Challenges to recruitment and retention of Black forensic pathologists.

BACKGROUND: Informal estimates place the number of practicing Black forensic pathologists (BFPs) in the United States (US) at somewhere between 35 and 45 which is less than 10% the estimated total of 600. The legacy of medical and institutional racism means that BFPs in the US encounter particular challenges to training and career development that their White peers do not have to contend with. METHODS: A survey developed on SurveyMonkey in English, was distributed through social media networks and by direct email to known BFPs. Their responses to questions about the challenges they faced in training and as qualified specialists and factors that eased or facilitated their progress were collected and analyzed. FINDINGS: BFPs report challenges to recruitment and retention that are like those faced by Black peers in other medical specialties. INTERPRETATION: While personal determination is an essential ingredient to career success as a BFP, there are certain structural barriers that must be eliminated to increase the total number of BFPs. The pipeline that produces BFPs must be nurtured, reimagined, and reinvigorated.

A social media primer for reluctant forensic pathologists.

Forensic pathologists are not as inclined as their peers in medicine and in the subspecialties of pathology, to use social media for professional reasons. Their reservations generally stem from concerns about respecting their rightful obligations to protect both the decedent's privacy and the integrity of judicial processes. While these are legitimate concerns, they should by no means be considered absolute barriers to participation on social media. The purpose of this paper is to provide clear guidelines on how forensic pathologists should navigate social media and how they could interact with colleagues and members of the public on social media platforms without comprising their integrity, decedent confidentiality or judicial processes.

Increasing engagement of forensic pathologists with the public on social media: Could there be room for live broadcasts?

In order to protect decedent privacy and to avoid the gratuitous use of photographs of death scenes and injuries by non-practitioners, professional meetings of forensic pathologists are never broadcast live to an audience beyond immediate conference attendees. However there may be topics of general interest which do not require censorship and to which outside viewers could be invited. Given the COVID19 pandemic and the need for virtual conferencing, it may be time to reconsider lifting this restriction for certain subject matter. Several platforms exist for live social media broadcasts which enable the broadcaster to exercise direct control over their content without having to go through an intermediary. When fully exploited, these live broadcasts could be of considerable value as another vehicle with which to educate the public about forensic pathology, an opportunity to promote forensic research and most important a recruiting tool to address critical manpower shortages.

The Potential Value of Video Abstracts to Dissemination of (Some) Information From National Association of Medical Examiners Annual General Meetings.

ABSTRACT: The purpose of this study is to determine whether video abstracts posted online to a social media platform (Twitter) increased dissemination of poster-abstract content from National Association of Medical Examiners (NAME) annual general meeting. At NAME meetings (2018, 2019), 20 authors accepted invitations to record visual abstracts. These were subsequently tweeted with their permission. Results were analyzed to determine how many times the video in each tweet was viewed and the number of impressions generated by the tweet. The NAME provided the number of attendees from each meeting to compare with online exposure to tweets.Video views per tweet ranged from 34 to 824 with a mean of 338. Of the 20 tweets, 5 (25%) had 600 or more views. The number of impressions per tweet ranged from 192 to 4629, with a mean of 1811. Seventy percent (14) had 500 or more impressions. Average conference participation for the meetings was 501.Given the numbers of views and even higher number of impressions, there appears to be a substantial increase in dissemination of poster abstracts beyond the conference attendees. The NAME should encourage authors of accepted abstracts to submit video summaries of their work. This will advertise forensic pathology research to a wider audience.

An overview of the challenges facing death investigation systems in certain resource limited countries.

A properly operated death investigation system (DIS) serves multiple stakeholders. Law enforcement, public health departments and members of the public, benefit in various ways from the information that it provides. This information must be collected systematically and efficiently. The system must also be flexible enough to respond to pressures on its resources such as occurs during mass disasters. These obligations on a DIS require an investment of public money. However even in affluent Western countries the recent world economic crisis has led to a cut in spending on public services that affect both the healthcare system and services associated with death investigation. Although pathologists and other stake holders (judiciary, police, families) would like to see death investigations conducted to international standards, the fact is that policy makers in resource limited countries face additional population health and sociopolitical pressures which generally result in very little funding for the service. The purpose of this paper is to review some of the challenges that impede the proper functioning of a death investigation system in resource limited countries in Sub-Saharan Africa and the Caribbean. Possible solutions are discussed.

Time till death study: how soon after "first contact" is a non-biologically related male likely to kill his partners child?

Non-biologically related males who are intimate partners of women with young children are the most likely perpetrators of homicidal violence against these children. The primary objective of this study is to determine the usual time interval between first child/unrelated adult male contact and the child's death. The secondary objective is to examine possible predisposing factors. First contact is defined as the time when the child initially interacted or met with the unrelated adult male, whether or not they lived together and for the purposes of this study is based on the length of the mothers relationship with her partner before the child was killed. The coroners office database in Indianapolis, Indiana was examined for records of child homicides from which victim data (age, sex, race and cause of death) was recovered. The associated child protective services (CPS) reports were examined to create a forensic epidemiologic profile including in particular, the length of time the unrelated adult male had known or lived with the child and when the child was killed. Over a period of 14 years, 79 cases of homicides were recovered in children aged 5 years and younger. Of these, there were 15 cases in which all relevant data was recorded. The time interval from first contact to death ranged from 14 to 240 days with a median of 75 days. Approximately 80% of all victims were killed within 90 days. The victims included 12 males and 3 females with an age range of 2-61 months. The median age was 22 months. There were 10 white, 4 black, and 1 Hispanic victim. Blunt force trauma to the head was the cause of death in 13 of 15 deaths. Forty percent (6/15) had prior CPS contact. Young children are most likely to be killed within 90 days of first unsupervised contact with a non-biologically related male. Most victims were male and blunt force trauma to the head was the leading cause of death.

Unusual diastatic separation of the sagittal suture: Avoiding confusion with inflicted head trauma.

Certain artifacts presenting on a fetus due to maceration or birth trauma, mimic inflicted head trauma (IHT) occurring post partum. In such cases, absent a thorough history and examination of the circumstances, the distinction may be impossible. This case report presents an unusual artifact occurring in a stillbirth delivered after the mother had complained of not feeling fetal movements for at least 24 hours. At autopsy, the macerated fetus presented with unusual widening of the sagittal suture and galeal/subgaleal hematomas. There were no other injuries. Review of the mothers antenatal, personal and social history combined with the absence of other injuries to the mother and fetus, helped distinguish the unusual birth-related diastatic separation from IHT. Consequently, in a case where the pathologist is presented with limited information for instance an abandoned fetus, a cautious approach to the determination of the cause and manner of death is strongly recommended.

The value of 100% retrospective peer review in a forensic pathology practice.

Peer review in forensic pathology practice has become an important cornerstone of continuous quality improvement. Although there are several components to an effective and transparent peer review process, one of the most essential is the review of completed reports. The autopsy report may be reviewed prospectively (report reviewed before sign out) or retrospectively (report reviewed after sign out). Prospective reviews are more likely to be performed on criminal or criminally suspicious cases, pediatric and SIDS deaths and high profile cases. Retrospective reviews on the other hand are performed on a proportion of all other signed-out routine medico-legal cases. The actual percentage varies by jurisdiction since there are no agreed minimum standards. Manpower and workload factors appear to be critical to determining what percentage of cases are reviewed retrospectively. The objective of this report is to present a mechanism by which a 100% retrospective review policy has been implemented, how it integrates with quality management protocols, the outcomes of the reviews and what challenges remain to improve compliance with key quality indicators especially turn around time (TAT) statistics.

Suicide by home made "guillotine" to the chest: a case report.

Cases of suicide by use of elaborate and complex devices are rare in the literature and popular media, despite the media attention such cases attract. These suicide cases have employed guillotines, contraptions involving guns and self-made firearms, and devices capable of delivering asphyxiating gases such as carbon monoxide. All previously reported cases of suicide by guillotine have been by decapitation. While suicidal sharp force injuries are rare, suicidal injuries to the chest are rarer still. This case is unusual because the lethal sharp force injury to the chest was inflicted by a home-made "guillotine". Investigators initially suspected a homicide because the body was found face down in the woods, far from human habitation. Thorough death scene and background investigation were essential in classifying it as an elaborate suicide.