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Detection and classification of composite resins in incinerated teeth for forensic purposes.

The great demand for esthetic restorations has resulted in placement of large numbers of composite resin fillings. The popularity of these materials is reflected in the quantity and variety of resin brands currently on the market. The ability to distinguish resin brands can aid in positive identification of burn victims, assuming that appropriate dental records exist. Scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS) was used to characterize the structure and composition of 10 modern resins. The structure of each resin was unique to manufacturer, and elemental analysis allowed separation into distinct groups. These 10 resins were also placed in extracted teeth and incinerated at 900 degrees C for 30 min, simulating near cremation conditions. The resins were identifiable by SEM/EDS after incineration, and the elemental composition remained almost unchanged. The data produced are immediately useful for resin identification in forensics, and comparative analysis can be readily performed using standard equipment. This work represents the initial stage of database generation.

Acrylic Resins↗

Elemental analysis of human cremains using ICP-OES to classify legitimate and contaminated cremains.

The Tri-State Crematory Incident in Nobel, GA (February 2001) revealed limitations in traditional human cremated remains (cremains) analytical methodology. The goal of this study was to develop a method for effectively classifying questionable sets of cremains as legitimate or contaminated. Eighty-eight samples of known human cremains, concrete, mixtures of the two, and questionable sets of cremains were acid digested and analyzed for 21 elements by Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES). Variable cluster and principle component analyses identified the seven elements (Sb, B, Li, Mn, Sr, Tl, and V) used to develop discriminant functions to classify questionable sets into two groups: cremains and concrete. The discriminant analysis shows that at the 0.90 probability level, mixtures of 50% or less human content were classified as concrete. Mixtures with 90% human content classified as cremains. Sixty percent and 75% human content mixtures remained in the questionable classification, but as the concentration of human increased in the mixture, the probability of assignment to the known cremains group increased. Most of the questionable human samples classified as cremains. This is a pilot study and cannot yet satisfy Daubert standards for courtroom admissibility, but it indicates that it is possible to determine the legitimacy of cremains using elemental analysis by ICP-OES coupled with multivariate statistical analysis.

Discriminant Analysis↗

Dentition of Chilean paleo-Indians and peopling of the Americas.

Teeth of 12 cremated paleo-Indians (11,000 years old) from caves in southern Chile have crown and root morphology like that of recent American Indians and north Asians, but unlike that of Europeans. This finding supports the view that American Indians originated in northeast Asia. This dental series also suggests that paleo-Indians could easily have been ancestral to most living Indians, that very little dental evolution has occurred, and that the founding paleo-Indian population was small, genetically homogeneous, and arrived late in the Pleistocene.

Aged↗

Practical management of perinatal death.

After the loss of a newborn baby the parents are usually too shocked and unfamiliar with the complicated administration procedures to cope with the registration of death and burial (or cremation). The medical and nursing staff also tend to be unfamiliar with the procedures. Some of these can be streamlined, thus reducing the stress caused to parents. By giving positive instruction the staff will in their turn be able to improve their care of the bereaved parents.

Birth Certificates↗

Muslim customs surrounding death, bereavement, postmortem examinations, and organ transplants.

Muslims are always buried, never cremated. It is a religious requirement that the body be ritually washed and draped before burial, which should be as soon as possible after death. Those carrying out this duty should be immunised against hepatitis B and be aware of the hazards of AIDS. Muslim women never attend burials and it is rare for funeral directors to be involved. Muslim jurists from the Arab world can justify organ transplantation, but those from the Indian subcontinent are against it. They are united in the belief of the sacredness of the human body and thus deplore postmortem examinations.

Attitude to Death↗

Attitudes of medical students to necropsy.

AIM: To compare the attitudes of students towards the necropsy at different stages of their undergraduate career. METHOD: Students in the first, fourth and sixth academic years (n = 283) were asked to respond anonymously to a questionnaire comprised of 26 attitude statements. These statements dealt with the importance of the necropsy in medicine, rapport with the bereaved family and emotional reactions to the necropsy. RESULTS: Of the students, 226 (80%) completed the questionnaire. Overall, the students agreed on/the importance of the necropsy. The three groups differed in 10 statements on the approach to the bereaved family and emotional reactions to the necropsy. First year students showed more personal involvement and would have more difficulties in approaching the family of the deceased as well as in attending a necropsy. These reactions were increasingly less noticeable with fourth and sixth year students. The latter group was also more inclined to accept cremation, organ donation and necropsy of their own corpses. CONCLUSION: The changes in attitudes towards the necropsy throughout undergraduate study may reflect both the influence of psychological defense mechanisms and the viewing of necropsy as a relevant tool in medical practice. Necropsy should be carefully and sensitively incorporated into programmes designed to teach students about death and dying. This might reduce both their reluctance to seek permission for necropsy and their difficulty in looking after the dying patient.

Adult↗

A prospective audit of pacemaker function, implant lifetime, and cause of death in the patient.

AIM: To audit prospectively the reasons for pacemaker implantation, the duration of the pacemaker use, the cause of death, and pacemaker function after removal from the patient. METHODS: Pacemakers were removed at necropsy, or from the bodies of patients awaiting cremation, in three hospitals over a three year period. The cause of death was taken from the results of the necropsy or from the certified cause of death. Demographic data, including the time of implant and reasons for implantation, were checked. The pacemakers were analysed in terms of battery status, program, and output under a standard 470 ohm load. RESULTS: 69 patients were studied. Average age at death was 78 and 80 years for men and women, respectively. The average duration since pacemaker implantation was 46 months. Eleven patients had necropsies, showing that three died from ischaemic heart disease, six from cardiomyopathy, one from an aortic aneurysm, and one from disseminated neoplasia. From the necropsy results and death certificates, the distribution of causes of death in the group as a whole were ischaemic heart disease (21), cardiomyopathy (8), cerebrovascular disease (11), neoplasia (11), chest infection/chronic obstructive airways disease (8), and other causes (10). In all cases the pacemaker box function was within normal limits. CONCLUSIONS: Neither primary nor secondary pacemaker dysfunction was found. The study highlights the impact of arrhythmias in cardiomyopathy, and raises questions about the true role of ischaemic heart disease in these pacemaker requiring patients. The relatively short gap between pacemaker implantation and death requires further study.

Age Distribution↗

Implications of Harold Shipman for general practice.

Harold Shipman was an English general practitioner who murdered at least 215 of his patients between 1974 and 1998. A public inquiry is underway, but general practitioners and all doctors also need to consider the implications for their profession. The aim of this paper is to stimulate debate. Issues identified as important to consider include: trust between doctors; attitudes towards failing systems such as cremation certification; acceptance of the duty of accountability; ensuring patients can have reasonable confidence in their doctors; commitment to preventing such a case occurring again; and relationships with patients. It is argued that restricting debate to methods to detect doctors who murder would limit the opportunity to improve medical practice and would constitute a failure to fulfil the duty owed by doctors to Shipman's victims and their families.

Anger↗

Effects of vasodilators on microcirculation of the rat cremaster muscle: a microscopic method for screening drugs.

Effects of vasodilating drugs on microcirculation of the rat cremaster muscle were investigated microscopically. Topical application and intravenous injection of papaverine produced dilatation of arterioles. Cyclandelate applied topically dilated the arterioles to a considerable extent. Topical application of bamethan induced arteriolar dilatation while bamethan given intravenously constricted the arterioles. Kallikrein applied topically induced a slight dilatation of arterioles, and intravenous administration of kallikrein produced an appreciable vasodilatation. Topical administration of bradykinin produced a vasodilatation of arterioles of the rat cremaster muscle. These results indicate that direct action of a drug on the microcirculation can be properly evaluated by the microscopic method in the rat cremater muscle, if the drug is applied topically, in the vicinity of small vessels under study.

Acetylcholine↗

Legal aspects of consent 14: organ removal, retention, storage.

Case Scenario: Sarah was born with a congenital heart condition. Unfortunately, the subsequent operation proved unsuccessful and Sarah died. Sarah's parents were asked if they would agree to a post mortem being performed to assist in research so that in future such conditions could be successfully operated upon. The parents agreed and subsequently they were notified that the body was available for disposal. They decided upon a cremation. Several years later, following an inquiry into the pathology services of the hospital, they were notified by the Chief Executive's department that Sarah's heart, lungs, liver and other organs had been retained. The parents were shocked. What is the law?

Autopsy↗

Review of recommendations for reforms to the coroner's office.

The Inquiry that was set up following the conviction of Dr Shipman for the murder of 15 of his patients produced three reports, the third of which considered the present system for death and cremation certification and the investigation of deaths by coroners (Shipman Inquiry, 2003b). The report makes extensive recommendations for reform of the coroner's office regarding the certification of death. This article outlines the recommendations made by the third report of the Shipman Inquiry and reviews the potential implications of such legislation.

Autopsy↗

Lymphocytic alveolitis in a crematorium worker.

An asymptomatic cremator was found incidentally to have lymphocytic alveolitis by bronchoalveolar lavage, and the basis for this finding was investigated. No known causes of lymphocyte alveolitis including sarcoidosis, hypersensitivity pneumonitis, berylliosis, tuberculosis, or fungal diseases of the lung were found. By exclusion, therefore, exposure to formaldehyde and/or to compounds in the residual ash likely were etiologic in the development of the lymphocytic alveolitis.

Adult↗

Identification of unknown body using DNA analysis and dental characteristics in chest X-ray photograph.

An unknown skeletonized body was identified by DNA analysis and dental information. The body had already been cremated when a candidate for the unknown body was proposed. Therefore, for DNA analysis we used teeth that had been kept for a long time after use for serological examination. We also used a chest X-ray photograph of the candidate and photographs of dentition, as well as dental X-ray photographs taken when the unknown body was found. Because DNA obtained from teeth was highly degraded, we amplified three PCR fragments to determine the 766 bp mitochondrial DNA (mtDNA) sequence including HV1 and HV2. Polymorphism of the ABO locus was also analyzed using small PCR fragments. Although the isolated DNA was contaminated, probably with DNA from a different individual, DNA polymorphisms of mtDNA and the ABO locus could be analyzed. We discuss the reliability of our conclusions from the point of view of the necessity of constructing an accurate mtDNA database. Although a dentist who had treated the teeth of the unknown body could not be found, a chest X-ray photograph for medical diagnosis was very useful in comparing dental characteristics, as it included an image of the frontal part of the lower jaw and upper teeth.

ABO Blood-Group System↗

An exploratory study of funeral cost for suicides.

Funeral cost was less for younger people and for cremation. Among 156 funerals examined, after matching for sex, age, and cremation/burial, the funerals of a small sample of 6 suicides cost less than those of the controls.

Burial↗

Consuming the dead: a Kleinian perspective on death rituals cross-culturally.

The author argues that Melanie Klein's theories of mourning shed light on certain funerary practices encountered widely in ethnographic literature, namely 'second burial'. Pointing out that the death of a loved person is experienced in fantasy as the destruction of the internalised mother imago, the author shows how various Kleinian processes involved in infantile fears of maternal loss--such as persecutory anxiety, guilt, depression, and attempts at reparation--are clearly expressed in rituals of mourning cross-culturally. The argument is illustrated with two extensive case studies, Bali (Indonesia) and the Mekeo of coastal Papua New Guinea. A number of other cultures are considered briefly to indicate the relevance of Kleinian theory to the symbolism of death rituals more broadly, including the role played by sorcery and witchcraft beliefs, fears of malevolent ghosts, repeated re-burial, mortuary gift exchange, cremation, mortuary cannibalism, and the denial of death in modern western funeral rites.

Attitude to Death↗

Parentage testing on blood crusts from firearms projectiles by DNA typing settles and insurance fraud case.

We describe a case of a fraudulent insurance claim. The family of an adult white male (DLF) notified the police of their son's disappearance. After a few weeks, a corpse that presented characteristics similar to those of the DLF was found in advanced stages of decay and was identified by the family as being DLF. The family then filed a claim for the life insurance that DLF had taken out just before he disappeared. Suspicions were raised about the identification of the corpse, because it had been done only visually, and because the insurance policy had been taken out just prior to DLF's disappearance. The insurance company requested a postmortem examination for identification. As the corpse had been cremated immediately after identification by the family, the biological material that was encrusted on the two projectiles removed from the body was used for analysis. The blood crusts provided enough genomic DNA for us to carry out PCR base typing of HLA-DQA1, D1S80, HUMCSF1PO, HUMTPOX, HUMTH01, D3S1744, D12S1090, D18S849, and amelogenin. Results from all loci typing from the corpse presumed to be that of DLF were then compared with that of his alleged biological parents, revealing genetic incompatibility.

Adult↗

Preliminary clinical experience with a new radioisotope-powered cardiac pacemaker.

A small light-weight nuclear-powered pacer has been developed. The pulse generator weight 61 Gm. and occupies a volume of 33 sq. cm. It is a standard R-wave inhibited (VVI) demand pulse generator. The unit has met all United States and foreign atomic energy commission safety specifications including mechanical shock, industrial fire, accidental crush, cremation, impact, and corrosion. Its calculated life is in excess of 20 years. The unit has been shown to be insensitive to electromagnetic interference (EMI) over a wide range of commonly encountered sources of interference. An extensive dog testing program has been carried out and is continuing. The United States Atomic Energy Commission (AEC) has issued a license to conduct clinical trials. These began in October, 1974, and a total of 30 units of 30 units have been implanted so far. An equal number of chemical battery-powered pulse generators has been implanted in a control series of 30 patients. Preliminary results have been gratifying.

Adult↗

A new radioisotope-powered cardiac pacer.

A small lighweight nuclear pacer is described. The unit weighs 6) Gm. and occupies a bolume of 33 c.c. It is a standard, R-wave inhibited, demand pacer and has been shown to be insensitive to electromagnetic interference. The unit has met all United States and Foreign Atomic Energy Commission (AEC) safety specification requirements, including cechanical shock, industrial fire, accidental crush, cremation, impact, and corrosion. Its calculated life is in excess of 20 years. Extensive dog testing has been completed and will be described in detail elsewhere. The United States AEC has been issued a license to conduct extensive clinical trials. These began in October 1974, and will be the subject of a later report.

Animals↗