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Terms modified by Deceased Selected AbstractsRadiographic Recognition of Dental Implants as an Aid to Identifying the DeceasedJOURNAL OF FORENSIC SCIENCES, Issue 1 2010John W. Berketa B.D.S. Abstract:, This study was undertaken to determine if dental implants can be radiographically differentiated by company type to aid forensic identification of the deceased. Recognition of dental implants on intraoral radiographic images was assessed in a blind study using a radiographic examination guide to highlight differences between dental implants. Inter- and intra-examiner comparisons were conducted and a computer program (Implant Recognition System®) was evaluated to see whether it improved the accuracy of implant recognition. The study found that dental implants could be radiographically differentiated by company type. The Implant Recognition System® in its current form was of little benefit for radiographic assessment of dental implants for forensic odontologists. Prior knowledge of implant types, with a McNemar's statistical value of 92.9, proved to be most significant in identification. [source] Care for the Adult Family Members of Victims of Unexpected Cardiac DeathACADEMIC EMERGENCY MEDICINE, Issue 12 2006Robert Zalenski MD Abstract More than 300,000 sudden coronary deaths occur annually in the United States, despite declining cardiovascular death rates. In 2000, deaths from heart disease left an estimated 190,156 new widows and 68,493 new widowers. A major unanswered question for emergency providers is whether the immediate care of the loved ones left behind by the deceased should be a therapeutic task for the staff of the emergency department in the aftermath of a fatal cardiac arrest. Based on a review of the literature, the authors suggest that more research is needed to answer this question, to assess the current immediate needs and care of survivors, and to find ways to improve care of the surviving family of unexpected cardiac death victims. This would include improving quality of death disclosure, improving care for relatives during cardiopulmonary resuscitation of their family member, and improved methods of referral for services for prevention of psychological and cardiovascular morbidity during bereavement. [source] Application of a New Intense Pulsed Light Device in the Treatment of Photoaging Skin in Asian PatientsDERMATOLOGIC SURGERY, Issue 11 2008YUAN-HONG LI MD BACKGROUND Intense pulsed light (IPL) technology has long been used in the treatment of photoaging skin. OBJECTIVE To evaluate the efficacy and safety of a new IPL device in the treatment of photoaging skin in Asian patients. METHODS One hundred fifty-two Chinese women with photoaging skin were enrolled in this open-labeled study. Subjects received four IPL treatments at 3- to 4-week intervals. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter, and a Corneometer. RESULTS One hundred thirty-nine of 152 patients (91.44%) experienced a score decrease of 3 or 2 grades, according to the dermatologist. One hundred thirty-six of 152 patients (89.47%) rated their overall improvement as excellent or good. The mean skin melanin index (MI) and erythema index values deceased with each session. MI on forehead and EI on cheilion decreased most significantly. Adverse effects were limited to mild pain and transient erythema. CONCLUSION IPL treatment is a safe and effective method for photoaging skin in Asian patients. Adverse effects were minimal and acceptable. [source] The Importance of Board Quality in the Event of a CEO DeathFINANCIAL REVIEW, Issue 3 2006Kenneth A. Borokhovich G34 Abstract We examine board quality and executive replacement decisions around deaths of senior executives. Stock price reactions to executive deaths are positively related to board independence. Controlling for such factors as the deceased's stockholdings, outside blockholdings, board size, and whether the deceased was a founder, board independence is the most significant factor explaining abnormal returns. Board independence is particularly important when there is no apparent successor and firm performance is poor. The results are consistent with independent boards being reluctant to discipline poorly performing incumbent managers, but nevertheless using the opportunity of an executive death to improve the quality of management. [source] Long-term stability of eating disorder diagnosesINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue S3 2007Manfred M. Fichter MD Abstract Objective: Data on the stability of eating disorder (ED) diagnoses (DSM-IV) over 12 years are presented for a large sample (N = 311) of female eating disordered patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Method: Assessments were made at the beginning of therapy and 2-, 6-, and 12-year follow-ups. Diagnoses were derived from the Structured Inventory for Anorexic and Bulimic Eating Disorders. Possible diagnostic outcome categories were AN, BN, BED, NOS, no ED, and deceased. Results: At all follow-ups, more patients changed from AN or BED to BN than vice versa. No diagnostic crossover from AN to BED or vice versa occurred. BED showed the greatest variability and AN had the greatest stability over time. While the long-term outcome of BN and BED is similar, AN had a considerably worse long-term outcome than either BN or BED. Conclusion: Of the ED diagnoses, AN was most stable and BED most variable. The considerable diagnostic flux between BN and BED and similarities in course and outcome of BN and BED point to common biological and psychological maintaining processes. AN and BED are nosologically quite distant. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Twelve-year course and outcome predictors of anorexia nervosaINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 2 2006Dipl-Psych, Manfred M. Fichter MD Abstract Objective The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Method Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. Results The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic,strictly empirically based,model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. Conclusion Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome. © 2005 by Wiley Periodicals, Inc. [source] Gender in elderly suicide: analysis of coroners inquests of 200 cases of elderly suicide in Cheshire 1989,2001INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2003Emad Salib Abstract Objectives The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable. Methods Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989,2001. The Coroner's office covers the whole county of Cheshire (population 1,000,000). Results Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2,0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2,1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively. Conclusion Suicide is an important problem in the elderly with gender playing an important part in their social behaviour but a high proportion of the deceased were not known to local services. Primary Care professionals have an important role to play in reducing elderly suicide as most contact with the health service in elderly suicide seem to be with GPs. Copyright © 2003 John Wiley & Sons, Ltd. [source] Mortality Risk in Older Inner-City African AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Theodore K. Malmstrom PhD OBJECTIVES: To investigate mortality risks in a sample of poor, inner-city-dwelling, older African Americans. DESIGN: Prospective cohort study. SETTING: St. Louis, Missouri. PARTICIPANTS: Six hundred twenty-two African Americans aged 68 to 102 at the time of their 1992 to 1994 baseline interviews. MEASUREMENTS: Risk factors previously identified in the literature were examined for seven categories: demographic, socioeconomic, psychosocial, biomedical, disability and physical function, perceived health, and health services utilization. Vital status was ascertained through 2002. RESULTS: Three hundred eighty-six subjects (62.1%) were deceased and 236 were alive (mortality higher than in matched controls). Significant risks for mortality were older age, male sex, annual income less than $10,000, cancer, cerebrovascular disease, dependencies in lower-body function, and number of physician visits in the 12 months before baseline. CONCLUSION: In addition to improving the risk factors for stroke and malignant disease in this population, studies focused on improving lower-body functioning may be warranted as a part of efforts aimed at enhancing longevity in older African-American adults. [source] Handgrip Strength and Mortality in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2002Soham Al Snih MD OBJECTIVES: To examine the association between handgrip strength and mortality in older Mexican American men and women. DESIGN: A 5-year prospective cohort study. SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 2,488 noninstitutionalized Mexican-American men and women aged 65 and older. MEASUREMENTS: Maximal handgrip strength, timed walk, and body mass index were assessed at baseline during 1993/94. Self-reports of functional disability, various medical conditions, and status at follow-up were obtained. RESULTS: Of the baseline sample with complete data, 507 persons were confirmed deceased 5 years later. Average handgrip strength ± standard deviation was significantly higher in men (28.4 kg ± 9.5) than in women (18.2 kg ± 6.5). Of men who had a handgrip strength less than 22.01 kg and women who had a handgrip strength less than 14 kg, 38.2% and 41.5%, respectively, were dead 5 years later. In men in the lowest handgrip strength quartile, the hazard ratio of death was 2.10 (95% confidence interval (CI) = 1.31,3.38) compared with those in the highest handgrip strength quartile, after controlling for sociodemographic variables, functional disability, timed walk, medical conditions, body mass index, and smoking status at baseline. In women in the lowest handgrip strength quartile, the hazard ratio of death was 1.76 (95% CI = 1.05,2.93) compared with those in the highest handgrip strength quartile. Poorer performance in the timed walk and the presence of diabetes mellitus, hypertension, and cancer were also significant predictors of mortality 5 years later. CONCLUSION: Handgrip strength is a strong predictor of mortality in older Mexican Americans, after controlling for relevant risk factors. [source] Cause of Death in Older Patients with Anatomo-Pathological Evidence of Chronic Bronchitis or Emphysema: A Case-Control Study Based on Autopsy FindingsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Jean Paul Janssens MD OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women) were autopsied between 1972 and 1996; mean age at death was 81.5 ± 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients (26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predominantly E. Pneumonia was the most frequent cause of death in all patients (21.8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5.1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in controls. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio (OR) = 1.89, P = .008), or in controls (12.7%; OR = 1.56, P = .0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older patients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls. [source] Individual and Family Decisions About Organ DonationJOURNAL OF APPLIED PHILOSOPHY, Issue 1 2007T. M. WILKINSON abstract This paper examines, from a philosophical point of view, the ethics of the role of the family and the deceased in decisions about organ retrieval. The paper asks: Who, out of the individual and the family, should have the ultimate power to donate or withhold organs? On the side of respecting the wishes of the deceased individual, the paper considers and rejects arguments by analogy with bequest and from posthumous bodily integrity. It develops an argument for posthumous autonomy based on the liberal idea of self-development and argues that this establishes a right of veto over donation. It claims, however, that whether the family's power to veto would conflict with posthumous autonomy rights depends on how it comes about. On the side of respecting the family's wishes, the paper first considers an argument from family distress. This supports a contingent, non-rights-based reason for the family's power that is trumped by the deceased's rights. It then outlines and criticises an argument based on family autonomy. The conclusion is that the individual has the right to veto the family's wish to donate and that, while the family has no right to veto the individual's wishes to donate, it can legitimately acquire this power and has done so in practice. [source] Radiographic periodontal attachment loss as an indicator of death risk in the elderlyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2000K. Soikkonen Abstract Objectives: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. Material and methods: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. Results: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0,4.7). Other associations were statistically insignificant. Conclusion: Periodontal attachment loss may indicate an increased risk of death in the elderly. [source] Death of a 10-Month-Old Boy After Exposure to EthylmorphineJOURNAL OF FORENSIC SCIENCES, Issue 2 2010Arne Helland M.D. Abstract:, Ethylmorphine, an opiate that is partially metabolized to morphine, is a common ingredient in antitussive preparations. We present a case where a 10-month-old boy was administered ethylmorphine in the evening and found dead in bed the following morning. Postmortem toxicological analyses of heart blood by gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry revealed the presence of ethylmorphine and morphine at concentrations of 0.17 ,M (0.054 mg/L) and 0.090 ,M (0.026 mg/L), respectively. CYP2D6 genotyping showed that the deceased had an extensive metabolizer genotype, signifying a "normal" capacity for metabolizing ethylmorphine to morphine. The autopsy report concluded that death was caused by a combination of opiate-induced sedation and weakening of respiratory drive, a respiratory infection, and a sleeping position that could have impeded breathing. This is the first case report where the death of an infant has been linked to ethylmorphine ingestion. [source] Radiographic Recognition of Dental Implants as an Aid to Identifying the DeceasedJOURNAL OF FORENSIC SCIENCES, Issue 1 2010John W. Berketa B.D.S. Abstract:, This study was undertaken to determine if dental implants can be radiographically differentiated by company type to aid forensic identification of the deceased. Recognition of dental implants on intraoral radiographic images was assessed in a blind study using a radiographic examination guide to highlight differences between dental implants. Inter- and intra-examiner comparisons were conducted and a computer program (Implant Recognition System®) was evaluated to see whether it improved the accuracy of implant recognition. The study found that dental implants could be radiographically differentiated by company type. The Implant Recognition System® in its current form was of little benefit for radiographic assessment of dental implants for forensic odontologists. Prior knowledge of implant types, with a McNemar's statistical value of 92.9, proved to be most significant in identification. [source] The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the legJOURNAL OF INTERNAL MEDICINE, Issue 5 2000P. Lindmarker Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601,606. Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. Design. An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. Setting. Sixteen hospitals in central Sweden. Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (±SD) period of 31(±29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4,1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis. [source] Reduction of mother-to-child transmission of HIV at Saint Camille Medical Centre in Burkina FasoJOURNAL OF MEDICAL VIROLOGY, Issue 2 2006J. Simpore Abstract One thousand three hundred and twenty-eight pregnant women with less than 32 weeks of amenorrhea received voluntary counseling and testing at Saint Camille Medical Center from May 1, 2002 to December 30, 2004. Following informed consent and pre-test counseling, HIV screening was performed in 1,202 women. According to the prevention protocol, HIV-positive women received a single dose of Nevirapine (200 mg) during their labor, while their newborn received a single dose of Nevirapine (2 mg/kg) within 72 hr from birth. HIV seroprevalence (11.2%) was higher than in the overall population. One hundred and ninty-three children were born at the end of December 2004; 53 children (27.5%) followed a short breastfeeding protocol for 4 months, while 140 (72.5%) were fed artificially. All the children underwent RT-PCR test for HIV 5,6 months after their birth: 173 (89.6%) were HIV negative whilst 20 children (10.4%) were HIV positive. Out of the 20 positive children 5/53 (9.4%) had received breast milk for 4 months, while the remaining 15/140 (10.7%) had been fed artificially (P,=,0.814). Artificially fed babies (3/140 (2.1%)) and 1/53 (1.9%) of those breast fed for 4 months deceased according to mortality rate of HIV-positive children. This shows that there is no statistically significant difference (P,=,0.648) between the mortality of artificially fed (3/140 or 2.1%) and breast-fed (1/53 or 1.9%) children. Artificially fed children (20/140 (14.3%)) and 5/53 (9.4%) of breast-fed children died within 6,10 months. This figure indicates that there is no significant difference between the mortality rate of artificially and that of breast-fed children (P,=,0.427). Although the HIV prevention program reduced significantly the vertical transmission of HIV at Saint Camille Medical Center, the mortality of artificially fed children was still high due to gastrointestinal diseases. The HIV diagnosis by RT-PCR technique was of great help in the early identification of HIV-infected children. J. Med. Virol. 78:148,152, 2006. © 2005 Wiley-Liss, Inc. [source] Increases in expression of 14-3-3 eta and 14-3-3 zeta transcripts during neuroprotection induced by ,9 -tetrahydrocannabinol in AF5 cells,JOURNAL OF NEUROSCIENCE RESEARCH, Issue 8 2007Jia Chen Abstract The molecular mechanisms involved in N-methyl-D-aspartate (NMDA)-induced cell death and ,9-tetrahydrocannabinol (THC)-induced neuroprotection were investigated in vitro with an AF5 neural progenitor cell line model. By microarray analysis, Ywhah, CK1, Hsp60, Pdcd 4, and Pdcd 7 were identified as being strongly regulated by both NMDA toxicity and THC neuroprotection. The 14-3-3 eta (14-3-3,; gene symbol Ywhah) and 14-3-3 zeta (14-3-3,; gene symbol Ywhaz) transcripts were deceased by NMDA treatment and increased by THC treatment prior to NMDA, as measured by cDNA microarray analysis and quantitative real-time RT-PCR. Other 14-3-3 isoforms were unchanged. Whereas up-regulation of 14-3-3, expression was observed 30 min after treatment with THC plus NMDA, down-regulation by NMDA alone was not seen until 16 hr after treatment. By Western blotting, THC increased 14-3-3 protein only in cells that were also treated with NMDA. Overexpression of 14-3-3, or 14-3-3, by transient plasmid transfection increased 14-3-3 protein levels and decreased NMDA-induced cell death. These data suggest that increases in 14-3-3 proteins mediate THC-induced neuroprotection under conditions of NMDA-induced cellular stress. © 2007 Wiley-Liss, Inc. [source] Morphometric analysis of CD34-positive vessels in salivary gland adenoid cystic and mucoepidermoid carcinomasJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 9 2009H. Luukkaa Background:, Carcinomas of the salivary glands are uncommon and morphologically a diverse group of malignancies. To evaluate the prognostic value of CD34 immunostaining of the vessels in adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC), an automated image analysis method was used. Method:, In a nationwide study, covering salivary gland cancer (SGC) patients in Finland 1991,1996, 37 AdCC and 18 MEC patients (M 25, F 30, age 25,90, mean 63) were included. In addition to clinical characteristics the size, shape, staining intensity and vessel density in CD34 immunostained histologic samples were measured. Results:, Altogether 4433 vessels were measured from AdCC and 2615 from MEC tumor. Of the total tumor vessels measured, 2651 were from patients who deceased with disease (Group I) and 4397 were from specimens derived from those who did not die of disease (Group II) during the 10-year follow-up. The staining intensity was significantly higher in MEC than in AdCC tumor (P = 0.0005). In MEC, the Group I patients had a higher staining intensity among high-grade patients compared with patients with low grade disease, whereas the tumors in Group II had a lower staining intensity among the high-grade compared with the low grade tumors (P = 0.018). A higher vessel density was found in patients with MEC in group II compared with group I (P = 0.017). Conclusions:, The staining intensity of CD34 positive vessels in MEC was higher than in AdCC. In MEC, higher staining intensity of vessels in high-grade tumors and lower vessel density in all MEC patients, predicted poor survival. [source] The Aetiology of Vampires and Revenants: Theological Debate and Popular BeliefJOURNAL OF RELIGIOUS HISTORY, Issue 2 2010DAVID KEYWORTH In this paper, I discuss the supposed aetiology of undead corpses (by which I mean corpses that refused to stay dead), and the theological explanations for their existence, as outlined in the historical documents at the time, and the various arguments that ensued. I examine the medieval notion that the Devil might reanimate a corpse and pretend to be the deceased, for example, the post-mortem effects of excommunication, and the incorruptibility of deceased saints and martyrs. In particular, I focus upon the vampires of eighteenth-century Europe and the aetiological explanations proffered by the theologians, philosophers and medical fraternity at the time, such as vestigium vitae and premature burial, compared to folk belief at the village level. Furthermore, I argue that despite the largely successful campaign by the socio-religious elite to eradicate such notions, muted belief in the existence of vampires continued to emerge thereafter because folk belief was fuelled by an entrenched early modern belief-system that had itself promoted the existence of undead corpses. [source] Prevalence and psychological correlates of complicated grief among bereaved adults 2.5,3.5 years after September 11th attacksJOURNAL OF TRAUMATIC STRESS, Issue 3 2007Yuval Neria A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5,3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed. [source] Death and International Travel,The Canadian Experience: 1996 to 2004JOURNAL OF TRAVEL MEDICINE, Issue 2 2007Douglas W. MacPherson MD, FRCPC, MSc(CTM) Background Death during international travel concerns several levels of the travel industry. In addition to the immediate effects for the traveler, their family and friends, the nature of travel-related mortality has important implications for pretravel health advisors and providers of medical care services. Methods The Consular Affairs Bureau, Foreign Affairs Canada provides information and assistance to Canadian civilians abroad. Beginning in 1995, the Consular Management and Operations System tracked Canadian deaths abroad notifications. The annual data for 1996 to 2004 was extracted for sex, age, and cause of death by location for all reports received. Results There were 2,410 reported deaths in Canadians abroad; reported sex was 32% female and 68% male, average age of 61.7 and 60.4 years, respectively. Recorded causes of death: natural (1,762), accidental (450), suicide (92), and murder (106). Country of death reflected the pattern of Canadian international travel for recreation, business, and ancestral linkages. Average age of natural death (66 years) distinguished it from all other causes of death: accidental (45), suicide (41), and murder (43). Conclusion Natural causes and suicide deaths may be anticipated or planned to occur abroad. The risk of death may be mitigated through personal knowledge and medical assessment and prevention strategies. Deaths due to vaccine-preventable diseases, exotic and infectious diseases were rare in this population. Consular services may be able to provide various types of support. Local laws and customs, as well as international regulations in health and quarantine govern other responsibilities such as funeral services and repatriation of the deceased to Canada. [source] Retained organs: ethics and humanityLEGAL STUDIES, Issue 4 2002Margaret Brazier This paper responds to John Harris's vigorous analysis of the ethical principles involved in organ retention. The author contends that Harris overlooks the context in which revelations about organ retention came about in the UK. He pays insufficient regard to deeply held cultural and religious beliefs, and does not fully address the claims of the living to determine the fate of their body after death, or the interests of bereaved families in laying a beloved relative to rest. The paper argues that the fundamental principle governing removal and retention of body parts after death must rest on a strong presumption that such body parts should be removed only with the suficient consent of the deceased or his family. [source] 12-month follow-up analysis of a multicenter, randomized, prospective trial in de novo liver transplant recipients (LIS2T) comparing cyclosporine microemulsion (C2 monitoring) and tacrolimus,,LIVER TRANSPLANTATION, Issue 10 2006Gary Levy The LIS2T study was an open-label, multicenter study in which recipients of a primary liver transplant were randomized to cyclosporine microemulsion (CsA-ME) (Neoral) (n = 250) (monitoring of blood concentration at 2 hours postdose) C2 or tacrolimus (n = 245) (monitoring of trough drug blood level [predose]) C0 to compare efficacy and safety at 3 and 6 months and to evaluate patient status at 12 months. All patients received steroids with or without azathioprine. At 12 months, 85% of CsA-ME patients and 86% of tacrolimus patients survived with a functioning graft (P not significant). Efficacy was similar in deceased- and living-donor recipients. Significantly fewer hepatitis C,positive patients died or lost their graft by 12 months with CsA-ME (5/88, 6%) than with tacrolimus (14/85, 16%) (P < 0.03). Recurrence of hepatitis C virus in liver grafts was similar in each group. Based on biopsies driven by clinical events, the mean time to histological diagnosis of hepatitis C virus recurrence was significantly longer with CsA-ME (100 ± 50 days) than with tacrolimus (70 ± 40 days) (P < 0.05). Median serum creatinine at 12 months was 106 ,mol/L with CsA-ME and with tacrolimus. More patients who were nondiabetic at baseline received antihyperglycemic therapy in the tacrolimus group at 12 months (13% vs. 5%, P < 0.01). Of patients who were diabetic at baseline, more tacrolimus-treated individuals required anti-diabetic treatment at 12 months (70% vs. 49%, P = 0.02). Treatment for de novo or preexisting hypertension or hyperlipidemia was similar in both groups. In conclusion, the efficacy of CsA-ME monitored by blood concentration at 2 hours postdose and tacrolimus in liver transplant patients is equivalent to 12 months, and renal function is similar. More patients required antidiabetic therapy with tacrolimus regardless of diabetic status at baseline. Liver Transpl 12:1464,1472, 2006. © 2006 AASLD. [source] Medical practice, procedure manuals and the standardisation of hospital deathNURSING INQUIRY, Issue 1 2009Hans Hadders This paper examines how death is managed in a larger regional hospital within the Norwegian health-care. The central focus of my paper concerns variations in how healthcare personnel enact death and handle the dead patient. Over several decades, modern standardised hospital death has come under critique in the western world. Such critique has resulted in changes in the standardisation of hospital deaths within Norwegian health-care. In the wake of the hospice movement and with greater focus on palliative care, doors have gradually been opened and relatives of the deceased are now more often invited to participate. I explore how the medical practice around death along with the procedure manual of post-mortem care at Trondheim University Hospital has changed. I argue that in the late-modern context, standardisation of hospital death is a multidimensional affair, embedded in a far more comprehensive framework than the depersonalised medico-legal. In the late-modern Norwegian hospital, interdisciplinary negotiation and co-operation has allowed a number of different agendas to co-exist, without any ensuing loss of the medical power holder's authority to broker death. I follow Mol's notion of praxiographic orientation of the actor,network approach while exploring this medical practice. [source] Clinical Judgment Versus Decision Analysis for Managing Device AdvisoriesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008MITESH S. AMIN M.D. Introduction: Implantable cardioverter-defibrillator (ICD) and pacemaker (PM) advisories may have a significant impact on patient management. Surveys of clinical practice have shown a great deal of variability in patient management after a device advisory. We compared our management of consecutive patients in a single large university practice with device advisories to the "best" patient management strategy predicted by a decision analysis model. Methods: We performed a retrospective review of all patients who had implanted devices affected by an advisory at our medical center between March 2005 and May 2006 and compared our actual patient management strategy with that subsequently predicted by a decision analysis model. Results: Over 14 months, 11 advisories from three different manufacturers affected 436 patients. Twelve patients (2.8%) were deceased and 39 patients (8.9%) were followed at outside facilities. Management of the 385 remaining patients varied based on type of malfunction or potential malfunction, manufacturer recommendations, device dependency, and patient or physician preferences. Management consisted of the following: 57 device replacements (15.2%), 44 devices reprogrammed or magnets issued (11.7%), and 268 patients underwent more frequent follow-up (71.3%). No major complications, related to device malfunction or device replacement, occurred among any patient affected with a device advisory. Concordance between the decision analysis model and our management strategy occurred in 57.1% of cases and 25 devices were replaced when it was not the preferred treatment strategy predicted by the decision model (43.9%, 37.3% when excluding devices replaced based on patient preference). The decision analysis favored replacement for all patients with PM dependency, but only for four patients with ICDs for secondary prevention. No devices were left implanted that the decision analysis model predicted should have been replaced. Conclusions: We found that despite a fairly conservative device replacement strategy for advisories, we still replaced more devices when it was not the preferred device management strategy predicted by a decision analysis model. This study demonstrates that even when risks and benefits are being considered by experienced clinicians, a formal decision analysis can help to develop a systematic evidence based approach and potentially avoid unnecessary procedures. [source] Children with corrected or palliated congenital heart disease on home mechanical ventilation,PEDIATRIC PULMONOLOGY, Issue 7 2010Jeffrey D. Edwards MD Abstract Infants and children with surgically corrected or palliated congenital heart disease (CHD) are at risk for chronic respiratory failure, necessitating home mechanical ventilation (HMV) via tracheostomy. However, very little data exists on this population or their outcomes. We conducted a retrospective chart review of all children with CHD enrolled in the Childrens Hospital Los Angeles HMV program between 1994 and 2009. Data were collected on type of heart lesion, surgeries performed, number of failed extubations, timing of tracheostomy, mortality, length of time on HMV, weaning status, associated co-morbidities, and Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) category. Thirty-five children were identified; six with single ventricle anatomy, who received palliative procedures. Twenty-three (66%) patients are alive; 8 (23%) living patients have been weaned off HMV. Twelve (34%) patients are deceased. The incidence of mortality for single ventricle patients was 50%, and only one of the surviving children has received final palliation and weaned off HMV. Eight of nine patients (89%) with a RACHS score ,4 died, and none have been weaned off of HMV. The 5-year survival for all CHD HMV patients was 68%; 90% for patients with RACHS ,3; and 12% for patients with score ,4. Children with more complex lesions, as demonstrated by single ventricle physiology or greater RACHS scores, had higher mortality rates and less success weaning off HMV. This case series suggests that caregivers should give serious consideration to the type of heart defect as they advise families considering HMV in children with CHD. Pediatr Pulmonol. 2010; 45:645,649. © 2010 Wiley-Liss, Inc. [source] Combination therapy with sulfonylureas and metformin and the prevention of death in type 2 diabetes: a nested case-control study,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2010Laurent Azoulay PhD Abstract Purpose To determine whether combination of sulfonylureas and metformin increases the risk of death from any cause in patients with type 2 diabetes. Methods A nested case-control study was conducted within a population-based cohort from the UK General Practice Research Database (GPRD). The cohort included patients over the age of 40 who were prescribed a first oral hypoglycaemic agent between 1 January 1988 and 30 June 2008. Cases included all patients who deceased during follow-up. Up to 10 controls were matched to each case on year of birth, date of cohort entry (±1 year) and duration of follow-up. Conditional logistic regression was used to estimate rate ratios (RRs) of death from any cause associated with the use of combination of sulfonylureas and metformin, relative to sulfonylurea monotherapy. Results The cohort comprised 84,231 users of oral hypoglycaemic agents, of whom 14,996 died from any cause during a mean of 4.3 years of follow-up (mortality rate 4.1 per 100 per year). Patients currently exposed to a combination of sulfonylureas and metformin were at a decreased risk of death from any cause compared to patients exposed to sulfonylurea monotherapy (adjusted RR: 0.77, 95%CI: 0.70, 0.85). Similar results were obtained for patients currently exposed to metformin monotherapy (adjusted RR: 0.70, 95%CI: 0.64, 0.75) when compared to sulfonylurea monotherapy. Patients had to be exposed to the combination therapy for at least 4 months prior to index date to experience a lower risk of mortality compared to sulfonylurea monotherapy. Conclusions The combination of sulfonylureas and metformin does not increase the risk of death. In contrast, it may moderately reduce this risk compared to sulfonylurea monotherapy. Copyright © 2010 John Wiley & Sons, Ltd. [source] Pharmacokinetics of valerenic acid after single and multiple doses of valerian in older womenPHYTOTHERAPY RESEARCH, Issue 10 2010Gail D. Anderson Abstract Insomnia is a commonly reported clinical problem with as many as 50% of older adults reporting difficulty in falling and/or remaining asleep. Valerian (Valeriana officinalis) is a commonly used herb that has been advocated for promoting sleep. Valerenic acid is used as a marker for quantitative analysis of valerian products with evidence of pharmacological activity relevant to the hypnotic effects of valerian. The objective of this study was to determine the pharmacokinetics of valerenic acid in a group of elderly women after receiving a single nightly valerian dose and after 2 weeks of valerian dosing. There was not a statistically significant difference in the average peak concentration (Cmax), time to maximum concentration (Tmax) area under the time curve (AUC), elimination half-life (T1/2) and oral clearance after a single dose compared with multiple dosing. There was considerable inter- and intra-subject variability in the pharmacokinetic parameters. Cmax and AUC deceased and T1/2 increased with increased body weight. The variability between the capsules was extremely low: 2.2%, 1.4% and 1.4%, for hydroxyvalerenic acid, acetoxyvalerenic acid and valerenic acid, respectively. In conclusion, large variability in the pharmacokinetics of valerenic acid may contribute to the inconsistencies in the effect of valerian as a sleep aid. Copyright © 2010 John Wiley & Sons, Ltd. [source] Variations in the mechanical properties of Alouatta palliata molar enamelAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 1 2010Laura A. Darnell Abstract Teeth have provided insights into many topics including primate diet, paleobiology, and evolution, due to the fact that they are largely composed of inorganic materials and may remain intact long after an animal is deceased. Previous studies have reported that the mechanical properties, chemistry, and microstructure of human enamel vary with location. This study uses nanoindentation to map out the mechanical properties of Alouatta palliata molar enamel on an axial cross-section of an unworn permanent third molar, a worn permanent first molar, and a worn deciduous first molar. Variations were then correlated with changes in microstructure and chemistry using scanning electron microscopy and electron microprobe techniques. The hardness and Young's modulus varied with location throughout the cross-sections from the occlusal surface to the dentin-enamel junction (DEJ), from the buccal to lingual sides, and also from one tooth to another. These changes in mechanical properties correlated with changes in the organic content of the tooth, which was shown to increase from ,6% near the occlusal surface to ,20% just before the DEJ. Compared to human enamel, the Alouatta enamel showed similar microstructures, chemical constituents, and magnitudes of mechanical properties, but showed less variation in hardness and Young's modulus, despite the very different diet of this species. Am J Phys Anthropol 2010. © 2009 Wiley-Liss, Inc. [source] Characteristics associated with discharge to home following prolonged mechanical ventilation: A signal detection analysis,RESEARCH IN NURSING & HEALTH, Issue 6 2006Yookyung Kim Abstract The objective of study was to identify characteristics associated with being home at 6 months in 80 patients on prolonged mechanical ventilation (PMV) (,7 days). At 6 months, 47.5% were home, 13.8% institutionalized, and 38.8% deceased and classified "not home." Using signal detection methodology (SDM), four mutually exclusive groups at high and low probability of being home were identified. The best outcome (94.4% home) was achieved by patients with an admission Charlson Comorbidity Score ,3 and an Acute Physiology Score (APS) ,21 and the worst outcome (23.4% home) by patients with an admission Charlson Comorbidity Score >3 and Health Assessment Questionnaire score >2.7. SDM provided an effective means of identifying subgroups likely to be discharged home using available information. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29: 510,520, 2006 [source] | ||||||||||||||||||||||||||||||||||||||||