bluuebunny/crossref_metadata_2025 huggingface dataset:
How to Write a Research Paper
Authors: Sens Mary Ann
Published: April 2017

Writing a scientific manuscript can be broken down into readily achievable defined steps. Authors should first select a topic and perform a literature search. When the topic of the manuscript is selected, authors should define specific topics to discuss in the manuscript, define the authors and authorship order involved and be aware of any regulatory issues with the study. Authors select a target journal for publication and after familiarizing themselves with the journal format and requirements, write the article from the topics defined earlier, incorporating relevant literature references and finalizing conclusions and interpretative findings. This manuscript also provides a general overview of the publication process for potential authors of scientific research papers.
Forensic Pathology Fellowship Training Positions and Subsequent Forensic Pathology Work Effort of past Forensic Pathology Fellows
Authors: Hanzlick Randy , Haden-Pinneri Kathryn
Published: April 2017

The purpose of this study is to document the number of accredited, funded, and filled forensic pathology fellowship positions in the United States and to document the subsequent work effort of forensic pathology fellowship graduates in terms of whether they go on to practice forensic pathology full time, part time, only as a consultant, or not at all. Also studied is the portion of fellows who become board certified in forensic pathology and/or become members of the National Association of Medical Examiners (NAME). Using surveys of training program directors and the NAME membership, information was obtained for 190 persons who did a forensic pathology fellowship sometime during the years 2000-2005. Information was also obtained from the 35 program directors about the number of accredited, funded, and filled positions in their programs. Among the 35 active programs, 78 positions are approved by the ACGME of which 53 are funded and 42 filled in 2011. Thus, only 68% of approved positions are funded, and 79% of the funded positions are filled. For the 2011 training year, 8 of the 35 programs (23%) have no fellow. Almost equal numbers of men and women trained during the study period. Board certification in forensic pathology was achieved by 67% of 190 trainees and 67% practice forensic pathology full time for an office which conducts official medicolegal death investigations. Unfortunately, 21% end up not practicing forensic pathology at all. 55% of past trainees belong to NAME. A lower portion of women trainees practice forensic pathology full time, and a higher portion of women (26%) do not practice forensic pathology at all, compared with men (15%). For those who obtained board certification in forensic pathology (n=128), 78% were working full time. For those who lacked board certification (n=62), 44% were practicing forensic pathology full time. Forensic pathology fellowship training directors need be aware of these statistics when developing strategies for program development, financial support, and fellow selection. More rigorous evaluation of candidates may be needed to identify those who truly plan to work full time in the field of forensic pathology. Training directors should also take measures to ensure that their programs are not discouraging fellows from continuing their career in forensic pathology. NAME may need to consider ways to attract more graduating trainees into its membership.
Professional Certification for Medicolegal Death Investigators - ABMDI
Authors: Howe Julie A.
Published: April 2017

The American Board of Medicolegal Death Investigators (ABMDI) was created and developed in 1998 by veteran, practicing medicolegal death investigators who were involved in the development of the National Institutes of Justice December 1997 publication National Guidelines for Death Investigation that was later renamed Death Investigation: A Guide for the Scene Investigator. The creation of the ABMDI allowed for the establishment of uniform criteria, ethical conduct and standardized practices for individuals investigating deaths that fall under the jurisdiction of the medical examiner/coroner. There are two levels of ABMDI certification: Registry Certification and Board Certification.

A survey was deployed to ABMDI certificants in 2005 and 2011 to determine how the profession has changed with respect to job title, systems employing certificants, educational level and the overall benefits and requirements of ABMDI certification. Results of the survey will be discussed.

The NAS report released in 2009 recommends professional certification for all forensic personnel, including medicolegal death investigators. Achievement of this recommendation requires legislative action, implementation strategy, and adequate time and budget. The Subcommittee on Forensic Science (SoFS) has established an Interagency Working Group (IWG) that is examining these recommendations. A Scientific Working Group on Medicolegal Death Investigation (SWGMDI) was developed in March 2011 to recommend best practices and standards, including a committee on Accreditation, Certification, Education and Training. The ABMDI is participating in the efforts to promote standardized medicolegal death investigation.
Principles of Investigation
Authors: Davis Joseph H.
Published: April 2017

The purpose of an investigation is to determine something; to find out what, why, and who. A researcher searches for something new, an advance in the field of study. A doctor determines a diagnosis, a form of investigation. A police officer, at the scene of a motor vehicle traffic crash, or a burglary, or a suspicious death similarly investigates in order to determine what happened, what laws were violated and who was responsible. All these have one thing in common—the necessity to gather facts (data), assess their relevance and integrate them into a sensible and reasonable and correct conclusion. This requires expertise.
Mistakes and Failures in Forensic Pathology
Authors: Davis Joseph H.
Published: April 2017

In 1956 Dr. Alan Moritz wrote a timeless manuscript entitled “classical mistakes in forensic pathology”. This treatise on the common personal and systemic failings within death investigation is considered by many to be a seminal work within the field, and all medical examiners would benefit by reviewing it annually. This brief manuscript reviews case examples where pathologists fail by substituting intuition for scientifically defensible fact, or by jumping to conclusions based on a limited data set. Without a doubt, forensic pathologists err, but it is when those pathologists refuse to accept or learn from their mistakes that they become a danger to the cause of justice.
Why Did He Die? He Wasn't Supposed To!
Authors: Davis Joseph H.
Published: April 2017

Forensic pathology is not simply autopsy pathology. Rather, the determination of why someone died is dependent upon the findings of a competent autopsy interpreted within the context of an excellent investigation of the circumstances of death. It is important that medical examiners remember the critical distinction between “dying with” and “dying of” something. Furthermore, our determination of “the” cause of death may not explain “why” someone died; identifying the underlying cause of death may not explain the mechanism through which the person died.
Apparent Natural Deaths
Authors: Davis Joseph H.
Published: April 2017

A natural death is one which is not caused by accident, by suicide, or by homicide. Natural deaths are those caused by disease. Diseases may be infectious, metabolic, degenerative, congenital, or neoplastic. The number of diseases causing death are innumerable. Coding manuals used by vital statisticians cover thousands of subcategories of diseases which are known to cause or accelerate death.

Natural diseases investigated by police are relatively few in number and likewise involve limited subsets of our society. There are also geographic and ethnic variations in different parts of the world.
Rare Tumors of the Sellar Region
Authors: Raghunathan Aditya , Takei Hidehiro , Powell Suzanne Z.
Published: April 2017

Context

The sellar/ parasellar region is the location for a vast array of neoplastic and nonneoplastic intracranial space-occupying lesions. While several common lesions arising in this location have been well-described in the literature, there are rare and challenging tumors that may also arise in this region.

Objective

We focus this review on five rare tumors reported to arise in the sellar region, including spindle cell oncocytoma of the adenohypophysis, pituicytoma, intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma. We review their clinical presentation, histologic features, differential diagnosis and outcomes for these tumors.

Data sources

All medical literature pertaining to these entities that was searchable on PubMed was comprehensively reviewed.

Conclusions

Spindle cell oncocytoma and pituicytoma have recently been included in the 2007 edition of the World Health Organization classification of tumours of the CNS, while intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma have only rarely been described in this region. Knowledge of these may help prevent possible diagnostic pitfalls during postmortem evaluation.
Corpora Amylacea and Unexpected Death: A Case of Adult Polyglucosan Body Disease Diagnosed at Forensic Autopsy
Authors: Williams Timothy L. , Reichard R. Ross
Published: April 2017

Adult polyglucosan body disease (APBD) is a rare neurodegenerative condition characterized by typical onset in middle age, progressive neurological impairment that is heterogeneous between cases, and death within 1-14 years of diagnosis. The histopathologic hallmark of the disease is massive deposition of corpora amylacea (designated polyglucosan bodies in this context) in the central nervous system, and variable deposition of similar material in other sites. While the cause of the disease is as yet unknown, recent research has identified mutations in proteins involved in glycogen metabolism in a subset of cases. In this paper, we present a case of unexpected death wherein APBD was diagnosed at forensic autopsy. This represents the first report of an unexpected death due to this disease reported in the medical and forensic literature.
Lethal Neurotoxicity Induced by Endosulfan Ingestion
Authors: Matshes Evan W. , McKenzie Brienne , Lew Emma O.
Published: April 2017

Endosulfan is a highly toxic agricultural pesticide that has been banned in many countries due to its significant neurotoxicity and environmental persistence. Accidental or intentional ingestion by humans induces severe neurological symptoms, which frequently culminate in coma or death. Forensic evaluation of suspected endosulfan toxicity cases can be challenging, given that endosulfan residue may not be detectable in the blood or tissues at the time of death. As such, evaluation of the case history in the context of the reported literature becomes extremely important. Although acute endosulfan toxicity in adults has been well documented, pediatric cases are rare within the literature. Here we present the case of a toddler who accidentally ingested an unknown quantity of endosulfan from an unmarked water bottle on his family farm. The child developed rapid-onset neurological symptoms, including vomiting and seizures, followed by coma. Despite medical intervention, the child was eventually pronounced brain dead and taken off life support. Autopsy revealed massive cerebral edema and its sequelae (sutural diastasis, pituitary necrosis, and dural venous thromboses), and pulmonary thromboemboli. Endosulfan was detected in the bottle from which the child drank. As endosulfan was not detectable in postmortem blood, the cause of death was certified based upon the totality of available information including history, consistency of the case history with the clinical presentation, and the autopsy findings.
Consistency vs. Cognition in Manner of Death Classification: “But That's how I Was Trained!”
Authors: Knight Laura D.
Published: April 2017

In the process of certification of manner of death, consistency and cognition can sometimes be seen to be at war. There are a number of reasons for the prevalence of practical conventions for certifying manner of death, including the desire to be consistent with one's prior manner determinations and with colleagues. Unfortunately, relying on conventions or the way that one was trained or mentored to certify certain cases may be adverse to independent thinking. A more discerning and informed sort of internal consistency is to be found in the use of a rigorous intellectual process by the individual certifier.
When to Autopsy: Idealistic and Realistic Considerations
Authors: Schultz Daniel
Published: April 2017

The decision to perform an autopsy depends on many things, but at the least, it rests with local statutory responsibility and the competent forensic pathologist's perceived needs of the specific case. Although cause and manner of death are at the heart of the mission of the forensic pathologist, there are other obligations that should be considered, such as: questions that could arise later, as well as the impact of an incorrect opinion on the affected family and society. Standards have been developed by the National Association of Medical Examiners (NAME) which state when an autopsy should be performed. The autopsy has value in nearly all cases; however, the indiscriminate use of the autopsy does not supersede the detailed gathering of pertinent investigative history. It cannot be performed in a vacuum. Idealistic virtues of the autopsy, even if based on experiential merit, must still meet the hard realism of budgets and staffing when it comes to categorical case selections for autopsy. Resources must be allocated rationally. The purpose of this discussion/review is to review considerations about whether or not to perform an autopsy, from an idealistic, and from a realistic viewpoint. The intent is not to promulgate dogma or zealous overindulgence in testing which could overburden death investigative systems that already have critical limitations in budget and staffing. The conscientious role of the physician pathologist is emphasized.
Should Pathologists be Reporting Forensic CT Scans?
Authors: Bedford Paul J.
Published: April 2017

The Victorian Institute of Forensic Medicine in Australia annually processes in excess of 4,000 bodies as per the Coroners Act of 2008. Routinely these admissions undergo a full body postmortem computed tomography (PMCT) scan with the imaging being primarily analyzed by forensic pathologists rather than radiologists. This is largely due to the lack of appropriately experienced radiologists. In practical terms reporting of images by pathologists is another example of “crossover” between disciplines in medicine. This manuscript proposes a model for how this crossover might be managed, especially in relation to quality control, education, review procedures and the potential for formal credentialing of medical staff.
Unexpected Death from Hemorrhagic Pericarditis Complicating IgA Nephropathy
Authors: Meyers Sarah E. , Crary Gretchen S. , Baker Andrew M.
Published: April 2017

IgA nephropathy is the most common cause of glomerulonephritis in the developed world; however, it is usually an indolent or slowly progressive disease presenting initially as self-limited hematuria, typically following a viral or bacterial infection. We report a case of previously undiagnosed IgA nephropathy manifesting with end stage renal disease, fibrinous pericarditis, and hemorrhagic pericardial effusion in a 26-year-old white male. Clinical manifestations of IgA nephropathy, the presumed pathogenesis, and complications are reviewed. This case highlights the importance of interdisciplinary collaborations with other specialized pathology services—in this case renal pathology, including direct immunofluorescence and electron microscopy—that may not be routinely available or used in forensic pathology practices. In this instance, such collaboration provided the etiologically specific diagnosis for an unusual presentation of a common disease.
The Autopsy and Toxicologic Deaths
Authors: Parai Jacqueline L. , Milroy Chris
Published: April 2017

Deaths from toxicologic causes is one of the main reasons for performing an autopsy. The approach to performing an autopsy involves knowledge of the scene and history, particularly for the presence of prescribed and illicit drugs. The external and internal examination, while often nonspecific, can provide specific information on route of administration and specific changes seen on naked eye and microscopic examination. Material for toxicologic analysis needs to be collected and may require discussion with the toxicology laboratory to make sure the appropriate material is sent. The opinion relating to cause and manner of death requires an analysis of all stages of the investigation. Such phenomena as postmortem redistribution and tolerance to a drug must be considered before making a determination. This paper reviews the autopsy in toxicologic death.
Classical Mistakes in Forensic Toxicology Made by Forensic Pathologists
Authors: Gill James R. , Stajíc Marina
Published: April 2017

The forensic pathologist interprets the toxicology results in the setting of the entire death investigation. This review focuses on potential errors by the forensic pathologist with regard to toxicology analysis encountered with death investigation. These include mistakes of determining the cause of death based solely on the drug concentration and failure to consider the postmortem nature of the specimen when interpreting results. The forensic toxicologist does analytical toxicology; i.e., determining what drug(s) is/are present and in what concentration. The forensic pathologist does interpretive toxicology, which requires consideration of the decedent's medical history, the circumstances surrounding death, the environment of the death, the autopsy findings, and the results of the analytical toxicology. Forensic pathologists must communicate with the forensic toxicologists, understand their limitations, and collect proper specimens. Providing appropriate clinical information to the toxicologists will result in more timely and thorough toxicological analysis. Toxicologic results should be included on the death certificate only when they make a pathologic contribution to death.
Opioid Related Deaths of Infants and Young Children
Authors: Kepron Charis
Published: April 2017

The prevalence of the opioid drugs is increasing worldwide. Greater access in turn increases the risk of infants and young children being exposed to potentially fatal concentrations of these drugs, either by accident or through the negligent or deliberate actions of a caregiver. This report reviews opioid-related fatalities in this population and discusses homicidal and accidental poisonings and the possible routes of exposure, including through breastfeeding. As with adults, autopsy findings in fatal pediatric opioid toxicity are nonspecific and such cases may mimic death from natural diseases such as metabolic disorders or channelopathies. A detailed review of the case history together with a complete autopsy and toxicology testing are essential for the correct certification of these deaths. Further challenges arise from the fact that toxic ranges for opioids are not well-defined in the pediatric population, and the forensic pathologist must rely on case reports and small case series’ to assist in the determination of “how much is too much”. Resources such as the National Association of Medical Examiners Pediatric Toxicology Registry (NAME PedTox) continue to be of great value, but depend on the voluntary submission of case data from members. Emerging phar-macogenetic data are revealing genetic variations associated with altered metabolism and tissue distribution of opioids; therefore, molecular autopsy techniques should be considered in these challenging cases, especially where the manner of death is unclear.
Fatal Envenomations - Snakes and Other Creatures
Authors: Williams Kona , Milroy Chris
Published: April 2017

Envenomations by toxic creatures is a global health problem with an annual mortality from snake envenomation of over 125,000 cases. While various snake species bites are the most commonly encountered fatal envenomation, scorpions, spiders and marine creatures can all cause fatalities. Although venomous creatures have specific geographical habitats, the keeping of exotic pets and modern transportation, along with venomous collections in zoos, means that fatal envenomations may be encountered in non-endemic areas. There are a variety of toxins that may be encountered including neurotoxins, proteases, and myotoxins that will result in a variable amount of tissue damage depending upon the species involved and the toxin they carry. The autopsy findings may be relatively nonspecific and a careful search of the skin may be required to identify the envenomation site, along with a consideration of the history and the scene. External and internal damage will vary with the specific toxin. This paper reviews fatal envenomations, the toxinology and likely autopsy findings.
The Dilemma of Surrogate Testimony for the Forensic Pathologist
Authors: Gill James R.
Published: April 2017

Forensic pathologists commonly testify in court. In the past, surrogate testimony by another forensic pathologist was usually done if the original prosector was not available. In the current legal environment, there is increasing judicial pressure for the forensic scientist who originally performed an examination to testify. This may be problematic if that person has relocated to another jurisdiction or is otherwise unavailable. The forensic pathologist's legal and ethical duties and possible recourse when summoned to a former jurisdiction to testify is examined. The legal issues, common scenarios, and various approaches to minimize, manage, and resolve these occurrences is discussed, as well as the current legal status of surrogate testimony for the forensic pathologist.
Peritoneal Membrane Roll - Searching for Peritonitis in a Child Abuse Case
Authors: Rascon Mario A. , Matshes Evan W.
Published: April 2017

An autopsy was performed on a young child who died of blunt abdominal trauma. The parietal peritoneum exhibited focal dusky areas, which were sampled via 1) longitudinal sections of the abdominal wall and 2) preparing a cross-sectional sample of the peritoneal membrane roll. Microscopically, the membrane roll sections showed prominent neutrophilic inflammation; the longitudinal sections were comparatively more banal. We suggest that a peritoneal membrane roll might be of greater utility in the documentation of inflammation than typical longitudinal sections.
Manifestations of Birth Trauma at the Forensic Pediatric Autopsy
Authors: Lear-Kaul Kelly C.
Published: April 2017

Despite a greatly decreasing incidence of birth injuries over the past several decades with birth trauma currently accounting for less than 2% of neonatal deaths, birth trauma continues to be a significant cause of morbidity and mortality. Birth trauma is usually recognized by obstetricians and pediatricians, particularly when associated with a difficult delivery; therefore many birth injuries are diagnosed and documented in the neonatal period. Other delivery-related trauma may remain clinically silent without premortem identification. The challenge for the pathologist at autopsy is to correlate a history of birth trauma with injuries seen at autopsy, and to interpret injuries existing at death to accurately include or exclude birth trauma as a potential cause. Recognition of the spectrum of birth trauma is important when considering other accidental and nonaccidental mechanisms of injury, particularly in cases of unwitnessed perinatal death following delivery of a concealed pregnancy or in cases of alleged nonaccidental trauma. Discussed here is a general review of birth trauma that may be seen in a forensic setting to aid in interpretation of injuries that can be encountered.
Two Fatalities Associated with Sibutramine
Authors: Jarvis Hannah C. , Gill James R.
Published: April 2017

Sibutramine is an amphetamine derivative that has been prescribed as an antidepressant and appetite suppressant. It was voluntarily removed from the U.S. market in 2010 following a clinical trial that showed an increased risk of stroke and myocardial infarction. It has been detected as a clandestine additive in some over-the-counter weight loss and herbal remedies available on the Internet and in retail stores. We describe two fatalities involving the non-prescribed use of sibutramine by women using over-the-counter, herbal, weight loss supplements. Physicians need to be aware of inadvertent ingestion of sibutramine by patients who take herbal remedies for weight loss. Medical examiners and coroners may consider further investigation of sudden deaths in people who are taking herbal remedies for weight loss even with a history of heart disease. Since routine toxicology screens may not detect sibutramine, the toxicology laboratory should be informed when sibutramine is suspected.
Acute Fatal Peritonitis: A New Organism for Consideration
Authors: Kocovski Linda , Fernandes John R.
Published: April 2017

A 40-year-old man died suddenly and unexpectedly at home. His comorbid conditions included central diabetes insipidus, obesity, and hypertension. Autopsy revealed acute and chronic pancreatitis with an abscess and associated purulent peritonitis. Peritoneal fluid cultures grew Raoultella planticola and a light growth of Candida albicans. The organism isolated, R. planticola, is a waterborne bacterium with limited previous clinical isolates causing morbidity but no previously described mortality. Vitreous humor analysis demonstrated concomitant acute water intoxication complicating the decedent's diabetes insipidus. Discussion includes a review of the literature with a description of the eight previous cases of human infection with R. planticola, a recently described organism that was previously in the genus Klebsiella. The proposed fatal pathogenesis includes retrograde entry of the organism from the gastrointestinal tract via the pancreatic duct to the pancreas and subsequent peritonitis. This is the first reported fatality caused by this organism.
Fatal Methemoglobinemia Due to Industrial Accident
Authors: Williams Samantha , Ward Michael E. , Fulcher James W.
Published: April 2017

This is a case of a male who fell into a vat of industrial chemicals while at work. He became unresponsive while being transported to the hospital and was pronounced dead shortly after arrival. At autopsy there was focal cyanosis, widespread first and second degree burns, chocolate-colored blood, and a postmortem methemoglobin concentration of 61.6%. An extensive search of English-language medical literature revealed that there has not been a reported case like this, in which a patient acquired methemoglobinemia by falling into a vat of industrial chemicals, was immersed in these oxidizing agents, and subsequently died. It is important when treating a victim of an accident such as this to note the chemicals to which the patient was exposed in order to understand their possible toxic effects. It is also important at autopsy to note the coloration of the blood because in this case, this is how the pathologist first suspected the possibility of methemoglobin and then ordered the appropriate diagnostic test.
Obesity and Non-Atherosclerotic Cardiovascular Disease
Authors: Maloney Katherine F. , Schoppe Candace H.
Published: April 2017

Obesity is an increasing epidemic in the United States, with approximately 70% of Americans falling into either the overweight or obese categories. There also has been a global increase in the number of obese individuals worldwide, and an estimated one in ten of the world's adult population are overweight or obese. The number of overweight and obese children also has greatly increased, which likely will predispose them to earlier onset of obesity-related morbidity and mortality and further contribute to the burden obesity places on society. Obesity is a preventable and treatable cause of many systemic diseases affecting the heart, liver, lungs, endocrine, and musculoskeletal systems. Though it affects almost all organ systems, this state of over-nutrition induces abnormalities that culminate in changes in hemodynamics, heart structure, cardiac myocyte metabolism, and coronary artery disease that often lead to consequences such as systemic and pulmonary hypertension, obesity cardiomyopathy, heart failure, atrial fibrillation, and/or sudden cardiac death. Despite the prevalence of obesity in our current society, the exact effects on health are still being elucidated and, interestingly, there are some data to suggest certain populations of obese individuals may have less cardiovascular morbidity than their non-obese counterparts. Forensic pathologists should be aware of the effects of obesity, particularly on the cardiovascular system, as the number of these decedents seen at forensic autopsy increases. This review describes the non-atherosclerotic effects of obesity on the cardiovascular system.
The Forensic Implications of Liposuction: A Review
Authors: Ely Susan F.
Published: April 2017

Liposuction continues to be one of the most popular cosmetic procedures in developed cultures worldwide. Since a 1999 report describing five liposuction-related deaths in New York City, three of which were incompletely explained, abundant analysis and literature has emerged. This paper aims to present the history of liposuction, review recent clinical safety/guidelines and forensic fatality literature, describe current and emerging trends and techniques, and offer an approach to the forensic investigation of these deaths.
Pediatric Obesity and the Liver
Authors: Hardee Steven , Morotti Raffaella A.
Published: April 2017

The obesity epidemic affects both the adult and pediatric populations. Obese children are at risk for comorbidities such as cardiovascular disease and nonalcoholic fatty liver disease (NAFLD). NAFLD is the most common cause of pediatric liver disease and prevalence rates are increasing in parallel to obesity rates. Pediatric NAFLD is a difficult diagnostic entity complicated by lack of accurate noninvasive screening tools. Currently, microscopic liver examination biopsy is the gold standard for diagnosis. Histologically, NAFLD can range from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Pediatric NASH is histologically distinct from typical adult NASH. Type 2 NASH, originally described as the most common pattern of pediatric NASH, is characterized by macrovesicular steatosis, portal tract inflammation, and variable fibrosis without ballooning degeneration or perisinusoidal fibrosis. Type 1 NASH, or adult NASH, is characterized by macrovesicular steatosis, ballooning degeneration, lobular inflammation, and variable fibrosis. Recent studies have shown that overlap patterns between NASH type 1 and 2 are more frequently encountered in the pediatric population. We address the association between pediatric obesity and nonalcoholic fatty liver disease (NAFLD) with discussion of disease demographics, histopathology, and the role of autopsy.
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: April 2017

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 the 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 antidepressant 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 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.
The Effect of Inquiry - Based on Science Technology and Society Methods to the social Learning Outcomes.
Authors: Suryani Yani
Published: April 2017

The background of this research is the issue of globalization that impact on society's lives, especially school-age children (students) who started to use the technology in every activity. The problem in this study is whether the method of inquiry – based on Science Technology and Society has a significant effect on social science learning outcomes of students in SMPN 1 Bandung.

This study use quasi-experimental approach, with nonequivalent (pretest and posttest) the Control Group Design. The average result of experimental class’ pre-test is 59.72, and the post-test average is 77.08, the gain is 0, 46, While in the control classroom the average of pre - test is 56.81, and the post-test is 68.75, and the gain is 0, 28. There seems to be a significant improvement between the experimental class and the control class. The results were analyzed using the data analysis software called SPSS 16 for windows shows the sig is 0.000 < α 0.05, which means the test results showed that Ho strongly rejected, means that there are some learning outcomes distinctions between the student who get a method of inquiry -based learning with Science Technology and Society Methods with those who received conventional learning at the post-test. Post-test results of the students who received inquiry -based learning with the Science Technology and Society Methods is better than the students who received conventional learning. It can be seen from the motivation to learn, learner inquiry frequency, the students learning outcomes in land use and settlement patterns material based on the physical condition of the earth's surface.

The recommendations were based on the research findings and the discussion of the effect of the use of inquiry -based science technology society method. It is expected that schools, Social Sciences’ MGMP, social science Teacher and the next researcher can use and develop the inquiry -based science learning technology methods community in the social science.
Pengaruh Metode Discovery Learning Terhadap Peningkatan Pemahaman Konsep Peserta Didik (Studi Kuasi Eksperimen pada Kompetensi Dasar Elastisitas Permintaan dan Penawaran di Kelas X Akuntansi SMK Negeri 1 Bandung Tahun Ajaran 2013/2014)
Authors: Islamiah Zakiyah Tsauroh
Published: April 2017

This research is conducted to reveal the influence of Discovery Learning method toward students’ concept understanding improvement on Introduction of Economy and Business subject in SMKN 1 Bandung. The method used in this research is quasi experimental with nonequivalent pretest-posttest control group design. The data analysis teknik with parametric statistical,  test of difference (paired samples t-test and independent samples t-test), gain score and effect size calculationused in this research is SPSS v21. The result shown that the use of Discovery Learning method is more effective toimprove the understanding of the concept than the ExpositoryLearning method does.
«Misión del ágrafo», de Antonio Valdecantos
Authors: Helgueta Manso Javier
Published: April 2017

Reseña del libro «Misión del ágrafo», de Antonio Valdecantos.
Radiosensitivitas dan Keragaman Ubi Kayu (Manihot esculenta Crantz) Hasil Iradiasi Sinar Gamma
Authors: Maharani Sadewi , Khumaida Nurul , Syukur Muhamad , Ardie Sintho Wahyuning
Published: April 2017

ABSTRACT

High genetic variability is one of important determinants in successful breeding of clonally propagated crops such as cassava. Induced mutation, including mutagenesis using gamma irradiation, is one strategy to increase genetic variability. The objective of this research was to obtain information of lethal doses (LD20-LD50) from five cassava genotypes (Jame-jame, Ratim, UJ-5, Malang-4, and Adira-4), to analyze the variability, and to obtain potentially high yielding cassava mutant candidates. Cuttings of several cassava genotypes were irradiated by 0, 15, 30, 45, and 60 Gy gamma rays. The results showed that genotype Malang-4 had the lowest LD20 (7.53 Gy) and LD50 (18.47 Gy), while genotype Jame-jame had the highest LD20 (24.94 Gy) and LD50 (33.24 Gy). The highest phenotype variability was obtained in the cassava population irradiated by 15-30 Gy gamma rays. The highest phenotype variability was also determined by the source of tissue, i.e., cuttings from the middle stem resulted in the highest phenotype variability. This research found 32 high yielding potential candidate mutants.

Keywords: gamma rays, LD20, LD50,mutant, mutation
Karakterisasi Anggrek Alam secara Morfologi dalam Rangka Pelestarian Plasma Nutfah
Authors: Hartati Sri , Darsana Linayanti
Published: April 2017

ABSTRACT

Morphological characters of natural orchids (species) is an important key for successful breeding program of orchids. This study was aimed to determine the morphological diversity and to study the genetic relationship among natural orchids from Java. The characterization was conducted on 12 orchids collected from Central, East and West Java from April to September 2012. Twenty five characters including stem, leaves, flower, pseudobulb, and root type were evaluated and scored based on Guidance of Orchid Characterization. Cluster analysis was done using the NTSYSpc version 2.02i under UPGMA function of SimQual. The study showed that there was a diversity on morphology of stem, pseudo bulb, leaf, flower and root type. Dendrogram based on genetic similarity at 52% clustered the population into two groups. The first group consisted of Paphiopedilum purpurascens, P. javanicum, P. glaucophylum, Coelogyne flexuosa, C. spesiosa, Dendrobium mutabile. Bulbophyllum blumei and B. biflorum. The second group was Coelogyne tomentosa, C. trinervis, D. crumenatum, and B. flavescens Lindl

Keywords: cluster analysis, dendrogram, diversity, morphology
Tanggap Tiga Varietas Padi Sawah terhadap Kombinasi Pemupukan dengan Sistem Pembenaman Jerami
Authors: Herdiyanti Tri , , Sugiyanta , Aswidinnoor Hajrial
Published: April 2017

ABSTRACT

Degradation of soil fertility due to inaccurate  application of fertilizer become one of the factors causing the stagnant rice productivity improvement in Indonesia. Straw incorporation, organic fertilizers and biofertilizers applications potentially reduces a rates of inorganic fertilizers and improves soil fertility. The aim of this study was to evaluate growth and yield of 3 lowland rice varieties (high yielding variety, new plant type, and local variety) in response to reduce NPK rates with straw incorporation, organic fertilizer, and biofertilizer in 7th planting season. The research was conducted at rice field in Karawang, West Java, from April-August 2013. The research was arranged in split plot randomized block design with 3 replications. The main plot was fertilizer application consisted of 10 treatments (combination of organic and inorganic fertilizers), while the sub plot was rice varieties (Ciherang, IPB 3S, and Mentik Wangi). The application of inorganic fertilizer, 400 kg NPK 30-6-8 ha-1, was control treatment. Plot size was 6.5 m x 10 m, with a double row spacing (25 cm x 15 cm x 50 cm). The result showed that growth of the three varieties was not significantly different so as the yield at 50% reduced NPK rate with incorporation of straw, organic fertilizer and biofertilizer. Adding of solid and liquid organic fertilizer, and biofertilizers on treatment of straw incorporation + 50% NPK rate was unnecessary due to insignificant yield increase.

Keywords: Ciherang, fertilizer, IPB 3S, local variety, Mentik Wangi, new plant type
Genetic landscape of sporadic vestibular schwannoma
Authors: Håvik Aril Løge , Bruland Ove , Myrseth Erling , Miletic Hrvoje , Aarhus Mads , Knappskog Per-Morten , Lund-Johansen Morten
Published: April 2017

OBJECTIVE

Vestibular schwannoma (VS) is a benign tumor with associated morbidities and reduced quality of life. Except for mutations in NF2, the genetic landscape of VS remains to be elucidated. Little is known about the effect of Gamma Knife radiosurgery (GKRS) on the VS genome. The aim of this study was to characterize mutations occurring in this tumor to identify new genes and signaling pathways important for the development of VS. In addition, the authors sought to evaluate whether GKRS resulted in an increase in the number of mutations.

METHODS

Forty-six sporadic VSs, including 8 GKRS-treated tumors and corresponding blood samples, were subjected to whole-exome sequencing and tumor-specific DNA variants were called. Pathway analysis was performed using the Ingenuity Pathway Analysis software. In addition, multiplex ligation-dependent probe amplification was performed to characterize copy number variations in the NF2 gene, and microsatellite instability testing was done to investigate for DNA replication error.

RESULTS

With the exception of a single sample with an aggressive phenotype that harbored a large number of mutations, most samples showed a relatively low number of mutations. A median of 14 tumor-specific mutations in each sample were identified. The GKRS-treated tumors harbored no more mutations than the rest of the group. A clustering of mutations in the cancer-related axonal guidance pathway was identified (25 patients), as well as mutations in the CDC27 (5 patients) and USP8 (3 patients) genes. Thirty-five tumors harbored mutations in NF2 and 16 tumors had 2 mutational hits. The samples without detectable NF2 mutations harbored mutations in genes that could be linked to NF2 or to NF2-related functions. None of the tumors showed microsatellite instability.

CONCLUSIONS

The genetic landscape of VS seems to be quite heterogeneous; however, most samples had mutations in NF2 or in genes that could be linked to NF2. The results of this study do not link GKRS to an increased number of mutations.
Chronic multisite brain recordings from a totally implantable bidirectional neural interface: experience in 5 patients with Parkinson's disease
Authors: Swann Nicole C. , de Hemptinne Coralie , Miocinovic Svjetlana , Qasim Salman , Ostrem Jill L. , Galifianakis Nicholas B. , Luciano Marta San , Wang Sarah S. , Ziman Nathan , Taylor Robin , Starr Philip A.
Published: April 2017

OBJECTIVE

Dysfunction of distributed neural networks underlies many brain disorders. The development of neuromodulation therapies depends on a better understanding of these networks. Invasive human brain recordings have a favorable temporal and spatial resolution for the analysis of network phenomena but have generally been limited to acute intraoperative recording or short-term recording through temporarily externalized leads. Here, the authors describe their initial experience with an investigational, first-generation, totally implantable, bidirectional neural interface that allows both continuous therapeutic stimulation and recording of field potentials at multiple sites in a neural network.

METHODS

Under a physician-sponsored US Food and Drug Administration investigational device exemption, 5 patients with Parkinson's disease were implanted with the Activa PC+S system (Medtronic Inc.). The device was attached to a quadripolar lead placed in the subdural space over motor cortex, for electrocorticography potential recordings, and to a quadripolar lead in the subthalamic nucleus (STN), for both therapeutic stimulation and recording of local field potentials. Recordings from the brain of each patient were performed at multiple time points over a 1-year period.

RESULTS

There were no serious surgical complications or interruptions in deep brain stimulation therapy. Signals in both the cortex and the STN were relatively stable over time, despite a gradual increase in electrode impedance. Canonical movement-related changes in specific frequency bands in the motor cortex were identified in most but not all recordings.

CONCLUSIONS

The acquisition of chronic multisite field potentials in humans is feasible. The device performance characteristics described here may inform the design of the next generation of totally implantable neural interfaces. This research tool provides a platform for translating discoveries in brain network dynamics to improved neurostimulation paradigms.

Clinical trial registration no.: NCT01934296 (clinicaltrials.gov)
Endovascular management of acute epidural hematomas: clinical experience with 80 cases
Authors: Peres Carlos Michel A. , Caldas Jose Guilherme M. P. , Puglia Paulo , de Andrade Almir F. , da Silva Igor A. F. , Teixeira Manoel J. , Figueiredo Eberval G.
Published: April 2017

OBJECTIVE

Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions.

METHODS

The study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group.

RESULTS

The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation.

CONCLUSIONS

This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.