bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction: Re-Igniting Critical Race In Canadian Legal Spaces: Introduction To The Special Symposium Issue Of Contemporary Accounts Of Racialization In Canada
Authors: Senthe Shanthi , Xavier Sujith
Published: April 2017

Osgoode Hall Law School, York University’s Challenging Conventions! Speaker Series organized Re-Igniting Critical Race: A Symposium on Contemporary Accounts of Racialization in Canada on November 2, 2012.  The symposium sought to explore critical race theory and its praxis within the Canadian legal academy by inviting emerging scholars and practitioners to engage with the scholarship of Professor Patricia Williams.
LOST AND FOUND
Authors: Lawrence Sonia
Published: April 2017

Reflection Piece
ACCESS TO JUSTICE FOR ALL: TOWARDS AN “EXPANSIVE VISION” OF JUSTICE AND TECHNOLOGY
Authors: Bailey Jane , Burkell Jacquelyn , Reynolds Graham
Published: April 2017

In this paper, the authors examine developments in the Canadian access to justice dialogue from Macdonald’s seminal 2005 analysis to the recent reports of the National Action Committee on Access to Justice in Civil and Family Matters [NAC].   They draw on the NAC’s call for an “expansive vision” of access to justice as the basis for critically evaluating examples of particular technologies used or proposed as responses to the access to justice crisis in Canada. In so doing, they illustrate the importance of conscious consideration of deliverables and beneficiaries in prioritizing technologies for deployment, in determining how the technology ought to be deployed, and in evaluating the potential of a technology to facilitate access to justice. The authors argue that nuanced accounts of the relationships between justice deliverables, technological mechanisms for delivery and intended justice beneficiaries are essential to developing good decision-making mechanisms with respect to access to justice and technology.
WEIGHING THE OPTIONS: A LEGAL APPROACH TO CHILDHOOD OBESITY
Authors: Solomon Jonathan
Published: April 2017

Growing childhood obesity rates are increasingly putting the lives of Canadian children at risk. Using schools as the foundation for tackling childhood obesity is significantly more achievable than attempting to place blanket measures that intrude into Canadian homes. Measures should be taken to address childhood obesity by promoting healthy eating, education and exercise. Yet it is important to recognise obesity both as a medical and as a pyschosocial problem in order to construct these preventative policies: by doing so we can begin to understand the potential challenges such as stigma along with negative exogenous influences in the home and as consumers.
THE EVOLUTION OF SMALL CLAIMS COURT: RISING MONETARY LIMITS AND USE OF LEGAL REPRESENTATION
Authors: McGill Shelley
Published: April 2017

Do higher small claims court monetary limits expand access to “simplified” justice or do they erode the character of the “People’s Court”? This paper reports the initial findings of a study of claims filed in the Toronto Small Claims Court in the two years before and after Ontario raised the Court’s monetary limit from $10,000 to $25,000.  Claim values and distribution across the value range are significantly changed following the monetary limit increase while claim volume remains at pre-increase levels. Predictably, proportionate use of legal representation by plaintiffs and defendants also increases after the limit increase.
ADVOCACY FATIGUE: SELF-CARE, PROTEST, AND EDUCATIONAL EQUITY
Authors: Basas Carrie Griffin
Published: April 2017

Much of the literature in education has focused on the experiences of teachers and school leaders as they encounter students with individualized or “special” learning needs and their families.  This body of literature places the professional at the center of its concern by studying such phenomena as burnout and compassion fatigue.  In this article, the Author argues that this vigilance for the experience of schools has overlooked the material, psychological, and social impact on families that must advocate for their students in the U.S. educational system.   Examining educational conflicts that occur in special education and English Language Learner [ELL] settings, the Author defines this “advocacy fatigue” as the increased strain on resources that comes from continued exposure to system inequities and inequalities.   In the final section of the Article, she identifies strategies for collaboratively addressing educational equity that range from resistance to self-care, community wholeness to professional development.
OUTSIDER EDUCATION: INDIGENOUS LAW AND LAND-BASED LEARNING
Authors: Borrows John
Published: April 2017

This article examines pedagogical developments in Canadian law schools related to outdoor education. In the process, it shows how recommendations from the Indian Residential Schools Truth and Reconciliation Commission can be applied, which called for law schools to create Indigenous-focused courses related to skills-based training in intercultural competency, conflict resolution, human rights and anti-racism. Land-based education on reserves can give law students meaningful context for exploring these Calls to Action. At the same time this article illustrates that taking students outside law school walls is not solely an Indigenous development. Thus, it first provides a few examples about how outdoors legal education is occurring in non-Indigenous settings. Next, the article examines unique Indigenous legal methodologies for learning law on and from the land. Finally, the author discusses his own experience in teaching Anishinaabe law on his reserve to demonstrate how students can develop deeper understandings of their professional responsibilities.
« PLACER LE CITOYEN AU CŒUR DU SYSTÈME » : ORIGINE ET FONDEMENTS D’UNE IDÉE POPULAIRE
Authors: Iavarone-Turcotte Cléa
Published: April 2017

This article looks into an idea which, today, seems to be on everyone’s lips. An idea put forward by observers of the legal world (academics, journalists) as well as by actors and decision makers taking part in it, and that is, thus, echoed not only in civil society, but also within the legal community’s inner circle. This idea is the following: to put the citizen at the very heart of the civil justice system.

     To assist in understanding this idea, which she calls “recentring”, the author provides the context in which it emerged. She does so in a two-step process: she first examines the background against which this recentring was first proposed; she then identifies its underlying justification, or the philosophy on which it is based.
BUSINESS DOMINANCE IN THE “PEOPLE’S COURT”: AN EMPIRICAL ASSESSMENT OF BUSINESS ACTIVITY IN THE TORONTO SMALL CLAIMS COURT
Authors: McGill Shelley
Published: April 2017

This article examines business dominance in small claims courts from four perspectives: party entity, party relationship, claim subject matter, and business plaintiff success. Using data collected from the Toronto Small Claims Court, it compares business activity before and after the monetary limit rose from CDN $10,000 to CDN $25,000. Although most claims are brought by business plaintiffs against individual defendants, business dominance did not worsen following the limit increase. In some ways, it actually receded. Individual defence rates rose, and business plaintiff success fell. In sum, capping monetary limits is not recommended to reduce business activity in small claims courts. Dans cet article, l’auteure étudie la dominance des entreprises devant les cours de petites créances sous quatre angles : celui de la personne morale, celui des rapports des parties entre elles, celui de l’objet revendiqué et celui du succès de l’entreprise demanderesse. En se servant de données provenant de la cour des petites créances de Toronto, l’auteure compare les proportions d’instances introduites par les entreprises avant et après le passage de 10 000 $ à 25 000 $ CDN de la limite pécuniaire des réclamations. Bien que la plupart des instances soient introduites par des entreprises demanderesses contre des particuliers défendeurs, la dominance des entreprises ne s’est pas accentuée après le relèvement de la limite pécuniaire des réclamations. À certains égards, cette dominance a en fait reculé. Les moyens de défense des particuliers se sont accrus et le taux de succès des entreprises demanderesses a baissé. En conséquence, il n’est pas recommandé de plafonner la limite pécuniaire des réclamations pour réduire la place que prennent les entreprises devant les cours de petites créances.
Terapia antirretroviral en la vida real: evidenciando los retos para alcanzar el último 90
Authors: Martínez Buitrago Ernesto
Published: April 2017

Terapia antirretroviral en la vida real: evidenciando los retos para alcanzar el último 90
Detección e identificación de Salmonella spp. en huevos para consumo humano, provenientes de diferentes localidades de Bogotá, Colombia, 2015
Authors: Castañeda-Salazar Rubiela , Pulido-Villamarín Adriana Del Pilar , Mendoza-Gómez María Fernanda , Carrascal-Camacho Ana Karina , Sandoval-Rojas Karen Lizeth
Published: April 2017

Objetivo: Determinar la prevalencia de Salmonella spp. en muestras de huevos para consumo humano en localidades de Bogotá.Materiales y métodos: Se obtuvieron 96 muestras en tiendas y plazas de mercado de 4 localidades de la ciudad. Se procesó de forma separada la cáscara y el contenido interno mediante métodos microbiológicos y moleculares para aislamiento e identificación Salmonella spp.Resultados: Se determinó una prevalencia total de Salmonella spp. de 9,4% (n=9),  de ésta el 55% (n = 5) provenían del contenido interno y 44% (n = 4) de cáscara, sin embargo no se logró tipificar el serovar de Salmonella entérica presente. Las localidades con mayor presencia del patógeno fueron Usaquén y Fontibón.Discusión: Estudios realizados en Colombia evidencian bajas prevalencias de Salmonella spp. (0–1,74%) en muestras de huevos, sin embargo los hallazgos de este estudio evidencian una mayor recuperación, lo que podría asociarse con inadecuadas condiciones de manejo y/o almacenamiento del producto.Conclusión: Se estableció la presencia de Salmonella spp. En las muestras de huevo evaluadas, lo que implica un riesgo potencial para la salud pública, por lo que es necesario ampliar este tipo de estudios para conocer la situación real a nivel nacional frente a este patógeno.
Morbilidad, mortalidad y falla al tratamiento antirretroviral en adolescentes con VIH / Sida en un hospital de referencia en Caracas, Venezuela
Authors: Monsalve-Arteaga Lia , Drummond Tatiana , Faneite Irene , Carballo Martín , Landaeta María Eugenia
Published: April 2017

Objetivo: describir las causas de morbilidad, mortalidad y de falla antirretroviral y relacionarlo con el mecanismo de adquisición del virus en adolescentes con VIH / SIDA atendidos en el Hospital Universitario de Caracas, período 2009 - 2013.Métodos: Estudio descriptivo de tipo retrospectivo a través del seguimiento de una cohorte. Se recolectaron los datos de las historias clínicas de pacientes con infección por VIH/SIDA con edades comprendidas entre 10 y 19 años del Hospital Universitario de Caracas durante el período 2009 - 2013.Resultados: se analizaron 79 historias y registros, según el mecanismo de transmisión, 29 (36,71 %) fueron de transmisión vertical (TV) y 50 (63,29 %) de transmisión horizontal (TH). La principal enfermedad oportunista encontrada fue tuberculosis, y no se encontró diferencias significativas para padecerla según el mecanismo de transmisión (p: 0,54). Al considerar los factores demográficos y diagnóstico inicial se observó que a una mayor edad de diagnóstico hay menor probabilidad de falla antirretroviral (OR: 0,75). Así mismo, independientemente del mecanismo de transmisión, sexo y tratamiento inicial el 50% de los pacientes presentará falla virológica luego de 90 meses de tratamiento.Discusión: el aumento en el número de casos de VIH en la población adolescente en Venezuela es un tema de relevancia en Salud Pública. Se necesita realizar un estudio en donde se apliquen estrategias dirigidas a mejorar las causas asociadas a la poca adherencia a los medicamentos antirretrovirales en esta población y determinar si dicha estrategia permite disminuir el número de fallas.
Seguimiento del primer año de tratamiento antirretroviral en pacientes naive en un hospital de tercer nivel
Authors: Gomez-Lobon Ana , Delgado Sanchez Olga , Peñaranda Vera Maria , Ventayol Bosch Pedro , Martin Pena María Luisa , Riera Jaume Melchor
Published: April 2017

Objetivo: El objetivo principal de este trabajo es determinar la tasa de fracaso virológico (FV) en pacientes naive que inician tratamiento antirretroviral (TAR) a 24 y 48 semanas en vida real en un hospital de tercer nivel.Material y método: Estudio retrospectivo de 3 años de duración. Se seleccionaron pacientes adultos VIH naive que iniciaron TAR entre 2012 y 2014.Se registraron datos demográficos (edad, sexo y nacionalidad), clínicos (mecanismo de trasmisión y estadio clínico), de laboratorio (carga viral (CV), linfocitos CD4 basales y existencia de test de mutaciones previo) y TAR elegido. Tras 24 y 48 semanas se registraron: CV y CD4, adherencia, seguimiento, problemas relacionados con la medicación, cambios de TAR y motivos de cambio.Resultados: Se seleccionaron 253 pacientes. 244 y 226 contaban con datos analíticos a las 24 y 48 semanas respectivamente. 142 (58,23%) tenían CV<50 copias/ ml y 204 (83,6%) CV<200 copias/ml tras 24 semanas. 198 (88,4%) tenían CV<50 copias/ml y 217 (96,0%) CV<200 copias/ml tras 48. La CV basal superior a 100.000 copias/ml y la mala adherencia se asociaron con un mayor riesgo de FV. Al 30,0% de pacientes se les cambió el TAR durante el primer año, principalmente por efectos secundarios (31,6%) y simplificación del tratamiento (23,7%).Discusión y Conclusiones: Un alto porcentaje de pacientes que inician TAR están indetectables o con menos de 200 copias/ml dentro del primer año de tratamiento. A pesar de tener fármacos altamente eficaces y cada vez mejor tolerados, los efectos secundarios siguen siendo el motivo mayoritario de cambio de TAR.
Monte Carlo method for the analysis of laser safety for a high-powered lidar system under different atmospheric conditions
Authors: Stillwell Robert A. , Pilewskie Peter , Thayer Jeffrey P. , O'Neill Michael , Neely Ryan R.
Published: April 2017

A major concern of high-powered atmospheric lidar systems is eye safety. Atmospheric lidars are often run unattended in adverse weather conditions where scattering redirects laser energy from the main beam. These naturally varying “soft targets” (such as fog and precipitation) are not accounted for in American National Standards Institute (ANSI) standards but, through multiple scattering events, can potentially create adverse viewing conditions. This paper introduces a Monte Carlo method that uses scattering phase functions for fog and snow and applies multiple scattering analysis to map the energy density within a scattering volume around the primary beam. Careful attention is given to accurately describing the forward scattering portion of the phase function as it scatters a significant amount of the beam energy. This method is compared to ANSI standard hazard zone calculations to determine what effect scattering has on the size of the hazard zone. For direct beam viewing, hazard zone size estimates are within about 3% of the ANSI defined Nominal Ocular Hazard Distance (NOHD) for clear air but are approximately 56% smaller than the NOHD as optical density increases for scattering in fog and approximately 33% smaller for scattering in blowing snow. For indirect beam exposure, clear air gives the worst approximation to the ANSI defined Nominal Hazard Zone (NHZ), in error by approximately 93%; fog approaches the ANSI results, within 30% error, whereas blowing snow shows 70% error. Finally, scattering enhancement mechanisms are considered which relate to the definition of the scattering layer of interest and increase scattered energy density observed by approximately 4%. In all cases, the ANSI calculated NOHD and NHZ are larger than the hazard zones that include scattering but the size of the zones is inextricably linked to the type of scattering ignored in the standard NOHD and NHZ calculations.
Moritz Revisited: Modern Mistakes about how we Think about Forensic Pathology
Authors: Oliver William R.
Published: April 2017

In 1956, Alan Moritz published a landmark article entitled Classical Mistakes in Forensic Pathology. This article has been required reading for two generations of forensic pathologists, and the mistakes he described are just as important today as they were 60 years ago. However, new technologies and challenges have changed how forensic pathology is practiced, and there are even more changes to come. A revisitation of Moritz is presented, with an emphasis on how we think about what we do.
Five-day Turnaround Time for Hospital Medical Autopsies: A Five-Year Experience
Authors: Tormos Lee M. , Schandl Cynthia A. , Batalis Nicholas I. , Presnell S. Erin
Published: April 2017

In order to improve the autopsy usefulness for quality assurance, teaching, and enhanced clinical relevance, a five-day turnaround time for medical autopsies within the Department of Pathology and Laboratory Medicine at the Medical University of South Carolina was implemented. Previously, turnaround times averaged approximately 30 days, with almost 20% extending to approximately 60 days. Procedures and processes were reviewed and changes were made in December 2009 in order to achieve an average turnaround time of five days on all medical autopsies, as was previously described in a 1996 article by Adickes and Sims; this is in lieu of the national standard as set by the College of American Pathologists, which recommends final reports be issued in 30 days for the majority of cases and a 60 days for all cases. Subsequently, turnaround times for the 2010–2014 calendar years averaged 4.72 days. Given our existing institutional framework, only minor changes were required to reduce turnaround times. Histology lab support is essential, as is commitment by the resident and attending physicians to review the cases in a timely fashion and order any case-appropriate special stains or immunostains upon review. In the instance where more time-consuming studies are required, the final report may be delayed or the additional studies may be reported in an addendum. The autopsy service has received mostly positive feedback from the clinical faculty, and the accelerated turnaround time improves teaching of residents and medical students on the autopsy rotation. The reduced turnaround time has not affected hospital billing.
The Medicolegal Issues Surrounding the Case of Steven Truscott -a Forensic Pathology Perspective
Authors: Williams Kona , Milroy Christopher M.
Published: April 2017

One of the most difficult and controversial issues for any forensic pathologist is the determination of time of death. One of the best known cases in Canadian history that exemplifies this was that of Steven Truscott, who was convicted of murdering his classmate in 1959. Estimation of the time of death was critical, and largely done by examination of stomach contents at autopsy. Expert opinions on time of death using stomach contents and gastric emptying were largely anecdotal; there was insufficient scientific literature to support such precise estimations. The use of such evidence was key in Truscott's conviction and represents one of the great miscarriages of justice in our system. The conviction was overturned in 2007. Over 50 years later, despite a large body of scientific research in both the clinical and forensic fields, estimating the time of death from gastric emptying times remains largely inaccurate.
Amnestic Somnambulism and Nocturnal Eating Disorder Associated with Zolpidem Use as a Contributing Factor in Accidental Death
Authors: Stump Michael , Presnell S. Erin
Published: April 2017

Zolpidem is a selective gamma-aminobutyric acid (GABA) receptor modulator used commonly in the treatment of insomnia. It is effective at initiating sleep and has primary effects similar to benzodiazepines. Zolpidem has gained some notoriety for its association with rare but unusual side effects of compulsive nocturnal activity with anterograde amnesia.

Review of the literature documents zolpidem-associated nocturnal activities, which include walking, eating, and more complex activities such as house cleaning or driving. During these events, the sleeper may be able to converse and initially appear normal to an observer, but has limited, if any, recollection of the event. Other literature reviewing zolpidem-related deaths, hospital admissions, falls, and somnambulism found a high rate of concurrent alcohol and/or other drug use than when using Zolpidem alone.

We present a case of a 67-year-old woman with a history of somnambulism and amnestic eating during the night after using Zolpidem who was found deceased on the pavement below her opened second story bedroom window. Autopsy revealed nonocclusive food substances in her airways, and head and neck trauma, consistent with a fall from the second story window. Toxicological analysis of peripheral blood revealed Zolpidem (69 ng/mL), pseudoephedrine (150 ng/mL), citalopram/escitalopram (400 ng/mL), and caffeine. Blood and vitreous ethanol concentrations were 194 mg/dL and 160 mg/dL, respectively. Given the decedent's nocturnal activity history associated with Zolpidem, Zolpidem use combined with ethanol was considered contributory to her death.
The Coronial System and Determining Manner of Death in Australia -An Overview
Authors: Phillips Bianca , Little Dianne , McDougall James , Langlois Neil El
Published: April 2017

Death investigation in Australia was initially founded on the British coronial system. Today it continues to operate under a coroner-based service with each of the individual self-governing states and territories responsible for enacting and administering their own coronial legislation. This has led to some variation within Australia; however, there is broad similarity. Deaths reported to the coroner generally include those where the cause is unknown, there are violent/unnatural circumstances, the death is as a result of an anesthetic or medical procedure, the death occurred whilst held in care/custody, or the identity of the deceased is unknown. Coroners are legally qualified individuals who are appointed to administer the Coroners' Act, but have no medical training. They are required to investigate deaths to determine who a deceased person is, as well as, how, when, where and what caused them to die. This is an inquisitorial process with the purpose of determining the circumstances of death to serve the public interest. Their findings are presented in a written report that outlines the circumstances surrounding death in an attempt to indicate whether a death was natural or unnatural (due to external factors), and in the case of unnatural deaths, to outline the intent and external factors that led to death. Hence, the “manner of death” is presented as a narrative within the coroners' findings. The coroners use information obtained during their investigations to make recommendations about public health policy, justice, and the prevention of similar deaths in the future.
Medicolegal Death Investigation in India: An Overview
Authors: Sharma Surendra Kumar , Bajpai Shweta
Published: April 2017

Every suspicious death in India is investigated, with one of the objectives being determining the manner of death. The autopsy is an integral part of the death investigation. Death investigations are accomplished in the form of inquests, which are conducted and directed by the police or, in some cases, by a magistrate. The police and the autopsy physician generally share their findings before opinions are reached, and the courts rely on autopsy physician testimony. In general, the autopsy physician opines only on the cause of death. In the Indian legal and medicolegal systems, manner of death is determined by the police. Unlike in the United States, where the certifier of death must record a manner of death on the death certificate, in India the manner of death is largely a legal (rather than medical) determination.
Death Investigation and Certification in Italy
Authors: Di Vella Giancarlo , Campobasso Carlo Pietro
Published: April 2017

The certification of cause and manner of death is fundamental for legal and epidemiological purposes. In Italy, as in several other European countries, the death certificate is legal proof of an individual's death. The incorrect assessment of cause and manner of death can have serious implications for public health and the judicial system. Unnatural deaths can be erroneously reported as natural deaths, leaving accidents or homicides undetected. Many reasons can explain such inaccuracy, such as the level of training of medical practitioners involved in death investigations or a lack of information regarding the decedent's medical history. In January of 2011, the Italian death certificate changed to conform to European rules dealing with statistical recording. This paper discusses the concept of manner of death in the Italian death investigation system, along with a brief history of Italian legislation, and discussion of the professionals involved in the certification of death, responsibilities for the determination of cause and manner, and how the manner of death is used.
Suicide by Hypothermia: A Report of Two Cases and 23-Year Retrospective Review
Authors: Wilcoxon Rebecca , Jackson Lorren , Baker Andrew M.
Published: April 2017

Hypothermia deaths are frequently accidental and associated with impairment by alcohol, injuries, mental illness, or natural disease. Hypothermia as a method of suicide is unusual, with only nine case reports in the scientific literature. In the early months of 2014, during one of the coldest winters on record, the Hennepin County Medical Examiner's office investigated and certified two unrelated cases of suicide by hypothermia; we describe the salient features of these cases. A retrospective review of all cases investigated by our office from January 1991-April 2014 identified 146 cases in which “hypothermia” or “environmental cold exposure” was listed as a cause of death, contributing condition, or mechanism of injury. Death investigation narratives and autopsy reports were reviewed to confirm hypothermia and evaluate for the presence or absence of characteristic hypothermia findings. In these cases the manner of death was certified as follows: 116 accident (79.4%), 15 undetermined (10.3%), 8 suicide (5.5%), 6 natural (4.1%), and 1 homicide (0.7%). Further examination of the eight suicide cases revealed that half were female and half were male, and most were younger individuals with only one decedent above 50 years of age. Four of these deaths were associated with drug toxicities, five were associated with additional self-inflicted injuries (blunt force, sharp force, and/or gunshot wounds), and none of them exhibited paradoxical undressing. It is important for medicolegal death investigation professionals to recognize that, while rare, hypothermia deaths may represent intentional injury, and suicide as a manner of death should be considered in all cases.
What Good are Partial Autopsies?
Authors: Gilliland M.G.F.
Published: April 2017

Partial autopsies are performed for a variety of reasons. They are regarded as safer in higher risk cases involving blood-borne pathogens. They can be completed more quickly - the examination of the body takes less time. With less information gathered at the initial examination, the turnaround time can be shorter or much shorter. Fewer resources are needed to perform partial autopsies so they are less costly to perform. Partial autopsies may be reimbursed at a lower rate and be lower cost to the funding agency. On the other hand, partial autopsies, by definition, do not provide complete descriptions of the extent of disease and nature of any injuries. A time-honored aphorism is relevant: “Partial autopsies provide partial answers.” Will the partial answer be sufficient? Reviewing the literature regarding the accuracy of the most partial autopsy — the external examination with toxicology specimens obtained — can help determine if partial autopsies can provide adequate answers to meet local requirements.
Benefits of Utilizing Full-Body Lodox Digital Radiography in Forensic Pathology
Authors: Jorgenson Kyla M. , Lanter Joshua , Wiens Do Andrea L.
Published: April 2017

Introduction

The purpose of this study was to measure the time spent by a single autopsy assistant in obtaining full-body radiographic imaging in a forensic pathology setting. The Lodox digital radiography (DR) system was compared with a traditional cassette-based portable computed radiography (CR) system to quantify time saved by the implementation of the Lodox imaging system.

Methods

Decedents were examined with the Lodox DR and portable CR systems to provide full-body coverage with each system. Timing was divided into preparation, acquisition, and postacquisition stages, with an additional transfer stage being required for the Lodox DR system. A neutral observer timed each stage for each decedent examined with both systems.

Results

The Lodox DR system provided an 87% time savings ( p < 0.001) over the portable CR system to complete full-body radiographic scanning. While the portable CR system was faster at image acquisition ( p < 0.001), the Lodox DR system was faster during the preparation ( p < 0.001) and postacquisition ( p < 0.001) stages.

Conclusions

The time required for a full-body radiographic examination is markedly shortened with utilization of the Lodox DR system. Seven full-body examinations can be completed with the Lodox DR system in the time that a single full-body examination is completed with the portable CR system. In a forensic pathology setting, the Lodox DR system is therefore more time-efficient than the portable CR system studied, as it provides the same scope in a shorter time period, allowing for streamlining of radiographic imaging studies.
Tracking the Opioid Drug Overdose Epidemic in King County, Washington Using an Improved Methodology for Certifying Heroin Related Deaths
Authors: Harruff Richard C. , Couper Fiona J. , Banta-Green Caleb J.
Published: April 2017

Guidelines of the National Association of Medical Examiners recommend that death certificates of overdose deaths list specific drugs. While this is important in tracking the national opioid drug overdose epidemic, differentiating heroin from morphine as the source drug remains problematic. To distinguish the two, a specific methodology was developed for death certification based on a combination of toxicology testing and scene investigation. This study evaluates the methodology in assessing the contribution of heroin. In two decades in King County, there were 3369 opioid drug overdose deaths, ranging from 139 in 1995 to 233 in 2014. In the 1990's, opioid overdose deaths were predominantly due to heroin; deaths due to prescription opioids were relatively uncommon. This trend reversed around 2003 with overdose deaths due to heroin declining and those due to prescription opioids increasing. The trend again reversed around 2012 with resurgence of heroin and declining deaths due to prescription opioids. Before the specific methodology was employed, it was known that heroin was the predominant opioid, but the summary data did not differentiate morphine and heroin. After adopting the methodology in 2004, the data reasonably tracked the contribution of heroin: out of 2125 opioid deaths, 34% were due to heroin, ranging from 14% in 2009 to 65% in 2014. The results of this study show an overall increase in opioid deaths and an inverse relationship between heroin and the prescription opioids. Furthermore, the specific methodology for certifying heroin deaths greatly improves accuracy in tracking opioid overdose deaths.
The Future of Forensic Pathology: Is Regionalization a Key?
Authors: Hanzlick Randy L.
Published: April 2017

The development of regional death investigation centers has been discussed as a way to provide death investigation services in areas of the country where such services are lacking or to improve existing services where needed. This article discusses possible regionalization in terms of Regional Death Investigation Centers (RDIC) and Regional Autopsy Centers (RAC) as options. Included is discussion of perceived need for, and potential value of, regional centers along with a review of existing regional centers of various types and some examples of novel approaches. The establishment of regional centers might not only provide services where needed, but could also help secure the profession of forensic pathology by creating more jobs in desirable facilities with reasonable caseload, reasonable salary, qualified coworkers, and a professional collegial environment.
The Future of the Forensic Pathology Workforce
Authors: Collins Kim A.
Published: April 2017

According to many published reports, testimonials, research studies, and data collected, there are not enough forensic pathologists to serve the United States. Forensic pathologists are responsible for the medicolegal investigation of death. Such investigation includes death scene, history, autopsy, and determining the cause and manner of death. To get an idea of the workload of the forensic pathologist, retrospective data can be examined. The numbers alone reveal that there has been and remains a shortage in the forensic pathologist workforce. If the overall goal is to remedy this forensic pathologist shortage, strategies must be broad and long-term. Also, not all goals will have concrete metrics that can be quantified, such as to increase and improve public image. Some of the underlying problems, trends, future predictions, and possible solutions are discussed.
The Toolbox Approach to Forensic Pathology
Authors: Krehbiel Kacy , Pinckard J. Keith
Published: April 2017

Medical examiners are physicians tasked with conducting medicolegal death investigations to determine cause and manner of death. Although the autopsy is the most frequent tool utilized in these investigations and the one most often associated with the practice of forensic pathology, there is a wide variety of tools available to the medical examiner, whose statutory duty mandates death certification. We discuss the evidence supporting the usage of these myriad tools, ranging from the older techniques of scene investigation, microbial cultures, and toxicology to the cutting edge of medicine such as advanced imaging, molecular genetic studies, and biochemical analysis/metabolic testing. The forensic pathologist must select the correct tools for a particular investigation based on the evidence supporting their usage and a medical judgment of each tool's pretest probability to produce a useful result, its appropriateness for the case, and the resources required for its utilization. The incorporation of these techniques into the forensic pathologist's toolbox improves our ability to conduct thorough medicolegal death investigations beyond that which can be accomplished by invasive autopsy alone.
Forensic Pathology Workload and Complexity: Designing a Complexity System that Accurately Represents Workload
Authors: Morin Jason
Published: April 2017

For the most part, workload is defined for forensic pathologists in North America by the number of cases per annum, with specific recommendations set out by the National Association of Medical Examiners (NAME) to perform no more than 250 autopsies in a year. However, this definition of workload is somewhat limiting as it doesn't reflect the case to case variability that forensic pathologists encounter. The variability translates into differing amounts of time needed on the part of the pathologist to devote to each case and those differences in time can be substantial. Complexity systems exist in surgical pathology to better reflect the case-to-case variability that surgical pathologists experience. Based on these complexity systems, departments can have a more accurate representation of workload and appropriately allocate resources and plan staffing. Many different complexity systems exist, but all of them, in their own way, attempt to lessen the gap between overvaluing simple specimens and undervaluing complex specimens. No formal system for gauging complexity exists in forensic pathology. The creation of one would provide a more detailed taxonomy to be better able to define forensic pathologists' workload and compare workload between pathologists and institutions.
The Changing Landscape of Maintenance of Certification: History, Value and Evidence Base, and Future Impact on Forensic Pathology
Authors: Knight Laura D. , Batalis Nicholas I. , Boggs Cassie L. , Martin Amy , Pandey Maneesha , Shelly Mark
Published: April 2017

Maintenance of certification (MOC) is a current hot topic in all disciplines of medicine, and no less so in pathology and forensic pathology, specifically. The extent of physician discontent with MOC has risen to a fevered pitch over the past few years, with reporting on specialty board activities and physicians' reactions reaching the popular media. This invited review authored by several of the members of the National Association of Medical Examiners Education Subcommittee on the Development of Self-Assessment Modules provides an overview of MOC as it relates to forensic pathology. We address the history of MOC and its value as stated by the certifying bodies that created, promote, and administer MOC, including the American Board of Medical Specialties and American Board of Pathology. We further provide an analysis of the existing medical literature proposed as an evidence base for MOC, which is somewhat limited in its scope, particularly nonrobust in pathology, and nonexistent in forensic pathology. We discuss recent changes that medical specialties have made to prescribed MOC programs, potential alternatives to MOC, and the impact that MOC in its current and potential future forms may have on the field of forensic pathology, including effects on the workforce, courts of law, and training pathways.
The Current and Potential Future Role of Postmortem Computed Tomography in Medicolegal Death Investigation
Authors: Daly Barry , Andrews Sam , O'Donnell Chris
Published: April 2017

The development of whole body, high resolution postmortem computed tomography (PMCT) with three-dimensional depiction has led some authors to describe the concept of “virtual autopsy” as a noninvasive replacement to conventional autopsy. A realistic appraisal of the capabilities of PMCT suggests its true role is more complex – in some settings such as accidental blunt trauma it has the potential to circumvent conventional autopsy and in others such as severe burns or drowning, PMCT can act as a triage tool to determine if autopsy is required. In many other cases, PMCT has a role of adjunct to conventional autopsy. Despite its myriad potential applications, PMCT remains underutilized in many countries. This paper addresses the background of PMCT, and describes its strengths, weaknesses, and indications. It discusses the economic and logistical challenges to its introduction, and emphasizes the clinical cooperation between diagnostic radiologists and forensic pathologists, and the training initiatives that are necessary for its success.
Concurrent Expert Evidence, an Australian Forensic Pathology Experience
Authors: Day Christopher , Little Dianne
Published: April 2017

Concurrent witness evidence or “hot tubbing” is a novel method of delivering expert witness evidence. It has been used primarily in civil litigation cases where evidence is tendered to the court by experts in a panel-style discussion. Experts from similar disciplines and often from competing interests are asked to give evidence together in an attempt to better understand the issues at hand and give clarity to areas of agreement and disagreement. In our experience, this method is of benefit, allowing key issues to be highlighted in a timely and efficient manner. Our experience of hot tubbing is relatively unique in the setting of forensic pathology and we present a case where evidence was given in this manner and briefly review its application.
The Evolution of the Autopsy
Authors: Hansma Patrick
Published: April 2017

Contrary to claims that the autopsy has not significantly changed over the past 150 years, this article will demonstrate the remarkable evolution of the autopsy at the hands of its practitioners since the 15th century and into the 21st. A solid understanding of the ongoing evolution of autopsy technique helps provide a firm argument for the continued utilization of the autopsy in daily practice and for the advancement of medicine.
Bicyclist Fatalities in New York City
Authors: Jarvis Hannah C. , Gill James R.
Published: April 2017

New York City has over 700 miles of bicycle lanes and over half a million residents use a bicycle several times a month. We searched the electronic death certificate database on all bicycling fatalities between April 2006 and August 2012 to study the autopsy findings, toxicological results, and the epidemiological patterns. Of the 146 bicyclists studied, most were male (n=134). The main ethnic group was white (n=48). Recreational use accounted for 40 fatalities. A survival interval occurred in 72 bicyclists (two hours to 33 years). Manhattan had the highest number of bicyclist fatalities per 100 000 population (2.65). Most fatalities occurred during the summer (n=62), or on a Saturday (n=28). Fifty-five cases reported clear weather. The most frequent motor vehicle involved was a four-door sedan (n=34). Fifteen decedents were documented to be wearing a helmet. Postmortem examination included 116 autopsies and 30 external-only examinations. All causes of death were due to blunt trauma and all manners of death were accident. The most commonly injured body region was the head (n=121). Fractures most commonly involved the skull (n=89). Toxicological analysis detected ethanol (n=22), cannabinoids (n=15), cocaine (n=11), and methadone (n=3). Similar to fatalities in motor-vehicle-only collisions, bicyclists also die from blunt injuries and drug/ethanol intoxication is not unusual. The overwhelming male predominance may be a reflection of a higher number of male bicyclists and/or related to increased risk taking among males. This information may be useful for public health considerations when looking for ways to prevent these deaths.
Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida
Authors: Pearson Julia , Poklis Justin , Poklis Alphonse , Wolf Carl , Mainland Mary , Hair Laura , Devers Kelly , Chrostowski Leszek , Arbefeville Elise , Merves Michele
Published: April 2017

In the last two years, an epidemic of 40 fatal heroin overdose cases has occurred in the Tampa area of Florida. Of these cases, 14 involved fentanyl and acetyl fentanyl. Victim demographics, case histories, toxicology findings, and causes and manners of death for all 40 deaths are presented. In 26 deaths in which acetyl fentanyl or fentanyl were not involved, free and total peripheral blood morphine concentrations were consistent with fatal heroin intoxications, averaging 0.16 mg/L and 0.35 mg/L, respectively. In the heroin cases with fentanyl present (n=7), the average free morphine concentration was 0.040 mg/L, the average total morphine concentration was 0.080 mg/L, and the average fentanyl concentration was 0.012 mg/L. In the cases with heroin, fentanyl, and acetyl fentanyl (n=3), the average free morphine concentration was 0.010 mg/L, the average total morphine concentration was 0.030 mg/L, the average fentanyl concentration was 0.018 mg/L, and the average acetyl fentanyl concentration was 0.008 mg/L. In the cases involving only acetyl fentanyl (without heroin or fentanyl, n=4), the average acetyl fentanyl concentration was 0.47 mg/L and the average acetyl norfentanyl concentration was 0.053 mg/L. The presented cases, with associated drug concentrations, case histories, demographics, and causes and manners of death may help provide assistance with the interpretation of the postmortem findings. Based on case circumstances, autopsy results, and toxicology results, it is evident that fentanyl and/or acetyl fentanyl, when present, contributed to the cause of death.
Decomposition Changes in Bodies Recovered from Water
Authors: Caruso James L.
Published: April 2017

Recovering bodies from water is a common task for any medical examiner or coroner office. Unfortunately, there will be a significant postmortem interval before many of these remains are found. A thorough scene investigation must be undertaken to determine if the location of the death and that of the body recovery are the same. Decomposition in a wet environment differs from that in other settings, both in the changes that occur and the rate at which they occur. It is essential that the forensic pathologist or medicolegal death investigator recognize and appreciate the uniqueness of immersed and submerged remains. The typical decomposition changes proceed more slowly in the water, primarily due to cooler temperatures and the anaerobic environment. However, once a body is removed from the water, putrefaction will likely be accelerated. Postmortem changes are not only affected by water temperature, but also by current as well as obstacles and structures, both natural and man-made, that may interact with the remains. The anaerobic nature of decomposition for wet or submerged remains may result in adipocere formation, a unique and fascinating process that results from incomplete transformation of lipids by bacteria. Insect and animal species feeding on the remains are different for submerged bodies. Postmortem predation may cause external defects that mimic injuries and should be interpreted with care. Forensic pathologists and medicolegal death investigators must be aware of the postmortem changes that may occur with submerged and immersed bodies.
Postmortem Change and its Effect on Evaluation of Fractures
Authors: Kemp Walter L.
Published: April 2017

Postmortem changes can both mask and mimic trauma, impairing interpretation of the injuries. Bones, while capable of surviving the postmortem period relatively intact, are not immune from these effects. Without attached soft tissue to aid an examiner, it can be difficult to determine the time frame of a fracture's occurrence (i.e., before death, at death, or after death). Bones are composed of both organic and inorganic material, each of which contribute to the biomechanical properties of the bones. With the loss of organic material, the biomechanical response of bones to trauma changes; however, the organic material can remain a part of the bone for an extended period after death. Bone with intact organic material is wet bone, and bone without the organic material is dry bone, and because of this difference, fractures of wet bone can appear different than fractures of dry bone. Important in distinguishing the two are differential coloration, various features of the fracture itself (e.g., angle, surface, outline), surrounding flaking of the cortex, and incomplete separation of bone fragments from the fracture. However, the changes are not absolute, and determination of the two types of fractures can be problematic. Although the terms antemortem, perimortem, and postmortem have been used to describe the general time frame of fractures in relation to the time of death of the individual, because of confusion among specialties regarding the definition of “perimortem,” its use may best be discontinued in favor of a descriptive approach when fractures are identified in skeletal remains.