bluuebunny/crossref_metadata_2025 huggingface dataset:
MORE THAN MEETS THE EYE: RELATIONAL AUTONOMY AND DECISION-MAKING BY ADULTS WITH DEVELOPMENTAL DISABILITIES
Authors: Salami Eniola , Lashewicz Bonnie
Published: April 2017

In Canadian law, the concept of autonomy is individualistic in nature, manifest as the capacity, or legal ability of an individual to actively understand the purpose and consequences of their actions according to whether they have faculties to comprehend and weigh risks and benefits.  Feminist scholars critique such conceptualizations of autonomy and, instead, argue the importance of “relational autonomy” which is predicated on the view that actions result from one’s own volition in combination with the influence of one’s social and relational connections. In this paper, we examine the dynamics and implications of relational autonomy in decision-making by adults with developmental disabilities by studying adults with developmental disabilities in interaction with their caregiving family members.  Our purpose is to contribute understandings of how and in what ways family caregiving relational contexts both support and hinder decision-making by adults with developmental disabilities.  We begin with an overview of conceptualizations and applications of autonomy, then illustrate relational autonomy dynamics through comparative analysis of data from two women with developmental disabilities who were interviewed together with their family caregivers about successes and struggles in giving and receiving care and making decisions. These two women, and their family caregivers (N=9) are selected from a larger sample of adults with developmental disabilities and their family caregivers (N = 26) because the contrasts, as well as the similarities, between their family care situations are striking, and taken together, illustrate a range of ways in which decision-making is supported and hindered.  We conclude by upholding the importance of relational autonomy for legal understandings of decision-making, yet we caution that critical examination of relationship dynamics is vital.
GROUNDING ACCESS TO JUSTICE THEORY AND PRACTICE IN THE EXPERIENCES OF WOMEN ABUSED BY THEIR INTIMATE PARTNERS
Authors: Mosher Janet E
Published: April 2017

For women seeking to extricate themselves from the web of entrapment woven together by the multiple threads that make up the coercive control repertoire of their abusive intimate partners, it is often difficult to avoid engagement with legal systems. Yet, the legal systems they encounter—criminal, family, child welfare, immigration among them—are frequently unwelcoming (if not hostile), controlling, demeaning, fragmented and contradictory. While there has been a recent explosion of interest in “access to justice,” little attention has been paid to how we might conceptualize access to justice in a manner that speaks meaningfully to the circumstances of women who experience abuse in their intimate relationships. For such women, access to justice is curtailed not only by lack of representation, delays, costs, and procedural complexities—the obstacles commonly associated with access to justice failings—but by three inter-related phenomena: the enduring hold of an incident-based understanding of domestic violence; the failure of legal actors to curb men’s strategic use of legal systems to further their power; and the host of complications—contradictory expectations, inconsistent orders, repetitious proceedings, sweeping surveillance—that arise when women are compelled to navigate multiple intersecting legal systems. What is required, I argue, is a conceptualization of access to justice that places women’s safety and well-being at its core.
ARCHITECTURE, RITUALS, AND NORMS IN CIVIL PROCEDURE
Authors: Gélinas Fabien , Camion Clément , Bates Karine , Grant Emily
Published: April 2017

In this article, the authors identify two important gaps in the literature on civil justice reform, both of which relate to the concept of stability in the law as an added value of public adjudication. The article aims to suggest avenues for future research on civil justice reform, especially in light of increasing recourse to private modes of dispute resolution. First, the article draws attention to the role played by judicial rituals and architecture in court-based, public adjudication, as a means of generating stability in the law and enhancing the legitimacy of dispute resolution. Second, from a more theoretical perspective, the article brings out the added value of formulating and formalizing legal norms through a public adjudicative process. Stability in the law encourages human agency and dignity by permitting individuals to form expectations and make decisions about their lives, acting in reliance on the law and the values that the law promotes. The value of stability must be taken into account in future research and policy work on civil justice reform, particularly as private justice, which lacks many of the characteristics that encourage stability in public adjudication, is increasingly explored as a potential solution to problems of access to justice.
STL’UL NUP: LEGAL LANDSCAPES OF THE HUL’QUMI’NUM MUSTIMUHW
Authors: Morales Sarah
Published: April 2017

Landscape is a part of every individual’s sense of being.  However, one cannot deny the special relationships that Indigenous peoples maintain with places they have inhabited since the beginning of creation.  These places are deeply imbued with meaning, and are sites of personal and community identity.  In addition, these places are legal in nature.  They teach Indigenous people about their legal obligations – to each other, their ancestors and the natural world.  This paper examines the connection between land and law for the Hul’qumi’num Mustimuhw, a group of Island Hul’qumi’num speaking First Nations, located on southeastern Vancouver Island.  It discusses how lands within Indigenous territories can be transformed into legal landscapes, when considered in relation to place, time and experience.  It also examines specific legal landscapes within the Hul’qumi’num territory and explores the laws and regulations that reside within and flow from them.  Through this paper, one can gain insight into how these places inform the Hul’qumi’num lgal tradition and impart important teachings to the Hul’qumi’num Mustimuhw about the nature of their relationship and their obligations to particular places and inhabitants of those places.
BUILDING INTERNATIONAL APPROACHES TO CLIMATE CHANGE, DISASTERS, AND DISPLACEMENT
Authors: McAdam Jane
Published: April 2017

On average, one person is displaced each second by a disaster-related hazard.  Most people move within their own countries, but some are forced across international borders. This article outlines the scope of existing international legal frameworks to assist people displaced in the context of disasters and climate change, and suggests a variety of different tools that are required to address the phenomenon. Legal, policy, technical and scientific interventions, including disaster risk reduction, climate change adaptation and mitigation, development, and migration opportunities, will determine whether, and for how long, people can remain in their homes, and whether doing so enables them to lead dignified lives or exposes them to risks and increased vulnerability. Identifying the need for a broad, complementary set of policy strategies necessarily affects how international law should be progressively developed in this area.
RECONCILIATION IN TRANSLATION: INDIGENOUS LEGAL TRADITIONS AND CANADA’S TRUTH AND RECONCILIATION COMMISSION
Authors: Anker Kirsten
Published: April 2017

One of the key elements of reconciliation identified in the recent final report of the Truth and Reconciliation Commission of Canada [TRC] is the revitalization of Indigenous law and legal traditions. Indeed, the practices of the TRC itself have attempted to embody this principle. However, a concern about state-sponsored reconciliation is that the recognition of Indigenous legal traditions is an empty gesture without a robust engagement with them. This article offers one possible method for outsiders to engage with Indigenous traditions in a way that goes beyond lip service and beyond the limitations of superficial forms of recognition in which equivalence is too quickly assumed. By paying attention to the ways that Indigenous principles and practices are embedded in a network of ideas about the world, a picture of a whole “legal sensibility” emerges that, through comparison, shows the dominant legal sensibility to be one alternative among many. In this way, reconciliation is approached as a process of “unsettling” what is taken for 4granted in mainstream understandings of reconciliation and law.
BEING THE CHANGE: SOCIAL JUSTICE IN EXTERNSHIP PROGRAM EVALUATION
Authors: Spillane Katie
Published: April 2017

Around the globe, clinical legal education [CLE] narratives resonate with a desire to promote social justice and the vindication of human rights. Yet scholarship exploring CLE’s accomplishment of these aims is scant and generally focuses only on student outcomes. This literature appears to be based not on theory and results, but hope: the hope that changed students will change the world. To invest on hope alone is unwise, particularly when all stakeholders face financially precarious times. In this context, this article argues that the existing focus on student outcomes is disproportionate and unhelpful. The existing narrow focus on student outcomes marginalizes other stakeholders and creates significant blind spots in program evaluation. This article proposes a broader analysis that would ask what value systems and power distribution CLE programs themselves create or reinforce, focusing on both the immediate impact of CLE programming and reinforcing the values human rights education seeks to inculcate by incorporating these into the structure of CLE programs themselves.
WHO IS MY NEIGHBOUR? THE DUTY OF CARE IN THE IMMIGRATION CONTEXT: A PERSPECTIVE FROM CANADIAN CASE LAW
Authors: Baglay Sasha
Published: April 2017

This article reviews and analyzes recent Canadian jurisprudence on immigration-related torts, situating it in the context of the contrasting logic of immigration and tort law. Immigration law’s focus on the absolute power of the state to control admission directs courts away from the recognition of the duty of care. In contrast, tort law theory does not preclude the possibility of private law duties to non-citizens, especially in light of the absence of other effective remedies to address the power imbalance between the host state and the non-citizen. The article examines how these two narratives were negotiated in cases of alleged negligence in immigration processing. It problematizes certain aspects of the current construction of the duty of care towards non-citizens and offers some suggestions for a more nuanced understanding of the factors considered under the Anns/Cooper test.
Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis
Authors: Thapa Sagun Bahadur , Kher Yeshwant Ramakrishna , Tambay Yashwant Gajanan
Published: April 2017

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period.

Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November  2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed.

Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD.

Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.
Effects of unconventional monetary policy on income and wealth distribution: Evidence from United States and Eurozone
Authors: Albert Juan-Francisco , Gómez-Fernández Nerea , Ochando Carlos
Published: April 2017

As an answer to the ?Great Recession? and Zero Lower Bound problem, main central banks had to use unconventional monetary policy (UMP). This research focuses on the distributive effects of these measures on household income and household wealth in the United States of America (USA) and the Eurozone. For this purpose, this paper presents four models that were constructed using the Structural Vector Autoregressive methodology (SVAR). The results suggest that the UMPs applied by the Federal Reserve (FED) in the USA could increase wealth and income inequality through the portfolio channel. However, the same results were not observed in the Eurozone.
Evolution of a Molecular Autopsy Program from within a Death Investigation System
Authors: Cunningham Kristopher S. , Pollanen Michael
Published: April 2017

The molecular autopsy has become an important adjunct to investigation of sudden cardiac deaths in individuals under 40 years of age. Consequently, this evolution in molecular medicine has led to significant changes in the evaluation of sudden cardiac deaths and vascular catastrophe in medicolegal death investigation systems. There is a recognition that increasingly detailed pathological examinations of the heart and vasculature are necessary, which must also be accompanied by retention of deoxyribonucleic acid (DNA) for possible genetic testing and communication that a possible heritable disease may be responsible for the unexpected death. Forensic pathologists are at the forefront of identifying possible cases of heritable disease and unless properly managed, surviving family members may not receive the opportunity for subsequent clinical evaluation or the diagnosis provided may be erroneous, with inappropriate labels placed on families. More than ever, forensic pathologists must be aware of the spectrum of heritable conditions that may contribute to death. This is necessary not only for natural deaths, but also in areas of classical forensic interest where a death has occurred under criminally suspicious means or following interaction with police involving struggle or restraint. Some genetic conditions are also recognized to cause changes that mimic inflicted trauma. This review outlines many of the issues we have considered in developing a molecular autopsy program and how processes developed at the time of postmortem examinations may be optimized to facilitate evaluation and treatment of surviving family members as well as enhance information provided to the courts.
Establishing a Multidisciplinary Network for the Workup of Sudden Cardiac Death
Authors: Duncanson Emily R. , Lynch Kate , Baker Andrew M. , Abdelhadi Raed H. , Mackey-Bojack Shannon M.
Published: April 2017

Sudden cardiac death (SCD) often falls under the jurisdiction of the medical examiner (ME). A recent expert consensus statement recommends cardiac evaluation for all first degree blood relatives of an individual with SCD and supports the referral of these family members to a multidisciplinary inherited arrhythmia clinic; however, most MEs lack the appropriate clinical network for a specific referral and family members are often not followed up. In 2010, Minnesota MEs and cardiovascular pathologists began collaborating with a cardiology referral center specializing in familial cardiac conditions to form a regional Sudden Death Network (SDN). The cardiac pathologists and MEs have established protocols for appropriate specimen retention in accordance with the National Association of Medical Examiners position paper on postmortem deoxyribonucleic acid (DNA) collection and for referring families for clinical evaluation. The expertise of a genetic counselor has been essential to the evaluation of these families in coordinating appropriate genetic testing and assisting with the identification of at-risk family members in extended pedigrees. This SDN uses a multidisciplinary approach for referral of family members for screening and treatment of SCD risk and represents an important resource for MEs. Development of SDNs across the country would lead to a more uniform approach to SCD follow-up and a more efficient use of clinical resources. The ME's role is essential in consulting cardiac pathologists when needed, establishing the correct diagnosis, collecting and retaining appropriate specimens, and initiating the referral of at-risk family members to specialists.
Overview of Technological Development, Complications, and Grossing Techniques in Percutaneous Coronary Intervention
Authors: Ball Christopher G. , Veinot John P.
Published: April 2017

Historical development of percutaneous coronary intervention (PCI) from percutaneous coronary transluminal angioplasty (PCTA) is outlined, along with the progression in the development of coronary artery stents—from the earliest bare-metal stents to drug-eluting stents to the current leading edge of bioresorbable and polymer-free stents. The early, medium, and late complications of PCTA and PCI are explained briefly, and with respect to stent development. Finally, common techniques to remove section stented vessels are outlined.
A Brief History of “Asphyxia”
Authors: Milroy Christopher M.
Published: April 2017

The term “asphyxia” has been used in different ways for the last two centuries in forensic medicine. While it has come to mean deaths associated with the deprivation of oxygen, its literal meaning is absence of the pulse. As well as having different meanings to different practitioners, the classic signs of “asphyxia” have been shown to be nonspecific and may be seen in nonasphyxial deaths. These findings are petechiae, cyanosis, congestion, fluidity of the blood, and dilatation of the right side of the heart. The changes are so nonspecific as to be referred to as the “obsolete quintet.” This paper traces the development of theories and findings in the English literature over the last two and a half centuries. It is the author's opinion that the use of the term “asphyxia” should now be abandoned as it serves more to confuse than enlighten.
Histological Aging of Bruising: A Historical and Ongoing Challenge
Authors: Parai Jacqueline L. , Milroy Christopher M.
Published: April 2017

Dating of bruises can be of great importance in forensic pathology. Such dating can be performed by both naked eye appearance and by using microscopic techniques. This paper reviews the literature on histological dating of bruising. Microscopic techniques have used standard histologic stains including hematoxylin and eosin and Prussian blue for iron; more recently, studies have employed immunohistochemistry. Biochemical techniques have also been used in an attempt to date bruises. These data have provided estimation of the age of bruises, without being able to give precise determinations. Findings that have been used to age bruises and factors that affect the aging of bruises are reviewed. Dating of bruising by laboratory techniques can only provide a range of time. Biological variation may prevent more accurate dating, despite newer techniques being used. Histological examination of bruises does have added value, but must be interpreted appropriately.
Beyond the Autopsy: Special Procedures Performed Postmortem
Authors: Collins Kim A.
Published: April 2017

Postmortem examinations have been performed for centuries. Around 300 BCE in the Egyptian city of Alexandria, for the first time in recorded history, physician-scientists performed dissections on humans. The first true autopsies were reported in the 1300s in Italy initially performed in cases of suspected poisoning or as part of the investigation of epidemics. Today, the autopsy, a medical procedure, is performed to certify the cause and manner of death, identify diseases, assess medical therapy, monitor public health, develop vital statistics, compare pre- and postmortem diagnoses, and serve as the number one quality assurance tool in medicine.
Creation of a Queryable Toxicology Database Available to Forensic Pathologists
Authors: Cain Matthew D. , Park Seung L. , Robinson C. Andrew , Davis Gregory G.
Published: April 2017

Purpose

Forensic pathologists typically depend upon case reports or published compilations of case reports when determining the role a drug may have played in death. Case reports may provide a helpful range, but the cases reported are typically few and often lack information on circumstances surrounding death and autopsy findings. A searchable database recording circumstances, autopsy findings, drug concentrations, and the cause and manner of death would allow forensic pathologists to compare a specific case to similar cases, facilitating evaluation and interpretation of toxicology results.

Method

This project uses data extracted by computer programs from over 18 000 computer files of autopsy and toxicology reports generated between 2004 and 2012. Using PHP Hypertext Preprocessor and MariaDB, a relational database, we developed a webpage that stores the data and allows for complex queries.

Results

Users can search for cases by specifying drugs and medical conditions, demographics, height, body mass, and manner of death. The number of cases with a given drug for this eight-year span from one office is comparable to the numbers reported in compilations of case reports.

Conclusion

Our webpage enables a pathologist evaluating a case to search the database for cases with similar circumstances and findings. New cases are easily added to the database as they are completed. The database allows other institutions to contribute data and records the data source, which increases the usefulness of the database even more. This database provides pathologists a powerful new tool for the evaluation of toxicology findings in their practice.
Forensic Entomology in the Medical Examiner's Office
Authors: Sanford Michelle R.
Published: April 2017

The application of forensic entomology to medicolegal death investigations has clear benefits to the role of the medical examiner's office (MEO) in evaluating insect activity as it relates to not only cause and manner of death but in the investigative role of the medical examiner as a resource to law enforcement. Until recently, applied forensic entomology in the MEO has been conducted by consulting forensic entomologists removed from the context of the investigation. The addition of a forensic entomologist to the staff of a MEO has provided an opportunity to explore the benefits and challenges of having the forensic entomologist involved at every step of the death investigation. In this study, data are provided on the types and variety of cases that the forensic entomologist has reported on for the Harris County Institute of Forensic Sciences in Houston, TX, over the first two years of the program. Case types, trends in colonization and insects involved in forensic entomology casework in this setting are highlighted, as well as the remaining challenges that forensic entomology must overcome on its path to standardization in the United States.
Trauma of the Pericardial Sac and Heart: An Autopsy Series
Authors: Zydowicz Sara , Adams Vernard I.
Published: April 2017

From 145 consecutive autopsies on traffic fatalities and leaps from heights performed by one author were found 38 cases with laceration of the heart, laceration of the pericardial sac, or contusion of the heart. Twenty-eight subjects had pericardial laceration: 13 of the left side singly, eight of the right side singly, one of the anterior wall singly, and six with multiple lacerations. Five of the 13 had herniation of the heart into a pleural cavity. Twenty-one of the 38 had laceration of the heart; 12 multiple and nine singly. The lacerations were equally distributed between atria and ventricles but almost all the atrial lacerations involved the right atrium. Thirteen of the 38 subjects had contusion of the heart in the absence of a cardiac laceration. Two of them also had a sprain injury of the intrapericardial portion of the inferior vena cava. The contusions were in epicardial fat depots in the atrioventricular sulci and along the acute and obtuse margins of the heart. None of the contusions was confined to the myocardium. Eleven of the 38 had a sternal fracture and 30 had rib fractures. Major craniocervical trauma and lacerations of the liver, spleen, aorta, and lung were common. Only six of 38 ever had a pulse after the crash or leap. The longest survival was 3.75 hours.

Pericardial lacerations most commonly occurred in the unbuttressed parts of the pericardium, namely, the left and right pleuropericardia. Pericardial laceration is essentially a traumatic rupture caused when the heart is compressed between the sternum and vertebral column and the sac gives way.
Fatal Hemoptysis Due to Undiagnosed Pulmonary Tuberculosis
Authors: Krehbiel Kacy , Zumwalt Ross E.
Published: April 2017

Although tuberculosis is a major infectious cause of morbidity and mortality worldwide, death from tuberculosis is uncommon in the United States. Sudden death due to this infection is most frequently a result of tuberculous pneumonia or massive hemoptysis. There are multiple etiologies for massive hemoptysis in pulmonary tuberculosis, including aneurysm formation, bronchial arteritis, lung cavitation, and tuberculous lymphadenitis. The identification of the exact anatomic etiology of massive hemoptysis, such as a fistulous connection or erosion of a pulmonary artery into a bronchus, is rare. We present a case of sudden death due to massive hemoptysis due to erosion of a pulmonary artery into a bronchus as a result of undiagnosed pulmonary tuberculosis.
Cerebral Toxoplasmosis Presenting as a Medical Examiner Case
Authors: Lelinski Jessica S. , Baker Andrew M.
Published: April 2017

Toxoplasma gondii is a common parasite, with infection rates ranging from 16–40% of the United States population to up to 80% in some Central and South American and European countries. Clinically significant toxoplasmosis is considerably rarer, primarily affecting those with compromised immune systems. In the era of widespread human immunodeficiency virus (HIV) testing and effective HIV therapies, toxoplasmosis is rarely encountered in the medical examiner setting. We report a case of previously undiagnosed cerebral toxoplasmosis in a prisoner not known to be HIV-positive, who was hospitalized and treated for a presumed head injury. Manifestations of toxoplasmosis, pathology, treatment, and outcomes are discussed. This case highlights the need for thorough autopsies not only for deaths apparently resulting from injuries in jails and correctional institutions, but also when prisoners are hospitalized for seemingly benign reasons, yet the cause of death remains unclear despite clinical evaluation and treatment.
Manner of Death for In-Custody Fatalities
Authors: Gill James R. , Girela-López Eloy
Published: April 2017

In-custody deaths are typically investigated by a medical examiner or coroner (ME/C) and include those that occur while in the custody of the police or in a government detention facility (e.g., prison). The potential manners of death are natural, homicide, suicide, accident, therapeutic complication, and undetermined. Once the cause of death is determined, the manner of death is certified based upon the cause and the circumstances of death. Deaths in custody may be challenging due to the potential for death at the hand of another (e.g., inmate, corrections officer, or law enforcement agent) or due to neglect. When a government takes a person's liberty, they have a duty to ensure safe and adequate housing, food, and medical care. Failure of a responsible party to exercise proper care of a person in-custody, may affect the manner of death. Since in-custody deaths at the hand of a government agent can be challenging to certify, we will focus on these manners of death including those associated with excited delirium (ED). Although manners are easily and consistently applied in most deaths, there are nuances in some instances which may result in jurisdictional variations in the determination of the manner of death. We will discuss these variations as the determination made by the ME/C is an opinion based upon his/her particular training, experience, and judgment.
Death with Dignity Laws and the Medical Examiner
Authors: Aiken Sally S. , Bundock Elizabeth A. , Gunson Karen L. , Aiken Katherine
Published: April 2017

Currently, three states (Oregon, Washington, and Vermont) have “death with dignity,” physician-assisted suicide laws. Twenty-five other states considered death with dignity (DWD) legislation in 2015. Americans and American physicians have mixed opinions about these laws. Oregon, Washington, and Vermont have similar DWD laws that establish criteria and define roles and responsibilities of the physician, patient, and pharmacist. States require record-keeping and statistical reports administered by public health agencies. Yearly summary reports in Oregon and Washington show that physician assisted suicide (PAS) is uncommon. In Oregon in 2014, 105 PAS deaths were documented, of approximately 34 000 total deaths. The majority of PAS deaths involve patients with terminal cancer or neurodegenerative disease. The laws require that the cause of death be attributed to and certified as the underlying natural disease, making the manner of death natural. The attending physician may sign the death certificate. Because the cause and manner of death are legally mandated, the physician assisted suicide laws have little impact on medical examiner offices.
Medical Therapy-Related Deaths and the Medical Examiner
Authors: Krehbiel Kacy , Matshes Evan W. , Lathrop Sarah , Pinckard J. Keith
Published: April 2017

Medical therapy-related deaths are incidents with great significance to public health and the medical community. However, there is controversy regarding the prevalence and the appropriate manner certification of these deaths given the paucity of guidelines regarding these cases. Our study aimed to identify potential medical therapy-related deaths in a large medical examiner jurisdiction and to determine the consensus rate regarding 1) identification of a case as being attributable to medical therapy, 2) manner of death, and 3) hypothetical utility of the “therapeutic complication” (TC) manner. Retrospective review over a 12-year period (2002–2013) revealed 113 appropriate cases, which were summarized and provided to forensic pathologists in our jurisdiction. Results were analyzed for consensus rate between pathologists and cases were categorized by complication type. The largest majority of these cases fell into the medication category (n=44; 39.0%) followed by operative (n=38; 33.6%), cases not medical therapy-related (n=31; 27.4%), and nonoperative (n=19; 16.8%). The interobserver agreement rate for original manner classification ranged from fair to moderate. The addition of TC as an available manner improved the consensus rate in four cases and decreased the consensus rate in 37 cases. There were 73 cases that at least one pathologist attributed to medical therapy, 19 of which were attributed to medical therapy by all pathologists. Our study indicates that there is disagreement about which cases are attributable to medical therapy and poor consensus in manner classification of medical therapy-related deaths. As such, guidelines are proposed for the classification of deaths thought attributable to medical therapy.
The Perfect Murder: How a Suicide Became a Homicide
Authors: Rogalska Agnieszka , Thompson Jonathan , Baker Andrew M.
Published: April 2017

This case report describes the death of a 51-year-old female, which presented by autopsy, scene circumstances, and social history as a suicidal ligature hanging. However, when her boyfriend walked into a police department in another state, months later, claiming to have killed the woman and staged a hanging, the medical examiner's office was asked to review the admission, as it was thought wholly inconsistent with the timeline provided. Upon reenactment of the admission, the perpetrator perfectly demonstrated the use of a lateral vascular neck restraint (carotid restraint), known to incapacitate and potentially kill an individual within a matter of seconds. The autopsy finding of severe atherosclerotic heart disease was important in understanding the mechanism of death, the timeline of events, and in corroborating the confession. This case demonstrates the value of performing an autopsy even though investigation and history suggested an obvious cause and manner of death.
Exploding Targets in Recreational Use
Authors: Bois Melanie C. , Reichard R. Ross
Published: April 2017

Exploding targets are marketed for their ability to indicate long-range marksmanship by detonating upon high velocity impact. The Internet has popularized recreational use of these targets outside of the scope of their intended design. We present a case of a 47-year-old man who was a bystander during recreational use of exploding targets. A .300 Winchester Magnum rifle was used to detonate an exploding target, on top of which was placed a fire extinguisher inside an aluminum pipe. The decedent was struck in the abdomen by a fragment of aluminum and collapsed. Despite emergency efforts at the scene, he was pronounced dead. Scene investigation revealed aluminum fragments throughout the blast radius. External examination and postmortem radiograph showed an entry wound of the left mid-abdomen without evidence of retained shrapnel. The autopsy findings included a hemoperitoneum due to transection of the right common iliac artery and inferior vena cava. A 10.6 g fragment of aluminum was recovered from within the abdomen. This case illustrates a dangerous misuse of exploding targets that has been popularized in the media. It also exemplifies a potential pitfall of a negative radiograph, despite the presence of metal shrapnel, because of the radiolucency of aluminum.
The First Use of Postmortem 3D Computed Tomography Images as Evidence in U.S. Criminal Courts: A Report of Four Cases
Authors: Ali Zabiullah , Daly Barry , Fowler David R.
Published: April 2017

Computed tomography (CT) is an imaging technique that has assumed an increasingly important role in clinical medicine since its invention in 1972 and has been admissible as evidence in court for many years. A recently introduced scientific application of CT, enabled by major advances in high-resolution imaging, postmortem CT (PMCT) allows unprecedented three-dimensional (3D) visualization of the whole body after death. As a novel scientific tool, PMCT may be subject to scrutiny for admissibility in court under Federal Rule of Evidence 702 and the Daubert standard. We present four cases of criminal prosecution for vehicular manslaughter where PMCT, including images generated with 3D reconstruction techniques, was admitted as evidence to demonstrate victim injuries to the jury in 2012. The use of PMCT for demonstrative proposes in court enabled the triers of fact to better understand and visualize injuries allegedly caused by the accused. Not only is PMCT a useful forensic tool, but it may also provide powerful and easily comprehensible visual evidence before a judge or jury. These cases may be used as precedent for future testimony in U.S. courts.
The Association between Laminectomy and Drug Overdose Deaths: A Matched Case-Control Study
Authors: Inusah Seidu , Griffin Russell L. , Gorman Emily F. , Davis Gregory G. , McGwin Gerald
Published: April 2017

Objective

To evaluate the association between death due to drug overdose and a history of laminectomy.

Design

A retrospective matched case-control study of 234 drug overdose decedents from the Jefferson County Coroner/Medical Examiner's Office in Birmingham, Alabama were matched 1:2 on age to a control group consisting of decedents with any manner of death (accident, natural, suicide, homicide, or undetermined). Laminectomy cases were identified by the presence of a linear surgical scar near the spine in an orientation and place typical for a laminectomy.

Results

Decedents whose cause of death was a drug overdose were 2.43 times (95% confidence interval [CI] 1.37-4.31) more likely to have a laminectomy scar compared to decedents in a control group consisting of all manners of death. This association held for males (odds ratio [OR] 2.34; 95% CI: 1.09-5.04) and whites (OR 2.35; 95% CI 1.06-5.18) after stratification.

Conclusion

In the absence of an obvious cause for death, the presence of a laminectomy scar suggests the possibility of a fatal overdose and is a factor to consider in favor of performing an autopsy and toxicological analysis for drugs of abuse.
Complications of Untreated Hypothyroidism (Hashimoto's Thyroiditis)
Authors: Garavan Fintan , Khanijow Vinod
Published: April 2017

Death associated with untreated hypothyroidism with no overt cardiovascular dysfunction is a rare occurrence and is usually classified as unexplained. Degenerative changes in the myocardium associated with hypothyroidism have not been reported in the English language literature since 1957. Historically, this was referred to as myxedema heart disease. This is a case report of untreated Hashimoto's thyroiditis resulting in marked histological changes associated with cardiac dysfunction causing death.
Os Odontoideum Mimicking Acute Odontoid Peg Fracture
Authors: Wang Amber R. , Nasrallah Ilya M. , Wardak Khalil S.
Published: April 2017

The atlantoaxial complex is a common site for cervical spine injuries, of which fractures of the axis (C2), occur most frequently. Over half of these fractures involve the odontoid process. Numerous developmental anomalies of the axis, although rare, can also occur and may simulate trauma. Specifically, os odontoideum is a cranial-vertebral junction anomaly in which the odontoid remains separate from the body of the axis as an independent ossicle. We report a case of a 53-year-old incarcerated male who was found by his five cellmates hanging partially suspended by a bed sheet. Emergency personnel re-established a pulse for a short time, and the patient was transferred to the hospital. Imaging of the cervical spine pointed to an avulsion fracture of the odontoid process of the axis, raising the possibility of trauma and foul play. Postmortem lateral radiographs revealed a smooth ossicle with a circumferential cortical rim superior to the axis, and a posterior neck dissection failed to reveal evidence of an acute injury. Contrary to the diagnosis of an isolated odontoid fracture, this is a case of os odontoideum. This case emphasizes the importance of a thorough dissection with direct visualization, accompanied by a complete investigation and radiographs. An overview of the development of the axis is discussed, including descriptions of various anomalies of the odontoid that may be encountered during postmortem cervical spine examination. Failure of the forensic pathologist to recognize the developmental anomalies of the axis could lead to improper certification of death, resulting in devastating medicolegal consequences.
Impact of Trauma, Massive Blood Loss and Administration of Resuscitation Fluids on a Person's Blood-Alcohol Concentration and Rate of Ethanol Metabolism
Authors: Jones Alan W.
Published: April 2017

Excessive drinking and drunkenness are tightly linked to many types of intentional and unintentional injuries involving trauma and blood loss, which often necessitate emergency medical intervention. This article considers the impact of trauma, massive blood loss, and the administration of life-saving replacement fluids on a person's blood alcohol concentration (BAC) and rate of ethanol metabolism. Both German and English language journals were reviewed and results from animal experiments, human studies, and actual victims of trauma undergoing life-saving treatment were considered. If trauma-related bleeding occurs when some ingested alcohol remains unabsorbed in the stomach, then under these circumstances continued absorption into portal venous blood is delayed, owing to altered splanchnic circulation. Hemodilution caused by administration of replacement fluids has only minimal effects on a preexisting BAC, because ethanol distributes into the total body water (TBW) compartment, which represents 50-60% of body weight. After hypovolemia there is a transfer of fluids from tissue compartments into the blood, which becomes more like plasma in composition with lower hematocrit and hemoglobin content. Unless the trauma or emergency treatment impedes hepatic blood flow, the rate of ethanol metabolism is not expected to differ from normal values, namely 0.10-0.25 g/L/h (0.01-0.025 g% per h). If ethanol is fully absorbed and distributed in all body fluids and tissues, neither massive blood loss nor administration of resuscitating fluids is expected to have any significant effect on a preexisting BAC or the rate of ethanol metabolism.
The Explosive Effects of Lightning: What are the Risks?
Authors: Blumenthal Ryan
Published: April 2017

The explosive effects of lightning have been known to exist for some time; however the precise risks associated with it have been generally unknown. This curious injury phenomenon has existed historically under many different names in the literature: “lightning's pressure blast wave,” “arc blast,” “shattering effects of lightning,” “pressures developed by arcs,” “thunder generation of shock waves,” and “the sixth mechanism of lightning injury” are but a few of the many divergent and disparate terminologies used in the past to describe this invisible blast phenomenon. Blunt force trauma injuries and barotrauma injuries are often identified on lightning strike victims. Lightning's pressure blast wave and its associated overpressure does appear to have significant injury implications associated with it. This paper takes an in-depth look at the explosive effects of lightning and the main blast-related pathologies seen on lightning strike victims. Knowledge and insight into this phenomenon may help forensic pathologists and those working in the fields of lightning injury and lightning protection. A general literature search of the medical, the electrical engineering, and the mechanical engineering literature was conducted. By looking exclusively at the pathology of barotrauma in the human body, forensic pathologists may now get a relatively good idea as to the possible overpressures and distances involved with regards to lightning's explosive effects.
Suicide in Jail: A Ten-Year Retrospective Study
Authors: Kucmanic Matthew J. , Gilson Thomas P.
Published: April 2017

Suicide in jails, like all death in custody, may involve complicated investigation. Allegations of mistreatment and/or abuse may be raised and these possibilities need to be addressed. Apart from these investigative concerns, the occurrence of suicides in such a controlled environment raises additional questions about potential preventative measures.

Between 2004 and 2014, there were ten deaths of incarcerated individuals in Cuyahoga County (metropolitan Cleveland) Ohio. Most (80%) were white and all were male. Similar to previous reviews, the majority of decedents hanged themselves (90%), with one case of asphyxiation by airway obstruction with a foreign body. Psychiatric disorders were noted in six of ten decedents while seven of ten had a history of substance abuse including alcoholism. Overall, nine of ten had at least one of these disorders.

All suicide deaths occurred within one year of incarceration, which may reflect the absence of a long-term prison fatality in our county. It is noteworthy that 70% of deaths occurred within the first month of incarceration with four of ten events occurring in less than a day including two deaths in less than 30 minutes. Positive toxicology for abused substances was noted in 75% (three) of the four individuals who died in less than a day and only in one other suicide, which occurred on the second day of incarceration.

Our data suggest that suicide in jail is predominantly a male phenomenon, with early incarceration being a particularly vulnerable period. The presence of another inmate in the same cell as the decedent was not seen to have an independent deterrent effect. Intoxication, particularly in individuals with a history of substance abuse and/or alcoholism, should raise concern for potential self-harm in recently jailed individuals. Possible interventions suggested by this study might include closer direct surveillance in the early incarceration period, earlier access to mental health services as well as design modifications in holding cells with possible dedicated short-term holding areas where self-harm risks are minimized and surveillance can be optimized.
Sudden Death Due to Spontaneous Small Bowel Perforation within an Incarcerated Umbilical Hernia
Authors: Maskovyak Amanda , Felo Joseph
Published: April 2017

Umbilical hernias are estimated to occur in up to 20% of patients with long-standing cirrhosis and ascites. Complications such as strangulation and infarction of the bowel or rupture of the bowel loops and/or hernia sac are uncommon but potentially life-threatening consequences. Often these events happen in association with abdominal trauma or after procedures such as paracentesis. Spontaneous rupture is more likely in cases where strangulation and subsequent necrosis of the bowel has weakened and thinned the incarcerated intestinal wall.

We report a case of a 63-year-old male with a history of alcohol abuse complicated by cirrhosis and ascites who was found dead in his home approximately 30 minutes after last being seen alive. He was found at rest in a seated position without evidence of recent trauma. At autopsy, an ulcerated umbilical hernia was present containing a loop of perforated, necrotic small bowel. There was evidence of peritonitis including one liter of yellow-red fluid accumulation in the peritoneal cavity, multifocal areas of fibrinopurulent debris adherent to the small bowel, and a dull gray discoloration to the peritoneal lining. The case was signed out as death due to peritonitis and spontaneous perforation of small intestine due to strangulated and infarcted small intestinal umbilical hernia and the manner, natural. Although spontaneous perforation of the bowel within a hernia sac is uncommon, it may contribute to sudden death in patients lacking a history of trauma or recent medical procedures and physicians certifying these deaths should be aware of the possibility.
Suicide by Bomb, with Decapitation
Authors: McLemore Amanda M. , Prahlow Samuel P. , Prahlow Joseph A.
Published: April 2017

Suicide by explosion is rare outside of the context of terrorist activities. We present a case of a man with a history of explosives expertise who committed suicide by bomb/decapitation. The case serves to remind forensic pathologists of several important issues when presented with a case involving explosives, such as ensuring the safety of all those involved in the investigation and the importance of interagency cooperation. Potentially invaluable ancillary tests at autopsy include performing radiology, collecting trace evidence, retaining clothing, ensuring the positive identity of the decedent, and recognizing the importance of documenting injury types and patterns.