Selective culturing and genus-specific PCR detection for identification of Aeromonas in tissue samples to assist the medico-legal diagnosis of death by drowning

The detection of autochthonous aquatic bacteria in tissue samples from drowning cases is increasingly considered as an alternative approach to assist the medico-legal diagnosis of death by drowning. Bacteria belonging to the genus Aeromonas may be suitable candidates for this application as they are ubiquitous in natural aquatic environments but are generally not part of the human microbiota. The research aims of this study were (i) to develop a sensitive, specific and rapid screening and confirmation method for Aeromonas species in tissue samples and (ii) to evaluate aseptic sternal puncture as a post-mortem sample technique and bone marrow as an alternative matrix to provide evidence of death by drowning. The presence of Aeromonas in tissue samples was verified by cultivation using the selective media Ampicillin Dextrin Agar (ADA) and Ryan's Aeromonas Medium. The use of ADA medium was found most optimal for the sensitive, inexpensive and quick detection of aeromonads in human tissue samples. Positive culture plates were confirmed by harvesting all colonies for DNA extraction and subsequent PCR amplification using Aeromonas genus-specific primers. Aeromonads were detected in lung swab, blood and bone marrow of drowned bodies (n=3), but were negative in these three matrices for all negative controls (n=90) tested. Bone marrow proved to be a suitable alternative matrix and can be sampled post-mortem by an aseptic sternal puncture. In conclusion, this study confirms previous indications that aeromonads in cultures from blood of water bodies can be considered a potential marker for drowning. Given the fact that the number of immersed bodies (drowned and non-drowned) included in this study is statistically not significant, however, more tissue samples need to be investigated to confirm the validity of these methods to aid the diagnosis of death by wet drowning.     

Facial symmetry in robust anthropometrics

Image analysis methods commonly used in forensic anthropology do not have desirable robustness properties, which can be ensured by robust statistical methods. In this paper, the face localization in images is carried out by detecting symmetric areas in the images. Symmetry is measured between two neighboring rectangular areas in the images using a new robust correlation coefficient, which down-weights regions in the face violating the symmetry. Raw images of faces without usual preliminary transformations are considered. The robust correlation coefficient based on the least weighted squares regression yields very promising results also in the localization of such faces, which are not entirely symmetric. Standard methods of statistical machine learning are applied for comparison. The robust correlation analysis can be applicable to other problems of forensic anthropology.     

A forensic medicine perspective on recurring episodes of intimate partner violence

During a three year period, 418 victims of intimate partner violence (IPV) were examined and their injuries documented at the Center for Victims of Violence (CVV) in Hamburg, Germany. All victims were questioned if their acute injuries were attributable to recurring acts of violence by the same intimate partner. The victims' experiences with recurring IPV were analyzed and associated risk factors as well as findings of acute physical injuries were integrated into the assesment. Overall, women were significantly more often victims of recurring episodes of IPV than men. In 35.4% of cases, victims of recurring IPV sustained injuries to three or more body regions. However, women who were victimized during a single act of violence, presented with the same distribution of injuries in only 21.1% of cases (p = 0.01). The results emphasize the fact that IPV often manifests itself in a spiraling escalation of physical violence. Furthermore, blunt force trauma to the head was diagnosed significantly more often (p = 0.05). The risk of sustaining a head injury was equally high for women who experienced a first-time violent episode by their ex-partner as it was for married women or women living in a non-marital partnership during recurring episodes of IPV. In an effort to reduce the increased risk for victims of IPV, health care personnel are highly encouraged to partake in forensic medicine based continuing education. This preventative measure may prepare clinicians to recognize IPV earlier as well as to treat and advise clients appropriately.     

Hanging deaths with bound hands: what is the manner?

In Franklin County, Ohio, 3 cases of hangings with bound hands were reported in a 4-month period in 2005. All of the victims were men. In 2 of the 3 cases, the hands were bound behind the back. One victim bound his hands in front of his body. In each case, the police ruled the deaths "suspicious" due to the fact that the victims' hands were bound. Complete investigation is required. Only after a thorough scene investigation, medicolegal autopsy, and knowledge of recent circumstances of the decedent's life can a determination of manner be made.     

Compulsory treatment with clozapine: a retrospective long-term cohort study

BACKGROUND: Clozapine is the gold standard in treatment of treatment-resistant psychotic patients. We know little about the effects of compulsory treatment in patients unwilling to accept the necessary treatment. AIMS: To assess the effectiveness, tolerability and safety of compulsory treatment with clozapine (CTC). METHOD: A cohort of 17 consecutive patients given compulsory treatment with clozapine were rated retrospectively by their treating psychiatrists on the basis of their case notes. RESULTS: CGI-S decreased significantly over time until last observation after a mean of more than 15 months. No patient deteriorated as measured by CGI-I. At last observation as many as ten of the 11 patients still on clozapine were classified as much to very much improved. The degree of custodial restriction at last observation showed improvement in 11 patients and no change in six. No serious adverse events were observed. CONCLUSION: A trial of compulsory treatment with clozapine showed this treatment to be feasible, effective, safe and well tolerated.     

Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Uncertainty of calculation results in vehicle collision analysis

In the analysis of road accidents two types of calculation result uncertainty can be distinguished: modelling uncertainty and uncertainty in calculation results [R.M. Brach, M. Brach, Vehicle Accident Analysis & Reconstruction Methods, SAE International Publisher, Warrendale, 2005]. The problem becomes very important first of all when minor modifications of input parameters or application of different models of the phenomenon lead to a fundamentally different answer to the question posed by the court. The aim of the paper was to prove the necessity of including the problem of uncertainty in calculations related to vehicle collision mechanics and to justify the application of different error analysis methods recommendable in vehicle collision reconstruction. The data file from crash test No. 7 [H. Burg, M. Lindenmann, Unfallversuche, Verlag Information Ambs, Kippenheim, 1982] was used, the selection restricted to the range typical of average police records of collision place. Collision speeds were calculated using two methods: reconstruction and simulation. The analysis of uncertainty was carried out. Maximum and mean square uncertainty were calculated by means of total differential of relevant forms. Since the reconstruction resulted in very broad error intervals of uniform distribution, additional calculations were performed by the Monte Carlo method using algorithm described in [W. Wach, J. Unarski, Determination of vehicle velocities and collision location by means of Monte Carlo simulation method, Special Publication Accident Reconstruction SP-1999, SAE Paper No. 2006-01-0907, 2006].     

Getting to Sweden,Part II: Breaking with Corruption in the Nineteenth Century

Issues about corruption and other forms of ‘bad government’ have become central in large parts of the social sciences. An unresolved question, however, is how countries can solve the issue of systemic corruption. In this article, based on Elinor Ostrom's theory of common pool resource appropriation, a new theoretical model for explaining this type of institutional change is developed. Sweden during the nineteenth century is used as an illustration of the model by showing how the country made a transition from being largely patrimonial, nepotistic and corrupt to a modern, Weberian, efficient and impartial state structure. Building upon a companion article about the importance of losing a war as a precondition for breaking systematic corruption, this article stresses the importance of three additional factors in Sweden: previous changes in courts and the legal system; recognition of the problem by the main contemporary political actors as shown in debates in the Diet; and the new liberal ideology that made an important impact on the Swedish political scene during this period.