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.     

Patella sex determination by 3D statistical shape models and nonlinear classifiers

Sex determination is one of the essential steps in personal identification of an individual from skeletal remains. Most elements of the skeleton have been subjected to discriminant function analysis for sex estimation, but little work has been done in terms of the patella. This paper proposes a new sex determination method from the patella using a novel automated feature extraction technique. A dataset of 228 patellae (95 females and 133 males) was amassed from the William M. Bass Donated Skeletal Collection from the University of Tennessee and was subjected to noninvasive high resolution computed tomography (CT). After the CT data were segmented, a set of features was automatically extracted, normalized, and ranked. The segmentation process with surface smoothing minimizes the noise from enthesophytes and ultimately allows our methods to distinguish variations in patellar morphology. These features include geometric features, moments, principal axes, and principal components. A feature vector of dimension 45 for each subject was then constructed. A set of statistical and supervised neural network classification methods were used to classify the sex of the patellar feature vectors. Nonlinear classifiers such as neural networks have been used in previous research to analyze several medical diagnosis problems, including quantitative tissue characterization and automated chromosome classification. In this paper, different classification methods were compared. Classification success ranged from 83.77% average classification rate using labels from a Fuzzy C-Means (FCM) clustering step, to 90.3% for linear discriminant classification (LDC). We obtained results of 96.02% and 93.51% training and testing classification rates, respectively, using feed-forward backpropagation neural networks (NN). These promising results using newly developed features and the application of nonlinear classifiers encourage the usage of these methods in forensic anthropology for identifying the sex of an individual from incomplete skeletons retaining at least one patella.     

An accidental death due to Freon 22 (monochlorodifluoromethane) inhalation in a fishing vessel

We have firstly presented a case using post mortem corrosive method in forensic medical practice after coronary stent implantation. Occlusions, fate of side branches could be detected during the clinical diagnostic angiography, intravascular ultrasound, computed tomography; however, the forensic medical determination of cause of death, identification of complications needs a careful post-mortem investigation. The injection-corrosive method seems to be a useful assistance in the characterisation of pathomorphological changes after stent implantation. Besides the classical techniques of histology, immunohistochemistry, electron microscopic investigation we have introduced a new synthetic resin corrosion cast method. This three-dimensional corrosion cast preparation may provide new data about the actual morphological condition of the coronary vessels and a better understanding of the pathomechanisms of sudden cardiac death after percutaneous coronary intervention.     

Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

Forensic drug intelligence: an important tool in law enforcement

Organised criminality is a great concern for national/international security. The demonstration of complex crimes is increasingly dependant on knowledge distributed within law-enforcement agencies and scientific disciplines. This separation of knowledge creates difficulties in reconstructing and prosecuting such crimes. Basic interdisciplinary research in drug intelligence combined with crime analysis, forensic intelligence, and traditional law enforcement investigation is leading to important advances in crime investigation support. Laboratory results constitute one highly dependable source of information that is both reliable and testable. Their operational use can support investigation and even provide undetected connections or organisation of structure. The foremost difficulties encountered by drug analysts are not principally of a chemical or analytical nature, but methodologies to extract parameters or features that are deemed to be crucial for handling and contextualising drug profiling data. An organised memory has been developed in order to provide accurate, timely, useful and meaningful information for linking spatially and temporally distinct events on a national and international level (including cross-border phenomena). Literature has already pointed out that forensic case data are amenable for use in an intelligence perspective if data and knowledge of specialised actors are appropriately organised, shared and processed. As a particular form of forensic case data, the authors' research focuses on parameters obtained through the systematic physical and chemical profiling of samples of illicit drugs. The procedure is used to infer and characterise links between samples that originate from the same and different seizures. The discussion will not, however, focus on how samples are actually analysed and compared as substantial literature on this topic already exists. Rather, attention is primarily drawn to an active and close collaboration between magistrates, forensic scientists, law enforcement investigators and crime analysts from different institutions with the aim of generating, using and validating relevant profiling case data as integral part of investigative and crime analysis processes. Original advances are highlighted through experiences from criminal investigations of offences related to the unlawful importation, exportation, supply and possession of illicit drugs.     

Back to the future? Diabetes, HIV, and the boundaries of public health

The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.     

Family caregivers: a shadow workforce in the geriatric health care system?

Based on two years of fieldwork, conducted between March 2003 and March 2005 in the health care industry of the northeastern United States, this study shows that the work of family caregivers of elders goes far beyond previously recognized care in the home to acknowledge care inside health care facilities and in conjunction with community services. It reveals that family caregivers--untrained, undersupported, and unseen--constitute a "shadow workforce," acting as geriatric case managers, medical record keepers, paramedics, and patient advocates to fill dangerous gaps in a system that is uncoordinated, fragmented, bureaucratic, and often depersonalized. Detailed examination of what family caregivers actually do in traversing multiple domains reveals the extent of their contribution to and the weaknesses in the present geriatric health care system. It suggests that the experiences of family caregivers must be central to the creation of new policies and a more coordinated system that uses the complex work of family caregivers by providing the training and support that they need.     

STR data for the AmpFlSTR identifier loci from an old settlement in northwestern Turkey

The polymorphism of 15 STR loci has been studied in a population sample of 193 healthy unrelated individuals from the population of Duzce, a city in the northwestern Turkey. The most valuable loci, from forensic point of view according to their power of discrimination values, were D2S1338, D18S51, FGA, and D19S433 where CSF1PO appeared to be the least powerful one. From paternity point of view, FGA, D21S11 were found to be the loci with highest exclusion value whereas D3S1358 and TPOX were the locus with the lowest exclusion.     

STR data for the 15 AmpFlSTR identifiler loci in the Western Romanian population

Allele frequencies for the 15 tetranucleotide short tandem repeat loci contained in the AmpFlSTR Identifiler kit were obtained from a population sample of 219 unrelated individuals born in the western part of Romania.     

"Life expectancy" of "ecstasy" tablets in Israel in the years 2001-2003

3,4-Methylenedioxymethamphetamine (MDMA) tablets known as "ecstasy" became a very popular drug amongst Israeli youth in the last decade. The ecstasy tablets have a simple design impressed on them (logos) making it relatively easy to distinguish between various logos. The life expectancy of ecstasy tablet logos, defined as the period between the first seizure by the police of a certain logo until the last seizure of the same logo, was monitored during the years 2001-2003. During this time interval, 58 different tablet logos were seized. A total of 26 logos, defined as common logos with at least 10 independent seizures, were observed. At any given time interval during this period, 8-10 common logos were found with an average life expectancy of approximately 9 months. Five of the observed 26 common logos were defined as the most common logos that appeared in at least 200 independent seizures each. Plots of the number of seizures and number of tablets seized as a function of time are presented and discussed as well as explanations for the high turnover rate of any given logo.