Evaluation of pediatric skull fracture imaging techniques

Radiologic imaging is crucial in the diagnosis of skull fracture, but there is some doubt as to whether different imaging modalities can accurately identify fractures present on a human skull. While studies have been performed to evaluate the efficacy of radiologic imaging at other anatomical locations, there have been no systematic studies comparing various CT techniques, including high resolution imaging with and without 3D reconstructions to conventional radiologic imaging in children, we investigated which imaging modalities: high-resolution CT scan with 3D projections, clinical-resolution CT scans or X-rays, best showed fracture occurrence in a pediatric human cadaver skull by having an expert pediatric radiologist examine radiologic images from fractured skulls. The skulls used were taken from pediatric cadavers ranging in age from 5 months to 16 years. We evaluated the sensitivity and specificity for the imaging modalities using dissection findings as the gold standard. We found that high-resolution CT scans with 3D projections and conventional CT provided the most accurate fracture diagnosis (single-fracture sensitivity of 71%) followed by X-rays (single-fracture sensitivity of 63%). Linear fractures outsider the region of the sutures were more identifiable than diastatic fractures, though the incidence of false positives was greater for linear fractures. In the two cases where multiple fractures were present on the same anatomical skull location, the radiologist was less likely to identify the presence of additional fractures than a single fracture. Overall, the high-resolution and clinical-resolution CT scans had the similar accuracy for detecting skull fractures while the use of the X-ray was both less accurate and had a lower specificity.     

The Role of Semi-Direct Democracy in Shaping Swiss Federalism: The Behavior of Cantons Regarding Revision of the Constitution, 1866-1981

Swiss federalism operates as a semi-direct democracy involvingreiterated constitutional choice by the people and the territorialunits. In this respect, the Swiss federal process is uniquein comparison to other federal systems. An analysis of constitutionalreferenda and constitutional initiatives conducted from 1866to 1981 was undertaken in order to characterize the politicalbehavior of Swiss cantons concerning the referenda that havealtered the original Constitution of 1848. The behavior of thecantons may be explained by their sociopolitical features. Threegroups of cantons are distinguished by their pattern of behaviortoward proposed revisions of the federal Constitution. In addition,a comparison was made of the similarity and divergence of thecantons with the pattern of behavior of the entire federationin order to measure the degree of cohesion of the Swiss partnership.Strikingly, some of the cantons with a minority subculture weremore frequently in the winning coalition than were some cantonsthat share more of the characteristics of the majority culture.The Swiss federal process is found to strengthen nation-buildingby means of the continual adaptation, along with some innovation,of the original constitutional design on the part of the peopleas a whole and the cantons.     

Books,Bureaus, and the Historiography of Cameralism

This paper traces a deep rift in the historiography of cameralism, demonstrating how historians have systematically separated cameralist writings from the context of the Holy Roman Empire’s fiscal chambers. Scholarship on the subject has been largely defined by an artificial separation between “cameralists of the book” and “cameralists of the bureau.” I argue that it is time to interrogate this distinction, which is itself a legacy of the nineteenth century.     

The characteristics of injuries to the thoracic spine in children with a forward flexion

Excessive flexure of the thoracic spine in childhood may result in latent lesions of the middle thoracic vertebra and intervertebral disks visible by X-ray and on sagittal cuts. The prior deformation may be judged by their morphological signs. Ability of infantile vertebral bodies to recover their form after load removal reduces reliability of mathematical processing of X-ray data. Use of X-ray method for examination of thoracic spine in expert practical work makes it possible to detect lesions and mechanism of their formation.     

Drowning in the bath tub after choking: Unusual death, accident or suicide? Reconstruction of an unusual fall

A thirteen-year old girl attending a special school who had been suffering from genuine epilepsy for about one year was found dead completely clothed in the full bathtub in the bathroom of her parent's flat. The characteristic features of death by drowning but also signs of strangulation as well as a condition after shackling of the hands were found in the forensic post-mortem examination and autopsy. The putative strangulation instrument was a pair of tights which was floating in the bathwater. The hands were probably tied with the lace of a sneaker. In the further course of events, the inquiries and investigations initially commenced on the assumption of a capital crime gave reason to consider suicide. A reconstruction experiment under comparable external conditions indicates that this is possible. From a forensic-psychiatric point of view, an exacerbative mental crisis situation can be inferred as a final motive from the known personality configuration and the immediate circumstances. The tragic outcome in the final phase appears to have been determined by the additional complication of a provoked grand mal epilepsy attack. All in all, this hypothesis is the most plausible. However, subjective and objective observations do not rule out the possibility of homicide.