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By Y. Hjalte. McNeese State University. 2018.
Suggestibility correlates with anxiety cheap augmentin 625mg, lack of assertiveness cheap 625 mg augmentin amex, poor self-esteem, and low intelligence (56). Compliance refers to the tendency of people to obey the instructions of others when they don’t really want to, because they are either overeager to please or simply unable to resist the pressure (57). The traits of both suggest- ibility and compliance are relevant to the issue of false confessions (58). Preventing False Confessions It is a fundamental tenet of both American and English law that reliance should only be placed on confession evidence that is given freely and voluntar- ily. In considering the voluntary nature of a confession, several factors need to be considered. These include the vulnerability of the accused (through factors such as age, mental illness and handicap, physical illness or injury, and intoxi- cation), the conditions of detention (lack of access to legal advice, failure to be given legal rights, and adequate rest periods during detention), and the charac- teristics of the interrogation (threats, physical abuse, and inducements). In America, the most important legal development designed to protect the rights of suspects and deter police misconduct relates to the case of Miranda v. The effect of this judgment was to ensure that all criminal suspects in police custody must be warned against self- incrimination and made aware of their right to remain silent and to receive legal advice. These rights have to be actively waived by the accused before interroga- tion can commence, and any violations of the requirements render any subse- quent confession inadmissible. In the United Kingdom, statutory safeguards are provided by the Police and Criminal Evidence Act 1984 and the Codes of Practice set up under sec- tion 66 of this Act (1), which regulate practice in respect to several matters, including the detention, treatment, and questioning of persons by police offic- ers. Confessions will generally be inadmissible if the provisions of the Codes of Practice are breached by the police (60,61). The role of the forensic physician when assessing a suspect’s fitness for interview is seen as fitting into this overall legal framework, the doctor’s primary concern being to recognize any characteristics that might render the individual vulnerable to providing a false confession so that adequate safe- guards can be put in place. To address this deficiency, Norfolk (63) proposed a definition that was used as the starting point for discussion by a subgroup set up by the Home Office Working Party on Police Surgeons in the United Kingdom. That working party made an in- terim recommendation (64) that has now been modified and included in the 2003 revision of the Police and Criminal Evidence Act Codes of Practice (1), thus providing the first Parliamentary approved definition of the term fitness for interview. The Codes of Practice state that: A detainee may be at risk in an interview if it is considered that: (a) Conducting the interview could significantly harm the detainee’s physi- cal or mental state (b) Anything the detainee says in the interview about their involvement or suspected involvement in the offense about which they are being inter- viewed might be considered unreliable in subsequent court proceed- ings because of their physical or mental state. Thus, a suspect with known ischemic heart disease who is experiencing chest pain satisfies the criteria of (a) above and clearly needs assessment and appropriate treatment before it is safe to conduct an interrogation. The concept of unreliability may be harder to evaluate and will require consideration of the various vulnerability factors associated with false confes- sions. In making an assessment, the Codes of Practice require the doctor to consider the following: 1. How the detainee’s physical or mental state might affect their ability to under- stand the nature and purpose of the interview, to comprehend what is being asked, and to appreciate the significance of any answers given and make rational deci- sions about whether they want to say anything. The extent to which the detainee’s replies may be affected by their physical or mental condition rather than representing a rational and accurate explanation of their involvement in the offense. How the nature of the interview, which could include particularly probing ques- tions, might affect the detainee. Scheme of Examination When assessing a detainee’s fitness for interview, the traditional medi- cal model of taking a history and then conducting an examination should be 222 Norfolk and Stark employed. As always, informed consent should be obtained and detailed and contemporaneous notes should be taken. The History As much background information as is practicable should be obtained and, when possible, an indication of how long any interview is likely to take. The demand characteristics of a long interview about a suspected murder will be much greater than a short interview about a shoplifting offense. A general medical history should be taken, with inquiry made about sig- nificant illness and any prescribed medication. The detainee should be asked whether he or she has suffered from psychiatric illness, past or present, and specific inquiry should be made about alcohol and drug misuse. There should be questions about the person’s educational background, because individuals with learning difficulties can be tough to recognize and inquiring about school- ing may aid identification. Ensure that the detainee has not been deprived of food or sleep, and inquire about significant social distractions (e. Detainees should be asked whether they have been detained before and, if so, whether they have had unpleasant experiences while in custody in the past. The Examination The examination should include observations on the general appearance, physical examination as appropriate, and mental state examination. A func- tional assessment should be performed regarding whether the detainee is aware of the reason for arrest, his or her legal rights, and is capable of making a rational decision (able to choose between relevant courses of action) and of carrying out the chosen course of action. Each examination needs to be tailored to the individual, but doctors should be able to assess the vulnerabilities of the detainees they have been asked to examine and thus ensure that any necessary safeguards are established before interrogation begins. Alcohol and Fitness for Interview It is generally accepted that severe alcohol intoxication renders a suspect unfit to be interviewed.
Anticholinergics are also called parasympatholytics cheap 375 mg augmentin, choliner- gic blocking agents augmentin 625mg discount, cholinergic or muscarinic antagonists, antiparasympathetic agents, antimuscarinic agents, or antispasmodics. Antiparkinsonism-Anticholinergic Drugs Antiparkinsonism-anticholinergic drugs are used to treat the early stages of Parkinson’s disease. These are typically combined with levodopa to control parkinsonism or alone to treat pseudoparkinsonism. These are the parkinsonism- like side effects of phenothiazines, which is an antipsychotic medication. Drugs for Parkinsonism Parkinsonism, better known as Parkinson’s disease, is a chronic neurological disorder that affects balance and locomotion at the extrapyramidal motor tract. Rigidity is the abnormal increase in muscle tone that causes the patient to make postural changes such a shuffling gate, the chest and head is thrust forward, and knees and hips are flexed. These movements are slow (bradykinesia) and the patient exhibits involuntary tremors of the head and neck which may be more prevalent at rest and pill-rolling movements of the hands. Another characteristic symptoms is the masked facies (no facial expression) common in patients with Parkinson’s disease. Dopaminergics decrease the symptoms of Parkinson’s disease by permitting more levodopa to reach the nerve terminal where levodopa is transformed into dopamine and the tremors are reduced. Dopamine agonists stimulate the dopamine receptors and reduce the symp- toms of Parkinson’s disease. However they can cause a hypertensive crisis if taken with certain foods (see Table 15-1). Spasms are caused by hyperex- citable neurons stimulated by cerebral neurons or from lack of inhibition of the stimulus in the spinal cord or at the skeletal muscles. There are two groups of muscle relaxants: centrally acting and peripherally acting. Centrally acting mus- cle relaxants depress neuron activity in the spinal cord or in the brain. They are used to treat acute spasms from muscle trauma, but are less effective for treating spasms caused by chronic neurological disorders. These drugs decrease pain, increase range of motion and have a sedative effect on the patient. Centrally acting muscle relaxants should not be taken concurrently with central nervous system depressants such as barbiturates, narcotics, and alcohol. Diazepam (Valium) and Baclofen (Lioresal) These are used to treat acute spasms from muscle trauma and for treating spasms caused by chronic neurologic disorders. Peripherally acting muscle relax- ants depress neuron activity at the skeletal muscles and have a minimal effect on the central nervous system. These are most effective for spasticity or muscle contractions caused by chronic neurologic disorders. This is also used to treat malignant hypertension which is an allergic reaction to anesthesia. Patients experience fatigue and muscle weakness—particularly in respiratory muscles, facial muscles, and muscles in the extremities. They have drooping eye- lids (ptosis) and difficulty in chewing and swallowing and their respiratory mus- cles become paralyzed which leads to respiratory arrest. They include ambenonium (Mytelase), edrophonium Cl (Tensilon), Neostigmine bromide (Prostigmin), and Pyridostigmine bromide (Mestinon). Multiple lesions of the myelin sheath that surround the nerve fibers occur that are called plaque. At times patients don’t experience symptoms and other times symptoms can become severe and debilitating. Interferonß-1B (betaseron) and interferonß-1a (avonex) These are used to reduce the frequency and severity of relapses. Copolymer 1 This drug is in clinical trials and appears to decrease the disease’s activity. Copaxone (glatiramer acetate injection) This drug reduces new brain lesions and the frequency of relapses in people with relapsing-remitting multiple sclerosis. Part of the patient’s brain that controls thought, memory, and language becomes impaired. Alzheimer’s disease affects 5% of people between 65 and 74 years of age and half of those older than 85 years. Although the cause of Alzheimer’s disease remains unknown, investigators have discovered Alzheimer’s patients have abnormal clumps of amyloid plaques and tangled bundles of fibers called neurofibrillary tangles in parts of their brain. Amyloid plaques, neurofibrillary tangles, and decreased chemical levels impair thinking and memory by disrupting these messages and causing nerve cells to die. Eventually, the patient loses mental capacity and the ability to carry out daily activities. Although there isn’t a treatment that stops Alzheimer’s disease, there are medications that provide some relief to patients who are in the early and middle stages of the disease.
Therefore qualitative and quantitative research has emphasized the importance of negotiation which seems to have been taken on board by Health Education Campaigns with advertisements highlighting the problem of raising the issue of safer sex (e augmentin 375 mg line. Are interviews simply another method of ﬁnding out about people’s cognitions and beliefs? Debates about methodology (quantitative versus qualitative) and the problem of behaviour as an interaction are relevant to all forms of behaviour but are particularly apparent when discussing sex order 625 mg augmentin fast delivery. This social context takes many forms such as the form and inﬂuence of sex education, the social meanings, expectations and social norms developed and presented through the multiple forms of media, and created and perpetuated by individual communities and the wider world of gender and inequality. However, it is important to have some acknowledgment and understanding of this broader world. They interviewed a group of young people in the south of England to examine how they interpreted ‘knowing their partners’. The results suggest that 27 per cent of the interviewees had had sex within 24 hours of becoming a couple, that 10 per cent of the sample reported having sex on the ﬁrst ever occasion on which they met their partner, and that over 50 per cent reported having sex within two weeks of beginning a relationship. In terms of ‘knowing their partner’, 31 per cent of males and 35 per cent of females reported knowing nothing of their partner’s sexual history, and knowing was often explained in terms of ‘she came from a nice family and stuﬀ’, and having ‘seen them around’. The results from this study indicate that promoting ‘knowing your partner’ may not be the best way to promote safe sex as knowledge can be interpreted in a multitude of diﬀerent ways. This presentation is epitomized by govern- ment health advertisement slogans such as ‘You know the risks: the decision is yours’. School sex education programmes Information about sex also comes from sex education programmes at school. It wasn’t really personal’ and ‘Nobody ever talks to you about the problems and the entanglements, and what it means to a relationship when you start having sex’. It has been argued that this impersonal and objective approach to sex education is counter- productive (Aggleton 1989) and several alternatives have been suggested. This approach would attempt to shift the emphasis from didactic teachings of facts and knowledge to a discussion of sex within a context of relationships and the broader social context. An additional solution to the problem of sex education is a skills training approach recommended by Abraham and Sheeran (1993). They argued that individuals could be taught a variety of skills, including buying condoms, negotiation of condom use and using condoms. These skills could be taught using tuition, role-play, feedback, modelling and practice. They are aimed at changing cognitions, preparing individuals for action and encouraging people to practise diﬀerent aspects of the sequences involved in translating beliefs into behaviour. In addition, the discussions about sex education in schools highlights the social context in which sex occurs. An individual’s social world Information about sex also comes from an individual’s social world in terms of one’s peers, parents and siblings. They redeﬁned the ‘problem of sex education’ as something that is broader than acquiring facts. They also argued that the resulting knowledge not only inﬂuences an individual’s own knowledge and beliefs but also creates their sexuality. They identiﬁed the following ﬁve sources: school, peers, parents, magazines, and partners and relation- ships. However, they also argued that women do not simply passively accept this version of sexuality but are in a ‘constant process of negotiating and re-negotiating the meaning which others give to their behaviour’ (Holland et al. Therefore, perhaps any understanding of sexual behaviour should take place within an understanding of the social context of sex education in the broadest sense. Power relations between men and women Sex has also been studied within the context of power relations between men and women. They presented examples of power inequalities between men and women and the range of ways in which this can express itself, from coercion to rape. For example, one woman in their study said ‘I wasn’t forced to do it but I didn’t want to do it’ and another explained her ambivalence to sex as ‘like do you want a coﬀee? Okay, ﬁne you drink the coﬀee, because you don’t really like drinking coﬀee but you drink it anyway’. In fact, empirical research suggests that men’s intentions to use condoms may be more likely to correlate with actual behaviour than women’s, perhaps because women’s intentions may be inhibited by the sexual context (Abraham et al. Social norms of the gay community Sex also occurs between two individuals of the same gender and within gay com- munities, which have their own sets of norms and values. The results provided some interesting insights into the norms of gay culture and the impact of this social context on an individual’s behaviour. First, the study describes how men gain access to the gay community: ‘through sex and socialising they come to recognise the presence of other gay men where once. For example, the interviewees described how feelings of romance, trust, love, commitment, inequality within the relationship, lack of experience and desperation resulted in having anal sex without a condom even though they had the knowledge that their behaviour was risky (Flowers et al. Therefore, sexual behaviour also occurs within the context of speciﬁc communities with their own sets of norms and values.
Some experts believe intercalated discs are not cellular junctions but rather special structures that help move an electrical impulse throughout the heart purchase augmentin 375mg free shipping. It’s the only muscle subject to voluntary control through the central nervous system augmentin 375 mg line. Skeletal muscle, which is also what’s considered meat in animals, is 20 percent protein, 75 percent water, and 5 percent organic and inorganic materials. Each multinucleated fiber is encased in a thin, transparent membrane called a sar- colemma that receives and conducts stimuli. The fibers, which vary from 10 microns to 100 microns in diameter and up to 4 centimeters in length, are subdi- vided lengthwise into tiny myofibrils roughly 1 micron in diameter that are sus- pended in the cell’s sarcoplasm. The following practice questions test your knowledge of muscle classifications: 9. Contribute to tactile perception Chapter 6: Getting in Gear: The Muscles 97 Contracting for a Contraction Before we can explain how muscles do what they do, it’s important that you under- stand the anatomy of how they’re put together. We base this description of muscle on the most studied classification of muscle: skele- tal. Each fiber packed inside the sarcolemma contains hundreds, or even thousands, of myofibril strands made up of alternating filaments of the proteins actin and myosin. Actin and myosin are what give skeletal muscles their striated appearance, with alter- nating dark and light bands. In the center of each I-band is a line called the Z-line that divides the myofibril into smaller units called sarcomeres. Each sarcomere contains thick fila- ments of myosin in the A-band and thin filaments of actin primarily in the I-band but extending a short distance between the myosin filaments into the A-band. Actin fila- ments don’t extend all the way into the central area of the A-band, which explains why the less-dense H-zone can be found there. Those thin actin filaments are anchored to the Z-line at their midpoints, which holds them in place and creates a structure against which the filaments exert their pull during contraction. The theory of contraction called the Interdigitating Filament Model of Muscle Contraction, or the Sliding Theory of Muscle Contraction, says that the myosin of the thick filaments combines with the actin of the thin filaments, forming actomyosin and prompting the filaments to slide past each other. As they do so, the H-zone is reduced or obliterated, pulling the Z-lines closer together and reducing the I-bands. Nucleus Sarcolemma Dark Light A band I band Myofibril Portion of skeletal muscle fiber H zone Thin (actin) filament Thick (myosin) filament I band A band I band M line Sarcomere Figure 6-1: Microscopic anatomy of Z line M Z line a skeletal muscle Thin (actin) filament Thick (myosin) filament fiber. We cover the details of the nervous system in Chapter 15, but here you can find out what’s happening as an impulse stimulates a skeletal muscle. The impulse, or stimulus, from the central nervous system is brought to the muscle through a nerve called the motor, or efferent, nerve. On entering the muscle, the motor nerve fibers separate to distribute themselves among the thousands of muscle fibers. Because the muscle has more fibers than the motor nerve, individual nerve fibers branch repeatedly so that a single nerve fiber innervates from 5 to as many as 200 muscle fibers. These small terminal branches penetrate the sarcolemma and form a special structure known as the motor end plate, or synapse. This neuromuscular unit consisting of one motor neuron and all the muscle fibers that it innervates is called the motor unit. Interference — either chemical or physical — with the nerve pathway can affect the action of the muscle or stop the action altogether, resulting in muscle paralysis. There also are afferent, or sensory, nerves that carry information about muscle condition to the brain. When an impulse moves through the synapse and the motor unit, it must arrive virtu- ally simultaneously at each of the individual sarcomeres to create an efficient contrac- tion. The fiber’s membrane forms deep invaginations, or inward-folding sheaths, at the Z-line of the myofibrils. The resulting inward-reaching tubules ensure that the sarcomeres are stimulated at nearly the same time. In other words, if a single muscle fiber is going to contract, it’s going to do so to its fullest extent. Following are some practice questions that deal with muscle anatomy and contraction: 13. False Pulling Together: Muscles as Organs A muscle organ has two parts: The belly, composed predominantly of muscle fibers The tendon, composed of fibrous, or collagenous, regular connective tissue. If the tendon is a flat, sheet-like structure attaching a wide muscle, it’s called an aponeurosis. Each muscle fiber outside of the sarcolemma is surrounded by areolar connective tissue called endomysium that binds the fibers together into bundles called fasciculi (see Figure 6-2). Each bundle, or fasciculus, is surrounded by areolar connective tissue called perimysium. All the fasciculi together make up the belly of the muscle, which is surrounded by areolar connective tissue called the epimysium. Blood vessels, lymph vessels, and nerves pass into the fasciculus through areolar connective tissue called the trabecula.
F The cytoplasmic projection of a neuron that carries impulses away from the cell body is called c discount augmentin 375 mg otc. Each neuron cell usually has only one axon cheap augmentin 625 mg with mastercard, although it may branch off several times. First we focus on how bones are formed before broadening the view to the axial skeleton (the parts that line up from head to toe) and the appendicular skeleton (the parts that reach out from the central axis). You review how muscles attach to that framework and watch the body take shape before wrapping this newly layered package in the body’s largest single organ: the skin. Chapter 5 A Scaffold to Build On: The Skeleton In This Chapter Getting to know your bones Keeping the axial skeleton in line Checking out the appendicular skeleton Playing with joints uman osteology, from the Greek word for “bone” (osteon) and the suffix –logy, which Hmeans “to study,” focuses on the 206 bones in the adult body endoskeleton. But it’s more than just bones; it’s also ligaments and cartilage and the joints that make the whole assembly useful. In this chapter, you get lots of practice exploring the skeletal functions and how the joints work together. Understanding Dem Bones The skeletal system as a whole serves five key functions: Protection: The skeleton encases and shields delicate internal organs that might other- wise be damaged during motion or crushed by the weight of the body itself. For exam- ple, the skull’s cranium houses the brain, and the ribs and sternum of the thoracic cage protect organs in the central body cavity. Movement: By providing anchor sites and a scaffold against which muscles can con- tract, the skeleton makes motion possible. The bones act as levers, the joints are the fulcrums, and the muscles apply the force. For instance, when the biceps muscle con- tracts, the radius and ulna bones of the forearm are lifted toward the humerus bone of the upper arm. Support: The vertebral column’s curvatures play a key role in supporting the entire body’s weight, as do the arches formed by the bones of the feet. Upper body support flows from the clavicle, or collarbone, which is the only bone that attaches the upper extremities to the axial skeleton and the only horizontal long bone in the human body. Mineral storage: Calcium, phosphorous, and other minerals like magnesium must be maintained in the bloodstream at a constant level, so they’re “banked” in the bones in case the dietary intake of those minerals drops. The bones’ mineral content is con- stantly renewed, refreshing entirely about every nine months. Blood cell formation: Called hemopoiesis or hematopoiesis, most blood cell formation takes place within the red marrow inside the ends of long bones as well as within the ver- tebrae, ribs, sternum, and cranial bones. Marrow produces three types of blood cells: erythrocytes (red cells), leukocytes (white cells), and thrombocytes (platelets). Most of these are formed in red bone marrow, although some types of white blood cells are pro- duced in fat-rich yellow bone marrow. In cases of severe blood loss, the body can convert yellow marrow back to red marrow in order to increase blood cell production. If you hesitated to choose “all of hemostasis, which is the stoppage the above,” ask yourself this: If you of bleeding or blood flow. Besides support and protection, the skeleton serves other important functions, including a. Divide different body areas Chapter 5: A Scaffold to Build On: The Skeleton 63 Boning Up on Classifications, Structures, and Ossification Adult bones are composed of 30 percent protein (called ossein), 45 percent minerals (including calcium, phosphorus, and magnesium), and 25 percent water. Mineral in the bones increases with age, causing them to become more brittle and easily fractured. Various types of bone make up the human skeleton, but fortunately for memorization purposes, bone type names match what the bones look like. They are as follows: Long bones, like those found in the arms and legs, form the weight-bearing part of the skeleton. Short bones, such as those in the wrists (carpals) and ankles (tarsals), have a blocky structure and allow for a greater range of motion. Flat bones, such as the skull, sternum, scapulae, and pelvic bones, shield soft tissues. Irregular bones, such as the mandible (jawbone) and vertebrae, come in a vari- ety of shapes and sizes suited for attachment to muscles, tendons, and ligaments. Irregular bones include seed-shaped sesamoid bones found in joints such as the patella, or kneecap. Unfortunately for students of bone structures, there’s no easy way to memorize them. So brace yourself for a rapid summary of what your textbook probably goes into in much greater detail. Compact bone is a dense layer made up of structural units, or lacunae, arranged in concentric circles called Haversian systems (also referred to in short as osteons), each of which has a central, microscopic Haversian canal. A perpendicular system of canals, called Volkmann’s canals, penetrate and cross between the Haversian systems. Compact bone tissue is thick in the shaft and tapers to paper thinness at the ends of the bones. The bulbous ends of each long bone, known as the epiphyses (or singularly as an epiphy- sis), are made up of spongy bone or cancellous bone tissue covered by a thin layer of compact bone.