Correlation of age and ossification of the medial clavicular epiphysis using computed tomography

OBJECT: The aim of this study was the examination of relationship between the age and the ossification of medial epiphysis of the clavicle referred to CT examination. MATERIALS AND METHODS: Concerning the epiphyseal ossification of the clavicle CT's of 100 patients (50 male and 50 female) between 16 and 25 years (10 patients for each year) were analyzed by three viewers. RESULTS: In the legal relevant age segment (16-25a) we saw a turnover from stage 3 to stage 4 at the age of 21 years. The calculated empiric distribution function showed 95% of stage 4 over 21 years while 75% of the patients with stage 3 were under 21 years. A reconstruction kernel suitable for osseous structures should be used, images should be viewed or presented in a bone window. CONCLUSION: According to these results it can be concluded that a person with stage 4 is probably 21 years or older, while a stage 3 leads to an estimated age under 21 years. On the other hand, a confidence level of 99.67% is not reached. Therefore, CT of the medial epiphysis of the clavicle will only be suitable for age estimation around the age of 21 years, if this relevant statistic obstacle is defeated. Bearing this in mind, further studies are needed to evaluate slice thickness as the most critical parameter.     

Government Risk-Financing Pools: An Assessment of Current Practices

Since 1970, state and local governments have experienced two “insurance crises;” the first occurred in the mid- to late-1970s and the second in the mid-80s. The result has been a twenty-year period of time in which state and local governments have been able to afford insurance only intermittently-if insurance has been available at all. In response to this problem, local governments, government associations, and state governments created alternative risk-finartcing mechanisms to provide coverage for themselves. These mechanisms, commonly referred to as self-insurance pools, enable local governments within a state to pool together risks and resources to finance the costs of fortuitous losses. In 1988, the first comprehensive examination of pooling practices was undertaken through a nationwide survey. This article reports the findings from the first follow-up study since the 1988 survey and further extends knowledge of pooling and pooling practices.