A comparison of maceration methods for the preparation of infant skeletal remains for forensic anthropological analysis.

Very little literature currently exists prescribing which maceration method to use when preparing infant human remains, resulting in bone quality that is suitable for forensic anthropological analysis. The aim of the study was to test five maceration methods to determine which is most suitable for infant remains for forensic anthropological analysis. The sample included five neonate pig carcasses (Sus scrofa domesticus), ranging between one to three days old. Five maceration methods were tested on the pig carcasses (one pig per maceration method) to determine their effectiveness. The methods included invertebrate maceration by meal worms, chemical maceration by bleach, chemical maceration by borax solution, enzymatic maceration by laundry detergent and sodium carbonate solution, and chemical maceration by sodium hypochlorite. A scoring method was created to assess the effectiveness of each maceration method. Invertebrate maceration and chemical maceration using bleach were the least successful methods of maceration (total maceration score = 8 respectively). Chemical maceration using borax and chemical maceration using sodium hypochlorite achieved complete maceration of the skeletal remains; however, they both resulted in artifacts that are unsuitable for forensic analysis (total maceration score = 14 respectively). Enzymatic maceration using laundry detergent and sodium carbonate was the most successful method (total maceration score = 17). The detergent technique subsequently successfully macerated all five sets of infant human remains. This study has validated that the enzymatic maceration technique using laundry detergent and sodium carbonate can be used to effectively macerate the remains of infant skeletal remains for forensic anthropological analysis.

Animal scavenging on pig cadavers in the Lowveld of South Africa.

Scavenging animals often scatter skeletal remains of forensic interest and leave bite marks. This study aimed to identify scavenging animals in the rural Lowveld of South Africa and to describe their scattering pattern and bite marks on bone. Ten pig cadavers (Sus scrofa domesticus) (40-80 kg) were placed at the Wits Rural Facility, Limpopo, South Africa during the summer and winter seasons. Motion activated cameras recorded the scavenging. Scavenger species were identified and their behaviors, scattering pattern, and bite marks were described. Scavenging was primarily by vultures (hooded, white-backed, and lappet-faced). Marabou stork, slender and banded mongoose, genet, civet, warthog and honey badger also actively scavenged. Vultures began to scavenge the pig cadavers after 18hrs in summer and between 26 and 28 h in winter and skeletonized pig cadavers rapidly between 5 and 98 min. Skeletonization occurred more rapidly and diffusely in summer while winter cases were densely scattered. Overall the scattered remains were within an area of 157.9 m2/1705.5 ft2 with a radius of 7.09 m/23.3 ft. Vultures cleaned bones thoroughly with very minimal markings - primarily nonspecific scores. The described scattering pattern and bite marks will assist in the recovery and analysis of scavenged remains.

Development and validation of an instrument for procedure-related death notification.

BACKGROUND: Anaesthesia-related mortality is an important, potentially avoidable cause of perioperative mortality. A procedure-related death notification (PRDN) instrument is completed by relevant medical practitioners after a procedure-related death and is used to audit practice and identify areas of care that require improvement. It is also used in medicolegal investigations when establishing cause of death, and in the case of litigation. The current South African (SA) PRDN instrument, designated the GW7/24 form, contains both surgical and anaesthetic sections and is considered to be outdated, inadequate and in need of revision. OBJECTIVES: To develop and validate a revised anaesthetic section of the SA PRDN instrument that can be used for procedure-related deaths in future and be used to update the GW7/24 form for epidemiological, forensic or academic use. METHODS: Lynn's two-stage model was utilised. After an extensive literature review, a provisional PRDN instrument was developed. This provisional instrument was debated and reviewed at a peer group discussion in which 6 local experts took part. These experts were anaesthetic and forensic pathology specialists who specifically have expert knowledge on procedure-related deaths. A revised PRDN instrument was developed, which was then rated by 8 national experts using a Likert scale. The content validity index (CVI) for each item and for the instrument as a whole was then established. Items with a CVI <0.88 were removed to formulate the final PRDN instrument. RESULTS: The provisional PRDN instrument consisted of 14 domains and 66 items. The revised PRDN instrument consisted of 13 domains and 65 items, of which 3 items with a CVI <0.88 were removed. The final PRDN instrument, after minor revisions based on suggestions from the 8 national experts, consisted of 18 domains and 79 items. Every item on the form was declared relevant and important by the national experts, with the final instrument scoring an overall CVI of 1. CONCLUSIONS: A comprehensive, updated and validated anaesthetic section of the SA PRDN instrument was developed. This could be used as a government and anaesthesiology society-endorsed template when updating the current GW7/24 form.

How reliable is the charred body scale? An interobserver reliability study on scoring burned remains.

The error rates of forensic techniques need to be evaluated. The charred body scale is a method for quantifying the level of decomposition in burned remains. 51 files containing photographs of burned pigs at different stages of decomposition were scored by nine participants. Each pig in the photographs was uniformly burned to a different level (Crow Glassman Scale levels 1 to 3). The Crow Glassman Scale describes five levels of burns that include singing of hair and epidermal blistering (CGS level 1) up to complete cremation of the body reducing it to ash (CGS level 5). The three CGS levels were selected to isolate potential scoring errors that may be caused by different burn levels (not accounted for in the development of the charred body scale). Each of the 51 photograph files was scored by participants using the charred body scale as if it were a unique forensic case at an unknown initial burn level and decomposition stage. Interobserver error, hence reliability, of the scores was tested using individual and average absolute agreement interclass correlations. The charred body scale is reliable for remains burned to a Crow Glassman Scale level 1 but not in higher burn levels. It is suggested that a universal scoring method be developed that accounts for multiple burn levels in a single case.

Paraquat poisoning. An overview of the current status.

Paraquat is a bipyridyl compound with no known chronic toxicity or teratogenicity. It is poorly absorbed when inhaled, but causes severe illness when ingested orally, death usually occurring within 2 days of ingestion of 50 mg/kg. At lower doses death may be delayed for several weeks. The toxic compound accumulates in lung tissue where free radicals are formed, lipid peroxidation is induced and nicotinamide adenine dinucleotide phosphate (NADPH) is depleted. This produces diffuse alveolitis followed by extensive pulmonary fibrosis. The most important prognostic indicator is the quantity of paraquat absorbed, as shown by the plasma paraquat concentration. While renal failure will develop in the majority of those patients who eventually die, it may not, if present alone, indicate a fatal outcome. The absence of caustic burns in the upper digestive tract indicates a good prognosis. Treatment of paraquat poisoning remains ineffective, but Fuller's earth, activated charcoal and resins may prevent some absorption of the toxin. When tubular necrosis occurs, renal excretion of the compound decreases rapidly. A 3-compartment pharmacokinetic model has been described following ingestion of tracer doses including a 'deep' compartment for active pulmonary accumulation. Haemodialysis, haemoperfusion and forced dialysis have been attempted, with no clear improvement in survival rates. Superoxide dismutase, glutathione peroxidase, N-acetylcysteine and other 'free radical scavengers' have failed to alter the outcome in poisoned patients. Other theoretical treatments, such as deferoxamine, immunotherapy, NADPH repletion and lung transplantation still require clinical validation.

The structure of psychological well-being revisited.

A theoretical model of psychological well-being that encompasses 6 distinct dimensions of wellness (Autonomy, Environmental Mastery, Personal Growth, Positive Relations with Others, Purpose in Life, Self-Acceptance) was tested with data from a nationally representative sample of adults (N = 1,108), aged 25 and older, who participated in telephone interviews. Confirmatory factor analyses provided support for the proposed 6-factor model, with a single second-order super factor. The model was superior in fit over single-factor and other artifactual models. Age and sex differences on the various well-being dimensions replicated prior findings. Comparisons with other frequently used indicators (positive and negative affect, life satisfaction) demonstrated that the latter neglect key aspects of positive functioning emphasized in theories of health and well-being.

Guidelines for prescribing psychiatrists in consultative, collaborative, and supervisory relationships.

Most psychiatrists enter into a variety of professional relationships with other clinicians in which they prescribe medications or make recommendations about pharmacotherapy. This paper describes a set of guidelines for prescribing psychiatrists involved in consultation, collaboration, and supervision with other clinicians. The guidelines were developed by psychiatrists for the Harvard Risk Management Foundation. The terms consultation, collaboration, and supervision are defined, and the psychiatrist's roles and responsibilities in each type of arrangement are described. The guidelines limit consultation and collaboration to relationships with professionals who are licensed or credentialed. Based on the definitions, the paper describes a structure for working with other clinicians, which begins with a thorough assessment of the context and circumstances of the clinical situation. The guidelines strongly encourage structured communication among clinicians and with the patient and significant others, as well as clarification by clinicians of their respective responsibilities for treatment and follow-up.

Fundamental differences in promoter CpG island DNA hypermethylation between human cancer and genetically engineered mouse models of cancer.

Genetic and epigenetic alterations are essential for the initiation and progression of human cancer. We previously reported that primary human medulloblastomas showed extensive cancer-specific CpG island DNA hypermethylation in critical developmental pathways. To determine whether genetically engineered mouse models (GEMMs) of medulloblastoma have comparable epigenetic changes, we assessed genome-wide DNA methylation in three mouse models of medulloblastoma. In contrast to human samples, very few loci with cancer-specific DNA hypermethylation were detected, and in almost all cases the degree of methylation was relatively modest compared with the dense hypermethylation in the human cancers. To determine if this finding was common to other GEMMs, we examined a Burkitt lymphoma and breast cancer model and did not detect promoter CpG island DNA hypermethylation, suggesting that human cancers and at least some GEMMs are fundamentally different with respect to this epigenetic modification. These findings provide an opportunity to both better understand the mechanism of aberrant DNA methylation in human cancer and construct better GEMMs to serve as preclinical platforms for therapy development.

Genome-wide DNA methylation studies suggest distinct DNA methylation patterns in pediatric embryonal and alveolar rhabdomyosarcomas.

Rhabdomyosarcoma is the most common soft-tissue sarcoma in children. While cytogenetic abnormalities have been well characterized in this disease, aberrant epigenetic events such as DNA hypermethylation have not been described in genome-wide studies. We have analyzed the methylation status of 25,500 promoters in normal skeletal muscle, and in cell lines and tumor samples of embryonal and alveolar rhabdomyosarcoma from pediatric patients. We identified over 1,900 CpG islands that are hypermethylated in rhabdomyosarcomas relative to skeletal muscle. Genes involved in tissue development, differentiation, and oncogenesis such as DNAJA4, HES5, IRX1, BMP8A, GATA4, GATA6, ALX3, and P4HTM were hypermethylated in both RMS cell lines and primary samples, implicating aberrant DNA methylation in the pathogenesis of rhabdomyosarcoma. Furthermore, cluster analysis revealed embryonal and alveolar subtypes had distinct DNA methylation patterns, with the alveolar subtype being enriched in DNA hypermethylation of polycomb target genes. These results suggest that DNA methylation signatures may aid in the diagnosis and risk stratification of pediatric rhabdomyosarcoma and help identify new targets for therapy.

The role of religious identity in the mental health of older working and retired adults.

This study investigates whether religious identity explains unique variance of the self esteem and depressive symptoms of older working and retired adults. Data were collected from a larger, five-year project begun in 1992 that compared the well-being of older workers and with that of new retirees living in the Raleigh-Durham-Chapel Hill, North Carolina metropolitan area. Data are from the third and final wave, collected between March and June, 1997, during which 242 of the eligible 255 people participated. Net of religious attendance, religiosity, and various control variables, religious identity predicted both mental health outcomes. As predicted, self esteem increased and depressive symptoms decreased as religious identity increased (i.e., viewing oneself as more competent, confident, and sociable as a religious person). Though there was a trend towards religious identity being more strongly predictive of mental health among retirees than among the working adults, these interactions did not reach statistical significance.

"Every defect is a treasure".

After seeing multiple providers for various complaints, a patient becomes frustrated with the healthcare system. She is diagnosed with acromegaly secondary to pituitary tumor when she transfers to another healthcare system.

The nexus of cardiovascular disease and depression revisited: the complete mental health perspective and the moderating role of age and gender.

This study employs a measure of mental health as a complete state that combines information about an individual's mental illness (i.e., major depressive episode in the past 12 months) and subjective well-being (i.e., mental health) status to investigate its linkage with cardiovascular diseases (CVD). Data are from a representative sample of USA adults between the ages of 25 and 74 collected in 1995 (n = 3,032). About 12% of adults reported any CVD. Independent of mental health status, risk for any CVD increased with age and as education decreased, and the risk of any CVD was higher among males, married adults, and unemployed adults. The prevalence of any CVD was lowest in adults who were mentally healthy and higher among adults with major depressive episode, with minor depression, with languishing, and with moderate mental health. The relationship of CVD and mental health was moderated by age and sex; mental health status was associated with significant risk for any CVD primarily among females between the ages of 45 and 74. Findings contribute to a growing literature on the protective effects of high, and risk effects of low, levels of subjective well-being, and the role of age and sex in specifying specific physical and mental health comorbidities.

The spectrum of NGC 7027 (367-650 nm).

NGC 7027 shows the richest spectrum of any known gaseous nebula. In the region of the spectrum surveyed we have measured lines of ions of H, He, C, N, O, F, Ne, Mg, Si, P, S, Cl, Ar, K, Ca, Mn, and Fe using the new Hamilton Echelle Spectrograph of Lick Observatory with a charge-coupled device (CCD) detector. Since a CCD is a linear detector, whereas photographic emulsions used in the most comprehensive previous studies were not, a considerable enhancement in the accuracy of line intensity measurements is possible.

International Ultraviolet Explorer satellite observations of seven high-excitation planetary nebulae.

Observations of seven high-excitation planetary nebulae secured with the International Ultraviolet Explorer (IUE) satellite were combined with extensive ground-based data to obtain electron densities, gas kinetic temperatures, and ionic concentrations. We then employed a network of theoretical model nebulae to estimate the factors by which observed ionic concentrations must be multiplied to obtain elemental abundances. Comparison with a large sample of nebulae for which extensive ground-based observations have been obtained shows nitrogen to be markedly enhanced in some of these objects. Possibly most, if not all, high-excitation nebulae evolve from stars that have higher masses than progenitors of nebulae of low-to-moderate excitation.

Medical malpractice and legal resolution systems in Japan.

Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars). Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-of-court review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians.

Ultraviolet spectrum and probable chemical composition of the high-excitation planetary nebula M1-1.

One of the highest excitation planetary nebulae known, M1-1, was studied with the image-tube scanner on the Shane 3-m telescope at Lick Observatory and with the International Ultraviolet Explorer. Large fractions of abundant elements such as C, N, O, S, and Ar exist in unobservable stages of ionization. Hence, it is difficult to establish the chemical composition of this nebula. The logarithmic abundance values of various elements compared with those of the Sun appear to be as follows: [Table: see text] Here log N(H) = 12. In contrast to NGC 6537, the composition of M1-1 does not appear to differ markedly from that of the Sun. N may be enhanced but there is no enhancement of He or C. In spite of its high excitation and its presumed origin from a relatively massive star, M1-1 shows no evidence for pronounced nuclear processing.

Chemical compositions of Magellanic Clouds' HII regions based on photoelectric spectrophotometry.

Detailed line intensity measurements secured at Cerro Tololo Interamerican Observatory and corrected for interstellar extinction are presented for 19 HII regions in the Large Magellanic Cloud and 6 in the Small Magellanic Cloud. The elemental abundances derived by simple methods appear to be in good accord with those found by other observers. Detailed discussion is deferred to a later paper.

Model nebulae and determination of the chemical composition of the Magellanic Clouds.

An analysis of previously presented photoelectric spectrophotometry of HII regions (emission-line diffuse nebulae) in the two Magellanic Clouds is carried out with the aid of theoretical nebular models, which are used primarily as interpolation devices. Some advantages and limitations of such theoretical models are discussed. A comparison of the finally obtained chemical compositions with those found by other observers shows generally a good agreement, suggesting that it is possible to obtain reliable chemical compositions from low excitation gaseous nebulae in our own galaxy as well as in distant stellar systems.