Opening up the black box: looking for a more capacious version of capacity in global health partnerships

Abstract

Some versions of capacity building construe the goal of North?South partnerships as rendering African laboratories, doctors, scientists, and universities indistinguishable from their counterparts in wealthier nations. The specificities, histories, peculiarities, or inner workings of African institutions and individuals are black-boxed ? no one needs to know about them. This article draws on research at Malawi’s College of Medicine and the work of other social scientists and historians to sketch out a more capacious model of capacity, one in which capacity building is grounded in specificity, attends to material difference, is flexible and innovative, and involves as much learning as teaching. This model of capacity building requires consideration of areas in which the Northern partners in “global health” can be brought to the level of their colleagues in Africa.     

Unusual and Fatal Case of an Undiagnosed Intravascular Large B-cell Lymphoma: The Oncologist’s Great Imitator†

Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

A Census of Medicolegal Death Investigation in the United States: A Need to Determine the State of our Nation’s Toxicology Laboratories and Their Preparedness for the Current Drug Overdose Epidemic

In 2007, the Bureau of Justice Statistics reported on 2004 data collected from the Census of Medical Examiner and Coroner Offices (CMEC). The CMEC was one of the first comprehensive reports on the state of the medicolegal death investigation system in the United States and included information on administration, expenditure, workload, specialized death investigations, records and evidence retention, and resources. However, the report did not include responses on questions that were related to toxicology such as specimen retention and type of testing. The purpose of this publication is to provide the community with toxicology laboratory-specific responses from nearly 2000 medical examiner and coroner (MEC) offices. Data obtained from a BJS CMEC public use dataset for any remaining information that was not reported in the 2007 BJS report were evaluated specific to the operation of toxicology laboratories within a MEC office or specific to toxicology testing. The CMEC includes information on average operating budget for MEC offices with internal or external toxicology services, budget for toxicology/microbiology services, respondents’ routine uses of toxicology analysis, toxicology specimen retention time, average turnaround times, use of computerized information management systems, and participation in federal data collections. These historical data begin to address the present state of our nation’s toxicology laboratories within the medicolegal death investigation system and their preparedness for the current drug overdose epidemic.     

Sudden Death Caused by Rupture of Spontaneous Ductus Arteriosus Aneurysm in an Adult

A 55-year-old man complained of sudden onset of severe neck pain. This was followed by prompt loss of consciousness and death. Autopsy revealed rupture of a saccular aneurysm, which was considered to have resulted from enlargement of the remaining ductal tissue, and was located on the medial aspect of the uppermost portion of the descending aorta. Dense blood extravasation was noted in the posterior mediastinum and extending to the strap muscles of the neck and larynx. Histological examination of the rupture site revealed disappearance of the medial elastic fibers and thickened intima covered with dense fibrous tissue. Spontaneous ductus arteriosus aneurysm in adults is a rare finding, but widespread use of imaging technologies has revealed that it develops more frequently than previously recognized. Fatal complications may occur even when the aneurysm is relatively small. Therefore, pathologists should be aware of this aneurysm as a potential cause of sudden death.     

新冠肺炎疫情期间公安法医应当加强尸体甄别和个体防护

因鉴定体制特点,公安法医除参与尸体有关的现场勘查工作外,还需进行尸体检验工作。在此过程中,可能面对很多风险,受伤和中毒等事件时有发生。然而,国内公安法医对新冠肺炎等传染病流行期间死亡的尸体如何甄别进行尸体检验鉴定,对现场勘查及尸体检验工作的防护只有少量规定,且内容不够详尽。本文对法医在现场勘查中遇到的尸体及尸体检验中实验室建设、职业现状、风险评估及防范措施等进行了论述。最后,建议出台相关的制度规定等具体约束规范措施,以保障公安法医现场勘查及尸体检验工作的顺利进行,以解除基层鉴定机构和鉴定人的后顾之忧。     

A health management research on the insured group who participate in medical insurance

Taking the insured group who participate in medical insurance as the main subject, Wendeng city carries out the health management and establishes health files for the insured. Through the free health checkup for the high-risk group, the targeted health interventions are conducted according to the physical examination results of those people, and relative health education has achieved satisfying effects. The health education in different western countries has been carried out for more than 20 years, which accumulates a wealth of experiences. However, health education in China has not yet gained sufficient attentions, and to develop the domestic health education becomes an imperative task at present.     

非法行医罪与医疗事故罪辨析及立法思考

非法行医罪和医疗事故罪在主体、客体、主观方面,客观方面各犯罪构成要件上都有区别,罪数形态上亦有区分执业医师擅自脱离执业地点和不按执业类别、执业范围执业的行为应以非法行医论处,有证医疗机构的无证“医务人员”从事诊疗、护理等活动造成损害的应以非法行医论,无证人员无偿提供医疗服务的仍属非法行医行为,刑法立法上应当对此作出相应规定以资完善.     

冠状病毒感染性疾病尸体检验相关病原学检测回顾与展望

冠状病毒曾经给世界带来两次严重的人类间大流行,包括严重急性呼吸综合征(severe acute re?spiratory syndrome,SARS)和中东呼吸综合征(Middle East respiratory syndrome,MERS),2019年岁末新型冠状病毒肺炎(coronavirus disease 2...     

监狱医疗困境与社会化医疗模式的构建

“全额保障”的现行服刑人员医疗体制无论在资金还是医疗技术方面都存在巨大的困难，这种制度并未得到监狱、监狱民警以及服刑人员在价值观念上的认可和行动上的支持，负性影响日趋显现。探索监狱医疗社会化模式，使其始终遵循社会公民一致性原则，将服刑人员纳入城乡居民基本医疗保险体系，使服刑人员在就医、缴费、保障上摆脱“免费困境”，无疑是解决问题的良方。