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1.
Radiology ; 288(1): 270-276, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29714682

ABSTRACT

Purpose To determine if postmortem computed tomography (CT) and postmortem CT angiography help to detect more lesions than autopsy in postmortem examinations, to evaluate the strengths and weaknesses of each method, and to define their indications. Materials and Methods Postmortem CT angiography was performed on 500 human corpses and followed by conventional autopsy. Nine centers were involved. All CT images were read by an experienced team including one forensic pathologist and one radiologist, blinded to the autopsy results. All findings were recorded for each method and categorized by anatomic structure (bone, organ parenchyma, soft tissue, and vascular) and relative importance in the forensic case (essential, useful, and unimportant). Results Among 18 654 findings, autopsies helped to identify 61.3% (11 433 of 18 654), postmortem CT helped to identify 76.0% (14 179 of 18 654), and postmortem CT angiography helped to identify 89.9% (16 780 of 18 654; P < .001). Postmortem CT angiography was superior to autopsy, especially at helping to identify essential skeletal lesions (96.1% [625 of 650] vs 65.4% [425 of 650], respectively; P < .001) and vascular lesions (93.5% [938 of 1003] vs 65.3% [655 of 1003], respectively; P < .001). Among the forensically essential findings, 23.4% (1029 of 4393) were not detected at autopsy, while only 9.7% (428 of 4393) were missed at postmortem CT angiography (P < .001). The best results were obtained when postmortem CT angiography was combined with autopsy. Conclusion Postmortem CT and postmortem CT angiography and autopsy each detect important lesions not detected by the other method. More lesions were identified by combining postmortem CT angiography and autopsy, which may increase the quality of postmortem diagnosis. Online supplemental material is available for this article.


Subject(s)
Autopsy/methods , Cause of Death , Computed Tomography Angiography/methods , Forensic Pathology/methods , Adult , Aged , Aged, 80 and over , Autopsy/statistics & numerical data , Computed Tomography Angiography/statistics & numerical data , Europe , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Young Adult
2.
Anal Bioanal Chem ; 410(4): 1217-1230, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28940009

ABSTRACT

Foodborne pathogens are a burden to the economy and a constant threat to public health. The ability to rapidly detect the presence of foodborne pathogens is a vital component of any strategy towards establishing a safe and secure food supply chain. Bacteriophages (phages) are viruses capable of infecting and replicating within bacteria in a strain-specific manner. The ubiquitous and selective nature of phages makes them ideal for the detection and biocontrol of bacteria. Therefore, the objective of this research was to develop and test a phage-based paper dipstick biosensor for the detection of various foodborne pathogens in food matrices. The first step was to identify the best method for immobilizing phages on paper such that their biological activity (infectivity) was preserved. It was found that piezoelectric inkjet printing resulted in lower loss of phage infectivity when compared with other printing methods (namely gravure and blade coating) and that ColorLok paper was ideally suited to create functional sensors. The phage-based bioactive papers developed with use of piezoelectric inkjet printing actively lysed their target bacteria and retained this antibacterial activity for up to 1 week when stored at room temperature and 80% relative humidity. These bioactive paper strips in combination with quantitative real-time PCR were used for quantitative determination of target bacteria in broth and food matrices. A phage dipstick was used to capture and infect Escherichia coli O157:H7, E. coli O45:H2, and Salmonella Newport in spinach, ground beef and chicken homogenates, respectively, and quantitative real-time PCR was used to detect the progeny phages. A detection limit of 10-50 colony-forming units per millilitre was demonstrated with a total assay time of 8 h, which was the duration of a typical work shift in an industrial setting. This detection method is rapid and cost-effective, and may potentially be applied to a broad range of bacterial foodborne pathogens. Graphical abstract ᅟ.


Subject(s)
Coliphages , Food Microbiology , Biosensing Techniques , Colony Count, Microbial , Culture Media , Escherichia coli O157/isolation & purification , Escherichia coli O157/pathogenicity , Limit of Detection , Paper
3.
Int J Legal Med ; 132(1): 197-203, 2018 Jan.
Article in English | MEDLINE | ID: mdl-28497398

ABSTRACT

The goal of this study was to assess whether early markers of myocardial ischemia, identified in a previous experimental work, can be applied in forensic pathology cases of sudden, ischemic cardiac death. These markers include desphosphorylated connexin 43 (Cx43), JunB, TUNEL assay, myoglobin, and troponin T. Fourteen cases of sudden cardiac death with gross and/or histological signs of myocardial infarction and 14 cases of sudden cardiac death with signs of early ischemia at histology and positive immunoreactions for fibronectin and C5b-9 were investigated. The control group was represented by 15 hanging (global hypoxia) cases. Immunohistochemical reactions were classified into four degrees and compared among groups. Cx43 and JunB were significantly more expressed in hanging than in ischemia/infarction, but they showed a different distribution in the tissue (sub-endocardial in ischemia/infarction, diffuse in hanging) and a different intensity of the signal. TUNEL assay was significantly more expressed in the group of early ischemia than in myocardial infarction. Myoglobin and troponin T did not show any significantly different expression among the three groups. Depletion markers have a limited application in forensic cases, and this is mostly because positive (depleted) areas are difficult to distinguish from artifactually paler areas. Nuclear markers (JunB and TUNEL), on the other hand, require a well-trained eye and a high magnification in order to be distinguished. Cx43, JunB, and TUNEL assays were confirmed to be early, sensitive markers for myocardial ischemia. Nonetheless, they are not specific, as they are expressed in global hypoxia as well, but with a different tissular distribution.


Subject(s)
Connexin 43/metabolism , In Situ Nick-End Labeling , Myocardial Ischemia/diagnosis , Myoglobin/metabolism , Transcription Factors/metabolism , Troponin T/metabolism , Adult , Aged , Biomarkers/metabolism , Case-Control Studies , Death, Sudden, Cardiac/etiology , Female , Forensic Pathology , Heart Ventricles/metabolism , Humans , Immunohistochemistry , Male , Middle Aged , Myocardial Infarction/diagnosis , Retrospective Studies
5.
Int J Legal Med ; 130(5): 1265-80, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27392959

ABSTRACT

The post-mortem diagnosis of acute myocardial ischemia remains a challenge for both clinical and forensic pathologists. We performed an experimental study (ligation of left anterior descending coronary artery in rats) in order to identify early markers of myocardial ischemia, to further apply to forensic and clinical pathology in cases of sudden cardiac death. Using immunohistochemistry, Western blots, and gene expression analyses, we investigated a number of markers, selected among those which are currently used in emergency departments to diagnose myocardial infarction and those which are under investigation in basic research and autopsy pathology studies on cardiovascular diseases. The study was performed on 44 adult male Lewis rats, assigned to three experimental groups: control, sham-operated, and operated. The durations of ischemia ranged between 5 min and 24 h. The investigated markers were troponins I and T, myoglobin, fibronectin, C5b-9, connexin 43 (dephosphorylated), JunB, cytochrome c, and TUNEL staining. The earliest expressions (≤30 min) were observed for connexin 43, JunB, and cytochrome c, followed by fibronectin (≤1 h), myoglobin (≤1 h), troponins I and T (≤1 h), TUNEL (≤1 h), and C5b-9 (≤2 h). By this investigation, we identified a panel of true early markers of myocardial ischemia and delineated their temporal evolution in expression by employing new technologies for gene expression analysis, in addition to traditional and routine methods (such as histology and immunohistochemistry). Moreover, for the first time in the autopsy pathology field, we identified, by immunohistochemistry, two very early markers of myocardial ischemia: dephosphorylated connexin 43 and JunB.


Subject(s)
Death, Sudden, Cardiac , Myocardial Ischemia/diagnosis , Animals , Antibodies/analysis , Biomarkers/analysis , Complement Membrane Attack Complex/immunology , Connexin 43/immunology , Cytochromes c/immunology , Fibronectins/immunology , Forensic Pathology , Immunohistochemistry , Male , Models, Animal , Myoglobin/immunology , Rats, Inbred Lew , Transcription Factors/immunology , Troponin I/immunology , Troponin T/immunology
6.
Forensic Sci Int ; 259: 1-9, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26707208

ABSTRACT

The late president of the Palestinian Authority, Yasser Arafat, died in November 2004 in Percy Hospital, one month after having experienced a sudden onset of symptoms that included severe nausea, vomiting, diarrhoea and abdominal pain and which were followed by multiple organ failure. In spite of numerous investigations performed in France, the pathophysiological mechanisms at the origin of the symptoms could not be identified. In 2011, we found abnormal levels of polonium-210 ((210)Po) in some of Arafat's belongings that were worn during his final hospital stay and which were stained with biological fluids. This finding led to the exhumation of Arafat's remains in 2012. Significantly higher (up to 20 times) activities of (210)Po and lead-210 ((210)Pb) were found in the ribs, iliac crest and sternum specimens compared to reference samples from the literature (p-value <1%). In all specimens from the tomb, (210)Po activity was supported by a similar activity of (210)Pb. Biokinetic calculations demonstrated that a (210)Pb impurity, as identified in a commercial source of 3MBq of (210)Po, may be responsible for the activities measured in Arafat's belongings and remains 8 years after his death. The absence of myelosuppression and hair loss in Mr Arafat's case compared to Mr Litvinenko's, the only known case of malicious poisoning with (210)Po, could be explained by differences in the time delivery-scheme of intake. In conclusion, statistical Bayesian analysis combining all the evidence gathered in our forensic expert report moderately supports the proposition that Mr Arafat was poisoned by (210)Po.


Subject(s)
Famous Persons , Forensic Toxicology/methods , Polonium/poisoning , Bayes Theorem , Cause of Death , France , Humans , Lead Radioisotopes/analysis , Lead Radioisotopes/poisoning , Radioisotopes
7.
Int J Legal Med ; 130(4): 995-1001, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26690910

ABSTRACT

The aim of this study was to measure catecholamines and their O-methylated metabolites in urine and vitreous humor collected in cardiac deaths and noncardiac control cases that underwent medicolegal investigations. Our first goal was to assess whether cardiac events of different types are characterized by different catecholamine/metanephrine urine and/or vitreous profiles. Our second goal was to determine whether noncardiac causes of death with different survival intervals are characterized by different catecholamine/metanephrine urine and/or vitreous profiles. Two study groups were prospectively and retrospectively formed, a cardiac death group (including three subgroups, according to the cause of death) and a noncardiac death group (including two subgroups, according to the length of the agonal period). Postmortem angiography, autopsy, histology, toxicology, and biochemistry were performed in all cases. First results seem to indicate that absolute values measured in urine and vitreous for each of the analyzed markers display no significant differences relating to each of the tested cardiac death subgroups. In the control group, absolute concentrations measured in urine and vitreous for each of the analyzed parameters failed to show significant differences relating to the length of agonal period. Our preliminary findings do not seem to confirm the conclusions of former studies and fail to corroborate the usefulness of urine catecholamine and metanephrine analysis to characterize stress response intensity or length of the dying process in the postmortem setting.


Subject(s)
Catecholamines/urine , Death , Heart Diseases/urine , Adolescent , Adult , Aged , Case-Control Studies , Dopamine/analogs & derivatives , Dopamine/urine , Female , Forensic Pathology , Humans , Male , Middle Aged , Vitreous Body/chemistry , Young Adult
8.
Am J Forensic Med Pathol ; 36(4): 239-44, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26280883

ABSTRACT

Postmortem imaging techniques, especially postmortem computed tomography, have become integral tools in forensic investigations. Multiphase postmortem computed tomography angiography (MPMCTA) visualizes the vascular system in detail and makes it possible to evaluate the perfusion of even the smallest vessels. Although the technique has been well described for adults, no pediatric cases have been reported and no pediatric protocol has been established for this type of investigation. We present the case a 7-year-old child for which we used a previously described MPMCTA protocol and adapted values of perfusion, with the same technical equipment as for adult cases. Our main objective was to propose a perfusion protocol adapted for the investigation of infants and children. Moreover, we discuss both the difficulties that we encountered and possible ways to further improve the investigation of pediatric cases by MPMCTA.


Subject(s)
Angiography/methods , Klebsiella Infections/diagnosis , Lung/diagnostic imaging , Multidetector Computed Tomography , Pneumonia, Bacterial/diagnosis , Respiratory Aspiration/diagnosis , Anemia, Sickle Cell/complications , Arterial Occlusive Diseases/diagnosis , Child , Contrast Media/administration & dosage , Diagnosis, Differential , Dose-Response Relationship, Drug , Female , Forensic Pathology , Humans , Mesenteric Artery, Superior/diagnostic imaging , Pneumonia, Bacterial/microbiology
9.
Radiol Med ; 120(9): 824-34, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25841652

ABSTRACT

The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.


Subject(s)
Angiography/methods , Contrast Media , Forensic Medicine/methods , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Autopsy/methods , Cause of Death , Humans , Postmortem Changes
10.
Am J Forensic Med Pathol ; 36(2): 79-83, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25881816

ABSTRACT

This article describes the case of a 17-year-old adolescent boy who received a foot kick in the trunk area from an expert in karate. He presented with immediate cardiocirculatory arrest. After a prolonged resuscitation, he was transferred to a hospital where he died 5 days later without ever regaining consciousness. Postmortem investigations including autopsy, radiology, histology, toxicology, and postmortem chemistry were performed that showed signs of multiple organ failure, an acute hemorrhage in the region of the celiac plexus, and signs of medical resuscitation. No preexisting disease, particularly those concerning the heart, was objectified. The cause of death was attributed to multiple organ failure after a prolonged cardiocirculatory arrest. Concerning the origin of the cardiac arrest, 2 hypotheses were considered-a cardioinhibitory reflex and a cardiac contusion (commotio cordis). Because of the presence of traumatic lesions in the celiac plexus, the first hypothesis was finally submitted. This case is reported because rare cases of sudden death from celiac reflex are described in the literature where it is almost impossible to find references with accurate documentation. The presented case confirms the importance of detailed documentation of the circumstances and postmortem investigations to establish a diagnosis of death due to cardioinhibitory reflex.


Subject(s)
Martial Arts , Myocardial Contraction/physiology , Reflex/physiology , Thoracic Injuries/physiopathology , Wounds, Nonpenetrating/physiopathology , Adolescent , Celiac Plexus/physiopathology , Fatal Outcome , Forensic Medicine , Heart Arrest/etiology , Humans , Male , Multiple Organ Failure/etiology , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications
11.
Int J Legal Med ; 129(5): 1035-42, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25874665

ABSTRACT

AIM: The aim of our study was to compare traumatic injuries observed after cardiopulmonary resuscitation (CPR) by means of standard (manual) or assisted (mechanical) chest compression by Lund University Cardiopulmonary Assist System, 2nd generation (LUCAS2) device. METHODS: A retrospective study was conducted including cases from 2011 to 2013, analysing consecutive autopsy reports in two groups of patients who underwent medicolegal autopsy after unsuccessful CPR. We focused on traumatic injuries from dermal to internal trauma, collecting data according to a standardised protocol. RESULTS: The study group was comprised of 26 cases, while 32 cases were included in the control group. Cardiopulmonary resuscitation performed by LUCAS2 was longer than manual CPR performed in control cases (study group: mean duration 51.5 min; controls 29.4 min; p = 0.004). Anterior chest lesions (from bruises to abrasions) were described in 18/26 patients in the LUCAS2 group and in 6/32 of the control group. A mean of 6.6 rib fractures per case was observed in the LUCAS2 group, but this was only 3.1 in the control group (p = 0.007). Rib fractures were less frequently observed in younger patients. The frequency of sternal factures was similar in both groups. A few trauma injuries to internal organs (mainly cardiac, pulmonary and hepatic bruises), and some petechiae (study 46%; control 41 %; p = 0.79) were recorded in both groups. CONCLUSION: LUCAS™2-CPR is associated with more rib fractures than standard CPR. Typical round concentric skin lesions were observed in cases of mechanical reanimation. No life-threatening injuries were reported. Petechiae were common findings.


Subject(s)
Cardiopulmonary Resuscitation/adverse effects , Cardiopulmonary Resuscitation/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Contusions/etiology , Contusions/pathology , Female , Forensic Pathology , Fractures, Bone/etiology , Fractures, Bone/pathology , Heart Injuries/etiology , Heart Injuries/pathology , Humans , Liver/injuries , Liver/pathology , Lung Injury/etiology , Lung Injury/pathology , Male , Middle Aged , Purpura/etiology , Purpura/pathology , Retrospective Studies , Rib Fractures/etiology , Rib Fractures/pathology , Sternum/injuries , Sternum/pathology , Time Factors , Young Adult
12.
Int J Legal Med ; 129(5): 1067-77, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25904078

ABSTRACT

The goal of this study was to assess the localization and types of thrombosed plaques in cases of sudden cardiac death attributed to coronary artery disease and to evaluate possible correlations with body mass index (BMI) and increased heart weight. This retrospective study was performed on forensic cases for which the cause of death was attributed to coronary artery disease. A complete autopsy and a multi-phase postmortem computed tomography (CT) angiography (MPMCTA) were performed in all cases. Eighty-five cases were selected (mean age, 55.18 ± 11.04 years; 72 men and 13 women). MPMCTA performed prior to autopsy enabled an evaluation of coronary artery perfusion before dissection of the body and helped therefore to guide sampling for histology. An acute coronary thrombosis was found in 57 cases, which included plaque erosion in 26 cases (mean age, 46.73 ± 8.33 years) and rupture or intra-plaque hemorrhage in 31 cases (mean age, 58.23 ± 10.62 years). Erosions were most frequently found in the left anterior descending artery (61.5%), while only 35.48% of ruptures were observed in this artery. Chronic coronary pathology was considered as the main cause of death in 28 cases (mean age, 59.64 ± 9.47 years). Sixty-two of the cases (72.94%) had a BMI in the overweight category (BMI ≥25), with the highest mean BMI in patients with chronic coronary pathology without acute thrombosis found at autopsy. The heart weight was above the predicted reference values in 52 cases (61.18%). Our results are in accordance with previously published studies on the spatial distribution of vulnerable plaques. We observed a higher percentage of eroded plaques than previously reported. Patients with coronary erosions were significantly younger than those with plaque rupture or those without an acute coronary thrombosis (p values <0.0001). BMI and heart weight were significantly higher for cases without thrombosis in comparison with those with plaque rupture (p values 0.028 and 0.003, respectively). Our results indicating that increased BMI and overweight hearts are associated with chronic ischemic heart disease are compatible with clinical studies. Performing more postmortem studies on forensic autopsies, including modern radiological examinations with MPMCTA, can enhance the detection of vulnerable plaques in living patients and prevent sudden cardiac death.


Subject(s)
Coronary Angiography , Death, Sudden, Cardiac/pathology , Plaque, Atherosclerotic/diagnostic imaging , Plaque, Atherosclerotic/pathology , Body Mass Index , Coronary Artery Disease/pathology , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/pathology , Female , Forensic Pathology , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Multidetector Computed Tomography , Myocardium/pathology , Organ Size , Overweight/complications , Retrospective Studies , Rupture/diagnostic imaging , Rupture/pathology
15.
Int Arch Occup Environ Health ; 88(2): 213-24, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24929794

ABSTRACT

OBJECTIVES: To assess consequences of physical violence at work and identify their predictors. METHODS: Among the patients in a medicolegal consultation from 2007 to 2010, the subsample of workplace violence victims (n = 185) was identified and contacted again in average 30 months after the assault. Eighty-six victims (47 %) participated. Ordinal logistic regression analyses assessed the effect of 9 potential risk factors on physical, psychological and work consequences summarized in a severity score (0-9). RESULTS: Severity score distribution was as follows: 4+: 14 %; 1-3: 42 %; and 0: 44 %. Initial psychological distress resulting from the violence was a strong predictor (p < 0.001) of the severity score both on work and long-term psychological consequences. Gender and age did not reach significant levels in multivariable analyses even though female victims had overall more severe consequences. Unexpectedly, only among workers whose jobs implied high awareness of the risk of violence, first-time violence was associated with long-term psychological and physical consequences (p = 0.004). Among the factors assessed at follow-up, perceived lack of employers' support or absence of employer was associated with higher values on the severity score. The seven other assessed factors (initial physical injuries; previous experience of violence; preexisting health problems; working alone; internal violence; lack of support from colleagues; and lack of support from family or friends) were not significantly associated with the severity score. CONCLUSIONS: Being a victim of workplace violence can result in long-term consequences on health and employment, their severity increases with the seriousness of initial psychological distress. Support from the employer can help prevent negative outcomes.


Subject(s)
Crime Victims/psychology , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Violence/psychology , Violence/statistics & numerical data , Workplace , Adult , Age Distribution , Crime Victims/statistics & numerical data , Female , Health Status , Health Surveys , Hospitals, University , Humans , Logistic Models , Male , Middle Aged , Risk Factors , Sex Distribution , Switzerland/epidemiology , Workplace/psychology , Workplace/statistics & numerical data
16.
Int J Legal Med ; 129(2): 301-5, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25194712

ABSTRACT

Urea nitrogen, creatinine, and uric acid are relatively stable in postmortem serum and may, therefore, be used for diagnostic purposes when chronic kidney disease and end-stage renal failure are investigated as causes of death. Nevertheless, uncertainties remain in defining the best alternative to postmortem serum for the identification and assessment of significantly decreased kidney function. In this study, we investigated urea nitrogen, creatinine, and uric acid levels in postmortem serum, pericardial fluid, and vitreous humor in a series of medico-legal cases (500 autopsies) with various causes of death. No postmortem interval-related differences were observed in any of the investigated fluids for any analyzed parameter, confirming the biochemical stability of all compounds after death. Data analysis failed to reveal statistically significant differences between postmortem serum and pericardial fluid urea nitrogen, creatinine, and uric acid concentrations. Conversely, statistically significant differences were observed in all analyzed biomarkers between postmortem serum and vitreous humor levels, with lower concentrations of all markers measured in vitreous. The results of this study suggest that, in order to estimate as accurately as possible blood analyte concentrations at the time of death, pericardial fluid should be preferred to vitreous humor.


Subject(s)
Blood Urea Nitrogen , Creatinine/analysis , Pericardial Fluid/chemistry , Postmortem Changes , Uric Acid/analysis , Vitreous Body/chemistry , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/analysis , Female , Forensic Pathology , Humans , Male , Middle Aged , Prospective Studies , Sex Factors , Young Adult
17.
BMC Geriatr ; 14: 123, 2014 Nov 24.
Article in English | MEDLINE | ID: mdl-25420615

ABSTRACT

BACKGROUND: In many countries, primary care physicians determine whether or not older drivers are fit to drive. Little, however, is known regarding the effects of cognitive decline on driving performance and the means to detect it. This study explores to what extent the trail making test (TMT) can provide indications to clinicians about their older patients' on-road driving performance in the context of cognitive decline. METHODS: This translational study was nested within a cohort study and an exploratory psychophysics study. The target population of interest was constituted of older drivers in the absence of important cognitive or physical disorders. We therefore recruited and tested 404 home-dwelling drivers, aged 70 years or more and in possession of valid drivers' licenses, who volunteered to participate in a driving refresher course. Forty-five drivers also agreed to undergo further testing at our lab. On-road driving performance was evaluated by instructors during a 45 minute validated open-road circuit. Drivers were classified as either being excellent, good, moderate, or poor depending on their score on a standardized evaluation of on-road driving performance. RESULTS: The area under the receiver operator curve for detecting poorly performing drivers was 0.668 (CI95% 0.558 to 0.778) for the TMT-A, and 0.662 (CI95% 0.542 to 0.783) for the TMT-B. TMT was related to contrast sensitivity, motion direction, orientation discrimination, working memory, verbal fluency, and literacy. Older patients with a TMT-A ≥ 54 seconds or a TMT-B ≥ 150 seconds have a threefold (CI95% 1.3 to 7.0) increased risk of performing poorly during the on-road evaluation. TMT had a sensitivity of 63.6%, a specificity of 64.9%, a positive predictive value of 9.5%, and a negative predictive value of 96.9%. CONCLUSION: In screening settings, the TMT would have clinicians uselessly consider driving cessation in nine drivers out of ten. Given the important negative impact this could have on older drivers, this study confirms the TMT not to be specific enough for clinicians to justify driving cessation without complementary investigations on driving behaviors.


Subject(s)
Accidents, Traffic/prevention & control , Aging/psychology , Automobile Driving/psychology , Risk Assessment/methods , Trail Making Test , Translational Research, Biomedical/methods , Age Factors , Aged , Cognition Disorders , Female , Follow-Up Studies , Humans , Male , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Retrospective Studies , Time Factors
18.
Bioanalysis ; 6(15): 2043-55, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25322781

ABSTRACT

BACKGROUND: Direct-infusion ESI-MS/MS is a powerful approach for the identification of substances in complex mixtures. The aim of this work was to investigate its applicability to the toxicological screening of blood samples. A simple protein precipitation was used, followed by a 15 min infusion of the extract in the mass spectrometer. RESULTS: The application of the procedure to commercial quality controls and authentic post-mortem blood samples demonstrated that the direct-infusion ESI-MS/MS approach enables the simultaneous identification of substances that require different chromatographic conditions. However, poor sensitivity was observed for benzodiazepine, amphetamines and opiate compounds. CONCLUSION: Considering the facile implementation and positive performance of direct-infusion ESI-MS/MS, this approach may to be a valuable complementary technique for systematic toxicological analysis procedures.


Subject(s)
Blood Chemical Analysis/methods , Spectrometry, Mass, Electrospray Ionization/methods , Toxicology/methods , Blood Proteins/analysis , Blood Proteins/chemistry , Chemical Precipitation , Humans
19.
Front Hum Neurosci ; 8: 772, 2014.
Article in English | MEDLINE | ID: mdl-25346674

ABSTRACT

When facing age-related cerebral decline, older adults are unequally affected by cognitive impairment without us knowing why. To explore underlying mechanisms and find possible solutions to maintain life-space mobility, there is a need for a standardized behavioral test that relates to behaviors in natural environments. The aim of the project described in this paper was therefore to provide a free, reliable, transparent, computer-based instrument capable of detecting age-related changes on visual processing and cortical functions for the purposes of research into human behavior in computational transportation science. After obtaining content validity, exploring psychometric properties of the developed tasks, we derived (Study 1) the scoring method for measuring cerebral decline on 106 older drivers aged ≥70 years attending a driving refresher course organized by the Swiss Automobile Association to test the instrument's validity against on-road driving performance (106 older drivers). We then validated the derived method on a new sample of 182 drivers (Study 2). We then measured the instrument's reliability having 17 healthy, young volunteers repeat all tests included in the instrument five times (Study 3) and explored the instrument's psychophysical underlying functions on 47 older drivers (Study 4). Finally, we tested the instrument's responsiveness to alcohol and effects on performance on a driving simulator in a randomized, double-blinded, placebo, crossover, dose-response, validation trial including 20 healthy, young volunteers (Study 5). The developed instrument revealed good psychometric properties related to processing speed. It was reliable (ICC = 0.853) and showed reasonable association to driving performance (R (2) = 0.053), and responded to blood alcohol concentrations of 0.5 g/L (p = 0.008). Our results suggest that MedDrive is capable of detecting age-related changes that affect processing speed. These changes nevertheless do not necessarily affect driving behavior.

20.
J Forensic Nurs ; 10(3): 144-52, 2014.
Article in English | MEDLINE | ID: mdl-25144585

ABSTRACT

BACKGROUND AND METHODS: The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). RESULTS: Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. DISCUSSION AND CONCLUSION: New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.


Subject(s)
Advanced Practice Nursing/organization & administration , Forensic Nursing/organization & administration , Nurse's Role , Clinical Competence , Crime Victims , Ethics, Nursing , Evidence-Based Nursing , Focus Groups , Hospitals, University , Humans , Interpersonal Relations , Leadership , Nurse-Patient Relations , Referral and Consultation , Switzerland
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