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I. Stan. Baylor College of Medicine.

Tomas Johnson and a Marquette University team reported development of a computerized method of collect- ing data on dental characteristics (oral presentations in Johnson et al buy zoloft 50 mg mastercard. Te method may be the frst step toward the creation of a database of the frequency at which dental characteristics and combinations of characteristics occur in a population purchase zoloft 50mg without a prescription. Roger Metcalf reported on an alternate method at the same 2008 meeting (oral presentation in Metcalf et al. Tat method is currently being investigated at the University of Texas Health Science Center in San Antonio. Tere is almost universal agreement among forensic dentists that human skin is a very poor material for faithfully and accurately recording those features. Most early bitemark-related papers that discuss skin con- centrate on the distribution of bitemarks, the classifcation of bitemarks, and the analysis of distortion in bitemarks or in preserved skin with bite- marks. Tose features must then be scientifcally analyzable, the distortion accounted for, and a statistical or mathematical basis for comparisons established. Also known as Leibniz’s law and the probability rule for indepen- dent variables, the rule is most commonly applied to problems in diferential calculus. For forensic research applications the following defnition may be most useful: “Te probability rule for independent variables, or product rule, states that the probability of the simultaneous occurrences of two indepen- dent events equals the product of the probabilities of each event. In the most ofen cited work on the subject of the uniqueness of teeth, the use of the product rule is essen- tial to the conclusion. Until signifcant research shows that the dental features are indeed independent, mathematical or statistical certainty cannot be assigned to either the features of the biting surfaces of the anterior dentition or to the marks that those teeth make in skin. As an alternative to those mathematical or statistical methods, research currently under way on collecting and recording data on the frequency of dental variation features is encouraging. To date there is insufcient scientifcally con- frmed information to support the association of bitemark patterns on human skin and sets of teeth with statistical or mathematical degrees of certainty. Te same seven sets of dental models served as the potential biters in all four cases. In only one of the cases, a bitemark in cheese, was the identity of the true biter known. Tis knowledge was based, at least in part, on the victim’s identifcation of the biter and the biter’s subsequent confession. Results were tabulated and two nondiplomates were authorized to perform a statistical analysis of the results and produce a paper for submission to a refereed journal. Te frst journal to which the paper was submitted, the Journal of Forensic Sciences, rejected the paper, citing the inappropriate design of the workshop for statistical analysis. Perhaps unfortunately, considering the later misinterpretations, the article was submitted to other journals and was ultimately published in 2001 in the journal Forensic Science International. In the paper the authors stated that the primary objective of the study was “to determine the accuracy of examiners in distinguishing the correct dentition that make a bitemark,” and the secondary 356 Forensic dentistry objective was “to determine whether examiner experience, bitemark certainty, or forensic value had an efect on accuracy. Consequently, mathematical or statistical analysis of the opinions of workshop participants was not possible without assuming that a true cause-efect relationship existed in each of the cases. Bitemark Workshop #4 was neither designed as, nor can it be used as, a profciency test for forensic odontology. Tests of consistency and validity (necessary in a profciency examination) were neither accomplished nor attempted; and, as subsequent reviewers of the data correctly pointed out, the construction of the examination and the workshop was not designed to produce an examination that had statistical validity and statistical con- sistency. In 2002 the Supreme Court of Mississippi was consider- ing a petition for postconviction relief in a death penalty case involving alleged bitemarks. Included in the petition was this material described by the court: In support of this claim, Brewer presents the afdavit of Charles Michael Bowers, D. He urges that this Court should not tolerate a science that, as Brewer claims, is more likely than not to identify the wrong suspect. Tese results counter balance the years of assured self-confdence shown by the dentists testifying on bite mark Bitemarks 357 evidence. Tus, they were wrong nearly half the time they tried to identify the source of a bitemark.

Other Injuries The other anal injuries that have been described in complainants of anal penetration are bruises (2–4%) 50mg zoloft, abrasions (4–5%) order zoloft 50mg mastercard, erythema (2–8%), and swell- ing/edema (2–6%) (90,134). Although bruises are indicative of blunt trauma, the other findings may have innocent explanations, for example, a superficial abrasion of the anal verge has been identified on a child who interrupted the medical to pass a motion (observation of D. Although erythema and swelling/edema are also nonspecific findings, if they have completely resolved at a follow-up exami- nation, it may be possible to relate them to the allegation. All these minor injuries would be expected to heal within 2 weeks of the incident without any residual scarring. Conse- quently, if the forensic practitioner has used lubricant (other than sterile water) on specula, proctoscopes, or gloved digits, it must be communicated to the 110 Rogers and Newton forensic scientist. In terms of lubricant analysis, the most frequent request received by the forensic science service is to check vaginal swabs for the presence of condom lubricant. A review of cases at the Las Vegas Metro- politan Police Department found that 19 of 80 complainants reported that either the assailant had worn a condom during the incident or they had expe- rienced consensual intercourse with a partner wearing a condom within the 72 hours preceding the assault (Cook, Y. However, various other substances have been used to facilitate penetration during a sexual assault, including hand cream, cooking oil, and margarine, the diversity of the products appar- ently reflecting what is immediately at hand. Therefore, when relevant, the forensic practitioner should ask if the complainant has applied anything to the genital/anal area in the preceding 2 days. This information should be noted on the paperwork that is made available to the forensic scientist so that scientist can source the relevant product to check what it contains. Dusting agents used on condoms may also be detected in the form of starch grains and lycopodium spores and can be used to correlate the finding of condom lubricant (Black, R. Therefore, the forensic practitioner should wear nonpowdered gloves when sampling the genital and anal area (194). To maximize the possibility of lubricant detection, the necessary swabs should be obtained as soon as possible after the incident. The forensic sci- ence laboratory must then be told that lubricant analysis may be relevant, because this potentially requires scientists from more than one discipline to examine the same sample, e. If the forensic science laboratory is not made aware of this requirement, potential evidence could be inadvertently destroyed during labo- ratory processes. Many factors may affect the length of time that a lubricant will persist on skin or in a body orifice. Condom lubricant has been detected on a swab taken from an unwashed penis 50 hours after intercourse and, in a different case, on a vaginal swab (also when the complainant had not washed or douched) taken 24 hours after intercourse, but detection after such prolonged periods would appear to be exceptional (Black, R. Reason for Analysis When drugs or alcohol have been consumed or possibly administered before or during a sexual assault, consideration should be given to the need to obtain samples of blood and urine for toxicological analysis. The length of time that a drug or its metabolites remain detectable in blood or urine depends on several factors, including the quantity taken, the individual’s metabolism, and the sensitivity and specificity of the analytical methods employed by the laboratory (196). Although the metabolites of some sub- stances may be excreted for up to 168 hours in the urine (196), many are detectable for only a few hours (see Subheading 12. In general, drugs and their metabolites will be identifiable for longer in urine than in blood. Blood It is good practice to request a sample of blood for drug/alcohol analysis when the incident has occurred in the preceding 4 days. A single sample of 10 mL of venous blood should be placed in a container with an anticoagulant (e. If volatiles are suspected, a portion of blood must be collected into a container with an intrinsic rubber bung to enable the dead space above the blood to be analyzed. Urine It is good practice to request a sample of urine for drug/alcohol analy- sis when the incident has occurred in the preceding 4 days. If the allegation exceeds this time limit, contact the forensic science laboratory for advice on whether a sample is required. Ideally, 20 mL of urine should be placed in a container with a preservative that prevents decomposition and fermentation (e. Complainants should be advised not to dispose of any towels, panty liners, or tampons at this stage. Taylor, members of the toxicology section of the Metropolitan Laboratory of Forensic Science, 2003. Forensic Analysis Forensic science laboratories have the capability of detecting a range of prescribed and illicit substances, but the persistence of different substances or their metabolites in the blood and urine of an individual depends on numerous factors.

When transposons transfer to a new site 25mg zoloft free shipping, it is usually a copy of the transposon that moves cheap 50mg zoloft amex, the original transposon remaining in situ. Transposons code for toxin production, resistance to antibiotics as wellas other fuctions. Disinfection: Destruction of microbes that cause disease; may not be effective in killing spores. Antisepsis: destruction or inhibition of microorganisms in living tissue there by limiting or preventing the harmful effect of infection. Chemical methods of sterilization and disinfection These chemical agents destroy any type of microbes with out showing any form of selectivity unlike antibiotics. Concentration of the agent There is a relationship between the concentration of the agent and the time required to kill a given fraction of the microbial population. Time of exposure Microbes are killed with a reasonable length of time with chemical agents. The non-ionized form passes through the bacterial cell membrane more readily than the ionized form. Temperature Bactericidal potency of the chemical agent increases with an increase in temperature. Presence of extraneous materials Organic materials like serum, blood or pus makes chemicals inert that are highly active in their absence. Quaternary ammonium compounds (Quates) It causes loss of cell membrane semi permeability leading to loss of nutrients and essential metabolites. Soaps and fatty acids It causes gross disruption of cell membrane lipoprotein frame work. Active at acidic P Phenolic compounds Phenol is highly effective in Gram positive bacteria. Currently used as a standard for measuring bactericidal potency of new chemicals i. Phenol coefficient is the ratio of the concentration of the new chemical agent being tested to the concentration of the reference standard (phenol) required to kill in a specific time. If phenol coefficient is less than one, the new chemical agent is less effective than phenol. If phenol coefficient is equal to one, the new chemical agent is equal to phenol in efficacy. If phenol coefficient is more than one, the new chemical agent is more effective than phenol. Active against Gram-positive bacteria, Gram-negative bacteria and acid-fast bacilli. Causes conformational alteration of proteins (unfolding of polypeptide chain) resulting in irregular looping and coiling of polypeptide chain. Acids like benzoic acid, citric acid and acetic acid are helpful as food preservatives: extending storage life of food products. Chemical agents that modify functional groups of proteins and nucleic acids Heavy metals 1. Hydrogen peroxide (3%) Used for cleansing of wound, disinfecting medical-surgical devices and plastic contact lenses. Formaldehydde Glutaraldehyde Ethylene oxide Formaldehyde 37% aqueous solution form is named as formalin. Dry heat : It is less efficient and requires high temperature and long period heating than moist heat. Incineration : It is an efficient method of sterilization and disposal of contaminated needles, syringes and cover slips at high temperature b. Red heat : Inoculating wires, loops and points of forceps are sterilized by holding them in the flame of a Bunsen burner until they are red hot. Flaming: Scalpels and neck of flasks, bottles and tubes are exposed for a few seconds, but it is of uncertain efficacy. Hot Air Sterilizer (Oven): it is essential that hot air should circulate between the objects being sterilized and these must be loosely packed and adequate air space to ensure optimum heat transfer. Tyndallization : Intermittent steaming (Fractional sterilization) 0 Steaming of the material is done at 100 c for 30 minutes on three consecutive days. The principle is that spores which survived the heating process would germinate before the next thermal exposure and then would be killed. It is used for sterilizing heat sensitive culture media containing materials such as carbohydrates, egg or serum.

However purchase zoloft 100 mg visa, several drugs may influence the rate of alcohol absorption by virtue of their affect on the rate of gastric emptying (Table 14) discount zoloft 25mg amex. Rate of Elimination The rate of elimination of alcohol has been determined experimentally. Reported values range from approx 10 mg/100 mL of blood per hour (mg/dL/h) to 25 mg/dL/h, with an average of 15–18. Ha- bituation to alcohol is the single most important factor affecting the rate of elimi- nation. One recent study reported the rate of ethanol disappearance in 22 alcoholics as ranging from 13 to 36 mg/dL/h, with an average of 22 mg/dL/h (140). The increased rate of elimination is believed to be because chronic alco- holics have facilitated liver enzyme systems. The apparent stimulatory effects of alcohol occur because it acts first on the so-called higher centers of the brain that govern inhibition (141). Although there is general agreement on the sequence of clinical effects caused by drinking alcohol, the blood alcohol concentrations at which these effects occur vary in different subjects. The difference in susceptibility is most marked between habituated and nonhabituated drinkers, but tolerance to the effects remains variable even within these broad categories (142,143). It should be noted that the effects are more pronounced when blood alcohol levels are rising than when falling. This is known as the Mellanby effect and is believed to result from an acute tolerance to alcohol that develops during intoxication (144). An angle of onset of 40° or less from the midline is a sensitive indicator of a blood alcohol level in excess of 100 mg/100 mL (143). Pupillary Changes In the early stages of alcoholic intoxication the pupils are said to dilate, often becoming pinpoint as the level of intoxication advances, particularly when the state of coma is reached (154). However, some commentators report the pupils as being normal-sized in alcohol intoxication (155), with current advice favoring the view that pupil size may be normal or dilated (156). Alcohol may slow the pupillary response to light, such an effect being one of the more reliable eye signs of intoxication, albeit a difficult one to detect clinically (151,157). Because it requires a high degree of coordination, it can be a sensitive index of alcohol intoxication 312 Stark and Norfolk (158). Reliable changes in speech are produced at blood alcohol levels above 100 mg/100 mL, although the effects of lower blood alcohol levels have been variable (159). Cardiovascular Effects Moderate doses of alcohol cause a slight increase in blood pressure and pulse rate (160,161). However, the most prominent effect with higher doses is a depression of cardiovascular functions. This depression is probably a com- bination of central effects and direct depression of the myocardium (144). Metabolic Effects Forensic physicians must be aware that severe hypoglycemia may accom- pany alcohol intoxication because of inhibition of gluconeogenesis. Alcohol- induced hypoglycemia, which develops within 6–36 hours of heavy drinking, typically occurs in an undernourished individual or one who has not eaten for the previous 24 hours. The usual features of hypoglycemia, such as flushing, sweating, and tachycardia, are often absent, and the person may present in coma. Death From Alcohol Poisoning Alcohol intoxication may result in death owing to respiratory or circula- tory failure or as a result of aspiration of stomach contents in the absence of a gag reflex. Levels of blood alcohol above 500 mg/100 mL are considered to be “probably fatal” (162), although survival at much higher concentrations is now well documented. In 1982, for example, the case of a 24-year-old woman with a blood alcohol level of 1510 mg/100 mL was reported. She had gone to the hospital complaining of abdominal pain and was noted to be conscious but slightly confused. Two days later, her pain had eased, her blood alcohol level fallen, and she was able to leave the hospital and return home (163). Death associated with blood alcohol levels below 350 mg/100 mL sug- gests that other complicating factors are present. Most commonly, this will be an interaction between alcohol and some other drug that has also been ingested. Diagnosis of Intoxication The terms alcohol intoxication and drunkenness are often used inter- changeably.