A new approach in virtopsy: Postmortem ventilation in multislice computed tomography

Although postmortem imaging has gained prominence in the field of forensic medicine, evaluation of the postmortem lung remains problematic. Specifically, differentiation of normal postmortem changes and pathological pulmonary changes is challenging and at times impossible. In this study, five corpses were ventilated using a mechanical ventilator with a pressure of 40 mbar (40.8 cm H(2)O). The ventilation was performed via an endotracheal tube, a larynx mask or a continuous positive airway pressure mask. Postmortem computed tomographic images of the lungs before and with a ventilation of 40 mbar (40.8 cm H(2)O) were evaluated and the lung volumes were measured with segmentation software. Postmortem ventilation led to a clearly visible decrease of both the density in the dependant parts of the lungs and ground glass attenuation, whereas consolidated areas remained unchanged. Furthermore, a mean increase in the lung volume of 2.10 l was seen. Pathological changes such as septal thickening or pulmonary nodules in the lung parenchyma became more detectable with postmortem ventilation. Intracorporal postmortem mechanical ventilation of the lungs appears to be an effective method for enhancing detection of small pathologies of the lung parenchyma as well as for discriminating between consolidation, ground glass attenuation and position-dependent density.

A two-centre study on facial morphology in patients with complete bilateral cleft lip and palate at nine years of age

The aim of this study was to compare craniofacial morphology and soft tissue profiles in patients with complete bilateral cleft lip and palate at 9 years of age, treated in two European cleft centres with delayed hard palate closure but different treatment protocols. The cephalometric data of 83 consecutively treated patients were compared (Gothenburg, N=44; Nijmegen, N=39). In total, 18 hard tissue and 10 soft tissue landmarks were digitized by one operator. To determine the intra-observer reliability 20 cephalograms were digitized twice with a monthly interval. Paired t-test, Pearson correlation coefficients and multiple regression models were applied for statistical analysis. Hard and soft tissue data were superimposed using the Generalized Procrustes Analysis. In Nijmegen, the maxilla was protrusive for hard and soft tissue values (P=0.001, P=0.030, respectively) and the maxillary incisors were retroclined (P<0.001), influencing the nasolabial angle, which was increased in comparison with Gothenburg (P=0.004). In conclusion, both centres showed a favourable craniofacial form at 9-10 years of age, although there were significant differences in the maxillary prominence, the incisor inclination and soft tissue cephalometric values. Follow-up of these patients until facial growth has ceased, may elucidate components for outcome improvement.

Negotiating conservation: the construction of meaningful spaces in a world heritage debate

According to one’s personal biography, social background and the resultant degree of affectedness, a person has certain ideas about the meaning of, in our example, a World Heritage Site (WHS), what he or she can expect from it and what his or her relation to it can and should be. The handling of potentially different meaningful spaces is decisive, when it comes to the negotiation of pathways towards the sustainable development of a WHS region. Due to the fact that – in a pluralistic world – multiple realities exist, they have to be taken seriously and adequately addressed. In this article we identified the ways the Jungfrau-Aletsch- WHS was constructed by exploring the visual and verbal representations of the WHS during the decision-making process (1998-2001). The results demonstrate that in the visual representations (images), the WHS was to a large extent presented as an unspoiled natural environment similar to a touristy promotion brochure. Such a ‘picture-book’-like portrait has no direct link to the population’s daily needs, their questions and anxieties about the consequences of a WHS label. By contrast, the verbal representations (articles, letters-to-the-editor, comments) were dominated by issues concerning the economic development of the region, fears of disappropriation, and different views on nature. Whereas visual and verbal representations to a large extent differ significantly, their combination might have contributed to the final decision of the majority of people concerned to support the application for inscription of the Jungfrau-Aletsch-Bietschhorn region into the World Heritage list. The prominence of economic arguments and narratives about intergenerational responsibility in the verbal representations and their combination with the aesthetic appeal of the natural environment in the visual representations might have built a common meaningful space for one part of the population.

Postmortem ventilation: A new method for improved detection of pulmonary pathologies in forensic imaging

Postmortem imaging has gained prominence in the field of forensic pathology. Even with experience in this procedure, difficulties arise in evaluating pathologies of the postmortem lung. The effect of postmortem ventilation with applied pressures of 10, 20, 30 and 40mbar was evaluated in 10 corpses using simultaneous postmortem computed tomography (pmCT) scans. Ventilation was performed via a continuous positive airway pressure mask (n=5), an endotracheal tube (n=4) and a laryngeal mask (n=1) using a portable home care ventilator. The lung volumes were measured and evaluated by a segmentation technique based on reconstructed CT data. The resulting changes to the lungs were analyzed. Postmortem ventilation at 40mbar induced a significant (p<0.05) unfolding of the lungs, with a mean volume increase of 1.32l. Small pathologies of the lung such as scarring and pulmonary nodules as well as emphysema were revealed, while inner livores were reduced. Even though lower ventilation pressures resulted in a significant (p<0.05) volume increase, pathologies were best evaluated when a pressure of 40mbar was applied, due to the greater reduction of the inner livores. With the ventilation-induced expansion of the lungs, a decrease in the heart diameter and gaseous distension of the stomach was recognized. In conclusion, postmortem ventilation is a feasible method for improving evaluation of the lungs and detection of small lung pathologies. This is because of the volume increase in the air-filled portions of the lung and reduced appearance of inner livores.

Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis

Femoroacetabular impingement due to metaphyseal prominence is associated with the slippage in patients with slipped capital femoral epiphysis (SCFE), but it is unclear whether the changes in femoral metaphysis morphology are associated with range of motion (ROM) changes or type of impingement. We asked whether the femoral head-neck junction morphology influences ROM analysis and type of impingement in addition to the slip angle and the acetabular version. We analyzed in 31 patients with SCFE the relationship between the proximal femoral morphology and limitation in ROM due to impingement based on simulated ROM of preoperative CT data. The ROM was analyzed in relation to degree of slippage, femoral metaphysis morphology, acetabular version, and pathomechanical terms of "impaction" and "inclusion." The ROM in the affected hips was comparable to that in the unaffected hips for mild slippage and decreased for slippage of more than 30 degrees. The limitation correlated with changes in the metaphysic morphology and changed acetabular version. Decreased head-neck offset in hips with slip angles between 30 degrees and 50 degrees had restricted ROM to nearly the same degree as in severe SCFE. Therefore, in addition to the slip angle, the femoral metaphysis morphology should be used as criteria for reconstructive surgery.

Immigrant Incorporation in Western Europe

Immigrant incorporation (or integration) is a subfield of migration studies, and it constitutes a genuinely interdisciplinary undertaking of sociologists, political scientists, anthropologists, lawyers, and historians. In none of these disciplines, however, has it carved out an established niche for itself. In contrast to the United States, where the study of immigrant integration (or “assimilation” as US researchers prefer to say) is more firmly grounded in sociology than in political science, a characteristic of the European scene is a larger prominence of political scientists, macro comparativists, and legal-institutional scholars. This reflects the fact that immigrant integration in Europe is, to a much larger degree than in the United States, framed by public policies, and it often goes along with major transformations of state institutions (most importantly citizenship) and national identities. European states (even France) are ethnic nation-states, where sedentariness and not moving is the norm, and they stand for countries that are much less attuned to, and constituted by, international migration than the classic immigrant nations of North America and Oceania. Overall, European scholarship is marked, on one side, by single-country studies by national experts, which are often solicited by their respective governments interested in policy advice (but increasingly also supported by supranational research bodies). On the other side, most agenda-setting work has grown out of qualitative single-person studies (often dissertations) by macro sociologists and political comparativists not (or only incidentally) rooted in national university systems and disconnected from policy contexts. The field is in need of further conceptual development and of theoretically reflected, genuinely comparative work of the second type, which is mostly off the public funding radar.

Dynamics of governance and control in inter-organizational software development

In recent years, development of information systems (IS) has rapidly changed towards increasing division of labor between firms. Two trends are emerging. First, client companies increasingly outsource software development to external service providers. Second, the formerly oligopolistic enterprise application software industry has started to disintegrate into focal partnership networks – so called platform ecosystems. Despite the increasing prominence of IS outsourcing and platform ecosystems, many of these inter-organizational partnerships fail to achieve expected benefits. Ineffective governance and control frequently plays a pivotal role in producing these failures. While designing effective governance and control mechanisms is always challenging, inter-organizational software development projects are often business-critical and exhibit additional dynamics and uncertainty. As a consequence governance and control have to be adapted over time. The three research projects included in this book provide a better understanding of how and why governance and control can be effectively adapted over time. The implications for successful management of inter-organizational software development projects are highly relevant for theory and practice.

Facial self-mutilation: an analysis of published cases

OBJECTIVES Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. METHODS We undertook a review of all published cases of facial self-mutilation (1960-2011). RESULTS We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target--seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation. CONCLUSIONS Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.

One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes

The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw with one-stage repair and 61 age-matched and sex-matched patients treated in Oslo with two-stage surgery were selected to evaluate craniofacial morphology. On each radiograph 13 angular and two ratio variables were measured in order to describe hard and soft tissues of the facial region. The analysis showed that differences between the groups were limited to hard tissues – the maxillary prominence in subjects from the Warsaw group was decreased by almost 4° in comparison with the Oslo group (sella-nasion-A-point (SNA) = 75.3° and 79.1°, respectively) and maxillo-mandibular morphology was less favorable in the Warsaw group than the Oslo group (ANB angle = 0.8° and 2.8°, respectively). The soft tissue contour was comparable in both groups. In conclusion, inter-group differences suggest a more favorable outcome in the Oslo group. However, the distinctiveness of facial morphology in background populations (ie, in Poles and Norwegians) could have contributed to the observed results.