bluuebunny/crossref_metadata_2025 huggingface dataset:
Turning Challenges into Opportunities: Advancing Studies of Nonprofit Organizations in China
Authors: Li Huafang , Chen Bin
Published: June 2018

This symposium is a collection of articles that showcases how to improve research on Chinese NPOs. We include articles that incorporate new theoretical frameworks and empirical analyses, and that draw upon novel data, such as the Research Infrastructure of Chinese Foundations (RICF). These articles provide important insights into addressing the main challenges of studying China's NPOs - the lack of a managerial focus, and sparse empirical data which has resulted in very few research strategies. The articles in this symposium illustrate how empirical studies and increased focus on managerial issues could contribute to improving research on Chinese NPOs and help address questions of general concern in public administration.
Impact of Social Influence and Users' Perception of Coolness on Smartwatch Behavior
Authors: Shin Donghee , Biocca Frank
Published: June 2018

We explored the motives behind switching one's smartwatch, focusing on 2 divergent motivations that relate to social influence and the mobile and visible nature of these watches. Our findings and a review of related work indicated that the social motive for switching a smartwatch was
coolness, that is, distinguishing oneself from others, because owning the latest model of smartwatch is a way to demonstrate having ample financial resources. The perceived benefit of switching one's smartwatch was associated more with coolness and the identity formation process, and less
with actual utility or social influence. Further, the effects of similarity avoidance based on smartwatch purchasing intention were mediated by the effect of identity formation. Our findings may shed light on the nature of smartwatch uses and the motives that drive smartwatch users' choice
to upgrade their devices.
Human Sex Differences in Emotion Prediction: Evidence from Event-Related Potentials
Authors: Ran Guangming
Published: June 2018

Women and men process emotion stimuli in different ways. Few of the previous researchers who have examined how emotion recognition differs between the sexes, looked at sex differences in emotion prediction. Thus, I investigated women's and men's perceptions of emotional faces in predictable
and unpredictable conditions. Results showed that behaviorally, women's response accuracy was higher than men's. In contrast, neurally, men had greater P1 amplitudes for happy faces compared with angry faces in right hemisphere electrodes, suggesting that men have a perceptual bias toward
happy faces. Further, women exhibited larger N170 amplitudes for predictable versus unpredictable angry faces in right hemisphere electrodes. This may reflect enhanced sensitivity to detecting anger. Finally, there was a significant positive correlation between behavioral and N170 predictability
effects. This result may indicate that emotion prediction enhances neural responses while improving recognition efficiency at the behavioral level. In this respect, the electrophysiological results and behavioral data were consistent.
Person–Organization Fit, Work–Family Balance, and Work Attitude: The Moderated Mediating Effect of Supervisor Support
Authors: Fan Peng
Published: June 2018

I examined the mediating effect of work–family balance between person–organization fit and what are broadly viewed as the most important components of work attitude, that is, organizational commitment, job satisfaction, and turnover intention. I also investigated the moderated
effect of supervisor support through this mediating process. I conducted a survey with 356 people employed in the information technology industry in China and found that work–family balance mediated the relationship between their organizational commitment and job satisfaction. I also
found that supervisor support moderated the linkage of person–organization fit, work–family balance, organizational commitment, and job satisfaction. However, the effect of turnover intention was nonsignificant in both the mediating and the moderated mediating model. The implications
of the findings in this study for future research are discussed.
How the Microfilm Marketing Strategy Stimulates Consumers' Purchase Intention
Authors: Su Pei-Jung , Lu Hsi-Peng , Lin Pei-Hsin
Published: June 2018

We integrated the determinant persuasive messages of microfilms with the elaboration likelihood model to examine consumers' affective and cognitive attitude change and purchase intention. Participants were 316 Taiwanese consumers who had seen "House of Little Moments," a successful
microfilm marketing campaign in Taiwan. The empirical results of confirmatory factory analysis with structural equation modeling revealed that argument quality predicted cognitive responses and story plot predicted affective responses; celebrity effect and microfilm popularity had positive
effects on both affective and cognitive responses; and purchase intention was affected by both cognitive and affective responses, with affective responses having the stronger effect. These results imply that the extent of consumers' emotional reaction to persuasive messages has a particularly
important influence on purchase intention in story-based advertising. Therefore, understanding the effect of persuasive messages in microfilm marketing is essential for both advertisers and marketers.
Want Engaged Temporary Agency Workers? Think Beyond the Money
Authors: Jiang Jianwu , Wang Rong
Published: June 2018

Using the framework of social exchange theory and social identity theory, we investigated how perceived organizational support and organizational image indirectly influence temporary agency workers' (TAWs) work engagement through the mediators of organizational identification and self-esteem.
A time-lagged design was employed (Time 1: baseline, Time 2: 6 weeks later, Time 3: 2 weeks later) and data were collected from 309 TAWs in China. Results showed that organizational identification mediated the relationships between perceived organizational support and work engagement, and
between organizational image and work engagement. However, self-esteem exerted no significant influence on the focal relationships. Our findings suggest that organizational identification plays a key role in deciding the extent to which TAWs engage in work at their current organization. Organizations
should take steps to enhance their reputations and support TAWs as much as possible to increase TAWs' organizational identification and thus achieve a competitive advantage.
Títeres para niños “de 2 a 80 años”. Representaciones cinematográficas del espectador infantil y de las configuraciones de maternidad y paternidad
Authors: Girotti Bettina Inés
Published: June 2018

A lo largo del siglo XX, el títere transitó por distintos espacios mientras perfilaba su destinatario ideal: el espectador infantil. En Buenos Aires, no fue extraño encontrar funciones para público adulto; sin embargo, niñas y niños se presentaron como principales destinatarios. Aquí abordaremos producciones cinematográficas que se hicieron eco de la relación títeres-niños y alimentaron la imagen del espectador infantil como público ideal. La concurrencia de niñas y niños a espectáculos teatrales estuvo –y está– mediada por la presencia adulta, de allí que nuestro análisis esté atravesado por las transformaciones de las configuraciones de maternidad y paternidad que tuvieron lugar entre 1950 y 1970 en Argentina y que contemple a quienes han acompañado y compartido estas diversiones. La heterogeneidad del corpus permite reconocer la puesta en escena del acontecimiento convivial como una constante en la construcción del espectador ideal, así como entrever cambios en las funciones atribuidas a madres y padres.
Perfil da População Remunerada pelo Salário Mínimo no Mercado de Trabalho no Brasil – 1997/2007
Authors: Sabóia João
Published: June 2018

A partir de meados da década de 90 o salário mínimo (SM) brasileiropassou por um período de forte recuperação de seu nível real, ao mesmo tempoem que a economia crescia a taxas relativamente modestas. Tal movimentodesperta a interesse sobre o tipo de transformação que poderia estar ocorrendocom a população remunerada pelo SM no mercado de trabalho.O artigo mostra que a maior parte das mudanças observadas entre aqueles querecebem o SM está associada a modificações ocorridas no conjunto da populaçãoocupada como um todo, como o aumento da escolaridade, da idade e da participaçãofeminina. Há, entretanto, algumas mudanças que podem ser atribuídas aoaumento do SM no período analisado, como o crescimento de sua importâncianas regiões menos desenvolvidas do país e no setor formal.Os resultados da pesquisa mostram que apesar de seu forte crescimento numperíodo de performance relativamente desfavorável da economia, houve quedado desemprego e aume nto da formalização das relações de trabalho no país.
Mercado de Trabalho e a Previdência Social – um olhar feminista
Authors: De Melo Hildete Pereira , Oliveira André Barbosa
Published: June 2018

O objetivo deste trabalho é analisar numa abordagem da economiafeminista a Previdência Social brasileira. A hipótese do trabalho é que a desigualdadeexistente entre os sexos no mercado de trabalho permanece na inatividadedos indivíduos. De acordo com esta abordagem estas diferenças combinamdiversos tipos de discriminação, tais como econômicas, culturais, sociais, raciaise de gênero. Uma análise descritiva desta discriminação é feita neste artigopara avaliar as diferenças da inserção feminina e masculina no mundo trabalhoe no sistema previdenciário, baseado nas informações das PNADs do IBGE edo Ministério da Previdência Social. Estes dados permitem traçar um perfil degênero das pessoas ocupadas e dos aposentados/pensionistas e avaliar de formaatuarial os valores recebidos por ambos os sexos. Concluí-se que as mulheressão quem menos usufruem os resultados práticos e monetários recebidos pelotrabalho produtivo, bem como pelas tarefas que reproduzem a vida (trabalhoreprodutivo). Pois a segmentação do mercado de trabalho reflete-se no fato deque a maioria dos benefícios recebidos pelas mulheres seja por aposentadoriasou pensões se concentram em rendimentos de baixo valor, e em média são 39%inferiores aos valores recebidos pelos homens.
Pluralismo, espaço hermenêutico e o método pragmático em Luiz Carlos Bresser-Pereira
Authors: Fernandes Danilo Araújo , Gala Paulo , Wjuniski Bernardo Stuhlberger
Published: June 2018

O tema do pluralismo e da diversidade de abordagens metodológicas na ciência econômica tem sido bastante discutido no meio dos economistas nos últimos anos. Uma série de trabalhos e textos publicados em revistas especializadas vêm sendo divulgados mais recentemente, abrindo uma nova discussão sobre os limites da economia convencional neoclássica e de sua tentativa em pressupor uma espécie de defesa epistemológica de um “exclusivo saber” para os métodos teóricos baseados em uma abordagem microeconômica sustentadas na ideia de agentes representativos (expectativas racionais,por exemplo),ouem formas similares de abordagens inspiradas no individualismo metodológico.
Crise econômica internacional e política brasileira de incentivos tributários: uma avaliação a partir dos setores-chave
Authors: Borghi Roberto Alexandre Zanchetta
Published: June 2018

O artigo avalia a compatibilidade entre a política de incentivos tributários adotada pelo governo brasileiro a partir de 2008, sobretudo mediante redução da alíquota do Imposto sobre Produtos Industrializados (IPI), e os setores com maior encadeamento na economia em termos da manutenção da produção e do emprego. Dos exercícios realizados a partir da matriz estimada de insumo-produto para a economia brasileira, resultam indícios mais fortes em favor do apoio de alguns setores beneficiados, como o automobilístico e o de construção civil, do que de outros, como o setor de eletrodomésticos e moveleiro, além da importância de setores não beneficiados diretamente.
Os Efeitos do Crescimento Econômico na Pobreza do Ceará: uma análise microrregional
Authors: Ribeiro Lilian Lopes , Feitosa Débora Gaspar , Araújo Jair Andrade
Published: June 2018

Este artigo analisa se o crescimento econômico no estado do Ceará, desagregado em nível microrregional, tem sido pró-pobre em suas áreas urbanas e rurais. Ou seja, se a renda dos pobres tem apresentado uma elevação superior ao verificado pela renda dos não pobres, induzindo, assim, uma redução na desigualdade. Nesse sentido, com base nos dados do Censo dos anos de 2000 e 2010, são construídas as curvas de crescimento-pobreza, proposta por Son (2004). Os resultados obtidos apontaram que apenas quatorze das trinta e três microrregiões do estado apresentam crescimento pró-pobre. Quando as microrregiões são desagregadas em área urbana e rural, verificou-se que vinte e três microrregiões apresentam crescimento em favor dos pobres nas áreas urbanas e somente quatro experimentam essa modalidade de crescimento na área rural. Nota-se, então, que o crescimento econômico do Ceará é pouco eficaz no combate à pobreza, principalmente no meio rural.
Indicadores sobre el Límite del Comercio Intrazonal en Zonas de Integración: Una Nota Metodológica
Authors: Oliveira Mauro Márcio
Published: June 2018

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Dilemas e alternativas ao financiamento das políticas públicas de trabalho e renda no Brasil
Authors: Cardoso Jr. José Celso , Gonzalez Roberto
Published: June 2018

Este trabalho discute o desenvolvimento do chamado Sistema Públicode Emprego, Trabalho e Renda (SPETR) no Brasil e os dilemas enfrentadospara garantir o seu financiamento pelo Fundo de Amparo ao Trabalhador (FAT).A seção 1 apresenta a estrutura atual do SPE e a trajetória de suas principaispolíticas ao longo do período 1995/2005. A seção 2 discute algumas limitaçõesimportantes do sistema, bem como a agenda para seu aperfeiçoamento, levantadano II Congresso Nacional do SPETR, realizado em 2005. Na seção 3, examina-se a evolução do patrimônio, das receitas e despesas do FAT; e discute-seespecificamente a razão da restrição de recursos para os serviços de emprego esuas respectivas conseqüências para o SPETR. Na última seção, são sugeridasalternativas para enfrentar a questão do financiamento deste sistema.
Gadung Tuber (Dioscoreae Hispida Dennst) As Potential Source Of Staple Food Supporting Food Diversification
Authors: Renate Dharia
Published: June 2018

Gadung tuber (Dioscoreae hispida Dennt), Indonesian called “umbi gadung”, is one of the potential sources of staple foods in supporting food diversification. Gadung tuber contains carbohydrateof 29.7g in every 100 g of material. It also contains 3.2 g of protein, vitamin C, vitamin B and other minerals. The purpose of this paper is to present how to eliminate dioscorine and cyanide acid and to process some food diversification of gadung tubers.  The innovation technology of post-harvest handling to eliminate dioscorine and cyanide acid content can be done by immersing and washing them in salt water or blanching. Gadung tubers of 2 mm slice immersed in salt water of 8% and 7.5% decrease cyanide acid content of 5.45 ppm; while shreded gadung tubers immerse in salt water of 7.5% for 72 hours can reduce cyanide acid content of 18.75 ppm. Gadung tubers can be processed to be stapple food such as flour, flake. Flour of gadung tubers combined with wheat flour or starch can be processed to become snack food such as cake, sponge cakes. Research conclude that gadung tubers is safety forconsumption by immersing in salt solution of 7.5% to 8% for 72 hours to eliminate dioscorine and cyanide acid content. Combination of 60% and 50% of gadung flour can be used to make good cake and sponge cake.
Hukum Progresif dari Satjipto Rahardjo
Authors: Aulia M. Zulfa
Published: June 2018

This article attempts at discussing the so called Hukum Progresif (the Progressive Law), a legal thought indtroduced by Satjipto Rahardjo. The idea was beckgrounded with the concerns about the macro application of law in Indonesia, including after the 1998 reforms, which seemed to have failed to meet its ideal direction, namely to make people prosper and happy. What happens with law-enforcement is a downturn and decline, among others seen in the judicial mafia, commercialization, and commodification of the law. To overcome such circumstances, according to Satjipto Rahardjo with hukum progresif, the punishment method must dare to break out of conventional ways and the status quo. The legal texts that have been prioritized should be regarded as being destined for humans and humanity. Law actors must dare to interpret legal texts by freeing themselves from the logic of the law alone, making the leap, so that problems in a dynamic society can be answered and resolved by “containers of static law”. This article shows that the hukum progresif can be a panacea in solving corruptive legal problems due to the limitations and attachments of legal texts, with the requirements of law actors behaving well. However, the mention of hukum progresif in the judgment or the determination of the law of a particular case is also very vulnerable to cause its own problems because it can be pinned speakers arbitrarily to identify the punishment which (as long as it is) out of the text of the law.

Abstrak

Artikel ini mendiskusikan Hukum Progresif, sebuah gagasan atau pemikiran hukum yang diperkenalkan Satjipto Rahardjo. Gagasan tersebut bermula dari keprihatinan terhadap kehidupan berhukum secara makro di Indonesia termasuk setelah reformasi 1998 yang tidak beranjak ke arah yang ideal, yaitu menyejahterakan dan membahagiakan rakyatnya. Apa yang terjadi dengan kehidupan berhukum justru suatu keterpurukan dan kemunduruan, antara lain terlihat pada mafia peradilan, komersialisasi, dan komodifikasi hukum. Untuk mengatasi keadaan demikian, menurut Satjipto Rahardjo dengan hukum progresifnya, maka berhukum harus berani keluar dari cara-cara konvensional dan status quo. Teks hukum yang selama ini didewakan harus dianggap sebagai sesuatu yang diperuntukkan untuk manusia dan kemanusiaan. Para pelaku atau aktor hukum harus berani menafsirkan teks hukum dengan membebaskan diri dari logika hukum semata, melakukan lompatan, agar persoalan di masyarakat yang bergerak secara dinamis dapat dijawab dan diselesaikan dengan “wadah hukum yang statis”. Artikel ini menunjukkan, hukum progresif bisa menjawab persoalan hukum yang karut-marut disebabkan keterbatasan dan keterikatan teks hukum, dengan catatan para aktor hukumnya berperilaku baik. Namun begitu, labelisasi berhukum sebagai hukum progresif rentan menimbulkan persoalan tersendiri disebabkan bisa disematkan penuturnya secara mudah dan sembarangan untuk mengidentifikasi putusan atau penetapan hukum kasus tertentu yang (asalkan saja) keluar dari teks hukum.
THE SELECTION OF PRODUCTIVITY KEY PERFORMANCE INDICATORS FOR CAR MANUFACTURING COMPANIES USING INTEGRATED PERFORMANCE MEASUREMENT SYSTEM
Authors: Amrina Uly , Firdaus Alfa
Published: June 2018

The increase in car market 17% in 2020, and ASEAN Free Trade policy only 5% for imported products, cause tightened competition in the automotive market. Car manufacturing companies face problems in selecting their performance indicators related to competitive challenges. The purpose of this research is to develop productivity key performance indicators in car manufacturing that conform to stakeholder requirements as a strategy to win the market. The conditions are manifested in a mapping of manufacturing symbols using the Integrated Performance Measurement System (IPMS) method. That manufacturing productivity indicators will become the focus of the top management to be controlled. There are four stages to go through, starting with the identification of stakeholder requirement, which produces six criteria and 12 stakeholder requirements and mapped into 16 goals and 24 key performance indicator (KPI). The second stage is benchmarking, and preparation of KPI hierarchy and the third stage is the description of each KPI in the form of KPI specification table. The fourth stage is the weighting of the six main criteria that result in 3 priority criteria which must be reported monthly between the manufacturing division (painting), finance and administration. Those are employee safety, manufacturing process effectiveness (painting) and waste elimination activities. The priority is obtained based on questionnaires answered by ten stakeholders (experts) processed with Analytical Hierarchy Process (AHP) approach and has been tested consistency in the number 0.09. These three criteria are described in 15 KPIs: performance rate, availability rate, quality rate, trained operator ratio, training value ratio> 80, delay ratio, attendance ratio, downtime losses, setup and adjustment losses, idle time, defect losses, yield losses, manpower efficiency, environmental impact and work accident ratio.
Pseudotime Ordering of Single Human β-Cells Reveals States of Insulin Production and Unfolded Protein Response
Authors: Xin Yurong , Dominguez Gutierrez Giselle , Okamoto Haruka , Kim Jinrang , Lee Ann-Hwee , Adler Christina , Ni Min , Yancopoulos George D. , Murphy Andrew J. , Gromada Jesper
Published: June 2018

Proinsulin is a misfolding-prone protein, making its biosynthesis in the endoplasmic reticulum (ER) a stressful event. Pancreatic β-cells overcome ER stress by activating the unfolded protein response (UPR) and reducing insulin production. This suggests that β-cells transition between periods of high insulin biosynthesis and UPR-mediated recovery from cellular stress. We now report the pseudotime ordering of single β-cells from humans without diabetes detected by large-scale RNA sequencing. We identified major states with 1) low UPR and low insulin gene expression, 2) low UPR and high insulin gene expression, or 3) high UPR and low insulin gene expression. The latter state was enriched for proliferating cells. Stressed human β-cells do not dedifferentiate and show little propensity for apoptosis. These data suggest that human β-cells transition between states with high rates of biosynthesis to fulfill the body’s insulin requirements to maintain normal blood glucose levels and UPR-mediated recovery from ER stress due to high insulin production.
Effectiveness of In-office Hydrogen Peroxide With Two Different Protocols: A Two-center Randomized Clinical Trial
Authors: Martins IEB , Onofre S , Franco N , Martins LM , Montenegro A , Arana-Gordillo LA , Reis A , Loguercio AD , da Silva LM
Published: June 2018

Objectives:

The aim of this study was to compare the bleaching efficacy and tooth sensitivity (TS) of a 38% hydrogen peroxide bleaching agent used for in-office bleaching, applied under different time protocols: a 40-minute application or two 20-minute applications.

Methods and Materials:

Forty-four patients from Brazil and Colombia, with right superior canines darker than C2, were selected for this multicenter, single-blind, randomized trial. The teeth were bleached in two sessions, with a one-week interval between them, in a split-mouth design. The bleaching agent was applied in two 20-minute (2×20) applications or one 40-minute (1×40) application in each session according to the manufacturer's instructions. The color changes were evaluated by using subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. Tooth sensitivity was recorded up to 48 hours with a 0-10 visual analog scale. Also, the pH values during the application of bleaching were recorded. Color change in shade guide units and ΔE were analyzed by using the Student t-test (α=0.05). The absolute risk and intensity of TS were evaluated with the McNemar test, the Wilcoxon signed-rank test, and the Friedman test, respectively (α= 0.05).

Results:

Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of a 40-minute application did not significantly influence the absolute risk of TS (68%, 95% confidence interval [CI] = 53-80) as well as the intensity of TS compared with the acid bleaching gel (absolute risk of 82%, 95% CI = 68-91). The pH values did not differ significantly between groups and at the different assessment periods (p=0.42).

Conclusion:

The use of a 40-minute in-office bleaching agent gel application produced the same whitening degree and TS that the two 20-minute bleaching agent applications did. The former preferably should be applied because one 40-minute application does not require gel refreshing.
The Death of SIDS
Authors: Nashelsky Marcus B. , Pinckard J. Keith
Published: June 2018

Sudden Infant Death Syndrome (SIDS) is an overly broad classification bin for sudden unexplained infant deaths. SIDS has become a “diagnostic” phrase that encompasses unidentified, disease-related causes of death, deaths likely due to accidental asphyxia, and possibly unrecognized homicides. There is a prevailing false concept that SIDS is a “real” and discrete diagnostic entity rather than a phrase that signifies an inability to state why an infant has died. This has been perpetuated by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), which recognizes SIDS as a “cause” of death. We propose simplified, unambiguous language for the death certificate in cases of sudden unexplained infant death. We propose changes to ICD-10 nomenclature and vital statistics tabulation practices of the National Center for Health Statistics (a division of the Centers for Disease Control and Prevention) to end the use of SIDS as a diagnosis.
The Underweight Elder: Maltreatment, Self-Neglect, or Normal Aging?
Authors: Collins Kim A.
Published: June 2018

An elder is an individual 65 years of age and older. In general, increased age is associated with numerous physical and cognitive changes. When an elder is underweight, the underlying cause can be due to a natural change of aging, an underlying disorder, secondary to medical treatment, elder neglect, or self-neglect. In order to accurately classify the cause of the weight loss, forensic pathologists and investigators must examine all aspects of the elder: the pathophysiology of aging, the autopsy and physical findings, past and recent medical history, and the scene and social environment.
National Association of Medical Examiners Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid Drugs
Authors: Davis Gregory G. ,   The National Association of Medical Examiners and American College of Medical Toxicology Expert Panel on Evaluating and Reporting Opioid Deaths
Published: June 2018

The American College of Medical Toxicology and the National Association of Medical Examiners convened an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance. The panel finds the following: 1. A complete autopsy is necessary for optimal interpretation of toxicology results, which must also be considered in the context of the circumstances surrounding death, medical history, and scene findings. 2. A complete scene investigation extends to reconciliation of prescription information and pill counts. 3. Blood, urine, and vitreous humor, when available, should be retained in all cases. Blood from the femoral vein is preferable to blood from other sites. 4. A toxicological panel should be comprehensive and include opioid and benzodiazepine analytes, as well as other potent depressant, stimulant, and anti-depressant medications. 5. Interpretation of postmortem opioid concentrations requires correlation with medical history, scene investigation, and autopsy findings. 6. If death is attributed to any drug or combination of drugs (whether as cause or contributing factor), the certifier should list all the responsible substances by generic name in the autopsy report and on the death certificate. 7. The best classification for manner of death in deaths due to the misuse or abuse of opioids without any apparent intent of self-harm is “accident.” Reserve “undetermined” as the manner for the rare cases in which evidence exists to support more than one possible determination.
National Association of Medical Examiners Position Paper: Retaining Postmortem Samples for Genetic Testing
Authors: Middleton Owen , Baxter Samantha , Demo Erin , Honeywell Christina , Jentzen Jeff , Miller Frank , Pinckard J. Keith , Reichard R. Ross , Rutberg Julie , Stacy Carl , MacLeod Heather
Published: June 2018

Sudden unexpected death is typically diagnosed in infants, children, teenagers, and young adults following completion of an autopsy that fails to identify a cause of death or when autopsy suggests a potentially genetic cause of death in an individual less than 40, such as cardiomyopathy or aneurysm. Such deaths may be a result of genetic abnormalities that are unable to be diagnosed by gross or microscopic inspection, but may be detectable by molecular studies. Unfortunately, the ability to perform postmortem genetic testing is frequently hindered by lack of an appropriate specimen following completion of an autopsy. This paper provides recommendations developed by the National Association of Medical Examiners with the assistance of genetic counselors. The recommendations establish procedures to facilitate postmortem genetic testing and DNA banking by health care professionals assisting families who have experienced sudden death in young relatives by clarifying proper sample acquisition and storage. Additionally, recommendations for discussion with surviving family members and test planning are provided. The objective of these recommendations is to ensure that postmortem samples suitable for DNA banking are retained, allowing at risk family members improved detection of potentially treatable genetic diseases.
Pulmonary Embolic Disorders
Authors: Batalis Nicholas I. , Harley Russell A.
Published: June 2018

Deaths due to pulmonary thromboemboli are frequently encountered by the forensic pathologist and account for a significant percentage of sudden, unexpected deaths. Diagnosing these straightforward cases is often not a challenge, but unfortunately some cases in which a thromboembolism is expected can become complicated. Occasionally, a postmortem clot may mimic a thromboembolism and lead to a mistaken diagnosis, and in other situations it may become paramount to attempt to age a thrombus as part of a medicolegal lawsuit. Additionally, many individuals use the less specific term, “pulmonary emboli”, when referring to these cases in which a portion of a thrombus, usually originating in the deep veins of the lower extremities, breaks off and travels to the pulmonary vasculature bed where it occludes vessels and leads to a rapid demise. One must remember, though, that several other materials and tissues including fat, amniotic fluid, air, tumors, solid organs, synthetic materials, and parasites may be displaced and embolize to the lungs and cause significant disease. In the following pages we will provide a thorough review of pulmonary embolic disorders, focusing on those diseases most likely to be encountered by the forensic pathologist. The aim of this review is to aid the pathologist in using proper terminology, diagnosing various types of embolic disorders, and recognizing potential mimics.
Ethanol, Trauma, and the Brain
Authors: Ramsay David A.
Published: June 2018

Alcohol intoxication plays a significant and causal role in various fatal injuries. In comparison to sober individuals, intoxicated people have a greater generic risk for being involved in hazardous activities that may result in fatal injuries. However, it is not clear whether the biological effects of acute alcohol intoxication result in worse injuries than those sustained by sober individuals who are injured by identical mechanisms. Alcohol intoxication has a neuroprotective effect in experimental animal models of traumatic brain injury (TBI) but the evidence for a similar effect in humans is controversial. Earlier studies found such a protective effect, but more recent large epidemiological studies have not confirmed this finding; some studies also suggest a dose-related protective or exacerbating effect of alcohol intoxication on TBI. There are two apparent alcohol-associated syndromes in which an otherwise survivable blunt force impact to the head of an intoxicated individual is fatal at the scene. The first is a fatal cardiorespiratory arrest (the so-called alcohol concussion syndrome or “commotio medullaris”); the second is “traumatic basilar subarachnoid hemorrhage” (secondary to tears in the cerebral arteries, particularly the intracranial and extracranial vertebral arteries).
Accidental Ingestion of a Grill Brush Wire Resulting in Death
Authors: Jacob Marisa , Nashelsky Marcus B. , Dailey Morris O.
Published: June 2018

Accidental ingestion of a foreign body is a rare occurrence in the unimpaired adult. The usual patient is aware of the ingestion event and seeks medical attention if needed.

We report a case of accidental, unrecognized, fatal ingestion of a foreign body discovered during a postmortem examination. In situ examination revealed a small perforation of the terminal ileum by a perforating metal wire. Fibrinopurulent peritonitis was the immediate cause of death. The foreign body was later found to closely resemble the wire bristles of a barbeque grill brush that family members brought to a family/clinician/pathologist conference.

There are few previous case reports of ingestion of a grill brush wire, all of which were nonfatal. Health care workers, including pathologists, should be aware of this potential ingestible foreign body given the widespread use of barbeque grills in food preparation. Additionally, manufacturers and users of grill brushes should be well aware of this ingestion hazard.
The Diagnostic Shift of SIDS to Undetermined: Are There Unintended Consequences?
Authors: Crandall Laura Gould , Reno Laura , Himes Barbara , Robinson Deborah
Published: June 2018

Over the last two decades, a diagnostic shift in regards to the certification of sudden deaths in infancy has emerged with reassignment of deaths previously certified as sudden infant death syndrome (SIDS) to a trend utilizing the classification of undetermined or asphyxia. The consequences of this shift outside the medicolegal death investigation (MDI) community is unknown. We surveyed US organizations working in the field of sudden infant death as well as bereaved parents to understand their perceptions of the current diagnostic trends. Two online anonymous surveys were utilized. Sixty-seven organizations and 55 parents with an infant death diagnosis of SIDS, sudden unexplained infant death (SUID), undetermined, or asphyxia participated. Just over 50% (34/67) of the organizations perceived the shift had an effect on their organization including barriers to bereavement support and education. Forty percent (22/55) of parent respondents stated they did not understand the final diagnosis of their infant's death. The highest frequency of themes elicited from parents were frustration that the diagnosis (regardless of terminology) did not fully explain the death, detrimental mental health effects, and negative perceptions towards the medical and public health communities. However, parents of children whose death was classified as SIDS were spared from negative perceptions towards the medical field, described the least amount of confusion, and reported the most instances of positives effects. Legal implications, perceived social stigmas, and research obstacles were also described. Recommendations from this study include the integration of collaborative efforts to combat sudden infant death with all stakeholders, in and outside of MDI, to achieve better understanding and eradication of these tragedies, improved public education, and effective care of all bereaved.
Medicolegal Death Scene Investigations after Natural Disaster- and Weather-Related Events: A Review of the Literature
Authors: Rocha Luciana A. , Fromknecht Catharine Q. , Redman Sarah Davis , Brady Joanne E. , Hodge Sarah E. , Noe Rebecca S.
Published: June 2018

Background

The number of disaster-related deaths recorded by vital statistics departments often differs from that reported by other agencies, including the National Oceanic and Atmospheric Administration-National Weather Service storm database and the American Red Cross. The Centers for Disease Control and Prevention (CDC) has launched an effort to improve disaster-related death scene investigation reporting practices to make data more comparable across jurisdictions, improve accuracy of reporting disaster-related deaths, and enhance identification of risk and protective factors. We conducted a literature review to examine how death scene data are collected and how such data are used to determine disaster relatedness.

Methods

Two analysts conducted a parallel search using Google and Google Scholar. We reviewed published peer-reviewed articles and unpublished documents including relevant forms, protocols, and worksheets from coroners, medical examiners, and death scene investigators.

Results

We identified 177 documents: 32 published peer-reviewed articles and 145 other documents (grey literature). Published articles suggested no consistent approach for attributing deaths to a disaster. Researchers generally depended on death certificates to identify disaster-related deaths; several studies also drew on supplemental sources, including medical examiner, coroner, and active surveillance reports.

Conclusions

These results highlight the critical importance of consistent, accurate data collection during a death investigation. Review of the grey literature found variation in use of death scene data collection tools, indicating the potential for widespread inconsistency in data captured for routine reporting and public health surveillance. Findings from this review will be used to develop guidelines and tools for capturing disaster-related death investigation data.
Carfentanil and Current Opioid Trends in Summit County, Ohio
Authors: Waite Kristy , Deeken Amy , Perch Steve , Kohler Lisa J.
Published: June 2018

Introduction

The Summit County Medical Examiner's Office (SCMEO) observed 52 unexplained deaths during the month of July 2016 in which drug overdose was suspected. A fentanyl screening immunoassay performed on autopsy specimens was positive, but gas chromatograph/mass spectrometry (GC/MS) failed to confirm its presence. Carfentanil, a large wildlife tranquilizer, was later identified through reference lab testing as the cause of the sudden increase in overdoses.

Methods

Due to the large volume of cases which followed, a method for identifying carfentanil was developed utilizing in-house instrumentation. In addition, a retrospective analysis for all drug overdose cases was conducted through the SCMEO database from January 2009 through December 2016.

Results

Assessment of the data revealed a 277% increase in yearly overdose-related fatalities when comparing 2009 to 2016. Carfentanil was not identified in any other fatal drug overdoses in the area before the first appearance in Akron in July of 2016. There was an initial spike of 35 deaths in both July and August, which then decreased to 12 deaths in December. There was an almost equal distribution of carfentanil as a single agent and carfentanil mixed with multiple other illicit drugs.

Discussion

Current observations suggest carfentanil concentrations in overdose cases are decreasing; however, it may be present in combination with other drugs, especially other fentanyl analogs. The lower concentrations of carfentanil are much more difficult to detect in urine and peripheral blood, therefore making the testing of scene paraphernalia, central blood, and organ tissue more of a necessity.
Opioid-Associated Deaths in South Carolina, 2013-2016: A Retrospective Review
Authors: Butler Daniel C. , Batalis Nicholas I.
Published: June 2018

Introduction

Rising rates of opioid abuse in the United States have generated an overdose epidemic. Particularly in the last few years, many offices across the country have seen a shift from prescription opioid toxicity to heroin, illicitly produced fentanyl, and, more recently, various fentanyl analogs.

Methods

A retrospective review was performed to better characterize the incidence of licit opioid, heroin, fentanyl, and fentanyl analog-associated deaths in South Carolina. Three-thousand three-hundred and fifty autopsy records from the Medical University of South Carolina's forensic pathology division were reviewed to identify cases in which oxycodone, hydrocodone, heroin, fentanyl, and/or fentanyl analogs were detected.

Results

In 2013, the incidence of both heroin and fentanyl-associated deaths was relatively rare (2.2% and 0.4%, respectively), but increased somewhat steadily throughout the ensuing years. The incidence of fentanyl-associated death increased from 0.4% to 2.4% between 2013 and 2016. A decrease in fentanyl-associated deaths was noted between 2015 and 2016; however, 2016 saw a dramatic increase in fentanyl analogs, likely accounting for this slight dip. Heroin rose from 2.2% to 4.5% between 2013 and 2016. Combined, heroin and fentanyl accounted for 2.6% of autopsy deaths in 2013 and increased to 7.6% in 2016, with more substantial increases in 2014 and 2015. Licit opioid-associated deaths remained relatively stable throughout the study period and, when identified, were almost always polydrug comixtures.

Discussion

These data illustrate general increases in illicit opioid-related deaths. In contrast to larger jurisdictions, particularly in the Midwest and Northeast, heroin continues to contribute most significantly to intoxication deaths, although synthetic fentanyl and fentanyl analog-associated deaths increased dramatically beginning in 2014.
Parachute Deaths in Southern Arizona
Authors: Cronin Rose , Winston David C.
Published: June 2018

Introduction

Parachuting is said to be a relatively safe activity. We sought to undertake a study to assess parachute-related deaths in our jurisdiction.

Methods

A retrospective study of parachute-related deaths in Southern Arizona was conducted by searching the Pima County Office of the Medical Examiner database between 2001 and 2016. This search revealed 24 deaths.

Results

The decedents ranged from 19 to 61 years of age, with a median age of 36 years. Twenty-two of the decedents were male. The racial breakdown was 22 white, one Asian, and one not recorded. The manner of death in all cases was classified as an accident. All deaths were due to multiple blunt force injuries and only one case was found to have no injuries to the head or neck. The most common circumstances were failure of chute deployment (seven), mid-air collisions (three), and becoming entangled with other parachutists (three). Six deaths occurred during military training. Four of the nonmilitary decedents were described as “experienced” parachutists and one case involved a tandem jump team with a survivor. Natural disease was found in four cases with three having moderate coronary artery atherosclerosis. Toxicology was performed in 21 of the deaths with three positive for cannabinoids, one positive for 7-aminoclonazepam, and one positive for 3, 4-methylenedioxymethamphetamine (MDMA).

Discussion

Parachuting is a relatively safe activity, with very few deaths. Investigation of these deaths should include a complete autopsy with toxicology as well as a thorough scene investigation and evaluation of the jumper's equipment.
A Pediatric Case of Diffuse Glioma Diagnosed at Autopsy
Authors: Ross Jennifer , Olar Adriana , Fuller Christine
Published: June 2018

Sudden death from an undiagnosed primary intracranial neoplasm is extremely uncommon and even rarer in the pediatric population. Gliomatosis cerebri (GC) represents a growth pattern demonstrable by a variety of gliomas, predominating in adults. Herein we present a rare occurrence of diagnosis of a pediatric glioma with a GC pattern of infiltration at autopsy and compare the immunohistochemical results and molecular characteristics in this tumor to the small amount of published knowledge available about pediatric diffuse gliomas with widespread brain invasion.
Deaths from Environmental Hypoxia and Raised Carbon Dioxide
Authors: Milroy Christopher M.
Published: June 2018

This paper reviews deaths in which there is an environment that is low in oxygen and/or has elevated levels of carbon dioxide. These deaths present problems to autopsy pathologists, as the autopsy is typically negative and postmortem toxicology cannot be used to detect the effects of hypoxia and raised levels of carbon dioxide. Deaths from hypoxia and raised carbon dioxide may be encountered in work-and nonwork-related environments. Typically these are accidents, but suicides may be encountered and criminal charges may follow these events. Environments that have been associated with these events include mines, tunnels, sewers, and pits. Transportation incidents may also be associated with hypoxic events, particularly aircraft and submarines. When an atmosphere low in oxygen is entered, collapse can be rapid, or immediate if the environmental oxygen is below 6%. Environments rich in carbon dioxide can also cause death, even with a high oxygen concentration. Such environments may be encountered in industrial settings, but also occur in natural disasters such as the Lake Nyos disaster. The identification of these deaths typically requires a coordinated investigation with safety inspectors and other experts in industrial- and work-related deaths.
High-Altitude Illness Death Investigation
Authors: Kurtzman Robert A. , Caruso James L.
Published: June 2018

High altitude illness (HAI) is the current accepted clinical term for a group of disorders including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), which occur in travelers visiting high-altitude locations. High-altitude illness is due to hypobaric hypoxia, is not associated with age or physical conditioning, and mild forms are easily treated. High-altitude cerebral edema and HAPE are medical emergencies that are fatal if not promptly treated and fortunately are uncommon. The cause of most high-altitude fatalities is not related to HAI and can be easily distinguished from HACE and HAPE; however, other causes of death may have symptoms and physical findings that overlap with HAI, making postmortem diagnosis challenging. Fatalities due to HAPE and HACE are diagnoses of exclusion. Medical examiners and coroners who work in jurisdictions with high-altitude locations should be aware of the risk factors, physiology, pathology, differential diagnosis, and classification of HAI to accurately recognize HAI as a cause of death. Medical examiners who do not work in jurisdictions with high-altitude locations may be asked to evaluate deaths that occur overseas associated with high-altitude trekking and mountaineering activities.
Lightning and the Forensic Pathologist
Authors: Blumenthal Ryan
Published: June 2018

This paper explores the pathology caused by lightning. It covers the basic physics and mechanisms of injury of lightning strikes followed by a short discussion. The purpose of this paper is to suggest an approach to the investigation and autopsy of a lightning-related death.