Performance-based partnership Agreements for the reconstruction of the health system in Afghanistan

The reconstruction of the health system in Afghanistan is in its early stages, and donors have proposed Performance-based Partnership Agreements (PPAs) through which to subcontract the delivery of health services to private organisations, both for-profit and not-for-profit. Beyond ideological debates, this article sets out to explain the model underlying the PPA initiative and sheds light on empirical data concerning the assumed benefits of such an approach. The article studies privatisation and the contracting-out of health services, though there is as yet no information that can demonstrate the superiority of private over public service provision. Similarly, the merits of subcontracting have not been fully proven and such arrangements raise several ethical issues. Where PPAs are to be attempted, it is important to remain cautious and to ensure that operations are organised in such a way as to permit proper comparison. The paper concludes with recommendations to organisations involved in or considering the advantages of PPAs.     

Child abuse with fatal sequelae in an Essen autopsy sample]

In the Institute of Forensic Medicine in Essen/Germany 24 cases of lethal child battering or neglect have been observed over 17 years from 1973 to 1989. The medicolegal and morphologic findings in these cases are presented and compared to the literature. The patterns of abuse/neglect in Essen compare to those frequently reported in the literature: skull/brain traumas caused by blunt impact, multiple hematomas, bone fractures, and symptoms of malnutrition, vitamin deficiency, and general neglect. In many cases the abuse could be shown to have been chronic. In the seven years 1983-1989 the cases of lethal child mistreatment and neglect amounted to 0.18 percent of all autopsies. Five cases of lethal sexual assault in children during the same period are compared to the mistreated cases.     

The detection of aromatic substances in biological material]

The author presents experimental data and suggests a method for extraction of aromatic substances from the blood, urine, lavage water, stomach and its contents, liver and kidneys. The extract is dissolved in 96% ethanol and the aromatic substances are detected in reactions with hydrochloric acid, Marki's reagent, 2,4-dinitrophenylhydrazine, diazotized o-dianisidine, phthivazide, chromotropic acid by UV spectrophotometry, thin-layer and gas-liquid chromatography. The sensitivity of the method is 0.1-0.5 mg %.     

Recycling offenders: Re-incarceration trends in Québec federal penitentiaries

Résumé Les statistiques fédérales au Canada comme aux états-Unis démontrent une croissance alarmante des retours en détention, au cours de la mise en liberté sous condition. Le modèle de gestion du risque qui émerge actuellement dans le contexte d’une ?nouvelle pénologie? semble mener inévitablement à l’augmentation de ces taux de retour. L’étude présentée dans cet article examine le processus de libération et le taux de retour qui en découle, enprivilégiant l’analyse desprises de décision et les mécanismes de gestion des détenus. Dans cette optique, les auteurs ont suivi, pour une période d’un an, tous les hommes libérés des pénitienciers du Québec en 1993. L’analyse a mis en évidence que le modèle de gestion de risque est à base du processus de gestion des détenus et semble avoir uneffet notable sur le ?recyclage? des délinquants. De plus, le type de libération et le type des condition de libération, plut?t que le nombre de condition, font de certains détenus des candidats plus vulnérables aux mécanismes de gestion derisque. Les ?retours? à la suite de manquements aux conditions de mise en liberté sont importants et le système carcéral s’alimente donc de plus en plus de ses propres libérés.      

Unusual suicides with chain saws

Two cases of suicide with bandsaws, undertaken by workers in carpenters' workshops are reported and discussed. Their choice of this method was based on the fact that they knew how dangerous such machines were. Both cases were watched by witnesses, who could not intervene due to the speed of the events. It was possible to exclude accident or homicide.     

Suicide with an unusual shotgun

The authors describe a special case of suicide, committed by a self-constructed nailgun. The inshot-wound, localized in the mouth, primarily remained undiagnosed. The patient survived two weeks and died of pulmonary embolism.     

Micromethod for MN antigen grouping of dried bloodstains

A micromethod based on the absorption elution technique was shown to be applicable to the detection of M and N blood groups of dried bloodstains on cotton cloth. Each antigen M and N was tested using two different types of antisera. Two hundred different bloodstains, stored up to six months, were analyzed. Conclusive results were obtained for M typing on 2.5-mm-long bloodstained threads. For N typing, some cross-reactivity of homozygous M stains with anti-N sera was observed. This may be explained by the structure of the M and N antigens on the red cell membrane.     

Age estimation from the rib by phase analysis: white females

Metamorphosis at the sternal extremity of the rib has already been established as a reliable indicator of age at death. Using a sample of white males, it was shown that an accurate estimation of age can be made by direct examination of the bone itself. However, because of sexual differences in hormonal production and dimorphism in the skeleton, the present study was carried out to develop an appropriate standard for age determination from the sternal rib in white females. The sample consisted of 86 ribs of known age, sex, and race. Observations were made at the costochondral junction with special attention to pit formation (its shape and depth), changes in the walls and rim surrounding it, and overall bone density and texture. Based on changes in these areas, the ribs were separated into nine phases (0 through 8). The most rapid metamorphosis occurred in Phases 1 through 4 (mean ages 14-28) with changes noticeable at 3 to 4 year intervals. After mean age 28, this process slowed, considerably expanding the interval between phases to 10 to 15 years. The female ribs showed both earlier initial pit formation and a different morphologic pattern of aging as compared with males. Statistical analysis revealed that the features chosen to delineate the phases are valid predictors of age. This study has shown that the sternal rib can provide an accurate estimation of age in females spanning a mean age of 14 to 76 years.