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Fingerprints and human identifcation 93 visible on the surface of the dermis if it has been successfully reconditioned discount xenical generic. If no detail is present discount xenical online american express, the hand can be placed back into the water for another fve to ten seconds buy xenical online now. When there is abrasion trauma to the skin, an alternate form of the procedure should be used where the water from the hot pot is indirectly applied to the hand, such as with a sponge, to control development and avoid increasing the size of any cuts that may obscure visible friction ridge detail. Because the body tissue dehydrates and shrinks, ofen resulting from exposure to arid conditions, the friction skin becomes unusually rigid with severe wrinkling. Te body also may display signs of rigor mortis, which must be overcome to successfully examine the remains. In order to break mild rigor, an examiner can forcefully straighten or fatten the fngers of the hand. If this does not work, the examiner can cut the tendon on the inside of the fngers to release the rigor and allow the fngers to straighten. Cases of extreme rigor, such as those involving desiccated remains, require the removal of the fngers from the hand. Afer approval is granted, the examiner may amputate the fngers and place them into sealable jars labeled with the corresponding fnger position. Hands associated with desiccated remains must be rehydrated in order to remove the wrinkles from the friction ridge skin. Tis is usually accom- plished by soaking the fngers in jars containing dishwashing liquid diluted with warm water. Alternatively, a number of diferent chemical methods can be used to rehydrate the skin, such as soaking the fngers in 1 to 3% sodium hydroxide or in the leather conditioner Lexol® (Summit Industries, Inc. Te rehydration of the fngers may take hours or days, depending on the extent of desiccation. Te examiner should try to stretch the skin to remove any creases and then use tissue builder to remove any remaining wrinkles, returning the fngers to a near natural appearance. If friction ridge detail is not visible or the fngers have become saturated from soaking, the boiling technique can be used afer rehydration to visualize any ridge detail that may be present. Tis type of damage results in brittle friction skin that can be further damaged through excessive handling of the body. When an individual is burned to death, the body will usually exhibit clenched hands. Clenching of the hands is a natural reaction that tends to protect the friction ridge detail on the fngers and pos- sible residual prints lef by the victim. Instead of forcing the fngers open, the tendon on the inside of the fngers should be cut and the fngers gently 94 Forensic dentistry Epidermis ermis Figure 6. At this point, photography is advised to capture any ridge detail that may be present on the fngers. Hardened and loose friction skin may be twisted of the fnger, while epidermal skin that has lifed of the dermis but is still attached to the hand should be removed using forceps and curved Metzenbaum scissors for recording purposes. Afer the skin has been removed, it should be rinsed with warm water and, if wrinkled, carefully fattened out prior to printing. If the epidermal ridges are unprintable, the underside of the epidermis can, in some instances, be used for recording purposes (Figure 6. Recovered prints from the underside of the epidermis, however, will be in reverse color and position. Tis means that ridge color and ridge fow of the recorded print will be the reverse image of the ridge color and ridge fow of the prints contained on the antemortem standard. In cases of extreme charring with no visible friction ridge detail, the boiling technique can be used as a last resort to clean of the hand and possibly raise ridge detail on the fngers. Tis can be a simple procedure that involves blotting the hands dry with paper or cloth towels, or in some instances, where moisture has penetrated deep into the tissue, more intensive Fingerprints and human identifcation 95 techniques may be required. One such technique involves the use of isopropyl alcohol to dry water-soaked friction ridge skin. Isopropyl alcohol is applied to the hands, which are then blotted dry with paper or cloth towels. Another technique involves using a hair dryer to dry the skin by setting the hair dryer on low heat and blow drying the hands. Te fnal method, called the fame technique, involves the use of a butane grill lighter to dry the skin. Te fame is moved back and forth across the friction skin for a few seconds, taking care to dry but not to char the skin. Te same results can be accomplished by roll- ing a fnger over a hot light bulb instead of using an open fame. Since the early days of fngerprinting, the standard method for record- ing fngerprints has been the application of a thin layer of black printer’s ink to the fngers and then recording the friction ridge impressions onto a fngerprint card. Although this technique works well with the living, it is more difcult in its application for printing the dead. Te examination of a body usually takes place with the deceased positioned on his or her back for eventual autopsy. Tis position makes it difcult or nearly impossible for the examiner to apply ink to the fngers using an inking plate, and thus requires that ink be rolled onto a spatula and applied to the fngers. Te application of too much ink may result in distorting/smudging of the recorded prints. It is also not feasible to roll the fnger impressions onto a fngerprint card, espe- cially when rigor mortis has set in the body. Te recording of inked impres- sions is thus accomplished using a tool called a spoon that can be placed on the end of the fnger. Fingerprint blocks are held in the spoon and are used to capture friction ridge detail and create a complete fngerprint record. Te recommended recording strategy for recovering fngerprint impres- sions from deceased individuals involves the use of black powder and white adhesive lifers. Tis technique is quick and easy to use, resulting in clear prints compared with those obtained through inking. Te frst step in the procedure is to lightly coat the fngers with black powder, covering the entire pattern area, using a traditional squirrel hair fngerprint brush or sponge-type paintbrush. Te lifer is placed just below the frst joint and then wrapped around the fngertip to record the powder impression. If debris from the fnger is being lifed along with the powder and obscures ridge detail, a less adhesive lifer, such as a mail label, should be used. Te recorded impression is then afxed to the back of an acetate fngerprint card (Figure 6. Tis type of clear plastic card can be produced by photo- copying a standard fngerprint card onto transparency flm. Some alternative printing strategies that are useful in recording quality postmortem impressions from difcult remains involve the use of Mikrosil® (Kjell Carlsson Innovation, Sundbyberg, Sweden) and AccuTrans® (Ultronics, 96 Forensic dentistry A B Figure 6.
Through the application of this theory generic xenical 60mg on line, I have come to know new possibilities for nursing practice discount xenical 60mg line. I believe now more than ever that 120 mg xenical mastercard, with the advancing roles of nurses, we need to be clear on what it is that we do that is different from other practitioners. As nurse practitioners continue to be lumped into categories with other midlevel practitioners, we need to demonstrate to our patients that our profession was born of a need from society, a need that only nurses can ﬁll. If there is no call to nursing, our profession will dissolve into the sea of midlevel practitioners. To ensure that our prac- tice maintains its identity, the practice must be built upon research-based nursing theory. Nursing Administration Quarterly, 25(1), nursing practice, ontology, epistemology. Cleveland: William Collings & World pinnings of an emergent methodology for nursing as caring Publishing Co. Krieger Giving of oneself on another’s behalf: The phenomenology of Publishing Co. New of nursing in high-technology environments: Outcomes re- York: National League for Nursing Press. Rethinking primary care: Connec- College of Nursing, Florida Atlantic University, 777 Glades tions to nursing. So, hand in glove, the have situated myself as a nurse and as a woman so research has constantly gone back and forth be- that the context of my scholarship, particularly as it tween “what’s wrong and what can be done about pertains to caring, may be understood. I consider it,” “what’s right and how can it be strengthened,” myself to be a second-generation nursing scholar. I and “what’s real to women (and most recently their was taught by ﬁrst-generation nurse scientists (that mates) who miscarry and how might care be cus- is, nurses who received their doctoral education in tomized to that reality. My struggles for identity of this line of inquiry has resulted in insights about as a woman and as an academician were, like many the nature of miscarrying and caring that might women of my era (the baby boomers), a somewhat otherwise have remained elusive. Third- Predoctoral Experiences generation nursing scholars (those taught by nurses whose doctoral preparation is in nursing) may ﬁnd My preparation for studying caring-based thera- my “yearning” somewhat odd. To those who might peutics from a psychosocial perspective began, offer critique about the egocentricity of my pon- ironically, in a cardiac critical care unit. Have we a unique sue a job at the brand-new University of Massachu- body of knowledge? I was drawn to that institution be- preciate that questions of uniqueness and entitle- cause of the nursing administration’s clear articula- ment have not completely disappeared. It was so have faded as a backdrop to the weightier concerns exciting to be there from day one. We were all part of making a signiﬁcant contribution to the health of shaping the institutional vision for practice. It of all, working collaboratively with consumers and was phenomenal witnessing myself and my friends other scientists and practitioners, embracing plu- (nurses, physicians, respiratory therapists, and ralism, and acknowledging the socially constructed housekeepers) make a profound difference in the power differentials associated with gender, race, lives of those we served. I realized that there was a pow- Turning Point erful force that people could call upon to get them- selves through incredibly difﬁcult times. Watching In September 1982 I had no intention of studying patients move into a space of total dependency and caring; my goal was to study what it was like for come out the other side restored was like witness- women to miscarry. Jean Watson, who guided me toward the need waiting room while they entrusted the heart (and to examine caring in the context of miscarriage. I lives) of their partner to the surgical team was awe- am forever grateful for her foresight and wisdom. It was encouraging to observe the inner reserves family members could call upon in order I believe that the key to my program of to hand over that which they could not control. I research is that I have studied human felt so privileged, humbled, and grateful to be in- responses to a speciﬁc health problem vited into the spaces that patients and families cre- (miscarriage) in a framework (caring) ated in order to endure their transitions through that assumed from the start that a illness, recovery, and, in some instances, death. Swanson: A Program of Research on Caring 353 all of these emotional insights had to do with nurs- such concepts as loss, stress, coping, caring, trans- ing. Four weeks into the same semester in completing my baccalaureate degree, I enrolled in which I was required to complete that exercise, my the Adult Health and Illness Nursing program at ﬁrst son was born. It so happened that an obstetri- as such, was invited to attend a two-day retreat to cian had been invited to speak to the group about revise the master’s program. Jacqueline Fawcett and being found his lecture informative with regard to the amazed at hearing her talk about health, environ- incidence, diagnosis, prognosis, and medical man- ments, persons, and nursing and claiming that agement of spontaneous abortion. However, when these four concepts were the “stuff” that really the physician sat down and the women began comprised nursing. It was like hearing someone to talk about their personal experiences with mis- give voice to the inner stirrings I had kept to myself carriage and other forms of pregnancy loss, I was back in Massachusetts. It really impressed me that suddenly overwhelmed with the realization that there were actually nurses who studied in such are- there had been a one-in-six chance that I could nas. Up until that point, it had and was hired at Penn on a temporary basis to teach never occurred to me that anything could have undergraduate medical-surgical nursing. First, I was acutely aware of the American “Why doesn’t a smart girl like you enter medicine? It was so clear to me that was more suited to my beliefs about serving people whereas the physician had talked about the health who were moving through the transitions of illness problem of spontaneously aborting, the women and wellness. I suppose it is safe to say that I was were living the human response to miscarrying. The problem, of course, was that I was a critical care nurse and knew very little about anything hav- Doctoral Studies ing to do with childbearing. An additional concern was that during the early 1980s, although there Such insights made me want more; hence, I applied was a very strong emphasis on epistemology, ontol- for doctoral studies and was accepted into the grad- ogy, and the methodologies to support multiple uate program at the University of Colorado. Watson nor I have ever seen my research pro- to guide me through a predissertation pilot study of gram as an application of her work per se, but we ﬁve women’s experiences with miscarriage in order do agree that the compatibility of our scholarship that I might learn about interpretive methods. I have come to view her work as hav- pervise my trek up the psychology-of-pregnancy ing provided a research tradition that other learning curve. At that time, the deﬁnitions this event, I became aware that in my later child- were fairly awkward and deﬁnitely tied to the con- bearing loss (having a not-well child at birth), I, text of miscarriage. In addition to naming those too, wished to receive the kinds of caring responses ﬁve categories, I also learned some important that my miscarriage informants had described. Kathryn ﬁnd any substance; (2) if you ask people to list be- Barnard, at the University of Washington, agreed to haviors or words that indicate that others care, you sponsor this investigation and ended up opening end up with a laundry list of “niceties”; (3) if you doors for me that still continue to open. With her ask people for detailed descriptions of what it was guidance, I spent over a year “hanging out” in the like for them to go through an event (i. In later years, this in- sionals who were responsible for the care of ﬁve sight would actually become the grist for a series of infants. They had were retained, they were grammatically edited provided care to 68 socially at-risk expectant moth- and somewhat reﬁned so as to be more generic.
Micronutrients | 19 Vitamin K • Essential for blood clotting; required for bone formation and cell growth generic xenical 120mg with visa. The body cannot make minerals so they must be obtained through the diet and/or supplements order xenical us. Animals get minerals from the plants they eat buy cheap xenical 60mg on line, and then we get these minerals indirectly by eat- ing the animal products. There are also some minerals present in drinking water, but this varies with geographic location, as does the mineral content of plants. Calcium, magne- sium, and phosphorus are considered major minerals since we require a substantial amount of these for health and wellness. The trace minerals, which are required in smaller amounts, are chromium, copper, ﬂuoride, iodine, iron, manganese, mo- lybdenum, selenium, and zinc. The minerals potassium and sodium are known as electrolytes, substances that dissociate into ions (charged particles) in solution, mak- ing them capable of conducting electricity. Most multivitamin/mineral supplements provide a small amount of calcium because it is quite bulky. Therefore, a separate calcium supplement may be necessary, especially for those at risk of osteoporosis and those with high blood pressure. Cooking these foods releases calcium that is bound to oxalic acid, thus improving the amount you can absorb. Phytic acid, which is found in wheat bran or dried beans, also reduces calcium absorption. Micronutrients | 21 • Other interactions: Magnesium reduces absorption of digoxin, nitrofurantoin, anti- malarial drugs, quinolone antibiotics, tetracycline, chlorpromazine, alendronate, and etidronate, so separate intake of magnesium from these foods by two hours. Most studies involving chromium were done with the picolinate form, which is readily absorbed and utilized by the body. Certain individuals (diabetics and those at risk for diabetes) may require an additional supplement. Others at risk: Premature and low birth- weight infants with diarrhea; infants fed only cow’s milk formula, which is low in copper; those with malnutrition, malabsorption syndromes (celiac disease), cystic ﬁbrosis, and those receiving intravenous feeding. Iodine • Required to make thyroid hormones, which regulate metabolism, energy produc- tion, and body temperature, and are essential for growth and reproduction. Micronutrients | 23 • Other interactions: Amiodarone (heart drug) contains high levels of iodine and may affect thyroid function; potassium iodide may decrease the anticoagulant effect of warfarin. These foods are a concern only for those who are iodine deﬁcient and consume high amounts of them. Symptoms include fatigue, paleness, headache, hair loss, brittle nails, rapid heart rate, increased risk of infections, and rapid breathing on exertion. To avoid this, separate intake of iron supplements from these products by two hours. Manganese • Required for the production and activation of enzymes that are involved in energy me- tabolism; bone, cartilage, and collagen formation; and the production of antioxidants. Molybdenum • Required for the production of enzymes that are cofactors in amino acid metabo- lism, formation of uric acid, and the metabolism of drugs and toxins. Selenium • Component of enzymes that function as antioxidants; involved in detoxiﬁcation; converts thyroid hormone to its active form; supports immune function; enhances the antioxidant activity of vitamin E. Zinc • Involved in numerous enzyme reactions; required for growth and development, im- mune and neurological function, reproduction and regulation of gene expression; stabilizes the structure of proteins and cell membranes. Micronutrients | 25 • Marginal deﬁciencies are common in malnourished people, vegetarians, pregnant women, the elderly, and those with celiac disease, Crohn’s disease, colitis, and sickle cell anemia. Depending on dietary intake and personal risk factors, additional potassium supple- ments may be necessary for some people. The table below contains nutrient recommendation for individuals 19 years and old- er, and women 19 years and older who are pregnant or lactating. To access guidelines for infants, children, and teenagers, refer to the Institute of Medicine’s Web site at www. Lactation = 12 Lactation = 40 High dosages of supplements may reduce copper levels. Today we know that what we eat is a major determinant of health, and that food provides both nutritive and healing properties. Functional foods, as deﬁned by the International Food Information Council, are “foods or dietary components that may provide a health beneﬁt beyond basic nutri- tion. Apple skins are a major food source of a type of ﬂavonoid called quercetin, which is a potent antioxidant that helps protect against heart disease and cancer. Anthocyanidins have antioxidant properties, preventing free radical damage and reducing the risk of chronic disease. These compounds are found in other cruciferous vegetables, such as kale, cauliﬂower, and cabbage. Carotenoids help protect against cardiovascular disease, cancer, macular degeneration, and cataracts, and they also promote good night vision. New research is looking at the effects of another phytonutrient in carrots, called falcarinol, and its ability to reduce the risk of colon cancer. To get the maximum amount of nutrients from carrots, eat them raw or lightly steamed. Oranges, grapefruit, lemons, and limes offer a wide range of nutrients (vitamin C, folate, and ﬁbre). Supplements of lutein have been shown to improve vision in those with macular degeneration and prevent disease progression. One to two serv- ings of kale or collard greens per week provide the recommended amount of lutein and zeaxanthin. Other food sources include spinach, broccoli, and leeks, but they contain a lesser amount. Preliminary research also shows that these compounds may help lower cholesterol, improve gum health, prevent ulcers, and prevent brain damage after a stroke. Health authorities recommend consuming Functional Foods | 35 no more than six meals per year of farmed salmon. To obtain all the beneﬁts, eat the milled ﬂaxseed or get whole seeds and crush them in a food processor or coffee grinder. Store milled seeds in the refrigerator or freezer in an opaque, airtight container; they will be stable for 90 days. Studies have found beneﬁts with as little as 900 mg of garlic per day, which is approximately equivalent to one clove. Clinical studies have validated its beneﬁts for preventing the symptoms of motion sickness (especially seasickness) and in the treatment of nausea and vomiting associated with pregnan- cy. The active compounds in ginger, called gingerols, have potent anti-inﬂammatory effects, making it helpful in the treatment of arthritis and other inﬂammatory condi- tions. Choose fresh ginger over the dry (powder) form to maximize intake of the active compounds. This compound has been found to reduce the risk of certain cancers, reduce the size of existing tumours, and inhibit tumour growth. It also sup- ports heart function by lowering blood pressure and reducing the risk of fatal heart attacks.