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Eldridge40 analysis used to assess the constitutionality of a procedure affecting due process41 would generally favor appointment of counsel in parental (1981) (No metabolic disease 2007 buy januvia american express. A state judge presides over the adjudicatory hearing that follows diabetes diet drinks buy januvia cheap online, and the hearing is conducted pursuant to the formal rules of evidence and procedure diabetes definition signs and symptoms order januvia pills in toronto. When the parent is indigent blood sugar 800 buy discount januvia 100 mg on-line, lacking in education, and easily intimidated by figures of authority, the imbalance may well become insuperable. The Lassiter case was thus decided in the context of a sustained period in which the national focus had been on removing children from what were considered unsafe homes and "bad parents" with what many critics regarded as little to no appreciation for the devastation that separation from their parents and families would have on the child. Although unsuccessful, a bill was twice introduced in Congress (in 2011 and 2013) proposing that federal funding be provided to the states to improve parental representation. The bill cited analyses of data from New York, Michigan, and Washington showing reduced rates of foster care placement and increased rates of reunification when parents receive high quality legal representation. In 1999 the federal Administration for Children and Families urged states to adopt standards to guide attorneys in this complex field. In 2007, it established the National Project to Improve Representation for Parents Involved in the Child Welfare System. The Project has been a singular force in driving national and state efforts to improve the quality of parental representation. Examples of Parent Representation Models Around the country, a wide variety of parental representation models exist. The number of state funded and administered parental representation systems is growing. Parents served by these organizations are represented by an advocacy team of a social worker, attorney, and a parent advocate. The attorneys have access to in-house investigators and regularly use expert services to assist in the defense of their clients. For children who did enter foster care, the median length of stay was less than 5 months, in comparison to the New York City median of 11. Reimagining family defense lawyering means working to ensure that every parent affected by the child welfare system has the kind of representation and advocacy exemplified in the following articles-client-centered, innovative, fierce. The articles in this Symposium issue help to advance the work of family defenders who zealously guard against the benevolent intentions of those who, in their eagerness to help, instead trample upon the personal rights and human dignity of impoverished parents and children. Firmly grounded in their intimate engagement with the parents, families and communities they serve, the authors critique prevailing narratives about the child welfare system, thereby elevating and reframing our understanding of the uses and abuses of state power to intervene into families in the name of child protection. And their concrete suggestions for recognizing, naming, confronting and combatting destructive child welfare practices and policies contribute tremendously to on-going efforts to improve the quality of parental representation and to advance the cause of justice for families. Tara Urs is an Attorney for the Defender Association Division of the King County Department of Public Defense. Rather than examining the disproportionately bad outcomes experienced by Black and Native American children, this paper looks at the system itself, and in particular, one central feature of child welfare decision-making in many parts of the country: volunteer child advocates. This paper turns attention away from discussions of the race and economic poverty of the families most affected by the system, and instead looks at the impact of the race and privilege of these volunteer child advocates on child welfare decision-making. Understanding the role of race, gender, and power in forming the structure of the child welfare system explains in part why our legal system so comfortably tolerates a volunteer advocate whose role, in any other context, would not survive even a halfhearted due process challenge. The term structural racism can call to mind invisible forces that shape the world in a discriminatory way. And that power works real, tangible harms on families who encounter the child welfare system. Why does the legal system assume that a group of volunteers-mostly middle-class white women-will make better decisions for a low-income child of color than her own family, community, or the child herself could make Although African-American children make up 15% of the children in this country, they comprise 37% of the children in the child welfare system. The flip side is that families with financial means and white families are far more likely to be left alone by the system despite experiencing the very same concerns that lead to child welfare intervention for low-income families of color, such as mental illness, alcoholism, recreational or habitual drug use, or domestic violence. In the literature, a variety of reasons for this disproportionality have been proposed, ranging from poorly substantiated claims that poor families and families of color actually mistreat their children at a higher rate13 to detailed accounts of the structural racism unspread agreement that compared to white children and families in the child welfare system, children of color and their families have less access to services and their outcomes are poorer.

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Smith G (2009) Democratic Innovations: Designing institutions for citizen participation diabetes mellitus is a disorder of which body system 100mg januvia overnight delivery, Cambridge diabetes mellitus heart disease generic januvia 100 mg with visa, Cambridge University Press diabetes insipidus electrolyte levels generic januvia 100mg fast delivery. Tammi T diabetes type 1 pathology buy januvia discount, Raisio H & Ollila S (2014) Oppilaitokset ja deliberatiivisen demokratian reunaehdot: Opiskelijoiden kokemuksia kolmesta kansalaisraadista, Suomen kasvatustieteellinen aikakauskirja 3/2014. Should youth recreational work only target those young people who are already marginalised Are there other subject positions than the role model, available to take up in youth recreation work Are experiences of marginalisation necessary in order for a desirable youth recreation leader to emerge The paper is conceptual whilst incorporating findings from a small-scale empirical study undertaken in 2016. Deeper and more critical understandings of learning, commitment and achievement are generally unrecognised and largely not valued by the state, remaining in the relatively invisible domain of third sector organisations, and at the level of community activism. We see the peer educator as generally similar to the individuals with whom and the groups with which they are working. They are likely to share characteristics including some (but not all) of the following: age, gender, ethnicity, social class, educational attainment, parental status, and specific social categories which may be applicable in relation to sexual orientation, and the use of alcohol and substances. The peer educators who participated in this study have worked together in circumstances that lead to mutual benefits which stand largely outside the educational mainstream. The paper is informed by thinking on the power of informal learning, on citizenship and co-production, and by issues relating to recognition and empowerment arising from informal learning through the peer educator role. It briefly considers the potential power of peer education in an age of connectivity through communications technology. Introduction Educational achievement is increasingly measured by certification, in a society where political rhetoric speaks of equality of opportunity and offers the promise of social mobility, and social cohesion, as rewards for individual effort. Occupational hierarchies have been 113 professionalised whilst what it is to be a professional has been drained of meaning by audit and regulation mechanisms (see Fisher and Fisher 2007). Austerity politics created a need for ameliorative social policy that can be operationalised outside shrinking state funded social care (Taylor-Gooby 2013). Working class identities have been transformed by the intensification of cultures of consumption, the breakup of traditional industries, and the global flow of labour (Standing 2014) as well as by access to new technologies. Deeper conceptions of learning, commitment and achievement are largely unrecognised and unvalued by the state, remaining in the relatively invisible domain of third sector organisations. This study, in recognising aspects of the social factors indicated above, focuses on young women within a peer educator scheme operated through the charity Home-Start. Informal learning and peer educators the benefits of peer learning, based on cognitive psychology derived from the work of Jean Piaget and Lev Vygotsky and their respective traditions, have long been recognised by educationalists (Damon 1984). Our focus, however, was on the experiences and feelings of the peer educators through interactions with other peer educators and with Home-Start. Shiner highlights the significance of aims and methods arguing that peer education is `. We see the peer educator as likely to share characteristics that would include some (but not all) of: age, gender, ethnicity, social class, educational attainment, parental status, specific social categories which may be applicable in relation to sexual orientation, and, in some instances, the use of alcohol and substances. Further issues arise from being at the intersection of professional and peer cultures, and from the contradictions around what peer educators are supposed to accept or resist. Southgate and Aggleton (2017) have encapsulated issues afflicting studies of peer education. This places a focus on who the peer is, and the extent to which they embody the qualities for the specific context of their work. Southgate and Aggleton point to a need for critical theories of power relations and authority. Frost et al found that, over a six month period, 64% of the sample saw an improvement in emotional well-being, 55% saw an improvement in their informal networks, 51% saw an improvement in parenting issues (with 6% reporting a deterioration).

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General component topics include pumps blood sugar yogurt discount januvia 100mg, motors metabolic disorder glucose generic januvia 100 mg free shipping, fitting and unitary equipment diabetes diet weekly plan discount januvia amex, and air conditioner/heat pumps diabetes insipidus hypernatremia order 100mg januvia mastercard. The central idea behind Six Sigma is that if you can measure how many defects exist in a process, you can systematically eliminate them and get as close to "zero defects" as possible. This course shows students how to identify and manage processimprovement projects using the systematic, analytical Six Sigma approach. Topics include manage ment roles and responsibilities that support Six Sigma philosophy, specific analysis techniques that can be applied to a process, and inspiring case studies of company successes. Class exercises include simulations that demonstrate the application of tools and techniques. This course also prepares students to take the American Society for Quality Green Belt Certification exam. This course prepares students to fulfill the role of a Six Sigma Black Belt, providing technical guidance and mentoring to Green Belts, leadership, and other team members. Subjects include strategic planning, measuring performance, team development, and understanding the customer. Learn the design cycle, manufacturing process, and regulatory approval requirements of this fast-growing field. Courses provide theoretical and practical knowledge you can apply immediately in this 6-course (24-unit) certificate. Medical Device Engineering this certificate consists of 6 courses (24 units), including 5 required courses and 1 elective. Advance your career or enter this field by increasing your knowledge of medical device design, manufacturing, quality control, biomaterials, biocompatibility, and European and U. Courses benefit engineers, program managers, regulatory and clinical staff, and suppliers. Bioengineering Biotechnology Engineering For a complete certificate description, visit uclaextension. It covers introduction of biopharmaceutical production, process development, product characterization, quality by design (QbD), risk management, quality assurance, process scaleup and validation, manufacturing facility, biological drug regulations, process economy, outsourc ing and vendor management, and overview of key topics. Instruction also includes strategies to get products to market quickly and in a safe and efficacious fashion. It will also include strategies to get products to market quickly and in a safe and efficacious fashion. The first part of the class covers the structure and proper ties of materials used as biomaterials including ceram ics, metals, synthetic polymers, and natural materials. The structures, chemistry, and surface morphology of these materials and how these factors ultimately define the biocompatibility of a material are reviewed. The second part of the course covers host reactions to biomaterials and emphasizes on common clinical applications of biomaterials. The process of material selection for biocompatibility is introduced with regards to body responses including cell and tissue interaction, immunological responses, and toxicity and safety. Students are presented with problems of property characterization, failure analysis, and performance testing. Design criteria, material selection, performance, property retention, stability, and typical failure modes are presented. Topics include construction for site and civil work; seismic resistance; technology of basic building materials; interior and exterior finishes; and plumbing, electrical, and mechani cal systems. Instruction discusses current develop ments in materials, systems, and construction techniques in light of changing factors of production, regulatory constraints, and current trends. Civil & Environmental Engineering Construction Management For a complete certificate description, visit uclaextension. Construction Planning and Management Systems Using Primavera v Offered as Remoter Instruction. Other topics include manage ment principles, estimating, scheduling, budgeting, purchasing, design, safety, insurance, construction techniques, labor, and public relations. Instruction emphasizes the Critical Path Method approach to develop ing baseline schedules, progress measurement, earned value, integrated management systems, and asplanned versus asbuilt analysis. The course also includes hands on computerized scheduling using Primavera Systems software. Topics include the preparation of quantity surveys (takeoffs) and the development of material, labor, and equipment costs, including pricing of contractor and subcontractor work from actual working drawings and specifications.

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It is therefore essential that emergency physicians are familiar with the most common and important presentations of stridor in children uncontrolled diabetes signs and symptoms purchase discount januvia on line, to enable prompt diagnosis and appropriate management diabetes mellitus is a disorder caused by malfunction of the buy discount januvia 100 mg online. As is the case for many paediatric problems diabetes insipidus in pregnancy order januvia with paypal, a careful history and examination will often provide the likely diagnosis and enable appropriate referral for definitive diagnosis diabetes 44 magnum cheap 100 mg januvia with visa, which often involvesairwayendoscopy. History the three most important aspects of the history are the age of the child at presentation,theageofonsetanddurationofthestridor. In acute stridor, the presence of associated symptoms such as fever, cough, coryza,droolingofsaliva,difficultyswallowingandrespiratorydistresssuggests an infectious cause. Alternatively, if acute stridor is accompanied by a rash, facial or peri-orbital oedema, collapse or syncope, wheeze or vomiting, anaphylaxis should be suspected. A history of choking on food, followed by stridor and respiratorydistressmayindicatethepresenceofalaryngealforeignbody. Detailsofthe perinatal history should be obtained, including premature delivery, whether endotracheal intubation was needed and if any underlying congenital abnormalitiesarepresent. Feeding should be assessed and longitudinal weights plotted (if available), as some children with chronic stridor have an increased caloricintakeduetoongoingincreasedworkofbreathing,whichresultsinsuboptimalweightgain. Examination Timingofthestridorinrelationtotherespiratorycycleiscrucial,asthecauses of a predominantly inspiratory noise differ from those in which the stridor is biphasic(presentonbothinspirationandexpiration). Signsofincreasedworkof breathing (including nasal flaring and head bobbing in neonates, and tracheal tug, intercostal and subcostal recession in infants) indicate more severe obstruction. Bacterial tracheitis is relatively uncommon but can present with symptoms identicaltocroup,whichfailtoimprovewithstandardtreatment(corticosteroids + nebulised adrenaline). High fever and a toxic appearance are typical, although some cases can present withouttoxicsigns. Antibiotictherapythat covers the common causative bacterial pathogens (Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae) is the treatment of choice. Epiglottitisisnowararecauseofacutestridor,followingtheintroductionof universal infant immunisation against Haemophilusinfluenzae type B. Examinationoftheairwayundergeneralanaesthetic by gas induction should be arranged immediately. Once the airway has been secured by endotracheal intubation, treatment with intravenous ceftriaxone usually results in rapid resolution of epiglottic oedema, and extubation can usuallybeundertakenwithin24hours. The patient is asked to clasp both hands together in the epigastriumandfeeltheirhandsmoveoutwardoninspirationduetodescentof the diaphragm. The patient is also encouraged to consciously slow his/her breathing rate and to concentrate on expiration rather than inspiration. Once the diagnosis is made and inappropriate treatments (such as inhaled bronchodilators)stopped,breathingexercisestoencouragevocalcordabduction oninspirationarealmostalwayscurative. Early recognition and prompt administration of subcutaneous adrenaline (epinephrine)(repeatedasoftenasnecessary)aretheappropriatetreatments. Thediagnosiscanbemadeeasilyif ahistoryofchokingfollowedbyrespiratorysymptomsisobtained;however,the diagnosis is often missed if the aspiration event is not witnessed. Most airway foreignbodieslodgeinthebronchi,butonrareoccasionstheycancausepartial obstruction of the larynx. Larynx Laryngomalacia (or floppy larynx) is the most common cause of congenital stridor. Markedrecessionatrestisasignofsevereobstruction, particularly if accompanied by poor weight gain.

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