Can computed tomography replace or supplement autopsy?

Postmortem computed tomography (PMCT) has been integrated into the practice of many forensic pathologists. To evaluate the utility of PMCT in supplementing and/or supplanting medicolegal autopsy, we conducted a prospective double-blind comparison of abnormal findings reported by the autopsy pathologist with those reported by a radiologist reviewing the PMCT. We reviewed 890 cases: 167 with blunt force injury (BFI), 63 with pediatric trauma (under 5 years), 203 firearm injuries, and 457 drug poisoning deaths. Autopsy and radiology reports were coded using the Abbreviated Injury Scale and abnormal findings and cause of death (COD) were compared for congruence in consensus conferences with novel pathologists and radiologists. Overall sensitivity for recognizing abnormal findings was 71% for PMCT and 74.6% for autopsy. Sensitivities for PMCT/autopsy were 74%/73.1% for BFI, 61.5%/71.4% for pediatric trauma, 84.9%/83.7% for firearm injuries, and 56.5%/66.4% for drug poisoning deaths. COD assigned by reviewing PMCT/autopsy was correct in 88%/95.8% of BFI cases, 99%/99.5% of firearm fatalities, 82.5%/98.5% of pediatric trauma deaths, and 84%/100% of drug poisoning deaths of individuals younger than 50. Both autopsy and PMCT were imperfect in recognizing injuries. However, both methods identified the most important findings and are sufficient to establish COD in cases of BFI, pediatric trauma, firearm injuries and drug poisoning in individuals younger than 50. Ideally, all forensic pathologists would have access to a CT scanner and a consulting radiologist. This would allow a flexible approach that meets the diagnostic needs of each case and best serves decedents' families and other stakeholders.     

Postmortem genetic testing in sudden unexplained death: A public health laboratory experience

Sudden unexplained death in the young poses a diagnostically challenging situation for practicing autopsy pathologists, especially in the absence of anatomic and toxicological findings. Postmortem genetic testing may identify pathogenic variants in the deceased of such cases, including those associated with arrhythmogenic channelopathies and cardiomyopathies. The Wisconsin State Laboratory of Hygiene (WSLH) is a state-run public health laboratory which performs postmortem genetic testing at no cost to Wisconsin medical examiners and coroners. The current study examines sequencing data from 18 deceased patients (ages 2 months to 49 years, 5 females) submitted to WSLH, from 2016 to 2021. Panel-based analysis was performed on 10 cases, and whole exome sequencing was performed on the most recent 8 cases. Genetic variants were identified in 14 of 18 decedents (77.8%), including 7 with pathogenic or likely pathogenic variants (38.9%). Whole exome sequencing was more likely to yield a positive result, more variants per decedent, and a larger number of variants of uncertain significance. While panel-based testing may offer definitive pathogenic variants in some cases, less frequent variants may be excluded. Whole exome testing may identify rare variants missed by panels, but increased yield of variants of uncertain significance may be difficult to interpret. Postmortem genetic testing in young decedents of sudden unexplained death can provide invaluable information to autopsy pathologists to establish accurate cause and manner of death and to decedent's relatives to allow appropriate management. A public health laboratory model may be a financially advisable alternative to commercial laboratories for medical examiner's/coroner's offices.     

An unusual blunt force trauma pattern and mechanism to the cranial vault: Investigation of an atypical infant homicide

This case report presents an unusual fracture pattern in the cranium of a four-month-old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra-auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair-step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.     

Symposium,Cannabis—Legal,Ethical, and Compliance Issues: Introduction

This introduction reviews six articles presented at the 2020 symposium, “Legal, Ethical, and Compliance Issues in Emerging Markets: Cannabis in the States.” Scholars from across the United States and Canada presented research using the lens of law and strategy, ethics, and compliance to focus on the U.S. cannabis industry. The articles are discussed within the framework of institutional voids common to emerging markets, which may include a lack of a fully developed regulatory system and issues related to financial markets. These institutional problems create complexity for consumers, producers, municipalities, and state governments in this industry, and make success for this market segment more challenging. The introduction contributes to the discussion by reviewing securities litigation involving the cannabis industry generally and specifically in light of some of the issues identified by authors in the special issue.     

The Israeli criminal justice system in action—Is justice administered differentially?

This study focuses on two major junctures in the Israeli criminal justice system, the preadjudication stage and the trial stage. The data are gathered from records accumulated during the period 1980 through 1992. For each year between 1980 and 1992, a random sample of 3637 persons, who had their first police contact that year, was drawn from the computerized central file at Israeli Police Headquarters. A total of 40,007 individuals, with a total of 97,000 records, constituted the study population. The results identify which criminal records were most likely to be terminated prior to adjudication and which records, once adjudicated, were most likely to conclude in conviction. Major emphasis was placed on the issue of nationality—being an Arab or a Jew—while the effect of other variables, such as the type of offense and the time period, were controlled. The criminal justice system was found to be less discriminating at the early stages of the criminal process, but as the offender moved along the process, the chances that nationality would play an important part increased. Authors are listed alphabetically and contributed equally to the writing of this paper.     

Religious and Ideological Dimensions of the Israeli Settlements Issue: Reframing the Narrative?

Whether or not it will be possible to relocate settlers from the "territories" depends not just on the willingness of the relevant Israeli officials to authorize evacuation of some or all of the West Bank and Gaza given the violence it may cause, but especially on the thinking and the changing attitudes of the settlers themselves. Only by understanding the views of the current settlers — their motivations, their beliefs, and the differences among them — will it be possible to formulate a sensible relocation strategy. That was the focus of the conference's first panel.     

On the employment effect of noncompliance with the minimum wage law

A major result of the economic literature on minimum wage noncompliance is that a competitive employer who opts not to comply with the minimum wage law will employ less labor than he would have in the absence of a law. The reason for this is that noncompliance entails the risk of getting caught and punished, consequently raising the marginal cost of labor to the employer. An implicit assumption underlying this result is that noncompliance does not affect the free market wage rate facing the competitive employer. The present note shows that noncompliance will bring about a fall in the market wage rate and that if employers and workers are risk neutral, the market wage rate will fall in a way that leaves the marginal cost of labor intact. Consequently, the enactment of a minimum wage law, if not accompanied by sufficient enforcement to induce compliance, will have no effect on the level of employment.