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Schrader Professor Forensic Odontology Consultant Faculty of Dentistry Travis County Medical Examiner University of British Columbia Austin order paxil 40mg visa treatment using drugs is called, Texas Vancouver, British Columbia, Canada and Bexar County Medical Examiner’s Ofce Michael P. Tabor San Antonio, Texas Chief Forensic Odontologist and Davidson County Clinical Instructor-Fellowship in Forensic State of Tennessee Odontology Nashville, Tennessee University of Texas Health Science Center at San Antonio Aaron J. Senn Latent Print Support Unit Director Federal Bureau of Investigation Laboratory Center for Education and Research in Quantico, Virginia Forensics University of Texas Health Science Center at Richard A. Weems San Antonio University of Alabama School of Dentistry San Antonio, Texas Forensic Odontologist Consultant and Alabama Department of Forensic Sciences Chief Forensic Odontologist and Bexar County Medical Examiner’s Ofce Jeferson County Chief Medical Examiner San Antonio, Texas Birmingham, Alabama the Contributors xv Franklin D. Wright Forensic Odontology Consultant Hamilton County Coroner’s Ofce Cincinnati, Ohio Science, the Law, and Forensic 1 Identifcation Christopher J. However, it is also mis- understood due to Hollywood’s resolve to complete every case within the context of a one-hour, commercials included, pseudo-real-life crime drama. When the actual real-life judicial system needs science to resolve a question, the person who is called upon to bring science into the courtroom is ofen a forensic scientist. Science is an empirical method of learning, anchored to the principles of observation and discovery as to how the natural world works. Scientifc knowledge increases human understanding by developing experiments that provide the scientist with an objective answer to the question presented. Trough the scientifc method of study, a scientist systematically observes physical evidence and methodically records the data that support the scientifc process. Te law, on the other hand, starts out with at least two competing parties with markedly diferent views who use the courthouse as a battleground to resolve factual issues within the context of constitutional, statutory, and decisional law. Science meets the law only to the extent that the legal system must look to science to help resolve a legal dispute. Scientists in today’s world no longer maintain the fction that all science is equal. Te fundamental paradigm of the judicial system in America is that science is an open process, collegial in nature, unlike the legal system, which is adversarial in nature and legal strategies are developed in secret. With a scientist, the objective of the scientifc endeavor is to reach a correct result that will withstand scrutiny from fellow scientists who can review the methodology and examine the data. Science is premised upon observable phenomena, logical deductions, and inferences that are transparent and open to scrutiny. Te inherently conficting underpinnings between science and the law frequently make forensic science controversial and the courthouse an open arena in which forensic scientists are used as pawns in the resolution of legal disputes. To complicate the legal process, each of the nonscientist par- ties has an interest in the outcome, be it signifcant sums of money, personal freedom, or even life itself in cases involving the death penalty. At the center of legal cases there sits a person who wears a long black robe to whom we refer as a judge. Te judge’s job, usually with the help of a jury, is to keep the adversarial parties at bay long enough to accomplish the orderly resolution of the factual questions raised by the warring litigants using applicable law. Te logic of the legal system is further complicated for the forensic scientist because ofen conficting forensic scientifc evidence that is generated by the opposing parties is ultimately submitted to the review and decision of twelve citizens, known as a trial jury. Te most common question asked by the legal system of a forensic sci- entist is a request to provide proof of identity of an item or person, which is a component of criminalistics. Tis area of forensic science involves the asso- ciation of an evidentiary item that is typically related to a crime. A forensic identifcation has two essential steps: Te frst step is a comparison between an unknown evidentiary item and a known item and having the forensic scientist render a judgment as to whether there is a sufcient concordance to say there is a “match. Te second part to the identifcation analysis should give some meaning to the concordance (match) by provid- ing a scientifc statement that would allow the trier of fact, a judge or jury, to weigh the signifcance of the matching association and answer a simple ques- tion for the beneft of the trier of fact: What does “match” mean? A forensic investigation requires a skillful blend of science using both proven techniques and common sense. Te ultimate efectiveness of the scien- tifc investigation depends upon the ability of the forensic scientist to apply the scientifc method to reach a valid, reliable, and supportable conclusion about a question in controversy. Overall, science and the law must coexist within the framework of our judicial system, although each discipline may and ofen does have conficting and competing interests. Any expert who is interested in the practice of a forensic science specialty must have a clear understanding not only of the fundamental principles of science, and presumably his or her chosen feld, but also of the applicable legal standards relating to that area of forensic science; they must know quite a lot about that area of the law. Every forensic scientist who is called into court to give the results of his or her study must frst be qualifed as an expert witness. A witness qualifes as an expert by reason of “knowledge, skill, experience, training, or education. Before a judge can make that determination, the profered scientifc evidence must frst pass a simple test of relevancy.
Long-term Goal Client will not harm others or the property of others (time dimension to be individually determined) cheap paxil 30 mg fast delivery treatment statistics. Be honest, keep all promises, and con- vey the message that it is not the person but the behavior that is unacceptable. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). A stimu- lating environment may increase agitation and promote aggressive behavior. Make the client’s environment as safe as possible by removing all potentially dangerous objects. Because of weak ego development, client may be unable to use ego defense mechanisms correctly. Helping him or her recognize this in a nonthreatening manner may help reveal unresolved issues so that they may be confronted. Help client recognize the signs that tension is increasing and ways in which violence can be averted. Activities that require physical exertion are helpful in relieving pent-up tension. Explain to the client that should explosive behavior occur, staff will intervene in whatever way is required (e. This conveys to the client evidence of control over the situation and provides a feeling of safety and security. The client is able to verbalize the symptoms of increasing tension and adaptive ways of coping with it. Related/Risk Factors (“related to”) [Central nervous system trauma] [Mental retardation] [Early emotional deprivation] [Parental rejection or abandonment] [Child abuse or neglect] [History of self-mutilative behaviors in response to increasing anxiety: hair-pulling, biting, head-banging, scratching] Goals/Objectives Short-term Goals 1. Client will cooperate with plan of behavior modification in an effort to respond more adaptively to stress (time dimen- sion ongoing). Intervene to protect client when self-mutilative behaviors, such as head-banging or hair-pulling, become evident. A helmet may be used to protect against head-banging, hand mittsto prevent hair-pulling, and appropriate padding to pro- tect extremities from injury during hysterical movements. Try to determine if self-mutilative behaviors occur in re- sponse to increasing anxiety, and if so, to what the anxiety may be attributed. Assist with plan for behavior modification in an effort to teach the client more adaptive ways of responding to stress. Encourage client to discuss feelings, particularly anger, in an effort to confront unresolved issues and expose internalized rage that may be triggering self-mutilative behaviors. Offer self to client during times of increasing anxiety, to pro- vide feelings of security and decrease need for self-mutilative behaviors. Anxiety is maintained at a level at which client feels no need for self-mutilation. Client demonstrates ability to use adaptive coping strategies in the face of stressful situations. Long-term Goal Client will be able to delay gratification and use adaptive coping strategies in response to stress (time dimension to be individu- ally determined). Often these individuals rationalize to such an extent that they deny that what they have done is wrong. Client must come to under- stand that certain behaviors will not be tolerated within the society and that severe consequences will be imposed on those individuals who refuse to comply. Encourage client to explore how he or she would feel if the circumstances were reversed. An attempt may be made to enlighten the client to the sensitivity of others by promoting self-awareness in an effort to assist the client gain insight into his or her own behavior. Throughout relationship with client, maintain attitude of “It is not you, but your behavior, that is unacceptable. Rewards and positive feedback enhance self-esteem and encourage repetition of desirable behaviors. Help client identify and practice more adaptive strategies for coping with stressful life situations. The impulse to perform the maladaptive behavior may be so great that the client is unable to see any other alternatives to relieve stress.
Diagnosis: Specimen: Lavage/drainage of sinuses Procedure: Gram staining order 20 mg paxil with mastercard symptoms 2 weeks after conception, culture, biochemical testing, serological testing and sensitivity testing Treatment: Amoxicillin/ampicillin Co-trimoxazole 2. Chronic suppurative otitis media Long standing ear disease characterized by periods of exacerbation with profuse ear discharge and pain; and remission with relatively dry ear. Risk factors: History of acute or chronic otitis media Parental history of otitis media Crowding Causative agent: P. Treatment: Little role of oral antibiotic agents in the treatment of chronic suppurative otitis media. Chronic sinusitis Painful sinusesand head ache are prominent symptoms; often associated with mucoid or purulent nasal discharge and nasal obstruction. Laboratory diagnosis: Specimen: Saline washings from the affected sinus Procedure: Gram staining, culture, biochemical and serological test for microbe identification. If antibiotic is given, it should be guided by sensitivity pattern or “best-guess” basis. Acute bronchitis It is an acute inflammation of the tracheobronchial tree generally self-limited and with eventual complete healing and return of function. Environmental irritants like indoor air pollution and tobacco smoking Clinical features: Symptoms of upper respiratory infection proceed acute infectious bronchitis. Initially dry cough followed by productive cough with mucoid or mucopurulent expectoration, low grade fever and substernal chest pain. Laboratory diagnosis: Specimen: Sputum Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Chronic bronchitis It is defined as chronic productive cough for at least three months in each of two successive years. Causative factors: Cigarette smoking Air pollution Exposure to noxious stimuli Clinical features: Chronic productive cough with mucoid expectoration, low grade fever, weakness, and occasional chest pain. It is characterized by remission and exacerbation of symptoms; the commonly exacerbating condition is superimposed bacterial infection. Bacteria that exacerbate chronic bronchitis are: Streptococcus pneumoniae Haempphilus influenzae Mycoplasma pneumoniae Branhamella catarrhalis Laboratory diagnosis: Specimen: Sputum Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Clinical features: Sudden onset of fever, chills, sweating, and productive cough of purulent or blood streaking sputum and pleuritic chest pain. Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Giardia lamblia causes diarrhea by physical coverage of the normal absorptive surface. Laboratory diagnosis: Specimen: Stool, rectal swab Wet mount preparation: Pus cells, red blood cells, parasites and ova. Incubation period and severity of disease in food infection is determined by inoculum of micro-organism ingested. Examples of food intoxication Organism Incubation period Clinical findings Related food item Bacillus cereus 1-6 hours Vomiting, cramp Rice, Pasta dishes Staphylococcus aureus 2-4 hours Vomiting Meat, Salads Clostridium botulinum 12-72 hours Flaccid paralysis Meat, Vegetables Table 4. Examples of food infection Organism Incubation period Clinical findings Related food item Bacillus cereus 6-24 hours Watery diarrhea Meat, Vegetables Salmonella spp. These are: Escherichia coli Pseudomonas aeruginosa Klebsiella pneumoniae Proteus spp. Enterobacter aerogens Other important causative agents: Enterococci Staphylococcus saprophyticus 318 Routes of infection 1. Obstruction: Congenital anomalies in youngs and prostatic adenoma, stricture and calculi in olds. Lower urinary tract infection: Infection of urethra and bladder which manifests with frequency of micturition, pain during micturition, blood-stained or cloudy urine, supra pubic tenderness. Gram stain: The presence of one bacterium in Uncentrifuged gram stained urine confirms Urinary tract infection. Culture: Blood agar medium, Mac Conkey agar medium Interpretation of culture results 5 1. Genital tract infection manifests as either genital discharge or genital ulceration with or without inguinal lymphadenitis. Ectoparasites Phthirus pubis Pubic hair louse infestation Sarcoptes scabei Scabies 321 Urethral and vaginal discharge 1.
Saliva from salivary glands in the mouth helps prepare food to be swallowed and begins the chemical breakdown of carbohydrates purchase paxil 40mg mastercard medications quinapril. Interestingly, studies have shown that taste preferences can change in reaction to the body’s specific needs. In addition, the smell of food can get gastric juices flowing in preparation for digestion. The mouth’s anatomy begins, of course, with the lips, which are covered by a thin, modified mucous membrane. The vestibule is the region between these dental arches, cheeks, and lips, whereas the oral cavity is the region inside the dental arches. Entering the vestibule The inner surface of the lips is covered by a mucous membrane. Within the mucous membrane are labial glands, which produce mucus to prevent friction between the lips and the teeth. The cheeks are made up of buccinator muscles and a buccal pad, a subcutaneous layer of fat. Elastic tissue in the mucous membrane keeps the lining of the cheeks from forming folds that would be bitten during chewing (usually — most people have bitten the insides of their cheeks at one time or another). Also stashed away in the cheek, just in front of and below each ear, is a parotid gland, which is the largest salivary gland; it releases saliva through a duct opposite the second upper molar tooth. Two other pairs of salivary glands also secrete into the mouth: the submaxillary glands along the side of the lower jaw and the sublingual glands in the floor of the mouth near the chin. The dental arches are formed by the maxillae (upper jaw) and the mandible (lower jaw) along with the gingivae (gums) and teeth of both jaws. The gingivae are dense, fibrous tissues attached to the teeth and the underlying jaw bones; they’re covered by a mucous membrane extending from the lips and cheeks to form a collar around the neck of each tooth. The gums are very vascular (meaning that lots of blood vessels run through them) but poorly innervated (meaning that, fortunately, they’re not generally very sensitive to pain). You have a number of different kinds of teeth, and each has a specific contribution to the process of biting and chewing. Babies between 6 months and 2 years old “cut,” or erupt, four incisors, two canines, and two molars in each jaw. These teeth are slowly replaced by permanent teeth from about 5 or 6 years of age until the final molars — referred to as wisdom teeth — erupt between 17 and 25 years of age. An adult human has the following 16 teeth in each jaw (for a total set of 32 teeth): Four incisors, which are chisel-shaped teeth at the front of the jaw for biting into and cutting food Two canines, or cuspids, which are pointed teeth on either side of the incisors for grasping and tearing Four premolars, or bicuspids, which are flatter, shallower teeth that come in pairs just behind the canines Six molars, which are triplets of broad, flat teeth on either side of the jawbone for grinding and mixing food prior to swallowing Regardless of type, each tooth has three primary parts, which you can see in Figure 9-2: Crown: The part that projects above the gum Neck: The region where the gum attaches to the tooth Root: The internal structure that firmly fixes the tooth in the alveolus (socket) Chapter 9: Fueling the Functions: The Digestive System 147 Teeth primarily consist of yellowish dentin with a layer of enamel over the crown and a layer of cementum over the root and neck, which are connected to the bone by the periodontal membrane. Cementum and dentin are nearly identical in composition to bone; enamel consists of 94 percent calcium phosphate and calcium carbonate and is thickest over the chewing surface of the tooth. Depending on the structure of the tooth, the root can be a single-, double-, or even triple-pointed structure. In addition, each tooth has a pulp cavity at the center that’s filled with connective and lymphatic tissue, nerves, and blood vessels that enter the tooth through the root canal via an opening at the bottom called the apical foramen. Now you know why it hurts so much when dentists have to drill down and take out that part of an infected tooth! Moving along the oral cavity The roof of the oral cavity is formed by both the hard palate, a bony structure covered by fibrous tissue and the ever-present mucous membrane, and the soft palate, a mov- able partition of fibromuscular tissue that prevents food and liquid from getting into the nasal cavity. The uvula, a soft conical process (or piece of tissue), hangs in the center between those folds. Beyond the soft palate, the palatopharyngeal (or pharyngopalatine) arch curves sharply toward the midline and blends with the wall of the pharynx, ending at the dorsum (back) of the tongue. Another structure, the anterior palatoglossal (or glossopalatine) arch, starts on the surface of the palate at the base of the uvula and continues in a wide curve forward and downward, ending next to the posterior (back) one-third of the tongue. At the base of these arches and between the folds lie the palatine tonsils — if a surgeon hasn’t removed them because of frequent childhood infections. The faucial isthmus or oropharynx is the junction between the oral cavity and the pharynx (described in detail in Chapter 8).
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