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By P. Dan. Rose-Hulman Institute of Technology. 2018.

Classic tubercles rarely Escherichia coli has been associated with a variety develop buy cheap residronate 35mg, and gross necropsy findings usually reveal of disease problems in passerine birds including di- minimal changes residronate 35 mg visa. Two histopathologic conditions arrhea purchase genuine residronate on-line, septicemia and ascending oviduct infections. Juve- niles and cock birds on the same premises were not Red-hooded Siskins may be particularly susceptible affected. Treatment of companion birds for placed on appropriate antibiotics (as indicated by Mycobacterium spp. Salmonella typhimurium var copenhagen is com- monly isolated from finches in Europe that develop a Listeria monocytogenes is a ubiquitous organism characteristic granulomatous ingluvitis, which can that may be transmitted by the oral route. Clinical signs include torticol- nal inflammation and focal necrosis in the heart, lis, tremors, stupor, paresis or paralysis. It has also ports of clostridial infections in Passeriformes are 21 been associated with acute septicemia and death. The organism is believed to have originated in ated with a proliferative, inflammatory reaction in Europe with worldwide dissemination occurring the proventriculus of canaries was described in through rodents on ships. In affected birds, the proventriculus had an problem in Australian aviaries where rodent control increased pH and altered synthesis of mucopolysac- is poor. Enteritis and pinpoint or large abscesses thinner in affected canaries than in a control group, throughout the liver and spleen are characteristic possibly as a result of the increased pH in the proven- gross findings. The organism identified in these birds ap- respond to therapy but treatment of exposed birds peared to be very similar, if not identical, to the with antibiotics based on sensitivity testing will usu- organism defined as “megabacterium” in psittacine ally stop an outbreak. The predisposing factors that al- teurella is often associated with fatal septicemias lowed organisms to colonize the bird should be iden- following cat bite wounds. Captured free-ranging birds are often ated with pale, voluminous droppings (“popcorn stressed, suffering from poor nutrition and kept in poohs”) in canaries and finches of a variety of spe- unclean surroundings with decaying organic mate- cies (particularly Gouldian Finches). It is not surprising that aspergillosis occurs vestigators have suggested that adding animal pro- under these conditions. Aspergillosis is also a com- tein, minerals and vitamins (soft food) to the diet mon postmortem finding in sporadic deaths in free- may strengthen the bird’s immune system and pro- ranging passerine birds. Antibiotics (par- this disease occurs in which nodules varying in color ticularly erythromycin and tetracyclines) may also from yellow to white may be seen in the liver, lungs, be useful. Mortality was con- The organism may cause foul-smelling diarrhea or trolled by nebulizing the birds with amphotericin B. Treat- ment should be based on sensitivity testing, as the Captive mynahs are reported to be particularly sus- bacteria is often resistant to routinely used antibiot- ceptible to aspergillosis, possibly because of their ics. Steps should be taken to identify and remove moist, messy droppings and the tendency for these environmental sources of contamination. It has been suggested that the fungus Identifying candida in fecal swabs from passerines might persist from year to year on the wood of poorly should be evaluated with caution. The organism has been associ- species are fed bread products that are made with ated with deaths in munia finches53 (see Chapter 35). Yeast blastospores may pass through the gas- trointestinal tract unchanged and appear in large Zygomycosis (Mucormycosis) numbers in the feces. These organisms do not reflect Multiple fungal granulomas have been identified in disease. Small numbers of candida blastospores may the lung, liver or brain in canaries and Gouldian also be present as a part of autochthonous flora. His- tologically, fungal hyphae are frequently associated Candida albicans is occasionally associated with up- with blood vessel walls. Vomiting, anorexia, weight loss and diarrhea Dermatomycoses are occasionally reported in passer- are characteristic findings. The lining of the crop ines and generally cause as alopecia (especially of the may be thickened and covered with whitish “turkish head and neck) or hyperkeratosis. One bird died when the owner attempted home treatment by Coccidia infections in passerine birds may be asymp- applying a propylene glycol-based product over ex- tomatic or associated with diarrheal syndromes tensive areas of the bird’s body. Systemic protozoal disease is occasionally diagnosed in avian Protozoa species, but it is difficult to classify the causative organism based solely on histologic appearance. Bengalese evaluation should be saved from patients where pro- Finches may be inapparent carriers of this organism; tozoal disease is suspected. Typical clinical signs include debility, de- host cells to produce a resistant oocyst. Most affected number of sporocysts, each with one or more sporo- birds are six to twelve weeks of age. The organism may be identified by direct wet prepa- Eimeriidae genera affecting passerines include: ration of fresh warm droppings or at necropsy using Eimeria (oocysts with four sporocysts each con- intestinal contents.

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At a follow-up examination 5 to 14 months after the initial session buy cheap residronate 35mg on line, six patients were free of hives and an additional seven reported improvement order residronate. Therapeutic Considerations The treatment goals in hives are straightforward: identify and eliminate the factors that are causing the release of histamine and other allergic compounds and decrease the body’s overreactivity generic residronate 35 mg otc. As noted above, allergy (to foods, food additives, and drugs) and stress are common causes of hives. The strictest elimination diets allow only water, lamb, rice, pears, and vegetables. Those foods most commonly associated with inducing hives (milk, eggs, chicken, fruits, nuts, and additives) should definitely be avoided. Foods containing vasoactive amines should be eliminated even if no direct allergy to them is noted. The primary foods to eliminate are cured meat, alcoholic beverages, cheese, chocolate, citrus fruits, and shellfish. If food additives do, in fact, increase the number of mast cells in the skin, they may also do the same in the small intestine, thereby greatly increasing the risk of developing a leaky gut. In addition to an elimination diet, there are several other factors that can be helpful, such as ultraviolet light therapy, vitamin C, vitamin B12, fish oils, quercetin, and thyroid hormone. Ultraviolet Light Therapy Ultraviolet light (from sunlight or tanning beds) has been shown to be of some benefit to patients with chronic hives. Patients with cold, cholinergic, and dermographic hives experience the greatest therapeutic response. Nutritional Supplements Vitamin C High-dose vitamin C therapy may help hives (as well as other allergic conditions) by lowering histamine levels. Vitamin B12 Although blood levels of vitamin B12 are normal in most patients with hives, additional B12 has been anecdotally reported to be of value in the treatment of acute and chronic hives. In one report, three patients with aspirin-induced urticaria experienced alleviation of symptoms following dietary supplementation with omega-3 fatty acids. Symptoms relapsed after the dose of fish oil was reduced, indicating that higher dosages may have to be maintained to keep symptoms from reappearing. Quercetin The flavonoid quercetin inhibits both the manufacture and the release of histamine and other allergic/inflammatory mediators by mast cells and basophils. A subset of patients with chronic hives respond to thyroid hormone, especially if they have antibodies to thyroid tissue. Four patients with high thyroid antibody titers repeatedly experienced worsening when therapy was discontinued and had repeated remissions when therapy with L- thyroxine was resumed. Although L-thyroxine did not always improve the patient’s urticaria or angioedema, when it did work the response was dramatic. Acute hives is usually a self-limiting disease, especially once the eliciting agent has been removed or reduced. Diet An elimination diet is of utmost importance in the treatment of chronic hives (see the chapter “Food Allergy”). The diet should eliminate not only suspected allergens but also all food additives. Hyperthyroidism • Weakness, sweating, weight loss, nervousness, loose stools, heat intolerance, irritability, fatigue • Racing heartbeat; warm, thin, moist skin; stare; tremor • Diffuse enlargement of the thyroid, nonpainful goiter • Increased blood levels of thyroid hormones Hyperthyroidism is a condition characterized by increased levels of thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The autoimmune disorder Graves’ disease accounts for up to 85% of all cases of hyperthyroidism. About 25 to 30% of people with Graves’ disease will also suffer from Graves’ ophthalmopathy (a protrusion of one or both eyes), in which the eye muscles become inflamed, attacking autoantibodies. In particular, it is eight times more common in women than in men and typically begins between the ages of 20 and 40. The classic clinical presentation of Graves’ disease is a young adult female complaining of nervousness, irritability, sweating, palpitations, insomnia, tremor, frequent bowel movements, and unexplained weight loss. Physical signs of hyperthyroidism include a smooth, diffuse, nontender goiter in the neck; a racing pulse, especially after exercise; loud heart sounds; and mild protrusion of the eyes with lid retraction. Other signs and symptoms include muscle weakness and fatigue, anxiety, heat intolerance, and fluid retention. Pigment changes such as vitiligo (areas with loss of pigment) can be associated with Graves’ disease, as well as increased pigmentation of areas such as skin creases and the knuckles. Causes Stress One of the key causes of hyperthyroidism and/or Graves’ disease is recent stress. This association has been recognized as a precipitating factor ever since Graves’ disease was first recognized. In fact, the most common precipitating event is an “actual or threatened separation from an individual upon whom the patient is emotionally dependent.

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Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications buy discount residronate on-line. Follow the same rules as used for author names buy residronate 35mg mastercard, but end the list of names with a comma and the specifc role generic 35 mg residronate with mastercard, that is, editor or translator. Teaching hospital costs: an annotated bibliography of the costs of medical education, patient care, and research at teaching hospitals. Separate the surname from the given name or initials by a comma; follow initials with a period; separate successive names by a semicolon. Standard citation without the word bibliography in the title (content type added) 3. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Marubini E (Istituto di Statistica Medica e Biometria, Universita degli Studi di Milano, Milan, Italy), Rebora P, Reina G, compilers. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Bibliography with compiler afliation(s) included Title for Bibliographies (required) General Rules for Title • Enter the title of a bibliography as it appears in the original document, in the original language • Capitalize only the frst word of a title, proper nouns, proper adjectives, acronyms, and initialisms • Use a colon followed by a space to separate a title from a subtitle, unless some other form of punctuation such as a question mark, period, or an exclamation point is already present • Follow non-English titles with a translation whenever possible; surround the translation with square brackets • End a title with a period unless a question mark or exclamation point already ends it or a Content Type follows it Specific Rules for Title • Titles not in English • Titles in more than one language • Titles containing a Greek letter, chemical formula, or another special character • No title can be found Box 16. Tabak i tabakokurenie: osnovnoi bibliografcheskii ukazatel otechestvennoi i zarubezhnoi literatury. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Poblacion y empleo en Bolivia (bibliografa anotada) [Population and employment in Bolivia (an annotated bibliography)]. Tabak i tabakokurenie: osnovnoi bibliografcheskii ukazatel otechestvennoi i zarubezhnoi literatury [Tobacco and tobacco smoking: bibliographic index of the Russian and foreign literature]. Chusu shinkeikei senten ijo bunkenshu: kore made no shinpo to kongo no kadai [Bibliographies of congenital central nervous system diseases]. Infant mortality and health in Latin America: an annotated bibliography of the 1979-82 literature. Beauge G, Bendiab A, Labib A, Longuenesse E, Roussillon A, Quiles J, Weyland P, compilers. In this circumstance, create a title from the frst few words of the text and place it in square brackets. Bibliography with titles with parallel text in two languages Content Type for Bibliographies (optional) General Rules for Content Type • A content type alerts the user that the reference is not to a standard book but to a bibliography • Place [bibliography] afer the book title if the word does not appear in the title • Follow the content type with a period unless the book is in a non-print medium (see Type of Medium below) Bibliographies 513 Specific Rules for Content Type • Titles ending in punctuation other than a period • Titles not in English Box 20. Chusu shinkeikei senten ijo bunkenshu: kore made no shinpo to kongo no kadai [Bibliographies of congenital central nervous system diseases]. Standard citation without the word bibliography in the title (content type added) Type of Medium for Bibliographies (required) General Rules for Type of Medium • Indicate the type of medium (microfche, ultrafche, microflm, microcard, etc. An overview of medical and public health literature addressing literacy issues: an annotated bibliography [microfche]. Chusu shinkeikei senten ijo bunkenshu: kore made no shinpo to kongo no kadai [Bibliographies of congenital central nervous system diseases]. Bibliography in a microform Edition for Bibliographies (required) General Rules for Edition • Indicate the edition/version being cited afer the title (and Content Type or Type of Medium if present) when a bibliography is published in more than one edition or version • Abbreviate common words (see Abbreviation rules for editions below) • Capitalize only the frst word of the edition statement, proper nouns, and proper adjectives • Express numbers representing editions in arabic ordinals. Specific Rules for Edition • Abbreviation rules for editions • Non-English words for editions • First editions Box 26. Bibliography with edition Editor and other Secondary Authors for Bibliographies (optional) General Rules for Editor and other Secondary Authors • A secondary author modifes the work of the author. Language Word for Editor Word for Translator Word for Illustrator French redacteur traducteur illustrateur editeur German redakteur ubersetzer erlauterer herausgeber dolmetscher Italian redattore traduttore disegnatore curatore editore Spanish redactor traductor ilustrador editor Russian redaktor perevodchik konstruktor izdatel Box 31. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Use the city of the frst organization found on the title page (or on the back of the title page if no publisher information appears on the title page), as the place of publication. Bibliography of 1690 citations on autohemotherapy, autogenous vaccines, and the works of E. Infectious diseases in twentieth-century Africa: a bibliography of their distribution and consequences. Bibliography with geographic qualifer added to place of publication for clarity 15. Bibliography with no place of publication or publisher found Publisher for Bibliographies (required) General Rules for Publisher • Record the name of the publisher as it appears in the publication, using whatever capitalization and punctuation is 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. Lisbon: Imprensa Medica; • Romanize names given in Cyrillic, Greek, Arabic, Hebrew, Korean Sofa (Bulgaria): Sofa Medizina i Fizkultura; • Romanize names or translate names presented in character-based languages (Chinese, Japanese). Place all translated publisher names in square brackets unless the translation is given in the publication. Tokyo: Medikaru Rebyusha; Beijing (China): [Chinese Academy of Social Sciences, Population Research Institute]; Taiyuan (China): Shanxi ke xue ji she chu ban she; [Note that the concept of capitalization does not exist in Chinese.

To produce large amounts of the adenoviral vector residronate 35 mg on line, packaging cells are infected with the plaque-purified adenoviral vector order residronate 35mg fast delivery. When a cytopathic effect is observed generic residronate 35 mg without prescription, the cells are broken up and the adenoviral vector is purified from the cellular debris using a variety of techniques including CsCl2 gradients and column chromatogra- 12 phy. Titers of up to 10 plaque forming units (pfu)/ml can be obtained and are stable to freezing. Preparations must be tested for the presence of wild-type adenovirus or other pathogens prior to use in humans. Use of Adenoviral Vectors for Gene Therapy Adenoviral vectors have been used to transfer genes in vivo into the lung, liver, muscle, blood vessel, synovium, eye, peritoneum, brain, and tumors in animals. The titers that can be achieved enable a high percentage of the cells to be transduced as well as express elevated levels of the transgene. A major limitation of adenovi- ral vectors is the transgene expression for less than one month primarily due to an immune response to the remaining viral proteins. This immune response can also result in severe inflammation at the site of delivery and organ dysfunction. Fur- thermore, the vigorous host immune response to the surface proteins of the aden- ovirus diminishes the efficacy of repeat administration. A strategy to prolong gene express is to inhibit the immune response to the adenoviral vector. Studies in immunodeficient mice have demonstrated that in the absence of antigen-specific immunity, gene expression is prolonged and secondary gene transfer is possible. The use of immunosuppressive therapy could provide persistent gene expression following adenovirus-mediated gene transfer and allow secondary gene transfer. Injection of adenoviral vector into neonates or into the thymus, result- ing in tolerization, allows subsequent injection of an adenoviral vector into adults without immune rejection. Evaluation of gene expression from adenoviral vectors has been complicated by its instability. It is therefore likely that the deletion of other early genes might modulate expression of an adenoviral vector in vivo. Additional experiments in which transgene expression is followed over time and normalized to the adenoviral vector copy number in various organs will be necessary to optimize expression levels in vivo. Risks of Adenoviral Vectors There are three potential risks of adenoviral vectors: (1) the development of organ inflammation and dysfunction due to the immune response to adenoviral vector- transduced cells, (2) the development of tolerance to an adenoviral vector that could result in fulminant disease upon infection with wild-type virus, and (3) the development of wild-type virus. For example, one patient with cystic fibrosis who received an adenoviral vector to the lung had a severe inflammatory response. It is likely that decreasing the immunogenicity of adenoviral vector-transduced cells or modulating the immune response will decrease this inflammation. The risks of mod- ulating the immune response to an adenoviral vector have not been adequately studied. It is possible that immunomodulation will predispose to fulminant disease upon infection with wild-type adenovirus of the same serotype. These risks cannot be assessed in animal models where the adenovirus does not replicate. The third risk of using adenoviral vectors is the generation of wild-type virus in vivo. This also could lead to fulminant infection if immunomodulation has led to tolerance. It is less likely that development of wild-type adenovirus would contribute to malig- nancy since the virus does not integrate. Summary: Adenoviral Vectors In summary, adenoviral vectors result in high-level expression in the majority of cells of many organs for 1 to 2 weeks after transfer. Gene transfer occurs in nondi- viding cells, a major advantage over most retroviral vectors. The insta- bility of expression is a serious impediment to the use of adenoviral vectors in the treatment of monogenic deficiencies. It is less of a problem for gene therapy approaches for cancer that require short-term expression. The immune response to adenoviral-transduced cells can lead to organ damage and has resulted in death in some animals. Any preexisting or induced antiadenovirus neutralizing antibodies could prevent an initial or subsequent response to adenoviral treatment. Modifica- tion of the adenoviral vector to decrease its immunogenicity or suppression of the recipient’s immune response may prolong expression and/or allow repeated deliv- ery to patients. It was first discovered as a satellite contaminant in human and simian cell cultures infected with adenovirus. They enter the cell by receptor-mediated endocytosis and are transported to the nucleus. Although the receptor has not yet been cloned, entry occurs in a wide range of mammalian species. The left open reading frame extends from map position 5 to 40 and encodes the Rep proteins.

To this aim 35mg residronate with visa, sophisticated but often expensive instruments are now at hand of clinicians purchase cheap residronate line. These instruments allow studying stability during qui- et stance buy discount residronate line, postural reactions to external disturbances, anticipatory pos- tural adjustments to perturbations caused by self-paced movements and gait. All these conditions mimic quite well known situations encountered in every-day life. Postural sway during standing and unexpected disturbances of bal- ance in random samples of men of different ages. Straube A, Bötzel K, Hawken M, Paulus W and Brandt Th: Postural control in the el- derly: differential effects of visual, vestibular and somatosensory input, in Amblard B, Berthoz A and Clarac A, (eds). Schieppati M, Tacchini E, Nardone A, Tarantola J and Corna S: Subjective perception of body sway. The limits of equilibrium in young and elderly normal subjects and in parkinsonians. A prospective study of laboratory and clinical balance measures as risk factors for falls in the community-dwelling elderly. Dynamic balance in older persons: effects of reduced visual and proprioceptive input. Aging and posture control: changes in sensory organization and muscular coordination. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Postural sensitivity to visual flow in aging adults with and without balance problems. Medium-latency stretch reflexes of foot and leg muscles an- alyzed by cooling the lower limb in standing humans. Age-related changes in compensatory stepping in response to unpredictable perturbations. Balance performance on the postural stress test: comparisons of young adults, healthy elderly and fallers. Static versus dynamic predictions of stepping following waist-pull perturbations in young and older adults. Postural coordination in el- derly subjects standing on a periodically moving platform. An epidemiological study of falls in older com- munity dwelling woman: the Randwick falls and fracture study. Impairment of posturo-kinetic coordina- tion during initiation of forward oriented stepping movements in parkinsonian pa- tients. The effect of posture and ‘postural set’ on leg muscle responses to perturbation, and its relation to the severity of the disease. Central programming of postural movements: adaptations to altered support surface configurations. Open-loop and closed-loop postural control mechanisms in Parkinson’s disease: increased mediolateral activity during quiet standing. Effects of deep brain stimulation and levodopa on pos- tural sway in Parkinson’s disease. Comparison between subthalamic nucleus and globus pallidus internus stimulation for postural performance in Parkin- son’s disease. Impaired scaling of long latency postural reflexes in patients with Parkinson’s disease. Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease. Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone. Selective depression of medium-latency leg and foot muscle responses to stretch by an alpha 2-agonist in humans. Postural set for balance control is normal in Alzheimer’s but not in Parkinson’s disease. Postural adjustments associ- ated with rapid voluntary arm movements in patients with Parkinson’s disease. Anticipatory postural reflexes in Parkinson’s dis- ease and other akinetic-rigid syndromes and in cerebellar ataxia. Postural instability in Parkinson’s disease: a comparison with and without a concurrent task. Effect of cognitive and motor tasks on postural stability in Parkinson’s disease: a posturographic study. Stance control is not affected by pare- sis and reflex hyperexcitability: the case of spastic patients. The evaluation of balance in hemiparetic stroke patients using lateral forces applied to the hip. Adapting human postural reflexes following lo- calized cerebrovascular lesion: analysis of bilateral long latency responses. Human neuronal control of automatic functional movements: interaction be- tween central programs and afferent input.

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If exudates are present purchase residronate from india, ap- sus is plucked and the skin is incised and reflected order residronate amex. The cortex is cracked and urate crystals can be confirmed by microscopic ex- small amounts of marrow are teased or gently amination of cytologic preparations (under polarized squeezed from the marrow cavity proven 35 mg residronate. Urate crystals will appear as re- preparations of bone marrow are made for cytologic fractile needles. The cortex should be cracked to promote rapid penetration of fixative into the tissues. Skin (including Crop Pancreas feathers, follicles) Proventriculus Ovary and oviduct Trachea Ventriculus (female) Lung Small intestine Testis (male) Whole Carcass Submission Air sac Large intestine Pectoral muscle Heart Ceca (if present) Bone marrow In instances where the entire carcass is extremely Kidneys Cloaca Cloacal bursa small, such as embryos, nestlings or very small adult Thyroid glands Spleen Thymus Parathyroid glands Liver Brain birds, the entire carcass may be submitted for his- Adrenal glands Gall bladder Ischiatic (sciatic) tologic examination. This is best accomplished by Esophagus (if present) nerve opening the thoracoabdominal cavity, gently separat- Selection of additional tissues will depend upon gross lesions observed at ing the viscera and fixing the entire carcass in for- necropsy. Exces- sively thick (one cm thickness) tissue slices or tissues that float (gas-filled intestine, fatty liver, lung) when immersed in formalin solution often do not fix and Specimen Collection become autolytic. Representative tissue specimens from all organ systems should be collected (Table for Ancillary Testing 14. When specific lesions are observed at necropsy, the tissue specimen collected should include a small margin of normal tissue adjacent to the lesion. Ancillary testing often is essential to confirm or es- Specimens should be shipped to the laboratory in tablish a definitive diagnosis. To de- should be collected routinely for histopathologic crease shipping weight, tissues that have been fixed evaluation; however, additional specimens (eg, swabs in formalin solution for at least 24 hours can be for bacterial culture, fresh tissues for bacterial cul- wrapped in a formalin-soaked gauze square that is ture and virus isolation, crop contents for toxicologic placed into a sealable plastic bag for shipment. In the analysis) are obtained as necessary based upon his- authors’ experience, a complete set of necropsy tis- torical, clinical and necropsy findings. Because specimens can be submitted along with the formalin- cost is often a consideration when submitting his- fixed tissues if the need for additional laboratory topathologic specimens to the laboratory, the practi- testing is obvious or they may be held under appro- tioner should consult a veterinary pathologist con- priate conditions for later submission if required. It cerning the tissues to be submitted in a particular is better to have taken specimens for ancillary testing case. The remaining fixed tissues can be held for and not need them, than to need the specimens and additional study if needed. The following information is designed to expedite specimen procurement and han- Hematologic and Cytologic Specimens dling to maximize the results obtained. A telephone call to the diagnostic laboratory prior to performing Preparation of blood and cytology specimens for mi- the necropsy is a prudent measure to ensure correct croscopic examination is detailed in Chapters 9 and specimen collection, preparation and handling. Tissue Histopathology scrapings may be smeared onto a clean glass slide, or squash preparations may be made if particles of Tissue specimens for histopathology should be pre- tissue are present. Tissue imprints are prepared by served in neutral-buffered ten percent formalin solu- blotting the tissue specimen on an absorbent surface tion. Buffered formalin is necessary to prevent acid (filter paper or paper towel) to remove excess blood hematin formation, which can obscure microscopic and tissue fluid. Furthermore, adequate preservation of touched to a clean glass slide several times or vice tissues requires rapid and complete penetration of versa. Tissue specimens may be antibody staining for chlamydiosis or herpesvirus placed in sealable plastic bags and frozen prior to infection). Swab specimens the laboratory immediately, they may be stored in are properly prepared by gently rolling the swab the the freezer until needed for diagnostic testing. Three such passes may be the definitive diagnosis has been made, remaining made on a single slide from top to bottom. If they are not stained before examination or submission to the diagnostic labora- Tissue specimens for fungal culture and identifica- tory, they should be protected from excessive mois- tion may be collected, placed in sealable plastic bags ture or formalin fumes, which could cause cellular and refrigerated or frozen until analyzed. Microbiology Parasitology Microbiology includes culture and identification of bacteria, viruses and fungi as well as certain sero- Fecal flotation for detection of parasite ova is per- logic assays to detect the presence of or exposure to formed frequently as a portion of the minimum data- these pathogens. Additional may include culture swabs, fresh tissues, body fluids fecal specimens may be taken for analysis at ne- or exudates, cytologic smears and imprints (eg, fluo- cropsy, especially in those patients with diarrhea, rescent antibody staining for chlamydia and herpes- where protozoal infection is a consideration. These specimens are perishable intact parasites such as cestodes, trematodes, nema- and should be shipped to the laboratory without todes or arthropods may be taken for specific identi- delay. Proper fixation of these para- Fresh tissues submitted for bacterial culture should sites is essential for successful identification by a be at least two cubic centimeters to yield accurate veterinary parasitologist. At the laboratory the surface of the tissue is preservation of fecal material and parasites are de- seared with a heated spatula to sterilize it, and a loop tailed in Tables 14. If the tissue Wet mounts of feces or a feces-saline slurry should be is too small, the entire specimen (including bacteria) examined within minutes of death to detect organ- is destroyed during the searing step, and a false- isms such as Giardia sp. Following in- tine bacterial culture can be placed in sterile, seal- itial examination, a small drop of Lugol’s iodine can able plastic bags and submitted immediately or be added to kill and stain protozoa and their cysts for frozen if a delay of more than 12 to 24 hours before more detailed examination. If unusual pathogens are sus- perishable and generally will not survive shipment to pected, the diagnostic laboratory should be consulted the diagnostic laboratory.

These samples should only be taken by a doctor or nurse for evidential purposes with the detainee’s fully informed consent and should be packaged in accordance with local procedures to ensure the chain of evidence residronate 35mg discount. Introduction The custodial interrogation of suspects is an essential component of all criminal investigation systems purchase discount residronate on line. The confessions and other incriminating state- 216 Norfolk and Stark ments that are obtained during these interrogations have always played an important role in prosecutions and continue to be relied on as evidence of guilt in a substantial number of trials cheap 35mg residronate visa. For example, in England and Wales, confes- sions provide the single most important piece of evidence against defendants in the Crown Court, being crucial in approx 30% of cases (37). Similarly, an influential American observational study found that interrogation was neces- sary for solving the crime in approx 17% of cases (38). The quest to obtain confessions from suspects’ mouths has seen a slow and uneven move away from the inquisitions aided by torture and oppression of the Middle Ages toward the doctrine that: A free and voluntary confession is deserving of the highest credit, because it is presumed to flow from the strongest sense of guilt and therefore it is admitted as proof of the crime to which it refers; but a confession forced from the mind by the flattery of hope or by the torture of fear comes in so questionable a shape when it is to be considered as the evidence of guilt, that no credit ought to be given to it; and therefore it is rejected (39). In the years since this judgment, considerable effort has been expended attempting to regulate the custodial interview to minimize the risk of false confessions while preserving the value of interrogation as a means of solving crime. In this section, the important psychological aspects of interrogation and confession are considered and the role the forensic physician can play in ensuring that suspects are fit to be interviewed is discussed. Police Interview Techniques Numerous American manuals detail the way in which coercive and manip- ulative interrogation techniques can be employed by police officers to obtain a confession (40,41), with similar techniques being advocated by Walkley (42) in the first such manual written for British officers. The authors of these manuals propound various highly effective methods for breaking down a suspect’s resis- tance while justifying a certain amount of pressure, deception, persuasion, and manipulation as necessary for the “truth” to be revealed. Walkley acknowledges that “if an interviewer wrongly assesses the truth-teller as a lie-teller he may subject that suspect to questioning of a type which induces a false confession. Although studies in the United Kingdom have suggested that coercive interview techniques are employed less frequently than in the past, manipulative and persuasive tactics continue to be used, particularly in relation to more serious crimes (43,44). Care of Detainees 217 Interrogators are encouraged to look for nonverbal signs of anxiety, which are often assumed to indicate deception. Innocent suspects may be anxious because they are erroneously being accused of being guilty, because of wor- ries about what is going to happen to them while in custody, and possibly because of concerns that the police may discover some previous transgres- sion. Furthermore, there are three aspects of a police interview that are likely to be as stressful to the innocent as to the guilty: the stress caused by the physical environment in the police station, the stress of being isolated from family and friends, and the stress caused by the suspect’s submission to authority. All these factors can markedly impair the performance of a suspect during an interview. Indeed, American research has suggested that for most suspects, interrogations are likely to be so stressful that they may impair their judgment on such crucial matters as the exercise of legal rights (45). Given the interview techniques employed by the police and the stresses interrogation places on the accused, there is little wonder that false confes- sions are occasionally made to the police. False Confessions During the last two decades, the United Kingdom has witnessed several well-publicized miscarriages of justice in which the convictions depended heavily on admissions and confessions made to the police that were subse- quently shown to be untrue (46–48). In reviewing 70 wrongful imprisonments that occurred between 1950 and 1970, Brandon and Davies (49) found that false confessions were second only to incorrect identification evidence as the most common cause of wrongful conviction. More recently, in 1994, Justice (50) identified 89 cases in which an alleged miscarriage of justice rested on a disputed confession. Thus, it is clear that people can and do make false and misleading admissions against their own interest. There is no single reason why people falsely confess to crimes they have not committed. Indeed, such confessions usually result from a combination of factors unique to the individual case. These categories are voluntary, accommodating-compliant, coerced-com- pliant, and coerced-internalized. Voluntary False Confessions Voluntary false confessions are offered by individuals without any exter- nal pressure from the police. Commonly, the individuals go voluntarily to the police to confess to a crime they may have read about in the press or seen reported on television. Often, they do so out of a morbid desire for notoriety because the individual seemingly has a pathological desire to become infa- mous, even at the risk of facing possible imprisonment. Alternatively, a voluntary false confession may result from the individual’s unconscious need to expiate guilty feelings through receiving pun- ishment. The guilt may concern real or imagined past transgressions or, occa- sionally, may be part of the constant feeling of guilt felt by some individuals with a poor self-image and high levels of trait anxiety. By contrast, some people making this type of confession do so because they are unable to distinguish between fact and fantasy. Such individuals are unable to differentiate between real events and events that originate in their thinking, imagination, or planning. Such a breakdown in reality monitoring is normally associated with major psychiatric illness, such as schizophrenia. Occasionally, people may volunteer a false confession to assist or protect the real culprit. Gudjonsson (52) highlights some evidence that confessing to crimes to protect others may be particularly common in juvenile delinquents. Finally, Shepherd (53) identifies a subset of individuals who falsely con- fess to crimes to preempt further investigation of a more serious crime.