The concept of forensic emergency medicine as illustrated by an unusual complication of pulmonary artery catheterization

Forensic pathologists are regularly confronted with emergency and invasive medical procedures performed on critically ill or traumatized patients. Basic knowledge of such procedures and their possible complications is therefore mandatory in medico-legal practice. In this article, we describe a very unusual complication of pulmonary artery catheterization: through-and-through perforation of the carotid artery, initially without hemodynamic consequence. Death resulted from an aggravation of the preexisting cerebral edema (secondary to a craniocerebral trauma). The misplacement of the pulmonary artery catheter was clinically missed because the guidewire was initially deflected on the cervical spine towards the subclavian vein where the catheter--by chance--entered the circulatory system and followed its normal route further. The forensic importance of leaving all invasive medical devices in situ on a deceased person when a medico-legal autopsy is to be expected and the mutual interaction between emergency and forensic medicine (forensic emergency medicine) are discussed.     

Effect of Lower Third Molar Segmentations on Automated Tooth Development Staging using a Convolutional Neural Network

Staging third molar development is commonly used for age estimation in subadults. Automated developmental stage allocation to the mandibular left third molar in panoramic radiographs has been examined in a pilot study. This method used an AlexNet Deep Convolutional Neural Network (CNN) approach to stage lower left third molars, which had been selected by manually drawn bounding boxes around them. This method (bounding box AlexNet = BA) still contained parts of surrounding structures which may have affected the automated stage allocation performance. We hypothesize that segmenting only the third molar could further improve the automated stage allocation performance. Therefore, the current study aimed to determine and validate the effect of lower third molar segmentations on automated tooth development staging. Retrospectively, 400 panoramic radiographs were collected, processed and segmented in three ways: bounding box (BB), rough (RS), and full (FS) tooth segmentation. A DenseNet201 CNN was used for automated stage allocation. Automated staging results were compared with reference stages – allocated by human observers – overall and per stage. FS rendered the best results with a stage allocation accuracy of 0.61, a mean absolute difference of 0.53 stages and a Cohen's linear κ of 0.84. Misallocated stages were mostly neighboring stages, and DenseNet201 rendered better results than AlexNet by increasing the percentage of correctly allocated stages by 3% (BA compared to BB). FS increased the percentage of correctly allocated stages by 7% compared to BB. In conclusion, full tooth segmentation and a DenseNet CNN optimize automated dental stage allocation for age estimation.     

Authority in statebuilding as communicative practice. The Joint Working Group on the Constitutional Framework in Kosovo

Post-war constitution-making touches the future identity of the concerned society. In externally led democratization, it can turn into a challenging negotiation process between international and so-called local actors. But who can claim the authority to define and interpret identity and fundamental norms of society, and on what grounds? Based on an analysis of the “Joint Working Group on the Constitutional Framework” held in spring 2001 in Kosovo, the article argues that external actors have a structural disadvantage in the authoritative communication with local actors, even if equipped with a strong international mandate. While external actors can set the opportunity structures to negotiate constitutional politics, local actors will use every chance to publically claim authority on their behalf in the process. Guided by the theoretical framework of interpretative authority (Deutungsmacht), the article concludes that we have to understand authority in statebuilding primarily, not as an attribute of actors, but as an outcome of communicative practices.     

Women’s Participation in Peace Negotiations and the Durability of Peace

There is an emerging consensus that women’s participation in peace negotiations contributes to the quality and durability of peace after civil war. However, to date, this proposition has remained empirically untested. Moreover, how women’s participation may contribute to durable peace has not been systematically explored. This article uses a mixed method design to examine this proposition. Our statistical analysis demonstrates a robust correlation between peace agreements signed by female delegates and durable peace. We further find that agreements signed by women show a significantly higher number of peace agreement provisions aimed at political reform, and higher implementation rates for provisions. We argue that linkages between women signatories and women civil society groups explain the observed positive impact of women’s direct participation in peace negotiations. Collaboration and knowledge building among diverse women groups contributes to better content of peace agreements and higher implementation rates of agreement provisions. We substantiate this argument with qualitative case study evidence and demonstrate how collaboration between female delegates and women civil society groups positively impacts peace processes. Our findings support the assumption that women’s participation in peace negotiations increases the durability and the quality of peace.     

Von der Organisation Krankenhaus zum Behandlungsnetzwerk?

The following paper is based on ethnographic studies in German hospitals and focuses on medical actions and decision-making. As the investigation was conducted as a panel, it is possible to perceive of how the organizational changes have affected the medical work in hospitals. In the first part of the study, from 2000 to 2002, field research took place in four different types of departments in several hospitals. In the second part of the study, in the year 2004, the general ward and the department of abdominal surgery were revisited. In the time period between the two field-research phases the hospitals in Germany were experiencing an extensive process of organizational change. On the one hand, the introduction of the new “Diagnose Related Groups” (DRG) brought a new cost accounting structure. The base for calculating the cost is now no longer length of hospital stays, but a billing system related to diagnosis. On the other hand, connected to the ongoing privatization of hospitals, concepts of modern management (computer based “controlling”, “outsourcing” and centralization of important functions) are beginning to enter into hospital life. These processes are significantly changing the context of medical work and also the way in which medical decisions are processed.     

Einigkeit, zwei kompatible Therapieansätze und etlicher Streit. Antwort auf Christian Welzel

Ohne Zusammenfassung     

Berlin's Republic: Parliamentary government in a German land

Berlin is the only German Land that has had to manage its own reunification and originally many hoped that it would turn into a model for east–west reconciliation. Yet 15 years later there is widespread consensus that Berlin failed to live up to the challenges of the time and adequately deal with the consequences of reunification. Instead of embarking on structural reforms Berlin produced its own version of a Reformstau. The article describes and examines some basic features of the party system in Berlin and the Berlin polity. It will thus give an answer to the question as to how unification affected the institutional setting in this Land. Overall it will be shown that the Reformstau in Berlin cannot be explained by a fragmented political system or powerful veto players. Political stagnation in Berlin rather was due to the combined effects of party system change, institutional stagnation, and constitutionally inhibited political leadership.     

Management im Krankenhaus – Eine Fallstudie zur Bearbeitung der Innen- und Außenspannungen unter den Bedingungen des deutschen DRG-Systems

The article discusses the management of a municipal hospital from the standpoint of its currently typical internal and external tensions. Based on the results of a reconstructive study, the paper investigates how the associated perspectives of reflection are processed and related to one another by actors. This provides insight into the main problems experienced by a contemporary hospital. In addition to the theoretical background of management sociology, the discussion draws attention to what research needs, both methodologically and metatheoretically, to be able to be sensitive not only to the empirical co-presence of multiple institutional logics and perspectives, but also to permit the question as to how these logics and perspectives are related to each other in concrete practice.     

A test of the ‘uneconomic culture’ thesis: An economic rationale for the ‘sacred cow’

This paper examines the validity of the ‘uneconomic culture’ thesis. A common assertion is that livestock have limited commercial value to the African, being accumulated mainly for social reasons. Two hypotheses are tested: (1) livestock accumulation can be profitable to the individual even if society incurs losses by such behaviour and (2) livestock purchases are the African's best investment opportunity. Support of the first hypothesis is found by indicating that the property system leads to divergences between private and social benefits. Support of the second hypothesis is indicated by calculating the present value of cattle in farming.     

Comments on ‘vietnamese anticolonialism’

Abstract

The review by Nguyen Cong Binh of Vietnamese Anticolonialism deals with the larger historical perspective of the anti-colonial movement from 1885 to 1925, questions of methodology, and theoretical concepts about Vietnamese history. Some aspects of the book are particularly interesting and germane to American readers, even if they have only a casual familiarity with contemporary Vietnamese history.