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In the absence of relevant re- to evaluate all these considerations when developing treat- search order discount ayurslim online, panels should be cautious about generalizing to ment guidelines 60 caps ayurslim sale. Good guidelines comment on evidence for the applicability of the treatment Clinical Utility to different cultural groups generic ayurslim 60 caps online. Important components of research addressing the issue of the patient’s gender (a this dimension include the generalizability of the interven- social characteristic) and sex (a biological characteris- tion across settings and the feasibility of implementing the tic) purchase ayurslim with amex. Interventions that are of demonstrable efficacy with intervention with various types of patients and in various male patients may not be applicable to female patients and settings. Interventions that are extent to which the intervention will be effective in the of demonstrable efficacy with middle-aged patients may practice setting where it is to be applied, regardless of the not be equally applicable for children or geriatric patients. The evaluation of clinical utility involves the assess- of the treatment for different age groups. Many aspects of clinical utility are them- take into account research and clinical consensus on selves increasingly the focus of systematic evaluation and other relevant patient characteristics. Good effect of a treatment is robust and therefore will be repli- guidelines comment on evidence for the applicability of the cated even when details of the context are altered. Relevant treatment to individuals with differing characteristics that factors include patients’ characteristics, health care profes- are relevant to the success of the intervention. Such factors as the professional’s skill, experience, gender, Factors such as age, gender, language, and ethnicity can all language, and ethnic background can affect outcome in affect treatment outcomes. To the extent possible, guide- take into account the effect of the health care profes- lines take into account the appropriateness of the treatment sional’s training, skill, and experience on treatment for patients characterized by each of the factors considered outcome. It is plexity and idiosyncrasy of patients’ clinical presenta- recommended that guidelines take into account whether the tions, including severity, comorbidity, and external recommended treatment was originally implemented by stressors. Successful treatment of the individual may well take into account the effects on treatment outcome of require attention to each problem. Good guidelines provide interactions between the patient’s and the health care for the treatment of patients as they present themselves in professional’s characteristics, including but not limited real-world settings. Interventions sarily, be affected by differences in backgrounds or eth- that are of demonstrable efficacy with one ethnic, cultural, nicities of the health care professional and the patient. A treatment with proven effectiveness in one type of setting Treatments may have adverse effects. Guideline panels should consider what training is a protocol, differing time frames for delivering treatment, required of the health care professional and whether it is and differing modes of delivering treatment (e. It may also be helpful for guidelines Feasibility to consider whether professionals might be reluctant to Feasibility refers to the extent to which a treatment can be deliver an intervention because the cost of completing it delivered to patients in the actual setting. Feasibility eval- exceeds the resources available, because the equipment is uation addresses such factors as the acceptability of the not available, or because it relies heavily on an incompat- intervention to potential patients, patients’ ability and will- ible treatment approach or theoretical orientation. When they do, costs need to considered sepa- of feasibility may also include consideration of the cost of rately from effectiveness and determined broadly. Scientific and clinical evidence of the effectiveness of There are many reasons why individual patients may prefer treatment and consideration of the costs of treatment are not to receive particular treatments, regardless of their conceptually distinct. Any integration of factors as pain, expense, duration, fear, side effects, ad- cost and effectiveness must be open and explicit. Patient choice may increase the clinical term costs to the patient, to the professional, and to the utility of a given intervention. Similarly, the unwilling- health care system, as well as the costs associated with ness of a patient to accept a specific treatment may withholding treatment. Some treatment interventions may require or delaying treatment may include the patient’s loss of time both in- and out-of-session activity on the part of the from work and disability costs. If the patient is unwilling or unable to participate in Cost savings associated with an intervention may in- treatment requirements, the intervention will not be effec- clude prevention of future disorders, as when an early tive. Sometimes patients do not adhere to treatment regi- intervention with a childhood disorder obviates the need for mens because of negative side effects or concern about treatment later on. Patients may also be unwilling or unable to vention makes other treatments unnecessary. For example, self-monitor activities, engage in or sustain new behaviors, interventions such as smoking cessation programs and di- or take medications regularly. Providing appropriate psychosocial ser- potential conflicts of interest should be described in the vices may also reduce medical visits in primary care. It is recommended that re- The process by which guidelines are developed includes sulting comments be fully and fairly considered by the not only the deliberations of the guideline panel, discussed panel before it makes final recommendations and above, but also the steps by which the panel was formed conclusions. Care members disagree on the interpretation and signifi- in constituting a balanced panel to develop guidelines can cance of specific evidence, these disagreements be noted help ensure that panel members will be able to evaluate the in the guidelines. Other panels include one or more individuals with expertise in guidelines may be more narrowly targeted. Determination the delivery of services in the subject area or areas of the target audience may affect the specific data-gathering under consideration. Sets of panels include one or more individuals with expertise in guidelines may be published in multiple versions, each one the scientific methodology of intervention evaluation in suitable to the needs of the specific audience. The panel should consider the be evaluated through such mechanisms as examining the evidence appropriate to the treatments being examined. Ascertaining whether the guidelines are inter- be reviewed and revised periodically to ensure that they preted and applied consistently by health care professionals do not become obsolete. Typically, reliabil- panel specify a time frame for a revision of the guide- ity would be approximated by independent review of the lines. Guidelines in treatment areas where knowledge is guidelines by alternative groups with equivalent expertise. Diagnostic and statistical retrospectively by independent consideration of the sub- manual of mental disorders (4th ed. Template for developing evaluate the evidence, and the relationship between the guidelines: Interventions for mental disorders and psychosocial aspects evidence and the ultimate recommendations. International statistical classification of diseases and related health problems (10th rev. Geneva, Swit- they lead to better therapeutic outcomes in the target pop- zerland: Author. International classification of func- vening them have the added responsibility of encouraging tioning, disability, and health. This guideline is more than 5 years old and has not yet been updated to ensure that it reflects current knowledge and practice. In accordance with national standards, including those of the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse (http://www. The March 2005 Guideline Watch associated with this guideline provides additional information that has become available since publication of the guideline, but it is not a formal update of the guideline. Specific Treatment Strategies for the Clinical Features of Borderline Personality Disorder. Standards of medical care are determined on the basis of all clinical data available for an individual patient and are subject to change as sci- entific knowledge and technology advance and practice patterns evolve. Adherence to them will not ensure a successful outcome for every individual, nor should they be interpreted as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psy- chiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. This practice guideline has been developed by psychiatrists who are in active clinical prac- tice. In addition, some contributors are primarily involved in research or other academic endeavors. It is possible that through such activities some contributors, including work group members and reviewers, have received income related to treatments discussed in this guide- line. A number of mechanisms are in place to minimize the potential for producing biased recommendations due to conflicts of interest. Any work group member or reviewer who has a potential con- flict of interest that may bias (or appear to bias) his or her work is asked to disclose this to the Steering Committee on Practice Guidelines and the work group. Treatment of Patients With Borderline Personality Disorder 5 Copyright 2010, American Psychiatric Association. This guideline contains many sections, not all of which will be equally useful for all readers. The following guide is designed to help readers find the sections that will be most useful to them. Part A contains the treatment recommendations for patients with borderline personality disorder. Section I is the summary of treatment recommendations, which includes the main treatment recommendations along with codes that indicate the degree of clinical confidence in each recommendation.

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Particulars of the charge or charges on which the prisoner of war is to be arraigned buy generic ayurslim 60 caps on line, as well as the documents which are generally communicated to the accused by virtue of the laws in force in the armed forces of the Detaining Power discount ayurslim 60caps line, shall be communicated to the accused prisoner of war in a language which he understands discount ayurslim 60 caps fast delivery, and in good time before the opening of the trial buy ayurslim without prescription. The same communication in the same circumstances shall be made to the advocate or counsel conducting the defence on behalf of the prisoner of war. The representatives of the Protecting Power shall be entitled to attend the trial of the case, unless, exceptionally, this is held in camera in the interest of State security. He shall be fully informed of his right to appeal or petition and of the time limit within which he may do so. This communication shall likewise be sent to the prisoners’ representative concerned. The Detaining Power shall also immediately communicate to the Protecting Power the decision of the prisoner of war to use or to waive his right of appeal. Furthermore, if a prisoner of war is finally convicted or if a sentence pronounced on a prisoner of war in the first instance is a death sentence, the Detaining Power shall as soon as possible address to the Protecting Power a detailed communication containing: 1) the precise wording of the finding and sentence; 2) a summarized report of any preliminary investigation and of the trial, emphasizing in particular the elements of the prosecution and the defence; 3) notification, where applicable, of the establishment where the sentence will be served. The communications provided for in the foregoing sub- paragraphs shall be sent to the Protecting Power at the address previously made known to the Detaining Power. These conditions shall in all cases conform to the requirements of health and humanity. A woman prisoner of war on whom such a sentence has been pronounced shall be confined in separate quarters and shall be under the supervision of women. In any case, prisoners of war sentenced to a penalty depriving them of their liberty shall retain the benefit of the provisions of Articles 78 and 126 of the present Convention. Furthermore, they shall be entitled to receive and despatch correspondence, to receive at least one relief parcel monthly, to take regular exercise in the open air,to have the medical care required by their state of health,and the spiritual assistance they may desire. Penalties to which they may be subjected shall be in accordance with the provisions of Article 87, third paragraph. Throughout the duration of hostilities, Parties to the conflict shall endeavour, with the co-operation of the neutral Powers concerned, to make arrangements for the accommodation in neutral countries of the sick and wounded prisoners of war referred to in the second paragraph of the following Article. They may, in addition, conclude agreements with a view to the direct repatriation or internment in a neutral country of able- bodied prisoners of war who have undergone a long period of captivity. No sick or injured prisoner of war who is eligible for repatriation under the first paragraph of this Article, may be repatriated against his will during hostilities. The conditions which prisoners of war accommodated in a neutral country must fulfil in order to permit their repatriation shall be fixed, as shall likewise their status, by agreement between the Powers concerned. In general, prisoners of war who have been accommodated in a neutral country, and who belong to the following categories, should be repatriated: 1) those whose state of health has deteriorated so as to fulfil the conditions laid down for direct repatriation; 2) those whose mental or physical powers remain, even after treatment, considerably impaired. If no special agreements are concluded between the Parties to the conflict concerned, to determine the cases of disablement or sickness entailing direct repatriation or accommodation in a neutral country, such cases shall be settled in accordance with the principles laid down in the Model Agreement concerning direct repatriation and accommodation in neutral countries of wounded and sick prisoners of war and in the Regulations concerning Mixed Medical Commissions annexed to the present Convention. The appointment, duties and functioning of these Commissions shall be in conformity with the provisions of the Regulations annexed to the present Convention. Prisoners of war who do not belong to one of the three foregoing categories may nevertheless present themselves for examination by Mixed Medical Commissions, but shall be examined only after those belonging to the said categories. The physician or surgeon of the same nationality as the prisoners who present themselves for examination by the Mixed Medical Commission, likewise the prisoners’ representative of the said prisoners, shall have permission to be present at the examination. Prisoners of war detained in connection with a judicial prosecution or conviction and who are designated for repatriation or accommodation in a neutral country, may benefit by such measures before the end of the proceedings or the completion of the punishment, if the Detaining Power consents. Parties to the conflict shall communicate to each other the names of those who will be detained until the end of the proceedings or the completion of the punishment. In the absence of stipulations to the above effect in any agreement concluded between the Parties to the conflict with a view to the cessation of hostilities, or failing any such agreement, each of the Detaining Powers shall itself establish and execute without delay a plan of repatriation in conformity with the principle laid down in the foregoing paragraph. In either case, the measures adopted shall be brought to the knowledge of the prisoners of war. The costs of repatriation of prisoners of war shall in all cases be equitably apportioned between the Detaining Power and the Power on which the prisoners depend. This apportionment shall be carried out on the following basis: a) If the two Powers are contiguous, the Power on which the prisoners of war depend shall bear the costs of repatriation from the frontiers of the Detaining Power. The Parties concerned shall agree between themselves as to the equitable apportionment of the remaining costs of the repatriation. The conclusion of this agreement shall in no circumstances justify any delay in the repatriation of the prisoners of war. On repatriation, any articles of value impounded from prisoners of war under Article 18, and any foreign currency which has not been converted into the currency of the Detaining Power, shall be restored to them. Articles of value and foreign currency which, for any reason whatever,are not restored to prisoners of war on repatriation,shall be despatched to the Information Bureau set up under Article 122. Prisoners of war shall be allowed to take with them their personal effects, and any correspondence and parcels which have arrived for them. The weight of such baggage may be limited, if the conditions of repatriation so require, to what each prisoner can reasonably carry. Each prisoner shall in all cases be authorized to carry at least twenty-five kilograms. The other personal effects of the repatriated prisoner shall be left in the charge of the Detaining Power which shall have them forwarded to him as soon as it has concluded an agreement to this effect,regulating the conditions of transport and the payment of the costs involved, with the Power on which the prisoner depends. Prisoners of war against whom criminal proceedings for an indictable offence are pending may be detained until the end of suchproceedings,and,ifnecessary,untilthecom pletionofthe punishment. The same shall apply to prisoners of war already convicted for an indictable offence. Parties to the conflict shall communicate to each other the names of any prisoners of war who are detained until the end of the proceedings or until punishment has been completed. By agreement between the Parties to the conflict, commissions shall be established for the purpose of searching for dispersed prisoners of war and of assuring their repatriation with the least possible delay. Death certificates, in the form annexed to the present Convention, or lists certified by a responsible officer, of all persons who die as prisoners of war shall be forwarded as rapidly as possible to the Prisoner of War Information Bureau established in accordance with Article 122. The death certificates or certified lists shall show particulars of identity as set out in the third paragraph of Article 17, and also the date and place of death, the cause of death, the date and place of burial and all particulars necessary to identify the graves. The burial or cremation of a prisoner of war shall be preceded by a medical examination of the body with a view to confirming death and enabling a report to be made and, where necessary, establishing identity. The detaining authorities shall ensure that prisoners of war who have died in captivity are honourably buried, if possible according to the rites of the religion to which they belonged, and that their graves are respected, suitably maintained and marked so as to be found at any time. Wherever possible, deceased prisoners of war who depended on the same Power shall be interred in the same place. Deceased prisoners of war shall be buried in individual graves unless unavoidable circumstances require the use of collective graves. Bodies may be cremated only for imperative reasons of hygiene, on account of the religion of the deceased or in accordance with his express wish to this effect. In case of cremation, the fact shall be stated and the reasons given in the death certificate of the deceased. In order that graves m ay always be found, all particulars of burials and graves shall be recorded with a Graves Registration Service established by the Detaining Power. Lists of graves and particulars of the prisoners of war interred in cemeteries and elsewhere shall be transmitted to the Power on which such prisoners of war depended. Responsibility for the care of these graves and for records of any subsequent moves of the bodies shall rest on the Power controlling the territory, if a Party to the present Convention. These provisions shall also apply to the ashes, which shall be kept by the Graves Registration Service until proper disposal thereof in accordance with the wishes of the home country. Statements shall be taken from witnesses, especially from those who are prisoners of war, and a report including such statements shall be forwarded to the Protecting Power. If the enquiry indicates the guilt of one or more persons, the Detaining Power shall take all measures for the prosecution of the person or persons responsible. Neutral or non-belligerent Powers who may have received within their territory persons belonging to one of the categories referred to in Article 4, shall take the same action with respect to such persons. The Power concerned shall ensure that the Prisoners of War Information Bureau is provided with the necessary accommodation, equipment and staff to ensure its efficient working. It shall be at liberty to employ prisoners of war in such a Bureau under the conditions laid down in the Section of the present Convention dealing with work by prisoners of war. Within the shortest possible period, each of the Parties to the conflict shall give its Bureau the inform ation referred to in the fourth, fifth and sixth paragraphs of this Article regarding any enemy person belonging to one of the categories referred to in Article 4, who has fallen into its power. Neutral or non-belligerent Powers shall take the same action with regard to persons belonging to such categories whom they have received within their territory. The Bureau shall immediately forward such information by the most rapid means to the Powers concerned, through the intermediary of the Protecting Powers and likewise of the Central Agency provided for in Article 123. This information shall make it possible quickly to advise the next of kin concerned. The Information Bureau shall receive from the various departments concerned information regarding transfers, releases, repatriations, escapes, admissions to hospital, and deaths, and shall transmit such information in the manner described in the third paragraph above.

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A record of disciplinary punishments shall be maintained by the camp commander and shall be open to inspection by representatives of the Protecting Power buy ayurslim 60caps line. Premises All premises in which disciplinary punishments are undergone shall conform to the sanitary requirements set forth in Article 25 cheap ayurslim 60caps without a prescription. A prisoner of war undergoing punishment shall be enabled to keep himself in a state of cleanliness cheap ayurslim 60caps fast delivery, in conformity with Article 29 quality 60 caps ayurslim. Officers and persons of equivalent status shall not be lodged in the same quarters as non-commissioned officers or men. Women prisoners of war undergoing disciplinary punishment shall be confined in separate quarters from male prisoners of war and shall be under the immediate supervision of women. In no case may he be deprived of the benefits of the provisions of Articles 78 and 126. A prisoner of war awarded disciplinary punishment may not be deprived of the prerogatives attached to his rank. Prisoners of war awarded disciplinary punishment shall be allowed to exercise and to stay in the open air at least two hours daily. They shall be allowed, on their request, to be present at the daily medical inspections. They shall receive the attention which their state of health requires and, if necessary, shall be removed to the camp infirmary or to a hospital. They shall have permission to read and write, likewise to send and receive letters. No moral or physical coercion may be exerted on a prisoner of General war in order to induce him to admit himself guilty of the act of principles which he is accused. No prisoner of war may be convicted without having had an opportunity to present his defence and the assistance of a qualified advocate or counsel. The death sentence cannot be pronounced on a prisoner of war unless the attention of the court has, in accordance with Article 87, second paragraph, been particularly called to the fact that since the accused is not a national of the Detaining Power, he is not bound to it by any duty of allegiance, and that he is in its power as the result of circumstances independent of his own will. A prisoner of war shall from not be confined while awaiting trial unless a member of the armed sentence, forces of the Detaining Power would be so confined if he were treatment) accused of a similar offence, or if it is essential to do so in the interests of national security. Any period spent by a prisoner of war in confinement awaiting trial shall be deducted from any sentence of imprisonment passed upon him and taken into account in fixing any penalty. The provisions of Articles 97 and 98 of this Chapter shall apply to a prisoner of war whilst in confinement awaiting trial. This period of three weeks shall run as from the day on which such notification reaches the Protecting Power at the address previously indicated by the latter to the Detaining Power. The said notification shall contain the following information: 1) surname and first names of the prisoner of war, his rank, his army, regimental, personal or serial number, his date of birth, and his profession or trade, if any; 2) place of internment or confinement; 3) specification of the charge or charges on which the prisoner of war is to be arraigned, giving the legal provisions applicable; 4) designation of the court which will try the case, likewise the date and place fixed for the opening of the trial. The same communication shall be made by the Detaining Power to the prisoners’ representative. If no evidence is submitted, at the opening of a trial, that the notification referred to above was received by the Protecting Power, by the prisoner of war and by the prisoners’ representative concerned, at least three weeks before the opening of the trial, then the latter cannot take place and must be adjourned. Failing a choice by the prisoner of war, the Protecting Power shall find him an advocate or counsel, and shall have at least one week at its disposal for the purpose. The Detaining Power shall deliver to the said Power, on request, a list of persons qualified to present the defence. Failing a choice of an advocate or counsel by the prisoner of war or the Protecting Power, the Detaining Power shall appoint a competent advocate or counsel to conduct the defence. The advocate or counsel conducting the defence on behalf of the prisoner of war shall have at his disposal a period of two weeks at least before the opening of the trial, as well as the necessary facilities to prepare the defence of the accused. He may also confer with any witnesses for the defence, including prisoners of war. He shall have the benefit of these facilities until the term of appeal or petition has expired. Likewise, information regarding the state of health of prisoners of war who are seriously ill or seriously wounded shall be supplied regularly, every week if possible. The Information Bureau shall also be responsible for replying to all enquiries sent to it concerning prisoners of war, including those who have died in captivity; it will make any enquiries necessary to obtain the information which is asked for if this is not in its possession. All written communications made by the Bureau shall be authenticated by a signature or a seal. The Information Bureau shall furthermore be charged with collecting all personal valuables, including sums in currencies other than that of the Detaining Power and documents of importance to the next of kin, left by prisoners of war who have been repatriated or released, or who have escaped or died, and shall forward the said valuables to the Powers concerned. Such articles shall be sent by the Bureau in sealed packets which shall be accompanied by statements giving clear and full particulars of the identity of the person to whom the articles belonged, and by a complete list of the contents of the parcel. Other personal effects of such prisoners of war shall be transmitted under arrangements agreed upon between the Parties to the conflict concerned. The International Committee of the Red Cross shall, if it deems necessary, propose to the Powers concerned the organization of such an Agency. The function of the Agency shall be to collect all the information it may obtain through official or private channels respecting prisoners of war, and to transmit it as rapidly as possible to the country of origin of the prisoners of war or to the Power on which they depend. It shall receive from the Parties to the conflict all facilities for effecting such transmissions. The High Contracting Parties, and in particular those whose nationals benefit by the services of the Central Agency, are requested to give the said Agency the financial aid it may require. Such societies or organizations may be constituted in the territory of the Detaining Power or in any other country, or they may have an international character. The Detaining Power may limit the number of societies and organizations whose delegates are allowed to carry out their activities in its territory and under its supervision, on condition, however,that such limitation shall not hinder the effective operation of adequate relief to all prisoners of war. The special position of the International Committee of the Red Cross in this field shall be recognized and respected at all times. As soon as relief supplies or material intended for the above- mentioned purposes are handed over to prisoners of war, or very shortly afterwards, receipts for each consignment, signed by the prisoners’ representative, shall be forwarded to the relief society or organization making the shipment. At the same time, receipts for these consignments shall be supplied by the administrative authorities responsible for guarding the prisoners. They shall be able to interview the prisoners, and in particular the prisoners’ representatives, without witnesses, either personally or through an interpreter. Representatives and delegates of the Protecting Powers shall have full liberty to select the places they wish to visit. Visits may not be prohibited except for reasons of imperative military necessity, and then only as an exceptional and temporary measure. The Detaining Power and the Power on which the said prisoners of war depend may agree, if necessary, that compatriots of these prisoners of war be permitted to participate in the visits. The delegates of the International Committee of the Red Cross shall enjoy the same prerogatives. The appointment of such delegates shall be submitted to the approval of the Power detaining the prisoners of war to be visited. Any military or other authorities, who in time of war assume responsibilities in respect of prisoners of war, must possess the text of the Convention and be specially instructed as to its provisions. General Each High Contracting Party shall be under the obligation to observations search for persons alleged to have committed, or to have ordered to be committed, such grave breaches, and shall bring such persons, regardless of their nationality, before its own courts. It may also, if it prefers, and in accordance with the provisions of its own legislation, hand such persons over for trial to another High Contracting Party concerned, provided such High Contracting Party has made out a prima facie case. Each High Contracting Party shall take measures necessary for the suppression of all acts contrary to the provisions of the present Convention other than the grave breaches defined in the following Article. In all circumstances, the accused persons shall benefit by safeguards of proper trial and defence, which shall not be less favourable than those provided by Article 105 and those following of the present Convention. Once the violation has been established, the Parties to the conflict shall put an end to it and shall repress it with the least possible delay. The Swiss Federal Council shall arrange for official translations of the Convention to be made in the Russian and Spanish languages. A record shall be drawn up of the deposit of each instrument of ratification and certified copies of this record shall be transmitted by the Swiss Federal Council to all the Powers in whose name the Convention has been signed, or whose accession has been notified. Thereafter, it shall come into force for each High Contracting Party six months after the deposit of the instrument of ratification. The Swiss Federal Council shall communicate the accessions to all the Powers in whose name the Convention has been signed, or whose accession has been notified. The Swiss Federal Council shall communicate by the quickest method any ratifications or accessions received from Parties to the conflict. The denunciation shall be notified in writing to the Swiss Federal Council, which shall transmit it to the Governments of all the High Contracting Parties. The denunciation shall take effect one year after the notification thereof has been made to the Swiss Federal Council. However, a denunciation of which notification has been made at a time when the denouncing Power is involved in a conflict shall not take effect until peace has been concluded, and until after operations connected with the release and repatriation of the persons protected by the present Convention have been terminated.

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They include: • Schools and universities • Hospitals, clinics, and health care providers • Social service agencies, including homeless shelters, day care centers, and senior centers Private service providers that receive Federal grants, contracts, or aid must comply with the same non-discrimination requirements under the Rehabilitation Act. Public accommodations (and other private entities covered by the Rehabilitation Act) must not discriminate in offering or providing their goods or services against individuals on the basis of their past, current or perceived disability. This means they must ensure individuals enjoy equal opportunity to participate and benefit from the facility’s goods and services, and receive goods or services in the most integrated setting possible. Example: Susan went to her friend’s primary care doctor because she had a terrible headache. The doctor refused to examine Susan because “we do not treat people on methadone” and said that she should go to the local health department instead. People do not need a lawyer to do this, and it can be faster and easier than a lawsuit and result in the same remedies. File a complaint with the nearest field office, which can be located at http://www. They may know of local resources and be able to provide information to educate employers, government agencies, and others who are discriminating. You can also try an Internet search typing the name of your state or city and the words “human rights agency. Those found liable for discrimination may be directed to stop discriminating, enact new policies, and/or pay money to the individual who suffered discrimination to compensate for out-of-pocket losses and other harm. Federal laws prohibit such discrimination in employment, housing, public accommodations, and government services. This brochure as well as the resources it references should help address concerns by employers and others who might otherwise discriminate. In the event that discrimination cannot be prevented through education, legal means are available through complaints with government agencies and lawsuits in court. New at least five years of market exclusivity depending on drugs have an enormous positive influence on global the time between patent validity and U. The lives, increasing life spans, reducing suffering, pharmaceutical industry is heavily dependent on the preventing surgeries and shortening hospital stays. Drug therapy is now an integral part of designed to cover past and future R&D expenditures. See below for a breakdown of pharmaceutical product Generics that are sold under the chemical name are sectors: known as “commodity generics. Drugs are produced in forms such as pills, Biologics (biotech drugs, biological drugs, tablets, capsules, vials, ointments, powders, solutions biopharmaceuticals) include a wide range of products and suspensions. In contrast to chemically Innovative (originator) chemically-derived drugs are synthesized drugs, which have a well-defined structure developed through extensive R&D and clinical trials in and can be thoroughly verified, biologics are derived both humans and animals. Department of Commerce | International Trade Administration | Industry & Analysis structure. Biologic medicines are revolutionizing the being released too early, allowing the drug to treatment of cancer and autoimmune disorders and are disintegrate into particles small enough to quickly 5 critical to the future of the industry. Gaining regulatory approval in pharmacopeias), including purity, toxicity and developed markets is far more complex for biosimilars absorption rates. Those that succeed will also have to Key Findings: Top Markets and Methodology compete with the originator companies who are unlikely to exit the market. The biosimilars market is This Top Markets Report examines 50 different markets expected to increase significantly with an approval in terms of economic development, value of U. Prices of exports, aging populations, per capita pharmaceutical biosimilars may not be drastically cheaper than their spending, degree of price controls, intellectual property 7 protection and other factors that contribute to patented counterparts. Though ranked lower, there are growing to determine that the product is safe to dispense opportunities in developing countries like China as without a prescription. Rankings of price the United States remains the global leader in controls are primarily sourced from a study by the innovative R&D investment, producing more than half 10 Information Technology & Innovation Foundation. See Appendix for performed in the United States has become more detail on methodology, data used, and full increasingly expensive relative to emerging economies rankings. Conditions that limited R&D offshoring in the past, such Economic impact as market proximity and availability of talent, are rapidly shifting. Directly strengths include an intellectual property system that and indirectly, the industry supports over 3. Although manufacturing jobs supported by the industry are considered the most rigorous in the world, the world’s expected to decline over the next decade due to largest scientific research base fostered by academic continued productivity gains, it will remain an institutions and decades of government research important source of high paying jobs, providing salaries funding, and robust capital markets. Around half of new medicines fail in the late stages of clinical trials, and even those Research and development (R&D) that succeed often fail to make a profit. Only two of out of 10 medicines generate returns that 1 The pharmaceutical sector has consistently been one of exceed average R&D costs. In the United States, more than 90 percent of the most R&D intensive industries in the United States. As a result, prices are comparatively manufacturing and research, and organizing mergers high to make up for lower profits in other countries and and acquisitions (M&As). The United States also has high per capita incomes, unmatched access to healthcare, a A long string of M&As over the last few years has led to large elderly population, a culture of end-of-life a more concentrated global industry with both prolongation, high rates of chronic diseases and drug innovative and generics companies engaging in consumption and a strong consumer preference for acquisitions of all sizes. All of these factors contribute to it smaller, more focused innovator companies for new being, by far, the world’s largest pharmaceutical drugs to accelerate the R&D process. The lines between market with $333 billion in sales in 2015, about triple innovator and generic companies or between the size of its nearest rival, China. The United States pharmaceutical and biotechnology companies have will remain the world’s most important market for the become increasingly blurred, and most major foreseeable future with healthy growth expected multinationals now incorporate both biologics and across all product sectors. As the prevalence of biosimilars grows, the high Industry trends manufacturing and regulatory costs involved in developing these drugs further clouds traditional Fast growing segments of the pharmaceutical market distinctions between innovative and generic business 18 include biologics and generics. Although generics make up only 22 percent products such as biologics, or imported from Western of total prescription sales, its share of filled European countries, such as Ireland, Germany and prescriptions has risen from 19 percent in 1984 to 88 Switzerland. The high volume and low value manufacturing, as imports account for only around a reflects an extremely competitive sector with low-cost quarter of the market by value. Nevertheless, the sheer imports adding increasing pressure on domestic size of the U. It also points to high saturation in at over $86 billion in 2015, making it the world’s largest the U. The industry is adjusting to a more competitive low cost manufacturing bases for foreign-derived sales environment by shifting manufacturing and other will inhibit the export potential of U. For example, most of the low value active Comparative effectiveness determinations and value- pharmaceutical ingredients and excipients used in based pricing are also starting to be mandated by some finished drugs in the United States are manufactured countries and insurers, who require evidence of cost 20 abroad, particularly in China and India. Products and savings or a clear clinical benefit before including new substances may cross borders at several points in the products in their formularies. Due to product perishability and into outcomes-based contracts with pharmaceutical supply chain costs, foreign companies tend to have companies. Such systems will force pharmaceutical substantial manufacturing operations in the United companies to dramatically adjust their business models States to better access the market. Likewise, there is from simply selling medicines to managing outcomes significant U. Doing so will require increased in foreign markets, such as Ireland and Singapore, from cooperation with the broader healthcare community which companies export to third countries. There are throughout government, academia, hospitals, also a growing number of product-based strategic technology providers and so on to build health alliances and joint ventures between U. The worldwide market for pharmaceuticals is projected Developing markets to grow from around $1 trillion in 2015 to $1. Several global demographic and economic markets in Asia, Latin America and elsewhere, where trends are driving pharmaceutical consumption, pharmaceutical sales are forecast to expand at double including a rapidly aging world population and an digit rates. Further reforms of legislative systems, associated rise in chronic diseases, increased especially regarding patent protection and urbanization and higher disposable incomes, greater enforcement, as well as improving regulatory government expenditure on healthcare and growing conditions, will make these markets increasingly demand for more effective treatments.

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