By J. Ayitos. Washington & Jefferson College.

The majority of cases with sig- nificant nerve damage either involve detainees who are intoxicated or have a clear history of excessive pressure being applied by the officers (5) generic dapoxetine 60 mg. Intoxica- tion may cause problems through a decreased awareness of local pain safe dapoxetine 60 mg, marked uncooperativeness buy 90mg dapoxetine with amex, or poor memory for the restraining episode when a signifi- cant struggle occurred. It is possible to have nerve damage with no skin break- age, reflecting undue pressure. Although some of the quoted studies predate the introduction of rigid handcuffs, because of the similar ratchet mechanism, direct pressure problems are still possible. Sensory nerve damage causes loss of pain, touch, and temperature sen- sation over an area of skin that is smaller than the nerve’s sensory supply because of the considerable overlap between the sensory territories of adja- cent peripheral nerves. Lesser degrees of damage lead to tingling, pain, and numbness in the appropriate sensory distribution. In acute compression of the nerve, symptoms appear more or less abruptly, and relief of this acute com- pression should lead to resolution in the course of some weeks. Associated motor weakness can be demonstrated by the correct clinical test within the hand. It should be noted that compression of the radial nerve at the wrist does not result in weakness. There was little formal training with these, but actual use was not that common, either because they were not terribly effective or the situations faced at that time could be dealt with differently. In 1993, trials of both side-handled and numerous straight batons were introduced, because there was a rise in the number of officers injured on duty and the adequacy of their equipment was called into question. Weighing approx 600 g with a shaft of polycarbonate plastic or aluminium, it has a fixed grip at right angles to the shaft toward one end. The addition of the handle to the shaft makes it versatile, with more than 30 blocking and striking techniques available to the officer. Correct use in stressful and challenging situ- ations requires extensive and ongoing training. It is carried unobtrusively on the belt and does not impede the general movement of the officer. This gives more weight distally, but it is prone to becoming flattened and rough over time because the baton is closed by striking this end against the ground. The acrylic patrol baton has a solid or hollow nylon shaft with a ring of rubber separating the shaft and handle. It is broader than the friction lock type and, therefore, less likely to cause injury because the imparted energy is spread over a larger area. The heavier weights of these types of batons are used in public order disturbances. In the United States, a 26-in hickory (wooden) straight baton is used (similar to group 3 in the previous list). The situation throughout the Austra- lian states is variable, with intrastate differences relating to specific police staff; for example, plain clothes staff may use an Asp-type baton, whereas uniformed officers are equipped with straight or side-handled batons. Strikes are made from an officer’s strong (dominant) or weak (nondominant) side, and clearly the potential for injury varies with the baton mass and velocity at impact, the target area, and to how much of the surface area the force is applied. Although no body area is absolutely forbidden to strike, an officer must use a proportionate response to the situation he or she faces knowing the potential to injure. Although target areas are divided into low-, medium-, and high-risk areas, maintaining a distinction between them can be difficult because strikes are made in dynamic situations where an initial target area may change as the potential detainee moves. Target areas with a low injury potential are the areas of the common peroneal, femoral, and tibial nerves on the legs and those of the radial and median nerves on the arms. There is a low probability of permanent injury, with the main effects being seen as short-lived motor nerve dysfunction, as in a “dead leg” and bruising. The medium injury potential areas involve bones and joints, including the knees and ankles, wrist, elbow, hands, upper arms, and clavicle. In these cases fractures, dislocations, and more extensive soft tissue injuries would be expected. Finally, those areas with the highest risk of injury include the head, neck and throat, spine, kidneys, and solar plexus. The most common injury is bruising, and this is often in the pattern of so-called “tramline bruising,” where two parallel lines of bruising are sepa- rated by a paler area. This is not unique to a baton injury but reflects an injury caused by any cylindrical hard object. The absence of bruising or other find- 200 Page ings does not mean that a baton was not used because, for example, a degree of cushioning can occur from clothing. It is possible for a detainee to have signs but minimal symptoms or even be unaware of being struck. Fractures need to be considered where there are the traditional clinical signs of local pain, swelling, and loss of function. Considering the forces that can be applied when necessary, there is the potential for significant injury with bruising and rupture of internal organs, including the heart, liver, spleen, or kidneys or a head injury. The forensic physician should refer suspected cases for hospital review without delay, es- pecially if a confirmatory history for events is unavailable. Particular care is needed in those who are intoxicated because they are difficult to assess. Because they cannot be released them- selves, snips to cut them are always available at the same time. Although quick and easy to apply, they have no way of being locked in position, so they can tighten in an uncontrolled manner, resulting in direct compression injuries. At least two ties are used on each detainee; one is placed on each wrist and then interlocked with the other. These plastic constraints are used in preplanned operations, where numerous arrests are expected or in special- ized operations. Excessive force, either directly applied by the officer or from a detainee continuing to move, can result in strains to joints, such as the wrist, elbow, and shoulder. Officers in the United Kingdom are not trained in any neck holds because of the high risk of serious injury or death as a result of large blood vessel or airway compression. Fatalities can occur quickly, and if a detainee complains of such holds being used, the neck should be examined carefully. Petechial bruising should be looked for in the face, particularly in and around the eyes, on the cheeks, and behind the ears. It is common for clothing to be held in a struggle to restrain, which may tighten it around the neck. Linear bruising Medical Issues of Restraint 201 may be seen at the site of tightening, as well as petechial bruising on the neck and above on the face. Clearly, the tactical firearms units are often required in these situations, but there is an increasing trend to look for other “nonlethal” options, which will incapacitate with a lower risk of serious injury. In the United Kingdom, the investigation of firearm inci- dents under the auspices of the Police Complaints Authority with its attendant recommendations is a major influence when looking at developments in this area (7). Different countries use different restraint equipment, such as water cannon or the firing of different projectiles (e. They were first introduced in Northern Ireland in 1970; 125,000 rounds have been fired, and 17 fatalities have resulted, the last one occurring in 1989.

Transudative effu- phagocytosis buy 60 mg dapoxetine free shipping, one cannot differentiate hemorrhage sions do not clot purchase 30mg dapoxetine amex. These poorly cellular fluids contain from peripheral blood contamination of the sample purchase dapoxetine 90mg amex. Transudates occur as a result of oncotic pres- likely contaminated with peripheral blood during the sure changes or other circulatory disturbances. Thrombocytes disappear rap- same causes for abdominal transudative effusions in idly in hemorrhagic effusions. These include cytosis is made by the detection of macrophages that hepatic cirrhosis, cardiac insufficiency and hypopro- have phagocytized erythrocytes (suggestive of recent teinemia. Hemosiderin appears as diamond-shaped, cytes predominate in this type of effusion with occa- golden crystals within the macrophage cytoplasm. Reactive Malignant effusions have features of either exuda- mesothelial cells tend to be round or oval with in- tive or hemorrhagic effusions, but contain cells com- creased cytoplasmic basophilia (Color 10. The nuclei have coarse chromatin and promi- result of blockage of blood or lymphatic vessels. Multinucleation, cytoplasmic vacuola- adenocarcinomas of the ovary of older female birds tion and mitotic activity are often associated with are a common cause of malignant effusions. Proliferation of mesothe- effusions can resemble hemorrhagic or exudative ef- lial cells results in the exfoliation of mesothelial cell fusions that contain epithelial cells with features of aggregates that appear as cellular sheets, balls or malignant neoplasia. Care should be taken not to aggregates of balls or rosettes and have cytoplasmic mistake these cells for malignant neoplasia. Transudative and modified transudative the abdomen of birds when urinary fluids leak into effusions are commonly found in the abdominal cav- the abdominal cavity. The cytology of the acute lesion ity of mynah birds suffering from hemochromatosis. These crystals Exudative effusions are characterized by high cellu- are the same ones found in the urate portion of the larity (total cell counts usually greater than 5000 bird’s droppings. The milky the cells found in exudative effusions are inflamma- appearance of this type of abdominal effusion resem- tory cells (Color 10. If demonstrate primarily a heterophilic inflammatory the bird survives this condition long enough, inflam- response; however, macrophages quickly move into matory cells will migrate into the fluid. Lymphocytes and Cytology of the Alimentary Tract plasma cells are often seen in long-standing exuda- tive effusions. Exudative effusions vary in color and The oral cavity, esophagus, ingluvies (crop) and clo- turbidity. They are frequently viscous, have a foul aca are often sampled for cytologic examination. Abdominal lesions often associ- sions in the oral cavity may have different etiologies ated with exudative effusions include septic peritoni- but similar gross appearance. Therefore, sampling of tis, egg-related peritonitis and abdominal malignan- oral lesions for cytologic examination is a quick and cies. An eosinophilic axostyle can often be seen as a sions include septic stomatitis, candidiasis, tricho- straight line running from the nucleus to the opposite moniasis and squamous cell hyperplasia. Eosinophilic flagella at the nuclear cytology of the oral cavity shows occasional end and an undulating membrane on one side of the squamous epithelial cells, varying amounts of back- cell are usually present. Because trichomonas proto- ground debris and extracellular bacteria represented zoa are not considered part of the normal flora and by a variety of morphologic types (Color 10. Bact- fauna of the alimentary tract of birds, an inflamma- eria associated with the surface of squamous epithel- tory response is usually found associated with tricho- ial cells are considered part of the normal flora. Much debris and extracellular bac- Alysiella filiformis, a gram-negative bacteria com- teria are usually present. The gross appearance of mon to the upper alimentary tract of birds, occurs as trichomoniasis can vary from ulcerations to the accu- small coccobacilli in pairs forming ribbon-like chains, mulation of large amounts of necrotic debris, depend- and is often associated with squamous epithelial cells6 ing on the host (species)-parasite relationship. The gross appearance of lesions caused by squamous Smears made from a bacterial abscess reveal either hyperplasia and metaplasia from hypovitaminosis A a heterophilic or mixed-cell inflammation with bact- can resemble lesions caused by bacteria, yeast and erial phagocytosis (Color 10. Heterophils protozoa; however, the cytology has a very different may appear degenerate if bacterial toxins are pre- appearance. Therefore, the cytology resem- stain deeply basophilic with the Romanowsky stains. It Occasionally they stain poorly, however, and may is equally important in the diagnosis of squamous appear as “ghosts” in the cytologic specimen. One does not see inflammatory alimentary tract of birds and may average as few as cells (at least in acute lesions), yeast or protozoa. The cytodiagnosis of Squamous hyperplasia often occurs in the tissue sur- candidiasis is made when the yeast increase in num- rounding the choanal slit in the roof of the mouth. Because these organisms can be part of the this lesion becomes increasingly chronic, secondary normal flora of the upper alimentary tract of birds, bacterial infections often occur, creating a septic in- low numbers of the yeast do not usually elicit an flammatory response associated with the squamous inflammatory response. The normal cytology reveals occasional squamous epi- Trichomoniasis is best diagnosed by observing the thelial cells and a variable amount of background movement of the piriform flagellate protozoa in a wet debris and extracellular bacteria (represented by a mount preparation. A rare yeast is accepted ognize these organisms in a stained cytologic sample as normal. It should be emphasized that some foods if wet mount preparations are not part of the cy- (eg, monkey biscuits) fed to birds may contain yeast tologic routine or trichomoniasis is not suspected. In these Trichomonads appear as basophilic, piriform cells birds, there may be a high number of nonbudding with flagella on Wright’s stained smears (Color 10. These cells vary in staining intensity from the crop will have a normal pH and no other cytologic poorly stained to deeply basophilic. A sample of the food can be stained to usually stains more eosinophilic than most cell nu- confirm the source of the nonbudding yeast. The cytology reveals a disorder involving the esophagus and crop is the marked amount of sodium and potassium urate crys- presence of many bacteria represented by one mor- tals. Abnormal urinary fluid is watery and may con- phologic type (as compared to the normal variety of tain cellular elements such as inflammatory cells types), even though there is no apparent inflamma- and cellular casts. This condition is typical of a peracute ingluvitis, and the disorder is often Cytology of the Respiratory Tract referred to as “sour crop. The pH is often greater than 7, whereas The normal cytology of tracheal wash samples con- normal crop pH is 6. Capillaria ova may be sists of a few ciliated respiratory epithelial cells and detected in cytologic samples from the esophagus or goblet cells (Color 10. These cells double operculated and may not stain (see Chapter may represent cellular contamination from the oral 36). Ciliated respiratory epithelial cells are reproductive tract, urinary tract or cloaca is sus- columnar or prismatic in shape and have an eccentric pected. The normal cytology of the cloaca reveals a nucleus at the small pole of the cell. Eosinophilic cilia few epithelial cells (noncornified squamous or colum- are located at the opposite, larger pole of the cell.

If you wish to cite all volumes for a journal that has changed title purchase dapoxetine 30 mg line, provide a separate citation for each title discount 90 mg dapoxetine visa. Authoritative information on a journal in an audiovisual format order 30 mg dapoxetine with mastercard, in order of preference, may be found on: (1) the opening screens or wording, (2) the case containing the audiovisual, and (3) any accompanying printed material. Note that the rules for creating references to journal titles are not the same as the rules for cataloging them. Continue to Citation Rules with Examples for Journal Titles in Audiovisual Formats. Citation Rules with Examples for Journal Titles in Audiovisual Formats Components/elements are listed in the order they should appear in a reference. An R afer the component name means that it is required in the citation; an O afer the name means it is optional. Title (R) | Edition (R) | Type of Medium (R) | Editor (O) | Place of Publication (R) | Publisher (R) | Volume Number (R) | Issue Number (R) | Date of Publication (R) | Physical Description (O) | Language (R) | Notes (O) Title for Journal Titles in Audiovisual Formats (required) General Rules for Title • Enter a journal title in the original language 1006 Citing Medicine • Do not abbreviate any words or omit any words • Use whatever capitalization and punctuation are found within the title • Follow the title with a colon and any subtitle that appears • Follow a non-English title with a translation whenever possible; place the translation in square brackets • End the journal title with a space Specific Rules for Title • Journal titles not in English • Journals appearing in more than one language • Journals appearing in diferent editions Box 49. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. If a journal is published in more than one edition: • Capitalize all signifcant words in edition information • Separate the edition from the title proper by a space and place it in parentheses • End all title information with the medium of the journal, placed in square brackets, followed by a period Examples: Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Audiovisual journal title published in multiple languages Edition for Journal Titles in Audiovisual Formats (required) General Rules for Edition • Indicate the edition/version being cited afer the title, if a journal is published in more than one edition or version • Do not abbreviate any words or omit any words • Use whatever capitalization and punctuation are found in the edition statement • Place the edition statement in parentheses, such as (British Edition) • End the edition statement with a space Specific Rules for Edition • Non-English words for editions Box 52. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Dutch Uitgave Uitg Editie Ed Finnish Julkaisu Julk French Edition Ed Box 52 continues on next page... Language Word Abbreviation German Ausgabe Ausg Greek Ekdosis Ekd Italian Edizione Ed Norwegian Publikasjon Pub Portuguese Edicao Ed Russian Izdanie Izd Spanish Edicion Ed Swedish Upplaga n. Audiovisual journal title with edition Type of Medium for Journal Titles in Audiovisual Formats (required) General Rules for Type of Medium • Indicate the type of medium (audiocassette, videocassette, etc. Standard audiovisual journal title that has ceased publication Editor for Journal Titles in Audiovisual Formats (optional) General Rules for Editor • Give the name of the current (or last) editor • Enter the name of the editor in natural order. Romanization, a form of transliteration, means using the roman (Latin) alphabet to represent the letters or characters of another alphabet. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Audiovisual journal title with unknown place of publication Publisher for Journal Titles in Audiovisual Formats (required) General Rules for Publisher • Record the name of the publisher as it appears in the journal, using whatever capitalization and punctuation are found there • Abbreviate well-known publisher names with caution to avoid confusion. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Designate the agency making the publication available as the publisher and include distributor information as a note. For publications with joint or co-publishers, use the name provided frst as the publisher and include the name of the second as a note, if desired, such as "Jointly published by the Canadian Pharmacists Association". Audiovisual journal title with publisher having subsidiary part Journals in Audiovisual Formats 1019 Volume Number for Journal Titles in Audiovisual Formats (required) General Rules for Volume Number • Precede the number with "Vol. Audiovisual journal title without volume or issue numbers Issue Number for Journal Titles in Audiovisual Formats (required) General Rules for Issue Number • Precede the issue number with "No. Philadelphia: American Law Institute-American Bar Association Committee on Continuing Professional Education. Philadelphia: American Law Institute-American Bar Association Committee on Continuing Professional Education. Audiovisual journal title without volume or issue numbers Date of Publication for Journal Titles in Audiovisual Formats (required) General Rules for Date of Publication • Include the month and year the journal began to be published, in that order, such as May 2004 • Convert roman numerals to arabic numbers. Enter closing volume and issue information followed by a comma and the closing month and year. Specific Rules for Date of Publication • Multiple years, months, or days of publication • Non-English names for months • Seasons instead of months • Options for dates Journals in Audiovisual Formats 1023 Box 68. Oct 1999-Mar 2000 Dec 7, 2002-Jan 9, 2003 • Separate multiple months of publication and multiple days of the month by a hyphen Mar-Apr 2005 Dec 1999-Jan 2000 Feb 1-7, 2005 Jan 25-31, 2001 • Separate multiple seasons by a hyphen, as Spring-Summer. Audiovisual journal title with season in date Physical Description for Journal Titles in Audiovisual Formats (optional) General Rules for Physical Description • Enter the medium on which the audiovisual title is issued, in plural form, followed by a colon and a space. Example: Videocassettes: Journals in Audiovisual Formats 1025 • Give information on the physical characteristics of an audiovisual, such as color and size Specific Rules for Physical Description • Language for describing physical characteristics Box 72. Physical description of a journal in audiovisual format is optional in a reference but may be included to provide useful information to the reader. For example, the size of an audiovisual indicates what equipment is needed to view it. Examples: "Videocassettes:" and "Audiocassettes:" • Include physical characteristics, such as color and size. Audiocassettes are produced in a number of other sizes, but the standard size is used for scientifc journals. Size is usually omitted from the description of audiocassettes unless it deviates from the standard. Te speed of the audiocassette, provided in terms of inches per second, is used in the description instead. Standard audiovisual journal title that has ceased publication Language for Journal Titles in Audiovisual Formats (required) General Rules for Language • Give the language of publication if other than English • Capitalize the language name • Follow the language name with a period Specific Rules for Language • Journals appearing in more than one language Box 73. Audiovisual journal title published in multiple languages Notes for Journal Titles in Audiovisual Formats (optional) General Rules for Notes • Notes is a collective term for any useful information about the journal itself • If the journal was published under another title, provide the name preceded by "Continues: ". Sponsored by the Albert Einstein College of Medicine and Montefore Medical Center. Audiovisual journal title with examples of other notes Examples of Citations to Journal Titles in Audiovisual Formats 1. Standard audiovisual journal title that is still being published Pulse: Emergency Medical Update [videocassette]. Standard audiovisual journal title that has ceased publication Leadership in Hospital Governance [videocassette]. Audiovisual journal title with edition Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Audiovisual journal title not in English Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Audiovisual journal title not in English, with optional translation Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [Italian Video Review of Gastroenterology (Digestive Endoscopy Edition)] [videocassette]. Audiovisual journal title published in multiple languages Video-Revista de Cirugia [videocassette].

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