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By T. Treslott. Eastern Illinois University. 2018.

Another problem was that it was dif- fcult to identify the appropriate expert community to answer the question of general acceptance buy penegra 50mg with mastercard. Some courts became concerned with the correctness of the Frye standard because the standard unfairly discredited new tests and accepted scientifc principles cheap penegra 50mg on line. In 1993 purchase 100 mg penegra visa, the Supreme Court developed a new standard for scientifc evidence in Daubert v discount 100 mg penegra mastercard. Tese factors included whether the technique has been or can be tested, whether the technique has been subjected to peer review or publication, the known or potential rate of error, whether the technique is generally accepted in the community, and whether the technique was created outside of the litigation process. Te Daubert test still allows courts to consider the issues addressed in the Frye standard because the “generally accepted” prong is one of many factors—instead of the sole factor in the analysis. Supreme Court made the trial judge a “gatekeeper” for the admissibility of any scientifc evidence11 (see Chapter 16). Forensic dentistry now has been an integral part of the American judicial system for well over three decades. Overall, forensic dentistry includes multiple areas of scientifc study, where the legal system and dentistry coincide. Tis specialized area of dentistry includes the gathering and interpretation of dental and related evidence within the overall feld of criminalistics. Forensic dental evidence ranges from the identifcation of persons using dental records (Chapter 9) to the identifcation and analysis of bitemarks on an object such as a food item, or a bitemark on a victim compared to a suspect, or on a suspect compared to a victim (Chapter 14), to the estimation of a person’s age based upon dental development or other characteristics (Chapter 13). Te forensic dentist is ofen an expert witness in civil disputes where dental injuries are at issue or there is a question of dental malpractice. Legal science, the law, and Forensic identifcation liability cases relating to injuries to the teeth, mouth, or jaw may involve the expertise of a forensic dentist (odontologist). A qualifed dental expert can provide opinion testimony on issues relating to the loss or damage to teeth and the efect of the loss or damage to an injured individual. For example, if a person was involved in an automobile accident or an altercation where legal liability is in question, the forensic dentist may explain to the jury how the accident or assault caused the dental injury to occur. In criminal cases, the forensic dentist will assist the judge or jury by relating expert testimony concerning a dental identifcation examination or by identifying bitemarks and giving an opinion as to who may have made the bitemark (Chapter 16). Dental identifcation of a person from dental records by a qualifed forensic dentist has long been established and accepted by courts as a means to prove the identity of an individual (Chapter 9). A question as to the identi- fcation of a person may arise from a mass disaster, such as an airplane crash, natural disaster, or a situation where multiple people died in a fre and the bodies are not otherwise recognizable (Chapter 12). Dental identifcations relying on x-rays and dental records universally have been considered to be a reliable identifcation method and rarely has a legal challenge been raised in court. Age estimation using dental evidence is necessary when a question arises as to a person’s correct age as it relates to court proceedings. Typically, if a person is accused of a crime, it may be signifcant to determine if the individual is a minor and therefore subject to the juvenile court jurisdic- tion or whether the person has reached adulthood, where he or she would be prosecuted as an adult (Chapter 13). Each of these subdisciplines of forensic dentistry is discussed in one or more of the chapters of this book. Forensic bitemark evidence to determine identity has become controversial over the last decade and has undergone a fundamental challenge by the greater sci- entifc community. Highly variable loci are called polymorphic and are useful to identify biological material as unique (discussed further in Chapter 7). Tis maternal inheritance pattern has two important implications in forensic testing. In order to understand the present status of forensic dentistry as a foren- sic identifcation science within the overall forensic science community, it is helpful to understand and trace the history of the development of forensic dentistry. As with many changes in our American society, forensic dentistry emerged as the result of landmark events (cases) that established and shaped forensic dentistry as a useful scientifc tool within the greater forensic science legal community. Te issue of the scientifc admissibility of bitemark evidence was established in 1976 in a landmark case in California. Te use of bitemark evidence afer that case grew dramatically and bitemark evidence became a sought-afer identifcation technique by law enforcement and prosecutorial agencies. Additional new bitemark identifcation methods were developed and used in thousands of cases throughout the United States and around the world (see Marx in Chapter 14).

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Smooth-Bore Weapons Shotguns proven 100mg penegra, which fire a large number of small projectiles buy 100 mg penegra with visa, such as lead shot purchase penegra 50mg visa, are the most common type of smooth-bore weapons purchase penegra 100mg with amex. They are commonly used in sporting and agricultural activities and may be either single or double- barreled. The ammunition for these weapons consists of a plastic or cardboard cartridge case with a brass base containing a percussion cap. Inside the main part of the cartridge is a layer of propellant, plastic, felt, or cardboard wads and a mass of pellets (lead shot of variable size) (see Fig. In addition to the pellets, the wads and/or cards may contribute to the appearance of the wounds and may be important in estimating range and possible direction. Rifled Weapons Rifled weapons are characterized by having parallel spiral projecting ridges (or lands) extending down the interior of the barrel from the breach to the muzzle. The rifling also leaves characteristic scratches and rifling marks that are unique to that weapon on the bullet surface. There are three common types of rifled weapons: the revolver, the pistol, and the rifle. The Injury Assessment 145 revolver, which tends to have a low muzzle velocity of 150 m/s, is a short- barreled weapon with its ammunition held in a metal drum, which rotates each time the trigger is released. In the self-loading pistol, often called “semi-automatic” or erroneously “automatic,” the ammunition is held in a metal clip-type maga- zine under the breach. Each time the trigger is pulled, the bullet in the breach is fired, the spent cartridge case is ejected from the weapon, and a spring mecha- nism pushes up the next live bullet into the breach ready to be fired. The rifle is a long-barreled shoulder weapon capable of firing bullets with velocities up to 1500 m/s. Most military rifles are “automatic,” allowing the weapon to continue to fire while the trigger is depressed until the magazine is empty; thus, they are capable of discharging multiple rounds within seconds. Shotgun Wounds When a shotgun is discharged, the lead shot emerges from the muzzle as a solid mass and then progressively diverges in a cone shape as the distance from the weapon increases. The pellets are often accompanied by particles of unburned powder, flame, smoke, gases, wads, and cards, which may all affect the appearance of the entrance wound and are dependent on the range of fire. Both the estimated range and the site of the wound are crucial factors in deter- mining whether the wound could have been self-inflicted. If the wound has been sustained through clothing, then important resi- dues may be found on the clothing if it is submitted for forensic examination. It is absolutely essential that the advice of the forensic science team and crime scene investigator is sought when retrieving such evidence. When clothing is being cut off in the hospital, staff should avoid cutting through any apparent holes. The entrance wound is usually a fairly neat circular hole, the margins of which may be bruised or abraded resulting from impact with the muzzle. In the case of a double-barreled weapon, the circular abraded imprint of the nonfiring muzzle may be clearly seen adjacent to the contact wound. The wound margins and the tissues within the base of the wound are usually blackened by smoke and may show signs of burning owing to the effect of flame. Because the gases from the discharge are forced into the wound, there may be subsid- iary lacerations at the wound margin, giving it a stellate-like shape. This is seen particularly where the muzzle contact against the skin is tight and the skin is closely applied to underlying bone, such as in the scalp. Carbon mon- oxide contained within the gases may cause the surrounding skin and soft Injury Assessment 145 revolver, which tends to have a low muzzle velocity of 150 m/s, is a short- barreled weapon with its ammunition held in a metal drum, which rotates each time the trigger is released. In the self-loading pistol, often called “semi-automatic” or erroneously “automatic,” the ammunition is held in a metal clip-type maga- zine under the breach. Each time the trigger is pulled, the bullet in the breach is fired, the spent cartridge case is ejected from the weapon, and a spring mecha- nism pushes up the next live bullet into the breach ready to be fired. The rifle is a long-barreled shoulder weapon capable of firing bullets with velocities up to 1500 m/s. Most military rifles are “automatic,” allowing the weapon to continue to fire while the trigger is depressed until the magazine is empty; thus, they are capable of discharging multiple rounds within seconds. Shotgun Wounds When a shotgun is discharged, the lead shot emerges from the muzzle as a solid mass and then progressively diverges in a cone shape as the distance from the weapon increases.

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A grenade can generate a concentration of 2000–5000 mg/m3 at the center buy penegra 50mg low cost, with concen- trations becoming significantly less within a few yards from the center of the explosion (38) penegra 50mg lowest price. Regardless of the amount of exposure 50 mg penegra free shipping, all exposures that oc- cur without the use of personal protective equipment where respiratory symp- toms do not improve should be evaluated generic penegra 50mg otc. The majority of patients will fully recover within minutes of removal from the agent and will not require medical attention (39). For patients who require medical evaluation, the first order of treatment should always be removal of contaminated clothing with special attention to eliminating secondary exposure by using protective equipment and not placing a contaminated patient in a confined space. Cloth- ing should be removed outside and placed inside a plastic bag, then bagged again. Some clinicians have recommended copious ocular irrigation with sterile saline, although this has been believed to cause an initial acute increase in ocular irritation (40,41) in some cases. A careful slit lamp examination of the anterior segment of the eye, including under the lids, should be done for persistent ocular irritation. If particles have become imbedded in the cornea or under the lids, they should be removed. If corneal abrasions are present, a few days of topical broad-spectrum antibiotics, cycloplegics, and appropriate analgesics in addition to close follow-up should be prescribed. Dermal irritation in the form of burning and blistering can be treated with irrigation, preferably with an alkaline solution other than sodium hypo- chlorite (30). Erythema can be common in skin that has been freshly abraded but resolves 45–60 minutes after exposure. Contact dermatitis can be effec- tively treated with topical corticosteroids and/or antihistamines, such as diphen- hydramine. Home remedies, such as application of cooking oils, are contraindicated and pose an increase risk for irritation and infection (41). Sodium hypochlo- rite solutions will exacerbate any dermal irritation and should not be used. Plain soap and water is effective, but in most cases, removal of clothing in a well-ventilated area is all that is needed. There are no data to support any claims of teratogenicity, or toxicity to the pregnant woman (12,43). These agents do not exacerbate chronic diseases, such as seizure disorders, respira- tory disease, or psychiatric illnesses. The possibility of secondary exposure to health care and law enforce- ment providers exists with the use of chemical crowd-control agents. Although published reports are few, effects can be minimized with common sense prac- tices, such as decontamination before the patient is placed in a confined area (e. The use of protective personal equipment, such as gloves and careful washing of exposed areas, avoids cross-contamination. Law enforce- ment officers should be educated on the common clinical effects and the appro- priateness of seeking medical care. Medical care should never be withheld from those who request it or in those prisoners who have lingering effects. To limit injury or potential liability, many police forces regulate the use of chemical crowd-control agents by establishing Crowd-Control Agents 191 policies to guide their use. Words are used first, followed by more defensive actions (such as chemical agents), then batons, and finally firearms. Use of these agents is monitored, and formal reports are filed when they are used. These agents afford control of violent offenders with much less risk to life and limb than do firearms, explosives, and battering. Nervous system degeneration produced by the industrial solvent methyl n-butyl ketone. Neurobehavioral effects from acute exposures to methyl isobutyl ketone and methyl ethyl ketone.

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Peplau asserted that nursing was an applied bias purchase 50 mg penegra free shipping, and previously acquired nursing knowledge” science and that nurses used established knowledge (Reed order penegra 100 mg on line, 1996 order 50mg penegra with mastercard, p discount 100mg penegra fast delivery. Decoding, subdividing data, categorizing data, identifying layers of meaning at different levels of abstraction, and applying a conceptual framework Peplau urged nurses to use nursing situa- to explain the phenomenon may occur as a means tions as a source of observations from of interpreting observations (Peplau, 1989b). At which unique nursing concepts could be that time, a structure for obtaining more informa- derived. Further ob- servation or interviewing leads to a clearer, more Peplau urged nurses to use nursing situations as a explicit description of the phenomenon or concept. To the collection of information about patterns or direct nurses in the development of practice-based processes that accompany the phenomenon. The nurse, as the interviewer, assists the patient in providing a thorough description of the Theory development begins with observations concept or process. In the first step, the nurse ob- view techniques that encouraged description; for serves a phenomenon, which is then named, cate- example: “Describe one time that you were... Only by thor- ing on existing literature to assist in naming the ough description of the concept or process can the concept, further information about the concept is nurse assure that all of the behaviors associated gained. Peplau viewed nursing depression—and culminating in the testing interventions as those that “assisted patients in of an intervention to reduce negative gaining interpersonal and intellectual competencies thinking in depressed women, Peplau’s evolved through the nurse-patient relationship” process of practice-based theory develop- (O’Toole & Welt, 1989, p. Useful interventions ment has provided direction and structure are derived and tested (Peplau, 1989c). Both she and her students collected verbatim recordings of interactions with patients. Nevertheless, a thorough description of students at Teachers College (Columbia University) the recovery process of women with depression was were asked to make carbon copies of their interac- not reflected in the literature. Peplau studied these and no- a clinical phenomenon and a review of available in- ticed that the students could not talk in a friendly formation related to that phenomenon were the way until the patients had said “I need you” or “I first steps in Peplau’s process. Seven quently to nursing interventions to decrease women who were recovering from depression anxiety (O’Toole & Welt, 1989). Peplau assisted in the design of the semistructured interview guide (personal commu- nication, December 14, 1990). The process of recovering was initiated by a crisis or “turning point” experience. It continued with pro- Applications fessional support and the support of friends and family. Recovering, according to the participants, Peplau’s work has had remarkable influence on required determination, work over time, and a nursing practice and education as we know it today series of successes that enhanced self-esteem and and on development of later nursing theories. The process was dynamic, oc- One of her major contributions to nursing was curring in a nonserial order, with back-and-forth reinforcing nurses’ awareness of the knowledge- movement among the categories and phases. This study raised many ques- chapter reviews in depth Peplau’s practice-based tions and provided further direction for study. It then discusses future applications of shared strategies or techniques that facilitated re- Peplau’s work. Peplau’s process of practice-based theory develop- Follow-up Study ment has directed a program of research in the area of depression in women (Peden, 1998). Beginning Continuing in step two of the process, a follow-up with the identification of a clinical phenomenon— study (Peden, 1996) was conducted a year later to women recovering from depression—and culmi- further describe the recovery process of women nating in the testing of an intervention to reduce who had been depressed. Peplau’s Process of Practice-based Theory Development and Its Applications 63 covering process were identified. Interventions that negative thoughts focused primarily on self, being assisted patients in recovering instilled hope were different, disappointing self and others, not being psychoeducational in nature, included cognitive in- perfect, and always failing. The women described terventions that change thinking styles, and pro- their self-talk as constant, negative, and demeaning. They identified various means of managing the Peden’s study (1996) concluded with the realiza- negative thoughts. Once again, the use of affirma- tion that more information was needed on the tions, positive self-talk, and learning to change symptom of negative thinking. To understand a thinking were identified as reducing negative think- phenomenon, one must analyze its etiology, its ing.

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