Identification of the unidentified deceased and locating next of kin: experience with a UID web site page, Fulton County, Georgia

BACKGROUND: Medical examiner and coroner offices may face difficulties in trying to achieve identification of deceased persons who are unidentified or in locating next of kin for deceased persons who have been identified. The Fulton County medical examiner (FCME) has an office web site which includes information about unidentified decedents and cases for which next of kin are being sought. METHODS: Information about unidentified deceased and cases in need of next of kin has been posted on the FCME web site for 3 years and 1 year, respectively. FCME investigators and staff medical examiners were surveyed about the web site's usefulness for making identifications and locating next of kin. RESULTS: No cases were recalled in which the web site led to making an identification. Two cases were reported in which next of kin were located, and another case involved a missing person being ruled out as one of the decedents. The web site page is visited by agencies interested in missing and unidentified persons, and employees do find it useful for follow-up because information about all unidentified decedents is located and easily accessible, electronically, in a single location. CONCLUSIONS: Despite low yield in making identifications and locating next of kin, the UID web site is useful in some respects, and there is no compelling reason to discontinue its existence. It is proposed that UID pages on office web sites be divided into "hot" (less than 30 days, for example) and "warm" (31 days to 1 year, for example) cases and that cases older than a year be designated as "cold cases." It is conceivable that all unidentified deceased cases nationally could be placed on a single web site designed for such purposes, to remain in public access until identity is established and confirmed.     

Suicide by electrocution with low-voltage current

Three cases of suicide by electrocution with low-voltage current were observed in five years (1994-1998) by medical clinical forensic examiners of an Emergency Forensic Unit of the Paris suburb among 2,000 external death examinations. The cases involved one woman, aged 72 and two men, aged 38 and 41. In the last two cases, electric burns were retrieved under bared electric wires, placed on the arms or fingers in order to realize a hand-to-hand electric circuit involving the heart muscle. In the other case, the electric circuit between mouth and foot also involved the heart muscle. Household low-voltage current delivered (220 V in France) had a sufficient strength to induce local muscular paralysis and heart fibrillation. In the three cases, blood samples taken have retrieved very high levels of muscular enzymes (CPK, LDH) correlated to the mechanism of electric death. The rareness of suicide by electrocution and its forensic characteristics are detailed in order to help the clinical forensic examiners, prosecutors, and police officers concerned by such death examinations.     

The Linux FAT32 allocator and file creation order reconstruction

The allocation algorithm of the Linux FAT32 file system driver positions files on disk in such a way that their relative positions reveal information on the order in which these files have been created. This provides an opportunity to enrich information from (carved) file fragments with time information, even when such file fragments lack the file system metadata in which time-related information is usually to be found.Through source code analysis and experiments the behaviour of the Linux FAT allocator is examined. How an understanding of this allocator can be applied in practice is demonstrated with a case study involving a TomTom GPS car navigation device. In this case, time information played a crucial role. Large amounts of location records could be carved from this device's flash storage, yielding insight into the locations the device has visited—yet the carved records themselves offered no information on when the device had been at the locations. Still, bounds on the records' time of creation could be inferred when making use of filesystem timestamps related to neighbouring on-disk positions.Finally, we perform experiments which contrast the Linux behaviour with that of Windows 7. We show that the latter differs subtly, breaking the strong relation between creation order and position.     

Forensic aspects of ocular injury

A case of homicidal stabbing resulting in bilateral penetrating ocular injuries is described. The case is noteworthy in that it highlights an unusual mechanism of death in homicidal stabbing. Disturbances in heart rhythm including asystole can be ascribed to the so-called oculocardiac or trigeminocardiac reflex. Although this phenomenon is well known to ophthalmologists, neurosurgeons, and anesthetists, it is much less familiar to forensic pathologists. This is a potential mechanism of death worthy of consideration in cases of sudden unexpected death occurring in the context of facial injury.     

The "utility" principle within the scope of forensic determination of blood kinship using serostatistics

A "realistic" prior probability is always based on case experience (Akten-a-priori). In serological opinions pertaining to parentage, the realistic prior probability is only one piece of information in the whole body of evidence before the judge and does not have any special significance per se. There is no such thing as a "neutral" prior probability. It either implies "ignorance," in which case it cannot be "information," or it must be taken in connection with the utility principle, in which case it is not a "probability." The utility principle is defined in law and cannot be expressed in figures. The utility principle takes effect only when the judge reaches a decision (on the basis of all the evidence before him). It determines the relative importance of the participant's objects of legal protection which are at issue in the case. The expert is bound to apply a neutral utility component, i.e., in a two-hypothesis case (the normal situation) the significance of both the null and the counter hypothesis must carry the same weight. A null and/or a counter hypothesis can combine several single hypotheses; the mean value of their frequencies is taken. As a rule, one should avoid using a "prior case probability" ("Akten-a-priori") when calculating a W value. An "expectation of error" should be as realistic as possible and hence be obtained using a "prior case probability."     

Commercial speech and off-label drug uses: what role for wide acceptance, general recognition and research incentives?

This article provides an overview of how the constitutional protections for commercial speech affect the Food and Drug Administration's (FDA) regulation of drugs, and the emerging issues about the scope of these protections. A federal district court has already found that commercial speech allows manufacturers to distribute reprints of medical articles about a new off-label use of a drug as long as it contains disclosures to prevent deception and to inform readers about the lack of FDA review. This paper summarizes the current agency guidance that accepts the manufacturer's distribution of reprints with disclosures. Allergan, the maker of Botox, recently maintained in a lawsuit that the First Amendment permits drug companies to provide "truthful information" to doctors about "widely accepted" off-label uses of a drug. While the case was settled as part of a fraud and abuse case on other grounds, extending constitutional protections generally to "widely accepted" uses is not warranted, especially if it covers the use of a drug for a new purpose that needs more proof of efficacy, and that can involve substantial risks. A health law academic pointed out in an article examining a fraud and abuse case that off-label use of drugs is common, and that practitioners may lack adequate dosage information about the off-label uses. Drug companies may obtain approval of a drug for a narrow use, such as for a specific type of pain, but practitioners use the drug for similar uses based on their experience. The writer maintained that a controlled study may not be necessary to establish efficacy for an expanded use of a drug for pain. Even if this is the case, as discussed below in this paper, added safety risks may exist if the expansion covers a longer period of time and use by a wider number of patients. The protections for commercial speech should not be extended to allow manufacturers to distribute information about practitioner use with a disclosure about the lack of FDA approval. Distributions of information about unapproved uses should not be acceptable unless experts consider the expanded use to be generally recognized as safe and effective based on adequate studies. The last part of this paper considers the need to develop better research incentives to encourage more testing and post-market risk surveillance by drug makers on off-label uses of their drugs. Violations of the Federal Food Drug and Cosmetic Act (FFDCA) can be considered violations of the False Claims Act, which opens the way to fraud and abuse suits. The scale of penalties involved in these suits may lead to more examination of the scope of FDA regulation and commercial speech protections. Thus this symposium's consideration of these issues is timely and important.     

Case report of suicide by inhalation of nitrogen gas

Nitrogen is an inert gas that is a normal constituent of the air that we breathe. It is a suffocating gas that does not support life and that can be a cause of death by the displacement of oxygen in the atmosphere. The majority of deaths associated with nitrogen have occurred in the setting of scuba diving. Although other suffocating gases have been used as a means of committing suicide, the literature contains little information about the use of nitrogen as a suicidal agent. A case of a 50-year-old man who committed suicide using a homemade suicide device and nitrogen gas is presented.     

Police GPS Surveillance on Vehicles and the Warrant Requirement: “For a While I’ve Been Watching You Steady”

The global positioning system (GPS) has become ubiquitous to modern American life. The system supplies direction for travel through navigation systems as well as employee monitoring capabilities (Rosenberg Washington Journal of Law, Technology, and Arts 6:143–154, 2010). Law Enforcement has also found GPS to be a valuable tool. The technology provides a relatively cheap and highly effective way to monitor a suspect’s movement. Depending on the device, travel data can be reported in real time or be retrieved from the implanted device at intervals (Shah Journal of Law, Technology, and Policy 2009:281–294, 2009). This paper will first explore the core foundational Fourth Amendment cases that shape the use of GPS devices by law enforcement. Next, the federal circuits and state supreme courts’ decisions that have addressed the use of GPS will be reviewed. Third, the case of U.S. v. Jones (2012), which was recently decided by the United States Supreme Court, will be examined. Last, the policy implications of the current legal landscape regarding the use of GPS by police will be discussed.     

Case commentary: anonymisation is not exoneration

This case commentary analyses a ruling that any use of information given in confidence for unconsented purposes is a breach of confidence capable of supporting a legal action (even if the information has previously been anonymised and aggregated). The ruling is being appealed. It is argued that, while it is reasonable to delineate a narrower duty of confidentiality (not to disclose personal information, against breach of which anonymisation protects), this must be within a broad duty of confidence (not to use private information, which using anonymous information can still breach). Thus, the ruling is fundamentally correct in holding that anonymisation does not permit information obtained in confidence to be used for unconsented purposes. This, however, implies that information obtained for a patient's treatment may not be used lawfully for medical research or NHS management purposes without consent, even if it is anonymised. Such a consequence is unacceptable as a matter of public policy. However, it is equally unacceptable to seek an exemption through the idea that patients give "implied consent" for medical research and NHS management purposes. It is also unacceptable to maintain that the public interest in medical research (regardless of its aims) justifies unconsented use of information obtained in confidence, even if the information is anonymised. The way in which Section 33 of the Data Protection Act 1998 creates an exemption to its Second Data Protection Principle provides a ready-made model for a public interest based exemption for medical research and statistical NHS purposes.     

The C.T.A. case: A study in political corruption

Between 1984 and 1987, a wide-ranging corruption scandal in Pennsylvania resulted in the conviction and disgrace of a number of high-ranking elected officials, as well as the much publicized suicide of state Treasurer R. Budd Dwyer. This C.T.A. case initially appeared to be a straightforward and almost commonplace affair involving bribes and kickbacks to secure state contracts; but on further examination, this seemingly uncomplicated case can be shown to have involved elaborate conflicts at both state and federal level, and the direction and outcome of the prosecution were heavily influenced by political factors and bureaucratic self-interest.This paper will provide a narrative of the C.T.A. case and related incidents, and also describe the external factors which shaped the investigation. Particular emphasis will be placed on the complex relationship between state-level political interests and the activities of federal prosecutors. The C.T.A. affair offers an excellent illustration of the difficulty of gaining an accurate understanding of even an apparently simple case of political corruption, and the implication is that more elaborate incidents are even less amenable to any kind of academic or social scientific observation. The case can only be understood if full account is taken of the prosecutorial and investigative process which turned the original illegal transactions into a full-blown public scandal, factors which are often insufficiently emphasized in research on political corruption.     

Major vascular neck injury from a handgun cartridge casing

We present a case from the Johannesburg General Hospital of a zone II low-velocity penetrating neck injury with involvement of the ipsilateral subclavian artery. When the "bullet" was retrieved, it was noted not to be an actual bullet but rather a cartridge casing. We speculate that this injury represents one of several possible misfiring scenarios from a homemade firearm. Injuries from homemade firearms are infrequent in the literature, and only one other similar case of a cartridge casing causing a penetrating injury was found. A brief review of homemade handheld firearms is offered.     

Disentangling privacy from property: toward a deeper understanding of genetic privacy

With the mapping of the human genome, genetic privacy has become a concern to many. People care about genetic privacy because genes play an important role in shaping us--our genetic information is about us, and it is deeply connected to our sense of ourselves. In addition, unwanted disclosure of our genetic information, like a great deal of other personal information, makes us vulnerable to unwanted exposure, stigmatization, and discrimination. One recent approach to protecting genetic privacy is to create property rights in genetic information. This Article argues against that approach. Privacy and property are fundamentally different concepts. At heart, the term "property" connotes control within the marketplace and over something that is disaggregated or alienable from the self. "Privacy," in contrast, connotes control over access to the self as well as things close to, intimately connected to, and about the self. Given these different meanings, a regime of property rights in genetic information would impoverish our understanding of that information, ourselves, and the relationships we hope will be built around and through its disclosure. This Article explores our interests in genetic information in order to deepen our understanding of the ongoing discourse about the distinction between property and privacy. It develops a conception of genetic privacy with a strong relational component. We ordinarily share genetic information in the context of relationships in which disclosure is important to the relationship--family, intimate, doctor-patient, researcher-participant, employer-employee, and insurer-insured relationships. Such disclosure makes us vulnerable to and dependent on the person to whom we disclose it. As a result, trust is essential to the integrity of these relationships and our sharing of genetic information. Genetic privacy can protect our vulnerability in these relationships and enhance the trust we hope to have in them. Property, in contrast, by connoting commodification, disaggregation, and arms-length dealings, can negatively affect the self and harm these relationships. This Article concludes that a deeper understanding of genetic privacy calls for remedies for privacy violations that address dignitary harm and breach of trust, as opposed to market harms, as the property model suggests.     

Staphylococcal scalded skin syndrome mimicking child abuse by burning

Determining the cause for the sudden death in young adults tends to be complex and difficult. Two cases of death of young people were autoptically investigated who died suddenly while carrying out their hobbies (a 22-year-old male musician and a 20-year-old female dancer). In both cases neither the police investigation, the autopsy, nor the toxicological investigations gave any relevant results. However, when investigating the histology fatty and fibrotic tissue in the right ventricle of the myocardium were found, whereas the myocytes proved to be degenerated--typical for arrhythmogenic right ventricular cardiomyopathy (ARVC). It is important to consider the possibility of heart rhythm failure if a clear reason for sudden death in young adults cannot be detected. Heart rhythm failure often involves the genetic background of the case, which suggests that genetic analysis should be carried out as a supportive means of diagnostics.     

"Homicide by heart attack" revisited

The sudden death of a person caused by an arrhythmia that is induced by physical and/or emotional stress provoked by the criminal activity of another person is sometimes referred to as "homicide by heart attack." Published criteria for such an event relate to situations where no physical contact occurs between the perpetrator and the victim. Situations involving physical contact, but with absence of lethal injuries, are frequently treated is a similar fashion by forensic pathologists. Herein, we propose a set of modified criteria, which include cases where physical contact has occurred. Five examples of so-called "homicide by heart attack" are presented, including a 40-year-old man who was struck in the head with a wooden statue, a 74-year-old man who was punched in the jaw by a robber, a 66-year-old woman who was started awake by a home-intruder, a 67-year-old woman who struggled with a would-be purse-snatcher in a parking lot, and a 52-year-old man who was in a physical altercation with a younger man. In each instance, autopsy revealed the presence of severe, underlying heart disease, as well as absence of lethal injuries. In each case, investigative information was such that the emotional and/or physical stress associated with the criminal activity of another individual was deemed contributory to the death. The presumed mechanism of death in each case was a cardiac dysrhythmia related to underlying heart disease, but initiated by the emotional and/or physical stress.     

Informing the Population About the Activity of State Agencies

Under the conditions of developed socialism, the general problem of informing the population, and that of its knowledge about matters of state and law in particular, becomes increasingly more pertinent. "The development of socialist democracy," said L. I. Brezhnev at a meeting with voters of the Bauman Electoral District in Moscow on June 10, 1966, "demands the solution of many problems that the Party has placed on the order of business." One of these tasks is "providing fuller information to the people about everything happening within the country and on the world scene, and increasing publicity [glasnost'] about the work of the agencies of Soviet government." The Communist Party associates improvement of socialist democracy particularly with the level of society's information "about the policies of the Party and state." (1) Therefore, the Soviet government pays much attention to the solution of questions associated with informing the citizenry about the work of governmental agencies and also about their regulation by law. Thus, for example, in the RSFSR law "On the District Soviet of Working People's Deputies of the RSFSR" (June 29, 1971), we read about the responsibility of the executive committee to inform the population about questions placed on the order of business of the soviet (Article 33), to bring decisions of the district soviet to the knowledge of the citizens (Article 38), and to report on its work at meetings of the working population and at citizens' places of employment (Article 55). Article 93 reads: "The district soviet of working people's deputies is responsible for informing the population about its functioning. …" Presidiums of the supreme Soviets of union and autonomous republics monitor observation of provisions of the law, assuring that the population will be widely informed on the work of state agencies. (2) In this connection, examination of the question of the content and forms whereby the population of the USSR becomes informed about the activity of state agencies is of interest.     

GHB. Club drug or confusing artifact?

GHB can be produced either as a pre- or postmortem artifact. The authors describe two cases in which GHB was detected and discuss the problem of determining the role of GHB in each case. In both cases, NaF-preserved blood and urine were analyzed using gas chromatography. The first decedent, a known methamphetamine abuser, had GHB concentrations similar to those observed with subanesthetic doses (femoral blood, 159 microg/ml; urine, 1100 microg/ml). Myocardial fibrosis, in the pattern associated with stimulant abuse, was also evident. The second decedent had a normal heart but higher concentrations of GHB (femoral blood, 1.4 mg/ml; right heart, 1.1 mg/ml; urine, 6.0 mg/ml). Blood cocaine and MDMA levels were 420 and 730 ng/ml, respectively. Both decedents had been drinking and were in a postabsorptive state, with blood to vitreous ratios of less than 0.90. If NaF is not used as a preservative, GHB is produced as an artifact. Therefore, the mere demonstration of GHB does not prove causality or even necessarily that GHB was ingested. Blood and urine GHB concentrations in case 1 can be produced by a therapeutic dose of 100 mg, and myocardial fibrosis may have had more to do with the cause of death than GHB. The history in case 2 is consistent with the substantial GHB ingestion, but other drugs, including ethanol, were also detected. Ethanol interferes with GHB metabolism, preventing GHB breakdown, raising blood concentrations, and making respiratory arrest more likely. Combined investigational, autopsy, and toxicology data suggest that GHB was the cause of death in case 2 but not case 1. Given the recent discovery that postmortem GHB production occurs even in stored antemortem blood samples (provided they were preserved with citrate) and the earlier observations that de novo GHB production in urine does not occur, it is unwise to draw any inferences about causality unless (1) blood and urine are both analyzed and found to be elevated; (2) blood is collected in NaF-containing tubes; and (3) a detailed case history is obtained.     

Characterizing macroeconomic shocks in the CEECs

In this paper we analyze the nature of the shocks hitting the Central and Eastern European countries (CEECs) over the recent years. To this end, we first evaluate the relative importance of symmetric versus asymmetric shocks, and then extract their temporary component. Our final aim would be assessing the vulnerability of the CEECs to temporary and asymmetric shocks, which would be the most harmful case for the operation of a monetary union. Finally, a comparison with the case of the current EMU members is also presented.     

Dental implant changes following incineration

ObjectivesThe conducted electrical weapon (CEW) is used by law enforcement to control potentially violent people. Much of the research in CEW safety has focused on the TASER X26, which uses a single deployment cartridge. New Generation CEW (NGCEW) technology has been developed that uses a different circuit and multiple cartridges that can be simultaneously deployed. The objective of this study is to examine the cardiovascular effects of the NGCEW in different deployment possibilities.MethodsThis was a prospective study of human subjects during NGCEW training courses. Subjects received a NGCEW probe deployment to the frontal torso in 1 of 3 configurations: 2, 3,or 4 embedded probes and then underwent a 10-s exposure. Before and after vital signs, electrocardiograms (ECGs), and serum troponin I values were obtained. Real-time echocardiography was utilized before, during and after the exposure to evaluate heart rate and rhythm.ResultsInitially, a 1st version NGCEW (NGCEWv1) that was in the final stages of manufacturer verification was used at the training courses. It had not been publicly released. During a NGCEWv1 exposure with 2 probes, there was an apparent brief episode of cardiac capture. Testing was halted and the manufacturer was notified. The device was redesigned and the study continued when a redesigned, 2nd version (NGCEWv2) was used. The NGCEW1 was studied in 8 subjects. The NGCEWv2 was studied in 45 subjects with no evidence of cardiac capture. There were no important post-exposure vital sign, troponin I or ECG changes found in any volunteers.ConclusionsAn apparent brief myocardial capture event occurred with the NGCEWv1. This device was not released and was redesigned. The NGCEWv2 appears to exhibit a reasonable degree of cardiac safety with frontal torso exposures and multiple probe combination configurations.     

Human identification by comparison if skull roentgen image

Comparison of X-rays was found to provide information just as accurate as dactyloscopy for person identification, which is attributable to the high variability of the skeletal system. Reported in this paper is the case of an unknown dead female whose body was found in a condition of advanced decay. That is why conventional methods of criminological identification were not practicable. Only inadequate results were obtained from a muscular sample, while no findings at all were obtainable from DNA analysis of two molars. Identification was achievable only after six months had passed from discovery of the corpse, when two X-rays of the presumed person's skull were retrieved. This case of successful identification has once again provided evidence to the fact that even in our era of DNA research X-ray comparison has retained a firm position in forensic diagnostics.     

PSJ & I and Integrated Justice

Information technology is changing the way we live and work. Government is not immune to this technology revolution. Emerging information technology now affords justice agencies the opportunity to work together in one integrated justice system. From dispatch and patrol, to arrest and booking, through the identification process and on into the courts, technology is allowing all segments of the justice community to work more efficiently and to work with both more information as well as more accurate information. IBM Corporation's Public Safety, Justice & Identification organization is playing an important role in assisting justice agencies in applying this new technology.In justice agencies around the world,computer aided dispatch and related systems allow more police officers to be where needed more rapidly. Mobile data systems for officers in the field allow them to gather and process information more quickly and accurately, and be back on patrol and available for another call more rapidly. Automated arrest and booking systems free up patrol officers more quickly so they can be back on patrol. These systemsalso allow the arrested person to be processed through the jail system more rapidly, by fewer people. In the courts, electronic case files, automatic document generation, automated scheduling and sophisticated programs for tracking court operations all mean more work can be accomplished faster, with greater accuracy and efficiency, without increased personnel. Most justice agencies today act as independent, yet interdependent entities. Their primary mode of communication is paper. Advances in information technology, together with the adoption of common technical standards and common business definitions, is now allowing justice agencies to integrate their operations by electronically sharing important information. It is through this integration process that justice agencies are making the term, 'justice system' a reality.