Office of Chief Medical Examiner

New York City, NY, United States

Office of Chief Medical Examiner

New York City, NY, United States
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We describe an approach for quantifying and characterizing the extent to which sudden and unexpected infant deaths (SUIDs) result from unsafe sleep environments (e.g., prone position, bedsharing, soft bedding); and present data on sleep-related infant deaths in NYC. Using a combination of vital statistics and medical examiner data, including autopsy and death scene investigation findings, we analyzed any death due to accidental threat to breathing (ATB) (ICD-10 W75 & W84), and deaths of undetermined intent (UND) (Y10-Y34) between 2000 and 2003 in NYC for the presence of sleep-related factors (SRF). Homicide deaths were excluded as were SIDS, since in NYC SIDS is not a certification option if environmental factors were possibly contributors to the death. All 19 ATB and 69 (75%) UND had SRFs as per the OCME investigation. Black infants and infants born to teen mothers had higher SRF death rates for both ATB and UND deaths. Bedsharing was the most common SRF (53%-ATB; 72%-UND deaths); the majority of non-bedsharing infants were found in the prone position (60%-ATB; 78%-UND deaths). We found a high prevalence of SRFs among ATB and UND deaths. This is the first local study to illustrate the importance of knowing how SUIDs are certified in order to ascertain the prevalence of infant deaths with SRFs. Advancing the research requires clarity on the criteria used by local medical examiners to categorize SUIDs. This will help jurisdictions interpret their infant mortality statistics, which in turn will improve education and prevention efforts. © 2010 Springer Science+Business Media, LLC.

Hartnett K.M.,Office of Chief Medical Examiner | Fulginiti L.C.,Maricopa County Office of the Medical Examiner
Journal of Forensic Sciences | Year: 2011

This research investigates the effects of household chemicals on human tissues. Five different human tissues (bone, tooth, hair, fingernails, and skin/muscle/fat) were immersed into six different corrosive agents. These agents consisted of hydrochloric acid, sulfuric acid, lye, bleach, organic septic cleaner, and Coca-Cola ® soda. Tap water was used as a control. Tissue samples were cut to consistent sizes and submerged in the corrosive liquids. Over time, the appearance, consistency, and weight were documented. Hydrochloric acid was the most destructive agent in this study, consuming most tissues within 24h. Sulfuric acid was the second most destructive agent in this study. Bleach, lye, and cola had no structural effects on the hard tissues of the body, but did alter the appearance or integrity of the hair, nails, or flesh in some way. The organic septic cleaner and tap water had no effect on any of the human tissue tested during the timeframe of the study. 2011 American Academy of Forensic Sciences.

Shapiro-Mendoza C.K.,Centers for Disease Control and Prevention | Camperlengo L.,Centers for Disease Control and Prevention | Ludvigsen R.,Oak Ridge Institute for Science and Education | Cottengim C.,DB Consulting Group Inc. | And 6 more authors.
Pediatrics | Year: 2014

Sudden unexpected infant deaths (SUID) accounted for 1 in 3 postneonatal deaths in 2010. Sudden infant death syndrome and accidental sleep-related suffocation are among the most frequently reported types of SUID. The causes of these SUID usually are not obvious before a medico-legal investigation and may remain unexplained even after investigation. Lack of consistent investigation practices and an autopsy marker make it difficult to distinguish sudden infant death syndrome from other SUID. Standardized categories might assist in differentiating SUID subtypes and allow for more accurate monitoring of the magnitude of SUID, as well as an enhanced ability to characterize the highest risk groups. To capture information about the extent to which cases are thoroughly investigated and how factors like unsafe sleep may contribute to deaths, CDC created a multistate SUID Case Registry in 2009. As part of the registry, the Centers for Disease Control and Prevention developed a classification system that recognizes the uncertainty about how suffocation or asphyxiation may contribute to death and that accounts for unknown and incomplete information about the death scene and autopsy. This report describes the classification system, including its definitions and decision-making algorithm, and applies the system to 436 US SUID cases that occurred in 2011 and were reported to the registry. These categories, although not replacing official cause-of-death determinations, allow local and state programs to track SUID subtypes, creating a valuable tool to identify gaps in investigation and inform SUID reduction strategies. Copyright © 2014 by the American Academy of Pediatrics.

Love J.C.,Office of Chief Medical Examiner | Derrick S.M.,Harris County Institute of Forensic science | Wiersema J.M.,Harris County Institute of Forensic science | Peters C.,University of Houston
Journal of Forensic Sciences | Year: 2015

Microscopic saw mark analysis is a well published and generally accepted qualitative analytical method. However, little research has focused on identifying and mitigating potential sources of error associated with the method. The presented study proposes the use of classification trees and random forest classifiers as an optimal, statistically sound approach to mitigate the potential for error of variability and outcome error in microscopic saw mark analysis. The statistical model was applied to 58 experimental saw marks created with four types of saws. The saw marks were made in fresh human femurs obtained through anatomical gift and were analyzed using a Keyence digital microscope. The statistical approach weighed the variables based on discriminatory value and produced decision trees with an associated outcome error rate of 8.62-17.82%. © 2014 American Academy of Forensic Sciences.

Wurmbach E.,Office of Chief Medical Examiner | Preiss A.,University of Hohenheim
Hereditas | Year: 2014

The Enhancer of split complex [E(spl)-C] comprises twelve genes of different classes. Seven genes encode proteins of with a basic-helix-loop-helix-orange (bHLH-O) domain that function as transcriptional repressors and serve as effectors of the Notch signalling pathway. They have been named E(spl)m8-, m7-, m5-, m3-, mβ-, mγ- and mδ-HLH. Four genes, E(spl)m6-, m4-, m2- and mα-BFM are intermingled and encode Notch repressor proteins of the Bearded-family (BFM). The complex is split by a single gene of unrelated function, encoding a Kazal-type protease inhibitor (Kaz-m1). All members within a family, bHLH-O or BFM, are very similar in structure and in function. In an attempt to generate specific mutants, we have mobilised P-element constructs residing next to E(spl)m7-HLH and E(spl)mγ-HLH, respectively. The resulting deletions were mapped molecularly and by cytology. Two small deletions affected only E(spl)m7-HLH and E(spl)mδ. The deficient flies were viable without apparent phenotype. Larger deletions, generated also by X-ray mutagenesis, uncover most of the E(spl)-C. The phenotypes of homozygous deficient embryos were analysed to characterize the respective loss of Notch signalling activity. © 2015 The Authors.

Tavora F.,Armed Forces Institute of Pathology | Cresswell N.,Armed Forces Institute of Pathology | Li L.,Office of Chief Medical Examiner | Ripple M.,Office of Chief Medical Examiner | And 2 more authors.
Pathology | Year: 2010

Background: Intraplaque haemorrhage has been shown to be important in necrotic core enlargement. Immunolocalisation of fibrin within progressive stages of plaque progression has not been extensively studied. Methods: Histological sections (n = 74) of human coronary arteries were stained immunohistochemically for fibrin II, red blood cell antigen (glycophorin A), and CD31. Plaques were chosen to represent a range of lesions [6 adaptive intimal thickening, AIT (AHA grade I); 4 intimal xanthomas (AHA grade II), 19 pathologic intimal thickening, PIT (AHA grade III, or pre-atheroma); 34 fibroatheromas, FA (AHA grade IV and V); and 11 thin cap fibroatheromas (TCFA, AHA grade IV)]. Results: Fibrin was generally absent in the intima of AIT and PIT, with moderate staining in cores of early FA (2.6±0.3). All late FA and TCFA demonstrated intracore fibrin, with mean scores of 2.9±0.3 and 3.0±0.3, respectively. Intimal vasa vasorum counts increased with intimal fibrin score (p<0.0001); in 68 of cores with fibrin staining, there was minimal or no evidence of red cell breakdown. Conclusions: Fibrin in necrotic cores is present proportional to intraplaque vasa vasorum and before red cells, suggesting leakage of vessels before frank intraplaque haemorrhage. Fibrin may play a role in the bridge between pre-atheroma and atheroma. © 2010 Royal College of Pathologists of Australasia.

Crowder C.,Office of Chief Medical Examiner | Heinrich J.,University of Toronto | Stout S.D.,Ohio State University
Methods in Molecular Biology | Year: 2012

Estimating the age at death in the adult skeleton is problematic owing to the biological variability in morphological age indicators and the differential response to environmental factors over an individual's life. It is becoming increasingly important for anthropologists to improve age estimates through the use of multiple age indicators and various modalities of assessment (e.g., macroscopic, microscopic, and radiological). Lack of instructional texts describing how to prepare histological samples and evaluate bone under the microscope has been a restricting factor in the widespread use of current histological methods within the field of forensic anthropology. The limited use of histological methods for age estimation often lies in the misunderstanding that the preparation and evaluation of cortical bone thin sections is a highly technical and an expensive endeavor. Like any method of age estimation, the researcher/practitioner must be guided through the analytical process to ensure reliable and repeatable results. This chapter provides a step-by-step instructional guide in the preparation and evaluation of histological samples removed from the sixth rib for histological age estimation. © 2012 Springer Science+Business Media, LLC.

Hartnett K.M.,Office of Chief Medical Examiner
Journal of Forensic Sciences | Year: 2010

This research tests the accuracy of age estimation from the pubic bone. Specimens were collected from decedents of known age, sex, and race at the Forensic Science Center (FSC) in Phoenix, Arizona. The collection consists of pubic bones and fourth rib ends from 419 males and 211 females, ranging in age from 18 to 99. Age-at-death was estimated by three observers using the Suchey-Brooks method. The correlation results indicate that there are significant differences in the observed versus actual ages (r = 0.68169, p < 0.001) and that there are significant interobserver differences. No significant differences were found in the intra-observer tests. The FSC pubic bones were sorted based on morphology without knowing age. New descriptions and age ranges were created. A phase seven was described and is comprised of males and females over 70 years of age-at-death. © 2010 American Academy of Forensic Sciences.

Hartnett K.M.,Office of Chief Medical Examiner
Journal of Forensic Sciences | Year: 2010

This research tests the accuracy of age-at-death estimation from the sternal end of the fourth rib. Age was estimated using the İşcan and Loth casts and written descriptions. The correlation results indicate that there are significant differences in the observed versus actual ages (r = 0.75329, p < 0.001) and that there are significant interobserver differences. Intraobserver tests showed that no significant differences were found within observers. Results of the rib end analysis compared to the results from the pubic symphyses suggest that the rib performs better than the pubic symphysis in age estimation. The rib ends were sorted based on morphology without prior knowledge of age. Summary statistics were calculated for each new phase, and descriptions were created. A variant form of the rib end was described, and the previously understated feature of bone quality was emphasized. © 2010 American Academy of Forensic Sciences.

Dominguez V.M.,Office of Chief Medical Examiner | Crowder C.M.,Office of Chief Medical Examiner
American Journal of Physical Anthropology | Year: 2012

Distinguishing human from non-human bone fragments is usually accomplished by observation of gross morphology. When macroscopic analysis is insufficient, histological approaches can be applied. Microscopic features, like plexiform bone or osteon banding, are characteristic of non-humans. In the absence of such features, distinguishing Haversian bone as either human or non-human proves problematic. This study proposes a histomorphometric approach for classifying species from Haversian bone. Two variables, osteon area (On.Ar.) and circularity (On.Cr.), are examined. Measurements were collected from three species (deer, dog, human) represented by various skeletal elements; only ribs were available for humans (ribs: deer n = 6, dog n = 6, human n = 26; humeri: deer n = 6, dog n = 6; femora: deer n = 6, dog n = 6). Qualitative analysis comparing human to non-human On.Ar. demonstrated that human ribs have larger mean On.Ar. (0.036 mm2) than non-human ribs (deer = 0.017 mm2, dog = 0.013 mm2). On.Cr. in the ribs showed minor differences between species (deer = 0.877; dog = 0.885; human = 0.898). Results demonstrated no significant difference across long bone quadrants in long bones. Discriminant analyses run on the means for each sample demonstrated overlap in deer and dog samples, clustering the non-human and human groups apart from each other. Mean On.Cr. proved a poor criterion (ribs only: 76.3%, pooled elements: 66.1%), while mean On.Ar. proved useful in identifying human from non-human samples (ribs only: 92.1%, pooled elements: 93.5%). When variables were combined, accuracy increased to 100% correct classification for rib data and 98.4% when considering data from all elements. These results indicate that On.Ar. and On.Cr. are valuable histomorphometric tools for distinguishing human from non-human Haversian bone. © 2012 Wiley Periodicals, Inc.

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