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By: L. Tragak, M.A., Ph.D.
Program Director, Florida Atlantic University Charles E. Schmidt College of Medicine
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If the halting and uncertain transition to stable democracy in Iraq has shown anything, it is that in the absence of security, civil society cannot sur vive, let alone thrive. This means, rst and foremost, that Palestinian citizens must feel safe in the streets and in their homes. In a successful state, they would be con dent that they enjoy equal recourse to law enforcement if they are robbed or injured by crimi nals, that crimes will be investigated swiftly and professionally, and that a criminal jus tice system will adjudicate such cases fairly and with due process. Citizens of the new state would be correspondingly con dent that they will not be subjected to political persecution under cover of judicial or police authority. Tus, the rst objective of this chapter is to show how a structure for the e ective and impartial administration of justice can be built in Palestine. Among other factors, the analy sis explores the infrastructural, training, equipping, sta ng, and monitoring require ments for the development of a judicial and police system in a society that has never had one. Given the level of internecine violence that now marks Palestinian society and the striking incapacity of the Palestinian Authority to monopolize the use of force, the possibility of armed confrontation between opposition movements and the state after independence cannot Internal Security 35 be disregarded. The proliferation of heavily armed militias and gangs and a spreading ethos that favors suicidal violence as a mode of political self-expression are harbin gers of a potentially grim and turbulent future. The increasingly permeable boundary between authorized law enforcement and paramilitary entities and terrorist organiza tions darkens this picture even more. The present study, which focuses on the decade following independence, assumes that much of this intramural violence will have been stanched prior to statehood. It is also possible that a well-established opposition group, like Hamas, will support an insurgency in pursuit of a religiously based political and social order that a majority of Palestinian voters would reject. A variety of other such rationales for insurrection could plausibly be postulated, especially in an environment where poverty is widespread, and there is no recent tradition of trust in governmental authority or belief in its primacy. Spe ci cally, we ask how best to restructure the existing welter of security-related entities, ensure that they are not only well-trained and equipped, but accountable and transpar ent in their operations and in the strongest position possible to stave o or counter violent challenges to the constitutional authorities of the new state. First, we provide a historical overview that high lights key issues since the 1993 Oslo Accords. Second, we identify the most important challenges confronting the Palestinian internal security system, including conditions that might engender renewed internal strife. Tird, we outline options for an e ective internal security system that helps promote domestic order and a durable peace with Israel. Historical Overview this section o ers a brief overview of the key historical issues since the September 1993 Declaration of Principles on Interim Self-Government Arrangements (Oslo Accords) and the May 1994 Agreement on the Gaza Strip and the Jericho Area.
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It ventilation syndrome, carpopaedal spasm (tetany), basically consists of: paraesthesias and loss of consciousness may occur. Neurotic, Stress-related and Somatoform Disorders 107 these symptoms are produced by hypocapnia (or ii. A short rest cycle to be voluntarily introduced the diagnosis is usually easy, if the possibility after each respiratory cycle. This produces technique is to have the patient re-breathe the the classical physical symptoms. Re-breathing in a paper bag, Treatment which is carried by the patient, quickly reverts the 1. Breathing more from the abdomen, thus avoid this is a common syndrome, often known by a large ing the use of accessory muscles of expiration. The patients usually present with one or more of the following symptoms: Premenstrual syndrome or premenstrual tension 1. Alteration of bowel habits (diarrhoea or constipa terised by a variety of physical, psychological and tion). Typically, the symptoms start after Quite often, all three features (abdominal pain a few days of ovulation, reach a peak about 4-5 days and diarrhoea alternating with constipation) are before menstruation and disappear usually around present together; also associated is atulence. The period between menstruation and patients often describe their stools in a dramatic next ovulation is normal. It is oedema, weight gain, swelling of breasts, a sense of more or less a stable disorder with frequent exacerba bloating of abdomen), gastroenterological changes, tions. The typical mode of onset or exacerbation is with the aetiology is probably multifactorial. The occurrence of a psychosocial stressor or emotional biological factors include faulty luteinisation, excess upheaval. Physiologically, there are two changes pos of oestrogens, and progesterone de ciency. Hypomotility, which is often associated with pain and attitudes towards menstruation and femininity less diarrhoea. Hypermotility, which presents clinically as painful Treatment constipation or rarely painful diarrhoea. The treatment of water retention can be by diu Treatment retics, and restricting the uid intake. Supportive psychotherapy is best carried out in (an aldosterone antagonist) is probably superior. Psychotherapy may be helpful in some cases where these patients often resent psychiatric referrals. Hormonal treatment with oral or parenteral pro aimed at dealing with stressors are very helpful.
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The personality change should be significant and be associated with inflexible and maladaptive behaviour not present before the pathogenic experience. The change should not be a direct manifestation of another mental disorder or a residual symptom of any antecedent mental disorder. The disorder is characterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of "being on edge" as if constantly threatened, and estrangement. The cause of these disorders is not understood and they are grouped together because of broad descriptive similarities, not because they are known to share any other important features. Excludes: habitual excessive use of alcohol or psychoactive substances (F10-F19) impulse and habit disorders involving sexual behaviour (F65. The hair-pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification. Many fetishes are extensions of the human body, such as articles of clothing or footwear. Other common examples are characterized by some particular texture such as rubber, plastic or leather. In some cases they simply serve to enhance sexual excitement achieved in ordinary ways. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. The patient is commonly distressed by this pain or disability, and is often preoccupied with worries, which may be justified, of the possibility of prolonged or progressive disability or pain. The motivation is obscure and presumably internal with the aim of adopting the sick role. Degrees of mental retardation are conventionally estimated by standardized intelligence tests. These can be supplemented by scales assessing social adaptation in a given environment.
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In the last section, I discuss the conclusions and suggest directions for future research. This question, as well as previous observations, led to the hypothesis that shy users prefer whistling. In addition to shyness, other factors are expected to affect the preferences and patterns of interaction. These may include age, gender, cultural background, social context, and physiological limitations. This seems to correspond with the following finding by Sporka and Kurniawan during a user study of their Whistling User Interface [Sporka et al. However, from a technical point of view, whistling produces purer sound, and therefore is more precise, especially in melodic mode. First Experimental Design and Setting the first experiment involved observing, writing field-notes, and studying video and voice recordings of players while they interacted with Expressmas Tree as a game during its exhibition in a canteen at Middlesex University. The experiment was conducted with one participant at a time while passers-by were watching. Participants were then given a questionnaire to record their age, gender, nationality, previous use of a voice-controlled application, why they stopped playing, whether playing the game made them feel embarrassed or uncomfortable, and which sound they preferred using and why. The aim was to find possible correlations between shyness levels, gender, and preferences and patterns of interaction. Results: As the tree was set up to look as indistinguishable as possible from a conventional Christmas tree, passers-by had to be informed that it was interactive. Those who were with friends were more likely to come and explore the installation. The presence of friends seemed to encourage shy people to start playing (Figure 66).
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Medication side effects are common contributors to nutritional problems in 15 Medical Management of Cerebral Palsy 235 this group of patients and should always be considered. For instance, practitioners may only consider the possibility of clinically signi cant gastroesophageal re ux when parents report chronic vomiting, but discomfort after meals, early satiety, or unexplained respiratory problems [41] may also be presenting signs. Swallowing Persons with cerebral palsy are at increased risk for dysphagia, which can affect their health in several ways. Dysphagia with aspiration may result in or contribute to recurrent pulmonary infections or reactive airway disease. It can limit food choices and compromise the ef ciency of intake, contributing to impaired nutrition. However, just as in the discussion of gastroesophageal re ux earlier, dysphagia may not always present as clinicians might expect. When documented to aspirate, most individuals with cerebral palsy do so silently, meaning they do not cough at the time of aspiration [42]. Thus, practitioners must have a high index of suspicion for dys phagia and seek indirect signs and symptoms of aspiration, such as congestion or wet vocal quality with meals. Dysphagia should also be sought in persons with recurrent pneumonia or reactive airway disease of unexplained cause or severity. Reliable assessment of swallowing coordination requires uoroscopic visualiza tion of swallow during intake of barium-containing foods and beverages. These studies are performed with the individual seated in a neutral position and are done in conjunction with a speech pathologist or occupational therapist with feeding experience. The therapist reviews a videotape of the study before interpretation, as aspiration can be missed at the time in a busy uoroscopic suite. Bedside assessments and upper gastrointestinal series studies cannot substitute for a formal video uoroscopic study, and ultrasound assessment remains investigational [44]. A thorough report will comment on risk factors for aspiration, such as residue in the valleculae and pyriform sinuses and laryngeal penetration, as well as the presence and frequency of aspiration. It should also discuss what compensations, if any, were seen to be effective, such as thickness and rate of ow of liquids given. If no liquid consistency can be found to be safe, alternative modes of nutrition and hydration need to be considered. Gastrointestinal Just as control of the muscles of the limbs and trunk is affected in cerebral palsy, so is the smooth muscle of the gastrointestinal tract. Persons with cerebral palsy have a high incidence of gastroesophageal re ux and constipation and may have altered gut motility as well, resulting in delayed gastric emptying and intestinal dysmotility [45]. Both gastroesophageal re ux and constipation can impair nutritional intake and 236 N. Re ux can contribute to acute and chronic pulmonary problems [46] and can be a source of blood loss leading to chronic anemia and to dental erosions [47]. Gastroesophageal re ux in persons with cerebral palsy differs from those in the general population in incidence more than treatment.