By X. Angir. Maine College of Art.
The techniques that are designed for restraint and the care of the individual after restraint must allow for safe restraint of the most vulner- able sections of the community purchase famvir master card. New research into the effects of restraint may possibly lead to a greater understanding of the deleterious effects of restraint and the development of safer restraint techniques order famvir discount. Although this experimental work is being performed discount famvir 250mg fast delivery, the only particular advice that can be offered to police officers is that the prone position should be maintained for the minimum amount of time only, no pressure should be applied to the back or the chest of a person restrained on the floor, and the individual should be placed in a kneeling, sitting, or stand- ing position to allow for normal respiration as soon as practical. It should be noted that an individual who is suffering from early or late asphyxiation may well struggle more in an attempt to breathe, and, during a restraint, this increased level of struggling may be perceived by police offic- ers as a renewed attempt to escape, resulting in further restriction of move- ment and subsequent exacerbation of the asphyxial process. Officers must be taught that once restrained, these further episodes of struggling may signify imminent asphyxiation and not continued attempts to escape, that they may represent a struggle to survive, and that the police must be aware of this and respond with that in mind. Since these matters were first brought to forensic and then public atten- tion and training and advice to police officers concerning the potential dan- gers of face down or prone restraints, especially if associated with any pressure to the chest or back improved, there has been a decrease in the number of deaths during restraint. However, even one death in these circumstances is too many, and it is hoped that by medical research, improved police training, and increased awareness of the dangers of restraint that these tragic deaths can be prevented. Positional asphyxiation in adults: a series of 30 cases from the Dade and Broward County, Florida, medical examiners offices from 1982 to 1990. Effects of positional restraint on oxygen saturation and heart rate following exercise. The effect of simulated restraint in the prone position on cardiorespiratory function following exercise in humans. The effect of breath holding on arterial oxygen saturation following exercise in man. All these fac- tors can be affected by drugs and alcohol, greatly increasing the risk of acci- dents. Many medical conditions (and their treatments) may impair fitness to drive and are considered first. In many jurisdictions, including Canada, Australia, and the United Kingdom, it is the motorist’s responsibility to inform the licensing authority of any relevant medical conditions. Similar requirements generally apply in the United States, except that six states (California, Delaware, Nevada, New Jersey, Oregon, and Penn- sylvania) require physicians to report patients with seizures (and other condi- tions that may alter levels of consciousness) to the department of motor vehicles (1). Drivers have a legal responsibility to inform the licensing authority of any injury or medical condition that affects their driving ability, and physicians should take great pains to explain this obligation. Occasionally, especially when dealing with patients suffering from dementia, ethical responsibilities may require doctors to breach confidentiality and notify patients against their will or without their knowledge (2); this situation is discussed in Subheading 2. When in doubt about the appropriate course of action, physicians should consult the appropriate guidelines. In Australia, the Austroads Guidelines for Assessing Fitness to Drive provides similar information (4). In the European Union, where Euro- pean Community directives have developed basic standards but allow dif- ferent countries to impose more stringent requirements, there is still variation from country to country. The situation is even more complicated in the United States, where each state sets its own rules and where federal regulations for commercial vehicles apply as well. Often, much of the required regulatory information can be acquired via the Internet or from organizations and foun- dations representing patients who have the particular disease in question. It should be assumed that all adults drive; drivers with disabilities should be given special consideration and may require modification of their vehicle or have certain personal restrictions applied. Cardiovascular Diseases Several studies have demonstrated that natural deaths at the wheel are fairly uncommon and that the risk for other persons is not significant (5,6). Even so, requirements for commercial drivers are generally much more rigid than for individuals, and in the United States, the Federal Highway Adminis- tration prohibits drivers with angina or recent infarction from driving. Restrictions for noncommer- cial car driving after first acute myocardial infarction are 4 weeks in United Kingdom but only 2 weeks in Australia. In general, ischemia itself is not considered an absolute disqualification, provided treadmill stress testing demonstrates that moderate reserves are present (7). Similarly, individuals with controlled hy- pertension are usually considered fit to drive, although physicians, no matter what country they are in, must give serious thought to just what sort of medi- cation is used to control hypertension; clonidine, methyldopa, reserpine, and prazosin can produce somnolence and/or impair reflex responses. Patients with dysrhythmias treated with medication or with the implan- tation of a defibrillator/pacemaker present a special set of problems (8). The tendency in the United States has been to treat such individuals as if they were epileptics (i. Until recently, that period was 6 months in a majority of jurisdictions but is increasingly Traffic Medicine 353 being shortened to 3 months in many locations. In the United Kingdom, patients with implantable cardioverter defibrillators are permanently barred from hold- ing a group 2 license but may hold a group 1 license, providing the device has been implanted for 6 months and has not administered therapy (shock and/or symptomatic antitachycardia pacing) (3). Epilepsy Epilepsy is the most common cause of collapse at the wheel, accounting for approx 30% of such incidents. In the United Kingdom, epilepsy is a pre- scribed disability (along with severe mental impairment, sudden attacks of disabling giddiness, and inability to meet eyesight requirements), and car driv- ing is not allowed for at least 1 yr after a seizure. All 50 of the United States restrict the licenses of individuals with epilepsy if their seizures are not well controlled by medication. Most states require a 6-months seizure-free period and a physician’s statement con- firming that the individual’s seizures have, in fact, been controlled and that the individual in question poses no risk to public safety. The letter from the physician is then reviewed by a medical advisory board, which may or may not issue a license. In the United States, even if the patient, at some later date, does have a seizure and cause an accident, the physician’s act of writing to the board protects him or her from liability under American law, provided the letter was written in good faith. Withdrawal of antiepileptic medication is associated with a risk of seizure recurrence. One study showed that 41% of patients who stopped treatment slowly developed a recurrence of seizures within 2 years, compared with only 22% of patients who continued treatment (9). The legal consequences of discontinuing medication without a physician’s order can be devastating. Patients who stop taking antiseizure medication and then cause an accident may face future civil liability and possibly even criminal charges if they cause physical injury (10). Of course, rules vary from country to country but, in general, a patient with seizures who does not inform the appropriate regulatory agency may face dire consequences (including the legitimate refusal of the insurance carrier to pay for damages). Diabetes Diabetes may affect the ability to drive because of loss of consciousness from hypoglycemic attacks or from complications of the disease itself (e. In January 1998, the British government introduced new restrictions on licensing of people with insulin-dependent diabetes (11). These 354 Wall and Karch restrictions were based on the second European Union driver-licensing direc- tive (91/4389), and under most interpretations of the law, they prevent insu- lin-treated diabetics from driving light goods and small passenger-carrying vehicles. In response to concerns expressed by the diabetic community in Brit- ain, the British Diabetic Association commissioned a report that found little evidence to support the new legislation. Regulations were therefore changed in April 2001 to allow “exceptional case” drivers to apply to retain their enti- tlement to drive class C1 vehicles (3500–7500 kg lorries) subject to annual medical examination. In the United States, the situation varies from state to state, but in many states, individuals with diabetes are subject to restrictive licensing policies that bar them from driving certain types of motor vehicles (12,13).
But the most common cause of  innocent people being falsely convicted is erroneous eyewitness testimony (Wells buy famvir with a visa, Wright buy famvir 250mg fast delivery, & Bradfield discount famvir line, 1999). Although cognitive biases are common, they are not impossible to control, and psychologists and other scientists are working to help people make better decisions. One possibility is to provide people with better feedback about their Attributed to Charles Stangor Saylor. Weather forecasters, for instance, learn to be quite accurate in their judgments because they have clear feedback about the accuracy of their predictions. Other research has found that accessibility biases can be reduced by leading people to consider multiple alternatives rather than focus only on the most obvious ones, and particularly by leading people to think about opposite possible outcomes than the ones they are expecting (Lilienfeld, Ammirtai, &  Landfield, 2009). Forensic psychologists are also working to reduce the incidence of false identification by helping police develop better procedures for interviewing both suspects and eyewitnesses (Steblay, Dysart, Fulero, & Lindsay,  2001). Schemas help us remember new information but may also lead us to falsely remember things that never happened to us and to distort or misremember things that did. Consider a time when you were uncertain if you really experienced an event or only imagined it. How do these knowledge structures bias your information processing and behavior, and how might you prevent them from doing so? Imagine that you were involved in a legal case in which an eyewitness claimed that he had seen a person commit a crime. Based on your knowledge about memory and cognition, what techniques would you use to reduce the possibility that the eyewitness was making a mistaken identification? When dreams become a royal road to confusion: Realistic dreams, dissociation, and fantasy proneness. Memory for expectancy-congruent and expectancy-incongruent information: A review of the social and social developmental literatures. Children report suggested events even when interviewed in a non-suggestive manner: What are its implications for credibility assessment? Reconstruction of automobile destruction: An example of the interaction between language and memory. Changing beliefs about implausible autobiographical events: A little plausibility goes a long way. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(2), 225–233. The myth of repressed memory: False memories and allegations of sexual abuse (1st ed. Memory accessibility and probability judgments: An experimental evaluation of the availability heuristic. When less is more: Counterfactual thinking and satisfaction among Olympic medalists. When less is more: Counterfactual thinking and satisfaction among Olympic medalists. Witnesses to crime: Social and cognitive factors governing the validity of people’s reports. Giving debiasing away: Can psychological research on correcting cognitive errors promote human welfare? Eyewitness accuracy rates in sequential and simultaneous lineup presentations: A meta-analytic comparison. The cognitive school was influenced in large part by the development of the electronic computer. Explicit memory tests include recall memory tests, recognition memory tests, and measures of relearning (also known as savings). Implicit memory refers to the influence of experience on behavior, even if the individual is not aware of those influences. Implicit memory is made up of procedural memory, classical conditioning effects, and priming. Priming refers both to the activation of knowledge and to the influence of that activation on behavior. An important characteristic of implicit memories is that they are frequently formed and used automatically, without much effort or awareness on our part. Sensory memory, including iconic and echoic memory, is a memory buffer that lasts only very briefly and then, unless it is attended to and passed on for more processing, is forgotten. Schemas are important in part because they help us encode and retrieve information by providing an organizational structure for it. The hippocampus is important in explicit memory, the cerebellum is important in implicit memory, and the amygdala is important in emotional memory. Evidence for the role of different brain structures in different types of memories comes in part from case studies of patients who suffer from amnesia. Cognitive biases are errors in memory or judgment that are caused by the inappropriate use of cognitive processes. These biases are caused by the overuse of schemas, the reliance on salient and cognitive accessible information, and the use of rule-of-thumb strategies known as heuristics. These biases include errors in source monitoring, the confirmation bias, functional fixedness, the misinformation effect, overconfidence, and counterfactual thinking. Understanding the potential cognitive errors we frequently make can help us make better decisions and engage in more appropriate behaviors. Summers, sparked an uproar during a presentation at an economic conference on women and minorities in the science and engineering workforce. During his talk, Summers proposed three reasons why there are so few women who have careers in math, physics, chemistry, and biology. One explanation was that it might be due to discrimination against women in these fields, and a second was that it might be a result of women‘s preference for raising families rather than for competing in academia. But Summers also argued that women might be less genetically capable of performing science and mathematics—that they may have less ―intrinsic aptitude‖ than do men. One of the conference participants, a biologist at the Massachusetts Institute of Technology, walked out on the talk, and other participants said that they were deeply offended. Summers replied that he was only putting forward hypotheses based on the scholarly work assembled for the conference, and that research has shown that genetics have been found to be very important in many domains, compared with environmental factors. As an example, he mentioned the psychological disorder of autism, which was once believed to be a result of parenting but is now known to be primarily genetic in origin. Many Harvard faculty members were appalled that a prominent person could even consider the possibility that mathematical skills were determined by genetics, and the controversy and protests that followed the speech led to first ever faculty vote for a motion expressing a ―lack of confidence‖ in a Harvard president. Summers resigned his position, in large part as a result of the controversy, in 2006 (Goldin,  Goldin, & Foulkes, 2005). The characteristic that is most defining of human beings as a species is that our large cerebral cortexes make us very, very smart.
Cocaine-induced ventricular arrhythmias and rapid atrial fibrillation temporarily related to naloxone administration 250mg famvir otc. Flunitrazepam intoxication in a child successfully treated with the benzodiazepine antagonist flumazenil buy discount famvir line. Diagnostic utility of flumazenil in coma with suspected poisoning: a double blind randomised controlled study purchase famvir no prescription. Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae. Mescaline, lysergic acid diethylamide and psilocybin: comparison of clinical syndromes, effects on color perception and bio- chemical measures. An association between the regular use of 3,4, methylenedioxy-methamphetamine (ecstasy) and excessive wear of the teeth. Acute systemic effects of cocaine in man—a controlled study by intranasal and intravenous routes. Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects, and a description of psycho- sis attributed to khat chewing. The effects of superphysiologic doses of testosterone on muscle size and strength in normal men. Three cases of nalbuphine hydro- chloride dependence associated with anabolic steroid use. Pharmacokinetics of gamma-hydroxybu- tyric acid in alcohol dependent patients after single and repeated oral doses. Presented at the 49th Annual Meeting of the American Acad- emy of Forensic Sciences, New York, 1997 107. Multistate outbreak of poisonings associated with the illicit use of gammahydroxybutyrate. Saturday night blue—a case of near fatal poisoning from the abuse of amyl nitrite. Biochemistry and physiology of alcohol: applications to forensic science and toxicology. Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal. Lack of observable intoxication in humans with high plasma alcohol concentrations. Alcohol and the law: the legal framework of scientific evidence and expert testimony. Eye signs in suspected drinking drivers: clinical examination and relation to blood alcohol. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Drunken detain- ees in police custody: is brief intervention by the forensic medical examiner fea- sible? The validity of self-reported alcohol consumption and alcohol prob- lems: a literature review. Assessment and management of individuals under the influence of alcohol in police custody. This chapter aims to pro- vide a broad basis for the understanding of the disease processes and the mecha- nisms that may lead to death and also to provide some understanding of the current thinking behind deaths associated with restraint. The worldwide variations in these definitions have caused, and continue to cause, considerable confusion in any discussion of this subject. For the purposes of this chapter, “in custody” relates to any individual who is either under arrest or otherwise under police control and, although similar deaths may occur in prison, in psychiatric wards, or in other situations where people are detained against their will, the deaths specifically associated with police detention form the basis for this chapter. It is important to distinguish between the different types of custodial deaths because deaths that are related to direct police actions (acts of commission) seem to cause the greatest concern to the family, public, and press. It is also important to remember that police involvement in the detention of individuals From: Clinical Forensic Medicine: A Physician’s Guide, 2nd Edition Edited by: M. These acts are considerably harder to define and perhaps sometimes result from the police being placed in, or assuming, a role of caring (e. Police involvement with an individual can also include those who are being pursued by the police either on foot or by vehicle, those who have been stopped and are being questioned outside the environment of a police station, and those who have become unwell through natural causes while in contact with or in the custody of the police. The definitions of “death in custody” are therefore wide, and attempts at simple definitions are fraught with difficulty. Any definition will have to cover a multitude of variable factors, in various circumstances and with a variety of individuals. The crucial point is that the police owe a duty of care to each and every member of the public with whom they have contact, and it is essential that every police officer, whether acting or reacting to events, understands and is aware of the welfare of the individual or individuals with whom he or she is dealing. The number of deaths recorded in police custody in England and Wales from 1990 to 2002 (2) shows considerable variation year to year but with an encouraging decline from the peak in 1998 (Fig. In contrast, the data from Australia for much of the same period show little change (3) (Fig. These raw data must be treated with considerable care because any changes in the death rates may not be the result of changes in the policy and practice of care for prisoners but of other undetermined factors, such as a decline in arrest rates during the period. Legal Framework In the United Kingdom, all deaths occurring in prison (or youth custody) (4) must be referred to the coroner who holds jurisdiction for that area. How- ever, no such obligation exists concerning deaths in police custody, although the Home Office recommends (5) that all deaths falling into the widest defini- Deaths in Custody 329 Fig. This acceptance that all deaths occurring in custody should be fully investi- gated and considered by the legal system must represent the ideal situation; however, not every country will follow this, and some local variations can and do occur, particularly in the United States. Protocol No standard or agreed protocol has been devised for the postmortem examination of these deaths, and, as a result, variation in the reported details of these examinations is expected. These differences in the procedures and the number and type of the specialist tests performed result in considerable varia- tion in the pathological detail available as a basis for establishing the cause of death and, hence, available for presentation at any subsequent inquest. The absence of a defined protocol hinders the analysis of the results of these examinations and makes even the simplest comparisons unreliable. There is an urgent need for a properly established academic study of all of these deaths, such as that performed in Australia under the auspices of the Australian Insti- tute of Criminology (6), to be instituted in the United Kingdom and the United States. Terminology In addition to the lack of reproducibility of the postmortem examina- tions, the terminology used by the pathologists to define the cause of death, particularly in the form required for the registration of the death, may often be idiosyncratic, and similar disease processes may be denoted by different pathologists using many different phrases. For example, damage to the heart muscle caused by narrowing of the coronary arteries by atheroma may be termed simply ischemic heart disease or it may be called myocardial ischemia resulting from coronary atheroma or even by the “lay” term, heart attack (7). This variation in terminology may lead to confusion, particularly among lay people attempting to understand the cause and the manner of death. A consid- erable amount of research (1,7) has been produced based on such lay assess- ments of the pathological features of a death, and this has, at times, resulted in increased confusion rather than clarification of the issues involved. If the issues regarding the definition of “in custody,” the variation in the postmortem examinations and the production of postmortem reports, and the use and analysis of subsequent specialist tests all raise problems within a single country, then the consideration of these deaths internationally produces almost insuperable conflicts of medical terminology and judicial systems.