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But I must explain to you how all this mistaken idea of denouncing pleasure and praising pain was born and will give you a complete account of the system and expound the actual teachings of the great explore

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    Namita Kattal, MD

    • Department of Obstetrics and Gynecology
    • Albert Einstein Medical Center
    • Philadelphia, Pennsylvania

    Treatment of most parotid tumors includes with 96 dissection and preservation of the facial nerve bacteria that causes diarrhea cheap doxycycline line. They are most frequently benign and so common virus 9 million order 100mg doxycycline with mastercard, particularly with advancing age antibiotic resistance among bacteria discount doxycycline 100 mg fast delivery, as to preclude biopsy and removal in every patient who presents with nodules antibiotic resistance rise 100mg doxycycline otc. However, o to laryngologists ofen recommend and perform removal of nodules that have a reasonable risk of being cancerous, as determined by multiple fac to rs that include those discussed below. Risk fac to rs for malignant thyroid nodules are based on gender, age, early radiation exposure, and family his to ry of thyroid cancer. This may be performed with or with out ultrasound guidance, depending on the size and location of the lesion. While cy to patho logic interpretation has improved, a clear diag nosis for malignancy is not always achieved. Certainly, any evidence of thyroid can cer in the neck nodes is an indication for to tal thyroidec to my and appropri ate neck dissection. Remember, that absent any risk fac to rs, there is a high degree of probabil ity that the nodule is benign. When multiple nodules are found, the thyroid is classifed as a multinodular 99 thyroid or goiter, and only the dominant or largest nodules are biopsied. Forms of Thyroid Cancer Tere are two essential classifcations of thyroid cancer: well diferentiated and other. Papillary Carcinoma Approximately 80 percent of thyroid cancers are papillary his to logically. Tese may have a follicular component, but any amount of papillary com ponent means the tumor will behave more like a papillary tumor. How ever, while papillary carcinoma patients under 40 years of age ultimately live longer, they also experience a higher rate of recurrence. His to rically, a to tal thyroid lobec to my and isthmec to my have been used to treat smaller papillary thyroid cancers (<1 cm). More recently, the trend has been to ward to tal thyroidec to my in patients with nodules containing pap illary thyroid cancers. The greatest risks of thyroid surgery are hypopara thyroidism secondary to injury or removal of the parathyroid glands, and recurrent laryngeal nerve injury, which may result in hoarseness, short ness of breath, and reduced exercise to lerance. Follicular Carcinoma Approximately 15 percent of thyroid cancers is the follicular cell type. The surgical specimen of all thyroid cancers must be sectioned completely to determine if the tumor capsule and/or lymphatic and blood vessels are invaded. The fndings of capsular and/or lymphovascular invasion are essential for diagnosis and cannot be determined by a fne-needle aspi rate. A variant is Hurthle cell carcinoma, which is a more aggressive form of follicular thyroid cancer and is marked by a high fre quency (75% or more) of Hurthle cells. Like papillary carcinoma, follicular carcinoma has an afnity for radioac tive iodine. A vision for the surgical management of papillary thyroid carcinoma: extensive lymph node compartmental dissections and selective use of radioiodine. Terefore, to tal thyroidec to my is the treatment of choice for follicular thyroid cancer. In either case, the parafollicular or C-cells are the cells of origin, and the tumor tends to be bilateral. All patients with medullary carcinoma should get a urinary metanephrine screen to determine whether there is an increase in circulating cate cholamines. If this test is positive, the pheochromocy to ma should be locat ed and excised frst. However, most surgeons elect to perform a to tal thyroidec to my with paratracheal, central compartment neck dissections. In patients with the familial form, only abnormal parathyroid glands should be removed, but a to tal thyroi dec to my is always indicated. Tyroid C-cells do not absorb radioactive iodine, so this common modality of adjuvant treatment in well-diferenti ated thyroid cancers is seldom efective. Anaplastic Carcinoma Anaplastic thyroid cancer is a rare, aggressive cancer with a very poor prognosis. The role of the surgeon is ofen limited to establishing diagno sis through open biopsy and securing the airway, which usually involves a tracheo to my. A rapid diagnosis and institution of appropriate therapy are neces sary to prevent airway obstruction. Treatment and cure are usually achieved by using a combination of chemotherapy and radiation. This brief discussion on thyroid cancer does not include a discourse on surgery of the thyroid gland. Tese conditions can also be treated medically using radioactive iodine-131, but further discussion is beyond the scope of this book. In this chapter we will provide background information about the disease, informa 105 tion on diagnosis and management, and a few case studies. Tese will help you understand how to integrate information and treatment modalities to afect a successful, modern approach to head and neck cancer. Head and neck cancer primarily refers to carcinomas of the larynx; naso-, oro-, and hypopharynges; paranasal sinuses; salivary glands; and oral cav ity. His to rically, the majority of these cancers occurred in patients with a his to ry of smoking and alcohol use, and were squamous cell carcinomas of the upper aerodigestive tract. The cancer originates from the cuboidal cells along the basement membrane of the mucosa. An adult patient with a persistent lump in the neck is very likely to have a malignant process, with its origins in the upper aerodigestive tract. A single course of antibiotics is warranted, but preparation should be made for imme diate consultation with an o to laryngolo Figure 16. Many diferent approaches to the evalua Needle aspiration confrmed the diagnosis of squamous cell carcinoma. The fact is that this neck mass repre sents a metastatic node from the upper aerodigestive tract, in this particu lar case the pyriform sinus of the hypopharynx. However, the more modern approach for this type of lesion is a fne-nee dle aspirate biopsy of the neck mass in the clinic following a complete head and neck exam. Hoarseness Patients who have been hoarse for more than two weeks should also be referred to an o to laryngologist for laryngeal examination. Six weeks of hoarseness in an adult is very suspicious for a precancerous (dysplasia) or cancerous lesion of the larynx. Tese also send branches to the ear, and sometimes a cancer in the throat can generate referred pain to the ear. Difculty in swallowing (dysphagia), pain on swallowing (odynophagia), or a persistent oral ulcer may be due to cancer. Sometimes a cancer in the nasopharynx can obstruct one of the eustachian tubes, causing uni lateral serous otitis media (fuid in middle ear) in an adult. The spinal accessory nerve runs over the to p of these nodes and can very easily be damaged if the physician is not experienced with this kind of surgery.

    A seven day treatment regimen was used with each antibiotic; no shorter durations were trialled bacteria function buy doxycycline 100 mg with visa. The authors note that reduced dosing frequency (eg antibiotics for acne pregnancy cheap 200mg doxycycline with amex, from four times daily to twice daily) improves patient compliance antibiotic zyvox order 200mg doxycycline overnight delivery. Therefore antibiotic resistance gmo buy cheapest doxycycline, a 400mg dose of mecillinam should be prescribed for patients with an increased risk of antibiotic resistance. The bacteriological cure for 400mg and 200mg three times daily was 80% (24/30) and 78% (7/9), respectively. All positive community urine samples from January 2012 to June 2015 were included and analysed. All cases were linked to national hospital activity data and patient-level community prescribing data. Risk fac to rs associated with antibiotic susceptibility were assessed using multivariable multinomial logistic regression. Results indicated that age, care home residence, and increasing comorbidity were significantly associated with both categories of resistance after adjustment for other fac to rs. Interestingly, there were no significant differences in repeat prescriptions within 42 days depending on whether patients were prescribed three (17. Participants received a first course (three, five, or seven days) of trimethoprim, nitrofuran to in, or norfloxacin. The authors note that treatment failure was highest in patients receiving a three day course of nitrofuran to in (18. The authors conclude that three day courses of nitrofuran to in are less effective than five and seven day courses in the treatment of uncomplicated urinary tract infections in women. However, expert opinion is that the patients given five or seven day treatment probably had different illness severity to those given three days treatment. Randomized comparative trial and cost analysis of 3 day antimicrobial regimens for treatment of acute cystitis in women. At four to six days after enrolment (early follow-up), only one of 40 participants treated with trimethoprim sulfamethoxazole had persistent significant bacteriuria with the initial infecting strain, compared to six out of 38 treated with nitrofuran to in, none of 37 treated with cefadroxil, and six out of 43 treated with amoxicillin. At four to six weeks after treatment (late follow-up), the trimethoprim sulfamethoxazole treatment arm achieved clinical cure in 82% of cases, compared to 61% in the nitrofuran to in treatment arm (p=0. This indicates that, if bacteriological clearance is important, a longer course of treatment may be appropriate. Symp to matic cure was reported as 32/39 for the trimethoprim-sulfamethoxazole group (82%), 22/36 for the nitrofuran to in group (61%), 21/32 for the cefadroxil group (66%), and 28/42 for the amoxicillin group (67%). The authors conclude that a three day regimen of trimethoprim sulfamethoxazole is effective in treating uncomplicated urinary tract infections, and should be considered as more effective than treatment with nitrofuran to in m/r, cefadroxil, or amoxicillin. Comparative efficacy of 3 day and 7 day chemotherapy with pivmecillinam in urinary tract infections in general practice. Findings indicated that all patients given seven days treatment had insignificant bacteriuria post treatment, and 91% in the 3 day group were cured of their infection. Both treatments seemed equally effective in infections due to sensitive and resistant organisms. Only two women who had received three days pivmecillinam were still infected with the original pathogen at follow-up. There was no significant difference between the two treatment regimens in symp to matic recurrences. Although seven days treatment gave a higher bacteriological cure rate (100%) when compared to that obtained with three days therapy (91%), this difference is not significant. A comparison between a 3 day and a 5 day course of pivmecillinam as a treatment for acute lower urinary tract infections in general practice. Patients were randomly assigned to a ten tablet (2g) course of pivmecillinam, either as a twice or three times daily dosage. Positive bacteriological cultures were obtained from 44 (50%) patients before treatment, and recorded bacteriological cure rates were 95% in the three day treatment group, and 96% in the five day treatment group. A good clinical response was seen in the majority of patients, and 55 (63%) patients became symp to m-free by the follow-up visit. Pivmecillinam was well to lerated, with side-effects reported in three (7%) patients in the three day treatment group, and nine (17%) patients in the five day treatment group. The authors conclude that a three day course of pivmecillinam is as effective as a five day course of treatment. Antibiotic duration for treating uncomplicated, symp to matic lower urinary tract infections in elderly women (Review). Short-course nitrofuran to in for the treatment of acute uncomplicated cystitis in women. Two treatment arms were included, one with women being treated with trimethoprim sulfamethoxazole one double-strength tablet twice daily for three days, and one with women being treated with nitrofuran to in 100mg twice daily for five days. Similar proportions of women reported adverse effects to medication (31% with trimethoprim; 28% with nitrofuran to in), with most effects being of a gastrointestinal nature. However, fewer women in the nitrofuran to in group required treatment for adverse effects (6%, compared to 11% in the trimethoprim group). The authors conclude that a five day course of nitrofuran to in is equivalent clinically and microbiologically to a three day course of trimethoprim sulfamethoxazole, and should be considered as an effective treatment. It is however noted that at three days, 98% of women had achieved microbiological cure. Of the 69% bacteriologically evaluable patients, eight to ten days after therapy, cure rates were 85%, 90%, 79%, and 28%, respectively. This suggests that both seven day regimens were better than the three day regimen (p=0. The authors conclude that a seven day treatment regimen gives better outcomes than a three day course, but clinical response may be better than bacteriological response. A multinational survey of risk fac to rs for infection with extended-spectrum beta-lactamase producing enterobacteriaceae in nonhospitalized patients. These risk fac to rs included: recent antibiotic use; residence in a long-term care facility; recent hospitalisation; aged 65 years or older; male sex. These are able to hydrolyse antibiotics that were designed to resist the action of older beta-lactamases. This guideline states that antibiotics should not be prescribed to treat asymp to matic bacteriuria in adults with catheters, as they are not effective, and can increase the resistance of the bacteria that cause urinary tract infections. This guideline states that asymp to matic bacteriuria is seldom associated with adverse outcomes in people with indwelling catheters. Treatment of bacteriuria causes increased short-term frequency of symp to matic infection, and re-infection with organisms of increased antimicrobial resistance. This guideline states that antibiotic treatment shows no benefit in patients with indwelling or supra-pubic catheters with asymp to matic bacteriuria, and antibiotics should only be given in the cases of systemic illness or suspected pyelonephritis. Antibiotics should be given based on local susceptibility patterns, and should be adjusted according to pathogen sensitivity. A diagnostic and treatment algorithm was implemented in the multifaceted intervention, suggesting that urine cultures should only be ordered if there is a fever of >37. Advice is given on when to order a urine culture if there is a urinary catheter in situ, including: new cos to vertebral tenderness; rigors; new onset of delirium; new onset burning urination, or two or more of: urgency; flank pain; shaking chills; urinary incontinence; frequency; gross haematuria; suprapubic pain. Antibiotics should only be prescribed in cases of systemic symp to ms of infection with an in situ catheter. Fewer courses of antimicrobials were prescribed in the intervention nursing homes than in the usual care homes (weighted mean difference -0. Healthcare-associated infections: prevention and control in primary and community care. Antibiotic prophylaxis should be considered for patients who have a his to ry of symp to matic urinary tract infection after catheter change, or in patients who experience trauma during catheterisation. This guideline defines trauma during insertion of a urinary catheter as frank haematuria after catheterisation, or two or more efforts to insert the catheter in one attempt. One study (n=78) compared antibiotic prophylaxis in patients at catheterisation only, versus antibiotic prophylaxis throughout the catheterisation period in patients with asymp to matic bacteriuria.

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    Benefits of immunotherapy with a standardized Derma to pha of injec to n therapy in ragweed hay fever antibiotics for acne erythromycin buy 200mg doxycycline free shipping. Ib goides pteronyssinus extract in asthmatic children: a three-year prospective study antibiotic yeast infection prevention order generic doxycycline line. Ib subclass response and relation to the clinical eficacy of immunotherapy with 469 virus kingdom buy generic doxycycline 100 mg on-line. Double-blind antibiotics chicken buy doxycycline 200 mg amex, placebo ted to specific immunotherapy or not: a retrospective study. Clin Exp Allergy controlled rush immunotherapy with a standardized Alternaria extract. Preventive aspects of immunotherapy: prevention for children at risk blind, multicenter immunotherapy trial in children, using a purified and standard of developing asthma. Ib double-blind, placebo-controlled immunotherapy dose-response study with stan 474. Ib asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: 499. Alvarez-Cuesta E, Cuesta-Herranz J, Puyana-Ruiz J, Cuesta-Herranz C, Blanco a retrospective cohort study. Ib Immunotherapy with cat and dog-dander extracts, V: effects of 3 years of treat 477. The value of hyposensitization therapy for bronchial eficacy of specific immunotherapy to cat dander: a double-blind placebo-con asthma in children: a 14-year study. Dose de after discontinuation of preseasonal grass pollen immunotherapy in childhood. Al pendence and time course of the immunologic response to administration of stan lergy 2006;61:198-201. Int Arch Allergy Immunol response to administration of standardized dog allergen extract at differing doses. Effect of specific immunotherapy tive study of specific immunotherapy to inhalant allergens: evidence of safety and added to pharmacologic treatment and allergen avoidance in asthmatic patients al eficacy in 300 children with allergic asthma. Double-blind comparative study of cluster and conventional immunotherapy Eur Rev Med Pharmacol Sci 2000;4:139-43. Ib study of the working mechanisms of immunotherapy for children with perennial 508. Hyposensitization in house dust allergy asthma: a double-blind controlled ment with allergoid immunotherapy with Parietaria: clinical and immunologic study with evaluation of the effect on bronchial sensitivity to house dust. Incidence of complications in ra specific induction of interleukin-2 recep to r on T lymphocytes from children diofrequency treatment of the upper airway. O to laryngol Head Neck Surg munotherapy with a standardized Derma to phagoides pteronyssinus extract, I: in 2004;130:291-9. Specific immunotherapy with a standardized Derma to phagoides pteronyssi tive technique for inferior turbinate reduction. A controlled dose-response study of between submucosal cauterization and powered reduction of the inferior turbi immunotherapy with standardized, partially purified extract of house dust nates. Comparison of microdebrider-assisted inferior Ib turbinoplasty and submucosal resection for children with hypertrophic inferior tur 514. Submucous turbinec to my de allergic rhinitis, comparing clinical outcome with changes in antigen-specific creases not only nasal stiffness but also sneezing and rhinorrhea in patients IgE, IgG, and IgG subclasses. Long-term effect double-blind house-dust-mite immunotherapy study in asthmatic adults. Laser surgery for allergic and hy immunologic evaluation of tyrosine-adsorbed Derma to phagoides pteronyssinus pertrophic rhinitis. American Academy of Family Physicians; American Academy of O to laryngol 74:524-35. Pediatrics 2004;113: controlled study of house dust mite immunotherapy in Chinese asthmatic patients. The role of immunotherapy in cock furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pe roach asthma. The role of to pical nasal steroids in the treatment of children (Engl Ed) 2007;73:75-9. Loratadine and terfenadine in pe creased incidence of head and neck abscesses in children. O to laryngol Head rennial allergic rhinitis: treatment of nonresponders to the one drug with the other Neck Surg 2007;136:176-81. Current concepts and therapeutic strategies for allergic rhinitis in of radiofrequency turbinoplasty and traditional surgical technique in treatment school-age children. O to laryngol Clin North Am multicenter, randomized, double-blind, placebo-controlled trial performed in the 1989;22:253-64. J Pediatr Health sensitisation early in life and chronic asthma in children: a birth cohort study. Sep to plasty and compensa to ry inferior turbinate hypertrophy: long-term domized controlled study of a computerized limited education program among results after randomized turbinoplasty. Argon plasma sur outcomes and self-management behaviors of inner-city children: a randomized gery for the inferior turbinate of patients with perennial nasal allergy. Effect of cetirizine, a new evaluation of an innovative multimedia educational software program for asthma histamine H1 antagonist, on airway dynamics and responsiveness to inhaled his management:repor to farandomized,controlledtrial. Educational intervention by computer in childhood asthma: a randomized a to pic asthma. Ib profen, and an H1 histamine recep to r antagonist, terfenadine, alone and in combi 562. Internet-based home moni to ring and education of children with nation on allergen induced immediate bronchoconstriction in man. Thorax 1987; asthma is comparable to ideal ofice-based care: results of a 1-year asthma 42:946-52. Internet tamine, on the early and late allergic reactions in a bronchial provocation test with enabled interactive multimedia asthma education program: a randomized trial. Childhood allergic rhinitis predicts asthma incidence and persistence to mid chronic middle ear immune response. Ciprandi G, Cirillo I, Vizzaccaro A, Tosca M, Passalacqua G, Pallestrini E, et al. Ia Seasonal and perennial allergic rhinitis: is this classification adherent to real lifefi Lancet 1974;1: ness in young children with allergic rhinitis and its risk fac to rs. Little to n type of sensitizing allergen can affect the evolution of respira to ry allergy. First trimester maternal medication use in Segmental bronchial provocation induces nasal infiammation in allergic rhinitis relation to gastroschisis. Impact of allergic rhinitis on asthma: effects on inhaled or intranasal budesonide. Meta-analysis finds use of inhaled corticoste andinfiammationbutalsoattenuatestheincreaseinbronchialresponsivenessduring roids during pregnancy safe: a systematic meta-analysis review. Beclomethasone dipropionate aerosol in long therapywithastandardizedDerma to phagoidespteronyssinusextract,V:durationof term treatment of perennial and seasonal asthma in children and adults: a report of the eficacy of immunotherapy after its cessation. Eficacy and safety of loratadine plus pseudoephedrine in patients with inhaled budesonide in early pregnancy. The safety of immunotherapy during preg reliability and validity of the short-form generic core scales and Asthma Module. J Allergy Clin Immunol 1996;98: resistance in healthy subjects and in patients with asthma and rhinitis. Consultation and referral guidelines citing the evidence: how the allergist-immu 648. Clinical pharmacology of new histamine H1 recep to r an nicians and epidemiologists. Histamine skin test reactivity following of its sensitivity in differentiating illness groups. Apharmacokineticprofileofdesloratadine tion: contradic to ry effects on lung function and quality of life. The tabolism of desloratadine, fexofenadine, levocetirizine and mizolastine in humans.

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    Police departments and jails are required to establish regular visiting hours during which a person in cus to dy is allowed to consult relatives and 85 family members antibiotic resistance gmo purchase doxycycline without prescription. The bail commissioner can release a person on personal recognizance antibiotic resistance usa today order doxycycline 100 mg without prescription, cash liquid oral antibiotics for acne discount doxycycline american express, an unsecured bond bacteria taxonomy purchase genuine doxycycline on line, a secured bond, or any combination of conditions. In certain domestic violence or stalking cases, however, a person will not be entitled to bail. For further discussion on protective orders, see the Model Pro to col for Police Response to Domestic Violence Cases, available at doj. If the person is unable to make bail, or has been charged with an offense for which bail cannot be set, he or she must be taken before the district court within 24 88 hours, Saturdays, Sundays, and holidays excluded, for arraignment. In some counties, arraignments are conducted by video-teleconferencing, which eliminates the need to transport a detainee to the court. Detaining Juveniles When a juvenile is taken in to cus to dy, the police may release the juvenile to a 89 parent, guardian, or cus to dian pending arraignment. If the minor cannot be picked up within a reasonable period of time, an officer is permitted, with court approval, to release the minor to an alternative to secure detention, pending the arrival of the 90 parent, guardian, or cus to dian. Under all circumstances, if the juvenile is not released to a parent, guardian, or cus to dian within four hours of arrest, the police must notify the court, which must then determine placement. The court has the option to order the juvenile released to the parent or other responsible adult, released under the supervision of a friend or 92 relative, placed in a foster home or other residential placement, or detained. Protective Cus to dy Taking a person in to protective cus to dy is a legally distinct action from placing a person under arrest. Protective cus to dy is a civil status, which is not necessarily connected to any suspicion that a person has engaged in criminal conduct. Its purpose is to protect the safety of the individual taken in to cus to dy, the safety of the public, or both. Because protective cus to dy is a civil status, the probable cause requirements for arrest do not apply. Mentally Ill Individuals A person may be taken in to protective cus to dy if an officer observes the person engaging in behavior that gives the officer: (a) reason to suspect that the person may be suffering from a mental illness; and (b) probable cause to believe that unless the person is placed in protective cus to dy the person poses an immediate 95 danger of bodily injury to himself or others. A person taken in to protective cus to dy under those circumstances must be transported promptly to a hospital emergency room or other site designated by the community mental health program. When taking a person in to protective cus to dy for either condition, officers may use reasonable and necessary force to protect themselves, the person, or others. If force is used, officers should document in a report the type of force used and the reason it was warranted. Officers are permitted to obtain proper identification from the person, as well as to search the person in order to reduce the likelihood of 99 injury. Pending the arrival of the parent or guardian, the minor must be held in an area separate from where any adults or any 101 minors charged with juvenile delinquency are detained. If, however, 29 Issued on: 7/15/2008 the person requests that there be no family notification, the request must be 102 honored. Incapacitated Individuals the options available to officers are broader if the person appears to be in the more serious state of incapacitation. The officers need not seek the consent of a parent or guardian before taking action in these circumstances. When a child is taken in to protective cus to dy under these circumstances, the police must promptly notify the district court, which can 106 authorize continued protective cus to dy pending a hearing. As a general rule, officers have broader authority when the suspected offense rises to the level of a felony. However, regardless of the level of suspected offense, an officer may not make a warrantless entry in to a home, without consent, to conduct a warrantless arrest unless the situation falls within a narrow set of circumstances. Exigent Circumstances Officers are permitted to make a warrantless arrest in a dwelling when there are exigent circumstances, i. Rather the issue is whether the potential harm of waiting to secure a warrant outweighs the privacy interests of those in the dwelling. However, exigent circumstances can never justify a warrantless entry in to a residence to make an arrest 115 for a non-jailable offense. For this exception to apply, 117 however, the pursuit must have been immediate and continuous, and law enforcement must have begun pursuit while the suspect was outside of the 118 dwelling. The exception does not apply when the underlying offense is a 119 violation-level offense. Under Maine and Vermont law, a New Hampshire officer is also authorized to enter the state to effect an arrest when the suspect is believed to be driving while in to xicated by drugs or alcohol. When feasible, before a New Hampshire law enforcement officer enters another state in fresh pursuit of a suspect, the officer should notify law enforcement officials in the host jurisdiction of the situation. New Hampshire law enforcement officers should consult with law enforcement officers of the host jurisdiction to learn where the suspect should be taken and held pending the court hearing. Police officers from Massachusetts, Vermont, or Maine have similar authority to cross in to New Hampshire in fresh pursuit to arrest a suspect believed to have committed a felony. Officers from Vermont and Maine also have authority to do so if 124 the suspect is believed to be driving while in to xicated. If a cross-border arrest is made in New Hampshire, the arresting officer is required to take the arrestee before a New Hampshire superior or district court 125 without unnecessary delay.

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