(i) safely reducing unnecessary criminal justice interactions, including by advancing alternatives to arrest and incarceration; supporting effective alternative responses to substance use disorders, mental health needs, the needs of veterans and people with disabilities, vulnerable youth, people who are victims of domestic violence, sexual assault, or trafficking, and people experiencing homelessness or living in poverty; expanding the availability of diversion and restorative justice programs consistent with public safety; and recommending effective means of addressing minor traffic and other public order infractions to avoid unnecessarily taxing law enforcement resources;
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Legislation S.4970-A/A.1023-A requires enhanced reporting by law enforcement to the state and federal gun databases. Agencies must report seized or recovered guns to the criminal gun clearinghouse; participate in the ATF's collective data sharing program; and enter the make, model, caliber, and serial number of the gun into the national crime information center.
Assemblymember Linda Rosenthal said, "Gun violence is the number one leading cause of death among our nation's young people. Our inaction in the face of so much preventable carnage is a national embarrassment. In light of the continued federal paralysis, New York is taking the lead once again to crack down on guns. Microstamping is a vital tool that will help law enforcement solve crimes. With a clearance rate on gun crimes of 30% in New York City, microstamping will help get dangerous criminals and their guns of the streets. This is one of the best ways to end the viscous cycle of violence. I am grateful to Speaker Heastie for his leadership on this issue and to Governor Hochul for signing it into law."
Erie County Executive Mark C. Poloncarz said, "Large numbers of Americans support common sense gun laws that protect our citizens, close loopholes, and prevent weapons of mass violence from being used in our communities. As we all know too well, too many lives have been destroyed, families devastated and much pain suffered by victims, their loved ones and communities from gun violence to let this moment pass. This law is a major achievement and an announcement to America that New York State is united and focused against gun violence. I thank Governor Hochul and our state Assembly and Senate leadership for their swift action. This comprehensive legislative package will help to save lives, protect our residents, and take guns out of the hands of people who should not have them."
Scarce treatment resources. The allocation of vast sums of money to law enforcement diminishes the funds available for drug education, preventive social programs and treatment. As crack use rose during the late 1980s, millions of dollars were spent on street-level drug enforcement and on jailing tens of thousands of low level offenders, while only a handful of public drug treatment slots were created. An especially needy group -- low-income pregnant women who abused crack -- often had no place to go at all because Medicaid would not reimburse providers. Instead, the government prosecuted and jailed such women without regard to the negative consequences for their children.
Would drugs be more available once prohibition is repealed? It is hard to imagine drugs being more available than they are today. Despite efforts to stem their flow, drugs are accessible to anyone who wants them. In a recent government-sponsored survey of high school seniors, 55 percent said it would be "easy" for them to obtain cocaine, and 85 percent said it would be "easy" for them to obtain marijuana. In our inner-cities, access to drugs is especially easy, and the risk of arrest has proven to have a negligible deterrent effect. What would change under decriminalization is not so much drug availability as the conditions under which drugs would be available. Without prohibition, providing help to drug abusers who wanted to kick their habits would be easier because the money now being squandered on law enforcement could be used for preventive social programs and treatment.
Natalie had been in other residential programs before RSAT and had not found them effective. After leaving prison, she did return to substance use briefly before desisting for some time. At the time of her interview, she reported that she had relapsed for a few months at the beginning of the current year and became pregnant at the end of that period, and now she felt that she would be clean for good.
In some cases, the cervical block is all that is needed. In other cases, its effects wear off. If a cervical block successfully numbed the pain, it is likely that a patient will have a good response to radiofrequency ablation. If it does not, the patient probably is not a good candidate for radiofrequency ablation.
How much pain is relieved after the procedure varies from person to person. It can take three or more weeks for the full effects of radiofrequency ablation to be felt. The pain relief may last six months to a year or even longer. Sometimes, nerves do grow back. In such cases, the radiofrequency ablation may need to be repeated.
This guideline's purpose is to provide direction to clinicians and patients regarding how torecognize interstitial cystitis /bladder pain syndrome (IC/BPS); conduct a valid diagnostic process; and approach treatment with the goals of maximizing symptom control and patient quality of life (QoL) while minimizing adverse events (AEs) and patient burden. The strategies and approaches recommended in this document were derived from evidence-based and consensus-based processes. IC/BPS nomenclature is a controversial issue; for the purpose of clarity the Panel decided to refer to the syndrome as IC/BPS and to consider these terms synonymous. There is a continually expanding literature on IC/BPS; the Panel notes that this document constitutes a clinical strategy and is not intended to be interpreted rigidly. The most effective approach for a particular patient is best determined by the individual clinician and patient. As the science relevant to IC/BPS evolves and improves, the strategies presented here will require amendment to remain consistent with the highest standards of clinical care.
Sexual dysfunction has an especially important impact on the QoL of IC/BPS patients. In IC/BPS patients, sexual dysfunction is moderate to severe44 and occurs at high rates compared with controls.45, 46 In women with treatment-refractory IC/BPS, poor sexual function is a primary predictor of poor mental QoL.47 Pain appears to mediate sexual dysfunction and its associated effects on QoL. Adult women with IC/BPS report rates of intercourse, desire, and orgasm frequency in their adolescence that are similar to those reported by controls, but rates diverge in adulthood, when IC/BPS patients report significantly more pain and fear of pain with intercourse and more sexual distress.45
The clinical diagnosis of IC/BPS requires a careful history, physical examination, and laboratory examination to document basic symptoms that characterize the disorder and exclude infections and other disorders (see Figure 1: IC/BPS Diagnostic and Treatment Algorithm).69-72 The clinical history should include questions about symptom duration. IC is a chronic disorder and symptoms should be present for at least six weeks with documented negative urine cultures for infection. The number of voids per day, sensation of constant urge to void, and the location, character and severity of pain, pressure or discomfort should be documented. Dyspareunia, dysuria, ejaculatory pain in men, and the relationship of pain to menstruation in women should also be noted.
Conflicting information is not surprising given that studies have been conducted on different patient populations and have had different purposes (e.g., documenting disease course versus treating the disease in the context of a controlled trial). It is clear, however, that there is a limited understanding of IC/BPS pathophysiology and that most treatments are targeted at symptom control. In addition, treatment studies suggest that no single treatment works well over time for a majority of patients. Until more definitively effective therapies are identified, the treatment approach should be tailored to the specific symptoms of each patient in order to optimize QoL. To optimally treat patients with a more complex presentation and/or when standard treatment approaches are ineffective, urologists may need to partner with other clinicians such as primary care providers, nurse practitioners, registered dietitians, physical therapists, pain specialists, gastroenterologists, and/or gynecologists.
Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately. Clinical Principle
Patients should be educated on normal bladder function and what is known and not known about IC/BPS. Patients should be made aware that it is typically a chronic disorder requiring continual and dynamic management and. of that no single treatment has been found to be effective for a majority of patients. Adequate symptom control is achievable but may require trials of multiple therapeutic options to identify the regimen that is effective for that patient. Patients should be counseled that identifying an effective pain relief regimen may require multiple trials of different medications in order to identify the medication(s) that produce optimal effects for that particular patient. Further, patients should be informed that, given the chronic nature of IC/BPS, the typical course involves symptom exacerbations and remissions. 2ff7e9595c
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