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Transitional/ Translational Justice Monday





















Aggression

9/11/2024

 
Val's Take/Conjecture
  • Especially in conceptualizing "Acts of Aggression," we're often conceptualizing these acts as acts of "Specific Intent."
  • Further, because these acts are acts of "Specific Intent" we're assuming the person is exercising "CONTROL" over these behaviors.
  • I don't necessarily think that is "WRONG" but I do think it is partial, and there are many other biological links in the chain prior to seeing the "Specific Intent."
  • Further, these BIOLOGICAL LINKS are often "But for" links --- without these biological links --- you wouldn't see the specific intent or the act.
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but-for test

The but-for test is a test commonly used in both tort law and criminal law to determine actual causation.

Scape·goat
/ˈskāpˌɡōt/noun
1. a person who is blamed for the wrongdoings, mistakes, or faults of others, especially for reasons of expediency.
When we start talking about "AGGRESSION" in human society ---- it is extremely complicated, not least of which because human beings are  AGGRESSIVE and we're "TOP PREDATOR."
I don't perceive "AGGRESSION" or "BULLYING" to be particularly rare among CHILDREN, ADOLESCENTS or ADULTS.
  • BUT there can be extreme differences in the level and intensity of that.
  • Further, most of us are trying to MASK our "AGGRESSION" --- some more successfully than others --- But usually at some point the MASK comes off.
  • As that MASKING has its limits, we try to TRANSFORM that AGGRESSION.
Further, if we weren't "AGGRESSIVE" to some extent --- we wouldn't be able to survive.

There are a lot of ways we try to deal with that "AGGRESSION" on a micro and macro level.
By and large --- we're often focused on "Who's to blame?"
  • That is not only what the LAW is focused on but it is also how we're pretty hard-wired to understand things.
  • We do need to understand "SPECIFIC" situations and "SPECIFIC" People>
  • Once you get enough EXAMPLES, I think we start seeing "PATTERNS"
  • BUT --- those patterns are generally IMPERFECT PATTERNS that need to be subject to REVISION and MODIFICATION for good cause.
I think the DSM 5 is an imperfect collection of "SYMPTOM CLUSTERS," and biological research and researchers are pushing the need to reform these CATEGORIES.
  • As CU Researchers have advised, let's get to something that is more grounded in individualized, precision medicine and "A LITTLE LESS BY THE BOOK [meaning the DSM 5]."
The UBIQUITOUS nature of:
  • Neuro-Developmental Disorders
  • Psychiatric Disorders,
  • Metabolic Problems and
  • Chronic Disease in the Society
    • is pushing new understandings.
Are "lifestyle choices" irrelevant --- no, BUT this is starting to look more complicated and in many cases DEVELOPMENTAL ISSUES and EPIGENETICS appear to be playing LARGE ROLES.
Further, maybe we knew that the IMMUNE SYSTEM was involved with Multiple Sclerosis and Cancer ---
  • How many of us knew the immune system was involved with Metabolism (this is a lot more than how much people weigh),
  • Further,  researchers are using METABOLOMIC BIOMARKERS to identify people with psychiatric disorders.
  • Maternal Immune Activation is greatly associated with neuro-developmental and psychiatric disorders.
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University of Tsukuba, Japan
Associations of the immune system in aggression traits and the role of microglia as mediators (2024)
Future anger management strategies and clinical control of excessive aggression and violent behavior may be realized by developing a therapeutic strategy that adjusts glial activity in the cerebellum. 
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Plasma and cerebrospinal fluid inflammatory markers and human aggression (2023)
A growing body of work suggests that individuals with aggressive behavior and/or aggressive tendencies have evidence of chronic, low level, inflammation as manifested by elevated circulating levels of acute phase reactant proteins and pro-inflammatory cytokines …
Aggression: Humanity's Ultimate Double-Edged Sword
One of the things that happened with the "ENLIGHTENMENT" and "WOKENESS" for that matter is people who really want to change things --- see them as SYSTEMIC.

The "Enlightenment" wasn't just a Political Enlightenment it was also a Scientific Enlightenment.

Stephen Hawking saw AGGRESSION as the primary problem facing Humanity --- and he absolutely understood that it had led to our SURVIVAL.
When we start thinking about things Systemically ---
  • We start identifying more Stakeholders
  • Often Complicated Challenges
  • The need to engage in INTEGRATIVE THINKING
  • And more often than not the need to come up with THIRD ALTERNATIVES.

Additionally, the more we start to look at this --- the more LATERAL THINKING may be possible.
What is Lateral Thinking?

"Lateral thinking (horizontal thinking) is a form of ideation where designers approach problems by using reasoning that is disruptive or not immediately obvious.

"They use indirect and creative methods to think outside the box and see problems from radically new angles, gaining insights to help find innovative solutions."
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Neurodiversity and Homelessness

8/17/2024

 
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The UK's No. 1 government & public sector news alerting service.
What can you do?

Take some time this week to reflect on how your service can further support those who are neurodiverse.

It is important that we take a person-centred approach, as every neurodivergent person has a unique pattern of strengths and challenges.

Please see a number of resources in the Neurodiversity section in our Knowledge Hub here.

It includes excellent resources to help your services to become more inclusive to those who are neurodiverse and experiencing homelessness, such as a learning disabilities and homelessness toolkit, resources from our dementia training project and an autism and homelessness toolkit.

The need to address ADHD and Criminal Justice

8/17/2024

 
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ADHD in the criminal justice system: a case for change – with Takeda

A special podcast from Spotlight, the New Statesman’s policy supplement.
(July 2024)

Excerpt from The New Statesman in the United Kingdom:
Attention deficit hyperactivity disorder (ADHD) affects millions worldwide, yet its presence within the criminal justice system is often misunderstood or overlooked. 

In this podcast we navigate the complex landscape where ADHD and the criminal justice system intercept; shedding light on the unique challenges and misconceptions faced by people with ADHD in prisons and the opportunities for improved care and support. 


From late diagnosis to repeated prison sentences, the impact of ADHD can shape outcomes in profound and often unrecognised ways. 



Host Emma Haslett is joined by Dr Tony Lloyd, the CEO of the ADHD Foundation; Sir Robert Buckland, the former Secretary of State for Justice and MP; Daley Jones, trustee at ADHD Liberty; and Sarah Templeton, an ADHD author and therapist, to explore the stories of those living at this intersection.

Val's Take/Conjecture
  • The Scandinavian Countries have recognized for awhile that there appeared to be a number of people with ADHD in their criminal justice systems.
    • Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study (2024)
  • Great Britain is issuing papers about Neuro-Diversity in the Criminal Justice System. 
    • Attention Deficit Hyperactivity Disorder (ADHD) in the Prison System (2019)
    • (UK Criminal Justice Joint Inspection) Neurodiversity in criminal justice system - more effective support needed, say inspectorates (2021).
  • Further, various members of British law enforcement are "coming out" as Neuro-Diverse --- with ADHD or Autism.   [See Police Neurodiversity Forum] That shouldn't be that surprising.
  • Additionally, certainly in Colorado, Law Enforcement and 1st Responders are advocating for resources to address their own mental health needs.
  • Clinicians, including some in Colorado, have recognized that there were a number of men with ADHD in Criminal Justice.
  • The US response is slowly starting to get more formalized.  See the University of Michigan Policing A Neurodiverse World (2024).
More recently, new paradigms are viewing Neuro-Developmental and Psychiatric Disorders as "Brain Energy" issues implicating mitochondrial dysfunction.
  • Mitochondrial-associated protein biomarkers in patients with attention-deficit/hyperactivity disorder (2019)
  • Mitochondrial Dysfunction in Attention Deficit Hyperactivity Disorder (2022)
  • Mitochondrial DNA copy number in autism spectrum disorder and attention deficit hyperactivity disorder: a systematic review and meta-analysis (2023)
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Buena Vista Correctional Complex
Warning:  The "R" word is used below.

If He Outgrew it --
What is he doing In My Prison


T. Dwaine  McCallon,  M.D.                
Medical Director, Buena Vista Correctional Facility,
Asst. Chief Medical  Officer, Colorado Dept. of Corrections  (1998)

If your ADHD is so disabling that you have found yourself living in  a remote walled  prison of over 1,000 men, then it is unlikely that you  will  progress  toward  rehabilitation without the aid of medication. 

Stimulant  medicine  can greatly enhance  the ability to learn how to develop caution and  judgment, and to learn a job  skill.

. . . Over half of these recall being told they would not need treatment beyond the teens as they would outgrow their ADD.

None whom we have worked with were treated into their twenties.18% had discovered that crystal meth on the street would give them focus and a sense of calmness.

20% found solace from the feeling of “being a meathead”, “still being the retard kid” by seeking oblivion with marijuana and heroin."

The quote above came from an article on Canadian Adult ADHD Coach Pete Quily's  website.
[Medication is controversial.  More and more genetic testing for psychiatric medication may be available --- people can have the same diagnosis and not be able to take the same medication.]
People with Neurodevelopmental Disorders and an IQ over 70 have traditionally gotten little support.

Generally, because people thought and the person themselves may have thought --- they didn't need help.

And they often don't need help "intellectually."

Further, it has been relatively recently that we've started to hone in on "Executive Functioning" challenges as a  legitimate challenge and worthy of accommodation.
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We do important work when we don't understand the issue or how to address it.

How to better understand issues and how to address them we learn through engaging with those issues.

Significant new paradigms are already here, we are also identifying biomarkers regarding ADHD and other neuro-developmental and psychiatric disorders.

Some researchers are already proposing new treatments based on new paradigms.

We need to consider the UK's policy recommendations with regard to neuro-diversity in the criminal justice system and come up with some policy recommendations of our own.

ATP, Mitochondria and Justice

8/5/2024

 
Val's Take/Conjecture
  • This is about a number of things
    • ATP -- adenosine triphosphate
    • Mitochondria
    • ROS (reactive energy species)
    • Oxidative Stress
    • Neuroinflammation
    • Maternal Immune Activation
With regard to justice, the paradigm emerging through the research provides a more comprehensive narrative of neuro-developmental and psychiatric disorders than what we had.

Further, this may lend itself to biomarkers.

That's important because there is skepticism about these neuro-developmental and psychiatric disorders.

What is most important to understand is that we are still at the stage of discovery and basic understanding, on the one hand.  On the other hand, recent discoveries are building on a long line of previous discoveries.
Even if we don't have all the answers we have enough to know that neuro-developmental and psychiatric disorders are wide-spread and more biologically complicated than we have appreciated.

This is a societal challenge and not just the burden of individual defendants, individuals in the community or their families.
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Dysfunctional mitochondrial processes contribute to energy perturbations in the brain and neuropsychiatric symptoms (2023)
Recent studies have revealed that neuropsychiatric disorders have a pro-inflammatory component in which ROS [Reactive Oxygen Species] is capable of initiating damage and cognitive malfunction.

Our current understanding of cognition suggests that it is the product of a neuronal network that consumes a substantial amount of energy.

Thus, alterations or perturbations of mitochondrial function may alter not only brain energy supply and metabolite generation, but also thought processes and behavior.

Mitochondrial abnormalities and oxidative stress have been implicated in several well-known psychiatric disorders, including schizophrenia (SCZ) and bipolar disorder (BPD).

As cognition is highly energy-dependent, we propose that the neuronal pathways underlying maladaptive cognitive processing and psychiatric symptoms are most likely dependent on mitochondrial function, and thus involve brain energy translocation and the accumulation of the byproducts of oxidative stress
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Metabolism of Autism Reveals Developmental Origins
The cell danger response is primarily regulated by adenosine triphosphate (ATP) the body’s chemical energy currency.

While these ATP-signaling pathways do not develop normally in autism, they may be partially restorable with existing pharmaceutical drugs.

In 2017, Naviaux and his team completed early clinical testing for suramin, the only drug approved in humans that can target ATP signaling and which is normally used to treat African sleeping sickness.
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Developmental Stage-Dependent Changes in Mitochondrial Function in the Brain of Offspring Following Prenatal Maternal Immune Activation (2023)
The accumulation of dysfunctional mitochondria leads to the intense release of free radicals that trigger oxidative stress and neuroinflammation, resulting in an interlinked vicious cascade.

More on anti-Social Personality disorder

8/3/2024

 
Val's Take/Conjecture
  • Researchers around the world are viewing Anti-Social Personality Disorder as related to ADHD.
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Maternal immune activation and neuroinflammation in human neurodevelopmental disorders (2021)
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Epigenetics and Neuroinflammation Associated With Neurodevelopmental Disorders: A Microglial Perspective (2022)
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Mitochondrial complex I activity in microglia sustains neuroinflammation (2024)
Academic Proposal that Anti-Social Personality Disorder is a Neuro-Developmental Disorder
We have had a tortured view of human behavior and "mental illness"  ---- there are the BIOLOGICALLY-BASED MENTAL ILLNESSES and the "OTHERS" that are not biologically-based.

Is that right?  I don't think so.

To come to terms with the BIOLOGICAL BASIS of BEHAVIOR and the influence of the ENVIRONMENT on BIOLOGY and FUTURE GENERATIONS --- that is a lot and it is fraught with peril.

We have made many steps along this road, and we need to start addressing the person (often a boy or a man) with an IQ over 70, a neuro-developmental disorder and behavior challenges.
The DSM 5, the Biological Basis of Behavior & the Need for Mitigation
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Microglia: Key players in neurodevelopment and neuronal plasticity (2018)
Highlights
  •  
  • Microglia originate in the embryonic yolk sac and migrate to the brain during prenatal development.
   
  •     Microglia survey the brain through expansion and retraction of radial processes, and are essential for normal brain development and function.
   
  •     In addition to maintaining homeostasis and responding to CNS injury, microglia regulate synaptogenesis, neuronal maturation and activity.
  
  •     Adult microglial function can be programmed by developmental insults.
  
  •     Microglial dysregulation is associated with brain aging, neurodegeneration and a range of brain pathologies.

The Complex problem of "Reasonable accommodations" for slow Processors

7/16/2024

 
Val's Take/Conjecture
  • I will be posting some traditional accommodations.
  • But what I'm really trying to get at is the complexity of Neuro-Developmental Disorders and Hyper-Connected Brains.
  • This does require Precision Medicine or at the very least Individual Assessment.
  • That individual Assessment has to include both STRENGTHS and WEAKNESSES.
  • Not all people with Neuro-Developmental Disorders are Savants, but a significant percentage have some abilities above the norm.
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Associations between ADHD traits and self-reported strengths in the general population (2024)
Results: We found positive correlations between ADHD traits and hyperfocus, sensory processing sensitivity, and cognitive flexibility. 
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Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths (2022)
The high number of children with skills in this study underscores the need for more research in this area, particularly using instruments focused on understanding the nuances of these strengths.

It is important for future studies to consider these skills in children with cognitive impairment.
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Impact of maternal immune activation and sex on placental and fetal brain cytokine and gene expression profiles in a preclinical model of neurodevelopmental disorders. (2024)
"Maternal inflammation during gestation is associated with a later diagnosis of neurodevelopmental disorders including autism spectrum disorder (ASD). However, the specific impact of maternal immune activation (MIA) on placental and fetal brain development."
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Those who were sad had rapid improvements in mood when they utilized their strongest skills.

​
           ---Jan. 23, 2022

So on the one hand it is critical to get the person in their strongest skills --- which can be quite high despite slow processing.

On the other hand, slow processing is often idiosyncratic processing that does bring practical and emotional challenges.
Often Overlooked: Slow Processing Speed

Yulika Forman, PhD, LMHC
  • Forman makes the point that processing speed issues can often look like Executive Functioning Issues.
  • Many highly intelligent people have slow processing speed and need environments that can accommodate both the slow processing speed and the intelligence..
    • This requires a lot of self knowledge that many of us just didn't have.
  • See also Careers for People with Slow Processing Speed

the Neuro-deveLopmental-Psychiatric continuum, Epigenetics &the Criminal Law

7/2/2024

 
Val's Take/Conjecture
  • Somebody is going to make a great documentary about the mess in Criminal Justice and Forensic Psychiatry in 25 years.
  • In the meantime, we need to start educating ourselves about large scientific anomalies that are raising reasonable doubt about how we handle situations involving People with Neuro-Developmental Disorders not only in the Criminal Law but also Homelessness.

It is this century that researchers refer to the Neurodevelopmental - Psychiatric Continuum and that is considered a significant Paradigm Shift.

Ultimately we need to get rid of Punishment not Safety -- and that Safety Burden will often be higher than that imposed by punishment.

As biomarkers become more and more available, it is going to be harder and harder to deny people the supports they need.

Additionally, I think as more directly practical and helpful supports are identified, more people will be interested in "treatment."

EPIGENETICS
  • The Epigenome in Neurodevelopmental Disorders (2021)

EXPOSOME
  • Exposome of attention deficit hyperactivity disorder in Taiwanese children: exploring risks of endocrine-disrupting chemicals (2021)

INFLAMMASOME
  • Inflammasome activation and regulation: toward a better understanding of complex mechanisms (2020)
  • Multiple inflammasome complexes are activated in autistic spectrum disorders (2016)

NEURODEVELOPMENTAL-PSYCHIATRIC CONTINUUM
  • Neurodevelopmental disorders-the history and future of a diagnostic concept (2020)
  • Psychotic Disorders and the Neurodevelopmental Continuum (2015)

PRECISION MEDICINE
  • Challenges and opportunities for precision medicine in neurodevelopmental disorders (2022)
  • Artificial intelligence for precision medicine in neurodevelopmental disorders (2019)
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Neurodevelopmental Disorders, Criminality, and Criminal Responsibility (2022)
{S}pecific training in NDs {Neurodevelopmental Disorders} is limited both in general psychiatry residencies and forensic psychiatry fellowships, this topic represents a common practice gap among forensic examiners.
The paper above, published in the Journal of the American Academy of Psychiatry and Law, begins to raise some important issues regarding Neuro-Developmental Disorders and Criminal Justice.

Additionally, medical assessments of the law tend to be simplistic and timid and a deeper analysis asking tougher questions is not so much side-stepped as not appreciated --- which is perhaps understandable.

On the other hand, psychiatry seems far behind the research in its own domain -- that is surprising until one realizes most medical professionals are not on top of the research. 

Further, most attorneys are not looking to become experts in the scientific research --- so if Forensic Psychiatry is behind so too are the attorneys who rely on its practitioners.

While the authors missed a lot, this nonetheless is HUGE.
Neurodevelopmental Disorders in the Criminal Law (and Homelessness) are the Elephant in the Room.
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Even a dog distinguishes between being stumbled over and being kicked
The Structure of Legal Revolutions
Psychiatry & the Criminal Justice System: Simplicity on the near side of complexity

Beyond the dsm 5 to new paradigms

4/27/2024

 
Val's Take
  • Attempted suicide is not a crime in most Western Countries, but it can serve as the basis for a Mental Health Certification.
  • Homicidality is a much more complicated issue -- and I suspect we will find bio-markers for that as well.
  • Dangerousness can also serve as a basis for a Mental Health Certification  --- but what is mental health and what's not is very subjective in 2024.
  • If "Anti-Social Personality Disorder" is really a form of ADHD according to some academics and researchers--- that matters.
  • We're at a little bit different place than just saying logically the DSM 5 doesn't hold up --- some stronger, biologically based paradigms seem to be emerging.
Decriminalization of attempted suicide law: Journey of Fifteen Decades (2015)
Internationally, Germany, in 1751, was the first country to decriminalize attempted suicide.

After the French revolution, all countries of Europe and North America subsequently decriminalized suicide.
n 1983, the Roman Catholic Church reversed the canon law that prohibited proper funeral rites and burial in church cemeteries for those who had committed suicide.

All of these developments have been instrumental in shifting attitudes about suicide in modern society.
Some countries like Scotland never considered suicide a crime and had no law for the same.

India recently announced the decriminalization of suicide, but its neighboring countries Pakistan, Bangladesh, Malaysia, and Singapore among others still continue to consider suicide a crime.
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How Many Angels Can Dance on the Head of a Pin and the Free Will vs. Determinism Debate
What is it going to take to get Mental Health Clinicians (and other clinicians) on top of the research?
  • the current general estimate to get new understandings from the researcher to clinician is 17 years.
  • that wasn't good enough for Covid
  • we don't have a SYSTEM of TRANSLATIONAL RESEARCH in this country that can bring clinicians up to speed in 6 months to a year.
  • further, so many mental health professionals are  busy chopping in the wrong forest with an unabated Mental Health Crisis--- they don't have time to incorporate significant new understandings.
  • It is easy enough to say that Researchers are far ahead of the Clinicians --- BUT THE RESEARCHERS ARE BEING PAID TO DO IT.
    • and that is a huge issue in this society.
    • Further, information overload is such a big issue and such a problematic issue in medical research that we can't expect Clinicians to solve this on their own.
Mitochondria Dysfunction --- is a hot topic for several complicated health issues, including the Neuro-Developmental/Psychiatric Continuum.  See video below.

See also Val's Tables.
Douglas C. Wallace, Ph.D.
Director, Center for Mitochondrial and Epigenomic Medicine (CMEM) Professor, Department of Pathology & Laboratory Medicine
The Children's Hospital of Philadelphia


A Mitochondrial Etiology of Common Complex Diseases
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Disability Law Colorado and an Important settlement

4/20/2024

 
Val's Take:  Building out the high end of the Continuum of Care in Medicaid Mental Health has been a fraught process.

D.J. Jaffe of the Mental Illness Policy Organization documented that in his book "Insane Consequences:  How the Mental Health Industry Fails the Mentally Ill."  I think advocates see a lot more common ground than they did 10 years ago.

Right now the scientific understandings are evolving quickly and they don't quite look like the DSM 5.  In another 10 years, Mental Health could be a much more standard medical discipline in which patients, families, Medicaid, private insurance, and the community at large would pay for medical care that included metabolomic biomarkers.

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Settlement expected to significantly improve intensive behavioral health services for Colorado youth receiving Medicaid

Pollution, damage to mitochondria and mental Ill Health

4/18/2024

 
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The lung microbiome regulates brain autoimmunity (2022)

"Our data demonstrate the existence of a lung-brain axis in which the pulmonary microbiome regulates the immune reactivity of the central nervous tissue and thereby influences its susceptibility to autoimmune disease development.
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Perspective: Cell danger response Biology-

The new science that connects environmental health with mitochondria and the rising tide of chronic illness
(2020)

PBS NewHour
Why air quality is getting worse in many places and how it puts human health at risk

2:24:  Ultra Fine Particles able to penetrate cell mitochondria.
Harvard
How Air Pollution Affects Our Brains
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    Transitional Justice is a term used by the United Nations and others to describe measures to REDRESS MASSIVE VIOLATIONS of HUMAN RIGHTS.

    ​​Translational Justice as we're using it refers to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE and is meant to echo TRANSLATIONAL MEDICINE.

    ​
    Translational Justice also means listening to those people impacted by our justice policies

    That means going 360
    ° -- that's hard work
    ​



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  • Home
    • About Orchid >
      • Why Orchid?
      • ORCHID'S SYSTEMIC FOCUS & "ROOT CAUSE" ANALYSIS APPROACH TO PROBLEM SOLVING WITH A COMMITMENT TO CREATIVITY & INNOVATION
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    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
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      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
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      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
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