By C. Hjalte. University of Alaska, Anchorage.

Age-at-death diagnosis and determination of life-history parameters by incremental lines in human dental cementum as an identifcation aid generic 5mg propecia mastercard. Dental pathology of American Indian tribes of varied environ- mental and food conditions order generic propecia canada. Tooth wear and culture: A survey of tooth functions among some prehistoric popula- tions proven propecia 1mg. Severity cheap propecia 1mg on-line, distribution, and correlates of occlusal tooth wear in a sample of Mexican-American and European-American adults. Te accuracy and precision of third molar development as an indicator of chronological age in Hispanics. Tird molar root development in relation to chronological age: A large sample sized retrospective study. Radiographic survey of third molar development in relation to chronological age among Japanese juveniles. Forensic age estimation in living subjects: Te ethnic factor in wisdom tooth mineralization. Reliability of third molar development for age estimation in a Texas Hispanic population: A comparison study. Te accuracy and precision of the third man- dibular molar as an indicator of chronological age. Dental maturity in South France: A com- parison between Demirjian’s method and polynomial functions. Some considerations regarding the use of amino acid racemization in human dentine as an indicator of age at death. Paleoanthropological applications of amino acid racemization dating of fossil bones and teeth. Aspartic acid racemisation in the human lens during ageing and in cataract formation. Postmortem estimation of age at death based on aspartic acid racemization in dentin: Its applicability for root dentin. A review of the methodological aspects of aspartic acid racemization analysis for use in forensic science. Dead victim identifcation: Age determination by analysis of bomb-pulse radiocarbon in tooth enamel. Te marks made by human teeth in inanimate objects and in human skin have been reported and recorded in both ancient and modern history. Although scientifc information is limited in early recorded history, the anecdotal information is vivid and sometimes astonishing. Although he was in prison at the time of the alleged attacks, the bitemarks were judged to have been made by Burroughs’s specter. B’s would then appear upon them, which could be distinguished from those of some other mens” (Cotton Mather in Burr3). Burroughs’s mouth was reportedly pried open in court and his teeth were said to match the bitemarks. Te above examples notwithstanding, there were other early cases that indicate that bitemark evidence was recognized and utilized in Europe, Asia, and North America, with cases cited in France, Belgium, England, Scotland, Japan, Canada, and the United States. Tese cases included bitemarks in foodstufs, other inanimate items, and human skin. Many of the same argu- ments that are ofered in modern cases were argued by both prosecution and defense teams in those cases. Te teeth of one of the two accused men were judged to “ft” the bitemark in the cheese, leading to a conviction. Some of the most noteworthy twentieth-century cases are listed here in chronological order and will be discussed in more detail in the next sections: Doyle v. Moldowan and Cristini, 1991—kidnapping and rape 308 Forensic dentistry of Maureen Fournier; People (Arizona) v. Te legal community, especially individuals and groups that work to prove the innocence of persons who have been wrongly convicted of crimes, has been instrumental in bringing attention and scrutiny to law enforcement practices, prosecutorial behavior and misconduct, and forensic identifca- tion sciences, with bitemark analysis being prominent among them. Te most well-known of those cases that include bitemark analysis as a key part of the investigation, prosecution, and expert testimony are discussed below. Lists of those cases assembled by Pitluck and others currently include cases in excess of three hundred. Doyle, 1954 Te frst reported case in the United States involving bitemarks was the appellate case Doyle v. Te fact that it was treated as a pattern or tool mark evidence is also signifcant. Te primary testimony was given by a frearms examiner with supporting testimony from a dentist. In addition to this being the frst reported American bitemark case, a signifcant lesson to be learned from this case is the manner in which the evidence from the biter was collected. Tis then was introduced and compared with the cheese from the crime scene to link Mr. It was challenged on appeal that same year on the grounds that Doyle was not provided his constitu- tional rights. A court order was not issued for the gathering of incriminating Bitemarks 309 evidence in violation of the Fifh Amendment, the right to protection from self-incrimination and the Fourth Amendment, the protection from illegal search and seizure. Torgersen (Norway), 1958 Tis case will be discussed in detail in the problem case section to follow. Hay (Scotland), 1967 Te body of ffeen-year-old Linda Peacock was discovered on August 6, 1967, in a cemetery in Biggar, Scotland. Gordon Hay, seventeen, had, for some time, been detained at a nearby minimum security school for troubled boys, the Loaningdale Approved School. Warren Harvey and Keith Simpson made a remarkably detailed examination of many Biggar residents, including the boys at the Loaningdale school, and made dental models on twenty-nine of them judged to be viable suspects. From those 29 the suspect population was reduced to fve from whom additional evidence was obtained. Unusual pits in the cusp tips of Hay’s right canine teeth were deemed consistent with similar features seen in the bitemark. As a minor he was sentenced to serve an undetermined term characterized as “at Her Majesty’s pleasure”8 (Figures 14. Paul Green, testifed that the teeth of Johnson were similar to the bite pattern on the breast of the victim. Johnson was convicted of rape and aggra- vated battery and his conviction was upheld at the appellate level. Marx, 1975 Te trial for the frst bitemark evidence case in California occurred in 1975. Marx, Walter Marx was charged with the murder of Lovey Benovsky in a case in which the bitemark was the only physical evidence ofered by the prosecution. In February 1974 Walter Marx was jailed initially for contempt of court for refusing to provide dental casts pursuant to a court order. At autopsy a pat- terned injury, “an elliptical laceration of the nose,” was noted. In March 1974, afer Marx fnally agreed made by the maxillary teeth are at the top. Tis was the frst known case in which a team of forensic odontologists worked together in the examination, testing, evaluation, and comparison of a bitemark on the skin of a victim to the teeth of a suspect. Test bites were performed in this case and a three-dimensional model of the nose was made. Overlays, three-dimensional comparisons, and scanning electron microscopy were also used. None of these techniques had been documented as having been used in previous 312 Forensic dentistry Figure 14. Te marked three-dimensional nature of the bite in the nose in this case remains an unusual fnding, even today. Direct comparisons were also made utilizing the dental casts from the only suspect, Walter Marx, directly to the three-dimensional model of the nose. Gerald Felando, Reidar Sognnaes, and Gerald Vale, testifed at trial that the teeth of Walter Marx made the bitemark in the nose of Lovey Benovsky. Te admissibility of the bitemark evidence and the conviction of Walter Marx were upheld on sub- sequent appeals.

One of the best ways to detect cardiac tissue under a microscope is to look for undu- lating double membranes called intercalated discs separating adjacent cardiac muscle fibers propecia 1mg generic. Gap junctions in the discs permit ions to pass between the cells propecia 1 mg with mastercard, spreading the Chapter 10: Spreading the Love: The Circulatory System 171 action potential of the electrical impulse and synchronizing cardiac muscle contrac- tions purchase propecia online pills. Potential problems include fibrillation cheap propecia online amex, a breakdown in rhythm or propagation of the impulses that causes individual fibers to act independently, and heart block, an interruption that causes the atria and ventricles to take on their own rates of contrac- tion. Left atrium Sinoatrial node (pacemaker) Purkinje fibers Atrioventricular node Figure 10-4: Right atrium The conductive Purkinje fibers system of the heart. Wolters Kluwer Health — Lippincott Williams &Wilkins A healthy heart makes a “lub-dub” sound as it beats. The first sound (the “lub”) is heard most clearly near the apex of the heart and comes at the beginning of ventricu- lar systole (the closing of the atrioventricular valves and opening of the semilunar valves). It’s lower in pitch and longer in duration than the second sound (the “dub”), heard most clearly over the second rib, which results from the semilunar valves clos- ing during ventricular diastole. Defects in the valves can cause turbulence or regurgita- tion of blood that can be heard through a stethoscope. S-A node → Purkinje fibers → Bundle of His → A-V node Riding the Network of Blood Vessels Blood vessels come in three varieties, which you can see illustrated in Figure 10-5: Arteries carry blood away from the heart. Small ones are called arterioles, and microscopically small ones are called metarterioles. Veins carry blood toward the heart; all veins except the pulmonary veins contain deoxygenated blood. Microscopically small capillaries carry blood from arterioles to venules, but sometimes tiny spaces in the liver and elsewhere called sinusoids replace capillaries. The walls of arteries and veins have three layers: the outermost tunica externa (some- times called tunica adventitia) composed of white fibrous connective tissue, a central “active” layer called the tunica media composed of smooth muscle fibers and yellow elastic fibers, and an inner layer called the tunica intima made up of endothelium that aids in preventing blood coagulation by reducing the resistance of blood flow. Arterial walls are very strong, thick, and very elastic to withstand the great pressure to which the arteries are subjected. In elastic arteries, found prima- rily near the heart, the tunica media is composed of yellow elastic fibers that stretch Chapter 10: Spreading the Love: The Circulatory System 173 with each systole and recoil during diastole; essentially they act as shock absorbers to smooth out blood flow. In muscular arteries, the tunica media consists primarily of smooth muscle fibers that are active in blood flow and distribution of blood. The larger blood vessels have smaller blood vessels, the vasa vasorum, that carry nourish- ment to the vessel wall. Venule Vein Capillaries Blood flow Figure 10-5: Arteriole The capillary Artery exchange. While larger in diameter than arteries, veins have thinner walls and are less distensible and elastic. Veins that carry blood against the force of gravity, such as those in the legs and feet, contain valves to prevent backsliding into the capillaries. Normally the blood that veins are returning to the heart is unoxygenated (contains carbon dioxide); the one exception is the pulmonary vein, which returns oxygenated blood to the heart from the lungs. Capillaries are breathtakingly tiny and capable of forming vast networks, or capillary beds. Blood from the digestive tract takes a detour through the hepatic portal vein to the liver before continuing on to the heart. Called the hepatic portal system, this circuitous route helps regulate the amount of glucose circulating in the bloodstream (see Figure 10-6). As the blood flows through the sinusoids of the liver, hepatic parenchymal cells remove the nutrient materials. Phagocytic cells in the sinusoids remove bacteria and other foreign materials from the blood. The blood exits the liver by the hepatic veins, which carry it to the inferior vena cava, which ultimately returns it to the heart. Wolters Kluwer Health — Lippincott Williams &Wilkins Beating from the Start: Fetal Circulation Because nutrients and oxygen come from the mother’s bloodstream, fetal circulation requires extra vessels to get the job done. Two umbilical arteries — the umbilical vein and the ductus venosus — fill the bill. Fetal blood leaves the placenta through the umbilical vein, which branches at the liver to become the ductus venosus before enter- ing the inferior vena cava that carries blood to the right atrium and then through a hole in the septum called the foramen ovale into the left atrium. From there it flows into the left ventricle and is pumped through the aorta to the head, neck, and upper extremities. It returns to the heart through the superior vena cava, to the right atrium, to the right ventricle, to the pulmonary trunk (lungs inactive), goes through the ductus arteriosus into the aorta, to the abdominal and pelvic viscera and lower extremities, and to the placenta through the umbilical artery. After birth, these circulation path- ways quickly shut down, eventually leaving a depression in the septum, the fossa ovale, where the hole of the foramen ovale once was. In fetal hepatic portal circulation, blood flows directly into the systemic circulation through the a. Number the structures in the correct sequence of blood flow from the heart to the radial artery for pulse. Number the structures in the correct sequence of blood flow from the forearm to the heart. Number the structures in the correct sequence of blood flow from the great saphenous vein back to the heart. Follow a drop of blood from the aortic semilunar valve of the heart to the forearm and back to the heart. Pulmonary circuit b The system for maintaining a constant internal environment in other tissues: c. Faster than that indicates the individual probably is exercising; slower than that means that the individual either is sick or is a highly trained athlete. Parietal pericardium j A tissue composed of layers and bundles of cardiac muscles: d. Right ventricle E –H Following is how Figure 10-3, the heart valves, should be labeled. Bicuspid valve I The cavity in the heart that contains the areas called the sinus venarum cavarum and a blind pouch called the auricle is the b. Chapter 10: Spreading the Love: The Circulatory System 179 K The cusps of the atrioventricular valves are held in place by b. L The atrioventricular opening between the right atrium and right ventricle is covered by the b. Sorry if this seemed a trick question, but even if you have trouble remember- ing the heart’s right openings from its left ones, you simply need to remember that the bicuspid and the mitral valve are the same thing, so “tricuspid valve” is the only correct answer here. Superior vena cava N Valve located between the right atrium and right ventricle: a. Tricuspid valve O Valve located between the right ventricle and pulmonary artery: d. Semilunar valve P Returns blood to the heart from the trunk and lower extremities: e. U In fetal hepatic portal circulation, blood flows directly into the systemic circulation through the c. Pulmonary vein W Number the structures in the correct sequence of blood flow from the heart to the radial artery for pulse. Brachial artery X Number the structures in the correct sequence of blood flow from the forearm to the heart. Superior vena cava Y Number the structures in the correct sequence of blood flow from the great saphenous vein back to the heart. Right atrium z Follow a drop of blood from the right atrium to the radial artery (for pulse). Radial artery Z Follow a drop of blood from the stomach to the inferior vena cava. Inferior vena cava 1 Follow a drop of blood from the aortic semilunar valve of the heart to the forearm and back to the heart. Right ventricle 3 Follow a drop of blood from the anterior tibial vein to the lungs. Lung capillaries Chapter 11 Keeping Up Your Defenses: The Lymphatic System In This Chapter Delving into lymphatic ducts Noodling around with nodes Exploring the lymphatic organs ou see it every rainy day — water, water everywhere, rushing along gutters and down Ystorm drains into a complex underground system that most would rather not give a second thought. Well, it’s time to give hidden drainage systems a second thought: Your body has one. Interstitial or extracellular fluid moves in and around the body’s tissues and cells constantly.

Attention span is impaired as is motor skills and overall sense of body boundaries purchase propecia online pills. The drug’s hallucinatory effects can occur long after the patient’s acute symptoms are gone buy discount propecia. The patient can experience psychotic disturbances which are exhibited by paranoid behavior safe propecia 1mg, self-destructive actions buy propecia 5 mg without a prescription, random eye movement, and excita- tion. These are combined with physiological changes such as tachycardia, hyper- tension, respiratory depression, muscle rigidity, increased reflexes, seizures, and an unconscious state with open eyes. The only treatment is to keep the patient quiet, in a dark room, away from sensory stimuli, and protected from self-inflicted injury. Don’t attempt to talk the patient down as the patient can per- ceive any interaction as a personal attack and may become very violent. The patient is commonly given diazepam (Valium) or haloperidol (Haldol) for their antianxiety and antipsychotic effects. They are volatile hydrocarbons and aerosols that are used to dispense a variety of chemical products that create a euphoric effect when inhaled. These products include airplane glue, paint thinner, typewriter correction fluid, lighter fluid, nitrous oxide, xylene, toluene, and include over 1000 household and commercial products. Treatment of abuse of inhalants uses a symptomatic approach rather than a pharmacological approach because there are no specific antidotes to these products. If used repeatedly, the individual can lose consciousness; high concentrations can cause heart failure or death. Some of the products can replace oxygen in the body and the individual can suffocate. Nursing Assessment Patients who abuse drugs require a careful and complete assessment which includes vital signs (temperature, blood pressure, heart rate, and respiratory rate). The physical response to drug use should be monitored and any infections or disease states must be treated. The plan should also include treatment for the abuse in a supportive and rehabilitative setting. This may include counseling, psychotherapy sessions, and medications to overcome the withdrawal symptoms. Nursing implementation may focus on managing the patient’s acute intoxica- tion and withdrawal and then monitoring the effectiveness of therapy to treat the patient’s substance abuse problem. The evaluation of the effectiveness of the treatment centers on how well the patient is successfully detoxified and withdrawn from the drug and how well the patient refrains from re-abusing the substance. It is important for nurses to realize that overcoming a drug addiction is a long and sometimes lifetime task. Patients may have many relapses along the way and the process can seem frus- trating and hopeless. However, the nurse should remain non-judgmental and objective when caring for substance abuse patients. Summary Substance abuse is one of the most widely misunderstood areas of pharmacol- ogy and has led some patients to avoid narcotics and pain-relieving drugs for fear of becoming addicted to the drug. Substance abuse is the indiscriminant misuse of medication that results in a physical and/or psychological dependence on the drug. A person is considered addicted to a drug if over a six month period they develop dependence for the drug, they experience withdrawal symptoms when the drug is no longer admin- istered, and they require increased doses of the drug to experience the same ther- apeutic effect. An addicted person also has an uncontrollable urge to use the drug and self- medication interferes with activities of daily life and continues despite the neg- ative consequence of using the drug. Drug abusers exhibit common behavioral patterns such as being unable to maintain a normal routine, have poor hygiene, and strained family and social relationships. Furthermore, revealing your own abuse of drugs places the healthcare provider’s license and livelihood in jeopardy. There are tests available to determine if a person has taken drugs, however those tests are not foolproof. Although many of the drugs that are in these groups are illegal in the United States, some of them are legal in other countries. A patient undergoing withdrawal from hashish is treated by (a) administering a lower dose of hashish. A licensed practitioner can help prevent a patient from becoming depend- ent on a drug by (a) using a prescribed management routine. A healthcare professional is ethically expected to report another health- care professional if there is a suspicion of drug abuse. In this chapter you’ll learn the proper way to administer medication and how to avoid common errors that frequently result in improper medica- tion administration that harms the patient. You’ll also learn how to assess the patient to determine if the patient experiences the therapeutic effect of the medication. This might seem unusual because the prescriber—prior to writing the prescription for the medication—has already assessed the patient. However, the patient’s condition can change between the prescriber’s assessment and the time the medication is administered. Assessing the patient also provides a baseline from which you can compare the patient’s reaction to the medication after administering the medication. The general assessment must determine: • Is the therapeutic action of the drug proper for the patient? This, too, appears unusual since the prescriber has already made this determination. However, the nurse is responsible to independently verify that the drug is proper for the patient. You do this by reading the patient’s diagnosis in the patient’s chart and looking up the medication in the drug manual where it will state the approved use of the drug. If the drug isn’t used for the patient’s condition, then the nurse should con- tact the prescriber. Although the prescriber specifies a route in the medication order, the patient’s current condi- tion might indicate a different route is appropriate. If the route is no longer appropriate, then the nurse should con- tact the prescriber and obtain an order to use an alternate route that is appro- priate for the patient’s condition. Sometimes the dose doesn’t match the prepared dose that the nurse has on hand requiring the nurse to calculate the dose. For example, the prescriber might write a med- ication order for 800 mg of ibuprofen. The nurse might have on hand 200 mg tablets and will have to calculate that the patient must be administered 4 tablets of 200 mg of ibuprofen. With some drugs the prescriber will order a dose based on the weight of the patient. It is the nurse’s responsibility to calculate the actual dose after weighing the patient. The nurse has 200 mg/5 mL on hand and calculates that the correct dose for the patient is 20 mL. The patient might have developed a condition since being assessed by the prescriber that makes it inappropriate to receive the medication. The nurse must review the drug’s profile in the drug manual to determine the drug’s con- traindications and then determine if they apply to the patient. If so, then the nurse must contact the prescriber to advise of the patient’s condition. This is particularly important since different healthcare professionals might prescribe the patient drugs. For example, the patient might be scheduled for an angiogram in 24 hours and the prescriber has a standing medication order for Glucophage. Gluco- phage reacts with contrast dyes and therefore cannot be administered to the patient within 24 hours of any dye procedures such as an angiogram. However, withholding medications should only be done after the healthcare provider has been notified. Drugs can have known side effects—some of which the patient can toler- ate and others that result in an adverse reaction. The nurse must review the pro- file of the drug in the drug manual to determine any side effects and adverse reactions that it might cause and monitor the patient for such signs and symp- toms. The nurse should alert the patient to the possible side effects before admin- istering the medication. In addition, the nurse can prepare to deal with a possible adverse reaction the patient might have to a medication.