, and in other situations becoming criminal entrepreneurs in their own right, engaging in actions such as kidnapping for ransom. Traders in illicit goods poison legitimate supply chains, markets, and communities with low-quality counterfeits, inherently illicit goods such as narcotics, and illegally procured goods such as blood diamonds that are traded on the black market. In some cases, organized criminal groups seize control of a legitimate supply chain or exploit the legitimate global financial infrastructure to launder the proceeds of crime. Most worryingly, threats such as international arms 216 Fighting Networks with Networks and narcotics trafficking, transnational organized crime, and terrorism are no longer acting in isolation, but converging faster than governments can deploy responses to keep up with them. Third-party facilitators grease the revolving door between converging threat networks. One type of criminal activity often depends on, stimulates, and feeds the capacity for a wide range of illicit conduct. Transnational criminal organizations may strike up a relationship with technical experts who occupy a gray zone between the underworld and the legitimate market, such as lawyers, business owners, bankers, scientists, and other specialists. These facilitators are crucial to the ability of illicit networks to move goods, launder money, and acquire funding, falsified documents, weapons, and logistical support.

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In 2009 the United Nations reported that life expectancy at birth for Sudanese citizens averaged 58 years hypertension va compensation purchase diovan now, 57 years for males and 59 for females blood pressure solutions cheap diovan 40 mg overnight delivery, an increase from 46 years in 1970 and 53 years in 1990 blood pressure monitor chart printable purchase discount diovan on line. This average compares positively with that of other African nations (52 years) and is comparable to other nations at a similar stage of economic development (58 years). Life expectancy is expected to continue to increase in coming decades; for example, the U. Census Bureau pre dicts that average life expectancy in Sudan will reach 66 years by 2025. The rate of infant mortality (under one year) was 69 deaths per 1,000 live births, and the total fertility rate (lifetime births per female) was 4. A household health survey conducted by the Southern government in 2006 found that the infant mortality rate was 102 deaths per 1,000 live births; the under-five mortality rate, 135 per 1,000; and the maternal mortality rate, 2,054 deaths per 100,000 live births, all among the highest rates in the world. For the most part, only urban elites have knowledge of basic family-planning practices. Migration and Refugees the era since independence has seen a notable increase in internal migration. In the early postindependence years, most migrants left their homes in search of employment in large agricultural projects or 73 Sudan: A Country Study in large urban centers, particularly the Three Towns, which attracted some 50 percent of all internal migrants. Their numbers escalated greatly in the late 1980s because of drought and famine, the civil war in the South, and Chadian incursions into the West. As in the past, migrants left their homelands for economic, social, and psychological reasons, but now with the added factor of personal survival. Internal migration created problems of employment, housing, and services, and it also had an enormous impact on ethnicity. Although migrants tended to cluster with their kinfolk in their new environments, the daily interaction with Sudanese from many other ethnic groups rap idly eroded traditional values learned in the villages. In the best of cir cumstances, this erosion might lead to a new sense of national identity as Sudanese, but the new communities often lacked effective absorp tive mechanisms and were weak economically. Ethnic divisions were thus reinforced, and at the same time social anomie was perpetuated. Refugees from other countries, like internal migrants, were a factor that further complicated ethnic patterns. In addition, some 30,000 refugees from neighboring countries also resided in Khar toum. As for the South, international organizations estimated that 4 mil lion people there had been displaced, more than 2 million deaths had occurred, and 600,000 were forced into exile between the resumption of the civil war in 1983 and its end in 2005. Figures for total displaced pop ulations within Sudan varied according to the source. For example, the Norwegian Internal Displacement Monitoring Centre reported that as of early 2009, about 4. Aside from Sudanese who have relocated within their own country, almost 700,000 had left Sudan altogether as of 2005, including the esti mated 600,000 from the South. Uganda hosted more than 200,000 of them; tens of thousands more had fled to Kenya. By January 74 the Society and Its Environment 2009, the number of Sudanese refugees in Chad had risen to almost 250,000, whereas the numbers in Kenya had declined to about 23,000. Aside from Egypt, a relatively small number of Sudanese have sought refuge in the Arab world in Lebanon and Syria. Many of these refugees had lived in eastern Sudan for more than 40 years as a result of conflict and famine in their homelands. Since July 2007, this region had seen a con tinuing influx of newcomers from Eritrea, Ethiopia, and Somalia. An estimated 30,000 refugees and asylum seekers resided in Khartoum, most of them Eritreans and Ethiopians; a few Ethiopian refugees were found in the South. As of early 2009, more than 2 million of the estimated 4 million from the South who had fled their homeland for the North were thought to have returned home. Many had done so with encouragement from the new Government of South Sudan, whose policy was to encourage Southerners to return to the South, apparently in view of the upcoming national census. Nonetheless, large numbers had chosen to remain in their places of refuge, including the estimated 1. By remaining in the North, however, the displaced faced generally squalid conditions in refugee camps and, in Khartoum, forced relocation as the government cleared land for urban development.

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