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Marloes E. M. Vester M.D. Ph.D. Kurt B. Nolte M.D. Ph.D. Gary M. Hatch M.D. Chandra Y. Gerrard M.P.H. B.S. Reinoud D. Stoel Ph.D. Rick R. van Rijn M.D. Ph.D. 《Journal of forensic sciences》2020,65(5):1568-1573
Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs. 相似文献
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Sophia K. Chiu M.D. M.P.H. Jessica F. Li M.S.P.H. Kurt B. Nolte M.D. 《Journal of forensic sciences》2020,65(4):1324-1327
Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls. 相似文献
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Although the devastation from Haiti’s 2010 earthquake was concentrated in Port-au-Prince, it had deep agrarian roots. This paper situates Haiti’s urban poverty in the chronic exploitation of the country’s peasant classes as a basis for assessing the competing contemporary visions for agricultural development. We argue that the post-earthquake reconstruction has fortified a neoliberal development that is incompatible with the aspirations of the Haitian peasantry. Given the interrelated power of domestic elites and international donors, and the proliferation of disconnected development projects, we conclude that any prospect for pro-poor development hinges on the growth and collaboration of peasant movements. 相似文献
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Towards a Guide for Constructing and Disseminating Counternarratives to Reduce Support for Terrorism
Despite widespread recognition that the use of counternarratives is an important strategic component of countering violent extremism, to date, there are no comprehensive guidelines on how to develop and distribute counternarratives to effectively reduce support for terrorism. To redress this, we offer communication and psychology theory-based procedures for (1) analyzing terrorist narratives, (2) constructing counternarratives that challenge terrorist narratives, and (3) disseminating the counternarratives to overcome barriers to persuasion. Analysts and practitioners can use such guidelines in developing counternarratives to reduce support for violent extremism. 相似文献
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Judicial decisions are one element in the erosion of local government budgetary discretion. For example, litigation concerning constitutional rights forces local government officials to allocate resources toward the rights-based population. While rights-based allocation decisions may narrow the budgetary discretion of public officials, some managers may, paradoxically, be "better-off"—defined as the ability to protect and defend their budgets — when discretion is reduced. This thesis is tested through a case study of jail overcrowding litigation in a county government. 相似文献
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Lotteries, the state fiscal gimmick of the eighties, operate in jurisdictions encompassing substantially more than half the nation's population and enjoy considerable public acceptance. The revenue they generate is small, rarely more than two percent of state general revenue, it is subject to major year-to-year swings, and it is very expensive to generate, particularly when vendor commissions are recognized as part of cost. Furthermore, lotteries bear a high implicit excise tax rate and, because of the pattern of play across income classes, appears to worsen the overall equity of the revenue system. Their economic impact appears to be that of an internal transfer, although states with major lottery equipment suppliers have most to gain, particularly if they do not operate their own lottery. Lotteries are not destined to become mainstays of government finance, although their spread is likely, even with the fiscal questions they raise. 相似文献
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A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy. 相似文献