'The healthcare system is not designed around my needs': How healthcare consumers self-integrate conventional and complementary healthcare services.

Objective: To explore healthcare consumers' experiences of healthcare service integration.

Methods: This phenomenological study comprised three focus groups of 13 participants who were purposively invited to span three broad generations: young adults, middle-aged adults and seniors. Transcripts of focus group recordings were analysed thematically.

An unusual case of homicidal near drowning followed by electrocution.

A young woman was found dead in a bath-tub with her facial orifices under water and current burn marks at the right big toe and at the neck near the hairline. Initial police investigations assumed an accidental electric shock due to a radio falling into the water. The forensic autopsy was followed by extensive histology and immunohistochemistry of the internal organs and skin marks.

Specific traces in stun gun deployment.

Stun guns are electric shocking devices that can be deployed as defensive or offensive weapons. The aim of this study was the identification of several types of trace evidence for corroborating deployment and providing clues to the weapon actually used. In a series of some 250 tests, the after-effects of firing a stun gun were studied under the differential influence of factors, such as time duration, distance from target, and bare skin vs clothing as target surface.

Fracture properties of the human mandible.

A total of seven human mandibles were struck to breaking point under standardised conditions using a pendulum. The cortical deformation for two impact directions was measured with strain gauge strips located at eight defined sites. Fronto-median impacts led to mostly bilateral and always multiple fractures in the posterior area of the bone, especially in the collum and the condyle.

Deformation characteristics of the human mandible in low impact experiments.

A total of 11 human mandibles were subjected to physical impacts under standardised conditions. Two impact sites and directions were tested and the impact load was varied in four steps. Two occlusional strengths were applied and the influence of simulated soft tissue covering was recorded.

Death due to intravenous application of enteral feed.

A 6-month-old male infant was treated with intravenous infusions and enteral feed via a naso-gastric tube. Accidentally, enteral feed containing pureed carrots diluted with water was injected intravenously and the child died immediately. Carrot material could be found in the pulmonary blood vessels and in various organs of the systemic circulation.

Structural basis of calcification inhibition by alpha 2-HS glycoprotein/fetuin-A. Formation of colloidal calciprotein particles.

Genetic evidence from mutant mice suggests that alpha(2)-HS glycoprotein/fetuin-A (Ahsg) is a systemic inhibitor of precipitation of basic calcium phosphate preventing unwanted calcification. Using electron microscopy and dynamic light scattering, we demonstrate that precipitation inhibition by Ahsg is caused by the transient formation of soluble, colloidal spheres, containing Ahsg, calcium, and phosphate. These "calciprotein particles" of 30-150 nm in diameter are initially amorphous and soluble but turn progressively more crystalline and insoluble in a time- and temperature-dependent fashion.

Surfactant-encapsulated clusters (SECs): (DODA)20(NH4)[H3Mo57V6(NO)6O183(H2O)18], a case study.

We present a comprehensive study of the partially reduced polyoxomolybdate [H3-Mo57V6(NO)6O183(H2O)18]21-encapsulated in a shell of dimethyldioctadecylammonium (DODA) surfacmolecules. Treatment of an aqueous solution of (NH4)21[H3Mo57V6-(NO)6O183(H2O)18] . 65H2O (1a) with a trichloromethane solution of the surfactant leads to instant transfer of the encapsulated complex anion into the organic phase.

Fatal intoxication due to excessive dichloromethane inhalation.

A 22-year-old white male was found dead at his working place in a car lacquering company. He had removed lacquer residues by using a solvent containing dicloromethane (DCM) without using a gas mask. Pathology revealed signs of asphyxiation with obvious petechial bleedings and expressed microthrombosis of the pulmonary arteries.

No stress--no whiplash? Prevalence of "whiplash" symptoms following exposure to a placebo rear-end collision.

Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms, but the cause of these symptoms remains unknown. It is unclear whether the symptoms arise from biomechanical stress causing injury or from psychological stress causing symptom expectation and anxiety. Similarly, the cause of symptoms remains obscure in virtually all "whiplash" patients because it is impossible to identify acute pathology in many cases.

[The practice of medical postmortem examination].

Background And Objective: The quality of the external examination of corpses has repeatedly been criticized. This study provides information on the performance of the external examination of bodies in practice which is necessary for improving the quality of the examination.

Methods: 1000 randomly selected medical practitioners from the "Arztekammer Westfalen-Lippe" were sent a questionnaire concerning personal data, the performance of the external examination of bodies and possible influencing of the decision on the manner of death (i.

Endochondral ossification of costal cartilage is arrested after chondrocytes have reached hypertrophic stage of late differentiation.

Late cartilage differentiation during endochondral bone formation is a multistep process. Chondrocytes transit through a differentiation cascade under the direction of environmental signals that either stimulate or repress progression from one step to the next. In human costal cartilage, chondrocytes reach very advanced stages of late differentiation and express collagen X.

Multiple interchanging of tissue samples in cases of breast cancer.

Due to the suspicion of a gynaecologist, a pathologist was suspected of incorrect diagnoses in cases of breast cancer and the interchanging of tissue samples. Many women applied to the attorney's bureau to clarify the reproaches. The privately owned laboratory for pathology was searched and 926 histological slides, roughly the same number of paraffin blocks and about 20 formalin fixed tissue samples were confiscated.

Relationship between impact velocity and injuries in fatal pedestrian-car collisions.

The most common type of fatal pedestrian-car collision, i.e. a passenger car with a wedge or pontoon shaped front striking an erect adult with this front, was investigated.

Post-mortem orthopantomography--an aid in screening for identification purposes.

Ante-mortem orthopantomograms may be of great value in the identification of human remains. This x-ray technique provides an overall view of the teeth and jaws and thus of numerous individual structural characteristics within a short time. Standardised post-mortem orthopantomography has previously not been feasible in the forensic practice.

Film Formation and Redispersion of Waterborne Latex Coatings.

Poly(vinyl acetate-co-ethylene) latex dispersions are prepared and their films investigated with a focus on the effect of composition upon redispersion. Films of dispersions containing sufficient amounts of poly(vinyl alcohol) (PVA) can be redispersed in water. This property is lost in the presence of surfactant, a fact which suggests a procedure to control film formation.

Injuries from hand grenades in civilian settings.

Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density.

Manipulated radiographic material--capability and risk for the forensic consultant?

As interest is being increasingly focused on the digital processing of radiographs for identification of the deceased, the benefits and risks of electronic image processing are presented. With digitization of all kinds of radiographic equipment being on the increase and image processing personal computers being readily accessible, increasing quantities of manipulated radiographic material are to be expected in the future. This potential risk is meanwhile highlighted from the legal aspect.

Inflammation of the cardiac conduction system in a case of hyperthyroidism.

A 37-year-old female showed signs of hyperthyroidism 2 weeks before death after a partial thyroidectomy was carried out 15 years previously. An examination 3 days before death revealed a normal blood cell count, an increased level of thyroidal hormones, sinus tachycardia and a high blood pressure of 170/90 mm Hg. A hyperthyroidism was diagnosed and therapy with carbimazol (2 x 10 mg) was started but 2 days later fever and chill occurred and before death short phases of unconsciousness and dyspnoea.

[Examining patients with facial skull fractures from an etiological and legal perspective].

Maxillofacial traumas are common and often associated with other injuries. From a forensic point of view, it is often necessary to relate the traumatic event to the subsequent injuries. The aim of this study was to explore the etiology of maxillofacial injuries due to objective signs and the anamnestic history of patients.

Proof of air embolism after exhumation.

The detection, storage, and analysis of gas taken from the heart ventricle is necessary to diagnose a fatal air embolism and this requires special precautions during autopsy. When the results of gas analysis correspond to the criteria defined by Pierucci and Gherson the diagnosis "air embolism" is justified. In cases showing putrefaction the diagnostic value of gas analysis was negated.

A new technique for the postmortem detection of tooth-coloured dental restorations.

Identification of unknown bodies is mainly made by dental examination and comparison with accurate dental records. Therefore it is necessary to examine the jaws carefully and to locate every tooth-coloured dental restoration. Overlooking dental fillings can make positive identification impossible.

Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics?

In clinical medicine, severe keto- or lactic acidosis associated with vomiting, nausea, abdominal pain, tachycardia or pathological respiration, has been described in chronic alcoholics. This study reports on fatalities of chronic alcoholics where the cause of death could not be determined by thorough autopsy, histology and toxicology including determination of alcohol concentration. In a first series, acetone was determined in the blood of such chronic alcoholics (n = 24), diabetics with metabolic decompensation (n = 7), cases of hypothermia (n = 7) and controls (n = 218).