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By M. Fraser. John Jay College of Criminal Justice. 2018.

Injury to this breast was thought to have been the result of an avulsive bite when viewed in the color photograph (Figure 11 cheap finax 1mg overnight delivery medications list template. The images show details indicating that a rope had been used to tie the neck of the bound victim to the headrest of an automobile order 1 mg finax with mastercard medicine plies. The details of the rope seen in the photographs indicated that the ligature marks on the neck were not caused by the border of the seat belt, as the defendant had claimed. Developing the skills necessary to competently document these injuries with visible and nonvis- ible light is one of the great challenges in forensic dentistry. Infrared photography, medical and scien- tifc photography: An online resource for doctors, scientists, and students. Tesis for doctor of philosophy, University of London, Oral Pathology, London Hospital Medical College. A theoretical and experimental study of light absorption and scattering by in vivo skin. Recapturing a fve month old bite mark by means of refective ultraviolet photography. Te World Trade Center attack, the Pentagon attack, and the Pennsylvania crash all related to the 9/11 terrorist’s attacks lef the United 245 246 Forensic dentistry States in shock. Te world watched in astonishment as the tsunami of December 26, 2004, wiped out entire cites and islands around the Indian Ocean. Te identifcation process is very important to the family members of the deceased for legal and psychological reasons. Every phase of the identifca- tion process should lead toward an accurate and scientifcally based iden- tifcation. Tose who read this chapter should have the ability to defne a multiple fatality incident and know the types and causes of those incidents. He or she should understand the principles of site management, relationships with other agencies, and the role of the forensic odontologist in the response, including the latest technological advances in imaging and forensic dental identifcation sofware. For instance, a transportation accident in the New York City area with one to two hundred fatalities could be well within the abilities of the local emergency manage- ment system, fre and police departments, and medical examiner. Conversely, in a juris- dictional area in the Midwest with sparse population and limited resources, a multicar accident with twenty fatalities could create a situation that would be beyond the capabilities of the existing system. Tis situation could be termed a mass disaster, and some sort of outside aid would be needed to assist the local responders. Of course, the survivors of a mass disaster are the initial concern of the responders. Once this priority is accomplished, the eforts intensify to locate, identify, and return to their families those victims who did not survive. Te response eforts to multiple fatalities include recovery, autopsy as required, dental identifcation in multiple Fatality incidents 247 identifcation, and release of bodies to families or to their country of origin. Embalming may be a consideration, but in respect to religious concerns, should be done only afer identifcation and legal release. In some situations the overwhelming numbers of fatalities or other extenuating circumstances may require mass management and no individual processing. Tis type of body disposition must be defned in planning and training sessions and implemented when the situation warrants. Te direct family members have sufered a tremendous loss with the death in their family, but also could have sufered injuries or sustained signifcant personal property losses. In cases like the 9/11 World Trade Center attacks, we found that the responders who were in the line of fre and the same people depended upon to supply fre and police protection and assistance became part of the missing persons list. Normally local agencies have some emergency management resources in place to begin the initial operation. A large major- ity of responders may be volunteers who feel the need to give aid to families and victims in a time of need. Ofen there are imposters who try to cross the secu- rity lines just to look at the scene. Tis type of security problem must be prevented, and a good protocol for accepting volunteers must be in place. Many governments supply either salaried employees or activated employees to work at a disaster site. Tese contractors work for an entity such as an air carrier or government and provide the requested services. Tis individual is usually a medical examiner, coroner, or assigned emergency management director.

This increase is reflected by reports of gender differences in cancer with lung cancer now being the leading cause of death in American women buy finax 1mg mastercard medications ibs. To explain increases in female smoking discount finax 1mg line medications prescribed for anxiety, research has focused on the perceived benefits of smoking, suggesting that smokers of both genders continue to smoke for fear of weight gain. Consequently, the present cultural obsession with thinness in women may account for increased female smoking. As a result, research suggests that female dieters may use cigarette smoking as a weight loss/maintenance strategy (Klesges and Klesges 1988; Ogden and Fox 1994). For example, in a recent study dieters showed greater agreement with statements relating to smoking initiation and smoking maintenance for weight control, the role of weight gain in previous experiences of smoking relapse, intentions to quit following weight loss and intentions to quit in five years (Ogden and Fox 1994). Smoking and changes in food intake How cigarette smoking influences weight is unclear with different possible mechanisms predicting either a change or no change in food intake. For example, it has been proposed that weight gain could be a result of decreased energy use due to withdrawal or fatigue, or that nicotine may increase metabolic rate; both mechanisms suggest no post-cessation changes in eating behaviour. Further research suggests that smoking cessation may result in increases in consumption of calories, increases in sucrose, fats and carbohydrate intake (see Ogden 1994 for an overview). Theories to explain the changes in food intake following smoking cessation have focused on physiological factors such as a release of brain serotonin following nicotine withdrawal (Benwell et al. However, an alternative explanation of the relation- ship focuses on the subjective experience of craving for a substance. The subjective experience of craving The desire to eat and the response to food deprivation is characterized by the experience of ‘emptiness’, ‘tension’, ‘agitation’, ‘light-headedness’ as well as more specific feelings such as a ‘rumbling stomach’. Smoking abstainers also describe their desire for a cigarette in similar ways, again using language such as ‘emptiness’, ‘agitation’ and ‘light-headedness’. A possible explanation of the interaction between smoking and eating is that sensations of deprivation may be interchangeable. Alcohol research suggests that craving for alcohol may be a form of misattribution of internal states, with the alcoholic labelling internal states as a desire for alcohol (Ludwig and Stark 1974; Marlatt 1978). With reference to eating and smoking, the desire to smoke may be labelled as hunger and therefore satiated by food intake. In a recent experimental study, smokers were asked either to abstain for 24 hours or to continue smoking as usual, and their craving for food and cigarettes and food intake was compared with each other and with a group of non-smokers (Ogden 1994). The results showed that smoking abstinence resulted in an increased craving for food and increased food intake. In addition, the results showed that an increased craving for cigarettes resulted in increased food intake. Furthermore, the results showed that this association between craving for cigarettes and food was greater in women than men, and particularly apparent in dieting women. These studies support a cross-behavioural perspective of addictions and suggest an interrelationship between different behaviours. It is possible that because women dieters may use smoking as a means to reduce their eating they develop an association between these behaviours. It is also possible that the substitution between addictive behaviours may also exist between other behaviours such as alcohol and smoking (stopping smoking increases drinking), or gambling and eating (stopping gambling increases eating). There are many different theories to explain why people smoke or drink and how they can be encouraged to adopt healthy behaviours. This chapter examined the different models of addiction, including the moral model, the disease models and the social learning perspective. Finally, this chapter examined the interrelationship between different behaviours, in particular smoking and eating, to examine the validity of a cross- behavioural perspective. Theories of addictions and addictive behaviour emphasize either the psychological or physiological processes. This separation is reflected in the differences between the disease models and the social learning perspectives. It is often assumed that the most recent theoretical perspective is an improvement of previous theories. In terms of addictive behaviours, the moral model is seen as more naïve than the disease model, which is more naïve than a social learning theory perspective. However, perhaps these different models also illustrate different (and not necessarily better) ways of explaining behaviour and of describing the individual. This book examines the different theories of addictive behaviours and in particular outlines the contribution of social learning theory. This book provides a detailed analysis and background to relapse prevention and applies this approach to a variety of addictive behaviours.

Hypophosphatemia Hypophosphatemia occurs in a patient’s whose serum phosphate is less than 2 buy finax 1mg with visa symptoms parkinsons disease. The nurse should monitor the patient for the following signs and symptoms of hypophosphatemia: • Bone and muscle pain cheap finax 1 mg amex symptoms in children. Electrolytes are positive and negatively charged particles that generate electrical impulses that, among other things, cause our muscles to contract. Fluids and electrolytes are stored in two compartments: intracellular (in- side the cell) and extracellular (outside the cell). There are three types of fluid concentrations: iso-osmolar (same concentration), hypo-osmolar (low concentration), and hyper- osmolar (high concentration). There are five key electrolytes: potassium, sodium, calcium, magnesium, and phosphorus. Diseases and treatment of diseases are two factors that can cause fluids and electrolytes to become imbalanced. The healthcare professional must quickly identify the signs and symptoms of the imbalance and then take steps to restore the balance between electrolytes and fluids. What is determined by the concentration of electrolytes and other solutes in water? The concentration of a hypotonic intravenous solution has the same con- centration as intracellular fluid. Insulin and glucose administered parenterally (a) forces potassium out of the cell. Yet today you’re probably eating more nutritional foods—foods you wouldn’t touch when you were a kid—because you’ve learned that healthy foods provide the balanced nutrition needed to fend off diseases. You might wonder how a chapter on nutrition slipped into a book on phar- macology. Nutrients are given to patients who are at risk for malnutrition caused by disease and caused by treatments given to cure diseases. Nutrients are also given to strengthen the patient following a trauma such as surgery. In this chapter, you’ll learn about nutritional support therapies, how to pre- pare them, how to administer them, and how to avoid any complications that might arise. Nutrition Nutrition is a three-step process that gives the body materials needed to make the body grow and function. Other nutrients become involved in enzyme activities and carbohydrate-fat-protein synthesis. And just like your car, your body can continue to operate without a full complement of nutrients—that is, without a full tank of gas. A healthy, well- nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. However, there comes a point when your performance sputters—the level of nutrients fall below the level needed to sustain your daily activity. You simply run out of fuel and become fatigued, irritable, and exhibit an abnormal appearance. These are surgery, trauma, malignancy, and other illnesses that break down (catabolize) the body. A nutritional deficit prolongs healing and severe cases can prevent total recovery. Critically ill patients have sufficient nutrients to sustain them for a few days to a week before they begin to show signs of nutritional deficit. Healthcare professionals provide nutritional support therapy for patients who are at risk for nutritional deficit. Nutritional support therapy replaces nutrients that the patient has lost and thereby provide the patient with the fuel needed for a full recovery. A nutritional deficit is called a negative nitrogen balance, which means that the patient lacks sufficient nitrogen to fight infectious disease. Healthcare pro- fessionals treat patients who are at risk for negative nitrogen balance by provid- ing the patient with nutrients before the imbalance occurs. A common misnomer is that dextrose 5% in water (D5W), normal saline, and lactated Ringer’s solution provide nutrients to the patient. The parenteral route is the least preferred because the process is three times more expensive than enteral with- out a significantly improved benefit. Enteral nutrition Enteral feeding is the preferred method of providing nutritional support to a patient.

Fitzgerald believed that organ malfunction resulted in tiny crystalline deposits of calcium and uric acid on the nerve endings of the feet cheap finax 1mg with mastercard medicine lookup, and that breaking down these deposits with massage would heal the organ (Griffiths 1995) generic finax 1mg without a prescription medicine venlafaxine. Fitzgerald identified ten energy zones of life-force running longitudinally through the body (not too dissimilar to the twelve meridians of Ki), reflecting the organs in specific parts of the feet (and hands). Reflexologists can therefore treat any part of the body using specialised foot massage that breaks down the crystalline deposits. If reflexology’s assumptions are correct, it is possible that nurses manipulating feet and hands (e. Griffiths (1995) warns that reflexology initiates a ‘healing crisis’ which can last up to 24 hours, although this is less likely to occur with the gentler Western approaches than the more vigorous approaches used in the East. The absence of any reported complications suggests this may not be an actual problem, but it leaves a (currently) unanswered question. Shiatsu Although derived from the Japanese for ‘finger pressure’, Shiatsu practice has gained wider connotations; it usually treats the whole meridian system (of vital energy/life force) in order to harmonise Ki (Stevensen 1995). Like other variants of massage, shiatsu is best left to those with specialist knowledge. Aromatherapy Aromatherapy implies the use of essential oils with direct chemical effects, not just burning something which emits pleasant smells (although boundaries between pleasure and therapy can become blurred when evaluating psychological benefit): burning neroli (see Massage above) can reduce anxiety. As active chemicals, essential oils can be considered to be drugs, albeit not restricted by regulations governing traditional medicines. Because of the nature of this therapy, the effects of aromatherapy may affect anyone (staff, other patients) in the immediate environment, so although relaxation may help some patients, it could be harmful to others, while possibly reducing staff efficiency. Complementary therapies 443 Placebo effect Throughout history significant minorities of people have benefited from inactive medicines (placebos); Hippocrates was familiar with the problems of patients who had been given unhelpful (and often harmful) treatments. Complex interactions between human physiology and psychology can make it difficult to ascribe a particular effect to a particular cause. When evaluating any treatment (complementary or orthodox), placebo, rather than active components, can benefit 35–52 per cent of patients (French 1989). Double-blind trials are designed to identify the extent of placebo effects, thus measuring whether any significant further benefit is gained from active ingredients. However, the value of quantitative research methodology for qualitative interventions is questionable. With their focus on the health of the whole person, rather than dysfunction of single organs, complementary therapist-client time typically exceeds the amount of time doctors can afford to spend with the majority of their patients. Thus, the benefits claimed for complementary therapies may result from prolonged human interaction rather than from active treatment. If nursing and touch are in themselves therapeutic, then benefits from many complementary therapies may be largely or solely due to nursing touch, rather than specific interventions. If the desired end effect of nursing is the comfort (in its widest sense) of patients and relatives, then utilitarian ethics can justify whatever means are used to gain that end. However, deliberate misinformation (such as injecting water instead of analgesia) breaks duty-based codes, and is (at best) ethically dubious. Nurses should therefore know what they are giving, the likely effects and, ideally, follow informed consent from their patients. While placebos can produce significant beneficial effects, their use raises many ethical problems. Nursing traditionally values ‘doing’; complementary therapies provide sets of actions, which may provide nurses with a sense of achievement (placebo) regardless of actual patient benefit. Anecdotally, many complementary therapies appear beneficial, but they need to be rigorously and objectively tested against placebo effects. Some complementary therapies rely on active chemicals (endogenous or exogenous), so that the effects of Intensive care nursing 444 interactions with other therapeutic drugs should be discussed. Most complementary therapies require the dedication of significant periods of time. If sufficient time cannot be allocated, it may be irresponsible to begin interventions that (knowingly) will not be completed. Nurses intending to practise complementary therapies should therefore ensure that they have sufficient time to complete their intervention. Interest in complementary therapies has created some (as yet) unresolved questions for nursing, such as: ■ What is treatment?

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