Forensic Medicine
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Early Post-Mortem Changes and Stages of Decomposition in Exposed Cadavers
Exp Appl Acarol (2009) 49:21–36 DOI 10.1007/s10493-009-9284-9 Early post-mortem changes and stages of decomposition in exposed cadavers M. Lee Goff Received: 1 June 2009 / Accepted: 4 June 2009 / Published online: 25 June 2009 Ó Springer Science+Business Media B.V. 2009 Abstract Decomposition of an exposed cadaver is a continuous process, beginning at the moment of death and ending when the body is reduced to a dried skeleton. Traditional estimates of the period of time since death or post-mortem interval have been based on a series of grossly observable changes to the body, including livor mortis, algor mortis, rigor mortis and similar phenomena. These changes will be described briefly and their relative significance discussed. More recently, insects, mites and other arthropods have been increasingly used by law enforcement to provide an estimate of the post-mortem interval. Although the process of decomposition is continuous, it is useful to divide this into a series of five stages: Fresh, Bloated, Decay, Postdecay and Skeletal. Here these stages are characterized by physical parameters and related assemblages of arthropods, to provide a framework for consideration of the decomposition process and acarine relationships to the body. Keywords Decomposition Á Forensic Á Acari Á Post-mortem changes Á Succession Introduction There are typically two known points at the beginning of the task of estimating a period of time since death: the last time the individual was reliably known to be alive and the time at which the body was discovered. The death occurred between these two points and the aim is to estimate when it most probably took place. -
Coma Stimulation: Suggested Activities
Coma stimulation: suggested activities Headway’s publications are all available to freely download from the information library on the charity’s website, while individuals and families can request hard copies of the booklets via the helpline. As a charity, we rely on donations from people like you to continue providing free information to people affected by brain injury. Donate today: www.headway.org.uk/donate. Introduction It is quite common for family members to feel ‘useless’ when a relative is in a coma, and to be desperate to do something to help. A coma stimulation programme (sometimes called a coma arousal programme) is an approach based on stimulating the unconscious person’s senses of hearing, touch, smell, taste and vision individually in order to help their recovery. There is still controversy over how effective it is to try to stimulate a person in coma. However, most would say that such programmes have some beneficial effect, even if only to provide something constructive for the family to do. It is very important that the activities used would have been enjoyable for the patient before the injury. For example, only play music they like and talk to them about subjects they are interested in. Try not to do anything for too long in order to avoid tiring the person out. A stimulation programme must only be started after discussion with the clinical staff, who will advise you what might be appropriate at any particular stage in the recovery process. Activity suggestions Here are some examples of activities that could form part of a coma stimulation programme: • Make sure that a few friends and family members visit regularly, rather than in large groups at a time. -
Evaluation and Management in an Urgent Care Setting
Syncope Evaluation and Management in an Urgent Care Setting Urgent message: When a patient presents to urgent care after a syncopal event, the clinician’s charge is to determine whether the episode was of benign or potentially life-threatening etiology and whether the patient should be transferred for further evaluation. Kenneth V. Iserson, MD, MBA, FACEP, FAAEM, Professor of Emergency Medicine, The University of Arizona, Tucson, AZ Introduction yncope is a sudden, transient loss of consciousness with a loss of postural tone (typically, falling). It results from an abrupt, transient, and diffuse cerebral Smalfunction and is quickly followed by sponta- neous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness. Many patients will ascribe their syncopal episode to a sit- uationally mediated vasovagal episode. Despite this, the goals in the urgent care setting include the following: Ⅲ Determining whether the patient’s episode was actually a syncopal or presyncopal event, and if it could have a life-threatening etiology Ⅲ Stabilizing the patient Ⅲ Transferring those patients who need further diag- nostic studies or therapeutic interventions © John Bolesky, Artville © John Bolesky, Epidemiology Syncope accounts for up to 3% of emergency depart- common in young adults, while cardiac syncope ment (ED) visits and up to 6% of hospital admissions becomes increasingly more frequent with advancing each year in the United States.1,2 At some time in their age.4 The chance of having at least one syncopal episode lives, up to about half the population (12% to 48%) of in childhood is between 15% and 50%.5 Though a people may experience syncope.3 benign cause is usually found, syncope in children war- Syncope occurs in all age groups, but it is most com- rants prompt detailed evaluation.6 mon in adults. -
Biologically Inspired Simulation of Livor Mortis
Vis Comput DOI 10.1007/s00371-016-1291-3 ORIGINAL ARTICLE Biologically inspired simulation of livor mortis Dhana Frerichs1,2 · Andrew Vidler2 · Christos Gatzidis1 © The Author(s) 2016. This article is published with open access at Springerlink.com Abstract We present a biologically motivated livor mor- in game worlds, which show no signs of decay and tend to tis simulation that is capable of modelling the colouration simply disappear from the world after a while. Simulating changes in skin caused by blood pooling after death. Our these post-mortem appearance changes can have a signifi- approach consists of a simulation of post mortem blood cant impact on the perceived realism of a computer generated dynamics and a layered skin shader that is controlled by scene. the haemoglobin and oxygen levels in blood. The object There are a number of different processes that affect the is represented by a layered data structure made of a tri- post-mortem appearance of a body. We concentrate on simu- angle mesh for the skin and a tetrahedral mesh on which lating the process of skin discolouration after death caused by the blood dynamics are simulated. This allows us to simu- blood pooling, which is referred to as livor mortis [41]. The late the skin discolouration caused by livor mortis, including blood flows through the human body via the vascular system, early patchy appearance, fixation of hypostasis and pressure which is made of blood vessels of varying size arranged in an induced blanching. We demonstrate our approach on two dif- irregular network. This network reaches into the lower layer ferent models and scenarios and compare the results to real of the skin. -
Death & Decomposition Part II
Death & Decomposition Part II Review: Why is TSD/PMI so important? Review: What happens in the Fresh (1st) Stage of Decomposition? STAGE 2: Bloat ⦿ 0-10 days ⦿ Putrefaction: bacterially-induced destruction of soft tissue and gas formation › Skin blisters and marbling › Build-up of fluids from ruptured cells and intestines Putrefaction – the gross stuff ➢ Decomposition that occurs as a result of bacteria and other microorganisms ➢ Results in gradual dissolution of solid tissue into gases and liquids, and salts Putrefaction ➢ Characteristics: ○ Greenish discoloration ○ Darkening of the face ○ Bloating and formation of liquid or gas-filled blisters ○ Skin slippage Putrefaction ➢ Begins about 36 hours after death ➢ Further destruction is caused by maggots and insects ➢ Above 40 F, insects will feed until the body is skeletonized Influences of Putrefaction ➢ Heavy clothing and other coverings speed up the process by holding in body heat ➢ Injuries to the body surface promote putrefaction ○ provide portals of entry for bacteria Marbling Stage 3: Active Decay ➢ 10-20 days after death ➢ Body begins to collapse and black surfaces are exposed ➢ Bloated body collapses and leaves a flattened body ➢ Body fluids drain from body Active Decay Active Decay: Destruction of Tissue • Severe decomp can result in complete destruction of soft tissue Active Decay: Advanced Decomposition Stage 4: Dry Decay ➢ 20-365 days after death ➢ Remaining flesh on body is removed and body dries out ➢ Body is dry and continues to decay very slowly due to lack of moisture ➢ -
Teshuva on Alkaline Hydrolysis Charna Rosenholtz 2020 Aleph Ordination Program 1
Teshuva on Alkaline Hydrolysis Charna Rosenholtz 2020 Aleph Ordination Program 1 New Technologies for Ancient Practices: Is Water Cremation a Viable Option for Interment of the Met in Jewish Burials? (A lamp of G-d is the soul of man (Mishlei 20:27 — רֵנ ,הָוהְי תַמְשִׁנ םָדָא תַמְשִׁנ ,הָוהְי רֵנ Introduction Each and every person who is alive or will ever be alive will die; this difficult truth hovers over us all. Along with the existential question of life itself, is the question, what happens to my body after death? How will the flesh that once was vibrant be disposed of? How can this happen in a way that honors the life of the person, comforts the mourners, and is practical regarding the land and workers that will be dealing with the body (heretofore call ‘the met’). In reviewing the topic of burial in the literature, we find that in ancient Israel, people were once buried in caves - considered burial in the ground. There was also a time when a met was buried in a field and after the flesh disintegrated, the bones were gathered and placed in the family ancestral cave, mound, or ossuary. Even as the tradition shifted from these practices, the minhag remained to bury in the ground. With over seven billion people on this earth, the current population will have to find places to be buried, even as the available earth to create proper burial sites will diminish over time. Fire cremation re-surfaced in the twentieth century as a viable option for interment1. Even as Teshuvot were written in the Reform, Conservative, and Orthodox movements that ruled against fire cremation, many Jews are creating a “consensus of the pious” that is questioning these rulings. -
Three End-Of-Life Cases: Resolving Their Moral Dilemmas
Vol. 33:2 Summer 2017 Three End-of-Life Cases: Resolving Their Moral Dilemmas RENÉ E MIRKES, OSF, PHD An organization of Roman Catholic physicians presented a set of questions to guide moral assessment of three end-of-life cases. The questions for each scenario highlight a corresponding ethical dilemma: (Case #1) the determination of brain death by neurological criteria; (Case #2) the decision to withhold or withdraw artificial nutrition and hydration from an unresponsive wakefulness syndrome (UWS) (formerly referred to as persistent vegetative state, [PVS]) patient; and (Case #3) the administration of pain medication that hastens death. To adjudicate the moral concern raised in each of these clinical cases, the following moral analyses appeal to the natural law perspective summarized in the Ethical & Religious Directives for Catholic Health Care Services1 and in other philosophical resources, both Catholic and secular. CASE #1 An 18-year-old involved in a motorcycle accident was brought to the emergency room with massive head trauma and life support. A brain angiogram showed no blood flow, and a neurological examination revealed no brainstem reflexes as well as persistent apnea. Blood pressure medication was required for heart rate and blood pressure control. Since the patient was an organ donor, the organ recovery team was called in after he was declared brain dead. Discussion (1) When and how do we declare a person dead? What is the difference between theological and scientific definitions of death? (A) A living human being is a substantial union of a (mammalian) body and a rational soul. We are not spiritual beings who use or have bodies. -
The 9Th SIDS International Conference Program and Abstracts
Program and Abstracts The 9th SIDS The9th International Conference SIDS International June 1-4 2006 in YOKOHAMA Conference June 1-4 2006 in YOKOHAMA www.sids.gr.jp Co-sponsored by The Japan SIDS Research Society and SIDS Family Association Japan Meeting with the International Stillbirth Alliance (ISA) and the International Society for the Study and Prevention of Infant Deaths (ISPID) Program and Abstracts Secretariat PROTECTING LITTLE LIVES, PROVIDING A GUIDING LIGHT FOR FAMILIES General lnquiry : SIDS Family Association Japan 6-20-209 Udagawa-cho, Shibuya-ku, Tokyo 150-0042, Japan Phone/Fax : +81-3-5456-1661 Email : [email protected] Registration Secretariat : c/o Congress Corporation Kosai-kaikan Bldg., 5-1 Kojimachi, Chiyoda-ku, Tokyo 102-8481, Japan Phone : +81-3-5216-5551 Fax : +81-3-5216-5552 Email : [email protected] Federation of Pharmaceutical WAM Manufacturers' Associations of JAPAN The 9th SIDS International Conference Program and Abstracts Table of Contents Welcome .................................................................................................................................................. 1 Greeting from Her Imperial Highness Princess Takamado ................................ 2 Thanks to our Sponsors!.............................................................................................................. 3 Access Map ............................................................................................................................................ 5 Floor Plan ............................................................................................................................................... -
The Vegetative State: Guidance on Diagnosis and Management
n CLINICAL GUIDANCE The vegetative state: guidance on diagnosis and management A report of a working party of the Royal College of Physicians contrasts with sleep, a state of eye closure and motor Clin Med 1INTRODUCTION quiescence. There are degrees of wakefulness. 2003;3:249–54 Wakefulness is normally associated with conscious awareness, but the VS indicates that wakefulness and Background awareness can be dissociated. This can occur because 1.1 This guidance has been compiled to replace the brain systems controlling wakefulness, in the the recommendations published by the Royal College upper brainstem and thalamus, are largely distinct of Physicians in 1996, 1 in response to requests for from those which mediate awareness. 6 clarification from the Official Solicitor. The guidance applies primarily to adult patients and older children Awareness in whom it is possible to apply the criteria for diagnosis discussed below. 1.6 Awareness refers to the ability to have, and the having of, experience of any kind. We are typically aware of our surroundings and of bodily sensations, Wakefulness without awareness but the contents of awareness can also include our 1.2 Consciousness is an ambiguous term, encom- memories, thoughts, emotions and intentions. passing both wakefulness and awareness. This dis- Although understanding of the brain mechanisms of tinction is crucial to the concept of the vegetative awareness is incomplete, structures in the cerebral state, in which wakefulness recovers after brain hemispheres clearly play a key role. Awareness is not injury without recovery of awareness. 2–5 a single indivisible capacity: brain damage can selectively impair some aspects of awareness, leaving others intact. -
Factors Predicting Acute Brain Injury in Cases of Carbon Monoxide Poisoning: a Prospective Registry-Based Study
toxics Article Factors Predicting Acute Brain Injury in Cases of Carbon Monoxide Poisoning: A Prospective Registry-Based Study Hoon Lim 1,†, Young Hwan Lee 1,†, Sangun Nah 1 , Sungwoo Choi 1 , Young Soon Cho 1, Gi Woon Kim 1, Ji Eun Moon 2 and Sangsoo Han 1,* 1 Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; [email protected] (H.L.); [email protected] (Y.H.L.); [email protected] (S.N.); [email protected] (S.C.); [email protected] (Y.S.C.); [email protected] (G.W.K.) 2 Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; [email protected] * Correspondence: [email protected] † Hoon Lim and Young Hwan Lee contributed equally to this work. Abstract: Carbon monoxide (CO) is one of the most common poisoning substances worldwide. Since acute brain injury (ABI) is an important determinant of the neurological outcome in CO poisoning, screening for patients at a high risk of developing ABI is essential for the proper treatment. This study identified predictors of ABI in patients with CO poisoning. This prospective registry-based study was conducted in patients who visited a tertiary care hospital for CO poisoning from August 2016 to June 2020. ABI was defined as the presence of acute hypoxic lesions on diffusion-weighted magnetic resonance imaging. Multiple logistic regression analysis was performed to identify the predictors of ABI. Of 231 patients, 64 (27.7%) showed ABI. Multiple logistic regression analysis showed that a Citation: Lim, H.; Lee, Y.H.; Nah, S.; Glasgow Coma Scale (GCS) score <9 at presentation (odds ratio [OR] 3.28, 95% confidence interval Choi, S.; Cho, Y.S.; Kim, G.W.; Moon, (CI) 1.08–10.01), creatinine level >1.2 mg/dL (OR 3.04, 95% CI 1.16–8.01), and C-reactive protein J.E.; Han, S. -
Fermentation of Non-Digestible Oligosaccharides by Human Colonic Bacteria
Proceedings of the Nutrition Society ( 1996), 55,899-9 12 899 Symposium 2 Fermentation of non-digestible oligosaccharides by human colonic bacteria BY GLENN R. GIBSON, ANNE WILLEMS, SALLY READING AND M. DAVID COLLINS Department of Microbiology, Institute of Food Research, Earley Gate, Reading RG6 6BZ The principal substrates for colonic bacterial growth are dietary carbohydrates which have escaped digestion in the upper gastrointestinal tract. These may be starches, dietary fibres, other non-absorbable sugars, sugar alcohols and oligosaccharides. In the large intestine, saccharolytic bacteria are able to metabolize carbohydrates for increased energy and growth with short-chain fatty acids (SCFA) and a variety of other metabolites, such as the electron-sink products lactate, pyruvate, ethanol, H, and succinate, being produced. The majority of human large intestinal micro-organisms, have a strictly anaerobic metabolism, whilst numbers of facultative anaerobes are many orders of magnitude lower than those of the obligate anaerobes. Of the culturable flora, numerically predominant anaerobes are Gram-negative rods belonging to the genus Bacteroides. Other groups which have hitherto been identified as quantitatively significant include bifidobacteria, clostridia, eubacteria, lactobacilli, Gram-positive cocci, coliforms, methanogens and dissimilatory sulphate- reducing bacteria. Generally, the various components of the large intestinal microbiota may be considered as exerting either pathogenic effects or they may have potential health- promoting values. Bifidobacteria and lactobacilli are considered to belong to the latter group. Bacteria in the colon respond largely to the available fermentable substrate, and there is currently some interest in the use of diet to specifically increase groups perceived as health promoting. Non-digestible oligosaccharides seem to have this (prebiotic) potential. -
Pdfs/Brainstemdeath.Pdf Disturbances Must Be Excluded As the Cause of Continuation of 12 Wijdicks EF
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.suppl_3.iii16 on 21 August 2003. Downloaded from NEUROLOGICAL CONSULTATIONS IN THE MEDICAL INTENSIVE CARE UNIT Saif S M Razvi, Ian Bone iii16* J Neurol Neurosurg Psychiatry 2003;74(Suppl III):iii16–iii23 ritical care therapy has advanced over the past two decades, treating more patients and pro- viding more complex care. However, the improved survival from septic shock, adult respira- Ctory distress syndrome (ARDS), and multiple organ system failure results in critically ill patients facing a spectrum of new complications secondary to both illness and treatment. A third of intensive care unit (ICU) admissions have a neurological complication detrimental to outcome.1 Neurological status (mainly depressed consciousness) is the major contributor to prolonged ventilation in a third of those who need it and is a significant factor in an additional 40%. Neurological complications double both the length of stay in hospital and the likelihood of death; the mortality rate for patients with neurological complications is 55% compared to 29% for those without. It is therefore unsurprising that neurologists are being increasingly called upon to review patients on the medical intensive care unit (MICU). A neurological opinion is usually requested: c to assess neurological manifestations of the primary disease process c to evaluate the consequences of critical care therapy c to offer a prognosis, or c determine brain death. The neurologist must approach these complex patients in a logical,