Barbara A Fivush, M.D.
- Associate Dean, Office of Women in Science and Medicine
- Professor of Pediatrics
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0004482/barbara-fivush
Each day cholesterol levels lab values cheap atorlip-20 20mg mastercard, parents with intellectual disabilities contend with prejudicial child welfare policies and practices that are based on the presumption that they are unfit to raise their children cholesterol lowering supplement discount 20 mg atorlip-20 with visa. And this removal is carried out with far less cause cholesterol definition and function cheap atorlip-20 20mg with mastercard, owing to specific foods to bring cholesterol down buy atorlip-20 20 mg cheap, preventable problems in the child welfare system. Nonetheless, there now is a sizable and growing body of scientific evidence relative to parents with intellectual disabilities and the wellbeing of their children. Part I provides a brief historical perspective on how the rights of parents with intellectual disabilities have evolved over time. Forced sterilizations-initially grounded in eugenics ideology- grew in popularity across the United States and provided a legal mechanism by which to restrict people with intellectual disabilities from procreating. From Sterilization to Marriage Restrictions the United States has a dark and shameful history of restricting people with intellectual disabilities from having families. Beginning in the early twentieth century with the eugenics movement, those considered "socially inadequate,"15 and especially women with intellectual or psychiatric disabilities, were routinely subjected 11 Maya Angelou, Poem Delivered at the Inauguration of President William J. Lombardo, Medicine, Eugenics, and the Supreme Court: From Coercive Sterilization to Reproductive Freedom, 13 J. Jaegers, Note, Modern Judicial Treatment of Procreative Rights of Developmentally Disabled Persons: Equal Rights to Procreation and Sterilization, 31 U. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. Indeed, as people with intellectual disabilities continue to be increasingly integrated into their communities, the number of parents with intellectual disabilities is expected to grow. Strikingly, although not as popular as previously, coercive sterilization of people with intellectual disabilities persists. President, Remarks on Signing the Americans with Disabilities Act of 1990 (July 26, 1990), bush41library. This Part begins with a discussion of the child welfare system broadly followed by an analysis of state dependency statutes and child welfare adjudications involving parents with intellectual disabilities. Tim Booth & Wendy Booth, Findings from a Court Study of Care Proceedings Involving Parents with Intellectual Disabilities, 1 J. See also Hayman, supra note 7, at 1219 ("[T]here is no reason to believe that mentally retarded parents are inherently unable to meet the physical needs of their children. Bias within the Child Welfare System the goal of the child welfare system is laudable: "to promote the well-being, permanency, and safety of children and families by helping families care for their children successfully or, when that is not possible, helping children find permanency with kin or adoptive families. For example, studies have consistently found that minority families are disproportionately involved with the child welfare system and disproportionately have children removed from the home. According to the Child Welfare Information Gateway, disproportionality occurs when there is "underrepresentation or overrepresentation of a. Intervention in these cases often takes place before birth, even though the parent has not done anything to harm or threaten to harm the child. Termination of Parental Rights Statutes the law has a long and shameful history of trying to restrict people with intellectual disabilities from raising children. Child Welfare Work with Parents with Intellectual and/ or Developmental Disabilities, 7 J. This problem also exists for other populations that face discrimination in the child welfare system. This is particularly notable because "[t]he entire parental rights termination process, from initial intervention to final adjudication, is driven by statute. Emotional illness, mental illness or mental deficiency of the parent which renders the parent consistently unable to care for the immediate and continuing physical or psychological needs of the child for extended periods of time. Judicial Decision-Making Bias against parents with intellectual disabilities is perhaps most rampant once these cases reach the courtroom. In a report dated June 20, 2007, a clinician who had twice interviewed the mother concluded that she had a cognitive impairment, with over-all intellectual ability in the low range. While he did not make a parenting evaluation, he noted that parents with her cognitive limitations `often experience significant difficulty in adequately caring for a child, especially as the child becomes older and the developing needs of the child become more complex. Yet, due to economic constraints, funding for these services was non-existent, leaving Ms. First, child welfare policies, practices, and adjudications are based-implicitly and at times, explicitly-on the postulation that parents with intellectual disabilities are inherently unfit because of their disability.
Drug and alcohol intoxication is often associated with personal/interpersonal violenceinthisolderagegroup cholesterol levels vs. blood pressure purchase atorlip-20 20 mg on-line. Thereareanumberofanatomicalandphysiologicalfeaturesofsmallchildren that must be appreciated when managing paediatric chest trauma cholesterol in an eggs discount atorlip-20 20 mg on line. Initialapproachintheemergencydepartment1 cholesterol hdl foods increase purchase atorlip-20 20mg amex,7 cholesterol medication causing constipation generic atorlip-20 20 mg visa,8 Initial management follows the usual priorities. Ongoingsignsofcirculatorycompromisewithout evidence of blood loss should raise the possibility of cardiac tamponade and myocardial contusioninachildwithchestinjuries. Radiological findings suggestive of abuse include multiplefractures,fracturesofvaryingagesandbilateralfractures. Multiple rib fractures (>1) increase the risk of severe intrathoracic injury, multipleinjuriesandmortality. The risk of mortality increases linearly with rib fractures, from associated injuriesthatareoftensevere. Flailchestinjuriesarerareinchildrenandclearlyindicateseriousinjury,with reducedventilatoryeffectivenessandassociatedlungcontusionscontributingto the significant potential for respiratory failure. Assisted ventilation is indicated for those with respiratory failure despite optimal non-invasive ventilation and analgesiaorassociatedinjuries,particularlytothehead. Pulmonary contusion most commonly results from blunt injury and requires significant force. Pathological findings are intra-alveolar haemorrhage, consolidationandoedemacausingventilation-perfusionmismatch,reducedlung complianceandsubsequenthypoxaemia. Both acute respiratory distress syndrome and pneumonia may complicate pulmonarycontusion. Pneumothorax6,13,14 Traumatic pneumothoraces vary in their size and clinical significance. They occur in about one-third of children with significant thoracic trauma, and associated injuries are common. All pneumothoraces should be considered as havingthepotentialtocausecardiorespiratorycompromise. Most other traumatic pneumothoraces require the insertion of a formal chest drain. Tensionpneumothorax Thisisaclinicalconditionresultingfromincreasingintrathoracicpressure,lung collapseandmediastinalshiftwithsubsequentimpairedgasexchange,decreased venous return and cardiovascular collapse. The diagnosis is clinical, and treatment should precede radiology in clear-cut cases. Signs are of reduced air entry, hyperresonance and hyperexpansion plus reduced movement of the affectedside. Immediateneedledecompressionwith a16Gcannulainsertedintothe2ndintercostalspaceinthemid-clavicularline should occur if finger thoracostomy and formal intercostal tube insertion via a lateralapproacharelikelytobedelayed. However, hypotension and/or hypoxaemia may have other causes in the traumatised child. Ifthediameterofthechest wound is approximately two-thirds or greater than that of the trachea, air will preferentially be sucked into the chest on inspiration, leading to acute severe respiratorycompromise. Pulmonarylacerations7 Pulmonary lacerations are principally caused by penetrating injuries but can occur with blunt mechanisms especially associated with rib fractures. Airembolismtypicallyoccursaftertheinitiation ofpositivepressureventilationandcausessuddenhaemodynamicdeterioration with or without focal neurological signs. Lung hyperinflation due to overly aggressive positive pressure ventilation may also cause cardiorespiratory compromiseandriskbarotrauma. In the rare event of air embolism, if suspected, management includes 100% oxygen and reduction of the ventilation pressures. Emergency thoracotomy with clamping of the hilum on the affected side and aspiration of ventricularairhasoccasionallybeenlife-saving. Haemothorax1,13,15 Clinically relevant haemothoraces occur in about 15% of cases of blunt chest trauma but are more common if the injury is penetrating. The bleeding most commonly originates from lacerations to the lung, intercostal or internal mammary vessels or occasionally from mediastinal vessel injury (often fatal). Drainage of massive haemothoraces may precipitate further bleeding as the tamponade effect is removed. Managementinvolvesoxygenationandventilatorysupportifindicated,urgent chest tube placement of the appropriate size via the lateral approach directed posteriorlyandvolumeresuscitation.
As described above definition of cholesterol wikipedia atorlip-20 20 mg line, many spill response activities are predicted to reduce rather than increase the risk of harm cholesterol test eating cheap atorlip-20 20 mg without a prescription. In order to harm a large fraction of the population cholesterol testosterone and estrogen are examples of discount atorlip-20 20mg online, a large and long duration spill cholesterol lowering drugs definition purchase 20 mg atorlip-20 amex, such as a well blowout spill, would have to occur. Spills on land tend to be smaller than spills in the water, due to the lack of dilution in water or dispersion by currents. Please refer to the Sea Otter Risk Analysis Unified Plan Biological Opinion 110 section above for a discussion of effects of spill response on food resources including marine invertebrates. The population size is determined, in part, by the quality and quantity of physical habitat and available food resources. When we apply the "Destruction or Adverse Modification" standard, we think in terms of the ecological function or "ecological carrying capacity" of the designated area. We ask whether direct or indirect effects of the proposed Action are likely to reduce the "carrying capacity", where the "carrying capacity" of the entire designation is the sum of the carrying capacities of the various sub-units. By this logic, a relatively large proportion of the critical habitat area would need to undergo substantial degradation from its present condition to reduce the ecological carrying capacity. This is highly unlikely, given the current depressed population status and the large availability of these ecologically intact habitat units. Spectacled eiders from all three breeding populations- the entire known global population of spectacled eiders-winter in open water leads in the pack ice in the Bering Sea between St. The probability of spills and associated response actions in the wintering area in the polynyas and lead complexes south/southwest of St. Lawrence Island is minimal, because most ships cannot or do not transit through the pack ice during winter. Currently, there is no planned oil or gas development in the area and limited shipping in winter due to extensive sea-ice. A main factor reducing the risk of population-level exposure for spectacled eiders is that the probability of spills in areas they frequent is low, making them highly unlikely to be exposed to a spill or the response action. Spill responses reducing quality or abundance of benthic invertebrates will result in a reduced quality of the critical habitat for the eiders. The frequency of vessel traffic through the area is higher than in summer, particularly by fishing vessels, but there are no important shipping routes, large urban centers, large industrial facilities, or oil development. Offshore oil and gas development in the Southern Beaufort and Chukchi seas increases the probability of spectacled eiders exposure to spill response actions near North Slope habitats in the summer. Birds stage near offshore oil and gas development before and after the breeding season. Probability of exposure varies with the amount of time spent in the area and the locations used. Males are less likely to spend time in this staging area than females, and when they do stage here, males use areas closer to shore. Land-based oil development on the North Slope increases the probability of exposure of nesting birds to spills in this region. Oil development is gradually spreading westwards across the North Slope from the original hub at Prudhoe Bay; expansion of industrial development is likely to continue. Factors associated with the low risk are that most spills projected to occur from oil and gas development are expected to be of low volume. For this reason, a relatively large proportion of the critical habitat area would need to undergo substantial degradation from its present condition to reduce ecological carrying capacities of these areas. Low probabilities of spills in these areas lead us to the conclusion that activities in the Unified Plan are not likely to reduce the quality and quantity of spectacled eider critical molting and breeding habitat. These factors combine to make the risk of the Action to spectacled eiders exceedingly low. A low probability of exposure (due to low vessel traffic and low spill probability), coupled with a high probability of harm (where the entire population to be exposed) still results only in moderate risk. At this point, we must also consider the possible responses to spill response Unified Plan Biological Opinion 112 activities. To determine that the Action would jeopardize the population, there must be evidence to suggest that activities associated with a response to a worst-case scenario spill would result in population level impacts above and beyond the spill itself. Our review of the best available science in the response analysis does not lead us to this conclusion. However, because most spills are small, exposure to impacts of the Action will most often be temporary and localized, occurring near the spill site, and affecting only a few individuals-far fewer than necessary for population-level effects. However, our review of the risks to listed species and critical habitat has revealed various geographic areas or time periods at which species may be particularly sensitive to effects of spill response.
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