By F. Hernando. Kean University. 2018.

This is of particular concern for the frequent use of mammography for the detection of breast cancer purchase danazol 200 mg on-line. Evidence for the harmful effects of the irradiation of breast tissue and the links to cancer can be found in reports of breast cancer in women who have been treated for benign conditions using radiation therapy (Metler et al safe 50 mg danazol. It has been argued that there is a threshold purchase danazol 50mg online, below which radiation could be considered totally safe, and that the above examples of an association between irradiation and breast cancer are due to the unusually high levels of radiation (Perquin et al. Furthermore, Strax (1978) suggested that if 40 million women were screened for 20 years, 120 would die from radiation-induced breast cancer. However, since these concerns were raised, the dose of radiation used in mammography has been reduced, although some concerns still remain. A false-negative result may lead to an illness remaining undetected, untreated and con- sequently progressing without medical intervention. Social harm Zola (1972) has argued that medicine is a means of social control and suggested that there is a danger if individuals become too reliant on experts. In terms of screening, monitoring and surveillance of populations could be seen as a forum for not only examining individuals but controlling them. This argument is also made by Illich (1974) in his book Medical Nemesis, where he argued that medicine is taking over the responsibility for people’s health and creating a society of medical addicts. Screening epitomizes this shift towards social control in that not only are the ill seen by the medical profession but also the healthy as all individuals are now ‘at risk’ from illness (Armstrong 1995). Skrabanek (1988: 1155) argued that screening and the medicalization of health ‘serves as a justification for State intrusion into people’s private lives, and for stigmatising those who do not conform’. The possibility that screening may exacerbate existing stigma of particular social groups is particularly relevant to the screening for genetic disorders. At present, society is constituted of a variety of individuals, some of whom have genetic deficits such as Down’s syndrome, cystic fibrosis and sickle-cell anaemia. Although these individuals may be subjected to stereotyping and stigma, society provides treatment and support and attempts to integrate them into the rest of the population. It is possible, however, that screening for such disorders would lead to terminations of pregnancy and a reduction in this stigmatized population. Although this would lead to fewer individuals with these disorders (this may be a positive consequence, as no one wants to suffer from sickle-cell anaemia) the individuals who are born with these problems may face increased stigma as they would be part of a greatly reduced minority existing in a world with reduced social provisions for support and treatment. Autonomy – the patient has a right to choose The third ethical principle is that of autonomy. This is based on the view that ‘mentally competent and mature individuals should make decisions about their own future, subject to the constraints required to ensure social order’ (Burke 1992). Proponents of screening argue that screening is central to promoting autonomy in that the individual has a right to have access to information about their health status. According to this model of screening, the doctor is the patient’s gatekeeper to relevant information. However, screening may also undermine an individual’s autonomy if it is construed as a form of social control and doctors are seen as ‘lifestyle police’. Justice – the equal distribution of resources The fourth ethical principle of justice refers to the need for an equal distribution of resources. In addition, the ‘inverse care law’ (Hart 1971), which suggests that those who seek out tests most frequently are often those who need them the least, when applied to screening, highlights a shifting of finances to the most healthy individuals in society. A cost-effectiveness analysis involves assessing either how to achieve a set objective at minimum cost or how to use a fixed resource to produce the best output. In terms of screening, this raises issues about the objectives of screening (to detect asymptomatic illness, which can be treated) and the degree of resources required to achieve these objectives (minimum interventions such as opportunistic weighing versus expensive interventions such as breast screening clinics). The economic considerations of screening have been analysed for different pol- icies for cervical screening (Smith and Chamberlain 1987). The different policies include: (1) opportunistic screening (offer a smear test when an individual presents at the sur- gery); (2) offer a smear test every five years; (3) offer a smear test every three years; and (4) offer a smear test annually. These different policies have been offered as possible solutions to the problem of screening for cervical cancer. The results suggest that annual screening in England and Wales would cost £165 million and would potentially prevent 4300 cancers, whereas smears every five years would cost £34 million and would potentially prevent 3900 cancers. Both studies indicated that intensive screening, counselling and health checks have only a moderate effect on risk factors and the authors discuss these results in terms of the implications for government policies for health promotion through doctor-based interventions. The study involved 26 general practices in 13 towns in Britain and recruited 12,472 individuals aged 40–59 years. The practices within each town were paired according to socio-demographic characteristics and were randomly designated as either the intervention or the com- parison practice. Intervention practices were then randomly allocated either to a further comparison group or to an intervention group. This provided both an internal and external comparison with the subjects receiving the intervention. All intervention practices received screening, but only the intervention group of these practices received lifestyle counselling and follow-up within the one-year period.

A caring occasion occurs whenever the nurse and • The one caring and the one being cared for are another come together with their unique life histo- interconnected; the caring-healing process is ries and phenomenal fields in a human-to-human connected with the other human(s) and with transaction buy danazol 100mg. It • The caring-healing-loving consciousness of the becomes transcendent trusted 50mg danazol, whereby experience and nurse is communicated to the one being cared perception take place order danazol 100mg online, but the actual caring occa- for. The process goes beyond itself yet arises from through and transcends time and space and can aspects of itself that become part of the life history be dominant over physical dimensions. It transcends clarify where one may locate self within the time, space, and physicality. The Caring Model or Theory can be considered a • Are those involved “conscious” of their caring philosophical and moral/ethical foundation for caritas or noncaring consciousness and inten- professional nursing and is part of the central focus tionally in a given moment, at individual and for nursing at the disciplinary level. It offers to expanding their caring consciousness and a framework that embraces and intersects with art, actions to self, other, environment, nature, and science, humanities, spirituality, and new dimen- wider universe? However, to truly “get it,” one has to experience This work, in both its original and evolving it personally. The model is both an invitation and forms, seeks to develop caring as an ontological- an opportunity to interact with the ideas, epistemological foundation for a theoretical- experiment with and grow within the philosophy, philosophical-ethical framework for the profession and to live it out in one’s personal/professional life. Nursing caring theory-based activi- 2004), provide us with a chance to assess, critique, ties as guides to practice, education, and research and see where or how, or even if, we may locate have developed throughout the United States ourselves within a framework of caring science as a and other parts of the world. The caring model is basis for the emerging ideas in relation to our own consistently one of the nursing caring theories used “theories and philosophies of professional nursing as a guide. Nursing thus ironically is interacting with the caring model to transform now challenged to stand and mature within and/or improve practice? The it mean to be human, caring, healing, becoming, future already reveals that all health-care growing, transforming, and so on? For example, practitioners will need to work within a in the words of Teilhard de Chardin:“Are we hu- shared framework of caring relationships and mans having a spiritual experience, or are we human-environment field modalities, pay at- spiritual beings having a human experience? Participants were invited to explore Transpersonal However, nursing’s future holds promises of Human Caring Theory (Caring Theory), as taught caring and healing mysteries and models yet and modeled by Dr. Jean Watson, through experi- to unfold, as opportunities for offering com- ential interactions with caring-healing modalities. Nursing has a critical role to play Returning from the retreat to the preexisting in sustaining caring in humanity and making schedules, customs and habits of hospital routine new connections between caring, love, and was both daunting and exciting. Caring Theory, and not as a remote and abstract philosophical ideal; rather, we had experienced car- ing as the very core of our true selves, and it was the call that led us into health-care professions. Our experiences throughout the re- treat had accentuated caring as our core value. Caring Theory could not be restricted to a single Application of area of practice. Nursing within acute care inpatient hospital set- Theory of tings is practiced dependently, collaboratively, and independently (Bernardo, 1998). Bernardo de- scribes dependent practice as energy directed by Human Caring and requiring physician orders, collaborative prac- Terri Kaye Woodward tice as interdependent energy directed toward activities with other health-care professionals, and independent practice as “where the meaningful role and impact of nursing may evolve” (p. Transpersonal Caring Theory and the caring Although Bernardo’s description of inpatient nurs- model “can be read, taught, learned about, studied, ing captures the composite and fragmented role researched and even practiced: however, to truly ‘get it,’ one has to personally experience it—interact and grow within the philosophy and intention of 1 See Watson,J. This section of Model® integrating theory, evidence and advanced caring-healing the chapter provides a look into Transpersonal therapeutics for transforming professional practice. Watson’s clinical caritas of deep respect for humanity and all life, of wonder processes are listed, as well as an abbreviated ver- and awe of life’s mystery, and the interconnected- sion of her guidelines for cultivating caring-healing ness from mind-body-spirit unity into cosmic throughout the day (Watson, 2002). Gadow (1995) describes written in Caring Theory language, expresses our nursing as a lived world of interdependency and intention to all and reminds us that caring is the shared knowledge, rather than as a service pro- core of our praxis. Caring praxis within this lived world is a Second, a shallow bowl of smooth, rounded praxis that offers “a combination of action and re- river stones is located in a prominent position at flection... A sign posted by the stones iden- and a relationship with the wider community” tify them as “Caring-Healing Touch Stones” invit- (Penny & Warelow, 1999, p. Caring praxis, ing one to select a stone as “every human being has therefore, is collaborative praxis. These stones serve as a reminder of our ca- in our endeavors to translate Caring Theory into pacity to love and heal. They reveal the nonlinear process and smooth cool surface, let its weight remind you of relational aspect of caring praxis. Share in the love openness to unknown possibilities, honor the and healing of all who have touched this stone be- unique contributions of self and other(s), and ac- fore you and pass on your love and healing to all knowledge growth and transformation as inherent who will hold this stone after you. These key elements support the Third, latched wicker blessing baskets have been evolution of praxis away from predetermined goals placed adjacent to the caring-healing touch stones. Through collaboration and cocreation, staff to offer names for a blessing by writing the we can build upon existing foundations to nurture person’s initials on a slip of paper and placing the evolution from what is to what can be. Every Monday through Friday, Our mission, to translate Caring Theory into the unit chaplain, holistic clinical nurse specialist praxis, has strong foundational support. Staff and families, our environment, and our caring tries not to enter patient rooms unless summoned. This book emphasizes that patients, the unit as evidence of our commitment to caring parents, and families are members of the health values. Depicting pictures of diverse families at the center, Sixth and most recently, the unit chaplain, child- the poster states our three initial goals for theory- life specialist, and social worker have organized a guided practice: (1) create caring-healing environ- ments, (2) optimize pain management through 2 Written by Terri Woodward.

Copyright Law generic danazol 50mg fast delivery, no part of this book may be reprinted generic danazol 50 mg line, reproduced buy 200mg danazol overnight delivery, transmit- ted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Forensic dentistry / editors, David R. We also want to remember and salute that small group of concerned odon- tologists who met on Fire Island, New York, afer the impetus for the formation of various forensic boards was announced. Several others, including one editor and another contributor to this book, were invited to be included in the original group. Te board was incorporated in the District of Columbia with the frst certifcates awarded on February 18, 1976. Tis board has grown and developed and now includes dip- lomates from many American states and Canadian provinces. We are proud of the progress the board has made and its continu- ing support of educational and research eforts. We want to especially dedicate this book to each of you who hold it in your hands. If you are a forensic odontologist, you must strive to constantly improve the science and the feld, as did your mentors, with lectures, papers, and in person. In order for forensic odontology to progress to a specialty of dentistry there must be a consistent stream of new ideas and original and applied research. If you are not a forensic odontologist and are referring to this book, we welcome you to this challenging and fascinating feld. It is our hope that the material presented in this book will be, in some way, helpful to you for your inquiry. He was my student in pathology in dental school and has gone the extra mile for this second edition. His eforts are refected in the high caliber of the chapters in the book before you. Tis project would not have been possible without his hard work and vigorous encouragement to our contributors. Paul Stimson Table of Contents Preface ix The Editors xi The Contributors xiii 1 Science, the Law, and Forensic Identifcation 1 Christopher J. Golden 12 Dental Identifcation in Multiple Fatality Incidents 245 Bryan Chrz 13 Age Estimation from Oral and Dental Structures 263 edward F. Federal and State Court Cases of Interest in Forensic Odontology 411 Compiled By hasKell m. Barsley Index 423 Preface Since the publication of the frst edition of Forensic Dentistry in 1997 the discipline of forensic odontology has experienced considerable growth. Like all forensic specialties, forensic dentistry or forensic odontology has enjoyed (some may say sufered) a great increase in public interest during this period. Forensic dentists assist medical examiners, coroners, police, other law enforcement agencies, and judicial ofcials to understand the signifcance of dental evidence in a variety of criminal and civil case types. Prosecution, plaintif, and defense attorneys rely on forensic odontologists to analyze, report, and explain dental fndings that impact their cases. Te growth and evolution of forensic odontology has not taken place without signifcant growing pains. Te editors and contributors have chosen not to attempt to rationalize those problems but to report them, analyze the causes, and ofer alternate courses to minimize the probability of similar dif- fculties in the future. Te editors did not intend for this book to include comprehensive, step- by-step instructions on how to practice each phase of forensic odontology. Instead, the editors and contributors have endeavored to look objectively and philosophically at the development, current state, and future of forensic dentistry and other closely associated forensic disciplines. We are of the mind that if sound scientifc principles are applied from the beginning, and continued throughout, then the specifc steps taken will follow that same model and will have the best opportunity to meet success. Tey have produced thoughtful and sometimes provocative chapters that ofer substance, fact, and ideas suitable for experienced forensic investigators or those who are just embarking on forensic careers. Te editors want to ofer particular thanks to our families and especially to our wives, who not only gave us gracious support, but endured, mostly graciously, our extended physical, emotional, and mental absence. He practiced general dentistry from 1969 until 1992 and has practiced and taught forensic odontology exclusively since 1992. He is director, Center for Education and Research in Forensics; director, Fellowship in Forensic Odontology; and director, Southwest Symposium on Forensic Dentistry. He has authored book chapters and articles in refereed journals on forensic odontology topics. He is a forensic odontology consultant and chief forensic odontologist for the Bexar County (Texas) Medical Examiner’s Ofce. He serves on the board of editors for the American Journal of Forensic Medicine and Pathology and is an editorial consultant for Forensic Science International.

Tese various shortcomings were overcome in subsequent studies using multiple linear regression methods and similar statistical techniques that more appropriately account for the nature of the data buy cheap danazol 200mg online. But generic danazol 50mg on-line, rather than pursuing his collective mix of six dental changes discount 200mg danazol fast delivery, most researchers have elaborated on the scientifc bases of one or another of these processes. Te procedure is destructive in that the tooth has to be extracted, sectioned, and polished before measurement. Root transparency develops due to pro- gressive sclerosing of the tubules, frst at the root apex, then advancing coro- nally. Aging causes the refractive indexes to converge, making the dentin transparent to transmitted light. Changes may be seen as early as the later teens, though typically starting in adulthood. Tey also suggest that the rate of sclerosis difers among populations (possibly due to dietary diferences), and that the rate may not be linear throughout adulthood (possibly slowing in older adults). Tese authors found that at least 55% of their age estimates deviated by more than fve years. Diferences in the alternating light and dark bands are due to their diferent crystal orientations. Interestingly, the annuli show evidence of certain life history events that negatively infuence calcium deposition, such as pregnancies, and renal and skeletal disease. A few specimens exhibited doubling, where there were about twice as many lines as anticipated from the person’s known age. Tese authors made several observations: (1) archaeological specimens tend to have fainter annulations (and should be decalcifed more gently), (2) cementum deposition may be afected by periodontal disease, (3) a few teeth possess no cementum annulations, (4) accuracy of the method diminishes with the person’s age, which is common to most aging techniques, and (5) population diferences need to be studied. Tis accuracy, however, was achieved afer about 16% of the sample was omitted where the cementum pattern was irregular—“where the cementum band partly surrounds artifacts or overlays itself in undulations”—or where image quality was poor afer tissue process- ing. Tese authors made the points that, in their hands, (1) males and females could be aged with equal precision and (2) periodontal disease did not afect accuracy. Rates of tooth wear are intimately associated with diet, particularly food preparation processes. Murphy141 was among the frst to develop a tooth wear grading system that accounted for morphologies of the individual tooth types as well as using enough grades to approximate a continuous scale (also see Molnar, 1971142; Scott, 1979143). Smith’s scheme is individualized for the diferent tooth types, and ranges from traces of wear (polished or small facets on the enamel) to loss Incisors & Molars Premolars Canines L U U U 1 2 3 4 5 6 7 8 Figure 13. In addition, there is a growing body of research using microscopic wear patterns to disclose dietary adaptations. In modern, Westernized countries there have been important demographic and oral health shifs. With people living longer—and retain- ing more of their teeth—the occlusal wear in the older age grades has been increasing (because teeth are less ofen extracted or decayed), and this trend is expected to continue. Moreover, and especially when abrasion and ero- sion are included in wear, it becomes relevant to consider all tooth surfaces, not just the occlusal. In most jurisdictions the attainment of a specifc calendar age marks adulthood and legal implications change signifcantly. Recently, the chronology of third molar development has been used extensively to judge whether an individual is a juvenile or an adult. Such estimations are ofen requested by immigration authorities in cases involving foreign nationals. Several studies have indicated that although actual age estimation using third molar development is relatively inaccurate because of large varia- tion among individuals, a reasonable evaluation as to whether a subject has reached adulthood can be made by this method. Te contributing dentists scored the stage of third molar development using the eight-grade scheme developed by Demirjian and coworkers62 (Figure 13. Only 54% of cases showed the same stage of crown-root development in both the maxilla and mandible. Only data from white subjects are shown in these computa- tions because too few from other racial groups were available to yield reliable estimates. Stages A and B did not occur in the ages under study, and Stage C was present in only 1%. As reported by others, staging of third molar development was shown to be inaccurate for prediction of chronological age. Tis means that age predictability within each stage consists of an interval of about eight years. As with the computation of chronological age, the relationship between third molar development and attainment of legal adulthood is quite variable. It was found that if third molar root formation was complete with closed apices and uniform Table 13. Probabilities for the terminal grade (H) presume that, based on other criteria, the subject is less than twenty-fve years of age. Max = Maxilla Mand = Mandible M = Male F = Female width of periodontal ligament (Stage H), there is a high probability that an individual is at least eighteen years old.