scholarly journals SARS-CoV-2 surveillance in decedents in a large, urban medical examiner's office

2020 ◽  
Author(s):  
Andrew F. Brouwer ◽  
Jeffrey L Myers ◽  
Emily T Martin ◽  
Kristine E Konopka ◽  
Adam S Lauring ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Statistical Difference ◽  
Warning Sign ◽  
Test Results ◽  
Manner Of Death ◽  
Wayne County ◽  
Catchment Population ◽  
Global Pandemic ◽  
Percent Positivity ◽  
Medical Examiners

Background: SARS-CoV-2 has become a global pandemic. Given the challenges in implementing widespread SARS-CoV-2 testing, there is increasing interest in alternative surveillance strategies. Methods: We tested nasopharyngeal swabs from 821 decedents in the Wayne County Medical Examiner's office for SARS-CoV-2. All decedents were assessed by a COVID-19 checklist, and decedents flagged by the checklist (237) were preferentially tested. A random sample of decedents not flagged by the checklist were also tested (584). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged by the checklist and not and between those SARS-CoV-2 positive and not. Results: Decedents were more likely to be male (70% vs 48%) and Black (55% vs 36%) than the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results: despite no statistical difference in the racial distribution between those flagged and not, SARS-CoV-2 positive decedents were substantially more likely to be Black (89% vs 51%). SARS-CoV-2 positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease. Conclusions: Disease surveillance through medical examiners and coroners could supplement other forms of surveillance and may serve as a possible early outbreak warning sign.

scholarly journals SARS-CoV-2 surveillance in decedents in a large, urban medical examiner’s office

2020 ◽  
Author(s):  
Andrew F Brouwer ◽  
Jeffrey L Myers ◽  
Emily T Martin ◽  
Kristine E Konopka ◽  
Adam S Lauring ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Statistical Difference ◽  
Warning Sign ◽  
Test Results ◽  
Manner Of Death ◽  
Wayne County ◽  
Catchment Population ◽  
Global Pandemic ◽  
Percent Positivity ◽  
Medical Examiners

Abstract Background SARS-CoV-2 has become a global pandemic. Given the challenges in implementing widespread SARS-CoV-2 testing, there is increasing interest in alternative surveillance strategies. Methods We tested nasopharyngeal swabs from 1094 decedents in the Wayne County Medical Examiner’s office for SARS-CoV-2. All decedents were assessed by a COVID-19 checklist, and decedents flagged by the checklist (298) were preferentially tested. A random sample of decedents not flagged by the checklist were also tested (796). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged by the checklist and not and between those SARS-CoV-2 positive and not. Results A larger percentage of decedents overall were male (70% vs 48%) and Black (55% vs 36%) compared to the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results: despite no statistical difference in the racial distribution between those flagged and not, SARS-CoV-2 positive decedents were substantially more likely to be Black (82% vs 51%). SARS-CoV-2 positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease. Conclusions Disease surveillance through medical examiners and coroners could supplement other forms of surveillance and may serve as a possible early outbreak warning sign.

scholarly journals Medical Examiner Review of the Characteristics of Fire-Related Homicides

2020 ◽  
Vol 10 (2) ◽  
pp. 87-93
Author(s):  
Kyle S. Conway ◽  
Carl J. Schmidt ◽  
Theodore T. Brown
Keyword(s):  
Cause Of Death ◽  
Retrospective Studies ◽  
Medical Examiner ◽  
Manner Of Death ◽  
Wayne County ◽  
Autopsy Findings ◽  
Cohb Level ◽  
Scene Investigation ◽  
Medical Examiners ◽  
Ancillary Studies

While fire-related deaths are regularly encountered by medical examiners, fire-related homicides are relatively uncommon. Although some large retrospective studies of fire-related deaths have been performed, few large studies have specifically reviewed fire-related homicides. Autopsy, scene investigation, and ancillary studies were reviewed for 38 fire-related homicides evaluated at the Wayne County Medical Examiner’s Office in Detroit, Michigan. The largest proportion of cases were inhalation-related deaths in dwelling fires (n = 21, 55%), followed by deaths from thermal injury after immolation (n = 8, 21%) and traumatic death with contemporaneous or subsequent immolation (n = 8, 21%). There was one case of postmortem immolation. Although carboxyhemoglobin (COHb) levels played a significant role in evaluation of these cases, no single factor was diagnostic of a particular cause or manner of death. Fire-related homicides present unique diagnostic challenges because multiple insults frequently contribute to the cause death. Death at the scene and COHb level above 10% are the most useful factors in establishing smoke and soot inhalation as the cause of death. Some autopsy findings are helpful in establishing or ruling out smoke and soot inhalation as contributing to or sole cause of death, but an evaluation of the entire circumstances and autopsy findings is necessary.

Review Paper on Machine learning-based prediction of Corona Virus

2021 ◽  
Vol 9 (8) ◽  
pp. 2225-2229
Author(s):  
Miss. Aakansha P. Tiwari
Keyword(s):  
Machine Learning ◽  
Prediction Models ◽  
Clinical Symptoms ◽  
Contact Tracing ◽  
Test Results ◽  
Effective Contact ◽  
Machine Learning Approach ◽  
Binary Features ◽  
Simple Features ◽  
Medical Examiners

Abstract: Effective contact tracing of SARS-CoV-2 enables quick and efficient diagnosis of COVID-19 and might mitigate the burden on healthcare system. Prediction models that combine several features to approximate the danger of infection are developed. These aim to help medical examiners worldwide in treatment of patients, especially within the context of limited healthcare resources. They established a machine learning approach that trained on records from 51,831 tested individuals (of whom 4769 were confirmed to own COVID-19 coronavirus). Test set contained data from the upcoming week (47,401 tested individuals of whom 3624 were confirmed to own COVID-19 disease). Their model predicted COVID-19 test results with highest accuracy using only eight binary features: sex, age ≥60 years, known contact with infected patients, and also the appearance of 5 initial clinical symptoms appeared. Generally, supported the nationwide data publicly reported by the Israeli Ministry of Health, they developed a model that detects COVID-19 cases by simple features accessed by asking basic inquiries to the affected patient. Their framework may be used, among other considerations, to prioritize testing for COVID-19 when testing resources are limited and important. Keywords: Machine Learning, SARS-COV-2, COVID-19, Coronavirus.

Vaccine Passport - A blockchain based architecture for secure, tamper-resistant, privacy-enhanced credentialing mechanism of vaccination and verification of test results (Preprint)

2021 ◽  
Author(s):  
Hsiu An Lee ◽  
Hsin-Hua Kung ◽  
Wei-Chen Wu ◽  
Jai Ganesh Udayasankaran ◽  
Yu-Chih Wei ◽  
...  
Keyword(s):  
Data Protection ◽  
Low Cost ◽  
Vaccination Rate ◽  
Data Accuracy ◽  
Test Results ◽  
Public And Private ◽  
Global Pandemic ◽  
Laboratory Test Results ◽  
Encryption And Decryption ◽  
International Data

BACKGROUND The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The prevention and treatment methods for COVID-19 are not yet clear. At present, there are at least 287 preventive vaccines against COVID-19 in the world, of which 5 vaccines are available for emergency use as of June 2021, but none has completed clinical trial. Nevertheless, with the development of vaccines, disease conditions in various countries are gradually controlled. OBJECTIVE The vaccination rate has increased in time, and activities in various countries have gradually recovered. Therefore, the focus of the next stage is confirming and proving that everyone is vaccinated to ensure that those without vaccines will not become a breach in the next wave of diseases. The vaccination or RT-PCR test results are all certified and verified by paper documents issued by hospitals or testing institutions. Meanwhile, falsified documents are a major risk factor in confirming the vaccination status and laboratory test results. Although the Vaccine Passport (VP) may become an important key to future global activities based on the current strategy, the problems of document verification and data use among countries have not yet been resolved. METHODS The blockchain architecture proposed in this research can be applied together by public and private entities and be rapidly expanded. Furthermore, the open ledger of blockchain achieves transparency and data accuracy. On the other hand, smart contracts (SCs) achieve authorization and authentication, while the encryption and decryption mechanisms achieve data protection. In order to make it globally available, the international data standard “Fast Healthcare Interoperability Resource (FHIR)” is adopted into this research. In general, this blockchain architecture can achieve global vaccine passport verification accurately and at a low cost. RESULTS The open nature of the blockchain contributes to establishing transparency and data accuracy. Total three entities are included in this blockchain architecture. All of the authorization are public in the open ledger. The smart certificate enables authorization and authentication, while the encryption and decryption mechanism ensure data protection. This proof of concept demonstrates the design of blockchain architecture which, when adopted, can achieve global vaccine passport verification accurately and at a cost country can afford. An actual vaccine passport case was established and demonstrated in this study. Open blockchain, individually authorized authentication mechanisms, and international standard vaccine passports were adopted. CONCLUSIONS Blockchain architecture is used to build the authentication process of an executable international vaccine passport, with advantages of low cost, high interoperability, effectiveness, security and verifiability.

scholarly journals Certification of Vehicular Hyperthermia Deaths in the Pediatric Population

2016 ◽  
Vol 6 (4) ◽  
pp. 657-662
Author(s):  
Reade A. Quinton
Keyword(s):  
Ambient Temperature ◽  
Cause Of Death ◽  
Pediatric Population ◽  
Clinical History ◽  
Infants And Children ◽  
Manner Of Death ◽  
Autopsy Findings ◽  
Scene Investigation ◽  
Medical Examiners ◽  
In Infants And Children

The investigation of vehicular hyperthermia deaths in infants and children requires coordination between the autopsy, clinical history, and scene investigation. Unfortunately, autopsy findings can be limited or nonspecific, clinical history may be unavailable, and details concerning ambient temperature and vehicular temperature may be vague. In cases where hyperthermia is established as the cause of death, the certification of manner of death can be challenging and inconsistent among medical examiners. This article provides an overview of vehicular hyperthermia deaths and the certification of cause and manner of death in these cases.

Skin color and investment performance in South Africa's mutual funds industry

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nixon S. Chekenya ◽  
Shingirai Sikomwe
Keyword(s):  
South Africa ◽  
Statistical Difference ◽  
White Male ◽  
Mean Difference ◽  
Test Results ◽  
Ceteris Paribus ◽  
Content Type ◽  
Fund Managers ◽  
Significant Difference ◽  
Level Of Significance

PurposeUsing data for the period 1965–2016, we investigate whether there are systematic differences between the investment performance of Black fund managers and those of other races in South Africa and whether investors recognize these differences. The two-tailed test results show that there is no significant difference between the two means considering the 12 months yield return at a hypothesized mean difference of zero. There is no statistical difference at 5% level of significance implying that the performance of Black fund managers is as equally as that of managers of other races. Our results also show that the percentage of Black fund managers in South Africa is still too low even as the workforce gets diverse. There's no single explanation for what is happening in this industry. The findings cannot be explained by differences in fund characteristics such as age, total assets under management or expenses or from the performance lenses. The results seem hard to reconcile with an explanation of differences in portfolio characteristics such as return volatility or market, size, value and momentum exposures.Design/methodology/approachWe test the glass cliff hypothesis by employing conditional logistic regression (CLR). The approach enables the use of case/control style of analysis where White/majority fund managers are the control population and professional minorities are the case group. The selection of these as fund managers is our event or outcome variable. To test savior effect hypothesis, we employ analysis of variance (ANOVA). The technique enables us to compare variances between the groups: when a White male fund manager replaces a professional minority, when a White male fund manager replaces a White male fund manager and when a professional minority replaces a professional minority.FindingsOur analyses so far have documented a woeful underrepresentation of Black fund managers in South Africa's mutual funds industry. We explore potential explanations for these trends. Our analysis is meant to be suggestive. Are Blacks, women, people of color and ethnic minorities finding success in the investment industry? Are they having rewarding and fulfilling careers? Or is the industry still homogenous (just a White man's world) with a thin veneer of diversity layered on for public relations effect? The percentage of Black fund managers in South Africa is still too low even as the workforce gets diverse. There is no single explanation for what is happening in this industry. The findings cannot be explained by differences in fund characteristics such as age, total assets under management or expenses or from the performance lenses. Also, the results seem hard to reconcile with an explanation of differences in portfolio characteristics such as return volatility or market, size, value and momentum exposures.Research limitations/implicationsThe two-tailed test results show that there is no significant difference between the two means considering the 12 months yield return at a hypothesized mean difference of zero. There is no statistical difference at 5% level of significance. Our results so far establish that, ceteris paribus, the performance of Black fund managers is as equally as that of managers of other races.Practical implicationsThe two-tailed test results show that there is no significant difference between the two means considering the 12 months yield return at a hypothesized mean difference of zero. There is no statistical difference at 5% level of significance. Our results so far establish that, ceteris paribus, the performance of Black fund managers is as equally important as that of managers of other races.Social implicationsThe two-tailed test results show that there is no significant difference between the two means considering the 12 months yield return at a hypothesized mean difference of zero. There is no statistical difference at 5% level of significance. Our results so far establish that, ceteris paribus, the performance of Black fund managers is as equally important as that of managers of other races.Originality/valueThis paper investigates whether there are systematic differences between the investment performance of Black fund managers and those of other races in South Africa and whether investors recognize these differences. Our hypothesis is that due to Broad-Based Black Economic Empowerment (BBBEE) laws in the country and possibly, due to a perception of discrimination in the market, it is only Black fund managers with superior fund management skills that enter the profession. As such, we expect to find superior performance among Black fund managers. We also conjecture that investors recognize this phenomenon and reward Black fund managers with more fund flows and more investment mandates than others.

scholarly journals SARS-CoV-2 detection in setting of viral swab scarcity: are MRSA swabs and viral swabs equivalent?

2020 ◽  
Author(s):  
Daniel G. Federman ◽  
Shaili Gupta ◽  
Gary Stack ◽  
Sheldon M. Campbell ◽  
David R. Peaper ◽  
...  
Keyword(s):  
Nasal Swab ◽  
High Rate ◽  
Test Results ◽  
Sample Collection ◽  
Transport Medium ◽  
Viral Transport ◽  
Global Pandemic ◽  
Viral Transport Medium ◽  
Nasal Swabs ◽  
Viral Media

AbstractBackgroundThe global pandemic of Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV2) has resulted in unprecedented challenges for healthcare systems. One barrier to widespread testing has been a paucity of traditional respiratory viral swab collection kits relative to the demand. Whether other sample collection kits, such as widely available MRSA nasal swabs can be used to detect SARS-CoV-2 is unknown.MethodsWe compared simultaneous nasal MRSA swabs (COPAN ESwabs ® 480C flocked nasal swab in 1mL of liquid Amies medium) and virals wabs (BD H192(07) flexible mini-tip flocked nasopharyngeal swabs in 3mL Universal Transport Medium) for SARS-CoV-2 PCR testing using Simplexa COVID-19 Direct assay on patients over a 4-day period. When the results were discordant, the viral swab sample was run again on the Cepheid Xpert Xpress ® SARS-CoV-2 assay.ResultsOf the 81 included samples, there were 19 positives and 62 negatives in viral media and 18 positives and 63 negative in the MRSA swabs. Amongst all included samples, there was concordance between the COPAN ESwabs ® 480C and the viral swabs in 78 (96.3%).ConclusionWe found a high rate of concordance in test results between COPAN ESwabs ® 480C in Amies solution and BD H192(07) nasopharyngeal swabs in in 3 mL of Universal Viral Transport medium viral media. Clinicians and laboratories should feel better informed and assured using COPAN ESwabs ® 480C to help in the diagnosis of COVID-19.

scholarly journals Recommendations for the Autopsy of an Infant who has Died Suddenly and Unexpectedly

2017 ◽  
Vol 7 (2) ◽  
pp. 171-181 ◽  
Author(s):  
Kathryn Pinneri ◽  
Evan W. Matshes
Keyword(s):  
Infant Death ◽  
Sudden Infant Death ◽  
The United States ◽  
Sudden Infant ◽  
Manner Of Death ◽  
Death Scene ◽  
Standards Of Practice ◽  
Unexpected Infant Death ◽  
Medical Examiners ◽  
Consultation Services

As the result of improved death scene investigations and the performance of more thorough and thoughtful pediatric forensic autopsies, there has been a widespread increase in the recognition of asphyxial mechanisms of death as well as lethal natural diseases that might have otherwise been erroneously labeled as sudden infant death syndrome (SIDS) or sudden unexpected infant death (SUID). Although it is fair to state that “more thorough autopsies provide more thorough medical evidence” from which to draw upon when determining cause and manner of death, there is no standard, accepted baseline from which forensic pathologists operate. Although anatomic pathologists are quite accustomed to practicing within well-defined boundaries for specimen (and thus diagnostic) adequacy, forensic pathologists are frequently hesitant to embrace or adopt such concepts. This has made it difficult to evaluate standards of practice in forensic pathology. Recommendations have been developed and published by the National Association of Medical Examiners for the postmortem assessment of suspected infant head trauma. However, significant variation exists in the way autopsies are performed on infants without trauma, such as the common scenario of an infant who has died suddenly and unexpectedly of asphyxial or apparent natural means. A wide variety of autopsy techniques and ancillary studies are available to forensic pathologists, but as survey data indicates, are not consistently used throughout the United States. This paper will discuss the different components of the pediatric autopsy and make recommendations for the best use of available tests and consultation services.

scholarly journals Thoracoabdominal mobility evaluation by photogrammetry in newborns after expiratory flow increase technique

2017 ◽  
Vol 30 (4) ◽  
pp. 789-795 ◽  
Author(s):  
Júlia Isabel de Araújo Guerra ◽  
Danilo Alves Pinto Nagem ◽  
Cristiane Aparecida Moran ◽  
Valéria Lidyanne Souza Gomes ◽  
Juliana Macedo Campelo de Carvalho ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Flow Direction ◽  
Test Results ◽  
Upper Airways ◽  
Mean Values ◽  
Hands On ◽  
Before And After ◽  
The Mean ◽  
Expiratory Flow ◽  
Paired T Test

Abstract Introduction: Expiratory flow increase is a maneuver of respiratory physical therapy that promotes flow direction to the upper airways however, when applied in newborns, it may result in changes of thoracoabdominal mobility. Objective: To evaluate the thoracoabdominal mobility by photogrammetry in newborns after expiratory flow increase technique. Methods: Experimental blind study performed with newborns in supine position on a support table with upper limbs flexed, abducted and externally rotated and hip flexed at 110°. Adhesive markers were allocated for geometric delimitation of the thoracoabdominal compartment and expiratory flow increase technique was performed for 5 minutes with the therapist’s hands on the thorax and abdomen. Newborns were filmed before and after the maneuver and the frames were analyzed in AutoCAD® software by a blinded investigator at the time of the procedure. The largest and the smallest thoracoabdominal area were expressed in cm2 and the mean values were compared between two moments (pre and post maneuver) by paired t test. Results: Twenty newborns with a mean age of 39 weeks were included. Before the maneuver, thoracoabdominal area was 56.1 cm2 during expiration and 59.7 cm2 during inspiration, and after the maneuver the value was 56.2 cm2 during expiration and 59.8 cm2 during inspiration, with no statistical difference between before and after (p = 0.97, p = 0.92, respectively). Conclusion: Results demonstrate that expiratory flow increase technique does not seem to change thoracoabdominal mobility of healthy newborns.

scholarly journals Attitudes Towards Forensic Autopsy Standard B3.7 and the Use of Physician Extenders in Select Autopsy Cases

2019 ◽  
Vol 9 (3-4) ◽  
pp. 181-190
Author(s):  
Cassie B. MacRae ◽  
Seth H. Weinberg ◽  
Mitchell L. Weinberg
Keyword(s):  
Gold Standard ◽  
National Association ◽  
Forensic Autopsy ◽  
Forensic Pathologist ◽  
Manner Of Death ◽  
Autopsy Findings ◽  
Physician Extenders ◽  
Medical Examiners ◽  
Administrative Responsibilities ◽  
Overdose Deaths

Studies have demonstrated that autopsy is the gold standard for determining cause and manner of death. Indeed, the current National Association of Medical Examiners standard B3.7 states that a forensic pathologist (FP) shall perform a forensic autopsy when the death is by apparent intoxication by alcohol, drugs, or poison. Unfortunately, the recent increase in drug-related deaths has led to some question about the feasibility of maintaining compliance with standard B3.7. We constructed a voluntary survey to address consensus on standard B3.7 and the use of supervised accredited pathologists’ assistants (PAs) in performing select medicolegal autopsies. Additional questions were included to help characterize variables related to FP’s workload and experience. Each of these variables was predicted to influence FP’s attitudes toward B3.7 and the use of PAs. Our respondent pool (n = 107) consisted primarily of actively practicing FPs with administrative responsibilities (42%) and actively practicing FPs without administrative responsibilities (41%). Sixty-five percent agreed that standard B3.7 is appropriate. Opinion on the use of PAs was split between those who agreed (45%) and those who did not (44%). Tendency to agree with either B3.7 or the use of PAs was not a function of FP’s individual or office workload; however, respondents were more likely to agree with B3.7 if they previously experienced a case where internal autopsy findings radically altered diagnosis in an otherwise suggestive overdose case (P < 0.001). In certain offices and under certain conditions, the use of PAs may be one solution to ensuring all potential overdose deaths receive an autopsy.

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