Condet

Griff Jones BSc MB BS MRCOG FRCSC

• Consultant Obstetrician and Gynaecologist, Winchester
• District Memorial Hospital, Winchester, Ontario, Canada

Lister relied on information from the police in preparing her preliminary investigation report (which led to the decision not to hold an inquest) cholesterol score of 9 cheap zocor 40mg online, and Ms cholesterol test good numbers proven 5 mg zocor. The historical criminalization of public intoxication in Canada Decriminalization in British Columbia the current practice in Vancouver for dealing with public intoxication a cholesterol levels green tea order zocor 10 mg mastercard. One study suggests that in the second half of the 1800s cholesterol statins cheap zocor 5mg overnight delivery, city and county jails were overflowing with drunkards, and there was some pressure to establish inebriate institutions or retreats for habitual drunkards. In most instances, due to a lack of political will or public funding, these institutions did not materialize. Some private institutions were established, but typically served clients who could pay for their treatment. In the 1860s, local option laws appeared, which gave individual cities, municipalities and counties the authority to vote on whether they wanted to prohibit the sale of alcohol. By 1918 that Act was no longer in effect, and over the next few years most provinces developed a system of government control over alcohol sales and conditions of use. This legislation was the predecessor to our current liquor control laws, which typically include the offence of public intoxication. The offence of public drunkenness has its roots in vagrancy laws, which sought to exert control over homeless, unemployed and unattached men. Drunks would be arrested, charged with an offence and brought to court, where they would typically receive short jail sentences, only to repeat the cycle many times. These centres were often affiliated with halfway houses, where alcoholics could be referred for treatment. Section 91(1) of the Offence Act (as it now reads) provides that if a peace officer finds, in a place to which the public has access, a person who is in a state of intoxication, the peace officer may take that person into custody. If it appears to the peace officer that the person may be in need of remedial treatment because of the use of alcohol, the peace officer must, within 24 hours, take the person to a physician (s. An application for a confirming order may be made to a justice of the peace or to a Provincial Court judge. Although the wording of the Orders in Council is ambiguous, I understand that peace officers had been authorized to detain intoxicated persons until they had o 2. It is not clear whether confirming orders were ever made in these two municipalities and, if they were, whether these jail premises were converted into detox and treatment facilities with appropriate medical and counselling services. Should the person be detained for being in a state of intoxication in a public place Although "intoxication" is not defined, section 91(3) might provide some assistance. If a person can be released when he or she has recovered capacity, this implies that the person did not have such capacity at the time of arrest. Delivery to the Jail: If the person is not eligible for admission to the sobering unit, the person must be delivered to the Jail, which includes a separate holding facility for intoxicated people. The Jail guard must physically check and assess intoxicated prisoners every 15 minutes, and move them into the recovery position if they are sleeping. Prior to release, the prisoner should be asked if she or he has a place to go and the means to get there. If appropriate, they should be offered bus tickets, Saferide, or a phone call to a friend/family member to pick them up, particularly in inclement weather. Walkem also makes a persuasive case for the development of culturally appropriate facilities and programs for chronic alcoholic Aboriginals, for several reasons. It was not controlled by the liquor control and licensing branch because, with two percent salt content, it was not considered palatable liquor. Frail recounted a two-year campaign that led, in December 1999, to the provincial government ordering that the sale of distilled rice alcohol be restricted to government liquor stores. This meant that the parties had only a limited time to devise a different strategy for the handling of chronic alcoholics. There was a recognition that public intoxication and detoxification were health issues, and that the Downtown Eastside of Vancouver was in desperate need of a sobering centre, a safe place to hold people intoxicated by drugs or alcohol. Until such a facility could be developed, it was proposed that the fourth floor of that building be renovated, for use as an interim sobering facility. It would have the capacity to hold people involuntarily until they were capable of making rational decisions. By July 1998, some parties were questioning the suitability of (and cost of renovating) the old Jail facility.

Accuracy of clinical examination in the evaluation of femoral false aneurysm and arteriovenous fistula cholesterol chart 2015 purchase zocor 20mg visa. Less often cholesterol test and fasting order zocor 10mg visa, ulcers develop over the heel cholesterol ldl definition 40 mg zocor, the plantar midfoot cholesterol test strips cardiochek purchase 10mg zocor amex, or previous amputation sites. The term ulcer area refers to the product of the maximum ulcer width and maximum ulcer length. Conventional examination often fails to detect diabetic polyneuropathy, however, and about half of patients with diabetic ulceration lack complaints of numbness or pain3 and can still detect the touch of a cotton wisp or pinprick. To use the monofilament, the patient should be lying supine with eyes closed, and the monofilament should be applied perpendicular to the skin with enough force to buckle it for approximately 1 second. The patient responds "yes" each time he or she senses the monofilament, as the clinician randomly *The nominal value of a monofilament represents the common logarithm of 10 times the force in milligrams required to bow it. In clinical studies, anywhere from 1 to 10 different sites on the foot are tested, but each study defines the abnormal result as inability to consistently sense the monofilament at any site. Testing the plantar surface of the first and fifth metatarsal heads may be the most efficient and, overall, the most accurate bedside maneuver. It is also possible, however, that a better indicator of protective sensation is one of the other seven monofilaments between 6. Although historically the most common causes were syphilis (affecting the larger joints of the lower extremity) and syringomyelia (affecting the larger joints of the upper extremity), the most common cause today is diabetes. In diabetic patients, the Charcot joint characteristically affects the foot, including the ankle, tarsometatarsal, and metatarsophalangeal joints. In the acute phase, soft tissue swelling typically appears at the ankle and midfoot, sometimes with marked rubor and warmth mimicking arthritis or cellulitis. Definition of findings: for positive probe test, ulcer area, and predictors of nonhealing wound, see text. One proposed test is the probe test, in which the clinician gently probes the ulcer base with a sterile, blunt, 14-cm 5-Fr, stainless-steel eye probe. The test is positive, suggesting osteomyelitis, if the clinician detects a rock-hard, often gritty structure at the ulcer base without any intervening soft tissue. The findings of erythema, swelling, or purulence are unhelpful in diagnosing osteomyelitis. Comparison of quantitative sensory-threshold S measures for their association with foot ulceration in diabetic patients. Clinical examination versus neuroV physiological examination in the diagnosis of diabetic polyneuropathy. TheNorth-WestdiabetesFootCareStudy: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patientcohort. Unsuspectedosteomyelitisindiabeticfootulcers: diagnosis and monitoring by leukocyte scanning with indium In 111 oxyquinoline. The most common causes of bilateral edema are congestive heart failure, chronic venous insufficiency, pulmonary hypertension without left heart failure, and drug-induced edema. In contrast to venous edema, lymphedema varies little during the day and ulceration is uncommon unless there is secondary infection. Even though lymphedema has high protein levels, clinical experience reveals that lymphedema does pit early in its course, although it eventually becomes nonpitting, hard, and "woody" as secondary fibrosis ensues. Primary lymphedema begins before the age of 40 years, may be bilateral (50% of cases), and affects women 10 times more often than men. Malignant obstruction affects patients older than 40 years and is almost always unilateral (>95% of cases). Several studies have shown that only proximal thrombi are associated with clinically significant pulmonary emboli, and thus only these thrombi require treatment with anticoagulation. The increased collateral flow around an obstruction could make the superficial veins more conspicuous, but skin surface temperature and color reflect blood flow and vessel size of the minute vessels of the dermis,15 which should not necessarily be different after venous obstruction. The presence or absence of erythema, tenderness, skin coolness, palpable cord, and Homans sign lack diagnostic value.

However optimal cholesterol levels nz buy discount zocor 10mg line, this protection does not apply if the officer has been guilty of dishonesty cholesterol medication causes muscle pain buy cheap zocor 40 mg on line, gross negligence or malicious or willful misconduct cholesterol in eggs without yolk cheap zocor 5mg without prescription, or if the cause of action is libel or slander which cholesterol medication is best buy zocor 20mg with amex. Investigative treatment of respondent officers When a civilian is suspected of causing a death, the practice of the police is to arrest the suspect, advise them of their rights under the Charter of Rights and 411 412 Police Act, s. Should the suspect request an opportunity to consult with legal counsel, the police must hold off their questioning until that consultation has taken place. Thereafter, it has been held to be lawful for police officers to aggressively question a suspect, notwithstanding repeated assertions by the suspect that he or she does not want to talk to them. Porteous testified that the unwritten policy underlying this practice is to ensure that the decision to charge or not to charge an officer with a criminal offence, is made by a neutral and independent third party. This policy and practice is an implicit admission of what to many would seem obvious-that the home police department may not be neutral and independent in such matters. Having said that, a duty report may not be admissible against a respondent officer in any resulting criminal proceedings, since it was made under compulsion: see R. Instead, the neutral Report to Crown Counsel introduces new problems, such as the risk that important inconsistencies and difficult issues arising in the evidence may not attract the critical attention they merit. However, I do have access to the Crown Counsel Policy Manual, as well as a considerable body of evidence and information that addresses the police practice in preparing these "neutral" Reports to Crown Counsel. As discussed earlier, the Criminal Justice Branch has developed different charge assessment procedures for when a police officer is alleged to have committed a criminal offence. The Crown Counsel Policy Manual explicitly attributes this different policy to concerns about conflict of interest and the need to maintain public confidence in the administration of criminal justice. However, as I examined the issue of the police investigating themselves, it soon became apparent that I should not limit my analysis to Vancouver alone, for several reasons. Second, when examining some of the essential elements of a new system, such as cost (as I will discuss later), one needs to know how many police departments will be participating in the new system. I appreciate that it is sometimes only good fortune that separates serious injury from death, and that the conflict of interest that jeopardizes the integrity of police-related death investigations applies with equal force to investigations of police-related serious injuries. I concluded that conflict of interest probably contributed to what I find to be an unsatisfactory criminal investigation in that case, and I am willing to extrapolate from that incident the existence of a risk that conflict of interest could taint other police-related death investigations. Then, after developing policies and practices, and gaining valuable on-theground experience, the decision can be made whether the mandate should be broadened and, if so, how much. The challenge lies in developing a new system for the investigation of police-related deaths. In considering what recommendations to make, I found it helpful to conceptualize the issue in terms of a spectrum. Independence If conflict of interest is the Achilles heel of the current system, then any new regime must move the criminal investigation of police-related deaths outside the home police department. While reliance on another police force or officers from ad hoc or dedicated teams to conduct these investigations may be adequate, it is equally true that they may not. Capacity to respond immediately Experienced police officers know the crucial importance of responding immediately to a suspicious death, identifying and questioning suspects, sealing off the incident scene, separating suspects and witnesses, conducting a thorough forensic investigation, and preserving evidence. This necessitates an examination of the human resources capacity, financial ability, and expertise of other police departments to conduct such investigations. Cost Currently, a home police department bears the cost of conducting a criminal investigation into a police-related death arising in its own municipality. Accountability Whatever new system for the criminal investigation of police-related deaths is implemented, it must ensure that there is an appropriate level of accountability, with respect to the substantive decisions made and the processes followed. Since the geographical configuration and relative sizes of the municipal forces bears on several of these options, it will be useful to set out that information here (Table 1): Statistics Canada 2006 Census; see 12. With respect to independence, reliance on another municipal police department is only one step removed from the home department, and would rely on serving police officers to conduct the investigation. If that is so, then all Vancouver-based police-related deaths would need to be investigated by the Delta or Abbotsford police departments. I am not satisfied that it would bring a necessary degree of independence and, given the disparate sizes and geographical configuration of municipal policing departments in British Columbia, I am not satisfied that an adequate level of expertise would be available in many cases.

Syndromes

• Liver biopsy
• Neuroblastoma
• Dry mucus membranes
• Breathing disorder in sleep (sleep apnea)
• Difficulty concentrating
• Blood tests to check for syphilis, HIV, or other sexually transmitted infections
• Damage to brain tissue
• Marfan syndrome

It began its activities in 2005 in Senegal and currently provides services to interact with customers (customer claims helplines) and back-office activities (payroll cholesterol ratio percentage zocor 20mg cheap, data entry and management cholesterol avocado 5 mg zocor overnight delivery, human resources management) is the cholesterol in eggs bad generic 20mg zocor free shipping. The two main customer groups for Computers Frontiers Senegal in 2012 were (1) multinational companies operating in Senegal and (2) U cholesterol score of 220 zocor 10mg with mastercard. The bulk of these exports (90%) were generated through the cross-border supply of services via email and Internet, consumption abroad via incoming calls, and the temporary movement of staff to directly provide services. Computers Frontiers Senegal faces several competitors in the domestic market, with another new entrant arriving in 2012. The second most senior officer has a degree from a Senegalese school of business and management. Call Me Call Me is 100% owned by Senegalese interests and was created in 2002 as a subsidiary of Chaka Group, the Senegalese computer engineering firm. Its creation followed a tender won by the Chaka Group to develop customer relationship software for Tigo Telecommunications Company. Call Me provides business process outsourcing services, including voice services and outsourced appointment-taking for visa applications to embassies. It also provides advisory services (quality management, team training, and performance increase in customer teams). Call Me has numerous customers in Senegal and abroad (France, Belgium, Switzerland). It started its activities in Senegal in 2006 and provides the following interaction services: sales support, membership management, claims, subscription renewals, order processing, customer telephone hotlines, and credit and billing issue management. Back-office activities are also provided: data entry and management services, data processing and database services, payment services, financial processing (information and financial data treatment/management), processing checks, credit/debit payment cards services, human resources management, and payroll services. Exports accounted for approximately 20% of sales, with customers located in Canada. These exports are delivered electronically through cross-border supply (telephone calls). The second most senior officer has a degree from a foreign school of business and management. It has established itself as an important global player in the contact centre market. It provides several categories of services: inbound pre-sales contacts (information on products and services, support to launch communication campaigns, traffic building, location of outlets), outbound pre-sale contacts (qualifying leads, supporting sales force, making appointments, market research, test marketing), inbound sales contacts (commercial service, order taking, reservations), outbound sales contacts (telesales to the general public and businesses, follow-up in the purchasing process, subscription), incoming after-sales contacts (after-sale service, technical support hotline, telephone helpline, consumer services by phone, and e-loyalty program management), outbound customer service contacts (additional cross-sales, billing, debt collection, loyalty campaigns), medium back-office services (activating new accounts, file management, claims processing, end-customer settlement processing, warehousing, light assembly, shipment), and business units support (recovery of clients and arrears, and training in call center management). Approximately 60% of its turnover is generated from African markets, with the remaining 40% generated from the European market. Based on the number of seats in operation, its market share in Senegal is estimated at 50 to 60%. Alongside additional insights shared by stakeholders surveyed for the paper, we also account for factors identified under A. In doing so, we adopt the framework set out by Goswami, Mattoo, and Saez in their 2012 edited volume, Exporting Services: A Developing Country Perspective. While accepted as given in the short run, they can be influenced by policy over the longer term. Policies affecting trade, investment, and labour mobility in services, including relevant policy reforms (autonomous or negotiated) influencing the conditions affecting the movement of factors of production, notably here as related to telecommunications. It measures the viability of countries as offshore destinations based on their financial attractiveness, people skills and availability, and business environment. The Fundamentals Labour/Human Capital Empirical literature points to the availability and quality of human resources as one of the primary factors shaping services export competitiveness. In addition, Senegal has a low secondary school and higher education enrolment rate compared to these locations (see Figures 5c and 5d). A number of Senegalese schools, however, command a good reputation for the quality of their computer science and engineering graduates-which have become sought after in the domestic market. Unfortunately, the number of graduates from these schools is not adequate for satisfying the export market. One of the main weaknesses of the training being provided for call centres in Senegal is the absence of strong English language components, although a growing number of higher education institutions are offering French/English bilingual programs. An increasing number of higher education institutions are now offering programs exclusively (or predominantly) in English.

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