Effect of History and Context on Forensic Pathologist Interpretation of Photographs of Patterned Injury of the Skin.

In a previous study, a survey-based analysis of pathologist diagnoses of patterned injury was performed. Subjects were provided with photographs of "classic" injuries and asked to diagnose the lesion in the absence of history or context. There was a relatively low diagnostic consensus among respondents. A second survey suggested that the disparate answers were not due to a strong belief in different diagnoses, but instead reflected how the respondents dealt with ambiguity. A third survey was created that asked participants to evaluate patterned injuries of the skin, but provided history and contextual information. The addition of history and contextual information increased consensus from a median of 80% to 98% on a per-question basis. Confidence increased from a median of 56%-92%. These results demonstrate the importance of history and context in medical diagnosis of patterned injuries of the skin.

Reasons for Lack of Consensus in Forensic Pathologist Interpretation of Photographs of Patterns of Injury of the Skin.

In a previous study, a survey-based analysis of pathologist diagnoses of patterned injury in which participants were asked makes diagnoses from photographs in the absence of history or context. The level of consensus was low. A follow-up survey was created to ask those who responded to the first survey why they answered as they did or why they were unsure of their answers. The most common reason for lack of consensus was that the lesion was nonspecific. Responses invoking ambiguity were more common than those that indicated a confident difference in diagnosis. There were differences between demographic groups, with age and experience being most prominent. These findings suggest that differences in image interpretation do not generally reflect firm differences in diagnosis as much as differing ways of dealing with ambiguity in the absence of history and context. A third survey will study the effect of the addition of contextual information.

Forensic Pathologist Consensus in the Interpretation of Photographs of Patterned Injuries of the Skin.

Forensic pathologists are commonly asked to evaluate injuries on the basis of photographs. Members of the National Association of Medical Examiners were asked to participate in an online survey in which they were presented with 68 patterned injuries of the skin and asked to make a diagnosis ranging from very general (e.g., "blunt" vs. "sharp") to specific (e.g., "baton blow"). This was not the case. Consensus for general diagnosis averaged 0.77 and 0.72 for specific diagnosis. While there was a strong correlation between consensus and confidence in aggregate, individual correlations were poor. Consensus diagnosis was inversely correlated with age, and positively correlated with jurisdictional size, medical degree, and whether or not the respondent was actively performing autopsies as a job function. A subsequent survey is exploring possible reasons for lack of consensus in low-consensus questions. The high correlation between confidence and consensus at the aggregate level and low correlation at the individual level may have implications for quality assurance protocols.

Digital UV/IR photography for tattoo evaluation in mummified remains.

The presence and location of tattoos can be an important component in the identification of remains in the extended postmortem period if remnants of skin persist. However, when there is significant mummification, visualization of tattoos can be problematic. Multiple methods have been proposed to make tattoos more visible, but all have limitation. In this case report, a mummified body was discovered. The presumptive victim was reported to have a small tattoo on her hand but it was not visible to the naked eye. The hand was photographed using ultraviolet (UV) and infrared (IR) light. A tattoo matching the description was noted in the photographs. In contrast to film-based IR and UV photography, digital UV and IR photography allows rapid visual evaluation of results and optimization of image utility. The ability to quickly modify photographic parameters quickly greatly increases the utility of IR and UV photography in the autopsy suite.

Can birth trauma be confused for abuse?

An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2-month-old-infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case.

Medical examiners, coroners, and biologic terrorism: a guidebook for surveillance and case management.

Medical examiners and coroners (ME/Cs) are essential public health partners for terrorism preparedness and response. These medicolegal investigators support both public health and public safety functions and investigate deaths that are sudden, suspicious, violent, unattended, and unexplained. Medicolegal autopsies are essential for making organism-specific diagnoses in deaths caused by biologic terrorism. This report has been created to 1) help public health officials understand the role of ME/Cs in biologic terrorism surveillance and response efforts and 2) provide ME/Cs with the detailed information required to build capacity for biologic terrorism preparedness in a public health context. This report provides background information regarding biologic terrorism, possible biologic agents, and the consequent clinicopathologic diseases, autopsy procedures, and diagnostic tests as well as a description of biosafety risks and standards for autopsy precautions. ME/Cs' vital role in terrorism surveillance requires consistent standards for collecting, analyzing, and disseminating data. Familiarity with the operational, jurisdictional, and evidentiary concerns involving biologic terrorism-related death investigation is critical to both ME/Cs and public health authorities. Managing terrorism-associated fatalities can be expensive and can overwhelm the existing capacity of ME/Cs. This report describes federal resources for funding and reimbursement for ME/C preparedness and response activities and the limited support capacity of the federal Disaster Mortuary Operational Response Team. Standards for communication are critical in responding to any emergency situation. This report, which is a joint collaboration between CDC and the National Association of Medical Examiners (NAME), describes the relationship between ME/Cs and public health departments, emergency management agencies, emergency operations centers, and the Incident Command System.

Novel selective small molecule agonists for peroxisome proliferator-activated receptor delta (PPARdelta)--synthesis and biological activity.

We report the synthesis and biological activity of a new series of small molecule agonists of the human Peroxisome Proliferator-Activated Receptor delta (PPARdelta). Several hits were identified from our original libraries containing lipophilic carboxylic acids. Optimization of these hits by structure-guided design led to 7k (GW501516) and 7l (GW0742), which shows an EC(50) of 1.1 nM against PPARdelta with 1000-fold selectivity over the other human subtypes.

Estimation of body exposure to explosion.

An ordnance-disposal expert was killed while disposing of a cache of explosives. The likely position of the body was reconstructed by modeling the explosion as an omnidirectional emission of particles from a model of the explosion site and noting the distribution of particles on a model of a human. The applications and limitations of this method in reconstructing the events and correlation with the injuries noted at autopsy are discussed.