Liza J. Enriquez, MD

• Departments of Anesthesiology
• Montefiore Medical Center
• Bronx, New York

Finally allergy forecast dfw buy quibron-t 400 mg with visa, increasing the operating frequency of the wireless biotelemetry of the device can also help in the miniaturization of the antenna allergy symptoms natural remedies discount quibron-t 400 mg with visa, as the wavelength and the frequency are inversely proportional allergy shots drowsiness buy quibron-t once a day. In the next chapter allergy shots given to cats purchase quibron-t 400 mg overnight delivery, a detailed analysis of a miniaturization process for implantable antennas is presented allergy shots negative effects buy quibron-t 400 mg with amex. Biocompatibility Implantable antennas must be biocompatible to ensure patient safety and prevent implant rejection allergy shots 5 year old purchase 400mg quibron-t with visa. Two main techniques are used to preserve the biocompatibility of the antenna, isolating the metallic radiator from the human tissue: employing a biocompatible substrate and/or superstrate; and the insertion of a thin layer of a low-loss biocompatible coating (biocompatible encapsulation) [101]. Table 3 shows biocompatible materials used to isolate implantable antenna presented in the literature. As I mention previously, a high permittivity allows greater miniaturization, while a low loss tangent means low losses and better antenna performance. In order to validate their dielectric properties, they are characterized using a rectangular waveguide cavity resonator (Figure 3) in the laboratory where my research is performed. Although an exhaustive analysis of the characterization by means of this method is not within the scope of this thesis, some results are given in Table 4. An example of the resonant frequency variations produced by fluctuations in a range close to the nominal values in substrate dielectric properties is given in [104]. However, variations in permittivity have to be considered at the modeling stage, as other designs could lead to significant frequency detuning (see Subsection 5. Set-up to measure the dielectric properties using a rectanup to measure the dielectric properties using a rectangular waveguidegular waveguide cavity resonator. Drawbacks of this technology are related to misalignment between the inductors,Drawbacks of this technology are related to misalignment between the inductors, slow data transfer rates and short distances of communicationand short distances of communication. Table 5 classifies several frequency bands that have been used in the literature forclassifies several frequency bands that have been used in the literature forclassifies several frequency bands that have been used in the literature for antennas used in biotelemetry. The criteria by which an antenna engineer selects the operating frequency bandThe criteria by which an antenna engineer selects the operating frequency bandThe criteria by which an antenna engineer selects the operating frequency band depend on the application. While low frequency links present lower losses through biological tissues (due to lower conductivities), high-frequency biotelemetrybiological tissues (due to lower conductiv frequency biotelemetry implies small antenna sizes and an enhancement of the communication speed. Field Regions Another important aspect that depends on the operating frequency selected is the space distribution of the field regions, as they substantially modify the behavior of the radiated power. The boundary between the near-field and the far-field regions in electrically small antennas ranges from 1 to 2 times the wavelength, and the reactive near-field zone finishes at a distance of /2, as illustrated in Figure 4. This reactive region has a great impact on the behavior of the radiated power of the antenna, as reported in [86], [134]. When implanted in biological tissue, the surrounding lossy medium dramatically decreases the radiation efficiency of the antenna because of its interaction with the reactive near-field. The dimensions of these regions for the three main frequency bands studied in this thesis are comparable with the dimensions of phantoms and implant depths, as can be appreciated from Table 6. Hence, additional considerations of substrate size or implant location have to be taken into account when defining the operating frequency. Frequency Detuning As reported in detail in [38], [111], [135], the working frequency of wireless biotelemetry systems becomes detuned, depending on the implant location, and this detuning varies for each individual. In the process of designing an implantable antenna, detuning effects have to be considered to establish a bandwidth large enough to ensure the communication link with the device in different individuals and implant locations. Bandwidth When an antenna is surrounded by lossy media, near field coupling produces strong dissipation into the environment, resulting in unusually wide band behavior [14]. This means that, although it enhances the bandwidth, the presence of the human body reduces the efficiency of the antenna. As seen in the previous subsection, a large bandwidth is desirable in the design of implantable antennas to diminish frequency detuning effects. The effect of bandwidth enlargement due to lossy media may not be enough to fulfill this requirement. In the design presented in [79], the bandwidth is increased by embedding the hook-shaped slots at the edges of the radiating patches; while in [82], the antenna shows wideband behavior using modified ground structure. In the study reported in [56], a new resonant frequency appears in close proximity to the fundamental one, due to the introduction of a strip connected to a simple dipole. In [136], a differentially fed dual-band implantable antenna that operates at two frequencies close to the MedRadio band is presented. A single wideband is achievable by retuning the geometrical parameters of the proposed antenna. Powering In the presence of a human body, the maximum input power for wireless transmission is limited by radiofrequency safety regulations, as mentioned before in this chapter. In addition, a great amount of this power is deposited in the body, reducing the radiated power and transmission range. Therefore, current research focuses on new powering methods or passive technologies to develop batteryless in-body devices [19]. Multiband antennas allow the utilization of different frequency bands for biotelemetry, wireless power transfer and/or a wake-up signal [83], [138]. Recent studies investigate various proposals to take advantage of environmental energy sources. Examples of power harvesting include electrochemical [141], [142], thermoelectric [143], kinetic [143], [144], ultrasound [145] and photovoltaic [146], to name only a few. Passive Technology Passive devices do not require any power storage, as in the fully-passive in-body devices presented in [147], [148]. The main issue here is that an external reader in close proximity to the antenna is required. Radiation Pattern the radiation pattern of an antenna is considerably affected by the surrounding environment, especially that in the near-field region [134]. Generally, an off-body transmission is required, meaning that the radiation pattern should substantially tend in the outwards body direction. In Chapter 4, I present a detailed analysis of the influence of phantoms on antenna performance. Efficiency In a medical device with wireless biotelemetry, the lossy matter surrounding the antenna strongly couples with the near-field, producing an increment in lost power. This phenomenon causes a drastic radiation efficiency reduction for in body antennas. By allocating part of the near-field to a lossless substrate instead of in lossy media, it is possible to mitigate this drawback [134]. An assessment of the radiator structure could also lead to an improvement in efficiency. Indeed, the next two chapters present a study of far-field features depending on the radiator shape, the influence of the phantom and the location of the antenna, among others. I consider that the radiated power is in the far-field region, outside the human body. Packaging the encapsulation or packaging, including the placement of electronic components, is an important factor in the design of antennas to be used in a medical device. Due to the electromagnetic coupling between electronics and the antenna, it is advisable to take the overall design into account in simulations by integrating all the elements so that the model is as similar as possible to the real case. In [152], a multilayer dual-band antenna integrated inside an implantable and biocompatible capsule is presented. The capsule includes a temperature sensor, a battery, a data transmitter module and a wake-up module. Examples of antennas embedded into endoscopic capsules or other cylindrical devices can be found in [48], [72], [75], [86], [100], [117] and [144]. The main features of encapsulated antennas are their small dimensions, wide bandwidth (especially for streaming video data) and circular polarization (to favor the capture of the signal from the external receiver given the arbitrary orientation of the endoscopic capsule). The fabrication method is based on processing each layer independently and then stacking and packaging them by a lamination and a firing process. This technology has shown appropriate electrical and mechanical properties and high reliability and stability, as well as allowing production of 3D integrated microstructures [100] and passive elements [99]. However, in spite of having several modeling methods and an advanced level of computation, there are still some issues that compromise the simulated results. Antenna Fabrication Substrate features or layer misalignments derived from the inaccuracies of the manufacturing process can cause deviation from the predicted antenna performance [104]. In addition, for multilayered structures, the utilization of glue between layers could increase thickness and modify the effective dielectric properties of the substrate, as indicated in [14], [61], [104]. Other factors that have to be considered during the migration from numerical models to prototyping are the thickness of metal patches and the feed method [104]. Antenna Characterization One of the main challenges in the design process for antennas to be used in the presence of a human body is experimental validation before becoming integrated with the whole device, especially in the case of in-body antennas. Regarding the literature on in-body antennas, only a few works present in-vitro, ex-vivo or in-vivo antenna measurements in order to confirm simulated results, especially for far field features. This is because, as discussed in [14], feeding through an unbalanced coaxial cable significantly alters antenna performance (frequency detuning up to 27 Chapter 2 25% was found in that study). Thus, consideration of the effects of the cable when experimentally characterizing antenna performance is advised. Several solutions have been developed to avoid disturbances due to the cable, such as baluns, chokes and ferrites ([61], [96] and [157]). While reflection coefficient measurements can be found in much literature, only a few studies present far-field characterization (gain, efficiency or radiation pattern). The Method of Moments (MoM), although not generally used in biomedical applications, is commonly applied to multilayer structures. The way to define the finite differences is to convert the target volume into small cuboid cells with 28 Chapter 2 significantly smaller dimensions than the radiation wavelength (Figure 6). Typically, the minimum spatial sampling is at intervals ranging from 10 to 20 per wavelength, thus obtaining temporal sampling that is fine enough to keep the algorithm stable. The electric fields are defined at the center of the edges of the cubes, while the magnetic fields are taken to be at the center of the faces, as proposed by Yee [159] (Figure 6). Thus, cells with three electric fields and three magnetic fields can be obtained, and the Maxwell equations in finite difference equations can be solved for each cell. Numerical methods used in the literature for the modeling of antennas in biomedical applications. The process is repeated iteratively until all values of the computational domain are obtained; but since the spatial domain is finite, a method of minimizing the reflection of boundaries at the end of the mesh is required. This also facilitates the visualization of the propagated fields and the post-processing development. The MoM is not commonly used in the design of antennas for use in the presence of a human body. MoM employs a surface mesh, which is not ideal for the modeling of complex 3D structures such as the human body. However, in the initial steps of the antenna design, MoM may be considered to obtain an initial frequency response, but only if the following two conditions are met: 1) the antenna follows a multilayered structure and 2) the canonical phantom is homogeneous. By evaluating the frequency response of the antenna with MoM, it is possible to save considerable time and resources at the beginning of the design process. In addition, in order to save time and computational resources, and depending on the problem characteristics, one method or another may be recommendable. As already mentioned, the advantages of using several computer programs and numerical methods are, on the one hand, the possibility of comparing the same design through different methods and, on the other hand, the significant reduction in the time and computing resources needed for simulations. Human Body Models the presence of a human body in close proximity to an antenna modifies its performance because, as mentioned before, the near-field strongly couples with the surrounding lossy media. Thus, correct selection of the human model or phantom during the antenna design is crucial for the assessment of an antenna proposed for a certain application. Several models of the human body have been presented and assessed in the literature over recent decades. The work presented by Ito [173] summarized some of the most relevant phantoms used for wearable and implantable applications. In this section I aim to complement and update those works by presenting a non-exhaustive overview and the state of the art of several aspects that should be taken into account when dealing with human body models, especially for implantable applications. The selection of one body model or another depends on several factors, such as the target application and the time and resources available. Generally, in the early stage of an antenna design, it is common to choose a theoretical or canonical phantom for two reasons: to save time and computational resources; and to be able to experimentally validate the results with the same model. However, at a more advanced validation stage, realistic or voxel phantoms are required. Simulations in such accurate phantoms must not be underestimated, since small fluctuations in the dielectric properties of the tissues lead to unexpected variations in antenna performance [173]. Dielectric properties of biological tissues are well established worldwide from the work of Gabriel et al. It is difficult to compare antennas presented in different works, as their performance strongly depends on the phantoms used. These models differ in a large number of parameters, such as geometry, size, targeted tissues, number of tissues, accuracy of the model, operating frequency range, placement and orientation of the medical device, and temperature dependency. A review of these parameters and a discussion of their influence on antenna performance is presented below. Theoretical or Canonical Phantoms these are mostly used at the beginning of the antenna design process, although they are also utilized for analytical assessment [134], [177], for experimental validation [54], [55], [64], [96], [118] and for comparison of the performance of different antennas in the same scenario. Basic shapes are commonly accepted in the literature to assess antenna performance in a human model. Rectangular cuboids are the most frequent phantom, mainly because they are easy to manufacture for validation purposes [54], [55], [64], [96], [118]. Cylindrical [121], [166], [178], [179] as well as spherical [55], [64], [134], [157], [177], [180] phantoms are widely proposed for a variety of applications, such as to represent the arm [179], the neck [121], the head [55], [64] or the eyeball [157]. For hyperthermia treatments, semispherical phantoms attempt to simulate breast models [181], [182]. Finally, a combination of various canonical shapes entails a more accurate approach to modeling the whole human body [183]. There is a huge range of sizes of proposed phantoms in the literature, which makes comparison of antenna performance between prototypes very difficult. As can be seen in Table 8, phantom volumes have a wide spread of values, ranging from 37 cm [180] to 14484 cm [96].

In addition to the planned activities designed in or around a particular formal learning event allergy treatment wiki buy quibron-t 400mg online, learning professionals need to consider the impact of learning activities that take place outside of their direct control or even full awareness allergy medicine bags for kids purchase quibron-t from india, such as independent self-directed learning allergy medicine and cold medicine 400mg quibron-t visa, informal ex periences allergy testing chattanooga buy generic quibron-t line, and other external formal activities (such as courses taught by other teachers on different subjects) allergy treatment emergency quibron-t 400 mg without prescription. Too often allergy virus trusted 400 mg quibron-t, teachers and trainers focus solely on the activities taking place within their purview, that is, within their formal learning episode. Connect learning across levels of abstraction When a child learns to read, we frst start by teaching sounds and letters; once these are learned, we teach words, sentences, punctuation, grammar rules, comprehension, and eventually one day maybe professional investigative journalism or creative screenwriting. The point is that different capabilities emerge from the integration of competencies at a given level of analysis. Computational neuroscience David Marr has gone so far as to say: Almost never can a complex system of any kind be understood as a sim ple extrapolation from the properties of its elementary componentsIf one hopes to achieve a full understanding of a systemthen one must be prepared to contemplate different levels of description that are linked, at least in principle, into a cohesive whole, even if linking the levels in complete detail is impractical. That concept is that we need to consider is how to better combine the micro and macro-level approaches to designing instruction (the typical instructional tactics and strategies experienced designers already use) along with new macro-level strategies to create a multidimensional, multilayered model that helps learners aggregate and make sense of learning experiences across devices, modalities, episodes, and learning dimensions. The idea is to support learners beyond the context of a given course or training event, to help them integrate these into a more holistic course of study. For instance, a university mentor might help a graduate student understand how the differ 232 | Modernizing Learning 3. How do we provide similar support, but more broadly and outside of a narrow academic context Unlike paint blotches, which are individually contained and otherwise inert, each learning experience is dynamic and complex. In other words, the challenge for learning professionals is this: How do we capitalize on the abundance and diversity of learning ex periences in creative and deeply meaningful ways Can we do more, for in stance, than simply reminding students of prior knowledge or asking working Instructional Strategies for the Future | 233 professionals to consider how new concepts ft into their jobs This involves more than just linking across time horizons or subject matters, although those are both relevant. It also in volves aggregating concepts at a given level so that new and integrated capa bilities emerge. Help learners flter overload As discussed in Chapter 4, cognitive overload poses a serious problem for individuals, who can readily become overwhelmed by the sheer amount and velocity of information. The challenge for learning professionals is to help learners navigate through infor mation overload and to develop the internal cognitive, social, and emotion al capabilities needed to self-regulate against it. Use the interplay of experiences to create something new 234 | Modernizing Learning competencies (Chapter 4), self-regulated learning skills (Chapter 15), and so cial learning supports (Chapter 14). Mentoring learners in these areas can help, as can specifcally teaching techniques for managing overload including connectivist skills, curation, and metacognition. Help learners use connectivist learning strategies Connectivism emphasizes the importance of distributed knowledge and capa bility. For example, rather than knowing how to bake banana bread, one sim ply needs to know where to fnd recipes online, how to select the best video tutorials, and which friend to phone when a little extra assistance is needed. Although the multi layered, interconnected model discussed so far has emphasized instructional strategies. Instructors and good instructional de sign can help learners develop their connectivist learning skills and associated self-regulation strategies to help them navigate complex social, cultural, and informational networks. Help learners curate resources and knowledge Information and communication technologies offer new ways of discovering, organizing, and later retrieving information. Often learning instances and other information can be digitally captured, processed, aggregated, and stored for retrieval across time, contexts, and devices. This notion relates to connec tivism, and it highlights the importance of developing related learning strat egies. Over the last decade, personal learning environments have become popular; these online Instructional Strategies for the Future | 235 systems help learners and their teachers manage learning resources. This fnal item highlights that both internal expert-directed learning controls as well as learner-directed self-regulatory interventions are critical. Over time, individuals should develop the desire and ability to exert more independent control. However, many learners need help cultivating their self-directed learning abilities, hence a negotiated mix of instructor-controlled and learning-controlled approaches is needed. The role of the instructor in these new multidimensional contexts, therefore, needs to expand and grow in fexibility, shifting to encompass the roles of activator, facilitator, coach, mentor, and advisor. Hundreds of instructional strategies and, likely, thousands of corresponding tactics have been tried and tested. Meaningful learning is grounded in and driven by epistemological orienta tions and theoretical foundations that are primarily constructivist, social con structivist, and connectivist in nature. In other words, the mind flters inputs from an environment or experience to produce its own unique reality or understanding. Therein lies the intentional (goal-directed, regula tory), active (manipulative, observant), constructive (articulative, refective), and authentic (complex, contextualized) principles of meaningful learning. In social constructivism and connectivism, learning becomes a process of col 10 lection, refection, connection, and publication. Therein lies the cooperative (collaborative, conversational) principles of meaningful learning. The program incorporates multiple courses delivered via didactic instruction and labs, followed by integrative in-the-feld clinical experiences. Throughout the program, her learning is supplemented by various digital tools including e-books, practice simulations, and a micro-learning study app. Scaffolding involves assessing what learners can do, helping them refect on what they know, identifying needs and goals, providing individualized assistance towards these goals, and offering oppor tunities for learners to internalize and generalize their learning. The instructional strategies of modeling and explaining can also be used to help transition learners in their learning trajectories. In modeling and ex plaining, instructors demonstrate a process while also sharing insights be yond the obvious, such as telling learners about why a task is performed in a certain way. Modeling and explaining can take place in authentic contexts, which helps present the concepts at the appropriate level of complexity and portray the interplay of dimensions associated with them. She might also be challenged to extend her knowledge beyond her comfort zone, such as to consider the next phase of her professional and personal development as a future paramedic. In addressing more macro-level instructional interventions, we can expand traditional strategies to incorporate organizational, elaborative, exploratory, metacognitive, collaborative, and problem-solving elements across the vari ous dimensions of learning. Upon completion of paramedic training, coaching and mentoring can be used as crossover instructional strategies to further scaffold learners towards the next phase or experience in their lifelong learning trajectory. They involve observing learner performance and offering assistance to bring it closer to expert performance (coaching), as well as acting as role model, advising, and supporting learners in attaining goals and in overcoming barriers and challenges (mentoring). As learners set goals for real-life situations, coaches and mentors provide support through dialogue, with social negotiation, and by engaging learners in actively seeking information, researching the issues, and fnding solutions to meaningful and 11 authentic problems. This type of experience allows learners to work in authentic settings, and it engages them in collaborative and conversational interactions with their coach or mentor as well as with their peers. As illustrated in this example, the instructional strategies of scaffolding, modeling and explaining, and coaching and mentor ing can be used as crossover instructional strategies to create meaningful con nections that help learners transition across experiences, set lifelong learning goals, and achieve those goals across the lifespan. Macro-level instructional strategies can inform larger and larger units of in structional and professional development, and adding meta-level structures also helps support a lifetime of growth across multiple careers, experienc es, and interests. This includes not only formal learning experiences but also informal and life experiences, all intimately connected. Viewing learning across the lifespan as a networked and connected ecosys tem of experiences opens new opportunities for instructional strategies. Each individual may have a different learning trajectory and mosaic of experiences threaded together across education and training, major career events, multiple careers, and other lifetime activities. The technological advances described throughout this volume have created the capacity to provide learn ers with connected and cohesive learning across their lifespans. Such learning experiences can be implemented using experiential, collabo rative, and personalized instructional models that target cognitive, psycho motor, emotional, and social skills across distributed contexts including in dividual and collaborative activities; these, of course, will also be facilitated by a variety of delivery formats, modalities, and technologies. Thus, we must consider a new model for how to organize and recommend instructional strat egies within this non-linear, lifelong, personalized learning continuum. How do we ensure such strategies are coherent to learners and that they improve upon (rather than add noise to) the potentially overloaded learning environ ment How do we help teachers, trainers, mentors, and automated systems, as well as learners themselves, use appropriate strategies in this crowded future learning environment We need a better system to federate and integrate multiple learning experiences throughout a career, across organizational units. As workers move through their organizations and careers, the learning record really should follow them more closely and accurately. It evolved from the following four in novations: the parsing of learning into specifc chunks of skills and knowl edge; the creation of learning outcomes to clearly establish levels of mastery; assessments that allow learners to demonstrate their mastery; and most re cently, a focus on the learner and the learning (outputs) versus a focus on the teacher, the curriculum, and the time invested (inputs). The frst of these advances traces back centuries to the age of guilds and apprenticeships. Master craftsmen parsed their specialties into a variety of discrete tasks and then trained their apprentices to perform those activities to appropriate levels of mastery. Another remnant of the age of guilds is the con cept of varying levels of mastery. Aspiring craftsmen started as apprentices and advanced through the assorted levels. Only after demonstrating mastery of every aspect of the craft, would the tradesman graduate the apprenticeship at the full craftsman status. This parsed-learning approach still exists across widespread training pro grams today. The military employs this approach with its enlisted personnel, training and certifying members on specifc tasks. Next, the apprentice would master the art of finishing the barrel, so it would seal.

Acute therapies therefore dog allergy symptoms uk order quibron-t 400mg amex, treatment decisions are typically made after are designed to minimize injury and accelerate recovery allergy young living 400mg quibron-t with amex, balancing the best available data on clinical efficacy allergy treatment in homeopathy purchase quibron-t australia, whereas preventative therapies are focused on reducing short-term and long-term adverse effects allergy pillow covers purchase quibron-t 400 mg without a prescription, comorbid attack frequency and severity allergy testing grand junction generic quibron-t 400mg with visa. Asian ethnicity allergy testing kaiser purchase quibron-t 400mg without a prescription, young age at onset,63 motor symptoms or tetraparesis at first myelitis attack, and more than one Treatment of acute attacks myelitis attack in the first year. IgG, or interfere with immune cell proliferation or acti Corticosteroids have a myriad of anti-inflammatory and vation. However, 13 of the 14 patients were co-treated with pred the clinical response suggests that lymphocytes might nisolone, tacrolimus or rituximab, the impact of which is promote disease activity through diverse and complex unknown. In most studies, rituximab Mycophenolate mofetil, a prodrug of the active metabo was administered at regular 6-month intervals begin lite mycophenolic acid, suppresses lymphocyte prolifera ning with four weekly doses of 375 mg/m2 followed by tion by inhibiting guanosine nucleotide biosynthesis. Given the increased relapse events were attributable to disease relapse; however, rate following delivery, rapid introduction of prophylac severe infections and cardiovascular failure were also tic therapy could be warranted; however, the benefits of reported. Progressive multifocal leukoencephalopathy these therapies should be balanced against the benefits of has been reported in rituximab-treated patients (though breastfeeding. To date, no published agents such as azathioprine66 and cyclosporine;84 com evidence is available to support this hypothesis. Prospective studies comparing combination mice caused dose-dependent placental inflammation and therapy, sequential therapy and induction therapy will be spontaneous abortion. IgG attacking the placenta causing spontaneous abor tion in humans has been reported. Natalizumab can accelerate disease activity by increasing Azathioprine, mycophenolate and methotrexate are the numbers of peripheral proinflammatory T cells or pregnancy category D or X and should not be continued eosinophils. In two studies,114,115 Granulocyte-targeted therapies fulminant disease activity was observed quickly after the One of the major histological differences between initiation of therapy. Streptococcus pyogenes-derived enzymes IdeS and EndoS selectively inactivate IgG through proteinase and endoglycosidase actions, respectively, producing blocking nonpathogenic antibody remnants. C3a and C5a anaphylatoxins cause granulocyte activation by binding to specific receptors. Aquaporumab is therapeutic approach for autoimmune diseases caused by currently in preclinical development. Several bacterial enzymes selec In an alternative approach, a target-based small tively target IgG-class antibodies. These future clinical trials, however, present IgG-induced damage in the mouse brain, which was substantial challenges. A review of the current literature and a guide to human complement produces neuromyelitis Eur. The two optica impair glutamate transport by down course in aquaporin-4 antibody-positive patients faces of neuromyelitis optica. Aquaporin 4-specific T cells permeability, plasma membrane M1/M23 neuromyelitis optica. Relapsing neuromyelitis optica: disorders: frequency, origin, and diagnostic during adaptive immune inflammation of the demographic and clinical features in Iranian relevance. Eosinophil azathioprine in neuromyelitis optica spectrum water channel proteins aquaporin-1 and pathogenicity mechanisms and therapeutics disorders with aquaporin-4 antibodies. Eosinophils are required for mitoxantrone in patients with highly relapsing causes placental inflammation and fetal death. A woman with acute myelopathy spectrum disorder developing a fulminant cyclophosphamide in neuromyelitis optica: in pregnancy: case outcome. Clinical improvement in a patient patients: creating strategies for therapeutic 101. Antibody to aquaporin-4 in the exacerbate neuromyelitis optica spectrum tocilizumab. Type I successfully treated with tocilizumab: a case leucoencephalopathy in patients treated with interferons: beneficial in Th1 and detrimental in report. Failure of natalizumab to prevent Unique neuromyelitis optica pathology produced in Oncol. Effect of neutrophil elastase particles formation as a treatment approach the myelin basic protein peptide (amino acids inhibitor (sivelestat sodium) in the treatment for neuromyelitis optica. Eosinophils: multifaceted biological converts pathogenic neuromyelitis optica directions of autologous hematopoietic stem cell properties and roles in health and disease. Current and Acknowledgements of neuromyelitis optica autoantibodies to future immunomodulation strategies to restore M. Therewas no difference in attack severity, onset of optic neuritis, and spasms between the two groups. These patterns can defned by the Transverse Myelitis Working be found in various combination in the spectrum Group8; (2). The exclusion criteria were patients with vasculitis, Demographic and clinical characteristics infection and malignancies. Two the patients recruited were subjected to patients had myelitis secondary to systemic lupus neurological examination and imaging before erythematosus, 3 due to multiple sclerosis, 6 had starting immunosuppressive therapy. The frst or the presenting neurological at the nadir of the attack was evaluated by using symptoms were similar in both the groups. Antinuclear antibody was the commonest Cerebrospinal fuid autoantibody detected though none had clinical Cerebrospinal fluid oligoclonal bands were features of other systemic disease. Follow up the mean duration of the follow up period was Visual evoked potentials 2. In contrast are reasonably effective in reducing the relapse to earlier studies our study patients did not show 28,31 10 rate. We used indirect tissue necessary to answer the role of immunotherapy immunofuorescence technique whose sensitivity in these patients. The which contrasted previous studies where the differential diagnosis of longitudinally extensive upper cervical segments was more frequently transverse myelitis. Neuromyelitis opticaIgG predicts relapse after probably be explained by the intense infammation longitudinally extensive transverse myelitis. The spectrum of neuromyelitis that the percentage of the patients with abnormal optica. Neuromyelitis optica and neuromyelitis optica the limitations of this study include its spectrum disorder: Natural history and long-term retrospective design, a small study population outcome, an Indian experience. J Neurosci Rural drawn from a single tertiary hospital and Pract 2015; 6(3):331-5. In conclusion, the characteristic clinical and Demographic and clinical features of neuromyelitis optica: A review. Interferon beta-1b exacerbates multiple sclerosis with severe optic nerve and spinal cord demyelination. Association of Th1/Th2-related chemokine receptors in peripheral T cells with disease activity in patients with multiple sclerosis and neuromyelitisoptica. Treatment of neuromyelitisoptica with mycophenolatemofetil: retrospective analysis of 24 patients. Distinct features between longitudinally extensive transverse myelitis presenting with and without anti-Aquaporin 4 antibodies. Antiacquaporin 4 antibodies detection by different techniques in neuromyelitis optica patients. Neuromyelitis optica positive antibodies confer a worse course in relapsing neuromyelitisoptica in Cuba and French West Indies. Relationship between neuromyelitisoptica-IgG status and spinal cordmagnetic resonance imaging in patients with neuromyelitisoptica. Aquaporin-4 autoantibodies in neuromyelitisoptica spectrum disorders: comparison between tissue-based and cell-based indirect immunofluorescence assays. A clinical and radiological profle of neuromyelitis optica and spectrum disorders in an Indian cohort. These are believed to be remote hemiparkinsonism 28 immunologically mediated efects of a neoplastc large tumefactve brain lesion 41 (malignant) process. Some neurological disorders diabetes mellitus, renal failure, porphyria, will be discussed here, without atemptng to be fully amyloidosis, liver failure, hypothyroidism comprehensive. Limbic encephalits is characterized by a severe Delalande et al (2004) 11 impairment of short-term memory. She had been initally treated with over a few weeks or months, but they may evolve over cortcosteroids and intravenous cyclophosphamide a few days. The patent responded within a few days on a weekly Infectous limbic encephalits dose of rituximab (375 mg/m) for four consecutve2 Infectous limbic encephalits is caused by invasion of weeks and the improvement sustained at least eight the brain by an infectous agent, usually a virus. The limbic brain the limbic brain includes the hippocampus, Large tumefactve brain lesion thalamus, hypothalamus and amygdala which are Sanahuja et al described a 50-year-old woman with involved in memory and much of the behaviour recurrent neurologic defcits. Doctors associatons with the kind of tumour, clinical features began to identfy patents who had the symptoms of in additon to the limbic symptoms, and the response paraneoplastc limbic encephalits but who did not to treatment (see table 8. Damage results from a lack of oxygen is the only autoimmune disease with an increased from decreased blood fow. Dermatomyosits is a rare disease that may can result from many diferent systemic disorders such also be paraneoplastc. The detecton of antneuronal nerve can lead to facial pain or trigeminal neuralgia. The cause is the prevalence of epilepsy in the populaton may even thought to be infammaton (ganglionits), for example be as high as 1-2%. It may be the frst multple sclerosis are suggested in several case symptom of the disease to be manifested. It is clear, however, that this is not evidence of pupil refers to an enlarged pupil that reacts poorly an associaton as both disease are common and prone to light but beter to accommodaton. The pupil is ofen irregular Disorders of peripheral nerves are usually divided on in form. The term pupil, a drooping eyelid and an inability to sweat on neuropathy means disease of a nerve. Mononeurits multplex Mononeurits multplex is a painful asymmetric sensory and motor peripheral neuropathy (see further). The somatc nerves control the skeletal muscles and run the somatc nervous system relays In the sympathetc nervous directly from the spinal cord to the the signal from the nerve to the system, signals in the ganglia muscles and transmit signals very muscles by means of the trans are also transmited by means fast. They via noradrenaline to adrenergic do not go directly to these organs Autonomic nervous system receptors that difer per organ. The receptors for for example, 1-receptors mainly by binding the transmiter to a this in the ganglia are nictoninic occur in the heart, 1-blockers are receptor. In the autonomic nervous receptors on the target organ system, a distncton is made (glands, heart or smooth muscles) Entrapment neuropathy Entrapment neuropathy refers to nerve dysfuncton the symptoms may start slowly and gradually caused by entrapment of the nerve. Afer example of this is carpal tunnel syndrome (see fgure sleeping for a while, the patent wakes with a hand that 8. The median nerve passes through a narrow tunnel feels numb and swollen, with fngers that are painful in the wrist. The symptoms are ofen worst in the nerve may become too tght, such as an old bone the thumb, index, middle and ring fngers. It is mainly a sensaton disorder, but sometmes paralysis of the thumb and fnger muscles may occur. Neurological investgaton is indicated and there are various possible treatments, depending on the cause and severity. Nerve entrapment can also occur in other tendon sheath parts of the body, including the foot and diagonally tendon below the knee. The Peripheral polyneuropathy may results from many shaded areas indicate the localisaton of symptoms diferent disorders (see table 8. It is spinal cord skeleton muscle expressed in the form of a tngling, burning or numb sensaton in the lower legs, feet or hands. It is a peripheral cord nicotnic-I neuropathy characterized by the impairment of receptor thinly myelinated A and unmyelinated C-fbres. Symptoms cord: spinal cord on a level with the sacrum, lumbar is of somatc nerve fbre dysfuncton, such as burning, on a level with the loins and thoracic with the chest.

We evaluated the full papers of these 62 quality that might impact on the robustness of the results of the studies allergy medicine injections cheap quibron-t 400 mg without prescription. However allergy treatment questions discount quibron-t 400mg with amex, due to the small number of included because they did not contain a no treatment group or wait list studies allergy symptoms checklist 400mg quibron-t mastercard, such analyses were not possible allergy testing kirkland wa quibron-t 400 mg discount. No additional studies were identied in the search analyses to examine the effects of the following allergy testing lansing mi quibron-t 400mg free shipping. Additional study aged 6 to 21 years are included in this review (Solomon 2004; characteristics are provided in the Characteristics of included Laugeson 2009; Frankel 2010; Koenig 2010; Lopata 2010) allergy treatment sample order generic quibron-t on-line. Study location Excluded studies All ve studies were conducted in the United States. Key characteristics of studies we felt were seminal work in method; one study (Solomon 2004) used a randomized controlled this area and exemplars of each reason for exclusion are shown in trial design with a no treatment control. Risk of bias in included studies Participants Four of the ve studies (Solomon 2004; Frankel 2010; Koenig 2010; Lopata 2010) examined social skills groups in children be tween the ages of eight to 11 years; one study (Laugeson 2009) Random sequence generation (selection bias) examined social skills groups in adolescents between the ages of 11 All included studies were randomized controlled trials. Allocation Risk of bias from poor allocation concealment was unclear in four Interventions studies and low in one (Koenig 2010). The duration of the social skills groups across studies was ve to 20 weeks or 12 to 125 sessions. Four of the ve studies had one session per week with a duration of 60 or 90 minutes; Lopata 2010 Baseline measurements had 25 weekly sessions that were 70 minutes each. Multiple social skills group curricula were used across studies, all of which focused the risk of important differencesbetweengroupsbefore treatment on a broad array of social skills that were taught and rehearsed was low in all ve studies. Four of ve studies (Solomon 2004; Laugeson 2009; Frankel 2010; Lopata 2010) included a parent component to the social skills group. Blinding Comparisons Participants and personnel (performance) All ve studies compared the treatment group with a group not partaking in a social skills group. Individuals with autism typically Due to the nature of the intervention, in which participants and receive many treatments (Green 2006; Goin-Kochel 2007), thus study personnel interact in group sessions, risk of bias from lack we did not have an included study in which participants were of blinding of participants and study personnel was high for all receiving no treatment. Outcome assessors (detection bias) Risk of biasfrom incomplete outcome datawaslowfor four studies Outcome assessors were not blind to treatment status in four stud (Solomon 2004; Laugeson 2009; Koenig 2010; Lopata 2010). It was unclear if the Selective reporting outcome assessors were blind to treatment in the remaining study In all ve studies the risk of selective outcome reporting bias was (Solomon 2004), which did not report data on the primary out low. Given that the primary outcome measure in the four studies in which assessors were not blind to treatment involved parent re Other potential sources of bias port, there is signicant potential for bias. A visual representation of the risk of bias in each study for each Incomplete outcome data domain is shown in Figure 2 and Figure 3. Effects of interventions the weighted mean effect size for difference in social competence See: Summary of ndings for the main comparison Social skills between treatment and control groups was g = 0. The resultsof the studieswere synthesized inaran social competence for the included studies is shown in Figure 4. Forest plot of social skills groups versus wait list control: Social competence (analysis 1. Although statistically signicant gains were made effects of social skills groups on participant ability to recognize by the treatment group, there were no post-treatment differences emotions. The results of the studies were synthesized in a random between the treatment and control groups (g = 0. Forest plot of social skills groups versus wait list control: Emotion recognition (analysis 3. The Friend ship Qualities Scale (Bukowski 1994) was used in Laugeson 2009 and the popularity subscale of the Piers-Harris Self-Concept Scale (Piers 1984) was used in Frankel 2010. The weighted mean effect size for difference in friendship quality be tween treatment and control groups was g = 0. Forest plot of social skills groups versus wait list control: Quality of life friendship (analysis 4. We chose not to conduct a meta-analysis on quality of life because different aspects of life were measured across studies (for example, Adverse events loneliness, depression), and we did not feel combining these con No adverse events were reported as a result of treatment in any structs would produce a meaningful result. A T R S l i ll l l 1 w P l: l 6 t o 21 S: l I n: ls ki ll O I ll * (95 % I) l l (95 % I) A C l l i ll S l T h lc T h lc 34 C 3 l 4 56 m ke lg 0. Two additional quality of life measures petence were used across studies), and publication bias, which were evaluated, with results of single studies suggesting decreased could not be ruled out. Given the nature of the intervention and loneliness (Frankel 2010) due to social skills groups but no ef the selected outcome measures, the risk of performance and de fect on child or parental depression (Solomon 2004). Parental report was the method of data collection for all studies reporting data on social competence (primary outcome measure). Given this high risk of bias, the re primary outcome variable (social competence) was gathered using sults should be interpreted cautiously. The risk of publication bias multiple instruments across studies, which likelydecreases the pre is unclear since it could not be assessed due to the small number cision of our results. Four of the ve studies (Solomon 2004; Frankel 2010; Koenig 2010; Lopata 2010) involved participants aged seven to 12 years old. One study (Laugeson 2009) evaluated a social skills Potential biases in the review process group intervention for adolescents, making generalization of the Although the systematic nature of Cochrane Reviews, including results to adolescents and younger children difcult. Limited ev the use of peer referees and publication of review protocols, de idence was located with respect to other outcomes (for example, crease the potential for bias, there still remain risks of bias in the social communication, quality of life). The greatest risk of bias of our review was the selec rigorous methods measuring a broad array of outcomes is needed tion of studies, or more specically, the fact we included all stud before more specic generalizations and recommendations about ies evaluating social skills groups and excluded studies evaluating who will benet most from social skills group interventions can a different treatment approach that might be similar in content be made with condence. Additional bias might Three published curricula were used or adapted for use in the have been introduced with our decision to limit our inclusion cri studies included in this review (Goldstein 2000; Frankel 2003; teria to randomized studies and the additional outcome that we Laugeson 2010), which might also limit the generalizability of added post hoc. Thus, the results Three published curricula were used, or were adapted, in the of this review are consistent with previous reviews suggesting more studies included in this review (Goldstein 2000; Frankel 2003; research is needed although emerging evidence is suggesting pos Laugeson 2010) and there are multiple other social skills curricula itive effects. It is un clear what effect, if any, the use of different social skills curricula had on the results of this review. The results of the meta-analyses and that study only reported the effectsonanarrow aspect of social in this review suggest that participants in social skills groups may communication, that being the ability to understand and interpret make modest gains in social competence, have better friendships, idiomatic language. To put these gains in more con social skills group interventions have a positive impact on this as crete terms, if measuring everyday social skills using the Vineland pect of social functioning. Moreover, little is known about the ef (Sparrow 2005), for example, an average participant from these fects of social skills group interventions on the neurosignatures of studies would increase their repertoire of social skills from 123 to brain activity. Finally, the studies included in this review measured 147 after participating in the social skills group, which is a clini social competence using multiple outcome measures (for example, cally signicant increase. As with having mul studies with relatively small sample sizes that evaluated different tiple curricula, multiple outcome measures should be considered social skills group curricula and assessed effects using different a confound of this review. Future research should consider using measures of social competence and a narrow range of additional and reporting the results of multiple outcome measures within a outcomes. Future studies practice guidelines on the characteristics of the most successful should also consider collecting data on a broad array of measures social skills groups. Implications for research the results of this review suggest much work remains to be done in establishing the efcacy of social skills group interventions. Future research should be conducted using Group, for searching relevant databases, and Geraldine Macdon true experimental designs with adequate power to detect clinically ald, Steve Milan, Laura MacDonald, and other members of the important effects. Research should also focus on expanding the Cochrane Developmental, Psychosocial and Learning Problems participant age range (that is, also including participants under 7 Group for their assistance and guidance throughout the review years of age and participants above 13 years of age) and cognitive process. R E F E R E N C E S References to studies included in this review junior Detective program. Godfrey 2005 Koenig 2010 Godfrey J, Pring T, Gascoigne M. Parent functioning autism to recognize complex emotions using assisted social skills training to improve friendships in teens interactive multimedia. Journal of Autism and Developmental Disorders for high-functioning autism spectrum disorders. Social skills training with verbal autistic Solomon 2004 adolescents and adults: a program model. Diagnostic and Statistical about the evolution of recognition of facial expression Manual of Mental Disorders. The differential Beaumont 2008 effectiveness of group psychotherapy: A meta-analytic Beaumont R, Sofronoff K. Evaluating the effectiveness Dawson 2011 of child and adolescent group treatment: A meta-analytic Dawson G, Burner K. Disorders, including High-Functioning Autism and Asperger Kanner 1943 Syndrome, and their Typical Peers. Meta-analyses involving cross Dening and quantifying the social phenotype in autism. New xation patterns during viewing of naturalistic social York: Brunner-Routledge, 2003. Autism spectrum traits in children with mood and Child and Adolescent Psychiatric Clinics of North America anxiety disorders. Volkmar 2009 Journal of Autism and Developmental Disorders 2010;40(2): Volkmar F, Wiesner L. Diagnostic Criteria for Research: Schultz 2000 International Classication of Disease. C H A R A C T E R I S T I C S O F S T U D I E S Characteristics of included studies [ordered by year of study] Solomon 2004 Methods Randomized controlled trial Participants 18 boys with autism spectrum disorders aged 8-12 years (mean age = 9. Laugeson 2009 Methods Randomized wait list control trial Participants 33 adolescents with autism spectrum disorders aged 11-17 years old (28 M, 5 F; mean age = 14. Additional methods that were not used Protocol Reason not used Reporting of multiple outcome time points Studies included in review only included one time point, which was immediately after treatment Assessment of measurement psychometrics not included in risk of this item was removed from the risk of bias assessment to be more bias consistent with current Cochrane tool Did not have to adjust for unit of analyses issues All trials were run as wait list control trials, in which data were analyzed after rst wave of research. Did not conduct subgroup analyses Small number of studies with little heterogeneity. Blinding was divided into two categories (blinding of participants and personnel and blinding of outcome data), selection bias was changed to baseline measurements, and treatment delity was removed. N O T E S this review is co-registered within the Campbell Collaboration and also published on the Campbell Library. Recognition and diagnosis of autism enables patients and their families to access autism 3,5 specific support and resources which, subsequently, can lead to more positive outcomes. The annual costs associated with resources and support in both the United Kingdom and United 1 States exceeds several billion. Interviews, observations, and tools are some of the methods used for screening and diagnosis. Disclaimer: the Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. Links: this report may contain links to other information available on the websites of third parties on the Internet. Methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses and guidelines. Where possible, retrieval was limited to the human population, under 19 years of age. The search was also limited to English language documents published between January 1, 2008 and June 3, 2013. Selection Criteria and Methods One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final article selection was based on the inclusion criteria presented in Table 1. In addition, guidelines were excluded if there was incomplete reporting of methods or if they were superseded by a more recent or more rigorous review or guideline. A numeric score was not calculated; instead the study strengths and limitations were described narratively. Of these, 390 citations were excluded during the title and abstract screening while 30 full text documents were retrieved based on their potential relevance. Of the 30 potentially relevant articles from the original literature search, none met the inclusion criteria and were subsequently excluded.

The watch system was composed of community volunteers whose primary duty was to warn of impending danger allergy shots brand names generic quibron-t 400mg without a prescription. Philadelphia created the frst day watch in 1833 and New York instituted a day watch in 1844 as a supplement to its new municipal police force (Gaines allergy testing jackson ms purchase quibron-t overnight delivery, Kappeler allergy medicine isn't working order 400mg quibron-t with amex, and Vaughn 1999) allergy medicine infant buy quibron-t 400mg otc. Augmenting the watch system was a system of constables allergy testing environmental buy quibron-t 400mg without prescription, ofcial law enforcement ofcers allergy shots long term side effects buy discount quibron-t, usually paid by the fee system for warrants they served. Constables had a variety of non-law enforcement functions to perform as well, including serving as land surveyors and verifying the accuracy of weights and measures. In many cities constables were given the responsibility of supervising the activities of the night watch. Tese informal modalities of policing continued well after the American Revolution. It was not until the 1830s that the idea of a centralized municipal police department frst emerged in the United States. In the Southern states the development of American policing followed a diferent path. The frst formal slave patrol was created in the Carolina colonies in 1704 (Reichel 1992). Slave patrols had three primary functions: (1) to chase down, apprehend, and return to their owners, runaway slaves; (2) to provide a form of organized terror to deter slave revolts; and, (3) to maintain a form of discipline for slave-workers who were subject to summary justice, outside of the law, if they violated any plantation rules. The key question, of course, is what was More than crime, it about the United States in the 1830s modern police that necessitated the development of local, centralized, bureaucratic police forces The States emerged United States was no longer a collection of as a response to small cities and rural hamlets. Mob violence, particularly violence directed at immigrants and African Americans by white youths, occurred with some frequency. Public disorder, mostly public drunkenness and sometimes prostitution, was more visible and less easily controlled in growing urban centers than it had been rural villages (Walker 1996). So, if the modern American police force was not a direct response to crime, then what was it a response to Tese economic interests had a greater interest in social control than crime control. Private and for proft policing was too disorganized and too crime specifc in form to fulfll these needs. Tese mercantile interests also wanted to divest themselves of the cost of protecting their own enterprises, transferring those costs from the private sector to the state. Maintaining a stable and disciplined work force for the developing system of factory production and ensuring a safe and tranquil community for the conduct of commerce required an organized system of social control. The developing proft-based system of production antagonized social tensions in the community. Inequality was increasing rapidly; the exploitation of workers through long hours, dangerous working conditions, and low pay was endemic; and the dominance of local governments by economic elites was creating political unrest. The modern police force not only provided an organized, centralized body of men (and they were all male) legally authorized to use force to maintain order, it also provided the illusion that this order was being maintained under the rule of law, not at the whim of those with economic power. The consumption of alcohol was widely seen as the major cause of crime and public disorder. This underclass was easily identifable because it consisted primarily of the poor, foreign immigrants and free blacks (Lundman 1980: 29). In addition, the creation of the modern police force in the United States also immutably altered the defnition of the police function. Policing had always been a reactive enterprise, occurring only in response to a specifc criminal act. The presence of police, authorized to use force, could stop crime before it started by subjecting everyone to surveillance and observation. Early American police departments shared two Police systematically primary characteristics: they were notoriously corrupt and fagrantly brutal. This should come took payofs to allow as no surprise in that police were under the illegal drinking, control of local politicians. The local political gambling and party ward leader in most cities appointed the police executive in charge of the ward prostitution. The ward leader, also, most often was the neighborhood tavern owner, sometimes the neighborhood purveyor of gambling and prostitution, and usually the controlling infuence over neighborhood youth gangs who were used to get out the vote and intimidate opposition party voters. In this system of vice, organized violence and political corruption it is inconceivable that the police could be anything but corrupt (Walker 1996). Police systematically took payofs to allow illegal drinking, gambling and prostitution. Police organized professional criminals, like thieves and pickpockets, trading immunity for bribes or information. They had no discernable qualifcations for policing and little if any training in policing. In the post-Civil War era, municipal police departments increasingly turned their attention to strike-breaking. By the late 19th century union organizing and labor unrest was widespread in the United States. New York City had 5,090 strikes, involving almost a million workers from 1880 to 1900; Chicago had 1,737 strikes, involving over a half a million workers in the same period (Barkan 2001; Harring 1983). The use of public employees to serve private economic interests and to use legally-ordained force against organizing workers was both cost-efective for manufacturing concerns and politically useful, in that it confused the issue of workers rights with the issue of crime (Harring 1981, 1983). The frst was the most obvious, the forced dispersal of demonstrating workers, usually through the use of extreme violence (Harring 1981). On a day-to-day basis it hauled nearly a million workers of to jail between 1975 and 1900. Anti-labor activity also compelled major changes in the organization of police departments. The patrol wagon system was instituted so that large numbers of people could be arrested and transported all at once. Horseback patrols, particularly efective against strikers and demonstrators, and new, improved, longer nightsticks became standard issue. Tree compelling issues faced early American police departments: (1) should police be uniformed; (2) should they carry frearms; and (3) how much force could they use to carry out their duties. The local merchants and businessmen who had pushed the development of municipal policing wanted the police uniformed so that they could be easily identifed by persons seeking their assistance and so they would create an obvious police presence on the streets. They felt that uniforms would subject them to public ridicule and make them too easily identifable to the majority of citizens who bore the brunt of police power, perhaps making them targets for mob violence. Early police ofcers began carrying frearms even when this was not department policy despite widespread public fear that this gave the police and the state too much power. Police departments formally armed their ofcers only after ofcers had informally armed themselves. The use of force to efect an arrest was as controversial in the 1830s and 1840s as it is today. Because the police were primarily engaged in enforcing public order laws against gambling and drunkenness, surveilling immigrants and freed slaves, and harassing labor organizers, public opinion favored restrictions on the use of force. But the value of armed, paramilitary presence, authorized to use, indeed deadly force, served the interests of local economic elites who had wanted organized police departments in the frst place. State police agencies emerged Because the police were for many of the same reasons. They were housed in barracks outside the towns so that they would not mingle with or develop friendships with local residents. In addition to strike-breaking they frequently engaged in anti-immigrant and anti-Catholic violence, such as attacking community social events on horseback, under the pretense of enforcing public order laws. Similarly, the Texas Rangers were originally created as a quasi-ofcial group of vigilantes and guerillas used to suppress Mexican communities and to drive the Commanche of their lands. By the end of 19th century municipal police departments were frmly entrenched in the day-to-day political afairs of big-city political machines. Police provided services and assistance to political allies of the machine and harassed, arrested and interfered with the political activities of machine opponents. Political machines at the turn of the century, were in fact, the primary modality through which crime was organized in urban areas. Politicians ran or supervised gambling, prostitution, drug distribution and racketeering. In fact, organized crime and the dominant political parties of American cities were one in the same. At the dawn of the 20th century, police were, at least de facto, acting as the enforcement arm of organized crime in virtually every big city. Police also engaged in and helped organize widespread election fraud in their role as political functionaries for the machine. In return, police had virtual carte blanche in the use of force and had as their primary business not crime control, but the solicitation and acceptance of bribes. It is incorrect to say the late 19th and early 20th century police were corrupt, they were in fact, primary instruments for the creation of corruption in the frst place. Police departments during the machine-era provided a variety of community services other than law enforcement. In New York and Boston they sheltered the homeless, kept tabs on infectious epidemics, such as cholera, and even emptied public privies. While this service function of police continues to be important today, it is important to recall that in the context of political machine, government services were traded for votes and political loyalty. And while there is no doubt that these police services were of public value, they must be viewed as primarily political acts designed to curry public favor and ensure the continued dominance of their political patrons. The outlawing of alcohol combined with the fact that the overwhelming majority of urban residents drank and wished to continue to drink not only created new opportunities for police corruption but substantially changed the focus of that corruption. During prohibition lawlessness became more open, more organized, and more blatant. Major cities like New York, Chicago and Philadelphia has upwards of 20,000 speakeasies operating in them. Overlooking that level of publicly displayed crime required that corruption become total. But most important to policing, Prohibition marked a change in how corruption was organized. Organized crime was able to emerge from the shadows and deal directly with corrupt police. In many cities police became little more than watchmen for organized crime enterprises, or, on a more sinister vein, enforcement squads to harass the competition of the syndicate paying the corruption bill.

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