Review of United States laws pertaining to the recovery and analysis of human skeletal remains.

Human skeletal remains (HSR) are routinely excavated from archeological contexts and analyzed by experts in human osteology. Contrarily, HSR in medicolegal contexts are usually recovered by law enforcement officers and examined by pathologists with limited osteological training. To examine legal requirements for expertise, we reviewed laws in the United States regarding the recovery and analysis of HSR from archeological sites, unmarked graves, and medicolegal contexts. Of the 50 states, 19 (38%) have laws stating that an anthropologist with osteological training should be involved in the recovery or analysis of HSR from an archeological context. Fifteen of those 16 states have laws requiring a minimum level of education to be a qualified skeletal analyst. In contrast, only one state, Texas, requires an anthropologist who handles forensic cases to have a doctoral degree. Including Texas, only eight states (16%) have laws that encourage but do not mandate consultation with a forensic anthropologist for medicolegal skeletal cases. Louisiana and Washington have state-funded laboratories, expert forensic anthropologists, and effective protocols for handling forensic cases. Due process and human rights concerns at stake in criminal cases require that those recovering and analyzing modern HSR have an equal or higher level of expertise than those working with archeological remains. Yet, legislators assume that law enforcement and pathologists are adequately trained. Because court standards demand expert testimony based on accepted methodologies and standard levels of competency, forensic anthropologists have a professional responsibility to engage with lawmakers to draft legislation to ensure proper handling of all skeletal cases.

Thrombocytopenia in dengue fever.

Dengue is probably the most important arthropod-borne viral disease in terms of human morbidity and mortality. We review the pathophysiology of thrombocytopenia and clinical bleeding in dengue across the spectrum of disease. The mechanisms of thrombocytopenia and coagulopathy are complex, involving platelet activation, procoagulant and anticoagulant arms of the coagulation system, complement, cytokines, and endothelial cells. Platelet counts do not correlate well with clinical bleeding. Although serious bleeding is rare, patients should be monitored closely for hemorrhagic manifestations and thrombocytopenia. Symptomatic thrombocytopenia may require platelet transfusion.

The lamellar peel: a sequential nonablative and ablative laser treatment for facial skin rejuvenation.

OBJECTIVES: Ablative and nonablative laser treatments have established themselves independently in the rejuvenation of aging skin. This study was designed to determine the effects of sequential nonablative and ablative laser treatments on facial skin. MATERIALS AND METHODS: Twelve patients, ages 32-56 years, with skin phototypes I-IV, received three treatments spaced six weeks apart. Each treatment consisted of one pass with 1319-nm Nd:YAG laser at 16 J/cm(2), 50 ms pulse duration. This was immediately followed by one pass of 2940-nm Er:YAG laser at 5 J/cm(2). Photographs and biopsies were taken prior to the first treatment and following the third treatment. RESULTS: Clinical improvements in facial skin tone and texture, acne scarring and dyschromia were noted in all patients. Histologic changes included a more compact epidermal granular layer and lamellar collagen formation with decreased solar elastosis in the dermis. Compared to controls, treated skin had a thicker, more homogeneous papillary dermis. CONCLUSION: The sequential use of nonablative and superficial ablative laser treatments clinically and histologically improved photodamaged and chronologically aged skin. This occurred with minimal recovery and little morbidity, demonstrating this laser application to be a safe and effective method for facial rejuvenation.