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Risk factors for suicide attempts in patients with borderline personality disorder included older age women's health center elmhurst hospital order cabergoline 0.5mg without prescription, prior suicide attempts, antisocial personality, impulsive actions, and a depressed mood, but not comorbid mood disorder or substance use disorder. Ahrens and Haug (194), in a case-control study of 226 patients with a personality disorder who were admitted to a psychiatric hospital, found that patients with a personality disorder (including, but not limited to , borderline personality disorder) were more likely than other hospitalized patients to have had a suicide attempt immediately before admission, with persistent clinically relevant suicidal behavior within the first 24 hours after admission (39% versus 24%). Furthermore, in patients with a personality disorder, suicidality was not related to the presence of a specific mood disorder, since only 3% of the patients with personality disorder met the criteria for a major affective syndrome. However, the rates of reported suicide attempts in individuals with personality disorder diagnoses varied with the treatment setting. Conversely, among individuals who attempt suicide, personality disorders are commonly observed. Multiple logistic regression showed that those who made suicide attempts had a high rate of conduct disorder or antisocial personality disorder (odds ratio=3. Thus, both borderline personality disorder and antisocial personality disorder appear to occur more frequently among suicide attempters. Of those with a diagnosis, 74% had a cluster B personality disorder and 46% had a diagnosis of borderline personality disorder. Individuals with a personality disorder were more likely to have attempted suicide in the past (78%, compared to 57% of those without a personality disorder diagnosis) and were more likely to have had psychiatric treatment in their lifetime (85% versus 57%); however, those with and without personality disorders did not differ in their degree of intent, hopelessness, somatic severity, or impulsiveness. Personality disorders were associated with a high degree of comorbidity, with comorbid alcohol dependence being particularly common and associated with greater difficulty in pursuing follow-up. A number of additional factors may act as contributors to risk for suicide attempts among individuals with personality disorders. In addition, the number of previous suicide attempts was associated with having a history of substance abuse. Comorbid mood disorders are also common among suicide attempters with personality disorder diagnoses. However, those with comorbid borderline personality disorder were more likely to have a history of multiple serious suicide attempts, and past suicidal behavior was better predicted by the number of personality disorder symptoms than by the number of depressive symptoms. Thus, they suggested that the severity as well as the presence of comorbid cluster B personality disorder symptoms should be ascertained in assessing the risk of suicide attempts in patients with major depressive disorder. Compared to patients with borderline personality disorder alone, all of the depressed patients had more severe observer-rated depression and lower levels of functioning. Patients with borderline personality disorder had higher rates of impulsivity, regardless of whether depression was also present. However, the diagnostic groups did not differ in their subjective intent to die, their degree of objective planning for death, the violence of the suicide method, or the degree of physical damage in the attempt as measured by the Beck Suicide Intent Scale. In summary, individuals with personality disorders, and particularly those with a diagnosis of borderline personality disorder or antisocial personality disorder, have increased risks for suicide and for suicide attempts. The severity of symptoms such as impulsivity may also play a role in increasing risk, suggesting that such factors should be identified and addressed in the assessment and treatment of individuals with personality disorders. Specific psychiatric symptoms a) Anxiety Anxiety has been suggested to increase the risk of suicide even when a specific anxiety disorder is not present. In a review of 46 cohort or case-control studies that used standardized or structured assessments of psychological dimensions to assess psychological vulnerability to suicide, Conner et al. In these studies, the anxiety levels associated with suicide often took the form of anxious ruminations, panic attacks, or agitation and were in the severe range. Assessment and Treatment of Patients With Suicidal Behaviors 97 Copyright 2010, American Psychiatric Association. With respect to the effect of anxiety on the risk of suicide attempts, the findings are more mixed. Thus, although the relationship between anxiety and suicide attempts is unclear, and specific measures of anxiety have not been found to be predictive of suicide (78), severe anxiety does seem to increase suicide risk at least in some subgroups of patients. In particular, psychic anxiety, which may not be obvious to the clinician, should be specifically assessed, since such symptoms can respond rapidly to aggressive short-term treatment with benzodiazepines, secondgeneration antipsychotic medications, and possibly anticonvulsant medications (109). Although a score of 10 or more on the Beck Hopelessness Scale correctly identified 91% of the patients who eventually died by suicide, there was significant overidentification of at-risk patients, with a false positive rate of 88%. A later longitudinal study that included 1,958 consecutive psychiatric outpatients examined whether the level of hopelessness at intake could predict eventual suicide (221). In this patient population, those with a suicide death scored significantly higher on both the Beck Hopelessness Scale and the Beck Depression Inventory. Although a Beck Hopelessness Scale score of 10 or more was associated with an 11-fold increase in the likelihood of suicide, the specificity was again low. Since a high level of hopelessness is common in psychiatric patients, applying this Beck Hopelessness Scale cutoff to a larger population would identify 100 patients as being at risk for every one or two eventual suicides (713).
The result of this process breast cancer charities cabergoline 0.5mg free shipping, after a few centuries of exposure in a temperate climate, is a softening and slight swelling of the stone surface, which is enriched in clay, calcium carbonate, and calcium sulfate crystals in polluted urban atmospheres. These salts are then carried away by rainwater as it flows down the building surface and turn into solid substances (calcium carbonate and calcium sulfate di-hydrate, i. In the surfaces that are directly hit by the rain, the dissolved material is washed away, but they are left roughened by the corrosion process and some re-precipitated gypsum and calcite crystals are deposited in cracks and other irregularities. This condition results in an eroded surface and a drastic change in the optical properties of the material. Light penetration creates the color of all objects because some of the wavelengths included in the white sunlight spectrum are absorbed by the particular system of atoms and bonds existing in the material (the color seen is the one that is complementary to the color absorbed). The roughening of surfaces gives rise to light scattering, that is, a dispersion of white light caused by the irregularities of the surface; the consequence of scattering is that part of the light is not allowed to penetrate inside the material and so the color fades, to disappear completely when light scattering is intense. Roman travertine, as an example, has a light brown color when its surface is smooth, as it is when used inside a house with a smooth finish; but the surfaces of the Roman churches that are washed by the rain are completely white because of the scattering caused by the eroded surfaces and the tiny crystals of gypsum hidden in their irregularities. Light scattering is reduced when the surfaces are wet and may be more permanently controlled by surface treatments. The surface of the stones is not dissolved-it even undergoes a slight increase in volume-but its strength is reduced and fissures appear on its surface; later in the process a transformed surface layer several millimeters thick shows a tendency to detach from the unchanged core. Volcanic rocks show a far better resistance than clay-matrix sandstones, but in the long run thick, softened layers are formed also on their surfaces, and particularly so in the case of stones like granite, where the thermal movements of large crystals create fissures that facilitate water penetration. If the relative humidity of the surrounding air is rather high, it may well happen that the temperature of the surface material drops below the dew point of the air (the temperature at which the relative humidity reaches 100%, i. Physicists who study atmospheric processes named this phenomenon "dry deposition" somewhat improperly, because after all some water is involved, even if much less than in the case of rain. Actually condensation in a city is a rather nasty thing because when water vapor condenses on a surface it sweeps away from the air all solid and gaseous impurities it contains, a dirty and dangerous material in a polluted urban atmosphere. Deterioration of Porous Building Materials 93 In a temperate climate not too close to the sea, condensation would occur at least half of the nights in winter and spring; in Venice, a very damp city surrounded by a lagoon, it has been said to occur about 80% of the nights throughout the year. In the country, the dust of the surrounding soils and vegetal pollens would provide a lighter coloration. Condensation may also sweep away the acids from the atmosphere or, alternatively, the gases may form the acids by reacting with oxygen on the wet solid surface with the help of catalysts provided by the deposited particles. If some penetration is possible, the acid liquid may reach inside the surface materials in the millimeter range, to react there with the solids according to the schemes discussed earlier in this section. In daytime the cycle is reversed because the dew evaporates when the temperature is higher and the air is drier, but only the water goes away while all the matter that was deposited during the previous night remains on the surface. The result of this chemical process is some weakening of the internal material that was affected by the acids and some consolidation of the particles that were deposited on the surface by dew condensation. Rainwater washes away all deposited material from the surfaces it impacts, or where it is allowed to run, causing the type of damage that was discussed earlier. Deterioration of Porous Building Materials 95 After some years of exposure to rain/dew cycles, the appearance of a historic building in a polluted atmosphere would be considerably changed because all surfaces protected by the cornices and other architectural details would be black, while those washed by the rain would be eroded and blanched by scattering. Furthermore, the penetration of acids might have affected some areas susceptible to deterioration because of defects, natural or induced by human activity (a typical example is relief work in which microscopic cracks are opened by prolonged chisel work); these might appear sound under the dark surface crust, but they may be on the verge of a collapse that could be precipitated by a random impact or periodical thermal expansion stresses. It is not surprising, therefore, to see that the symptoms and the velocity of decay processesarequitevariablenotonlyindifferentlocationsbutevenwithinthe samebuilding. Thepresentconservationtechnologywasdevelopedinthesecondhalfof thetwentiethcentury;itisaimedatmitigatingthedecayfactors,reconstitutingthe cohesion of the materials if compromised by the foregoing events, and delaying theonsetoftheunavoidablefuturedecayprocesses. What technology can offer today is instead a sequence of operations, with several options available at each step, whoseresultsmaybetrustedonlywithinthe limits of a service life that,asthingsarenow,isnotexceedinglylong. Among the available options, the most suitable should be chosen according to the results of preliminary inquiries on the structure of materials and the causes of deterioration;thematerialsthatwillbeusedshouldbetestedtoevaluatetheir durability under the conditions they are going to face, and so to estimate the servicelife,attheendofwhichtheywillhavetoberepairedorsubstituted. Wethinknowthattheaimofconservationtechnologyshouldnotbeextreme durability,butratheraservicelifeoftwentytotwenty-fiveyears,thetaskofthe present generation of conservators being to hand over the "cultural property" in goodconditiontothenextone,which,wehope,willhavebettermeansandbetter knowledgeatitsdisposal. Today,however,someofthematerialsweusedonotallowforeseeingaservicelifelongerthantenyearsorevenless;asaconsequence,asystemofperiodic Conservation of Architectural Surfaces 97 inspection and maintenancemustbesetupastheonlypossibleguaranteeforlongtermconservation.
Fir seeds store well for 3 to 10+ years in sealed containers (Allen 1957; Gradi 1966) pregnancy labor and delivery purchase cabergoline online now, but such containers are not a panacea if the seeds have not been properly prepared (Gradi 1966; Tumbarello 1960). Experiences with fir-seed storage durations and conditions have been amply reported (Allen 1957; Carrillo and others 1980; Isaac 1930a, 1934; Issleib 1956; Larsen 1922; Roe 1948b; Rohmeder 1953; Rudolf 1952; Schubert 1954; Vilmorin 1944; Vlase 1960), and cryopreservation of fir seeds also has had some success (Jorgensen 1990; Neuhoferova 1994; Stanwood and Bass 1978). In principle, storage temperature is of greater significance when seed moisture content is high and, conversely, has less effect when moisture content is low (Barton 1953; Magini and Cappelli 1964a&b). For firs in general, the critical safe moisture level appears to lie between 5 and 8% of seed fresh weight (Wang 1974). Dormancy in fir may be both physical and physiological, but it apparently does not reside in the embryo, because embryos excised from unstratified noble fir seeds grow just as well as those from stratified seeds (Edwards 1969). Reasons for fir seed dormancy may be poor oxygen exchange or an inhibitor, because chipping the seedcoat to expose and remove a sliver of megagametophyte was as effective as (or more so than) stratification in stimulating germination of seeds of noble, Pacific silver, and grand firs (Edwards 1969) and European silver fir (Gogala and Vardjan 1989). Stratification also probably overcomes dormancy by reducing the mechanical restraint of the tissues surrounding the embryo (Edwards 1962, 1969; Jones and others 1991; Speers 1962; Wang 1960). Although stratification is routinely prescribed for European silver and Fraser firs, there are reports (Speers 1967; Zentsch and Jahnel 1960) that some seedlots of both species show little or no dormancy. The only way to determine whether or not a lot is dormant is to perform 2 germination tests-one with stratified seeds and one with unstratified seeds (Edwards 1962). The response to stratification may be regarded as an indicator of the degree of dormancy in the lot; after stratification, more-dormant seedlots germinate more rapidly than less dormant lots. In noble fir, an increasing response to stratification as the seeds matured suggested that dormancy increased also, and that dormancy and maturity are interrelated (Edwards 1969). Whereas much of the variability in dormancy among seedlots may be attributable to seed origin, crop year, and time of collection, it may also be due to methods of cone processing, seed cleaning, and seed storage (Franklin 1974b; Wang 1960). Laboratory and nursery stratification is often performed by refrigerating previously hydrated seeds in plastic bags or other containers-the "naked stratification" method (Allen and Bientjes 1954) favored in many nurseries for its ease of seed handling. More traditionally, dry seeds (at storage moisture contents) are placed on a moist medium (filter paper, vermiculite, or wet sand) and refrigerated. The moist filter paper method produced higher germination in noble fir because it was believed that the preliminary water soak that is the first step in the naked stratification procedure damaged the seeds by too-rapid tissue hydration, a phenomenon well-documented in legumes (Jones and others 1991). However, no direct evidence for the damage, particularly its location, was provided. It was found that noble fir embryos require hydration of between 48 and 72 hours, even at room temperature, before they absorb enough moisture to be safely excised (Edwards 1969). Furthermore, when dry noble fir seeds are placed on a moist medium and refrigerated, they absorb water slowly during the entire chilling period and achieve a higher moisture content than seeds soaked in water at room temperature for the same length of time (Edwards 1971). Thus, in the above comparison, the moisture content of soaked seeds averaged 36%, whereas that of seeds chilled on moist filter papr averaged 43% (Jones and others 1991). This difference, small as it may appear, may have been significant due to the moisture content in soaked seeds possibly being less than adequate for optimal stratification to occur. In the development of the stratification/redry method (see below), it was found that if fir seeds were initially hydrated only to 35% moisture content (the same moisture content achieved after redrying), subsequent stratification was far less effective (Edwards 1986). If noble fir seeds are sensitive to imbibitional damage as claimed (Jones and others 1991), then the stratification/redry method-which involves a preliminary soak at room temperature-must repair such damage since germination is greatly increased. However, no evidence for this repair, or the initial imbibitional-damage phenomenon, has been documented. In any event, crop year, seed source, seed vigor (as distinct from seed quality), as well as chilling method and germination temperature played roles in the response of different seedlots of Pacific silver fir to stratification (Leadem 1986).
Obesity identification menstruation 8 weeks postpartum order 0.5mg cabergoline amex, assessment and management of overweight and obesity in children, young people and adults. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a metaanalysis and systematic literature review. Reversal of type 2 diabetes: normalisation of beta cell function in associa tion with decreased pancreas and liver triacylglycerol. Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational followup study. Effects of anti obesity drugs, diet, and exercise on weightloss maintenance after a verylowcalorie diet or lowcalorie diet: a systematic review and metaanalysis of randomized controlled trials. Effects of adding exercise to a 16week very lowcalorie diet in obese, insulindependent type 2 diabe tes mellitus patients. Comparison of a lowenergy diet and a very lowenergy diet in sedentary obese individuals: a pragmatic randomised controlled trial. Improved nutri tional status and bone health after dietinduced weight loss in sedentary osteoarthritis patients: a prospective cohort study. Daytime pattern of postexercise protein intake affects wholebody protein turnover in resistance trained males. Comparison of three different weight maintenance programs on cardiovascu lar risk, bone, an vitamins in sedentary older adults. Risk of sympto matic gallstones and cholecystectomy after a verylowcalorie diet or lowcalorie diet in a commercial weight loss pro gramme: 1year matched cohort study. Preoperative weight loss with a very lowenergy diet: quantitation of changes in liver and abdominal fat by serial imaging. Changes in body composition induced by pre operative liquid lowcalorie diet in morbid obese patients undergoing RouxenY gastric bypass. Effect of weight loss on the cardiovascular risk profile of obese patients with psoriasis. Effects of antiobe sity drugs, diet, and exercise on weightloss maintenance after a verylowcalorie diet or lowcalorie diet: a systematic review and metaanalysis of randomized controlled trials. Weight lossinduced plasticity of glucose transport and phos phorylation in the insulin resistance of obesity and type 2 dia betes. Low energy diet and intracranial pressure in women with idio pathic intracranial hypertension: prospective cohort study. Multicenter evaluation of an inter disciplinary 52week weight loss program for obesity with regard to body weight, comorbidities and quality of life: a pro spective study. Interventions using a group format offer a model of obesity treat ment that facilitates social interaction and peer sup port and can allow health professionals to reach a wider number of people. There are examples of the effectiveness of group interventions in other areas of health improvement such as diabetes education  and smoking cessation ; however, evaluation of effective weight management group processes has received less attention. It is often assumed that programmes provided in a onetoone setting are transferable to groupbased settings and vice versa. However, planning, leading and managing groups call for different skills from those employed in onetoone interventions for weight management. In addition, there are consid erations such as the group composition, group set ting, treatment length and leadership style. Health professionals currently have very little guidance on how to deliver effective group interventions. This chapter explores the use of groupbased interven tions across a range of obesity treatments and exam ines evidence for the effectiveness of groupbased approaches for obesity management in adults. Research literature relating to group processes and group dynamics comes mainly from fields such as behavioural and social psychology and sociology. However, aspects such as defining groups and their characteristics in healthimprovement contexts have not been ade quately described .
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Registrar & CEO of PNG Security Industries Authority
Manager Finance & Administration
Manager Licencing & Compliance
Front left – right Ms Margaret Biskum- Security Inspector New Guinea Islands, Ms Alicia Nana – Executive Secretary & Mrs Mackey Kembi Office Janitor
Back left – right Mr. Rinson Ngale – Security Inspector NCD/Southern Region, Mr. Emmanuel Tumbe HR Officer, Mr. Elijah Fave – Accounts Officer, Mr. Andrew Kaiap – I.T Officer
Front left – right Ms Nelison Roberts – Office Secretary / Reception , Mr. Elvis Otare – Office Admin Assistance / Driver & Acting Momase Region Inspector
Back left – right Vacant – Office Manager & Security Inspector Momase Region, Mr. Pius Moi – Acting Office Manager Security Inspector Highlands Region
Visit us at the Top floor of the Former Fraud Squad blue building, Gorobe Street, Badili, 2 Mile, Port Moresby NCD or Lae at Post Office Building, second street, top floor, suite # 14, Lae Morobe Province or write to the Chairman Security Industries Council PO BOX 80 Port Moresby National capital District. You can also contact Manager Licensing & Compliance – Mr. Spencer Gelo on telephone 3239851 / 3257930, or email email@example.com
The Registrar now invites all the registered security companies, service receivers and interested stake holders for their written submission to amend the current Security Protection Act to cover many grey areas of the law.
The submissions should clearly state what provisions of the current Security Protection Act 2004 and the Security Protection regulation 2012 are to be amended to enhance the growth of the industry. This is necessary in light of numerous complaints from the security companies and interested stake holders of the short falls in the current Act which is said to be hindering the growth of the industry.
All submissions must be dropped at The Authority Head Office: Former Fraud Squad Office, Top Floor, Gorobe Street, 2 Mile Drive, Badili,Boroko NCD in Port Moresby. They can also be posted or emailed using the address on the last page. Copies of the current Security Protection Act 2004 can be obtained at the Security Industries Authority office for K35 to use as a guide to prepare the submissions.