Catch me if you can-emission patterns of human bodies in relation to postmortem changes.

The present study examines for the first time the emission patterns and olfactory signatures of 9 complete human corpses of different stages of decomposition. Air sampling was performed inside the body bags with solid sorbents and analysed by coupled gas chromatography-mass spectrometry after thermal desorption (TD-GC-MS). Furthermore, odour-related substances were detected by gas chromatography-olfactometry (GC-O). Sulfurous compounds (mainly dimethyl di- and trisulfide) were identified as most important to the odour perception. Around 350 individual organic substances were detected by TD-GC-MS, notably sulfurous and nitrogenous substances as well as branched alkanes, aldehydes, ketones, alcohols, carboxylic acids, carboxylic acid esters and ethers. A range of terpenes was detected for the first time in a characteristic emission pattern over all decomposition stages. Concentrations of the substances varied greatly, and no correlation between the emission patterns, the stage of decomposition and the cause of death could be found. While previous studies often analysed pig cadavers or only parts of human tissue, the present study shows the importance of analysing complete human corpses over a range of decomposition stages. Moreover, it is shown that using body bags as a kind of "emission test chamber" is a very promising approach, also because it is a realistic application considering the usual transport and store of a body before autopsy.

Men's Access to Outpatient Psychosocial Cancer Counseling.

BACKGROUND: Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it. METHODS: In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically for male patients) over a period of 12 months would be able to increase the percentage of men among patients seeking outpatient cancer counseling (primary endpoint, initial contact; secondary endpoint, all contacts). The intervention effect was quantified by the fitting of generalized linear mixed models to obtain an odds ratio, which was adjusted for cluster structure and for the percentages of first contacts and of all contacts during the 12 months before the start of the intervention. RESULTS: In 12 regions of Germany (6 each in the intervention arm and the control arm), 11 986 people had first contacts with outpatient cancer counseling, 6004 of them during the intervention phase. The percentage accounted for by men was 30.7% in the intervention arm and 25.7% in the control arm, corresponding to a statistically insignificant model-based adjusted odds ratio (OR) of 1.2 (95% confidence interval [1.0; 1.4], p = 0.08) for the primary endpoint. There were a total of 51 842 counseling sessions (both initial contacts and subsequent contacts), 26 651 of them in the intervention phase. The percentage of these that was accounted for by men was 27.6% in the intervention arm and 22.2% in the control arm; the adjusted OR for this secondary endpoint was 1.3 [1.1; 1.6], p = 0.01). CONCLUSION: The targeted implementation of malespecific measures on multiple levels can increase, by a small amount, the percentage of men among persons seeking outpatient cancer counseling.

Esophageal rupture through extreme sadomasochistic practice.

We report the case of a woman in her thirties who suffered an esophageal rupture while participating in extreme sadomasochistic practices. After herself seeking help in a hospital for complaints alleged to be from a fall, she was initially diagnosed with several broken ribs and a pneumothorax. The cause of the pneumothorax was later discovered to be an esophageal rupture. When confronted with this atypical injury for a fall, the woman admitted to have accidentally swallowed an inflatable gag, which her partner had afterwards inflated. In addition to the esophageal rupture, the patient also had numerous other externally visible injuries of various ages, reportedly also from sadomasochistic acts. Although an in-depth police investigation was conducted and a "slave contract" was found, the woman's consent to the extreme sexual practices performed by her life partner could not be substantiated conclusively. The man was convicted for intentional infliction of serious as well as dangerous bodily injury and sentenced to a long term in prison.

Changes in the pattern of suicides and suicide attempt admissions in relation to the COVID-19 pandemic.

The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March-December 2019 and March-December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality.

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

Endogenous formation of 1-propanol and methanol after consumption of alcoholic beverages.

INTRODUCTION: In cases of drunk-driving, allegations that alcohol has been consumed after the incident, are proved by analyzing congener alcohols in the blood sample. 1-Propanol, one of the main congener compounds, was tested, whether it is also endogenously formed when a person has consumed alcoholic beverages. METHODS: Eleven male and 13 female volunteers consumed congener-free vodka (37.5 vol% ethanol, individual doses: 0.15-0.32 l) within one hour. Blood samples were taken up to 10 h and analyzed for ethanol and congener alcohols by headspace gas chromatography-mass spectrometry. RESULTS: Ethanol concentrations reached in blood a maximum of 0.65-1.23 g/l and decreased by 0.18 g/l/h (median values). Of the congener alcohols analyzed, only methanol and 1-propanol were detected in the plasma samples of all subjects. The endogenous methanol concentration increased from 0.66 mg/l by 0.22 mg/l/h to 2.19 mg/l (medians). 1-Propanol was not detected prior to alcohol consumption. Maximum concentrations of 0.10-0.32 mg/L were measured after 1.0-4.5 h. A plateau of the 1-propanol concentration was observed in the plasma samples of the 18 subjects lasting for 0.5-4.0 h and this alcohol was completely eliminated at ethanol concentrations of 0.17 g/l (median, range 0.03-0.55 g/l). CONCLUSION: The results of the study confirm the formation of 1-propanol after consumption of 1-propanol-free beverages, which should be taken into account when evaluating its concentration.

Definitions of frontal bone inclination: Applicability and quantification.

In sex determination from crania, a "vertical" forehead is considered a female feature, while a "sloping" forehead is considered a male feature. Precise description of frontal inclination with a quantitative measure like an angle is considerably more difficult as it requires accurate identification of clearly defined craniometric points. In the literature, the morphognostic terms "frontal bone inclination," or "frontal profile," are defined in numerous ways. The aim of this study was to determine which of these frontal inclination definitions is best suited for sex estimation. In a study in the context of the digital forensic osteology project, 10 of the frontal angle definitions described in the literature were assessed for their usefulness in sex determination on 211 virtual crania, reconstructed from postmortem CT-data. Custom-developed software was used for the automated measurement of frontal bone inclination angles from lateral-profile, volume-rendered 3D cranial images in which 10 anthropometric landmarks had been manually marked. Discriminant function analysis was performed to determine if satisfactory accuracy rates for the classification of sex could be achieved with defined variables. Four of the ten examined definitions were found to be highly significant for sex determination; three of these, also provided satisfactory intra- and inter-observer reliability. The frontal angle according to Schwalbe provided the best accuracy rate of 75.4% and a critical discriminatory value (separation value) of 88.6°: angles greater than this, suggest female sex; angles smaller than this, suggest male sex. Further, the open-source, custom-developed software introduced here proved compatible with commonly used image-processing and statistical programs and allowed quick, automated, valid measurement of numerous cranial angles. Other craniometric angles can, thus, also be quickly and easily determined with this software.

Fatalities of stowaways traveling in airplane wheel wells.

The earliest mention of a stowaway in the wheel well of an airplane dates back to 1947: A 30-year-old man chose this mode of travel for a trip from Lisbon to Brazil and survived (Véronneau et al., 1996). In a retrospective study, we evaluated cases with lethal outcome of stowaways in airplane wheel wells by focusing on forensic autopsy results, in particular, in regard to hypothermia, hypoxia, and injuries. In addition, the flight routes, flight altitudes, and flight durations were analyzed. Using the forensik® program, a search of all the autopsies performed between 1994-2017 at the Institute of Legal Medicine in Frankfurt am Main, Germany, was conducted, using the key words "airplane," "flights," and "wheel well." All of the thus retrieved autopsy reports, medicolegal expert reports, and police investigation reports were then evaluated. Five cases were included in our study. The decedents were all men, aged between 14 and 26 years. Four of the decedents had been discovered at the Frankfurt Main airport within airplane wheel wells; the fifth man had been discovered in a woods underlying one of the flight approach paths to the airport. Two stowaways had died of hypoxic asphyxiation, possibly in conjunction with hypothermia as a contributing factor. One stowaway died of the polytrauma he sustained when he was crushed by retracting landing gear. For a further stowaway, the cause of death could not be macroscopically determined at autopsy. In one case, only an external postmortem examination had been performed, without autopsy. Analysis of the flight routes, altitudes, and durations showed that the flights had been international flights, the flight altitudes had varied between 7000m (∼23,000ft) und 11,000m (∼36,000ft), and the flight duration had been between 4 and 9.5h. At high altitudes, the ambient conditions in wheel wells, which are not pressurized, are rarely survived by stowaways, with hypoxic asphyxiation likely posing greater peril than hypothermia. Further dangers are that of being crushed by retracting landing gear after takeoff, or of falling out of a wheel well, from a great height, when the landing gear is deployed. When it appears conceivable that a stowaway may have fallen from an aircraft wheel well during landing or takeoff, an autopsy and discovery scene investigation are essential to reconstructing the course of events.

Morphometric investigations to assess the compatibility of mandible and skull.

When a morphologically separated skull and mandible are found in the same case context, the possibility of a match arises. Two criteria with which to determine a match are the rough articulation between the mandibular condyles and cranial base itself and, most importantly, the fit of the teeth. However, when there has been intravital or postmortem tooth loss, this important criterion is not available. To date, only Reichs (1989) has investigated further compatibility criteria to solve the question of putative commingling in a case where a mandible seemed to originate from a female, while all other bones originated from a male individual. In a different reported case (Preißler et al. 2017), a mandible seemed too big for a skull; DNA analysis, however, confirmed that both originated from the same female individual. To investigate the metric relationship between mandible and skull we measured the postmortem CT data records of 223 corpses (virtual skulls) in OsiriX© MD for the following linear parameters: bicondylar breadth (KDB), biradicular breadth (AUB), and bizygomatic breadth (ZYB). The indices KDB/ZYB and KDB/AUB were developed and used to define ranges for matches and mismatches. Furthermore, the intra-observer reliability for the method was assessed. An intraclass correlation coefficient of >0.99 for every parameter showed that the used measurements are highly reliable. The 2.5-97.5 percentile for the KDB/AUB index lay between 0.91 and 1.05, while the range for the KDB/ZYB index was between 0.87 and 1.00. Within these ranges, it is possible to roughly assess whether or not a mandible and skull might be compatible, even if this can only be verified by forensic DNA analysis. If an index value lies outside these ranges, it can be assumed that skull and mandible do not match. Future studies should include more samples from a broader population spectrum so that these metric relationships can be used for different populations.

[Pre- and perimortem bone trauma vs. postmortem damages-- Principles of differentiation]. / Prä- oder perimortale Knochentraumata vs. postmortale Defekte--Grundlagen der Differenzierung.

In medicolegal practice, evidence of trauma or damage on human skeletons or single bones raises the question whether this was inflicted in an antemortem, perimortem, or postmortem time frame. Trauma that occurred around the time of death, i. e., perimortem trauma, is of special forensic interest, as it can yield clues about the manner and cause of death. Perimortem traumas thus need to be carefully distinguished both from antemortem injuries that were evidently survived (these can still be useful for identification purposes) and from postmortem damage, as may occur during retrieval of remains. This study offers an up-to-date review of the specialist literature, e. g. textbooks and pubmed-listed publications, identifying differentiation criteria for ante- and perimortem traumas and postmortem damage. The results that are useful for practice in actual medicolegal casework are presented, and an overview of all macroscopically visible criteria (including simple magnifications, i. e., magnifying glass) that can be used to distinguish between ante- and perimortem traumas on the one side, and postmortem damage on the other is given. The difficulty of distinguishing antemortem trauma and postmortem damage from perimortem trauma rises sharply the closer in time they were inflicted to the time of the death event. Additional postmortem changes due to exposure of the bones to the surrounding deposition conditions may also occur after the relevant postmortem damage or antemortem trauma was inflicted and further complicate the problem. In this context, the "perimortem interval" and the "Fracture Freshness Index" (FFI) are discussed as means to classify the time frame of traumas.