In South Africa, the high rate of violent deaths, the lack of proper identification documents, and internal migration within the country stemming from the previous socio-political dispensation of society, has led to a high incidence of unidentified human bodies being found, a large proportion of which are skeletal remains, mainly of indigent Black persons. The low incidence of dental records, especially in disadvantaged, rural populations adds to the failure of identification. Without positive identification of individuals, an inquest or criminal case cannot succeed. In routine post mortem practice, only broad groupings of identity are recorded before disposal of remains. The basic rights of these deceased individuals to be properly identified with regards to police investigations and other legal, religious and cultural requirements are disregarded. Further, a large number of persons are reported missing on a daily basis in the country, some never to be found. This study suggests that national legislation be developed to allow for the administration of affairs in respect of missing persons and unidentified bodies, with regulations under this to provide for the mandatory preservation and storage of all medical and radiological records, a national policy and a national plan of action be established to deal with the burden of missing persons and found bodies, and the establishment of a central database of records of unidentified bodies and missing persons. The study also reviews the strengths and weaknesses of available human identification techniques that can be used to facilitate the identification of bodies, and by use of a case report, proposes to demonstrate to the South African Courts that frontal sinus radiographic identification comprises a useful, rapid and inexpensive method as an application in forensic science that can be compared to the individuality of fingerprints, and serves as a reliable additional method in establishing human identity. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2007.

Despite progress in prenatal diagnosis, fetal invasive autopsy remains crucial for diagnosis and counselling for recurrence risk in a subsequent pregnancy. However, a decline in parental consent rate has been repeatedly reported in recent years, mainly due to concerns about body disfigurement. Consequently, non-invasive postmortem imaging technologies have been studied as a possible alternative or adjunct to invasive autopsy.However, the accuracy of the most studied 1.5-T magnetic resonance imaging (MRI) was poor for small fetuses and cardiac examination. Furthermore, only one large study had been published at the beginning of the present thesis, and other data were from small series or case reports.Therefore, the objectives of this thesis were to investigate the performance of postmortem MRI (PMMRI) using 1.5-T and 3-T magnets, to evaluate the contribution of postmortem ultrasound (PMUS) and to explore specific alternatives for small fetuses, such as microfocus computed tomography (micro-CT). We began by investigating the comparative accuracy of 1.5-T and 3-T PMMRI with autopsy in a prospectively acquired sample of 135 fetuses. 3-T PMMRI presented better image quality with increased tissue contrast and provided higher accuracy and diagnostic rate, particularly for fetuses ≤20 weeks of gestational age (GA) and for cardiac examination. We demonstrated that training influenced the performance of PMMRI and a diagnostic accuracy similar to that obtained by an expert radiologist could be achieved after a period of self-directed learning.To increase access to postmortem imaging, we prospectively evaluated the diagnostic accuracy of 2D ultrasound using high-frequency probes in 2 studies including 163 and 160 fetuses. 2D PMUS provided acceptable accuracy of 78% when performed by operators blinded to prenatal diagnosis. In direct comparison with 3-T PMMRI, PMUS was more often non-diagnostic, although it presented comparable accuracy when both techniques were diagnostic. To assess the factors increasing the non-diagnostic rate of PMUS, we retrospectively analysed the data of all fetuses terminated ≥20 weeks GA. We identified several factors that were associated with an increased risk of a non-diagnostic PMUS. Longer delays between fetocide and delivery adversely affected the diagnostic rates for the brain, and both intracardiac injection and advancing gestational age were related to non-diagnostic cardiac PMUS.However, the examination of fetuses ≤20 weeks of GA remained unsatisfactory using 3-T PMMRI or PMUS. Therefore, we explored the feasibility of micro-CT for whole-body postmortem imaging in early gestational fetuses. This technology, initially used in industry, was recently applied in human pathology. We demonstrated a 97% agreement with invasive autopsy in a group of 20 fetuses between 11 and 21 weeks of GA. Micro-CT also produced images comparable to low-power histology in a 7-week human embryo. Unfortunately, access to micro-CT machines for human studies, is currently limited to a few specialist centres. We therefore explored the effect of gadolinium staining before 3-T PMMRI in 5 fetuses ≤16 weeks, however, this method did not improve the image contrast.Finally, in order to initiate the research on the clinical implementation of minimally invasive autopsy, including postmortem imaging and biopsies, we evaluated the parental acceptance rate of such an approach and demonstrated a 20% increase compared to autopsy.In conclusion, our research has defined the diagnostic accuracy of different clinically accessible postmortem imaging technologies, suggesting the best clinical indications for each method. Further research is needed to assess the optimal diagnostic approach using all possible postmortem investigations in order to achieve the maximal diagnostic yield and as a consequence, improved parental counselling. / Malgré les progrès récents des techniques de diagnostic anténatal, l’autopsie fœtale invasive reste primordiale pour obtenir le diagnostic final et établir le risque de récurrence pour les grossesses suivantes. Le nombre d’autopsies fœtales ne cesse de diminuer ces dernières années en raison du refus des parents pour lesquels la défiguration corporelle que le geste entraîne est insupportable. C’est pourquoi, un intérêt croissant pour les technologies non-invasives par imagerie post-mortem a été rapporté dans la littérature, considérées comme des alternatives ou des compléments à l’autopsie invasive.L’imagerie par résonnance magnétique (IRM) à 1,5-T post-mortem est la technique la plus étudiée chez le fœtus. Cependant, la performance diagnostique est moindre pour les foetus ≤20 semaines d’aménorrhée et pour l’examen du coeur foetal. Quant à la littérature, seule une étude avec un large échantillon avait été publiée au début de ce travail, pour le reste il s’agit de description de cas clinique ou de petites séries. Dans ce contexte, la présente thèse a pour objectif d’investiguer les performances diagnostiques de l’IRM post-mortem à 1,5-T et à 3-T, d’évaluer la contribution de l’échographie à haute fréquence en post-mortem, et d’explorer des alternatives spécifiques pour les fœtus <20SA telles que la tomodensitométrie microfocale (micro-CT).Nous avons d’abord comparé la performance diagnostique de l’IRM post-mortem à 1,5-T et à 3-T avec l’autopsie classique sur 135 foetus recrutés prospectivement. Nous avons ainsi démontré que l’IRM 3-T offrait une meilleure qualité d’images en augmentant le contraste tissulaire, permettant plus fréquemment un examen diagnostic, particulièrement pour les fœtus <20 SA et dans les anomalies cardiaques fœtales. Par ailleurs, nous avons également montré que l’entrainement influençait la performance de l’IRM post-mortem: une performance diagnostique similaire à celle d’un expert pouvait être obtenue après une période de 18 mois d’auto-apprentissage.Afin de faciliter l’accès à l’imagerie post-mortem, nous avons évalué la performance diagnostique de l’échographie bidimensionnelle en utilisant des sondes à hautes fréquences dans 2 études prospectives incluant respectivement 163 et 160 fœtus. L’échographie post-mortem a présenté une précision diagnostique acceptable de 78% quand elle était réalisée par des opérateurs en aveugle. Mais quand elle est comparée à l’IRM post-mortem 3-T, nous avons pu déterminer que l’échographie était plus souvent non-diagnostique. Cependant, quand les deux techniques obtenaient un diagnostic, l’échographie offrait une sensibilité et une spécificité comparables à l’IRM. Ensuite, afin d’évaluer les facteurs influençant le taux d’examens non contributifs par l’échographie post-mortem, nous avons analysé rétrospectivement les données de fœtus issus d’interruptions médicales de grossesses après 20 semaines d’aménorrhée, chez qui un foeticide préalable était réalisé. Nous avons démontré d’une part qu’un long délai entre le foeticide et l’accouchement augmentait le taux d’examen non concluant pour le cerveau ;d’autre part un foeticide par injection intracardiaque et un âge gestationnel avancé conduisaient à des examens cardiaques non-diagnostiques.Quant à l’examen des fœtus ≤20 semaines d’aménorrhée, les résultats apportés par l’IRM post-mortem à 3-T ou l’échographie post-mortem restaient insuffisants. Dès lors, nous avons exploré la faisabilité du micro-CT pour l’imagerie du corps entier chez les fœtus à un âge gestationnel précoce. Cette technologie, qui était initialement utilisée en industrie, a trouvé récemment des applications en anatomo-pathologie humaine. Nous avons obtenu par micro-CT une concordance diagnostique de 97% avec l’autopsie invasive pour un groupe de 20 fœtus âgés de 11 à 21 semaines d’aménorrhée. Le micro-CT était également capable de produire des images de qualité comparable à des coupes histologiques à faible grossissement pour un embryon humain de 7 semaines d’aménorrhée. Cependant, l’accès aux machines de micro-CT reste limité actuellement à certains centres spécialisés. C’est pourquoi, nous avons investigué l’effet d’une immersion dans une solution de gadolinium avant une IRM post-mortem 3-T sur 5 fœtus ≤16 semaines d’aménorrhée. Cette méthode n’a pas pu démontrer une amélioration du contraste des images.Enfin, pour initier la recherche sur une future application clinique des autopsies mini-invasives, incluant une imagerie post-mortem et des biopsies, nous avons demandé l’avis des parents faisant face à une perte fœtale. Nous avons montré une augmentation de 20% du consentement pour l’autopsie mini-invasive comparée à celui de l’autopsie classique.En conclusion, nos recherches ont décrit la performance diagnostique de différentes technologies d’imagerie post-mortem accessibles en clinique, en suggérant les meilleures indications cliniques pour chaque méthode. Des recherches ultérieures sont nécessaires pour investiguer la meilleure approche diagnostique possible en utilisant toutes les technologies post-mortem accessibles afin d’obtenir un rendement diagnostique maximal, pour un meilleur conseil de récurrence aux parents endeuillés. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

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At the Third Turner Resource Network Symposium, a working group presented the results of collaborative discussions about the importance of autopsy in Turner syndrome (TS). Considerable gaps in understanding the causes of death in TS can only be closed by more frequent death investigations and autopsies. The presentation included an overview of autopsy methods, strategies for utilizing autopsy, and biobanking to address research questions about TS, and the role of palliative care in the context of autopsy. This review highlights strategies to promote autopsy and tissue donation, culminating with an action plan to increase autopsy rates in the TS community.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2021 / Though it is difficult to determine the prevalence of intimate partner murder-suicide (IPMS), it does appear that this phenomenon is reported in different parts of the world. The psychological consequences of this phenomenon to the surviving family members have also been widely reported. The aim of the study was to conduct a psychological autopsy (PA) on male perpetrators and female victims of IPMS in a rural community in Limpopo Province. The research objectives were; 1) To understand the psychological intent, motives and behaviour of male perpetrators and female victims in IPMS; 2) to identify role played by male perpetrators and female victims in effecting their death; 3) To investigate multiple trajectories (that is, psychological, social, environmental and cultural/historical context) contributed to IPMS; 4) To identify other factors or events that may have triggered fatal behaviour of both male perpetrators and female victims of IPMS; 5) To understand circumstances around IPMS; 6) To develop guidelines to assist in responding to IPMS. The study was qualitative in nature. In particular, the case study design was used. Interpretative phenomenology approach was adopted. The study was informed by the Theory of Planned Behaviour. Purposive sampling used to select cases of intimate partner murder-suicide. Snowball sampling used to select participants and archival sampling was used to select archived record. Thematic Content Analysis (that is, inductive analysis) was used to identify patterns of meaning across the datasets in order to provide answers to the research objective. The research revealed five major themes. These themes are psychological profile of perpetrators, psychological profile of victims, multiple trajectories towards IPMS, possible triggers in IPMS and circumstance around IPMS. Research findings suggest that although IPMS came as a total surprise there were psychological intent, motive, behaviour on the part of male perpetrators and female victims. The study recommends the need for further PA studies to shed the light on the psychological intent of male perpetrators and female victims of IPMS. The psychological intent of male perpetrators and female victims of IPMS heighten the urgency for policy makers to develop IPMS prevention strategies and policies / National Institute for the Humanities and Social Science (NIHSS), and South African Humanities Deans Association (SAHUDA)

Student Number : 0516841M - MSc research report - School of Public Health - Faculty of Health Sciences / Objective This work investigates the hypothesis that individuals recently migrating into rural areas have a higher mortality than those always resident and that migrant deaths are more likely to be HIV/AIDS related than non migrant deaths. Methods Data from the Africa Centre Demographic Surveillance System (ACDIS), South Africa, was used for the analysis. A total of 41519 adults aged 18 to 60 years since their last visit dates were categorized into three groups; internal migrants, external in migrants and always resident individuals since 2001. Follow up period was from 1st January 2001 to 31st December 2005. Cox proportional hazard regression method was used to quantify the additional risk of dying for migrants who have recently migrated into the DSS area. Logistic regression was used to examine the relationship between migration status and dying from AIDS related complications for the members in the sample whose cause of death have been identified using verbal autopsy procedures. Results External in migrants into the DSS area were 1.52 times more likely to die than those always resident. After adjusting for the effects of sex, age group, socio-economic status and educational level an external in migrant has a relative risk of 1.19, [adjusted HR=1.19, P=0.001, 95% CI (1.08,1.32)] of dying compared to those always resident. Internal migrants were 18% less likely to die compared to always resident individuals, [adjusted HR=0.82, P=0.008, 95% CI (0.71, 0.95)] and males were 1.38 times more likely to die within the follow up period compared to females, [HR=1.38, P<0.001, 95% CI (1.28, 1.49)]. These results were statistically significant at 95% confidence level. Out of a total of 1119 deaths that occurred in 2001 and 2002 whose cause of death have been identified through verbal autopsy procedures, 763 (66%) died of AIDS. The odds of dying from AIDS are 2.09 if you are an external in migrant compared to an always resident member, [unadjusted OR = 2.09, P = 0.009 95% CI (1.38, 3.16)]. After controlling for other factors in the model, the odds of dying from AIDS as an external immigrant was 1.79 times, [adjusted OR = 1.79, P = 0.009, 95% CI (1.15, 2.77)] compared to those always resident. There was no significant difference in AIDS mortality between always resident individuals and internal migrants. The odds of a female dying of AIDS was 2.33 times, [OR = 2.33, P<0.001, 95% CI (1.78, 3.06)] compared to males after controlling for migration status, age, socioeconomic status and educational level. Conclusion External in migrants have an increased risk of death among adults aged 18 to 60 years compared to those always resident. External in migrants are also more at risk of dying from AIDS related illnesses than those always resident. Internal migrants are less likely to die than those always resident. Females are more at risk of dying from AIDS than males. In resource-poor settings, especially in many parts of Africa and other developing countries with very high prevalence of HIV/AIDS and over burdened health services in rural areas, it is important to identify and quantify some of these trends contributing to high disease burdens and mortality in rural areas in order to put in place effective interventions to better the health conditions of the people in these areas.

Background Mortality data are critical to understanding and monitoring changes in population health status over time. Nevertheless, the majority of people living in the world’s poorest countries, where the burden of disease is highest, remain outside any kind of systematic health surveillance. This lack of routine registration of vital events, such as births and deaths, constitutes a major and longstanding constraint on the understanding of patterns of health and disease and the effectiveness of interventions. Localised sentinel demographic and health surveillance strategies are a useful surrogate for more widespread surveillance in such settings, but rigorous, evidence-based methodologies for sample-based surveillance are weak and by no means standardised. This thesis aims to describe, evaluate and refine methodological approaches to mortality measurement in resource-poor settings. Methods Through close collaboration with existing community surveillance operations in a range of settings, this work uses existing data from demographic surveillance sites and community-based surveys using various innovative approaches in order to evaluate and refine methodological approaches to mortality measurement and cause-of-death determination. In doing so, this work explores the application of innovative techniques and procedures for mortality surveillance in relation to the differing needs of those who use mortality data, ranging from global health organisations to local health planners. Results Empirical modelling of sampling procedures in community-based surveys in rural Africa and of random errors in longitudinal data collection sheds light on the effects of various data-capture and quality-control procedures and demonstrates the representativeness and robustness of population surveillance datasets. The development, application and refinement of a probabilistic approach to determining causes of death at the population level in developing countries has shown promise in overcoming the longstanding limitations and issues of standardisation of existing methods. Further adaptation and application of this approach to measure maternal deaths has also been successful. Application of international guidelines on humanitarian crisis detection to mortality surveillance in Ethiopia demonstrates that simple procedures can and, from an ethical perspective, should be applied to sentinel surveillance methods for the prospective detection of important mortality changes in vulnerable populations. Conclusion Mortality surveillance in sentinel surveillance systems in resource-poor settings is a valuable and worthwhile task. This work contributes to the understanding of the effects of different methods of surveillance and demonstrates that, ultimately, the choice of methods for collecting data, assuring data quality and determining causes of death depends on the specific needs and requirements of end users. Surveillance systems have the potential to contribute substantially to developing health care systems in resource-poor countries and should not only be considered as research-oriented enterprises.

There is no rapid diagnostic technique at medical examiners' offices to determine if a decedent is infected with Mycobacterium tuberculosis. Present diagnostic testing requires at least one month for results. A biosensor-based sandwich immunoassay for the detection of M. tuberculosis was developed in this study. M. tuberculosis polyclonal antibody was used for target antigen capture and detection in the immunoassay. Live attenuated M. tuberculosis (ATCC 25177) suspended in phosphate-buffered saline with 0.1% Tween 20 was used as the antigen in the detection assay. The Analyte 2000 was the initial biosensor platform. Initial testing was of Freund's adjuvant complete. M. tuberculosis was detected 50% of the time at 1,000,000 CFU/ml and 100% of the time at 10,000,000 CFU/ml and 100,000,000 CFU/ml. Live attenuated M. tuberculosis was also tested using the Analyte 2000 biosensor. Detection was obtained 87.5% of the time at 1,000,000 CFU/ml and 100% of the time at 10,00 0,000 CFU/ml and 100,000,000 CFU/ml. The RAPTOR, an automated, portable instrument, was then tested as the fiber optic biosensor platform. Positive biosensor detection was obtained 75% of the time at cell concentrations of 1,000,000 CFU/ml, 95% of the time at 10,000,000 CFU/ml, and 99% of the time at 100,000,000 CFU/ml. Live attenuated M. tuberculosis suspended in PBST and seeded into decedent lung tissue was tested using the RAPTOR. Positive detection was obtained 21% of the time at cell concentrations of 1,000,000 CFU/ml, 86% of the time at 10,000,000 CFU/ml and 100% of the time at 100,000,000 CFU/ml. Antibody specificity studies using ELISA were performed to determine the anti-M. tuberculosis antibody's cross reactivity with microorganisms other than M. tuberculosis. M. tuberculosis actively growing in the lung of an individual is found at levels of 10,000,000 to 1,000,000,000 CFU in the lesions of the lung. This study determined that the RAPTOR biosensor assay was capable of detecting the presence of M. tuberculosis in lung tissue homogenate within three hours when the concentration of M. tuberculosis was 10,000,000 to 1,000,000,000 CFU/ml.

Thesis (doctoral)--Bayerische Ludwig-Maximilians-Universität, Munich, 1934.

Thesis (doctoral)--Bayerische Ludwig-Maximilians-Universität, Munich, 1934.