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A general approach to determination of age follows: Fetal period: Estimation of fetal developmental age assumes forensic importance in most jurisdictions because it is usually an indicator of viability buy generic actonel 35mg. In instances of criminal death of a pregnant individual courts may decide whether to prosecute more than one homicide depending upon the age (i buy actonel 35mg on line. Knowing the age of a discovered fetus may also assist in matters of identifca- tion discount 35 mg actonel with mastercard. Usually, diaphyseal lengths may be used in various algorithms to estimate crown–rump length, which may then be translated into lunar age. Te timing of appearance of primary and some secondary ossifcation centers is also of use. Several sources give good accounts of the statistical reliability of various bones and measurements for both gross and radiographic fetal age determination. As noted, dental and osteological age should correlate well within this develop- mental interval. In recent years anthropologists and odontologists have become increasingly aware of diferences in rates of skeletal and dental maturation among various populations,34 and have begun to apply adjustments to their age estimates accordingly. Sixteen to thirty years: As attachment of primary and secondary ossif- cation centers occurs throughout the skeleton, attention turns to the completion of fusion of these centers. Numerous investigators have Forensic anthropology 145 established rating scales that describe the degree to which growth cartilages (metaphyses) have been replaced by bone, signaling the completion of that skeletal element or an articulation. Tese techniques usually take the form of a semantic diferen- tial, which describes changes in the appearance characteristics of a particular structure at known points in time based upon controls. Tirty years and beyond: As the last epiphyses (usually the medial clavicles) complete development, skeletal age may still be estimated, albeit with increasing error. As a result of endocrine-driven cellular interactions that constantly remove bone and replace it, the skeleton continues to “turn over” approximately every seven to ten years, remodeling itself to accommodate gravity and the mechani- cal habits of its owner. Alongside this process, the skeletal cartilages that separate and cushion bones undergo increased hardening with resulting grossly observable wear at the articulations, i. Age-related changes in the weight-bearing joints (ankle, knee, hip, sacroiliac, spine, etc. For example, as the marrow of long bones assumes a larger part of the hemopoetic burden with age, one can observe an advance of the apex of the marrow cavities in femora and humeri. As old cortical bone is scavenged by osteoclasts to maintain mineral homeostasis, new vascular pathways import osteoblasts that replace it. As the skeleton moves through time, the amount of unremodeled lamellar bone seen 146 Forensic dentistry in microscopic cross sections of cortex will diminish, and the num- ber of partly replaced structural units of old bone, osteon fragments, will increase. Tese changes have been documented and calibrated by various authors for a number of sites in the skeleton,43–45 and are of use in the aging skeleton because the process of turnover on which it is based extends throughout life. As is the case with other techniques, error in the calculated age range by histomorphological methods increases with time. Since the estimated stature derives from long bone lengths that do not change signifcantly afer matu- rity, this approach gives a range that does not take into consideration loss of stature from compression of the spinal fbrocartilages. A correction is usu- ally applied for individuals whose age is estimated to be over thirty years. When long bones are incomplete because of trauma or taphonomic efects, it is sometimes possible to estimate the vital length of some bones by proportionality techniques. In general, the best estimates of stature are based upon multiple bones, which are used in algorithms derived from population data refecting current secular trends. Anthropologists are sometimes asked to render estimates of the living weight of a decedent who has been reduced to bones. Putting aside ancillary information such as belts, shoes, and other clothing that may accompany remains, the answer will require strong qualifcation. Since an individual may lose as much as 50% of his or her body mass over a relatively short time (e. Accordingly, statements about frame size, proportionality, and the distribu- tion of muscularity are preferable. Cross-sectional thickness or simply the weight of various bones in combination with proportionality ratios can pro- vide information about how much sof tissue weight an individual might be expected to carry. Tis picture may be refned by a careful examination of entheses, the points of tendon insertion, which are modifed by muscular activity over a period of time. Tus, one may arrive at an estimate of how Forensic anthropology 147 well developed an individual may have been for a particular frame size and stature at some point in life. Examination of the pattern in which the skeleton has reinforced itself in response to habitual or repetitive biomechanical action has sometimes proved useful in the inclusion or exclusion of certain occupations, sports, or other activities performed over a period of several years, which may alter a list of suspected matches. When these data, combined with a list of unique identifers, are compared to a database of missing persons, the list of possible matches usually reduces to a manageable few. At the discovery of unknown human remains, the authorities will either have a theory about the identity of the decedent or not. Tis will include dental charts, bitewings and pano- graphic images if available, old x-rays, or other medical images (e. When images are unavailable, medical records describing pros- theses, pacemakers, shunt devices, cosmetic implants, orthopedic devices, and the like may be sufciently detailed for comparison to the postmortem evidence. Antemortem records of diseases that would be expected to leave evi- dence in the hard tissues are also useful, particularly when the incidence of a disorder is known. In some cases of suspected identity, when none of the foregoing is available, it is sometimes useful to perform a skull-to-photograph superimposition. Although tradition- ally used to exclude matches, some have successfully employed video super- imposition to achieve positive identifcations when a complete skull and good quality photographs from several angles are available.

The first culture-fair test cheap 35 mg actonel otc, called Army Ex- takers are also penalized in ways other than their unfa- amination Beta order 35 mg actonel visa, was developed by the United States mil- miliarity with specific facts actonel 35mg on-line. Beginning in the postwar period, cul- them, further reduced by low levels of trust in and identi- ture-fair tests, which rely largely on nonverbal questions, fication with the person administering the test. In addi- have been used in public schools with Hispanic students tion, students from a minority culture may be more like- and other non-native-English speakers whose lack of fa- ly to interpret and answer a question in ways that differ miliarity with both English language and American cul- from the prescribed answer. The Cattell tests in predicting success in school, suggesting that in scales are intended to assess intelligence independent of their quest for academic success, members of minority cultural experience, verbal ability, or educational level. The tests consist mostly of paper-and-pencil questions involving the relationships Further Reading between figures and shapes. The Bell Curve Wars: Race, Intelligence, and the youngest age group, utilize various objects instead of the Future of America. The Bell Curve: children age eight and up, include completing series, Intelligence and Class Structure in American Life. Culture-fair testing is a timely issue given current Mensh, Elaine, and Harry Mensh. His father was a successful provincial physician, and his grandfather, Erasmus Darwin (1731-1802), had been a distinguished intellectual figure. Young Darwin attended the Shrewsbury School, and his early failure to achieve academic distinction continued at Edinburgh University, where he studied medicine, and at Cambridge University, where he studied theology. While at Cambridge, however, Darwin enthusiastically pursued natural history as an avo- cation, drawing the attention of botanist John Stevens Henslow (1796-1861) and geologist Adam Sedgwick (1785-1873). In 1831, through his connection with Henslow, Darwin joined the expedition team aboard the survey ship H. Beagle headed for the coasts of South America, the Galápagos Islands, New Zealand, and Tas- mania. There is some indication that Darwin went on the voyage in order to accompany Captain FitzRoy. FitzRoy, as captain, was not to socialize with the lower status crew members on the ship, and he was worried about maintain- ing his mental health during the long, solitary voyage. Upon his return to England, Darwin de- principles hold that in the struggle for existence, some veloped his theory of evolution, one of the major intellec- individuals, because of advantageous biological adap- tual achievements of the nineteenth century. However, be- tation,are better able to occupy effectively a given eco- cause of his creationist perspective, some of the observa- logical niche and therefore will produce more offspring tions made during the voyage were not useful in the devel- than individuals who are less able. In 1858, when another theory challenged biblically oriented views about the scientist, Alfred Russell Wallace (1823-1913) shared his nature and origins of humans and animals, Darwin was observations gathered in the Malay Archipelago, Darwin extremely cautious and continued his research for an- hastened to publish The Origin of Species to ensure his other 18 years before publishing it in 1859 as On the own work would receive recognition. Origin of Species by Means of Natural Selection; or, the Darwin’s theory of evolution postulates that all Preservation of Favoured Races in the Struggle for Life. Within a few years, scientists were convinced and James Angell (1869-1949) in the United States, of the soundness of the theory, although popular debate who together founded the functionalist movement at about its ideological and theological implications has the University of Chicago. Sigmund Although psychology was one of the fields for Freud’s younger colleague, George J. Romanes (1848- which Darwin’s theory had revolutionary implications, 1894), to whom Darwin turned over his notes on ani- it was largely left to others—notably Darwin’s cousin mal behavior shortly before his death, established the Francis Galton—to expand them publicly. Paralleling the sci- toward the end of his career, Darwin published three ence of comparative anatomy, this field seeks to pro- books in which he explored how human mental quali- vide insights about human beings by studying the sim- ties could be understood as the result of evolution. In ilarities and differences between human and animal The Descent of Man (1871), he supported the contro- psychological functioning. In addition, Darwin’s prin- versial position that human beings are descended from ciple of natural selection led to a greater interest in animal ancestors. In line with this idea, he argued that variation and individual differences among members the mental activities of humans and animals are funda- of the same species. He identified the presence in animals of “human” qualities such as courage and devotion, and Darwin’s other books include The Variations of Ani- “human” emotions, including pride, jealousy, and mals and Plants under Domestication (1868), Insectivo- shame. After examining these and other common men- rous Plants (1875), and The Power of Movement in tal functions, such as memory, attention, and dream- Plants (1880). He was awarded membership in the Lon- ing, Darwin concluded that the mental difference be- don Geological Society in 1836 and won election to the tween humans and the higher animals is one of degree Royal Society in 1839. The Survival of Charles Darwin: A Biogra- mals (1872), Darwin posited that human emotional ex- phy of a Man and an Idea. New York: Random House, pressions have evolved over time because of their link 1984. The Autobiography of Charles Darwin, 1809- For example, an animal baring its teeth in rage is literally 1882. Darwin on Man: A Psychological Study of or flight” reaction, a heightened state of nervous arousal, Scientific Creativity. Daydreaming Darwin’s final contribution to psychology was the A temporary escape from daily reality by forming publication in 1877 of Biographical Sketch of an Infant, mental pictures, usually in spontaneous, brief based on a detailed log he had kept on the development episodes, of other experiences. This milestone in the history of child psychology was probably the first Daydreams are a form of imagination. One seminal idea expressed in dreams, the person forms a mental image of a past expe- this short work is that the individual’s development par- rience or of a situation that he or she has never actually allels the development of the species to which it belongs. A daydream may be triggered by a situation, a memory, or a sensory input (sight, Darwin’s work had far-reaching influences on the taste, smell, sound, touch). Its emphasis on the individual’s adaptation to the environment helped es- The daydreamer may use these mental pictures to tablish the “functional” view of the mind and of human escape from reality temporarily, to overcome a frustrat- behavior, influencing such thinkers as John Dewey ing situation, or to satisfy hidden wishes. When the daydreamer’s daily routine is disrupt- ed—a driver misses an exit on the freeway continuously, or a student does not hear the teacher assigning home- Deductive reasoning work—he or she may want to consider whether the day- dreams are a symptom of a psychological problem. Although most psychologists view daydreams as generally healthy and natural, this was not always the Deductive reasoning is a way of reasoning that re- case. In the 1960s, for example, textbooks used for train- lates two or more general concepts or conditions to a ing teachers provided strategies for combating daydream- specific case.

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Encourage client to keep follow-up appointments with physician or to call phy- sician’s office prior to follow-up date if problems or concerns arise buy actonel 35mg with visa. Client is able to make independent decisions regarding life- style considering change in health status cheap actonel 35 mg free shipping. Client is able to express hope for the future with consider- ation of change in health status discount 35mg actonel with amex. Psychiatric Home Nursing Care ● 355 Possible Etiologies (“related to”) Alterations in mental status Inability to engage in satisfying personal relationships Unaccepted social values Unaccepted social behavior Inadequate personal resources Immature interests Alterations in physical appearance Altered state of wellness Defining Characteristics (“evidenced by”) Expresses feelings of aloneness imposed by others Expresses feelings of rejection Developmentally inappropriate interests Inability to meet expectations of others Insecurity in public Absence of supportive significant other(s) Projects hostility Withdrawn; uncommunicative Seeks to be alone Preoccupation with own thoughts Sad, dull affect Goals/Objectives Short-term Goal Client will verbalize willingness to be involved with others. Long-term Goal Client will participate in interactions with others at level of abil- ity or desire. Be with the client to offer support during activities that may be frightening or difficult for him or her. Most individuals keep the same style of relationship development that they had in the past. Help the client identify present relationships that are satisfying and activities that he or she considers interesting. Only the cli- ent knows what he or she truly likes, and these personal pref- erences will facilitate success in reversing social isolation. Risk Factors Caregiver not developmentally ready for caregiver role Inadequate physical environment for providing care Unpredictable illness course or instability in the care receiver’s health Psychological or cognitive problems in care receiver Presence of abuse or violence Past history of poor relationship between caregiver and care receiver Marginal caregiver’s coping patterns Lack of respite and recreation for caregiver Addiction or codependency Caregiver’s competing role commitments Illness severity of the care receiver Duration of caregiving required Family/caregiver isolation Goals/Objectives Short-term Goal Caregivers will verbalize understanding of ways to facilitate the caregiver role. Long-term Goal Caregivers will demonstrate effective problem-solving skills and develop adaptive coping mechanisms to regain equilibrium. Ensure that caregivers are aware of available community sup- port systems from which they can seek assistance when re- quired. Examples include respite care services, day treatment centers, and adult day-care centers. Caregivers require relief from the pressures and strain of providing 24-hour care for their loved one. Studies have shown that abuse arises out of caregiving situations that place overwhelming stress on the caregivers. Release of these emotions can serve to prevent psychopathol- ogy, such as depression or psychophysiological disorders, from occurring. Encourage participation in support groups composed of members with similar life situations. American Association on Intellectual and Developmental Disabilities—(800) 424-3688 c. Alzheimer’s Association—(800) 272-3900 Hearing others who are experiencing the same problems discuss ways in which they have coped may help the caregiver adopt more adaptive strategies. Individuals who are experi- encing similar life situations provide empathy and support for each other. Caregivers demonstrate adaptive coping strategies for deal- ing with stress of caregiver role. Bellfield and Catalano (2009) have stated: Forensic nursing is an emerging field that forms an alliance between nursing, law enforcement, and the forensic sciences. Forensic nurses provide a continuum of care to victims and their families beginning in the emergency room or crime scene and lead- ing to participation in the criminal investigation and the courts of law (p. Nurses in general practice Clinical Forensic Nursing in Trauma Care Assessment Lynch, Roach, and Sadler (2006) have stated, “Forensic nurse specialists are specifically trained to deal with cases of sexual assault, child abuse, acute psychiatric emergencies, and death investigation” (p. All traumatic injuries in which liability is suspected are considered within the scope of forensic nurs- ing. Reports to legal agencies are required to ensure follow-up investigation; however, the protection of clients’ rights remains a nursing priority. Several areas of assessment in which the clinical forensic nurse specialist in trauma care may become involved include: 1. Evidence from both crime- related and self-inflicted traumas must be safeguarded in a 358 Forensic Nursing ● 359 manner consistent with the investigation. Evidence such as clothing, bullets, bloodstains, hairs, fibers, and small pieces of material such as fragments of metal, glass, paint, and wood should be saved and documented in all medical accident in- stances that have legal implications. Sharp-Force Injuries: Sharp-force injuries including stab wounds and other wounds resulting from penetration with a sharp object. Blunt-Force Injuries: Includes cuts and bruises resulting from the impact of a blunt object against the body. Dicing Injuries: Multiple, minute cuts and abrasions caused by contact with shattered glass (e. Patterned Injuries: Specific injuries that reflect the pattern of the weapon used to inflict the injury. Defense Wounds: Injuries that reflect the victim’s attempt to defend himself or herself from attack. Hesitation Wounds: Usually superficial, sharp-force wounds; often found perpendicular to the lower part of the body and may reflect self-inflicted wounds. Fast-Force Injuries: Usually gunshot wounds; may reflect various patterns of injury. When deaths oc- cur in the emergency department as a result of abuse or acci- dent, evidence must be retained, the death must be reported to legal authorities, and an investigation is conducted. It is therefore essential that the nurse carefully document the appearance, condition, and behavior of the victim upon ar- rival at the hospital.

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