This study applied the Massachusetts Treatment Centre Revised Rapist Typology (MTC:R3) to classify 10 high-risk rapists in New Zealand who were selected for a sex offender treatment pilot program. The study found that the MTC:R3 typology could successfully classify this sample and mean differences were observed in risk assessment scores between the typology groups. The results suggest the typology may help differentiate patterns of risk for rapists and could have applications for treatment programs.
Culture, Norms, and Process in Adult Sex Offender Groups: Getting Reacquaint...James Tobin, Ph.D.
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Most clinicians who treat adult sex offenders utilize group therapy. However, facilitation of groups for sex offenders is often highly idiosyncratic, with great variance in the content and process of groups, cliniciansâ views of intervention goals, strategies, and technique, and how the cultural fabric of the group is established. Moreover, clinicians who treat sex offenders typically have expertise in the assessment of risk, relapse prevention, and individual factors that impact the nature and magnitude of aberrant sexual beliefs and tendencies, yet have never had or donât readily recall advanced training in group psychotherapy. To address this issue, this presentation will describe and delineate transtheoretical factors of group psychotherapy, including here-and-now processing, vicarious learning, group-as-a-whole phenomena, and developmental dynamics across the evolution of the group. Attention will be devoted to the relevance of these factors for adult male sex offender groups, with clinical case material used to illustrate significant themes. Additionally, empirically-based measures that assess group process factors showcased in this talk will be introduced. Attendees will leave this presentation with a greater repertoire of intervention strategies from which to draw, and a theoretical framework for understanding the common events and dynamics that emerge in groups for adult male sex offenders.
Culture, Norms, and Process in Adult Sex Offender Groups: Getting Reacquaint...James Tobin, Ph.D.
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Most clinicians who treat adult sex offenders utilize group therapy. However, facilitation of groups for sex offenders is often highly idiosyncratic, with great variance in the content and process of groups, cliniciansâ views of intervention goals, strategies, and technique, and how the cultural fabric of the group is established. Moreover, clinicians who treat sex offenders typically have expertise in the assessment of risk, relapse prevention, and individual factors that impact the nature and magnitude of aberrant sexual beliefs and tendencies, yet have never had or donât readily recall advanced training in group psychotherapy. To address this issue, this presentation will describe and delineate transtheoretical factors of group psychotherapy, including here-and-now processing, vicarious learning, group-as-a-whole phenomena, and developmental dynamics across the evolution of the group. Attention will be devoted to the relevance of these factors for adult male sex offender groups, with clinical case material used to illustrate significant themes. Additionally, empirically-based measures that assess group process factors showcased in this talk will be introduced. Attendees will leave this presentation with a greater repertoire of intervention strategies from which to draw, and a theoretical framework for understanding the common events and dynamics that emerge in groups for adult male sex offenders.
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA A single counseling CEU course is available at https://www.allceus.com/member/cart/index/product/id/392/c/ or the complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
These PowerPoint presentations are intended for use by crime prevention practitioners who bring their experience and expertise to each topic. The presentations are not intended for public use or by individuals with no training or expertise in crime prevention. Each presentation is intended to educate, increase awareness, and teach prevention strategies. Presenters must discern whether their audiences require a more basic or advanced level of information.
NCPC welcomes your input and would like your assistance in tracking the use of these topical presentations. Please email NCPC at trainings@ncpc.org with information about when and how the presentations were used. If you like, we will also place you in a database to receive updates of the PowerPoint presentations and additional training information. We encourage you to visit www.ncpc.org to find additional information on these topics. We also invite you to send in your own trainer notes, handouts, pictures, and anecdotes to share with others on www.ncpc.org.
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA A single counseling CEU course is available at https://www.allceus.com/member/cart/index/product/id/392/c/ or the complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
These PowerPoint presentations are intended for use by crime prevention practitioners who bring their experience and expertise to each topic. The presentations are not intended for public use or by individuals with no training or expertise in crime prevention. Each presentation is intended to educate, increase awareness, and teach prevention strategies. Presenters must discern whether their audiences require a more basic or advanced level of information.
NCPC welcomes your input and would like your assistance in tracking the use of these topical presentations. Please email NCPC at trainings@ncpc.org with information about when and how the presentations were used. If you like, we will also place you in a database to receive updates of the PowerPoint presentations and additional training information. We encourage you to visit www.ncpc.org to find additional information on these topics. We also invite you to send in your own trainer notes, handouts, pictures, and anecdotes to share with others on www.ncpc.org.
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International Journal of Drug Policy 25 (2014) 556â561
Contents lists available at ScienceDirect
International Journal of Drug Policy
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o
esearch paper
ingle room occupancy (SRO) hotels as mental health risk
nvironments among impoverished women: The intersection of
olicy, drug use, trauma, and urban space
elly R. Knight a,â, Andrea M. Lopez b,c, Megan Comfort c, Martha Shumway d,
ennifer Cohen e, Elise D. Riley b
Department of Anthropology, History and Social Medicine, University of California, San Francisco, United States
Department of Medicine, University of California, San Francisco, United States
Urban Health Program, Research Triangle Institute International, United States
Department of Psychiatry, Trauma Recovery Center, University of California, San Francisco, United States
Department of Clinical Pharmacy, University of California, San Francisco, United States
r t i c l e i n f o
rticle history:
eceived 8 May 2013
eceived in revised form
8 September 2013
ccepted 30 October 2013
eywords:
uilt environment
RO hotels
omen
rauma
ental health
rug use
thnography
a b s t r a c t
Background: Due to the significantly high levels of comorbid substance use and mental health diagnosis
among urban poor populations, examining the intersection of drug policy and place requires a consid-
eration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and
progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key
urban built environment used to house poor populations with co-occurring drug use and mental health
issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma,
which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and
depression when compared to stably housed women.
Methods: We report data from a qualitative interview study (n = 30) and four years of ethnography
conducted with housing policy makers and unstably housed women who use drugs and live in SROs.
Results: Women in the study lived in a range of SRO built environments, from publicly funded, newly
built SROs to privately owned, dilapidated buildings, which presented a rich opportunity for ethno-
graphic comparison. Applying Rhodes et al.âs framework of socio-structural vulnerability, we explore
how SROs can operate as âmental health risk environmentsâ in which macro-structural factors (housing
policies shaping the built environment) interact with meso-level factors (social relations within SROs)
and micro-level, b ...
Effect of item order on self-reported psychological aggression: Exploring the...William Woods
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There are a plethora of data indicating that intimate partner violence (IPV) occurs at high rates in college students (Shorey, Cornelius, & Bell, 2008). Although studies have repeatedly demonstrated these high rates of IPV, some researchers have criticized the reliability and validity of the self-report measures commonly used to assess these rates (Follingstad & Ryan, 2013; Ryan, 2013). There is some research to suggest that subtle factors, such as item order, can impact self-reports of violence victimization and perpetration (Ramirez & Straus, 2006). This phenomenon has been most widely studied in the context of the Revised Conflict Tactics Scales (CTS2; Straus, et al., 1996), a widely used measure of IPV, which may not comprehensively assess psychological aggression. Thus, in the current study we examined differences in self-reports of psychological aggression victimization and perpetration using the Multidimensional Measure of Emotional Abuse (MMEA; Murphy & Hoover, 1999) when it was administered in either the standard format or in a format in which question order was randomized. Given that there may be gender differences in victimization and perpetration, we also examined the impact gender would have on item order effects.
Presented at ABCT, Nov. 2015.
Fetal alcohol spectrum disorder and risk-need-responsivity theory published v...BARRY STANLEY 2 fasd
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Breach of probation is one of the most common judicial offences for those with FASD.
Risk assessments are carried out daily. The risk assessment tools that forensic psychiatry uses have never been validated for those with FASD: their cognitive, memory, information, and executive function disabilities are rarely taken into account.
This paper suggests ways to promote natural justice for those with FASD
AGGRESSIVE BEHAVIOR
Volume 29, pages 366â380 (2003)
Perpetrators of Alcohol-Involved Sexual Assaults: How Do They Differ From Other Sexual Assault Perpetrators and Nonperpetrators?Tina Zawacki, l Antonia Abbey, 1 Philip O. Buck, 1 Pamela McAusIan,2 and A. Monique Clinton-SherrodI
Wayne State University, Detroit, Michigan
2University of MichiganâDearbom, Dearborn, Michigan
Approximotely 50% of sexual assaults involve alcohol. Researchers have documented situationul characteristics that distinguish between sexual assaults that do and do not involve alcohol, but little attention has been paid to differences bctwcen the perpetrators of these two types of assault. In this study, discriminant function analysis was used to distinguish between college men (N = 356) who reported perpetrating sexual assault that involved alcohol, sexual assault that did not involve alcohol, or no scxuul assault. Predictors of sexual assault perpetration thut have been documented in pust research differentiated nonperpctrators from both types of perpetrators. Pcrpctrators of scxuol assaults that involved alcohol were in most wuys similar to perpetrutors of sexual assautts that did not, although they did differ on impulsivity, alcohol consumption in sexual situations, and beliers about alcohol. These findings suggest mechanisms through which alcohol is involved in sexual assault thut are relevant to theory and prevention. Aggr. Behav. 29:366â380, 2003. 2003 Wiley-Liss, Inc.
Key words: sexual assault; alcohol; antisocial behavior
The problems of rape and sexual assault have been studied intensely for the past 30 years. Rape is typically defined as vaginal, anal, or oral intercourse that is physically forced or occurs when consent could not be given because of the victim's age or mental impairment, which may be due to intoxication [Bureau of Justice Statistics, 1995; Koss, 19921. Sexual assault includes rape as well as other types of physically forced sexual contact and verbally
Tina Zawacki is now at the Department or Psychology. Addictive Behaviors Research Center. University of Washington.
A. Monique Clinton-Sherrod is no'.,v at RTl international. North Carolina.
Grant support: National Institute on Alcohol Abuse and Alcoholism to AA.
*Correspondence to: Tina Zawacki. Department of Psychology-ABRC. Box 351525, University of Washington. Seattle, WA 98195. E-mail: [email protected] u.washington.edu or Antonia Abbey, Department or Community Medicine. Wayne State University. 4201 St. Antoine, Delroil. MI 48201.
Published online in Wiley Jnterscience (wuw.intcrscience.wiley.com). DOI: 10.100>ab.10076
0 2003 Wiley-Liss, Inc.
coerced sexual intercourse [Koss, 19921. In a watershed study, Koss et al. [19871 surveyed a nationally representative sample of approximately 6,000 college men and women and found thal 25% or the men reported perpetrating some level of sexual assault since the age or 14; 54% of the women reported experiencing some level of sexual assault since the agc of.
Gang Membership, Violence, and Psychiatric Morbidityjeremy coid
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Gang members engage in many high-risk activities associated with psychiatric morbidity, particularly violence related ones. The authors investigated associations between gang membership, violent behavior, psychiatric morbidity, and
use of mental health services. The study concluded that gang members show inordinately high levels of psychiatric morbidity,
placing a heavy burden on mental health services. Traumatization and fear of further violence, exceptionally prevalent in gang members, are associated with service use. Gang membership should be routinely assessed in individuals presenting to health care services in areas with high levels of violence and gang activity. Health care professionals may have an important role in promoting desistence from gang activity.
Presented by
John Lynch, Yamhill Co. Juv. Dept.
SUPERVISION & TREATMENT
OF SEXUAL OFFENDERS
1
Almost every hand youâve shaken has touched a penis.
THINK ABOUT THIS
FOR A SECONDâŠ
To gain knowledge regarding the broad range of considerations when supervising offenders who have committed sexual offenses and to examine effective intervention strategies.
LEARNING GOAL
Myths about sex offenders
Common characteristics of sex offenders
Sexual offense recidivism rates
Risk factors that are/are not associated
with recidivism
Common tactics of sex offenders
WE WILL COVERâŠ
âSuccess-orientedâ supervision model
The importance of communication
Specialized supervision conditions and
success-oriented goals
How to respond to violations
WE WILL COVERâŠ
Effective interventions
Common treatment goals
Use of the polygraph
Doing your job better & reducing your
stress
WE WILL COVERâŠ
SEX OFFENDER VERSION
7
Most sexual offenses are committed by strangers.
Most sexual offenses are committed by someone known to the victim or victimâs family, regardless if the victim is a child or an adult.
Approximately 60% of boys and 80% of girls who are sexually victimized are abused by someone known to the child or the childâs family.
From 2005 to 2010, 78% of sexual violence involved an offender who was a family member, intimate partner, friend, or acquaintance.
Debunking the Myths
Bullet 2 â (60% boys / 80% girls) is from Lieb, Quinsey, and Berliner, 1998.
In a 2009 study conducted by the US Dept. of Justice, Office of Juvenile Justice and Delinquency Prevention, 13,471 juvenile sex offender cases were evaluated which revealed that in 88.2% of reported incidents, the victim was either a family member or acquaintance.
Only 2.5% involved a victim who was considered a stranger to the offender.
Victim Relationship
Rape and sexual assault victimizations against females by victim-offender relationship
1994â1998, 1999â2004, and 2005â2010Victim-Offender Relationship1994-19981999-20042005-2010Stranger
Non-stranger21%
79%25%
75%22%
78%Intimate Partner
(includes former spouse, BF, GF)28%30%34%Relative9%3%6%Acquaintance42%42%38%
Source: Bureau of Justice Statistics, National Crime Victimization Survey, 1994â2010.
Female Victims of Sexual Violence, 1994-2010 (March 2013). Special report published by the US Dept. of Justice, Office of Justice Programs, Bureau of Justice Statistics.
Sexual offense rates are higher than ever and continue to climb.
Despite the increase in publicity about sexual crimes, from 1995 to 2010, the estimated annual rate of female (age 12 or older) rape or sexual assault victimizations has declined 58%.
Debunking the Myths
Only a fraction of those who commit sexual offenses are apprehended and convicted for their crimes.
Debunking the Myths
Debunking the Myths
This figure taken from the Rape, Abuse & Incest National Network (RAINN) website, acces.
Assessing Gender Role of Partner-Violent Men Using the Minneso.docxgalerussel59292
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Assessing Gender Role of Partner-Violent Men Using the Minnesota
Multiphasic Personality Inventory-2 (MMPI-2): Comparing Abuser Types
David M. Lawson
Stephen F. Austin State University
Dan F. Brossart
Texas A&M University
Lee W. Shefferman
University of Northern Colorado
This study investigated traditional masculine gender role differences between male partner abuser types
using the Masculinity/Femininity subsection scales of Minnesota Multiphasic Personality Inventory-2
(MMPI-2) Structural Summary. We examined differences between four groups of partner-violent men
(borderline, antisocial, psychotic features, and nonpathological partner violent) and one group of
nonpartner-violent men on five MMPI-2 subscales: Masculinity-Femininity, Gender Role-Feminine,
Gender Role-Masculine, Ego Inflation, and Low Self-esteem. Results indicated that the borderline group
reported the most consistent traditional feminine gender role orientation of all the groups, whereas the
antisocial group reported the most consistent traditional masculine gender role orientation of all the
groups. The psychotic features group reported characteristics associated with both traditional masculinity
and traditional feminine gender role making it distinct among all the groups. The nonpathological
intimately violent group and the nonpartner-violent group reported no extreme scores when compared
with the other three groups. The borderline and antisocial groups reported significantly more exposure
to family of origin violence and use of more severe forms of partner abuse than the other three partner
abuse groups. Treatment implications are addressed.
Keywords: masculinity, gender role, partner violence, domestic violence
Intimate partner violence (IPV) is a pattern of abusive behavior
(physical and psychological) in a significant relationship and is
often used by one partner to gain or maintain power/control over
another partner (Office of Violence Against Women, 2009). Fam-
ily conflict research indicates approximately equal rates of IPV for
men and women (12% each) in national community samples (Stets
& Straus, 1990; Straus, 1999). Crime studies, such as the National
Violence Against Women in America Survey (NVAW; Tjaden &
Thoennes, 2000), indicate a much higher rate of assaults by men
(i.e., 61%), but at a much smaller prevalence rates. Regardless of
the type of survey, evidence indicates that women often experience
more severe injuries and longer lasting symptoms, such as post-
traumatic stress disorder (PTSD), depression, and anxiety (Cas-
cardi, Langhinirichsen, & Vivian, 1992; Stets & Straus, 1990).
Some scholars account for this phenomena by asserting that men
have a greater tendency to use IPV to control and coerce women
based on traditional masculine gender role and societal norms
(Cascardi et al., 1992; Dobash & Dobash, 1998). This study
investigated gender role differences between types of male partner
abusers using the Minnesota Multiphasic Personality Inventor.
Running head SPOUSE VIOLENCE 1SPOUSE VIOLENCE8.docxtodd521
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Running head: SPOUSE VIOLENCE 1
SPOUSE VIOLENCE 8
Annotated Bibliography
Joshua D. Musick
PSAD 410 7980 Public Safety Research and Technology
Professor: Angela Edwards
University of Maryland University College
April 6, 2019
Institution
Spouse violence
This is a type of domestic violence and it magnitude can be determined based data from government agencies and pieces of research by scholars. Some factors such as drug abuse, money problems, and health of community contribute and cause spouse violence.
Thesis: Spouse violence is important public safety concern and it reflects quality of intimate partner life.
Kaur, R., & Garg, S. (2008). Addressing Domestic Violence Against Women: An Unfinished Agenda. Indian Journal of Community Medicine, 33(2), 73â76. doi:10.4103/0970-0218.40871
According to this journal, domestic violence affect many sectors of social system such as health systems and the development of a nation. Also, the researcher believe the problem is widely dispersed geographically and has serious impact on the victim, mostly women. Based on research conducted in this journal, 85% of violent abuse target women compared to 3% of abuse experienced by men. Some of the causes of domestic violence are cultural mores, economic and political conditions, and religious practices precede the violence. The authors further argue that spouse violence undermine economic, spiritual, economic, and psychological wellbeing of victim, the perpetrator and society. According to research, an incident of spouse violence translate to lose of minimum of seven working days. In US the loss due to domestic violence is about 12.6 billion dollars annually.
Alejo, K. (2014). Long-Term Physical and Mental Health Effects of Domestic Violence. Research Journal of Justice Studies and Forensic Science, 2(5), 82-90.
This is a qualitative journal and it used existing studies to determine the magnitude and effect of spouse violence. According to the author domestic violence against men considered mild to society and parties affected. Further this paper shows that men and women who suffer from long-term health problems have high potential of causing domestic violence. The likelihood to cause violence is determined by the published statistic on prevalence of spouse violence in heterosexual relationships. The researchers analyze the results from existing studies to determine health effect of the spouse violence. According to the findings both men and women sustain injuries, however, women suffer more.
M. Pilar Matud. (2007). Dating Violence and Domestic Violence. Journal of Adolescent and health, 40(4), 295â297.
The journal states that spouse violence include sexual violence, emotional abuse, and controlling partner. The journal use quantitative and qualitative approaches to establish the prevalence of spouse violence. The author used 48 studies and the data shows between 10% and 69% of women are victim of assault and abusive behavior. The journal shows .
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowmanâs Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
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Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinsonâs Management: A Holistic ApproachAyurveda ForAll
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinsonâs care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMENâS CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. Thatâs why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminateâŠDr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMENâS CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. Thatâs why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminateâŠDr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Knee anatomy and clinical tests 2024.pdfvimalpl1234
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganongâs Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Application of the MTC:R3 Typology to New Zealand High-Risk Rapists: A Pilot Study. Sarah Reid Dr Doug Boer Dr Nick Wilson
2. Background Rapist heterogeneity Across interpersonal, psychological, cognitive and behavioral domains is a common research finding (Langton & Marshall, 2001). Classification systems Offer an organizing structure. enable greater understanding of differentiating core characteristics and offence motivations.
4. Sexually Motivated Opportunistic Impulsive, little planning. Motivated by immediate sexual gratification. Sexual Sadistic Presence of sexual fantasies. Fusion of sexual and aggressive drives. Sexual Non-Sadistic Enduring sexual preoccupation.
5. Pervasively Angry Undifferentiated anger, in all areas of life. Poor behavioural control and impulsivity. Vindictive Anger focussed solely on women. Goal is to humiliate, degrade, harm their victim. Usually socially isolated, displays little impulsivity. Anger Motivated
6. Based on needs of CSOâs (Gannon et al, 2008). Meta-analytic data Not enough evidence to determine whether rapist treatment approaches had been effective (Polaschek et al, 1997; Losel & Schmuker, 2005). Current treatment approaches Differentially effective for subgroups of rape offenders (Beech et al, 2004). Rapist Classification and Treatment
7. Study Questions Can the MTC: R3 be used to classify a sample of high-risk New Zealand rapists? Are there mean differences in these high-risk rapists on risk assessment scores based on MTC: R3 classifications?
8. 10 offenders selected for the Adult Treatment Sex Offender Treatment Pilot Programme (ASOTP). Index offence for serious sexual assault (sentenced to five years plus) of an adult victim (over 16 years old). 6 NZ European , 4 Maori. 31 - 49 years. Participants
9. The Risk of re-Conviction X Risk of Re-Imprisonment model (RoC*RoI) (Bakker, OâMalley, & Riley, 1998). The Automated Sexual Recidivism Scale (ASRS) (Skelton, Wales & Vess, 2006). The Static-99 (Hanson & Thornton, 1999). The Violence Risk Scale-Sexual Offender Version (VRS-SO) (Wong, Olver, Nicholaichuk, & Gordon, 2003). Measures
10. Can the MTC: R3 be used to classify a sample of high-risk New Zealand rapists?
16. Conclusions Results supported the application of the MTC: R3 typology to this sample of New Zealand high-risk rapists. Mean differences on risk assessment items suggest that rapists may present differing patterns of risk on the basis of MTC: R3 classification. The MTC: R3 typology may have potential applications in rapist treatment programmes.
17. Further Information Reid, S., Wilson, N., & Boer, D. (2010). Risk, needs, and responsivity principles in action: tailoring rapist treatment to rapist typologies. In D.P. Boer, R. Eher., L. A. Craig., M. H. Miner., & F.Pfafflin(Eds.), International Perspectives on the Assessment and Treatment of Sexual Offenders: Theory, Practice, and Research (pp. 287-297). West Sussex: Wiley-Blackwell. Reid, S.L., Wilson, N.J., & Boer, D. P. (2010). Application of the Massachusetts treatment centre revised rapist typology to New Zealand high-risk rapists: A pilot study. Sexual Abuse in Australia and New Zealand, 2(2): 77-84.
18. References Bakker, L., O'Malley, J., & Riley, D. (1998). Storm Warning: Statistical Models for Predicting Violence. Christchurch, New Zealand: Department of Corrections, Psychological Service. Beech, A., Olver, C., Fisher, D., and Beckett, R. C. (2004). STEP 4: An evaluation of the relevance of the core sex offender treatment programme for rapists and sexual murderers. A report to the British Home Office by the STEP team. Gannon, T. A., Collie, R. M., Ward, T., & Thakker, J. (2008). Rape: Psychopathology, theory and treatment. Clinical Psychology Review, 28, 982-1008. Hanson, R. K., & Thornton, D. (2000). Static 99: Improving Actuarial Risk Assessments for Sex Offenders. Ottawa: Department of the Solicitor General of Canada. Knight, R. A., & Prentky, R. A. (1990). Classifying sexual offenders: The development of corroboration of taxonomic models. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of Sexual Assault (pp. 23-52). New York: Plenum. Langton, C. M., & Marshall, W. L. (2001). Cognition in rapists: Theoretical patterns by typological breakdown. Aggression and Violent Behavior, 6, 499-518. Lösel, F., & and Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis, Journal of Experimental Criminology, 1, 117â146. Polaschek, D. L. L., Ward, T., & Hudson, S. M. (1997). Rape and rapists: Theory and treatment. Clinical Psychology Review, 17 (2), 118-144. Skelton, A., Riley, D., Wales, D., & Vess, J. (2006). Assessing risk for sexual offenders in New Zealand: Development and validation of a computer-scored risk measure. Journal of Sexual Aggression, 12, 277-286. Wong, S., Olver, M., Nicholaichuk, T., & Gordon, A. (2000).Manual for theViolence Risk Scale: Sex Offender Version (VRS:SO). Saskatoon Regional Forensic Centre, Saskatoon, Canada.
Editor's Notes
Recognition of heterogeneity amongst rape offenders has encouraged the development and investigation of classification systems since the 1950âs (Koss, 2005). Supporters of these classification approaches argue that understanding the differential characteristics and motivations of rape offenders will lead to the development of more effective intervention approaches and prevention of recidivism (Robertiello & Terry, 2007).
Knight and Prentky, (1990) Of these rapist classification approaches the Massachusetts Treatment Centre (MTC) Rapist Typology has been labelled the most methodologically sophisticated (Polaschek, 2003).response to the lack of a well operationalised, reliable and empirically grounded classification system. The Massachusetts Treatment Centre Revised Rapist Typology, Version 3 The original MTC rapist typology was developed in the 1980âs using both inductive and deductive techniques. There has been a concentrated effort put into validating the typology, and the MTC: R3 (Knight & Prentky, 1990) has grown out of this validation research. Knight, (1999) highlights the substantial body of evidence that supports the concurrent validity, cross-temporal stability, and predictive potency of this classification system. At the most basic level rapists can be classified as primarily following either an anger or a sexual pathway. The typology then identifies five main rapist categories. The Opportunistic and the Sexually Motivated rapists (split into Sadistic and Non-sadistic) follow the sexual pathwayPervasively Angry and the Vindictive rapists follow the anger pathway
The rapes of the Opportunistic rapist are impulsive, involve little planning and are controlled largely by immediately antecedent situational factors. These offenders have a long history of antisocial behaviour, poor impulse control and lack interpersonal awareness. Immediate sexual gratification is the motivation for rape; however the rape is non-paraphiliac and not the result of ritualised fantasies. If the opportunity to rape is not available the Opportunistic rapist will not plan an assault. Aggression is usually instrumental and limited to what is necessary to complete the rape. Anger may arise due to victim resistance but is not a motivator for the attack. Enduring sexual preoccupation is evident in all sexually motivated rapists. They are divided into Sadistic and Non-sadistic subtypes based on the presence or absence of sadistic themes within their rapes or fantasies. The Sexual Sadistic rapist is marked by the presence of sexual fantasies and a fusion of sexual and aggressive drives. The poor differentiation between sexual and aggressive drives leads to the eroticisation of destructive behaviours, resulting in highly planned and rehearsed assaults. Sexual aggression is focussed on victim humiliation and inflicting physical harm in a ritualised fantasy driven offence. The Sexual Non-Sadistic rapist is marked by enduring sexual preoccupation without the fusion of aggression. They present a range of deviant sexual interests and paraphiliaâs, of which the rape is just one manifestation. Their fantasies derive from sexual arousal combined with cognitive distortions surrounding sexual masculine and feminine stereotypes. They exhibit little interpersonal aggression in their rape or daily life and may flee if they encounter victim resistance. These rapists possess a low masculine self-image, feelings of sexual inadequacy, and are socially isolated.
The Pervasively Angry rapist is motivated by undifferentiated anger, in all areas of life and directed toward males and females alike. These rapists have a long history of antisocial and aggressive behaviour and exhibit poor behavioural control and impulsivity across social contexts. Their anger is not sexualised and assaults are not driven by sexual fantasies. The rage experienced by these rapists is exhibited in the gratuitous expressive aggression in their rapes. They inflict high levels of pain and injury on their victims and excessive violence is likely even with a compliant victim. The Vindictive rapist expresses misogynistic anger focussed solely on women. They lack sexualization or paraphiliac fantasies in their offence as the goal is to humiliate, degrade and harm their victim. Aggression can range from verbal abuse to homicide at the most extreme. The Vindictive rapist is usually socially isolated and displays little evidence of lifestyle impulsivity.
Traditionally rapists have been treated using generic programmes developed primarily from on research examining the treatment needs of child molesters (Gannon, Collie, Ward & Thakker, 2008). This approach has continued despite findings suggesting that these populations differ in many ways, including rapistsâ lower sexual recidivism rates and higher non-sexual recidivism rates when compared with child molesters (e.g. Polaschek and King, 2002). Meta-analytic studies examining the efficacy of rapist treatment have failed to validate this approach. In 1989 Furby, Weinrott and Blackshawfound a lack of information supporting treatment efficacy, highlighting methodological issues and outdated treatment content as possible reasons.More recently Losel and Schmuker (2005) using 69 studies found a 6.4% reduction in sexual recidivism, a 5.2% reduction in violent recidivism, and a 11.1 % reduction in general recidivism for all treated sexual offenders. Cognitive behavioural therapy was found to be the superior treatment format. They concluded that there was a positive treatment effect for rapists, but this was based only on 5 studies. This small number of available studies gives support to Polaschek, Ward and Hudsonâs (1997) earlier conclusion that due to the lack of reporting of offender type data, the low number of rapists in mixed samples and resulting lack of statistical power, meta-analytic data did not provide enough evidence either way to allow a conclusion of whether rapist treatment approaches had been effective. Individual rapist treatment studies have found some promising results. Marques, Day, Nelson and West (1994) found a reduction in sexual recidivism in their sample of 22 rapists, however due to the small sample size this reduction was not statistically significant. Nonsexual recidivism rates remained unchanged by treatment. Beech, Olver, Fisher, and Beckett (2005) evaluated the effects of treatment in a sample of 112 rapists and 58 sexual murderers. Their results indicated a significant post-treatment decrease in rape supportive attitudes and an increase in rapistsâ ability to regulate emotions and deal with anger. No change found for sexual preoccupation overall. This study also investigated treatment changes across the three motivational groups identified in their study sample. The sexual motivated group represented the âtypical sex offenderâ (e.g. Sexual Non-Sadistic). This group exhibited changes in their entitlement beliefs surrounding sex, exhibited decreased anger, and showed improved emotional control post treatment. The grievance motivated rapist group (e.g. Vindictive and Pervasively Angry) did not exhibit change throughout treatment, especially with regard to the key targets of anger and emotional regulation. The sadistic group exhibited a high level of treatment engagement and accepted increased responsibility for their offending and reduced the level of grievance beliefs and hostility toward women. The finding that treatment may be differentially effective for subgroups of rapists suggests that analysis of rapist classification typologies may be beneficial in treatment. In order to test this idea it is important to determine if the classification system can be applied to the population being targeted in treatment and to analyse differential risk factors and criminogenic needs in each subtype.
Using computerised records, a 2005 prison muster of New Zealand inmates located offenders with an index offence for serious sexual assault (sentenced to five years plus) of an adult victim (over 16 years old). The muster revealed 386 offenders who met this criteria. Three actuarial risk measures were then used to select a high-risk rape offender sample; the Risk of re-Conviction X Risk of Re-Imprisonment Model (RoC*RoI), the Automated Sexual Recidivism Scale (ASRS), and the STATIC-99. Using these measures a group of 182 offenders were identified as the high-risk rape offender sample. From this sample 10 volunteer participants were selected for the pilot programme. Four were strangers and two were prostitutes. Of the four victims that were known to the offender one was an intimate partner. Nine of the ten participants engaged in vaginal rape, two engaged in anal rape, two in oral sex and one in an indecent act.
Risk of re-Conviction X Risk of Re-Imprisonment model (RoC*RoI) Developed for the New Zealand Department of Corrections, the RoC*RoI (Bakker, OâMalley, & Riley, 1998) predicts risk of conviction and imprisonment on the basis of static risk variables. The measure was developed based on the criminal histories of 133,000 offenders. A number of variables under the following categories contribute to the final risk score; personal characteristics, jail and time at large, seriousness of offending and offence type. Total scores range from 0.0 to 1.0 (1 representing a 100% risk of serious recidivism). The Automated Sexual Recidivism Scale (ASRS) The ASRS (Skelton, Wales & Vess, 2006) is a computer-scored actuarial risk instrument designed to predict sexual recidivism. Static risk factors are assessed via official record review. The ASRS was developed using the New Zealand Department of Corrections database of historical offender variables. Scores range from 0 to 9, and offenders can be categorised as low, medium-low, medium-high and high-risk. Static-99The STATIC-99 (Hanson & Thornton, 1999) is a brief actuarial instrument designed to assess the long-term potential for sexual recidivism among adult male sex offenders. This scale determines risk through the assessment of 10 static risk variables that are empirically related to sexual recidivism. Examples include the offenderâs age, having prior sexual offences, having unrelated, stranger or male victims. Probability estimates are provided with regard to the offenderâs likelihood of reconviction. Though it is possible to score up to 10, a score of 6 is considered to indicate a high-risk level.The Violence Risk Scale-Sexual Offender Version (VRS-SO) The VRS-SO (Wong, Olver, Nicholaichuk, & Gordon, 2003) is a rating scale designed to assess risk, predict sexual recidivism, and to inform sexual offender treatment delivery. The measure includes 7 static and 17 dynamic risk variables. Static risk items are a replication of those in the Static-99. A literature review provided the dynamic items, each of which is empirically, theoretically, or conceptually related to sexual recidivism. The VRS-SO has been found to predict both sexual and nonsexual violent recidivism.
Procedure This research was conducted using psychometric and file data gathered by the Department of Corrections prior to the ASOTP. Upon assessment, written consent was given by all offenders to use their psychometric assessment data and offence descriptions in research, with the provision that they would not be identified in this research. Rapists MTC: R3 classifications were determined by treatment programme psychologists and the primary researcher. Using the variables outlined by the developers of the MTC: R3 typology (Knight & Prentky, 1990) an assessment tool was developed to assist in the file-based classification of rapists. Once the coding protocol was developed, the inter-rater agreement for MTC: R3 classifications was assessed by having four post-graduate psychology students independently classify each offender based on a description of the MTC: R3 typology and a summary of each offenders background, details of their index rape and their current convictions and sentence. All raters were blind to the Department of Corrections file and primary researchers classifications, and were previously unfamiliar with the MTC: R3 typology. To allow an analysis of the efficacy of the assessment tool two of these students used the assessment tool and decision tree and two completed their assessment based solely on a description of the classifications and offender details.The inter-rater reliability of the MTC: R3 primary rapist subtype classification and anger versus sexual pathway were evaluated using intra-class correlations. A two way random effects model with an absolute agreement definition was used. Previous research (Knight, Prentky & Cerce, 1994) found good reliability for primary rapist subtype (r =. 68) according to Cicchetti & Sparrowâs criteria for interpreting intraclass correlations (<. 40 = poor, .40 -.59 = fair .60 - .74 = good and >.74 = excellent). Agreement between the primary researcher and the Department of Corrections File classification was excellent for primary rapist subtype classification (r = .100) and the anger versus sexual pathway (r = .100). Agreement between the primary researcher and both raters who used the MTC: R3 Discriminating Variables Coding Tool was excellent for subtype (r = 1.00; r = .77) and pathway (r = 1.00; r = .82). Of the raters who did not use the coding tool, one obtained excellent agreement for subtype (r = .79) and pathway (r = .82). The other obtained fair agreement for classification (r = .42) and good agreement for pathway (r = .62).Based on the Department of Corrections file and the primary researchers classifications rapists were split equally with regard to rape pathway, with five following a sexual pathway and five following an anger pathway. The MTC: R3 classifications are displayed in Figure 2. Of the sexually motivated rapists none were classified as Sexual Sadistic. Three rapists were classified as Sexual Non-sadistic due to their high levels of sexualisation and sexual fantasies preceding the rape. The other two sexually motivated rapists were classified as Opportunistic rapists as their rapes were impulsive and unplanned acts, both occurring in the context of burglary. Of the anger motivated rapists four were classified as Vindictive due to the focus of their anger being directed solely at women. The one rapist classified as Pervasively Angry showed evidence of a long history of global anger.
MTC: R3 Classification Risk The following section involves discussion of mean differences on risk assessment scores by MTC:R3 classification. References to mean differences in this section do not infer that these differences are statistically significant. Instead this section aims to reveal patterns that could be evaluated with further research. Risk Scales: Roc*Roi; ASRS; Static-99Table 2 presents group means for the RoC*RoI, ASRS and Static-99 risk measures. Pervasively Angry rapists had the highest mean risk score on the RoC*RoI general recidivism measure. With regard to the more specific measures of sexual recidivism, Sexual Non-sadistic rapists had the highest mean score on the ASRS, and the Opportunistic group had the highest mean score on the Static-99.
Violence Risk Scale: Sex Offender Version (VRS:SO)Figure 3 displays group means for each VRS:SO item. Sexual Non-sadistic (first 4 items) rapists exhibited the highest mean score on: Deviant Sexual PreferenceSexual CompulsivitySexually Deviant LifestyleSubstance AbuseOpportunistic and Sexual Non-sadistic rapists shared highest mean scores on Sexual Offending Cycle.Cognitive DistortionsOffence PlanningOpportunistic rapists exhibited the highest mean score on: Treatment ComplianceCompliance with Community Supervision
Pervasively Angry rapists exhibited highest mean scores on Impulsivity. Community SupportInsightEmotional Control,Interpersonal Aggression Criminal PersonalitySexual Non-sadistic and Pervasively AngryReleased to High-risk Situation (HRS)
While the results of this study do not in their current form have the strength inform treatment, they do suggest that the MTC: R3 typology may have potential applications in rapist treatment programmes. The first research question asked âcan the MTC: R3 be used to classify a sample of high-risk New Zealand rapists?â Results indicate that this sample was able to be classified using the MTC: R3 typology. All 10 rapists in this sample could be assigned to a classification by the six people who participated in the classification process. Use of the MTC: R3 Discriminating Variables and Coding Tool increased inter-rater agreement with regard to both classification and pathway. This tool will be further refined through future research and development.The MTC: R3 Discrimination Variables Coding Tool has shown value even with raters who are unfamiliar with the MTC: R3 typology and it is likely that with further development it will prove useful in the context of both research and treatment. Further research into the relationship between MTC: R3 subtypes and the psychometric risk measures used within the current study will allow a greater understanding of the risk patterns, criminogenic needs and relevant treatment targets for each subtype and allow a more individualised treatment approach.
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