Polysarcia adiposa: morbid obesity

From October 1988 to March 2005, there were at least 92 autopsy cases where morbid obesity was present and/or where it was attributed to the cause of death in the coronial district of Auckland, New Zealand, a city with a population of over 1 million people. Obesity has been researched internationally, and much is known about associated comorbidities such as atherosclerotic disease, hypertension, and diabetes, to name a few. However, in the morbidly obese (body mass index>or=40 kg/m2), only 14 of 92 cases were found to have ischemic heart disease due to coronary atherosclerosis as the principal cause of death, and slightly over half (48/92) have some degree (mild, moderate, severe) of coronary atheroma. There is a strong positive correlation between heart weight and body weight. Only 8 livers were normal, all others showing some form of steatosis, venous congestion, and fibrosis/cirrhosis. The mean weights of the heart, lungs, and liver were above the normal reference range in almost all cases. In conclusion, the study did not follow the widely published finding of the positive correlation between morbid obesity and ischemic heart disease in terms of mortality, but the study was consistent with other studies on the organ manifestations of morbid obesity, particularly for the heart, lungs, and liver.     

Higher education and the general [lack of] agreement on trade in services: from Doha to Hong Kong and beyond

What international framework, if any, is higher education subject to in terms of its work, not in the sense of validating its programmes or safeguarding its academic freedom, but in terms of its funding, its operating environment and its stakeholders? Is it viewed as a business in some sense? Is it subject to trade rules and negotiations? All of these questions have, to some extent, been raised in the World Trade Organisation's ‘Doha Round’ of negotiations. Has agreement been reached or has the overall operating context of economies submerged higher education, in particular agriculture? This article analyses the brief history of the Doha Round and the possible categorization of higher education within a commercial framework. Conclusions are reached at the end.     

Integration and offender mental health

Integrated care can introduce seamless coordinated pathways that are focused around the individual needs of patients, helping to prevent missed opportunities for intervention. Within offender healthcare, sequential funnelling through designated areas where screening can take place, along with co-location of services, lends itself to integrated working, at least in theory. However, within the offender healthcare pathway, service fragmentation and autonomous, disconnected (often referred to as siloed) working, has historically been the norm. If commissioned and designed to ensure and incentivise connections between services, whilst developing high quality service-focused research activities, pathways could enable clinical and social interventions, and outcomes, on a public health scale for these highly morbid populations. As such, offender healthcare offers a real opportunity to model integration for wider introduction across other health and social care areas. Discussed within is the call for integration, its concept, and its role within offender healthcare.     

'The Responsive Public Servant': Coombs the Man, Coombs the Report

In the light of the Coombs Royal Commission's failure to establish a central proposition, and subsequent contradictory attempts by academics to find one, Rowse offers the tension between the public servant and the public intellectual, manifest in Coombs' career, as a possible prototype of the 'responsive public servant'.     

Forensic odontology lessons: multishooting incident at Port Arthur, Tasmania

On Sunday 28 April 1996 a lone gunman killed and injured many people at the historic penal settlement ruins at Port Arthur in South Eastern Tasmania, Australia. Thirty-two victims were shot dead and 19 were injured in a short time inside a cafe and along the roadway leading to the site entrance. The gunman then took one hostage to a nearby guest house which was occupied by a married couple. Police stood siege during the night. Early the next day the cottage began to burn and a man suspected to be the gunman eventually ran unarmed from the building with his clothes alight and was arrested. The house burned to the ground. Three bodies were later located in the burnt ruins.Forensic odontology played a role in the retrieval of evidence and identification of the incinerated victims. Lack of antemortem dental records for one victim necessitated the reliance on a single CT scan radiograph for matching with the remains. Fire scene procedures, evidence collection and other issues were reviewed.The overwhelming scale of this tragedy and its adverse effects on the Tasmanian community, especially the victims’ families and survivors, cannot be overestimated. While acknowledging this, it is important that lessons are learnt from tragedies such as these. This paper is presented with a view to assisting forensic odontologists in the investigation of complex incidents.