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By R. Jaffar. University of Puerto Rico, Mayaguez. 2019.

With their var- used to alter not only overt behavior but also the thought ied experiences generic urispas 200mg line, clinicians are qualified to participate in re- patterns that drive it cheap 200 mg urispas with amex. Clinical psychologists overlap in what these professionals do discount 200 mg urispas with visa, there are also routinely contribute to the training of mental health profes- specific distinctions between them. As of 1996, clinical sionals and those in other areas of health care, serving on psychologists cannot prescribe drugs to treat psychologi- the faculties of universities and independent institutes of cal disorders, and must work in conjunction with a psy- psychology, where they teach courses, supervise chiatrist or other M. They also carry out administrative appointments way for prescription privileges for psychologists. The which call for them to assist in the planning and implemen- clinical psychologist has extensive training in research tation of health care services and are represented in inter- methods and in techniques for diagnosing, treating, and national groups such as the World Health Organization. Seeing Both Sides: Classic Controversies Most cliques are fairly complex and have a mixture in Abnormal Psychology. Even if a group exerts posi- tive peer pressure, it may also be exerting negative peer pressure by being exclusive on the basis of race, class, religion, sexual orientation, or ethnicity. Cliques A group of people who identify with each other Further Reading and interact frequently. Lockers, Lunch Lines, Chemistry, and people who interact with each other more intensively Cliques. It is used to describe an adolescent social group that excludes others on the basis of superficial differences, exercising greater than average amount of peer pressure upon its mem- Cocaine bers. The numerous terms teenagers use to describe themselves and others—such as jocks, druggies, popu- See Drugs/Drug abuse lars, brains, nerds, normals, rappers, preps, stoners, rock- ers, punks (punx), freaks (phreaks), and skaters—exem- plify both levels of meaning in the word “clique. A term used to describe a person who is intimately A clique consists of a particular group of people involved with a person who is abusing or addicted within a particular location. Joining cliques, having the desire to person involved with the dependent person in any inti- join a particular clique, and being excluded from cliques mate way (spouse, lover, child, sibling, etc. The definition of the term has been expand- Joining cliques helps children to develop, identify, and ed to include anyone showing an extreme degree of cer- regulate social interaction. Generally children begin to tain personality traits: denial, silent or even cheerful tol- be more aware of differences and form cliques in late el- erance of unreasonable behavior from others, rigid loyal- ementary school, between the ages of 8 and 10 years old. Some consider it a pro- greatly exaggerated between ages 10 and 12 years old, gressive disease, one which gets worse without treatment when a child’s clique may change on a daily basis. Progressive codependence can ing middle school and high school, and membership in lead to depression, isolation, self-destructive behavior cliques can have a strong effect on the adolescent’s sense (such as bulimia, anorexia, self-mutilation) or even sui- of self-worth. There is a large self-help movement to help code- consistent, though their composition may change. The therapeutic beling and a weak, dependent, victim mentality that ob- process begins with identification of distorted percep- scures more important underlying truths of oppression. These critics believe that all families fit the of thinking identified by Aaron Beck include all-or-noth- “dysfunctional” label; by diagnosing a person as “code- ing thinking; magnifying or minimizing the importance pendent,” all responsibility for the individual’s dissatisfac- of an event; overgeneralization (drawing extensive con- tion, shortcomings, and failures comes to rest on the indi- clusions from a single event); personalization (taking vidual and his or her family. Larger issues of cultural, so- things too personally); selective abstraction (giving dis- cietal, or institutional responsibility are ignored. However, proportionate weight to negative events); arbitrary infer- some proponents of the codependence definition are ence (drawing illogical conclusions from an event); and widening their perspective to look at how society as a automatic thoughts (habitual negative, scolding thoughts whole, as well as separate institutions within society, func- such as “You can’t do anything right”). Once negative ways of thinking have been identified, the therapist helps the client work on replacing them with Further Reading more adaptive ones. Codependent No More: How to Stop Control- ling Others and Start Caring for Yourself. San Francisco: techniques, including self-evaluation, positive self-talk, Hazelden/HarperCollins, 1987. The Codependency Con- alone, with the therapist, and also, wherever possible, in spiracy: How to Break the Recovery Habit and Take the actual settings in which stressful situations occur (in Charge of Your Life. Today cognitive behavior therapy is widely used Cognitive behavior therapy with children and adolescents, especially for disorders involving anxiety, depression, or problems with social A therapeutic approach based on the principle that maladaptive moods and behavior can be changed skills. Like adult clients, children undergoing cognitive by replacing distorted or inappropriate ways of behavior therapy are made aware of distorted percep- thinking with thought patterns that are healthier tions and errors in logic that are responsible for inaccu- and more realistic. The therapist then works to change erroneous beliefs and per- Cognitive therapy is an approach to psychothera- ceptions by instruction, modeling, and giving the child a py that uses thought patterns to change moods and be- chance to rehearse new attitudes and responses and prac- haviors. Pioneers in the development of cognitive behav- tice them in real-life situations. It is used either alone havior therapy has become increasingly popular since or together with other therapies and/or medication as the 1970s. Currently, almost 70% of the members of the As- and adolescents suffering from depression. It can help sociation for the Advancement of Behavior Therapy free depressed children from the pervasive feelings of identify themselves as cognitive behaviorists. Children in treatment are assigned to tends to be short-term (often between 10 and 20 ses- monitor their thoughts, and the therapist points out ways sions), and it focuses on the client’s present situation in that these thoughts (such as “nothing is any fun” or “I contrast to the emphasis on past history that is a promi- never do anything right”) misrepresent or distort reality. Cognitive behavioral therapy is also used for chil- American Society for Adolescent Psychiatry. Through instruction, modeling, role playing, and other techniques, they learn to react to events in socially ap- propriate, nonviolent ways. Other childhood conditions Cognitive development for which cognitive behavior therapy has been effective include generalized anxiety disorder and attention The development of thought processes, including remembering, problem solving, and decision-mak- deficit/hyperactivity disorder. States, but they have come under increasing criticism for defining intelligence too narrowly and for being biased Cognitive therapy is generally not used for disor- with regard to race and gender. In contrast to the empha- ders, such as schizophrenia or autism, in which think- sis placed on a child’s native abilities by intelligence ing or communication are severely disturbed. The Essential Albert Ellis: Seminal Writ- ronmental factors in shaping the intelligence of children, ings on Psychotherapy. Adolescent Anger Control: Cognitive-Behav- behaviors rewarded and others discouraged. Behind the One-Way Mirror: Psy- nitive development is that of French psychologist Jean chotherapy and Children. Although Thinking: Breaking the Cycle of Depressing and Anxious Piaget was interested in how children reacted to their en- Thoughts.

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If the operator cannot stand at this desired distance buy 200 mg urispas with amex, a protective barrier or apron must then be provided buy urispas 200 mg without a prescription. Tis is most likely due to the dramatic reduction in exposure times brought about by high-speed flm and even more so by direct digital receptors generic 200 mg urispas fast delivery. Past studies of occupational exposure to a large sample of dental personnel have shown that the typical exposure is less than the minimum detectable dose, or less than 1 mSv/year. Also, special considerations may be necessary in a disaster morgue setting where numerous individuals are nearby the x-ray source in the dental section. During that operation it was assumed that operators using the device were “safe” based on dose studies conducted by the manufacturer and the device’s approval by the U. Tese studies demonstrated extremely small tube head leakage and backscatter to the oper- ator. Subsequent research simulating morgue usage in a mass fatality setting has confrmed the safety of those working within the dental station. A study simulating doses to those comprising the dental team over a two-week deployment (5,760 exposures) showed that the team member receiving the highest dose at that position (60° to the side of the emanating beam) received an exposure of 0. Tis dose corresponds to 1/200th of the annual occupational limit of 50 mSv and approximately 3. A tomograph is a radiographic presentation Forensic dental radiography 197 of a thin slice of tissue selected from within the object being imaged. Te three planes are also linked to each other so that any entity within the object may be observed from three diferent views in an interactive manner. Te beam is instead three- dimensional and produces three hundred or more full-size images of the selected tissue feld from 360° of rotation about the patient. Where a pixel is a lateral and vertical image unit, the voxel is in the shape of a cube (e. At least two machines currently available scan the subject in the supine position, which makes them suitable as morgue and mass disaster equipment. Any intraoral or extraoral flm image view can be reconstructed from one scan, with the operator having the ability to select any desired slice location and orientation. Tus, it is possible to plot a plane within the confnes of the dental arches and produce a panoramic image without the overlying ghost images and artifacts of conventional panoramic radiography. Te thickness of the panoramic image layer may also be deter- mined in an unlimited manner. Also, computer algorithms correct for the geometric distortions that are present within all plane flm images. Also, a single scan of the victim can later be compared to any possible variety of submitted ante- mortem plane flm images (i. Tis establishes the orientation of the flm series as if the viewer is facing the patient. However, a very common concern in forensic dentistry is the orien- tation of duplicate antemortem radiographs where the dimple of the original flm can be seen but not felt. Te most reliable method of determining if the dimple was up at the time of duplication is to consider the location of the bump relative to the corners of the individual flms themselves. Whenever the dimple is placed upward or out on a flm, its location will always be in the lower right or upper lef corner of the flm when it is oriented horizontally (Figure 10. Te letters stamped on the flm read correctly when the dimple is up or out when viewed on the view box. Tat is, the beam should enter from the buccal or facial with the flm placed to the lingual. Should this not be taken into account, the flm-orienting dimple will be positioned incorrectly and the teeth will appear to be from the opposite side of the arch and will be misidentifed. Tat is, the beam is always directed upward and from lingual toward buccal or facial. Consequently, when attempting to emulate ante- mortem panoramic views with postmortem intraoral radiography, it may be helpful to reverse the beam direction by placing the flm or sensor on the buccal or facial and directing the beam from the lingual upward. As the panoramic beam is directed upward, lingual objects will be projected higher than buccal objects that are at equal heights. Using computers to diagnose and plan treatment of approximal caries detected in radiographs. Occupational exposure to ionizing radiation in the United States: A comprehensive review for the year 1980 and a summary of trends for the years 1960–1985. Radiation safety for the Nomad™ portable x-ray system in a temporary morgue setting. Historically, photography has been the most signifcant method of preserv- ing the physical evidence of patterned injuries in skin. Te need to accu- rately photograph injury patterns as they appear on skin is paramount to the odontologist, pathologist, law enforcement, and the legal system. Since vast amounts of time ofen elapse between the commission of crimes and the trial 203 204 Forensic dentistry of the perpetrator, photographs frequently are the only permanent record of the injuries to the victims. Terefore, it is imperative that the forensic investi- gator be able to properly photograph injury patterns as a means of preserving such evidence. Tis chapter is better understood if the reader has a good grasp of photo- graphic terminology and the skills for operating basic camera equipment. Tere are many publications that can provide the necessary background to improve one’s understanding of the photographic principles described in this chapter. Two readily available and easy reading books are Basic Photography by Michael Langford1 and Te Basic Book of Photography, Fifh Edition, by Tom Grimm. It will also present the historical photographic tech- niques utilizing traditional flm and the exploding era of digital imaging. Tese wavelengths are measured in millionths of millimeters, referred to as nanometers (nm). Photographic images can be recorded on flm emulsions that are sensitive to light wavelengths anywhere between 250 and 900 nm. Visible light, which we see with our unaided human eye, comprises only from 400 to 760 nm. Most modern digital cameras and traditional photographic flms are specifcally designed to record images seen in the visible range of light as we see them However, it is also possible to record images we cannot see when specifcally illuminated in the shorter ultraviolet range (210 to 400 nm) and longer infrared range (750 to 900 nm). Since ultraviolet and infrared radiations are outside the visible range of the spectrum, they are commonly referred to as nonvisible light. Recent genera- tions of digital cameras have been designed to allow the recording of pat- terned injuries in skin using both visible light and nonvisible light. While the electronic transfer of light to magnetic recording media is very diferent than exposing photographic flm, for the most part, the techniques utilized for image capture are basically the same.

A weeklong evi- dentiary hearing was held in Tallahassee buy 200mg urispas visa, at which time a circuit court judge heard evidence as to bitemark evidence and ruled as to its admissibility in the courts of the State of Florida buy urispas 200mg mastercard, that is purchase 200mg urispas free shipping, a Frye hearing. Souviron, Levine, and Sperber all testifed at the evidentiary hearing in Tallahassee. His testimony was that Bundy’s teeth were “not that unique” 314 Forensic dentistry and produced preorthodontic treatment dental models of fve individuals that had similar lower anterior teeth arrangement. It was a valid idea but a tactical disaster for the defense, as these individuals were eleven to thirteen years old, none of whom were in Tallahassee in January 1978, and none of whom could have bitten the victim. Bundy was convicted of the aggravated battery of three of the victims and the murder of the other two Chi Omega sorority sisters, Lisa Levy and Margaret Bowman. He was sentenced to death on both counts of murder and life without parole on the aggravated batteries. Bundy was again on trial for the murder of twelve-year-old Kimberly Leach of Lake City and was again sentenced to death. Te appeals on the Leach murder were exhausted before those of the Florida State University students. Bundy was a suspect in approximately forty homicides of young females from the states of Washington, Oregon, Colorado, Utah, and Florida. Bundy were very distinctive and the bitemark recorded the pattern clearly and with little distortion. Bundy acted as his own attorney, taking the deposition of the state’s odontologist, Dr. As a result, a food of additional cases in which bitemark evidence was used followed. From 1950 through 1978, the number of “reported” bitemark cases in the United States was fewer than twenty. From 1979 through 2000 the number of cases challenged on appeal was in the hundreds. Stewart, 1979 Concurrent with the Bundy trial and at the same courthouse, there was another murder trial involving bitemark evidence. Margaret Hazlip, a sev- enty-seven-year-old woman, had been sexually assaulted and murdered in February 1979. Souviron, the prosecution expert, was asked whether the pieces of bologna had been bitten by Ms. If she were lying on her partial it certainly could have made “tooth marks” in the skin of her thigh. Te odontologist compared the partial denture to the bologna and in his opinion the bitemarks in the bologna were not made by Ms. Te bitemark on her hip was analyzed, and it was determined that the biter profle would indicate that there was a Bitemarks 315 large diastema (space or gap) between the upper two central incisors. Roy Allen Stewart was subsequently arrested and charged with the murder of Margaret Hazlip. As mentioned previously, the trial took place in the same courthouse and at the same time that jury selec- tion was being conducted in the Bundy trial. Bundy’s defense team (fve attorneys) all attended the prosecution’s forensic dentist’s testimony and made notes to challenge his later testimony at the Bundy trial. Levine, did not take the stand but provided useful information for the defense to cross-examine Dr. Stewart was subsequently convicted, sentenced to death, and afer numerous appeals, executed in the electric chair at Florida state prison in 1994. Souviron was referred to as an expert in bologna, implying that the same adjective could be applied to bitemark analysis. Bitemark evidence consists of patterned and other features that contain variables, not only in the teeth of suspected biters but in the material bitten, especially if that material is human skin. Tree-dimensional informa- tion can be critical, not only in making a correlation between the biter and the injury, but also in determining if the injury occurred around the time of death. Tese cases point out the importance of cooperation and consultation among forensic dentists, the value of applying science to the analysis of bite- mark evidence, and underscore the need for caution and the recognition that bitemark evidence can become controversial. Te valid question “How can highly qualifed experts have diferent opinions when analyzing the same material? Te quality of the evidence, the distinctive patterns of a biter’s teeth, the abundance or paucity of individual charac- teristics that are recorded in the bitemark—all go to the value and weight of the evidence. In the 1979 Hazlip case, although the defense expert could not exclude the defendant as being the biter, he was able to provide valuable information to the defense attorney in challenging not only the validity of bitemark evidence, but the credentials and testimony of the expert witness for the state. Each and every bitemark case that has proceeded to trial, and especially those that have been reported, contain valuable information that can help odontologists in obtaining, analyzing, and presenting bitemark evidence in a court of law. Had these cases been reviewed and analyzed by attorneys and odontologists in some of the bitemark cases that followed, 316 Forensic dentistry many of the issues that made them problem cases may have been and should have been avoided. Milone, already noted, the following signifcant and problematic cases will be discussed in the next section, on problem cases: Oklahoma v. It can be argued that, if bitemark analysis is prop- erly conducted, there should be no problem cases. Is there a common theme in these cases even though the individuals and circumstances are diferent? Te details of the following few cases will hopefully shed light on the problems and pitfalls of bitemark analysis and help prevent errors in the future. She had been sexually assaulted and the cause of death was listed as manual strangulation. A forensic dentist from the University of Oslo, Professor Ferdinand Strom, collected the bitemark evidence and he and another dentist testifed in the original trial in 1958 linking the teeth of Torgersen with the bitemark (Figures 14. Te only other physical evidence was the presence of nonspecifc feces on Torgersen’s shoes and some common tree needles in his jacket pockets and the cufs of his trousers. Te court engaged Professor Gisele Bang of Sweden to review the original materials in 1975. A team of persons believing in Torgersen’s innocence succeeded in convincing the Norwegian court to look into the matter again. In 1999 and 2000 Professors Gordon MacDonald and David Whittaker of Scotland and Wales reviewed the material and wrote reports generally supporting the earlier conclusions. David Senn from Texas to Oslo to review the remaining materials in the University of Oslo laboratory of Professor Tore Solheim.

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Children at this age will likely sense changes in the atmosphere of the home where a death has occurred cheap 200mg urispas otc. They often react to the emotions of adults by becoming more irritable and crying more urispas 200 mg low cost. Preschoolers and kindergartners have some understanding about death but often have difficulty distin- guishing between fantasy and reality purchase 200 mg urispas with mastercard. They believe death is reversible, and their thoughts about death may include magical thinking. For example, they may believe that their thoughts or behaviors caused a person to become sick or to die. They become frightened if they feel a threat to themselves or to their loved ones. They are concerned with safety issues and require a great deal of personal reas- surance that they will be protected. Regressive behaviors, such as loss of bladder or bowel control, thumb sucking, and temper tantrums, are not uncommon. They are able to understand a more de- tailed explanation of why or how the person died, although the concept of death is often associated with old age or with accidents. They may believe that death is contagious and avoid association with individuals who have experienced a loss by death. Death is often personified in the form of a “bogey man” or a monster—someone who takes people away or someone whom they can avoid if they try hard enough. Normal grief reactions at this age include regressive and aggressive behaviors, withdrawal, school phobias, somatic symptoms, and clinging behaviors. Preadolescent children are able to understand that death is final and eventually affects everyone, includ- ing themselves. They are interested in the physical aspects of dying and the final disposition of the body. They understand death to be universal and inevitable; however, they have difficulty tolerating the intense feelings associated with the death of a loved one. They may withdraw into themselves or attempt to go about usual activities in an effort to avoid dealing with the pain of the loss. It is often easier for adolescents to discuss their feelings with peers than with their parents or other adults. Some adolescents may show regressive behaviors whereas oth- ers react by trying to take care of their loved ones who are also grieving. Although they understand that their own death is inevitable, the concept is so far-reaching as to be imperceptible. Loss and Bereavement ● 401 Adults The adult’s concept of death is influenced by cultural and reli- gious backgrounds (Murray, Zentner, & Yakimo, 2009). Behaviors associated with grieving in the adult were discussed in the section on “Theoretical Perspectives on Loss and Bereavement. By the time individuals reach their 60s and 70s, they have experienced numerous losses, and mourning has become a life- long process. Those who are most successful at adapting to losses earlier in life will similarly cope better with the losses and grief inherent in aging. Unfortunately, with the aging proc- ess comes a convergence of losses, the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs. Because grief is cumulative, this can result in bereavement overload; the person is less able to adapt and reintegrate, and mental and physical health is jeopardized (Halstead, 2005). Bereavement overload has been implicated as a predisposing factor in the development of depressive disorder in the elderly person. It is important to understand the difference between the depression of normal grieving and the disorder of clinical depression. Long-term Goal Client will progress through the grief process in a healthful manner toward resolution. Reviewing the events of the loss can help the client come to full aware- ness of the loss. Until client can recognize and accept personal feelings regarding the loss, grief work cannot progress. The anger may be directed at the deceased, at God, displaced on others, or retroflected inward on the self. Encourage the client to examine this anger and validate the appropriateness of this feeling. Many people will not admit to angry feelings, believing it is inappropriate and unjustified. Expression of this emotion is necessary to prevent fixation in this stage of grief. Help the client by reviewing the cir- cumstances of the loss and the reality that it could not be prevented. Help the client to put the feelings of helplessness into perspective by pointing out ways that he or she managed situations effectively without help from others. Interpret normal behaviors associated with grieving and provide client with adequate time to grieve. Understanding of the grief process will help prevent feelings of guilt gen- erated by these responses. Individuals need adequate time to accommodate to the loss and all its ramifications. This involves getting past birthdays and anniversaries of which the deceased was a part. Support groups of individuals going through the same experiences can be very helpful for the grieving individual. Assist the client in understanding why these are not healthy defenses and how they delay the process of grieving. Encourage the client to make an honest review of the rela- tionship with what has been lost. Only when the client is able to see both positive and negative aspects related to the loss will the grieving process be complete. Client verbalizes stages of the grief process and behaviors associated with each stage. Client acknowledges own position in the grief process and recognizes the appropriateness of the associated feelings and behaviors. Risk Factors (“related to”) Loss [of any concept of value to the individual] Low self-esteem Natural disasters Physical illness Depression; anxiety; stress Separated from support systems Life change Goals/Objectives Short-term Goal Client will identify meaning and purpose in life, moving forward with hope for the future.

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