Fatal choking in infants and children

Food asphyxiation in infants/children follows a different pattern from the adult "cafe coronary." In the absence of ethanol intoxication, infants/children are prone to mishandling nonfriable, firm, slippery foods/objects with a rounded contour. The Dade County Medical Examiner's files were searched from 1956 to mid-1983 for accidental pediatric choking deaths. Seventeen food and six foreign body asphyxiations were found. The male/female ratio was 1.4/1 and 1/1, respectively. The white/black ratio was 0.9/1 for food asphyxiation whereas no black victims were encountered choking upon foreign objects. Seventy-eight percent of all victims were between 2 months and 4 years of age. Infants/children asphyxiated on items such as a hot dog, hard candy, peanut, toy rattle, tissue paper, balloon, marble, etc. The choking event was recognized by nearby adults in most instances. Risk factors include the availability of riskful foods/objects, natural diseases with difficulty feeding, poor eating habits, and uneducated or ignorant parents/others at the scene. Although public education, package labeling, and changes in food/object design may be appropriate, the ubiquituous risk foods and small foreign objects will, on occasion, escape the eye of even the most watchful parent.     

FDA approved? A critique of the artificial insemination industry in the United States

Artificial insemination by donor is becoming an increasingly popular means to achieving parenthood. While the majority of couples use artificial insemination to overcome fertility problems, many recipients use artificial insemination to avoid passing a genetic disease to their children. However, case studies reveal the inherent dangers of artificial insemination, namely the lack of proper screening methods to avoid passing genetic diseases to children born by artificial insemination. State-by-state regulation, federal guidelines, and private adjudication have all proven to be inadequate methods of regulating the artificial insemination industry. Ginsberg proposes federal regulation as the only means of achieving a safe artificial insemination industry. The proposed federal regulation would include better genetic screening, a more efficient national sperm donor system, and limited disclosure to recipients of artificial insemination and their children. These measures would help to ensure that couples using artificial insemination get what they expect--healthy sperm, a safe artificial insemination process, and ultimately, a healthy child.     

Public participation in health planning agencies: promise and practice

Federal legislation provided an opportunity for health planning to "catch up" with the expanding citizen participation movements of recent years. Although the literature on health planning is mounting, there as yet has been no comprehensive, systematic effort to inventory the status of participation on a national scale. This note reports on a national study of Health Systems Agencies designed to inventory the participation objectives and methods in use, identify major participants and obstacles, and analyze impacts and factors influencing practice in the field. Among the findings are that agencies have favored "safe" participation methods that satisfy minimum federal requirements and provide information and public relations without transfer of power to consumers; and have broadened the base of participation in planning without mobilizing consumers or reducing the dominance of providers, who remain the most active, organized, and influential participants.     

Deaths associated with choking in San Diego county

Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.     

Detection of diatoms in blood by a combination of membrane filtering and chemical digestion

An improved method for detecting diatom in blood is reported. Blood of cadavers was obtained by cardiac puncture at inquest or from the left atrium directly at autopsy. The blood was hemolyzed by sodium dodecyl sulfate (SDS) and filtered through membrane filter (47 mm in diameter and 5 microns in pore size). When the blood was putrefied, two or three pieces of membranes filters were needed because of choking membrane pore. The membrane filters were digested with fuming nitric acid and diluted with distilled water. The diluted solution was filtered through membrane filter (25 mm in diameter) again. After drying the membrane filter was immersed in oil. Diatoms on the membrane filter were clearly observed microscopically.     

Determination of sex from femora

The determination of sex from bones or bone fragments considerably contributes to identifying unknown bodies or skeletal remains. Due to temporal change and regional differences anthropometric standards have to be constantly renewed. The present study provides measurements of femoral dimensions in a contemporary German population and analyses sexual dimorphism by discriminant analysis. Maximum length (male: 46.4+/-2.4 cm, female: 43.4+/-2.4 cm), maximum midshaft diameter (male: 3.1+/-0.2 cm, female: 2.8+/-0.2 cm), condylar width (male: 8.4+/-1.0 cm, female: 7.7+/-0.5 cm), vertical head diameter (male: 4.9+/-0.3 cm, female: 4.4+/-0.3 cm), head circumference (male: 15.7+/-0.8 cm, female: 13.8+/-1.0 cm) and transverse head diameter (male: 4.9+/-0.3 cm, female: 4.3+/-0.3 cm) were measured in 170 femora, 100 from male (age: 16-92 years, mean: 60.8 years; body height: 153-190 cm, mean: 171 cm) and 70 from female (age: 20-96 years, mean: 72 years; body height: 146-175 cm, mean: 161 cm) individuals. In the discriminant analysis (leave-one-out-method) 67.7% of cases could be grouped correctly with the maximum length alone, 72.4% with the maximum midshaft diameter, 81.4% with the condylar width, 86.8% with the vertical head diameter, 87.7% with the head circumference and 89.6% with the transverse head diameter. The stepwise procedure with all head measurements showed that the results for the transverse head diameter could not be improved. With all measurements subjected to stepwise procedure 91.7% of cases could be classified correctly combining midshaft diameter and head circumference (D=3.012xmidshaft diameter in cm+0.780xhead circumference in cm 20.569).     

ALL CHILDREN ARE NOT CREATED EQUAL: PRWORA'S UNCONSTITUTIONAL RESTRICTION ON IMMIGRANT CHILDREN'S ACCESS TO FEDERAL HEALTH CARE PROGRAMS

The lack of health insurance for children is a serious problem in the United States, especially for those children in families that earn too little to get private health insurance and too much to qualify for Medicare. Even within this subclass of children, immigrant children are particularly vulnerable to the problems faced by lack of health care. Nevertheless, with the passage of the Personal Responsibility and Work Reconciliation Act (PRWORA) by Congress, equality interests of low‐income immigrant children are undermined when immigrant children are denied federal benefits for the first 5 years of residency in the United States. The first part of this Note examines the importance of child health care and the long‐term problems with uninsured children, especially with uninsured immigrant children and pregnant women. The next part introduces Medicaid as well as State Children's Health Insurance Program, a supplemental federal program designed to increase health care coverage to all children, while contrasting these programs in light of the restrictive anti‐immigrant PRWORA provisions. The third part explains the passage of PRWORA, its anti‐immigrant provisions, and how these provisions prevent needy immigrant children from receiving federally funded health care. Then, the fourth part uses both the Equal Protection Clause of the Fourteenth Amendment and the Due Process Clause of the Fifth Amendment to argue the unconstitutionality of the anti‐immigrant provisions. Finally, the last part lays out the recommendation to amend the Social Security Act so that the PRWORA barriers can be removed and recent immigrant children can receive federally funded health care.     

The PMMA epidemic in Norway: comparison of fatal and non-fatal intoxications

During a 6 month period (July 2010-January 2011) we observed 12 fatal intoxications and 22 non-fatal cases related to the drug paramethoxymethamphetamine (PMMA) in Norway (4.8 mill inhabitants). This toxic designer drug, also known as "Death", is occasionally found in street drugs offered as "ecstasy" or "amphetamine". The present study aimed to evaluate the cause of death, and to compare the PMMA blood concentrations in fatal and non-fatal cases. Methods for identification and quantification of PMMA are presented. The median age of fatalities was 30 years (range 15-50) with 67% males; in non-fatal cases 27 years (20-47) with 86% males. In the 12 fatalities, the median PMMA blood concentration was 1.92 mg/L (range 0.17-3.30), which is in the reported lethal range of 0.6-3.1 mg/L in peripheral blood and 1.2-15.8 mg/L in heart blood. In the 22 non-fatal cases, the median PMMA concentration was 0.07 mg/L (range 0.01-0.65). Poly-drug use was frequent both in fatal and non-fatal cases. The PMA concentrations ranging from 0.00 to 0.26 mg/L in both groups likely represented a PMMA metabolite. Three fatalities were attributed to PMMA only, six to PMMA and other psychostimulant drugs, and three to PMMA and CNS depressant drugs, with median PMMA concentrations of 3.05 mg/L (range 1.58-3.30), 2.56 (1.52-3.23) and 0.52 mg/L (0.17-1.24), respectively. Eight victims were found dead, while death was witnessed in four cases, with symptoms of acute respiratory distress, hyperthermia, cardiac arrest, convulsions, sudden collapse and/or multiple organ failure. In summary, all fatalities attributed to PMMA had high PMMA blood concentrations compared to non-fatal cases. Our sample size was too small to evaluate a possible impact of poly-drug use. A public warning is warranted against use and overdose with illegal "ecstasy" or "speed" drugs.     

Extent and characteristics of woman batterers among federal inmates

Efforts to identify men who batter women in clinical settings have increased in recent years, but batterer research in United States federal prisons is lacking; low security federal prisons are logical places to consider batterer screening and treatment given the number of men, the domestic violence "risk markers" associated with these men and the likelihood they will be released and return to female partners. This study examined intake assessment data for 115 low security federal inmates. The inmates evidenced high levels of risk markers for woman battering, one in three (33%) acknowledged recent physical violence against women partners, 1 in 10 (13%) admitted severe violence, and the self-identified batterers showed more substance use and personality problems than other inmates. The findings suggest that batterer screening and treatment may be needed in federal prisons and that more research is warranted with a burgeoning male population that ultimately returns to society.     

Long-Term Follow-Up of Young Children Placed in Foster Care: Subsequent Placements and Exposure to Family Violence

This study examined the quality or characteristics of permanent placements at 6 years of age for 254 children who had been removed from their homes prior to attaining 3.5 years of age (mean = 13 months). Although the primary objective when removing children is protection, subsequent permanent placements are prioritized by federal legislation with a stable family environment, especially one with the biological parent(s), being preferred. Three a priori comparisons (i.e., reunified vs. nonreunified, adopted vs. foster care, relative vs. nonrelative foster care) were conducted for caregiver and child reports of exposure to family violence. The results indicate that both reunified children and their parents report more family violence (witnessed and child victimization) than do nonreunified children and their caregivers. Adoptive parents did report that they used more minor violence in disciplining their children than did foster caregivers, but their children reported witnessing significantly less physical violence in the home. Recognizing that the development of children removed from their homes because of maltreatment is likely a function of both the maltreatment as well as the quality of subsequent family experiences (i.e., violence exposure), implications of the findings for determining placements are discussed.     

Government delays release of medical marijuana supply

The federal government's initiative to make marijuana available for medical use continues to run into problems and delays. In a recent development, the first crop produced by the government's designated grower turned out to be too impure to use. The delays have led to the launch of a lawsuit against the federal government.     

Evaluation of seven methods of estimating age at death from mature human skeletal remains.

Different approaches to the estimation of age at death in mature human skeletal remains were evaluated utilizing samples from 19 recent French autopsy individuals of known age at death. Methods of estimating age at death from single-rooted teeth, the sternal ends of the fourth ribs, the symphyseal face of the pubis and femoral cortical remodeling were evaluated by two independent observers (three observers for the teeth). Comparison included ages estimated from three more comprehensive approaches utilizing data from the application of two or more of the individual methods. The results indicate that the comprehensive approaches are superior to the individual ones and the success of the latter reflects not only the morphological expression of the aging process, but also the technique complexity and the experience of the investigator. Of the individual techniques, the "Lamendin" dental technique was most effective for individuals of ages greater than 25 years.     

A NOT SO HAPPY BIRTHDAY: THE FOSTER YOUTH TRANSITION FROM ADOLESCENCE INTO ADULTHOOD

Every year close to 25,000 youth age out of our foster care system; without the anchor of a family, former foster youth disproportionately join the ranks of the homeless, incarcerated, and unemployed. While the average age of financial independence in America is twenty‐six years of age, we presume that foster youth can somehow attain financial and emotional independence by age eighteen. Instead, these adolescents are woefully unprepared for independent adult life, and when they falter, too often no one is there to provide support or guidance. As a result, former foster youth are ten times more likely to be arrested than youth of the same age, race, and sex and one in four youth who age out of foster care will end up in jail within the first two years after leaving care. This article will discuss strategies for changing these disheartening outcomes for transitioning foster youth, including breaking down our silos and collectively taking charge of the lives of children in our care; keeping a watchful eye on data and outcomes and using that information to guide our actions; ensuring that the voices of youth are an ever‐present part of decisions and processes that will chart their future; and educating ourselves about best practices and new approaches. This article also discusses new opportunities that now exist to support foster youth as they move into adulthood, including new federal legislation that—for the first time—will allow states to support foster youth beyond age eighteen. Finally, this article provides a backdrop for this Special Issue and summarizes the insightful articles and innovative thinking contained herein.     

A CALL TO CONGRESS TO GIVE BACK THE FUTURE: END THE "WAR ON DRUGS" AND ENCOURAGE STATES TO RECONSTRUCT THE JUVENILE JUSTICE SYSTEM

While the "War on Drugs" has been criticized in many respects, there has been little attention given to the detrimental impact it has had on children. Fortunately, both state and federal governments are recognizing the problem and have begun taking steps to combat the negative effects the "War on Drugs" has had on children. More work however, still needs to be done. This Note advocates for Congress to amend the Juvenile Justice Delinquency and Prevention Act to induce states to offer rehabilitation to nonviolent youth drug offenders, rather than incarceration, which will reduce incarceration and its detrimental effect on children, promote public safety and save money. As a funding stipulation, the amendment will require states to develop and implement deinstitutionalization programs for nonviolent juvenile drug offenders.     

Ontogeny of Size and Shape Sexual Dimorphism in the Ilium: A Multislice Computed Tomography Study by Geometric Morphometry

We studied sexually dimorphic differences in the ilium using geometric morphometric analysis of 10 osteometric landmarks recorded by multislice computed tomography, based on three‐dimensional reconstructions of 188 children (95 boys, 93 girls) of mixed origins living in the area of Toulouse, southern France, and ranging in age from 1 to 18 years. We used geometric morphometrics methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). On the basis of statistical significance testing, the ilium shape became sexually dimorphic at 11 years of age, although visible shape differences were observed as early as 1 year of age. There was no statistically significant difference in size between sexes. Trajectories of shape (development) and size (growth) differed throughout ontogeny and between sexes.     

Ontogeny of Size and Shape Sexual Dimorphism in the Pubis: A Multislice Computed Tomography Study by Geometric Morphometry

Few studies have been conducted to determine sex differences in the immature coxal bone and the results were often contradictory. The authors studied sexual dimorphic differences of the pubis using geometric morphometric analysis of five osteometric landmarks recorded by multislice computed tomography (MSCT), based on three‐dimensional reconstructions of 188 children (95 boys, 93 girls) living in the region of Toulouse, southwestern France, ranging in age from 1 to 18 years old. They used geometric morphometric methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). Based on statistical significance test results, the pubic shape became sexually dimorphic at 13 years old, although visible shape differences were observed as early as 9 years old. This work showed that the trajectories of pubis shape (development) and size (growth) differed throughout ontogeny and between sexes.     

Risk Factors for Family Abduction: Demographic and Family Interaction Characteristics

Previous research in the study of family abduction has been plagued by three problems in efforts to establish risk factors for the experience of these events: (1) failure to use appropriate comparison groups; (2) focus on only the most severe cases of abduction, without consideration of the full spectrum of these events; and (3) use of data drawn only from some “reported” source (i.e., police, court, or missing children agency reports). This paper addresses these three methodological difficulties, using data drawn from a national sample of families, and including both abducted and nonabducted children. We find that race, age of children, family size, and incidence of violence in the family all appear to bear on the risk of experiencing a family abduction event. Further, recency of divorce or separation appears to be associated with the risk for more serious or alarming cases of family abduction.     

Adoptions Gone Awry: Enhancing Adoption Outcomes Through Postadoption Services and Federal and State Laws Imposing Criminal Sanctions for Private Internet Rehoming

The federal government should invest in adopted children who make up the future of the country and are in dire need of rehabilitation and therapy because of their past circumstances. If the government steps in to rescue vulnerable children from inadequate or abusive birth parents by removal, it should also intervene when adopted families are faced with behavioral problems of adopted children that the adopted parents cannot address on their own. Postadoption services need to be accessible and effective to ensure the success of adopted families. Assisting families in crisis postadoption will lower the instances of dissolution and rehoming and keep adoptive families intact. In cases in which postadoption services fail, uniform federal legislation is necessary to make it a federal crime to advertise children for adoption on the Internet without proper certification and state legislation is required to make it a crime to pass on adopted children to strangers without judicial consent, to dissuade Internet rehoming. Internet rehoming of adopted children should be a serious crime as it is tantamount to child trafficking.© 2014 Association of Family and Conciliation Courts

Key Points for the Family Court Community:
• Postadoption services need to be more accessible and more narrowly tailored to the needs of adoptive families to ensure the success of adoptions.
• Better postadoption services create better adoptive families and adoptive parents will not reach the point of dissolution or private Internet rehoming.
• Adoptive parents should be provided with information regarding all available postadoption resources after adoption is finalized and a government Web site should be created that lists all available resources.
• The federal government needs to provide funding to states that specifically target postadoption services.
• A uniform federal statute is required to punish parties who use Internet forums to avoid government oversight and privately rehome their adopted children.
• States should enact laws that criminalize the unauthorized interstate placements of children.

     

Sex determination and estimation of stature from the long bones of the arm

The determination of sex and the estimation of stature from bones play an important role in identifying unknown bodies, parts of bodies or skeletal remains. In medico-legal practice statements on the probable sex of a decomposed body or part of a body are often expected even during autopsy. The present study was, therefore, restricted to few easily accessible dimensions from bones which were prepared only by mechanically removing soft tissues, tendons and ligaments. The specimens came from the Anatomical Institutes in Munich and Cologne from the years 1994-1998 including a total of 143 individuals (64 males and 79 females). The mean age was 79 years (46-108), the mean body height 161cm (134-189). The following measurements were taken: maximum humeral length (mean: 33.4cm in males; 30.7cm in females), vertical humeral head diameter (mean: 5.0cm in males, 4.4cm in females), humeral epicondylar width (mean: 6.6cm in males; 5.8cm in females), maximum ulnar length (mean: 26.5cm in males, 23.8cm in females), proximal ulnar width (mean: 3.4cm in males, 2.9cm in females), distal ulnar width (mean: 2.2cm in males; 1.8cm in females), maximum radial length (mean: 24.6cm in males; 22.0cm in females), radial head diameter (mean: 2.6cm in males, 2.2cm in females) and distal radial width (mean: 3.6cm in males; 3.2cm in females). The differences between the means in males and females were significant (P<0.0005). A discriminant analysis was carried out with good results. A percentage of 94.93% of cases were correctly classified when all measures of the radius were applied jointly, followed by humerus (93.15%) and ulna (90.58%). Applied singly, the humeral head diameter allowed the best distinction (90.41% correctly grouped cases), followed by the radial length (89.13%), the radial head diameter (88.57%) and the humeral epicondylar width (88.49%). The linear regression analysis for quantifying the correlation between the bone lengths and the stature led to unsatifactory results with large 95%-confidence intervals for the coefficients and high standard errors of estimate.