Abstracting data from medical examiner/coroner reports: concordance among abstractors and implications for data reporting

The purpose of this study was two-pronged: 1) to determine the level of concordance (agreement) between multiple records abstractors who extracted defined data elements from printed medical examiner/coroner (ME/C) death investigation records; and 2) to identify data items for which improved reporting could facilitate the effective use of ME/C reports and data. Four hundred ninety four printed death investigation records were obtained from 224 medical examiner/coroner offices throughout the United States. Trained abstractors were asked to extract information for 110 data elements from investigative reports. Additional data elements for each toxicology workup were abstracted from toxicology laboratory reports and six-digit AIS codes were also abstracted for each injury as described in autopsy reports. The ability of multiple abstractors to identify each data element and identically abstract the data was assessed using Kappa statistical methods. Level of agreement for many data elements was very good (>0.9), but for some data elements agreement was marginal to poor, especially for items related to toxicology, the nature of specific injuries, and dates, times of the occurrence of death and injury. Many data items can be easily abstracted from ME/C records. However, some data items seem difficult to abstract reliably in all cases. Standardizing the report formats used by ME/Cs and/or standardizing the electronic storage of ME/C data would make the abstraction of such data easier and improve the usefulness of ME/C data.     

The conversion of coroner systems to medical examiner systems in the United States: a lull in the action

Coroner and medical examiner systems in the United States conduct death investigations for most deaths that are sudden and unexplained, or which involve external causes such as injury and poisoning. They play a very important role in the criminal justice, public health, public safety, and medical communities, and they also contribute a substantial portion of autopsy-based mortality data to the state and federal mortality statistics systems. Death investigations often involve complex medical issues and necessarily require the involvement of appropriately trained physicians. Over the years, there has been a trend to replace the elected lay coroner systems with systems run by appointed, physician medical examiners. Presently, about 31% of counties in the United States are served by a medical examiners at the county, district, or state level. Between 1960 and 1989, there was considerable conversion to medical examiner systems, but this trend slowed in the 1990s. Since 2000, only 6 counties in the United States have converted to a medical examiner system, no states have converted since 1996, and 1 county has reverted to a sheriff-coroner system. Possible reasons for this decline are discussed, including legislative, political, geographical, financial, population-based, and physician manpower distribution factors. It is important to ensure that all death investigation systems have appropriate access to medically educated and trained physicians such as forensic pathologists.     

Recovery of decomposed and skeletal human remains in the "Green River Murder" Investigation. Implications for medical examiner/coroner and police

The Green River Murder Investigation in King County, Washington, is currently the longest active serial murder investigation in U.S. history. During its course, over 26 separate scenes with from one to five victims each have been processed. The experience of the authors is presented in order to acquaint other agencies with techniques of outdoor scene processing that have evolved during recovery of remains from Green River and other skeletal cases.     

The role and duties of the shoeprint/toolmark examiner in forensic laboratories

Shoeprint and toolmark examinations have been carried out for forensic purposes for a great number of years. According to literature, the first case of footwear identification dates back to the year 1786. This particular case was worked out by a local police constable. Who then, are the persons working in crime laboratories and specialising in shoeprint and toolmark examinations today? Are they responsible for some other kind of duties, and if ‘yes’, what kind of duties? To find answers to these questions, a questionnaire was prepared and sent to 78 forensic laboratories, 62 laboratories in 27 European countries and 16 laboratories in six countries outside Europe. Forty-three laboratories (55%) in 23 countries; 35 laboratories in 19 European countries and eight laboratories in four countries outside Europe returned the questionnaire. The conducted study shows that the shoeprint and toolmark examiners are performing a great variety of tasks besides shoeprint and toolmark examinations, and also that the tasks vary a lot from one laboratory to another.     

Public Health Service--Privacy Act of 1974. Notification of new system of records: "clinical research; records of subjects in intramural research, epidemiology, demography, and biometry studies on aging."

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to adopt a new system of records. "Clinical Research: Records of Subjects in Intramural Research, Epidemiology, Demography, and Biometry Studies on Aging." DHHS/NIH/NIA, 09-25-0142. These records will be used to accomplish scientific research conducted by intramural scientists employed by the National Institute on Aging (NIA), and by hospitals, universities, research centers and research foundation under contract with NIA. These research activities aim at determining the health status of individuals and changes in health status over time, the incidence and prevalence of certain diseases and problems of the aged in certain populations, and changes that take place as the individuals age who are under study.     

MicroRNAs法医学应用的可能性和局限性

MicroRNAs是一类长度约18~24nt在转录后水平调控基因表达的内源性小分子非编码RNA。microRNA的高度保守性、时序性和组织特异性,使其在法医体液鉴别、个体年龄推断、死亡时间推断、毒物分析、伤因死因分析等中的应用成为可能。但法医学中microRNA鉴定数量的有限性,以及研究方法的不确定性也限制了其从理论研究到实践应用的发展。     

Breaking the stalemate: a prospective regulatory framework for unforseen research uses of human tissue samples and health information

The legal and ethical issues raised by new research uses of previously collected human tissues and health information are increasingly important to genetics research. This Article discusses and criticizes current positions on such uses, including the recent report of the National Bioethics Advisory Commission, Research Involving Human Biological Materials. It then proposes a new regulatory framework for tissue and information collected in the future that would better protect the interests of the people who provide them. It ends by suggesting a resolution for the problems of previously collected tissue and information.     

GFAP和VEGF在创伤性脑损伤中表达的研究进展

创伤性脑损伤是世界上导致死亡及残疾的主要原因之一。检测对中枢神经系统损伤有高度特异性和敏感性的生物标志物,可以在一定程度上反映损伤情况。胶质纤维酸性蛋白与血管内皮生长因子均可作为颅脑损伤的生物学标记物,其表达变化规律、峰值出现时间,与创伤性脑损伤的严重程度及损伤时间的推断密切相关,对于法医病理学具有重大意义。该文对胶质纤维酸性蛋白与血管内皮生长因子的分子生物学特性及其在创伤性脑损伤中的表达进行综述。