Post-mortem examination prior to cremation--an instrument to verify the quality of medical post-mortems and uncover non-natural deaths?

The external post-mortem examination, its deficient quality and possible causes have been the subject of numerous political and professional discussions. The external post-mortem examination is the basis for the decision whether further criminal investigations are required to clarify the cause of death. It is thus an essential instrument to ensure legal certainty. Before cremation, a second external post-mortem examination is performed by a public medical officer to make sure that errors of the first post-mortem are corrected. In the present study, cases were retrospectively analyzed in which a forensic autopsy had been ordered on the basis of the results of the post-mortem examination performed before cremation. The entries on the death certificate regarding the manner and cause of death were compared with the autopsy results. Between 1998 and 2007, 387 autopsies were ordered after external examination before cremation. In 55 cases (14.2%), the autopsy revealed a non-natural death, although a natural death had been attested on the death certificate. In descending order, a wrong manner of death was attested by clinicians, general practitioners and emergency physicians. With regard to the place where the first external post-mortem had been performed the lowest error rate was seen in nursing homes. Concerning the cause of death, discrepancies between the first post-mortem and autopsy were found in 59.4% of the cases. In this respect, general practitioners and clinicians were ranking first, whereas in nursing homes the cause of death was wrongly assessed in over 70% of cases. At present, the medical post-mortem does not meet the required quality standards, especially with regard to legal certainty. Determination of the cause of death on the basis of the external post-mortem examination is a challenging task even for the experienced medical examiner. As to the categorization of the manner of death it has to be stated that non-natural deaths are often not recognized or that the possibility to certify a death as unclear is not sufficiently used. As a result, it seems important to demand intensive, qualified, additional training in external post-mortem examinations for physicians.     

Intergenerational transmission of longevity is not affected by other familial factors: evidence from 16,905 Dutch families from Zeeland, 1812-1962

ABSTRACT

Studies have shown that long-lived individuals seem to pass their survival advantage on to their offspring. Offspring of long-lived parents had a lifelong survival advantage over individuals without long-lived parents, making them more likely to become long-lived themselves. We test whether the survival advantage enjoyed by offspring of long-lived individuals is explained by environmental factors. 101,577 individuals from 16,905 families in the 1812–1886 Zeeland cohort were followed over time. To prevent that certain families were overrepresented in our data, disjoint family trees were selected. Offspring was included if the age at death of both parents was known. Our analyses show that multiple familial resources are associated with survival within the first 5 years of life, with stronger maternal than paternal effects. However, between ages 5 and 100 both parents contribute equally to offspring’s survival chances. After age 5, offspring of long-lived fathers and long-lived mothers had a 16-19% lower chance of dying at any given point in time than individuals without long-lived parents. This survival advantage is most likely genetic in nature, as it could not be explained by other, tested familial resources and is transmitted equally by fathers and mothers.     

Scheduled Castes Policies in Interstate Perspective: Constitutional Power,Argumentative Practices,and Governance in India

The article discusses legal and administrative dimensions that are relevant for comparing development policies for the Scheduled Castes across Indian states. The policies for the Scheduled Castes are subject to more central control than several other policy domains. The article therefore highlights the logic in India’s multilevel system of governance while specifying the constitutional meaning of the Scheduled Caste category, its related terms and discursive relevance. This provides a background to outline the relevant institutional dimensions at the center of India’s political system and the level of the regional states. The article suggests that the Scheduled Castes Development Corporations provide a useful basis to develop interstate comparisons. However, the comparison of development policies for Scheduled Castes cannot be complete without acknowledging the extent to which policies are often a result of argumentative practices among Dalit movements and actors in context, since their demands may generate decisions or information about policies.     

Parent-Child Agreement on Parent-to-Child Maltreatment

Parent-child agreement on child maltreatment was examined in a multigenerational study. Questionnaires on perpetrated and experienced child maltreatment were completed by 138 parent-child pairs. Multi-level analyses were conducted to explore whether parents and children agreed about levels of parent-to-child maltreatment (convergence), and to examine whether parents and children reported equal levels of child maltreatment (absolute differences). Direct and moderating effects of age and gender were examined as potential factors explaining differences between parent and child report. The associations between parent- and child-reported maltreatment were significant for all subtypes, but the strength of the associations was low to moderate. Moreover, children reported more parent-to-child neglect than parents did. Older participants reported more experienced maltreatment than younger participants, without evidence for differences in actual exposure. These findings support the value of multi-informant assessment of child maltreatment to improve accuracy, but also reveal the divergent perspectives of parents and children on child maltreatment.     

Measuring the intercondylar shelf angle using radiographs: intra- and inter-observer error tests of reliability

This study presents a test of intra- and inter-observer measurement error rates of the intercondylar shelf angle of the distal femur, as measured on lateral radiographs. This measurement is the central element of a method to determine racial affiliation from the distal femur. Four observers independently radiographed a set of 33 complete and partial femora from collections housed at the Joint POW/MIA Accounting Command, Central Identification Laboratory. Each observer then measured the intercondylar shelf angles in each radiograph, following the original method's guidelines. A supplementary inter-observer error test was conducted by four additional observers on one set of radiographs. Statistically significant differences were found for both intra- and inter-observer error based on the results of Student's t-tests, paired samples t-tests, and ANOVA analyses. The results of this study indicate that further experimentation should be undertaken in order to develop refined measurement techniques that may help improve standardization and reduce the observer error rates.     

Comparing social,emotional, and behavioral health risks among youth attending public versus parochial schools

Parochial schools are assumed to provide better social and academic experiences; however, few studies account for selection bias when comparing with public schools. This study contrasted public versus parochial schools using propensity score matching across a range of outcomes (e.g., perceptions of school, emotional symptoms, substance use, bullying). Using a sample of 58 public and 5 parochial high schools, the nonmatched analyses suggested a significant advantage for parochial schools students (e.g., better on 23 of 32 indicators). However, the propensity score matched analyses revealed nine differences (e.g., weapon carrying, smoking), two of which (i.e., stress and cyberbullying) favored public schools. While at first glance parochial schools generally appear to be healthier and safer learning environments, accounting for selection bias, the gap was narrowed. Students in parochial schools may struggle with issues related to social, emotional, and behavioral health risk, and thus prevention programs should also be implemented in these settings.