Objective frequency-specific hearing thresholds definition for medicolegal purposes in case of occupational NIHL: ASSR outperforms CERA

Audiological use of the 40 Hz-ASSR (auditory steady state responses) could be valuable for objectivelyestimating the frequency-specific threshold in adults undergoing an expertise examination for medicolegal and/or compensation purposes. The present prospective study was set up to clarify the relationship between the thresholds obtained by cortical evoked response audiometry (CERA) and by 40 HzASSR, in the same ears, within a large homogeneous sample of 164 subjects (328 ears) with NIHL andwell documented exposure to noise. All these subjects claimed financial compensation for occupationalNIHL, and there was a suspicion of exaggeration of the reported NIHLs. ASSR thresholds show a goodcorrelation with the CERA thresholds. However, a systematic shift is noticed, ASSR thresholds being onaverage (1e2 e 3 kHz) 4.38 dB lower (i.e. showing less hearing loss) than CERA thresholds. Moreover, thebinaural multiple ASSR technique allows a considerable time gain when compared to the CERA.

Investigation of litigation in trauma orthopaedic surgery

BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.AIM To review the cases of medical complaints in orthopedic patients who had been involved in a traumatic accident.METHODS A retrospective multi-center review of trauma orthopaedic-related malpractice lawsuits from 2010 to 2021 was conducted utilizing the regional medicolegal database. Defendant and plaintiff characteristics along with fracture location, allegations, and litigation outcomes were investigated.RESULTS A total of 228 claims referred to trauma-related conditions with a mean age of 31.29 ± 12.56 were enrolled. The most common injuries were at hand, thigh, elbow, and forearm, respectively.Likewise, the most common alleged complication was related to malunion or nonunion. In 47% of the cases, the main problem that led to the complaint was the inappropriate or insufficient explanation to the patient, and in 53%, there was a problem in the surgery. Eventually, 76% of the complaints resulted in a defense verdict, and 24% resulted in a plaintiff verdict.CONCLUSION Surgical treatment of hand injuries and surgery in non-educational hospitals received the most complaints. The majority of litigation outcomes were caused by a physician’s failure to fully explain and educate the traumatic orthopedic patients and technological errors.

Diffusion tensor imaging in the courtroom:Distinction between scientific specificity and legally admissible evidence

Interest and uptake of science and medicine peer-reviewed literature by readers outside of a paper’s topical subject,field or even discipline is ever-expanding.While the application of knowledge from one field or discipline to others can stimulate innovative solutions to problems facing modern society,it is also fraught with danger for misuse.In the practice of law in the United States,academic papers are submitted to the courts as evidence in personal injury litigation from both the plaintiff(complainant)and defendant.Such transcendence of an academic publication over disciplinary boundaries is immediately met with the challenge of application by a group that inherently lacks in-depth knowledge on the scientific method,the practice of evidence-based medicine,or the publication process as a structured and internationally synthesized process involving peer review and guided by ethical standards and norms.A modern-day example of this is the ongoing conflict between the sensitivity of diffusion tensor imaging(DTI)and the legal standards for admissibility of evidence in litigation cases of mild traumatic brain injury(mTBI).In this review,we amalgamate the peer-reviewed research on DTI in mTBI with the court’s rationale underlying decisions to admit or exclude evidence of DTI abnormalities to support claims of brain injury.We found that the papers which are critical of the use of DTI in the courtroom reflect a primary misunderstanding about how diagnostic biomarkers differ legally from relevant and admissible evidence.The clinical use of DTI to identify white matter abnormalities in the brain at the chronic stage is a valid methodology both clinically as well as forensically,contributes data that may or may not corroborate the existence of white matter damage,and should be admitted into evidence in personal injury trials if supported by a clinician.We also delve into an aspect of science publication and peer review that can be manipulated by scientists and clinicians to publish an opinion piece and misrepresent it as an unbiased,evidencebased,systematic research article in court cases,the decisions of which establish precedence for future cases and have implications on future legislation that will impact the lives of every citizen and erode the integrity of science and medicine practitioners.

性窒息死的法医学鉴定——附2例

［ 摘要］ ［ 背景］ 实际生活中性窒息死案例并不多见，这给法医学鉴定工作带来一定的困难．［ 案例报告］ 两案例在现场服饰打扮、生前表现等方面均有与一般机械性窒息死不同的特点．［ 讨论］ 性窒息案件不易与其它窒息案件鉴别，所以应以发生现场、窒息者装扮、窒息方式、平常表现等案情综合分析，排除他杀。

Delirium after emergency hip surgery-common and serious, but rarely consented for

A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay.Yet it is often unrecognised,poorly managed,and rarely discussed by doctors.Delirium is important not only to the affected individuals and their families,but also socioeconomically to the broader community.Delirium increases mortality and morbidity,leads to lasting cognitive and functional decline,and increases both length of stay and dependence on discharge.Delirium should be routinely and openly discussed by all members of the clinical team,including surgeons when gaining consent.Failing to do so may expose surgeons to claims of negligence.Here we present a concise review of the literature and discuss the epidemiology,causative factors,potential consequences and preventative strategies in the perioperative period.

The Impact of COVID-19 on Adolescent Suicide Deaths in the State of Maryland

On March 11, 2020, the World Health Organization officially declared the SARS-CoV-2 virus (COVID-19) a worldwide pandemic. As of December 2021, there have been over 278 million cases and 5.4 million deaths reported. One area of concern regarding the pandemic was its potential impact on mental health, and it was feared that the onset of such a devastating pandemic would lead to increased suicide risks among the general population. With suicide being a leading cause of death in adolescents, it is important to assess the potential mental health consequences that the COVID-19 pandemic may impose. Aim: The aim of the study was to analyze the impact of COVID-19 on suicide deaths among adolescents in the state of Maryland from 2019 to 2021. Subjects and Methods: This was a retrospective study of adolescent suicide victims, aged 10-19 years, from January 2019 to December 2021 in the state of Maryland. De-identified data were collected from the statewide medical examiner’s office which is responsible for the medicolegal death investigation in Maryland. Results: A total of 102 adolescent suicide deaths were investigated statewide by the Maryland Office of the Chief Medical Examiner during these 3 years. The number of adolescent suicide cases stayed relatively stable during the COVID-19 pandemic, with slightly more cases during the pre-COVID-19 pandemic period (2019: n = 37;2020: n = 31;and 2022: n = 34). Looking at months of incidence, less cases were reported in March-May 2020 (n = 5), which marks the beginning of the pandemic when compared to the same period in 2019 (n = 13). The number was higher for August-November 2020 (n = 15) than for that of 2019 (n = 8) and 2021 (n = 8). The male-to-female suicide ratio was 3.7:1 (n = 80/22). However, the data exhibited a significant increase in the number of female adolescent suicides, from 8.11% in 2019 (n = 3) to 25.81% in 2020 (n = 8) and 32.35% in 2021 (n = 11). Of the cases examined, more than 50% were white and approximately 27% were African-Americans. The two leading causes of death were hanging (47%) and firearm injuries (29%). Maryland consists of 23 countries and Baltimore City. The majority of adolescent suicides occurred in county residents with only 8.8% of cases in Baltimore City.

Effectiveness of a Structured Orientation Program for Medical Interns in Increasing the Awareness of Informed Consent

Background:Informed consent has medicolegal implications and is imperative in presentday medical practice.Aims and Objectives:The objectives of this study were to estimate the awareness regarding informed consent in interns and to determine the effectiveness of sessions in interns’orientation programs about informed consent.Materials and Methods:Pretest-Posttest study was conducted with a validated questionnaire distributed through Google Forms to interns attending the orientation program at our institute.Responses were recorded on the Likert scale(−2 to+2).Paired t-test was used to compare the mean pretest and posttest scores.The number of interns with a positive score(+1,+2)for every question in pretest and posttest were also compared.Results:One hundred and seventyone out of 232 interns who attended the program submitted both pretest and posttest responses.In the pretest,12 interns scored<50%and 46 interns scored more than 75%.A significant increase in posttest responses was seen in the mean score(P<0.001)and questions related to consent in research,radiological investigations,regarding the need for consent in the additional nonlifesaving procedure.There was an increase in the number of interns having a positive score(+1,+2)for all the questions in posttest as compared to pretest,but a statistically significant increase was seen in questions related to consent in ultrasound and need for consent in the additional nonlifesaving procedure.Conclusion:A wellstructured interns’orientation program is effective in improving awareness regarding consent.Certain gaps in knowledge regarding various aspects of consent need to be emphasized.

Contributions of forensic anthropology to positive scientific identification:a critical Review

This review covers previous and current literature on the impact of forensic anthropologists on the positive scientific identification of human remains and aims to provide an under-standing of what information a forensic anthropologist can contribute to an investigation. Forensic anthropologists looking to identify human remains study traits of the skeleton and any orthopedic devices present. In order to obtain a positive scientific identification, evi-dence that is both sufficiently unique to the individual and comparable to available ante-mortem data from that individual must be found. The increased availability of radiographs, scans and implants in recent decades has facilitated the identification process. When these records are unavailable, other techniques, such as craniofacial superimposition and facial approximation, can be employed. While these methods may assist the identification process, they are most useful for exclusion of certain individuals and gathering leads from the public. Forensic anthropologists have heavily relied on the skull and its complexities for identifica-tion – typically focusing on the frontal sinus and other unique traits. Post-cranial remains can provide important information about bone density, possible disease and other character-istics that may also be utilized. Techniques used to positively identify individuals are not limited to medicolegal death investigations, and have been useful in other legal contexts. In the future, a team approach, utilizing all the information gathered by multiple forensic scientists–including forensic anthropologists–will most likely become more common.

Neck-MRI experience for investigation of survived strangulation victims

For the medicolegal evaluation of victims of survived strangulation,a neck-magnetic resonance imaging(MRI)can be performed for assessing lesions in the inner soft tissues(fat,muscles or lymph nodes,for example).In our institute,such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation.We retrospectively reviewed medicolegal reports from all victims examined during the test period.We extracted objective lesions(e.g.petechiae,bruising and abrasions)and reported clinical symptoms(e.g.vision disorder,dysphasia)from the reports.These findings were compared to those reported from the neck-MRI.In total,112 victims were clinically examined after suspected strangulation.Eleven of these victims underwent an MRI examination of the neck.Eighty-four of the victims presented objective lesions during the clinical examination,with eight showing signs of both petechiae and bruising.Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI.Of 76 victims with bruising as the only objective finding,66 victims described clinical symptoms.Of those 66 victims,seven were examined by MRI and two demonstrated lesions in MRI.When MRI was performed,relevant findings were detected in 45%of the cases.This leads to the suspicion that many more findings could have been detected in the other victims,if an MRI had been performed in those cases.Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful,and strict indications for its application should be established.

The Impact of COVID-19 on Teenage Homicide Incidence:A Retrospective Review of Forensic Autopsy Cases in Maryland from 2018 to 2021

Homicides in the United States disproportionately affect minorities,and previous research also indicates that increased economic deprivation and social disorganization correlates with increased rates of homicide.The COVID-19 pandemic has exacerbated economic disparities and may have magnified existing disparities in homicide rates.Few studies have examined the incidence of teenage homicides throughout the United States,especially during the COVID-19 pandemic.This was a retrospective case review of homicides involving youth between the age group of 13 and 19 years from 2018 to 2021 in the state of Maryland.The aim of this study was to assess COVID-19 affected rates of youth homicide.A total of 230 teenage homicides occurred in Maryland from 2018 to 2021 with 113 cases during the pre-COVID-19 pandemic period(2018/2019)and 117 cases during the COVID-19 pandemic(2020/2021).The majority of teenage homicide victims were African−American male.More than 83%and 79%of victims were African−American in 2018/2019 and 2020/2021,respectively.Victims were also predominantly male(90%in 2018/2019 and 88%in 2020/2021).Maryland has a population of approximately 6 million people and is made up of 23 countries and Baltimore City.Nearly half of the overall incidents of teenage homicide took place in Baltimore City(49.6%pre-COVID-19 and 44.4%during COVID-19,respectively).While the average victim age did not vary considerably between 2018/2019(17.8 years)and 2020/2021(17.5 years),the percentage of cases involving victims ages 13-15 years more than doubled from 5.3%of cases in 2018/2019 to 12%of cases in 2020/2021.The majority of teenage homicide cases were due to firearm injuries(91.7%,n=211),but during the COVID-19 pandemic,there was a rise in violence involving sharp objects such as knives.The incidence of teenage homicide did not change considerably during the COVID-19 pandemic,although we did observe a trend toward younger males who were African American.