Forensic pitfalls

The lives of forensic psychiatrists are complicated and subject to stressful experiences because they have elected to interact with a social system very different from their own. This article presents discussion of these frequently troublesome areas commonly encountered by forensic psychiatrists in trying to respond to the law's requests and needs without sacrificing their medical integrity: (1) legitimate definition of expertise; (2) reasonable medical certainty; (3) generally accepted standard of care. They are explored with emphasis on the exercise of self-assessment by the involved forensic psychiatrists lest their incautious application of knowledge and expertise become pitfalls of their own making.     

As outcomes measurement and management become widespread, providers should beware of legal pitfalls

Until new statutes and court decisions clarify the law applicable to outcomes research, providers will continue to face new questions. In the meantime, paying careful attention to satisfying the requirements of existing laws protecting peer review information will put providers in the best position to minimize their exposure. Providers should review their current outcomes measurement and management systems to ensure that (1) they are structured to take full advantage of the confidentiality protections available under state law, and (2) appropriate access to outcomes data for those who need it is clearly provided for in the relevant documentation.     

19个STR在人群地域推断中的初步探索

本文汇总了近二十年19个常染色体STR(Short Tandem Repeat)在25个省份汉族人群中的研究报道。统计发现19个STR共有642个等位位点,其中等位位点数目最少的为D8S1179,有20个;数目最多的是D21S11,有60个等位位点。杂合度(He)为0.6203(TPOX)~0.9187(Penta E),多态性指数(PIC)为0.5600(TPOX)~0.9130(Penta E)个体识别率(PD)为0.6279(TPOX)~0.9859(Penta E)。19个STR的CPD、CPE和CMP分别为0.999999999999999999998、0.99999993和1.97×10^-21。通过POPTREE2.0对25个省份汉族19个STR进行聚类分析,发现我国汉族人群的分布有明显南北方地域差异,分为南方省份和北方省份。通过主成分分析也进一步证明了我国汉族人群分布具有南北方地域特点。另外,通过对15个少数民族与其所在省份汉族人群和无关省份汉族人群的STR聚类分析,发现新疆维吾尔族、哈萨克族与新疆汉族聚类在一个亚分支中;广西汉族、云南汉族与该省份的少数民族聚类在一起,这也进一步证明了我国汉族人群和少数民族具有一定的地域分布特性。综上所述,STR不仅可以应用于个体识别、亲子鉴定等,未来还可用于人员地域推断。伴随着STR数量的不断增加和人员STR数据库的不断丰富以及与测序技术的结合,STR技术将会在各类案件中发挥更多作用。     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.     

论中国马克思主义发展的前提、特点和主要障碍

中国马克思主义是马克思主义普遍原理与中国具体情况相结合的产物,毛泽东思想、邓小平理论和"三个代表"重要思想是中国马克思主义发展史上的伟大丰碑.中国马克思主义发展形成了自己的特点,这就是正确认识和坚持马克思主义基本原理,科学总结历史经验教训,在反倾向斗争中主要是防"左"反"左",根据实践的需要,在理论观点上对马克思主义作突破性的发展.     

Statistical inference and meta-analysis

Statistical inference is a common feature of meta-analysis. Statistical inference depends on a formal model that accurately characterizes certain key features of how the studies to be summarized were generated. The implications of this requirement are discussed and questions are raised about the credibility of confidence intervals and hypothesis tests routinely reported.

Pharmacist misconduct: the pitfalls of practice

This article identifies the changing role of pharmacists in the provision of health care and analyses 78 complaints against pharmacists over a recent 12-year period in New South Wales, finding that the majority of complaints were in relation to the oversupply of particular medications, from which some pharmacists made significant financial gains. A number of other areas of complaint were identified, including issues in relation to the recording and labelling of medications and the roles and responsibilities of pharmacists, dispensing errors, fraud, and sexual misconduct. As the roles of pharmacists continue to expand, with the growth of "compounding chemists", and the suggestion that pharmacists are now performing basic medical tasks which were once the domain of a general practitioner, it is increasingly important that pharmacy take its place in any debates about the provision and regulation of health services.     

Suicide by fire in a car trunk: a case with potential pitfalls

We present an unusual case in which an adult female committed suicide by fire while enclosed in the trunk of her vehicle. A finding of suicide was reached only because several key investigative facts were uncovered. Without these discoveries the case may still remain open as a suspicious death. Fire is rarely used as a mechanism of suicide in Western culture, and, as such, similar cases should be reported to advance our recognition of this phenomenon.     

Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as ‘of internal origin’ based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.     

基于27-plex SNPs的四川地区四个族群遗传推断研究

目的基于27-plex SNPs族群推断体系对四川地区汉族、藏族、羌族及彝族四个族群遗传结构及成分进行研究。方法使用27-plex SNPs试剂检验四个族群1054份样本并获取SNPs位点分型,利用主成分分析、聚类分析及系统发育树综合分析族群间遗传关系,使用族群推断软件(DNA Ancestry Analyzer,DAA)推断样本的族群来源并统计推断结果的准确性。结果系统发育树显示四川汉族、藏族、羌族、彝族和其他东亚族群共同聚为一支;主成分分析和聚类分析结果显示四川汉族、藏族、羌族及彝族主要祖先成分均为东亚。除1例样本祖先来源不排除东亚或混合族群外,其余1053份样本均来源于东亚。结论四川地区汉族、藏族、羌族和彝族均为典型的东亚族群,藏族、彝族和羌族的遗传关系较近。使用27-plex SNPs族群推断系统对四川汉族、藏族、羌族和彝族进行遗传推断,结果可靠。     

脑组织与其相关分析推断死亡时间的研究进展

推断死后间隔时间(postmortem interval,PMI)一直是法医学鉴定中需要解决的重要问题之一.可用于推断PMI的尸体检材有很多种,脑组织因其独特的解剖学位置与生理功能,是推断PMI的重要检材之一.本文从三个方面将根据脑组织推断PMI的方法进行综述,包括了通过脑组织的温度、形态特点等尸体现象推断PMI;通过...     

根据足迹掌宽值推断体重公式的修正计算

目的为提高实战中对留痕人体重推断的准确率;方法根据足迹长宽的比值更能准确地反映人的胖瘦这一规律,提出修正计算公式m=2.5M/R进行初步实验检验;结果该方法是对原根据足迹掌宽值推断留痕人体重公式的补充,对偏离标准体态的人,用该公式修正使足迹掌宽值与体重的关系有了较为准确的反映。