Edward Christian Healy, M.B.A., M.D.

https://www.hopkinsmedicine.org/profiles/results/directory/profile/2290046/edward-healy

With stout ships and even stouter hearts they searched the world to create an empire androgen hormone testosterone purchase 60ml rogaine 5. But not until the reign of Queen Elizabeth I prostate oncology kansas rogaine 5 60 ml generic, a Protestant mens health diet pdf generic rogaine 5 60 ml on line, did the English take a serious interest in the New World prostate oncology veterinarians generic rogaine 5 60ml on line. For the most part they struck at Spanish power by attacking its merchant and treasure ships plying the high seas androgen hormone urinary rogaine 5 60 ml cheap. Buccaneers such as John Hawkins and Francis Drake brought home to their queen a hoard of gold and silver prostate cancer nih rogaine 5 60ml discount. Elizabeth both disclaimed any involvement in the raids and at the same time knighted Drake after he circumnavigated the globe and scooped up a veritable fortune. Between the intrepid British sailors, their highly maneuverable ships, and punishing storms at sea the armada was crippled, and only about half the original number of Spanish ships reached the safety of their ports. England could now make a bid for possession of a healthy chunk of the North American continent. A few years earlier, in 1585, Sir Walter Raleigh dispatched a small group of settlers, who landed on a tiny island off present-day North Carolina and named it Roanoke. The attempted invasion of England by the Spanish Armada postponed any effort to keep Roanoke supplied. When assistance did arrive in 1591, the would-be rescuers found the island completely deserted. Despite this disaster, adventurous English merchants still had hopes of sponsoring colonization of the New World in the expectation of imitating the discoveries of the Spanish. A group of them formed a joint-stock company, the London Company, in which shares were sold to stockholders for twelve pounds ten shillings, in order to sponsor colonization by settlers in North America. A charter granted by James I, the first of the Stuart kings, who succeeded Elizabeth upon her death in 1603, allowed the company to develop the land from the coastline westward to the Pacific Ocean. The area was named Virginia after Elizabeth, known as the Virgin Queen because she had never married. Three ships, the Susan Constant, the Goodspeed, and the Discovery, sailed from England in December 1606 and landed in Virginia in April 1607: the settlement was named Jamestown. They received help from the Powhatan tribes who taught them how to grow corn and where best to catch fish. But relations between the Indians and the English became strained to the breaking point because of the rapaciousness of the English, and Smith was taken prisoner by a hunting party while on an exploring expedition. He was turned over to Opechancanough, who was probably the half Discovery and Settlement of the New World 11 brother of Chief Powhatan, and threatened with death. He was sent to Spain to learn western customs and culture and the Spanish language so that he could be trained and serve as an interpreter and translator between the Indians and the Spanish. On his return home, sometime in the late 1570s, he renounced his Spanish affiliations and reclaimed his position of authority within the Powhatan tribe. He may also have been instrumental in the slaughter of the missionaries who accompanied him back to Virginia. Most likely he would have killed John Smith, had it not been for Pocahontas, the favorite daughter of the Powhatan chief. At the time, Pocahontas was only eleven years of age, so it is unlikely that there was a romantic reason for her action. She converted to Christianity and married John Rolfe, one of the settlers, in 1614, and their marriage strengthened the friendship between the Powhatans sand the settlers. Pocahontas later traveled to England, where she was treated with the deference due her Indian rank and presented to the king and queen. Instead of gold, the colonists discovered the value of tobacco, which the Indians had smoked for centuries. Introduced in Europe, this "filthy" habit, as King James labeled it, became very fashionable, and the increasing demand provided the settlers with a cash crop they desperately needed to survive. As a result, large plantations soon evolved to grow the plant, and Virginia became a thriving colony. The London Company sent Thomas Dale, a military man, to govern Virginia, and he instituted stern measures to ensure the continued life of the community. Then, in 1619, the company instructed the governor to summon two landowning representatives from each of the 12 a short history of the united states small settlements in the colony to meet in Jamestown to provide advice. But it was clear right from the beginning that English settlers were prepared to go their own way and address problems they felt were important for their safety and livelihood. Their action demonstrated a degree of independence that would be imitated by future legislative bodies in North America in asserting their right to solve their own problems in their own way. As the settlers in and around Jamestown prospered, their number steadily increased, so that by 1620 there were roughly 2,000 colonists. Early in the morning of March 22, 1622, a number of Indians who were unarmed circulated in several settlements and appeared to be friendly. Then, suddenly, they seized muskets and axes and began a systematic slaughter of the inhabitants. It was a typical Indian ploy: an outward show of friendship to allay the apprehensions of the colonists, followed by a sudden, swift killing spree. They wiped out about a third of the settlers, who retaliated with lethal force and attempted to drive the tribe further west. Then, in 1644, he launched what the colonists called the "great assault" of 1644, in which Opechancanough killed over 500 settlers. But the chief was old, possibly about 100 years, and his faculties were sharply diminished. During the interim the House of Burgesses made every effort to meet regularly, and in 1639 the king instructed the governor to summon Discovery and Settlement of the New World 13 the Burgesses together each year, a recognition of what had already become regular practice. No t a l l the settlers who came to America searched for gold or other forms of financial gain. Following the Protestant Reformation and the religious wars between the various sects and creeds, persecution of opposing religious beliefs became standard practice. In England the Anglican church was established by the monarchy in opposition to the Roman Catholic church, although Anglicanism retained many Catholic ceremonies and rituals. As a consequence, any number of Protestants felt that the Church of England needed to be purified of such trappings, and they became known as Puritans. Others, more radical in their thinking, felt compelled to separate themselves from the Anglican church altogether. A group of English separatists sought even more religious freedom and fled to Holland in 1608, only to find life in this foreign country totally unsuited to their needs and temperament. Thus authorized, they departed Holland and sailed aboard the Mayflower to the New World. They landed at Plymouth on Cape Cod on November 21, 1620, and before they left the ship to establish their colony, forty-one of them signed a compact by which they pledged allegiance to their "dread sovereign, the King" and did "covenant and combine" themselves into "a civil Body Politick. It is interesting to note that these settlers made an agreement that they committed to paper, stating their position on government and the means by which they had formed their society. The Mayflower Compact became one of many more such documents to follow, by which the people of this New World spoke openly about the ways they would 14 a short history of the united states be governed and the principles on which their government would rest. Relying on a written document as an authority became an American custom in enunciating principles and practices by which the inhabitants in the society would be governed. The Indians also taught them how to raise corn and showed them the best places to fish and hunt. The colony survived and prospered, and the colonists gave thanks for their good fortune. Back in England, King Charles I, who succeeded the "dread sovereign" James I, gave a group of Puritans permission to form a joint-stock company in 1629 called the Massachusetts Bay Company, by which they could establish a colony in an area north of Virginia that John Smith had described in one publication as New England. John Winthrop, like many other Puritans, had become deeply troubled about the moral life in England and the future of religion. As an influential administrator of the Company, he was chosen to lead a "Great Migration" of Puritans to America. Numbering more than 1,000 men, women, and children aboard a fleet of 17 ships, these Puritans left England on May 22, 1630, with John Winthrop as their governor, and arrived in America on June 12, 1630, eventually settling in Boston. Upon their arrival, Winthrop assured his followers that if they bound themselves together "as one man," God would protect them and ensure their prosperity. Church, state, family, and individuals were bound together as a unit to create a government and community in accordance with demands of the Almighty. Many of the settlers were well educated and had enough money to set themselves up in trade, commerce, or farming. Within a few years the population of the colony numbered 20,000, dispersed among several surrounding towns. The Massachusetts Bay Company had decided to relocate its entire operation to America, taking the charter along as well. That meant Discovery and Settlement of the New World 15 there was no need to consult with or take directions from any group in England in making governmental decisions. The colony was administered by the governor and eighteen assistants elected by the freemen, called the General Court. In 1634 the General Court, responding to criticism, allowed each town to elect deputies to sit with the assistants. Then, ten years later, the court divided into two houses, thus creating a bicameral legislature to fashion the laws for the entire Massachusetts Bay Colony. But there were dissenters among them who objected to particular rulings or actions, or the system of government. One of these was Roger Williams, a young Puritan who led a congregation in Salem and who preached unacceptable heresy-at least it was heresy to the ruling clergy in Boston. He was banished from the colony because he questioned the right of a civil government to enforce religious beliefs. But he foiled an attempt to ship him back to England by escaping into the wilderness and fleeing south. With a group of his followers he founded the town of Providence, the fi rst Rhode Island community where religious freedom and separation of church and state were made possible. Anne Hutchinson, another dissenter, held meetings in her home to discuss religious matters and the worth of individual clergymen. She and her disciples fled to Rhode Island and joined the followers of Roger Williams. One of the most popular preachers in the Massachusetts Colony was Thomas Hooker, and his very popularity generated jealousy among other preachers, most notably John Cotton, the senior minister in the 16 a short history of the united states colony. Rather than face expulsion, Hooker decided to lead his congregation across the wooded wilderness to the Connecticut River valley, where his followers established themselves in Hartford, Windsor, and Wethersfield. In an effort to establish a colony that would be loyal to the Anglican church and would act as a rival to Massachusetts, Sir Ferdinando Gorges obtained a charter to establish a settlement in Maine; but he died before he could attract immigrants, and his heirs sold the charter to Massachusetts. Moreover, another attempt at colonizing a northern portion of New England in what is now New Hampshire also failed. The area was subsequently settled in 1638 by another preacher who had been banished from Massachusetts, John Wheelwright, the brother-in-law of Anne Hutchinson. The original grant was subsequently revoked, and in 1679 New Hampshire became a royal colony. George Calvert, the first Lord Baltimore, obtained a charter in which he hoped to establish a colony for Catholics, he himself having converted to that faith. Under his plan, he would be the proprietor, and the land, involving millions of acres, his private estate. Those who settled on this property would pay him a land tax, called a quitrent; he, in turn, was required to pay the king two Indian arrows each Easter. Calvert was empowered to appoint the governor, judges, and councilors; organize the court system; and authorize a legislature to enact the laws. Unfortunately, the area impinged on the charter granted to the Virginia Company, provoking repeated conflicts between the two authorities. And although Calvert expected to dictate his wishes to the settlers as commands, the settlers had other ideas. When the first Maryland legislature met in 1635, it insisted on the right to enact its own laws, and Calvert wisely agreed to this. But Catholics Discovery and Settlement of the New World 17 did not swarm into Maryland as the proprietor had hoped. Instead many more Protestants took advantage of his liberal land grants, and by the end of the century they outnumbered Catholics ten to one. But since non-Christians were excluded from the colony, this legislation had only limited claim to toleration. Thus, over a relatively short period of time, there developed in the English colonies in America three forms of government: royal, corporate, and proprietary. This colony lay between Virginia and Spanish Florida, and the charter was granted in 1663. The proprietors expected to attract settlers from Barbados, Virginia, and New England and profit from a trade in rice, ginger, and silk. One distinctive feature of this proprietary colony was the plan of government drawn up by one of the proprietors, Anthony Ashley Cooper, the earl of Shaftesbury, and his secretary, John Locke. It was called the Fundamental Constitutions of Carolina, and it attempted to engraft in America a feudal system with a sharply defined social structure, including titles, and a similar hierarchical judicial system. Although it recognized and legalized slavery-Carolina was the first colony to do so openly-it did provide for religious freedom and a representative assembly. Settlers were drawn to this inviting area, but they disregarded the feudal aspects- which could never take root in America, because of the vastness of the land-and enjoyed the more liberal attractions of the Fundamental Constitutions. Both areas prospered and enjoyed increased migration from other parts of the English colonies. In South Carolina, because of the moisture, temperature, and soil conditions, the colonists cultivated rice and indigo, which is used as a dye. Many of the Carolina colonists were Scots-Irish who were predominantly Presbyterian in their religious beliefs and had initially moved from lowland Scotland to northern Ireland, where they remained for many years before crossing the ocean and settling in the Carolinas. They engaged the various Indian tribes in defending themselves against the Spanish in Florida.

Reading List 339 George Dangerfield mens health february 2014 order 60 ml rogaine 5 with visa, the Awakening of American Nationalism (1965) androgen hormone oxytocin buy 60ml rogaine 5 mastercard. Richard Hofstadter mens health big book of exercises pdf discount 60 ml rogaine 5 free shipping, the American Political Tradition and the Men Who Made It (1948) mens health 2pm generic 60 ml rogaine 5 mastercard. Robert Fogel and Stanley Engerman prostate cancer psa 01 purchase 60ml rogaine 5 visa, Time on the Cross: the Economics of American Negro Slavery (1974) prostate 28 order rogaine 5 60ml on-line. Alan Trachtenberg, the Incorporation of America: Culture and Society in the Gilded Age (1982). Morton Keller, Affairs of State: Public Life in the Late Nineteenth Century (1977). Bruce Schulman, the Seventies: the Great Shift in American Culture, Society, and Politics (2001). John Karaagac, Between Promise and Policy: Ronald Reagan and Conservative Reformism (2000). William Berman, From the Center to the Edge: the Politics and Policies of the Clinton Administration (2001). Sam Roberts, Who Are We Now: the Changing Face of America in the Twenty-First Century (2004). Karl, 244 Dole, Robert, 288, 311, 312 Dominion of New England, 23 Donnelly, Ignatius, 178, 183 Dos Passos, John, 209 Douglas, Stephen A. See president Ex parte Milligan, 164 Expedition Act (1903), 194 "Exposition and Protest" (Calhoun), 93 Fair Deal, 253, 257, 258 faith-based initiative, 323 Fall, Albert B. Thomas, 37, 38 Galloway, Joseph, 37 Gama, Vasco da, 5 Gandhi, Mahatma, 117 Garfield, James A. Dennis, 320 Hawaii, 189, 191, 236, 265 Hawkins, John, 9 Hawthorne, Nathaniel, 112, 117 Hay-Bunau-Varilla Treaty (1903), 195, 290 Hayes, Rutherford B. Danforth, 302, 306 Quebec, 8; siege of, 28 Quebec Act (1774), 36 Plumer, William, 83 Plymouth, 13, 27 Pocahontas, 11 Poe, Edgar Allan, 118 Poindexter, John M. See also Half Breed faction; Insurgent Republicans; Radical Republicans; Stalwart Republicans Republican Party (Jeffersonian). Louis, the (monoplane), 207 spoils system, 99 Spotsylvania, Battle of, 150 Sprague, Adm. Hideki, 236 Toleration Act (Maryland, 1649), 17 Toombs, Robert, 129 Tordesillas, Treaty of (1494), 6 Toussaint-Louverture, 68 Tower, John, 298 Tower Commission, 298 Townsend, Dr. House of Representatives: African-Americans in, 164, 213; anti-communism and, 254; assumption of state debt and, 56; Bank of U. See also Robber Barons Index Winthrop, John, 14 wiretapping, 327, 335 Wisconsin, 178, 196 Wolfe, Gen. Winner of the National Book Award for the third volume of his study of Andrew Jackson, he has also written biographies of Henry Clay, Daniel Webster, John Quincy Adams, and Joseph Smith, in addition to many other books. Remini the House: the History of the House of Representatives Joseph Smith John Quincy Adams Andrew Jackson and His Indian Wars the University of Illinois at Chicago: A Pictorial History (with Fred W. Holli) the Battle of New Orleans Daniel Webster: the Man and His Time Henry Clay: Statesman for the Union Andrew Jackson: A Bibliography, Bibliographies of the Presidents of the United States (with Robert O. By payment of the required fees, you have been granted the non-exclusive, nontransferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins e-books. It is also recognized that this information might differ from locality to locality, and that each training program, or system should identify and provide special training requirements. For every person named, there are 50 or more individuals that should be identified for their contributions. Special thanks for the knowledge, expertise, and dedication given to this project by the Project Director, Principal Investigator, Co-Medical Directors, and all the members of the Curriculum Development Group and Medical Oversight Committee. The Medical Oversight Committee developed the medical/clinical component of the curriculum. A six-member writing group and Principal Investigator actually "put pen to paper", once the objectives and format were approved by the Curriculum Development Group and Medical Oversight Committee. The National Registry also contributed significantly to the design and development of the skill sheets that are contained within this curriculum. The role of medical direction is paramount in assuring the provision of highest quality prehospital care. Medical Directors should work with individuals and systems to review prehospital cases and strive to achieve a sound method of continuous quality improvement. Review and development of a blueprint/model and core curriculum for each provider level, based upon task analysis focusing on field impact (evaluating positive/negative outcomes) and the most utilized knowledge and skill areas. Include an objective assessment of all published studies in peer journals when revising curricula. Emphasize rescuer and patient safety components, including infection control, in all curricula. Develop a nationally acceptable core curriculum for each provider level, with a mechanism for customizing for local needs. The model has the medical and trauma information on either side of patient assessment. Three additional lessons are needed to complete the advanced airway elective, if offered. The name of each lesson is followed by the recommended time needed to complete the instruction. The cognitive, effective, psychomotor objectives and the total number of objectives for that lesson are provided. The percentage of cognitive and percentage of hours is based on the entire core curriculum. This information may prove to be beneficial in designing written and practical evaluation tools. Lesson 1-3 Medical/Legal and Ethical Issues Explores the scope of practice, ethical responsibilities, advance directives, consent, refusals, abandonment, negligence, duty to act, confidentiality, and special situations such as organ donors and crime scenes. A brief overview of body systems, anatomy, physiology and topographic anatomy will be given in this session. Lesson 2-2 Practical Skills Lab: Airway Provides supervised practice for students to develop the psychomotor skills of airway care. The use of airways, suction equipment, oxygen equipment and delivery systems, and resuscitation devices will be included in this lesson. Lesson 3-4 Focused History and Physical Exam - Medical Patients Describes and demonstrates the method of assessing patients with medical complaints or signs and symptoms. This lesson will also serve as an introduction to the care of the medical patient. Lesson 3-5 Detailed Physical Exam Teaches the knowledge and skills required to continue the assessment and treatment of the patient. It will also provide instruction on assessment of respiratory difficulty and emergency medical care of respiratory problems, and the administration of prescribed inhalers. Lesson 4-4 Diabetes/Altered Mental Status Reviews of the signs and symptoms of altered level of consciousness, the emergency medical care of a patient with signs and symptoms of altered mental status and a history of diabetes, and the administration of oral glucose. Lesson 4-6 Poisoning/Overdose Teaches the student to recognize the signs and symptoms of poisoning and overdose. Information on aquatic emergencies and bites and stings will also be included in this lesson.

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Most victims who met offenders in person went to such meetings expecting to have sex (Wolak androgen hormone young order 60ml rogaine 5 overnight delivery, Mitchell prostate 22 buy 60 ml rogaine 5 otc, and Finkelhor man health nursing environment rogaine 5 60 ml fast delivery, 2003) prostate cancer after surgery rogaine 5 60ml low price. There was also an increase in offenders claiming to be minors at some point in the online communication from 5% in 2000 to 20% in 2006 (Wolak prostate miracle buy 60ml rogaine 5 free shipping, Finkelhor prostate gland rogaine 5 60ml on-line, and Mitchell, 2009). Of those communicating online 60% requested a meeting with the child, 130 - Child Molesters: A Behavioral Analysis 46% sent child pornography to the child, 44% got on the telephone with the child, 42% requested a picture of the child, 35% provided attention/social support to the child, 28% engaged in cybersex with the child, and 27% offered gifts (Eakin, 2009). Offenders can use the online computer to troll for and communicate with potential victims with less risk of being identified. The use of a vast, loose-knit network like the Internet can sometimes make identifying the actual perpetrator difficult. On the computer the offender can assume any identity or characteristics he wants or needs and gain access to a large reservoir of potential child victims. Much of the grooming/ seduction process can now begin and progress utilizing online text, voice, and visual communication. Although children from dysfunctional families and families with poor communication might be at higher risk for seduction, all children are vulnerable. Adolescent boys confused over their sexual orientation are at particularly high risk of such contacts. By no reasonable definition should an individual with whom a child has regularly communicated online for months be considered a "stranger," even if that individual has lied about his true identity. Many offenders are in fact reasonably honest about their identity and some even send recognizable photographs of themselves. They spend hours, days, weeks, and months communicating, including a lot of listening, with children. Through the use of webcams, offenders can, in real-time, display sexually explicit behavior to children (exhibitionism) and observe children engaging in suggested sexually explicit behavior (voyeurism). This interaction can be enhanced by digital teleconferencing that allows for online voice and visual participation, even by multiple offenders, in the sexual victimization of children. Such "cybersex" can call into question traditional definitions of child molestation as "hands-on" contact. The child can also be evaluated for future face-to-face contact and direct victimization. Investigators must recognize many of the children lured from their homes after online computer conversations are not innocents who were duped while doing their homework. Most are normal, curious, rebellious, or troubled adolescents seeking sexual information or contact. Society has to stop focusing on the naive belief that teenagers are "accidentally" getting involved. Investigation will sometimes discover significant amounts of adult and child pornography and other sexually explicit material on the computer of the child victim. Investigation can also sometimes discover the child victim has made as many, if not more, misrepresentations as the offender. Most of them have been seduced and manipulated by a clever offender and usually do not fully understand or recognize what they were getting into. The child victim may believe the offender is a "true love" or rescuer with whom they want to have sex. Even if they do fully understand, the law is still supposed to protect them from adult sexual partners. Consent should not be an issue with child victims even if they are "compliant" (Lanning, 2005). Investigators must recognize and address these dynamics when interviewing these online child victims (see the chapters titled "Acquaintance-Exploitation Cases," beginning on page 63, and "Investigating Acquaintance Sexual Exploitation" beginning on page 137). Comments Concerning Prevention Reality about documented cases and child development should be incorporated into awareness and prevention programs intended to keep children safer when on the Internet. The reason we protect children and limit their accountability is because they are developmentally immature, not because they are innocent. Adolescent children are interested in sex and often engage in high-risk behavior without considering or comprehending the consequences. Generally speaking children younger than 12 years of age tend to listen to adults, but do not fully understand what they are saying. Most offenders in these Internet cases did not deceive their victims about the fact they were adults who were interested in sexual relationships. The victims in these cases were young adolescents with 99% being age 13 to 17, and none younger than 10. Most victims met and had sex with the adults on more than one occasion and half the victims were described as being in love with or feeling close bonds with the offender. There was no evidence the online offenders were stalking or abducting unsuspecting victims based on information they posted at social-networking sites. Most offenders were open about their sexual motives in their online communication with youth. Using the terminology defined in this publication, they are child victims who engaged in compliant behavior. Most online child victims take risks on- and offline and see the online relationships as romances and sexual adventures. It appears some of the most risky behavior involves being rude or nasty online, discussing sex online with persons they do not know in person, sending ("sexting") sexy images, engaging in cybersex, and receiving online sexual 132 - Child Molesters: A Behavioral Analysis solicitation (Wolak, Finkelhor, Mitchell, and Ybarra, 2008). Children creating, sending, and receiving sexually explicit images of children (including themselves) also involves serious violations of the law for which they could be prosecuted. It is easier to prevent things that both the parent/guardian and child do not want to happen. It is harder to prevent things the parent/guardian does not want to happen, but the child does. Public-service announcements warning about online dangers occasionally appear on television. Commercials for online sites where you can find the love of your life or your soul mate, however, run all day long. Parents/guardians also recognize the problem of asking your children to "do as I say, not as I do. With the computer in the family room, many children will simply use another computer or some portable high-tech device to engage in their high-risk behavior. Adolescent children are unlikely to tell about sexual contacts and solicitations when they perceive this activity to be fun, adventurous, or desirable. Sexual activity with adults is a problem whether or not it is "wanted" by the child. Warning children about online "predators" can communicate a false impression of the nature of the danger. Making children safer online should rely less on hardware, software, and dire warnings about online predators and more about involvement in their lives, communication, and love. Proactive Investigations When law-enforcement officers are pretending to be children as part of authorized and approved proactive investigations, they must remember the number of potential offenders is proportional and the "appeal" of the case is inversely proportional to the "age" of the "victim. If you can effectively pretend to be a 12-year-old, it makes less sense Child Molesters: A Behavioral Analysis - 133 to pretend to be a 13- or 14-year-old. One alternative used by some investigators is to pretend to be an adult with access to young children. Posing as an adult with access to children can be more productive in eliciting corroborative evidence and identifying additional victims after meeting the offender. Investigators must also remember when pretending to be a boy online, the "relationship" usually moves a lot faster and they must be prepared to take appropriate action faster. The percentage of arrested offenders who solicited undercover investigators online increased sharply among young adults (ages 18 to 25) from 7% of arrests in 2000 to 34% in 2006 (Wolak, Finkelhor, and Mitchell, 2009). To suggest such responses to proactive investigations are not or should not be crimes because no real child is involved or harmed is ridiculous. In addition, in spite of their current popularity and the cooperation of some law-enforcement agencies, proactive investigations should never be conducted by civilian groups or the media. Only law-enforcement officers as part of official, authorized investigations should be conducting proactive investigation or downloading child pornography on a computer. When caught in these proactive investigations, some offenders claim it was all part of their own undercover "investigation" or a means of communicating with and helping a troubled child. When caught in these proactive investigations, some offenders claim to be suffering from "Internet-addiction syndrome. This might be of some relevance if they were charged with the "crime" of spending too much time on the Internet. After developing a relationship online, some offenders who are arrested attempting to meet with children (or individuals they believe to be children) to engage in illegal sexual activity claim they were not really going to have "sex. This is highly unlikely for a need-driven offender and few offenders are willing to submit to an objective test of this skill. They point to their lack of a psychiatric or criminal history of child molestation. Their sexual activity is supposed to be more about escaping stress and less about sexual gratification and influenced by the anonymity, convenience, and escape of the Internet. It is hard to understand why the forbidden activity they are drawn to involves sex with children. This so-called "fantasy defense" is popular among better educated, wealthier defendants. There are mental-health experts who claim to know how to distinguish true "pedophiles" from the "fantasy user" and will so testify. In contrast the "fantasy user" frequents adult chatrooms or sites, role plays as a child with adults, quickly and bluntly discusses sex, openly admits his identity, and is indifferent to the relationship. First is the fact the so-called "pedophile" pattern is a stereotype that although commonly circulated does not represent many valid cases. These mental-health experts seem to have uncritically accepted an invalid stereotype. The current research concerning actual cases and documented online behavior indicates many "true" offenders do not follow these claimed "pedophile" patterns and do follow the claimed "fantasy-user" patterns. Many of these so-called "fantasy-user" behavior patterns are in fact consistent with criminal interaction with actual adolescent victims. In addition most actual online victims are pubescent adolescent children who are of sexual interest to many individuals who are not diagnostically pedophiles. The second and biggest problem with this theory, however, is the basis for the "fantasy-user" pattern. Of necessity it is based on the study of people who claim they do not do something. It is apparently "research" concerning self-reported, nonbehavior that is difficult to document. How does the mental-health expert know the "fantasy users" studied have never offended Most arrested online offenders have no prior arrests and were theoretically "fantasy users" until caught. Some of these experts even claim sexual fantasies have nothing to do with sexual behavior. My 35 years of studying criminal sexual behavior tells me not all sexual fantasies are acted out but many sex crimes are born in sexual fantasy. Documented sexual behavior has been compared with the seized collections and fantasy material of sex offenders. To suggest regular, repeated, time-consuming sexual fantasies accompanied by masturbation have nothing to do with behavior is absurd. The idea that all communication about sex on the Internet is just fantasy is absurd and not consistent with the reality of many Internet relationships. Activities such as masturbation, viewing pornography, use of props and dolls, verbal role-playing, and cybersex often involve both. In my opinion, however, no expert should ever be allowed to testify there is a profile of people who do not do something and a defendant on trial is not guilty because he fits that profile. Those wanting to read an appellate decision discussing the admissibility of defense expert testimony concerning the fantasy defense from a legal perspective should see United States v. Child Molesters: A Behavioral Analysis - 135 Staleness of Probable Cause Because of delays in communicating details from proactive investigations, staleness is a common problem in computer-exploitation cases. It may take weeks or months for the details learned from an undercover Internet investigation in one part of the country to be disseminated to investigators with jurisdiction over the target computer in another part of the country. The informational basis for a search warrant may constitute probable cause, but it may be so old that it is now considered stale. Obviously the best way to address the staleness of probable cause is to "freshen" it up with current investigation and information. Staleness of probable cause can also be addressed with an "expert" search warrant setting forth an opinion that certain types of offenders may be an exception to the staleness doctrine. It has been my experience that true preferential sex offenders will rarely destroy their collections, even if they believe they are under investigation. Before using this technique, investigators and prosecutors should do legal research and be aware of appellate decisions that support or deny this approach. Another way to address "staleness" is to recognize the information in question may not be stale. It is a matter of differing opinion as to when the informational basis for probable cause in a computer case becomes stale. I believe this time interval varies based on the type of information and evidence. Because of characteristics of technology and human behavior, in my opinion, probable cause about evidence on a computer should not even be considered stale for at least one year.

Limited views about what constitutes sexual abuse and who engages in abuse also can be a barrier to prosecution prostate cancer female rogaine 5 60ml sale. Patricia Caruso mens health zac efron photoshop order rogaine 5 60 ml with visa, Director of the Michigan Department of Corrections prostate swelling purchase rogaine 5 60 ml line, testified to the Commission about a case in which a female staff member had sexually abused a male prisoner: "I know that sometimes people feel that parties may be in love or that it is `consensual prostate cancer 30 years old discount rogaine 5 60 ml fast delivery. For a long time prostate gland enlargement 60 ml rogaine 5 for sale, it was more acceptable for women [than men] to resign and go on with their life mens health protein 60ml rogaine 5. Caruso requires prison wardens throughout Michigan to take the same kind of initiative. Part of being a warden-I was a warden more than half of my career in this department. In Massachusetts, for example, county district attorney offices have appointed a "prison "I told the wardens when you have a case of sexual liaison. These agreements should be the basis for making cases of prison sexual violence a higher priority for prosecutors. They can also provide a framework for the kind of working relationship that leads to effective investigations and more criminal convictions. Sanctions should never be the sole response to rape and other serious forms of sexual abuse. Staff is subject to disciplinary It is crucial that sanctions be fair, consistent, and sufficiently stringent to sanctions up to and including serve as a deterrent to continued abuse. Applying sanctions in an arbitrary termination when staff has vioor biased fashion undermines their purpose and the broader mandate to lated agency sexual abuse polidemonstrate zero tolerance to sexual abuse. The presumptive disciplindata exist on which to base conclusions about whether correctional faciliary sanction for staff members ties are consistently meting out discipline appropriate for the culpability who have engaged in sexually abusive contact or penetration and conduct of perpetrators. All terminations for vicharge (44 percent of all sanctions), demotion/diminished responsibilities olations of agency sexual abuse policies are to be reported to (1 percent), reprimand/discipline (10 percent), and transfer to another falaw enforcement agencies and cility (1 percent). When the perpetrators of abuse were other prisoners, the Bureau of Justice Statistics reported the following sanctions, applied alone or in combination: placement in solitary confinement (78 percent of all sanctions), cell confinement (16 percent), placement in a higher level of custody (22 percent), loss of privileges (20 percent), and transfer to another facility (22 percent). Termination Until more cases are successfully prosecuted, however, may also be the appropriate remany perpetrators of serious sexual abuse will be subject sponse when staff deliberately or repeatedly violate sexual only to administrative discipline, making sanctions abuse policies, such as the duty in these cases especially important. Correctional agencies must also provide law enforcement agencies and relevant licensing entities with the names of all terminated staff to help prevent an employee fired for sexual abuse from being employed by a facility in another jurisdiction and potentially abusing prisoners there. When determining what type of sanction, if any, to impose, the disciplinary process must consider whether a mental disability or mental illness may have contributed to the abusive behavior. Interventions designed to address and correct underlying reasons or motivations for sexual abuse, such as requiring the perpetrator to participate in therapy or counseling, also must be considered. In particular, perpetrators should not be placed for prolonged periods in disciplinary segregation because conditions in these units have the potential to cause or aggravate symptoms of mental illness and to limit access to needed mental health services. Although agencies must sanction staff for sexual contact with prisoners, incarcerated persons should not be punished for their involvement, regardless of whether or not the encounter was allegedly consensual. The power imbalance between staff and prisoners vitiates the possibility of meaningful consent. In addition, the threat of being punished for a relationship deemed to be consensual would deter prisoners from reporting sexual abuse by staff. Of course, prisoners sometimes engage in sexual relationships with staff to further illicit activities. In sum, everyone who engages in sexual abuse in a correctional facility or other corrections setting must be held accountable for their actions. The Commission designed its standards in this area to change the dynamic by encouraging incarcerated individuals and staff to report abuse and by requiring correctional facilities to protect those who speak out, conduct effective investigations, and ensure appropriate punishment. Disciplinary sanctions for inmates Inmates are subject to disciplinary sanctions pursuant to a formal disciplinary process following an administrative ruling that the inmate engaged in inmate-on-inmate sexual abuse or following a criminal finding of guilt for inmate-oninmate sexual abuse. As inmates and male and female staff mingled in the heat on Daskalea testified in court that she felt "constant stress, this particular evening in 1995, anxiety, and dread of imminent sexual attack. Daskalea crowd soon formed and several suffered from insomnia, struggled with eating disorders, inmates began dancing. Sunday and "spent months emotionally and psychologically Daskalea, the victim of ongoing sexual harassment while de- debilitated, withdrawn and depressed. Two inmates dragged Daskalea out of her cell and into the center of the crowd, where the officer in charge ordered her to dance. Daskalea complied, removing all her clothes except her underwear, but was so frightened that her legs trembled. Staff and inmates watched her as she danced, "shouting and clapping; some flashed money. When Daskalea was questioned about the incident a few days later, she told the interviewer she was afraid something would happen to her if she provided any details. Indeed, a few days later, all of her underwear was confiscated as "contraband" and she was placed in solitary confinement, initially without a mattress. Daskalea reported the abuse to jail officials and to the judge who sentenced her; although the judge held a hearing and recommended that Daskalea be moved out of the D. She testified in court that she felt "constant stress, anxiety, and dread of imminent sexual attack. Daskalea suffered from insomnia, struggled with eating disorders, and "spent months emotionally and psychologically debilitated, withdrawn and depressed. Court of Appeals for the District of Columbia, "These injures are hardly surprising or unexpected in light of the abuse Daskalea suffered. Court records do not reveal what clinical treatment, if any, Daskalea received following the attempted rape and the extraordinary abuses she endured while confined, but her testimony suggests that she was in urgent need of counseling and support services while she was incarcerated and after her release. As corrections administrators work to create a protective environment in the facilities they manage, they also have a legal duty to ensure that when systems fail and abuse occurs, victims have unfettered access to appropriate medical and mental health services. This chapter describes common mental and physical effects of sexual abuse-underscoring why treatment is so important-and explores why many victims do not seek or receive the medical and mental health care they need and to which they are entitled by law. A 126 An Assault on Body and Mind s sexual assault nurse examiner Jennifer Pierce-Weeks told the Commission, experiences of sexual abuse have the potential to harm a person in every dimension of life: "psychological, physical, spiritual, and social. Hope Hernandez was raped by a corrections officer in 1997 in the hospital ward of the same jail in which Daskalea was sexually abused. In her testimony to the Commission, Hernandez spoke about the lasting effects of sexual assault. Studies of incarcerated individuals also suggest that men and women victims may react differently and in varying degrees to sexual trauma. Other prisoners or staff also may taunt a male victim about being a "woman" or make the victim feel that his sexual orientation was compromised as a result of the experience. For both men and women, responses like chronic anxiety, hyper-arousal, sleep disturbances, and eating disorders are strongly associated with development of long-term health problems, including cardiovascular disease, ulcers, and a weakened immune system. Depending on the degree of force, the size of the perpetrator in relation to the victim, and any weapons involved, physical injuries can include bruises, lacerations, bleeding, broken bones, concussions, knocked-out teeth, internal injuries, and even more serious physical damages. Men assaulted by other prisoners were somewhat more likely than those assaulted by corrections staff to be injured physically (67 percent compared with 53 percent). Only a quarter of the injuries documented in this study-those to the anus or throat-were a direct consequence of forced penetration. However, victims of sexual assaults by other prisoners were more likely to sustain internal injuries or be knocked unconscious than victims of physical but nonsexual assaults. Sexually transmitted infections, such as gonorrhea, syphilis, and chlamydia, are also prevalent in the incarcerated population. Because of the disproportionate representation of minority men and women in correctional settings, it is likely that the spread of these diseases in confinement will have an even greater impact on minority men, women, and children and their communities. Daniels did not report the rape or seek treatment until she began to feel ill and suspected she might be pregnant. Although Daniels reported feeling upset following the rape and had a history of emotional problems as well as developmental disabilities, she was not offered rape counseling or any other form of therapy at the facility, but only prescribed antidepressants. Daniels failed to persuade the court that prison officials were deliberately indifferent to her health care needs. However, experts testified on her behalf that antidepressants alone are not an appropriate form of treatment for a woman who has been raped. Gamble that deliberate indifference to the health of prisoners is a form of cruel and unusual punishment. A study published in 1999 that focused on mental health care found that only 60 percent of Federal and State prisoners and 41 percent of individuals confined in jails reported receiving necessary mental health services. Gamble that deliberate with careful classification, will protect vulnerable prisoners indifference to the health of prisoners is a form of cruel and from sexual victimization. Since then, correctional agencies have Chapter 3 for a detailed discusstruggled, and sometimes failed with tragic results, to meet sion of risk and vulnerability. Health practitioners, not security or other staff, must determine the nature and scope of the treatment based on their professional judgment. As Jennifer Pierce-Weeks told the Commission, "receiving compassionate care at the time of the assault by an appropriately trained examiner. Victims of sexual abuse may experience health problems that manifest weeks or months after the abuse has occurred. The standard also requires facilities to conduct a mental health evaluation of all known abusers and to provide the treatment recommended. Although diagnosing and treating emotional and psychological repercussions of sexual abuse is complex, there are a number of effective interventions and treatment modalities. Clinicians have used other treatment approaches with victims of sexual abuse, including psycho-education and cognitive behavioral therapy, and can easily adapt these approaches to correctional settings. Correctional administrators seeking the evaluation and treatment of sexual abuse victims must guidance on how to meet this standard can look to their peers in Alabama, include appropriate follow-up Minnesota, and Texas. These systems provide this kind of training to the services, treatment plans, and, 55 health care practitioners who work in their facilities. The level of open, communal nature of community corrections may allow for types of medical and mental health care provided to inmate victims must treatment that would not work as well in more secure settings. Treatment match the community level of in juvenile facilities will also differ from treatment in adult facilities due to care generally accepted by the the psychological, cognitive, and developmental differences between youth medical and mental health proand adults. The fafor juvenile facilities require that medical and mental health practitioners cility conducts a mental health working with youth be specially trained on how to provide treatment to evaluation of all known abusers and provides treatment, as young victims of sexual abuse. The Commission acknowledges that meeting this seemingly simple standard is a real challenge, especially for facilities in remote locations, where specialists, community providers, and other treatment resources may be scarce. Partnerships between correctional systems and local "[R]eceiving compassionate care at the time of the assault by medical and mental health care an appropriately trained examiner. Through the program, doctors, nurses, and case managers from the community serve as the medical and mental health care practitioners in the jail. For example, the Connecticut Department of Correction contracts with the University of Connecticut to provide health care to all State prisoners. Incarcerated individuals who are victims of sexual assault can receive free counseling and other medical and mental health services for as long as necessary. Anyone can understand the desire for absolute confidentiality, especially when the circumstances involve something as intimate as sexual abuse, but the nature of life in a correctional facility and the goals of safety and security make that impossible. And in an ideal world, I would concur wholeheartedly," Art Beeler told the Commission. If this information was not available to correctional personnel, your decision in housing an offender may be, in fact, a death sentence. As Beeler noted, "The ethical dilemma of whom to share information with in a prison environment is probably as old as prisons are themselves. On the other side is the need to keep staff and inmates safe and the institution secure. Many States-including New Mexico where Puisis worked, as well as California, Georgia, and Texas-already have policies that meet this standard. At the same time, correctional mental and medical health care professionals must discreetly handle information provided by victims of sexual abuse, sharing it with other staff only on a need-to-know basis and following clear protocols. They also must inform prisoners of their duty to report before providing services. Because physician-patient confidentiality is a hallmark of medical care in the community, doctors, nurses, and counselors must be clearly informed about their duties as mandatory reporters. Beeler explained that facility staff need to practitioners requires facilities to ensure that all full- and part-time know when abuse occurs and who is allegedly involved to staff receive training on how and adequately protect victims. Policies on mandatory reporting must also be covered in sexual abuse education programs for prisoners. Clear policies communicated effectively to both medical and mental health care practitioners and prisoners ensure that everyone has the same understanding of what mandatory reporting entails. M Offering Other Options any incarcerated individuals will only access medical or mental health treatment if they feel confident that doing so will not put them at risk for further harm. Individuals who testified before the Commission often expressed fear that speaking out about abuse and naming abusers may lead to retaliation. Lost privileges, internal sanctions, and threats of injury are possible when individuals name perpetrators of sexual abuse. Victims as well as witnesses may be reluctant to seek treatment because they are afraid to name the perpetrator and follow through with a formal complaint and investigation. Without this policy, sexual abuse victims may decide that the risk of further harm is too great and elect not to access treatment. The facility provides such access by giving inmates the current mailing addresses and telephone numbers, including toll-free hotline numbers, of local, State, and/or national victim advocacy or rape crisis organizations and enabling reasonable communication between inmates and these organizations. The facility ensures that communications with such advocates are private, confidential, and privileged, to the extent allowable by Federal, State, and local law. The facility informs inmates, prior to giving them access, of the extent to which such communications will be private, confidential, and/or privileged. The Commission realizes that some victims will never feel comfortable or safe disclosing their experience of sexual abuse to a corrections employee. The standards, therefore, require facilities to give prisoners information about how to contact victim advocates and other support services in the community and underscore that victim communication with outside advocates be private and confidential to the extent permitted by law. Meeting this standard can be as simple as prominently posting tollfree hotline numbers.