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Cock- The spores were documented in kidney tubules generic carvedilol 6.25mg overnight delivery blood pressure medication recreational, lung cheap carvedilol 25mg free shipping arteria japan, roaches can serve as transport hosts by eating in- liver and the lamina propria of the small intestine purchase carvedilol 12.5 mg without a prescription heart attack neck pain. One report gave chickens have been suggested as a method of control- the details of a die-off of 140 lovebirds in Great ling cockroaches within a compound (see Chapter 2) buy generic carvedilol 12.5mg blood pressure chart standing. Britain in which the birds were moved to a different facility, stopped eating and lost condition. Sarcocystis was responsible for the deaths of 37 Old World Psittaciformes in a zoologic collection over a An infected Amazon parrot developed progressive 15-month period. Lories, cockatoos, Pesquet’s Parrot, anorexia, weight loss, respiratory disease and diar- Port Lincoln Parrot, lorikeets, Princess Parrot and rhea over a one-month period. About included pale, swollen kidneys and an enlarged, mot- half of the birds developed clinical signs prior to tled liver. Kidney tubular epithelial cells were filled death, while the other birds died with no premoni- with tiny spores, as were epithelial cells in the liver tory signs. Histologic changes were charac- cluded anorexia, diarrhea, weakness, tachypnea, terized by multifocal nephritis, hepatitis and enteritis. Some birds had clinical signs that lasted Haemosporidian parasites have been detected in several hours while others had clinical signs that parrots being imported into England and Ja- progressed over a 52-day period. Four of the mitting the species of Haemoproteus or Leucocyto- Eclectus and two of the Amazon parrots died. Clinical signs included reproduction occur in biting flies, resulting in the weakness, dyspnea and blood in the oral cavity. Af- production of sporozoites that localize in the salivary fected birds died one to 36 hours after presentation. Asex- Radiographic findings indicated an increased lung ual reproduction also occurs in an infected bird. Some birds that were only slightly lethargic cies of Haemoproteus are considered nonpathogenic and had no other clinical signs survived following and a few species of Leucocytozoon and Plasmodium treatment with 0. The lymphoid- with improved attitude, appetite and decreased se- macrophage system becomes hyperplastic. Muscle biopsies after treatment parasitemias of apathogenic Haemoproteus and Leu- revealed multifocal myositis and sarcocysts, indicat- cocytozoon can cause clinical problems if a bird is stressed or immunosuppressed. In contrast, only 5% of avian reticuloendothelial system followed by the de- long-term captive cockatoos were found to have velopment of pigmented schizonts and gametocytes Haemoproteus. Some European dieoffs of psittacine Plasmodium may cause asymptomatic infections in birds that were attributed to Leucocytozoon were cockatoos and passerine birds. Clinical signs are most common in re- demonstrated that development of large schizonts cently infected birds and are characterized by ano- occurred following inoculation of sporozoites. Six species of Plasmodium and one of Haemoproteus Although there have been occasional reports of Leu- have been reported from Psittacidae. The of eggs per gram of feces did decrease dramatically schizonts are usually in a polar position and are following therapy. Eosinophilia has been discussed as a Flatworms include digenetic flukes and tapeworms. Flukes found in psittacine birds may reside in the However, there has been no direct relationship dem- liver (Platynosomum, Lyperosomum, Dicrocoelium onstrated between parasitism and eosinophilia in and Brachylecithum) or in the blood vasculature (a birds. In general, infections are nonpathogenic al- schistosome believed to be Gigantobilharzia). Flukes: Flukes living in the bile ducts are members Tapeworms require intermediate hosts, and infec- of the family Dicrocoelidae. All of the cases reported tions are uncommon in birds that do not have access in North America have probably occurred in imported to the ground. Either proglottids or whole worms birds (Old World species) that were infected by en- may be noted in the feces. Birds may be Biporouterina are single whereas those of Raillietina infected by eating an arthropod, which serves as a and Cotugnia are passed in clusters encased in a second intermediate host. Focusing through the indi- been demonstrated in New World Psittaciformes, vidual rounded eggs to see the hooks on the hexa- even though there are a number of genera that occur canth larva may be necessary to demonstrate that in North American avifauna. Infections may not be de- ciated with liver fluke infections include hepa- tected during routine fecal exams unless a proglottid tomegaly, depression, anorexia, mild anemia, weight present in the feces has ruptured. The eggs contain loss, diarrhea, hepatic necrosis, elevated liver en- six hooks on oncosphere and hexacanth larvae. Numerous trematode eggs were seen on direct subcutaneous regions, body cavity and air sacs smears of the feces. Necropsy findings were primar- (Eulimdana, Pelecitus,Cardiofilariaand Cyathospira). In found in birds that are maintained in enclosures with some birds, trematodes were found in dilated bile access to ground. Clinical im- psittacine birds include Ascaridia columbae (shared provement following treatment with fenbendazole with pigeons), A. The eggs are resistant to disinfec- tants but can be controlled with steam or flaming. Mild infections can cause malabsorption, weight loss, anorexia, growth abnormalities and diarrhea. Heav- ier parasite loads may cause intussusception, bowel occlusion or death (Figure 36. Providing a dry clean environment will decrease the possibility that eggs will survive to embryonate. Piperazine, pyrantel pamoate and fenbendazole may be effective in resolving infections. Cerebrospinal nematodiasis caused by larvae from Baylisascaris procyonis (raccoon ascarids) has been reported in gallinaceous birds, cockatiels, ratites and several Passeriformes. When they enter the central nervous system, the larvae induce considerable damage lead- ing to ataxia, torticollis, depression and death. The earliest clinical signs developed 35 days after potential exposure to the raccoons. Because no diagnostic stages of the parasite are re- The bird did not respond to supportive care. This bird was main- tained in a mixed species outdoor exhibit with access to the ground. The best means of control is to prevent access Ascarids in the genus Heterakis can infect the ceca of of free-ranging raccoons to aviaries, and thus prevent gallinaceous birds, Anseriformes and other birds. In some species (quail), infections are subclini- Four genera of eyeworms (Thelazia and Ceratospira) have been reported (see Color 26). The worms were nematodes that may infect the gastrointestinal tract removed after they were incapacitated with 0. Severe infections can cause diarrhea (which recovered from the eye of several macaws.

If no signs of drug influence are found carvedilol 25 mg visa arteria zygomatico orbital, the procedure is termi- nated; if any medical problems are found buy discount carvedilol 6.25 mg line blood pressure very low, a medical assessment is obtained carvedilol 12.5mg free shipping arteria renal, and if drugs are still suspected buy carvedilol 12.5mg without prescription heart attack the alias radio remix, a full assessment is carried out. If at any time during the assessment a serious medical condition is suspected, a medical opinion will be obtained. Eye examination: the driver is assessed for horizontal gaze nystagmus, vertical gaze nystagmus, and convergence. Divided attention tests: once at a police station, the Romberg balance test, walk and turn test, one-leg stand test, and the finger-to-nose test are carried out. These are all examples of divided attention tests whereby balance and movement tests are performed in addition to remembering instructions. Vital signs examination: blood pressure, temperature, and a second recording of the pulse are carried out. Darkroom examination: pupil size is measured in room light and then in near total darkness, using both indirect artificial light and direct light. Muscle tone: limb tone is assessed as some drugs cause rigidity, whereas others, for example, alcohol, cause flaccidity. Injection sites examination: the purpose is to seek evidence of intravenous or injection drug abuse. Toxicology testing: at the same time, samples are obtained for toxicological examination, either a blood or urine sample being taken for analysis of common drugs. The mere detection of a drug does not prove impairment unless, of course, the jurisdiction has per se laws whereby the detection of drugs at some predeter- mined level is ruled, by law, to be proof of impairment. Whether the examination is carried out by a forensic physician in London or an emergency room physician in San Francisco, the aim of the examination is to exclude any medical condition other than alcohol or drugs as the cause of the driver’s behavior. The differential diagnosis is wide and includes head injury, neurological problems (e. The procedure should include introductory details, full medical history, and clinical examination. Similar forms are not available in the United States, but there is nothing to prevent any emergency department in the United States from drafting and providing a similar document. Even if no special form is provided, most of the relevant material will have been (or at least should be) recorded in the emergency department record. Introductory Details These should include the name, address, and date of birth of the driver and the name and number of the police officer, as well as the place and date Traffic Medicine 379 the examination took place, and various times, including time doctor con- tacted, time of arrival at police station/hospital, and time the examination com- menced and ended. The doctor will need to know brief details of the circumstances leading to arrest and the results of any field impairment tests that may have been car- ried out by the police officer. Full Medical History Details of any current medical problems and details of recent events, par- ticularly whether there was a road traffic accident that led to the event, should be recorded. Past medical history (with specific reference to diabetes, epilepsy, asthma, and visual and hearing problems), past psychiatric history, and alcohol and drug consumption (prescribed, over the counter, and illicit) should be noted. Clinical Examination This should include general observations on demeanor and behavior, a note of any injuries, speech, condition of the mouth, hiccoughs, and any smell on the breath. The cardiovascular system should be examined and pulse, blood pressure, and temperature recorded. Examination of the eyes should include state of the sclera, state of the pupils (including size, reaction to light, convergence, and the pres- ence of both horizontal or vertical nystagmus). A series of divided attention tests should be performed including the Rom- berg test, finger–nose test, one-leg-stand test, and walk and turn test. A survey of forensic physicians’ opinions within Strathclyde police demonstrated concerns regarding the introduction of standardized field sobriety tests with the walk and turn test and the one-leg-stand test, causing the highest levels of concern (90). The mental state should be assessed and consideration given to obtaining a sample of handwriting. Fitness for detention is of paramount importance, and any per- son who is not fit to be detained because of illness or injury should be transferred to hospital and not subjected to a Section 4 assessment. If the person refuses to consent to an examination, it is prudent to make observations on his or her man- ner, possible unsteadiness, etc. At the end of the examination, the doctor should decide whether there is a condition present that may result from some drug. In the case of short-acting drugs, the observations of the police officer or other witnesses can be of cru- cial importance. In a recent case, a person was found guilty of driving while unfit resulting from drug use on the basis of the officer’s observations and the results and opinion of the toxicologist; the forensic physician was not called to give evidence (91). Similarly, if the police officer reports that the person 380 Wall and Karch was swerving all over the road but the doctor later finds only minimal physi- cal signs, this may be sufficient to indicate that a condition may be present because of some drug (e. The doctor should inform the police officer whether there is a condition present that may be the result of a drug, and if so, the police officer will then continue with the blood/urine option. On this occasion, 10 mL of blood should be taken and di- vided equally into two septum-capped vials because the laboratory requires a greater volume of blood for analysis because of the large number of drugs potentially affecting driving performance and their limited concentration in body fluids; indeed, if the driver declines the offer of a specimen, both samples should be sent. If they fail, they will be considered as a suspect drug driver and examined by a forensic physician and a forensic sample obtained and ana- lyzed if appropriate. The drug incidence in the two groups will then be compared, as will the police officers’ and doctors’ assessments using standardized proformas. In Victoria, Australia (93), forensic physicians with relevant qualifica- tions and experience act as experts for the court by reviewing all the evidence of impaired driving, the police Preliminary Impairment Test, the forensic physician’s assessment, and toxicological results and provide an opinion. However, there were several inconsistencies in the physical examination with the drugs eventually found on toxicological examination, cases where the individual were barely conscious, where a formal assessment should not even have been considered, and missed medical and psychiatric conditions. For Medical Practitioners: At a Glance Guide to the Current Medical Standards of Fitness to Drive. Austroads Assessing Fitness to Drive: Austroads Guidelines for Health Profession- als and Their Legal Obligations. Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers. Modification of patient driving behavior after implantation of a cardioverter defibril- lator. In: T86: Proceed- ings of the 10th International Conference on Alcohol, Drugs, and Traffic Safety, Amsterdam, September 9–12, 1986. Crash Risk of Alcohol Impaired Driving in T2002 Proceedings of the 16th Inter- national Conference on Alcohol, Drugs and Traffic Safety. Proceedings of the 12th International Conference on Alcohol, Drugs, and Traffic Safety, Cologne, Ger- many, 1992. The specific deterrence of administrative per se laws in reducing drunk driving recidivism. Comparative study of ethanol levels in blood versus bone marrow, vitreous humor, bile and urine. Study into the ability of patients with impaired lung function to use breath alcohol testing devices. Study into the ability of healthy people of small stature to satisfy the sampling requirements of breath alcohol testing instruments. Comparative studies of postmortem ethyl alcohol in vitreous humor, blood, and muscle. Effects of alcohol, zolpidem and some other sedatives and hypnotics on human performance and memory.

Romanization order carvedilol 25mg overnight delivery blood pressure chart for 35 year old man, a form of transliteration purchase 6.25mg carvedilol visa blood pressure variation during the day, means using the roman (Latin) alphabet to represent the letters or characters of another alphabet carvedilol 12.5 mg low cost blood pressure medication pregnancy. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications buy carvedilol 6.25mg mastercard blood pressure systolic. Books and Other Individual Titles in Audiovisual Formats 899 Box 6 continued from previous page. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Language Word for Editor French redacteur editeur German redakteur herausgeber Italian redattore curatore editore Russian redaktor izdatel Spanish redactor editor Box 8. An organization such as a university, society, association, corporation, or governmental body may serve as an author. International Union of Pure and Applied Chemistry, Organic and Biomolecular Chemistry Division. American College of Surgeons, Committee on Trauma, Ad Hoc Subcommittee on Outcomes, Working Group. Books and Other Individual Titles in Audiovisual Formats 901 Box 8 continued from previous page. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Follow the same rules as used for author names, but end the list of names with a comma and the specifc role, that is, editor or translator. Collaborative research with communities: value added & challenges faced [videocassette]. Separate the surname from the given name or initials by a comma; follow initials with a period; separate successive names by a semicolon and a space. Audiovisuals authors with particles or prefxes in their names (give as provided in the publication) 7. Audiovisuals with organization as author with subsidiary part of organization named 10. Books and Other Individual Titles in Audiovisual Formats 905 Box 11 continued from previous page. 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. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Books and Other Individual Titles in Audiovisual Formats 907 Box 13 continued from previous page. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 12. Audiovisuals with author afliation included Title for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Title • Enter the title of an audiovisual as it appears on the opening screen(s) or in the text accompanying text, 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; place the translation in square brackets • End a title with no punctuation unless a question mark or exclamation point already ends it Specific Rules for Title • Audiovisual titles not in English • Audiovisual titles in more than one language 908 Citing Medicine • Audiovisual titles ending in punctuation other than a period • Audiovisual titles containing a Greek letter, chemical formula, or another special character • No audiovisual title can be found Box 15. New York: Society for French American Cultural Services and Educational Aid; 1991. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Books and Other Individual Titles in Audiovisual Formats 909 Box 15 continued from previous page. New York: Society for French American Cultural Services and Educational Aid; 1991. Udalenie doli legkogo pri tuberkuleze [Lung lobe resection in tuberculosis] [motion picture]. Books and Other Individual Titles in Audiovisual Formats 911 Box 17 continued from previous page. Place the type of medium in square brackets and end title information with a period. Audiovisual titles containing a Greek letter, chemical formula, or another special character. Occasionally an audiovisual does not appear to have any formal title; it simply begins with the text. Audiovisuals with Greek letters in titles Type of Medium for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Type of Medium • Indicate the type of medium (videocassette, audiocassette, videodisc, motion picture, slide, etc. Place [videocassette], [audiocassette], [motion picture], and similar types inside the period. Books and Other Individual Titles in Audiovisual Formats 913 Box 20 continued from previous page. New York: Society for French American Cultural Services and Educational Aid; 1991. Examples: Microhemagglutination assay methods in the diagnosis of syphilis [audiocassette + slide]. Case studies in human growth and development: a fexible instructional module [audiocassette + videocassette]. Audiovisuals with more than one type of medium Edition for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Edition • Indicate the edition/version being cited afer the type of medium when an audiovisual 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. Books and Other Individual Titles in Audiovisual Formats 915 Box 23 continued from previous page. Specific Rules for Edition • Abbreviation rules for editions • Non-English words for editions • Both an edition and a version • First editions Box 24. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Books and Other Individual Titles in Audiovisual Formats 917 Box 24 continued from previous page. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Examples: ĉ or ç becomes c ⚬ Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Examples: ŏ becomes o ū becomes u ⚬ Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Books and Other Individual Titles in Audiovisual Formats 919 Box 24 continued from previous page. If an audiovisual provides information for both an edition and a version: • Give both, in the order presented • Separate the two statements with a semicolon • End edition/version information with a period Examples: Epidural anesthesia [videocassette]. Audiovisuals with edition/version Producer, Editor, and other Secondary Authors for Books and Other Individual Titles in Audiovisual Formats (optional) General Rules for Producer, Editor, and other Secondary Authors • A secondary author modifes the work of the author.

International Union of Pure and Applied Chemistry effective 12.5 mg carvedilol pulse pressure definition, Organic and Biomolecular Chemistry Division buy carvedilol 25mg with mastercard heart attack what everyone else calls fun. American College of Surgeons carvedilol 12.5mg amex hypertension uncontrolled icd 9 code, Committee on Trauma purchase carvedilol 25 mg without a prescription blood pressure chart kidney disease, Ad Hoc Subcommittee on Outcomes, Working Group. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Separate the surname from the given name or initials by a comma; follow initials with a period; separate successive names by a semicolon and a space. Standard report written by the performing organization and published by the sponsoring organization 3. Report with optional limit to the frst three authors (use "et al" or "and others") 398 Citing Medicine 6. Scientifc and Technical Reports 399 Specific Rules for Author Affiliation • E-mail address given • Abbreviations in afliations • Organizational names for afliations not in English • Names for cities and countries not in English • Authors from more than one organization Box 11. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Marubini E, Rebora P, Reina G (Istituto di Statistica Medica e Biometria, Universita degli Studi di Milano, Milan, Italy). Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Box 14 continues on next page... Standard report written by the performing organization and published by the sponsoring organization 13. Report with authors from both the performing and sponsoring organizations Title for Reports (required) General Rules for Report Title • Enter the title of a report 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 • Translate titles not in English into English, whenever possible; place the translation in square brackets • End a title with a period unless a question mark or exclamation point already ends it or a Type of Medium follows it Specific Rules for Report Title • Titles not in English • Titles in more than one language • Titles containing a Greek letter, chemical formula, or another special character Box 16. Xianggang chuan ran bing tong ji shu zi 1946-2001 [Statistics on infectious diseases in Hong Kong, 1946-2001]. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Eidgenossische Volkszahlung 1990: die Wohnbevolkerung der Gemeinden [Federal population census 1990: the population of communities]. Tendances recentes de la mortalite par cause en Russie 1965-1994 = Sovremennye tendentsii smertnosti po prichinam smerti v Rossii 1965-1994 [Recent trends in mortality by cause in Russia, 1965-1994]. Lindane (γ-hexachlorocyclohexane): health-based recommended occupational exposure limit. Report with a title containing a chemical formula, Greek letter, or other special character 18. Report in a microform Scientifc and Technical Reports 407 Type of Medium for Reports (required) General Rules for Type of Medium • Indicate the specifc type of medium (microfche, ultrafche, microflm, microcard, etc. Blood carbon monoxide and hydrogen cyanide concentration in the fatalities of fre and non-fre associated civil aviation accidents, 1991-1998 [microfche]. Report in a microform Edition for Reports (required) General Rules for Edition • Indicate the edition/version being cited afer the title (and type of medium if present) when a report 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 • Editions with dates • Non-English words for editions Box 22. Report titles are frequently followed by phrases such as "Annual report", "Interim report", and "Final report". Report with an edition Editor and other Secondary Authors for Reports (optional) General Rules for Editor and other Secondary Authors • A secondary author modifes the work of the author. Focus on Children community planning manual: needs assessment and health planning for children, including children with special health care needs. Chicago: University of Illinois at Chicago, Division of Specialized Care for Children; 1996 Oct. Joint publication of the Division of Family Health, Illinois Department of Public Health, Springfeld. Report place of publication with geographic qualifer added for clarity Scientifc and Technical Reports 417 21. Report with place of publication inferred Publisher for Reports (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 • When a division or other subsidiary part of a publisher appears in the publication, enter the publisher name frst. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Place all translated publisher names in square brackets unless the translation is given in the publication. Tokyo: Tokyo-to Kenko Anzen Kenkyu Senta; Beijing (China): [Chinese Academy of Social Sciences, Population Research Institute]; Peking (China): Mei tan gong ye bu zhi ye yi xue yan jiu suo; [Note that the concept of capitalization does not exist in Chinese. Terefore in transliterating Chinese publisher names only the frst word and proper nouns are capitalized. Tokyo: Tokyo-to Kenko Anzen Kenkyu Senta [Tokyo Metropolitan Institute of Public Health]; • If the name of a division or other part of an organization is included in the publisher information, give the names in hierarchical order from highest to lowest Valencia (Spain): Universidade de Valencia, Instituto de Historia de la Ciencia y Documentacion Lopez Pinero; Box 33 continues on next page... Place all translated publisher names in square brackets unless the translation is given in the publication. Designate the agency that issued the publication as the publisher and include distributor information as a note, preceded by the phrase "Available from: ". Focus on Children community planning manual: needs assessment and health planning for children, including children with special health care needs. Chicago: University of Illinois at Chicago, Division of Specialized Care for Children; 1996 Oct. Joint publication of the Division of Family Health, Illinois Department of Public Health, Springfeld. For those publications with joint or co-publishers, use the name given frst as the publisher and include the name of the second as a note if desired. Focus on Children community planning manual: needs assessment and health planning for children, including children with special health care needs. Chicago: University of Illinois at Chicago, Division of Specialized Care for Children; 1996 Oct. Joint publication of the Division of Family Health, Illinois Department of Public Health, Springfeld. Report with joint publication Date of Publication for Reports (required) General Rules for Date of Publication • Always give the year of publication • Convert roman numerals to arabic numbers. A copyright date is identifed by the symbol ©, the letter "c", or the word copyright preceding the date. Negotiating the new health system: a nationwide study of Medicaid managed care contracts. Washington: George Washington University Medical Center, Center for Health Policy Research; c1998. Sydney (Australia): University of New South Wales, National Drug and Alcohol Research Centre; 2003. Sydney (Australia): University of New South Wales, National Drug and Alcohol Research Centre. Report with no date of publication, but a date of copyright Pagination for Reports (optional) General Rules for Pagination • Provide the total number of pages on which the text of the report appears • Do not count pages for such items as introductory material, appendixes, and indexes unless they are included in the pagination of the text • Follow the page total with a space and the letter p • For reports published in more than one physical volume, cite the total number of volumes instead of the number of pages, such as 4 vol.