By W. Javier. Tennessee Temple University. 2018.

Presented at the 49th Annual Meeting of the American Acad- emy of Forensic Sciences super avana 160mg sale, New York 160mg super avana amex, 1997 107 160mg super avana visa. 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.

In addition discount super avana 160 mg with mastercard, we touch on the sensory organs that bring information into the human body 160 mg super avana with amex. Part V: Mission Control: All Systems Go 238 Building from Basics: Neurons purchase super avana 160mg on-line, Nerves, Impulses, Synapses Before trying to study the system as a whole, it’s best to break it down into building blocks first. Neurons The basic unit that makes up nerve tissue is the neuron (also called a nerve cell). Its properties include that marvelous irritability that we speak of in the chapter introduc- tion as well as conductivity, otherwise known as the ability to transmit a nerve impulse. The central part of a neuron is the cell body, or soma, that contains a large nucleus with one or more nucleoli, mitochondria, Golgi apparatus, numerous ribosomes, and Nissl bodies that are associated with conduction of a nerve impulse. Two types of cytoplasmic projections play a role in neurons: Dendrites conduct impulses to the cell body while axons (nerve fibers) usually conduct impulses away from the cell body (see Figure 15-1). Each neuron has only one axon; however, each axon can have many branches called axon collaterals, enabling communication with many target cells. In addition, each neuron may have one dendrite, several dendrites, or none at all. There are three types of neurons, as follows: Motor neurons, or efferent neurons, transmit messages from the brain and spinal cord to effector organs, including muscles and glands, triggering them to respond. Motor neurons are classified structurally as multipolar because they’re star-shaped cells with a single large axon and numerous dendrites. Sensory neurons, or afferent neurons, are triggered by physical stimuli, such as light, and pass the impulses on to the brain and spinal cord. Sensory fibers have special structures called receptors, or end organs, where the stimulus is propa- gated. Monopolar neurons have a single process (a projection or outgrowth of tissue) that divides shortly after leaving the cell body; one branch conveys impulses from sense organs while the other branch carries impulses to the central nervous system. Association neurons (also called internuncial neurons, interneurons, or interca- lated neurons) are triggered by sensory neurons and relay messages between neurons within the brain and spinal cord. Here are a couple of handy memory devices: Afferent connections arrive, and efferent connections exit. Sensory Neuron Dendrites Cell body Nucleolus Nucleus Nucleolus Axon Nucleus Nucleus of Schwann cell Figure 15-1: Cell body The motor neuron on Schwann cell Axon the left and Node of Ranvier sensory neuron on the right show the cell struc- tures and the paths of Synaptic bouton impulses. Nerves Whereas neurons are the basic unit of the nervous system, nerves are the cable-like bundles of axons that weave together the peripheral nervous system. There are three types of nerves: Afferent nerves are composed of sensory nerve fibers (axons) grouped together to carry impulses from receptors to the central nervous system. Efferent nerves are composed of motor nerve fibers carrying impulses from the central nervous system to effector organs, such as muscles or glands. The diameter of individual axons (nerve fibers) tends to be microscopically small — many are no more than a micron, or one-millionth of a meter. The longest axons in the human body run from the base of the spine to the big toe of each foot, meaning that these single-cell fibers may be 1 meter or more in length. Each axon is swathed in myelin, a white fatty material made up of concentric layers of Schwann cells in peripheral nerves. Oligodendrocytes in the central nervous system are also associated with myelinated nerve fibers. Gaps in the sheath called nodes of Ranvier give the underlying nerve fiber access to extracellular fluid, to speed up propagation of the nerve impulse. Nonmyelinated nerve fibers lie within body organs and therefore don’t need protective myelin sheaths to help them transmit impulses. Many peripheral nerve cell fibers also are protected by a neurilemmal sheath, a membrane that surrounds both the nerve fiber and its myelin sheath. Part V: Mission Control: All Systems Go 240 From the inside out, nerves are composed of the following: Axon: The impulse-conducting process of a neuron Myelin sheath: An insulating envelope that protects the nerve fiber and facilitates transmission of nerve impulses Neurolemma (or neurilemma): A thin membrane present in many peripheral nerves that surrounds the nerve fiber and the myelin sheath Endoneurium: Loose, or areolar, connective tissue surrounding individual fibers Fasciculi: Bundles of fibers within a nerve Perineurium: The same kind of connective tissue as endoneurium; surrounds a bundle of fibers Epineurium: The same kind of connective tissue as endoneurium and perineurium; surrounds several bundles of fibers There also is a class of cells called neuroglia, or simply glia, that act as the supportive cells of the nervous system, providing neurons with nutrients and otherwise protecting them. Glia include oligodendrocytes that support the myelin sheath within the central nervous system; star-shaped cells called astrocytes that both support nerve tissue and contribute to repairs when needed; and microgliacytes, cells that remove dead or dying parts of tissue (this type of cell is called a phagocyte, which literally translates from the Greek words for “cell that eats”). Impulses Neuron membranes are semi-permeable (meaning that certain small molecules like ions can move in and out but larger molecules can’t), and they’re electrically polarized (meaning that positively charged ions called cations rest around the outside mem- brane surface while negatively charged ions called anions line the inner surface; you can find more about ions in Chapter 1). A neuron that isn’t busy transmitting an impulse is said to be at its resting potential. But the nerve impulse theory, or membrane theory, says that things switch around when a stimulus — a nerve impulse, or action potential — moves along the neuron. A stimulus changes the specific permeability of the fiber membrane and causes a depolarization due to a reshuffling of the cations and anions. It’s called an all-or-none response because each neuron has a specific threshold of excitation. After depolarization, repolarization occurs followed by a refractory period, during which no further impulses occur, even if the stimuli’s intensity increases. Intensity of sensation, however, depends on the frequency with which one nerve impulse follows another and the rate at which the impulse travels. That rate is deter- mined by the diameter of the impacted fiber and tends to be more rapid in large nerve fibers.

You can see that cheap 160 mg super avana visa, if the infant‘s gaze time increases when a new stimulus is presented purchase 160 mg super avana amex, this indicates that the baby can differentiate the two stimuli order 160mg super avana free shipping. Although this procedure is very simple, it allows researchers to create variations that reveal a great deal about a newborn‘s cognitive ability. The trick is simply to change the stimulus in controlled ways to see if the baby ―notices the difference. For instance, in one experiment reported by Karen Wynn (1995), 6- month-old babies were shown a presentation of a puppet that repeatedly jumped up and down either two or three times, resting for a couple of seconds between sequences (the length of time and the speed of the jumping were controlled). After the infants habituated to this display, the presentation was changed such that the puppet jumped a different number of times. Karen Wynn found that babies that had habituated to a puppet jumping either two or three times significantly increased their gaze when the puppet began to jump a different number of times. Cognitive Development During Childhood Childhood is a time in which changes occur quickly. During this time the child learns to actively manipulate and control the environment, and is first exposed to the requirements of society, particularly the need to control the bladder and bowels. According to Erik Erikson, the challenges that the child must attain in childhood relate to the development of initiative, competence, and independence. Children need to learn to explore the world, to become self-reliant, and to make their own way in the environment. Neurological changes during childhood provide children the ability to do some things at certain ages, and yet make it impossible for them to do other things. This fact was made apparent through the groundbreaking work of the Swiss psychologist Jean Piaget. During the 1920s, Piaget was administering intelligence tests to children in an attempt to determine the kinds of logical thinking that children were capable of. In the process of testing the children, Piaget became intrigued, not so much by the answers that the children got right, but more by the answers they got wrong. Piaget believed that the incorrect answers that the children gave were not mere shots in the dark but rather represented specific ways of thinking unique to the children‘s developmental stage. Just as almost all babies learn to roll over before they learn to sit up by themselves, and learn to crawl before they learn to walk, Piaget believed that children gain their cognitive ability in a developmental order. These insights—that children at different ages think in fundamentally different ways—led to Piaget‘s stage model of cognitive development. Piaget argued that children do not just passively learn but also actively try to make sense of their worlds. He argued that, as they learn and mature, children develop schemas—patterns of knowledge in long-term memory—that help them remember, organize, and respond to information. Furthermore, Piaget thought that when children experience new things, they attempt Attributed to Charles Stangor Saylor. Piaget believed that the children use two distinct methods in doing so, methods that he called assimilation andaccommodation (see Figure 6. If children have learned a schema for horses, then they may call the striped animal they see at the zoo a horse rather than a zebra. In this case, children fit the existing schema to the new information and label the new information with the existing knowledge. When a mother says, ― “No, honey, that‘s a zebra, not a horse,‖ the child may adapt the schema to fit the new stimulus, learning that there are different types of four-legged animals, only one of which is a horse. Piaget‘s most important contribution to understanding cognitive development, and the fundamental aspect of his theory, was the idea that development occurs in unique and distinct stages, with each stage occurring at a specific time, in a sequential manner, and in a way that allows the child to think about the world using new capacities. Object permanence Children acquire the ability to internally represent the Theory of mind; rapid world through language and mental imagery. They also increase in language Preoperational 2 to 7 years start to see the world from other people‘s perspectives. They can Concrete increasingly perform operations on objects that are only operational 7 to 11 years imagined. Conservation Adolescents can think systematically, can reason about Formal 11 years to abstract concepts, and can understand ethics and scientific operational adulthood reasoning. Abstract logic The first developmental stage for Piaget was the sensorimotor stage, the cognitive stage that begins at birth and lasts until around the age of 2. It is defined by the direct physical interactions that babies have with the objects around them. During this stage, babies form their first schemas by using their primary senses—they stare at, listen to, reach for, hold, shake, and taste the things in their environments. Piaget found, for instance, that if he first interested babies in a toy and then covered the toy with a blanket, children who were younger than 6 months of age would act as if the toy had disappeared completely—they never tried to find it under the blanket but would nevertheless smile and reach for it when the blanket was removed. Piaget found that it was not until about 8 months that the children realized that the object was merely covered and not gone.

An electric synapse — generally found in organs and glial cells — uses channels known as gap junc- tions to permit direct transmission of signals between neurons cheap super avana 160 mg without a prescription. But in other parts of the body purchase super avana 160 mg with amex, chemical changes occur to let the impulse make the leap cheap super avana 160mg free shipping. The end branches of an axon each form a terminal knob or bulb called a bouton terminal (that first word’s pro- nounced boo-taw), beyond which there is a space between it and the next nerve path- way. Synaptic vesicles in the knob release a transmitter called acetylcholine that flows across the gap and increases the permeability of the next cell mem- brane in the chain. An enzyme called cholinesterase breaks the transmitter down into acetyl and choline, which then diffuse back across the gap. An enzyme called choline acetylase in the synaptic vesicles reunites the acetyl and choline, prepping the bouton terminal to do its job again when the next impulse rolls through. Capacity to record, store, and relate information to be used to determine future action 6. The terminal structure of the cytoplasmic projection of the neuron cannot be a(n) a. Contains storage vesicles for excitatory chemical Minding the Central Nervous System and the Brain Together, the brain and spinal cord make up the central nervous system. The spinal cord, which forms very early in the embryonic spinal canal, extends down into the tail portion of the vertebral column. But because bone grows much faster than nerve tissue, the end of the cord soon is too short to extend into the lowest reaches of the spinal canal. In an adult, the 18-inch spinal cord ends between the first and second lumbar vertebrae, roughly where the last ribs attach. The cord continues as separate strands below that point and is referred to as the cauda equina (horse tail). A thread of fibrous tissue called the filum terminale extends to the base of the coccyx (tailbone) and is attached by the coccygeal ligament. Part V: Mission Control: All Systems Go 244 Spinal cord An oval-shaped cylinder with two deep grooves running its length at the back and the front, the spinal cord doesn’t fill the spinal cavity by itself. Also packed inside are the meninges, cerebrospinal fluid, a cushion of fat, and various blood vessels. Three membranes called meninges envelop the central nervous system, separating it from the bony cavities. The dura mater, the outer layer, is the hardest, toughest, and most fibrous layer and is composed of white collagenous and yellow elastic fibers. The arachnoid, or middle membrane, forms a web-like layer just inside the dura mater. The pia mater, a thin inner membrane, lies close along the surface of the central nerv- ous system. The pia mater and arachnoid may adhere to each other and are considered as one, called pia-arachnoid. There are spaces or cavities between the pia mater and the arachnoid where major regions join, for instance where the medulla oblongata and the cerebellum join. Spaces or cavities between the arachnoid layer and the dura mater layer are referred to as subdural. Two types of solid material make up the inside of the cord, which you can see in Figure 15-2: gray matter (which is indeed grayish in color) containing unmyelinated neurons, dendrites, cell bodies, and neuroglia; and white matter, so-called because of the whitish tint of its myelinated nerve fibers. At the cord’s midsection is a small central canal surrounded first by gray matter in the shape of the letter H and then by white matter, which fills in the areas around the H pattern. The legs of the H are called anterior, posterior, and lateral horns of gray matter, or gray columns. Posterior (dorsal) Lateral white column root of spinal nerve Posterior (dorsal) Posterior gray horn root ganglion Posterior median sulcus Spinal nerve Posterior white column Anterior (ventral) root of spinal nerve Gray commissure Central canal Axon of sensory neuron Figure 15-2: A cross- Anterior gray horn Cell body of sensory neuron section of Anterior white column Lateral gray horn the spinal Anterior white cord, show- commissure Dendrite of sensory neuron ing spinal Cell body of motor neuron nerve con- nections. Anterior median fissure Axon of motor neuron Illustration by Imagineering Media Services Inc. The white matter consists of thousands of myelinated nerve fibers arranged in three funiculi (columns) on each side of the spinal cord that convey information up and down the cord’s tracts. Ascending afferent (sensory) nerve tracts carry impulses to the brain; descending efferent (motor) nerve tracts carry impulses from the brain. Each tract is named according to its origin and the joint of synapse, such as the corti- cospinal and spinothalmic tracts. Thirty-one pairs of spinal nerves arise from the sides of the spinal cord and leave the cord through the intervertebral foramina (spaces) to form the peripheral nervous Chapter 15: Feeling Jumpy: The Nervous System 245 system, which we discuss in the later section “Taking Side Streets: The Peripheral Nervous System. In this section, we review six major divisions of the brain from the bottom up (see Figure 15-3): medulla oblongata, pons, midbrain, cerebellum, diencephalon, and cerebrum. Medulla oblongata The spinal cord meets the brain at the medulla oblongata, or brainstem, just below the right and left cerebellar hemispheres of the brain. In fact, the medulla oblongata is con- tinuous with the spinal cord at its base (inferiorly) and back (dorsally) and located anteriorly and superiorly to the pons. All the afferent and efferent tracts of the cord can be found in the brainstem as part of two bulges of white matter forming an area referred to as the pyramids.