Acronyms of dying versus patient autonomy

In medical practice in Germany and several other countries abbreviated orders linked to end-of-life decisions, such as DNR (do not resuscitate), are increasingly used. In order to investigate their legal status, this article gives an overview of the recently passed German law, which regulates the process of end-of-life decision-making and the use of living wills, giving primacy to patient autonomy. Concerning the risk of misinterpretation of acronyms, the article describes the impacts of such orders on patient autonomy and safety and suggests a clear systematic classification of the different DNR orders in order to investigate their legal status under the German law. Their general binding force is to be acknowledged, depending on its origination and the fulfilment of certain requirements.     

Suicidal single gunshot injury to the head: differences in site of entrance wound and direction of the bullet path between right- and left-handed--an autopsy study

The aim of this study was to determine the differences in the anatomical site of a gunshot entrance wound and the direction of the bullet path between right- and left-handed subjects who committed a suicide by a single gunshot injury to the head. The retrospective autopsy study was performed for a 10-year period, and it included selected cases of single suicidal gunshot head injury, committed by handguns. We considered only contact or near-contact wounds. The sample included 479 deceased, with average age 47.1 ± 19.1 years (range, 12-89 years): 432 males and 47 females, with 317 right-handed, 25 left-handed, and 137 subjects with unknown dominant hand. In our observed sample, most cases involved the right temple as the site of entrance gunshot wound (about 67%), followed by the mouth (16%), forehead (7%), left temple (6%), submental (2%), and parietal region (1%). The left temple, right temple, and forehead were the sites of the gunshot entrance wounds, which were the best predictors of the handedness of the deceased (Spearman ρ = 0.149, P = 0.006). Our study showed that the direction of the bullet intracranial path in cases of suicide was even a more potent predictor of the handedness of the deceased (Spearman ρ = 0.263, P = 0.000; Wald = 149.503, P = 0.000).     

Fatal subarachnoid hemorrhage during sexual anal self-stimulation in a female: a case report

Sudden death after sexual activity is a well-known entity, but it is rare in females. Herein we present a case of fatal, massive subarachnoid hemorrhage from a ruptured berry-shaped aneurysm, during sexual anal self-stimulation. A 39-year-old woman was found dead on a couch, with the wooden handle of a spring twirl whisk inserted inside her anus and rectum as a dildo-like object. External examination was unremarkable with no signs of injuries. Intracranial examination showed a massive subarachnoid hemorrhage, up to 6 mm in thickness, especially around the brainstem and the inferior side of the brain. After removing the blood clots, the saccular aneurysm was found at the site of the bifurcation of the left internal carotid. In this case study, we underline the utility of forensic autopsy, as well as death scene investigation, in reconstructing the mechanism of death, as well as the dynamics of the event.     

Party,Regional and Linguistic Proportionality Under Majoritarian Rules: Swiss Federal Council Elections

The elections to the Swiss Federal Council in December 2015 re‐established a system of party‐centred concordance, cherished in consociational theory, consisting of two representatives of the Swiss People's Party, two Radicals, two Social Democrats and one Christian Democrat. At the same time, the government has rarely been as unbalanced in terms of the representation of Switzerland's languages and regions. The article analyses the concept of concordance with regard to both aspects of governmental inclusiveness. It also highlights the crucial role of electoral rules used in governmental elections. It argues that they resemble the Alternative Vote, a majoritarian electoral system that has been criticized in consociational theory but prescribed by the rival, centripetalist approach to power sharing.     

The mechanics of democracy promotion tools: bridging the knowledge-to-practice gap

By drawing upon the literature that diagnoses the gap between academics and practitioners, this article categorises and describes the traditional democracy promotion tools developed by international governmental and non-governmental organisations to bridge the gap between knowledge and practice. Further, it examines the utility of ICTs in promoting and upholding democratic change. The findings inform considerations and specific recommendations offered to the tool developers on how to converge traditional and new democracy promotion tools. These are intended to assist in focusing tool design and development efforts, and promoting standardisation and innovation.