Rozprawy doktorskie na temat „Post-mortem care”

This thesis investigates artistic post-mortem photography in the context of shifting social relationship with death in the 1980s and 1990s. Analyzing Nan Goldin’s Cookie in Her Casket and Andres Serrano’s The Morgue, I argue that artists engaging in postmortem photography demonstrate care for the deceased. Further, that demonstrable care in photographing the dead responds to a crisis of the late 1980s and early 1990s in America. At the time, death returned to social and political discourse with the visibility of AIDS and cancer and the euthanasia debates, spurring on photographic engagement with the corpse. Nan Goldin’s 1989 post-mortem portrait of her friend, Cookie in Her Casket, was first presented within The Cookie Portfolio. The memorial portfolio traced the friendship between Cookie and Goldin over fourteen years. The work relies on a personal narrative, framing the works within a familial gaze. I argue that Goldin creates the sense of family to encourage empathy in the viewer for Cookie’s loss. Further, Goldin’s generic and beautified post-mortem image of Cookie is a way of offering Cookie respect and dignity in death. Andres Serrano’s 1992 The Morgue is a series of large-scale cropped, and detailed photographs capturing indiscriminate bodies from within an unidentified morgue. I assert that Serrano intentionally presents these corpses as objects, outside of life. His stark lighting, emphasis on texture and the rich colours of Cibachrome print beautify and lavish aesthetic care on the corpse-objects. I propose a reading of The Morgue through Serrano’s deliberate use of beauty to transform the corpses into icons, and read the entire series as a visualisation of the sublime within the abject. Goldin and Serrano have fundamentally different approaches to post-mortem photography. Goldin’s work follows an artistic and historical tradition of memorial portraits taken of the deceased by friends or family; whereas Serrano follows from a forensic framework appropriated by artists who photograph within a morgue. Previous discourse separated memorial and forensic post-mortem photography in order to better appreciate the historical trajectory of each field. In the context of a time where death was moving from near invisibility into the mainstream, comparing Goldin and Serrano offers insight into the changes in America’s visual relationship with death.

Bakgrund: När en patient avlider fortsätter vården även efter dödsögonblicket, vårdpersonal tar hand om både patient och närstående även efter att döden har inträtt. Att göra iordning den avlidne (post mortem care) är en uppgift omgärdad av symboliska handlingar och ritualer. Utbildningar lägger ringa vikt vid att lära ut färdigheter kring denna typ av vård och upplevelsen av att vårda en avliden patient är sparsamt undersökt i forskning och litteratur. Syfte: Att beskriva vad sjuksköterskor upplever som viktigt och meningsfullt i sitt arbete med vård av avlidna patienter i palliativ verksamhet. Metod: Arbetet har en deskriptiv design och är en kvalitativ intervjustudie med både fokusgruppintervju och enskild intervju som datainsamlingsmetod. Materialet bearbetades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier och sju underkategorier: Kunskap och erfarenhet: teoretisk kunskap erfarenhetsbaserad kunskap Relationer och roller: sjuksköterskors relation till patienten närståendes roll och betydelse för sjuksköterskor Handlingar och ritualer: symboliska handlingar avslut och avsked reflektion Diskussion: Resultatet diskuterades med KASAM som teoretisk referensram och överensstämmer med tidigare forskning. I resultatet framkom att vården av avlidna ansågs vara meningsfull och en arbetsuppgift som sträcker sig längre än omvårdnad, t.ex. inkluderades närståendestöd och egen reflektion som delar av post mortem care. Resultatet visar också att kunskapen till största del är erfarenhetsbaserad och att deltagarna i studien tycker det är viktigt att erfarna får tid och möjlighet att lära nya/oerfarna.

In three separate studies, this thesis examined stress and coping in nurse practitioners during first time exposure to post-mortem care. Using a self report questionnaire and a retrospective design, Study 1 (N=97) examined the nurse's first experience administering post-mortem care to the recently deceased. The results obtained from this exploratory investigation established that many nurses reported significant distress and used emotion-focused coping strategies (avoidance and palliation) to manage the experience. These data are consistent with those reported by others who have researched in the area, and support the hypotheses that first time exposure to post-mortem care can induce significant distress in some nurses, and that the memory is vividly recalled many years after the event. The second study used a prospective design. Base line data were collected prior to the nurse performing post-mortem care (N=59), 24 hours after they participated in their first post-mortem care procedure, and 1 and 5 weeks post-event. The General Health Questionnaire-28, the Revised Ways of Coping Checklist, the Revised Collett-Lester Fear of Death and Dying Scale, and the Impact of Event Scale were used to obtain data which were compared with that of a control group (N=59) of nurses undertaking an academic examination. The results confirmed that beginning nurse practitioners resort to using predominantly emotion-focused coping strategies when faced with stressful life events. Moreover, a direct linear relationship between the participants' fear of death and dying scores and the way they rated the impact of performing post-mortem care was found. Colaizzi's (1978) method of data analysis was used in the third and final study in the series (N=6) that explored the lived experience of nurses performing post-mortem care. The essence of the first experience was embedded in six key themes that structured the lived experience. Psychic disorganisation was experienced by the participants because they were unprepared both psychologically and educationally to deal with the experience and resorted to using emotion-focused coping strategies. It is concluded that nurses' first exposure to post-mortem care procedures is stressful and they use predominately emotion focused coping strategies to deal with the experience.

In three separate studies, this thesis examined stress and coping in nurse practitioners during first time exposure to post-mortem care. Using a self report questionnaire and a retrospective design, Study 1 (N=97) examined the nurse's first experience administering post-mortem care to the recently deceased. The results obtained from this exploratory investigation established that many nurses reported significant distress and used emotion-focused coping strategies (avoidance and palliation) to manage the experience. These data are consistent with those reported by others who have researched in the area, and support the hypotheses that first time exposure to post-mortem care can induce significant distress in some nurses, and that the memory is vividly recalled many years after the event. The second study used a prospective design. Base line data were collected prior to the nurse performing post-mortem care (N=59), 24 hours after they participated in their first post-mortem care procedure, and 1 and 5 weeks post-event. The General Health Questionnaire-28, the Revised Ways of Coping Checklist, the Revised Collett-Lester Fear of Death and Dying Scale, and the Impact of Event Scale were used to obtain data which were compared with that of a control group (N=59) of nurses undertaking an academic examination. The results confirmed that beginning nurse practitioners resort to using predominantly emotion-focused coping strategies when faced with stressful life events. Moreover, a direct linear relationship between the participants' fear of death and dying scores and the way they rated the impact of performing post-mortem care was found. Colaizzi's (1978) method of data analysis was used in the third and final study in the series (N=6) that explored the lived experience of nurses performing post-mortem care. The essence of the first experience was embedded in six key themes that structured the lived experience. Psychic disorganisation was experienced by the participants because they were unprepared both psychologically and educationally to deal with the experience and resorted to using emotion-focused coping strategies. It is concluded that nurses' first exposure to post-mortem care procedures is stressful and they use predominately emotion focused coping strategies to deal with the experience.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology
Full Text

Background: Health policy in England has increasingly promoted coordinated and integrated health and social care services delivered through partnerships with public, private and voluntary sector organisations. End of life care would likely benefit from improved coordination as patients in the last few months of life with incurable, irreversible illness often require access to a range of services. A regional partnership project, which served as a case to study the implementation process, proposed to coordinate end of life care through establishing a Navigation Centre, shared electronic palliative care patient record (EPaCCS) and working groups to develop new patient pathways within the region. There is a gap in understanding how such complex, multi-innovative programmes are implemented by partnerships. Aim: This study draws on implementation theory to explore the implementation process of a project delivered by a partnership, specifically the shape of the process, what influenced the shape and what implementation outcomes were achieved. Design and Methods: The study adopted a pragmatic, pluralist design using primarily qualitative methods including: document review, observations, interviews, focus group and telephone interviews. A thematic analysis was conducted using the Framework approach which allows for the data to be reduced and sifted through to find linkages and patterns in the data by both source and theme as part of an inductive and deductive analytical process. Findings: The implementation of the Project was characterised by an interactional, over-lapping process in which planning, development, implementation and adaptation of the various innovations proceeded simultaneously, though at the end of the two year project period many tasks were incomplete. Barriers to implementation included: the NHS reforms, lack of robust project management, interconnected project elements, and competition from similar innovations. Facilitating factors included: leadership by the Hospice as experts in end of life care, work benefit, individual motivation, and sole ownership and management over implementation. External threats to the Project had variable influence on the partners and suggests that project resiliency is particularly important for complex multi-organisational programmes which are implemented over time and by multiple stakeholders from different sectors. This study's contribution to knowledge is that resilience to unplanned events in a project appears to be the product of implementation strategies, innovation adaptiveness and implementer characteristics. Future research should look further at what contributes to project resiliency and how projects can develop resilient factors to ensure their success.

The Aim of the Study: The aim of this study was to explore the experiences of ICU nurses performing post mortem care in an intensive care unit at a private hospital in Cape Town. In addition, the study set out to identify educational needs and to offer recommendations that may address these needs for this sample of ICU nurses. Background to the Study: Post mortem care (care after the death of a human being) is still viewed by contemporary society as a taboo and clandestine aspect of life and is more often avoided both in conversation, writing and thinking. In many hospitals and other healthcare facilities, post mortem care is performed behind closed doors, in which an aura of mystery is created as to what happens to the dead body in this scenario. The nurses’ experience of post mortem care differs from that of other occupational groups (ambulance officers, medical practitioners and police) as the nurse sees the body before and after death and has an established relationship with the person who has died. The practical procedure of post mortem care is widely explored by many authors using various procedural guidelines and/or manuals. However, little is known about the nurse’s experiences of post mortem care. Methodology: A qualitative research design using a descriptive method was used to explore the experiences of a purposive heterogeneous sample of six ICU nurses who were working in an ICU of a private hospital in Cape Town. Data Collection and Analysis: A semi-structured interview which was audio-taped and transcribed verbatim was employed to collect data. Colaizzi’s (1978) seven step inductive method was used to formulate naïve themes. Following participant feedback, three main themes emerged: (i) care of the dead body; detachment and (iii) thanatophobia. Findings: Safeguarding the integrity and physical appearance of the dead body was the major finding and of the utmost priority for the participants in this study. Regardless of how the ICU nurses felt about death, providing professional and quality care to the dead body and the family was seen as significantly important. The ICU nurses, whilst performing post mortem care, experienced detachment from various relationships. This comprised of the ICU nurse detaching him/herself professionally and emotionally from the dead patient, the family and him/herself from the death experience. This ‘unspoken’ experience of thanatophobia became apparent when the ICU nurses were confronted by the reality of their own deaths. Conclusion and Recommendations: These three themes were discussed in relation to the available literature and recommendations put forward for education and nursing practice and further research.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
O presente trabalho foi desenvolvido a partir de dois experimentos descritos em dois capítulos. O primeiro com objetivo de verificar se a adipogênese contribuiria para discrepância no teor de gordura intramuscular presente na carne de animais Nelore comparado a animais Angus em fase de terminação. Objetivou-se ainda investigar se possíveis diferenças na quantidade de células adipo-fibrogênicas presentes no tecido muscular esquelético de animais Angus e Nelore estaria associada à diferença no teor de gordura intramuscular da carne oriunda desses animais. Foram utilizados 6 animais da raça Nelore (peso inicial = 372,5 ± 37,3 kg) e 6 da raça Angus (peso inicial = 382,8 ± 23,9 kg), mantidos sob as mesmas condições experimentais. Os animais foram abatidos no final do período de terminação, e amostras do Longissimus dorsi foram coletadas logo após a sangria, para posterior ánalises de expressão gênica (RT-PCR) e expressão proteica (Western blot). Outras amostras na mesma região muscular foram coletadas 24 horas após o abate, para posterior análise de extrato etéreo e colágeno. Os genes adipogênicos avaliados foram: C/EBPα, PPARγ e Zfp423; Sendo que o PPARγ e Zfp423 também tiveram sua expressão proteica avaliada. Os genes fibrogênicos avaliados foram: COL1A1, COL3A3, FN1, LOX, MMP2, TIMP1, TIMP2, TIMP3 e TGF-β, para o TGF-β também foi realizada expressão de proteína. Além dessas, foram realizadas expressão proteica da SMAD (proteína envolvida na iniciação da fibrogênese) e da PDGFRα (proteína indicadora de células indiferenciadas), comum às vias de sinalização adipogênica e fibrogênica. Não foi observada diferença significativa para expressão gênica dos mRNA adipogênicos e fibrogênicos (P > 0,05). No entanto, houve diferença significativa entre Angus e Nelore para expressão proteica do SMAD (P < 0,05), PPARγ (P < 0,05) e PDGFRα (P < 0,05), em que tais proteínas foram mais expressas nos animais da raça Angus. Embora não tenha sido encontrada diferença para quantificação química de colágeno e sua solubilidade (P > 0,05), houve diferença entre as raças para quantificação química do extrato etéreo, indicando maior deposição de gordura intramuscular em Angus do que em Nelore (P < 0,001). Conclui- se que existe diferença na adipogênese intramuscular entre animais Angus e Nelore, o que contribui para diferenças na quantidade de tecido adiposo intramuscular depositado na carne destes animais. Além disso, a maior expressão de PDGFRα em Angus em relação a Nelore evidencia maior número de células mesenquimais indiferenciadas em músculo esquelético de animais Angus em relação a animais Nelores. Dada à capacidade adipo- fibrogênica das células PDGFRα associado à ausência de diferenças entre as raças quanto à fibrogênese, a maior abundância de células mesenquimais indiferenciadas observada no tecido muscular esquelético dos animais Angus explica a diferença quanto à adipogênese intramuscular entre as raças estudadas. No segundo experimento, objetivou-se avaliar a atividade da calpastatina e expressão de mRNA de possíveis marcadores da maciez da carne no músculo Longíssimus dorsi de Angus e Nelore. Foram utilizados os mesmos animais do experimento anterior. Os animais foram abatidos no final do período de terminação, e amostras do Longissimus dorsi foram coletadas logo após a sangria, para posterior ánalises de expressão gênica (RT-PCR) para calpaína 3 (CAPN3), calpastatina (CAST), caspase 3 (CASP3) e HSP70 (DNAJA1) e também expressão proteica (Western blot) para calpaína e calpastatina. Outras amostras na mesma região muscular foram coletadas 24 horas após o abate, para posterior análise de atividade da calpastatina, força de cisalhamento e índice de fragmentação miofibrilar (IMF). Não houve diferença significativa para expressão gênica da CAPN3, CAST, CASP3 e DNAJA1 (P > 0,05). Apesar da atividade da calpastatina ter sido maior em Nelore do que em Angus (P = 0,0292), não houve diferença para a expressão proteica da calpastatina e nem da calpaína (P > 0,05). No entanto, observou- se diferença significatica para o índice de fragmentação miofibrilar (P = 0,0051), em que a carne de Angus apresentou maior IMF que a do Nelore. Conclui-se que embora haja diferença na atividade da calpastatina entre os dois grupos genéticos estudados, não se é verificado diferença quanto a abundancia dessas proteínas na carne de Nelore e Angus. No entanto, o maior índice de fragmentação miofibrilar dos Angus indica maior degradação miofibrilar post – mortem e consequentemente carne mais macia do que Nelore. A ausência de diferença na expressão da caspase e da HSP70 aqui encontrada, deve ser melhor investigada a fim de esclarecer melhor a importancia destas proteínas no amaciamento da carne de bovinos Nelore e Angus.
This work presents two experiments that were described separately in chapters. The first trial was conducted to evaluate if the difference between Angus and Nellore on intramuscular fat content after finishing period can be explained by adipogenesis. In addition, was evaluated if discrepancy of intramuscular fat content in beef from Nellore and Angus is associated with differences on amount of intramuscular adipo/fibrogenic cells. Six Nellore (initial body weight = 372.5 ± 37.3 kg) and six Angus (initial body weight = 382.8 ± 23.9 kg) were confined at the same experimental conditions. At the end of finishing period, the animals were slaughtered and longissimus muscle samples for quantitative real-time PCR (qPCR) and Western blot were collected just after exsanguination. Longissimus muscle samples for ether extract and collagen assays were obtained at the same carcass region after 24 hours chilling. The qPCR were performed to evaluate mRNA expression of adipogenic genes (C/EBPα, PPARγ and Zfp423) and fibrogenic genes (COL1A1, COL3A3, FN1, LOX, MMP2, TIMP1, TIMP2, TIMP3 and TGF-β). Western blot assays were performed to evaluate protein expression of adipogenic markers (PPARγ and Zfp423), the fibrogenic marker TGF-β and genes related with both pathways (SMAD and PDGFRα). No differences (P > 0.05) were observed for mRNA expression of neither adipogenic nor fibrogenic markers. However, the breed affected (P < 0.05) protein expression of SMAD, PPARγ and PDGFRα, which were greater in Angus than Nellore. Although meat collagen content and solubility did not differ (P > 0.05) among breeds, Angus meat presented greater (P < 0.001) ether extract content than Nellore, proving greater intramuscular fat in Angus beef. In conclusion, the Angus enhanced adipogenesis contribute to greater intramuscular fat content of this breed in contrast to Nellore cattle. In addition, Angus higher PDGFRα expression likely indicate greater muscle content of undifferentiated mesenchymal cells than Nellore. Our data suggest that although PDGFRα cells have adipo/fibrogenic capacity, fibrogenesis is not different among breeds thus greater density of undifferentiated mesenchymal cells in Angus explain the greater adipogenesis compared to Nellore. The second trial aimed to evaluate calpastatin activity and gene expression of meat tenderness markers of longissimus muscle from Angus and Nellore. The same animals from the first trial were used. At the end of finishing period, the animals were slaughtered and longissimus muscle samples for quantitative real-time PCR (qPCR) and Western blot were collected just after exsanguination. The qPCR were performed to evaluate mRNA expression of calpain 3 (CAPN3), calpastatin (CAST), caspase 3 (CASP3) and HSP70 (DNAJA1). Protein expression (Western blot) of calpain and calpastatin were also evaluated. Longissimus muscle samples for calpastatin activity, Warner-Bratzler shear force and myofibrillar fragmentation index (MFI) assays were obtained at the same carcass region after 24 hours chilling period. The mRNA expression of CAPN3, CAST, CASP3 and DNAJA1 genes did not differ (P > 0.05) among breeds. Although Nellore calpastatin activity was greater (P = 0.0292) than Angus, no difference was observed (P > 0.05) among breeds for calpastatin and calpain protein expression. The MFI differ (P = 0.0051) among breeds, which was greater in Angus than Nellore beef. In conclusion, although calpastatin activity is different among breeds the calpastatin and calpain protein abundance are not. Beef from Angus presents greater postmortem myofibril proteolysis and consequently greater tenderness than Nellore beef. Furthermore, the absence of HSP70 and caspase expression differences needs further investigation to better clarify the role of these proteins on meat tenderness.

L’entità e la velocità con cui avviene l’acidificazione muscolare post-mortem e il valore di pHu raggiunto sono fattori in grado di influenzare le caratteristiche qualitative e tecnologiche della carne. Questa tesi ha avuto lo scopo di caratterizzare il metabolismo post-mortem di tre muscoli del pollo da carne selezionati in base al contenuto di carnosina ed appartenenti ai tagli anatomici di maggiore interesse alimentare (petto, sovracoscia e fuso) e stabilire l’effetto della concentrazione di composti istidinici sulla glicolisi post-mortem. I tre muscoli considerati hanno mostrato cinetiche di acidificazione differenti, in accordo con le loro caratteristiche metaboliche. Gli andamenti dei metaboliti glicolitici (lattato, glucosio, glucosio-6-fosfato, glicogeno) sono risultati coerenti con le dinamiche di acidificazione muscolare. Tuttavia, la concentrazione residua di glicogeno nel muscolo pettorale a 24 h post-mortem suggerisce che la glicolisi avrebbe potuto continuare e consentire il raggiungimento di valori di pHu inferiori. Infatti, il muscolo pettorale, caratterizzato da un metabolismo glicolitico, ha mostrato velocità ed entità di acidificazione limitate se paragonato ai muscoli ossidativi della coscia. Allo stesso tempo, il muscolo del petto ha presentato una concentrazione di dipeptidi istidinici (anserina e carnosina) e una capacità tampone notevolmente superiori rispetto agli altri muscoli considerati. Pertanto, è possibile affermare che tali composti, in virtù del loro spiccato potere tampone, hanno esercitato un considerevole effetto sul metabolismo dei muscoli nella fase che precede il raggiungimento del rigor mortis. Alla luce dei risultati ottenuti si può affermare che, grazie a strategie di tipo genetico e/o alimentare in grado di modulare la concentrazione muscolare dei dipeptidi istidinici, si potrebbe regolare la cinetica di acidificazione post-mortem al fine di migliorare la stabilità microbiologica e/o i parametri qualitativi delle carni.

O trabalho tem como objetivo avaliar o perfil morfométrico e o metabolismo post mortem de bovinos Nelore com diferentes taxas de crescimento da desmama ao sobreano. Foram confinados 154 bovinos Nelore, machos não-castrados, com idade média de 18 meses e 350 kg de peso vivo. Os animais foram designados a um delineamento inteiramente casualizado com dois tratamentos (alta taxa de crescimento [ATC] e baixa taxa de crescimento [BTC] da desmama ao sobreano). Foram selecionados cinco animais extremos de ATC e cinco extremos de BTC (10 animais de cada ano) para realização das analises de cor (L*, a*, e b*), força de cisalhamento, perdas por cocção, e também analise do perfil morfométrico muscular. Amostras também foram coletadas para simulação da glicólise in vitro para a determinação de pH, glicose, glicose-6-fosfato e glicogênio nos pontos 0, 0,5, 2, 4, 8, 12 e 24 horas. Os dados foram analisados utilizando o software SAS 9.4. Não houve efeito da taxa de crescimento sobre as características de desempenho, carcaça nem qualidade de carne. Animais BTC apresentaram maior frequência de fibras do tipo I, enquanto animais ATC apresentaram frequência de fibras tipo IIa 4% maior. Em relação à área transversal das fibras musculares, fibras do tipo I provenientes de animais ATC foram 17% maiores. Os animais ATC apresentaram maior concentração de glicogênio nos pontos 0 e 8 horas. Os animais BTC apresentaram maiores concentrações de G6P nos postos 2 e 8 horas. Animais BTC apresentaram maiores concentrações de glicose nos pontos 8 e 24 horas. Em conclusão, a seleção de bovinos com alta taxa de crescimento no período da desmama ao sobreano promove um perfil de fibras mais glicolítico. Entretanto, essa mudança no perfil morfométrico não altera a queda do pH nem a qualidade da carne.
The objective of this study was to evaluate the morphometric profile and the postmortem metabolism of Nellore cattle with different growth rates from weaning to yearling. 154 non castrated Nellore males with 18 mo/old and 350 kg live weight were confined. The animals were assigned to a completely randomized design with two treatments (high growth rate [ATC] and low growth rate [BTC] from weaning to yearling). Five animals from ATC group and five animals from BTC group (10 animal each year) were selected. Analysis of color (L*, a*, and b*), shear force, morphometric profile, simulation of in vitro glycolysis for the determination of pH, glucose, glucose-6-phosphate and glycogen in 0, 0,5, 2, 4, 8, 12 e 24h were performed. The data were analyzed using SAS 9.4 software. There was no effect of growth rate on performance, carcass or meat quality characteristics. BTC Animals had a higher frequency of type I fibers, while ATC animals presented a 4% greater frequency of type IIa fibers. Regarding the cross-sectional area of muscle fibers, Type I fibers from ATC animals were 17% larger. ATC animals showed higher glycogen concentration at 0 h and 8 h. BTC animals had higher concentrations of G6P at 2h and 8h. BTC animals presented higher glucose concentrations at 8 h and 24 h. In conclusion, the selection of cattle with a high growth rate from weaning to yearling leads to a more glycolytic fiber profile. However, this change in the morphometric profile neither alters the pH drop nor the meat quality.

Violence and resulting injuries are critical health burdens worldwide, accounting for the death of millions of individuals annually. The literature reports an association between drug use and violence, providing data indicating that the use of psychoactive substances increases the risk of morbidity and mortality due to violent acts. South Africa has a long history of violence, with one of the highest rates of recorded violence- and injury-related deaths in the world. This is complicated by an increase in illicit substance use and abuse, particularly in the Cape Town Metropole, located within the Western Cape Province. The use of toxicological findings from victims of violent death (homicides, suicides, and accidents) to examine community-specific drug-related violence is slowly increasing in different parts of the world. In South Africa, however, monitoring drug trends in violent fatalities using toxicological analysis is uncommon, and hence drug toxicology of violent-related fatalities is limited. Divided into three contextual sections, this research study focuses on the post-mortem toxicology of violent deaths in a South African setting. The first section provides a general idea of the research problem and an initial development of the investigation process. The second section provides a theoretical basis for performing routine toxicological analyses in deaths due to violence, reports important research work conducted in the field worldwide, and emphasizes the need to monitor toxicological data derived from violent fatalities in Cape Town, South Africa. The last section, in the form of a manuscript, presents the overall research study including the methodology, outcomes, and concluding findings in a concise and illustrative manner. The primary aim of this pilot study was to investigate the prevalence and characteristics of illicit substances in violent fatalities (homicides, suicides, and accidents) of the Salt River mortuary in Cape Town, South Africa. The objectives were to conduct a comprehensive drug toxicology analysis to generate qualitative and comparative data from the aforementioned cases. In addition, this study investigated the dynamics between psychoactive substance use and violent deaths in terms of toxicological trends, and the demographics and circumstances of death of the victim. Lastly, the author discusses potential qualitative associations between illicit substances and violence-related deaths in a South African setting, and provide suggestions for future toxicological analyses in these fatalities.

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Universidade Estadual Paulista (UNESP)
Quanto menor o intervalo de tempo entre o achado post mortem e o diagnóstico da tuberculose, mais rapidamente se estabelecerão prioridades de ação frente a decisão sanitária a ser tomada pela Inspeção de Produtos de Origem Animal quanto a carcaça em questão. A citologia por ser um método rápido, de fácil realização e de baixo custo sendo importante instrumento na clínica bovina, especialmente quando usada em conjunto com achados físicos. Foram avaliadas amostras de 41 fragmentos de linfonodos de bovinos de matadouro-frigorífico com avaliação macroscópica e coletado material para exame histológico, citológico e cultura bacteriológica e parte delas analisadas pelo PCR. De 17 linfonodos sem lesões típicas de tuberculose em 9 visualizaram-se células gigantes de Langhans; 4 isolaram-se o M. bovis; sendo duas destas PCR positivo e 4 citologias sugestivas de tuberculose. Resultados deste estudo indicam que nem todos os animais infectados têm lesões macroscópicas observadas na linha de abate. Permitem também concluir que há a necessidade do uso de métodos laboratoriais no auxílio do diagnóstico da tuberculose em matadouros-frigoríficos.
The short the time gap between the post mortem found and the tuberculosis diagnosis, the faster wil the action priorities be established towards the sanitary decision to be made by slaughter surveillance concerning the carcass in the issue. Cytology being a fast, rather feasible and low-cost method and important tool in bovine practice, especially when used in conjunction with the physical findings. 41 samples of fragments from bovine lymph nodes coming from slaughterhouse have been analyzed macroscopically and material for histological, cytological and bacteriologic culture has been collected, part of wich has been analyzed by the PCR. Of the 17 lymph nodes with no TB lesions, 9 present giant Langhans cells; in 4 was the M. bovis isolated, 2 of those being PCR positive, and 4, TB suggestive cytology. Results from this study indicate that not all infected animals have macroscopic lesions observed at slaughter line; allowing as well to be concluded, that there is a need for use of laboratorial methods in assisting the diagnosis of tuberculosis in slaughterhouse.

L’anomalia Spaghetti Meat (SM) è un difetto che colpisce il muscolo P. major dei moderni polli da carne, provocandone la perdita di integrità strutturale e determinando notevoli perdite economiche legate alla necessità di declassamento. In questo contesto, l'obiettivo del presente lavoro è stato quello di indagare le relazioni esistenti fra l’anomalia SM e le principali caratteristiche dei lotti dei polli di provenienza, valutare l’incidenza del difetto SM a livello commerciale e gli effetti delle cinetiche di abbassamento del pH e della temperatura nel periodo post-mortem nei petti affetti. Dai rilievi effettuati su 30 lotti di polli medi e pesanti è emerso che l’incidenza di SM è stata mediamente pari all’11% e quindi superiore a quanto osservato in un’indagine condotta nel medesimo stabilimento nel 2020. Inoltre, i lotti con una maggiore incidenza di SM presentavano un peso alla macellazione tendenzialmente più elevato e una maggior percentuale di individui femmine. Dai rilievi analitici effettuati al macello su oltre 300 petti, è emerso che la velocità e l’entità dell’acidificazione post-mortem dei muscoli P. major affetti da anomalia SM risultano essere ridotte rispetto a quelle delle carni normali, probabilmente a causa della diminuzione delle riserve di glicogeno conseguente alla degenerazione delle fibre muscolari. Allo stesso tempo, sono stati registrati valori superiori di temperatura nei muscoli affetti da anomalia SM a 15 minuti e 3 ore post-mortem, tuttavia tali differenze non sono verosimilmente attribuibili a modificazioni metaboliche quanto piuttosto al peso più elevato delle carcasse di provenienza. I risultati ottenuti in questo lavoro di tesi rappresentano un’importante punto di riferimento per futuri studi finalizzati alla valutazione dell’effetto di diverse cinetiche di raffreddamento delle carcasse sul processo di acidificazione muscolare, allo scopo di verificare le possibili implicazioni sul livello di gravità dell’anomalia SM.

Orientador: Noeme Sousa Rocha
Banca: Julio Lopes Sequeira
Banca: Germano Francisco Biondi
Banca: Rosilene Fressatti
Banca: Antonio Carlos Faria dos Reis
Resumo: Quanto menor o intervalo de tempo entre o achado post mortem e o diagnóstico da tuberculose, mais rapidamente se estabelecerão prioridades de ação frente a decisão sanitária a ser tomada pela Inspeção de Produtos de Origem Animal quanto a carcaça em questão. A citologia por ser um método rápido, de fácil realização e de baixo custo sendo importante instrumento na clínica bovina, especialmente quando usada em conjunto com achados físicos. Foram avaliadas amostras de 41 fragmentos de linfonodos de bovinos de matadouro-frigorífico com avaliação macroscópica e coletado material para exame histológico, citológico e cultura bacteriológica e parte delas analisadas pelo PCR. De 17 linfonodos sem lesões típicas de tuberculose em 9 visualizaram-se células gigantes de Langhans; 4 isolaram-se o M. bovis; sendo duas destas PCR positivo e 4 citologias sugestivas de tuberculose. Resultados deste estudo indicam que nem todos os animais infectados têm lesões macroscópicas observadas na linha de abate. Permitem também concluir que há a necessidade do uso de métodos laboratoriais no auxílio do diagnóstico da tuberculose em matadouros-frigoríficos.
Abstract: The short the time gap between the post mortem found and the tuberculosis diagnosis, the faster wil the action priorities be established towards the sanitary decision to be made by slaughter surveillance concerning the carcass in the issue. Cytology being a fast, rather feasible and low-cost method and important tool in bovine practice, especially when used in conjunction with the physical findings. 41 samples of fragments from bovine lymph nodes coming from slaughterhouse have been analyzed macroscopically and material for histological, cytological and bacteriologic culture has been collected, part of wich has been analyzed by the PCR. Of the 17 lymph nodes with no TB lesions, 9 present giant Langhans cells; in 4 was the M. bovis isolated, 2 of those being PCR positive, and 4, TB suggestive cytology. Results from this study indicate that not all infected animals have macroscopic lesions observed at slaughter line; allowing as well to be concluded, that there is a need for use of laboratorial methods in assisting the diagnosis of tuberculosis in slaughterhouse.
Doutor

In Brazil, in 2006, 35.650.000 turkeys were slaughtered, totalizing 353,278 ton, 156,056 were exported generating a cambial prescription of US$ 262.820.985, 00. Objecting evaluate the occurred convictions in turkeys slaughter in the Rio Grande do Sul were evaluated the spread sheets of turkeys conviction under fiscalization in the Rio Grande do Sul ´s Federal Supervision (RS), in the period of January of 2005 until December of 2006. The results demonstrates that almost of the eight million turkeys carcasses (7.984.528 birds), 19.9% had some kind of postmortem condemnation. Most condemnations were partial 1.539.939 (97.1%) and 46,628 (2.9%) were totally condemned. The principal causes of partial condemnations were: contusion/breaking (7.025%), abscess (3.698%), contamination (2.942%), callus of chest (1.995%), arthritis (1.428%), airsacculitis (1.101%), dermatosis (0.937%) and excessive scald (0.056%). The causes of total postmortem condemnation were: repugnant aspect (0.255%), wasting (0.085%), excessive scald (0.077%), airsacculitis (0.040%), colibacillosis (0.033%) and contamination (0.025%). It was observed that the most of these condemnations are related to the imperfections in the transport and in the slaughter process of these animals showing the necessity of improvements, as corrective actions that can minimize bruises, harm bleeding, like others.
No Brasil, em 2006, foram abatidos 35.650.000 perus, totalizando 353.278 toneladas. Destes 156.056 foram exportadas gerando uma receita cambial de US$ 262.820.985,00. Com o objetivo de avaliar as condenações ocorridas no abate de perus no Rio Grande do Sul foram estudadas as planilhas de condenação de perus sob a fiscalização do Serviço de Inspeção Federal (SIF) no Estado do Rio Grande do Sul (RS), no período de janeiro de 2005 até dezembro de 2006. Os resultados demonstram que dos quase oito milhões de perus abatidos no Estado (7.984.528 aves), 19,9% foram condenados. Destes 1.539.939 (97,1%) foram condenados parcialmente e 46.628 (2,9%) foram condenados totalmente. As principais causas de condenação parcial foram por: contusão/fratura (7,025%), abscesso (3,698%), contaminação (2,942%), calo de peito (1,995%), artrite (1,428%), aerossaculite (1,101%), dermatose (0,937%) e escaldagem excessiva (0,056%). E as principais causas de condenação total foram: aspecto repugnante (0,255%), caquexia (0,085%), escaldagem excessiva (0,077%), aerossaculite (0,040%), colibacilose (0,033%) e contaminação (0,025%). Sendo que se observou que as maiorias destas condenações estão relacionadas à falhas no transporte e no processo de abate desses animais traduzindo a necessidade de melhorias, como ações corretivas que podem minimizar contusões, má sangria, entre outras.

Thesis (MMed (Pathology. Forensic Medicine))--University of Stellenbosch, 2010.
Bibliography
ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services.
AFRIKAANSE OPSOMMING: Agtergrond – Die werkslading van die forensiese patoloog en ander personeel van die Forensiese Patologie Dienste word vermeerder deur die verwysing van moontlik onnodige natuurlike gevalle na die Forensiese Patologie Dienste. Die primêre doelwitte van die medies-geregtelike nadoodse ondersoek is beperk tot die bepaling van ‘n oorsaak van dood in vermoedelik onnatuurlike gevalle, en om nalatigheid of kriminele aksies uit te skakel. Doelwit – Om die finale uitkomste van medies-geregtelike nadoodse ondersoeke in “skielike en onverwagte” volwasse sterftes oor ‘n 5-jaar tydperk te bepaal. Metodes – ‘n Observasionele, retrospektiewe, beskrywende studie is uitgevoer. “Skielike en onverwagte” volwasse sterftes wat verwys is na Tygerberg Forensiese Patologie Dienste vanaf 1 Januarie 2001 tot 31 Desember 2005 is hersien. Inligting is versamel vanaf die nadoodse ondersoekverslae, kontemporêre notas en hospitaalnotas. Bevindinge – Agthonderd en sestien volwasse gevalle van skielike en onverwagte sterftes is oor die 5-jaar periode verwys na Tygerberg Forensiese Patologie Dienste. Volledige lykskouings is uitgevoer in 74% (601/816) van die gevalle. Die vermoedelike wyse van die sterfte was natuurlik in 79.04% en ‘n toename in die aantal natuurlike gevalle wat lykskouings ondergaan het, is waargeneem oor die 5-jaar studie tydperk. Siektes van die kardiovaskulêre, respiratoriese en sentrale senuweestelsel was verantwoordelik vir die meerderheid natuurlike sterftes. Infektiewe toestande was verantwoordelik vir die meeste sterftes in die jongste ouderdomsgroep (18-29 jaar) wat bestudeer is. Akute alkoholvergiftiging was verantwoordelik vir die sterftes van 35 (6%) gevalle, met ‘n gemiddelde bloed-alkohol-konsentrasie van 0.38g/100mL in hierdie gevalle. Agt sterftes was dwelm-/middelverwant. Die wagtyd vir bloed-alkohol en toksikologie resultate het vermeerder oof die 5-jaar studie tydperk. Die oorsaak van dood was nie gevind in 10.6% van gevalle. Afleidings – Die vraelys en onderhoud-struktuur kan moontlik verbeter word om sodoende beter inligting te verkry voor die uitvoering van ‘n lykskouing, en om die aantal “onnodige” medies-geregtelike nadoodse ondersoeke te verminder, en sodoende die kostedruk te verminder op die Forensiese Patologie Dienste.

Nurses' experiences with post-mortem care and death were diverse and represented a confluence of factors. Nurses' personalities, religious beliefs, cultural value systems, customs, life experiences, and the unit's orientation all converged and influenced their attitudes toward death. Culture and the unit's orientation exerted the strongest influence on nurses' attitudes. Exposure to dying was the most influential factor in determining attitudes toward death and dying, with palliative care nurses being most comfortable in dealing with death. Cultural differences also emerged, with Canadian and Israeli nurses entertaining divergent attitudes toward death, spirituality and post-mortem care. Death was conceptualised by some nurses as the end of an organism, and by others as the beginning of another form of existence. Post-mortem care was reported as an emotionally demanding task, yet most Canadian nurses considered the experience rewarding. The wrapping of the body in a plastic shroud and the covering of the face was the aspect nurses disliked the most; they felt it was repugnant, dehumanising and disrespectful.

碩士
國立成功大學
護理學系
105
Critical care nurses have a high proportion facing death. Appropriate post-mortem care helps families experience acute grief. However, There are few previous studies on post-mortem care. The purpose of this study was to investigate how critical care nurses carry out post-mortem care in terms of nurses’ thoughts and feelings, as well as the difficulties and obstacles they face when doing so. The research was conducted as a cross-sectional study. The data were collected by self-designed structured questionnaire to explore the current status of the post-mortem care in ICU. The results showed that ICU nurses felt competent to do body care, but it is weakness on bereavement care.

Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services.
Health Studies
D. Litt. et Phil. (Health Studies)